California has committed billions of dollars to building new behavioral health treatment capacity, but some substance use disorder projects are stalling at city council meetings before they can open.
Robb Layne, executive director of the California Association of Alcohol and Drug Program Executives, told Becker’s that local opposition has become one of the biggest barriers to expanding access in the state.
“We can spend the dollars to stand these facilities up. We can give the grant programs to be able to open up these facilities, but if communities block them in a discriminatory way, it doesn’t make a difference how much money is available,” Mr. Layne said. “It doesn’t make a difference on how many people need that treatment if the doors of these treatment facilities won’t be able to open because the community will stand in the way and say no, not in my backyard.”
Much of the new capacity is funded through the state’s Behavioral Health Continuum Infrastructure Program, which awards competitive grants to build, buy and expand treatment sites. The state had awarded $1.7 billion through the program before voters approved Proposition 1 in March 2024. The bond measure’s first funding round added $3.3 billion in awards in May 2025.
Applicants must provide substance use disorder services, commit to becoming Medi-Cal providers and expand services enough to make an impact in underserved communities, Mr. Layne said.
One of the most visible setbacks came in San Pedro, where the state rescinded a conditional $73.4 million award to Fred Brown Recovery Services for its proposed Serenity Recovery Campus. The project, which drew heavy local opposition, was planned as a 106-bed inpatient center that would also serve about 200 outpatients a day, according to a July 17 report from the Los Angeles Times.
Mr. Layne said the award was pulled because of local opposition and political pressure. The California Department of Health Care Services gave a different reason in a July 15 letter: The provider did not meet a cash match requirement or resolve discrepancies in an appraisal document, the Times reported.
“If a facility doesn’t open, it doesn’t stop people from needing treatment, and I don’t think community members really understand that,” Mr. Layne said.
Stigma
Many of the projects need city approval for permitting or zoning, Mr. Layne said. When they land on a council agenda, residents turn out to object, and some cities side with them based on public comment.
Mr. Layne compared substance use disorder treatment centers to dialysis clinics. Both serve patients who visit three to four times a week for hours at a time, use parking and add traffic. Only one draws organized opposition.
“Nobody stands up in a city council and says, ‘I will not have a dialysis treatment facility in my community because it brings home prices down,'” he said. “We don’t think that people who need kidney dialysis have a fault in it.”
He made a similar point about Type 2 diabetes, noting that clinicians don’t take insulin away from patients who struggle to manage the disease or tell them to hit rock bottom first. Substance use disorder is likewise a diagnosable medical condition, with established clinical criteria and medications that treat it, he said.
When care isn’t available locally, patients are often forced to leave the communities that support their recovery, Mr. Layne said. Those who can’t get treatment tend to cycle through emergency departments.
“The most expensive thing in the world is to have somebody show up in an emergency department because of an accidental overdose and treat them in that space,” he said. “It makes much more sense to offer them community-based treatment.”
Federal policy will raise the stakes. Mr. Layne pointed to H.R. 1, the budget reconciliation law signed in July 2025 that includes major Medicaid changes.
“[H.R. 1] is going to create pressures around care that I don’t think anybody really understands right now in California,” he said.
A legal strategy
The association has worked with attorneys who argue that blocking treatment facilities for discriminatory reasons violates four sets of laws:
- Americans with Disabilities Act: People with substance use disorders are considered people with disabilities, and Title II bars local governments from using zoning, permitting or licensing to block treatment facilities with discriminatory intent.
- Fair Housing Act: The law provides independent civil rights protections for sober living facilities and recovery residences.
- Section 504 of the Rehabilitation Act: The law bars recipients of federal funds from discriminating against people with disabilities. Mr. Layne said it applies to California providers funded through the Drug Medi-Cal Organized Delivery System.
- California state law: State statutes add further protections, he said.
The association sent a letter to city attorneys across California in recent months warning that such opposition is illegal, and it is educating member providers on their rights, Mr. Layne said.
“We need local elected officials to say, ‘We hear what you have to say. Unfortunately, there’s four laws … that prevent us from blocking these types of things,'” he said.
Some counties are getting it right, he said. Riverside County has supported its providers, and ABC Recovery Center in Indio completed a $27 million state-funded expansion next to its existing campus in June. The project added 120 treatment beds, and about 90% of the center’s patients rely on Medi-Cal. The center offers inpatient, outpatient, detoxification and youth programs, as well as medication for addiction treatment, Mr. Layne said.
A national issue
Mr. Layne, who also sits on the board of Treatment Communities of America, said providers in other states report the same resistance. He acknowledged that his view is based on those conversations rather than data.
“Stigma is alive and well in every single one of our 50 states,” he said.
In California, access varies widely across 58 counties, each with its own behavioral health system, and hundreds of cities, Mr. Layne said.
“The biggest determining factor that you have around access to healthcare is your ZIP code,” he said. “Every community can say, ‘Of course we want treatment,’ but if you want treatment, then open up facilities, recruit facilities, [and] make them feel welcome.”
He urged communities to reframe the debate around one principle.
“The punishment for drug use should not be death,” Mr. Layne said. “If we reframe the conversation around that specific topic, I hope we can agree that community treatment is where we need to put in our investment.”
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