Across the East River in lower Manhattan, Tribeca Twelve, a new venture of the Minnesota rehab institution Hazelden, was launched in October, offering "collegiate recovery housing," says its executive director, Barbara Kistenmacher. "On one end of the spectrum is the undergrad who might've taken a leave of absence due to addiction-related problems. On the other is the graduate student who's longtime sober but needs support during the stress of, say, finishing a dissertation." Tribeca Twelve's 12-foot ceilings, fireplaces, roof deck, and Brazilian-cherry hardwood floors are "trendy and fun and definitely luxurious," Kistenmacher says. "But the goal is to support the independent side of an adult as well as the part that needs more structure, establishing a healthy community in a space that gives them dignity."

Such modish settings are meant to rewire the addict's core assumption that abstinence equals deprivation, a notion that's typically reinforced by the image of the stereotypical induction into sober life: an Alcoholics Anonymous meeting in a church basement, full of older men who smoke, complain, and scold. While the 12-step model remains central at these chic, upscale facilities, their founders say that as the profile of the typical addict has changed, so, too, has the method of recovery. "AA was developed for alcoholics in the gutter who were not functioning at any level," Joe Schrank says. "The truth is that AA is a wonderful organization that does not work for everybody, but in certain respects they're becoming the evangelicals of the recovery movement."

David Vieau is the youthful 41-year-old president and CEO of Turning Point, in New Haven, Connecticut, which uses paintball, music, snowboarding, and mixed martial arts as part of a program that gets referrals from treatment centers all over the world. The facility's vibe suggests an Internet start-up more than a halfway house, which makes sense given that increasing access to more addictive prescription drugs has been accompanied by a drop in the average age of Turning Point's clients from 33 to 20 in the nine years it has been in operation. "A lot of kids go from Ivy League schools to here," Vieau says. "Today, treatment needs to be cool in some way. So rock stars, movie actors, and others in the public eye can help or hurt us in doing our job. We run groups dissecting songs or movies with respect to sobriety. Last week there was a group intensely studying Eminem. So you have an unhappy person seeking happiness in the form of narcotics and it didn't work. Now he's singing about it, talking about it, and telling you guys, 'So what are you getting out of it? What are you going to do about it?' Let me tell you, that did not happen in treatment centers of the past."

From his vantage point in the power corridor between Boston and New York, Vieau traces the emergence of a more dynamic view of sobriety to one youth-culture touchstone of the past decade. "The Red Hot Chili Peppers started it. There's a lot of people who saw them singing about it," he says. "That's what I think Eminem is taking over now."

Less-triumphant celebrities like Lindsay Lohan, Pete Doherty, and the not-so-winning Charlie Sheen are, surprisingly, often just as helpful. "They have their place in it too," Vieau says. "We have groups where we talk about Charlie Sheen. You know what they say? 'He's just an idiot.' Here's what I say to them: 'Listen, the game's not over. You're watching a guy that hasn't committed, he hasn't surrendered to the fact it's not working for him—he's just justifying his life. How many times have you done that?'"

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It's safe to assume that Hollywood Recovery Services is the only addiction-treatment center with photos of Darby Crash and Sid Vicious hanging on its walls—reflections of the twisting, and twisted, path its founder took to get to this place. Years before Bob Forrest was Dr. Drew's sage, wizened, fedora-wearing consigliere on Celebrity Rehab, his renown was spreading on two other fronts simultaneously: on stage (and records) as the often-crazed singer-songwriter of the critically acclaimed L.A. band Thelonious Monster, and offstage as a drug buddy to, apparently, pretty much everyone. "I'm the Zelig of show business in the last 20 years," he says, settling into a club chair in his main office. "I was always in the room—I don't know why or how."

Forrest, 50, wears scruffy steel-toed Doc Martens with white laces, Levi's cords, and a vintage polyester shirt over a black T-shirt featuring Rick Ross' crew Self Made. He has three silver rings on his abbreviated right ring finger, which was cut off in a childhood bicycle accident, a Clash tattoo on one wrist, and a Beatles tattoo on the other ("because I can't slit my wrists over the names of my favorite bands," he says).

A lifelong Hollywood resident, Forrest has seen an absolute inversion in the culture of rock and roll. "In L.A. now, it's uncool to be high and be in a band," he says. "That's how much the tide has turned. In my generation and the generation before it, we thought drugs were the thing helping you achieve your goals. Now kids see them as problematic to their success. If your reputation is doing coke all the time, there's other people that are sober who will replace you. That's a seismic change."