Freethinkers are seldom understood or accurately framed in their time. Years from now, Bob Forrest may be seen as a fearless innovator or a misguided idealist. He sees his role as “the conscience of the recovery industry,” asking questions that elude simple, one-dimensional answers. Legacy preservation is not his concern; he’s too busy engaged in the messy business of helping young suffering addicts recover.
Forrest has received more media attention than most. Between his presence on Celebrity Rehab, and the recent documentary about his life as a musician-addict-recovery advocate (Bob and the Monster), thousands of words have been written about him.
Defining a man’s essence is no simple task. In Bob’s case it’s harder still, separating media mythology from fact. If he were to be characterized by one word, it would be survivor.
Unlike some of his peers in recovery who have walked away from the business after devastating losses, he recalibrated and continues to move forward. That’s part of what makes his work and thoughts about the future of the recovery industry relevant. This survivor is willing to look at every crack in the facade of the addiction treatment system, with the intent to build a more effective model.
Forrest is a study in contradictions. This quality enables him to be a fiercely independent reformer with heart. Working with clients on the path to recovery is not a linear pursuit. If a practitioner cannot abide in a system rife with unresolved conflicts and navigate his way through a clutter of conflicting ideologies, he will have limited success.
A complex figure, he is inspired by a desire to change the paradigm of the recovery community while working in its nucleus. He characterizes rehabs as businesses “who have lost their souls.”
That said, he is a partner in Alo House/Bob’s Place which includes an inpatient center, outpatient facility and a sober living house. More than anything he wants to improve the outcomes for treatment centers. This change won’t happen without modifications to the way addiction is treated today.
The Problems Rehab Treatment
Corporate-owned rehab facilities charge significant fees to direct clients to 12-step meetings. With a success rate hovering at about 5% it seems logical and worthwhile to give more to a client than a week in detox and 21 days to get acquainted with the “Big Book.”
Many in chemical dependency study the “Minnesota Model” of recovery firmly rooted in the practices of 12-step programs. Recovery is contingent upon group membership and practicing the 12 steps of AA. Clients are told they are in the grip of a fatal disease, and that there is only one path to its cure.
AA and its associated fellowships are not the only types of treatment programs available for individuals with substance abuse issues. The principles of AA, however, are utilized in the majority of treatment programs.
Bob thinks integrated therapies are more effective techniques. They require synthesizing a variety of modalities. Since addiction affects every aspect of personhood, all components of the psyche need to be addressed.
Reliance on one method for recovery creates an obvious disconnect. Informing clients that they’ll die if they don’t join a program that depends upon religious conversion guarantees that many will develop resentments that can only distract from recovery.
Forrest is critical of this approach while admitting that he is an active participant in 12-step meetings. He has learned from working with young addicts that proficiency with a number of tools is required.
He has many clients for whom AA doesn’t resonate. For those in which the temperance, tone, and focus on religious conversion is a problem — there are options.
The pillar of Bob’s philosophy is to meet clients at the psychic place they inhabit. He applies the concept of rigorous honesty to himself, as well as the patient. If asked if he is sober, he answers the question as well as admitting to his (former) drug of choice. Immediately this differs from the protocol of many clinicians.
Often a therapist will not indicate whether they have ever had a substance abuse problem. Bob thinks this creates an atmosphere of distrust with clients, and creates an inability to form attachments with the treatment team. He believes trust, empathy, and accountability are the foundation for creating change in those seeking recovery.
Forrest focuses mainly on addiction in young adults. He practices a form of attachment therapy, which in this case means bonding with the client and talking honestly about every aspect of recovery. While he may be a role model for staying clean, he never infers he has perfected the art of living. This kind of sharing engenders confidence in his clients, some of whom continue to work with him for years while they reshape their own lives.
Some clients who were initially resistant to 12-step programs change their minds after a time. As Bob often says, “It’s where all my friends are.” There’s also SMART Recovery, Rational Recovery and S.O.S. (Secular Organizations for Sobriety). He’s willing to direct clients to solutions that work for them.
Battle Scars of Recovery
After working in the recovery business for over 20 years, on the front lines in intervention, recovery education and relapse prevention, Forrest has strong opinions on what approaches achieve the best results.
He believes in a team model where doctors, psychologists, CADAC counselors and technicians work together to create a treatment plan that is tailored for each client. Like Dr. Gabor Maté, who implores us to ask, “Not why the addiction, but why the pain?” Bob and his team search along the same lines, sourcing the roots of an individual’s addictive behavior.
Because of the economic climate rehab centers operate in, many jobs have been cut at treatment facilities. This means that marriage and family therapists are relied upon to counsel clients who might have also have worked with certified addiction specialists in the past.
Every state has different laws, but the combination of weak oversight and communication lapses between officials makes adult rehab centers easy marks for fraud and insufficient treatment. The lack of regulation for adult treatment centers is a source of ire for Bob.
Recovery is a dirty business. No one knows this better from all sides of the equation. As a patient at 24 different rehabs, and now as the owner of a facility, he has a perspective that few can claim. His view is that in recovery meccas like Malibu, treatment centers have gotten lazy. This is a bone of contention Forrest is eager to chew.
His disdain for inefficient practices boils over into every discussion we have. It seems that knowing most of the clients will fail at staying clean has freed some institutions of their ethics altogether.
While many who run such facilities are in recovery themselves, he has no doubt the motivation is collecting fees and keeping the patient count high. Forrest would like to take a suitcase full of dynamite and blow up that paradigm. However, he is not a terrorist.
After resigning from one facility in protest and watching his first recovery center fail, he learned how to wade through ambiguity and contradiction into a focus on results.
Through his work at treatment facilities and his own enterprises, Bob has learned some hard lessons. When he took a stand against the use of detox drugs like Suboxone as maintenance for opiate addicts, the facility he worked at took a hit. A sucker punch strong enough to reduce the patient population by more than 50%. Recovery centers cannot be sustained on those figures, and ultimately the battle against Suboxone maintenance was lost, for that moment at least.
Bob has a torrent of ideas, expressed with the explosive cadence of an open fire hydrant. Sorting through, picking out the pieces and reassembling them is a worthwhile effort, because above everything else Forrest is onto something that works.
The recovery business has morphed into a mashup of a hospital and a high-end spa. To compete, offerings like personal chefs and the latest treatments (equine therapy, neurofeedback techniques) are requisite.
When you strip away the accoutrements, there are a few things that really count:
- Did the client gain skills that will help them navigate the world without addiction in the driver’s seat?
- Is there an extended aftercare program where the client is accountable to check in, and participate in processes that begin after a 30-day inpatient stay has ended?
- Is there someone in which that client has developed a level of trust and honesty with who can help get through the first tenuous phase of living clean?
Bob’s Plan to Overcome “Failure to Launch”
The methods Bob embraces are not transcribed from someone else’s book or theories. He has been influenced by innovative thinkers, from Alice Miller to Carl Jung. He believes in making clients accountable for their actions. His advice to clients is geared to help them move towards a life of purpose and helping others. There are mandatory workdays at soup kitchens and homeless shelters.
At first the clients moan, but after a time, many like the work and even look forward to it. He often refers to getting back to basics. When Bob utters this phrase, he means really basic concepts, getting a job and paying your own rent, showing up when you say you will, and giving what you can to others in need.
He helps clients to create a fulfilling life and manage it, something many young rehab veterans have never done. The “failure to launch” phenomenon is pandemic in certain communities where it’s not unusual to find people well into their 30s who have yet to establish a career or independence from parental financial support.
None of this is exclusive to Malibu; in communities across America you can find recent rehab graduates living in an apartment their parents are bankrolling. It’s no sin to accept help from family. But for the sake of recovery, the age-old concepts of self-sufficiency and selflessness are fundamental to the process. It is the glue that helps a shattered life come together again.
Overcoming Learned Helplessness
There is a culture of young people who rotate in and out of recovery centers. One of the downsides of becoming “institutionalized” is that years go by, and the 20-something with an addiction problem and no job can easily turn into a 30-something whose point of reference has become institutional life.
Bob’s business partner (and Alo House founder) Evan Haines recently wrote an essay about learned helplessness that characterizes its origins and extensions. This phenomenon is one of the big issues that both Bob and Evan tackle in their work with clients.
People who spend too much time in the highly-structured environment of treatment centers become most comfortable in those zones. The effect on their personalities is tragic. They become unsure of themselves outside of group therapy sessions, fearful of going out and living real lives.
In Bob’s work with the youth population, he has seen clients compartmentalize perceptions of a “work life” or “recovery,” failing to integrate the two.
One focus of his work is to encourage clients to get out into the real world and to develop “emotional autonomy.” This is accomplished through a combination of therapy and life coaching.
In life coaching, clients are walked through the process of getting jobs and making financial contributions to their own existence. The payback for being self-sustaining is huge. Replacing those hours once spent using drugs and alcohol with a job, one’s own apartment and a life that they feel proud of, is a strong antidote to falling back into old destructive patterns of living.
Evan made it clear that the goal of the treatment methods they work on is not to shelter their clients from living. They will go out into the world and surely get bumps and bruises along the way. Sometimes they’ll fail, but by making mistakes and moving through them, strength is developed.
People learn and make steps towards becoming fully actualized adults, which is the goal of treatment.
Bob does not position himself as a policeman or disapproving parent. One of the strongest takeaways I received from my talks with Bob is that he is able to offer unconditional support to clients. This kind of support is something that many of them haven’t had before. Once they are able to trust and take it in, instinctively they want more. Clients become self-motivated to achieve goals they have participated in setting.
Working in recovery requires the ability to look at ones own actions in the uncompromising light of day. There is a fine line between supporting a client emotionally, and co-signing further development of learned helplessness. The therapists that work with Bob in treatment constantly ask difficult questions of themselves, keeping a living set of checks and balances on each other.
I asked Bob how he guards against bringing client dramas home with him, or allowing them to take over his life. With candor he replied, “therapy and marriage counseling.”
The Issue of Relapse
One issue I wanted to explore was relapse. Research indicates clients can go through four rehab stints and nine years of trying before sustained recovery occurs. Bob often comments that inpatient treatment itself may not be a necessity — this, coming from someone whose current livelihood is tied to an inpatient model.
There is ample research that suggests the outcomes for people who go to treatment are no better than those who don’t. The investigation coming from different sources is often contradictory. Some research reveals an absolute correlation between length of treatment and reduced incidence of relapse.
There is a school of thought that sets up 90 days of treatment, combining residential, outpatient and aftercare services. The National Institute of Drug Addiction (NIDA) characterizes programs shorter than 90 days “of limited effectiveness” and has recommended remaining in treatment “significantly longer.”
Forrest agrees with the idea that long-term care is more effective. He thinks the key is in extended aftercare to help clients rebuild their lives, brick by brick. Like many others in recovery, he knows relapse is part of the process.
During a relapse, he notes that “Some people will die…we’re all going to die. I could have a heart attack today.” Such comments could be taken out of context as flippant. As a former addict, he’s well aware of the possibilities and an outspoken pragmatist.
If a client relapses, Bob confronts the individual in a loving way. He doesn’t believe you can shame clients into sobriety. By allowing the person to identify the ways their lifestyle is not working out for them, he helps the client to see triggers for relapse. He continues to work with them on developing new coping strategies.
For his clients, the answer to sustained recovery is to create a life of purpose and accountability. It’s a day-by-day effort that adds up, but takes far longer than 90 days. He has no specified end date for treatment, and will work with clients and their families for as long as it takes to achieve their goals.
No matter what route taken, recovery is a lifetime process. It’s a deeply personal journey, some parts of which will be faced alone. Bob is above all else an optimist. He recognizes his own shortcomings, but never stops working to prevail over them. He is an atheist who is a true believer in the resilience of the human spirit.
Forrest works in a business that has wilted the joy out of many lives, but somehow he comes back for more, ready to help the next troubled soul. The fact that he has a wife and two young children (in addition to an adult son) is testament to his hope for a better future. Maybe his ability to live recovery in a joyful and creative way is his most potent gift.
Forrest has big plans for the future, and can imagine pioneering recovery compounds well beyond the confines of the Pacific Coast Highway. For now, our conversation is finished abruptly, the ongoing drama of client’s lives often interrupt his day. He knows he needs to modify his work with clients, in order to create a sustainable system to help more people recover.
All the same, when the phone rings and someone is in need, Bob is the guy you can count on to answer the call.