The Trump administration on Wednesday unveiled a new framework for helping Americans facing the often-intertwined circumstances of addiction and homelessness.
In a new toolkit, the White House unveiled a “treatment first” model that boosts faith-based interventions while rejecting harm reduction principles and the “housing first” strategy that characterized the Biden administration’s approach. While the new strategy favors medicalized approaches to treating addiction, it cites abstinence as the ultimate goal as opposed to also celebrating decreased drug use and related harms.
The toolkit is in keeping with the Trump administration’s previous actions on addiction issues, ranging from its Great American Recovery Initiative, to a “tough love” approach toward people who use drugs, to a broader hostility toward harm reduction principles.
“Treatment must come first. Recovery begins when we connect people with effective care, not leave them trapped in addiction and homelessness,” health secretary Robert F. Kennedy Jr. said in a statement. “This toolkit gives communities practical, evidence-based strategies to expand treatment, support lasting recovery, and help people reclaim their independence.”
The new program stresses a holistic approach to aiding addiction recovery and helping people experiencing homelessness, ranging from encouraging consistent sleep cycles and daily schedules for treatment-related activity to making employment a central component of the overall strategy.
Above all, the administration stressed that it opposed providing access to housing on an unconditional basis, citing one study that showed veterans in a supportive housing group were more likely to die of a drug overdose. Abstinence, too, was a primary goal, though the toolkit made clear that relapse should be treated as a setback but not necessarily a failure, and that recovery is not necessarily linear.
“I have met men and women whose lives have been transformed by treatment and recovery,” Scott Turner, the secretary of the Department of Housing and Urban Development, said in a statement. “Housing is essential, but housing alone is not enough.”
Despite the Trump administration’s intense opposition, “housing first” strategies have seen some success in recent years, perhaps most notably in Houston, where the city moved 25,000 people from the streets into homes over the course of a decade. City officials widely describe the program as both a local success and a national model, though more recently, the program has struggled with funding while homelessness rates have held steady.
The new strategy also favors prioritizing people who have lived experience with addiction, homelessness, and recovery for influential jobs and positions within organizations conducting homeless outreach and offering pathways to recovery.
The strategy makes only passing mention of two medications known to vastly reduce one’s odds of dying of opioid overdose, methadone and buprenorphine. In recent months, a number of federal government actions have cast doubt on the administration’s support for medication-assisted treatment, also known as medications for opioid use disorder.
While many addiction medicine and harm reduction advocates are likely to be dismayed by the document’s anti-harm reduction bent, they are likely to be relieved at the administration’s proposal for treating meth addiction.
Notably, the document lists contingency management, or the practice of offering financial incentives to people who reduce their drug use or stop altogether, as a favored strategy. While the strategy is aligned with current evidence, many contingency management providers feared it would prove ideologically incompatible with the new administration.
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