Really Mr. Secretary, Drunk Farms?
A colleague working for a local government health department, not in recovery themselves, often laments that professionals in the field who are themselves in recovery are often blinded by the means through which they became clean and sober. Whether through twelve step therapy, cognitive behavioral therapy, medical assisted therapy, “the pledge” or any of the myriad approaches, their colleagues tend to be firmly rooted in that method to the extent of discounting other approaches. By this reckoning Secretary Robert Kennedy’s promotion of rural, back to the earth approaches is curious.
"I became a drug addict when I was 15 years old," Kennedy said during an interview with podcaster Lex Fridman. "I was addicted for 14 years. During that time, when you're an addict, you're living against conscience ... and you kind of push God to the peripheries of your life." Mr. Kennedy went on to credit his faith and 12 Step programs, which also have a spiritual foundation, and the influence of a book by philosopher Carl Jung for helping him beat his own opioid addiction.
In a report on NPR online (“RFK Jr. says he'll fix the overdose crisis. Critics say his plan is risky”, Brian Mann, January 2025) Brian Mann quotes the Secretary, "I'm going to bring a new industry to [rural] America, where addicts can help each other recover from their addictions," Kennedy promised. "We're going to build hundreds of healing farms where American kids can reconnect with America's soil."
In our colleague’s experience Mr. Kennedy, based on his personal recovery journey, would be promoting 12 Step programs and faith. This is a very common connection in Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Nar-Anon et al. The Third Step actually calls for “turning our will and our lives over the care of God as we understand Him”. It should be no surprise that people in recovery would have a belief in an approach that likely saved their jobs, health, marriage, finances and ultimately their lives. Yet, Mr. Kennedy seems to be promoting once popular “drunk farms” as a back to the earth solution. In fairness to the Secretary, we read nothing that suggests that he would not incorporate 12 Steps, self-help, and faith based pillars in these locales.
On the other hand, Secretary Kennedy’s anti-science is well reported. In articles too numerous to cite, the Associated Press and Forbes have detailed his anti-science and often conspiracy related claims. A short list would include:
· The CDC, HHS, FDA approve drugs without evidence
· Vaccines cause autism
· Pesticides cause gender dysphoria
· Lyme Disease is an engineered weapon
· Ivermectin is a cure for Covid
The list could go on.
To be certain, we believe that there are many paths to recovery. We also do not discount therapeutic communities entirely. Writing in “Psychology” Jonathan and Joseph Avery (“The Current Importance of Therapeutic Communities”, Jonathan Avery, MD, and Joseph Avery, JD, MA, April 3, 2021 ) note, “Outside the United States, the therapeutic community (TC) model is widely embraced, with currently 65 countries offering treatments and over 3,000 TC models incorporated into community settings across the world. Since its global expansion beginning in the 1980s, the “modern TC” has evolved to adapt to the unique needs and structures of the setting, such as prisons, women’s treatment centers, and shelters. In this sense, such institutions carry therapeutic principles and concepts, which are often complemented with other treatment modalities.”
Perhaps the most documented effort was The Addiction Research Center (ARC) operated in Lexington, KY from 1948 to 1976. According to the National Institute for Drug Abuse (“A Look at Treatment History: The Narcotic Farm”, Written by IRETA, September 2014) advances from that effort included advancing the use of methadone in treatment, explaining repeated relapses even after successful treatment, demonstrating that drug dependence is not limited to opiates, identifying multiple opioid receptors, recognizing the significance of opioid antagonists for opiate abuse treatment, and developing an opioid antagonist as a lifesaving antidote for heroin overdoses.
While recognizing these successes, fifty years of recent research and practice have identified several evidenced-based approaches to alcohol and other drug abuse and addiction. The Recovery Research Institute at Harvard University lists three general pathways to recovery.
The “Clinical Pathway” includes:
Pharmacology – Medication-Assisted Treatment
Acceptance and Commitment Therapy (ACT)
Community Reinforcement Approach (CRA/A-CRA)
Cognitive Behavioral Approaches (CBT)
Contingency Management (CM)
Relapse Prevention (RP/MBRP)
Motivational Interviewing and Motivational Enhancement Therapies (MI/MET)
Family Therapy
These pathways emerge from the biomedical community and include drug therapies that have been tested and tried since the discovery and deployment of methadone. They also include a heavy dose of psychiatric approaches often but not always based in cognitive behavioral therapy (CBT). These approaches have their critics. Drug substitution is a critique often levied especially where those drugs are not combined with counseling. Some of the family oriented therapies run afoul of the criticisms surrounding codependency as a diagnosis.
There are several “Non-clinical Pathways” listed includ9ng:
Recovery Residences
Recovery Community Centers
Peer-Based Recovery Support
Education-Based Recovery Services
Faith-Based Recovery Support
This pathway often deploys 12 step approaches and/or faith based initiatives. They are often managed by people in recovery through 12 Step communities, rely heavily on peer counseling and support, and often employ certified alcohol and drug counselors usually licensed by the local State.
Finally, the “Self-Managed Pathway” describes individually designed and managed approaches. The most famous among these is “The Pledge” where an individual dependent or addicted will “pledge” to never use again usually with a minister and in the “sight of God”. While these approaches are in disfavor today, there is little doubt that thousands of people since the American Temperance Movement began have stopped using based on The Pledge. It is widely rumored that a recent United States President was self-managed in recovery.
We would argue that there is value in therapeutic community. We would also argue that there are many paths to recovery. We would argue that Secretary Kenndy too often under appreciates that his seemingly unstructured development of ideas is hurtful. We would argue that an overemphasis on therapeutic communities at the expense of further development of evidence based treatment is hurtful. 480,000 Americans die from nicotine addiction, 178,000 from alcohol abuse, 105,000 from other drug overdose annually. We cannot afford to abandon further investment in evidenced based approaches.
