As director of The Pew Charitable Trusts’ behavioral health programs, Dr. Brandee Izquierdo oversees the organization’s projects on substance use treatment and prevention and suicide risk reduction. This interview about her professional, academic, and lived expertise has been edited for length and clarity.
A: The journey was rocky in the beginning. I’d been using drugs and alcohol since I was a child, and eventually, in my 30s, I got arrested. That was a wake-up call. But I was lucky to meet some great people early on. I had a substance use counselor who broke protocol and told me she was a recovering alcoholic. That was monumental to me. It gave me hope that I could succeed in recovery and maybe even have a career helping others.
I first worked as a peer recovery specialist helping people navigate the health, housing, and legal systems. That’s where I saw that bad policies were making it hard for people to get treatment and stay in recovery. I realized that I could have a bigger impact by working to change those policies. So I went back to school and got a bachelor’s degree, then my master’s, and finally a doctorate in public administration.
While in school, I worked at Maryland’s behavioral health administration and then several nonprofits that were focused on expanding access to treatment for substance use disorder. At each step I saw again and again how data transforms policy, so I was eager to join Pew, which uses data so effectively for so many issues I’m passionate about.
A: I didn’t recognize it as a mental health challenge at the time, but early in my youth I had anxiety and depression so severe that it made me too physically ill to participate in family events. A lot of that arose from my having been abused at an early age. It got to a point that when I was 11 years old, I raided my parents’ liquor cabinet. I found that alcohol gave me this sense of relief or numbness. I said I would never do it again, but I found myself unleashing that beast of addiction.
When I drank or used drugs, it released my inhibitions and took away the fear I felt inside. It wasn't until later on when I got into treatment that I was diagnosed with anxiety. And even then, my health care providers didn’t examine my depression, and I didn’t receive any care for mental health, just substance use. Eventually, through my recovery, I developed tools to navigate life.
A: It does matter, but it shouldn’t. How you’re initially diagnosed and what system you enter—treatment, criminal legal, child protective services, etc.—makes a big difference in the way you get treated. My primary diagnosis was for substance use and alcohol use disorders, and that’s what I was treated for; because of how the health system is siloed—its funding, education, training, services, payment, and more—I wasn’t treated for the underlying mental health challenges stemming from my youth. The treatment’s not holistic, but it should be. We have to treat the whole person no matter how or where their system entry point is.
A: Along with the substance use counselor I just mentioned, I had a very supportive probation officer. He told me that he believed I could be successful, and he’d only seen that quality in one other person. It was pivotal in my early recovery to hear that kind of confidence from an authority figure.
I also have a tight circle of friends and colleagues who’ve been important for me throughout my recovery.
In the very beginning of my recovery, I had one friend in particular who knew I had to go to fellowship meetings because I was court ordered to do so. Even though he was actively using at the time, he said he’d go with me. No one had done anything like that for me before, so that was huge.
Today he’s my husband, and we’re in recovery together. He continues to support me and everything I do. And obviously my four kids: They’re my world and they’re proud of me. They keep me moving forward; we walk this journey together.
A: I always remain vigilant in my recovery and try to recognize signs of anxiety and/or depression early so that I can take the steps and use the tools I have to decrease the impact these conditions have on my life. I tend to share where I am with the people around me, because if I don’t, it could lead me down a dark path I’m not willing to travel again.
I put my hands up and enjoy the ride, no matter how life shows up. My mind, body, and spirit need to be aligned. That’s the way I maintain wellness.
And I take bubble baths.
A: I’m very hopeful because there’s a growing recognition in the behavioral health field that prevention is critical, particularly for young people. I’m passionate about engaging kids because mental health and substance use became issues for me in my childhood; it’s critical to change the trajectory of people’s lives earlier. I’m excited about the school-based prevention work that we’re developing at Pew, aimed at kids who often fall through the cracks and who often feel left out or pushed to the side.
The health system is focused on treating illness, but it should be working to prevent disease and promote wellness. That’s so much more effective. And it costs so much less to do that—to look at the big picture and address problems before they give rise to disease. If more people have access to safe housing, quality education, nutritious food, and other basics, more people are going to stay healthy.
There’s still a long way to go, and it’s going to take a significant level of commitment and consistency to make lasting and meaningful change. But as I always say, nothing changes if nothing changes.
A: Absolutely not. My experiences give me the ability to be empathetic and compassionate and work with other people who struggle. I wouldn't change anything. It's my story, and I’m not ashamed of it.
"My experiences give me the ability to be empathetic and compassionate and work with other people who struggle. I wouldn't change anything. It's my story, and I’m not ashamed of it."
Dr. Brandee Izquierdo, Director, Behavioral Health Programs The Pew Charitable Trusts