To illustrate the stigma advocates for addiction issues are up against, veteran lobbyist Carol McDaid holds up a recent issue of Time magazine that purports to show the face of addiction -- a horrific, twisted caricature staring out at the reader. "This is what [policymakers] think you look like," she tells supporters of treatment and recovery services attending a conference session on the "ABCs of Effective Advocacy" -- part of last month's Mobilizing Recovery Through Technology Conference, co-sponsored by Join Together, the National Council on Alcoholism and Drug Dependence (NCADD) and the Center for Substance Abuse Treatment.McDaid recently was hired by NCADD to represent its interests on Capitol Hill, part of what President Stacia Murphy describes as an effort by the venerable addiction organization to get back to its stigma-fighting roots. "We want to respond to policy in a more formal way," Murphy told Join Together, adding that NCADD intends to be far more proactive on such issues as charitable choice, underage drinking, and .08-percent DUI laws.
NCADD has never had a top-down leadership style: The group's 91 affiliates largely set their own agendas, and NCADD has sometimes been criticized for a lack of national coordination. Murphy, who headed the group's New York affiliate prior to taking over for longtime President Paul Wood in 1999, says she hopes to improve both the quality and quantity of NCADD's advocacy efforts -- promising a 20-percent growth in the ranks of NCADD affiliates by early next year, for instance. "If people respect your leadership, they will follow," Murphy says. "I think [the affiliates] see me as knowing what I am talking about."
Perhaps nothing illustrates NCADD's recommitment to policy advocacy than the hiring of McDaid, whose background includes representing addiction treatment programs in Washington. Like many in her profession, McDaid's approach to advocacy is practical and unsentimental. At the conference in New Orleans last month, she described addiction-field advocates as "among the most committed and dedicated people I know," but quickly added that, "We can't let ourselves fall prey to the notion that we are victims of an unjust political system. That's just not so."
"I'm convinced that the possibilities for our success are limitless," but only if advocates understand the process and politics of getting things done in the national and state capitals, McDaid said. "You need to know the environment in which you operate," she told an audience that included a large contingent of grassroots recovery advocates. "You can go in on your high horse and not win, or you can play the game and get something done."
McDaid offered advocates detailed instruction for meeting with politicians, government officials and other policymakers in order to push their agenda on issues like parity coverage for addictions. The first step, she said, is to identify who has the real power in the organization you are targeting. "You need to know where the pressure points are," she said. For example, McDaid pointed out, when meeting with a state agency administrator who is a political appointee, it's usually wise to zero in on the agenda of the governor who got him or her their job.
"You need to get into the head of your target and figure out what they need from the meeting," said McDaid. Review the policymaker's career and talk to people who know them well, she said. See if they have been motivated by power, prestige, the satisfaction of "being right," the opportunity to be a hero, or the chance to build a legacy.
All politicians nee money, added McDaid, so find out who their supporters are and explore any possible synergies. Even a potential negative can be turned to your advantage if handled carefully, she pointed out. "If they have a relationship with the alcohol industry, acknowledge that, and say that this is an opportunity to balance your record," she said.
Prior to meeting with policymakers, said McDaid, advocates need to identify any existing relationships that exist between their staff and supporters and decisionmakers and their staff. So-called "grasstops" -- influential community leaders, like the head of the local United Way -- can be especially effective advocates if they already have a personal or professional relationship with your target. And, "Don't underestimate the value of building relationships with staff," stressed McDaid. "They hold the keys to the kingdom for you."
Legislative advocacy should always start locally, said McDaid, because local lawmakers have the most to gain if you can offer substantial, organized support in return for their help.
Meeting preparation also should include research into where the policymaker has stood on your issues in the past. Advocates also need to learn about any pet interests the target might have -- even if they are not the issues you are supporting. If you feel that the policymaker is friendly to your cause or at least neutral, send them materials in advance of the meeting, said McDaid. Don't do so if they are hostile, however: "They will use them to develop talking points to slam you," she warned.
McDaid likened preparing for an advocacy visit to prepping for a job interview: some politicians like to spring tough questions on advocates, such as, "If you had a million dollars, what would you spend it on?" or "Where do you think the money for your programs should come from?" McDaid said advocates need to be ready with answers by knowing their top priorities cold.
A firm grasp of the prevailing fiscal and political climate is also invaluable. These days, for instance, the budget surplus is an easy answer to the funding question. "Have an offset in mind, but think it through carefully," McDaid said. You don't want to pick on the lawmaker's pet issue, for instance. And advocates need to avoid the trap of pitting one group against another, such as funding addiction services at the expense of mental health care. It also can be helpful to point out any well-researched cost savings that your proposal might generate, according to McDaid.
Finally, tell your hosts how many people will attend them meeting -- don't bring a cast of thousands, said McDaid -- and let the policymaker's staff know who the attendees are. Surprise attacks are a bad idea.
Meeting Day and Beyond
When the day of the meeting arrives, dress to the level of your target, McDaid advised; wear a suit when meeting with a government official. Don't sit down until your hosts do, and open every meeting by thanking them for taking the time to discuss your issues. Then introduce all the attendees.
Advocates need to truly appreciate the value of the policymaker's time. It's "incredibly important" to be concise in your presentation, laying out three or four major issues at the outset of the meeting and then discussing them in brief detail, McDaid said. "Have extra copies of everything available, but don't hand them out until the end of meeting," she advised; that way, your listeners won't be distracted by flipping through pages or reading while you are speaking.
If the meeting gets contentious, said McDaid, don't argue back. "If they raise their voice, lower yours," she said. This will allow you to regain control of the meeting, acknowledge your differences, and at least leave behind some materials for the leader and staff to consider. "You need to take charge because of stigma -- you need to overcome that," said McDaid. "You have to be a step better than everyone else, because the insurance industry and alcohol industry will be right in behind you."
At the end of the meeting, ask if you can have the policymaker's support on the issue. Regardless of their response, send thank-you notes to the leader and staff members after the meeting, and be sure to follow up on any unanswered questions or requests with accurate answers, said McDaid. If policymakers are noncommittal, call them back weekly until you get an answer; you may seem like a pest, McDaid said, but it will win you respect. "If they blow you off, try using e-mail to reach staff; they respond better in some cases," she said.
In addition to Congress, advocates must target state legislators, county boards, state agencies, the business community, and behavioral-health organizations as they push their issues, said McDaid. On issues like parity, for instance, advocacy with state lawmakers will be critical, since the GOP-controlled Congress is unlikely to move on this issue in the near future, she said.
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