This week, Director of National Drug Control Policy Michael Botticelli will depart after two years of service as the leader of the Obama Administration’s drug policy efforts. We sat down with him to hear his ideas about his work, the relationship between Office of National Drug Control Policy and SAMHSA, and where the field of recovery is headed.
What are some of the things you think have changed about the idea of recovery during your career?
The most significant change in how people view recovery is that it has truly become a movement. In the early days, the tradition of anonymity in 12-step programs kept many people from talking about being in recovery. So there wasn’t a visible and vocal recovery movement that you could see other than the fellowship that people in 12-step programs had with each other.
When I started as the Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, I was fairly open about my recovery. Some people counseled me not to be public about it at the time. But since then, especially over the past five years, it’s really taken off as a movement. Today’s young people who are in recovery are more transparent, open and honest about who they are. There has been a growing scientific acknowledgement of the role recovery plays, and now we see recovery coaches and recovery community organizations. So I think we’re seeing it both as a service movement as well as an advocacy movement.
What are your most significant achievements at the Office of National Drug Control Policy?
Through the course of the Obama administration, we have really changed the conversation and reframed how we approach issues of substance use and addiction. While we still have some ways to go, there is general consensus across political stripes, with public health and public safety, that this is a health issue. While law enforcement and our justice system have a role to play, substance use and addiction need to be dealt with as a health issue. That is a legacy this administration leaves for those who follow.
I think we’re at the point where most of us understand that people with addiction need treatment—they need health interventions, and that arrest and incarceration will do little or nothing to change the trajectory of people with substance use disorder.
Is there a moment that reflects that understanding?
Certainly watching the President sign the 21st Century Cures Act was a huge moment for not only us at ONDCP, but all of us in the field. I was sitting next to [SAMHSA Deputy Assistant Secretary for Mental Health and Substance Use] Kana Enomoto as it was signed, and many other people in the field were a part of that signing ceremony. Prevention and treatment of opioid addiction is a top priority for the administration, and we backed that up with a huge investment.
How has your relationship with SAMHSA helped advance drug control policy?
SAMHSA has played a huge role in in our execution and implementation of a public health-based national drug control strategy. SAMHSA is probably our premier partner, if you will, in terms of moving from policy to implementation on a practical basis. Our strategy has focused on public health responses like monitoring, prevention, early intervention, treatment and recovery support, and increasing access to medication-assisted treatment. I’d be hard pressed to think of a single health-focused strategy item we have that SAMHSA has not played a significant role in accomplishing. So it was very important to me personally that when I came in as Deputy Director of National Drug Control Policy and then as Director, that we had a strong ongoing partnership SAMHSA leadership.
What are some of the significant accomplishments you’ve collaborated with SAMHSA on?
This is recent so it’s top of mind maybe. The 21st Century Cures Act obviously gave us a substantial infusion of dollars. SAMHSA did a tremendous amount of work to get the money out as soon as possible. The funding opportunity was announced the day after the legislation was signed. We worked closely with them in terms of the structure of the application.
The funding is one example, but if you look over the past four years, I could think of probably 20 examples in our response to the opioid epidemic that SAMHSA helped orchestrate. Recovery Month is another good example. SAMHSA has for a long time been the organizer of Recovery Month nationally and helped coordinate local events. Without SAMHSA, I don’t think we would have as strong of a recovery movement.
What do you see coming next in the field of recovery?
A couple things. I think we’ve come a long way, whether it’s health systems or Medicaid or state and community providers really understanding the role that peers in recovery play in the service delivery structure. And not just in treatment programs. We now have peer recovery coaches reimbursed by Medicaid and other payers, and we have seen peers as parts of service teams and emergency departments and primary care settings. So from the service stand point we have come a long way, but we are still understanding the role of peers in our service delivery system.
Another change I would like to see is this: It should not happen by accident that people in recovery are in policymaking roles at the federal, state and local levels. We should strive to make sure we have people in recovery in those roles. They have an understanding that no one else can bring to the table. I would like to see continued advocacy for recovery.
What advice do you have for others who are in recovery?
Part of what is important is for anyone who is in recovery and does advocacy, to be grounded and secure in their own recovery before venturing out in other, more public ways. Sometimes I’ve worried when I’ve seen people who are very early in recovery playing a public and prominent role. I’m not saying they shouldn’t talk about it at all, but early recovery is stressful enough. Then again, even at this level, it’s important for me to put my recovery above a job or political environment. Recovery is the greatest treasure we have.
What would you say to the family and friends who are close to someone in recovery?
You can’t underestimate the support of friends and family. Substance use disorders don’t affect just one person. It’s important for the people around someone who is in recovery to understand the fundamentals of what addiction is, and what it means to be in recovery. Sometimes people think they’re being supportive, but they may not be. It also a good idea for those loved ones to have some support themselves so they can not only take care of themselves but offer support for a loved one who is in early recovery.