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Elizabeth Vargas

Hello, everybody. Welcome to Heart of the Matter. I am your host, Elizabeth Vargas. And if you listen to this podcast, you know we talk a lot about the fact that fewer than 20% of people who need help dealing with substance use disorder actually get help. It is I think the only disease I can think of, that anybody can think of, where the numbers are that small. I mean, think about it. Cancer, diabetes, heart disease. People go get help, but they don’t when they’re dealing with addiction.

And today I have as my guest, one of the nation’s leading experts on addiction, Michael Botticelli. He has more than 30 years experience in the field. He was during the Obama administration the director of the Office of National Drug Control Policy, otherwise known as the drug czar. He was the first person actually to have that position in any administration who actually also had firsthand experience in recovery. Michael Botticelli has more than 32 years sober. And he’s got a lot to say, and I had a lot of questions for him. With the pandemic still raging and people really still struggling with mental health and substance use, we thought it would be a great time to welcome Michael Botticelli. I think you’re going to find him really interesting.

Michael Botticelli, welcome. As you know, I spoke a while back with the drug czar for President Trump about what he felt like he had accomplished while he was in that position. You were the drug czar for President Obama. Drugs czar is the nickname it’s been given. And as I just said, you were the first person in recovery to hold that position. You’ve done so much work over so many years fighting the stigma that surrounds the disease of addiction.

And I was so struck a couple of weeks ago in listening to the George Floyd trial and listening to George Floyd’s girlfriend take the stand and in very emotional testimony talk about the battle that she in George had fought against opioid addiction and the fact that days before his death, she felt that she could see the signs that he had relapsed. And the reaction in the public, especially on so many newscasts that I watched when people were expressing surprise that the defense would try and hit her on that because so many people, as they said, every family in America has experienced addiction in one way or another through a loved one, a member of the family, a neighbor, a colleague, a friend, that sort of thing. What did you think of all that discussion about addiction and her testimony?

Michael Botticelli

Despite I think the statistics that you just cited about how widespread addiction is, we know that stigma still pervades people’s attitudes with addiction. From my standpoint and probably to a lot of other people’s, it really wasn’t a surprise. I think it’s an all too familiar narrative, quite honestly, that his drug use becomes central to the defense’s argument, and [crosstalk 00:03:36]-

Elizabeth Vargas

They’re trying to argue he died because he had a small amount of fentanyl in his system, not because a police officer was kneeling on his neck for nine minutes and 29 seconds.

Michael Botticelli

Correct. And I’m not talking about the medical components of it, right? That’s really for forensic psychologists. I think what those of us who really understand this issue have known for a long time that when you talk about someone’s addiction, it conjures up this image in most people’s mind … This is how stigma manifests itself, right … in bad people and bad characters. And we’ve seen this time and time again, and that if someone … and not in this case, it’s pretty apparent he did not die of an overdose … but that those people who are addicted and who do die as a result of their addiction are somehow less human and those lives are not as tragic as people who died from other medical conditions.

I think it struck me and a lot of other people that beyond just the medical considerations and the forensic considerations of it, that drug use does have a tendency in most people’s minds to make us think less of the person, and even though someone might have had a history of recovery, that relapse is often seen as a failure, not just part of what many people’s normal recovery trajectory is. I do think I really fear and suspect quite honestly that the drug use issues mean a lot more to people in a negative way than just what the medical repercussions were in those situations.

Elizabeth Vargas

Right. I found myself feeling so happy to hear all these journalists on television saying, “Every family in America has experienced addiction,” and this is not going to be the death nail that I think the defense attorney hopes it will be et cetera, et cetera, et cetera. And then I thought, yeah, but, yes, but still so many don’t seek help because of the stigma and the shame around the disease. Fewer than 20% seek help. Polls show a third of Americans think addiction is a moral failing, a third. There is still any enormous component out there of people who blame the victim in this case.

Michael Botticelli

And quite honestly, media portrayal is a really powerful messaging tool where many people do feel that stigma, right? Even in the context of opioid addiction, it’s often characterized in a criminal justice, in a crime way, like we see in this case, or from a moral failing. How the media contextualizes that and the words that they use in even covering that are really powerful conveyors, if that’s the right word. How the media talks about this and how they portray it and how they put that in context I think are really, really powerful in terms of either de-stigmatizing addiction or perpetuating the stigma of it.

Elizabeth Vargas

You were talking just a second ago about the fact that people often blame the addict when they die or something happens to them and they’re under the influence. I was struck by the fact that when rapper DMX recently died, there were people tweeting out, one in specific that I remember responding to, “He had all the money and resources he could have in the world and he didn’t get sober and it’s his fault.” It was like, “Wow, really?”

Michael Botticelli

Well, and I also think we have to name the intersection of stigma and race, right, not only in DMX, but in George Floyd. We see that with gender too, right, with pregnant women and addiction there, that I think that there is this intersectionality with the stigma of addiction and things like racism and sexism and homophobia. When they’re combined, they I think can really be tremendously powerful in terms of playing into people’s attitudes around that. But, you know, I, I think we have to acknowledge that there is this intersectionality between stigma and race and class and sex and all the other systemic issues that we have as a culture.

Elizabeth Vargas

Are you saying people were more judgmental of DMX or George Floyd because they were black?

Michael Botticelli

Oh, absolutely, absolutely. One of the things when I was the drug czar that really struck me quite honestly is many people say, and I think there’s some truth to it, that our general approach to opioid addiction as a health issue and the consensus around that in no small part was a function that the vast majority of people that it was affecting were white people, so-

Elizabeth Vargas

We took it more seriously because the victims were white?

Michael Botticelli

Yes, exactly, and again, I think had a much more sympathetic and a much more health-focused response because it was largely white people that it was affecting. And I think we have to acknowledge that, that our response and our drug policy was not only rooted in addiction as a moral failure and as a criminal justice issue, but around issues of race and particularly for people of color.

Elizabeth Vargas

Rather than a medical issue.

Michael Botticelli

Rather than a medical-

Elizabeth Vargas

We certainly saw that when it came to criminalizing crack cocaine versus powdered cocaine.

Michael Botticelli

Correct. Correct. That I think is a really stunning example, right, from our past where there were dramatic different sentencing options for crack cocaine versus powder cocaine because here’s our image, right? The white affluent Wall Street banker doing cocaine and an African-American poor folk using crack.

Elizabeth Vargas

Two versions of the same drug.

Michael Botticelli

Two version of the same drug.

Elizabeth Vargas

Let’s make it very clear. There’s no difference. They’re just in two different forms.

Michael Botticelli

They’re two different forms.

Elizabeth Vargas

It’s funny you mentioned also women are judged more harshly with addiction. I was just talking about this with the actress, Kristen Johnston, on this podcast. And she feels that, and I agree, that somehow a drunk woman is seen much more judgmentally, and it can often prevent women from seeking help or admitting to somebody that they have an issue.

Michael Botticelli

Yep. Absolutely. One of the more stunning examples from the opioid epidemic, I remember that there were a number of states that were actually enacting enhanced criminal penalties particularly for pregnant women who had an opioid addiction, right? Despite the fact that we were moving this as a health condition, that there were many states that put enhanced criminal penalties for pregnant women with-

Elizabeth Vargas

Couldn’t the argument be made that a pregnant woman is not just putting our own health at risk, she’s obviously putting the health of her unborn child at risk?

Michael Botticelli

Yeah, but I think it misses the understanding that for many women, pregnancy can be the event where women actually do seek treatment, and the last thing that you want to do is scare a pregnant woman so that she won’t come for help, right?

Elizabeth Vargas

If she comes forward when she’s pregnant and says, “I need help getting detoxed or off this drug or off alcohol”-

Michael Botticelli

Yep. Well, and again, and I think-

Elizabeth Vargas

… she could face charges.

Michael Botticelli

… that we’ll do everything to keep women out of care. But to me, it’s a very stunning example of how stigma and gender and gender discrimination play into our response to addiction.

Elizabeth Vargas

Which is it? I mean, I was filled with optimism as I read the stories and heard the reports of how George Floyd’s girlfriend humanized opioid addiction with her testimony on the stand, and yet so dismayed to see, amid a lot of the tributes to DMX after his death from an overdose, that handful of … and getting a lot of play, of people blaming him for not being able to get clean. Are we at a point where we should be feeling hopeful and optimistic about chipping away at the stigma and the shame or are we still waist-deep in the morass of judgment and shame and moralizing and criminalizing and blaming the victim?

Michael Botticelli

I will forever be an optimist around this. And I do think that there is cause for us to be optimistic about it. And I think George Floyd’s girlfriend is a great representation of how when people come forward in an authentic, real way, like yourself, and talk about their stories, that’s how we begin to change opinion. And it’s been really interesting for me, as I’m sure it is for you, to watch people … and I don’t have scientific evidence around this, this is just my observation … how people often feel much more comfortable about talking about addiction in their own family, right? President Biden just did it. Hunter Biden is putting it in his book, so-

Elizabeth Vargas

President Trump had a brother who died of alcoholism. President George Bush himself suffered from alcoholism.

Michael Botticelli

He did. And I saw that in my time in Washington, I saw that in my time around the country, how often people when they’re talking about this issue will often talk about it from a personal standpoint, about either them, their family member, a friend that they had around this issue, because I do think that’s one of the foundational ways that we continue to chip away at the stigma around this issue is by this collective coming out of our own stories. And I do see that changing. We certainly have a ton more work to do.

But the other reason that I’m optimistic is as I get more advanced in my years, there’s this whole young generation of people who are really living their lives out loud about their recovery and their addiction and their sexuality. And it’s really, I think, opening up a different world in a different conversation that we’re having. We’re seeing young people in recovery. We’re seeing the proliferation of collegiate recovery programs. I think it’s really going to be young folks who do really take up the charge and change the conversation and really normalize the conversation around addiction.

Elizabeth Vargas

Right. I think watching George Floyd’s girlfriend on the stand talk so emotionally and vulnerably about her efforts repeatedly to stay sober and clean and the relapses and the fresh starts and counting days again, I do feel like perhaps it was a tiny window for many Americans to see what it’s like to live with this disease, especially this particular addiction to opioids that is so powerful and so difficult to break, and to see her be very honest and open about the fact that we tried repeatedly over and over and then we would relapse and then we would try together again and we both started taking these painkillers because of neck pain and back pain. Everybody’s got neck pain and back pain there but for the grace of God go I if some doctor prescribed me an opioid pain reliever that I became addicted to.

Michael Botticelli

Yeah. I think you hit on really two important points here. One, just the common experience that many people had around being prescribed opioid medication for pain. I mean, it was so prolific that everybody basically had a prescription for pain medication, and I think many people said to themselves, or said out loud, “Wow, I was really lucky here. I didn’t develop an addiction,” and various reasons why.

But I think that the other point that you mentioned that I think really resonated with many, many people is their experience with other people with addiction, right? How many families have we heard the same stories with loved ones who have repeated attempts around recovery? I often heard, and I think I’m right around this, that it takes about eight quit attempts for smoking before you finally achieve recovery from smoking. And the same is true with addiction, right, that we know it often takes numerous attempts at recovery. It’s almost like we’re practicing recovery until we achieve a significant time of recovery. And I think many people can understand that story and have lived that story. Not only did she, I think, humanize her own challenges, but I think her experience really resonates with people on many levels.

Elizabeth Vargas

I was so struck by something you said when you confronted stigma of your own when you were nominated to be President Obama’s drug czar. You said at one point a congressional staffer told you that there was no way you would be confirmed as drug czar because of your past. And this was despite the fact that you had been in recovery for more than 20 years. I can’t believe that. Is that true?

Michael Botticelli

It is true. And I think it’s unfortunately pervasive in our society, right? The longer that I’m around and I am in this field, I’ve really fundamentally come to the conclusion that unless we fundamentally change the way that people view people with addiction and reduce that stigma, that we’re still going to encounter those kinds of attitudes no matter where we go, right? The United States government is not the only employer, quite honestly, that I think has a level of stigma around addiction. And that stigma very clearly pervades public policy.

My good friends at Johns Hopkins Bloomberg School of Public Health did a survey on how people view people with addiction, and significant numbers of people said that people with addiction don’t deserve health benefits or don’t have a right to hold a job, didn’t want to marry into a family with someone with addiction.

Elizabeth Vargas

Wow.

Michael Botticelli

When we talk about stigma, it sounds like it’s this amorphous thing, but when you really look at policies and how people feel, it’s really, I think, fundamental for us to change our attitudes about people with addiction, because I think that subsequently changes public policy.

Elizabeth Vargas

Is it disappointing that more isn’t being done given the fact that we have two men in the White House who have personal experience with this disease?

Michael Botticelli

Absolutely. It’s really heartbreaking for me. Even I’m very proud of the accomplishments that we made, but I don’t think any of us felt satisfied with what we had done, particularly in the middle of the opioid epidemic. I can’t help but reflect. Today … I’m not sure when this will air, but today, we’ll probably surpass a half million people who died of COVID, right? But we’re approaching that same number of people who died of a drug overdose. And we don’t hear that. We don’t hear it reported. Certainly the number of overdoses have skyrocketed in the middle of this COVID epidemic.

Elizabeth Vargas

Oh my gosh. We have a mental health crisis. And I mean, nobody’s really talking about that, but they are, I mean, but not as much, I mean-

Michael Botticelli

Not as much, not as much.

Elizabeth Vargas

With our kids, especially. I think young adults and children are being impacted more than we can even imagine with anxiety, depression. Use of substances has gone way up as a result of this pandemic. It’s really hitting people.

Michael Botticelli

It really is. But you were talking about stigma. I think that’s one way that stigma manifests itself, right? And not to diminish any of the heartbreak and significance around the COVID epidemic, but nearly that same number have died of a drug overdose in the United States. And somehow, do we feel like those people, that there’s less heartbreak, that there’s less attention to it?

The older I get, which is getting old now, it really breaks my heart that I feel like the entirety of our work has been to get people to pay attention to this issue. And I still think we have a really, really long way to go before people see the urgency around not just the current opioid epidemic, but just the urgency around dealing with substance use and mental health issues. Maybe this pandemic and the ramifications and consequences for years to come, maybe it will. Maybe it will shine more of a light on it, but I think it’s always been a challenge to have people respond to this the way that it deserves.

Elizabeth Vargas

I can guarantee you that many people blame the people who die of drug or alcohol overdoses. I mean, I hear it all the time [crosstalk 00:23:28].

Michael Botticelli

I think that’s part of it. And I think I’ve always heard, “Yeah, it might be a disease, but they still did it to themselves,” right?

Elizabeth Vargas

Like it’s a choice.

Michael Botticelli

Like it’s a choice. I mean, there are behavioral components to diabetes and heart disease and a whole bunch of other diseases, but we don’t withhold care and treatment because there are behavioral components to it, right? I do think it’s that sort of thinking that actually pervades our response and prevents a much more robust response to this issue.

Elizabeth Vargas

When we talk about those precarious early days of sobriety and the expectation, unrealistic though it may be, of so many people, family and friends around the person and new recovery, it’s like, “Well, you’re all better now.” We don’t expect people with cancer to just stop having cancer, like it’s all better now. We wait until you go back for the six month checkup and the year checkup and the five year checkup to make sure you’re really cancer-free. We’re patient with people with cancer in a way that we aren’t with people in recovery. And relapses in recovery are greeted with much judgment, not just from loved ones, from companies who say, “I’m sorry, you relapsed? You’re fired.” Nobody says that to somebody whose cancer came back. Even though the statistics show that only a third … God help us … only a third of people think addiction is a moral failing, I think personally, the numbers are three quarters to even higher still blame the person who struggles.

Michael Botticelli

A couple of things reflecting on what you just said here. Actually, many addiction treatment programs actually kick people out that if they have a relapse, right? And I often thought it was … and I think it was William White who said, “We need to stop kicking people out of treatment for exhibiting the symptoms of the disease that they have,” right? But here’s the positive piece about this. I think that one of the things that I think that we are seeing in the United States not only are longer continuum of care, but much more emphasis on recovery supports, not just the inpatient treatment, but a significant influence in understanding that people need a whole host of recovery supports to maintain and get to long-term recovery, right? Whether those are things like recovery high schools, collegiate recovery programs, recovery support centers.

One of the things that I always used to hear, and the data support this out, that I always used to ask people in early recovery, “What do you need most to be stable in your recovery?” And invariably, they would say, “I need a job and I need housing,” right? And so it’s really interesting that we are seeing this movement toward recovery-friendly housing and recovery-friendly employers. I think more and more employers are understanding that not only do we need to support employees with addiction, but we need to provide them with ongoing recovery and support. I’m heartened that we are seeing … And that gets played out not only in insurance reimbursement, but federal grants I think are supporting not just high-end acute treatment, but much more emphasis on supporting people not just in early recovery, but throughout their recovery. I’m optimistic that people are understanding the chronic nature of this disease and that relapse is often a part of it, and ensuring that people have adequate access not just to treatment, but to all the supports they need to get to long-term recovery.

Elizabeth Vargas

You are actually what I would call the unicorn in the room in that once you decided to get sober, you stayed sober.

Michael Botticelli

I did.

Elizabeth Vargas

Yeah. You’ve been sober for 32 years.

Michael Botticelli

32 years now. It’s really amazing.

Elizabeth Vargas

Congratulations. Wow.

Michael Botticelli

But you look back, and a reporter once asked me, “If you had to say one thing that contributed to your long-term recovery, what would it be?” And without hesitation, I said a recovery community. And I’m still getting a little chill talking about it 32 years later. When I first came into the program, I was just surrounded by all of these people in recovery who we just ran around as a pack together. We went from meeting to meeting to meeting and we hung out and we went to breakfast and we went to dinner. We had coffee together and many of them are still my friends to this day. And I really do think that that’s where I am 32 years later and I think that many people who are in long-term recovery … I shouldn’t speak for other people, but can attribute their ongoing recovery to how close they stay to a program and how close they stay to other people in recovery.

Elizabeth Vargas

Yeah. There’s nothing like the power of sitting in a room with people who nod their head and say, “Me too,” when you share your most embarrassing, most mortifying, deeply secretive stories that you feel great shame about.

Michael Botticelli

Great shame about, and we’d laugh, right? [crosstalk 00:29:49]-

Elizabeth Vargas

I know. The power of laughter.

Michael Botticelli

I think it’s a good illustration of the power of people’s stories, right, not only to heal each other and to heal ourselves, but in that same vein to diminish stigma and to decrease some of the shame that people have. I’ve often said that being in recovery this long, I’ve heard tens of thousands of stories, right? And invariably, they always move me.

Elizabeth Vargas

Yeah, me too.

Michael Botticelli

Right? And you would think we would get desensitized to that.

Elizabeth Vargas

Never, never.

Michael Botticelli

But they don’t. And I do think that there is something significant in saying those things out loud. I firmly believe really in the power of people’s stories to heal ourselves, to heal other people, and I think to make great advancements in how we view people with addiction.

Elizabeth Vargas

I’ve always said that I think part of the power of those meetings is that I can hear other people’s stories that are so similar to mine, and I can show them empathy and be so much more generous toward them than I am toward my own self. In other words, it was by listening to other people’s stories that it taught me to finally forgive my own self for some of the things that I did when I was drinking.

Michael Botticelli

No, I think it’s really, really true. I think it’s in that power of identification of hearing yourself and seeing yourself in other people that I think is really when the restorative power of recovery comes into play.

Elizabeth Vargas

Finally, I’m just curious, what are the three things you hope to see the Biden administration accomplish and whoever he appoints as your successor in the position of quote-unquote “drug czar”?

Michael Botticelli

Well, I think first and foremost, just really leaning in to implementing programs and services with proven effectiveness. I think that that is particularly important. I think that the second thing is I really would like to see this as a priority within the administration. I can tell you from experience, when the president and the senior people in the administration say things are a priority, things happen. And so-

Elizabeth Vargas

Don’t you think there’s a good chance of that given President Biden’s son’s very public struggles? And I mean, I don’t know, I know there’s a lot on his plate right now with this pandemic and unfortunately, a lot of things get set aside, but I don’t know. Maybe call me too optimistic or naive, but I’m really optimistic that he will … because I remember interviewing him a couple of years ago about the book he wrote about his son Beau, and he said to me, “I read your book. It was really great. And my family, we have these issues too,” and that he’s never had a drink. He told me he’s never had a drink in his entire life. I don’t know. I’m hoping that he’s aware enough to make that a priority, because as you said, there’s nothing more powerful than the commander-in-chief saying, “This is a priority.”

Michael Botticelli

I do feel optimistic. I really do, in a number of ways. One, when he was a senator, he was actually one of the coauthors of the legislation that started the Office of National Drug Control, so this is an important priority to him. I think his personal connections to this are particularly important. I think we’ve seen evidence by the people that he is appointed already. One of the things that really excites me … hopefully by the time this airs, they’ll be confirmed … we have two cabinet secretaries who are actually openly in recovery.

Elizabeth Vargas

Who?

Michael Botticelli

Mayor Marty Walsh from Boston. Mayor Walsh is a good friend of mine. I have known him for a long time, who’s very public about, and uses every opportunity to talk about his own recovery. And Deb Haaland, who’s the nominee for Secretary of the Interior, not only is she Native American, but she’s openly in recovery as well. We’ve seen a number of appointees already who are openly in recovery. And what that says to me is not only this is an important issue, but instead of seeing recovery as a liability, see it as an asset, right? And so that gets me really excited when I see that. My good friend, Tom Quadair, is the acting administrator for SAMHSA. Tom, not only a great guy, he’s openly in recovery.

I think we have every reason to believe that this is going to be a priority, not only now. And the last thing that I’ll say in terms of what I think our focus should be is, I think it’s really, really important to focus on things that are … One of the things that we’ve seen with the COVID, we had begun to make a little bit of modest progress in drug overdose deaths. Unfortunately, this epidemic has reversed that curve and I think there are 40 states now that are experiencing significant increases. I think there’s some near-term work about implementing programs and policies to reduce drug overdose deaths in the short-term.

Elizabeth Vargas

Right. By the way, did anybody in your confirmation hearings ask you about your recovery, any of the senators?

Michael Botticelli

No, no, no.

Elizabeth Vargas

After the senate congressional staffer said, “I don’t think you’re going to make it because”-

Michael Botticelli

Yeah. I was actually unanimously confirmed by the senate. It was like 92 to nothing. And that also gives me … We’re living in a highly partisan world right now and highly partisan government, but I hope that level of bipartisan support for how we approach this continues in congress because I think that’s really, really important that we not have to play politics with this issue. And so I feel hopeful that we’ll continue to have significant bipartisan congressional support for this issue.

Elizabeth Vargas

Michael Botticelli, it’s great to talk to you. And really, your recovery is inspirational to those of us who are less far along on the path, but most importantly, the work you’ve done on behalf of people who suffer from this disease and families who are so impacted by this disease. Can’t thank you enough and look forward to seeing what else you do on this [crosstalk 00:37:08].

Michael Botticelli

Thank you, Elizabeth. And again, I think it’s just been so … I’m so grateful to be able to meet you and talk with you. I’ve been equally impressed by your openness and your honesty and your willingness that can often come with great consequence to be open about your own recovery, and glad to see that it has actually had the opposite effect, that you have flourished.

Elizabeth Vargas

Well, I’m hoping we can get to a day when we’re talking about all these cabinet members and so many people in my field, people in so many fields are in recovery. It’d be great for people to be open about recovery. It doesn’t define you. I’m many, many, many other things, as you are you, but it would be lovely if more people were more open, I think. I think it would do a lot to help reduce the stigma that still really impacts and frightens so many people away from getting the help they need.

Michael Botticelli

Yeah, I do. And if we can end on a really positive note, I think it’s really young people who are changing that. I think that many, many young people don’t live their lives openly, whether that’s social media or other. I think we are just seeing an explosion of young people who are just much more willing to be open and honest. And I think that that gives me great hope for the future here that we are going to see a big change in people’s attitudes.

Elizabeth Vargas

From your lips to God’s ears, as they say. Thank you. Thanks so much. Great to talk to you.

Michael Botticelli

Great. Good to talk to you, too.

Elizabeth Vargas

Thank you so much for listening to my talk with Botticelli. You can find this podcast on Apple Podcasts, Spotify, and on our website at drugfree.org/podcast. And as a reminder, if you need help with a loved one who is struggling with substance use, you can text 55753 or visit drugfree.org. Talk to you soon.

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