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Drugs

US drug czar approaches challenge from a different angle: as a recovering alcoholic

LYNN, Massachusetts — The United States’ top drug control official had a confession.

Michael Botticelli was seated on a tattered purple couch in an old Victorian here, just outside of Boston. Above his head was a photo of Al Pacino as a drug kingpin in “Scarface,” and gathered around was a group of addicts who live together in the house for help and support. On one door hangs a black mailbox labeled “urine,” where residents must drop samples for drug tests. Botticelli is listening to their stories of addiction and then offered this:

“I have my own criminal record,” he said.

“Woo-hoo!” one man yelled after Botticelli’s declaration. The crowd burst into applause.

The nation’s acting drug czar has a substance abuse problem.

Botticelli, 56, is an alcoholic who has been sober for a quarter century. He quit drinking after a series of events including a drunken-driving accident, waking up handcuffed to a hospital bed and a financial collapse that left him facing eviction.

Decades later, Botticelli is tasked with spearheading the Obama administration’s drug policy, which is largely predicated around the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system.

Botticelli’s life story is the embodiment of the policy choice and one that he credits with saving his own life.

The approach at the White House Office of National Drug Control Policy has been, Botticelli said, a “very clear pivot to, kind of, really dealing with this as a public health-related issue of looking at prevention and treatment.” He now heads an office that has shifted away from a “war on drugs” footing to expanding treatment to those already addicted and preventing drug use through education.

Botticelli became the acting director of drug-control policy earlier this year, about a year and a half after he came to Washington to be former drug czar Gil Kerlikowske’s deputy. The White House has not formally nominated him to take over the job permanently. It is a job that has previously been held by law enforcement officials, a military general and physicians. But for now, it is occupied by a recovering addict.

The nation is in the midst of an epidemic of prescription drug and heroin abuse. The number of drug overdose deaths increased by 118 percent nationwide from 1999 to 2011, most of it driven by powerful prescription opioids and a recent shift that many users are making away from prescription drugs to heroin, which can be cheaper and more accessible.

Drug trends and issues tend to vary geographically, making a sustained national effort difficult. Insurance companies often do not cover inpatient treatment and an obscure federal rule restricts the expansion of addiction treatment under the Affordable Care Act. The White House is also grappling with the legal, financial and political implications of medical and legalized marijuana. Botticelli’s office has taken the administration’s toughest stance against legalization.

“Part of this is, ‘How do we look at solutions that work for the entirety of the drug issue?'” he asked. “And not just the entirety of the drug issue, but the entirety of the population?”

Botticelli is trying to expand on some of the programs he used at the Massachusetts Department of Public Health, where he was director of the state’s bureau of substance abuse services. They include allowing police to carry naloxone — a drug commonly known as Narcan that can reverse a heroin overdose — and helping people who have completed treatment find stable housing and jobs.

Botticelli spends much of his time on the road, meeting with state and local officials. He visits treatment programs where he is, by all accounts, treated like a rock star by people with substance-abuse issues, a group he calls “my peeps.” While Botticelli easily shares his struggles, those who worked with him said that he doesn’t let it dictate policy.

“He was very good at separating his story from the work, which I think allowed him a little more objectivity,” said Kevin Norton, chief executive of Lahey Health Behavioral Services in Massachusetts.

Botticelli drank in high school and college, and he once got fired from a bartending job after repeatedly telling the manager he couldn’t work, only to show up as a patron. In the 1980s he moved to Boston, where he spent most of his time outside of work at the Club Café, a legendary Boston gay bar. Along with a group of regulars, Botticelli would stay well into the next morning, knocking back drinks and ridiculing people who were heading into the gym below the bar for an early workout.

“A lot of the center of gay life, particularly in urban areas, focused on bars,” Botticelli said. “And so that’s where you went to socialize, to meet people.”

Michael Botticelli was an alcoholic who went into treatment after he was rear-ended a disabled tractor-trailer on the Massachusetts Turnpike more than 25 years ago. His life story dovetails with the approach the Obama administration is taking toward drug-addiction, that putting people in treatment is better than sending them to jail.

Photo by Michele McDonald for The Washington Post

In May 1988, Botticelli was drunk when he left a Boston bar and drove west on the Massachusetts Turnpike. What happened next is hazy: He may have been reaching for a cigarette in the console of the car. Botticelli’s car collided with a disabled truck. He remembers being placed on a stretcher and put in an ambulance.

Hours later he woke up in the hospital, handcuffed to a bed. A state trooper stood sentry in his room. Botticelli was lucky: His injuries consisted mainly of bumps and bruises. He was taken to the state police barracks, booked and had his license suspended.

“At some level I knew I had a problem,” Botticelli said. “But at another level, because my license was taken away, I thought that my problems were solved. Because I wasn’t drinking and driving anymore, so how could it really be an issue?”

The case was continued without a finding after Botticelli paid the fines and restitution associated with the case. It is no longer a matter of public record. Botticelli had to ask his brother for the money to make the payments, but his downward spiral continued that summer. He ended a relationship and drank heavily, despite going to a court-ordered course on the dangers of drinking and driving and a 12-step recovery group.

“I felt that because I wore a suit to work and a lot of the other people in the class came from more blue collar jobs, that somehow I was better and I didn’t have a problem. There was a sense of arrogance about me,” he said.

Botticelli’s path to recovery began in, of all places, a bar. He met a man who acknowledged that he was an alcoholic. The two swapped stories and went on a date. The romance didn’t materialize, but they remained friends. Botticelli was soon after served an eviction notice and called his brother, who asked if Botticelli was an alcoholic. Botticelli talks with his hands, one of them often nursing an iced coffee.

“I finally said, ‘Yes,’ ” he said. “I remember distinctly thinking to myself, ‘If I say I’m an alcoholic, there’s no going back.'”

Botticelli’s friend took him to a 12-step meeting in downtown Boston. The following night Botticelli stepped into the Church of the Covenant in Boston, a neo-gothic sanctuary with Tiffany glass windows. In the basement there was a 12-step recovery program for gays and lesbians.

“That’s the first time that I raised my hand and said that my name was Michael, and I was an alcoholic, and that I needed help,” he said. “At that point people kind of rally around you.”

Botticelli stuck close to that group, attending meeting after meeting and avoiding his old haunts, going so far as to cross the street when walking past the Club Café. He said he learned something then that has guided him since: Identify with people who have a problem, but don’t compare yourself.

Botticelli had worked in higher education since finishing graduate school but pivoted toward a career in public health. He started working on AIDS issues and then turned toward helping others with addiction issues. He eventually felt comfortable going to bars and not drinking. He met his husband, David Wells, at one in 1995. They got married in 2009.

One of Botticelli’s recent trips took him back to Boston earlier this month. Soon after arriving, he was smoking a cigarette outside a Starbucks when a woman had a question: Why are there burly agents standing around? (He gets a protective detail). They chatted; she told Botticelli she was addicted to prescription painkillers, progressed to heroin and became homeless. She began recovery months earlier and started working at Starbucks the week before.

“And that was like ‘Oh my God, our work is done here,’ ” Botticelli said in the back of a black SUV that weaved through the streets of Boston. “Anything else was going to pale in comparison to just listening to people’s stories.”

Botticelli’s day was packed with meetings on what he called his home turf. There was a roundtable with more than a dozen doctors, nurses, law enforcement agents, elected officials and others. He met with Boston Mayor Marty Walsh, who is also an alcoholic. Botticelli had sandwiches with law enforcement agents who spoke about the massive spike in heroin addiction. Here in Lynn, a city of 91,000 people, there were 188 opiate overdoses and 18 deaths in 2013; as of July 31 there were 163 overdoses and 20 deaths.

Botticelli hugged and shook hands people at the home here, and spoke to the men about the struggles of addiction and finding what he called a bridge job — something that you do while getting better to make money and get back into the workforce.

“Don’t be ashamed to work at Dunkin’ Donuts,” one of the men, Pat Falzarano, said. Botticelli nodded.

Hours later, Botticelli stood outside of the church where his recovery started and marveled at how he got from there to the White House.

“When I first came here was, all I wanted to do was not drink and have my problems go away,” he said, choking up. “I’m standing here 25 years later, working at the White House. And if you had asked me 25 years ago when I came to my first meeting here if that was a possibility, I would’ve said you’re crazy. But I think it just demonstrates what the power of recovery is.”

© 2014, The Washington Post

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Buzzby1949

This sounds great for drug users whose use is problematic and who have addiction issues. The problem is that the great majority of drug users, like the great majority of alcohol users, are not addicts and their use is entirely recreational. As long as the law treats all users of recreational drugs other than alcohol as drug abusers and addicts, we’re going to have people rousted from their homes, subject to arrest and incarceration, and facing the lifetime stigma of having a drug conviction. The only problem that these people have with drugs is that their recreational drug of choice is not alcohol and is therefore arbitrarily illegal. We need to treat problematic drug use as a public health issue and non-problematic drug use as purely a matter of personal choice.

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