Can A Polarizing Kennedy Deliver on the Great American Recovery Initiative?

US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s beliefs and philosophy on addiction and recovery can elicit strong emotions and reactions.

There are some who refer to him as a “crackpot,” pushing antiquated, ineffective, and potentially dangerous solutions instead of focusing on evidence-based treatments and programs that research has demonstrated to be effective. His promotion of “healing farms,” for example, has been much maligned among some advocacy movements.

To other, less vocal camps, Kennedy is a sane voice in the wilderness, a sage put in a position of power to not only carry a message of real recovery but to implement policies that align with his own experience. He is not shy about his recovery from addiction through a 12-step program for which a higher power is a foundational element.

President Trump’s recent executive order establishing the Great American Recovery Initiative is the most concrete example yet of Kennedy’s opportunity to imprint the treatment and recovery system.

According to a Feb. 2 press release from HHS, “The centerpiece of this plan is a $100 million investment to solve long-standing homelessness issues, fight opioid addiction, and improve public safety by expanding treatment that emphasizes recovery and self-sufficiency.”

The $100 million will fund a pilot program called STREETS – Safety Through Recovery, Engagement and Evidence-Based Treatment and Supports. It intends to build “integrated care systems for people experiencing homelessness, substance abuse and mental health challenges and helping them find housing and employment.”

Reaction has been lukewarm at best and highly critical at worst, likely in part to the dearth of details about the pilot program, including basic information about how the program will actually operate as well as which eight cities will be included. Moreover, this very work to attempt to integrate beyond physical and behavioral health to include health-related social needs has been going on in communities for many years. In addition, the Trump administration’s ongoing negative rhetoric about and actions toward harm reduction and its whipsaw approach to SAMHSA grant funding have generated skepticism and criticism. Kennedy himself is a reason for much of the apprehension.

His unabashed embrace of abstinence, spirituality, and God—hallmarks of 12-step programs that many advocates have continually criticized for their doctrine of powerlessness over addiction—feels threaded throughout STREETS. In fact, Kennedy intends to “welcome full participation from faith-based organizations in (SAMHSA’S) programs and activities.” And descriptions of his own recovery seem to differ from what had been a recently emerging mentality that claimed someone is in recovery when they say they’re in recovery, despite other personal actions that may conflict with longstanding recovery beliefs.

Yet to this point, Kennedy has not implemented any policies that have directly limited access to medications to treat addiction. As well, there is an argument to be made that his emphasis on connection, spirituality, and religion are, in fact, rooted in science.

Is Kennedy’s approach and demeanor at times hard to accept? Is he (even purposely) out of touch with or dismissive of how the public discourse and science have evolved over the past 15 to 20 years? For many, yes. Consider the example of how he refers to “addicts” and “alcoholics” in recently launching a bipartisan initiative called Action for Progress with his cousin Patrick Kennedy.

Still, he has the opportunity to walk the tightrope to leverage his experience and philosophies in a way that improves the treatment model in place today, creating a stronger continuum of care—including medication and other evidence-based practices—for those suffering from substance use disorder, enabling social connectedness, sense of community, belongingness, and meaning and purpose. Not only are these values Kennedy holds, they are key tenets of SAMHSA’s working definition of recovery.

With his first substantive SUD initiative in his hands, time will soon tell whether he can—or is willing—to walk that line.