The Daily - The Sunday Read: ‘Opioids Ravaged a Kentucky Town. Then Rehab Became Its Business.’

Episode Date: January 19, 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.

My name is Oliver Wang, and I'm a contributor to the New York Times magazine. I started reporting this story about five years ago, when I moved to eastern Kentucky during the pandemic. It was a perfect respite during lockdown. Endless hills and hidden streams. The trees are spectacular in the fall. But the region has a troubled past. Many communities were established as single company coal mining camps, company towns.

When the industry flagged and companies exited the area, high rates of poverty were left behind, not to mention high rates of disability from the hazards of coal mining. This created fertile ground for drug companies like Purdue Pharma to promote opioids such as OxyContin to doctors in the region. And as we've seen over the past 25 years, opioid addiction rates in Appalachia have

risen higher than anywhere else in the country. There are now generations of people who are addicted to opioids. 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 AHRQ for short. AHRQ 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 ARK 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, Arc 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 ARC. 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 nursing assistants. They were these kind of model examples of ARC 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, ARC 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 ARC for fraud. And all of the company's success in revitalizing the town of Louisa and helping people like Ingrid and Latasha was called into question. So here's my article, read by Eric Jason Martin. Our producer is Jack Dissidoro and our music was written and performed by Aaron Esposito. Thanks for listening. Lousy

Louisa, Kentucky is a small town of about 2,600 on the border of West Virginia with a single pair of railroad tracks running through it. If you followed these tracks south against the flow of the Big Sandy River, you'll go between the Public Library and the Main Street Park and over Lick Creek, one of the manifold creeks that web eastern Kentucky-like capillaries. Follow Lick Creek past a baseball diamond and a pawn shop, and you'll arrive behind an ordinary gray mobile home in a small lot of grass where Ingrid Jackson was living in the fall of 2023. The days were still long and the afternoon sun settled gently on nearby mountains, turning

leaves a lambent red. Reedy gospel music played from inside the trailer, announcing Jackson's presence as she opened the door. Her hair, normally figured in light brown curls, was packed into a shower cap. She smiled from the entryway. It was a smile difficult not to smile back at. Jackson had never lived in a trailer before, or a small town. She was born in Louisville, the daughter of a man with schizophrenia,

who in 1983 decapitated a 76-year-old woman. Jackson was one 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 one came in 2022 after her son was sentenced to life in prison for murder, he was 21.

In Louisville on Christmas Day, she called a residential rehab company named Addiction Recovery Care, which has its headquarters in Louisa. So now she was here in Appalachian cold country, in a trailer along Lick Creek. In a town a tiny fraction the size of her home city, working as a nursing assistant in a nearby nursing home, sharing a trailer with Latasha Kidd, a local woman 12 years her junior, with a mountain accent, a fade and blood orange bangs.

This is culture shock, Jackson said. I'm a city girl, and there's not a lot of us around, and I'm like, mama. Jackson and Kidd were about as different as you could make them. Jackson was black, Kidd white, Jackson outgoing, kid reserved, Jackson neat, kid messy, Jackson devout, kid agnostic, Jackson straight, kid queer. Still, they became fast friends in rehab, and now, five months out, inhabited a somewhat fragile existence together in the period of addiction recovery that many people in long-term recovery say is the most difficult, the space between leaving rehab and getting back on your feet.

More than a million people in the United States are arrested every year on drug-related charges, and for them, finding a steady job, consistent housing, and reliable transportation can be even more difficult than the tremors, hallucinations, and nausea of detox. Studies have shown that relapse rates for people in recovery may be as high as 85% within the first year. Another woman with whom Kid and Jackson went through recovery, who was supposed to live with them, relapsed and overdosed the day before moving in. Jackson often worried that something similar might happen to Kid, who had struggled with addiction so long that until recently,

she didn't know how to pay her bills. At 29, Kid hadn't yet held a full time job. So I have to push her sometimes, Jackson said, cuz when I wanna go in my own direction, I don't want Tasha to be left upside down." In eastern Kentucky, a region plagued by poverty and 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 medical clinics, offering not just chemical but also spiritual and logistical services with the aim of helping people in addiction find employment and reenter society. And in the two five-year periods between 2008 and 2017, eight of the ten counties in America with the steepest decline in overdose mortality rates were in eastern Kentucky. The state now has more residential treatment beds per person than any other state in the country, and provisional data show that, in the 12 months ending on June 30th this year, the number of overdose deaths dropped by 20% over the previous 12-month period.

Eastern Kentucky is one of the places where you're most likely to die of a drug addiction, but also the place where you're most likely to receive treatment for it. Among the rehab companies around, none have taken this holistic recovery philosophy further than addiction recovery care. ARK, whose motto is crisis to career, has treated tens of thousands of people in addiction since its founding in 2008. In the 2010s, as the power utility moved away from coal energy, the area lost hundreds of mining jobs and

ARC began buying up abandoned buildings and turning them into businesses staffed by clients in recovery. There is an event planning brick and mortar, a cafe, a bakery, a small gallery, an old theater that the company renovated, a pharmacy, a welding company, an accredited Christian college, a private Christian school, a landscaping company, and an auto body shop. All are owned and run by ARC and its chief executive, Tim Robinson. About half of the company's 1,000 current employees in the state are in recovery from some kind of substance use disorder,

and one-third have gone through one of the company's more than 30 residential rehab programs themselves. ARC has formed relationships with several accredited colleges and trade schools, and in 2023 received $130 million from Medicaid, making it the state's largest provider of treatments for substance use disorders. That year, ARC bought a psychiatric hospital in Russell, Kentucky, and began planning to open centers in Ohio and Virginia. The company's rapid growth may have helped draw the attention of the FBI, which in August made public an investigation into ARK for potential healthcare fraud.

In Louisa, there was skepticism about the company's place in town, which turned on rumors of exploitation and brainwashing and greed. It's like ARK has taken over everything, a resident told me once. People joke that it's a cult. Around town, the company's logo, a drawing of an Arc, popped up on buildings and lawn signs and brick walls, often next to images of Noah Thompson, a young country singer from town who, in 2022, won American Idol. He too had worked for Arc in construction.

Jackson and Kidd, both of whom had criminal records, were among the first group of Arc graduates to complete their nursing assistant training while in recovery as part of a new collaboration between the company and a local nursing home. Their co-workers described them as the most beloved caretakers on staff, and neither had missed a day of work since starting there in July. David McKenzie Jr., the nursing home's sandy haired owner and administrator, was one of their biggest proponents.

They're ready to run through walls, he said. I see tremendous effort, tremendous willpower, determination, grit, they have transformed my view. McKinsey first approached Robinson in February 2021, amid a labor shortage caused by the pandemic. Like other supporters of ARC, he sees the potential of a combined humanitarian commercial approach to addiction treatment. Not only can it be used to address a systemic health issue in the region, not only can it return meaning to people who have lost their way, but

in doing so, it can bring life back to the region. We were a coal community, McKinsey told me, and that's disappeared over the past few decades. It's by and large gone now. And now we have a new industry and it's addiction recovery and it's revitalized our town. Tim Robinson moved to Louisa in 2005. He grew up about 30 miles south of town and

came back after completing his law degree to work as an assistant county prosecutor. His docket, he quickly found, was grim. Nearly every case had something to do with opioids, use, trafficking, theft, abuse, assault, and most defendants ended up in jail. Kevin Mullins, who was the district court judge in nearby Letcher County for 15 years before his death in September, told me there were so few treatment centers in 2009 in Eastern Kentucky that if someone came into court wanting to go to rehab, they would have to wait several weeks for a bed 100 miles away.

Our knee-jerk reaction was, we're going to incarcerate ourselves out of this problem, Mullins said, that approach has continued to haunt us to this day. In 2021, Kentucky was found to have the second highest jail incarceration rate and the tenth highest prison incarceration rate in the country. Robinson himself was an alcoholic and was arrested twice for public intoxication. One day in the winter of 2006, he came to work hungover and, on running into a local pastor, prayed with him. When I stood from my praying, I felt like the burdens of my life literally fell off my back, he said.

That started the process of me forgiving myself. He got sober. A few months later, in the summer of 2007, he quit his job and began trying to open an addiction treatment center for women in Louisa, what would later become addiction recovery care. It was difficult to get the business off the ground. I had people come up to me in restaurants wherever say, we don't want what you're trying to do.

We don't want those people, Robinson told me. Financially, there were other restrictions. Most people in Eastern Kentucky could not afford private insurance, and federal insurance plans didn't cover addiction treatment. insurance and federal insurance plans didn't cover addiction treatment. When Robinson finally opened his first rehab as a nonprofit in 2010, much of his funding came from family, friends, and church donations. A vast majority of the revenue came from treatment vouchers issued by Operation Unite, a state-funded nonprofit group formed in 2003

in response to Kentucky's opioid epidemic. Everyone on staff was a volunteer. Then in 2013, Kentucky's Governor Steve Beshear, father of the state's current governor Andy Beshear, expanded Medicaid's addiction treatment benefit under the Affordable Care Act to cover residential care for people in addiction. A new funding model appeared. Though the state paid for only 30 days of residential care,

its coverage of treatments was comprehensive, which allowed Robinson to take in more insured clients, charge for more services, and open more rehabs. This tracked a statewide trend that began with the Medicaid expansion. In 2014, there were 347 qualified addiction treatment centers or hospitals in the state, 170 of which accepted Medicaid. By 2020, there were 477 treatment centers, 382 of which accepted Medicaid. I first spoke to Robinson in his office in 2021.

It was a spacious room on the top floor of ARC's headquarters in Louisa, between the Food City and the County Courthouse, filled with mementos to the mid-20th century Los Angeles Dodgers. Robinson was large behind his desk, cutting the image of a lay preacher with lively hazel eyes and a well-trimmed dark beard. By that point, Ark owned more than two dozen treatment centers and had helped turn Kentucky into what Mullins called a treatment on demand state. Most people in addiction could get a bed in rehab within 24 hours of asking for

one, regardless of their insurance. Lawn signs dotted the town, advertising the company's telecare rehab effort called Arc Anywhere. Over the years, as I spent more time getting to know people who went through rehab at Arc, I began to notice a certain archetypal story that drifted down from Robinson to his executives, to his employees and clients. It opened with horror. One man I spoke to struggled with addiction since his teens, was in and

out of jail, and was still trying to put his life back together when his daughter went into the hospital for surgery and died. He overdosed in the parking garage of a hospital, then spent more than a year using heavily until he was ordered to rehab by court. Kayla Parsons, who was born 45 minutes north of Louisa, was sexually assaulted at 19, after which she turned to drugs. She became pregnant with her first daughter at 21, was arrested for drug trafficking, went to rehab, relapsed, lost custody of her daughter,

was arrested again, went to jail, got sober, relapsed again. In 2016, her family sent her, dopesick, to an ARC treatment center. I didn't see a way out, she told me. I thought the only way out of that was going to be death. So every single time I got high, my one and only goal was to overdose. At some point, there would come an intimation of hope. For Parsons, it was when she heard about ARC's commitment to find jobs for clients. Many workers at AR Arc facilities are interns, paid a small stipend for

half a year while they transition from clients to employees. They train to be peer support advisors at outpatient clinics and work as receptionists at residential centers and cashiers at Masterpiece Cafe, which is Robinson's coffee shop in downtown Louisa. Freedom Fabrication, Robinson's welding shop, trains people in addiction for a welding career. His auto body shop, Second Chance Auto, employs almost exclusively people in recovery. Many of the company's outpatient and residential treatment centers are lined with framed testimonials from clients turned employees.

Each a journey starting at a nadir, each one its own miracle. Parsons is now the senior vice president of administration at ARC and married to a man she met through recovery. That is a huge part of it, changing that narrative. I can have a career, she told me. But on the other side of it is, I don't have to be that awful human. But that awful human isn't wasted either. Robinson recapitulates these points when talking about his business, his experience as assistant prosecutor, his working class childhood, his history of addiction,

his baseball obsession, which began in elementary school as a trading card business and led to a mentorship from the local bank president and now serves as inspiration for the company's vocational and peer support specialist training, combine to describe an almost holy struggle against social injustice to bring a depressed region back from the brink. Since the days of coal companies, the regional economy has largely been run from afar, often to poor effect. Mineral rights were systemically signed away by unsuspecting landowners.

Black lung continues to plague miners and their families in the area. An accelerated phase of the opioid epidemic began in central Appalachia when Purdue Pharma promoted Oxycontin to doctors serving poor laborers. Dispatches in the national news often cite high poverty rates, overdose rates, obesity rates, and widespread emigration. Go look at any bad list. We're toward the top. And all the good lists were toward the bottom, Robinson told me. In a region whose destiny had long been determined by outsiders, Arc's success was Louisa's redemption in Robinson's telling. He recast the story of the town. in Robinson's telling, he recast the story of the town. We've not been part of writing the next part of the narrative, Robinson said, picking up

a printed map of Ark's treatment centers. But when I look at this, he said, shaking the paper, this is one thing we've done. This has been us. When I first met Jackson and Kid, they had been living in their trailer together for nearly half a year. They met at a small ARC recovery center in Louisa in late 2022. Jackson was the only black woman in the facility and one of the most garrulous, often saying things like, every day is a good day and my greatest asset is my alcoholism.

She was the loudest woman in church, praising wildly, flinging her arms about her. I had to sit six feet back, said Kidd, who grew up about 45 minutes west of town in a county where 99% of the population was white. Kidd was more reserved than Jackson, sometimes spending much of her non-working day on the couch under a blanket. She had entered rehab after a seven-month stint in jail, so she was used to the daily limitations.

6 a.m. wake-up time, reading material restricted to faith-based literature, punishments for breaking house rules. But she found it difficult to buy into the treatment itself. She had been using pain pills since she was nine, she told me, and her parents were addicted to opioids. But she had never spoken at length about her addiction. She lost custody of her four children after being arrested on child endangerment charges relating to her stepson.

The older two were in Alabama with her grandmother, and the younger two, twins, were in Kentucky with her aunt. Now, in treatment, Kid was constantly being asked to reflect on these facts, which she found almost unbearable. For a long time, I thought that my mamaw had took them, she said of her children. Eventually, she realized that she had abandoned them. Sometimes she would shove the center's door open and sprint toward the road.

She would stop at the pavement each time, turn around, and walk back inside. Jackson entered treatment three months after Kid, but she made progress quickly. A model patient, she adhered to a precise schedule, even by rehab standards. She rose at 4.30 AM every day to write in her journal, composed letters to her incarcerated son. And sat in front of small books full of devotions, whispering them over and over, folding down the corner of the page when she was done. As two of the oldest patients in the center,

Kid and Jackson began spending more time together, acting like the elder statesmen of the group. The other women in the center started calling them the older sisters, and Kid started taking on some of Jackson's confidence. She came out as a lesbian and began wearing a rainbow pride shirt that Jackson had ordered for her online. She was baptized and began praying with Jackson in church. Eventually, the pair began training at David McKenzie's nursing home together.

They worked constantly, excited by the prospect of getting out. Coming from poverty with criminal records, finding employment without Arc's help was a dubious prospect. Multiple times throughout my life, I'd go to prison, get out, there's nothing to do, said Michael Clark, who was addicted to opioids for two decades before going through treatment elsewhere and landing a job at Ark in 2018. When money got tight, Clark's grandmother crocheted blankets for sale.

But with no similar skill to fall back on, Clark would resort to dealing. The worst time in my life wasn't when I was using, it was when I was clean, but I couldn't find a job, he told me. Kid and Jackson moved through the program in only a few months. After graduating, in July of 2023, they rented a trailer from McKinsey's father, and each morning walked together across the creek for 12-hour shifts. Jackson, who had just turned 42, was saving up to buy a car, and Kidd, who didn't have

a license, was studying for her permit. By the time I met them, the thrill of their new independence had worn off, and a mundane reality had set in. Right now, it's just work and back, work and back, Kid said. The boredom felt more dangerous than anything. This is something that many people in recovery realize. No matter how much you change in treatment, whether you find a new religion or a new partner, you'll find your old self waiting for you back in the real world. Beneath the promises of peer support specialists, the gleam of vocational programs, and the

excitement of a new job in a new town where few people know your name are the same impulses, the same issues, that drove your addiction. In response, Jackson leaned into her structure and her faith. Her bed was always made with a floral quilt, prayer books stacked neatly in a bag, certificates spaced regularly along her dresser. She made daily calls to her daughter in Louisville. Everything became a sign of deliverance, the first month's rent, which Mackenzie covered while she and Kid were getting on their feet.

The furniture that employees at the nursing home had provided, the Section 8 housing vouchers she was in the process of applying for. When I say God provided all this, I mean God provided this, Jackson told me. I called my mom and I said, God is going to put me up on an Appalachian mountain. For Kid, every day seemed to present some new complication. The case worker 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, pe packing 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 People's opinions about addiction treatment in general were often mixed with their personal struggles with addiction or the struggles of those they knew, and their opinions about addiction in general were often conflated with their opinions about addiction recovery care. A result was a muddle of criticism. There was the company as offering salvation narrative from people like Robinson, but among other Louisans,

there was at best a charged ambivalence toward the company and its mission, and at worst outright hostility. Complaints were varied. Arc was attracting addicts. It was dominating smaller businesses, running them into the ground. It was increasing crime in the area. It was profiting off vulnerable people. A lot of good things came from them being there, you can't deny that, said one Louisan, who asked to remain anonymous out of fear of retaliation from the company. I still don't like them. I don't like Robinson. I think he uses religion and addiction to make himself rich. I don't trust him. They do not have a good

reputation, they do not, someone else from town told me. But I wish they had come a little sooner, for my brother. He died, addicted, a decade ago. The more enmeshed Ark became with Louisa, the more complicated the recovery dynamics grew. The company and town formed a polychrome ball of altruistic idealism, entrepreneurial ambition, and small- town drama. To analyze, for example, the financial benefits of ARC without factoring in the stigma around addiction, or the politics of religion, or

the sentimental attachment lifelong residents formed with their hometown, would be like trying to extract the blue play-doh out of the brown blend you get after massaging all the colors together. The blue play-doh out of the brown blend you get after massaging all the colors together. When Lisa Robertson, a real estate agent with an office in downtown Louisa, praised the company and offered me two extra tickets to Little Shop of Horrors, showing at the Ark Run Garden Theater, was it because Ark had been good for her business, or because she was happy that they were saving a lot of people, or because she had her lawn mowed by ARC's second chance lawn care, or because she sent her two children to the ARC-run private school.

When Tracy Cavins, who owns a novelties store off South Main Cross Street, told me that she saw a lot more homeless people around town than she did ten years ago, and that she didn't feel it was safe to come here by myself at night? Was that because she was frustrated that Ark has been buying up all the neighboring properties, or because the company brought more people in addiction to town for treatment, or because she distrusted a corporation with a single man at the helm, exerting outsize influence over her town.

ARC's packaging of addiction recovery as a community-centered activity could be seen as a progressive initiative, creating an environment where addiction is normalized and people in recovery have support. It could also be seen as a profit-driven strategy, exerting economic power to shape a town and its people to a company's benefit. They make you feel like you either do things in their way, believing in God and working for them, or you're failing, one former Ark client told me. Another former client told me about a friend of hers who went through recovery at Ark and

then relapsed while working for the company. An addict in recovery or who's gotten sober? They tend to be the hardest worker, she said. And to take advantage of that, I told Tim Robinson to his face that money replaced God for him. One ARC employee told me, you can easily let work become your new drug. ARC's expansion enabled more people to gain access to treatment, which brought in more money from insurance claims and more ways to cut costs through scaling, larger treatment centers, more efficient kitchens and food services,

and more employment opportunities for graduates. food services, and more employment opportunities for graduates. Over the past decade, as Kentucky has sought to address the addiction and mental health crises, funding has flowed loosely. You would struggle to find anything that's not reimbursed in behavioral health, said Stephanie French, the former executive director of communications and public affairs for the Kentucky Cabinet for Health and Family Services. At ARC, this money is used to help pay for beds for patients beyond their normal 30-day allotment, but also to support its other

businesses and to pay Robinson and his wife a total of more than $500,000 a year. The couple have donated generously to state political campaigns, both for the conservative governor Matt Bevin in 2019, and his progressive successor Andy Beshear in 2023, and built a large gated house on the edge of town that some people called the mansion. This past summer, the FBI issued a call for information from former patients of ARC, asking in a questionnaire whether any medical procedures,

exams or services from ARC were not adequately rendered. When I walked around town soon after that, people were amused to see me. The sentiment seemed to be that the company had it coming. The FBI declined to comment directly on the investigation, but one local conjecture was that it was spurred by Robinson's frequent campaign contributions. Another was that the company was continuing to bill insurers after patients left treatment or was skimping on care.

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 when texted, that'll be a major blow to the community. That is, if Robinson was in trouble, Arc was too, and the town could be reclaimed. But maybe if Arc 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.

Arc's 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. 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. She brought up the arc-wide convocations that they attended, which feature employees who have remained in recovery long term. Somebody's story is always going to be up there, Jackson said. Tasha, our story is going to be up there one day. Recovery narratives follow an appealing arc, always with the promise of closure. The person remains sober, the town bounces back, the region battles the addiction crisis from the ground up.

But reality is more confounding. In late November, a week after I last saw her, Jackson went back to Louisville for Thanksgiving. It was her first time visiting home in more than a year, and she stayed with her daughter Charlie. That was literally the best day of my life, Charlie told me. It was like a hug I'd been needing. On Sunday, Jackson went to her mother's house,

where her son had been arrested four years before, and relapsed. She overdosed and died in the early morning. Kid heard the news later that morning and informed me in the afternoon. My heart is crushed, she texted. There was a vigil held for Jackson in town, and someone from ARC stayed with Kid through the night. When I saw Kid again a few months later, she had started dating a woman, Brittany, who had moved into the trailer and began working at the nursing home with her.

Kid told me that sometimes when she's stressed, she imagines finding a Xanax or Valium lying around. She would never act on such thoughts, she said, but they have become a kind of dark joke that helps her cope with the urge. The world seemed to move faster than when she was in rehab or in jail, and going back to where she grew up didn't feel the same anymore. Ingrid was the exact same way, she said. We were destined to be together. A year after Jackson's death, Kid told me that she still thought about her friend every day. After Jackson's death kid told me that she still thought about her friend every day

When she was spiraling while thinking of the future. She said Jackson would take her hand and say we're going to finish this out together, buddy Thank you.