One afternoon in May, some 20 second graders sat in pairs around their classroom in Ravenswood, West Virginia, playing an arithmetic game with dice. Trudy Humphreys, their teacher, sat to one side, with a student whose glasses protruded from her elfin face. “How’s it going? What’s been happening lately?” Humphreys asked as the girl counted on her fingers, adding up 11 and six. “My parents have finally been getting along,” the child responded brightly. Carefully, she marked “17” on the paper in front of her.1

When that game was over, Humphreys played with a serious, curly-headed boy who spoke in a voice so soft that I could barely hear his response when she asked how things were at home. It’s a question she’s been asking more often lately, as “home” has become a complicated subject for many of her students. The boy lives with an adoptive family after being removed from his birth parents; the girl once lived with her family under a bridge a few counties over.2

Humphreys, who speaks in a high, gentle voice and rides motorcycles in her spare time, was once a student at Henry J. Kaiser Elementary School, or HJK. She’s spent most of her 31 years of teaching at the school, too, which is named for the steel and aluminum magnate who, in the 1950s, brought thousands of jobs and a few decades of prosperity to the small community on the banks of the Ohio River. When Humphreys was growing up, Ravenswood was a placid town where everyone knew everyone, and your parents heard what happened at school before you got home. According to local legend, Ravenswood once held the Guinness world record for most churches per capita. People left their doors unlocked, and “You could walk into someone’s house and not worry about what was in there,” Humphreys recalled.3

Once expected to employ more than 12,000 people, the facility that Kaiser built now has some 1,100 workers. The bloodletting began in 1981, when over 1,500 people were let go. Since then, as the aluminum industry has declined nationwide, Ravenswood—with a population of fewer than 4,000—has seen successive rounds of layoffs, plant closures, and union battles. More than 650 people lost their jobs when another local factory shuttered in 2009. Today, Ravenswood’s main street is a short strip of fast-food restaurants, vacant storefronts, and dimly lit antique shops. Over a quarter of the residents live below the poverty line. HJK, which teaches about 370 students in pre-kindergarten through second grade, has more students living in poverty than any other school in the county; every student there gets free breakfast and lunch.4

Along with the layoffs came drugs. Between 2006 and 2008, at least 16 teenagers and young adults in Jackson County, where Ravenswood is located, died from prescription-drug overdoses, their bodies found in parked cars and neighbors’ yards. Amy Haskins, the administrator of the Jackson County Health Department and the director of the county’s antidrug coalition, said those deaths were the first local sign of the nationwide wave of opioid addiction that now kills more Americans a year than car crashes. At one point, Haskins said, tiny Ravenswood had three “pill mills”—clinics and pharmacies that prescribed painkillers indiscriminately. “We went from having a pill problem to heroin to shake-and-bake meth, back to heroin, fentanyl, and now we are at crystal meth again,” she said.5

Few states have been harder hit by these combined crises than West Virginia. The state has the highest rate of death by overdose, and of babies born dependent on drugs, in the United States. Each individual case of addiction is like a stone dropping into water, sending countless ripples outward through the wider community, disrupting families and straining public institutions that in many cases have already been weakened by years of disinvestment. There are 6,300 children in the foster-care system in West Virginia; nearly half were separated from their parents because of substance misuse. The secretary of the state’s Department of Health and Human Resources has said that his agency has run out of homes in which to place these kids.6

A rising number of students at HJK have lost their parents, either to the prison system, overdose, or the haze of addiction, and many carry complex emotional needs with them into the classroom. Two years ago, a quarter of the students in Humphreys’s class of second graders were being raised by grandparents or in foster care. This year, at least eight teachers at the school have two or more children in their classrooms with a parent who has been incarcerated on drug charges. One kindergarten teacher is raising three young girls, including an infant, whose parents lost custody because of their drug use.7

“The baggage they have—it’s overwhelming,” Humphreys said, referring to her students. She often finds herself acting as a counselor as much as a teacher; the quiet check-ins during the arithmetic game are just one of the strategies she’s adopted to give certain students a bit of extra attention.8

She and other teachers have noticed a marked uptick in behavioral problems—students who are defiant, who throw chairs and tip over tables or bolt from the classroom. More students are having trouble with concentration and with working memory—the ability to remember information in the short term and then apply it to various tasks. Sometimes, these kids fall into what the school’s principal, Amber Hardman, described as a “gray area”: They don’t meet the criteria for a learning disability, and yet they aren’t progressing academically alongside their peers.9

“It’s easy to connect the dots,” Hardman told me when I visited the school in May. A native West Virginian, she has worked in high-poverty school districts throughout her 17 years as a teacher and administrator. While many kids in Ravenswood have the same basic needs as others she’s worked with—they don’t get enough to eat at home, for instance—the scale of the emotional outbursts and memory issues struck her as exceptional. Particularly in a small town, teachers often know a lot about their students’ lives—and Hardman’s staff noticed that many of the students struggling in school were those whose family lives had been upended by addiction.10

Like many other areas roiled by the opioid epidemic, Jackson County has few public services for families struggling with substance use, or for children with mental-health needs. In the absence of other institutions, public schools find themselves filling some of the void. But the schools themselves are underresourced, and the teachers are overworked. Everyone I spoke with at HJK said they felt overwhelmed by the number of students affected by trauma. The school doesn’t even have a full-time counselor. “I just feel kind of at a loss,” said first-grade teacher Beverly Smith. She and several of her colleagues told me that this year has been the worst of several difficult years, with the extra pressures of the drug crisis piled on top of low teacher pay and limited school funding—all of which boiled over in February, when a statewide teachers’ strike closed schools for nine days.11

The addiction crisis has strengthened certain social bonds in the county, drawing parts of the community closer. Elderly adults are putting aside their retirement plans in order to raise children in need of a home; teachers stay late at work, devising new lessons. But it’s also exposed the atrophy of public services across small-town America. “These kids are watching their parents die,” said Jessica Wooten, a nurse practitioner who works in a local primary-care center. “How do we deal with that in a little rural health clinic? Because that’s what we have here.”12

Linda McClung didn’t expect to raise more children. At 66, she’d hoped to retire from her job as the chief executive of a federal credit union. Maybe she’d run for the school board and be more involved at church. She and her husband could travel; he’d play more golf.13

Instead, the McClungs are parenting three brothers whose mother has been in and out of prison for heroin possession and other charges. How the McClungs ended up caring for them is a tangled, drawn-out story, and a circumstance she chalks up to an act of God—one that has reconfigured her life. McClung is far from the only person in her social circle raising someone else’s children. She counts six families in her church in a similar situation; about 11 of the 57 children in the local Boy Scout troops have been separated from their parents.14

Dylan, now 7, likes pancakes. He is wary of strangers and often has nightmares. He’s afraid of taking baths; McClung believes something happened to him in a tub when he was a baby. Adam, now 8 and thin as a rail, is autistic. He’s into duct tape and Legos, and he hates bugs. The two blond, blue-eyed boys both attend HJK, which is just down the hill from the McClungs’ house in Ravenswood. Tyler is 13 and plays soccer and football and runs track. When I visited them at home, Tyler offered me a firm handshake before settling into the couch with the dog to play a video game. (The names of the boys have been changed to protect their privacy.)15

On his first day of kindergarten at HJK, Dylan walked up to his teacher and said, “My mom’s in jail.” McClung told me, “We didn’t realize he even thought about that.” On Mother’s Day this year, Dylan asked if he could bring his mom the potted flowers that their church was handing out. We’ll plant them and give them to her when she’s released, McClung promised him. The boys haven’t seen their mother in more than two years. “We love them beyond belief, but they have definitely been affected” by the separation, McClung told me. “We do our best to give them the best. But no matter what we give them, we can’t give them what a mom and dad who truly loved them could have given them.”16

Rebecca Wendell, a psychologist who comes to HJK a few days a week, described family separation as leaving students with a constant emotional hole, which often manifests itself in uncontrollable outbursts in the classroom. A small thing, such as a request from a teacher, can set a child off into a cascading tantrum. “It’s almost like their brain is short-circuiting,” she said. These children often can’t calm down, and ultimately try to flee or hide under their desks, a behavior pattern that Wendell said is new. She sees other kids who are “at emotional war with themselves. They’re told drugs are bad, but they see their parents using.”17

The McClungs are devoted guardians. Even so, they’ve had trouble finding support for the boys, simply because of a lack of services in the area. Adam is on a waiting list for occupational therapy; it’s 27 months long. For students whose families can’t find outside specialists, the schools are the only place where they might get counseling, and even that is limited. “A lot of our children need play therapy,” Amber Hardman said. “There’s no one who is doing that anywhere close. Those who do, leave. There’s just not a lot of support in terms of any mental health.” Hardman would also like to hire a full-time behavioral-support specialist, but even if she could get the money, she’s not sure she could find someone qualified. (The county did recently secure funds for a new social worker who will be stationed at HJK, though shared with other schools in the district.)18

Thanks to a series of tax cuts passed by the State Legislature since 2007, West Virginia has lost more than $425 million in tax revenue each year, according to the West Virginia Center on Budget and Policy, leaving the state ill-prepared to respond to the added burden of the drug epidemic. West Virginia now spends 11 percent less in general funding per student than it did in 2008, and its teachers are among the lowest-paid in the country. During the 2017–18 school year, the majority of the state’s school districts didn’t have a full-time social worker, and seven of the 55 districts didn’t have a full-time psychologist on staff.19

On one of the mornings I spent visiting the school, I headed to Dylan’s first-grade classroom, which is at the end of one of HJK’s three corridors. When I arrived, a few boys were clustered around the desk of their teacher, exploring a rock collection. A boy in a Batman T-shirt handed over a textured, whitish piece of coral. “It’s a dinosaur foot!” he exclaimed. (His father, I learned later, is in prison.) Another gave me a lump of dull black rock; I realized later that it was coal.20

The boys’ teacher, Laurel Tanner, is a brash talker with long, dark hair, who grew up on the outskirts of Charleston, the state capital—“On the other side of the tracks, I guess you could put it”—in a place called Mud Suck. Her father was a moonshiner, like his father before him. “People don’t get it. They don’t see what these kids go through at home,” she told me. “I understand them better than most because I lived it.”21

But empathizing with her students doesn’t necessarily make her job less exhausting. “This is absolutely the hardest year I’ve ever had,” she said during a quiet moment when her students were in another classroom. She has more students who are impulsive and emotional. “They can’t stop moving,” Tanner said. A typical interaction: “Sit down, honey, sit down. I told you two minutes ago—sit down. Honey, you’re up again!” Other children disappear behind an opaque emotional curtain. A few students whose families have been affected by drug use have so much trouble focusing and retaining information that they’ve “flatlined” academically all year. “It’s gotten progressively worse,” Tanner said. “I think, ‘Oh, they’ve got it.’ No, they don’t. They can’t retain.”22

Later that morning, the students sat cross-legged on the floor, reading along with Tanner. Dylan sat in the front row, in a bright green T-shirt, his ears slightly pink. He watched his teacher intently, but rarely spoke the words aloud with the other students. Then Tanner read the story of Paul Bunyan and the popcorn blizzard, about a day so hot that the corn kernels exploded right off their cobs. She sent the students off to write their own tall tales. As the kids bent excitedly over their notebooks, I noticed Dylan sitting quietly alone at his desk, fiddling with a pencil. Eventually, he pulled out his journal and set it in front of him. A few minutes went by, and then it was time for recess. Dylan put the unopened notebook back in his desk and ran outside to join the others.23

It occurred to me later that I might not have noticed Dylan at all if I hadn’t known about his history. I thought of something McClung had said, about the way he and his brothers have been affected by the separation from their mother—that they feel it not just emotionally, but also socially. “You know which kids are affected by drugs, and sometimes it really affects how they’re treated,” McClung told me. I began to wonder whether the teachers’ knowledge of their students’ home life was ever stigmatizing rather than helpful. If the teachers weren’t aware that a particular student had been removed from his home, or that he was born dependent on opioids, would his classroom behavior still seem exceptional and be taken as evidence of an epidemic?24

In 1990, The New York Times reported that schools in inner cities across the country were facing an “onslaught” of as many as 4 million children “prenatally exposed to crack.” Researchers, the article continued, “agree these children’s neurological, emotional and learning problems will severely test teachers and schools, and many fear this is a test schools are doomed to fail.” Two years later, another Times story referred to such students as “a different breed of pupils.” Fears about the long-term impairment of “crack babies” proved to be overblown—poverty and associated factors like stress had far greater impacts on development—but they created a lasting stigma for African-American mothers as well as for their children, both in and out of the classroom.25

Media and public officials have expressed more empathy toward people affected by the current wave of addiction. “Because the opioid crisis is perceived as a ‘white problem’ the response has generally been more humane than the response taken toward the crack crisis which was perceived as a ‘black’ problem,” Pedro Noguera, a professor of education at UCLA, noted in an e-mail. Still, some discussions—with people in Ravenswood, and in the public sphere generally—about the rising number of babies born dependent on opioids carry echoes of the “crack baby” panic.26

Between 2000 and 2012, the number of infants diagnosed with drug withdrawal at birth (officially known as neonatal abstinence syndrome, or NAS) increased fivefold. While those babies do require specialized care, the evidence for long-term developmental impacts is murky. “You’re really asking the million-dollar question,” said Marie Hayes, a professor at the University of Maine who studies the effects of prenatal opioid exposure, when I asked her how those children fared in the long run. “The short answer is that there are almost no uncontaminated studies”—meaning studies where the impact of opioids alone can be isolated from other factors, such as alcohol or tobacco use and poverty.27

With so much unknown, many child-development experts caution against repeating history. “I think we really should be mindful of the lessons of the cocaine epidemic just a few decades ago,” said Dr. Stephen Patrick, a neonatologist and professor at Vanderbilt University who cares for and studies opioid-exposed infants. “We had a lot of hysteria around a ‘lost generation’ from cocaine exposure, [and] the language around that just served to be stigmatizing and sensationalizing. When I look at where the literature is right now, what it suggests to me overall is there’s likely some subtle findings, but it doesn’t suggest to me that there’s a massive issue there. Now, with that said, I think it’s an area where we need better science.”28

This leaves educators with a fine line to walk. “Substance-exposed infants should be referred to early-intervention services,” Patrick said, and school systems should be aware of and provide specialized services for children who need them, while “at the same time balancing the potential to stigmatize entire populations.”29

While the long-term impacts of prenatal exposure are unclear, there is solid evidence that childhood trauma can have a significant, negative impact on children’s behavior and cognitive development, as well as their health in adulthood. In a landmark study published in 1998, researchers at Kaiser Permanente and the Centers for Disease Control found that a number of adverse childhood experiences (ACEs) correlated with negative outcomes later in life. The adverse experiences included substance misuse at home, emotional and physical abuse, and domestic violence; children who experienced these factors were more likely to have chronic illness, depression, and substance-abuse problems as adults.30

Research also indicates that trauma and chronic stress can change how a child’s brain functions. Stress activates the most basic, primal parts of the brain, the areas that regulate “fight or flight” responses, while suppressing activity in areas responsible for higher-order cognition, such as reasoning and planning. “That part of the brain kind of languishes when you have toxic stress, because the more primitive parts of the brain are always turned on,” explained Amanda Moreno, a professor at the Erikson Institute in Chicago who studies the connections between children’s social and emotional well-being and learning. The fight-or-flight response “is effective for getting a child through that situation, but then the brain gets stuck in that mode and the child cannot do the kinds of things asked for at school, such as inhibiting knee-jerk reactions.”31

It isn’t just “trauma with a capital T”—such as the incarceration or death of a parent—that can alter children’s brains, Moreno continued; something as seemingly minor as never knowing exactly when you’re going to be picked up from school, or by whom, can also have an effect over time. “When you’re that child, you cannot project yourself into the future: ‘When I get home, I’m going to have this snack, I’m going to do my homework in this space, and it’s going to be safe and predictable,’” Moreno said. “It’s not this obvious trauma; it’s just that [these children] have less brain space to be able to focus on learning because they’re focusing more on things like, ‘Where am I going to be in the next five minutes? Who’s going to care for me in the next hour?’”32

The years between kindergarten and second grade are a particularly vulnerable time for kids: It’s a period of developmental transition, when they start to exhibit more advanced, adult-like thinking. I asked Moreno whether the lapses in working memory that the teachers at HJK had observed in their students could be linked to trauma and chronic stress. “That would be extremely consistent with what we do know,” she acknowledged. “Working memory is a big part of executive function.”33

Eric Hupp, a jocular, burly counselor who comes to HJK two half-days a week, said many of the students he talks to live in homes marked by unpredictability and stress. Hupp described “little Johnny,” a pseudonym for a student: “He bounces at night from house to house, because his parents are using, you know, and it’s a difficult situation. He’s bouncing from house to house, and he comes in maybe unclean, maybe unfed…. At that point, the teacher has to be a social worker.” Other kids have seen their parents being hauled out of the house by police in the early hours of the morning. “Fast-forward an hour, that kid is sitting in class. He doesn’t care what the teacher has to say…. The only thing [he’s] worried about is: ‘What just happened to my dad and mom, and are they going to be there when I get home tonight?’”34

These issues are hardly unique to Ravenswood. Educators in places as far-flung as Cape Cod, Massachusetts, and Snohomish County in Washington State report that, as overdose rates and the number of students in foster care have grown in their communities, so have trauma-related behavioral and learning issues in the classroom. This situation has left schools scrambling to find funding for mental-health services. In New Hampshire, the Laconia school district turned to outside state and federal funding to hire social workers and establish grief groups in its elementary schools. “These kids are coming into our building experiencing so much ongoing and pervasive trauma in their lives that if we are not supporting them in that way, we really can never get to the educational part of school,” said McKenzie Harrington-Bacote, the district’s grants administrator. “Most districts who really need it don’t have the money to support it, because they’re impoverished communities.”35

This has been a challenge for public schools in Allegany County in Western Maryland, which also has a growing number of students affected by addiction, according to district superintendent David Cox. Since the recession, the district has suffered budget cuts that Cox characterized as “devastating,” and which led to the loss of about 240 full-time positions. This year, the district has had only a single behavioral specialist for 13 elementary schools. “It just makes teachers’ jobs all the harder.”36

For HJK and many other schools in rural and suburban areas, the growing number of children bringing traumatic life experiences to the classroom is a brand-new phenomenon. But many other schools, particularly in low-income urban neighborhoods, have for decades taught students experiencing not only the chronic stress associated with extreme poverty but also family dislocation due to mass incarceration, which disproportionately affects black families. One in four black children in the United States has a parent who has been incarcerated; children of color are also more likely than white children to be removed from their parents by Child Protective Services.37

As the body of research linking chronic stress to cognitive and behavioral problems has grown, some schools have begun to adopt “trauma-informed” teaching methods that de-emphasize punitive discipline. “Really, what we’re talking about is bringing an attachment-based perspective into the classroom,” Moreno said, which essentially means making students feel safe and cared for.38

A few years ago, a counselor helped Trudy Humphreys set up a corner of her classroom with a cozy bean-bag chair and a saltwater fish tank. She sends students there “on vacation” when she senses their anxiety building. They can read, watch the orange- and black-striped fish, or just stare into space. Usually, within a few minutes, they’re ready to rejoin their classmates. Humphreys said the method has reduced classroom misbehavior immensely. One little boy who had been known to throw chairs began taking himself “on vacation” almost every day without her prompting. He’d sit and, using a notebook she gave him, record the bad dreams that had been bothering him.39

“I feel sometimes that our society sets our kids up for failure right away,” Humphreys said one morning when I visited her classroom. Her adult son is in the process of becoming a foster parent with the intention to adopt, and she’s been frustrated by the number of people who have warned him against taking in a child who’s been exposed to drugs. “Everyone keeps saying, ‘Oh, it’s in their genes—if it’s a drug baby, it’s going to be on drugs when it grows up.’” She paused for several seconds. “Give them help,” she said finally. “That’s what we don’t have enough of.”40

Even if teachers wanted to wall themselves off from what’s happening in their students’ lives, it would likely be impossible. Almost everyone in Ravenswood has an intimate awareness of how badly drug addiction has torn the fabric of the community. Most staff members I spoke with at HJK said they had friends or family members who had struggled in recent years with substance use, or whose lives had been affected by it. One of Humphreys’s former students recently died from an overdose, as did a relative; another of her family members is incarcerated on drug charges.41

Many people talked about these friends and relatives with a mix of sorrow, frustration, compassion, and anger. In the break room one afternoon, I joined several teachers who were eating lunch and discussing how their students were being affected by their parents’ drug use. Several spoke resentfully about adults who, they felt, chose drugs over their kids’ well-being. Beverly Smith, the first-grade teacher, interjected: “After a while, it’s not a choice.”42

Smith’s son has been incarcerated twice on drug charges. “When he’s in prison, I’m comfortable with that,” she said. “He’s his normal self…. He’s my kid, not the drug addict I deal with at other times.” But her son is out now, “floating” somewhere in the county, bouncing from house to house. She sees him sometimes on the road, hitchhiking, and stops to pick him up. She recognizes him by the way that he walks. It baffles her that he gets clean only to return to using. “I don’t know how to explain it, because it doesn’t make sense to me,” she told me later. “You lay down there in that jail on the floor for 30 days, detoxing. What in the world would possess you to go back to that?”43

Jackson County offers few resources to people trying to recover from substance-use disorders. Dr. Tyler Hill, who directs the emergency department at Jackson General Hospital in Ripley, said that he often has nowhere to direct people if they come to the ER seeking help, or when they’re discharged after an overdose—and certainly nowhere affordable for people who are uninsured. “It’s really sad,” Hill said. “We get a few that actually, legitimately want help, and it’s… well, it’s either going to take days, or it’s having to do it on an outpatient basis—and those patients are having to call around and do the legwork on their own.” He described a recent weekend in which a man came into the ER on a Saturday looking for help with a heroin addiction. He’d been sober for a few days. The private rehab facility in the area was closed, so the hospital staff made an appointment for him for the following week. But by the time his appointment came, the man couldn’t find a ride—and the treatment center said they couldn’t help him after all, because his insurance had expired.44

Throughout the state, and in many other areas grappling with high rates of addiction, drug misuse is both related to and made more difficult to address by a flimsy mental-health infrastructure. West Virginia has regional facilities for mental-health care, but not all of them are accessible to remote, rural populations, and many don’t offer appointments in the evenings. “With the loss of jobs, with a lot of the depression around here with the way the economy is, [and] with a lack of access to mental-health care, we’re seeing a lot of self-medication,” Hill said. The issue spirals in on itself: Even now that hiring has picked up in the area—in part due to a natural-gas pipeline being built through Jackson County—people whose drug use has resulted in felony convictions, or who can’t pass a drug test, often can’t get hired. Just as damaging as too little work can be too much work: “There’s a big issue with people in the state who work themselves to death, until they have severe injuries that they need pain treatment for,” said Jessica Wooten, the nurse practitioner. “If we can’t give them narcotics, you know, there’s not usually physical therapy, there’s not a yoga class they can go to.”45

From foster care and health care to the schools, it’s hard to name a public service that hasn’t been stretched thin. Ravenswood’s chief of police, Lance Morrison, says that the vast majority of the calls his department receives now are drug-related. His officers seized over $1 million worth of drugs in traffic stops in the past two years, often from drivers coming or going over the Ohio River. “It’s like we’re a caboose at the end of a train that’s a mile long trying to catch the locomotive, honestly,” Morrison said. “It’s out of control—my budget’s blown for overtime from drug busts.”46

In February, teachers across West Virginia—and then in Kentucky and Oklahoma—decided they’d had enough. Schools closed for nine days as educators went on strike, many of them flooding the State Capitol to protest rising health-care costs and poor pay. In Ravenswood, Amber Hardman and some of her staff spent those mornings going to certain students’ homes with food to make sure that, even if they missed school meals, they wouldn’t go hungry.47

The strike didn’t explicitly have anything to do with the opioid crisis. But a few of the teachers I spoke with said that having so many students with complicated emotional, behavioral, and cognitive needs did contribute to a greater feeling of being overworked and underappreciated. “We are stressed to the gills,” said Christy Archer, who was working at the time as a reading and math intervention specialist. When she met with legislators at the Capitol, she was frustrated by the disinterest some of them responded with. (Archer, an animated, petite blonde, has been a Republican since she turned 18.)48

“Do you know what we do every day?” she asked rhetorically, raising her arms. “Are you serious?” She went on: “The buildup of the frustration, the extra pain, the stress—we feel hopeless. We want to help this child learn to read, but they can’t… because of the things beyond our control.”49

In Ravenswood, that hopelessness can feel immense. But it’s not a mystery what the school needs, what parents and kids and the town need. Like so many other places in the United States, they need access to doctors and treatment centers, to jobs that don’t leave them with broken bodies. They need funding for teachers, for classroom supplies, for counselors. “This little town has all the potential in the world,” Hardman told me shortly before I left the school. “We just need help.”50