When she went to sleep on July 27, 2022, McKayla wasn’t worried about the storm that was raging outside her trailer in southeastern Kentucky. Intense storms came frequently in summer. While the creek in front of her home would often rise, water never came close enough to be a concern.

But at 6:30 the next morning, one of her children rushed into her room panicked. McKayla ran to the window to see their neighbors’ belongings floating by. “I started waking the kids up,” she recalled. “But by that point, there was absolutely no way we could have got out. From 6:40 to 7:10, the water had just started coming through the house. At 7:10 we were standing on my kitchen counter.”

Her oldest son busted a hole in the ceiling, cutting the trailer’s tin roof back with scissors. McKayla pushed the kids up onto the roof before hoisting herself up. They stayed on the roof for hours until a National Guard boat rescued them.

The devastation was vast. McKayla lost her home and everything in it.

She had been in recovery from substance use disorder when the flood hit, and the trauma and instability upended her recovery.

“I started using drugs again,” she told me while participating in a study I led about the effects of disasters on drug use. I’m not using her real name here to protect her privacy.

“It was just one of those things. I lost everything I had,” she said. “There was nothing in the house that was savable.”

McKayla’s story is more common than people may realize.

When flooding hits rural areas like Appalachia, it can weaken support systems that have taken years to build. At the same time, residents in drug or alcohol recovery are under extraordinary stress from the loss of homes, jobs and sometimes friends and family.

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