Whether or not you have gone through addiction personally or you have watched a loved one struggle with addiction, you've probably heard the phrase they have to "hit rock bottom." In the addiction treatment field, professionals will often use this phrase to describe an addict's lowest point, that time at which something profound happens and he or she finally has a staggering revelation that they need to get treatment and quit their substance use. Many treatment professionals firmly believe that for treatment to be successful, their patients need to want treatment, and that to want treatment, they must hit rock bottom. There exists the belief that once an addict sees how bad life can be on substances, experiences this bottom, they can finally turn their life around.
But this can be a deadly way of thinking.
According to David Sheff, acclaimed author of Clean: Overcoming Addiction and Ending America's Greatest Tragedy, the follow-up to his New York Times #1 bestseller Beautiful Boy: A Father's Journey Through His Son's Addiction, the concept of an addict needing to "hit rock bottom" is an all-too-familiar story that he hears time and time again in letters from people all over the world. David recounted to me recently the story of one father writing to tell him about his son who had been in and out of treatment. The father had been told by the treatment provider after his son's most recent relapse that his son needed to hit rock bottom and learn to accept help in order to succeed. In the midst of waiting for his son to hit this rock bottom, the father read David's book and the very next day went to find his son, dragged him home, and got him into a treatment program. The very next weekend, the son's best friend died of an overdose.
"Waiting for someone to hit rock bottom is a dangerous concept," David told me. "Experts advise parents of it, but the reality is that studies show people who are coerced into treatment by way of their parents or even the legal system have an equal chance of doing well as those who 'choose' to be there." [See references below.]
Not just a dangerous term for the family and friends of an addict, consider this perspective: I had a brief but intense experience with addiction from 1979-1985. In 1982, I suffered a small stroke as a result of my cocaine use. I fully recovered, but what some might see as "rock bottom" didn't actually stop me from using again. After all, I recovered, right? I lost jobs, apartments, friends, but none of this stopped me from using. At some point, I knew I couldn't achieve what I wanted in life if I kept using. At the time, I just wanted to keep one job and one apartment for a year and get into college. I found out that I couldn't quit on my own, so I got help in 1985 (by 1993 I had my Ph.D. and had been sober for eight years). What if I had waited for that elusive bottom? I hadn't been arrested, hadn't overdosed, etc. If I thought, well, I'd like to quit but I guess it won't work until I hit rock bottom, I would likely still be using or, more likely, I would be dead. Saying an addict needs to "hit bottom" may allow them to put treatment off as long as they wake up to see another day. Who's to say what each person's "rock bottom" looks like, after all?
"The longer you wait for that rock bottom, actually, the sicker someone can get," said David. David firmly believes his son Nic, whom he wrote about in Beautiful Boy, would not be alive today if he had waited for him to hit rock bottom.
The irony with this whole concept is that addiction is a chronic, treatable disease. We would have a hard time accepting that a person with any other chronic disease such as diabetes or asthma would actually need to "hit rock bottom" to have treatment for their condition be successful. Just like other chronic diseases, addiction has heritability and behavioral factors, it is treatable and the goal is self-management in the community. So why is the concept of hitting rock bottom only tolerated with addiction? Some might say that it has to do with our feelings of helplessness when dealing with a loved one who abuses drugs or alcohol, that we get tired of our loved ones relapsing or of helping them when they don't want it, or think they don't need our help. As someone who has dealt with this very personally, I would never suggest that anyone wait for their loved one to hit bottom; would we wait for a loved one with diabetes to do the same?
Unfortunately, the answer may lie in the fact that, while research and science indicate it to be true, many still have a hard time accepting addiction is a disease. They believe it is a choice and that we're letting people off the hook for bad behavior by calling it a disease. For them, it's a matter of letting an addict wallow in the despair they have created long enough until they are ready to ask for help.
I don't see it that way at all. That addiction is a disease means that we can do something about it, to prevent it, to treat it and take responsibility to self-manage it. David captures this eloquently in his book, and I work each day to spread the message that successful treatment and recovery are possible.
I've had two very minor lapses in the past 27 years, but took responsibility for my illness and became abstinent again immediately. And I didn't have to wait till I hit "rock bottom" to get back on track.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
Gregoire, T.K. & Burke A.C. The relationship of legal coercion to readiness to change among adults with alcohol and other drug problems. (2004, Jan). J Subst Abuse Treat. 26(1):337-43. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/14698797
Miller, N.S & Flaherty, J.A. Effectiveness of coerced addiction treatment (alternative consequences): A review of the clinical research (January 2000) J of Subst Abuse Treatment, Volume 18, Issue 1, Pages 9-16. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/14698797
Sullivan, M. A., Birkmayer, F., Boyarsky, B. K., Frances, R. J., Fromson, J. A., Galanter, M., Levin, F. R., Lewis, C., Nace, E. P., Suchinsky, R. T., Tamerin, J. S., Tolliver, B. and Westermeyer, J. (2008), Uses of Coercion in Addiction Treatment: Clinical Aspects. The American Journal on Addictions, 17: 36-47. doi: 10.1080/10550490701756369. Available online at:
Wild, T. C. (2006), Social control and coercion in addiction treatment: towards evidence-based policy and practice. Addiction, 101: 40-49. doi: 10.1111/j.1360-0443.2005.01268.x. Available online at: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01268.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false
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