In 1975, after struggling with alcoholism and dropping out of high school, Marvin Seppala applied for a janitorial job at the Mayo Clinic.

Years later, he would graduate from its prestigious medical school.

Today, Dr. Seppala is chief medical officer for the Hazelden Betty Ford Foundation, a nonprofit with 17 locations across the country, including an in-patient treatment center in Newberg.

He's a soft-spoken man with strong views on addiction treatment formed, in part, from personal experience. Being forced into treatment helped him, and he thinks it can help others.

Seppala grew up in rural Minnesota. He had his first drink on a farm at age 12, after a friend swiped some whiskey from his house.

"Innocent, but for me it was life-changing," he said. "The one thing I got out of it was I would do it again. And it didn't happen immediately, but it absolutely happened again and again and again."

Seppala started drinking heavily. After he dropped out of school at age 17, his parents forced him into Hazelden's treatment center in Center City, Minnesota. He became the first adolescent treated there, admittedly a "strange notoriety" for someone who would later speak to Congress on behalf of the organization.

"I'd never heard of Hazelden, I'd never heard of addiction treatment. It wasn't widespread in 1974," he said. "I didn't know what was wrong with me. I knew there was something. I couldn't understand why I kept doing what I was doing. I thought I was getting relief from intoxication, I didn't think it was the problem."

Seppala didn't want to be in treatment, but his parents threatened to go to court and have him committed if he didn't stay. It may have been a bluff, but it worked.

He spent 28 days at Hazelden and lasted five days sober when he returned home – but the Marshall Tucker Band was his undoing. He relapsed at their concert and was subsequently kicked out of the house.

Relapse is a common story for those with addiction.

But it doesn't have to be the end of the story.

Seppala was living out of his car and working odd jobs when he applied for a janitor's position at the Mayo Clinic in Rochester, Minnesota. The clinic contacted him two weeks later, not about janitorial work, but for a lab technician job in a cardiovascular research lab.

It proved to be life-changing. He enjoyed the work and decided he wanted to become a doctor. To do that he'd need to get his high school diploma, go to college and quit drinking.

He'd learned about Alcoholics Anonymous in treatment and was now ready to try meetings.

"So, I finally walked into a 12-step meeting in Rochester," he said. "There were three guys there. I was 18 at the time and they were all over 70. Whatever was said, I can remember at least feeling cared for, and I went back. Same meeting, same three guys. And I kept going back every Sunday."

One year later, he attended his first college class.

A 2012 report from the National Center on Addiction and Substance Abuse found that between three and 12 hours of medical school curriculum were spent on addiction studies.

"There's less than a day on average on addiction in medical schools across the country," Seppala said – this despite the millions of public dollars devoted to fighting and treating addiction.

As a result, many doctors don't understand the neurobiology of addiction. It leads to over-prescription of pain pills and misunderstandings about addiction causes and treatment. The problem inspired Seppala to study psychiatry, with a focus on addiction treatment.

Seppala says one symptom of addiction ­– as in his own case – is the inability for patients to recognize they have a disease. People with a substance abuse disorder are not capable of making a rational decision regarding their treatment, he said.

Last month, Seppala spoke at a town hall at George Washington University about involuntary civil commitments for those struggling with addiction, saying it could be another tool in the fight against opioid overdose deaths.

"We may need to intervene in extreme cases to pursue treatment, even when it is against the individual's wishes," he said.

Oregon is one of 13 states with no laws allowing for someone to be civilly committed for treatment of a substance abuse disorder. Laws on civil commitment vary greatly state to state, but Seppala says we should consider some form of involuntary treatment for those with a high risk of death – particularly those addicted to heroin.

"Err on the side of civil liberties, but also try to take care of those with really severe addiction who've had some overdoses and are bound to die," Seppala said. "It's happening so frequently it's hard to stand by and say 'Well, nothing we can do.'

"We'll incarcerate parents who don't get medical care for their child in Oregon," he said. And yet, we do little to get medical care to adults with an opioid use problem.

But Rep. Mitch Greenlick, chair of the Oregon House Committee on Health Care, said civil commitments would be "a tough sell" to lawmakers.

He said Oregon is using other tactics to address the crisis. "One issue is cutting off the supply," Greenlick said.

Multnomah County recently filed a $250 million lawsuit against drug manufacturers and providers, claiming they pushed doctors to treat chronic pain with opioids despite the great risk of addiction. Many heroin users first became addicted to opioids through prescription pills.

Greenlick co-sponsored House Bill 2114, which in its original version would have prevented doctors from issuing a prescription for more than a 7-day supply of an opioid – though what was ultimately signed into law was a watered-down bill referring doctors to prescription guidelines for opioids.

But Seppala raises an interesting point: After ending the practice of mass institutionalization in the 1970s, has the pendulum swung too far in the other direction? Can we craft a law that can save lives without being misused? At what point is it crueler to do nothing?

There are no easy answers, but the difficult questions are the ones worth asking.

-- Samantha Swindler

@editorswindler / 503-294-4031

sswindler@oregonian.com