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2025 Federal Addiction and Mental Health Treatment Policies Under the Trump Administration Part 2

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The United States continues to face a devastating overdose crisis and widespread unmet mental health needs in 2025. Federal policy under the Trump administration is playing a pivotal role in shaping addiction treatment, mental health services, behavioral health programs, and recovery housing. This comprehensive review examines the latest federal initiatives and policies – and their impacts on patients, providers, and policymakers – in a fact-based, politically neutral manner. We’ll explore everything from funding and Medicaid rules to harm reduction, workforce shortages, and housing supports for people in recovery, with data-driven insights and expert perspectives throughout.

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A Worsening Addiction and Mental Health Crisis

The scale of America’s substance use and mental health crisis is sobering. Drug overdose deaths reached record highs during the past few years, with nearly 107,000 people dying of an overdose in 2021 alone (Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021 | National Institute on Drug Abuse (NIDA)) – a roughly 15% increase from the prior year (U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 - But Are Still Up 15% ). Opioids (especially illicit fentanyl) are driving the epidemic, contributing to about 75% of overdose deaths (Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021 | National Institute on Drug Abuse (NIDA)). These losses are compounded by rising rates of mental illness. In 2020, an estimated 53 million U.S. adults experienced some form of mental illness (Behavioral Health: Available Workforce Information and Federal Actions to Help Recruit and Retain Providers | U.S. GAO). Serious mental illness (SMI) affected about 10 million adults in 2016, yet only 65% received mental health services that year (CMS expands state access to Medicaid waivers for IMD services | AHA News) – underscoring gaps in care.

Millions of Americans need treatment for substance use disorders (SUD) or mental health conditions, but many don’t receive it. Fewer than 20% of adults with opioid use disorder received medications like buprenorphine or methadone to treat it in 2021 (Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021 | National Institute on Drug Abuse (NIDA)). Overall, only about 10%–20% of those with a SUD get any specialty treatment in a given year, leaving a vast unmet need. “Failing to use safe and lifesaving medications is devastating for people denied evidence-based care. What’s more, it perpetuates opioid use disorder, prolongs the overdose crisis, and exacerbates health disparities,” warns Dr. Nora Volkow, Director of the National Institute on Drug Abuse (Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021 | National Institute on Drug Abuse (NIDA)). In the wake of COVID-19, mental health needs have also spiked, with increased anxiety, depression, and trauma. The demand for services is higher than ever, putting strain on an already stretched behavioral health system.

Workforce shortages compound the challenge. The U.S. faces a significant deficit of addiction treatment and mental health professionals across many communities. A federal analysis projected that by 2025 the nation would be short over 6,000 psychiatrists and nearly 17,000 substance abuse and mental health social workers (Behavioral Health Workforce – BHECON). HRSA’s latest models foresee even steeper shortfalls by 2037 if current trends continue (e.g. a 50,000 shortage of psychiatrists and ~113,000 addiction counselors) (Health Workforce Projections | Bureau of Health Workforce). Rural areas are especially hard-hit, with many counties lacking a single psychiatrist or licensed SUD counselor. These workforce gaps mean patients often wait months for appointments or travel long distances for care. In short, the need is great and growing, but access remains limited – a reality that federal policy must confront.


Federal Leadership and SAMHSA Initiatives

Tackling the addiction and mental health crisis has been a stated priority for President Trump’s administration. Early in his first term, in October 2017, President Trump declared the opioid epidemic a national public health emergency (Ending America’s Opioid Crisis – The White House), signaling an “all-of-government” response. The administration convened a federal commission on the opioid crisis and in 2018 unveiled the President’s Initiative to Stop Opioid Abuse, a strategy with three prongs: (1) reduce demand and over-prescription through education and safer prescribing, (2) cut off the supply of illicit drugs (e.g. by cracking down on trafficking and securing the border), and (3) help those struggling with addiction through evidence-based treatment and recovery support (Ending America’s Opioid Crisis – The White House). This balanced rhetoric acknowledged that enforcement alone is not enough – expanding treatment and recovery services is equally critical.

SAMHSA (Substance Abuse and Mental Health Services Administration) – the agency at the helm of federal behavioral health efforts – has seen its role and resources grow in recent years. SAMHSA administers major grant programs that fund prevention, treatment, and recovery supports nationwide. Under the Trump administration, funding for these programs has expanded significantly. For example, SAMHSA’s budget for substance abuse treatment programs climbed from about $2.1 billion in FY2016 to $3.7 billion in FY2018 (Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency and Major Programs) as new opioid crisis grants were launched, contributing to an overall SAMHSA budget of $5.9 billion by FY2020 (Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency and Major Programs). These funds flow to states, communities, and providers, enabling them to serve more patients. The administration secured $6 billion in new funding in 2018–2019 specifically to combat the opioid epidemic (Ending America’s Opioid Crisis – The White House), and worked with Congress to pass the SUPPORT Act (discussed below) – the largest legislative package ever enacted to address a drug crisis (Ending America’s Opioid Crisis – The White House).

Key SAMHSA initiatives in 2025 include the ongoing State Opioid Response (SOR) grants, which give every state and territory flexible funding to expand treatment capacity, distribute overdose-reversal drugs, and support recovery programs. These grants have shown tangible results. By 2020, SOR grantees had distributed over 645,000 naloxone kits (the lifesaving antidote for opioid overdose) and documented 32,300 overdose reversals thanks to those kits (2020 Report to Congress On the State Opioid Response Grants). States also used SOR funds to expand medication-assisted treatment (MAT) – providing FDA-approved medications like buprenorphine and methadone – and reported treating over 288,000 patients with opioid use disorder via grant-supported programs (2020 Report to Congress On the State Opioid Response Grants). Many states adopted hub-and-spoke care models, mobile treatment units, and 24/7 treatment access points with SOR funding (2020 Report to Congress On the State Opioid Response Grants) (2020 Report to Congress On the State Opioid Response Grants). SAMHSA requires that all three forms of MAT (methadone, buprenorphine, and naltrexone) be made available, pushing grantees toward evidence-based care (2020 Report to Congress On the State Opioid Response Grants). For patients, this has meant new avenues to access treatment – for example, more same-day intake options and broader availability of medications that greatly improve recovery outcomes.

SAMHSA also continues to oversee the major block grants – the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant – which support core treatment services in every state. In recent budgets, block grant funding has been maintained or increased, often with added set-asides (e.g. for opioid responses or crisis services). Another important advance was the launch of the 988 Suicide & Crisis Lifeline. In 2020, President Trump signed the law establishing 988 as a nationwide three-digit mental health crisis line, which went live in 2022. This created an easy-to-remember access point to connect people in mental health or substance use crises with trained counselors. The administration has worked to increase grant funding for community crisis systems and Certified Community Behavioral Health Clinics (CCBHCs) – a care model that integrates mental health and SUD treatment and provides 24/7 crisis response. The CCBHC program, initially a pilot, was extended to more states, bolstering coordinated care for complex behavioral health needs.

It’s worth noting the administration’s emphasis on certain approaches. Trump officials have voiced strong support for faith-based treatment programs and peer recovery initiatives, reflecting a belief that community and spiritual support can be important in recovery. At the same time, the administration has pressed for evidence-based practices. For instance, Elinore McCance-Katz, Trump’s first Assistant Secretary for Mental Health and Substance Use (head of SAMHSA), was a proponent of expanding access to MAT for opioid addiction and improving care for those with serious mental illness. Under her tenure, SAMHSA released new treatment guidelines and promoted integrated care models for those with co-occurring mental illness and addiction. The administration has also convened the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) – mandated by Congress – to improve federal coordination on SMI issues such as schizophrenia treatment and reducing homelessness and incarceration for those with mental illness.

From a federal leadership standpoint, the Office of National Drug Control Policy (ONDCP) has coordinated the cross-agency strategy. ONDCP’s national drug control strategies under Trump have continued a trend of allocating substantial resources to both supply reduction and demand reduction. (Critics point out that historically a majority of the federal drug control budget still goes to law enforcement and interdiction rather than treatment; however, treatment and recovery funding has unquestionably grown during the opioid crisis.) The administration’s law-and-order stance is evident in calls to intensify prosecution of drug traffickers (even suggesting death penalties for high-level traffickers) and initiatives to curb the influx of fentanyl. Yet, simultaneously, federal leaders have acknowledged that addiction is an illness that requires treatment, not just punishment. This duality is reflected in the policies discussed below, which try to balance public health and public safety.


Expanded Treatment Access Through Legislation (SUPPORT Act of 2018)

One of the most consequential policy moves came with the passage of the SUPPORT for Patients and Communities Act of 2018, a sweeping bipartisan law addressing the opioid crisis. President Trump signed SUPPORT into law in October 2018, and it remains a cornerstone of federal addiction policy going into 2025. The law contains dozens of provisions that span prevention, treatment, recovery, and enforcement. Notably, it expanded treatment access in Medicare and Medicaid and removed many barriers for providers and patients. Key measures included:

  • Medicaid IMD Exclusion Reform: The law partially repealed the longstanding Medicaid “IMD exclusion,” allowing states to receive federal Medicaid funds to cover inpatient SUD treatment in residential facilities (Institutions for Mental Diseases) for up to 30 days per patient per year (). This was a significant change – historically Medicaid could not pay for adults 21-64 in mental health or SUD facilities with more than 16 beds, which severely limited residential treatment options. With this reform, states gained the option to expand beds for addiction treatment via Medicaid. For patients, this means greater access to rehab programs that were previously often inaccessible to Medicaid enrollees.

  • Children’s Health Insurance Program (CHIP) Parity: SUPPORT required all state CHIP programs to cover mental health and SUD services for children and pregnant women on par with medical/surgical benefits (). States can no longer impose stricter limits on behavioral health treatment in CHIP than they do for other health needs. This ensures vital coverage for youth and expectant mothers facing behavioral health issues.

  • Expanding the Addiction Treatment Workforce: To increase the pool of treatment providers, the law expanded prescribing authority for medication-assisted treatment (MAT). It made permanent the ability of nurse practitioners and physician assistants to prescribe buprenorphine for opioid use disorder, and authorized clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe buprenorphine for a 5-year trial period (). It also codified that qualified physicians can treat up to 275 patients with buprenorphine (up from the previous 100-patient limit) (). These steps have been critical in allowing more patients to receive MAT, especially in underserved areas where physicians are scarce. For providers, it reduced regulatory hurdles and empowered a broader range of practitioners – for example, a rural clinic’s nurse practitioner can initiate buprenorphine treatment without needing a specialized doctor on staff.

  • Medicare Coverage Improvements: The SUPPORT Act established that Medicare would cover OUD treatment services furnished by opioid treatment programs (OTPs, such as methadone clinics) for the first time. Starting in 2020, seniors and disabled Medicare enrollees with opioid addiction gained access to methadone treatment as a covered benefit, addressing a gap for older adults. The law also expanded Medicare’s telehealth coverage for SUD treatment and added an opioid misuse screening to the Medicare annual wellness visit ().

  • Support for Alternative Pain Management: In the realm of prevention, the law launched initiatives to encourage alternatives to opioids in pain management. It created demonstration programs for hospitals to develop non-opioid pain protocols in emergency departments and provided best-practice toolkits to reduce unnecessary opioid prescribing. For patients, this can mean being offered physical therapy or non-opioid medications after an injury instead of automatically receiving opioids – potentially preventing new cases of addiction.

  • Other Provisions: The SUPPORT Act encompassed many other actions: increasing penalties for opioid manufacturers that fail to report suspicious orders, bolstering drug trafficking interdiction, funding research into non-addictive painkillers, and more. It also authorized new grant programs, including funding for comprehensive recovery centers and support for family-focused residential treatment for pregnant/postpartum women with SUD. In essence, the law took a comprehensive approach to the opioid crisis, touching virtually every aspect of federal policy – from law enforcement to healthcare financing – to lower barriers to treatment and marshal more resources into communities.

For policymakers at the state and local level, the SUPPORT Act provided both new tools and new mandates. States had to update their Medicaid and CHIP plans to comply with the coverage requirements, but they also gained financial support to broaden services. Many states took advantage of the IMD rule flexibility (either under this law or through pre-existing waivers) to open or fund new residential treatment slots. At least 17 states obtained waivers by 2018 to pay for inpatient SUD treatment in IMDs (prior to the law’s passage) (CMS expands state access to Medicaid waivers for IMD services | AHA News), and the SUPPORT Act’s partial repeal extended that opportunity nationwide. State officials report that this has increased treatment capacity and access for patients who need more intensive care.

Overall, the SUPPORT Act’s implementation has been a positive development for patients, who now face fewer legal barriers to treatment, and for providers, who have more support and flexibility to deliver care. By standardizing SUD treatment coverage across federal programs and expanding the workforce, the policy environment is more favorable for getting people into effective treatment. However, gaps remain – for instance, not all eligible providers immediately began prescribing buprenorphine despite the expanded authority (due to stigma or lack of training), and some states have been slow to roll out new Medicaid-covered treatment options. Still, the legislation is widely seen as a milestone in federal addiction policy, with millions of dollars flowing to states to fund treatment and prevention and important regulations updated to reflect modern best practices.

Medicaid Policy: Coverage, Waivers, and Reforms

Medicaid is the single largest payer for addiction and mental health treatment in the U.S., so federal Medicaid policy under the Trump administration has profound effects on access to care. The administration’s approach has combined new flexibility for SUD treatment with attempts to restructure Medicaid more broadly.

On one hand, as noted, Trump’s CMS (Centers for Medicare & Medicaid Services) encouraged states to expand SUD treatment through Medicaid waivers. Even before the SUPPORT Act’s statutory change, CMS in 2017–2018 invited states to apply for Section 1115 demonstration waivers to cover inpatient SUD services in IMDs. States from New Jersey to Ohio to Arizona jumped at this opportunity. By late 2018, 17 state waivers had been approved to pay for residential opioid use disorder treatment in IMDs (CMS expands state access to Medicaid waivers for IMD services | AHA News) – a major departure from past policy. Then in November 2018, CMS went further, announcing it would also consider waivers to cover treatment in IMDs for serious mental illness (SMI) and serious emotional disturbance in youth (CMS expands state access to Medicaid waivers for IMD services | AHA News). HHS Secretary Alex Azar emphasized the need for “more inpatient and residential options” for mental health while ensuring community care is also strengthened (CMS expands state access to Medicaid waivers for IMD services | AHA News). This signaled a new openness to funding psychiatric hospital care via Medicaid for the first time in decades, as part of a broad strategy to improve mental healthcare. A few states (like Vermont and Washington, D.C.) have since pursued SMI IMD waivers (CMS expands state access to Medicaid waivers for IMD services | AHA News).

For patients, these waivers and Medicaid changes mean expanded access to treatment that was previously inaccessible. Low-income adults struggling with addiction can now utilize Medicaid to enter a residential rehab program (typically 28 days or less) without being turned away due to the old funding prohibition. Likewise, someone with severe bipolar disorder or schizophrenia might find a psychiatric bed available under Medicaid in a state with an SMI waiver, whereas before they might have languished without care or ended up on the street or in jail. Providers (like treatment facilities and hospitals) have gained the ability to receive Medicaid reimbursement for services they provide in these larger inpatient settings, which has incentivized them to increase capacity. Early outcomes from states suggest improved continuity of care: patients can transition from inpatient detox to ongoing outpatient care more smoothly when Medicaid is covering the whole continuum (CMS expands state access to Medicaid waivers for IMD services | AHA News).

On the other hand, the Trump administration also pursued Medicaid policies that raised concern among behavioral health advocates. A signature (and controversial) initiative was pushing Medicaid work requirements. CMS under Trump signaled openness to state waivers that would require certain Medicaid beneficiaries to work or volunteer as a condition of coverage. Several states (including Arkansas, Kentucky, and others) received approval for work requirement waivers in 2018. Critics argued this could especially harm people with SUD or mental illness, who often have fluctuating job capacity and could lose coverage during relapses or crises. Those concerns were borne out in Arkansas: when it implemented a work requirement, over 18,000 people lost Medicaid coverage in 2018 for not meeting the reporting rules (Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018 | KFF). Many of these were likely vulnerable adults, some possibly dealing with untreated health issues. The policy was later halted by courts and ultimately reversed, but it highlighted a tension in priorities. Policymakers in favor of work requirements argued they would encourage self-sufficiency, but many health experts warned that the sudden loss of coverage for thousands would interrupt care for chronic conditions, including addiction treatment. From the patient perspective, getting disenrolled from Medicaid could mean an inability to afford therapy, medications, or recovery support – potentially leading to relapse or worse. As of 2025, Medicaid work requirements are not in effect (the Biden administration rescinded remaining approvals), but the Trump administration’s stance made clear that such reforms were on the table.

Another major front was the effort to repeal and replace the Affordable Care Act (ACA). While not specific to addiction, ACA repeal would have had huge ripple effects on behavioral health. The ACA’s Medicaid expansion extended coverage (including SUD/MH benefits) to millions of low-income adults, and the law’s essential health benefits requirement ensured that private insurance plans must cover mental health and SUD treatment. President Trump supported ACA repeal bills in 2017, which ultimately failed in Congress by a slim margin. Had they succeeded, an estimated 20+ million Americans could have lost health insurance, and parity protections for mental health/SUD coverage might have been rolled back (Budget deal includes $6 billion to fight opioid abuse - The Hill). Even though repeal did not happen, the uncertainty and repeated attempts caused concern among providers and patients. Many states with high overdose rates (like West Virginia, Kentucky, Ohio) had greatly benefited from Medicaid expansion – seeing increased addiction treatment admissions and improved outcomes. Policymakers in those states, including some Republicans, voiced that rolling back Medicaid expansion would undermine progress in fighting the opioid crisis. In the end, the ACA remains intact in 2025, and in fact more states have adopted expansion (North Carolina being a recent example). But the Trump administration’s position highlighted a partisan divide: whether to treat Medicaid mainly as a flexible health safety-net (with potential eligibility restrictions) or as a broad entitlement that is expanded to cover more people with behavioral health needs. From a neutral stance, it’s clear that maintaining insurance coverage is critical for patients to access addiction and mental health care. Any policy that reduces coverage tends to increase unmet need, whereas policies that expand coverage (Medicaid expansion, parity requirements) increase treatment utilization.

Beyond coverage, the administration has also promoted innovative approaches like Medicaid health homes for opioid use disorder and encouraged states to use federal funds for wraparound services. Under SUPPORT Act authority, a time-limited enhanced federal matching rate was offered for states to develop comprehensive SUD treatment “health homes” – care models that coordinate medical, psychological, and social services for people with addiction. Several states opted into this, aiming to improve care coordination for high-need patients. Additionally, CMS issued guidance making it easier for states to pay for non-clinical services (transportation, housing support, peer recovery coaching) through Medicaid managed care, recognizing that social factors are key to successful recovery.

In summary, Medicaid under Trump has been a mix of expansion and restriction: expanding what services Medicaid can pay for (more treatment options), but exploring restrictions on who can enroll or stay enrolled (through work rules or ACA changes). For now, the net effect in 2025 is that Medicaid is covering more SUD/MH services than ever before – especially in states that take advantage of federal options – but access to Medicaid itself still varies by state (since 10 states have not expanded Medicaid, leaving many low-income adults uninsured). Patients in non-expansion states, often in the South, continue to fall into a coverage gap that makes it hard to afford rehab or psych care, a disparity that remains a challenge for policymakers to address.

Building the Behavioral Health Workforce

A critical foundation for any treatment or prevention effort is the workforce – the counselors, social workers, psychologists, psychiatrists, peer specialists, and other professionals delivering care. All the funding and insurance coverage in the world won’t help if there aren’t trained providers available. Policymakers have increasingly recognized the behavioral health workforce shortage as a national emergency in its own right, and the Trump administration has taken some steps to address it.

One important initiative was expanding incentives for providers to enter and stay in the field. The Health Resources and Services Administration (HRSA) runs programs like the National Health Service Corps (NHSC) that repay student loans for clinicians working in underserved areas. During Trump’s tenure, additional funding was directed to the NHSC and new programs were created specifically targeting addiction treatment professionals. For example, the Substance Use Disorder Treatment and Recovery Loan Repayment Program was established (authorized under the SUPPORT Act) to offer loan forgiveness to SUD counselors, nurses, social workers, and others who work in high-need communities (Health Workforce Projections | Bureau of Health Workforce). Similarly, the** Behavioral Health Workforce Education and Training (BHWET) grants** have been enlarged to support training for a range of providers at universities and clinics (Health Workforce Projections | Bureau of Health Workforce). Over 80% of behavioral health providers who received training or scholarships through HRSA programs from 2012–2020 remained in underserved areas at least two years later, indicating these investments can yield durable gains (Behavioral Health: Available Workforce Information and Federal Actions to Help Recruit and Retain Providers | U.S. GAO).

Telemedicine has also emerged as a force-multiplier for the workforce. The COVID-19 pandemic in 2020 led to historic flexibilities in telehealth for behavioral care, many of which have been extended. SAMHSA and the DEA allowed buprenorphine prescriptions to be initiated via telehealth (without an initial in-person visit) and permitted opioid treatment programs to move counseling services online. The administration is considering making these changes permanent. Tele-mental health usage exploded, with patients attending therapy and medication management appointments from home. This technology helps bridge provider shortages by allowing one clinician to reach patients across a wider geographic area. A rural patient can now connect with an addiction psychiatrist in a city, for instance, rather than doing without specialized care. Telehealth doesn’t replace the need for more providers, but it alleviates access issues and maximizes the impact of the current workforce.

Despite these efforts, the shortage remains acute in 2025. As mentioned earlier, projections showed major deficits in key professions by 2025 – e.g. 6,080 fewer psychiatrists than needed and short thousands of clinical psychologists and social workers (Behavioral Health Workforce – BHECON). The aging of the current workforce (many psychiatrists are near retirement) and burnout are contributing factors. A recent survey found 48% of U.S. behavioral health workers have considered leaving their jobs due to stress and workload (Behavioral Health Workforce Shortage Will Negatively Impact Society), an alarming figure that threatens to worsen turnover. The Trump administration has acknowledged these challenges in its rhetoric, often mentioning the need to “recruit the next generation of healers” to combat addiction. But some critics say more aggressive action is needed – such as boosting reimbursement rates for mental health services (to make the field more financially attractive), expanding training slots for psychiatrists and psychologists, and allowing psychologists to prescribe in more states to extend capacity.

From the provider perspective, the federal focus on workforce has been welcome but only partially relieving. Loan repayment programs, for example, are competitive and not all who apply receive awards. Many front-line counselors earn low wages (often in the $30-40k range) despite high responsibility, a problem not directly solved by current federal programs. Policymakers are exploring ideas like increasing Medicare payment for psychotherapy or supporting peer support specialist credentialing to grow that segment of the workforce. The Trump administration in its second term proposals has floated the idea of accelerating licensing compacts to allow behavioral health professionals to practice across state lines (leveraging telehealth further) and fast-tracking visas for foreign-trained mental health professionals to fill gaps – although these are not yet formal policies.

It’s important to highlight one bright spot: peer recovery specialists and community health workers for behavioral health have expanded with federal support. These are individuals with lived experience of recovery who are trained to support others. Federal grants often fund peer positions in emergency rooms, drug courts, and outreach teams. Peers help engage patients in treatment and provide non-clinical support (like mentoring and navigating systems). They have become an indispensable part of the workforce, and their growth helps offset some clinician shortages. The Trump administration has praised faith-based and peer-led recovery, which indirectly boosts acceptance of these roles.

In conclusion, workforce initiatives under Trump have made incremental progress. Thousands of providers have been incentivized to practice in high-need areas and telehealth has expanded reach. However, the demand still far outstrips supply, and workforce development will remain a major policy focus. Patients ultimately feel the workforce shortage as long wait times or lack of local services. Providers feel it as overwhelming caseloads and burnout. Addressing this will likely require sustained efforts beyond what we’ve seen so far, including education pipeline expansions and better pay parity for behavioral health services. The administration and Congress are starting to recognize that without a robust workforce, the bold goals for treatment access cannot be fully realized.

Recovery Supports and Housing

Recovery is about more than acute treatment – it’s about sustaining long-term wellness. Federal policy has increasingly emphasized recovery supports like housing, employment assistance, and peer networks to help people maintain sobriety and stability after treatment. Under the Trump administration, notable strides have been made in supporting recovery housing in particular, as well as integrating services to address the broader needs of people in recovery.

A landmark effort was the creation of the Recovery Housing Program (RHP), a pilot authorized by the SUPPORT Act. In 2020, HUD (Department of Housing and Urban Development) officially launched this program, which provides grants to states to supply stable, transitional housing for individuals in recovery from SUD (HUD Archives: HUD LAUNCHES RECOVERY HOUSING PROGRAM TO AID AMERICANS RECOVERING FROM SUBSTANCE ABUSE). Initially funded at $25 million, the RHP targeted 24 states plus D.C. that had overdose death rates above the national average (HUD Archives: HUD LAUNCHES RECOVERY HOUSING PROGRAM TO AID AMERICANS RECOVERING FROM SUBSTANCE ABUSE). The idea is to give people exiting rehab or early in recovery a safe, drug-free living environment for up to 2 years while they work to secure permanent housing. This can take the form of Oxford House-style sober homes, supervised apartments with peer support, or other recovery residence models. As HUD Secretary Ben Carson said at the program’s launch, “HUD's Recovery Housing Program is bringing new funding and new partners to the fight against the opioid crisis, broadening the spectrum of collaboration… and providing housing – a critical need for those in recovery.” (HUD Archives: HUD LAUNCHES RECOVERY HOUSING PROGRAM TO AID AMERICANS RECOVERING FROM SUBSTANCE ABUSE). Carson emphasized removing stigma and making “access to treatment as easy as access to drugs” while helping the “whole person” (HUD Archives: HUD LAUNCHES RECOVERY HOUSING PROGRAM TO AID AMERICANS RECOVERING FROM SUBSTANCE ABUSE), reflecting the administration’s recognition that housing and social support are integral to recovery.

For patients in recovery, federal support for housing can be life-changing. Many people overcoming addiction face homelessness or unstable home lives, which can trigger relapse. A stable recovery residence offers structure, accountability (often with drug testing and house meetings), and support from peers who are also committed to sobriety. Research shows that recovery housing reduces relapse risk and improves outcomes – longer stays in sober living homes are associated with higher rates of employment and sustained abstinence ( For people in treatment, who engages with recovery residences, and does it boost retention? – Recovery Research Institute ). One study found that those who stayed at least 6 months in an Oxford House had significantly better substance use outcomes than those who left earlier (Oxford Recovery Housing: Length of stay correlated with improved ...). By investing in recovery housing, the federal government helps individuals build recovery capital (like stable housing, employment, and social support) that makes long-term sobriety attainable. Early reports from states indicate the RHP grants have funded hundreds of recovery residence beds and linked participants to job training and other wraparound services.

Providers and community organizations are also positively impacted. Non-profits that run sober living homes or transitional housing have new funding streams to expand capacity or improve facilities. Some states pass RHP funds through to local levels, where community groups can apply to create programs. This federal-state-local partnership spurs innovation – for example, one state might use funds to convert an old motel into recovery housing, while another might contract with a faith-based group to run a women’s recovery home that also provides child care for mothers in recovery. By coordinating with HHS programs (like SAMHSA block grants and State Opioid Response funds), RHP is being woven into a broader support network, ensuring participants also get access to ongoing treatment, mental health care, and case management (HUD Archives: HUD LAUNCHES RECOVERY HOUSING PROGRAM TO AID AMERICANS RECOVERING FROM SUBSTANCE ABUSE).

Beyond housing, recovery support includes employment programs, education, transportation, and peer coaching. The Department of Labor has implemented grant programs (like the SUPPORT Act’s workforce pilot) to help those in recovery train for new careers – because meaningful employment is a key predictor of sustained recovery. The Trump administration’s focus on economic growth and job training has dovetailed with these efforts, promoting second-chance hiring and removing employment barriers for those with past substance use or criminal records. Some specific initiatives under discussion include expanding family leave protections to support people seeking treatment. In fact, President Trump has indicated support for extending the Family and Medical Leave Act (FMLA) to cover needed time off for addiction treatment (Potential Health Policy Administrative Actions in the Second Trump Administration | KFF). Currently, FMLA can cover some addiction treatment situations, but Trump’s 2024 campaign suggested explicitly adding job-protected leave for those going to rehab (Potential Health Policy Administrative Actions in the Second Trump Administration | KFF). If enacted, this would be a significant policy change – policymakers see it as enabling more working individuals to pursue treatment without fear of losing employment. It would directly benefit patients who might otherwise avoid or delay rehab for fear of job loss.

Case Study: Consider a veteran in early recovery from opioid addiction. After completing a 30-day residential treatment (made possible by Medicaid IMD waiver coverage), he moves into a federally funded recovery home for six months. There, he has a stable place to live, participates in peer support meetings, and gets help from a case manager who connects him to an apprenticeship program. With newfound job skills, he lands a steady job. During this time, a peer recovery coach (funded by a State Opioid Response grant) checks in weekly and helps navigate any relapse triggers. After a year, he transitions to independent housing and continues attending outpatient counseling. This continuum – from treatment to recovery housing to employment – is increasingly supported by braided federal and state programs. This hypothetical illustrates how the pieces come together to change lives.

The federal government is also working on quality standards for recovery housing to ensure safety and effectiveness. There have been concerns about unscrupulous “sober home” operators in some states taking advantage of patients or running inadequate facilities. In response, SAMHSA and HUD have developed best practice guidelines and technical assistance for states to certify recovery homes. The goal is to promote quality, ethical recovery residences so families and referring treatment providers know that a given home meets certain standards (for example, trained house managers, drug-free environment, support services, etc.). Aligning with National Alliance for Recovery Residences (NARR) standards is one approach many states are taking, often encouraged by federal guidance.

In essence, recovery support policies under Trump have started to treat addiction more like a chronic condition that requires ongoing management and social support. This is a shift from past eras where policy was more narrowly focused on the short-term clinical treatment. It recognizes that issues like housing and employment are not “extras” but core components of successful recovery. The conversation has also broadened to encompass mental health recovery – e.g., supportive housing for those with serious mental illness and co-occurring substance issues, and programs like SSI/SSDI Outreach, Access, and Recovery (SOAR) to help eligible individuals obtain disability benefits and housing.

Looking ahead, the Project 2025 conservative agenda (influencing Trump’s second-term planning) hints at focusing on treating homelessness by addressing mental illness and addiction, even if that means more mandated treatment. There’s talk of building new residential facilities for homeless individuals with addiction/mental illness – a shift from “housing first” toward “treatment first” models (Reading the Tea Leaves of Trump's Behavioral Health Policies). Any such move would be controversial, balancing civil liberties with the urgent need to help those living on the streets in dire conditions. It underlines the administration’s viewpoint that untreated mental illness and addiction lie at the root of many social problems, and thus investing in treatment and structured environments (like recovery housing or inpatient facilities) is a priority.

Federal Funding Trends and the Road Ahead

Federal funding for addiction and mental health has unquestionably increased over the last decade, and that trend continues under the Trump administration’s budgets. As noted, SAMHSA’s budget grew significantly from 2016 to 2020 (Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency and Major Programs), largely due to targeted opioid crisis appropriations. Congress (in bipartisan fashion) has sustained those funding levels, even as attention broadens to other substances (like methamphetamine and polysubstance use) and to mental health needs like suicide prevention and youth anxiety.

The federal drug control budget – which includes not only HHS treatment funding but also DOJ, DHS, and other agencies – reached over $40 billion by mid-2020s. An increasing share of that is devoted to demand reduction (treatment, prevention, recovery) versus supply reduction (law enforcement, interdiction). Still, about half of drug budget funds go to law enforcement/interdiction in recent years, meaning efforts to curtail drug supply receive tens of billions, while treatment and prevention also receive tens of billions (Ending America’s Opioid Crisis – The White House). The Trump administration has continued funding key Obama-era initiatives like the CURES Act State Targeted Response grants (now the SOR grants) and increased the mental health block grant by setting aside funds for crisis services (e.g., the 988 rollout and mobile crisis teams). Importantly, in 2020 the COVID-19 relief bills provided additional one-time funds for behavioral health (recognizing the pandemic’s toll) which the administration deployed to bolster services.

For 2025 and beyond, the administration is focusing on sustainability of funding. Many opioid-specific grants (like SOR) have been funded through annual appropriations and need reauthorization or renewal. There is discussion in Congress about creating a more permanent funding stream to address addiction – some advocates call for an “opioid epidemic fund” akin to the HIV/AIDS Ryan White program, which would ensure stable funding not subject to political whims. Thus far, the approach has been adding money year by year; the Trump administration has signaled support for continuing these investments, but long-term assurance is still needed. Policymakers are also grappling with how to allocate funds across emerging needs: for example, stimulant overdoses (from meth and cocaine) now kill thousands, so should more grant money be flexible beyond opioids? The 2020 expansion of SOR to cover stimulants ([PDF] 2021 Report to Congress on the State Opioid Response Grants (SOR)) was a step in that direction.

Another trend is integrating mental health funding and substance use funding, since co-occurring disorders are common. Federal grants and programs are increasingly taking a unified “behavioral health” approach. The proposed FY2025 budget (President’s request) for SAMHSA is around $8.1 billion ([PDF] samhsa-fy-2025-cj.pdf), which reflects further planned increases in both addiction and mental health program spending. This would support initiatives like expanding CCBHCs nationwide and implementing a new grant program for community-based recovery support services. Policymakers from both parties seem to agree that mental health, in particular, needs a major infusion of resources given the youth mental health crisis and suicide rates. We can expect continued bipartisan support for funding measures – for instance, the 2023 Bipartisan Safer Communities Act (although under a different administration) set aside considerable funds for school-based mental health; a Trump administration in 2025 would likely implement those and potentially seek more.

One potential challenge is that while Congress holds the purse strings, administrative priorities influence how funds are directed. The Trump administration has favored block grants and state-driven solutions over new federal entitlement programs. We see this in how funds are often given to states with flexibility (as opposed to, say, expanding Medicaid even further or creating a universal federal treatment program). Providers and patient advocates sometimes express frustration at the patchwork nature of grant funding – a clinic might rely on 5 different grants to keep the doors open, each with its own rules and time limits. A more streamlined approach (like increasing Medicaid reimbursement or establishing permanent funding channels) could improve stability. This is an area of ongoing policy development.

Finally, political neutrality and evidence-based policy are crucial. The addiction and mental health crises do not discriminate by party, and successful solutions have come from bipartisan efforts. The SUPPORT Act was near-unanimous in Congress; expansion of 988 and mental health services has broad support. As the Trump administration implements policies in 2025, it faces the task of evaluating what’s working – through data and research – and adjusting accordingly. For example, if overdose deaths remain high, are there mid-course corrections needed (perhaps embracing more harm reduction)? If workforce shortages persist, do we need bolder educational incentives? These decisions should be guided by outcomes and expert input.

In the end, the measure of success will be seen in health outcomes: fewer overdoses, more people receiving treatment and achieving recovery, reduced suicide rates, and improved quality of life for those with mental illness. Federal policies under the Trump administration have laid important groundwork by expanding funding, removing certain barriers, and promoting a full continuum of care from prevention to recovery. Patients, providers, and policymakers are now working within this evolving framework. There is optimism in some corners – overdose death increases slowed in 2022 for the first time in years (Drug Overdose Deaths in the United States, 2002–2022 - CDC), and more Americans are seeking help for mental health issues than before. But there is also urgency, as the problems remain enormous.

To maximize impact, engagement and collaboration at all levels is needed: federal leadership setting the agenda and providing resources; state and local authorities tailoring programs to their communities; providers innovating and delivering quality care; and patients and families bringing their voices to the table to inform policy. The Trump administration’s policies in 2025 will continue to shape these efforts. With sustained commitment and evidence-based refinements, the hope is to turn the tide on addiction and mental illness – helping Americans live healthier, fuller lives in recovery.

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