President Donald Trump’s Jan. 29 executive order, “Addressing Addiction through the Great American Recovery Initiative,” aimed to reshape the nation’s response to addiction by emphasizing evidence-based treatment, long-term recovery and coordination across sectors — priorities that align with existing best practices.
However, its ultimate impact will hinge on execution, funding stability and broader healthcare coverage trends, Groups Recover Together CEO Cooper Zelnick told Becker’s.
“This executive order from January seeks to address addiction as a chronic, treatable disease, and as I see it, focuses on investing in treatments that are evidence based, that are community based, and that address the root of this problem,” he said.
The order establishes a federal initiative to coordinate addiction treatment, prevention and recovery efforts across agencies, while expanding access to evidence-based care and reducing stigma. It also frames addiction as a national economic and public health priority, emphasizing long-term recovery support, cross-sector collaboration and improved alignment of federal funding and programs.
Mr. Zelnick said the policy’s overall design reflects a strong foundation but leaves open questions about implementation. “These pillars — the structure of the executive order — is evidence based and awesome, and it’s all about the follow-through.”
He pointed to several areas within the order that align with current treatment priorities, including expanding access to medication-assisted treatment and addressing stigma and long-term recovery. At the same time, he noted signals of unease around harm reduction in the broader policy environment.
“There seems to me to be a little bit of skepticism toward harm-reduction approaches. I think harm reduction is really important, and as a philosophy, we need to keep investing in it,” Mr. Zelnick said.
The timelines for measurable impact remain unclear and will depend on how the order is carried out. One persistent tension, he added, is how the U.S. allocated resources between enforcement and treatment.
“I do think that there is tension in where we as a country direct our resources, and my vote would be that if we direct our resources toward treatment and prevention that’s probably a better return on investment than enforcement,” Mr. Zelnick said. “However, I think enforcement has a role to play.”
He also highlighted external factors that could influence outcomes, particularly shifts in insurance coverage. “You think about some of the broader trends like the expiry of the ACA subsidies at the end of 2025, the One Big Beautiful Bill [Act] and its impact upon Medicaid funding and Medicaid enrollment,” Mr. Zelnick said.
He expects coverage declines to shape access to care in the coming years. “Broadly, the trend we’re seeing in 2026 is a far greater number of Americans who will be uninsured than there were in 2025. In 2027 I think that number will continue to increase. There will be even more uninsured Americans,” he said.
Those shifts could affect patient outcomes and system costs. “My concern is, regardless of one’s politics, reducing rates of insurance coverage will increase both fatal overdose and high-cost, low-value emergency spending. We do care for the uninsured in this country. We just do it in a highly inefficient way,” he said.
He added that these broader structural trends may complicate otherwise well-designed policy efforts. “The investment in addiction treatment and in approaches to addressing this epidemic is very well conceived and much needed. Doing that against the backdrop of a health insurance or healthcare landscape where far fewer individuals will have coverage is potentially going to blunt the impact that the administration is hoping to have.”
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