EO looks to shift addiction treatment toward community-based recovery

Terry Gerton We have a great topic to talk about, and it may not have gotten a lot of attention. At the end of January, the president signed an executive order announcing the Great American Recovery Initiative, focused on substance use disorder and recovery. From your perspective, what is the core shift that this executive order is trying to make in how the federal government is thinking about substance addiction and recovery?

Melissa Sosinski Yeah, I think coordination was a really key part and it felt really familiar based on conversations I’ve had with other people in this field. A lot of the language in the executive order reflects things that a lot of federal, state and local leaders have been saying and working toward for years, that recovery is broader than treatment alone and that access works best when systems fit into people’s lives. The cross-agency framing also stood out in that regard, because recovery doesn’t happen in one program or one moment, it unfolds over time and across systems. So yes, we see the Substance Abuse and Mental Health [Services] Administration’s leadership involved, but we also see that the EO taps agencies like the departments of the Interior, Housing and Urban Development and Education. This points to the same kind of holistic, coordinated approach that we see in the field of recovery and how they’re trying to take it on.

Terry Gerton This feels to me very similar to the approach the federal government has taken in the past to homelessness, trying to create a really comprehensive, integrated solution space for individuals that face housing insecurity. What might you think this comprehensive approach to substance use disorder and recovery will ultimately entail?

Melissa Sosinski So, I think that we are going to be seeing a lot more going beyond treatment, which is where a lot of the substance use disorder rhetoric tends to come from. One example that stuck out with me has come from Palm Beach County, where the county’s drug czar talked about how they implemented a recovery capital index. So instead of measuring success only by whether someone has completed treatment, they looked at things like housing stability, as you were mentioning, employment and social support. So this shifted the conversation to, again, that more holistic view of recovery, asking whether someone’s life has actually become more stable than it was before, and not just whether they’ve touched a particular service. This index created metrics around how people were doing across these personal, social and cultural support systems. So what this all meant was it sort of formed a measurable way to determine a person’s overall well-being, and where their strengths were across their journeys of recovery. I think that this example sort of encapsulates what we’re seeing with this executive order. It’s a move toward what we’re already seeing in the field with people trying to address SUD recovery in this holistic way.

Terry Gerton There’s a really interesting statistic in this executive order. It says, among the 40.7 million adults who had a substance use disorder in 2024 and who did not receive substance use treatment, 95.6% of them, or 38 million people, did not perceive that they needed treatment. What about that describes some of the barriers, both that individuals face in seeking treatment, but also that are going to have to be overcome by the structure that’s set up in this executive order?

Melissa Sosinski Yeah, it really is a shocking statistic. And we know that often for people, it’s not that services don’t exist for people to tap. It’s that these services don’t fit into people’s lives. So people have busy work schedules, transportation barriers, caregiving responsibilities, or even the fear of stigma that can prevent people from really engaging. So that’s why you hear so much focus on access in the recovery space. So one example that stands out to me is in San Francisco, we heard of something called a night navigator program. This is something that uses telehealth to connect people on the streets with support outside of traditional nine-to-five business hours. It’s really a practical way to make sure that services are there when people will actually need and use them. And while we know that what may be effective for supporting recovery, people’s schedules, and again, personal obligations can prevent them from accessing services.

Terry Gerton I’m speaking with Melissa Sosinski. She’s the media content lead and the host of the Empathy Affect podcast at Fors Marsh. Melissa, let’s follow on with that telehealth opportunity, I guess. From your perspective, where does telehealth make the biggest difference in recovery support? We’re seeing it show up in more and more healthcare programs. How do people tap into it?

Melissa Sosinski Yeah, I mean, just especially looking back at the pandemic when we were sort of forced into a remote environment, it became a big boon and it remains one in the mental health SUD space because you can tap support from wherever you are, whether it’s in rural health situations or just like everyday support. We’ve seen it more at agencies like the VA, across HHS. And so seeing it become a tool that people in the SUD space have been using has been really great to see, and they’re being creative. And again, like going down to that local level, I think is where we see a lot of the innovation and creativity in its application.

Terry Gerton Are there still policy or operational barriers that limit how agencies can use these more flexible tools? I’m thinking here about crossing state lines, for example. Can you provide telehealth to someone in Minnesota if you’re a care provider in Kansas?

Melissa Sosinski Yeah, I think that with many providers they need to be licensed in certain states, so there are barriers in terms of across state lines, but many providers do get licensing in several states so that they can be available as telehealth providers in mental health, in SUD and other kinds of spaces.

Terry Gerton  One of the big focuses of this executive order is also on workplaces. What do we know about how employers, and especially managers, can support employees who might be navigating a recovery journey?

Melissa Sosinski I’m so glad you brought this up because we know that the workplace is ready to support people in recovery. What we hear consistently is that managers and colleagues want to be supportive but they don’t always know how. In one Empathy Affect conversation we had with ONDCP, which is the Office of National Drug Control Policy, we talked about a recovery-friendly workplace toolkit they were developing. So this toolkit centers on four pillars, prevention and risk reduction, training and education, hiring and employment, and recovery and treatment support. But just as importantly, this toolkit focuses on practical questions, like how supervisors should respond if they learn someone is struggling, or how to help an employee access available benefits to seek help with their substance use disorder. And while this toolkit has been out for a couple of years now, at Fors Marsh we conducted a national survey with both employees and organizational leaders. And what we’ve seen is that managers are often the first person someone goes to when navigating recovery. So we know that the willingness to support is there, but the bigger gap is in the training, clarity, benefits and policies. Recovery-friendly workplaces tend to succeed when systems are designed thoughtfully, not just when people have good intentions. The evidence is there, and it’s great that this toolkit has become a resource for federal agencies and other organizations that are interested in becoming recovery-friendly workplaces.

Terry Gerton It does sound like that toolkit would have lots of very useful information, but if there’s a manager out there who hasn’t heard about it, whether they’re a federal manager or anybody else, where should they look to find that toolkit?

Melissa Sosinski It is located with the Department of Labor. They have a page for it, you can download it. They have the tips in there, they’re very simple and also a long glossary of other information so managers can point them out to their HR teams or to their organizational leaders if they’re interested.

Terry Gerton That is a very helpful resource. And as we think more broadly about how this EO might get implemented as it moves forward and the on-the-ground examples that you’ve provided, what is the most important thing you think agencies should keep in mind if they want to create an environment that is supportive of recovery, that it feels fair and workable in people’s lives?

Melissa Sosinski I think starting somewhere is the best first step. What I’ve seen across conversations is that recovery works best when systems are designed around real lives, not just ideal pathways, and there are evidence-based ways that people can implement these policies in their organizations. The executive order is coordinating federal agencies around this point and creating an opportunity to turn principles into everyday practice, whether it’s in programs, in our workplaces, and how the government shows up for people.

Terry Gerton There is a long list of things that this executive order promises to do, including how to implement programs that integrate prevention, early intervention, treatment, recovery support, and reentry into all relevant public health, health care, criminal justice, workforce, education, housing and social service systems. What will you be looking for in the future that would demonstrate that this executive order is having some impact?

Melissa Sosinski Yeah, I mean, I think overdose mortality has been something we’ve had our eye on, the rates have been going down. But going back to that holistic view, we want to see people not just survive, but thrive. I’ve heard that over and over again, and to hear people on the ground who are recovering, thriving, many of those people give back and end up working in positions where they are supporting other people in recovery. Those are indicators. So again, it’s beyond whether people are not dying from overdoses, but where they go, whether they’re thriving with their families, with their communities, in their jobs. I think those will be indicators, soft indicators, albeit, but that’s what really gets us from just the treatment to the recovery.