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 has spoken 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 sprang from the gate with a novel idea: healing farms for people with addiction. Yes, I know, the US has seen such farms before, but it’s been a while, right? So healing farms are a little like slouchy low-rise jeans, which were popular in the 1960s, 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 probably feel bold and innovative!

So 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 is healthier than hunting large animals with sharp horns and pointy teeth, especially if you’re the one wielding the spear. But farms whose intention is healing are an 18th-century invention, and those designed to heal addiction first appeared even later, in the Progressive era. Often sponsored by faith-based temperance organizations, they ran the gamut from near-prisons to idealistic utopian communities.

When healing farms came back into fashion in the mid-1930s, they tended to be the prison-y kind, such as the infamous Lexington Narcotic Farm, a jail-cum-hospital-cum-plantation, 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. Others, alas, were counter-productive, especially when they rewarded inmates’ compliance with heroin or cocaine. In the end, these recovery farms weren’t very successful, as most inmates returned to their drug of choice upon release. For those and other reasons,this generation of farms didn’t last long in their original form and tend to be pure prisons today.

The next vogue for healing farms coincided with the very first appearance of loose-legged low-slung 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. These latter institutions were Christian or psychoanalytic or utopian communities that welcomed people with a range of mental illnesses and social adjustment problems, including–but not particularly focused on–SUDs. They 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 today, examples being Jacob’s Ladder and Gentle Path.

As far as we can tell, Kennedy’s proposed healing farms will draw from all these earlier eras, from the mid-eighteenth century through the 1970s. They’re heavily AA-based, dedicated to spiritual renewal, and focused on communal living, considered healing in and of itself. They take as a given that physical labor can cure, especially agricultural labor, which is regarded as closer to nature than other forms of work. 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 profound disappointment for those of us who’d like to see AUDs treated more like health issues than like moral failings. In other words, while I appreciate that healing farms treat addiction as a multi-dimensional problem requiring multi-dimensional solutions, Kennedy’s proposal (like AA itself) minimizes the psychological dimension in defiance of recent research demonstrating that more than 50 percent of people with addiction also suffer from mental-health issues. And that 60-75 percent have a history of childhood trauma.

In sum, 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 pay for 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 or most of the people likely to 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. And given Kennedy’s own zeal for budget-cutting! But we’re supposed to get an update on May 22 in the secretary’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, my support could even turn to enthusiasm! In fact, I like the focus on education and training, especially if there’s a wide range of skills on offer, 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 I write these words, I remember that RFK Jr considers psychiatric medications, not treatments for addiction, but addictions themselves, 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 a form of purity, a body and mind purged of chemicals, whereas, for me, purity is impossible, and its pursuit can lead in dangerous and unhealthy directions. For me, sobriety doesn’t reinstate purity; it integrates the impure with the pure, the torn with the mended, the broken with the whole–and does so in a way that liberates because it draws from the unique history of each individual. For that reason, there are as many ways to achieve this integration as there are people struggling with addiction, rather than a single “right way” that punishes deviance with calamity and death. A great healing farm would help all of us 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 tenth combination doesn’t take, but continuing to work collaboratively and creatively until one finally 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 partly 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 worried minds long before their time. Then, rather than solving these problems or at least mitigating them a bit with decent health care and social support, we offer a drink that kills the pain, a drink we’re well aware creates dependency in vulnerable individuals, yet we shame those who develop 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 fail to maintain perfect abstinence. 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.

In truth, 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 long-sober 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 . . . no. When he speaks systemically about addiction, he utters 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? 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. Shades of Uncle Jack’s “Ask not . . .” line, right? Oh, and we also need to ban cell phones in schools and at the dinner table.

In other words, RFK Junior’s radical “systemic” thinking produced the goal of treating addiction by getting phones out of schools and family dinners while living by the principles of AA. As HHS has absolutely no control over schools or dinner-tables or the principles that guide people’s behavior, this is probably the cheapest program he could possibly have devised, so it’s in keeping with the Trump administration’s commitment to not helping anyone except the already-wealthy. But, to be fair, schools have already started to ban phones in classrooms, so, heck, maybe addiction rates will decline—more than they were already declining, that is,¹—and Kennedy will be able to claim credit!

Also alarming is the fact that, in restructuring his department, he is eliminating the Substance Abuse and Mental Health Services Administration (SAMHSA) and plans to 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!

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Update: It’s now Friday morning, and what did Kennedy have to say? Nothing. Nada. 沒有什麼。Could it be because his report, titled Make Our Children Healthy Again, focuses on the youngest among us? The ones who absolutely, positively do not have—and cannot possibly acquire—IDs to buy a handle of vodka at Costco or Bitcoin to pay an online dealer for fake oxy? Or older siblings and friends who will buy for them? Or parents and grandparents with well-stocked liquor and medicine cabinets? I suppose that’s possible, but the stated reason is because the report wants to address the causes, not the symptoms, of childhood ill health.

Alcohol use among children, presumably, is a symptom. As for the causes, they include Kennedy’s favorite boogeymen: ultraprocessed foods, screen addiction, and, yes, vaccines. Leaving aside the question of whether it’s really so easy to distinguish causes from symptoms, let’s look at some simple facts to see if it makes any sense not to consider drugs and alcohol in a major report on children’s health.

Let’s start with alcohol, and let’s start with infants, whose biggest health challenge is being born with health challenges. What, you may wonder, is the leading cause of mental retardation and other developmental disabilities in American babies? Is it moms getting vaccinated while they’re pregnant? Nope. Moms getting COVID while pregnant, that’s not great for developing fetuses, but vaccines appear to be completely fine. In fact, some studies show lower overall rates of birth defects among vaccinated moms!

No, the leading cause of these tragic birth defects is maternal drinking, especially binge drinking during critical stages of brain development. And we are not talking tiny numbers here. Though exact counts are hard to come by, the most reliable find that, in every thousand births, full-on Fetal Alcohol Syndrome (FAS), with its cruel slate of lifetime disabilities, affects between 0.3 and 1.0 newborns. But FAS is only the most severe and obvious disorder caused by alcohol; there are many more that may take weeks or months or even years to become evident because, let’s face it, most babies are clumsy and not very articulate in their early months (unless they’re TikTok babies), so it can be hard to tell right away if something is wrong with them.

Anyway, when researchers assess children a little later in life, they find that from one in a hundred to five in a hundred suffer from Fetal Alcohol Spectrum Disorder (FASD). That top number represents one in twenty Americans! Though FASD sufferers may not require the lifetime care that FAS demands, many nonetheless face lifetime challenges: intellectual, social, physical, and psychological. And they’re more likely than their neurotypical peers to develop substance use disorders themselves, passing their disability to another generation, which would seem good reason to develop interventions targeted at those among them likely to get pregnant.

And that’s just one way that alcohol affects children’s health. How many of the moms who drank while pregnant gave up booze when they saw the effects of their consumption on their children? How many hard-drinking moms and dads cut down or quit so as to become better parents, and how many instead found parenthood so challenging that they drank more? How many new caregivers joined the family unit with a drinking problem already well-established? Before Kennedy gave it the axe, SAMHSA estimated that one in ten American children have at least one parent with an AUD. The American Academy of Child and Adolescent Psychiatry makes that one in five children who have lived with an “alcoholic relative.”

I could go on for another 10,000 words, but you get the point: Kennedy, who, of all people, should know better, is letting his personal obsessions dictate the policies and priorities of a health system he is ill-equipped to run. I did give him a respectful hearing (see my article defending former surgeon general Jerome Adams, if you don’t believe I can be fair to a Trump appointee), but I honestly think his policies will set addiction research and treatment back decades, sending it right back to the 1980s, when Kennedy himself was lucky to find a good fit between AA and his own personality. As for those less likely to find that fit? And the researchers genuinely pursuing knowledge that will help them? At the moment, I don’t see an up-side to Kennedy’s tenure, but, heck, maybe there’s a way in which canceling all research that mentions the word “woman” will turn out to be a good thing!

Yes, he actually did that, and I’ll write about it soon if I can manage to stop screaming long enough….

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1. Statistics on addiction rates are hard to come by, especially with the Trump government slashing budgets on the government agencies that track them, but the 24 percent drop in overdose deaths in the year leading up to September 2024 suggests a likely reduction. ↩︎

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