BOSTON — The president of a leading addiction medicine group issued stark warnings on hardline Trump administration policies on substance use, low rates of addiction treatment uptake, and a rise in problem gambling.
But Stephen Taylor, the president of the American Society of Addiction Medicine, tempered his remarks with optimism. In particular, he expressed hope that his organization could find common ground with the Trump administration on access to addiction medications, and that GLP-1 medications could prove as effective for treating addiction as they have for diabetes and weight loss.
The remarks came on Thursday during the annual STAT Summit in Boston, where Taylor spoke on a range of issues roughly six months after becoming president of ASAM, a major advocacy group representing many addiction clinicians.
“We’re still focused on what we’ve always been focused on, which is making sure that we can maximize and increase access to care for people who have substance use disorder,” Taylor said. “We’re talking about 48.4 million Americans who meet criteria for substance use disorder, at least as of 2024. Close to 90% of those folks, about 88% of those folks, do not receive treatment. So we’ve got a lot of work to do.”
Taylor spoke amid a lapse in government funding that has largely shuttered the Substance Abuse and Mental Health Services Administration, the largest federal agency focused on addiction, and in the wake of major cuts to Medicaid, which pays for the lion’s share of addiction care nationwide.
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He took issue, also, with a claim made by health secretary Robert F. Kennedy Jr. during a Senate confirmation hearing: That 12-step recovery programs, as opposed to medications like methadone and buprenorphine, represent the “gold standard” for treating opioid addiction. Instead, Taylor cited remarks from Sen. Bill Cassidy (R-La.), a physician who chairs a Senate committee focused on health care, referring to the medications as the standard of care. Taylor argued that neither intervention should be entirely dismissed in favor of the other.
Taylor was also sharply critical of one Trump administration policy in particular: the employment of involuntary civil commitment, which effectively forces many people experiencing homelessness and addiction or mental health conditions into care institutions against their will.
Taylor said involuntary commitments can themselves cause harm, and struggled to parse Kennedy’s prior calls for employing “tough love” as a strategy for addressing America’s addiction, mental health, and homelessness crises.
“What does the evidence say? There is no evidence that tells us the potential benefits of involuntary civil commitments outweigh the risks and the adverse effects,” Taylor said. “We’re not in favor of involuntary civil commitment as a way to help people with substance use disorder who happen to be homeless.”
But he stressed many points of potential agreement with Kennedy. He cited remarks from Kennedy’s speech at the Rx Summit in Nashville last April, when the health secretary said that medications for opioid use disorder — like methadone and buprenorphine, as well as the overdose-reversal drug naloxone — were essential elements of the nation’s opioid crisis response.
Separately, Taylor delivered a foreboding message on the rise in problem gambling, especially amid the proliferation of online sports betting platforms that allow users to wager huge sums from their phones — no casino required.
“People don’t necessarily think about it as a health problem, but it is,” Taylor said. “Of all the different addictions, whether it’s heroin or cocaine or alcohol or other behavioral addictions, gambling is the one most closely associated with suicidality.”
Taylor ended the session on a notably positive note, pointing to the promise of GLP-1 medications, currently used as treatments for obesity and diabetes, to treat addiction. The optimism surrounding their use in addiction medicine is “not just hype at all,” he said.
“There is some really impressive-looking data — but it is preliminary data — that suggests it could be helpful for alcohol use disorder, and even tobacco use disorder and opioid use disorder,” Taylor said. “The data is impressive, it looks promising, but it is preliminary, and I like to remind people that we already have FDA-approved treatments for alcohol use disorder that really should be the thing we’re trying to increase access for.”
Correction: This story has been updated to reflect Taylor’s accurate citation of statistics regarding treatment rates among Americans with substance use disorders.
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