New federal toolkit prioritizes “treatment first” approach

The Office of National Drug Control Policy (ONDCP), Department of Health and Human Services (HHS), and Department of Housing and Urban Development (HUD) released the Best Practices Toolkit: Addressing Homelessness and Addiction Through Treatment First to “provide communities with practical and proven strategies to help Americans transition from homelessness and addiction to recovery and self-sufficiency.”

• The main point: The toolkit advances a “treatment first” model that “prioritizes coordinated and accountability-driven engagement in evidence-based treatment and recovery support services.” It boosts faith-based interventions while rejecting harm reduction principles and the “housing first” strategy.

The details:

• The toolkit blasts housing-first approaches as resulting in “fragmented systems of care, repeated relapses, and recurrent homelessness.” The administration stressed that it opposed providing access to housing on an unconditional basis.
• The toolkit cites abstinence as the goal. But it makes clear that relapse should be treated as a setback but not necessarily a failure and that recovery is not necessarily linear.
• The strategy 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 strategy.
• It favors prioritizing people who have lived experience with addiction, homelessness, and recovery for positions within organizations conducting homeless outreach and offering pathways to recovery.
• The toolkit makes only passing mention of medications for opioid use disorder, but it does list contingency management as a favored strategy for treating methamphetamine addiction.

The context: The effort aligns with the White House’s rejection of harm reduction and programs that help house people experiencing homelessness without sobriety or treatment as preconditions. It is also in-step with the rest of HHS’s focus on cracking down on fraud in health care programs and promoting faith-based organizations.

• BUT: The messaging conflicts with widespread support for housing-first approaches among public health researchers, who argue the framework supports long-term housing stability.

And then: Days later, in a joint letter to behavioral health and housing partners, HHS Secretary Kennedy and HUD Secretary Turner outlined the administration’s “Treatment First” approach, pairing safe housing with services that address addiction and serious mental illness.

• Under the “Treatment First” approach, HUD will restore its Continuum of Care Program “to its original congressionally established goals, abandoning ‘Housing First’ policies to the fullest extent possible.”
• HHS and HUD will strengthen coordination between federal housing and behavioral health systems and work with Continuums of Care, housing providers, treatment and recovery grantees, state and tribal partners, faith-based organizations, social service organizations, businesses, and other community stakeholders.

Read more: Trump administration’s new ‘treatment-first’ addiction toolkit emphasizes faith, abstinence; Treatment-first addiction push; Kennedy goes west