By Jason Snyder, Director, SUD Treatment Services, BH Division and
Chris McKenzie, Community Relations Coordinator, Pinnacle Treatment Centers
November 10, 2025

Editor’s note: I asked my good friend Chris McKenzie, Community Relations Coordinator at Pinnacle Treatment Centers, to collaborate with me on a blog about what we both see as a gap between what research tells us about medications to treat opioid use disorder and the prevailing attitudes toward it in the treatment and recovery communities. Last month, we shared our firsthand experiences as Part I of a two-part blog. Here in Part II, we discuss our suggestions for greater genuine acceptance of multiple pathways to recovery.

So how do we move closer to true acceptance of multiple pathways to recovery, including the use of medications to treat opioid use disorder (MOUD)?

Promoting multiple pathways to recovery by providing rote education and training on medication is not enough.

Our experiences highlight the urgent need to provide living proof that reality does in fact reflect the research.

We can argue that the stigma held against those who recover with medication is the same stigma that stops them from coming forward, but, for the most part, it’s hard for us to buy that. In a past professional experience, one of us (Jason) undertook an effort to identify clients being treated with methadone who were willing to tell their stories publicly and had no problem finding them. Not coincidentally, every one of them essentially said the same thing: abstinence-based residential treatment did not work for them, and methadone saved their lives.

In 2019, the City of Philadelphia launched a media campaign urging people battling opioid addiction to seek medication-assisted treatment. The campaign featured several people whose recovery pathway included medication. Sadly, six years later, we’re still having the same conversation. Perhaps it’s time to revisit a similar campaign.

Our experiences also highlight the urgent need to do more to align research with actual practice.

Relative to the services they provide, programs — from recovery community organizations to treatment providers to recovery houses — must begin to explicitly recognize and genuinely honor all evidence-based and lived-experience pathways. Recognition will help people feel validated in whatever pathway fits them the best and positions community organizations as inclusive, increasing access and retention, two critical components to long-term recovery.

Though many organizations will say they do this, the rhetoric often doesn’t match reality. Within the last two months, one of us (Jason) heard a nursing director of a large residential treatment facility repeatedly call the organization’s attempt to retain patients in treatment through liberal medication policies “gross.” That is the front line of medical services, and it’s impossible to believe that perspective does not permeate much of that facility and organization.

Clearly, then, in many instances, culture needs to change, from the grass tops to the grassroots.

Developing an ambassador program is one strategy to begin to change culture. Components of such a strategy include: identifying and training employee MOUD ambassadors to help educate peers and walk the walk, so to speak, of recognition and validation of multiple pathways we suggest; enabling the ambassadors to serve as linkage between peers on the front line of treatment and senior leadership to elevate concerns and questions and, conversely, bring back solutions; and supporting them in delivering the message that MOUD works.

Advocacy is also essential. Advocating for recovery houses to meet licensing standards, for example, which include accepting all forms of MOUD, will expand housing options and reduce discrimination while ensuring that people have access to stable and supportive environments. Similarly, advocating for treatment providers to genuinely meet contractual obligations to accept anyone using any Food and Drug Administration-approved MOUD will remove artificial barriers to appropriate levels of care.

Finally, and most importantly, is the involvement of people with lived experience in policy and practice design. Establishing advisory boards with a diverse set of voices will give the people who are affected by recovery-related policies real power to shape the services that they are using and reduce feelings of marginalization because programs reflect their needs. For organizations, this means increased trust and community buy-in that will help avoid costly mistakes in program design.

Ultimately, bridging the gap between research and reality is about respect for other people’s experiences and goals. When organizations embrace this broader view of recovery, communities thrive, and people are given every opportunity to succeed.

What are your thoughts on moving closer to true acceptance of multiple pathways to recovery, including the use of medications? If you have any ideas about this or thoughts on the subject or the blog in general, let us know.

Email Jason or Chris with your thoughts, or start a conversation on LinkedIn

By Jason Snyder, Director, SUD Treatment Services, BH Division
June 2, 2025

In the latest legislative run at involuntary substance use disorder (SUD) treatment, two Pennsylvania senators co-sponsoring SB 716 are looking to amend Pennsylvania’s Mental Health Procedures Act to include SUD and alcohol use disorder (AUD) by themselves as mental illnesses. Doing so would, under the law, subject those with the disorders to involuntary commitment in the same way mental health is today; that is, individuals with an SUD can then be forced into treatment against their will, mainly through a court-petitioning process, just as an individual in a mental health crisis can be involuntarily committed to psychiatric care today.

As to whether SUD and AUD are in fact mental illnesses, Sens. Laughlin and Williams appear to be on solid ground. The most recognized and credible medical association in the country, the American Medical Association, includes SUD as a mental illness, and the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies it as such. In fact, 34 states allow involuntary commitment for SUD, whereas all 50 allow involuntary commitment for a mental health issue.

But beyond that, the senators’ rationale is debatable.

Although we absolutely are still dealing with a continually evolving SUD epidemic, as of today, I would not call the epidemic unprecedented. In 2017, Pennsylvania was in unprecedented times with the highest number of annual overdose deaths ever seen at 5,456. Earlier in May of this year, the Centers for Disease Control released preliminary data that showed overdose deaths down 31 percent to 3,358 in Pennsylvania in 2024 over 2023. Had it not been for the Covid years, we may well have seen a continual annual decline from 2020 through today [read full blog post here].

By Jason Snyder, Director, SUD Treatment Services, BH Division

For as long as I’ve been active in the recovery community and addiction treatment system, the prevailing mentality around people who couldn’t “get it” – with “it” mostly meaning compliance with a program and an outcome of sustained abstinence – was that they just weren’t ready, or they just didn’t have enough willingness to do the things that are necessary to stop using drugs and begin to recover. That attitude is much more pronounced in certain recovery communities, much more nuanced in the treatment environment, but it’s an accepted way of thinking in both. It’s a kind of thinking that blames the individual for failing, as opposed to the system failing the individual.

But what if a large subset of individuals with substance use disorder (SUD) really can’t get it, with “it” not only being abstinence or reduced use, but, more consequentially, the cognitive demands of treatment – alertness, attention, cognitive processing, memory, and executive functioning? What if these individuals are neurologically incapable – even if only temporarily – of engaging in treatment for their SUD the way the treatment system expects them to, because they have either an acquired or traumatic brain injury from or driving their SUD?

Such a recognition by the broad treatment system, the subsequent implications for improved individualized treatment and, most importantly, actual modifications to SUD treatment could be huge [read full blog post here].

By Jason Snyder, Director, SUD Treatment Services, BH Division

There are many stakeholders in the broad substance use disorder (SUD) landscape who are nervous about how US Department of Health and Human Services Secretary Robert F. Kennedy Jr. will steer policy. But from a treatment perspective, given his beliefs and experiences, he could drive significant improvement in the way those Americans who suffer most severely from SUD are treated.

In January, after President Trump took office and nominated Kennedy to be secretary, many SUD treatment providers and advocates, along with several media outlets, immediately raised concerns. Pointing predominantly to the 45-minute documentary Kennedy made as part of his early campaign for the presidency, some advocates feared that if he was confirmed as secretary of HHS, he would use his personal experience and preferences to unduly influence the country’s SUD treatment policy away from evidence-based treatment, including the use of medications like methadone and buprenorphine.

In “Recovering America – A Film About Healing Our Addiction Crisis,” Kennedy, who is in long-term recovery from heroin addiction, featured “healing farms” – a form of therapeutic communities – as successful models for treating SUD. Therapeutic community is a treatment approach built on the premise that for recovery to occur, a change in lifestyle and social and personal identity is vital. He said that if he was elected president, he would open hundreds of healing farms across the country.

Of course, he did not become president, but he was confirmed as secretary of HHS in February.

Kennedy’s support of healing farms is not the only concern of some advocates. The pathway to his own recovery – a 12-step program – and his staunch support and continued participation in that program, which many criticize for its abstinence-only philosophy, including its rejection of medications to treat SUD, is also a red flag [read the full blog post here].

By Jason Snyder, Director, SUD Treatment Services, BH Division

As I watched Pennsylvania Governor Josh Shapiro give his budget address last Tuesday, it occurred to me that the light Pennsylvania government had brightly shined on the addiction epidemic for nearly the past 10 years has greatly dimmed.

In a speech of nearly 11,000 words, not one of them was “addiction.” Not one mention of treatment. No mention at all of an overdose death epidemic. Over the course of a 90-minute budget address, Gov. Shapiro, a man who likes to “get stuff done,” did not even attempt to take credit for overdose death numbers that are trending downward. He didn’t acknowledge them at all.

Granted, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) continues to release pots of opioid settlement and federal money, including State Opioid Response (SOR) funding, into the behavioral health ecosystem, though not all of it is available to DDAP-licensed treatment providers. Counties also continue to spend opioid settlement dollars from multiple sources, including a national settlement with the three largest pharmaceutical distributors that netted more than $1 billion for Pennsylvania. [Read the full blog post here.]

By Jason Snyder, Director, SUD Treatment Services, BH Division

If they haven’t already, very few people seeking addiction treatment will ever experience it as Tom Coderre did.

Coderre is principal deputy assistant secretary for the Substance Abuse and Mental Health Services Administration (SAMHSA). Last week, in kicking off its inaugural Substance Use Disorder Treatment Month, SAMHSA published a blog in which Coderre’s treatment story was retold.

“I started treatment at the end of May 2003, after an arrest for possession of a controlled substance, when a compassionate judge strongly suggested it,” the former Rhode Island state senator said. “The treatment program offered flexible lengths of stay, determined on an individual basis … For me, that treatment episode lasted five and a half months and I then transitioned into a recovery house.”

You read that correctly. Five-and-a-half months. Not five-and-a-half-months in the continuum of residential to halfway house to partial hospitalization to intensive outpatient to outpatient, but five-and-a-half months in an intensive residential treatment center before transitioning to a recovery house. And keep in mind, Coderre’s treatment was funded by a federal block grant, not out of pocket or through commercial insurance.

Coderre’s story truly is remarkable. He gave a great interview to William White in 2016 that details his story and demonstrates the power of treatment and recovery. But to hold up this treatment experience in a blog that kicks off national SUD Treatment Month is to suggest, in my read, that this is what addiction treatment could look like today. And, barring some very specific and unique cases, that is simply not true, and certainly not in Pennsylvania [read full blog entry].

By Jason Snyder, Director, SUD Treatment Services, BH Division

Nothing about us without us.

That is the mantra that emanates from the recovery community any time policy decisions are being considered that would affect those seeking or already in recovery from substance use disorder (SUD) or mental health issues.

The thinking goes that no one knows the plight and the needs of the person seeking recovery better than those who have sought and found recovery themselves. The peer profession is based largely on this tenet. I can attest to the power of the peer. Without those with lived experience helping me early in my recovery and, in fact, to this day, my life likely would not have followed the path that it has.

“Nothing about us without us” is a spoken tie that binds, and often times it’s a rallying cry in an us-against-them mentality. It’s no different from any other special interest, including the addiction treatment providers who I represent, rallying their own against perceived threats from outside influences. It’s what we as advocates do.

But that tie is being tested with a yet-to-be-introduced bill – called Promoting Recovery, Opportunity, Professionalism, Ethics, and Longevity (PROPEL) – that would radically change the way peer services are provided in Pennsylvania. It is being tested because the bill lacks widespread support within the recovery community. Few in the recovery community had any hand in shaping it. In fact, from the many conversations I’ve had with those in the peer community, most had no idea this bill was even in the works. Many probably still don’t know it’s been written [read full blog entry].

By Jason Snyder, Director, SUD Treatment Services, BH Division

In September 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a report, “Recovery from Substance Use and Mental Health Problems Among Adults in the United States.”

Although the definition and concept of recovery from addiction have been morphing for some time, the self-reported data contained in the report, coupled with SAMHSA’s definition of recovery, lays out starkly that what is considered recovery today is far different from what it has been considered historically. In some ways, it begs the question, then, “What is the purpose of addiction treatment?” What are the implications for addiction treatment providers, who for decades have operated with a mission of helping their patients stop their use of drugs and alcohol?

Using data from the 2021 National Survey on Drug Use and Health (NSDUH), SAMHSA’s report shows that 70 million adults aged 18 or older perceived that they ever had a substance use or mental health problem. For substance use specifically, of the 29 million adults who perceived that they ever had a substance use problem, 72 percent (or 20.9 million) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem (see SAMHSA’s press release). [read full blog entry]