On January 29 President Donald Trump issued an executive order launching “The Great American Recovery Initiative,” a White House campaign that doubles down on the brain disease model of addiction. Though for the moment it seems to be a redundant effort that does not meaningfully build on the administration’s existing response to substance use disorder (SUD), it puts a heavy emphasis on medicalization at a time when jurisdictions around the country are finding new pretexts to expand civil commitment of people who use drugs.
The initiative will be co-chaired by Health and Human Services Secretary Robert F. Kennedy Jr. and newly appointed Senior Advisor for Addiction Recovery Kathryn Burgum, who is married to Secretary of the Interior Doug Burgum. There will also be an as-yet-unnamed executive director, as well as representatives from more than a dozen federal agencies.
“This initiative represents a fundamental shift from reaction to prevention, from fragmentation to coordination, from stigma to science, from short-term fixes to long-term recovery,” Burgum, who like Kennedy is public about being in long-term recovery from alcohol use disorder, stated at the Oval Office signing ceremony. “And for the first time we’re aligning federal leadership across health, justice, labor, housing, veterans, social services, the faith office and education.”
This is already the job of Sara Carter Bailey, the newly appointed director of the Office for National Drug Control Policy, who was standing a few feet away. So is most of the initiative’s agenda—coordinating the government’s response across different federal agencies, overseeing efforts to increase awareness, providing data-driven updates, etc. Everything else, even Burgum’s signoff—“Recovery is not the exception, it is the expectation”—is reminiscent of work already underway at the Substance Abuse and Mental Health Services Administration. (Christopher D. Carroll, who by process of elimination is the official currently leading SAMHSA, did not appear to be in attendance.)
Though the ONDCP’s budget is currently on the chopping block and the already-gutted SAMHSA continues to exist in a state of turmoil, the new initiative doesn’t appear to be replacing or supplementing those efforts so much as borrowing their talking points.
The signing ceremony was light on detail, though Kennedy did state that further major announcements about the initiative would follow the next week. Trump read an obligatory series of statistics about drug enforcement and overdose, almost all of which were wrong. The only ones that were technically accurate were that the government has seized over 47 million fentanyl pills and 10,000 lbs of fentanyl powder, which does match Drug Enforcement Administration seizure totals from 2025. He then claimed that “that’s a record,” which is not true for either figure.
Toward the end of the ceremony he informed those in attendance that he’d appointed Doug Burgum to his cabinet because of Kathryn’s physical appearance, so perhaps the initiative’s existence as a vehicle for getting her appointed as a White House advisor should also be considered.
“Addiction is … not simply a behavioral issue,” Burgum states. “Addiction is a lifelong, chronic, relapsing medical disease.”
“Addiction is not a moral failure. It is not a character flaw. And it’s not simply a behavioral issue,” Burgum continued. “Addiction is a lifelong, chronic, relapsing medical disease—as real as diabetes, cancer and heart disease.”
The brain disease model of addiction is popular among policymakers claiming to take a compassionate, evidence-based and non-carceral approach to drug use. In reality, rhetoric like Burgum’s is largely used to scapegoat drugs and alcohol as uniquely, insidiously addictive—people develop compulsive behaviors around all kinds of non-chemical things, from gambling to sex to video games—and to downplay the socioeconomic factors that are more relevant to understanding SUD.
The executive order does not have an overt law-enforcement bent; its veiled references to the private sector and faith-based organizations point more toward the rehab industry. Though the new initiative may not amount to anything more than messaging for messaging’s sake, the medicalization of SUD—or, more accurately, of public drug use—would support the administration’s escalating agenda around involuntary treatment.
“Addiction is a chronic, treatable disease with relapse rates similar to other chronic diseases,” the order states. “Unfortunately, very few Americans who need treatment ever receive it or believe they need it.”
Image via the White House