At the End of the Day

Responding to the Critics

At the end of the day, advocacy is all about helping people.

Critics of my work sometimes point to our efforts to expand insurance coverage for the treatment of substance use disorders. Just the other day, a woman sent me this note: "Mr. Moyers, your argument and your efforts are nothing more than a bald-faced, selfish ploy to fatten the bottom line of Hazelden Betty Ford. It is really disgraceful that your employer is profiting from the suffering of addicts. You're a nonprofit, aren't you?!?!!!!"

Old blue-bloods and zealots of Twelve Step recovery throw darts like this one: "Boo on you for violating the principles of anonymity. Shame on Hazelden Betty Ford for drawing Alcoholics Anonymous into public debate about treatment or any other issue. As a grateful 'graduate' of your program (1988), I find it distressing to see this institution encouraging your patients and alums to break their anonymity too. You should be above that harmful rhetoric."

Finally—and most vociferously, of late—are opponents to our approach to treating some opioid-dependent patients with an opioid-based medication called Suboxone: "You're ruining AA by discharging people into the community who are under the influence," a man 45 years in recovery claimed in a friendly, face-to-face coffee talk with me.

I've also heard on the street that another man I respect, an alumnus no less, has been spouting around town, "Hazelden Betty Ford has unleashed a virus in this community."

My answer to each, in order:

We can't have a mission without a margin.

We're not.

You don't get it.

Fortunately, such sentiment is the exception rather than the rule these days. As I referenced in my last blog, I've seen a lot of change in public perception and public policy over the decades. Even from among our own ranks, resistance to change and reluctance to get involved have eased.

Still, the comments I've included here aren't from the Dark Ages of the addiction advocacy arena. They were made in the past six months.

In other words, we've come a long way. But we still have a ways to go.

That's why I say to such critics, "Thanks for reaching out. And keep those comments coming."

It's also why I take great pains and spend a lot of time to respond to each and every letter, email, Facebook or Twitter message, text and chance encounter on the sidewalk or in the audience at one of my speeches. I owe an answer or explanation to everyone who has a question or criticism about these issues because even in these times, addiction remains the most misunderstood chronic illness in the nation.

To the woman who questioned Hazelden Betty Ford's "profit" motive, I explained that when revenue exceeds expenses that amount is plowed back into the overall operations of the organization, not returned to investors or stockholders as it is in for-profit companies. On the plus side of the balance sheet of any nonprofit, it is the mission that benefits. Besides, I reminded her, substance use disorders are a chronic illness. And insurance is all about providing health care resources for people suffering from any illness.

To the man worried about anonymity and AA in the public arena, I explained that nothing we do in advocacy is a break from the traditions that have guided Twelve Step programs for so long now, and successfully protected them from outside influence or debate.

I stand up and speak out all the time. But because I too revere these principles, I always try to steer clear of speaking for or representing any recovery program. I do so as a person in recovery who got well via multiple treatments a long time ago and as a representative of Hazelden Betty Ford.

Above all, I never encourage others to break their anonymity, and in fact, urge them to weigh carefully the pros and cons of sharing their own stories in a public setting. To each his own I always say.

To naysayers of medication-assisted therapy or treatment, I remind them that the scientific strides in understanding the brain-oriented illness of addiction have resulted in remarkable innovation in how to treat the illness. This includes pharmacology: not at the exclusion of treating the whole person—there is more to healing the mind, body and spirit than simply taking a pill or getting a shot. But appropriately prescribed medications like Suboxone can help people with opioid use disorders overcome their cravings while they find traction toward sustainable recovery in Twelve Step or other recovery programs.

However, what prompted the genesis of this week's blog doesn't have much to do with these questions or my answers. Instead, it is the death of several people I had tried to help. One was shot to death. Two others died of overdoses. One was killed in a drunk-driving accident, and another died from the health consequences of decades of drinking six-packs of cold beer.

It's been a rough week for me, professionally and personally. But in mulling over the lives and deaths of these victims, I've come up with a one-liner that I plan on using the next time somebody is critical of what I do and how I do it.

Go back and read the opening sentence of this missive. It really is this simple.
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