Kristina Brant has completed research for her dissertation, "In the Epicenter: Surveilling, Supporting, and Punishing Families amid the Rural Opioid Crisis," supported by the NSF Dissertation Improvement Grant.  During her funding period, she continued ethnographic fieldwork in Appalachian Kentucky and completed 164 in-depth interviews with parents who use(d) drugs, relative and fictive kin caregivers, and representatives of local criminal justice, child welfare, social support, and health institutions.  Having the opportunity to live in the region, travel to numerous field sites across the region, and conduct sustained interviews and observations over the course of her study was essential for the breadth and depth of data she was able to collect.

Kristina's completed dissertation offers a rare glimpse into the rather remote and isolated communities of rural Appalachia, often regarded as ground zero for many of the issues which plague the wider nation, like poverty and addiction.  Her dissertation is split into two parts.  First, she considers how the opioid crisis has both been shaped by and altered the social fabric of rural communities, detailing how rural communities have come to understand and respond to increased substance use.  Second, she considers how families within these communities navigate parental substance use disorder, tracking how families experience substance use-related child custody shifts and interface with the local institutions who dictate and monitor these shifts.

By considering the Appalachian opioid crisis through the lens of Appalachian history, Kristina first shows how local responses to addiction have exacerbated local inequalities, both within and between communities.  She argues that Appalachia's long history of corporate exploitation primed local people to embrace the narrative that Big Pharma's greed and deceit had created the destruction of the opioid crisis.  While this has decreased the stigma associated with legal prescription opioid use, communities have instead vilified people who use other drugs, like heroin and meth.  Distrust of outsiders, which evolved from this historical corporate exploitation, has also made communities resistant to substance use services started by non-residents, like medical innovations.  While local people have come together to design their own solutions, they may lose some of the benefits which these outsiders could bring to their communities. 

Turning to families navigating substance use disorder, Kristina considers how and why local institutional responses to substance use have led to relatives taking children into care.  She argues that the criminal justice system subjects parents who use drugs to an additional level of derision and stigma precisely because they are parents. While these systems have increasingly utilized addiction treatment, this medicalized approach has not brought additional sympathy.  Rather, the combined use of both therapeutic (i.e. rehabilitation) and punitive (i.e. incarceration) responses to substance use actually contributes to the derision and stigma wielded at parents who use drugs, who go through a "revolving door" of alternating treatment and punishment.  The entanglement of these therapeutic and punitive responses also deters parents from seeking help, potentially furthering the trauma and harm that may be incurred by their substance use disorder.

Given that a child is being taken in by a relative, Kristina then tracks the legal process by which such a caregiving shift happens.  When relatives step in to raise these parents' children, either on their own accord or due to state intervention, they must choose one of a number of different legal arrangements that define their caregiving role.  Kristina finds that caregivers' ability to choose the arrangement best suited to their family's needs depends on the social capital derived from their connections to key players in their local legal system.  While those who are well-connected may be able to maximize their stability and minimize the level of surveillance they must endure, caregivers who are poorly connected lack the power to do so for their own families.

Finally, Kristina demonstrates how kinship care arrangements--and specifically the policies and mandates which regulate these arrangements--fundamentally shape the relationships between parents and relative caregivers.  She finds that while the child welfare system leans on families' natural support systems when placing children with relatives, it simultaneously breaks those support systems by removing relatives' abilities to assist the children's parents.  By forcing relatives to essentially choose between the parents and children, the child welfare and social welfare systems actually encourage families to avoid state intervention at all costs.  However, this assumes parent-relative relationships were positive to begin with; relatives and parents may also possess negative or difficult social ties to one another.  In this case, both relatives and parents may exploit the child welfare and social welfare systems in order to punish the other person.  Alternatively, the cumbersome and adversarial nature of child custody shifts can create such negative or difficult ties between relatives and parents.  In either case, families' abilities to support their children in the best way possible suffer.

Last Modified: 09/30/2021
Modified by: Kristina P Brant