TEDxMidAtlantic
Michael Botticelli: Addiction is a disease. We should treat it like one
邁可·波提切利: 成癮是一種疾病，我們應該給予治療。
Filmed:
Readability: 4
1,620,936 views
在美國，只有九分之一的物質濫用與成癮者，能得到所需要的照顧和治療。前任國家毒品管制政策主任邁可·波提切利，正在致力於結束物質成癮的流行，並且以友善、同情和公平的方式對待成癮者。在這場講述親身經歷，而引人深思的演說中，他鼓勵數百萬的美國人踏上戒癮之路，讓自己的聲音被聽見，並且勇敢面對物質濫用相關的污名。
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. Full bio
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
Double-click the English transcript below to play the video.
二十八年前，我的內心充滿絕望。
00:13
Twenty-eight years ago,
I was a broken man.
I was a broken man.
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00:16
And you probably wouldn't be able
to tell that if you met me.
to tell that if you met me.
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但是當你遇見我時，
可能根本看不出來。
可能根本看不出來。
00:20
I had a good job at a well-respected
academic institution.
academic institution.
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我有一份很好的工作，
任職於受人尊敬的學術機構。
任職於受人尊敬的學術機構。
00:24
I dressed well, of course.
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當然，我的外表光鮮亮麗。
00:27
But my insides were rotting away.
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但是我的內心腐朽不堪。
00:30
You see, I grew up in a family
riddled with addiction,
riddled with addiction,
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我生長在一個
充滿物質成癮的家庭，
充滿物質成癮的家庭，
00:34
and as a kid, I also struggled
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在孩童時期，
我也因為自己的性傾向
我也因為自己的性傾向
00:36
with coming to terms
with my own sexuality.
with my own sexuality.
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而內心充滿掙扎。
00:38
And even though I couldn't name it then,
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儘管當時的我，
並不知道這是怎麼回事，
並不知道這是怎麼回事，
但是身為一個同性戀者，
00:41
growing up as a gay kid
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成長只是加劇了我的孤立和不安。
00:43
just compounded my issues
of isolation and insecurities.
of isolation and insecurities.
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但是喝酒，能帶走這些感覺。
00:48
But drinking took all of that away.
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00:52
Like many, I drank at an early age.
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和許多人一樣，我很早就開始喝酒。
我的整個大學生涯，也持續在喝酒。
00:56
I continued to drink
my way through college.
my way through college.
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在 80 年代初期，我終於決定出櫃，
00:59
And when I finally did come out
in the early 1980s,
in the early 1980s,
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01:02
about the only places
to meet other gay people,
to meet other gay people,
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而當時只有在同性戀酒吧，
才能遇到其他同性戀者，
才能遇到其他同性戀者，
01:05
to socialize,
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與他人來往，
或是作回我自己。
01:07
to be yourself, were gay bars.
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01:10
And what do you do in gay bars?
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你在同性戀酒吧會做什麼？
01:12
You drink.
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喝酒。
我也是，
01:14
And I did --
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而且喝了很多。
01:15
a lot.
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01:17
My story is not unique.
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我的故事並不獨特。
01:19
Like millions of Americans,
my disease progressed undiagnosed.
my disease progressed undiagnosed.
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就和數百萬計的美國人一樣，
我的酒癮在不知不覺中逐漸惡化。
我的酒癮在不知不覺中逐漸惡化。
01:24
It took me to people
and places and things
and places and things
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它把我帶領到，
我絕對不想選擇的人、地和事物。
01:26
that I never would have chosen.
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01:29
It wasn't until
an intersection with the law
an intersection with the law
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直到我觸犯法律，
01:32
gave me an "opportunity" to get care,
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給了我一個接受治療的「機會」，
於是開始了我的戒除成癮之旅。
01:35
that I began my journey of recovery.
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01:39
My journey of recovery
has been filled with love and with joy,
has been filled with love and with joy,
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我的戒癮之旅充滿了愛和喜悅，
01:43
but it hasn't been without pain.
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但它並非沒有痛苦。
01:45
Like many of you, I've lost too many
friends and family to this disease.
friends and family to this disease.
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和你們當中的許多人一樣，
成癮問題讓我失去太多朋友和家人，
成癮問題讓我失去太多朋友和家人，
我聽過太多人的心碎故事，
01:49
I've heard too many
heartbreaking stories
heartbreaking stories
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01:51
of people who've lost
loved ones to addiction.
loved ones to addiction.
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都是由於物質成癮，
而失去所愛的人。
而失去所愛的人。
01:54
And I've also lost
countless friends to HIV and AIDS.
countless friends to HIV and AIDS.
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我也有數不清的朋友
感染愛滋病毒和愛滋病而死。
感染愛滋病毒和愛滋病而死。
01:59
Our current opioid epidemic
and the AIDS epidemic
and the AIDS epidemic
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不幸的是，我們目前的
鴉片成癮和愛滋病，
鴉片成癮和愛滋病，
02:02
tragically have much in common.
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兩者擁有許多共同之處。
02:06
Right now, we are in the midst of one
of the greatest health crises of our time.
of the greatest health crises of our time.
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現在，我們正處於
當代最大的健康危機之中。
當代最大的健康危機之中。
02:11
During 2014 alone, 28,000 people
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光是在 2014 年，就有 28000 人
02:15
died of drug overdoses associated
with prescription drugs and heroin.
with prescription drugs and heroin.
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由於過量使用處方藥
和海洛因導致死亡。
和海洛因導致死亡。
02:22
During the 1980s, scores of people
were dying from HIV and AIDS.
were dying from HIV and AIDS.
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在 1980 年代，很多人因
感染愛滋病毒和愛滋病而死亡。
感染愛滋病毒和愛滋病而死亡。
02:27
Public officials ignored it.
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政府官員視而不見。
有些官員甚至避而不談。
02:30
Some wouldn't even utter the words.
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他們不想面對。
02:33
They didn't want treatment.
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02:36
And tragically, there are many parallels
with our current epidemic.
with our current epidemic.
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而可悲的是，這與目前
物質成癮的流行有許多相似之處。
物質成癮的流行有許多相似之處。
02:40
Some called it the gay plague.
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有些人將同性戀視為瘟疫。
他們要求隔離同性戀者。
02:43
They called for quarantines.
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02:46
They wanted to separate
the innocent victims from the rest of us.
the innocent victims from the rest of us.
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他們希望將這些無辜的犧牲者
與其他的民眾隔離。
與其他的民眾隔離。
我很擔心我們正在從
這場戰役中落敗，
這場戰役中落敗，
02:52
I was afraid we were losing this battle
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02:54
because people were
blaming us for being sick.
blaming us for being sick.
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因為人們責怪我們帶來疾病。
羞辱和恐懼
02:58
Public policy was being held hostage
by stigma and fear,
by stigma and fear,
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不止綁架了公共政策，
03:03
and also held hostage
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也綁架了同情，關懷，
研究，戒癮和治療。
研究，戒癮和治療。
03:05
were compassion, care,
research, recovery and treatment.
research, recovery and treatment.
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但是，我們改變了這一切。
03:11
But we changed all that.
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03:14
Because out of the pain of those deaths,
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因為從這些生離死別的痛苦中，
我們看到了
社會和政治運動正在興起。
社會和政治運動正在興起。
03:17
we saw a social and political movement.
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03:20
AIDS galvanized us into action;
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愛滋病促使我們行動，
讓我們站起來，大聲說出口，
並付諸行動。
並付諸行動。
03:24
to stand up, to speak up and to act out.
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03:30
And it also galvanized
the LGBT movement.
the LGBT movement.
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而這也激勵了同志文化運動。
03:34
We knew we were
in a battle for our lives
in a battle for our lives
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我們知道，我們正在為
自己的生命而戰鬥，
自己的生命而戰鬥，
03:36
because silence equaled death,
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因為沉默等於死亡；
03:38
but we changed,
and we made things happen.
and we made things happen.
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但我們要改變，我們要讓改變發生。
03:42
And right now, we have the potential
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而現在，我們有希望看到
愛滋病毒及愛滋病
愛滋病毒及愛滋病
03:45
to see the end of HIV/AIDS
in our lifetime.
in our lifetime.
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在我們有生之年消失。
03:50
These changes came in no small part
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這些改變，是由一大群人
03:53
by the courageous, yet simple decision
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作出一項勇敢卻簡單的決定：
03:57
for people to come out
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他們公開宣告出櫃，
03:59
to their neighbors,
to their friends, to their families
to their friends, to their families
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直接面對他們的鄰居、
他們的朋友、他們的家人，
他們的朋友、他們的家人，
以及他們的同事。
04:05
and to their coworkers.
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04:08
Years ago, I was a volunteer
for the Names Project.
for the Names Project.
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好幾年前，
我是「名冊計劃」的志工。
我是「名冊計劃」的志工。
04:12
This was an effort started
by Cleve Jones in San Francisco
by Cleve Jones in San Francisco
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這項由克利夫·瓊斯
在舊金山發起的活動，
在舊金山發起的活動，
展示了死於愛滋病的患者
04:15
to show that people who died of AIDS
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04:17
had names
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他們的名字、
他們的臉孔、他們的家人
04:19
and faces and families
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以及喜愛他們的人。
04:23
and people who loved them.
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04:27
I still recall unfolding
the AIDS memorial quilt
the AIDS memorial quilt
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我還記得，當愛滋紀念拼布
在國家廣場展開時的情景，
在國家廣場展開時的情景，
04:32
on the National Mall
on a brilliant day in October, 1988.
on a brilliant day in October, 1988.
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那是在 1988 年 10 月，
充滿光輝的一天。
充滿光輝的一天。
04:43
So fast forward to 2015.
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接著我們很快來到 2015 年。
04:46
The Supreme Court's decision to strike
down the ban on same-sex marriage.
down the ban on same-sex marriage.
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根據最高法院的決定，
推翻了同性婚姻禁令。
推翻了同性婚姻禁令。
04:51
My husband, Dave, and I walk over
to the steps of the Supreme Court
to the steps of the Supreme Court
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我的丈夫戴夫，和我一起
走到最高法院外的階梯，
走到最高法院外的階梯，
和許多人一同慶祝這項決定，
04:54
to celebrate that decision
with so many other people,
with so many other people,
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04:57
and I couldn't help but think
how far we came around LGBT rights
how far we came around LGBT rights
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我忍不住想起，我們走了多遠的路，
來捍衛同志族群的權利；
來捍衛同志族群的權利；
05:03
and yet how far we needed to go
around issues of addiction.
around issues of addiction.
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而對於全國各地的成癮問題，
我們仍然有很遠的路要走。
我們仍然有很遠的路要走。
05:10
When I was nominated
by President Obama
by President Obama
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當我被歐巴馬總統提名，
05:12
to be his Director of Drug Policy,
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擔任他的毒品管制政策主任時，
05:14
I was very open about my recovery
and about the fact that I was a gay man.
and about the fact that I was a gay man.
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我完全公開了我的戒癮過程，
以及身為同性戀者的事實。
以及身為同性戀者的事實。
05:18
And at no point during
my confirmation process --
my confirmation process --
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在國會的審查過程中，
從頭到尾都沒有──
從頭到尾都沒有──
至少就我所知──
05:21
at least that I know of --
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05:22
did the fact that I was a gay man
come to bear on my candidacy
come to bear on my candidacy
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沒有因為我是同性戀者的事實
而影響我的候選資格，
而影響我的候選資格，
05:26
or my fitness to do this job.
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或者我擔任這項職務的能力。
但是我的成癮記錄卻受到質疑。
05:29
But my addiction did.
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05:32
At one point, a congressional staffer
said that there was no way
said that there was no way
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有一次，一名國會助理
表示「不可能」。
表示「不可能」。
05:36
that I was going to be confirmed
by the United States Senate
by the United States Senate
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由於我過去的成癮記錄，
我不可能通過
美國參議院的同意任命，
美國參議院的同意任命，
05:39
because of my past,
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05:40
despite the fact that I had been
in recovery for over 20 years,
in recovery for over 20 years,
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儘管事實上
我已經戒除成癮二十多年，
我已經戒除成癮二十多年，
儘管擔任這項職務，
05:44
and despite the fact
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需要對於成癮有一點瞭解。
05:45
that this job takes a little bit
of knowledge around addiction.
of knowledge around addiction.
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（笑聲）
05:48
(Laughter)
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05:51
So, you know, this is the stigma
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所以，你知道，
對於物質使用成癮的人來說，
05:54
that people with
substance use disorders
substance use disorders
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這是每一天都得面對的污名，
05:56
face every single day,
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05:58
and you know, I have to tell you
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而且你知道嗎？我必須告訴你，
06:00
it's still why I'm more comfortable
coming out as a gay man
coming out as a gay man
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這就是為什麼我覺得
出櫃承認自己是同性戀，
出櫃承認自己是同性戀，
會比承認自己的成癮歷史，
來得舒服一些。
來得舒服一些。
06:03
than I am as a person
with a history of addiction.
with a history of addiction.
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06:07
Nearly every family in America
is affected by addiction.
is affected by addiction.
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幾乎每個美國家庭，
都受到物質成癮的影響。
都受到物質成癮的影響。
然而，不幸的是，很多時候，
這個話題無法被開誠佈公地討論。
這個話題無法被開誠佈公地討論。
06:11
Yet, unfortunately, too often,
it's not talked about openly and honestly.
it's not talked about openly and honestly.
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06:18
It's whispered about.
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它只能在私底下討論。
06:19
It's met with derision and scorn.
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它還遭受到嘲諷和鄙視。
一次又一次，
我們從電視上、網路上、
我們從電視上、網路上、
06:23
We hear these stories,
time and time again, on TV, online,
time and time again, on TV, online,
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從政府官員，或是家人和朋友口中，
聽到這些故事。
聽到這些故事。
06:28
we hear it from public officials,
and we hear it from family and friends.
and we hear it from family and friends.
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06:33
And those of us with an addiction,
we hear those voices,
we hear those voices,
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對於我們這些成癮者來說，
不知為何，這些聲音卻讓我們相信，
我們並不值得受到照顧和治療。
我們並不值得受到照顧和治療。
06:37
and somehow we believe that we are
less deserving of care and treatment.
less deserving of care and treatment.
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06:43
Today in the United States,
only one in nine people
only one in nine people
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如今在美國，九個成癮者當中，
06:46
get care and treatment for their disorder.
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只有一位能得到照顧和治療。
只有 1/9。
06:49
One in nine.
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06:50
Think about that.
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想想看。
06:52
Generally, people with other diseases
get care and treatment.
get care and treatment.
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一般來說，人們得到其他疾病，
都能得到照顧和治療。
都能得到照顧和治療。
06:55
If you have cancer, you get treatment,
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如果你有癌症，你得到治療；
06:57
if you have diabetes, you get treatment.
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如果你有糖尿病，你得到治療。
06:59
If you have a heart attack,
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如果你的心臟病發作，
你會接受急救，並且得到後續照顧。
07:01
you get emergency services,
and you get referred to care.
and you get referred to care.
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07:05
But somehow people with addiction
have to wait for treatment
have to wait for treatment
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但不知何故，成癮的人需要治療時，
他們必須等待，
甚至經常得不到治療。
甚至經常得不到治療。
07:08
or often can't get when they need it.
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07:11
And left untreated, addiction
has significant, dire consequences.
has significant, dire consequences.
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而成癮患者如果沒有即時接受治療，
將會造成嚴重、可怕的後果。
將會造成嚴重、可怕的後果。
07:16
And for many people
that means death or incarceration.
that means death or incarceration.
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對許多人來說，
結局就是死亡或被監禁。
結局就是死亡或被監禁。
07:21
We've been down that road before.
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我們一直走在這條道路上。
長期以來，我們的國家認為，
07:23
For too long our country felt
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07:24
like we could arrest our way
out of this problem.
out of this problem.
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我們可以藉由逮捕成癮者，
來解決這個問題。
來解決這個問題。
07:27
But we know that we can't.
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但我們很清楚，我們做不到。
07:30
Decades of scientific research has shown
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數十年來的科學研究顯示，
這是一個醫學問題──
07:33
that this is a medical issue --
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07:35
that this is a chronic medical condition
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這是一種慢性疾病，
而且一代傳一代，不斷地發展。
07:37
that people inherit
and that people develop.
and that people develop.
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07:42
So the Obama administration
has taken a different tack on drug policy.
has taken a different tack on drug policy.
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因此歐巴馬政府對於毒品管制政策，
採取了不同的方針。
採取了不同的方針。
07:46
We've developed and implemented
a comprehensive plan
a comprehensive plan
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我們制定並實施了更為廣泛的計畫，
包括擴大預防服務，治療服務，
07:49
to expand prevention services,
treatment services,
treatment services,
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07:52
early intervention and recovery support.
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早期介入，以及戒癮支持。
07:56
We've pushed criminal justice reform.
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我們推動刑事司法改革。
07:59
We've knocked down barriers
to give people second chances.
to give people second chances.
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我們排除萬難，給人們重生的機會。
08:02
We see public health and public safety
officials working hand in hand
officials working hand in hand
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我們看到，公共衛生與公共安全官員
在社區層面攜手合作。
08:06
at the community level.
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08:08
We see police chiefs across the country
guiding people to treatment
guiding people to treatment
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我們看到全國各地的警察局長，
引導人們進行治療，
引導人們進行治療，
08:11
instead of jail and incarceration.
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而不是將他們關進監牢。
我們看到執法部門
與第一線的急救人員，
與第一線的急救人員，
08:14
We see law enforcement
and other first responders
and other first responders
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使用納洛酮救回成癮者，
給他們後續治療、獲得重生的機會。
給他們後續治療、獲得重生的機會。
08:17
reversing overdoses with naloxone
to give people a second chance for care.
to give people a second chance for care.
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08:23
The Affordable Care Act
is the biggest expansion
is the biggest expansion
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歐巴馬的「可負擔健保法案」，
對於物質濫用成癮的治療，
是本世紀最大的突破，
是本世紀最大的突破，
08:26
of substance use disorder
treatment in a generation,
treatment in a generation,
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並且要求將成癮治療
納入基本的保險給付範圍。
納入基本的保險給付範圍。
08:29
and it also calls for the integration
of treatment services within primary care.
of treatment services within primary care.
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但是從根本來說，
所有這些工作仍然不夠。
所有這些工作仍然不夠。
08:36
But fundamentally,
all of this work is not enough.
all of this work is not enough.
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08:40
Unless we change the way
that we view people with addiction
that we view people with addiction
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除非我們能改變整個美國
看待成癮者的方式。
08:44
in the United States.
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08:47
Years ago when I finally
understood that I had a problem
understood that I had a problem
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幾年前，當我意識到我有問題時，
我知道我需要幫助，
08:51
and I knew that I needed help,
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08:53
I was too afraid to ask for it.
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但是我害怕尋求協助。
08:56
I felt that people would think
I was stupid, that I was weak-willed,
I was stupid, that I was weak-willed,
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我覺得人們會認為我很愚蠢，
意志薄弱，
意志薄弱，
09:01
that I was morally flawed.
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我在道德上是有缺陷的。
09:05
But I talk about my recovery
because I want to make change.
because I want to make change.
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但是，我會談論我是如何戒癮，
因為我想作出改變。
因為我想作出改變。
09:10
I want us to see that we need to be open
and candid about who we are
and candid about who we are
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我希望讓大家看到，
我們需要開誠佈公，說出我們是誰，
我們需要開誠佈公，說出我們是誰，
以及我們能做些什麼。
09:16
and what we can do.
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09:18
I am public about my own recovery
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我公開自己的戒癮過程，
09:20
not to be self-congratulatory.
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不是為了自我誇耀。
09:23
I am open about my own recovery
to change public opinion,
to change public opinion,
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我公開自己的戒癮過程，
是為了改變輿論，
是為了改變輿論，
09:27
to change public policy
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改變公共政策，
改變這個流行病的歷程，
改變這個流行病的歷程，
09:29
and to change the course of this epidemic
and empower the millions of Americans
and empower the millions of Americans
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並對於還在這條路上奮鬥的
數百萬美國人，
數百萬美國人，
給他們力量，
09:33
who struggle with this journey
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讓他們能坦率地說出自己是誰。
09:35
to be open and candid
about who they are.
about who they are.
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09:38
People are more than their disease.
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我們應該重視人，更勝於重視疾病。
09:41
And all of us have the opportunity
to change public opinion
to change public opinion
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我們大家都有機會
可以改變大眾的觀念，
可以改變大眾的觀念，
09:45
and to change public policy.
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改變公共政策。
09:48
All of us know someone
who has an addiction,
who has an addiction,
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我們所有人都知道哪些人成癮；
09:51
and all of us can do our part
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我們所有人，
都可以盡自己的一分力量，
都可以盡自己的一分力量，
09:53
to change how we view people
with addiction in the United States.
with addiction in the United States.
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改變美國看待成癮者的方式。
09:58
So when you see
someone with an addiction,
someone with an addiction,
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所以當你看到某位成癮者時，
不要只想到他是一位酒鬼、
煙毒犯、癮君子或是藥物濫用者，
煙毒犯、癮君子或是藥物濫用者，
10:00
don't think of a drunk or a junkie
or an addict or an abuser --
or an addict or an abuser --
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10:07
see a person;
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把他視為一個人，
10:10
offer them help;
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給他們幫助，
10:11
give them kindness and compassion.
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給他們友善和同情。
10:14
And together, we can be part
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同時，我們可以成為
美國正在持續增長的浪潮
當中的一份子，
當中的一份子，
10:16
of a growing movement
in the United States
in the United States
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10:18
to change how we view
people with addiction.
people with addiction.
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改變我們看待成癮者的方式。
10:21
Together we can change public policy.
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我們可以一起改變公共政策。
10:24
We can ensure that people
get care when they need it,
get care when they need it,
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我們可以確保
人們在需要時得到照顧，
人們在需要時得到照顧，
就像任何其他疾病一樣。
10:28
just like any other disease.
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10:31
We can be part of a growing,
unstoppable movement
unstoppable movement
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我們可以成為這股不斷增長、
無法阻擋浪潮的一份子，
無法阻擋浪潮的一份子，
10:34
to have millions of Americans
enter recovery,
enter recovery,
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讓數百萬美國人進入戒癮之路，
並且結束物質成癮的流行。
10:37
and put an end to this epidemic.
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10:39
Thank you very much.
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非常感謝大家。
10:41
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Michael Botticelli - Drug policy expertAs 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.
Michael Botticelli | Speaker | TED.com