This week, the United States government committed to following the best practices in addiction treatments identified through decades of research at the National Institute on Drug Abuse (NIDA) and other federal agencies. April Fools!

American taxpayers have spent billions of dollars to analyze the causes and cures for addictive disorders. The number of federal government agencies involved in this research, analysis, and policy recommendations is astonishing:

• National Institute on Drug Abuse (NIDA)
• Department of Health and Human Services (HHS)
• Department of Housing and Urban Development (HUD)
• Department of Education 
• Department of Labor 
• Department of Justice
• The Veterans Administration (VA)
• Centers for Disease Control (CDC)
• Centers for Medicare and Medicaid Services (CMS) 
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Office of National Drug Control Policy

Those are just the top-level federal government agencies, each receiving millions of dollars every year for drug abuse research, prevention, and treatment. The totals add up to $6.6 billion just for HHS for fiscal year 2024/2025.

Then there are additional millions spent each year by non-governmental organizations (NGOs), nonprofit corporations, charitable organizations, and religious institutions on substance abuse research, prevention, and treatment. By far, the largest expenditures for addiction research, prevention, and treatment are the individual states.

Two billion of state spending is covered by block grants provided by SAMHSA and included in the federal spending. California spent $6.7 billion in 2024. New York spent $4.5 billion. Pennsylvania spent $3.6 billion. The folks at Rehabs.com have done a fascinating analysis of state spending on mental health, finding that:

• States that spend over $300 per capita: Alaska, Maine, D.C., and Vermont
• States that spend less than $50 per capita: Arkansas, Florida, and Louisiana
• States that spend more than $9,000 per client served: Alaska, Hawaii, California, and D.C.
• States that spend less than $2,000 per client served: Kentucky and Arkansas

They say everything is bigger in Alaska, where substance abuse certainly is. The state ranks #4 in the percentage of adults with a substance use disorder (Washington, D.C., is right behind at #5). Alaska spends over $10,000 per client per year, which is $317 per person. Perhaps that’s why this year, Alaska is using its opioid settlement funds to try something they know works: providing housing for people in addiction treatment.

Is the majority of government spending on drug abuse research, prevention, and treatment invested in recovery housing? Not a chance. The bulk of the billions the governments spend each year goes into something we know doesn’t work: school-based drug abuse education programs such as D.A.R.E.

Drug addiction research has not experienced a major breakthrough since buprenorphine was approved for opioid use disorder (OUD) in 2002. The biggest breakthrough in addiction comes not from addiction research but from diabetes research. Recent studies show the effectiveness of GLP-1 drugs in preventing and treating substance use disorders (SUDs).

It is only with great reluctance that the major drug companies have funded studies into the use of GLP-1 drugs against drug addiction. It will never be a major source of profit due to the fact that most people in addiction treatment are on Medicaid or Medicare. Exenatide has been around as long as buprenorphine; why hasn’t the government funded this research? It could save the federal government and the states enormous sums of money.

The single action that most impacted drug addiction in America was most likely the child tax credit in 2021, which lifted more than two million children out of poverty. Interventions at the beginning of life pay the greatest dividends in terms of resistance to substance abuse. Instruction in music, the arts, exercise, and stress management has also proven to bring more benefits in terms of resistance to teen substance use than the zillions of wacky educational programs inflicted on children with zero results on substance use rates.

More than half of the people receiving treatment for SUDs are victims of sexual abuse. How much of the drug use prevention budget is spent trying to reduce the incidence of sexual abuse? I have yet to come across a hint of attention to this issue in several years covering the addiction beat. My guess is that reducing the poverty rate would also reduce the rate of sexual abuse, something worth exploring in a future post.

For now, we know the best practices in drug abuse research, prevention, and treatment, and that’s not what we’re getting for our billions this April Fools Day. We’re getting avatars to help guide patients through the lack of care and police forces to arrest the homeless rather than provide housing during care.

Instead of frontloading our system by spending big on the poor and reaping the lifetime rewards, we are ensuring that misery and substance abuse linger for generations to come, which is exactly why we are paying such a high price to deal with it today.

Written by Steve O’Keefe. First published April 1, 2026.

Sources:

“Federal and State Funding Sources for Substance Use Disorder Treatment,” National Academy for State Health Policy, February 19, 2025.

“Map Shows States With Highest Drug Use Issues,” Newsweek, May 2, 2025.

“Mental Health Spending By State Across the US,” Rehabs.com, July 10, 2025.

“Directory of Federally Funded Prevention Programs,” National Archives, 2011.

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