In this 2013 photograph, Michael Botticelli attends a panel discussion on prescription drug misuse at Washington University in St. Louis, Missouri.

In this 2013 photograph, Michael Botticelli attends a panel discussion on prescription drug misuse at Washington University in St. Louis, Missouri.

The White House Office of National Drug Control Policy is usually led by someone with a law enforcement background. But the new director of the federal drug control agency comes from a different perspective. Michael Botticelli is the first in his position to be open about his substance abuse disorder. He has been in recovery for alcoholism for 25 years. He’s worked for more than two decades supporting drug and alcohol treatment programs. Botticelli talks about his efforts to make the government’s response to illegal drug use less punitive and more focused on prevention and recovery.

Guests

  • Michael Botticelli director, White House office of National Drug Control Policy

Transcript

  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The White House director of National Drug Control Policy is often called the nation's drug czar. But Michael Botticelli, the new director, dislikes that term. He calls it an outdated label that evokes the drug war and law enforcement. Michael Botticelli joins me in the studio. He wants to talk about the administration's new focus on treatment and recovery to reduce illegal and harmful drug abuse.

  • 11:07:28

    MS. DIANE REHMI invite you to be part of the program. Give us a call, 800-433-8850. Send an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Director Botticelli, it's good to meet you.

  • 11:07:48

    MR. MICHAEL BOTTICELLIThank you, Diane. It's really a pleasure to be here.

  • 11:07:50

    REHMThank you. I know this is really personal for you. You're the first director of drug policy whose open about being in recovery from alcohol addiction. Talk about that.

  • 11:08:06

    BOTTICELLISure. You know, it's really an astounding position to be in and I think of kind of my own personal background that I, you know, I always say that kind of 26 years, I never dreamed that I would be in a position that I am. But I'm also very cognizant of the fact that my story is not unique. You know, I grew up in this very loving, loud Italian family that, like many families in the United States, had addiction running through it.

  • 11:08:38

    BOTTICELLIAnd never talked about it, you know. It was always kind of a secret and so I was a classic example of someone who was at-risk. We know that there's a strong genetic predisposition to many diseases, including addiction. And, you know, I grew up in a community that kind of -- where underage drinking was the norm. I went to college where binge-drinking was considered a rite of passage. And, you know, I don’t recall, despite the fact that I was at risk for developing this disease, that I had any sort of intervention, whether a physician, you know, kind of told me I was at risk like we do with many diseases.

  • 11:09:20

    BOTTICELLIAnd, you know, unfortunately for me, and this is true of very many people that kind of my addiction caused an intersection with the law. I had a drunk driving car accident and as a result of that -- and I was very fortunate that I was given the opportunity to get treatment and not pursue a path within the criminal justice system. And it really show us and it has shown me from both a policy perspective how I translate my own experience, both in terms of my addiction, of how we translate that into public policy.

  • 11:10:01

    REHMTell me about the incident that caused you to seek help and then stay sober.

  • 11:10:09

    BOTTICELLISo, yeah, I was 30 years old. I was living in Boston at the time and I, you know, like many nights, I had gone out drinking and was driving home, was very drunk on the way home and had a car accident. I rear-ended a car on the Massachusetts turnpike on the way home. Fortunately, I was not significantly injured and didn't injure anybody else in the incident. You know, as a result of that, I had to go to court for my drunk driving. And at the time, was offered a choice, as kind of a forced a choice, but I was offered a choice of getting help and care and treatment and as long as I stayed compliant with that treatment, no further criminal penalties were assessed.

  • 11:10:57

    REHMYou were, at the time, at Brandeis University.

  • 11:11:02

    BOTTICELLIThat's correct.

  • 11:11:03

    REHMDid they ask you to leave or did you leave of your accord? I mean, what was that like?

  • 11:11:13

    BOTTICELLIYou know, I was very fortunate and this is what we're trying to encourage from a policy perspective, that my employers were incredibly supportive of my recovery and my care and treatment and did everything they could to help support that. And it's really what we encourage from a policy perspective, that, you know, we know that people need second chances and third chances and fourth chances and, you know, both within our criminal justice system, but also that employers make sure that people are getting care and treatment and that we're not implementing punitive approaches.

  • 11:11:44

    BOTTICELLISo I was very fortunate that I, you know, had an employer that supported my recovery, that understood my recovery and it's been very, I think, enlightening to see particularly colleges who have been establishing recovery communities. I worked in student affairs at Brandeis at the time and it's really been great to see college and university communities really supporting not only their staff, but students in recovery.

  • 11:12:16

    REHMYou talked about the fact that there was addiction throughout your family, lots of folks look at especially alcohol and drug addiction as a moral failing. Is that how you saw it in yourself initially?

  • 11:12:36

    BOTTICELLII did. And, you know, I saw that in my family, too, that -- and for many, many years, you know, we did not have a really good scientific understanding of addiction and we did see it as a moral failing, that people were weak-willed, that they were stupid. And I really remember, Diane, when I understood that I had a problem and, you know, I remember thinking to myself that if I admit it, if I say it out loud that I have a problem, that people would think that I was stupid, that people would think that I didn't the willpower, that I should be smarter than this.

  • 11:13:08

    BOTTICELLIAnd what we've come to understand is that addiction is a disease of the brain. You know, research from the National Institute of Drug Abuse has conclusively shown that addiction is a disease of the brain, but unfortunately for me and for many, many other people with addiction, that that shame and that stigma and that feeling of worthlessness really prevents people from seeking care.

  • 11:13:32

    REHMCan you talk about the kind of care that you received and that ultimately was successful?

  • 11:13:41

    BOTTICELLISure. So, you know, as a result of my arrest, I actually had to go to a 16-week course that taught me about addiction. It was a group counseling class. And also, I had to attend 12-step meetings. And it was very, very interesting because one of the things that I did not see was that on the other side of addiction this kind of vibrant recovery community. I actually remember thinking to myself that, you know, if I stop drinking, my life was going to be over, that I was gonna have a really dull, boring, isolating existence.

  • 11:14:22

    BOTTICELLIAnd because I had to go to 12-step meetings, I saw that there was this huge community of recovering people out there who were incredibly welcoming and supporting so not only did I get treatment, but I got exposed to this recovery community. And part of our work at ONDCP and kind of my personal mission by telling my own story is to really highlight for people that there is this incredibly vibrant community of people in recovery.

  • 11:14:49

    REHMWere you actually able to stop cold turkey?

  • 11:14:55

    BOTTICELLISo, you know, I was. So unfortunately, I was able -- so once I admitted that I had an addiction, because I had treatment and because I had good support, I was able to maintain my recovery continuously for over 26 years now. But I will say, and, again, this is where I think it's important that we know addiction is a chronic disease and like many chronic diseases, like diabetes or other things that people often relapse. You know, think of how many times you've tried to stay on a diet or quit smoking, for example.

  • 11:15:33

    BOTTICELLIAnd I think, you know, they say that people need to quit -- go through eight quit attempts to stay abstanate (sic) from smoking. So while I've been very fortunate to have continuous sobriety, that we know relapse can often be a part of someone's recovery process and so we need to make sure that, again, we're not shaming people because -- if they do have a relapse and make sure that we continue to engage with them.

  • 11:15:57

    REHMAre you saying throughout that 26 years, you never had a relapse?

  • 11:16:04

    BOTTICELLII never had a relapse. I was...

  • 11:16:06

    REHMGood for you. How wonderful.

  • 11:16:06

    BOTTICELLI...I have been very, very fortunate to be able to do that. But I think it points to the fact that when people have the necessary treatment, when they have the necessary community supports, when they have a loving family who embraces them like I do, you know, that it really becomes important. I had an employer. I had a job. I had access to stable housing. And those are all of the things, not just for my own recovery, that -- those are all of the components that we know often go into what creates a successful recovery for people.

  • 11:16:40

    REHMHow did your family react to what they already know?

  • 11:16:47

    BOTTICELLIYou know, I get kind of emotional when I talk about it 'cause I, you know, I have this incredibly loving family and, you know, they just did everything they could to support me. It was actually my eldest brother who I called in the kind of depths of my despair who, because of his own education around addiction, was the one that really prompted me to really make a commitment to my recovery. So, you know, I'm really indebted to family and friends who really supported me and employers who supported me and that's the kind of environment we want to create.

  • 11:17:25

    REHMAnd what about wife, children?

  • 11:17:26

    BOTTICELLII'm actually gay so I was in a not particularly healthy relationship at the time. And, again, like many people who are in recovery, they have to reexamine their relationships that they have in their life and make sure they're moving away from people that are not healthy for them. And so I had to reestablish, you know, they say in recovery that the easiest thing to do is to stop drinking and it's the staying stopped that's hard.

  • 11:17:57

    REHMMichael Botticelli, he's director of National Drug Control Policy. You can join us, 800-433-8850. Short break, we'll be right back.

  • 11:20:02

    REHMAnd with me in this hour, the White House Director of National Drug Control Policy, Michael Botticelli. He is a recovering addict. He abused alcohol for a number of years, until he had an accident on the Massachusetts Turnpike at age 30, for which he was arrested and, thank God, turned his life around with the support of family, employers, friends, people who loved him and helped him get into treatment. And, Michael Botticelli, you clearly do not support locking up people for minor drug offenses. Now you're going to have to differentiate for us what you mean by minor versus some other kind.

  • 11:21:10

    BOTTICELLISure. For a very long time, you know, we based our responses to people who had addictive disorders in a very, very punitive way, you know? And we thought these were bad people who were doing bad things. And, you know, we used our jails and prisons for many, many years as, unfortunately and not very successfully, as our de facto treatment programs. Our jails and prisons are full of people who have addictive disorders. And not only is it inhumane, it's really costly. And we are paying a burden for that cost. And part...

  • 11:21:45

    REHMWhat are we doing about that now? What are we doing about those who are in prison for minor or even major drug offenses?

  • 11:21:55

    BOTTICELLIOne of the basic principles of our drug policy in the United States is criminal justice reform. And we want to create opportunities at every turn where we can divert people away from the criminal justice system, who have often come in contact with them as a result of their own addiction. So, again, I was very fortunate that, because of my arrest, I got care. So we want to make sure that we are diverting people away from arrest and incarceration and getting them the help and treatment that they need. We need to continue to promote our public health response to this issue. You know, one of the areas in drug policy under the Obama Administration that we have continued to pump additional resources into our public health response.

  • 11:22:43

    BOTTICELLISo we clearly want to make sure that people have access to good care and treatment and that we're diverting them away from the criminal justice system.

  • 11:22:51

    REHMSo define for us where the dividing line is between minor and major.

  • 11:22:58

    BOTTICELLISo one of the things that we talk about is that people are often involved in minor, non-violent drug offenses as a result of their addiction.

  • 11:23:07

    REHMLike what?

  • 11:23:08

    BOTTICELLILike burglary, you know, these are often financial-related crimes as a result of their addiction, often financial in nature, non-violent. And those people should be diverted away. You know, we have -- one of the areas where we've been focusing on are drug courts. So we now have over 2,000 drug courts in the United States that have taught us that the criminal justice system can divert people away and in treatment but also be accountable for their actions. You know, one of the things that I get to do is travel the country and I talk to local law enforcement. And it's astounding to me, at the local level, where you have local police officers, who are saying that we can't arrest our way out of the problem.

  • 11:23:53

    BOTTICELLISo they know, at a local level, that they need to partner with public health entities to make sure that we're not continually arresting people but that we're getting them into care and treatment. So not only from a policy perspective, but it has really, I think, created a sea change among local enforcement to really have a different response as they encounter people who have an intersection with the law.

  • 11:24:19

    REHMSo you're agency was actually created during the Reagan Administration's war on drugs. In addition to working with local law enforcement around the country, what else does your office do?

  • 11:24:38

    BOTTICELLISo our office is primarily responsible for setting the Obama Administration's national drug control strategy. That strategy is based on several principles. One, that addiction is preventable. And we need to continue to focus on preventing substance use. You know, like my own story, substance use is a disease of early onset. But we now have good science and good programs that show us we can prevent the disease from happening. We want to make sure that we -- people have good access to high-quality treatment. And one of the major factors driving those increases to care and treatment has been the Affordable Care Act.

  • 11:25:16

    BOTTICELLISo for a long time, only a small percentage of people who had an addiction were able to seek care and get care. And one of the major factors that contributed to that treatment gap, as we call it, is for many people who didn't have access to insurance. And one of the things that the Affordable Care Act does, it defines substance-use disorder treatment as one of the ten essential health benefits that are required for plans to offer. And that can create a sea change for people who can't afford care and who really need to have an adequate access to insurance to access good treatment.

  • 11:25:54

    REHMSo if the Supreme Court rules against the ACA?

  • 11:26:01

    BOTTICELLIIt will be a disaster for people with substance-use disorders. I can't tell you how many parents I've talked to who go through their life savings, who have to set -- put -- take out second mortgages on their home, to afford care and treatment. And so, you know, treatment should not be just for people who can afford it. But it really should be an essential health benefit as part of our health care system.

  • 11:26:26

    REHMWhy do you think President Obama chose you to head this agency?

  • 11:26:32

    BOTTICELLII think I know why he chose me. Because he clearly wants a more public health response to this issue and wants us to continue to focus on criminal justice reform issues as part of his larger priorities. You know, I have had the opportunity to talk with him on many occasions. And, you know, he clearly wants us to continue to focus on prevention, intervention, treatment recovery support and continuing to reform our criminal justice system to deal with both the disproportionate impact it has on some of our most disenfranchised communities, but also to make sure that we are having a compassionate response to people with addiction.

  • 11:27:14

    REHMBut at the same time, both abuse and deaths from heroin and opioids have risen dramatically.

  • 11:27:25

    BOTTICELLIIt's one of the -- it's probably the single most important issue that our office has focused on, Diane. You know, one of the issues that we have seen is a significant increase in dire health consequences and mortality, largely related to the vast overprescribing of prescription pain medication in the United States. We clearly want people who are suffering pain to get care and treatment. But in our zeal to do that, you know, we have created a situation now where we are prescribing enough pain medication to give every adult American 75 pills on an annual basis. And this is a medical community that, despite the fact that they're well intended, it's a medical community that hasn't been trained on addiction, doesn't understand who is at risk.

  • 11:28:17

    BOTTICELLIAnd so part of what we are trying to focus on is not only to decrease the mortality that we have -- we have 120 people dying every single day of a drug overdose, many of those tied to prescription pain medication, and now a burgeoning heroin issue.

  • 11:28:34

    REHMBut I gather you want first-responders to be trained to administer -- how do you pronounce...

  • 11:28:44

    BOTTICELLIIt's called naloxone.

  • 11:28:45

    REHMNaloxone. Tell me about naloxone.

  • 11:28:48

    BOTTICELLISo, first and foremost, we want a comprehensive response to the prescription drug situation that we have in the United States. And one of the areas we want to really focus on is how do we decrease this 120 people? It's really a tragic situation that we have now. And what we have been promoting has been the use of this overdose antidote drug called naloxone. First responders have used this for years in their response to people with an overdose. It's a safe, non-toxic substance that can be administered, what we found, by a wide variety of non-medical personnel, including first responders.

  • 11:29:29

    REHMAt the same time, doesn't that somehow open the door to users of heroin and other opioids to think, well, if I pass out, if I'm on the verge of dying, some will call me and get me this drug.

  • 11:29:49

    BOTTICELLISure. There's no evidence to suggest that naloxone actually promotes or enhances drug use. The way that we talk about it is, fundamentally, I think we have to value each person's life. And first and foremost, you know, saving someone's life, giving them a second chance or a third chance at getting into treatment is something that we all value. One of the things that our office has been promoting, since we know police and other first responders are often the first on scene, to really been promoting their use of naloxone. And I am -- we have just been tremendously overwhelmed...

  • 11:30:28

    REHMHmm.

  • 11:30:29

    BOTTICELLI...by the response by local law enforcement. When I was in Massachusetts, we actually trained the first police force in the country to administer naloxone. And when you hear from police who are able, in a matter of minutes, to save someone's life, it really changes the dynamic.

  • 11:30:46

    REHMHow expensive a drug is it?

  • 11:30:49

    BOTTICELLIWell, unfortunately, the cost of naloxone has gone up dramatically. And part of our work at the federal level is to create greater access to naloxone. And part of what the president has proposed, as part of his FY '16 budget, are additional grants to local communities to support naloxone and naloxone purchase. We have also looked at our federal grants and have put out letters to states that they can use some other federal grant dollars to help to support the purchase of naloxone.

  • 11:31:26

    REHMAnd what about the distribution of clean syringes for intravenous drug users?

  • 11:31:34

    BOTTICELLIOh, you know, one of the other significant consequences that we've seen as it relates to the dramatic increase in injection-drug use, with both prescription drugs and heroin, has been an overwhelming increase in viral hepatitis as well as HIV. I know many of your callers are probably familiar with Scott County in Indiana, that just is going through a significant outbreak of HIV and viral hepatitis. So in this small rural county, that had about five new HIV cases annually, they have identified well over 150 new cases of HIV largely linked to the injection of prescription pain medication.

  • 11:32:17

    BOTTICELLISo clearly our response, not just from an overdose perspective, needs to also include how we minimize some of the other health harms that are associate with injection-drug use, particularly viral hepatitis and HIV.

  • 11:32:33

    REHMAnd what people are doing is exchanging needles?

  • 11:32:38

    BOTTICELLISo, you know, as someone who was involved in HIV work, for a long, long time, we did a great job at educating many people and particularly injection-drug users on safe needle use and also making sure they had access to clean syringes. And this just demonstrates to us that we need to redouble our efforts. Many of the cases that we're seeing now, and particularly in Scott County, are in rural parts of the country that have extreme poverty rates. They don't have an infrastructure -- either a primary care infrastructure or a substance-use treatment infrastructure. So we have a lot of work ahead of us in terms of stemming not only the overdose deaths, but some of the other dire health consequences that we've seen attached to this epidemic.

  • 11:33:25

    REHMMichael Botticelli, he's director of National Drug Control Policy. And you're listening to "The Diane Rehm Show." We've got lots of callers. I want to open the phones now. 800-433-8850. Let's go, first, to St. Louis, Mo. Doris, welcome to "The Diane Rehm Show."

  • 11:33:55

    DORISOh, thank you so much. I'm so pleased I was able to get through. So many of your topics are so very important to me. But the reason I'm calling today is that my one granddaughter, she's a lovely person. When she was quite young, she got on heroin at school. And her parents, of course, didn't know what was going on. And she ran away. Oh, she did all kinds of terrible things. And they then tried to put -- they found her and got her into treatment centers and she wouldn't even stay. She's get away. But what happened is, they finally diagnosed her as bipolar. And after they started to treat that, the bipolar illness, she was able to straighten out. And then she was able to go to college and graduate from college.

  • 11:34:45

    DORISOf course, she has to see the psychiatrist all the time and she's on her medication. And then, her -- then she was married. And she has -- she's very artistic. She's got this interesting job that she does. But, I mean, it cost the family so much money.

  • 11:35:02

    REHMAh.

  • 11:35:02

    DORISAnd everybody stuck with her all the way. And so now she's a lovely person. But on being bipolar -- oh, she does have hepatitis C. And so that will be treated. But that's so expensive to treat, too, I guess. There...

  • 11:35:16

    REHMOh, yes. Doris, I'm so glad for your granddaughter, that she is now living a stable life. But there are the consequences -- hepatitis C, for example.

  • 11:35:32

    BOTTICELLISure. When -- and I really appreciate you calling. And I love hearing stories of people's recovery. And a couple things that you said are, I think, incredibly important in terms of this conversation. One, that we know many people who have a substance-use disorder also have a co-occurring mental health disorder. And that we know quality care really hinges on the fact that they're dealing not only with their addiction but with their co-occurring disorders. And we know that if you deal with one without dealing the other that there's a high probability of relapse, as your granddaughter's story illustrates. I'm really heartened to hear her recovery.

  • 11:36:09

    BOTTICELLII often say that my story is not unique. There are millions of Americans, like me and like your granddaughter, who have been able to go on to really accomplished lives. But, unfortunately, some of the consequences of this disorder have really been severe. And part of what we are really trying to call for is more early intervention and prevention services to really prevent these diseases from really reaching their most acute phase. And we don't, as a medical community, really do a good job at early identification and diagnosis of this disorder, like we do with other diseases. So I really appreciate you calling. I really appreciate you sharing the story. We wish her the best of luck.

  • 11:36:52

    REHMI should say. What's been the reaction from Congress to your approach?

  • 11:37:00

    BOTTICELLIOne of the, I think, tremendously heartening areas -- I was actually unanimously confirmed by the Senate -- has been, I think, a tremendous amount of understanding on both sides of the aisle in Congress about an enhanced public health approach and reforming our criminal justice system. So I think whether -- it's a tremendous amount of bipartisan effort supporting our approach to drug policy and also supporting our support of criminal justice reform.

  • 11:37:32

    REHMShort break here. When we come back, your questions, comments for Michael Botticelli, director of National Drug Control Policy. Stay with us.

  • 11:40:02

    REHMAnd welcome back. If you've just tuned in, Michael Botticelli is with me. He's Director of National Drug Control Policy. He served as Director of the Massachusetts Bureau of Substance Abuse Services. He is also in long term recovery from substance abuse himself. Celebrating 26 years of sobriety. Let's go now to Ken in Portsmouth, New Hampshire. Hi there, Ken. You're on the air.

  • 11:40:46

    KENGood morning Diane and guest. Another great Diane Rehm Show.

  • 11:40:48

    REHMThank you.

  • 11:40:49

    KENI have a question for your guest. You know, he mentioned when he was going through the process of recovery that he had a loving family, which most of us do, of course. But, and he had a lot of support. He hadn't lost too much before he was able to get into the recovery program. I'm what we call, you know, in our 12 step program, I have to watch tradition here, that, you know, I ended up being a little boredom drunk as we call it. And there was, you know, I had nothing left. I lost all, if you will.

  • 11:41:20

    KENFortunately, I was able to finally say, help, you know, and I've recovered now. And I've been in recovery for some years. So, I was just wondering if he has something in his plan and thank you for going to work for our president that will help that area of people who are, you know, in that low bottom class if you will. I'm sure you've heard of that, being 26 years.

  • 11:41:37

    REHMAnd Ken, congratulations to you for being in recovery. I'm so pleased you called.

  • 11:41:46

    BOTTICELLIKen, thank you for your call and I really appreciate your sentiments, because it's really important for us. You know, one of the things that I think is unfortunate about this field, and, you know, we often talk about the fact that people with addictive disorders have to hit bottom. Meaning, like you, they have to lose everything and I find that really unfortunate. Because we don't do that with any other disease. You know, if you have hypertension, we don't say to people, well, you have to wait until you have a heart attack before we offer care and assistance.

  • 11:42:14

    BOTTICELLIAnd what we're trying to do, and I think our stories are probably illustrative of the fact that, you know, we should be doing, screening with people along the way to make sure that they are not misusing alcohol or other drugs. That we're doing interventions before people have to lose everything to get care.

  • 11:42:34

    REHMBut how? I mean, if for example, Ken talked about his family, perhaps they tried to help him. Perhaps they said, Ken, we need to get you help. And Ken refuses. Instead, Ken spends all his money, goes into debt and hits bottom.

  • 11:42:56

    BOTTICELLISure. So, one of the areas that we've been focusing on, and again, I think my story, probably Ken's story is, you know, every time you go to the doctor's office, you should be getting a screening for your substance use issues before it reaches its most acute phase.

  • 11:43:11

    REHMMaybe he never went to the doctor.

  • 11:43:11

    BOTTICELLIMaybe he never went to the doctor, but part of this is, we want to make sure that we are looking at good prevention efforts so that we are not developing a disorder, that we're looking at intervention opportunities along the way. You know, unfortunately, one of the largest referral sources to treatment is still our criminal justice system. And not our healthcare, and we shouldn't have to wait until people hit bottom. Now clearly, some people do and they suffer dire consequences to it.

  • 11:43:43

    BOTTICELLIBut we should be doing interventions at any place, whether that's in the family, in the medical community, within our schools, to make sure that we are diverting people from developing the most acute phase of their disorder.

  • 11:43:57

    REHMAll right. Here's a tweet from Bryce. If addiction is a disease of the brain, why is it not treated with medication like other brain diseases?

  • 11:44:13

    BOTTICELLISo, this is, I think, a really important question. One of the areas of great promise is that we actually do have a wide variety of highly effective medications for addictive disorders. Not for everything, but, you know, our opioid use disorder epidemic in the United States I think is a good illustration. We have three highly effective medications that have been shown, when combined with other behavioral therapies and supports, to bar out -- outperform treatment without these medications.

  • 11:44:47

    BOTTICELLIUnfortunately, they are highly underutilized. We want to see more physicians trained to administer these drugs. We want to encourage more treatment programs to use these and we want to make sure our criminal justice system is also using these medications.

  • 11:45:05

    REHMGive me an example of the type of medication you're talking about.

  • 11:45:09

    BOTTICELLISo, one of the most effective medications that has been around for over 50 years for opioid use disorders is Methadone. And Methadone treatment. Unfortunately, it requires a level of daily dose, but over the past 15 years, we've seen new medications come on the market. One is called Buprenorphin and the other one is Vivotrol. Injectable now (unintelligible) . The remarkable things about these two drugs is they can actually be administered by a physician in the privacy of his or her own office.

  • 11:45:42

    BOTTICELLIAnd you think about how that can diminish stigma, is that, you know, you can walk into a physician's office, be indistinguishable from any other patient who is seeking care. We know through evidence and science that these medications, when combined with other behavioral therapies and supports, far outweigh and outperform treatment without these substances.

  • 11:46:05

    REHMInteresting. All right. Do you still regard Alcoholics Anonymous, AA, the 12-step program, as one of the most effective approaches to alcohol addiction?

  • 11:46:26

    BOTTICELLISo, I think that part of, and you know, it's been challenging to actually do a lot of scientific studies around AA, but there's been a number of studies to show that 12 step and 12 step recovery support programs are tremendously helpful in terms of people's recovery and treatment. So, we know that they are really important. We also know however that there are some people who need really more significant treatment than just 12 step work. That, when you combine the two, we know that usually, there's a synergistic effect, that you can get a tremendous amount with both treatment and ongoing support.

  • 11:47:07

    BOTTICELLIYou know, we have, I believe that yesterday was AA's 80th anniversary, and there are millions and millions of Americans who have been helped through the support that 12 step programs, like AA, and NA have been able to offer.

  • 11:47:21

    REHMAll right. To Battle Creek, Michigan. Hi there, Ralph. You're on the air.

  • 11:47:27

    RALPHYes, I just wanted to ask about marijuana policy and whether marijuana is considered addictive or it's not addictive and benign. And whether the Obama administration is taking actions to decriminalize it.

  • 11:47:50

    BOTTICELLISo, let me tell you our approach to marijuana. And I'll first talk about medical marijuana. That one of the areas that is important to our administration is that we continue to study the potential therapeutic value of components of marijuana. Not smoke marijuana. Even the Institute of Medicine has said that smoking marijuana is probably not a good delivery device for a medication. But part of, I think, our efforts are continue to support research that looks at the potential therapeutic value of medical marijuana.

  • 11:48:25

    BOTTICELLIAnd rely on the FDA process to be able to do that. Our policy has not been supportive of legalized marijuana. And precisely because of the public health implications that we see. And particularly the effect that marijuana has on the youth of our country. That, you know, one of, that we know that despite some of the rhetoric that marijuana is addictive. About one in nine people develop a significant addiction to marijuana. We know marijuana has been linked to poor academic performance. It's been linked to drunk driving and increased mental health related issues.

  • 11:49:06

    BOTTICELLIAnd despite the progress that we made in the United States in a wide variety of areas, we now have more 12th graders smoking marijuana than they are tobacco. We've seen, and tracked, over the past 40 years that youth do not see risk associated with occasional marijuana use. And I believe it's because the messages that youth are getting in regard to the marijuana conversation that we've had in the United States.

  • 11:49:34

    REHMAll right. To Kevin. He's in Fayetteville, North Carolina. Hi there, Kevin.

  • 11:49:41

    KEVINHi. How are you doing?

  • 11:49:42

    REHMI'm pretty well.

  • 11:49:45

    KEVINYeah, I have a two part question for Michael. One being, it's more of a personal question. I'm in the military and I grew up in an alcoholic household. And so, I was well educated. I went to rehabs with my mother and I was always well educated on it, more, I'd say, than my peers. And so, growing up, I always figured that I had the knowledge, I could beat it. I knew I was predisposed to alcohol addiction, or addiction in general. But I realize now that with my behavior in the military that I'm starting to seek treatment and help for my addiction problem.

  • 11:50:26

    KEVINAnd my question is, when you started beginning changing your lifestyle and not drinking, how hard was it for you to change your habits and, you know, friends and stuff like that, because I know you have to change a lot in your life, because you can't do the same things, like going out to bars and socializing in that way. So, that's my first part of my question. And my second question is are there anything in the works -- you hit on a little bit about early education about it. Is there anything in the works with trying to put a program into the school system?

  • 11:50:58

    KEVINI know parents like to think that any kind -- whenever they hear drugs, they don't want their kids being around it, but I think it's important that kids sort of like a first aid response, they understand the signs of like when someone's having a stroke. The signs that when someone's having a problem with addiction, they look for those signs. And they're able to help a friend or someone like that, because there's so many times in high school I realized people were having a problem with drinking or smoking. And I didn't step in, because I just didn't feel like it was my place.

  • 11:51:30

    REHMAll right. Kevin, thank you for your service and for your questions.

  • 11:51:34

    BOTTICELLIGreat. Thank you, Kevin. I think you're bringing up a couple of great points. You know, again, my story is not unique. That, you know, people are very, including myself, we're very vulnerable in early recovery. And you know, part of the reason is that you need to develop new skill sets to deal with life, other than drinking or using drugs. And one of the areas that we've been focusing on to help support people in early recovery are really establishing good recovery support programs in the community. You know, we have seen the development of recovery high schools.

  • 11:52:12

    BOTTICELLIBecause we know schools play an important role. We've seen collegiate recovery programs across the country. We've seen the development of community recovery centers and recovery organizations. Because we know that that early recovery is really hard. You know, I remember personally, you know, I was living in Boston at the time, and I would actually cross the street from bars that I used to visit, because I was so afraid that, you know, kind of my instincts were going to kick in and I was going to walk in.

  • 11:52:40

    BOTTICELLIAnd I think my experience is probably like yours, that particularly in early recovery is when people are really vulnerable.

  • 11:52:49

    REHMAnd what did you do when that bar was right across the street?

  • 11:52:53

    BOTTICELLII crossed the street and, you know, made sure that I called people if I felt vulnerable. That I stuck within a recovery community. And again, those are the kinds of programs and policies that we are trying to put in place.

  • 11:53:08

    REHMSo, you had to let go some of the friends, some of the close friends and drinking buddies that you used to hang out with?

  • 11:53:18

    BOTTICELLIYeah, we -- and that's typical of many, many people, that they really have to move away from destructive places and destructive people and really embrace more healthy people and healthy lifestyle.

  • 11:53:31

    REHMAnd you're listening to "The Diane Rehm Show." A caller now in Alexandria, Virginia. Hi there, Shannon. You're on the air.

  • 11:53:44

    SHANNONHi Diane. Thank you so much for your show.

  • 11:53:47

    REHMThank you.

  • 11:53:47

    SHANNONAs always, very, very, good topic.

  • 11:53:48

    REHMThank you.

  • 11:53:49

    SHANNONHi, Michael. I got sober April 24, 1989.

  • 11:53:52

    BOTTICELLICongratulations.

  • 11:53:53

    REHMGood for you.

  • 11:53:53

    SHANNONThank you. Thank you. You as well, my friend. What I'm calling about, actually, is I worked on a -- I was an interviewer in a federal study in Sacramento, California in 1999 and 2000. I believe it was called the Adam Project. And what we did is we interviewed newly incarcerated people coming into the Sacramento County jail. We had 60 questions. Most of the questions had to deal with drug use. And what the point of the study was was to show the obvious correlation, I think, of recidivism and drug use.

  • 11:54:27

    SHANNONAnd it asked questions about, you know, lifestyle, where do you live? Are you homeless? Are you, you know, when was the last, what was the last grade you completed? Things like that. And one of the questions was, if you were given the opportunity for a recovery program, would you take it? And I don't have the data, but I remember, just in a perception trend, everybody said yes, no matter what their crime. My question to you is, what happened to that study? Have you heard of it? I've never been able to find the results.

  • 11:54:54

    BOTTICELLIActually, we do, unfortunately, we've had some diminished resources to do as wide a survey with our Adam Study. But we actually still do that study in selective cities, because I think it's really important for us to understand who is coming in contact with the criminal justice system. Not only the drugs that they're using, but the circumstances of their lives, to be able to do it. So, I really appreciate your participation, because it's really important to do that. And I think you're absolutely right, that people, you know, kind of looking back.

  • 11:55:23

    BOTTICELLIParticularly as it relates to their intersection and that their intersection with the law can be a powerful motivator to get them in to care and treatment. I, you know, we don't want to see that happen. We want to see people get care earlier, but anybody that does come in contact, we want to use that as an opportunity to get people into care. You know, my experience is like a lot of other people's, that, you know, when you have an intersection with the law, it can be a particularly powerful motivator to get care.

  • 11:55:50

    REHMBig wake up call.

  • 11:55:50

    BOTTICELLIIt's a big wake up call. I would rather see that wakeup call earlier in people's lives and not have to be involved with the law to do that, but we also want to make sure our criminal justice system has a compassionate response.

  • 11:56:03

    REHMBut I'd like to go back to your family of origin, because didn't they say things to you? Didn't they try to help you? Didn't they say, Michael, be careful? This is what we see happening to you.

  • 11:56:26

    BOTTICELLIYou know, I did understand that addiction was in my family, and for -- you know, like many people, I thought it wouldn't affect me. And I thought because, you know, my dad was a factory worker and I thought, because I had a college degree and a master's degree that I was somehow smarter than addiction. You know he, I always say, he drank cheap booze in cheap bars and I drank good booze in good bars. And I somehow had this denial like many people do that it wasn't going to happen to me.

  • 11:56:56

    BOTTICELLII was living away from home for most of my life, so but once I asked them for help, they really helped me out tremendously.

  • 11:57:05

    REHMWell, and I'm delighted that you're now at the helm of the agency trying to help so many people in this country. Thank you.

  • 11:57:15

    BOTTICELLIGreat. Thanks for doing this story.

  • 11:57:17

    REHMMichael Botticelli, Director of National Drug Control Policy. Thanks for listening all. I'm Diane Rehm.

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