First, there was MAGA. Then MAHA. Should we now be getting ready for MASA? Will our new Health and Human Services (HHS) Chair, Robert F. Kennedy, Junior, dedicate himself to Making America Sober Again?

It would make sense, right? After all, his own story of addiction and recovery is one of the foundations of his personal brand. And, in his current role, he continues to talk quite a lot about addiction, calling it a national security threat and vowing to spend $4 billion combating it.

But do these facts promise more and better help for people struggling with alcohol use disorders? Let’s look at the evidence.

As HHS Chair, he bounded out of the gate with a novel idea: healing farms for people with addiction. Yes, I know, the US has seen such farms before, but it has been a while, right? So healing farms are a little like slouchy low-rise jeans, which were popular in the 1960’s, then in the late 1990s and early 2000’s, and now they’re back for a third go-round with the resurgence of “indie sleaze.” If you remember one or both of the earlier low-rise eras, then the jeans probably don’t seem new to you. If you’re, say, under 30, they may feel quite bold and innovative!

Here’s a thumbnail history of healing farms.

Farms that improved people’s health have been around since the Neolithic Revolution because, let’s face it, growing barley tends to be a lot healthier than hunting large, bad-humored animals with sharp horns and teeth, especially if you’re the one wielding the spear. But farms whose intention is healing, especially healing addiction, were pioneered in the Progressive era, often by faith-based temperance organizations, and they ran the gamut from near-prisons to idealistic utopian communities.

When healing farms came back into fashion in the mid-1930s, they were the prison-y kind, such as the infamous Lexington Narcotic Farm, a jail-cum-hospital-cum-farm, where people with addictions did agricultural labor, attended AA meetings, and served as subjects for experiments, some of which (e.g. those that helped develop methadone) actually turned out useful results. But they didn’t last long in their original form and tend to be pure prisons today.

The next vogue for healing farms coincided with the first appearance of hipster jeans and took a variety of approaches, from the cultish, confrontational approach of Synanon and its imitators to the peer-directed focus of Phoenix House to counter-cultural communities, such as The Farm, which welcomed people with SUDs among other civilizational discontents to small, short-lived Christian or psychoanalytic or utopian institutions. Those tended to fail for various reasons, from scandal over ill treatment of residents to lack of funding, but a few survived, evolved, and continue to thrive, examples being Jacob’s Ladder and Gentle Path.

As far as we can tell, Kennedy’s proposed healing farms would have been right at home in all these earlier eras, from the mid-nineteenth century through the 1970s. They’re heavily AA-based, focused on communal living, and dedicated to spiritual renewal. They find therapeutic value in work and education, as well as immersion in nature. I don’t see any evidence that residents will be locked down or experimented upon, but I also don’t see any evidence that they’ll be treated like patients with medical or psychiatric problems. So that’s a disappointment for those of us who’d like to see AUDs treated more like health issues than like moral failings. And for those of us profoundly weary of watching addiction science held back, not just by people who secretly believe that punishment is the proper treatment for substance use disorders, but by fundamentally well-meaning people who got sober through AA themselves and are therefore convinced that everyone with the same problems can do as they did.

So, if there’s one thing you remember from this article, let it be this: RFK’s healing farms, as described so far, are the opposite of new or inspiring or fresh or bold or evidence-based or in any way reflective of the (admittedly slender) progress made in addiction science over the past forty years. From everything I have seen or read, they appear to be the same old same old, and their chief value will be to people who would have done fine in the rehab that already exists, assuming they could afford it. Maybe a little bit better because of a longer stay and more attention to life beyond rehab.

Will RFK do something revolutionary to make healing farms available to all who would benefit? I don’t see how, given that his boss plans to reduce spending on, well, everything but the military, military parades, tax cuts, and snazzing up his new Qatari plane, but we’re supposed to get an update on May 22 in Kennedy’s MAHA report, so I’ll fill you in afterward.

One last word about the farms: because there is a population that responds well to AA methods, I would support a pilot program. And, if such a program had an appropriately large budget and a genuinely experimental outlook, I could actually become a fan! In fact, I like the training requirement, especially if there’s a wide range of skills and crafts practiced, and I like the required spiritual or philosophical component, as long as it’s not overtly or covertly dogmatic but instead responsive to the beliefs and interests of the person with the SUD. And, most importantly, as long as it doesn’t serve as a substitute for any necessary health or mental health treatment.

But, as soon as I write these words, I remember that Kennedy considers psychiatric medications “addictions,” and I realize that he and I will never see the same thing when we try to imagine what a healing farm could be. For him, I think, sobriety is some kind of purity, a body and mind free of chemicals, whereas, for me, purity is impossible and not worth chasing anyway, For me, sobriety is a reconciliation of impure and pure, torn and mended, broken and whole, and there are as many different paths to it as there are people. A great healing farm would help all of us still struggling with AUDs find the combination of medication, mental health treatment, physical health enhancement, vocational or avocational training, and lifestyle-reinvention that works for us, not blaming us if the first or the second or the sixth combination doesn’t take, but continuing to work collaboratively until one does.

So, aside from healing farms, what else does RFK Jr say about addiction—or about health generally—that could indicate his administration’s approach to alcohol problems?

First, he thinks that the problem of addiction, hence the solution, is largely systemic, and that view I endorse, as any reader of this blog already knows. We’ve created a hyper-individualistic, winner-take-all culture that is profoundly isolating, that breaks down hard-working bodies and anxious minds long before their time. Then, rather than solving these problems or at least mitigating them a bit with decent health care and restorative recreation for all, we offer a drink that kills the pain, a drink we’re well aware creates dependency in vulnerable individuals, yet we shame anyone who develops the dependency, make them wholly responsible for staying sober and blame them if, after seeing hundreds of bottles every day in restaurants, bars, supermarkets, drug stores, gas stations, furniture stores, movie theatres, sports arenas, airports, and the like, they finally reach for one. We shame them for taking the drink that beckons from every corner of their built environment, from the airwaves, and from inside their own skulls, which hold thousands of hours of pro-alcohol propaganda blasted their way since they were young children cracking Daddy up by imitating the “Whassup” Budweiser ad.

And we could do something about that culture to make it less toxic, less prone to produce alcohol dependency in its citizens. There are lots of things, in fact, from laws that prevent the exploitation of large populations to restrictions on the advertising and sale of alcohol. I’ve made a whole bunch of suggestions at the end of this post, if you’re interested. And who better to do all these things than a head of HHS who has the ear of a militantly non-drinking president?

So, does Kennedy’s belief that addiction is systemic lead him toward any systemic solutions, not just mine but the many proposed by others?

Mmm . . . not really. When he speaks systemically about addiction, he tends to issue vague platitudes such as “We need to focus on reestablishing historic ties to the community,” as he does in this recent speech. What does he mean by that? It’s a little hard to tell at first because he explains himself by telling the story of the first AA meeting, an ad hoc conversation between founders Bill Wilson and Dr. Bob, but what he means is that we can prevent—and treat—addiction by giving sufferers opportunities to be of service to their communities. And by banning cell phones in schools and at the dinner table.

In other words, treat addiction by putting phones away and living by the principles of AA. Sorry, folks, we keep ending up back in the same place! There’s nothing new—or systemic—here, though, of course, there are people who can and will get sober this way. But, if Kennedy has any revolutionary impulses, he’s saving them for other issues because, when it comes to addiction, HHS is taking a giant step (or twelve) backwards.

Also alarming is the fact that, in restructuring his department, he plans to eliminate the Substance Abuse and Mental Health Services Administration (SAMHSA) and absorb its functions into his new Administration for a Healthy America (AHA). He has already given SAMHSA a “hatchetation” worthy of Carrie Nation, firing people and cutting budgets without any seeming plan, even when pressed by Congress, until lawmakers and observers began expressing public doubt about the future of addiction services in the US. In addition, even if AHA does manage to pick up some of these services, I can’t help being concerned about the de-emphasis on addiction as a discrete problem with multiple dimensions. Moreover, as alcohol use disorders already take a back seat to opioid overdoses despite having a much higher death toll and despite leaving a worse legacy of harm in former users, and despite being on the rise, while opioid deaths are falling, I worry that AUDs will all but vanish as a concern right at the point when science has finally begun to raise awareness of alcohol’s dangers.

But let’s wait and see what Kennedy has to say on Thursday. Maybe my fears are unfounded, and he’ll propose something truly visionary—there’s no way to know until he tells us!