The Daily
The Sunday Read: ‘Opioids Ravaged a Kentucky Town. Then Rehab Became Its Business.’
Sun, 19 Jan 2025
Ingrid Jackson had never lived in a trailer before, or a small town. She was born in Louisville, Ky., the daughter of a man with schizophrenia who, in 1983, decapitated a 76-year-old woman. Jackson was 1 at the time. In 2010, at 27, she was in a car accident and was prescribed pain pills. Not long after that, she began using heroin. Over the next decade she went through nine rounds of addiction rehab. Each ended in relapse. Her most recent attempt came in 2022 after her son was sentenced to life in prison for murder; he was 21.In eastern Kentucky, a region that is plagued by poverty and is at the heart of the country’s opioid epidemic, the burden of addressing this treatment gap has mainly been taken up by addiction-rehab companies. Many stand more like community centers or churches than like medical clinics, offering not just chemical but also spiritual and logistical services with the aim of helping people in addiction find employment and re-enter society. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.
Chapter 1: What is the story of Ingrid Jackson?
Chapter 2: How did addiction impact eastern Kentucky communities?
But while eastern Kentucky is one of the places where you're most likely to die of a drug addiction, it's also one of the places where you're most likely to receive treatment for it, regardless of your income or background. which is what set me off on this years-long reporting journey and brought me to a local rehab company called Addiction Recovery Care, or ARC for short.
ARC was founded in 2008, emphasizing the long-term aspect of addiction recovery. People would be allowed to remain as inpatients for an extended period of time, sometimes more than a year. They'd get counseling, medical treatment, housing, and job training. And ARC would also often employ its patients once they graduated from rehab, even those with criminal records.
When I first came across the company in 2020, it had around 700 employees, half of whom were in recovery themselves. And the most unusual feature of the company was that it had started buying out a bunch of properties in the small town where it's based. a town right on the West Virginia border, called Louisa. On the surface, Arc felt like the kind of company that was on the right side of things.
In the past, there hadn't been many options for treatment. And now, here was Arc helping people get clean, providing them with jobs, and revitalizing a town. But when I'd actually go into Louisa and talk to people about Arc, criticisms would emerge. They'd say, Ark is bringing more addicts to town. They're buying up all the property and running out small businesses. They're exploiting workers.
The company's executive is using the profits to build himself this big house on a hill. I mean, if you go down the main street in Louisa, there's a cafe, a bakery, an art gallery, a little pharmacy, a theater. They're all owned by Ark. They own an auto body shop. a welding studio, a private school. It can feel very much like a company town.
And yet, I spoke to many people who'd worked for ARC or had gone through their rehab program, and they loved the company and the changes it had brought to Louisa. Over the years, I lost touch with some of these people. A few relapsed. But I kept coming back to two women in particular, named Ingrid and Latasha.
They'd both gone through AHRQ's inpatient program and were living together and working as nursing assistants. They were these kind of model examples of AHRQ's success as a rehab. Sometimes I would mention to Ingrid and Latasha the suspicions that Louisa was becoming a company town. And they'd be like, yeah, I get it. But they really helped me.
By 2023, AHRQ was the largest addiction treatment services provider in Kentucky, taking in more than $130 million from Medicaid reimbursements and employing roughly 1,400 people. So I wanted to find out, could AHRQ's rehabilitation program be a model for the rest of the country? And was it really working?
Then, last August, things took a turn when the FBI opened an investigation into Ark for fraud. And all of the company's success in revitalizing the town of Louisa and helping people like Ingrid and LaTosha was called into question. So here's my article, read by Eric Jason Martin. Our producer is Jack D'Isidoro, and our music was written and performed by Aaron Esposito. Thanks for listening.
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Chapter 3: What role does Addiction Recovery Care play in treatment?
The caseworker from the Department for Community-Based Services was difficult to reach. One of her children fell ill, and she wasn't able to go for her weekly visit. A new client at the nursing home wouldn't stop screaming. She had been receiving injections of naltrexone in rehab to help with her withdrawal, but transitioned off them.
One day, feeling suffocated, she walked to an arc outpatient clinic and obtained suboxone, a mild opioid often used to help people remain sober. Scared of getting high, she later flushed the tablets. I have days where I come back and I just cry because I'm trying to be an adult and it's tough, she said. Sometimes I just wish I could go back to being a kid.
On a sunny day in the fall of 2023, I walked to a pawn shop in downtown Louisa. Leaves were on the ground outside, their dry tips curling inward, and the sidewalk was gritty with dust. Inside, the shelves were mostly barren, a few loose wires dangling off old kitchen appliances.
In the far corner, a man with short white hair stood behind a glass case filled with pistols and knives, pecking dip into his bottom lip. His name was Mike Hudson, and he was the store's owner. When I asked him about addiction recovery care, he began speaking broadly about the state of the addiction epidemic nationwide.
Federal officials weren't doing enough to target gangs moving contraband across the border. Law enforcement was too soft on drug use. Locally, he said, there seemed to be a better balance between support and punishment. Tim Robinson, he gives them every chance, he said, of people in addiction. They put them through the program, they give them a job. But he won't stand for you peeing dirty.
They gotta want it themselves. The door creaked open, and a man and a woman walked in. The woman had red hair and thick foundation on her face. The man was large and square. They were both carrying big gulps. As Hudson continued speaking, I could see the woman glancing our way. She sidled closer, then said, what you say about Ark is right.
She had been sober since 2014, she said, and her partner had been sober five and a half years. He had just been released from prison. The woman said that he had been addicted to heroin and meth. I saw his teeth, which were few and rotten, elongated like thin dominoes. I tried to get him in two rehabs. He didn't want it. He didn't do it, she said. I just walked out, the man said.
That changed after he was locked up, with no other option but to face his recovery. The main thing is, if you don't want it, you aren't going to do it. He sipped the drink in his hand. We gotta have stronger punishment systems, the woman said. Used to be, if you had two grams of meth, you'd get eight, ten years. Now you can get out in 48 hours.
Hudson interjected, my biggest problem is we got hundreds of thousands of people sitting on death row costing us. Go ahead and execute them, and then you have space for the rest. As I had found in the years since I first visited town, this kind of pontificating was inescapable.
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Chapter 4: How has ARC revitalized Louisa, Kentucky?
In a statement, the company acknowledged that it had potentially overcharged for services and said that it is cooperating with the investigation. Online, when a resident posted about the investigation on Facebook, someone commented, finally some good news.
But over the next few months, blaming significant Medicaid reimbursement cuts, the company laid off about a quarter of its workforce, more than 300 employees, including school teachers, peer support specialists, and human resources representatives, and a few residents reached out to me, conflicted. My main worry is what might happen if something major goes down, like a shutdown, one texted.
That'll be a major blow to the community. That is, if Robinson was in trouble, Ark was too, and the town could be reclaimed. But maybe if Ark collapsed, Louisa would also collapse.
When I first spoke to Louisa's mayor, Harold Sloan, in 2020, he seemed hesitant to say anything of substance about ARC, suggesting that I direct questions to Matt Brown, ARC's chief administration officer, now president, who was serving on the six-member city council at the time.
I figured this had something to do with the fact that Ark sponsored nearly every event in town, and that anything Sloan said would get around. But one evening, in late 2023, we talked in his backyard. Smoke from a wildfire in West Virginia floated across the river and glazed the sky. I find it hard to say a lot bad about Ark, I really do, Sloan said.
We used to see people lined up down the street waiting to get their prescriptions. We knew what was happening and didn't say anything about it. I brought up the fact that some people in town saw Robinson as an opportunist, using the addiction crisis for financial gain and personal power. Do you think the hospital benefits from us being sick? Sloan asked.
The more accidents, wrecks, the more COVID, the more we show up at the ER, the more profit it makes. ARCs, the same thing. There are some people who talk to me. They say that nobody should be profiting from what they're doing. Well, we know in America that it just doesn't happen that way. In November 2023, I visited Kid and Jackson in their trailer.
Outside, the sun was setting, casting the river valley in a slow blue shadow, the trees shuddering a deep orange. Jackson was eating reheated Taco Bell and Kid was curled on the couch. She seemed transparent, like a glass bead with bright red hair. She told me that she had a tough day at work. Sometimes, she said, when she gets home, she puts her face in her pillow and screams.
Jackson left her quesadilla and walked over to the middle of the living room. She had recently showered and had pulled a cap over her curls, her skin dewy from the water. She reminded Kid how much she had changed since entering rehab. I remember when we first met, you couldn't really read good, and now you read like a champ, she said.
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