Interview with Michael Botticelli, Obama's "Recovery Czar"

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Interview with Michael Botticelli, Obama's "Recovery Czar"

By John Lavitt 11/13/15

President Obama's Director of National Drug Control Policy talks to The Fix about the Affordable Care Act, Medication Assisted Treatment, 12-Step programs and how his personal experience informs his position.

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Why Obama’s Drug Czar is Now a Recovery Czar
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Michael Botticelli was sworn in as Director of the Office of National Drug Control Policy (ONDCP) at the White House on February 11, 2015. As Director of the ONDCP, Mr. Botticelli leads the Obama Administration’s drug policy efforts to balance the health needs of the American people with a public safety approach. Since being confirmed, Michael Botticelli has helped advance and transform the drug policies of the nation in light of healthcare reform and a new emphasis on evidence-based treatment options. He has been an active proponent of innovations in prevention, criminal justice, treatment, and recovery.  

Although his position is widely known as the Drug Czar, he prefers being called the Recovery Czar, particularly in light of his own experience in long-term recovery. Mr. Botticelli is the first person in recovery from a substance abuse disorder to hold the position. Instead of limiting him, as it might have done in the past, his personal experience in recovery is seen as proof of the government’s shift away from the War on Drugs and towards a zeitgeist of treatment and healing. The Fix is honored to have the opportunity to interview him.

At the recent White House Symposium on Addiction Medicine, you stated in your opening remarks, “America must bring the power of medicine and public health to bear to reduce substance use and its consequences. Today’s symposium can help ensure that the next generation of physicians is well-equipped to bring an effective public health response to substance use disorders.”

Can you describe how the surge in the role of addiction medicine is related to healthcare reform and the Affordable Care Act? 

Sure. Just to kind of step back for a minute, John, I think that we’ve known for a long time that we’ve treated diseases of the brain differently than we’ve treated diseases of the body. We’ve looked at diseases of the brain as being entirely separate issues. We’ve had specialty treatment programs for a long time, but we still haven’t seen the integration of issues around addiction as part of mainstream medicine, and that gets reflected in the minimal amount of education that physicians and other healthcare providers get around addiction. We still see very few referrals to treatment coming from the medical community.

The Affordable Care Act has done a number of different things to face a number of different challenges. In light of what has happened in the past, it is really unbelievable and impressive that the Affordable Care Act sees substance use disorder as one of the 10 essential health benefits. ACA looks at integration issues about addiction in primary medical care through a number of really innovative programs. What we also want, however, is as we see increased demand, we have to increase the number of providers who are able to treat addiction within a primary care setting. We know we need to do a better job integrating substance use issues as part of broad medical education. 

As a result, this forum was really historic in that it brought together ONDCP and other federal agencies as well as a whole host of people in the medical community. Not only the American Board of Addiction Medicine, but the American Society of Addiction Medicine as well as many specialty societies that are providing primary care came together with the goals of walking away with specific pledges and actions to do a better job at integrating substance use disorder education into medical education. For example, looking at things like screening and brief intervention within primary care settings. 

The Affordable Care Act really provides an opportunity not only for increased coverage, but better integration between mental health and behavioral health services. 

How have evidence-based treatment options become more important in the national discussion about the treatment industry? Is the treatment industry going to have to change its methodologies of treating addicts and alcoholics whether it wants to or not?

One of the bright spots, John, that I think is really helpful in working in this field is that our evidence based on what is considered effective treatment has grown enormously over the past 20 years. Our goal at the federal level is to ensure that treatment programs, particularly federally funded treatment programs, are implementing evidence-based treatment as part of their curriculum. 

With your background, you know that in response to the opioid epidemic we have been significantly pushing treatment providers, but also the criminal justice entities to make sure that people with opioid use disorders are getting access to medication-assisted treatment. The evidence has been clear for a long time that people with opioid use disorders that get medications combined with other behavioral and recovery support services do far better than people who don’t get those medications. It’s become very clear that we want to make sure that every treatment program offers, either in the program itself or by association with other providers, medication-assisted treatment. 

I think it’s really, really important, and I hear this time and time again from parents who identify that they have a son or daughter or a loved one that has an addiction that they often feel confused. They are unsure how to pick a treatment program, and these people are making probably the most important decision of their lives as it relates to the care of a loved one. We want to make sure that treatment programs continue to implement effective and evidence-based treatment options for their patients.  

Without question, Medication-Assisted Treatment (MAT) is at the forefront of the latest options being championed for addiction treatment. Despite the proven effectiveness of such options, like Suboxone for the treatment of opioid dependence and abuse, there has been a wave of resistance in the 12-step community. Like myself, you are a member of a 12-step program in long-term recovery. What would you say to 12-step members that are resistant to MAT, claiming that such patients are not really sober?

As a member of a 12-step program, I would say that such a reaction actually goes against what 12-step programs actually talk about when it relates to medications. I am sure you are probably familiar with a widely-used pamphlet that basically says if people need medication, then they need medication. We need to continue to foster that information. 

I do think, John, such perspectives are dramatically changing in 12-step programs. I have visited many community recovery organizations that don’t see this division between people who are in recovery on medications versus those who are not. I think that we’ve come a long way as a recovery community, knowing that there are multiple paths to recovery and that medications for many people are an important part of their path. 

We are really seeing a diminution of this arbitrary line between people who are in recovery who are on medication and those who are not. As a 12-step community, as a recovery community, we understand that there is no one right path and that each person has their right to their own individual path to recovery. I feel optimistic that these kinds of dividing lines are falling away, and the opioid epidemic is really accelerating that change in beliefs for many people.

Given your past tenure as director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, what do you think of the Angel Program in Gloucester that has been initiated by Gloucester police chief Leonard Campanello to help addicts access treatment and the path of sustainable recovery as opposed to being arrested and punished for their disease?

One of the experiences, John, which has just been extraordinary for me is that as I travel the country and I talk to local law enforcement, there is a huge and growing consensus about the fact that we can’t arrest our way out of the problem. I hear that echoed back to me by law enforcement officers all across the country. You know that we’ve seen dramatic increases in law enforcement personnel who are administering naloxone as part of their day-to-day operations. 

I look at the program in Gloucester as another example of how police are coming together with the treatment community with the understanding that they play a pivotal role, not just by arresting people, but by how they can help get people to treatment. It’s really amazing to me when I look at programs in Gloucester and other communities. 

I actually just met a police chief in Dayton, Ohio, who’s creating what he calls "Conversations For Change" where they identify people who have experience with overdoses, and they invite them and their loved ones to come to a community session. Law enforcement is not involved in it. They do motivational interviewing with peers and treatment programs to try to get people care. We are seeing this huge expansion of public safety working together with treatment programs to try to facilitate people’s access to care. I see it as this huge bright spot in this otherwise very devastating opioid epidemic that we have law enforcement that are willing to be innovative and partner with treatment programs. Rather than arrest people, they are trying to get them into care and treatment. It’s really been remarkable to see law enforcement step to the table in very dramatic and innovative ways to try to look at how we get people into care and treatment. 

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