Rhetoric vs. Reality: Trump’s New Plan for Addiction and Homelessness.

The Trump administration's new "Treatment First" toolkit outlines their plan for responding to Americans who are struggling with drug addiction and homelessness.

It gets one big thing right: our systems are fragmented, and treatment is too hard to access. We support efforts to increase access to treatment, detox, and recovery services along with making medications for opioid use disorder more widely available-we've championed these approaches for years.

The problem is that the administration takes a good idea-more treatment-and uses it to justify a bad one: making treatment, abstinence, employment, and "self-sufficiency" conditions of getting and keeping housing. Instead of making stable housing the foundation for recovery, it makes recovery a prerequisite for housing.

You shouldn't have to recover from addiction before you deserve a home.

While a "Treatment First" approach may sound good on paper, the details matter. When looking at rhetoric versus reality, we have major concerns.

There is no new funding, and staggering cuts have been made to federal funding that supports treatment and healthcare. Their new plan comes with no new funding. They claim the cost will be covered by existing federal funding, including Medicaid. But they cut nearly $1 trillion from Medicaid-the biggest source of addiction treatment funding in the U.S. And they want to cut even more next year.

Requiring recovery for housing shuts people off from care and denies a fundamental human right to housing. They want to make people prove they're sober, employed, or treatment-compliant before they get housing. Although relapse is a normal part of the recovery process, they want to take away housing if someone slips up or struggles. Requiring strict rules like these often sets people back and cuts off help for those who need it. This is completely counterproductive if the goal is to encourage healing and long-term recovery.

Electronic surveillance of people in treatment puts their chance of real recovery at risk and raises broader privacy concerns. It is alarming that they want to monitor people's daily activities via electronic ID card to ensure they are participating in residential treatment programs. Expanding surveillance of people getting care undermines the trust and therapeutic relationships that are necessary for successful and lasting recovery and stability.

Expanding use of coercive treatment while backlogs exist means more people will sit waiting in jail. Massive waitlists already exist for those who are voluntarily seeking treatment. At the same time, there is a backlog of civil commitment cases that can leave people waiting in jail. This plan doesn't make voluntary treatment more accessible or affordable, nor does it shorten the backlog-people will still struggle to get treatment and care.

This toolkit is not supportive of Housing First programs, which prioritize affordable housing to people without preconditions like sobriety, treatment adherence, or income. If Housing First programs aren't providing enough treatment, add treatment. Don't take away the housing. The Department of Housing and Urban Development (HUD) helped put the toolkit together and has made it clear in years past that Housing First is not "housing only." A host of HUD's own research found that providing permanent housing without sobriety or treatment prerequisites produced better housing stability than strict abstinence-only, perfect adherence to treatment settings.

What a real plan for addiction and homelessness looks like:

• Restore federal funding for critical addiction and treatment services, including Medicaid.
• Remove barriers to treatment by making it attractive, affordable, and available to anyone that wants it. It means recognizing treatment is not one-size-fits-all and requires a full range of options that meet people's needs.
• Make healthcare affordable.
• Provide affordable housing without the condition of abstinence or perfect treatment-compliance.
• Implement community crisis response teams that can stabilize and engage people living on the street and help make connections to available care.

Homelessness and addiction can overlap, and when they do, we should address both. But treating addiction alone cannot solve the housing crisis. It cannot create affordable housing, lower rising rents, raise stagnant wages, or strengthen an inadequate social safety net. Punishing someone for struggling with addiction by taking away their housing can make stability harder to achieve and increase overdose risk.

Housing and treatment aren't competitors. We need both housing that people can afford and treatment that people can access.