Substance help from one who struggled
US drug czar Botticelli builds on the lessons of his own recovery
WORCESTER — Michael Botticelli knows this crowd. They are his people, the often-underpaid foot soldiers of the no-finish-line struggle to stem the scourge of addiction. And hundreds of them return the love, giving him rock-star treatment as he walks across the stage at Worcester State University.
“It’s hard to get the words out: I work in the White House,” said the 56-year-old Botticelli, looking slightly sheepish. “It’s really wild.”
Botticelli is the country’s acting drug czar, leading the nation’s fight against substance abuse less than two years after performing a similar job with the Massachusetts Department of Public Health.
He is also the first person in addiction recovery to hold the job, having turned his life around since a drunken driving accident on the Massachusetts Turnpike more than 25 years ago. And unlike some of his predecessors, Botticelli is not a police officer, does not come from the military, and is not a doctor.
Instead, he brings trench-level experience in treatment and prevention to the post, and decades of extending a hand instead of a threat to people struggling with substance abuse. Since his appointment in March, the mantra has remained the same.
“There is no shame in this. This is a disease,” Botticelli said in Worcester, addressing a recent conference sponsored by the New England School of Addiction and Prevention Studies.
Much of what Botticelli brings to his bully pulpit finds its foundation in his own cathartic story. It’s a story rooted in family alcoholism, and it’s a journey that led to desperation as a young man in Boston before Botticelli emerged in sobriety and began a long run as director of the state’s Bureau of Substance Abuse Services.
“I can look back at my own experience and say this didn’t have to happen this way. And that, from both the positive and problematic perspective, is what’s helpful about being in recovery,” Botticelli said.
“I walk across the street every day, and I go to the senior staff meeting in the Roosevelt Room” at the White House, Botticelli added. “I run by the president’s chief of staff, all his senior staff are in the room, and I say to myself, ‘How the hell did I get here?’ ”
Botticelli got there despite drinking regularly since he was a high school junior, spiraling into alcoholism through his 20s, and being arrested for drunken driving in 1988 after a rear-end crash with a disabled truck on the Massachusetts Turnpike.
He recalled being handcuffed to his hospital bed and later being unable to drive because his checks to the Registry of Motor Vehicles bounced when he tried to reinstate his license. Eviction notices began arriving with soul-sapping regularity at his Boston apartment.
“I knew I had to stop drinking, but I couldn’t imagine what life was like on the other side,” said Botticelli, who paused as his eyes welled up. “I thought, if I stop, my life is going to be over. I’ll just be this kind of miserable wretch and sit around all day doing nothing.”
Botticelli, an openly gay man married to his longtime partner, said his turn to sobriety was jump-started 25 years ago at a recovery meeting for gays in Boston.
“I remember being astounded by the fact that there were 200 gay men and lesbians who were happy. It seemed like there was light coming out of their eyes, and it was something that I wanted,” said Botticelli, a native of Troy, N.Y. “It’s not to say that they weren’t having problems, but there was this level of collegiality and community that I just didn’t know existed.”
Shortly afterward, Botticelli began work in the recovery field even as he built, day by day, on an alcohol-free life. After a brief stint in the private sector, he began working for the state Department of Public Health in 1994 in a succession of jobs: coordinator for HIV-related policies and services, assistant director for policy and planning, chief of staff to the public health commissioner, and director of substance abuse services from 2003 to 2012.
“He’s a remarkable leader. He’s humble and smart . . . and he has a great strategic sense about designing systems,” said Andy Epstein, former special assistant to the public health commissioner. “If you’re going to be a bureaucrat, he’s a great one.”
Now, Botticelli is trying to bring to the national arena some of the strategies and programs he said worked well in Massachusetts. That includes expanded use of drugs such as Narcan and Suboxone to help opioid addicts, and a broad, integrated approach to prevention that involves stakeholders from health care, government, law enforcement, the courts, and addicts and their families.
His approach caught the eye of Gil Kerlikowske, the previous drug czar, when he visited Massachusetts during Botticelli’s tenure as substance-abuse director. Kerlikowske, who had been Seattle police chief and now is commissioner of US Customs and Border Protection, asked Botticelli to leave Massachusetts and become his deputy director at the Office of National Drug Control Policy.
Specifically, Kerlikowske was impressed with the creation of a recovery high school in Boston under Botticelli’s watch; the state pilot program that enabled Quincy police to carry Narcan to reverse opioid overdoses; and the expansion of treatment for substance abuse at community health centers.
For these programs and others, Botticelli said, Massachusetts is regarded as a national leader. “It’s a pretty remarkable place,” he said. “There was always this thread of social justice that underpinned all the work we were doing.”
For Botticelli, the best way to fight substance abuse is to reduce demand instead of funneling immense amounts of money and manpower into jailing dealers and penalizing users. In the country’s long and fitful war on drugs, this approach can seem revolutionary.
“That’s a monumental shift when we think about what the balance of law enforcement, treatment, and prevention is in the country,” said Hilary Jacobs, who succeeded Botticelli as director of the state’s Bureau of Substance Abuse Services.
That assessment was echoed by Kevin Norton, chief executive officer of Lahey Health Behavioral Services, who interacted with Botticelli, often on a weekly basis, during his tenure in Massachusetts.
“Michael is an incredible advocate for treatment services, for making sure that the voice of the consumer is always heard,” Norton said. “Our war on drugs hasn’t done anything, and to have someone in that role who values and recognizes the audience around treatment is incredible.”
For all his innovative ideas, Botticelli raised some eyebrows in Massachusetts when, during congressional testimony in February, he defended the Obama administration’s opposition to federal legalization of marijuana. However, he also testified under tough questioning that he does not think marijuana is as dangerous as alcohol.
Many media outlets seized on Botticelli’s testimony as evidence of mixed signals from the administration. Far more than in Boston, the words he utters in Washington have the potential to go viral. But that exponentially greater power, Botticelli said, can be an advantage.
“You realize the magnitude of what this office can do merely by promoting effective programs,” he said.
Promoting the message also includes high-visibility stories of recovery, including his own.
It’s a story, Botticelli said, that “speaks to the redemptive power of treatment and how it can restore people’s lives.”