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Maia Szalavitz Maia Szalavitz

Bob Forrest Should Keep His Ignorance to Himself


Dr. Drew's Celebrity Rehab sidekick now has his own treatment program and blog, which he's using to dispense a dangerous brand of intolerance.

6 Substance
Score


The consensus of international scientific opinion? Or Bob Forrest?Photo via

Bob Forrest gives the finger to opioid maintenance—and to the consensus of international scientific opinion. Photo via

In a better world, there would be no conflict between abstinence-based treatment and harm reduction: As in other types of medicine, addiction care would occur on a continuum. Just as you don’t see cancer doctors blogging that radiation is a “con” and only chemo should be used in all cases, you wouldn’t see addiction counselors making a similar case that abstinence should always be used, never maintenance.

Unfortunately, thanks to the likes of Bob Forrest, that’s not the world we live in. Forrest, who identifies himself on his website as the “longtime partner of Dr. Drew,” now runs his own treatment program, Acadia Malibu. It’s hard to believe, but yes, a man who worked on Dr. Drew’s Celebrity Rehab actually advertises this fact to sell addiction services—despite the show having a mortality rate of nearly 13% among its “patients.”

Forrest opposes maintenance treatment—even though three of the five patients who died after their season on the show lost their lives to opioid overdose or its complications, which could have been prevented if they had been given support for maintenance, rather than told abstinence is the One True Way.

Nonetheless, here’s what Forrest—after noting, “I thought of calling this blog ‘The Open-Minded Report’”—writes about harm reduction:

“It’s a con in my opinion. I have seen the suffering and degradation it causes: the confusion it brings to the 12-step community about who is sober and who is not; the irrational fear of detox, where the list of medications designed to help you avoid actually experiencing any withdraw symptoms grows longer and longer every year; and just generally, the lies and danger and horror it is causing. The medical profession and pharmaceutical industries drive the use of Suboxone and Subutex. This is code for ‘profitable to doctors and drug companies.’”

Nearly everything about this paragraph is wrong. For one, if harm reduction—by which he means opioid maintenance here—is a “con,” why is it endorsed by every major public health organization that has investigated the issue, from the Centers for Disease Control and the National Institutes of Health in the US to the National Institute for Health and Care Excellence in the UK and the World Health Organization?

Why does the Cochrane Collaboration—an independent organization widely viewed as producing the highest-quality evidence on which to base medical decisions—say this about methadone: “It retains patients in treatment and decreases heroin use better than treatments that do not utilize opioid replacement therapy,” while concluding of 12-step programs that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-Step Facilitation] approaches for reducing alcohol dependence or problems”?

And why does research show that patients who leave methadone treatment double their risk of dying—and quintuple their risk of overdose death if they are injection drug users? Why do studies consistently find death rates among addicted people in methadone treatment to be about one-quarter or one-third the rate of those not on maintenance? Even if Forrest relies only on anecdote, not data, his own experience with Celebrity Rehab deaths clearly bears this out.

OK, so it’s clear that Forrest is on the fringes here, ignoring both an overwhelming international consensus on best practices and the evidence of his own eyes. Let’s move on.

Is there any truth to the idea that maintenance treatments are simply a profit center for doctors and drug companies? While some money is being made, a look at the actual history of maintenance makes evident that if this is a pharma conspiracy, it’s an extremely strange one, because the US government basically had to pay drug companies to participate in it.

Forrest opposes maintenance treatment—even though three of the five patients who died after their season on the show lost their lives to opioid overdose or its complications, which could have been prevented if they had been given support for maintenance, rather than told abstinence is the one true way.

Let’s start with methadone. It’s a generic drug, long off patent and therefore definitely not of current interest to Big Pharma. As an addiction treatment, methadone was developed by Vincent Dole and Marie Nyswander of Rockefeller University in the mid-1960s—starting with money scraped together mainly from the government of New York City, not drug companies.

At first, virtually all methadone treatment was funded by the federal government as an anti-crime measure—and while there certainly have been unscrupulous providers, that’s linked far more to the stigma of addiction, and the lack of oversight of the care addicted people actually get for the money spent on us, than to any drive for pharmaceutical profit related to selling methadone.

What about Suboxone? It, too, was first studied as an addiction treatment, by the government—in fact, there was so little commercial interest in it that the National Institute on Drug Abuse had to push the FDA to give it “orphan” status in order to get the company that now makes it to enter the market. As Nancy Campbell writes in Discovering Addiction: The Science and Politics of Substance Abuse Research, “Lack of coordination between public and private interests delayed development far longer than the notoriously slow FDA approval process. To bring ‘bupe’ to market, NIDA worked to stimulate private interest.”

In other words, we have Suboxone despite the disinterest of pharma in the addiction market—not because it saw dollar signs when it looked into our eyes. While Reckitt Benckiser did ultimately profit from the drug, this is not a scandal like the overselling of antipsychotic medications, for which every single manufacturer has paid at least multimillions, and sometimes billions, of dollars in fines for misleading marketing. Indeed, it’s an example of a drug that is doing precisely what a drug is supposed to do: restoring health more often than harming it.

Of course, it’s not completely wrong to say that there is an excess of shady doctors in the Suboxone business—but again, the reason for this is that addicted people are, to put it mildly, not popular with physicians. Those who have the choice not to work with us generally make that decision whenever they can—because of both the stigma and the legal scrutiny that maintenance treatment for addiction brings.

All of this is not to say that everyone who has ever had an opioid addiction should be on maintenance: I am personally an example of someone who is not. But good medical practice is about finding the right treatment for the right person—not prescribing the same therapy at the same dose for every patient with every variant of the disorder in which you supposedly specialize.

Finally, I have to add that it’s laughable that someone like Forrest would claim that maintenance proponents are scaring people away from abstinence by raising fear about withdrawal—when on Celebrity Rehab, patients were brutally detoxed in the most uncomfortable way possible.

Need I remind him that one person who later died of an overdose actually became psychotic during withdrawal on the show and another, who later committed suicide, suffered a seizure? Actual experts say that neither symptom should have been allowed to emerge in appropriate medical treatment with slow, careful detox—but this is the picture of withdrawal that the supposed abstinence advocate presented to the world.

There’s truly no need for abstinence and harm reduction advocates to be at each other’s throats: Both forms of treatment are needed and belong in the continuum of care. Not every person addicted to opioids needs lifelong maintenance—but some do; likewise, while some people benefit greatly from 12-step participation, others don’t. We can, and should, all get along here, to paraphrase Rodney King, another patient who died after Celebrity Rehab.

While there is room for many different approaches in addiction treatment, we’ve got to start being intolerant of this absurd and often deadly intolerance.

Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She blogs for Healthland.com, and has contributed to TimeThe New York TimesScientific American MindThe Washington Post and many other publications. She has also published three books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006)—the first book-length exposé of the “tough love” business. Her last column for Substance.com was about animal-rights advocates’ efforts to ban addiction research on animals.


6 Comments

6 comments on “Bob Forrest Should Keep His Ignorance to Himself

  1. Shaun Shelly
    Shaun Shelly

    Well put. This is the reason that I am currently developing a cumulative continuum of care based program where harm reduction and abstinence can co-exist within the same framework, and that effective interventions can be delivered according to the continuum of care, as well as be matched to the stage of change, and build upon each other until the patient’s final goal is reached – whether that be abstinence or less chaotic/harmful using.

    Counselorchick

    Schmuck. He and Dr. Death Drew should be sued and put out to pasture. For good.

    Tony O'Neill

    I left a comment on Bob’s blog. I doubt it will get approved, so I will repost it here where there is a less authoritarian regime when it comes to comments.

    *

    Bob, this post is not only misinformed, it’s fucking dangerous. You’ve spent so much time with Drew you seem to have morphed into him. Harm reduction is not a “con”, it’s a life saver. Reading this the first time I could barely believe my eyes, it’s like when you read the climate change deniers for the first time… people actually THINK like this? Jesus!

    Like some junkie Uncle Tom you are using your sobriety and celebrity as a platform to bash one of the ONLY PROVEN interventions when it comes too opiate addiction. This is the kind of b.s. that might easily kill a vulnerable addict who reads it when they are at their weakest point. After all this abstinence-only method you seem to love4 so much killed plenty of the poor bastards who turned to Dr Death… uh, I mean Dr Drew… for help.

    Still, what’s a few dead junkies versus good ratings, huh? Can’t make an omelette and all of that…

    Methadone and suboxone saved my life. And now I’m 10 years clean. I do not consider myself any more or less clean than friends of mine who remain on maintenance scripts. The only shitty thing for them is that they still have to meet with doctors, and aren’t allowed to travel freely with the medication they need. But hopefully as we seem to be moving toward a more sane drug policy in the US, maybe that will start to change in our lifetimes. Being on methadone or suboxone should be no more controversial than needing an asthma inhaler.

    “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…”

    Oh yeah? What about the hell that Mike Starr’s family experienced when they got the call informing them that he was dead? Or Mindy McCreedy’s family? Or Jeff Conaway’s family? If we had sane drug laws in this country, and they were encouraged to have their opiate doses stabilized and monitored, without this whole bullshit “you’re not really clean” guilt trip being laid on them by the likes of you and the “good” Doctor they might still be alive. But no, just like all religious fanatics, the fundamentalist faction of AA would rather have a bunch of dead martyrs than living proof that their belief system is a crock.

    I’m not hiding behind a screen name. I don’t have the power of television to make my voice louder, but I hope you’ll reconsider abusing your position in such a reckless way. We need more hard reduction in this country, not less.

      counselorchick

      Thank you Tony! He along with Dr. Death Drew are steppers of the worst kind. They are the kind of predators and scammers the cult religion of AA was invented just for them. You might like my blog.

      Here’s a sample.

      http://cougarblogger.com/2013/03/14/the-home-of-alcoholics-anonymous-how-it-works/

      Congratulations on you success with methadone and suboxone! The cultural hold this cult religion has on America not only allows for predators like Dr. Death Drew, it makes it impossible for Bob to see the Forrest through his greedy ass.

      Tommy

      Tony,

      I have been off sub for two years in May. I am struggling big time with using thoughts. If you do not mind me asking, How do you stay clean and fight off cravings? I tried AA/NA for six months and hated it.

    James

    The Fix has recently released an article that is on Bob Forrest. The article does not touch on his history with DR Drew or Celebrity Rehab and the unfortunate events that transpired. The article is a PR move for his new treatment center Acadia Malibu. I hope his facility is not affiliated with Acadai Health Care. When I tried to post a comment informing the readers about his past with Celebrity Rehab and DR Drew the Fix blocked me and deleted the comment. At the same time they are using me as a source for an article on the troubled teen industry. Please Maia if you are reading this I encourage you to comment under the new article written by Dawn Roberts.

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