By now everyone who cares knows that thousands of people have died as the result of drug abuse in Kentucky, leaving tens of thousands of wounded family members and friends.
They know that the federal and state governments have showered hundreds of millions of dollars on the problem and the state of Kentucky has spent, literally, billions locking up people who have committed crimes related to their drug dependency.
As Bill Estep carefully documented in a group of chilling stories in Sunday's Herald-Leader, the war against drug abuse in Eastern Kentucky is well into its third decade. And, while individual stories of recovery are many and gratifying, no one sees victory on the horizon.
The most basic reason for this frustrating, tragic and expensive stalemate is lack of opportunity.
Noting that a key predictor for drug abuse is low social rank, Estep quoted Robert Walker, a researcher at the University of Kentucky's Center for Drug and Alcohol Research.
"It's the belief that I can't do anything to fix this or make my life any better," Walker told Estep. "That is a profound risk condition for drug abuse."
This is the same finding researchers elsewhere report. "Addiction always has a social element, and this is magnified in societies with little in the way of work or other ways to find fulfillment," David Nutt, a British researcher, told The New York Times.
The Times reported on the findings of Columbia University's Carl Hart, whose research with crack and meth users found they turned down drug use when an attractive alternative was presented in the form of a monetary reward, even though it was delayed — a rational response. The response when no reward is on the horizon is equally rational, according to Hart.
"If you're living in a poor neighborhood deprived of options, there's a certain rationality to keep taking a drug that gives you some temporary pleasure," Hart said.
The solution is both simple and overwhelming: Change the economic and social environment.
It's really the task that confronts the more than 1,000 people who will gather Monday in Pikeville for the SOAR (Shaping Our Appalachian Region) summit convened by Gov. Steve Beshear and Rep. Hal Rogers to find ways to move Kentucky's Appalachian region forward.
There are a dozen good reasons to improve educational opportunities in Eastern Kentucky, fight political corruption and create a diverse economy that offers good jobs that can lead to better ones.
But they all come back to the same thing: We no longer can tolerate, or afford, the human wreckage that grows out of despair.