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Editor's Note: This article includes firsthand accounts of substance use and addiction.
Josh Golomb and Ruben Vega grew up side by side, part of the same large, close-knit Mexican-American family, spending holidays together, trading hand-me-down clothes, performing at family talent shows, and looking out for one another the way brothers do. They were the two cousins closest in age, and in many ways closest in spirit.
But their paths through life could not have looked more different. Josh went on to college, built a career in education and health technology, and eventually co-founded Hazel Health, the leading school-based telehealth provider that has expanded access to care for nearly two million children across the country. Ruben, talented and curious and full of energy as a kid, started using methamphetamine at age 12, struggled with addiction for 25 years, and ultimately served a 10-year prison sentence before finding his way to sobriety, purpose, and a second life.
In an episode of the Expanding Access podcast, the two cousins sat down together to do something they had been wanting to do for a long time: have an honest conversation about what shaped them, what separated them, and what their parallel journeys reveal about the systems that catch some kids and miss others.
The result was one of the most candid and moving conversations in the series.
Both men are quick to point out how much they shared growing up. They came from a family of roughly 30 first cousins, all living within 20 to 30 miles of each other in Southern California. Their mothers were sisters in a family of nine siblings. Family gatherings were a constant, and the cousins were as close as most kids are to their schoolmates.
But Josh, who is biracial and more white-presenting, grew up in what he describes as the most middle-class branch of the family, with access to better schools and teachers who expected the best from him. He was pushed toward honors classes and the SAT. Ruben grew up in a tougher neighborhood, attended an elementary school where he witnessed persistent violence, and struggled with bullying that left lasting marks on his confidence and sense of safety.
“I was just trying to bob and weave my way out of any kind of trouble, but it ultimately led to me getting picked on and bullied. I struggled with insecurity issues at a young age.” — Ruben Vega
Ruben was talented in ways the family could see clearly. Josh describes him at those childhood gatherings as charismatic, funny, and magnetic, doing full John Travolta impressions and commanding a room. But at school, those gifts did not translate. His community did not recognize them. And the gap between who he was at home and who he felt he had to be at school was one he would spend years trying to fill.
Ruben was 12 years old the first time he tried methamphetamine. It was 1990, in the parking lot of a Burger King, on a whim, with an older kid from school. He did not even know what it was at first.
But he knew immediately what it did for him.
“It took away all the worries, all the struggles that I had going on. It took me away from my everyday life, whether it was trouble at home, trouble on the streets, trouble with friends. It filled up this void that I had been searching for so long.” — Ruben Vega
He describes learning to function with the drug throughout high school, managing to stay out of serious legal trouble for years while steadily losing his grip on school, sports, and the future he might have had. He dropped out in 10th grade. He traded tacos and burritos for drugs at the fast food job he worked at 16. He gravitated toward people who could supply what he needed.
By the time he met his wife Maria, fell in love, and had his first daughter, he was living what he calls a double life: holding down a job, buying a house, putting food on the table, while hiding the addiction that had consumed him since he was a child. He was so good at hiding it that even the people closest to him did not fully understand what was happening.
“In everybody else’s eyes, I just looked normal. I would drink to make it seem like, oh, maybe he just drinks a lot. But in reality it was something totally different.” — Ruben Vega
He used for 25 years. In the last 10, everything started to fall away: the houses, the cars, his marriage. Maria eventually moved their daughters to Washington State. And then, still using and increasingly desperate, Ruben made a decision that landed him a 120-month prison sentence for home invasion robbery.
Ruben describes the moment of his arrest with an unusual kind of clarity. After 25 years of addiction, the relentless motion of his life finally stopped. There were no drugs accessible. His family was not there. There was nowhere to go and nothing to do but sit with himself.
He had already been in and out of county jail. He knew the prison system. But this time, something was different.
The turning point came four years into his sentence, when his daughter Madison finally turned 18 and was allowed onto his visiting list. Ruben was in solitary confinement at the time, six months into an isolation stretch. She came to see him through the glass. She could not hug him. She asked why. And then she said the thing that changed everything.
“She looks me in the eye and she says, ‘You know what? Mom was right. You’re not going to change.’ That was the biggest wake-up call I had in my life.” — Ruben Vega
He had already been clean for four years by then. But that moment moved him from abstinence to real commitment. He threw himself into every program the Department of Corrections offered: 12-step groups, journaling, cognitive behavioral therapy, alternatives to violence. He started paying attention to the men who were never getting out and noticed something that surprised him. They were happy. They were exercising, smiling, helping each other.
He also watched the men who left and came back, listening carefully to what they said went wrong. He noticed they always said the same thing: I know what I’m going to do this time. What he decided was different.
“I never heard them say, ‘I know what I’m not going to do this time.’ For me, I know what I’m not going to do. I’m not going to go back to my old people, places, and things.” — Ruben Vega
Ruben has been out of prison and in recovery ever since. He works as a plumber and sewer estimator in Seattle. He has rebuilt his relationship with his daughters. He attends meetings and sponsors others. And he goes back into prisons, county jails, and rehab centers to share his story with people who are still in the middle of theirs.
He describes those moments with a kind of wonder, the way the gifts that went unrecognized in school, the natural charisma, the ability to hold a room, the willingness to be completely honest, turn out to be exactly what the work requires.
“I’m a walking example of what life can be. Trust me when I say that you can leave prison and do it a different way.” — Ruben Vega
Josh witnessed one of those moments firsthand, at the celebration of life held after Ruben’s mother passed away last summer. More than 100 family members were there, at different stages of grief, and Ruben took the microphone without any notes, any plan, or any script and held the whole room together. Josh describes it as one of the most extraordinary things he has ever seen.
Ruben credits recovery not with giving him something new but with returning something he had lost. Going to meetings. Working the steps. Praying. Staying focused on the people he loves. Keeping it simple. Not taking on too much. Recognizing that the struggle does not disappear when you get sober. It just becomes something you face without a drug to hide behind.
Both Josh and Ruben were asked what, looking back, might have made a difference for Ruben in those early years. The answers were practical, specific, and grounded in what each of them actually lived.
Ruben points to three things. First, safe after-school spaces: a Boys and Girls Club, a YMCA, something structured and consistent to fill the hours between school and home, hours that in his neighborhood tended to fill themselves in dangerous ways. Second, extracurricular activities with embedded mentorship, not just something to do, but someone to do it alongside. Third, and most importantly, a place to talk freely without fear of judgment.
“I really wish I had someone to talk to and speak freely without judgment and criticism. I feared being criticized and bullied my whole life. I couldn’t tell my dad because I didn’t want him to look at me a certain way.” — Ruben Vega
Josh points to a peer counseling program at his high school that he credits as more significant than he fully realized at the time. Learning to ask questions, practice empathy, and sit with other people’s struggles turned out to be a way of processing his own. And it revealed something important: his family was not the only one navigating hard things. That realization, he says, was quietly transformative.
“I think those things can really help a lot of young people. It’s been really fun to see a lot of cool new companies come up that are driving more and more peer support.” — Josh Golomb
Both cousins also reflect honestly on the role of circumstance. Josh acknowledges that the path he walked was shaped by the choices he made, but also by the schools he attended, the teachers who expected things of him, and the way the world read him. He wonders, openly, what might have happened if they had swapped places.
Ruben, for his part, does not blame his family. He says they gave him everything they had. What they could not give him was something he could not even name at the time: a way to talk about the darkness, a place where the version of himself he was hiding could finally be seen.
When asked what payers, providers, and schools could do to reach more young people like Ruben, the answers built on each other.
For payers, Ruben is direct: counseling access matters. Not just crisis counseling but consistent, voluntary, judgment-free spaces where young people can process what they are carrying. He is also a strong advocate for 12-step programs and CBT, especially peer-delivered versions. He points to a program inside one of the prisons he served time in, where inmates developed a cognitive behavioral therapy curriculum for other inmates, as a powerful example of what happens when the people being served are the ones doing the serving.
“There’s something special about an inmate and an inmate working together, or an addict and an addict working together. A lot of these kids would shut down on counselors who had no shared experience. But that’s what I learn most from: the 12 steps and working with people who’ve been there.” — Ruben Vega
For schools, both cousins point to the same thing: schools are uniquely positioned to be trusted connectors. Josh suggests that schools can be part of the broader medical neighborhood, a place where families can be linked to resources they would not otherwise know how to find or access.
Josh reflects on how hard it is to navigate the healthcare system even with every advantage he has, working in health care, with time and resources and knowledge. For families without those advantages, the barriers are far higher. Schools that actively bridge that gap, linking struggling kids and their parents to services and support, can do something no other institution in a young person’s life can quite replicate.
“Schools are generally a place of trust, places of connecting. Finding a way to bring more and more things for kids that might need it, particularly kids who might not have as much access, through schools is such a huge opportunity to close gaps.” — Josh Golomb
One of the most quietly powerful moments in the conversation came near the end, when Josh asked Ruben something he had never asked directly before: what could the family have done differently when Ruben was at his worst?
Ruben’s answer was generous and honest in equal measure. He says the family gave him everything he needed. They were always there. He just could not see it through the fog. And the addiction was so well hidden that even the people who loved him most could not have known how to intervene in the way he needed.
“The person that I am today is because of our family. There was a time where I was foggy and I thought about what could have been done different. But it got to the point where I had a choice. And I hid it so well, nobody would have known.” — Ruben Vega
He reflects that every person in the family gave him something he carries today. Every one of the 30 cousins contributed something to who he became. The path was supposed to be exactly what it was, he says. Despite the suffering, he found his way through it and came out on the other side.
Josh closes by naming what Ruben has given him in return: a living reminder of how much circumstance shapes outcomes, and how much courage it takes to keep showing up regardless. So much of what Josh has tried to build at Hazel, the focus on kids who are hardest to reach, the belief that schools can be connecting forces, the investment in peer support, has its roots in this family and in the parallel paths he and his cousin walked from the same starting point.
Ruben describes himself as a miracle in progress. His gratitude is practical and daily, an attitude he returns to again and again as a tool for staying present, staying sober, and staying focused on the work of giving back. He ends the conversation the same way he tries to end every day: with patience, gentleness, kindness, and love.
It is a simple list. It is also, as this conversation makes clear, a hard-won one.
To learn more about Hazel Health, visit hazel.health. For more episodes of the Expanding Access podcast, visit behavioralhealthtech.com/podcast.
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