I am not sure what the answer is, but let me say that, I was born in Johnstown PA and lived around Altoona when I was a kid. Then in my teenage years, I worked in Red Hook Brooklyn and around NYC. Back in the early 90s in Brooklyn, I remember driving down Hamilton Ave. and seeing huge lines in front of the methadone clinics and zombies walking the streets around 5am when I was on my way to work.
Now, when I go to those parts of Brooklyn its Tesla's and Maseratis. Even today, despite what those cheering on the demise of NYC want to spine it.
Meanwhile though, you have zombies and clinics now in places like Altoona and Johnstown. It's really sad to see.
It is hard to say what the answer is, but whatever we are doing right now isn't working.