It happened at the beginning of the New Hampshire Forum on Addiction and the Heroin Epidemic, well before the 5 mid-card presidential candidates who participated in the event showed up to speak. About halfway through the morning portion of the forum, Senator Jeanne Shaheen (D-NH) stepped up to the podium and began her speech with a little audience participation. After doling out the requisite amount of praise to those in attendance, Senator Shaheen decided to take an informal poll of who exactly it was that she was speaking to:
“How many of you in the audience have a family member or a friend who is an addict?” Senator Shaheen asked. The majority of those in the room raised their hand.
“How many of you are treatment professionals of some kind?” she asked next. A smaller, but still substantial group of people raised their hand.
“How many of you are involved in drug policy work?” she said to the crowd, prompting a smattering of hands to go up in the air.
“How many of you are working for a presidential campaign?” Shaheen asked, this time eliciting one hand raise from a member of Governor John Kasich’s staff who had gotten to the event early.
And then, happy with the response she had gotten, Senator Shaheen ended that portion of her appearance and got on with her speech. I looked around the room and pretty much everyone looked satisfied—or at the very least uninterested—and ready to hear the Congresswoman’s remarks. No one outside of myself, it seemed, found it odd or insulting that Senator Shaheen had asked about the backgrounds of attendees at a forum on addiction and neglected to ask if there were any recovering addicts in the room, an omission that is far too common in the corridors of power in America to blame squarely on Senator Shaheen or any of the political actors in the room that day. Nonetheless, it was still disconcerting that a forum on heroin addiction would seem to go out of it’s way to avoid communicating directly with those in recovery and active addiction while spending a significant amount of time painting addicts as passive actors in the fight against their own addiction.
Having worked in The Office of National Drug Control Policy (ONDCP) for the better part of a year some time ago, this open neglect of those in both active addiction and recovery at a forum ostensibly for their benefit shouldn’t have surprised me. Yet, owing to the vagaries of human memory and my desire to place rose tinted gels over the lights shining on my past, I had managed to block much of that portion of it from my mind. But, the fact of the matter is there are very few politicians and policy makers out there shaping drug policy who are in recovery themselves. At the current moment, we are lucky enough to have Michael Botticelli as our nation’s “drug czar”, the first person to hold this position who is himself in recovery from drug addiction/alcoholism or to have a background rooted in public health as opposed to law enforcement.
I had the good fortune to work in ONDCP’s Office of Demand Reduction when Mr. Botticelli was brought in as the office’s Deputy Director and can say that work he has done while I was there and after—along with that of ONDCP’s Recovery Branch Chief Peter Gaumond, who is himself in long-term recovery—has done a great deal to bridge the gap of trust and understanding among many advocates and treatment professionals in the recovery community who have long seen government outfits like ONDCP as being punitive in nature and only interested in paying lip service to the importance of substance abuse prevention, treatment and recovery services in our nation’s approach to drug addiction.
This is not to suggest that those who occupy leadership positions within the government organizations that inform our nation’s drug policy have to be in recovery. There are many people within ONDCP, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the federal government who are not addicts or alcoholics and who do phenomenal work, but it is vital that any comprehensive federal drug strategy be firmly rooted in the experience and needs of those who have gone through the crucible of active drug addiction and come out the other side. At the present, folks like ONDCP Director Botticelli are the exception to the rule, rather than the rule itself and, while I can’t speak for everyone else in recovery and active addiction, it would be greatly reassuring to see the next President of the United States nominate someone for Drug Czar who is in recovery from drug addiction or, at the very least, has an extensive background in public health and not law enforcement.
Now, while it is encouraging that pretty much all the candidates have publicly acknowledged that drug addiction is a disease and not a moral failing, it would seem as if many presidential hopefuls still aren’t addressing it through a public health framework. This was evident at the New Hampshire Forum on Addiction and the Heroin Epidemic, when all of the candidates on stage said that they would be against allocating any funding to drug abuse prevention programs, with some candidates openly mocking the idea of formal drug abuse prevention altogether.
Normally, if a candidate is talking about their opposition to funding drug prevention programs, they would cite cost as their primary rationale. However, the prevailing sentiment among the 5 GOP candidates that day seemed to be: Why would I want to waste money on something that anyone could do for free? Governor Kasich seemed to think it was ludicrous that government fund prevention efforts based on comprehensive education and best practices, instead arguing that teachers should be tasked with the job of keeping the kids off drugs—because, you know, all teachers are trained in drug prevention and clearly don’t have anything else occupying their time and energy, like teaching. For many of the other candidates, the onus of prevention was placed less on schools and more on parents, a plan which is absurd for many reasons, particularly because the only way to expect better outcomes in parental prevention of drug abuse is to fund educational and outreach programs to provide them with the resources to do so and because a large percentage of potential youth addicts have parents who are addicted to drugs as well.
And beyond the effectiveness of these programs, it would seem to me that for a group of people who claim to love to save money, the Republican presidential candidates (and to a certain degree the Democratic ones as well) have a very poor grasp on how to effectively reduce healthcare costs. You see, the funny thing about disease is, if you prevent it from happening, you don’t have to pay for its eventual treatment. For example, it’s remarkably expensive, both in cost and loss of life, to treat those suffering from an addiction to opioid painkillers. It is much, much cheaper to invest money in comprehensive drug education programs for both children and parents and to provide families with free or discounted pill safes to keep teens and newly recovering addicts from abusing medications not prescribed to them.
Ending the opioid epidemic, and doing so in a cost-effective manner, requires the organization of frequent Rx pill buy-back days with local law enforcement to keep opioids and benzodiazepines and the like from just hanging around the house, the widespread enforcement of Prescription Monitoring Programs, and, perhaps most importantly, it is essential that the pharmaceutical companies be held accountable for profiting on the misery of the American people and that physicians be encouraged to prescribe opioid painkillers judiciously and in smaller numbers, with larger numbers of refills, so that those in pain have access to medications, but rarely have extras when they recover.
All of this is much easier said than done, especially with regards to the reining in of Big Pharma, which is easily one of the most universally reviled industries in the country, but is also a top contributor to many presidential candidates. Jeb Bush, Chris Christie and Hillary Clinton all currently count the pharmaceutical and health product industries as one of the 20 biggest contributors to their campaigns, with both Bush & Clinton taking in over $1 million from them. This fact, by itself, does not mean that Secretary Clinton or Governors Bush & Christie can’t propose a number of substantive measures towards increasing access to drug treatment and creating a national drug control strategy that is based firmly in public health and recovery instead of law enforcement and incarceration, but it does mean that I have very little faith that they will attempt to enact policies that will significantly cut into Big Pharma’s bottom line.
At the end of the day, all but one of these candidates will be moving into The White House this time next year, which means that the vast majority of the drug reform rhetoric that’s being thrown around on the campaign trail will wind up being just that—rhetoric. However, just because a candidate doesn’t win the general election or their party’s nomination doesn’t mean that they can’t use their soap box to shape the national discourse on drug addiction, for better and for worse. After listening to the 5 GOP candidates in New Hampshire and, to a lesser extent, the Democrats during their debates, it seems pretty evident that most of those running for president have opted for heartstring-pulling anecdotes and political preening rather than substantive policy solutions.
In Alcoholics Anonymous, there’s a particular type of lead or share during a meeting that is known as a drunkalogue (I would imagine there’s a similar term in Narcotics Anonymous, but I spend less time in that fellowship and have not heard it). A drunkalogue is, in essence, when an alcoholic tells his/her story and focuses almost exclusively on instances of drinking and using, without talking much about the recovery process or how he/she is coping with life in sobriety. In terms of it’s utility in helping an alcoholic stay clean and sober, the drunkalogue is virtually useless as it mainly serves to glorify past use—a phenomenon known as “war storying”.
The tendency of politicians to spend the bulk of their time talking about the suffering of addicts that they have known personally throughout the course of their life is in many ways an offshoot of the drunkalogue. In a place like New Hampshire, which currently has the 3rd highest drug overdose rate in the nation, residents hardly need to be educated as to the severity of heroin epidemic, so the only purpose these stories serve are to make the candidate seem relatable and sympathetic to the voting public. Some of the politicians that spoke at the forum were so desperate for a personal addict story that they resorted to talking about their hairdresser’s children. However, it’s not simply the proximity of the addict to speaker that characterizes this form of pandering, but the way they talk about the addict.
On the positive side of the spectrum, I will say that Jeb Bush’s remarks about his daughter’s struggles with addiction were done tastefully and without over-dramatization. He spoke less about what he personally had done during his daughter’s struggles and didn’t provide some woebegone accounting of her addiction, choosing instead to talk more about the work his wife Columba did to combat drug addiction when she was First Lady of Florida. I certainly didn’t agree with everything Governor Bush had to say during his speech, but he did do a good job at avoiding using his daughter’s struggles with addiction as a political prop.
The same can certainly not be said about Carly Fiorina, whose speech about the death of her step-daughter after a prolonged battle with prescription pill addiction and alcoholism filled me with a sort of muffled anger. As she spoke about her step-daughter’s retrospectively inexorable descent into addiction, the words coming out of mouth were so overwrought and maudlin I felt ill. “As Lori grew progressively sicker, the potential disappeared from behind her eyes”, Fiorina told her audience. “The light, the sparkle she once had, left her. What remained was a dull, flat void. It was the look of hopelessness. And that look is what haunts me most.” In a vacuum, those words might seem genuine and touching, but just looking at her I knew it was an act. I knew it before I went back to my hotel room that night and Googled her remarks and found they had already been written in an op-ed published the day before, which was taken almost verbatim from the book she published back in May. And I most certainly knew it before it came out that she had ushered a bunch of unwitting preschoolers onto a stage where she was giving an anti-abortion speech in front of a giant picture of a fetus.
It is unfortunate when those in the political realm refuse to include those of us who are in recovery or active addiction in the formulation of drug policy. It is unacceptable when they use our suffering as a stepping stone to elected office.