In September 2024, Hurricane Helene tore through the mountains of western North Carolina. Devon rushed from room to room in his house, hearing trees snap in the darkness.
The wind lashed at the steep hill where his family resided in Asheville, shaking windows and breaking branches. Twenty pine trees fell in sequence, with five crashing onto the porch and a corner of the house. The creek behind their home swelled rapidly, sweeping away anything in its path.
Inside, Devon’s wife and their five-year-old daughter took refuge in a closet, crying as the house trembled. Devon shouted over the storm, trying to anticipate which part of the house might be struck next. Though physically present, his mind drifted to distant memories he struggled to suppress.
“For me, it was very triggering,” he said. “I felt like I was in a war situation.”
Devon, an Iraq war veteran who relocated from Florida to the mountains in 2019, preferred to be identified only by his first name, respecting the anonymity of 12-step programs. At 41, he returned from the Middle East in 2006 with post-traumatic stress disorder and a traumatic brain injury that led him to seek relief through drugs. He started with pills, progressed to heroin, and eventually to a mix of heroin and cocaine. “I was so physically addicted,” he said. “The sickness was unbearable. I couldn’t imagine life without drugs.”
In Asheville, Devon gradually reclaimed his life. He joined Narcotics Anonymous, attended meetings, and began therapy to address his trauma. His wife, who moved with him, gave birth to their daughter in 2020. Life in their wooded home was gradually stabilizing.
But the storm changed everything.
Disasters like Hurricane Helene can devastate communities and disrupt even the most stable lives. For those recovering from addiction, they can also dismantle vital support systems: 12-step meetings, treatment programs, transportation, and social networks essential for maintaining sobriety. When these systems break down, the likelihood of relapse and overdose increases.
Penn State University sociologist Kristina Brant has researched the long-term effects of floods on communities, finding “an increase in overdose deaths that persists for a decade after a flood.” Grief and trauma can linger for years, she noted, posing significant risks to recovery efforts.
The Appalachian region, spanning 13 states from New York to Mississippi, faces heightened risks. A long-standing drug crisis has severely impacted the area. Although overdose death rates in Appalachian counties have slightly decreased in line with national trends, mortality during prime working years still exceeded the national average by 52 percent in 2023. Contributing factors include limited healthcare access, physically demanding jobs, and economic hardship. In six western North Carolina counties, including Buncombe, overdose mortality surpassed 36 per 100,000 residents as of 2022.
The intensifying storms and flooding, exacerbated by climate change, worsen these vulnerabilities, damaging infrastructure and the support systems people depend on to survive.
For individuals like Devon, the aftermath of Helene unraveled lives they had painstakingly rebuilt.
Stability is crucial for recovering from substance use disorder. Routine helps individuals stay connected to relationships and services that support long-term sobriety, creating a network where absence is noticed.
Across Appalachia, this support network is already under strain. Rural areas lack redundancies that facilitate attending alternative meetings, finding different clinics, or securing another therapist. Long distances and high poverty rates add further obstacles.
Disasters exacerbate these challenges. Hospitalizations for substance use disorders rose 30 percent after Hurricane Katrina, continuing to increase for years in heavily affected neighborhoods.
“When a disaster like Helene hits, amplifying existing barriers exponentially, it can become genuinely impossible for many patients to access their care,” said Erin Major, a Boston University doctoral candidate studying substance misuse in Appalachia.
In Devon’s Arden apartment, just south of Asheville, his pit bull, Qball, greeted him as he entered. Devon, tall and slender with a straightforward demeanor, understands the importance of routines, having spent years establishing his own.
After serving in a scout platoon in Iraq for two years, he returned to Georgia in 2006 and began college. There, he realized the impact of his brain injury and PTSD, which caused nightmares and job instability, leading him to self-medicate. “Once I started using harder opiates, I was using against my will,” Devon said, petting his dog. He experienced several near-fatal overdoses.
Jesse Barber / Grist
His personal relationships deteriorated, and he eventually found himself homeless. He and his wife separated as they faced financial difficulties. In an effort to save their marriage and finances, the couple moved to Asheville in 2019, where his wife’s family resided. The city offered abundant recovery resources, offering hope for a fresh start.
Devon began rebuilding his life. Though on disability and unable to work, he and his wife managed to purchase a home. Suboxone, a daily prescription, alleviated his opioid cravings. Narcotics Anonymous meetings provided support and a sense of progress. His daughter was born in 2020, and despite some challenges, his marriage and recovery felt increasingly stable.
Hurricane Helene shattered this stability.
In the storm’s aftermath, Devon’s recovery routines began to falter. His 12-step group temporarily moved meetings online. When in-person meetings resumed, he found it difficult to attend, preoccupied with home repairs. The demands of storm recovery left him with little time for therapy, and financial concerns overshadowed personal goals.
“There was a huge interruption,” Devon said. Online meetings are “not the same as being in person… I can do service like chair a meeting, help set up literature, greet people, or set up chairs.”
Service is crucial to Devon’s recovery journey, and he sought fulfillment by assisting neighbors in rebuilding. He spent days clearing debris, organizing supplies, and delivering them to those in need. “We were just pitching in the best we can, and I feel like I was using my experience in the program,” he said.
He formed new connections along the way, including with church volunteers who helped remove the trees from his house. Initially, the spirit of cooperation united people. But as time passed, the camaraderie waned, and the losses became more apparent. Despite receiving a $750 emergency stipend from the Federal Emergency Management Agency for immediate needs, they had already spent $20,000 on repairs. Even with insurance, refinancing the house seemed inevitable.
By last summer, the strain became overwhelming. Devon and his wife decided to sell the house for $30,000 less than they had hoped. Disputes with the insurance company and escalating personal conflicts led to divorce — a common outcome after such life-altering events. North Carolina law required them to live separately for a year before finalizing the divorce, prompting Devon to move into a hotel, facing increasing isolation.
He managed to avoid relapse, though he had to be cautious with activities that tempted him to drink, like poker. As summer 2025 turned to fall, he felt spiritually lost. The combined toll of divorce and storm-related expenses amounted to about $100,000 in losses. It was overwhelming. “I was suicidal,” he said, reflecting on his despair.
For those in recovery, relapse can be more perilous than initial drug use. After a short period of sobriety, tolerance diminishes, increasing the risk of overdose, particularly in the initial days of relapse. The mental health effects and cumulative losses from a disaster can further derail recovery.
In the storm’s immediate aftermath, communities, volunteers, and recovery groups stepped up to temporarily bridge the gaps left by disrupted routines and slow federal assistance.
Researchers note a “honeymoon phase” after a disaster, marked by strong social cohesion as people unite in shared loss to support each other. However, this unity often weakens as trauma and loss accumulate over time.
John Kennedy observed this shift in Buncombe County.
Kennedy, a guitarist, and his wife, Cinnamon Kennedy, a drummer, have long distributed naloxone — a lifesaving opioid overdose antidote — to nightclubs, music halls, and venues across the county. This harm reduction initiative aims to provide education and tools to prevent infection, illness, and death among active drug users. The project began after John lost several friends and his brother to overdoses. The Kennedys leverage their network of musicians and venues to ensure supplies reach those in need.
While driving through Swannanoa, a small working-class town near Asheville, Kennedy pointed out reminders of the frayed social fabric, even a year and a half after the storm.
The last music venue in Swannanoa shut down post-storm, and other local venues either closed or stopped booking bands. A survey revealed that small businesses across 23 counties lost an average of $322,000 due to Helene, leading many to closure. This has reduced communal gathering spaces, prompting Kennedy to worry that more people are using drugs alone. Research indicates hurricanes and tropical storms can lead to higher mortality rates for up to 15 years, meaning the region is only at the start of recovery.
Kennedy lamented the loss of community spaces. “Just the ability for people — like a church service, like a job — to show up and come in and be able to check on everyone, see how people were doing,” he said, driving past Silverados, a venue that carried naloxone before permanently closing. One after another: shuttered, shuttered, shuttered.
He pointed out the RVs lining the roads, sheltering people who lost homes to the storm. Fields where trailer parks once stood. Hardened mud and debris where gas stations, farmers markets, woodworking shops, and a veteran’s clinic used to be. “It’s not what it was.”
Kennedy continues to deliver naloxone, mostly to Asheville venues where people are more accessible. Despite the community’s battered state, he remains hopeful that it will slowly recover.
In the storm’s immediate aftermath, opioid treatment providers struggled to track patients and maintain records, according to Major, the Boston University doctoral candidate. Some providers reported stable or increased treatment numbers as street drugs became scarce. However, others lost patients, with one provider seeing 15 patients drop out or relocate, and only some eventually returning.
How to support people with substance use disorder during and after disaster
FIRST at Blue Ridge, a halfway house in nearby Black Mountain, saw about 30 residents leave to manage Helene’s aftermath, complicating record-keeping. Some residents lost homes they planned to return to. Others, placed there as a probation condition, had to navigate poor cell service to inform court officials and gain permission to assist families. A few simply walked off, hoping to hike home. Most returned, but one or two never came back. The center conducts drug tests for arrivals and departures, finding several had relapsed during their absence.
Similar disruptions occurred across the mountains, particularly where the legal system intervened. Cordelia Stearns, chief medical officer at High Country Community Health in Watauga County, noted that displacement can trigger events leading to incarceration for patients at her clinic.
One patient lived in a shed after Helene and accidentally set it on fire while trying to stay warm during winter. He walked hours to reach the clinic and maintain his treatment for opioid addiction. “He did actually make these heroic efforts to stay in care,” Stearns said.
Despite his efforts, he faced multiple incarcerations for nonviolent drug offenses. Currently unreachable, Stearns assumes he is probably in jail. She expressed concern, saying, “It’s always a little nerve-racking when you can’t reach people.”
Stearns has observed similar patterns repeatedly, especially among unhoused individuals. Access to medications like Suboxone or methadone often hinges on individual jail policies, and incarceration can reintroduce people to environments where drugs are easily accessible. “I’m not totally sure who it’s supposed to be helping,” she said.
In Buncombe County, community health worker Brandi Hayes has witnessed how swiftly recovery can unravel amid turmoil. She works with the county’s Post-Overdose Response Team, checking on recent overdose survivors and directing them toward treatment. Like many in her field, Hayes has a personal connection to addiction, making the work deeply meaningful.
Brandi Hayes (left) works for the Buncombe County Post-Overdose Response Team, which works with recent overdose survivors. Her organization offers treatment services, like Suboxone (right). Jesse Barber / Grist
In the weeks following Hurricane Helene, Hayes and her team traversed the wreckage to check on patients, deliver essentials like food and water, and maintain connections to treatment and care. While some patients remained on track, others vanished. One case particularly resonated with her: a man who had been progressing well in his opioid treatment, even regaining his license and car after legal issues.
“Then the storm came,” Hayes said. “He had to take care of someone else that wasn’t in the sober mind state that he was in.” He stopped attending treatment, resumed drug use, cycled through jail multiple times, and lost his car.
“I don’t even know where he’s at right now or what he’s doing, ’cause he’s fallen off so bad and not going to appointments and things like that,” Hayes said. She remains vigilant for signs of struggle in those she serves. “It’s very easy to backslide.”
A similar pattern emerged across Appalachia. When floods struck eastern Kentucky in 2022, Jeremy Haney lost nearly everything: his apartment, belongings, and his job at Troublesome Creek Stringed Instrument Company, where he crafted mandolins. In recovery from painkiller and methamphetamine addiction, Haney had found purpose in his work. As the floodwaters receded, the factory temporarily closed with no clear reopening date, leaving him uncertain about his future.
“My first initial thought is, ‘OK, our factory’s gone. We’ve got no job,’” Haney recalled. Reluctant to return to Morgan County, he reflected, “I’ve put all this work and effort into relocating and rebuilding my life here in Knott County, and now I’m going to have to start all over again.”
Doug Naselroad, who oversees the recovery-to-work program, dreaded informing the men that their jobs were lost. Instead, he secured funding from the Eastern Kentucky Concentrated Employment Program — a state and federal Department of Labor initiative — allowing them to work in disaster relief. “Nobody missed a paycheck,” Naselroad said. “But they had to rethink what they did for a living, and for months they just slogged away in the mud.”
Haney spent that time cleaning and reorganizing the factory, assessing what could be salvaged and what needed discarding. Despite the upheaval, he received $1,800 from FEMA for his lost possessions. But when his landlord joined a FEMA program aimed at reducing future disaster risk, the building was cleared, and everyone had to leave. Haney spent months searching for a new home. The factory eventually reopened, allowing him to resume his work as a luthier, but much had changed.
The Kentucky flood destroyed nearly 9,000 homes and apartments, with about 31% of Knott County homes damaged. Rental housing was scarce. Even with approved federal homeowners’ loans, Haney struggled to find an affordable option. “There just ain’t that many homes around here that would be cheap enough for me to be able to afford the payment,” he said. His landlord had another apartment available, but the situation felt precarious.
He worried about returning to Morgan County, where he risked falling back into addiction. The cleanup job helped him stay grounded. Eventually, he qualified for a unique state post-disaster housing program for flood survivors, enabling him to purchase his first home last year. He moved in just before Christmas, over three years after the flood. Haney credits his support network for helping him navigate this challenging period — assisting with moves, furniture, and social support.
“That’s a big thing in recovery,” Haney said. “Asking for help.”
For Devon, community connections have been invaluable. Despite battling depression and hopelessness for over a year, he has remained sober.
As the afternoon light faded across the carpet of Devon’s apartment, he reflected on moments when he felt tempted to use drugs again.
“I’ve thought about it, but very rarely,” Devon said. “If I do, I have a support system where I can call somebody. I would really have to be in a bad place to use.”
He leans on people who’ve weathered their own crises — divorces, financial ruin, other disasters. Some friends have returned to drug use, but Devon remains grateful for his sponsor and fellow Narcotics Anonymous members. “This is, like, why we do what we do — when shit hits the fan,” he said.
Life for Devon is quieter now. He maintains appointments and stays connected with friends in recovery. He attends weekly meetings, occasionally leading them, and has resumed individual therapy to manage lingering anxiety from the hurricane.
It’s not the life he once envisioned, but he has come to terms with it. “I try to focus on my daughter,” Devon said. “I’m just doing the best I can.”
Caring for her gives him purpose. He looks after her while his ex-wife is at work, structuring his life and routines around her activities — ballet, gymnastics, kickboxing. For Devon, the structure helps him keep moving forward.
This coverage is made possible through a partnership between Grist and BPR, a public radio station serving western North Carolina.
