Abolish SAMHSA? On advocacy and criticism

I’ve seen this article shared several times recently. Here’s the premise:

The incoming Trump administration wants to improve public safety, push back on progressive cultural politics, and cut wasteful federal spending. One way to do all three? Abolish the Substance Abuse and Mental Health Services Administration, the federal mental-health agency.

Trump Should Abolish the Federal Mental-Health Agency. (2025, January 2). Retrieved February 17, 2025, from City Journal website: https://www.city-journal.org/article/federal-mental-health-agency-samhsa-trump-abolish

The article was published in early January but has taken on new salience with the first wave of SAMHSA staff terminations this weekend, including the Office of Recovery.

I could easily offer several criticisms of SAMHSA — I believe their messaging has, at times, suggested we can prescribe our way out of the opioid crisis; I also believe they’ve conflated harm reduction and recovery, muddied the boundaries of recovery in ways that can have real-world consequences, and conflated addiction with other substance use problems.

That said, I also see a lot of good coming out of SAMHSA. I have friends and colleagues whose lives were saved and restored because of treatment they received that was supported by SAMHSA grants. I sit on the board of a community coalition that engages local families and other stakeholders to help prevent and respond to adolescent drug use in our community. I’ve used materials they developed, published, and made freely available to train staff in things like suicide prevention and motivational enhancement therapy, CBT, multidimensional family therapy, and contingency management. I’ve distributed literature that they provide to scared parents and people contemplating seeking help for themselves or a friend.

I have no doubt there’s a lot within SAMHSA to criticize. There may be some programs that should be cut. There may be some priorities that should be reconsidered. However, as I read the article, I thought about how easy destructive criticism is. The author offers no improvements and no replacement ideas. She also smuggles in a lot of questionable ideas, like there should be no public health response to lower-severity mental health problems.

This brought to mind the post below, which was originally published in 2020. It was written in response to burn-it-down and cheap-shot criticism from activists animated by harm reduction philosophies and progressive politics. It seems just as relevant with the burn-it-down attacks from wreckless conservative activists.

Of course, it’s one thing to criticize and call out the flaws from the sidelines or even from within, it’s another thing to initiate the actual destruction of institutions. The terminations I’m seeing look indiscriminate and have little regard for the people harmed by this destruction. The terminated employees are one group being harmed, but there are millions of citizens who will be harmed because services, information, and knowledge development weren’t there when they, a loved one, or a neighbor needed help.

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On Advocacy and Criticism

I’m not sure why, but I’ve been missing Roger Ebert recently. I’ve posted about him a few times before and commented on my appreciation that he was a film lover first and a film critic second.

I think it’s safe to say that social media has multiplied and elevated critics. I’ve been thinking about the role of critics in addiction treatment and recovery advocacy. I wondered this morning whether Ebert has anything to teach us.

We see an abundance of criticism of mutual aid groups, treatment providers, treatments, advocates, language, policy, media coverage, etc.

So, what should we make of criticism?

Ebert described the criticism of criticism this way:

Criticism is a destructive activity. … They think they know better than creators. They praise what they would have done, instead of what an artist has done.

He goes on to quote Anton Ego, the food critic from the film Ratatouille. Anton offers an important insight into the role of the critic. [emphasis mine]

“In many ways, the work of a critic is easy. We risk very little yet enjoy a position over those who offer up their work and their selves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is more meaningful than our criticism designating it so. But there are times when a critic truly risks something, and that is in the discovery and defense of the new.

Of course, Ebert’s observations can only take us so far—art criticism is about the subjective. In addiction treatment and recovery, we all seek to occupy a much more objective space.

We seek to put everything in objective terms—policies, pathways, and treatments, as well as the impact of things like language and media coverage. This is good. We all should want policies and practices that are fact-based.

However, I tend to think most critics in our field overestimate what we know (or can know) objectively. These critiques and arguments don’t feel subjective, but they are much less objective than often make them seem.

So … if we’re frequently operating outside of the objective, maybe Ebert has something to teach us about criticism that is worth doing.

Ebert meditates on the meaning of Anton’s statement and doesn’t agree completely. He questions whether the creation of “junk” is actually more meaningful than criticism of the junk.

He adds the following about criticism worth doing:

[the artist] discovered the new. A critic can defend it, publicize it, encourage it. Those are worth doing. … you must know why you like a film, and be able to explain why, so that others can learn from an opinion not their own. It is not important to be “right” or “wrong.” It is important to know why you hold an opinion, understand how it emerged from the universe of all your opinions, and help others to form their own opinions.

He seems to be saying that good criticism emanates not from the interrogation of the subject (or target) but from the interrogation of oneself. Further, good criticism encourages others to think for themselves rather than telling them what to think.