President Donald Trump and Vice President JD Vance on January 20, 2025

In her new book, "The Nature of Pain: Roots, Recovery, and Redemption Amid the Opioid Crisis," author and Kentucky native Mandi Fugate Sheffel describes her recovery from addiction and the opioid struggles that continue to plague Appalachia. Sheffel also describes those struggles in an article published by Salon on October 11.

"I want to write about the first time I did a pill," Sheffel explains. "It was a turning point, one of those things you'll think you’ll never forget. But I can't. I don't remember. I don't remember any of my first-time meetings with drugs except for OxyContin. It was my junior year of high school, and OxyContin was showing up everywhere — in the hallways at school, parties on the weekend and in medicine cabinets all over central Appalachia. I was with my cousin Eric, who was like a brother, the first time I did an OC."

Sheffel notes that that she might seem an unlikely candidate for addiction, as she was senior vice president of her high school in Kentucky and graduated with a 4.0 GPA in 1999.

"I was not supposed to be a drug addict," Sheffel recalls. "But that's exactly what I became. In 2002, after my third failed attempt at college and living away from home, I returned to Eastern Kentucky — and I had no way of knowing what I was coming home to. Over the past year and a half, I had no communication with my friends in the region. OxyContin was everywhere. People I had known my whole life who would have never considered drugs were now full-fledged addicts…. After years of active addiction and struggle, I finally found recovery through rehab and working the 12 steps."

Sheffel continues, "I'm now a small business owner in Hazard, Kentucky; I run a small independent bookshop called the Read Spotted Newt, which fuels my creativity and offers me a way to make amends to the community I abused for years."

The struggles in Appalachia, from poverty and unemployment to addiction, were a prominent theme of now-Vice President J.D. Vance's 2016 book, "Hillbilly Elegy: A Memoir of a Family and Culture in Crisis."

The book was published during Trump's first presidential campaign. Vance, at the time, was conservative-leaning but not far-right and not MAGA — in fact, he was quite critical of Trump. And the book's admirers, including a fair amount of liberals, hailed it as a gripping account of the problems Appalachia was facing.

After giving himself an ultra-MAGA makeover and becoming a strident Trump ally, Vance was elected to the U.S. Senate and, in 2024, became Trump's running mate. Vance, during the campaign, drew heavily on the "Hillbilly Elegy" themes while joining Trump in promising to go after opioid trafficking.

But now, almost nine months into Trump's second presidency, critics of his drug policies are arguing that he places too much emphasis on going after traffickers but doesn't pay enough attention to either drug treatment programs or the socioeconomic conditions in a region like Appalachia — conditions described in "Hillbilly Elegy" and more recently, in Sheffel's book.

Sheffel, in her Salon article, laments that the addiction crisis continues to plague Appalachia many years after her own struggle.

"People have lost their family homes, and there's no one to fall back on when times get hard," Sheffel observes. "People are living on the streets, and the faces change every day.… Thirty years later, we are still learning how to navigate this epidemic. Gone are the old adages of tough love and hitting bottom. Now, we approach this disease with community — with meeting people where they are. That's why it's important for me to live my recovery out loud. To give hope and instill empathy in those who are tempted to give up the fight."

Mandi Fugate Sheffel's full article for Salon is available at this link.