Changes Coming To Addiction Treatment Under The Trump Administration

What Is Happening To Addiction Treatment Under The Trump Administration?

In March 2025, the U.S. Department of Health and Human Services (HHS) announced a large restructuring of several programs that support health, research, and addiction treatment programs. The plan is to consolidate several programs, including the Substance Abuse and Mental Health Services Administration (SAMHSA), into a unified entity under the new Administration for a Healthy America (AHA).

Some people in the addiction treatment industry are raising concern about what the consolidation or elimination of SAMHSA could mean for individuals living with an addiction.

What Does SAMHSA Do?

SAMHSA was created in 1992 to spotlight the need for mental health and substance abuse services and broaden their availability.

SAMHSA states that its goal is to lead public health efforts and provide resources to promote mental health, prevent substance misuse, and provide treatments that foster recovery while ensuring better outcomes for all. Some of the tools they have offered for the past 32 years include:

• National Helpline: a free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals facing mental and substance use disorders.
• 988 Suicide & Crisis Lifeline: a free, confidential lifeline for people to call, text, or chat for help when going through a mental health crisis.
• Treatment Center Locator: a free, online treatment center locator so people seeking help can find a rehab that accepts their payment type and meets other essential criteria.
• Grants: funding for organizations providing addiction and mental health services, research, training, and technical assistance.

SAMHSA is further divided into 12 centers and offices that focus on specific areas, which include:

• The Center for Mental Health Services
• The Center for Substance Abuse Prevention
• The Center for Substance Abuse Treatment
• The Center for Behavioral Health Statistics and Quality
• The Office of Recovery

How Will Addiction Treatment Be Affected?

One of the changes that has occurred with the restructuring is the appointment of a new Principal Deputy Assistant Secretary, Dr. Arthur Kleinschmidt. Formerly a Senior Advisor at SAMHSA and Director of the White House Office of National Drug Control Policy, Kleinschmidt has a long professional and personal history in recovery.

He is expected to prioritize evidence-based approaches, reduce stigma, and improve access to mental health and substance use services.

Additional changes to SAMHSA and other organizations moving under the AHA include the significant reduction of approximately 20,000 positions eliminated through layoffs and early retirements. This move has concerned many mental health experts who have expressed worries about the impact this will have on mental health services for millions of Americans, specifically how it will affect their ability to respond to public health crises.

Addiction Center spoke to Paolo del Vecchio, the former Director of the Office of Recovery at SAMHSA, who shared that so far, about 50% of the SAMHSA staff have been eliminated.

Those [cuts] included the entire staff that managed the National Survey of Drug Use and Health, which is one of the most critical data collection surveys that the federal government does; one of the only few on mental health and addiction organizations in the United States. Losing that data will really set us back in terms of trying to track our progress as we face these crises.

Grants And Funding

On May 2, 2025, the Trump administration proposed cutting over $28.6 billion in spending in their discretionary budget for 2026. These proposed cuts include:

• $3.6 billion from the Centers for Disease Control and Prevention (CDC)
• $1.7 billion from the Health Resources and Services Administration (HRSA)
• $1 billion from the Substance Abuse and Mental Health Services Administration (SAMHSA)
• $129 million from the Agency for Healthcare Research and Quality

As the budget is still awaiting approval, there has been a standstill in funding for addiction treatment programs.

Since the inauguration, SAMHSA hasn’t issued a single grant announcement.

A lack of funding from the federal government puts more pressure on the states to support their local treatment services. Paolo del Vecchio shared that they have already seen many programs being forced to shut their doors. Addiction Center reached out to the county of San Diego on how they may be affected by the changes to SAMHSA:

SAMHSA provides critical guidance, technical assistance, and funding that support behavioral health systems nationwide. Any significant reductions or disruptions would represent a loss of essential resources for local service providers and our most vulnerable clients, and we are still assessing the impact to services locally.

Overdose Prevention Programs

Drug overdose prevention programs aim to save lives by providing education, resources, and medication to those living with a drug addiction. Some of these programs include:

• Naloxone distribution programs: these programs help distribute Naloxone, a drug that can reverse an opioid overdose, to communities.
• Fentanyl testing strip distribution: these programs provide access to testing strips, so people can test a drug to see if it contains fentanyl.
• Syringe services programs (SSPs): these programs provide sterile syringes and injection equipment, while simultaneously providing information on treatment, offering vaccinations, and testing.
• Medication-assisted treatment (MAT): these programs provide access to medications like methadone or buprenorphine for people with an opioid use disorder.

The 2026 discretionary budget from the Trump administration states that, “SAMHSA grants were used to fund dangerous activities billed as “harm reduction,” which included funding “safe smoking kits and supplies” and “syringes” for drug users,” to explain why funding for these programs should be cut. Syringe services programs (SSPs) have an associated 50% reduction in HIV and HCV infections and teach drug users how to recognize and respond to an overdose, as well as providing them with naloxone.

Data from the CDC shows that there were 87,000 drug overdose deaths from October 2023 to September 2024, down from around 114,000 the previous year. This is the lowest number of overdose deaths recorded in any 12-month period since June 2020. Those who oppose the budget cuts are concerned that defunding these overdose prevention programs may result in an increase in overdose deaths.

Who Will These Changes Most Affect?

Critics of the restructuring worry about the significant challenges this could cause for underserved and low-income Americans, particularly those living in rural areas. These areas already face barriers to mental health and substance abuse services, including a shortage of providers and transportation challenges.

They also see higher suicide and substance abuse rates and have fewer providers and resources to meet these needs. Many mental health professionals worry that SAMHSA’s move under the AHA will result in the loss of targeted resources for these rural populations.

Additionally, the elimination of programs aimed at helping underserved populations, such as the LGBTQ+ Youth Suicide & Crisis Lifeline, has also been criticized by mental health professionals. LGBTQ+ youth are disproportionately affected by mental health issues, and the service has received 1.3 million calls, texts, and chats since 2022. Many worry that the loss of this program could endanger countless lives.

The closure of the Centers for Medicare and Medicaid Services’ civil rights office has further fueled debates over the new administration’s commitment to protecting civil rights with healthcare. Medicaid is the largest payer of mental health and substance abuse services in the U.S., so a reduction in Medicaid funding could mean decreased access to mental health and substance abuse treatment for many.

What Are The Priorities of the AHA?

While many are skeptical of the new AHA, the administration has outlined its priorities, which include:

• A focus on chronic disease prevention
• Maternal and child health
• Mental health services

Proponents of the restructuring claim that consolidating agencies into a single entity will help streamline services and public health efforts, enhancing access to care.

In response to our inquiry, Emily Hilliard, Deputy Press Secretary for the U.S. Department of Health and Human Services, spoke in favor of the restructuring, saying, “The reorganization of SAMHSA into AHA is part of ongoing efforts to improve the efficiency and effectiveness of public health programs. By consolidating SAMHSA’s operations under AHA, we aim to streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively.”

They did not reply to further questions on how consolidating SAMHSA under the AHA will streamline resources.

Whether for or against these changes, the restructuring of SAMHSA under the new AHA marks a shift in U.S. public health policy, with significant implications for mental health and substance abuse services nationwide.