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Sober as a U.S. Drug Czar
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Michael Botticelli has been President Obama's Acting Director of the Office of National Drug Control Policy (also known as the U.S. Drug Czar) since Gil Kerlikowske stepped down from the position in March. He brings with him a unique perspective to the position, having been in recovery for more than 25 years, and he understands all too well the effects addiction has on the community. Previously he was the deputy director of ONDCP, following a long career as Director of the Bureau of of Substance Abuse Services at the Massachusetts Department of Public Health. In The Fix Interview, Botticelli explains how his sobriety and experience as a gay man has informed his work in the addiction field and drug policy.
How does being in recovery affect your position and your outlook?
So my own recovery really helps me in a very deep and personal way to understand what we’re trying to accomplish here. I go back to my own experience, and my own story and I think about - jeez, where were the missed opportunities along the way? How might we have done a better job at, for instance, our health care providers catering to LGBT communities? How do we do things like periodic screening and intervention with those people who are developing a problem? I just have to look back at my own experience both positively and negatively. When I got sober I found a tremendously supportive LGBT community of sober folks that I never knew existed.
Where did you get sober?
How did you get sober? Through treatment and rehab, or a 12-step fellowship?
A little of both. I was arrested as a result of a drunk driving accident and I was mandated to go to 16 weeks of treatment and part of that treatment also required that I go to 12-step meetings. And you know how coincidences work in our world. Around that same time I met somebody who was sober, who took me to my first meeting. So it was a confluence of intervention with the criminal justice system, treatment and 12-step meetings.
Would you say arrest was your bottom?
Not quite. That was the beginning of the end. That’s the way I frame it. It took me probably six more months of staying out there until I really finally recognized that I had a problem.
Any big changes to the 2014 national drug strategy?
We’ll keep you on hook for that. But again the strategy will again continue to emphasize that addiction is a disease, and we need good prevention treatment support services. Our law enforcement entities have a key role to play, but fundamentally this is a public health related issue, so we’ll continue to amplify that as our national strategy.
Did you come out of the closet before you got into recovery?
I did. And it’s interesting that I remember this. I came out, and that night someone took me to a gay bar. But I think its particularly telling to me that the first thing someone said to me is ‘oh you’re gay, you need to go to this bar.’
How long have you been in this field?
I’ve been in this field for over 20 years. I was two years sober when I started doing this work.
How did you get involved in the policy side of recovery and addiction?
When I was living in Massachusetts, I started working with treatment programs that wanted to develop a specialty track for LGBT people within the treatment program. So part of my job was to do outreach to the LGBT community in Boston, and work with a treatment program to design a specialty track for LGBT Folks. From there I started working at the Massachusetts health department and I worked in our HIV/AIDS division. The last nine years [in Massachusetts] I was the director of substance abuse services. That’s how I got to know the folks here at the Office of National Drug Control Policy.
Do you think that the current administration’s strategy and policy has changed a lot from the previous one?
Dramatically so. Coming from a state perspective, I was in Massachusetts, which is a pretty forward leaning state, particularly in health and health policy. I remember the inaugural strategy for this administration when the director talked about this as a public health issue and talked about addiction as a disease saying, we couldn’t arrest our way out of the problem. [He] really endorsed a wide variety of evidence-based practices, supporting things like needle exchange programs and overdose prevention programs. I mean this sincerely, it really both surprised and pleased me the extent to which this drug policy under this administration really made a significant change in terms of how we deal from a national perspective around issues of substance use.
One issue I know is a problem is prescription drug abuse. The Centers for Disease Control has called this an epidemic. Can you talk about that?
In 2011 our office produced a prescription drug abuse prevention plan to deal with the issue. I won’t talk about all four of the main components but the first one was around education. We have to ensure that the general public understands that just because these drugs were prescribed by a doctor [doesn’t mean] they’re safe and there’s no harm associated with them. We have to ensure that physicians, who often get little to no training around addiction in general, start specifically getting training around how to safely prescribe opioids.
This is where my own experience comes into play. When I was in Massachusetts, I had a health care provider who knew I was in recovery and knew I was the director of substance abuse programs for the state. After a procedure he asked me if I wanted a prescription for pain medication. It was a really teachable moment for me to say to him “you know I am not the person you should be giving these medications to.”
What we’re calling for is physicians to understand who’s at risk, and to look at alternative prescribing, other than just pain medications, because we have always promoted a balanced approach. We don’t want to see people in pain needlessly suffer though. But we also know that part of the reason why we have such an issue around prescription pain medications and overdoses is the direct result of the vast over-prescribing of pain medications.
I want you to also talk a little bit about marijuana. How is the administration approaching this issue going forward?
We don’t look at this as a political issue. We look at this as a public health-related issue. We really rely on science and research to guide our way. In the U.S., based on the last national survey of high school students, it showed that we now have more students 12-17 [years old] smoking marijuana than tobacco. We see more adolescents in treatment as a result of marijuana dependency. We see a dramatic reduction to all time low levels of adolescents who see smoking marijuana as harmful.
It relates to your point about prescription drugs that when youth see that marijuana has a medicinal purpose…many adolescents [then] don’t see marijuana use as harmful. We know [marijuana is] related to a wide variety of health-related issues in terms of poor academic performance.
A study showed regular marijuana use can reduce IQ when it’s started as an adolescent. We know that one in nine people who use marijuana become dependent on marijuana. So we really look at the science and data to guide our policy on this issue.
Many people who become addicted to prescription drugs or heroin often start their drug use at a very early age and often they start with alcohol, tobacco, and marijuana, often in combination.
From a prevention standpoint we want to make sure our youth are not turning to these substances because we know there are life long implications.
As a member of the LGBT community you’ve really tried to bring the LGBT perspective to the issues around substance abuse. Can you talk about that?
Part of what I have been doing since I started this job is when I travel I will do roundtables with LGBT leaders in the community in terms of talking about how do we make sure that that we, as a community, are addressing the issues in the community? Part of my personal story, and where it comes into play is...it was really inconceivable for me to think about being a gay man who didn’t drink or who didn’t go to a bar. I didn’t see, until I got sober, [that] there was this incredibly vibrant recovery community of gay men. So how do we promote the positive image that recovery can play within the LGBT community? Things have evolved to a great extent, but how do we ensure that LGBT people are getting good culturally competent treatment and making sure that significant others, spouses are being included as a part of the treatment protocol?
I’ll also do a lot of listening sessions with LGBT youth to talk about the issues that they see and they face. So I really try to do a tremendous amount of outreach to both national, state and community level folks in terms of raising the issues around LGBT substance abuse.
What are the issues that you hear about?
I think one is around ensuring good culturally competent care so - just like with any specific population - making sure providers are trained on the particular issues that LGBT folks face, and how to provide that culturally competent care. We work with the prime federal agency, the Substance Abuse and Mental Health Services Administration. They’ve actually put out and developed culturally competent standards of care for LGBT providers, making sure our substance abuse providers understand those issues as they deal with it. The other piece is looking at how do we, as a community, begin to really think about changing norms around substance use issues?
What do you mean by changing norms?
One of the things that has always kind of struck me is if you look at marketing and advertising, particularly in gay publications, you’ll see an inordinate amount of alcohol advertising. [The LGBT community has] historically been targeted by the alcohol industry because they know there is elevated alcohol use, so we have a responsibility, as a community, to change that kind of normative view that sometimes alcohol and drug use is part and parcel of what it means to be gay.
Technology is changing the ‘bar culture’ and there is a growing ‘app culture’ especially in the gay male community where Crystal Meth is a growing problem. How do you address that?
I think there is [a problem]. This is a good example of how we make sure that we’re doing targeted prevention and intervention. Again how do we [make that not] acceptable within the gay community? How do we work with our medical providers to do prevention and intervention work? And how do we make sure people have good culturally competent care and treatment?
Again I go back to my own experience. I found it very very hard to think of myself as a gay man who didn’t drink and do drugs. And so how do we make sure we have a good vibrant and visible recovery community within the LGBT community to show people that there is a way to have a really happy life on the other side of substance use?
Jason Parsley lives in Boynton Beach, Florida and is the Associate Publisher of the South Florida Gay News.