← Thriving with Addiction with Dr. Jonathan Avery
Thriving with Addiction with Dr. Jonathan Avery
From Capitol Hill to Recovery: Patrick Kennedy’s Fight for Change
00:40:08
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- [00:00]
A
Welcome to the Thriving with Addiction podcast where we explore how recovery is not just about surviving, but about truly living. Each week we'll dive into the science stories and strategies that help people and families heal from addiction and build healthier, more resilient lives. I'm your host, Dr. John Avery. Let's get started.
- [00:26]
B
John I'm John Avery and welcome to Thriving with Addiction. Today we're very lucky to have Congressman Patrick J. Kennedy. During his time in Congress, Patrick Kennedy was the lead author of the landmark Mental Health Parity and Addiction Equity act, the federal parity law which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body. As founder of the Kennedy Forum, he now unites advocates, policymakers and business leaders to advance evidence based practices and policies in mental health and addiction. In 2023, the Kennedy Forum launched the Alignment for Progress, a movement to align leaders from across industry and across the aisle to transform our mental health and addiction systems. He currently serves as co chair of the National Action alliance for Suicide Prevention's Mental Health and Suicide Prevention national response to COVID19 and he's co chair of the Bipartisan Policy Center's Behavioral Health Integration Task Force. Congressman, thank you for joining me today.
- [01:28]
C
I appreciate you having me.
- [01:30]
B
I'll also mention author of two of my favorite books, one, Profiles and Mental Health Courage and a Common Struggle, two that I recommend all the time to my patients or anyone interested in mental health and substance use. Those were such seminal works I feel in helping others.
- [01:48]
C
Oh, I appreciate it. Well, I had a terrific partner in them, Stephen Fried, who is tremendous writer and I'm, I'm always very interested in how do we tell these stories much more effectively because I think in the past a big con contributing factor to stigma is that we, we have a very, you know, very superficial narrative and, and if we were able to capture more of the nuance and complexity of these illnesses, first of all, more people would, I think less people would feel isolated one, and then more people would be able to identify and not be quite as judgmental as they end up being because we try to either sugarcoat it on the one side or we over dramatize it on the other end in the process. You know, it's easy to point to quote those people if there's someone other than you and yours and they don't kind of resemble anything that's familiar to you. And that's the biggest challenge in, in this whole issue. Jonathan is kind of integrating this as kind of part of the normal process. If we do that, then everybody becomes a stakeholder in ensuring that we all are in better position to manage life because we have these organs called our brains and they don't always work right. And just like the rest of healthcare, we should be promoting their health and just like we do other organs of the body, and yet we just neglect the brain, you know, repeatedly in our medical system. So I first of all, thank you for going into a, a vocation, a profession that is focused on how do we better treat the mind and, and the brain and, and how we treat the brain to better fix the mind. And this is the new frontier that gets me excited every day about the advocacy. And you certainly have, having chosen this field, are really helping this whole, not just your patients, but our country and society at large.
- [04:18]
B
Well, I appreciate that, but I feel like you've really set the stage for how to combat stigma and you sharing your story, I've seen it impact so many people and my research is on the stigma of addiction and it shows exactly what you're saying, that the most stigmatized condition that exists in society, but even in the places that should be the safest, like among doctors and lawyers, even in our own family members. And I think having those sort of rounded, reasonable, non sensationalized narratives is really a way through. I agree completely. And maybe take me back to the beginning of your story. So when did addiction and mental health first become a part of your personal, personal story?
- [04:57]
C
I mean, from the beginning of time for me. Because of course, both my parents, you know, suffered from addiction and like all other illnesses, these illnesses manifest in different ways for different people. So it's like we, the big problem again with stigma is we kind of stereotype what someone with addiction looks like. And then we say, that's not me. And my mother is very, very dysfunctional, kind of really debilitated by her addiction. My dad, like many in society, very functional, still grappled with, with addiction, but was also, like many people, very, very successful. And so, and as you know, in this thing, in this business of tackling this, you know, our biggest, single greatest characteristic of addiction is the lack of insight to know that you have addiction, right? It's the feeling and the thinking that, oh, I've got this, I can manage, or look at me, I'm super successful. I can't be, you know, compromised by addiction because look at how much I'm able to do. So. You know, my mom and dad are studies in contrast. You know, my dad probably one of the most successful United States Senators and in US History singularly, like, authored more pieces of major legislation than any other US Senator in history, but, you know, suffered terribly. My mom, you know, she had addiction. The thing with my mom's story is that, you know, she just passed two weeks ago.
- [07:02]
B
Oh, sorry.
- [07:05]
C
Thank you. She. Yeah, it always was said that she had addiction because of my dad, because she was married into the Kennedys. And there was obviously tons of tragedy in her life after she, you know, along with my. Because she. She was there in the early days of campaigning for President Kennedy and Bobby and. And of course, my dad and. And, you know, so she. But she had a real predisposition to addiction well before she even, you know, know, kind of met my dad and. And of course, I didn't know much about that until I wrote my book A Common Struggle, because she never told me about it. She never told me about the. The home that she grew up in. The fact, the first time I'd even heard that I had grandparents on her side because they were not even. There was no concept. There were no pictures. There was no discussion. There was no visits. I didn't know who these people were. I mean, that's pretty strange. I didn't really think about this till way down the line, but her mom died at 61 in Cocoa Beach, Florida, and wasn't found for over a week because she was her. Her alcoholism and so pathologized, she had pushed everyone away, which, as you know, is part of the end stage of these illnesses is the isolation. And I remember walking into my mom's room, seeing her cry. It was the first time in my life I'd ever seen my mom cry. And she said her mom had died and I didn't even know who her mom was. Yeah. And later on, I tried to get my mom to talk about it, much like you probably try to get your patients to talk about things that they don't want to talk about. My mom just did. Not ever, in spite of all the efforts I made to try to get her to talk about her experience growing up in an alcoholic home. So these illnesses just let frame. It's about everyone, because we all have these diseases in our lives, whether we're suffering from them or not. Our family members are, and we're all impacted, and particularly children of alcoholics. And that's a whole phenomena of public health that we haven't even begun to scratch the surface of. But I would like to think in my lifetime, we can begin to really appreciate that true prevention and treatment will be better. Treating the whole Family when we begin treatment for the individual who's suffering from the disease, because it's, as you know, a whole family illness right now.
- [09:56]
B
We actually created a free family support program here at Cornell for that exact reason. I think you need, if you neglect the family, then you neglect so much of what drives the substance use. And a lot of that is trauma I'm hearing from you. I mean, your mom had. Seems like a lot of trauma growing up. Your dad certainly losing members of his. Murder. Having members of his family.
- [10:18]
C
Yeah, murder. We say assassination, but I mean.
- [10:23]
B
Yeah, no, I was struck when I've heard you talk before. You, you used that word. Yes. And that speaks to how traumatic it was. So in this environment,
- [10:33]
C
how did mental
- [10:33]
B
health and addiction emerge, merge for you?
- [10:36]
C
So I, you know, I just, I remember drinking, like, 13, 14, you know, there was no one really paid attention. You know, it was, everybody was drinking. I had two older siblings, six and seven years older, so they were well on to, you know, older, what older kids do and drinking and drugging. And I, and my parents were, you know, just divorced, getting divorced. It was just after my dad's presidential campaign. He, you know, his life was chaotic. My mom's, needless to say, very chaotic. She was sep, like living separately from my dad at that point. I had, you know, babysitters and somewhere, but, but there was just, just not a lot that was kind of the wild west. So. Yeah, I just remember feeling really good whenever I drank or used any substance, you know, which at the end of my story, I've used everything to which I use as an example. Doesn't matter what it is. It's like someone said to me, you know, addiction is like lacing up the sneakers. You, you're running away from your problems. It doesn't matter what colors those sneakers are. And, you know, so, you know, stimulants. I was addicted to Adderall, Opioids. You know, back in the day before prescription drug monitoring programs, I was addicted to OxyContin and, and every other kind of pain medication and benzodiazepines, you know, uh, definitely got addicted to those. Alcohol, cocaine. Um, yeah, I, I, I, I just remember, like, getting addicted to one as my primary addiction. Going to treatment for it, taking care of it, coming back, getting addicted to something else. It was like the, the concept that it's the disease of addiction. It doesn't know what the substance is. Kind of tracked with society's view of addiction, which is what, oh, this is an opioid crisis, right. Or this is an alcohol Use disorder crisis or this is a stimulant crisis. You know, there isn't a person I know who's addicted that doesn't use a number of different substances at the same time. It's, it's a poly drug addiction crisis. And in any event. Yeah. So.
- [13:26]
B
And also a crisis of trauma and mental health and, you know, all these things marry together in ways that are tough to untangle and sometimes treatment fails to address all of these co occurring issues as well, which I know you've been outspoken on. Was that true for you early on too, that it was mostly the addiction that was being addressed as opposed to the, the other stuff?
- [13:47]
C
Yeah, I mean, I mean, I remember not even trusting my psychiatrist not to rat on me because I grew up with this kind of hyperbolic kind of worry about maybe it wasn't paranoia that people were gonna, you know, say whatever it was that I said that was, quote, a family secret.
- [14:08]
B
I mean, I'm filled with rage every time I hear your story about how the National Enquirer was the reason we ended up having to share it probably before we were ready. And I think your mom similarly. Yeah, her, her struggles were.
- [14:18]
C
Yeah.
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B
Broadcast by them as well.
- [14:21]
C
Yeah. She had her roommate. It was, it was like deja vu for me. But her roommate in treatment sold her story of being in treatment with Joan Kennedy back in the 70s. It was absolutely devastating to my mom, who already felt. And we. Everybody already knew, but like the glare of that. And the same thing happened to me. I, the guy that I was a roommate with at drug rehab and when I was 17, wrote a diary about being in rehab with me and then he sold it to the National Enquirer. Luckily for me, I was in my first term as a state legislator, which may not sound like it was lucky, but at least I had gotten into office. Hmm. I would never have initially gotten elected if, if, you know, quote, the, my past had been known, but once I was in. And then they found out this guy had told a story on me and they ratted on me, so to speak. My constituents, they weren't very tolerant of, of his kind of ratting on me. So I got reelected mostly because people didn't want to look like they were taking the side of this other guy and they'd rather stick with me. So ironically, it did two things. One, it lifted that stigma and veil for me, which would have meant that I would have kept it secret. Instead, now that I survived politically, I was able to dive in and be an advocate in this space, which I, in my Heart of hearts I probably always wanted to do and which in my life has been the most fulfilling thing that I could have ever imagined or hoped for as a purpose in my life. But at the time I just thought, you know, the world was crashing down and this was going to be the end of my political career. And little did I know it was just going to be the opposite. It was just going to be the beginning.
- [16:13]
B
Right. When you first entered Congress, mental health wasn't really discussed the way it is today, and certainly not addiction. What was it like to be a champion of the cause then? And especially in the setting of your story being public for the first time?
- [16:27]
C
Yeah, so as I said, I'm, I was. Rhode island is the best. I mean, Rhode Islanders just, they weren't going to have the stigma and they, they elected me, Mike. And remember, I first ran. My opponent stood in the middle of the downtown and did a press conference. Patrick Kennedy, tell us your drug dealers. You know, I was like, oh my God. And I, and I, and I want, you know, it was like back then, this stuff was like, you know, of course the goalposts have shifted a lot on what, you know, knocks you out of politics these days. Pretty much nothing can knock you out of being a candidate. But back then this was, and you know, my constituents backed me up. I, I authored the Mental Health, Parenting and Addiction Equity act out in, in Congress after I had been a co sponsor of it in the Rhode island legislature. Um, and in any minute, I became the sponsor of the parity law, which as you mentioned at the outset, guarantees that insurance companies must treat illnesses of the brain no differently than any other illness of the body. Inpatient in network, outpatient in network, inpatient out of network, outpatient out of network, pharmacy benefits and emergency room benefits. I say that because I really want your audience to know that the law is comprehensive. It, it doesn't leave any room for, for insurance companies to maneuver in terms of their obligations just to treat any depression, anxiety, addiction, schizophrenia, bipolar, any differently they would cardiovascular disease, diabetes, cancer. That said, obviously we've had a long battle over other aspects of the law which just again, level set prohibited any higher co pays for people seeking care for addiction, any higher premiums or any lower lifetime insurance caps for, for people who aren't familiar with the history. That used to be the case. You used to not be able to get any mental health coverage at all. Now we still can't get any mental health coverage. But it's for a different set of challenges and those are medical management, you know, Utilization review, utilization management kind of reasons. And that's where the more insidious battle for parody has been waged. And I'm proud to say the Kennedy Forum has been leading the fight across the country in writing model state laws and state regulations, in addition to working with consumer groups to hold payers accountable through working with attorneys general and so forth, to get consent decrees on what's allowable, what isn't under mostly state law, application of parity. So, anyway, I became sponsor because no one else really wanted the moniker of having their name near the words mental and addiction, because keep in mind, the bill is called the Mental Health Parody and Addiction Equity Act. So if your name is number one as the sponsor, of course the press are going to say, well, do you have a mental illness or addiction? Of course, for me, I could, you know, sponsor it, because they already knew the answer to that. It wasn't like some big reveal. Whereas for a lot of my colleagues, they likely did not want to dive in and be the champion, because, of course, they knew that everywhere they went, people would ask. And in many cases, as I learned later on, you know, a lot of my colleagues also suffer and their family members suffer. And I remember when we passed the bill out of the House, one of my colleagues who had shared with me this very intimate kind of story about his daughter having severe eating disorder, he voted against the bill. And I went to him after I said. I remember he told me that story. And he said, patrick, I just. I wanted to vote for it, but I couldn't. And he said, I come from the buckle of the Bible belt in my part of the country. These illnesses are still seen as moral failings, not medical failings. And he said, and furthermore, if I were voting for that bill, then the press may want to look into why I might have an interest in it. And if they ever found out that my daughter had an eating disorder, I can't be sure she would still be alive today. Which, basically, he was worried about her taking her life if the shame of that exposure of her own illness became public. And that story happened to me many times in terms of colleagues of mine who couldn't vote for the bill because they were too worried about the political exposure.
- [21:41]
B
But both passing that act, I mean, it's had such profound impact in the mental health and addiction landscape. But to do it through such stigma, to continue to do the great work you're doing now, I mean, we've. Everyone in the addiction space really applauds you, and you've been such a champion. I really appreciate you.
- [21:58]
C
Thank you.
- [21:59]
B
Tackling that all those years ago and then through such challenging and continued challenging circumstances.
- [22:05]
C
Well, I, I mean, I'm a big believer these days that nothing's an accident in life. And I never would have, you know, imagined myself having the honor and opportunity and the sense of purpose it's given me to be able to do what I do in this space. When I started in politics, just furthest finger from my mind, my family did civil rights, workers rights, healthcare for all, labor rights, you know, mental health. Even though as well represented my family's work, obviously President Kennedy did, did the original Community Mental Health Act. It was, that was never kind of the thing that my family was like celebrated for. So. And it wasn't what I expected I'd be advocating for when I went to Congress, so. But you know, when you look back in life, there's more rhyme and reason than initially seemed to be the case when I was starting off. So I feel very blessed.
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B
We all are. For your work. And even after, though you were dealing with that, you were still struggling at times with substance use through that time. What was it that finally tipped you into recovery and the next chapter in your life?
- [23:28]
C
Yeah, thank you for that. So, yeah, like most other people, I go to rehab, get the tune up, be kind of clean if you will, sober, dry, whatever you want to call it, but not really in recovery. And of course I would revert back and before long be right back where I started from. So I went to probably a dozen treatments over the years and 90% of them were secret, like, because I, I couldn't stand the thought of here I am the advocate on behalf of mental health and addiction and I got treatment and why do I need to go back? Like, what's my problem? Because even I didn't get. These are chronic illnesses like viscerally so. And of course I kept it a secret. Even though I had already been outed, I still felt the stigma. Even though I'm the champion to breaking down the stigma. I go under assumed names into rehab. I mean, it's just the insanity of this whole illness is just unbelievable. But for me, I had multiple debacles. I mean, I was arrested by the Capitol police, by the Coast Guard, by the airport police. I couldn't go anywhere without my disease being with me. And every single one of my major kind of conflicts with the law all involved me being under the influence. So in any event, it was, you know, we talk about these moments of clarity and so it wasn't when I woke up, you know, After I'd gotten my last DWI and I was on the COVID of all the newspapers and top of the news and had, and everyone's calling on me to resign my office and blah, blah, blah, that was not the wake up call you would have thought. It would have been the wake up call. What ended up happening is I, we got the parity law passed. We got the Affordable Care act passed, which thankfully we'd gotten the parity law first, because then it got embedded in the Affordable Care act, thereby guaranteeing coverage to every American. But it was when my dad died, and then I, you know, was back out, active. Active in addiction. And I knew just in my heart of hearts, something was just not going to change unless I changed everything. And I had the momentary insight to talk to someone about it, who I really, really respected and admired. And he said to me, I said to him, I think I have to leave Congress because I just. This is not going to end well. I just know it like my heart. And he said, you better tell Nancy. And this fellow's an old family friend, great, close to my dad and also at the time, very close to Speaker Pelosi. And so I, ironically, was going to vote the very evening we had late night votes that I had told him, I think I can't stay here. And I went and I, I ran to her on the floor of the House. I said, madam Speaker, I need to come and talk to you. Now, the only reason I said that to her is because he told me that I needed to tell her before I spoke to another person, because, you know, she had been a family friend and big, big, you know, personal champion and supporter of mine and me of hers. So I, I said, I need to talk to her. She said, come by in the morning. Can you come by for breakfast? Or came by in the breakfast the next morning? And, and we came in, I came in her office and no one was there. She was just saying, what can I do for you? And I said, madam Speaker, I think I have to leave Congress. And then I burst into tears. And I just, you know, it was like the first time I'd really, really grieved, just the whole process of knowing that I had to change everything. And I said, I'm really worried about leaving under the cloud of stigma and scandal because, of course, that has occupied so much of my family's history, story of scandal and stuff like. And she said, I'll make sure that no one knows. And, and she like, what a champ. So she said, you talked to David Axelrod. So He, David, was, was my political consultant. And this was before I had him, before he went on to become President Obama's architect. And David Pluff, by the way, was my campaign manager. I had great people helping me out. And they cut an ad of me announcing my retirement that no one even in my office knew. I literally kept it to like three or four people. And so the ad, all I did was buy, you know, enough ad time for the ad to get out and then the news reran and I got to leave Congress on my own terms where I said that I, I was ready to leave and not because I was in this phalanx of cameras, why I had to leave because I was a drug addict and alcoholic and a mess. And, and what I did was I changed everything. I left Congress, I sold my house in Rhode Island, I sold my place in Washington, D.C. i didn't know or have anybody in my life. Pretty much my, as I said, my siblings are much older and they had their own families. But I, I was dating this woman in New Jersey off and on, and that was like my next best thought was maybe I go there. And I went and I said, and you know, I said, I want to kind of explore dating you further. She says, I can't date you. You're. You're a mess. And I said, she said, if you want to go to treatment or meetings, you know, that's great, but I can't, I can't date you if you don't get treatment. So I started going to meetings. I never really did the 12 step meeting thing. I went through rehab. I came back, thought I could do it on my own. And of course, I never trusted anybody, you know, to be, to, you know, confide in. And I just went to meetings all the time, Jonathan and I, and I got a sponsor, my sponsors, the, I mean, who could have made it up was President Trump's lawyer. I mean, what are the chances? I had no idea. Yeah, no idea. I only found this out later on because Trump had a big investment, obviously down here in New Jersey, where I now live, so the Trump casinos. Anyway, the bottom line is he told me to clear out my phone of all my old contacts, and so I did that. And so I'm sober. I mean, to say that not just chemically, but I'm sober in a lot of other ways that we now measure our sobriety by that are the new barometers for me. So I've been faithful to my wife in my marriage with her, and I'm mentioning this not to pat Myself on the back. But to say that, you know, sex addiction is part of overall addiction, gambling addiction, you know, I live in Atlantic City, so gambling addiction, all of these other, quote, process addictions, you know, of course technology in general are, I think the new wave of addiction that most Americans haven't figured out are going to be as detrimental as, you know, opioid and alcohol and everything else. I think the sports betting thing really gets me. There's no organized advocacy, by the way, Jonathan, around combating this proliferation of sports betting, let alone marijuana. How that thing creeped up after years of fighting Big Tobacco. You know, my late father and Henry Waxman held all those tobacco companies to account for the fact they lied about the addictive nature of cigarettes. And then, you know, what did they do? They moved all their investments over to marijuana and they've successfully legalized marijuana and. And how many? Two dozen states. And that's going to be so destructive to our mental health and addiction. And, and now sports betting is going to be an absolute disaster. And, and you know, so I now am not only fighting to get poor people treatment, because that's what my law requires, but I'm trying to get people to say, why should we put it be putting so many people who need help into. Into this vulnerable place because we allow these addiction for profit industries to the prey, to prey on Americans. So that's kind of my new passion is we can't just treat our way out of this problem. We've got to try to prevent our way. And we can't talk about prevention if we're looking the other way. While we're allowing these algorithms to be embedded in every product that's in social media and sports betting and everything else.
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B
I mean, to your analogy previously about the sneakers, I mean, to be sober, which you've entered that state, is to be mindful of all these other things that are addictive that seem like, you know, there's some promise where it's not addictive or safe. But you know, it puts a lot of people at risk to have access to all these things, including recovery.
- [34:08]
C
You know, my profiles and Mental Health Courage book, I got the stories out there, a little about gambling addiction and sex addiction. But to be honest, I really tried to get more stories and it was impossible. Impossible because people with really developed both sex addiction and gambling addiction. It's really hard to tell that story without the shame. I mean, like having cocaine, opioid, alcohol addictions, like a picnic compared to the shame that comes with these other addictions these days. And it Was very. I wish we could get more stories and narratives around these other addictions so that we could just sensitize policymakers, Americans, to the fact this is ubiquitous.
- [35:16]
B
I agree completely. I think it's through the stories, like your story that we really can. Can make a difference. So what gives you hope, though? So I mean, as we, as a country, as we, you know, as we tackle addiction and mental health going forward, you've. You've put us in a much better spot through telling your story and through the work you've done. What gives you hope as you look ahead?
- [35:39]
C
Well, I really think the recovery community has so much to offer this country. As I said, the single number one characteristic of addiction and mental illness is the lack of insight. It's the inability to identify that you have a problem. It's the denial that you have addiction or a mental illness. So I frankly think our country writ large has a lack of insight. It's suffering from a, from denial that as a nation we are in real crisis and we can't see the forest from the trees in terms of our mental health crisis. And I believe this is kind of a cultural demand upon us, not just a kind of medical issue and a prevention, but it's what, as, as a culture do we want to tolerate. And we have tolerated a high level of dysfunction. You know, that's what we do as children of alcoholics. We learn to tolerate a lot of dysfunction. It becomes normalized. And then when we, When I became an addict and I active, I tolerated a lot of things that later today I would never accept. But it, it's like. And I think this nation could benefit frankly from the, the work that we in recovery do on a daily basis to become more aware and to help one another and to be more conscious and to really think about the importance of purpose and service to our fellows. I think all of Those principles of 12 step recovery could our solutions for our country. And so I, you know, I'm just. I think that the people in recovery have a lot to offer what our country needs now. We're, we're really at a, I think, an existential moment in terms of the stress and the despair and the level of addiction. We really need to have a moment of clarity as a nation. And, and I think that's going to come from, you know, any number of parts of our society. But I think people in recovery get this, and I think it may well come from. From someone or something about the recovery community could help and still this new mindset as to what we want in our society at large.
- [38:35]
B
Well, I love that and I love you and your story, and I really appreciate you taking the time to come talk with me. And I look forward to doing the good work together to get us to that better spot. So thank you, Congressman, so much for joining me today. I really appreciate it.
- [38:49]
C
Well, Jonathan, I look forward to getting your book and learning more about this whole concept that it's not just about surviving addiction, it's. It's how do we thrive. And addiction is really great in the sense that it breaks us. And in breaking us, it. It opens us up to a new way of thinking and, and being. That means that we can actually be better because of our illness. It's not just getting back to normal for us. It's getting to a new normal, which is a life beyond our wildest dreams.
- [39:33]
B
That's so well said. And you are a great example of thriving with addiction. And again, I can't thank you enough for joining me today.
- [39:41]
A
Thanks for listening to the Thriving with Addiction podcast. If you found today's episode helpful, please follow and subscribe. Wherever you listen to your podcasts and share it with someone who might benefit, you can also connect with me on Instagram, LinkedIn and YouTube or visit thrivingwithaddiction.com to learn more. Stay tuned for next week's episode. And remember, thriving is possible.