Steve Adami, the head of an abstinence-based recovery program run by the Salvation Army, will lead a new unit within San Francisco’s Department of Homelessness and Supportive Housing focused on recovery.
City officials confirmed Adami’s appointment this week after Mission Local asked them about the rumored posting.
“Steve Adami brings a unique combination of public-sector leadership and hands-on experience developing recovery-focused services to this important new role,” said Mike Levine, executive director of the city’s homeless department.
“His appointment reflects our commitment to doing more for people who are in recovery or interested in pursuing recovery.”
The move comes at the behest of Mayor Daniel Lurie, who helped create the role for Adami, department sources said. As the director of the recovery services and initiatives within the city’s homelessness department, Adami will oversee the expansion of programs focused on sobriety.
Critics within City Hall and at homelessness nonprofits, however, have expressed concern over Adami’s views on solving San Francisco’s drug crisis, and questioned his lack of a medical background.
Adami, who is formerly incarcerated and in recovery, is a strong critic of harm reduction, a public-health approach long used in San Francisco that seeks to minimize the negative effects of drug use, but without requiring abstinence.
These include efforts like programs that provide sterile syringes and pipes to prevent diseases such as Hepatitis C, and the use of Narcan to prevent overdoses.
Adami, who worked at the adult probation department under Mayor London Breed until 2023 before going to the Salvation Army’s “Way Out” abstinence program, once called the city’s harm-reduction approach on X “one of the greatest policy blunders of my lifetime.”
He frequently posted videos of people bent over on the street in the throes of addiction, referring to their stance as the “fentanyl fold” and drug users as “zombies.” He drew criticism for dehumanizing people who are suffering.
Adami’s new position would be tasked with helping those people. Days before news of his hire was to be announced, he deleted his X account.
Adami has pushed for San Francisco to adopt an abstinence-based approach instead, a philosophy that has been embraced in its extreme over the past year by President Donald Trump’s administration and the conservative think tank the Cicero Institute.
Adami, along with the Cicero think tank, also heavily criticizes “housing-first,” a policy championed by California homelessness advocates to provide homeless people with access to permanent housing as quickly as possible, without pre-conditions like sobriety.
But an abstinence-based approach hasn’t been wholly conservative. Both Lurie and Breed, moderate leaning Democrats, moved towards treatment and recovery programs and away from harm reduction in recent years.
Because of this, City Hall sources who learned of Adami’s appointment said it is “not surprising.”
Last April, Lurie banned nonprofits from distributing drug paraphernalia like clean needles without first connecting people to counseling and treatment.
This year, the mayor took things a step further and, in July, signed legislation sponsored by Supervisor Matt Dorsey mandating that new permanent supportive housing sites — long-term affordable housing for those experiencing chronic homelessness — be drug-free. This only affects housing built without state funding.
Proponents of abstinence programs say the city went too far in approaching drug use with harm reduction, and point to the fentanyl epidemic and rising deaths from overdoses. They say that the approach has done little to address the harm of drugs not just to the user, but to the surrounding community.
In a 2024 op-ed in the San Francisco Standard, Adami, who wrote the article with recovery advocate Cedric Akbar, wrote that San Francisco’s approach to drug-use “enabled” addiction.
“San Francisco’s approach of tolerating drug use and giving people the freedom to do what they want on our streets was not helping people address their addiction,” they wrote.
Keith Humphreys, a professor of psychiatry at Stanford University who served as senior White House drug policy adviser in the Obama administration, has also said that many programs fail to provide treatment in addition to clean drug supplies.
Such programs, he said in an op-ed, “frequently failed to take the responsibility to promote treatment seriously, and indeed, in some cases, has denigrated the value of treatment and recovery as goals.”
But critics of Lurie’s current policies say an abstinence-only approach is also not a one-size-fits-all solution, and often does not work for those with mental health challenges or severe drug addiction, including to fentanyl and meth.
They point to the science backing the efficacy of harm reduction and argue that the two approaches should work hand in hand.
In many cases, medical professionals say, an abstinence-first approach without harm reduction — which can prevent infection or an overdose — can kill.
Dr. Ayesha Appa, a clinician investigator in addiction medicine, said that harm reduction was “one of the most important tools” to help her clients move towards recovery. “Harm reduction and treatment are part and parcel,” she said.
For some, Adami’s appointment raised concern about the city’s direction.
Whit Guerrero, a commissioner on the Homelessness Oversight Board, said that “creating a costly new role for a politically controversial figure” would further erode trust between harm reduction service providers and recovery-focused communities.
“In my opinion,” said Guerrero, “This is a signal that this administration is not serious.”
Hiring Adami, one City Hall source said, signals a transition.
“Generally speaking, the recovery community has wanted a bigger voice in San Francisco for a while now.”
The fundamental flaw in abstinence-first policies is that they make sobriety a prerequisite for the very stability that makes recovery possible.
Housing first isn’t about giving up on recovery. It’s about creating the conditions for recovery to succeed. Someone with a permanent address can be consistently reached by case managers, connected to treatment, and supported through setbacks. Someone cycling between sidewalks and shelters is far harder to keep engaged in care.
Abstinence-based programs may work for some, but making sobriety a condition of housing excludes many of the people who need help most. Relapse shouldn’t mean losing your home and starting over.
Housing first doesn’t mean treatment never. It means giving treatment a fighting chance to work.
Well said. I also find it profoundly disappointing that in a city now overwhelmingly funded by so-called “data driven” tech companies, our public leaders and wealthiest donors choose to ignore the data and preponderance of evidence that shows that housing first and harm reduction in conjunction with treatment is more effective approach to treating substance abuse than abstinence only. Yes, abstinence works for some and that’s amazing for them, but when it comes to civic policy we need to support treatment that works for the greatest number of people.
I also hate the argument that we should spend city funds on treatment and instead just lock drug users in jail. Do these people not know that incarcerating someone costs MUCH MORE than housing and treating them? The cognitive dissonance is astounding.
The City most definitely never went “too far” in providing a “housing-first” approach. Going “too far” would mean every single person having safe, secure, stable housing, and every single person having access to mental health care and addiction treatment. Instead, we have 8,000 people on the street, a waiting list even for the shittiest shelters, no actual housing or even a plan for it, nowhere near enough addiction treatment. No place in the U.S. has ever actually gone near far enough — instead, they throw a piddly little half-baked solution at an enormous problem and then say that the solution is fundamentally flawed. No, it isn’t flawed. You just never enacted it.
Where did the 8,000 people come from, and why did they come? Give everyone free housing, what free housing? Build it, and they will come. House 8,000 tomorrow, and we’ll see 16,000 on the street next year. Do you believe the parasitic line that: “This City is full of billionaires! They can pay for it.” The homeless living on the street and high out of their gourds aren’t thinking that way; however, the people who hope to profit off of the problem probably are thinking that way. They’re going to provide a place to pitch a tent at $6,000, per tent, per month? They say it costs $3,000, per month, to house a stray cat, through agency programs. Government needs to better steward tax dollars, which represent labor and sacrifice.
Tell em
It’s an awful lot of money – hundreds of millions – the City&County spends every year on a solution that’s “fundamentally flawed”. I suppose we might as well cancel that altogether then, and use the funds for more worthy cases. Muni, the schools and hospitals could put that money to good use.
It’s a shame there isn’t enough money in this city for everyone to have housing and food. Oh wait…
Just say no!!! This model totally works and is worth putting all city funds towards.
NOT… Such a waste of tax payers dollars.
Researchers and public health experts widely view the campaign as ineffective because it lacked an empirical foundation, oversimplified the complex root causes of addiction (such as trauma, mental health, genetics, and environment), and relied on fear-based messaging.
Proponents of the campaign sometimes point out that regular teen illicit drug use did decline during the 1980s—dropping from 37% in 1981 to 19.7% in 1989. However, researchers and historians point out that parallel downward trends in substance use were already happening or driven by broader cultural shifts, and there is no direct proof the slogan itself caused the drop.
As punitive policies tied to the movement expanded, federal and state incarceration for non-violent drug crimes rose dramatically from roughly 50,000 in 1980 to 400,000 by 1997.
Promoting people to power who are in with Manhattan Institute fellows which include the likes of Chris Rufo is only good for fascists, racists, queer phones and white supremacists.
“Harm reduction” has played a substantial role in the 800, or so, deaths that have occurred annually, year after year. How are we supposed to sweep that fact under the rug? And, as for the cost of ‘permanent supportive housing,’ under a “Housing First,” policy, who in their right mind wants to fund that? The prize for showing up jobless, penniless, and homeless is a free housing unit? It is bad enough when drug addiction is enabled, through laws that allowed for the criminal funding of addiction, through substantial shoplifting, and auto burglary, after attempting to destigmatize such activities as passing out in the gutter. “Harm reduction” can also be viewed as dehumanizing, given the highly visible, public spectacle, of human misery which has resulted from that policy. The policy of “tolerance” has resulted in socially intolerable activities becoming common; such as defecating on sidewalks. How is that not dehumanizing, how is that behaviour supposed to escape stigma? The enabling has got to end.
Captain Yelp continues his extended bar crawl and appoints a twitter troll to lead recovery? What could go wrong?
Captain yelp that’s a good one… hereby adopted and my compliments
Sounds like reasonable actions what we’ve been doing the last 20 years has been making things worse
Where, exactly, are the authorities supposed to send addicts for involuntary treatment? There aren’t enough slots now for people who profoundly *want* treatment. And the selection of someone affiliated with the homophobic Salvation Army is not a good match for San Francisco.
In SF, “housing first” just means “please come do your drugs in an SRO hotel” because the judges release people who do drug related crimes, and left-progs think getting people off drugs is somehow oppression so we don’t fund addiction treatment enough.
“Housing First” in SF means “Give housing, live in denial about the drugs”.
they mayor is exactly the nepo baby rich guy joke he seemed to be.
Harm reduction is an oxymoron
The city never funded and implemented Treatment-on-Demand; never has had enough beds for people wanting to get into treatment; but instead of seeing the problem as it is, it rather conjures up a fake conflict between Harm Reduction and Abstinence strategies when in fact they have both always been part of any practitioner’s toolkit. The Abstinence-only grifters are riding high today but the addicts seeking treatment are no better off.
Excellent news!
Now cut off all taxpayer funds to Whit Guerrero and his fellow “harm reduction / addiction enabling” fellow travelers.
And upon passage of Prop F, relieve him of his seat on the Homelessness Oversight Board. There needs to be a complete cleaning of the house.
Where, exactly, authorities supposed to addicts for involuntary rehab? There aren’t enough slots open for those people who profoundly want to enter treatment. And an appointee associated with the homophobic Salvation Army is hardly a good match for San Francisco.