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TEDxMidAtlantic

Michael Botticelli: Addiction is a disease. We should treat it like one

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Only one in nine people in the United States gets the care and treatment they need for addiction and substance abuse. A former Director of National Drug Control Policy, Michael Botticelli is working to end this epidemic and treat people with addictions with kindness, compassion and fairness. In a personal, thoughtful talk, he encourages the millions of Americans in recovery today to make their voices heard and confront the stigma associated with substance use disorders.

- Drug policy expert
As Director of National Drug Control Policy, Michael Botticelli led the Obama Administration’s drug policy efforts to diminish the consequences of substance use through evidence-based prevention, treatment and recovery support services. Full bio

Twenty-eight years ago,
I was a broken man.
00:13
And you probably wouldn't be able
to tell that if you met me.
00:16
I had a good job at a well-respected
academic institution.
00:20
I dressed well, of course.
00:24
But my insides were rotting away.
00:27
You see, I grew up in a family
riddled with addiction,
00:30
and as a kid, I also struggled
00:34
with coming to terms
with my own sexuality.
00:36
And even though I couldn't name it then,
00:38
growing up as a gay kid
00:41
just compounded my issues
of isolation and insecurities.
00:43
But drinking took all of that away.
00:48
Like many, I drank at an early age.
00:52
I continued to drink
my way through college.
00:56
And when I finally did come out
in the early 1980s,
00:59
about the only places
to meet other gay people,
01:02
to socialize,
01:05
to be yourself, were gay bars.
01:07
And what do you do in gay bars?
01:10
You drink.
01:12
And I did --
01:14
a lot.
01:15
My story is not unique.
01:17
Like millions of Americans,
my disease progressed undiagnosed.
01:19
It took me to people
and places and things
01:24
that I never would have chosen.
01:26
It wasn't until
an intersection with the law
01:29
gave me an "opportunity" to get care,
01:32
that I began my journey of recovery.
01:35
My journey of recovery
has been filled with love and with joy,
01:39
but it hasn't been without pain.
01:43
Like many of you, I've lost too many
friends and family to this disease.
01:45
I've heard too many
heartbreaking stories
01:49
of people who've lost
loved ones to addiction.
01:51
And I've also lost
countless friends to HIV and AIDS.
01:54
Our current opioid epidemic
and the AIDS epidemic
01:59
tragically have much in common.
02:02
Right now, we are in the midst of one
of the greatest health crises of our time.
02:06
During 2014 alone, 28,000 people
02:11
died of drug overdoses associated
with prescription drugs and heroin.
02:15
During the 1980s, scores of people
were dying from HIV and AIDS.
02:22
Public officials ignored it.
02:27
Some wouldn't even utter the words.
02:30
They didn't want treatment.
02:33
And tragically, there are many parallels
with our current epidemic.
02:36
Some called it the gay plague.
02:40
They called for quarantines.
02:43
They wanted to separate
the innocent victims from the rest of us.
02:46
I was afraid we were losing this battle
02:52
because people were
blaming us for being sick.
02:54
Public policy was being held hostage
by stigma and fear,
02:58
and also held hostage
03:03
were compassion, care,
research, recovery and treatment.
03:05
But we changed all that.
03:11
Because out of the pain of those deaths,
03:14
we saw a social and political movement.
03:17
AIDS galvanized us into action;
03:20
to stand up, to speak up and to act out.
03:24
And it also galvanized
the LGBT movement.
03:30
We knew we were
in a battle for our lives
03:34
because silence equaled death,
03:36
but we changed,
and we made things happen.
03:38
And right now, we have the potential
03:42
to see the end of HIV/AIDS
in our lifetime.
03:45
These changes came in no small part
03:50
by the courageous, yet simple decision
03:53
for people to come out
03:57
to their neighbors,
to their friends, to their families
03:59
and to their coworkers.
04:05
Years ago, I was a volunteer
for the Names Project.
04:08
This was an effort started
by Cleve Jones in San Francisco
04:12
to show that people who died of AIDS
04:15
had names
04:17
and faces and families
04:19
and people who loved them.
04:23
I still recall unfolding
the AIDS memorial quilt
04:27
on the National Mall
on a brilliant day in October, 1988.
04:32
So fast forward to 2015.
04:43
The Supreme Court's decision to strike
down the ban on same-sex marriage.
04:46
My husband, Dave, and I walk over
to the steps of the Supreme Court
04:51
to celebrate that decision
with so many other people,
04:54
and I couldn't help but think
how far we came around LGBT rights
04:57
and yet how far we needed to go
around issues of addiction.
05:03
When I was nominated
by President Obama
05:10
to be his Director of Drug Policy,
05:12
I was very open about my recovery
and about the fact that I was a gay man.
05:14
And at no point during
my confirmation process --
05:18
at least that I know of --
05:21
did the fact that I was a gay man
come to bear on my candidacy
05:22
or my fitness to do this job.
05:26
But my addiction did.
05:29
At one point, a congressional staffer
said that there was no way
05:32
that I was going to be confirmed
by the United States Senate
05:36
because of my past,
05:39
despite the fact that I had been
in recovery for over 20 years,
05:40
and despite the fact
05:44
that this job takes a little bit
of knowledge around addiction.
05:45
(Laughter)
05:48
So, you know, this is the stigma
05:51
that people with
substance use disorders
05:54
face every single day,
05:56
and you know, I have to tell you
05:58
it's still why I'm more comfortable
coming out as a gay man
06:00
than I am as a person
with a history of addiction.
06:03
Nearly every family in America
is affected by addiction.
06:07
Yet, unfortunately, too often,
it's not talked about openly and honestly.
06:11
It's whispered about.
06:18
It's met with derision and scorn.
06:19
We hear these stories,
time and time again, on TV, online,
06:23
we hear it from public officials,
and we hear it from family and friends.
06:28
And those of us with an addiction,
we hear those voices,
06:33
and somehow we believe that we are
less deserving of care and treatment.
06:37
Today in the United States,
only one in nine people
06:43
get care and treatment for their disorder.
06:46
One in nine.
06:49
Think about that.
06:50
Generally, people with other diseases
get care and treatment.
06:52
If you have cancer, you get treatment,
06:55
if you have diabetes, you get treatment.
06:57
If you have a heart attack,
06:59
you get emergency services,
and you get referred to care.
07:01
But somehow people with addiction
have to wait for treatment
07:05
or often can't get when they need it.
07:08
And left untreated, addiction
has significant, dire consequences.
07:11
And for many people
that means death or incarceration.
07:16
We've been down that road before.
07:21
For too long our country felt
07:23
like we could arrest our way
out of this problem.
07:24
But we know that we can't.
07:27
Decades of scientific research has shown
07:30
that this is a medical issue --
07:33
that this is a chronic medical condition
07:35
that people inherit
and that people develop.
07:37
So the Obama administration
has taken a different tack on drug policy.
07:42
We've developed and implemented
a comprehensive plan
07:46
to expand prevention services,
treatment services,
07:49
early intervention and recovery support.
07:52
We've pushed criminal justice reform.
07:56
We've knocked down barriers
to give people second chances.
07:59
We see public health and public safety
officials working hand in hand
08:02
at the community level.
08:06
We see police chiefs across the country
guiding people to treatment
08:08
instead of jail and incarceration.
08:11
We see law enforcement
and other first responders
08:14
reversing overdoses with naloxone
to give people a second chance for care.
08:17
The Affordable Care Act
is the biggest expansion
08:23
of substance use disorder
treatment in a generation,
08:26
and it also calls for the integration
of treatment services within primary care.
08:29
But fundamentally,
all of this work is not enough.
08:36
Unless we change the way
that we view people with addiction
08:40
in the United States.
08:44
Years ago when I finally
understood that I had a problem
08:47
and I knew that I needed help,
08:51
I was too afraid to ask for it.
08:53
I felt that people would think
I was stupid, that I was weak-willed,
08:56
that I was morally flawed.
09:01
But I talk about my recovery
because I want to make change.
09:05
I want us to see that we need to be open
and candid about who we are
09:10
and what we can do.
09:16
I am public about my own recovery
09:18
not to be self-congratulatory.
09:20
I am open about my own recovery
to change public opinion,
09:23
to change public policy
09:27
and to change the course of this epidemic
and empower the millions of Americans
09:29
who struggle with this journey
09:33
to be open and candid
about who they are.
09:35
People are more than their disease.
09:38
And all of us have the opportunity
to change public opinion
09:41
and to change public policy.
09:45
All of us know someone
who has an addiction,
09:48
and all of us can do our part
09:51
to change how we view people
with addiction in the United States.
09:53
So when you see
someone with an addiction,
09:58
don't think of a drunk or a junkie
or an addict or an abuser --
10:00
see a person;
10:07
offer them help;
10:10
give them kindness and compassion.
10:11
And together, we can be part
10:14
of a growing movement
in the United States
10:16
to change how we view
people with addiction.
10:18
Together we can change public policy.
10:21
We can ensure that people
get care when they need it,
10:24
just like any other disease.
10:28
We can be part of a growing,
unstoppable movement
10:31
to have millions of Americans
enter recovery,
10:34
and put an end to this epidemic.
10:37
Thank you very much.
10:39
(Applause)
10:41

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About the Speaker:

Michael Botticelli - Drug policy expert
As Director of National Drug Control Policy, Michael Botticelli led the Obama Administration’s drug policy efforts to diminish the consequences of substance use through evidence-based prevention, treatment and recovery support services.

Why you should listen

Michael Botticelli was sworn in as Director of National Drug Control Policy at the White House on February 11, 2015, after being unanimously confirmed by the Senate. He joined the White House Office of National Drug Control Policy (ONDCP) as Deputy Director in November 2012 and later served as Acting Director. He is currently the Executive Director of the Grayken Center for Addiction Medicine at Boston Medical Center and also a Distinguished Policy Scholar at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

As Director of National Drug Control Policy, Botticelli led the Obama Administration's drug policy efforts, which are based on a balanced public health and public safety approach. The Administration advanced historic drug policy reforms and innovations in prevention, criminal justice, treatment and recovery.

In response to the national opioid epidemic, Botticelli coordinated actions across the Federal government to reduce prescription drug abuse, heroin use and related overdoses. These include supporting community-based prevention efforts; educating prescribers and the public about preventing prescription drug abuse; expanding use of the life-saving overdose-reversal drug naloxone by law enforcement and other first responders; and increasing access to medication-assisted treatment and recovery support services to help individuals sustain their recovery from opioid use disorders.

Botticelli has more than two decades of experience supporting Americans affected by substance use disorders. Prior to joining ONDCP, he served as Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, where he successfully expanded innovative and nationally recognized prevention, intervention, treatment and recovery services for the Commonwealth of Massachusetts. He also forged strong partnerships with local, state and Federal law enforcement agencies; state and local health and human service agencies; and stakeholder groups to guide and implement evidence-based programs.

Botticelli has served in a variety of leadership roles for the National Association of State Alcohol and Drug Abuse Directors. He was a member of the Advisory Committee for the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and the National Action Alliance for Suicide Prevention. He has also co-authored many peer-reviewed articles that have significantly contributed to the field.

Born in Upstate New York, Botticelli holds a Bachelor of Arts degree from Siena College and a Master of Education degree from St. Lawrence University. He is also in long-term recovery from a substance use disorder, celebrating more than 28 years of recovery.

More profile about the speaker
Michael Botticelli | Speaker | TED.com