Drug czar approaches challenge from a different angle: As a recovering alcoholic
By Katie Zezima
The Washington Post
LYNN, Mass. — The nation’s top drug-control official had a confession.
Michael Botticelli was seated on a tattered couch in an old Victorian in this city just outside 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 to receive help and support. On one door there was a black mailbox labeled “urine,” where residents left samples for drug tests. Botticelli was listening to their stories of addiction and then offered this:
“I have my own criminal record.”
“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 waking up handcuffed to a hospital bed after a drunken-driving accident and a financial collapse that left him facing eviction.
Decades later, he is tasked with spearheading the Obama administration’s drug policy, which is largely predicated on the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system.
Botticelli’s story is the embodiment of the policy — a view that he credits with saving his life.
The approach at the White House Office of National Drug Control Policyhas 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 heads an office that has shifted away from a “war on drugs” and is instead expanding treatment to addicts and preventing drug use through education.
Botticelli became the acting director of drug-control policy in March, about a year and a half after he came to Washington to be then-czar Gil Kerlikowske’s deputy. The White House has not formally nominated him to take over the job permanently. It is a position that has been held by law enforcement officials, a military general and physicians. But for now, it is occupied by a recovering alcoholic.
The nation is facing an epidemic of prescription-drug and heroin abuse. The number of fatal overdoses increased by 118 percent nationwide from 1999 to 2011, mostly driven by powerful prescription opioids and a recent shift that many users are making from prescription drugs to heroin, which can be cheaper and more accessible.
In recent years, the White House has placed great importance on tackling opiate addiction, holding two national summits on the subject. But even given the administration’s attention, the battle remains a huge challenge on the federal, state and local levels.
Drug trends and issues tend to vary geographically, making a sustained national effort difficult. Insurance companies often do not cover inpatienttreatment, and an obscure federal rule restricts the expansion of addiction treatment under the Affordable Care Act. The White House also is 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 said. “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 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 problems, a group he calls “my peeps.” Although Botticelli easily shares his struggle, those who worked with him said 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 ofLahey Health Behavioral Services in Massachusetts.
The bar scene
Botticelli drank in high school and college, and he once was 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 Cafe, a legendary 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,” he said. “And so that’s where you went to socialize, to meet people.”
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. His car collided with a disabled truck. He remembers being placed on a stretcher and put in an ambulance.
Hours later, he woke up at a 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 and booked; his driver’s license was 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 fines and restitution. 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 attending a court-ordered course on the dangers of drinking and driving as well as 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.
‘I finally said yes’
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 received an eviction notice soon after 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 was a recovery program for gay men 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 Cafe. 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 facing addiction. He eventually felt comfortable going to bars and not drinking. He met David Wells at one in 1995. They got married in 2009.
Power of recovery
One of Botticelli’s recent trips took him back to Boston this month. Soon after arriving, he was smoking a cigarette outside a Starbucks when a woman had a question: Why are burly agents standing around? (He has 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 officers, elected officials and others. He met with Boston Mayor Marty Walsh (D), who also is a recovering alcoholic. Botticelli had sandwiches with law enforcement agents who spoke about the major increase in heroin addiction. Here in Lynn, a city of 91,000 people, 188 opiate overdoses and 18 deaths occurred in 2013; as of July 31, there were 163 overdoses and 20 deaths.
Botticelli hugged and shook hands with 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,” said one of the men, Pat Falzarano. Botticelli nodded.
Hours later, Botticelli stood outside the church where his recovery started and marveled at how he got from there to the White House.
“When I first came here, 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.”
Katie Zezima covers the White House for Post Politics and The Fix.