The loosely packed snowball disintegrated in midair before reaching a white van and sprinkling the three people standing inside with fine snow.
The three jean-clad people in the van — and the snowball lobber — laughed. The smiling lobber was Chris Alderman, program manager of Rise Above. The three standing inside the van were Rebecca Akers, Rise Above case manager, and Josh Talbert and Devin Perdue, Rise Above outreach staff who are both certified peer recovery specialists.
Rise Above is a van-based, mobile clinic that’s part of the NRV Recovery Ecosystem run by the New River Health District, which serves Floyd, Giles, Montgomery, Pulaski and the city of Radford. “The name Rise Above reflects a belief that recovery and healing aren’t about labels or shame. It’s about creating a community where participants, service providers and neighbors alike can rise above stigma and adversity to show up as their authentic selves and be met with dignity, compassion and possibility,” said Alderman, who started the program in 2023.
In 2025, Rise Above served 466 participants across 2,577 visits, according to New River Health District epidemiologist Erica Short. Participants can visit the van wherever it is located in the NRV on a certain day, or the outreach staff will drive the van to participants on an “on-demand” basis.
Participants go through an intake process, which does not require identifying information. Staff doesn’t ask for names or social security numbers. Instead, participants are assigned their own unique code and receive a participant card that they can show law enforcement, if necessary. “I’ve told police that if you’ve got somebody and you want to call me to see if they’re in the program, then call me at 2 a.m.,” said Alderman.
Alderman has been in recovery for over 20 years. He’ll tell you that the most valuable thing in the Rise Above van isn’t the syringes. Yes, the van is stocked with sterile syringes. The purpose of the syringes is to prevent diseases such as HIV and hepatitis C.
Participants can get 40 syringes for the week. To get more, they have to come back — bringing used syringes with them. The person-to-person interaction that happens when they come back is really the most valuable thing in the van: Human connection is the centerpiece of Rise Above.
“Most of them [participants] literally have no one they can call to talk to who’s actually going to listen or be kind to them. It’s a very lonely life. We get people connected to whatever services they may need, but most importantly connected to people.”
Less about needles and more about trauma
Addiction, Alderman will tell you, is about emotional pain. “Hurt is the driving force, whether it’s food or sex or gambling or achievement or drugs,” he said.
“We need to make it less about the drugs or the needles and more about the trauma they’ve endured. We need to make it more about why they need to use drugs [rather] than the drugs themselves,” said Dr. Noelle Bissell, the New River Health District director who oversees Rise Above.
Alderman’s trauma comes from abandonment, from being given up for adoption and never knowing where he came from. “The fact that I’ve lived my whole life knowing my parents didn’t want me, it messed me up.”
Alderman is 47 years old. It was at age 8 — about the age children learn multiplication and start collecting things like baseball cards — that Alderman felt suicidal for the first time. “[Recently] there’s been a thing going around social media [with a message] about everything — all the life — you would’ve missed if you had killed yourself. And I’m like, ‘Which time?’”
By the time he was 14, Alderman was smoking marijuana. He got into heroin, cocaine, Xanax, and more. From 1999-2004, he used drugs “daily, chaotically” trying to numb his pain, trying to survive:
“It ain’t about the drugs. It’s about something deeper,” he said.
To address those deeper, fundamental issues, Rise Above is designed and implemented as a “wrap-around service” that links participants to a variety of life resources such as housing. Dr. Bissell says that most participants are housing- and food-insecure. “It’s hard to expect people to become more self-sufficient when they don’t have their basic needs met,” she said.
There’s a whirlpool of emotional pain, trauma, drug use, food insecurity and lack of housing. If people try to escape the whirlpool by quitting drugs, excruciating withdrawal symptoms make things spin even faster, stronger, more intensely. “Most people who get to that point of their life aren’t using drugs to have fun. It’s to not be dope-sick,” said Alderman.
The whirlpool is deadly. In the last 25 years, more than 1 million people in the U.S. have died of drug overdose. In Virginia alone, 663 people died of drug overdose in 2025. Back in 2021 — the overdose peak in Virginia — 2,622 people died. “We’re losing a lot of great minds to death, stigma and system failures. They’re some of the greatest people I’ve ever met in my life,” said Alderman.
The majority of drug overdose deaths come from opioids. In the 1990s, the deaths were from prescription opioids like oxycodone. By 2010, more deaths involved heroin. Around 2013, a third wave of the opioid crisis was fueled by fentanyl, a synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. Just 2 milligrams of fentanyl can be lethal: The amount of fentanyl equivalent to 10-15 grains of salt can kill a person.
Hundreds of reversed overdoses: ONEbox enables access to help
In 2021, manufacturers, distributors and pharmacies that were alleged to contribute to the opioid crisis reached a settlement with states and the District of Columbia. Between 2022 and 2041, Virginia expects to receive over $1 billion from the settlements. To oversee distribution of the funds, the Virginia General Assembly has established an independent body called the Opioid Abatement Authority.
Rise Above — including supplies and staff salaries — is funded by monies from the OAA. For example, last Wednesday, Alderman learned that Rise Above would receive $30,000 for overdose response kits called ONEbox. Similar to AED kits, ONEbox kits are mounted on a wall and help bystanders save a life. ONEbox is specific to reversing an opioid overdose.
Each ONEbox kit contains an instructional video in English or Spanish, plus a face shield, gloves, wipes and naloxone, a nasal spray that rapidly reverses an opioid overdose. Rise Above distributed 100 ONEbox kits in 2024. When the new kits arrive, Alderman will start by placing them in schools and in highway rest stops, where, he says, overdoses happen after “drug runs.”
In 2025, Rise Above participants reported reversing 286 overdoses, according to epidemiologist Short. All of the reversals were successful; participants reported 0 unsuccessful reversals. In contrast, in 2024, participants reported 8 unsuccessful reversals — 8 deaths.
Alderman attributes the improvement to “getting a lot of naloxone out there, doing lots of [overdose prevention] community events, outreach, and mainly making so many connections to build the trust.”
Overdose survival rate promising but just one part of the work
The promising results of Rise Above’s approach to naloxone distribution aligns with emerging scientific evidence. In 2025, public health researchers published a scientific paper analyzing over 40 studies on the effectiveness of naloxone distribution in community settings. The researchers report a 93-98% overdose survival rate when naloxone was administered by people who use drugs, family members or police.
Scientific evidence about the effectiveness of strategies like naloxone might persuade organizations to have ONEbox kits — like Virginia Tech now has in all residence halls. But it’s personal credibility that may attract and retain a person who uses drugs to Rise Above, and from there to recovery, according to Alderman.
Both Josh Talbert and Devin Perdue — Rise Above’s outreach staff — are certified peer recovery specialists. The word “peer” doesn’t just designate their training. It’s a word designating what they’ve gone through with substance use: Talbert and Perdue, like Alderman, are in recovery.
“It’s the mutuality, it’s the lived experience that builds the trust,” said Alderman.
Bissell says that the growth and success stories of Rise Above reflect how “my team works well together and really cares because they all have that lived experience.”
Getting away from the ‘war on drugs’ imagery
Rise Above outreach peers sit in hospitals with participants who felt unsafe. They help raise donations for a participant whose house burned down. They teach participants how to give rescue breaths and care for wounds and use test strips to find hidden ingredients in drugs. In 2025, they gave out over 7,500 fentanyl test strips.
Rise Above outreach peers also understand how transportation and stigma and fear of law enforcement are barriers to getting help for substance use. “With all the services, we can’t wait for people to come to us. We have to go to them,” said Alderman.
When Alderman was hired as a contractor to figure out a harm reduction substance use program, the first thing he did was use his instincts and intuition and lived experience to “get out [in the NRV] and see what the needs were. I hadn’t used drugs in 20 years, so I had to go back and see what was going on.”
Alderman calls it a “boots on the ground” approach. But it’s not the kind of combat boots that come to mind when you listen to Richard Nixon declare drugs “public enemy number one” in 1971. That was the start of the “war on drugs,” a substance use approach based on criminalization and moralization.
“War on drugs made people get treated less than,” said Alderman.
Bissell explained that the war on drugs mentality contributed to deep stigma and dehumanization of people who use drugs, even from healthcare providers and agencies providing services. “[People who use drugs] already felt a lot of guilt and shame, and then people who are supposed to be helping them give them even more,” she said.
Harm reduction approach targets high risk behaviors and practical strategies
Scientific research in rural Virginia backs up what Alderman and Bissell said about the prevalence of stigma. In one survey that asked rural Virginians to choose a word that describes a person who injects drugs, 8 out of 10 participants chose “weak” rather than “strong.” A third of people surveyed chose “worthless” over “deserving.” And more than a third agreed with the statement that drug addiction is a choice, not a disease.
Bissell said, “[People who use drugs] are a very challenging population to work with, but we can’t lose sight of why.”
The multifaceted, complex “why” — the trauma and emotional pain and lack of housing and insecure food and unique situation of every individual — underscores the importance of Rise Above’s “harm reduction” approach.
Harm reduction includes practical strategies that reduce the negative effects of drug exposure. Harm reduction strategies backed by scientific evidence include syringe exchange programs, overdose education, naloxone distribution, test strip distribution, and Medication for Opioid Use Disorder clinics, like the one Bissell has established alongside Rise Above.
The harm reduction approach addresses multiple high-risk behaviors, such as driving under the influence and domestic violence, and multiple behavioral consequences, such as financial problems or hepatitis C infection.
Central to the harm reduction approach is delivering services in a respectful and caring way. “It’s about kindness and compassion. It’s not punitive. It’s treating humans like humans,” said Alderman.
‘Celebrate any recovery’
Meet people where they are is not just a cliché when it comes to harm reduction. Rise Above has what’s known as “low threshold” entry: People using drugs can connect to services without having to commit to quitting.
“Harm reduction strategies may help individuals move from active use to a state of abstinence; however, their primary focus is on improving safety independently of changes in use patterns or abstinence initiation,” according to public health researchers at Johns Hopkins School of Medicine.
Bissell says that abstinence is not the only path to recovery and that, “We shouldn’t be telling [participants] what recovery looks like or imposing our values. We need to support people, meet them where they are, and celebrate any recovery.”
Rise Above’s motto is Any positive change. “Even the slightest bit of change is positive. Even carrying naloxone is a positive change. Even just coming to us at outreach is huge,” said Alderman.
Rise Above’s harm reduction approach brings to mind East of Eden by John Steinbeck, near the end, when Lee said to Abra, “And now that you don’t have to be perfect, you can be good.”
When it comes to Rise Above and harm reduction, there’s no one way or judgment about being “good.” Each person’s recovery is unique, according to Bissell.
Local ways to learn more
According to the Virginia Department of Health, there were 41 drug overdose deaths in Montgomery County, Pulaski County and Radford in 2021. In 2025, there were 20. It’s unlikely that 2026 will have 0.
Yet, there’s regional resistance to Rise Above’s harm reduction approach. Both Alderman and Bissell talked about the public perception that syringe exchanges, distributing naloxone to reverse overdoses, and the new MOUD clinic is promoting drug use. “So many people still consider it enabling or just substituting one drug for another, which shows a complete lack of understanding of the neurophysiology of addiction and how it alters the brain,” said Dr. Bissell.
Reducing stigma and helping NRV residents understand the harm reduction approach is why the New River Health District is hosting a series of free community forums in regional libraries (schedule below). The forums include panels of harm reduction services providers and people in recovery who tell their stories.
Alderman says the turnout has “not been great.” There were less than 10 people at the Pulaski forum, closer to 15-20 in Christiansburg, and about a dozen in Blacksburg.
Alderman says that people face practical barriers to entering in-patient treatment programs, like pet care. “People don’t go to treatment because where’s their dog going to stay?”
To meet that need, Erica Short — the epidemiologist with Rise Above statistics — has started Tails of Recovery. Tails of Recovery is a nonprofit organization that provides pet foster services for individuals entering treatment for substance use disorders and mental health issues.
Rise Above participants ready to enter treatment have come to Alderman about Tails of Recovery. But there’s a problem, Alderman said: “We don’t have any fosters.”
No one has signed up to foster — yet.
Upcoming Community Forums hosted by Rise Above with the New River Health District:
Monday, Feb. 9, 5:30-7:30 p.m. at the Pearisburg Public Library
Wednesday, Feb. 11, 5:30-7:30 p.m. at the Radford Public Library
Monday, Feb. 23, 5:30-7:30 p.m. at the Jessie Peterman Memorial Library (Floyd)
Tuesday, Feb. 24, 5:30-7:30 p.m. at the Meadowbrook Library (Shawsville)
