In April 1978, former President Gerald Ford and First Lady Betty Ford announced to the nation that Mrs. Ford had sought treatment and was recovering from addiction to alcohol and other drugs. It was a riveting moment in the history of addiction treatment and recovery in America, but the Ford family had further contributions to make to that history. On October 4, 1982, the Betty Ford Center opened on the grounds of the Eisenhower Medical Center in Rancho Mirage, California. When Mrs. Ford sought a leader for the treatment center that would bear her name, she chose John Schwarzlose. Since then, the Betty Ford Center has achieved international esteem under his leadership and has treated more than 80,000 patients (half of whom have been women).
I have known John Schwarzlose as a valued colleague and friend for most of my career and welcomed the opportunity to interview him in between sessions of the 2010 annual meeting of the National Association of Addiction Treatment Providers. Join me in this sweeping discussion of John’s career and the work of the Betty Ford Center. (The complete interview is posted at www.williamwhitepapers.com).
Education and Early Career
Bill White: John, let me start with the question all of us in this field are often asked: “How did you choose to work in this most unusual profession?”
John Schwarzlose: Well, it’s an interesting story. I enrolled in a Master’s program in Community Mental Health– Northern Illinois University that combined elements of community and educational psychology. In 1971, as part of that program, I began working at a state psychiatric facility where I met a psychiatrist, David Stinson, who had a great passion for alcoholism treatment. I also liked working with alcoholics, so I told my professors that I wanted to pursue a career in the alcoholism field. They were appalled. They said, “Why would a bright young man want to work with alcoholics and addicts? That would be such a waste of your time.” In spite of their discouragement, I continued to pursue this interest with a visit to the Alcoholism Treatment Unit at Lutheran General Hospital, where Dr. Nelson Bradley, Gene Rossi, a psychologist, the Rev. John Keller, a Lutheran minister, and others were adapting the Minnesota Model of alcoholism treatment for delivery within a community hospital. Through them, I became even more excited about the future of alcoholism treatment.
Bill White: What was your first job in the field?
John Schwarzlose: I worked with skid row alcoholics as an evening counselor for the Peoria Area Council on Alcoholism for the robust salary of $8,000 a year. The whole thing was a kind of trial by fire. I worked the 3 to 11 shift and got to know alcoholism up close and personal. We had no medicine, no nurses, only tender love and care. And of course, I learned more from that experience than from all of the books I had read in school. I saw men virtually reborn through that work. In 1974, the Peoria Mental Health Clinic was forced to hire an alcoholism counselor as a condition of their federal funding. So, the clinic director hired me for $12,000 a year on the condition that I generate that amount of patient fees to cover my salary. I later became the coordinator of the alcohol and drug division and had three counselors working for me.
Bill White: Peoria’s a good size city, and yet in 1971, you’re describing a city with few alcoholism treatment resources.
John Schwarzlose: There weren’t many. Most people going to inpatient alcoholism treatment at that time had to go to Hazelden in Minnesota, Lutheran General Hospital near Chicago, or a bit later to the Hyland Center at St. Anthony’s Medical Center in St. Louis. Most communities at that time did not have local inpatient alcoholism treatment.
Bill White: How did the opportunity to move to Proctor Hospital come about?
John Schwarzlose: Proctor Hospital— which was the smallest of the three hospitals in Peoria—decided that they wanted to have an inpatient alcoholism unit, and they contracted with Dan Anderson of Hazelden to help them plan the unit. I was hired by Dan Anderson and John Smith, the administrator at Proctor, to open the unit. In preparation, I spent five weeks at Hazelden in the fall 1978. They wanted me to learn everything about Hazelden, so I began the experience by going through the program as if I were a patient. Like many other programs of that era, we modeled ourselves on the Minnesota Model. My work there kept me in touch with Dan Anderson, who had become something of a mentor to me and encouraged me to enroll in the University of Illinois’ Executive MBA program.
Bill White: Dr. James West has also been an important mentor in your life. When did you first meet him?
John Schwarzlose: In 1974, I got involved with the first effort in Illinois to create a certification system for alcoholism counselors. I volunteered to work on one of the committees supporting this effort, and at our very first meeting, this very distinguished looking gentlemen entered and said, “I am Dr. James West. The Illinois Medical Society felt we should have a representative here.” He further introduced himself as a recovering alcoholic physician. To have had Dan Anderson and Jim West as my mentors, God was definitely smiling on me! They were both men of such integrity whose constant thought was “the patient comes first.”
Early Days of The Betty Ford Center
Bill White: How did your involvement with The Betty Ford Center begin?
John Schwarzlose: In early 1982, Dan told me that I would be getting an invitation to come to Palm Springs, California, to interview for the CEO position of the newly opening Betty Ford Center. In part, due to strong recommendations from Dan Anderson and Dr. West I was offered the position, which I accepted with great excitement. I was only 33 years old.
Bill White: What do you recall about the earliest days of the Center?
John Schwarzlose: By the time I got there in early ’82, we had just started to lay the foundation for the original campus, and fundraising was heavily underway. Mrs. Ford and President Ford had gone to Sacramento months earlier and pushed passage of a new law creating the licensed addiction hospital. I recall Dr. Jim West, Dr. Joe Cruse and I having endless questions and walking through every aspect of the treatment design for the Center. Dan Anderson, in his wisdom, advised us, “This is not Hazelden West. This is the Betty Ford Center. You have an opportunity here to do something great and unique.” So we drew on earlier traditions but created our own brand of addiction treatment.
Mrs. Ford and Mr. Firestone were intensely interested in everything that was going on. Before we opened our doors, we took the original 22 staff, some volunteers, Mrs. Ford and Mr. Firestone, divided it in half, and each group stayed three days and nights overnight so we could test everything from the showers to the food. I didn’t find out for almost 20 years that Mrs. Life Ford really didn’t stay those nights. At about 10 o’clock when everybody was going to bed, the Secret Service quietly took her to her home a half mile away. We got a good laugh years later when she finally confessed that.
Bill White: The Ford family seems to have been involved throughout the development of the Center.
John Schwarzlose: Mrs. Ford and President Ford were involved in every step. He always let Mrs. Ford play the lead role with the Center, but he was involved in fundraising and legislative matters. He always said “This is Betty’s place.” In fact, one of the things a lot of people don’t realize is that she was very much against putting her name on the Center because she only had three-plus years of recovery when it opened. She said, “That’s not very long to be clean and sober. What if I take a drink and my name is up there?” President Ford, to his credit, said, “Honey, you’re right, and it’s the reason why you keep practicing this program one day at a time, but think of the impact of having your name on there. It will be like a beacon to people that this is an okay place to go.”
Mrs. Ford understood this because of the early response to the candor with which she had handled her treatment for breast cancer while in the White House.
Bill White: What was the initial response to the opening of the Betty Ford Center?
John Schwarzlose: We had a dedication October 3, 1982, with at that time, Vice President George H. W. Bush, his wife, Barbara, and Bob and Delores Hop who had given all the land for Eisenhower Medical Center, and who then gave us land for the Betty Ford Center. The following morning, Monday, October the 4th, Betty went on Good Morning America live from California with David Hartman. From the beginning, Betty’s prominence made this an international center.
But here’s the part that people don’t know: Betty would spend two or three days a week at the Center, not looking at financial statements, but talking with the patients. She would come eat lunch with the patients and go over to the patio of a men or women’s hall and sit and have iced tea while she talked with the patients. They’d just be shocked. If we had a patient who had a particularly difficult time accepting treatment, the counselor would sometimes send a request asking if Mrs. Ford might spend a little time with that patient. She couldn’t get there fast enough. She loved it.
Bill White: I seem to recall that Mrs. Ford also had an influence on the segregation of men and women patients during their treatment.
John Schwarzlose: Mrs. Ford supported experimenting with an all-women’s unit and then discussed this issue with Dan Anderson. She told him, “Based on our follow-up phone calls, it seems the women are doing better in the allwomen’s unit.” So Dan said, “Then what are you waiting for? Make a statement to the world about what you’ve discovered with this trial.” So we made two women’s halls, two men’s halls, and declared that future treatment at Betty Ford Center would be gender-specific. She knew immediately it was the right thing to do.
Bill White: My impression is that Mrs. Ford also had great affection for the staff at the Center.
John Schwarzlose: One day, Mr. Firestone and Mrs. Ford came into my office. We’d been open several months. They said, “John, how do you think the patients are doing?” I looked at these two co-founders that I loved so much, and I said, “I don’t have the slightest idea.” The look on their faces was like, “You smartaleck.” I said, “But if we’ve hired the right staff, I know the patients are going to be okay.” They came to understand that the key was the staff. They talked it over, and Leonard Firestone came to a board meeting shortly after that and said, “We have to give our counselors a raise. They are our doctors.”
Bill White: Did your focus on alumni services begin early in the Center’s history?
John Schwarzlose: At our one-year anniversary in October ’83, we invited everybody who had gone through treatment to come back and spend the weekend with Mrs. Ford to celebrate their recovery. We had around 200 come back the first year. Betty was amazed. After that, we would have a special weekend for alums once a year. We are committed to staying in personal touch with each patient for a year after discharge.
Betty Ford Center: Image Versus Reality
Bill White: The Betty Ford Center got an early reputation of being a treatment center for celebrities—the rich and famous.
John Schwarzlose: We did get that reputation, and it drove us nuts. We’d been open one year, and I looked out of my office window and saw a Gray Line tour bus driving through the campus. I called the local Gray Line operator to protest and he said, “After Frank Sinatra’s home, you’re the second- most requested place tourists want to see.” I explained, “Well, that’s very nice, but you can’t drive your bus on our campus.” We have treated some very famous people, but they are not our typical patient. This image began to change when people saw us sponsoring such things as children’s programs for the migrant community.
Bill White: I seem to recall you also taking steps to increase access to the Center.
John Schwarzlose: Yes, from the earliest days, we offered patient scholarships. No one comes for free because we believe each patient and family have to have a personal investment in their treatment. But we said that if the family could come up with a couple thousand dollars and meet all other criteria for admission, we would pay all the rest of their treatment costs out of a scholarship fund. So, we raised lots of money to do that. Today, we give more than $4 million a year in patient scholarships.
Betty Ford Center Programs
Bill White: John, give our readers a feel for some of the specialty programs that emerged at Betty Ford Center, particularly the focus on family and children.
John Schwarzlose: Betty and I were convinced that family involvement should begin the day treatment started, but many people cautioned us to wait until late in treatment to involve the family. We said, “No, we’re going to have two family counselors the day we open our doors so that when family members bring their loved ones in for admission, they can meet with the family counselor for support and make plans for Family Week.” So, our tradition of having early family engagement and an intense Family Week during the third week of treatment started from day one when we opened.
Bill White: What about the children’s program?
John Schwarzlose: Early in our experience with Family Week, we recognized that the children were sitting all day long in groups and lectures and other activities. We started thinking about the needs of these children and pulling them out for activities that more specifically met their needs. Then in late 1996, we hired Jerry Moe to develop a specialized children’s program and raised private funds to support the program. Betty was so excited about the children’s program and the potential we had to change the family legacy.
Bill White: John, let me ask you about another program that I think will surprise some of our readers. Talk about the history of the Betty Ford Center’s involvement with Native American communities.
John Schwarzlose: This involvement began when the Indian Health Service approached us about treating Native American people from their western region, including Utah, Arizona and California. We readily accepted this proposal and provided training to our staff that would help address cultural aspects of treatment and recovery for these patients. Then in the late 1990s, members of the Alkali Lake Tribe in British Columbia visited the Betty Ford Center. They told us the story of this tribe’s remarkable transformation from a community that had once suffered from a 90 percent addiction rate. We were so impressed with their story that several staff visited Alkali Lake, and they asked us if we would become involved with their recovering community, which we were honored to do. We have been involved there ever since and have a staff person, Patrick Haggerson, who goes up there regularly to meet with tribal leaders and to provide educational and counseling services, including programs for families and children. Our latest involvement with Native American communities is with the Lakota Sioux on the Rosebud Reservation in South Dakota. This is the part of the work of the Betty Ford Center that is obscured by our celebrity reputation.
A Personal Commitment
Bill White: John, you’re one of the most tenured addiction treatment CEOs in the United States at this point. You once told me a story about a personal commitment that Mrs. Ford had asked of you. Could you tell that story?
John Schwarzlose: Sure. We’d been open about five years, and Betty came to me and said, “John, will you give me a commitment?” I said, “To the Betty Ford Center?” “No,” she said, “To me.” I said, “Absolutely.” Over the years, when other leading centers had openings for a CEO, I was very flattered to get calls or visits inquiring about my availability. I Life would explain to them that I could not leave the Betty Ford Center because of a personal commitment I had made to Mrs. Ford years earlier. I didn’t fully comprehend at the time the enduring power of the oath I had given her.
Bill White: I’ve witnessed the rise and fall of a lot of the leaders in our field. Given your tenure, what guidance do you have about how people can sustain themselves and their health over a long career?
John Schwarzlose: I think you have to have a life outside of the Center. When I was coaching my son’s Little League team or going on a hike with one of my daughters, I wasn’t thinking about the Center. Being totally preoccupied with a singular part of your life can destroy people. I don’t walk around with a Blackberry or an iPhone glued to my hand. The day I have to have e-mail access 24/7, I’m in trouble.
The Betty Ford Institute
Bill White: One of the recent endeavors of the Betty Ford Center is creation of the Betty Ford Institute (BFI). Could you describe the Institute and its mission?
John Schwarzlose: Betty Ford Institute was the last piece of Betty’s vision before she stepped aside as Chair of the Board of the Betty Ford Center. She did not want the Betty Ford Center franchised into a national treatment system, but she wanted to be able to have a platform through which the Betty Ford Center could influence the larger field. So, we launched the Institute to focus on translating research on treatment, recovery and prevention. Most of the existing institutes—TRI, Lighthouse Institute, and others—are supported primarily by funds from the federal government. Our vision was to support the Betty Ford Institute through private philanthropy to assure its independence of voice. So, we’ve done that and taken on such projects as creating a consensus definition of recovery, exploring post-treatment continuing care and reviewing graduate medical education on addiction. This September, we’re having a conference on parenting and recovery. For Betty, it was a way to keep the legacy going by reaching beyond the treatment provided at the Betty Ford Center.
Bill White: John, after a long and very productive career in this field, do you have any major regrets—anything you’d do differently looking back?
John Schwarzlose: Every once in awhile, people say to me, “Do you ever get bored doing the same thing?” I don’t know how anybody could be bored in a treatment center because every day is different and challenging. I make mistakes every day. When I stop learning from those mistakes, it will be time to retire. When I start taking myself too seriously, it will be time to step aside. I’ve learned so much from Mrs. Ford about not taking yourself too seriously, to have the impact that you can, and then step aside. We often say to new staff, “There’s a process that goes on in a place of healing like this. As staff, we often have to get out of the way and let it happen.” I hope that lesson is being talked about in all treatment centers. We’re not fixing the patient. We’re not saving the patient. We’re not even really treating the patient. The patient is doing the work.
Bill White: Do you have any closing words for people who may be considering entering or may have just started work in this field?
John Schwarzlose: The most important message is the incredible impact you can have on people’s lives whether you are working with patients or their families or with children or with communities. To be of that kind of help is a deep blessing to one’s own life.