When people visit with friends and neighbors in southern West Virginia, where paved roads give way to dirt before winding steeply up wooded hollows, the talk is often of lives that never got off the ground.

“How’s John boy?” Sabrina Shrader, 30, a former neighbor, asked Marie Bolden one cold winter day at what Ms. Bolden calls her “little shanty by the tracks.”

“He had another seizure the other night,” Ms. Bolden, 50, said of her son, John McCall, a former classmate of Ms. Shrader’s. John got caught up in the dark undertow of drugs that defines life for so many here in McDowell County, almost died of an overdose in 2007, and now lives on disability payments. His brother, Donald, recently released from prison, is unemployed and essentially homeless.