Face to Face
Beyond Addiction
Hazelden’s chief doctor, Marv Seppala, is living proof that addicts can recover.
By Kim Kiser
Marv Seppala, M.D., looks ill at ease. As he steps forward to receive an award from the De Paul Treatment Centers in Portland, Oregon, for his contributions to addiction treatment, the audience claps, then stands. Seppala looks at the ground, shifts his weight from one foot to the other, then sidles up to the podium. When the applause ends, he explains that he’s never received an award and that he feels he isn’t deserving of such recognition.
Seppala, who is chief medical officer for the Hazelden Foundation and works out of Hazelden’s Springbrook facility in Newberg, Oregon, isn’t being singled out for the leadership he has provided in treating addiction. He’s being honored for sharing his own story and for showing the world that addiction is just as likely to affect a doctor as a drug dealer. “I just do what I need to do to stay sober,” he tells the audience, which again breaks into applause when they learn he’s been able to stay drug- and alcohol-free for more than 30 years.
The 50-year-old Seppala also does what he needs to do to spread the word to professionals and the public that addiction is a disease that affects the reward centers of the brain—the parts that control our drive to survive. “Survival, food, water, shelter, interaction with other humans are no longer as important. It’s all about getting the drugs,” he explains, the words occasionally stumbling out as emotion gets the better of him during the talk. “And it drives you to do things that you can’t explain.”
From Car to Cardiovascular Lab
Seppala’s story is one that in many ways can’t be explained. It begins in the late 1960s in Stewartville, Minnesota, a town of about 5,500 eight miles south of Rochester. The son of an IBM engineer, Seppala started using alcohol at age 12. By 13, he was smoking pot. And by 15, he was using “anything I could, pretty much every day,” he says in a very matter-of-fact way during a phone interview from his Oregon office.
He dropped out of band, chorus, sports, and eventually high school. “I was stealing from my family to get drugs,” he says. “I was lying constantly and was gone all the time.” Knowing that their son was in trouble, Seppala’s parents got him into treatment at Hazelden in Center City, Minnesota.
That was 1974, and at the time, Hazelden staff knew little about treating 17-year-olds. Seppala was one of the first—if not the first—adolescents that they took on. He was placed in a unit with men who were much older but who shared similar experiences and stories. “I started to realize I fit right in,” he recalls. “And I began to accept that I really had this disease.”
It would be a coup for Hazelden if one of the first youths treated there never touched alcohol or drugs after leaving, repaired the damaged relationship with his family, finished high school, went on to college, and walked the straight and narrow. But that’s not what happened.
Five days after leaving Center City, Seppala relapsed. He found himself living out of his car or going from one friend’s place to another. He would take dead-end jobs, work a few days or weeks, collect a paycheck, then quit or fail to show up. His family disowned him, and Seppala gave up on himself. “I thought I would die very young and that would be that,” he says.
Seppala’s need for money to support his habit, which by then included not just alcohol and marijuana, but also cocaine, led him to Mayo Clinic, where he applied for work as a janitor. Several weeks later, the human resources department tracked him down. Seppala went to what he thought would be an interview for a custodian position and ended up interviewing for a job as a technician in a cardiovascular research lab—a switch no one could explain at the time and that Seppala still can’t explain today.
Seppala, who lied about graduating from high school, got the job and worked under the guidance of David Donald, Ph.D., and John T. Shepherd, M.D., who were studying cardiovascular physiology in animal models. “I did animal surgery every day. It was incredible. And to think I had applied for a janitor job,” Seppala says, the awe still audible in his voice.
In the lab, he met researchers from all over the world. They kept asking him about his future plans and encouraged him to pursue medicine. “I had no vocational plans at all. But, ultimately, I decided I wanted to be like them,” he says of the scientists.
Seppala got into a 12-step program and this time remained clean and sober. When he decided to share his plans to go to college and become a doctor with his sponsor, Seppala didn’t know what sort of reaction to expect. “He could have doubted me in some manner, and I would have crumbled,” Seppala says. “I had no confidence I could do this. It was like a dream almost.” The sponsor told Seppala that if it was God’s will, it would happen. “I hung on to that,” he says. As he accepted the award from De Paul, he told the audience that he still hangs on to that philosophy every day.
Confronting the Stigma
With the help of former high school teachers who let him come to their homes during the summer after he was to have graduated to finish his studies, Seppala earned his high school diploma. He started at St. Olaf College in Northfield, then transferred to Drake University in Iowa after he and his wife, Linda, were married. He came back to the lab at Mayo each summer and decided he wanted to be a surgeon.
While applying to medical school, Seppala ran into an unexpected obstacle—the stigma surrounding addiction. “I was advised not to say anything about my past and my addiction. I was told by two physicians at Mayo that I knew who were in recovery that if I said something I would not get in,” he says. Seppala kept quiet but presented a resume filled with volunteer activities associated with addiction recovery. After he was accepted at Mayo, Seppala told the dean his story. “He didn’t ask me to leave,” Seppala says with an infectious laugh that often edges its way into conversations.
As a medical student, Seppala discovered how little physicians knew about addiction. “I saw people on hospital rounds who had addictions and alcoholism. Maybe it would be identified, maybe it wouldn’t. But people weren’t being referred to treatment,” he says. Some of the other physicians told him to do something to change the situation. So instead of pursuing surgery, Seppala went into psychiatry, which had a relatively new subspecialty—addiction medicine.
But encounters with the stigma didn’t end. As a resident at the University of Minnesota, Seppala had trouble getting a medical license. “The medical board at the time didn’t know what to do with me,” he says. They had experience with established physicians who had developed an addiction but never with a new physician with a history of addiction. After a full investigation, the board gave Seppala a license without stipulation.
“Every time I apply for a job or malpractice insurance, I have to reveal that this is a problem,” he explains. (He says he has known of other physicians who’ve had trouble getting back into practice after treatment because they can’t get the blessing of the managed care organizations that employed them.)
“We don’t treat this like other illnesses,” he says. “Even if people are involved in a diversion program and doing everything they need to and are proven to be good, effective physicians, there is still a bias and stigma associated with it.”
Seppala is living proof that individuals who have struggled with addiction can be productive members of the medical community. “Someone like Marv, who is a physician, is able to look at this problem both from a scientific standpoint and from the role the standard 12-step program plays,” says Keith Berge, M.D., a Mayo Clinic anesthesiologist who met Seppala during one of their first days of medical school. That meeting changed Berge’s beliefs about alcoholism.
At a party for the incoming class, Berge offered Seppala a beer: Seppala declined and explained that he was an alcoholic and couldn’t drink. “That stunned me,” says Berge, who has become a close friend of Seppala’s and meets up with him a couple of times a year to fly fish or ski. “At that point in my life, I had only viewed alcoholics as down-and-out skid-row bums.”
Because of his friendship with Seppala, Berge became interested in narcotic addiction among anesthesia providers. He now chairs a committee at Mayo that deals with chemical dependency issues and narcotics control in the operating room, has created a policy for dealing with operating room employees who are suspected of having a drug problem, and has done interventions with employees who have diverted drugs from patients in order to feed their own addictions.
Berge says Seppala, whom he describes as one of the best listeners he’s ever met, also taught him about the importance of taking action when he suspects a patient or a colleague may have a problem. “I now insist that we get the CD [chemical dependency] people involved,” he says. “Many of my colleagues would say there’s no point in doing that, that no one ever gets better. Marv is my one that got better, so I know it’s worth trying because it can change people’s lives.”
Fixing Brain and Soul
When Seppala joined Hazelden in May of 2002, his story came full circle. “Even though I didn’t get sober right after Hazelden, I still believe it’s where everything started,” he says. And the way he got back there, like other things in his life, is in some ways not easily explained.
Seppala had always wanted to work for Hazelden but had given up on the idea after he took a job with a treatment facility in Portland in 1988. Four years ago, the Hazelden Foundation bought Springbrook Northwest, where Seppala was working as chief of psychiatry and addiction medicine. Hazelden administrators asked Seppala to be chief medical officer for the entire organization.
In that role, Seppala, who travels between Oregon and Minnesota several times a month, oversees medical care at Hazelden’s facilities in Minnesota, Oregon, Illinois, and New York. In addition, he speaks to physicians and other health care professionals in the United States and around the world—sometimes on his own time and his own dime— and looks for ways to incorporate the latest treatment approaches into Hazelden’s offerings. “Marv is an innovative thinker in regard to the evolution of addiction medicine. Much of addiction treatment is locked into the 12-step model,” Berge says. “Marv is working to anticipate what the treatment programs of the future will look like—inpatient versus outpatient treatment, augmenting an outpatient pharmacologic program with trained counselors. There are big changes coming, and he’s in a unique position to see and anticipate the fallout of some of those coming changes.”
Douglas Lyons, director of clinical services for Hazelden Springbrook, has worked with Seppala for 13 years. He says Seppala’s humble nature (he insists on being called Marv, rather than Dr. Seppala) and his ability to see the world through the eyes of his patients set him apart from other physicians who work in addiction medicine. “He has less ‘MDiety’ than the average physician,” says Lyons. “So many psychiatrists primarily look at the needs of patients through the medical lens. Marv is on the cutting edge of all current medications and their applications, but he has an ability to connect with patients that’s really rare.”
Lyons has seen that connection happen with young patients, to whom Seppala tells the story of his addiction and recovery. “The instillation of hope that’s created by that is phenomenal. They think that if he can do it, perhaps I can do it,” he says. “I’ve worked with a lot of young adults who are now 10 to 12 years sober who talk about how that conversation changed their lives.”
What also distinguishes Seppala, Lyons says, is his understanding of the importance of the patient’s spiritual well-being. “Alcoholism is a disease of the brain and a disease of the soul,” Seppala explains. “If your life’s in the balance and if you’ve lost control and if you lose the will to survive, your soul is in jeopardy.” And he believes fixing the soul requires much more than abstaining from alcohol and other drugs or taking a pill that can curb cravings; it requires the help of a higher power.
Seppala later tells how preparing his acceptance speech brought back memories of all the people who touched his life—and his soul—on his journey to where he is today. “So many people did so many things for me,” he says, recalling the Mayo researchers who gave him the job in the lab and who knew he was capable of much more than assisting with their work, the teachers who helped him finish high school, the medical school dean who didn’t throw him out upon learning of his addiction, the people in his recovery groups who encouraged him to pursue his career goals. “I don’t know how to explain that,” he says, then pauses. “I don’t know how to explain any of this.” MM
Kim Kiser is associate editor of Minnesota Medicine