Every Saturday afternoon, Andrea Clements and her husband, Dale, stuff their phones, keys, scarves, and jackets into a locker at a detention center in Jonesborough, Tenn., and walk through the metal detector on their way to the jail’s visiting room. Jason Greer, a 42-year-old recovering opioid addict who has spent nearly half his life behind bars, awaits them on the other side of a plexiglass window in the semi-private booth they settle into.

Greer has known these two visitors for two years—a relationship that formed when he was first released on probation and staying with a relative. He was bewildered by the world beyond incarceration, and a counselor encouraged him to call Andrea, or Andi, as most people know her. He did, and they talked on the phone for an hour, during which she invited him to her church and offered to pick him up.

Greer agreed, and for the past two years the two have talked on the phone almost every day—with the exception of those times when he has relapsed and was too ashamed to call. Miss Andi, as Greer calls her, is there with a listening ear in times of trouble and an invitation to a church that has become his family.

Holy Friendship

That kind of wrap-around care lies at the heart of a new response to the opioid crisis being developed by Clements, an experimental psychologist at East Tennessee State University in Johnson City, and several other like-minded people in the area.

Johnson City recently ranked ninth among all cities in the nation for opioid abuse. But the magnitude of the opioid epidemic extends far wider. It has ravaged the southern Appalachia region of northeast Tennessee and southwest Virginia,
and the overdose deaths keep multiplying from year to year.

Recently, some dedicated Christians formed a new collaborative alongside experts from Duke Divinity School’s Theology, Medicine, and Culture initiative to find new ways for churches to respond to this devastating problem. The Holy Friendship Collaborative, the nonprofit organization that has grown out of this mission, has been working to better understand the scope of the opioid epidemic: why it has hit this mountainous region with such ferocity, who is especially vulnerable to it, and what resources churches might tap into. With that information, the organization hopes to develop models that churches can use to lift up and help addicts who have slipped through the cracks.

“Churches haven’t thought of being that involved,” said Clements, executive director of the new collaborative and a member of a Johnson City start-up church whose mission is to help those struggling with addiction. “They’ll take (addicts) a meal or send socks. This is much more an intensive call to action, because that’s what I think it will take.”

Clements’ experience with Greer has been instructive. She has helped coordinate medical care for him when he contracted Hepatitis C from sharing needles, sought church funds to defray the cost of a private attorney, andÊresearched options for rehabilitation after his prison release.

But most of all, she has spent hours upon hours listening to him and extending Jesus’ unconditional love.

Greer, who said he underwent a conversion to Jesus in 2014 while in jail, cannot thank her enough.

“I’ve lived a very troubled life for 20 years or better,” said Greer, a Tennessee native whose long rap sheet includes multiple convictions for burglary, theft, and forgery, as well as assault.

“I’m just adjusting to everything. But I do want to change. But with Miss Andi and Dale and the church behind me, I feel like I have more options than I’ve ever had before.”

A Hospital Wing for Addicted Babies

Two years ago, Dr. Raymond Barfield, a pediatric oncologist and professor of pediatrics and Christian philosophy with a joint appointment at Duke’s medical and divinity schools, was set to give a lecture in Johnson City about one of his specialties: palliative care and end-of-life treatment. He had been invited by a Duke Divinity School alumnus who was managing a merger of two health care systems in Tennessee and Virginia.

But on a tour of Johnson City’s new Niswonger Children’s Hospital, Barfield saw something he had never seen before: a special 16-room wing built to care for babies born with neonatal abstinence syndrome (NAS). NAS affects babies born dependent on opioids or addictive drugs that the mother used during pregnancy.

“I was surprised, so I asked, ‘What’s the rest of the community like? What’s the drug and alcohol problem?’’’ Barfield said.

Once he learned about how expansive the problem was, Barfield promised: “I’ll come back. I want to meet with the people
who are struggling.”

In 2017, the most recent year for which numbers are available from the Tennessee Department of Health, 1,090 babies were born with NAS. Those numbers have grown consistently since 2013 when the state first started to keep records on the syndrome.

NAS is only one symptom of a growing problem. Tennesseans received nearly 7 million prescriptions for painkillers in 2017, and many more people are addicted to street heroin or illegally produced fentanyl, a powerful synthetic opioid similar to morphine, according to the National Institute on Drug Abuse.

The problem is not limited to Tennessee, where 1,268 people died of opioid overdose in 2017. In neighboring Virginia, 1,445 died of opioid overdoses that year, and 1,884 died in North Carolina. The whole Appalachian region, stretching from northern Mississippi to southern New York—and critically the central Appalachian region—has been dubbed “the cradle of the opioid epidemic,” a region where opioids are abused at rates far exceeding national averages.

Roger Leonard, the Masters of Theological Studies alumnus who invited Barfield to give lectures in the region, quickly realized that opioid addiction was the most urgent health crisis there. With Barfield’s encouragement, he began planning a two-day conference bringing together key leaders in health care, social services, law enforcement, and the church with scholars from Duke’s Theology, Medicine, and Culture initiative.

The Holy Friendship Summit, which took place in May 2018, was the first step. After the conference, Duke researchers and community leaders in northeast Tennessee and southwest Virginia pressed on with the launch of the Holy Friendship Collaborative.

They’re now deep in the work of developing best practices that churches should be able to adapt and build on to meet the specific needs of their congregations and communities.

“The opioid epidemic is a wicked problem and it will require churches to be much more engaged,” said Leonard, president of the Holy Friendship Collaborative. “It’s about helping congregations become more connected with other congregations, with health care, and with government to become a volunteer workforce providing wrap-around support for people suffering from addiction.”

Developing a Test Garden

It’s not as though churches in southern Appalachia haven’t tried. Many churches in the region and across the country offer a weeknight gathering to help people dealing with addiction. The format is typically based on Celebrate Recovery, a 28-year-old program started at Saddleback Church in Lake Forest, Calif.

But the Celebrate program, which consists of a worship service incorporating the 12 steps to recovery as defined by Alcoholics Anonymous followed by smaller group sessions, does not specifically address opioids or even drug addiction. Participants struggle with a range of issues, from eating disorders to sexual abuse.

Often, participants with similar problems form their own support groups apart from the regular life of the congregation.

The Rev. Mark Hicks, a former pastor at State Street United Methodist Church just over the Tennessee border in Bristol, Va., started a weeknight program for addicts trying to turn their lives around.

“The folks in the recovery program really enjoyed being their own congregation of people,” Hicks said. “It wasn’t so much that we took volunteers from the larger church. They would volunteer with one another.”

Shame may be one reason why people struggling with addiction don’t show up for services or ask church members for help. The stigma attached to addiction—some describe it as “the new leprosy”—may be another. Studies suggest that people in recovery, sometimes for decades, still run into community members with judgmental, if not contemptuous, attitudes.

And then there’s the social isolation so common to mountain communities.

“Here in southern Appalachia, the culture is very independent,” said Leonard. “We believe people should pull themselves up by their bootstraps and be self-sufficient.”

But the needs brought on by the opioid crisis are so great that many religious leaders realize congregations will have to come together as a community to stem the tragic tide.

It’s why 450 community leaders showed up for the Holy Friendship Summit, and it’s why the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, recently awarded the collaborative a $200,000 federal planning grant.

Duke Divinity’s Theology, Medicine, and Culture initiative scholars have been helping the collaborative figure out innovative and theologically grounded programs and practices. The idea is to find local solutions rather than a generic, one-size-fits-all program. The collaborative is inviting individuals and churches to take part, and hopes to identify a cohort of eight to ten congregations willing to spend 18 months in theological discernment developing different ideas.

“We want to develop a test garden or plot,” said Dr. Farr Curlin, Josiah C. Trent Professor of Medical Humanities and co-director of the Theology, Medicine, and Culture initiative. “We’ll see what grows in the soil, what flourishes, and we hope to learn from that lessons that can be taken up and disseminated.”

Getting educated on the complexity of the opioid epidemic is key.

“Part of the problem with the opioid crisis is that there are these institutional silos where public health has its response, the criminal justice system has its response, social services has its response, the health care system and nonprofits have their response,” said Brett McCarty, assistant research professor of theological ethics at Duke Divinity, who studies the ethics of attending to people in pain.

“They’re all speaking their own language, and the people on the receiving end are always scrambling to catch up,” McCarty said. “What’s really exciting is the possibility of churches in the region providing a big tent. How might churches enable those different folks to come together and share a common language of religious commitment and respond in more fitting ways to the people most affected by the opioid crisis?”

“One in Heart and Mind”

On the face of it, Sunday services at Christ-Reconciled Church in downtown Johnson City feel like any other church service. The band plays an energetic version of “Rock of Ages” and “Leaning on the Everlasting Arms.”

But this six-year-old start-up that meets in a flat-roofed cinderblock building surrounded by car-salvage yards, a tire service, and auto-parts dealers has become a kind of laboratory envisioned by Duke Divinity scholars.

Its members, including Andi Clements and her family, and now Jason Greer, are uncommonly committed to each other and to the mission of saving lives physically and spiritually.

There’s also Brenna and Caleb Bennett, a young couple that has fostered or provided emergency respite care for 13 children during the two and a half years they’ve been married. They are now caring for an 11-month-old baby who was brought to their home in the middle of the night, malnourished and homeless.

“I like that this church is small and there are no secrets,” said Brenna Bennett, a social worker who works as a family coordinator for an elementary school serving children in a low-income district. “Everybody knows what’s going on. We’re in each other’s lives.”

After the service, 30 plus members sat down at a long folding table to eat grilled cheese sandwiches and tomato soup, lunch prepared by Dale Clements and another church member.

They welcomed a few children from a nearby public housing project, who stopped in for a free meal.

Bennett cites the book of Acts as the theological basis for the practice of keeping close tabs on one another. She refers to Acts 4:32, a passage that describes the nascent Christian community as being “one in heart and mind” and sharing their possessions.

Forming a tight-knit community that shares information and holds each other accountable makes practical sense too—especially if a congregation wants to reach out to people caught in cycles of addiction. If there’s one thing all too common among substance abusers, it’s a sense of social isolation. They might have burned out and burned bridges to family and friends who tired of trying to help.

“Real healing requires being in a circle of support,” said Leonard. “People need the support of someone walking alongside them, mentoring them, being there and providing the care and love human beings need. All of us have challenges in our lives. Those challenges take time.”

Ben McCurry, a member of Christ-Reconciled Church who has struggled with addiction, knows that too well.

“Recovery is a journey,” he said. Once addicted to prescription drugs, the 31-year-old began to abuse alcohol when his marriage broke up, a predilection toward destructive behavior that hangs over him. “It’s something I’ll have to deal with my entire life.”

Which is why Clements believes the church must stand by those in recovery for the long haul—in good times and bad.

“Even when they don’t want to be helped, we have to keep helping,” Clements said. “You have to love them enough to intrude.”

The Right Way to Live

Jason Greer hopes to be released in April after his next court date. But he will remain on probation for at least another decade. If he relapses, as he has before, he may end up in jail again.

Andi Clements has been working hard to try to find him a long-term treatment program. There are two that said they’ll take him, one in Tennessee and another a few hours away in North Carolina.

In the meantime, the two continue to talk daily, and on her trips every Saturday to the jail Clements adds more money to his calling card. The bond between them has grown over the last two years. Clements was there to buy him clothes, find him furniture, and enroll him for food stamps the last time he was released.

As Greer conceded: “I did not know how to navigate out here. I had no clue.”

He’s enormously grateful for all the help—and especially for the practice of cultivating relationships.

“I’ve never had people in my life like that,” Greer said. “The church has shown me that I can be loved no matter what my circumstances have been. I’ve done some terrible things that I’ve accepted responsibility for, and I know that I’m being punished because of my actions in the past. But they’re teaching me the right way to live.”

But Clements also knows there may come a time, and probably soon, when Greer will have to strike out on his own, and not just at a rehabilitation facility, which will likely provide him a safety netÊand support system for a year.

“He needs to be hours away to remove him from the people, places, and things connected to drug use,” Clements said. “Jason knows that it would be best if he creates a new life wherever he goes to treatment and doesn’t come back to this area.”

She knows he will really miss his church family, and she will miss him. But she tells him that the lessons he’s learned from members of Christ-Reconciled will carry over wherever he goes.

“I reassure him often that the big ‘capital C’ church is like us,” she said, “and he will develop those new connections wherever he is.”