Addiction is a disease. We should treat it like one | Michael Botticelli

譯者: 庭芝 梁 審譯者: 易帆 余

Twenty-eight years ago, I was a broken man.

二十八年前，我的內心充滿絕望。

And you probably wouldn't be able to tell that if you met me.

但是當你遇見我時， 可能根本看不出來。

I had a good job at a well-respected academic institution.

我有一份很好的工作， 任職於受人尊敬的學術機構。

I dressed well, of course.

當然，我的外表光鮮亮麗。

But my insides were rotting away.

但是我的內心腐朽不堪。

You see, I grew up in a family riddled with addiction,

我生長在一個 充滿物質成癮的家庭，

and as a kid, I also struggled

在孩童時期， 我也因為自己的性傾向

with coming to terms with my own sexuality.

而內心充滿掙扎。

And even though I couldn't name it then,

儘管當時的我， 並不知道這是怎麼回事，

growing up as a gay kid

但是身為一個同性戀者，

just compounded my issues of isolation and insecurities.

成長只是加劇了我的孤立和不安。

But drinking took all of that away.

但是喝酒，能帶走這些感覺。

Like many, I drank at an early age.

和許多人一樣，我很早就開始喝酒。

I continued to drink my way through college.

我的整個大學生涯，也持續在喝酒。

And when I finally did come out in the early 1980s,

在 80 年代初期，我終於決定出櫃，

about the only places to meet other gay people,

而當時只有在同性戀酒吧， 才能遇到其他同性戀者，

to socialize,

與他人來往，

to be yourself, were gay bars.

或是作回我自己。

And what do you do in gay bars?

你在同性戀酒吧會做什麼？

You drink.

喝酒。

And I did --

我也是，

a lot.

而且喝了很多。

My story is not unique.

我的故事並不獨特。

Like millions of Americans, my disease progressed undiagnosed.

就和數百萬計的美國人一樣， 我的酒癮在不知不覺中逐漸惡化。

It took me to people and places and things

它把我帶領到，

我絕對不想選擇的人、地和事物。

that I never would have chosen.

It wasn't until an intersection with the law

直到我觸犯法律，

gave me an "opportunity" to get care,

給了我一個接受治療的「機會」，

that I began my journey of recovery.

於是開始了我的戒除成癮之旅。

My journey of recovery has been filled with love and with joy,

我的戒癮之旅充滿了愛和喜悅，

but it hasn't been without pain.

但它並非沒有痛苦。

Like many of you, I've lost too many friends and family to this disease.

和你們當中的許多人一樣， 成癮問題讓我失去太多朋友和家人，

I've heard too many heartbreaking stories

我聽過太多人的心碎故事，

of people who've lost loved ones to addiction.

都是由於物質成癮， 而失去所愛的人。

And I've also lost countless friends to HIV and AIDS.

我也有數不清的朋友 感染愛滋病毒和愛滋病而死。

Our current opioid epidemic and the AIDS epidemic

不幸的是，我們目前的 鴉片成癮和愛滋病，

tragically have much in common.

兩者擁有許多共同之處。

Right now, we are in the midst of one of the greatest health crises of our time.

現在，我們正處於 當代最大的健康危機之中。

During 2014 alone, 28,000 people

光是在 2014 年，就有 28000 人

died of drug overdoses associated with prescription drugs and heroin.

由於過量使用處方藥 和海洛因導致死亡。

During the 1980s, scores of people were dying from HIV and AIDS.

在 1980 年代，很多人因 感染愛滋病毒和愛滋病而死亡。

Public officials ignored it.

政府官員視而不見。

Some wouldn't even utter the words.

有些官員甚至避而不談。

They didn't want treatment.

他們不想面對。

And tragically, there are many parallels with our current epidemic.

而可悲的是，這與目前 物質成癮的流行有許多相似之處。

Some called it the gay plague.

有些人將同性戀視為瘟疫。

They called for quarantines.

他們要求隔離同性戀者。

They wanted to separate the innocent victims from the rest of us.

他們希望將這些無辜的犧牲者 與其他的民眾隔離。

I was afraid we were losing this battle

我很擔心我們正在從 這場戰役中落敗，

because people were blaming us for being sick.

因為人們責怪我們帶來疾病。

Public policy was being held hostage by stigma and fear,

羞辱和恐懼

不止綁架了公共政策，

and also held hostage

也綁架了同情，關懷， 研究，戒癮和治療。

were compassion, care, research, recovery and treatment.

But we changed all that.

但是，我們改變了這一切。

Because out of the pain of those deaths,

因為從這些生離死別的痛苦中，

we saw a social and political movement.

我們看到了 社會和政治運動正在興起。

AIDS galvanized us into action;

愛滋病促使我們行動，

to stand up, to speak up and to act out.

讓我們站起來，大聲說出口， 並付諸行動。

And it also galvanized the LGBT movement.

而這也激勵了同志文化運動。

We knew we were in a battle for our lives

我們知道，我們正在為 自己的生命而戰鬥，

because silence equaled death,

因為沉默等於死亡；

but we changed, and we made things happen.

但我們要改變，我們要讓改變發生。

And right now, we have the potential

而現在，我們有希望看到 愛滋病毒及愛滋病

to see the end of HIV/AIDS in our lifetime.

在我們有生之年消失。

These changes came in no small part

這些改變，是由一大群人

by the courageous, yet simple decision

作出一項勇敢卻簡單的決定：

for people to come out

他們公開宣告出櫃，

to their neighbors, to their friends, to their families

直接面對他們的鄰居、 他們的朋友、他們的家人，

and to their coworkers.

以及他們的同事。

Years ago, I was a volunteer for the Names Project.

好幾年前， 我是「名冊計劃」的志工。

This was an effort started by Cleve Jones in San Francisco

這項由克利夫·瓊斯 在舊金山發起的活動，

to show that people who died of AIDS

展示了死於愛滋病的患者

had names

他們的名字、

and faces and families

他們的臉孔、他們的家人

and people who loved them.

以及喜愛他們的人。

I still recall unfolding the AIDS memorial quilt

我還記得，當愛滋紀念拼布 在國家廣場展開時的情景，

on the National Mall on a brilliant day in October, 1988.

那是在 1988 年 10 月， 充滿光輝的一天。

So fast forward to 2015.

接著我們很快來到 2015 年。

The Supreme Court's decision to strike down the ban on same-sex marriage.

根據最高法院的決定， 推翻了同性婚姻禁令。

My husband, Dave, and I walk over to the steps of the Supreme Court

我的丈夫戴夫，和我一起 走到最高法院外的階梯，

to celebrate that decision with so many other people,

和許多人一同慶祝這項決定，

and I couldn't help but think how far we came around LGBT rights

我忍不住想起，我們走了多遠的路， 來捍衛同志族群的權利；

and yet how far we needed to go around issues of addiction.

而對於全國各地的成癮問題， 我們仍然有很遠的路要走。

When I was nominated by President Obama

當我被歐巴馬總統提名，

to be his Director of Drug Policy,

擔任他的毒品管制政策主任時，

I was very open about my recovery and about the fact that I was a gay man.

我完全公開了我的戒癮過程， 以及身為同性戀者的事實。

And at no point during my confirmation process --

在國會的審查過程中， 從頭到尾都沒有──

at least that I know of --

至少就我所知──

did the fact that I was a gay man come to bear on my candidacy

沒有因為我是同性戀者的事實 而影響我的候選資格，

or my fitness to do this job.

或者我擔任這項職務的能力。

But my addiction did.

但是我的成癮記錄卻受到質疑。

At one point, a congressional staffer said that there was no way

有一次，一名國會助理 表示「不可能」。

that I was going to be confirmed by the United States Senate

由於我過去的成癮記錄，

我不可能通過 美國參議院的同意任命，

because of my past,

despite the fact that I had been in recovery for over 20 years,

儘管事實上 我已經戒除成癮二十多年，

and despite the fact

儘管擔任這項職務，

that this job takes a little bit of knowledge around addiction.

需要對於成癮有一點瞭解。

(Laughter)

（笑聲）

So, you know, this is the stigma

所以，你知道，

對於物質使用成癮的人來說，

that people with substance use disorders

face every single day,

這是每一天都得面對的污名，

and you know, I have to tell you

而且你知道嗎？我必須告訴你，

it's still why I'm more comfortable coming out as a gay man

這就是為什麼我覺得 出櫃承認自己是同性戀，

than I am as a person with a history of addiction.

會比承認自己的成癮歷史， 來得舒服一些。

Nearly every family in America is affected by addiction.

幾乎每個美國家庭， 都受到物質成癮的影響。

Yet, unfortunately, too often, it's not talked about openly and honestly.

然而，不幸的是，很多時候， 這個話題無法被開誠佈公地討論。

It's whispered about.

它只能在私底下討論。

It's met with derision and scorn.

它還遭受到嘲諷和鄙視。

We hear these stories, time and time again, on TV, online,

一次又一次， 我們從電視上、網路上、

we hear it from public officials, and we hear it from family and friends.

從政府官員，或是家人和朋友口中， 聽到這些故事。

And those of us with an addiction, we hear those voices,

對於我們這些成癮者來說，

and somehow we believe that we are less deserving of care and treatment.

不知為何，這些聲音卻讓我們相信， 我們並不值得受到照顧和治療。

Today in the United States, only one in nine people

如今在美國，九個成癮者當中，

get care and treatment for their disorder.

只有一位能得到照顧和治療。

One in nine.

只有 1/9。

Think about that.

想想看。

Generally, people with other diseases get care and treatment.

一般來說，人們得到其他疾病， 都能得到照顧和治療。

If you have cancer, you get treatment,

如果你有癌症，你得到治療；

if you have diabetes, you get treatment.

如果你有糖尿病，你得到治療。

If you have a heart attack,

如果你的心臟病發作，

you get emergency services, and you get referred to care.

你會接受急救，並且得到後續照顧。

But somehow people with addiction have to wait for treatment

但不知何故，成癮的人需要治療時，

他們必須等待， 甚至經常得不到治療。

or often can't get when they need it.

And left untreated, addiction has significant, dire consequences.

而成癮患者如果沒有即時接受治療， 將會造成嚴重、可怕的後果。

And for many people that means death or incarceration.

對許多人來說， 結局就是死亡或被監禁。

We've been down that road before.

我們一直走在這條道路上。

For too long our country felt

長期以來，我們的國家認為，

like we could arrest our way out of this problem.

我們可以藉由逮捕成癮者， 來解決這個問題。

But we know that we can't.

但我們很清楚，我們做不到。

Decades of scientific research has shown

數十年來的科學研究顯示，

that this is a medical issue --

這是一個醫學問題──

that this is a chronic medical condition

這是一種慢性疾病，

that people inherit and that people develop.

而且一代傳一代，不斷地發展。

So the Obama administration has taken a different tack on drug policy.

因此歐巴馬政府對於毒品管制政策， 採取了不同的方針。

We've developed and implemented a comprehensive plan

我們制定並實施了更為廣泛的計畫，

to expand prevention services, treatment services,

包括擴大預防服務，治療服務，

early intervention and recovery support.

早期介入，以及戒癮支持。

We've pushed criminal justice reform.

我們推動刑事司法改革。

We've knocked down barriers to give people second chances.

我們排除萬難，給人們重生的機會。

We see public health and public safety officials working hand in hand

我們看到，公共衛生與公共安全官員

在社區層面攜手合作。

at the community level.

We see police chiefs across the country guiding people to treatment

我們看到全國各地的警察局長， 引導人們進行治療，

instead of jail and incarceration.

而不是將他們關進監牢。

We see law enforcement and other first responders

我們看到執法部門 與第一線的急救人員，

reversing overdoses with naloxone to give people a second chance for care.

使用納洛酮救回成癮者， 給他們後續治療、獲得重生的機會。

The Affordable Care Act is the biggest expansion

歐巴馬的「可負擔健保法案」，

對於物質濫用成癮的治療， 是本世紀最大的突破，

of substance use disorder treatment in a generation,

and it also calls for the integration of treatment services within primary care.

並且要求將成癮治療 納入基本的保險給付範圍。

But fundamentally, all of this work is not enough.

但是從根本來說， 所有這些工作仍然不夠。

Unless we change the way that we view people with addiction

除非我們能改變整個美國

看待成癮者的方式。

in the United States.

Years ago when I finally understood that I had a problem

幾年前，當我意識到我有問題時，

and I knew that I needed help,

我知道我需要幫助，

I was too afraid to ask for it.

但是我害怕尋求協助。

I felt that people would think I was stupid, that I was weak-willed,

我覺得人們會認為我很愚蠢， 意志薄弱，

that I was morally flawed.

我在道德上是有缺陷的。

But I talk about my recovery because I want to make change.

但是，我會談論我是如何戒癮， 因為我想作出改變。

I want us to see that we need to be open and candid about who we are

我希望讓大家看到， 我們需要開誠佈公，說出我們是誰，

以及我們能做些什麼。

and what we can do.

I am public about my own recovery

我公開自己的戒癮過程，

not to be self-congratulatory.

不是為了自我誇耀。

I am open about my own recovery to change public opinion,

我公開自己的戒癮過程， 是為了改變輿論，

to change public policy

改變公共政策， 改變這個流行病的歷程，

and to change the course of this epidemic and empower the millions of Americans

並對於還在這條路上奮鬥的 數百萬美國人，

who struggle with this journey

給他們力量，

to be open and candid about who they are.

讓他們能坦率地說出自己是誰。

People are more than their disease.

我們應該重視人，更勝於重視疾病。

And all of us have the opportunity to change public opinion

我們大家都有機會 可以改變大眾的觀念，

and to change public policy.

改變公共政策。

All of us know someone who has an addiction,

我們所有人都知道哪些人成癮；

and all of us can do our part

我們所有人， 都可以盡自己的一分力量，

to change how we view people with addiction in the United States.

改變美國看待成癮者的方式。

So when you see someone with an addiction,

所以當你看到某位成癮者時，

don't think of a drunk or a junkie or an addict or an abuser --

不要只想到他是一位酒鬼、 煙毒犯、癮君子或是藥物濫用者，

see a person;

把他視為一個人，

offer them help;

給他們幫助，

give them kindness and compassion.

給他們友善和同情。

And together, we can be part

同時，我們可以成為

of a growing movement in the United States

美國正在持續增長的浪潮 當中的一份子，

to change how we view people with addiction.

改變我們看待成癮者的方式。

Together we can change public policy.

我們可以一起改變公共政策。

We can ensure that people get care when they need it,

我們可以確保 人們在需要時得到照顧，

just like any other disease.

就像任何其他疾病一樣。

We can be part of a growing, unstoppable movement

我們可以成為這股不斷增長、 無法阻擋浪潮的一份子，

to have millions of Americans enter recovery,

讓數百萬美國人進入戒癮之路，

and put an end to this epidemic.

並且結束物質成癮的流行。

Thank you very much.

非常感謝大家。

(Applause)

（掌聲）