In this week’s episode, Elizabeth joins former U.S. Representative Patrick J. Kennedy. Patrick has gone from fighting his own demons to fighting on behalf of others who need help and support the most. In 2013, he founded The Kennedy Forum, a nonprofit that unites advocates, business leaders, and government agencies to advance evidence-based practices, policies, and programming in mental health and addiction.
Today on Heart of the Matter I talk with former US Representative Patrick J. Kennedy. Throughout much of his life, Patrick has struggled with his own addiction and mental health challenges, both in private, and sometimes glaringly public. But Patrick has gone from fighting his own demons to fighting on behalf of others who need help most.
You are listening to Heart of the Matter, a podcast where addiction meets recovery and families find hope.
During his time in Congress, Patrick Kennedy was the lead author of the groundbreaking Mental Health Parity and Addiction Equity Act, which requires insurers to cover treatment for mental health like they do any other medical treatment. And in 2013, he founded the Kennedy Forum, a nonprofit that unites advocates, business leaders, and government agencies to advance evidence-based practices, policies, and programming in mental health and addiction. Patrick has also written a memoir called A Common Struggle. Patrick, thank you so much. Good to have you with us today.
Thank you, Elizabeth.
I was struck by something that you’ve spoken about. You call it a conspiracy of silence around the disease of addiction. Why does it exist still to this day?
Well, historically, going back centuries, this was seen as a sin. When you acted out in a way that was inappropriate, you had to go to the church and get some penance for your misdeeds. And there was really a moral judgment made on people because there was the expectation that they could control their behavior. And obviously there is a moral obligation for those of us like myself who are in recovery to work at staying in recovery. But when you’re in the throes of addiction or mental illness, that free choice to decide what really to do in your life is taken away from you. It’s the nature of the disease. You’re really held hostage by your brain not working.
Right. I actually remember writing in my own book that no little girl lies in bed at night and says, “Oh, I hope I grow up and be an alcoholic.” And nobody ever wakes up in the morning and says, “Today’s a great day to drink myself unconscious.” Nobody plans to do this. And yet you talked about how people in the past used to have to go for penance because there was this expectation that everyone could control their behavior. That still persists today.
It does. But I would say Elizabeth, in just the last six months, we, I think have seen the most significant transformation in attitudes around mental health and addiction because literally it has affected every single American to some extent or another.
I was struck by a statistic, Patrick, fewer than one in five people who need substance use treatment receive any treatment. Why are the numbers so low?
Well, we’ve never paid for mental health.
And we still don’t.
We still don’t. And frankly, that means that we don’t get the numbers in our workforce to treat people with mental health conditions in order that are commensurate with the demand. So unless you pay for this, people aren’t going to go into it and provide that treatment.
So it’s really important that organizations like the American Medical Association and their subgroups, which advise the Centers for Medicare and Medicaid, which provide the benchmarks for reimbursement by the government forced under Medicare and Medicaid for cancer, and they pay for all kinds of other care, and they do it and quantify it in certain ways. No one has begun to quantify those metrics in a way that allows mental health to get an increase in reimbursement.
That’s part of the problem here, is that even with the act that you authored and pushed so hard to get passed into law, the reality is insurance companies still are not reimbursing families for the expensive costs of treatment.
Well, it’s because the system is set up to fail. In other words, the only way these managed care organizations make money is by denying care. They have a profit motive that says they’ve got a capitated rate, a fixed rate for their budget to treat these people. And if they exceed that, then they’re not making their profit.
It’s not just underfunded, Patrick, it’s under regulated. Why do we see this explosion of really disreputable irresponsible treatment centers proliferating as well? How are they able to make money and stay in business? And many of them I’ve interviewed, and we’ve done exposés on really bad rehab centers that are run by drug addicts who are using with their patients. And I’ve heard over and over again that the ACA Act allowed many of these really shoddy rehab centers to open and make a dime. How is that possible?
Well, it’s possible because as I said, historically we’ve never caught up with the rest of medicine in imposing quality metrics and reimbursing enough to implement those quality metrics. Frankly, across the mental health space, rarely, I mean less than 50% of all mental health and addiction providers practice towards the evidence-based treatments that they are providing.
Wait a second. Less than half?
Less than half. So what that means is… I was in analysis and psychotherapy for years with the best psychiatrists in Washington, DC and Rhode Island. And it wasn’t until I finally left Congress and I got both a therapist and continued in 12 step recovery full time, I was able to look back and say, the benefit of 12 step recovery for me is it’s cognitive behavioral therapy. They emphasize you have to act your way into different thinking.
You have said, and you have lived through the saying that relapse is part of recovery. There is, part of the stigma, the very stubborn stigma that continues to stick to the issue of addiction and mental health is that there’s this expectation from people on the outside looking in to those of us in recovery or those of us struggling, that, “Why can’t you get better? And you went to rehab. And what you drank again, you use drugs again?”
Talk about that, about the fact that there are very few diseases where we say, “You get 28 days to get cured. And oh, I’m sorry, your cancer came back? Okay, you’re fired.” We only do that with addiction in this country. You got one shot to get sober and clean, and after that, “Sorry, you’re on your own.”
And when you have chronic diabetes and you have too much sugar or you don’t take care of your health, no one condemns you for the real symptoms that create much higher physical costs to the healthcare system. But what we need is chronic care management, not episodic acute care, which is like repeated inpatient visits. Because whenever I went into rehab, I thought I was fine when I came out, even though I kind of knew, well, these are chronic illnesses.
How many times did you go to rehab?
I lost count, but easily 10 times. Easily.
Wow.
And I would go on my vacations. I didn’t go when it was medically necessary. I went when I knew no one would see me go to rehab. And this was even while I was the main sponsor of the national bill, essentially to end stigma by ensuring the payers pay in the same way for mental health and addiction that they paid for medical and surgical.
By the way, for your listeners, inpatient in-network, outpatient in-network, inpatient outer network, outpatient outer network, and in pharmacy and ER. So we were very comprehensive. We said, no higher deductibles, no higher copays, no higher premiums, and no lower lifetime caps. And we said that we had to measure your medical management because we knew that was an insidious way that insurance companies often, as we talked about earlier, impose much higher treatment thresholds for reimbursement for your care.
So I show up at Mayo, and I’d go to Mayo because if anyone found out I was at Mayo, they might think I had a real illness.
A “real” illness.
Yeah. Because of course, if they found out that I was down the street along, by the way, the margins of the Mayo campus at the Generose building where all the drug addicts and people with mental illness went, they might not have the same sympathetic judgment.
I’m just so struck by the fact that at the same time that you were pushing for this groundbreaking legislation, you were secretly seeking treatment for addiction yourself, and on vacation at the Mayo Clinic so that nobody would find out. It’s almost schizophrenic.
Yeah. Well, as those of us who’ve been through this know, the specific characteristic of someone with mental illness and addiction is they lack insight. In other words, they don’t appreciate the severity of their illness, and they don’t see themselves as suffering as much as they are suffering. They justify it. They develop a denial that becomes impenetrable in many respects. And so these kind of sneaky ways to go around acknowledging the real truth become a second way of life. And so I lacked this. I should have said, “This is really strange. I’m supposed to be the one that says, ‘I’m more than happy to be getting this treatment. It’s a chronic illness, and I should be getting treated. It will make me a stronger person.'” Instead, I had that negative view, even though I was the primary sponsor of the Mental Health Parity and Addiction Equity Act. So it does say it all in a sense.
Yeah. You were talking about the fact that doctors need to include family histories of addiction and mental health in their… I know my doctor asks me, “Heart disease, family cancer.” And in the book you wrote, A Common Struggle, you talk very honestly and openly about your struggle with addiction. Your mother was an alcoholic. You say your father was an alcoholic, the great senator Ted Kennedy. And I was so struck by the fact that you said in this book that you were drinking heavily by the time you were 13 years old, that you used to fill up water bottles with vodka.
Well, as you said, I grew up in an alcoholic household and it was part of the culture. The surroundings that I was in there were lots of parties, cocktail parties. My brother and sister were six and seven years older than me, so their peers would be hanging around, not my peers. So I was exposed earlier than most to that type of drinking and drugging.
I will say, in terms of secrecy, I really felt that this was a secret, even though it was widely reported that both my parents suffered, and Lord knows you could appreciate why given all the trauma that they had both experienced in their lives, and the fact that their family members had also suffered from these illnesses. So my grandmother on my mom’s side died alone and wasn’t found for a week because she had so isolated herself from my grandfather, who by the way, she had divorced in the ’50s, which was totally unheard of back then. And so many of my cousins on my mom’s side have suffered from this.
So it’s just amazing that I wanted to keep all of this secret until one day I’m walking through the bookstore, and of course I look at the Kennedy section of the bookstore. And I leaf through a couple of the quote “exposés” on my family, and they’re replete with all the things that I thought I was keeping a secret. So part of the pervasive aspect of these illnesses is that we still think that we’re hiding them, that we’re keeping them secret, and that silence is the best approach.
You went to rehab for the first time when you were 17 years old. There must’ve been family conversations about that. You talk about the secrecy and nobody talking about the elephant in the room, but surely there must’ve been some conversations in your family? Your mom and dad must’ve said, “Whoa, you’re out of control. We’re going to send you to get help.” Did they?
So I had been up for about four days straight on cocaine and alcohol, and obviously I lost my mind at the end and called my parents. And of course, spilled my guts in a way that I was never otherwise able to do without totally destroying every inhibition that I had about sharing how I felt. And of course, I was a mess. And I think my parents immediately turned me off because that’s what you do in order for them to cope with the idea that their child is suffering. That’s not easy for them to deal with. And they basically had people get me into treatment. And hadn’t really, afterwards had much interaction with me for quite some time. It was like I had disappointed them, and I felt that way.
Really. You felt like you had disappointed them?
Yeah.
Even though, I mean Patrick, your mom was very publicly struggling with the same disease.
Yes. And frankly, at the time, and my dad had had convened all the best medical experts when my brother Ted had bone cancer. And he had done the same for my mom, and he did it for me. And basically the consensus was I was genetically front-loaded for addiction and alcoholism. And on top of that, clearly I grew up in a family that had real after effects of a lot of trauma and family addiction. So it was kind of a perfect storm.
And their prognosis was that I was going to struggle like my mother had. And of course, my mother had been so pinpointed as this is what happens. She constantly felt like a disappointment in my family because she never was able to really piece time together until in the ’80s. And then she had continued difficulty. But in other words, four DWIs in the period of a year, and falling downstairs, and being picked up on Boston curbsides. And by the way, not wanting to go to treatment again. And my brother and sister and I had to go to court and get a commitment and guardianship for our mother in order to save her life.
But the point is that that was the frame of reference that my father had with respect to me. And I kind of felt like he said, “Well, this is going to be a grind.” And I think for his own mental health, he probably just withdrew. Fortunately for me, in some respects, I was successful. I did ultimately get a relationship with my father, albeit it was built in part because of my professional interaction with him when I got to Congress. But that helped me because when he ultimately passed away, our relationship had changed. I wasn’t stuck as an adolescent, which could have been the way he looked at me for the rest of his life. He saw me increasingly as my own man, even though he knew I was dealing with things. He also saw that I was a success in quote “the family business”. And I think he respected that.
In fact, I know that at the very end of his life, he did tell me that he was actually very proud of the work I’d done on mental health and addiction. That was the closest he ever came to actually talking about mental health and addiction, was because I actually had to negotiate with my father to get the Mental Health Parity and Addiction Equity Act passed. He was the chairman of the Senate Committee that was negotiating with the House Committee, which Jim Ranson and I were leading on the parity law. And the irony is the House version covered all the problems that my family had, addiction, depression, anxiety, trauma, and the Senate version only covered quote unquote “serious mental illness”, schizophrenia, bipolar, and the like. And we had to come to a consensus and there wasn’t a consensus.
But Patrick, I want to go back to something you just said, really striking, that your dad didn’t talk to you about your addiction until you were talking to him about this bill? All those years you suffered without your father, and talking about this enormous issue, and it wasn’t until you were trying to negotiate the parity act that the two of you talked about it?
Well, what happened was when we were fighting for the parity law on the house side, I ultimately obviously shared my own experience, partly not out of personal courage at stepping forward, but because I got arrested for a DWI and was flashed all over the papers. And I’d already been a champion for parity, so when I continued to fight for it, they wrote a story about me making this cause personal, which wasn’t quite accurate. I had already been fighting for it for years. It wasn’t a response to my DWI.
But my dad did not like the article that ran on the front page of the New York Times where I basically talked about coming from an alcoholic family, and that this was a family illness, and we were all affected by it. And of course, I had inherited it in some respects because these are genetic illnesses. And all the science tells us that they’re just, if not more, genetic than many other physical illnesses. And of course we weren’t supposed to talk about it. And he was very upset about that.
But as I said, one thing that I can give him credit for is that he worked on changing those attitudes. As I said, at the end of his life, he really saw the value of the parity law, and he really respected political achievement. So I’m not sure whether he necessarily was willing to talk about it on an interpersonal level, but he was sure proud that I had accomplished something big. That’s how he called it. He said, “Patrick, you’ve really done something big.” So that was the best I could get, but it was still better than nothing. And I’ll take it.
You’ll take it.
You are now working very hard to help people find good care, care that works, care that’s based on evidence-based research. The Kennedy Forum has done great work in trying to break the stigma. How much of an impact do you think you’ve been able to make? And how much more is there yet to do?
I was struck. A friend of mine is in recovery and is a breast cancer survivor. And she said, “I’ll take breast cancer any day. Because when you have breast cancer, everybody gathers around you, and brings you food baskets, and offers to take you to chemotherapy, and all the things that people do to support you. And even if it comes back once, twice, three times, they’re still all there for you.” She said, “When I was struggling with addiction, I was all on my own.”
Well, I was actually kind of lucky in the sense that I couldn’t struggle with it alone. It was everywhere I went. Everybody looked at me and it was like I had alcoholic tattooed on my forehead. So I had to address the elephant in the room, especially after my DWI.
I was running for reelection, and this guy started walking towards the polling place. And it was about 10 o’clock, so the big rush in the morning had already subsided. And I knew he didn’t like me because Rhode Island, we know everybody. And I didn’t want to say hi to him because I knew he was going to chew me out on something. But he came up to me, he said, “Patrick, I’ve never voted for you.” And I’m like, “Okay, just go in and do the vote.” He said, “But this election I’m going to vote for you.” And I stopped, stunned. And he said, “Because I got to thinking. I’ve got alcoholism in my family and something needs to be done about it on a national level. And if anyone can understand it, I believe you can. And so I’m going to vote for you in this election.”
It was 10:30 that morning in Warren, Rhode Island, and I knew I’d already won the election even though I’d had a DWI. In fact, I ended up winning that election by nearly 70% of the vote, the highest plurality of my whole congressional career came a year after I got a DWI. So I’m not saying that that’s the ticket to success, but it really did illustrate that my constituents ultimately backed me up. And if they hadn’t reelected me, we didn’t get the parity law passed until the next session. And it wasn’t my doing, but it was the fact that I knew Chris Dodd and the fact that Chris Dodd knew my dad, which is the reason we got the parity law. So if my constituents hadn’t voted for me, that bill wouldn’t have been passed.
And when I retired, because I knew I was still struggling and I needed to get out of Congress, I went around my congressional district and I thanked all of them for being there for me, not just politically, but it’s so personal when you’re in a small state like that. And I felt such a sense of satisfaction of being able to tell them that I was glad that they stuck with me because I was trying in some way to make it right, that they had taken a risk on me by supporting me.
And it was a really nice way to wrap up your political career. And obviously I still feel very connected with all my old neighbors and constituents. And I was lucky, unlike many people, I didn’t leave under a cloud of shame and scandal. I knew that was coming if I didn’t get out of Congress. But fortunately, I got out just before it hit me again.
Because you were still struggling with addiction?
I was still struggling, and I had that moment of clarity, but my cousin, Chris Lawford, wrote a book about called A Moment of Clarity-
I read it.
… And I send it to everybody who wants to read great stories.
And it said to me, listen, I can’t stay here. I’m in too much trouble. And I told one other person that that thought had entered my mind. And they jumped on it and they said, “You’ve got to talk to Nancy Pelosi and tell her.” I said, “I’m just talking it over with you. I haven’t made up my mind.” “Well, you’ve got to at least tell her you’re thinking about it because she loves your family and she loves you.” And I said, “Okay.” I wasn’t really thinking.
I saw Nancy less than an hour later. I said, “Madam Speaker, I have to talk to you.” She said, “Come by for breakfast in the morning.” I came by in the morning, went into her office, and she looked at me, she said, “What can I do for you?” And I burst into tears, and it was at that moment I said, “I’m not running.”
So first time I ever said I wasn’t running was to the speaker of the House. And then I said to her that I needed her help to make sure that when I announced that I wasn’t going to run, that it wasn’t going to be a story about all of my problems. But so what we did is she basically engineered the fact that I did a political ad announcing my retirement on my terms, as opposed to having all your former colleagues and colleagues from the media world descend upon me with the announcement. I put everything I wanted to say in that ad and then let it roll. And the ad set everything for itself. And I didn’t have to look like I was barraged and that there was this cloud of scandal over my head.
Why do you think you had that emotional reaction to Speaker Pelosi that morning?
I think what it was is I said to her, because I used to be chairman of the Democratic Congressional Campaign Committee, which meant I was in charge of making sure there were enough candidates to run for office. And my seat had previously been held by a Republican. And I was thinking very shallow. As I said, I didn’t really have a good perspective. I said to her, “I want you to know we’re going to hold the seat. Don’t worry, I’m going to make sure that…” and she said to me, “I don’t care a thing about that seat, I care about you.” And I knew she meant it, because after my DWI, when I was heading back to treatment, she called me on my cell phone. She said, “We all love you. We’re going to be here when you get back. You get the help.” No, “You ought to think of resigning,” none of that stuff.
And ironically, they had a very important vote. I had to go to the vote even though I was in rehab. So I had a little day pass. This wasn’t Mayo. I was out of this great place called Havre de Grace, Maryland. Drove to the Capitol, cast my vote, and Nancy was there, and said, “Now you can go back to rehab.” It was basically, “Okay, we got your vote. Go back and get help.”
So anyway, we had had a very close personal connection. She obviously very close to many other members of my family, so it was very moving for me.
It sounds in that moment that she was very maternal toward you?
Yeah, I had known her my whole life. When I was growing up, we’d stay at her house when we went out to California before she was even a member of Congress. And so as I said, I knew her very well. So it was more than just, she’s my Speaker.
Right. But you’ve also spoken just now about the fact that your family didn’t discuss such things. And it sounds like she was the person who was there, and held that, and held you in that, in that crisis, and was very comforting?
Very. She basically said, “I won’t tell anyone. I’ll get this thing set up. I’ll tell everybody that you got to do this CODEL on my behalf. It’s a congressional delegation trip. So because if I read the word to staff, it would get out, no time. You have that now, time to do that ad. Once you get it done, you can move on. So she really was very practical in her support for me, and very supportive, just in general, and personally.
So that all meant a lot to me. Because it could have gone down in any number of other ways that would’ve permanently affected my life and my post congressional career. Because I was able to leave on my own terms and then dive into recovery after I left, and then subsequently build my life back as an advocate as I got some sobriety myself. That would’ve been difficult to do had I just been tarnished with this image of me as a scandal. So I was very, very blessed.
How do you stay sober?
I go to meetings every day. Now during Covid, I Zoom with my fellow drudgers every morning at 7:30. And then I have a couple other meetings that are international 24/7. Fantastic. It’s amazing. I’m listening to people from India, Ireland, and all over the place. And it’s good. And I obviously keep in touch with my sponsor. And I have a couple of close friends, some close trusted friends who I can really talk to about what’s going on.
The person that I was really most close to was my cousin, Chris Lawford, because being a member of my family, having walked this road of recovery, and dealt with all the interpersonal issues of my family, knowing intuitively the stuff that I was grappling with, and knowing my dad, and knowing my mom, knowing the whole family dynamic, he was indispensable to me in my early recovery when I was all over the board emotionally. He really was a central part of my success today.
And I always think about him and am grateful that he was in my life when he was. And again, that didn’t need to happen. And if that hadn’t happened, who’s to say whether I’d even be able to this interview today. Because some people just have that pivotal impact on you that sets you on a different trajectory. And he clearly was that person in my life.
Thank you so much for talking to us today. And thank you for your work in Congress on behalf of all those who seek treatment for addiction and mental health, because the Parity Act is, at least as it stands on the books, gives us a fighting chance at getting the help we need to pay for that treatment. Thanks so much.
Well, I appreciate your interview, Elizabeth. Thank you for getting these issues out, having people be able to learn more about it. thekennedyforum.org is one of those websites that they can learn a lot more about this movement.
All right. You can find this podcast on Apple Podcast, Spotify, and our website at drugfree.org/podcast. And if you want to learn more about Patrick Kennedy and his work, visit patrickkennedy.net.
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.