Title:The path forward

Empowering leaders in addiction policy for better outcomes in prevention, treatment, and recovery

METROPOLITAN STATE HOSPITAL
MARCH 6, 1969

Dear Betty,
Coming out of a delirium of intoxication, coupled with prolonged insomnia and near starvation, must be an incredible strain on an already weakened body, and I have God to thank that up to now, at least, I have escaped convulsions, the DTs, and more severe g-i symptoms.

Tuesday night was panicky (as nothing they seemed to give me produced any relief of the wild urge I had for more alcohol). Yesterday was somewhat of a blank—too sick to refuse any medication, helplessly clinging to my bed.

This morning, the brilliant sun is streaming in, and mostly through God’s grace, I’ve been able to get on my feet, face the dreadful reality of having put myself back here again, get myself set for the embarrassment of accepting this failure, and start moving instead of slipping backward. If I’m to survive, I’ve got to have hope!

With my heart aching with shame and love,
Bill

My father, Bill Ketchum, was a Harvard-trained M.D. He was also—as the neighborhood kids reminded me—a drunk. He began self-medicating to relieve pain from stomach ulcers and became addicted to elixir of terpin hydrate, a cough syrup laced with codeine and alcohol. For more than a decade, he cycled in and out of jail, mental hospitals, and the combination prison-hospitals in Bridgewater, Massachusetts, and Lexington, Kentucky. He wrote the letter above to my mother, Betty, while going through detox at a state hospital.

Addiction ruined his career and shattered our family.

A new approach

Much has changed in our approach to substance use disorder since my father’s experience in the 1960s and ’70s—including a far better understanding of the neuroscience of addiction. The national opioid epidemic that began nearly two decades ago has had a major impact on public awareness and public attitudes.

Yet too often, policies relating to substance abuse on the local, state, and national level continue to be founded on erroneous assumptions. Regina LaBelle (L’92) witnessed this while working as chief of staff and senior policy advisor in the Office of National Drug Control Policy (ONDCP) from 2009 to 2017 in President Barack Obama’s administration. “So much of our addiction policy is based on stigma, and also what my old boss and I used to call the ‘I knew a guy’ approach,” she says.

LaBelle cites the example of resistance to distributing naloxone, commonly known as Narcan, which has proved to be a highly effective, life saving antidote for opioid overdoses. “There were people in leadership positions in previous administrations who argued that we shouldn’t make naloxone available because opioid users might need that overdose to wake them up to get treatment,” she says.

“There’s a huge body of science out there, but it’s not being put forth in policymaking. I found from my eight years in the Obama administration that the scientists didn’t understand policymaking, and the policymakers didn’t understand science.”

In 2018, after leaving government service, LaBelle established the Center on Addiction and Public Policy at Georgetown Law’s O’Neill Institute for National and Global Health Law, spearheading an effort to shape informed, evidence-based policymaking. Recognizing the need to train the next generation of policy leaders, she went on to create the interdisciplinary Master of Science Program in Addiction Policy & Practice (ADPP) at Georgetown.

“We spent quite a bit of time meeting with people at the Medical Center, as well as people in the field and people with lived experience asking ‘If you were designing a program, what would it look like?’ We took all their ideas, and developed a curriculum,” LaBelle explains.

Rooted in compassion

The program welcomed its first cohort in 2021, at the same time LaBelle was working in the Biden White House as ONDCP acting director (also referred to as the “drug czar”)—the first woman to hold the position. She served in the position from January to November 2021.

In addition to academic expertise, many of LaBelle’s ADPP faculty colleagues share her enormous depth of experience in the field. Wilson Compton, a psychiatrist who teaches the Foundations of Addiction course, is deputy director of the National Institute on Drug Abuse; Rear Admiral Christopher M. Jones, instructor for the course in Data and Statistics of Drug Policy, is director of the Center for Substance Abuse Prevention at the U.S. Department of Health and Human Services.

Other multidisciplinary core courses include neurobiology, epidemiology, and health care finance. In her integrative seminar, LaBelle also includes international policy, such as Portugal’s pioneering decriminalization of drugs.

Georgetown’s guiding value of cura personalis is foundational to ADPP. “We felt it was really important to build this unique program to train people in the science of addiction, but also make sure our curriculum is rooted in compassion,” LaBelle says.

In Fall 2025, the program relocated from the Graduate School of Arts & Sciences to a new academic home at the School of Health, located on Georgetown’s Capitol Campus. “The ADPP program complements our growing portfolio of graduate programs at the intersection of public health, health care, and policy,” says Dean Christopher King. “Our expanded community will catalyze innovation.”

“Students are going out and really making a difference,” LaBelle adds. “There’s an opportunity for Georgetown to make a real mark on this very important issue.”

A form of healing

Students come to ADPP from a wide variety of backgrounds. “In general, half of the students in each cohort have some type of personal experience with addiction—either they’re in recovery themselves or they have family members with substance use issues. We’ve had students who in the past have been incarcerated for drug- or alcohol-related issues,” LaBelle says.

Gina Malagold (G’22) was teaching Spanish language and Latin American studies at the Georgetown School of Foreign Service when her younger brother Dylan died of an overdose. “He was struggling with his mental health during the pandemic, so he started to self-medicate. His drug of choice was Xanax.”

The toxicology report showed that the drugs in his system were actually pure fentanyl, a synthetic opioid—the pills he’d procured online were mislabeled, an all-too-common occurrence. Just 2 milligrams of fentanyl (similar to 5-7 grains of salt) can be fatal.

“I had a really difficult time with the loss for many reasons, the guilt and shame, and also the pure sadness of losing a 26-year-old brother,” she says. When Malagold saw a campus notice about the then-new master’s program in addiction policy, she decided to apply.

“I’m a scholar, and applying to the program was my way of initially moving through loss—to try to learn what happened to Dylan, the neuroscience of it, the disease of addiction, so that I could really understand what happened to him as a form of healing.”

As part of her experience in ADPP, Malagold served as an intern in the White House working with the Drug-Free Communities Support Program, a prevention arm of ONDCP. “One of the things I’m most proud of is reinforcing the importance of bringing in bereaved families to help shape policies that are grounded in lived experience.”

Malagold advised in convening a roundtable that included family-led advocacy organizations and individuals impacted by overdose, chaired by ONDCP director Rahul Gupta. “Speaking to this group, I felt like I was really growing into my new identity as an advocate, policymaker, and voice for the bereaved,” she says.

Circle of experts

Similar to Malagold, J. Chad Jackson (G’23) enrolled in ADPP as a result of his lived experience. He has been in recovery since March 14, 2014.

With a background in business, he decided to focus on the management side of addiction treatment. “When I started my journey in recovery, I saw a lot of bad actors on the entrepreneurial level, and I wanted to be a good actor in that area,” he says. “I became the executive director and part owner of a couple of intensive outpatient programs, at both the Medicaid and commercial insurance level.”

From his vantage point, Jackson saw the effects of policies on a granular level. At one point, for example, he was involved with a federal program in Maryland for recently released prisoners, working to enroll them in Medicaid once they left the prison health system. The program operated under the terms of the 2018 SUPPORT Act to help improve recovery and treatment rates for opioid abuse.

As Jackson notes, the legislation was seen as a win on a national level. But working with individual clients, he found they were extremely reluctant to enroll in Medicaid because of a lack of trust—evidence that even well-meaning policies need to take into account the lived experience of those affected.

Jackson was inspired to apply to ADPP to gain an in-depth understanding of policymaking from the top down. “In the program, I learned so much about how we were getting to the places downstream where the treatment providers were finding failures,” he says.

“It’s hard to think of a class I didn’t get something out of. I still use everything on a regular basis,” says Jackson, who currently chairs the DC Opioid Abatement Advisory Commission and manages a sober living house for women.

“I feel so well-equipped to discuss policy issues. I have access to a circle of experts on a national level—I could never have been in these circles without Georgetown’s program.”

Action and advocacy

Substance use disorder is vastly complex and ever-evolving. ADPP’s faculty, students, and alumni are working in all areas, from prevention to treatment to recovery, to improve outcomes and find solutions to complicated, seemingly intractable problems.

Through her work at O’Neill’s Center on Addiction and Public Policy, for example, LaBelle and her colleagues—including associate director Shelly Weizman, who is also on the ADPP faculty—have advanced the use of the Americans with Disabilities Act to ensure that incarcerated individuals are receiving evidence-based treatment with medications such as methadone and buprenorphine, FDA-approved medications shown to reduce overdose deaths and sustain recovery. Treatment for individuals while imprisoned has also been proven to reduce death from overdose after their release.

“Rhode Island was the first state in the nation to provide medications in all its jails and prisons, and it decreased overdoses in that population by 60%,” LaBelle says. “A lot of this work was done on a bipartisan basis. We’re not at 100%, but we’re a lot better than we were even five years ago.”

After several years working in the federal government, Malagold is now focused on prevention in her role as director of multicultural affairs for the national family-led advocacy group Song for Charlie, which promotes education for youth and families about fentanyl and the evolving synthetic drug landscape.

Malagold had met the organization’s founders, Ed and Mary Ternan, at the White House roundtable with bereaved families in 2022. The Ternans’ son Charlie died from taking a “fentapill”—a Percocet that was actually fentanyl—three weeks before his college graduation.

In 2023, the Ternans contacted Malagold and asked her to help Song for Charlie build a Spanish-language, culturally resonant program to complement their English-language education programs. Malagold convened a group of experts to develop an awareness and education campaign, La Nueva Drug Talk, launched in community gathering spots—such as coffee shops, community centers, churches, and ESL programs—and keeping in mind the role of family and intergenerational conversations.

“We are also looking for opportunities for cultural celebration and cultural recognition,” she says.

“There’s a natural element that comes up in every single convening that we do, whether it’s a school assembly or a group of Spanish-speaking MLB players—it might be food or music or our humor. It’s a moment of pride, showing up as Latinos, unapologetically and without fear.”

Malagold’s role has now expanded to encompass broader multicultural outreach. She recently met with Tribal leaders in Seattle and worked with the Black community in her home state of Wisconsin to discuss awareness and prevention programs. “It can’t be overstated how important lived experiences and culturally grounded interventions are,” she says.

‘OK when things are not OK’

LaBelle emphasizes that there needs to be far more attention and funding directed toward long-term recovery efforts. “There’s a lot of money being invested in research on what types of treatments are best. The issue is sustained recovery,” she says. “We need to open the aperture to what treatment and recovery look like. It’s not a washing machine—you don’t come out clean after 28 days.”

“Being in recovery is more than just not using the substance,” Jackson adds. “When I got sober, I still had a problem because I wasn’t changing my life. It takes a while to get healthy and to change the way you think about the world and think about yourself.”

Jackson has brought his lived experience to his current work as co-founder and operations manager for Ardan Community Living, a nationally certified sober house for female-identifying clients in DC. Understanding that recovery looks different for different populations, Jackson and his colleagues have designed the house’s programming to meet the specific needs of women in early recovery.

“Women are societally invested in their personal communities—their spouses, children, parents. When you leave a treatment facility and go right back into that complex situation, and for instance your child gets bullied in school, your own sense of internal value goes down. Your resilience to staying in recovery deteriorates,” Jackson says.

“One woman in my house had been in treatment previously and they had recommended a sober living community,” he continues. “She said, ‘No, I don’t need that. I’ve been here for 28 days and I’m fine.’ A few months later, she was back in treatment.”

As Jackson explains, the sober living house provided her with the opportunity to gain strength and resilience as an individual, separate from her identity as a mother and wife, before she transitioned back to the stresses of day-to-day living.

She learned that she could still be OK when things weren’t OK. “Having the independence to look at the world one step away from those family issues allowed her to develop positive self-worth and to believe that she deserved to remain sober.”