04/26/2026
Robert F. Kennedy Jr. has spoken publicly about 12 step programs and abstinence based recovery saving his life. That was my experience also.
But here’s where the conversation has to get more honest and more complete. 12 step programs and abstinence based recovery have existed for more than a century, long before fentanyl, long before the current overdose crisis we are living through. And despite that long history, and despite millions of people participating in those pathways, overdose deaths in the United States have continued to rise, not fall.
That doesn’t mean abstinence based recovery is “wrong.” It means it is not the only path that works, and it has never been enough on its own to address the scale and complexity of substance use in a modern drug supply shaped by fentanyl, contamination, and unpredictable potency.
What actually has been shown to reduce overdose deaths in real time is harm reduction.
Things like naloxone (Narcan) distribution, fentanyl test strips, syringe services programs, overdose prevention education, and medication assisted treatment (MAT) have all been linked to reduced mortality, reduced disease transmission, and increased engagement in recovery over time.
And now there are growing concerns in the public health and recovery space about policy direction shifting away from these tools toward tighter restrictions, forced tapering discussions around MAT, and potential reductions in harm reduction funding and infrastructure.
That’s where organizations like the American Society of Addiction Medicine (ASAM) have been clear: addiction is a chronic medical condition, and treatment should be individualized, evidence based, and not forced into a single pathway. MAT is not a “crutch” it is a gold standard treatment backed by decades of research.
So the real question isn’t “abstinence vs harm reduction.”
It’s why are we trying to erase one of the only approaches that has actually reduced deaths in the middle of a poisoned drug supply crisis?
People deserve multiple pathways to recovery:
* abstinence based recovery
* medication assisted treatment
* harm reduction strategies that keep people alive long enough to choose recovery.
Because no one can recover from something they didn’t survive.
And at a time when overdose deaths are still devastating families across this country, the priority should not be narrowing options it should be expanding what works, not eliminating it.
