Editor’s note: This is the last in a three-part series examining the impact of the coal industry on health, the environment and overall quality of life for the people of West Virginia. The first part looked at residents beginning to speak out in the aftermath of January’s chemical spill. Part 2 examined the environmental and employment effect of mountain top removal.

WAR, W.Va. — When Principal Florisha McGuire wants a clue about what’s going on in the homes of her students at Southside K–8 school, she often finds the answers on their feet.

“If you look at their little shoes, you can tell who has and who doesn’t,” McGuire said. “Their shoes give it away.”

But it’s their socks — more specifically, she said, if they have any — that often give away their parents’ neglect here in McDowell County, where at least one-third of residents are living below the poverty line and the money that many parents do have is spent on drugs.

McDowell’s children are the latest wave of victims as widespread addiction rips families apart — more misery for communities already suffering economic hardships from job losses in the coal industry.

In War, which inherited its name from an ancient Indian battle and is the southernmost in the state, McGuire and teachers at Southside tend to the most vulnerable casualties in the community’s ongoing tug-of-war with addiction. The battle is so pitched that the county has become the state’s poster child of what it looks like to be down and out. Out of West Virginia’s 55 counties, McDowell has the highest drug overdose death rate (PDF). It’s an infamous claim to fame that overshadows its other high rankings, for binge drinking and suicide.

McDowell residents are self-medicating, McGuire said.

But it wasn’t always that way. The county’s coal mines have been among the most productive in the state, which brought periods of boom that echoed throughout the hollows. Locals reminisce about how there were once three movie theaters in the county and the population swelled to more than 100,000. It was a dependence that would prove unsustainable. By the 1980s, a bust was well underway throughout the region’s coal hills. Mining mechanization eroded jobs, and the steel industry — coal’s main buyer — was in sharp decline.