Substance use and addiction are traditionally associated with urban areas. The novel confronts a difficult reality that the Centers for Disease Control has termed a plague of significant dimensions. Substance use disorder disproportionately affects the Appalachia region more than other regions of the country. Deaths directly related to opioid use are more than 70% higher in rural Appalachia (“Mental Health Facts for Appalachian People.” American Psychiatric Association, 2018). In the Wild Light touches on some of the reasons that might explain the opioid crisis in Appalachia, particularly among those born after 2000. The area’s principal economic industries—farming and mining—face apocalyptic downturns leaving the region’s long-time residents struggling to make ends meet. And those industries, where they are still in operation, pose the risk of catastrophic long-term injuries for which prescription medications become part of rehab programs and, in turn, trigger dependency.

The insular nature of Appalachian culture brings about suspicion toward government agencies and outreach programs designed to address substance use and provide specialized counseling. Doctors, public health service representatives, and therapists alike are dismissed as interfering outsiders. Given the limited economic opportunities and impoverished home lives, Appalachia’s Gen Z, bored and depressed, turn to substance use as an escape—and, for some, like Jason Cloud, as a reliable income stream.