Recovery doesn’t begin or end in an emergency room.
Across the greater Roanoke region — including the rural communities that surround it — recovery unfolds in the moments that follow: when someone leaves treatment, tries to figure out the next step or looks for support across systems that don’t always line up the way we imagine.
In our region, those moments often come with real barriers. Follow-up appointments can be weeks away. Transportation may be limited. Services might exist, but not in the same place or on the same schedule. For people doing everything they can to seek wellness, the path forward can feel uncertain and unnecessarily complicated.
Recovery succeeds not because of a single program or place, but because of the people involved along the way. The first responder who treats someone with dignity. The nurse who explains what comes next. The peer who answers the phone after discharge. The employer willing to offer a second chance.
Together, those relationships form a recovery ecosystem — a network designed to catch people before they fall through the gaps and to keep momentum moving toward wellness. When systems are disconnected, even small setbacks can derail hard-won progress.
By coordinating services and improving communication across sectors, recovery ecosystems help organizations with limited resources work more efficiently and reduce duplication. This coordination decreases strain on emergency response, health care and social service systems while improving outcomes for the people they serve.
On March 5-6 at The Hotel Roanoke & Conference Center, Virginia Tech, Roanoke Valley Collective Response, and other partner organizations will host the second Recovery Ecosystems Conference. The goal is to not only showcase successful programs, but to bring together people who rarely all share the same room: practitioners, peers with lived experience, researchers and community leaders.
The conversations are grounded in what’s already happening here — what has helped people stay engaged in recovery, where handoffs break down and how relationships can be strengthened across systems that too often operate in silos.
These questions matter deeply in rural parts of our region, where the need for addiction treatment and recovery support is high but options can be limited. Getting help may require long drives or long waits. Stigma and fear can make asking for help even harder, increasing the risk that people disengage at critical moments.
As author and conference keynote speaker Beth Macy chronicles in “Dopesick,” addiction often takes root in communities where opportunity, support and understanding are unevenly distributed. Southwest Virginia knows this story well. Recovery, then, depends not only on individual resolve but on whether communities invest in pathways that make healing possible close to home.
Peer recovery specialists — people navigating recovery themselves — often serve as connective tissue in these efforts. They bridge gaps between emergency care, treatment and long-term support. They walk alongside people when programs end and paperwork runs out, translating systems that can feel overwhelming.
If recovery is shaped by who people meet along the way, strengthening the recovery ecosystem is work that belongs to all of us.
By aligning efforts across health care, public safety, education, the courts, employers and community organizations, our region can reduce the chances that someone falls through the cracks and increase the likelihood that recovery can be sustained.
That is the work underway in the greater Roanoke region. It is ongoing, imperfect and necessary. And its success depends on whether we continue to show up — together.
Register for the Recovery Ecosystems Conference at bit.ly/RecoveryEcosystem2026
Bailey Medeiros is director of Roanoke Valley Collective Response, a program of the Roanoke Valley-Alleghany Regional Commission that works to build, sustain and support communities responding to addiction.
Scott Weimer is executive director of Roanoke Regional Initiatives for Virginia Tech, advancing graduate education, professional development and community-driven partnerships through the Virginia Tech Roanoke Center.