What Bob Forrest Got Wrong

What Bob Forrest Got Wrong

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Medication-assisted treatmentRemember Bob Forrest, Dr. Drew’s head counselor on Celebrity Rehab and Sober House—that tough-love kind of guy who looked and sounded like he’d been through the trenches (which, by he way, he has)? I didn’t hate the guy because he seemed to genuinely care about addicts; at the same time, he didn’t strike me as being an expert any more than the rest of us.

On a Pretty High Horse

Nowadays, he’s out from under Dr. Drew’s wing, having opened his own treatment facility and started describing himself as “one of the finest drug counselors living today.” The former rocker known for intoxicated rants and onstage antics is now in charge and unedited and it shows.

In a recent post, he joked that his blog ought to be named The Open Minded Report, because, as he described them, his writings were an antecedent to “close-minded Southern Californian AA Fascist[s].”

And it gets better from there.

The rest of the post is basically him shaking his fist at Big Pharma and railing against the dangers of harm reduction, which he strangely seems to define as drug replacement therapy. (This is actually not what harm reduction is— more on that in a minute). The gist of the post is that maintenance medications like Suboxone deprive people a chance at living a sober life (which Bob defines as “total abstinence”); they cause confusion among the 12-step community about who is sober and who is not; their existence and prescription creates an “irrational fear” of detox.

Bob, You’re out of Touch

Sure, I agree that the pharmaceutical industry has profit, rather than a patient’s interests at heart and yes, I respect that medication-based treatment as opposed to abstinence-based treatment is a thorny topic. But for a guy who’s presumably been through it to describe detox as an “irrational fear”? That’s just weird. And to ignore the fact that replacement medications like Suboxone have enabled a smoother detox and a bridge to sober living for many is willfully ignorant and just plain irresponsible.

Jennifer Matesa, for one, does a great job of reporting on the complicated debate while telling her own story of using Suboxone as a bridge to sobriety; she writes, “I might not be here today if it weren’t for Suboxone.”

It’s an antecedent, shall we say, to Bob’s rant:

There is no hell worse than being stuck on 24 or 32 milligrams a day of this stuff, with no hope of getting clean, enslaved to the poison machine your doctor put you on, a doctor who took the Hippocratic Oath, pledging, ‘I will do no Harm.’ Motherf#&!ing lying sacks of shit.

“No hope of every getting clean” is just wrong. You can successfully transition off of replacement medications like Suboxone—Matesa’s story serves as an example—and until you do, you are welcome to begin recovery, including 12-step, where the only requirement for membership is a desire to stop drinking or using.

Sober or Not Sober? That Is the Only Question

I’m not pro-Suboxone per se but I am pro-people on Suboxone feeling welcome into 12-step programs (and not feeling pressured to get off of it or like their time doesn’t count until they do). As far as Bob’s concern that drugs like Suboxone and Subutex cause confusion among the 12-step community: in my mind, there’s no confusion about who is sober and who isn’t. Because this is not a question I allow myself to ask. On the issue of medication, AA literature makes it clear that “we are not doctors.” As I tell my dog when we’re out on a walk and he goes to sniff a passing stranger’s crotch, “Mind your business, Spud!”

In other words, what another fellow alcoholic or addict may or may not be taking is not of my concern.

Personally, my definition of sobriety has changed throughout the years. In the beginning, it was don’t drink. As years progressed, I gave more consideration to my emotional sobriety. I’ve set more bottom lines and identified accessory behaviors to avoid acting out in other compulsive ways. At seven plus years sober, emotional sobriety means staying present, not avoiding feelings, practicing certain principles in all my affairs. If someone would have told me that all of this is what was required of me when I entered into recovery, I probably wouldn’t have stopped drinking.

I had a sponsor early on that dumped me because I was on medication for a medical condition it turns out I didn’t have—still, it wasn’t her call. I had another sponsor, years later, tell me that sex outside a committed monogamous relationship was akin to taking a drink. Ah, no. It is most definitely not. Taking a drink is akin to taking a drink. And even then, were that to happen, I get to decide what that means. Of course, I know Suboxone is not like taking an antidepressant—it’s an opiate, and I know that opiates get people high.

Progress Not Perfection

I think the real reason I’m bothered by Bob’s stance is because of the work I do at a needle exchange in Upper Manhattan. It’s the kind of place where heroin users are being encouraged to use clean needles (especially if they’re sharing) and condoms (especially when they’re selling sex). We hand out safer smoking kits and teach people about various risks so that they can make more informed choices. This is what harm reduction means: it means meeting people where they’re at and treating them with respect. It means supporting a heroin user who’s trying to not smoke crack or encouraging an addict to sniff rather than shoot up (if this is a better choice, according to that person). I know the people I work with sometimes go to 12-step meetings. Like anyone else at that meeting, they’re trying to improve their lives or just stay alive, one day at a time. I don’t disqualify and wouldn’t want to discourage these efforts.

Bob reminds me of those old timers you find in the back of the room, yelling on after their four minutes are long up about how the newcomer needs to take the cotton out of their ears and stick it in their mouths. I’m sure there’ll be things he says that I agree with but the tone of this particular post was unwelcoming, intolerant, and not helpful—certainly not the attitude of ‘Unconditional Positive Regard’ that Bob’s new rehab is supposedly all about.

Photo courtesy of Supertheman (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons (resized and cropped)

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7 Comments

  1. Melissa…it is painfully obvious that you don’t know the living hell that is “Suboxone” I say this with all the certainty and truthfulness I possess, it is IMPOSSIBLE to get off suboxone. Suboxone is simply a “replacement” for street opiates. It IS a very powerful and intoxicating opiate that people that have been in rehab for heroin have said was 5 times harder to try to get off than heroin itself. Suboxone does nothing more than keep a person from street drugs. THAT IS IT. Suboxone will not make you a sober person…..it will make you a slave. I cannot believe that ANYONE who has never had a Suboxone experience would dare to try and tell everyone else how wrong they are. Educate yourself Melissa….Bob Forrest was a SEVERE addict who made it back from an abyss….I will take his word over any half assed, uneducated 2nd year doctor ANY DAY.

  2. I got off of a long battle with heroin by taking methadone. I was determined to use this medication correctly and turn my life around. It took six years of very slowly going down to zero but I eventually did. In those six years I got a college degree, a job, friends, a dog, a house, a car and most importantly self respect. I wasn’t ready to one day be on absolutely nothing. I needed the process. I lover Bob Forrest, but there is no one model that works for everyone. X

  3. Jeremy Anderson on

    Thinking back to before I got sober my clearest recollections of help along the way are of the people who did not judge my actions. I remember at least three people who responded to my using in a way I can only call not responding. For me, the door to change seemed less a guarded portal than a wide open outdoors. The narrow place was the one with the drugs and the alcohol and the minding all the things that were none of my business, like what people thought. If someone comes into recovery dependent on anything, it is their business to determine whether it is a problem, not mine.

  4. Melissa, 12 step programs also have 12 traditions. The 11th tradition seems to be one you overlooked when you decided to write this article, along with the 12th which reminds us to place principles over personality. It’s people that write articles like yours that will scare people away from a program, not Bob Forrest.

  5. Melissa, go on suboxone for two years, try to come off it, THEN talk to me. Bob is there sticking it to big pharm, the biggest cause of drug deaths in the world. He threatens the industry. Or rather, the industry is threatened by him, and by Dr Drew. So it is NO WONDER that a personal backlash like this happens. As he becomes more visible and successful in his criticism, there will be more of these counter-discourses in the media. There was absolutely no reason for this article to exist, except to shill for big pharm, Melissa. Hopefrully, they paid you. You are doing sterling work for them.

  6. Chuck Sigler on

    I see concerns with medication-assisted recovery on a few of different levels in 12 Step groups. First, as you point out, Suboxone, Subutex, methadone are all addictive opioid drugs. So their use in “treating” addiction is antithetical to a philosophy of abstinent-based 12 Step recovery. A drug is a drug, is a drug. I remember a friend once told me of a classroom discussion/ debate that took place between him (a recovering heroin addict who advocated abstinence) and a person who supported methadone maintenance. In the middle of a statement supporting maintenance, my friend said the guy nodded out for several seconds; and then continued his statement on how methadone maintenance was a legitimate treatment approach. My friend’s response was “I rest my case.” My point is that there seems to be a systematic blindness with many medication-assisted advocates to the dangers and negative consequences of that approach.

    Abstinent-based 12 Steppers also have to be more attentive to their Traditions on membership (Tradition Three) and primary purpose (Tradition Five) when carrying the message of total abstinence to individuals who aren’t there yet. Speaking the truth in love should always shape how this message is communicated.

    Second, the extended half life for methadone (about 20 hours) and buprenorphine (around 40 hours) over heroin and most other opiates (about 3 to 4 hours) incrementally extends the difficulties experienced during withdrawal. The longer a person is on a maintenance program, the more difficult their withdrawal from methadone or bupe seems to be. Maintenance treatment with methadone and bupe requires that opioids are daily ingested by an addict for months and even years. So maintenance therapy can physically entrench addiction far beyond what was possible when the addict had to rely on their own resources to get drugs and not a clinic or a doctor to supply them.

    A related issue I’ve seen is the failure to distinguish between acute withdrawal and post acute withdrawal. The original logic of maintenance treatment was to provide a way to gradually taper off of methadone and minimize the withdrawal symptoms that typically drove the addict back to using heroin. But this only seems to work with acute withdrawal. The difficulties of coping with the debilitation of post acute withdrawal (not thinking clearly, difficulty managing feelings and emotions, problems remembering things, difficulties sleeping restfully, problems managing stress, etc.) which can last for weeks and months, needs the support and encouragement of other recovering addicts who have gone through it to abstinence. My sense is that maintenance therapy prolongs post acute withdrawal beyond what would have been experienced if traditional medical treatment of acute withdrawal had been the approach. Using buprenorphine as a detox drug, where the treatment goal is abstinence, avoids or minimizes these dangers while giving an assist during the crucial stage of acute withdrawal.

    A third concern seems to come from an unacknowledged view of human nature. Are we just a biophysical machine; or are we something more? If addiction is understood as simply a brain disease, then psychological/mind/soul concerns are subsumed within some kind of physiological paradigm. We lose our humanity in the biophysical machine. If we are body and soul, then abstinence (from drugs in the body) plus change (in the soul or spirit of our being) leads to recovery.

  7. If that’s your picture there? You look like a good kid. I wouldn’t think anyone would want to hurt you by bursting your bubble or invading your space. This is just business. You are obviously entitled and well established in a system that supports your beliefs. Great for you. You take what you need and there you are handing out hand sanitizer to the masses on weekends..

    This Bob guy? I don’t know of him except for the write up on the Fix before that poor site jumped the shark. I’ve never watched Dr. Drew or any of that bright light stuff. What about Bob? Bob may be like many of us who have seen enough, has had “one hundred too many” sad cases jammed with their prescription for a full time babysitter, and well? Can’t help voicing occasionally just how absurd it is watching addicts fix themselves by rearranging symptoms. Or how to live and support symptoms of addiction without any accountability whatsoever. Just new arrangements like… show up for meds, needles, condoms.. Why get off the train, out of the system, why work and support yourself when you can get housing, clothes, money, cell phone, food card, suck some emotional security out of the strength in numbers, oh yeah needles condoms and meds. Stand in line for your new identity. The system provides all you need to monkey down with your sickness.

    I remember my beautiful daughter doing her best to convince me that alcohol was bad, smoking herb was totally healthy, organic, her life was actually much better with it than without it. Then she turned 30.

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About Author

Melissa Petro is a freelance writer and writing instructor living in New York City. She has written for NY Magazine, The Guardian, Salon, The Daily Beast, The Huffington Post, Jezebel, xoJane, The Fix and elsewhere. She is the founder of Becoming Writers, a community organization that provides free and low cost memoir-writing workshops to new writers of all backgrounds and experiences.