Drug policy in America is at a critical inflection point. Following a period dominated by extreme harm reduction approaches, we're witnessing a significant shift back toward accountability-based treatment models. This transformation comes as cities like San Francisco and states like Oregon roll back failed experiments that provided tools for addiction without addressing its root causes.

Dr. Kevin Sabet joins us fresh from United Nations meetings in Vienna, where American representation was noticeably diminished – a symptom of the current administration's still-developing drug policy strategy. Together, we analyze Dr. Nora Volkow's recent Stat News interview, where the longtime NIDA Director expressed skepticism about universalizing 12-step approaches despite compelling research supporting their effectiveness. As Sabet points out, studies from leading institutions demonstrate that 12-step programs often outperform traditional psychotherapy while lowering healthcare costs.

The encouraging decline in opioid overdose deaths presents a complex puzzle we attempt to unravel. Is it increased naloxone availability? Greater public awareness of fentanyl dangers? The tragic reality that many vulnerable users have already died? The answer likely combines these factors, highlighting why comprehensive approaches that blend harm reduction tools with accountability-focused recovery pathways remain essential. As America recalibrates its drug policy strategy, this conversation offers crucial context for understanding what works, what doesn't, and why the pendulum is swinging back toward treatment models that emphasize personal responsibility alongside compassionate care.

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