The Power of Personal Narrative

David: Hello and welcome to this episode of Recovery Unscripted, a podcast powered by Foundations Recovery Network. I’m David Condos, and I’m honored to welcome today’s guest, Michael Botticelli. As director of national drug control policy, he led the Obama administration’s efforts to advance reforms in policy, prevention, criminal justice and treatment. Michael sat down with me at the Innovations in Recovery conference in San Diego to describe how the power of personal narrative can go beyond the reach of scientific data to influence widespread change. Also, we’ll stay with the presidential theme for our trivia segment called This Week in Recovery History.

Our question highlights the pivotal statement delivered by former first lady Betty Ford in which she bravely revealed her own addiction to the public on this very week in which of the following years: 1978, 1980, or 1982? Find out after the interview.

David: Michael, I want to thank you, welcome you to our 52nd national conference here at Innovations in Recovery in San Diego. We were so honored to have you offer the keynote address this morning about the power of personal narrative. Thank you for time.

Michael: It’s great to be here this morning.

David: In your talk, of course, you referenced the time you spent as the national director of drug control policy. You traveled a bit of a different path, had a different background than a lot of people who have served in that role like you said. Could you tell us a little bit more about your background and how your journey began?

Michael: Like many people who got into this work this is not part of my professional background. I actually got into this work because of my own recovery and my own struggles with addiction, which I think many people find themselves who do this work. That has been the pathway that they do it in. Spent 18 years working at the public health department in Massachusetts, so I’ve always thought about this issue from a public health standpoint.

Also, coming from a place where I was very personally connected because of my own personal journey. It was really an important aspect and perspective for me to bring to my role because I could see how my own journey reflected what I think many people go through in their struggles with addiction. I also think it really speaks to how people who are affected by addiction need to be part of the conversation. They need and should be part of the decision-making process.

I was fortunate to do that at a pretty high level in terms of the last administration. Wanted to make sure that I was using the bully pulpit of my role. Also really talk from a personal perspective about my own recovery because we’ve seen how that can really change people’s attitudes about people with addiction.

David: In your presentation, you reference some of the limitations of science and data on their own and the way that they can affect public attitudes, and ultimately public policy. How can personal narrative have the power to break through that barrier and change the conversation on a larger scale?

Michael: We’ve seen time and time again, particularly when you have stigmatized people and stigmatized diseases like an addiction, that often, despite the fact that we’ve known it’s a disease and needs to be treated with good treatment, and love and compassion, we still are a ways away from that. Part of the reason for that is because for a long time we’ve seen people with addiction as the other folks, right? “Not in my family,” “not in my community.” That’s one of the reasons why people have been treated so poorly, not having a treatment benefit, often criminalized.

The more that we can create this personal connection, the more that we know that it really does change people’s attitudes. The more that we change people’s attitudes, we’re likely to see a more health-focus approach to this. That’s why I try to use my own story. Encouraging people who are in recovery to be open to the extent that they can about their own journey because I do think that that does change people’s attitudes and changes public policy. One of the things that I can talk about is the foundation for recovery has always been about people storytelling.

We have known those of us in recovery know the power and the healing power of those kinds of stories. I don’t think that just relates to people who are in recovery. I’ve seen time and time again how a lot of the stigma that we have, a lot of the myths and misconceptions that we have about addiction can really be changed by people getting to know one another, and sharing their own journey through addiction and recovery. Particularly the hope aspect. One of the reasons that we know people don’t seek treatment is because they don’t see a life on the other side of it.

That was profoundly true for me. I knew that I needed help. I knew that I needed treatment but I was really afraid to get it. Not only because what people would think, but in essence I couldn’t see a life without drinking, without using drugs. If there had better more vibrant and visible recovery community, that that would have given me more hope to see, “Oh my God, I can have this great life … I can have a great life in recovery,” if there had been a more visible community. We need to give hope to people out there that you can and do get better.

You can have this great life. I’m sitting here talking with you and looking over your shoulder at this beautiful beach and this beautiful ocean, and none of that would have been possible without recovery. It’s those kinds of stories and those kinds of images that can have dramatic impact on someone’s life.

David: Related to this, as you were giving your presentation, I was struck by how you compared the stigma of addiction with other stigmas related to other mental health issues, and then your own experience with the LGBT community. How can the progress that’s been made in some of those other areas, and specifically you talked about the coming out movement, how can that offer us a template or a path to breaking this stigma of addiction through telling stories and everything that goes with that?

Michael: There’s a couple of ways. Part of what we know — September is recovery month. That has always been kind of a special month for us to be highly visible in the community, so there are things that we can do around recovery. I’ve also been moved by many employers who now are beginning to understand how issues of addiction impact their employees and their families. At Boston Medical Center, at GE, at other very large employers, they are beginning to showcase people in recovery because they know that it’s really important for them to support their employees.

I can’t help but think throughout the course of my recovery, and this is very commonplace with other people who disclose that they’re in recovery. Invariably, people come up to them and say, “You know what? Me too. My family too.” With always this kind of tinge of secrecy and shame about it. That’s really unfortunate. If we can amplify that to the millions and millions of people who are in recovery, that we can really have a profound impact on the stigma that’s often associated with the addiction that keeps people from asking for help.

David: Yes, and that can be the first step toward starting that conversation, is even just having that one and one even if it feels like it’s secrecy in that moment, it still is opening it up and saying, “Me too.”

Michael: It’s really true. I can’t help but think during my time at the White House, how many people, even in the White House, came up to me and disclosed either they were in recovery or the partner was in recovery, or their family has been impacted by this. There is this liberation. This kind of very liberating quality for people to be able to share their stories. One of the expression in 12-Step groups is that you are as sick as your secrets. That’s really true. We know that addiction can be very isolating and that people can get mired in that secrecy.

There’s this kind of healing property of telling our stories, and that healing extends to other people.

David: During your presentation, you also referenced that one of your passions is exploring the power that language can have. I love that. I’m a words guy. What are some ways that the words we use can end up having really an immense impact, beyond what we might think they would when it comes to how people are viewed and treated in addiction?

Michael: Those of us who’ve been doing this work for a very long time keep coming back to the role that stigma plays, both in terms of its personal impact, in terms of keeping people from asking for help. Also, how it influences public policy. People often ask, “What are things that we can do to diminish stigma?” I often say one of the low hanging fruits that we have if we really want to change the impact that stigma has, is changing our language. Language connotes some very powerful themes to people and to the public at large.

When we use words like “addict” and “junkie,” and even “substance abuse” and “substance abuser,” that has certain connotations and people often react to those kinds of words. If we want to de-stigmatize issues of addiction, we need to change or language and use clinically appropriate terminology. I think about the words that we use to describe people with mental illness. Highly judgmental, highly derogatory. It’s the same way with addiction. At the level of media, in our discourse that it’s really important for us to be able to use clinically appropriate terminology.

One of the glaring things, and often from people in recovery will refer to them as, “I’ve been clean for X amount of time.” While I celebrate that, the opposite of that connotes dirty. People with addiction are not dirty. People with an addiction have a disease and they need treatment. They’re not bad people who are doing bad things. These are about sick people who need help. I think there are many ways that we can modify our language so that we’re not continuing to perpetuate the stigma of that, unfortunately, still surrounds this disease.

David: Yes. It was fascinating looking at carrying this into a therapeutic context. You referenced a study where they gave medical professionals set of basically identical patient information or whatever it would be called, and one of them used these words that you’re saying can be harmful and of them used the updated words, and the treatment was different. The way they looked at those patients was different.

Michael: Yes. This was a study that was done by my good friend and colleague Dr. John Kelly who runs The Recovery Research Institute at Harvard Massachusetts General Hospital. He gave trained professionals — we’re not talking just the general public. These are folks who you would think would know how to deal with this issue from a therapeutic standpoint. Just even changing simple phrases like referring to someone as “the substance abuser” elicited a more primitive response than a person with a substance use disorder that elicited a more therapeutic response.

I love talking about that study because I think it even shows that among trained professionals in this field, that language is important and language matters. If you talk to many people in recovery and they will tell you, even within the healthcare system, how they often feel– Don’t often discuss that they’re in recovery because they really fear significant judgmental attitudes by folks who you would think would be otherwise trained to treat everybody with dignity and respect.

David: Michael, thank you for your time. It’s been such an honor to have you here. Before we go, what’s next for you? I know you work with the Grayken Center there in Boston, Johns Hopkins. What do you have coming up?

Michael: One of the things that I think has been important for us at Boston Medical Center is how do we continue to spur clinical innovation in the work that we’re doing. Part of the work that I see going forward for me at the Grayken Center is to continue to focus on how do we do a better job of treating people with addiction issues. Not just in the clinical context, but we know that people with addiction need access to stable housing and stable employment. They need a whole host of work.

Part of what I hope to continue to contribute to this field is how do we continue to promote really good evidence based care.

David: Yes. All right. Michael, it’s been a pleasure. Thank you again for your time.

Michael: Great. The pleasure’s been all mine. Thank you very much.

David: Thanks again to Michael for sharing that with us. Thank you for sticking around to the end of this episode for another installment of our trivia segment This Week in Recovery History.

Today’s question focused on Betty Ford’s pivotal statement revealing her addiction given on April 21, 1978. 10 days earlier on April 11th, she was admitted to the Long Beach Naval Hospital for what hospital officials initially called “over medication related to arthritis pain.” But in her own statement given to reporters at the hospital on the 21st, the former First Lady disclosed that she was not only addicted to pain medication but to alcohol as well.

Beginning with a pinched nerve she endured in 1964, Betty Ford was introduced to prescription painkillers and this quickly compounded with her existing alcohol use, which had already increased due to the stress of life in politics.

She kept her struggle hidden for several years until finally admitting she needed help during an intervention her family staged at their home in California. Just like when she publicly discussed her struggle with breast cancer in 1974, her motivations for speaking out her addiction were simple. To encourage other people with similar problems to face them and attempt to solve them.

Her desire to break the stigma greatly advanced the world of addiction recovery and continues to be one of her defining legacies.

That’s Betty Ford’s first public statement about her addiction delivered this week in the year 1978. Stay tuned for more trivia from recovery history in future episodes.

David: This has been the Recovery Unscripted podcast. Today we’ve heard from Michael Botticelli, former director of National Drug Control Policy. For more about his current work with the Grayken Center for Addiction, visit bmc.org.

Thank you for listening today. If you’ve enjoyed this episode, please pass it along to someone else who might enjoy it as well. See you next time.