Challenges to the Substance Abuse Treatment Community: Addiction and the Policymaking Process

1. Challenges to the Substance Abuse Treatment Community: Addiction and the Policymaking Process September 21, 2012 Barry R. McCaffrey General, USA (Retired) 211 N. Union Street, Suite 100 Alexandria, VA 22314 brm@mccaffreyassociates.com 703-519-1250 1 of 12

2. BIOGRAPHY OF GENERAL BARRY R. MCCAFFREY, USA (RET.) Barry McCaffrey served in the United States Army for 32 years and retired as a four-star General. At retirement, he was the most highly decorated serving General, having been awarded three Purple Heart medals (wounded in combat three times), two Distinguished Service Crosses (the nation’s second highest award for valor) and two Silver Stars for valor. For five years after leaving the military, General McCaffrey served as the Director of the White House Office of National Drug Control Policy (ONDCP). Upon leaving government service, he served as the Bradley Distinguished Professor of International Security Studies from 2001-2005; and an Adjunct Professor of International Security Studies from 2006-2010 at the United States Military Academy at West Point, NY. He served as an Associate Professor in the Department of Social Sciences from 1973-1976 teaching American Government and Comparative Politics. General McCaffrey has been elected to the Board of Directors of the National Association of Drug Court Professionals and the Atlantic Council of the United States. He is also: a member of the Council on Foreign Relations; an Associate of the Inter-American Dialogue; Chairman of the Vietnam Veterans Memorial Education Center Advisory Board; and is a member of the Board of Advisors of the National Infantry Foundation and the National Armor & Calvary Heritage Foundation. He has served on the Board of Directors of several corporations in the engineering design, technology, and services sectors. He is on the Board of Directors of CRC Health Group – the nation’s largest behavioral health care company. General McCaffrey attended Phillips Academy, Andover, Mass.; and graduated from West Point with a Bachelor of Science degree. He earned a master's degree in American Government from American University and attended the Harvard University National Security Program as well as the Business School Executive Education Program. In 2007 he was inducted into the US Army Ranger Hall of Fame at the US Army Infantry Center, Ft. Benning, GA. In May 2010, he was honored as a Distinguished Graduate by the West Point Association of Graduates at the United States Military Academy. General McCaffrey is married to Jill Ann McCaffrey. They have three married adult children and six grandchildren. Their son, Colonel Sean McCaffrey, just retired from the Armed Forces after his third combat tour. Currently, General McCaffrey is President of his own consulting firm based in Alexandria, Virginia www.mccaffreyassociates.com. He also serves as a national security and terrorism analyst for NBC News. 2 of 12

3. THE NATURE OF ADDICTION • Adolescent drug behavior. • Neuro-chemical changes in brain function. • Co-morbidity (mental health). • The influence of environment. • The influence of genetics. 3 of 12

4. DEALING WITH ADDICTION • Prevention and education. • Science based treatment: • 12 step model • Cognitive theory • Behavioral health care • Medical/Pharmaceutical intervention • Maintaining sobriety • Drug Courts and Social Disapproval. 4 of 12

5. THE COSTS OF ADDICTION • The impact of an addict on the work force, medical system, public safety, criminal justice. • A three generation disease. • Good government and corruption. • Drugs, terrorism, international crime. 5 of 12

6. VETERANS – THE NATURE OF ADDICTION • History of adolescent drug behavior. • Addictive Neuro-chemical changes in brain function. • Co-morbidity (mental health). • The influence of environment (parents, peers). • The influence of genetics. • U.S. military illegal drug use rates low but increasing. • Alcohol abuse a major problem – 27% returning Iraq/Afghanistan troops. • Prescription drug misuse up 11%. 6 of 12

7. ONDCP USDA HHS Congress DoJ/DEA Treasury Customs DoS THE POLICYMAKING PROCESS Policy Evaluation Problem Recognition and Definition POLICIES Agenda Setting Policy Implementation Budgeting Policy Formulation Policy Adoption 7 of 12

8. REAL DECISION-MAKING IN WASHINGTON • Shape health care policy arguments based on logic-merit-principle. Do not anticipate what the politics will allow. (Colin Powell) • Write the concept paper – own the argument. (If your spouse can’t follow the jargon – it will not work on Congress and the media.) • Talk about the policy – control the budget. • Trick the senior policy officials into readingyourwork. (They never forget old-bad data.) • Form inter-agencyteams at the career professional level. (Integrity and good ideas.) • Work the media with experts – the people have a right to know. • Work the Congress and staff – do not hide until end game. 8 of 12

9. WORKING WITH CONGRESS ON HEALTH POLICY ISSUES • Educate and inform – no “lobbying.” Absolute integrity. • Leverage travel opportunities – CODELs and STAFFDELs to key behavioral health care events. • Listen and respond rapidly. • Anticipate Congressional concerns to proposed policies. • Propose prompt solutions to problems that have Congressional interest or require Congressional assistance. • Build and maintain relationships with Members of Congress and staff. 9 of 12

10. THE POLICY PROCESS AND THE MEDIA • The media can’t do their job effectively unless you help. • The career bureaucrats tend to automatically hide information – both good and bad. The senior political leaders leak all their info. • The media need news – sound bites, conflict, names. • They work on deadlines. They will be objective. They will keep their word. • Form long-term relationships with serious print media. • When there is a problem – get in front of TVcameras. • You can refuse to help shape the story – they will still do the story. 10 of 12

11. INFLUENCING HEALTH POLICY IN CONGRESS • Professional Associations. • House and Senate Health Policy Caucus. • Former Health experts working on the Hill • Health Care Industry Government Relations Representatives. • HHS, DOJ, Department of Education -- Legislative Affairs Offices and Principals. • The Media. 11 of 12

12. CHANGING DRUG POLICY • We must “work” both the Executive and Legislative Branches. • Active and honest engagement with Congress is essential in gaining support for health policy with the resources needed. • Engaging Congress is not a burden – it is a Constitutional requirement. • Healthcare industry must maintain independent, best expert judgment and advice regardless of Administration. 12 of 12