Don’t Wait To “Hit Bottom”

Woman drinking glass of wineHave you ever been told a person has to “hit bottom” before they can begin to recover? What do you suppose that even means? What exactly is “hitting bottom?”

Do you suppose it’s really a good idea to wait until you’re divorced, or bankrupt, and/or facing another DUI before looking for an answer to your drinking problem? We don’t think so.

The concept of waiting to hit bottom isn’t just useless – it’s dangerous. How? Consider how that tenet would play out in the case of a disease like cancer. “Well, you know,” they’d say, “you really can’t do anything about cancer until it’s metastasized.” Huh?

Let’s look at alcoholism as a disease. What do we know about real illness? Well, first there’s prevention, regular checkups, early detection, then…oops. Early detection? What happened to “hitting bottom?”

Of course that’s the problem. With other diseases, we don’t wait until the patient is nearly dead before beginning treatment. Effective treatment is begun, good follow-up maintains the progress, and changes in the patient’s life are instituted that will sustain the recovery. It shouldn’t be surprising that this same model works well for diverting a client from alcohol abuse and dependence. The trouble is people have been discouraged – by mythology, stigma, and “lifelong recovery” – from getting help in the early stages when remission is not only possible, but likely.

How did that happen? Twelve step-based programs make the same mistake we all do – they generalize from themselves. And generalizing from a tiny number of terminal alcoholics to drinkers in general simply doesn’t work. But treatment programs have almost always been founded by that 1% for whom the model seems to work – true believers who think that they’re typical. In fact, they’re very isolated cases and methods drawn from their experience aren’t applicable or effective for most of us.

But if “true believers” keep saying something loud enough for long enough, and if they drown out dissent, a lot of people will be convinced. Remember, not too long ago, everyone believed the world was flat and that the universe revolved around Earth, That’s exactly what’s happened with twelve step-based programs. Now everyone from Dear Abby to the DUI court assumes that these programs are an effective treatment model, and that underlying mythology is somehow gospel.

So don’t be lulled by thoughts like “I’m not that bad off” and “I don’t drink as much as Larry” and other rationalizations. You don’t need to “hit bottom,” whatever that may mean to you. Act before drastic measures are needed and dire consequences appear. Get a handle on your problem while it’s still that, a problem, not a life-threatening avalanche hanging over your head.

© Copyright 2008 by Edward Wilson, Ph.D., MAC, therapist in Rolling Hills Estates, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Donna

    Donna

    June 16th, 2008 at 6:11 AM

    This is so interesting because against what all of us have ever heard about the problems of an alcoholic or drug addict. . . that they actually have to hit rock bottom before they can be helped. I like the jist of this article that this does not have to be the case. There needs to be more in the way of early prevention and intervention rather than just waiting until a situation is completely out of control.

  • Jeni

    Jeni

    June 17th, 2008 at 10:44 AM

    Don’t you think though that for a person to really appreciate all of this help that he truly has to hit bottom first? I am all for prevention but I do think that for some people they will never realize just how much they need help until they hit bottom. And for these diseases unlike cancer a large part of success is dependent upon the attitude of the addict and not so much about medical miracles.

  • Kyle

    Kyle

    June 18th, 2008 at 4:39 AM

    My own brother had to have his own health scare before totally stopping drinking but that is what did it for him. He was scared to death and that is what made him stop cold turkey. So maybe rock bottom does apply to some.

  • upstatesc

    upstatesc

    June 20th, 2008 at 3:22 AM

    Yeah I have to agree with you a bit. I know it goes against everything else in the medical community but there is a time when some have to see for themselves just what hitting bottom looks like before they can decide that this is not where they want to be anymore.

  • Sandy

    Sandy

    June 23rd, 2008 at 2:33 AM

    This is so fascinating because I have never read that we should take more preventive steps in cases like this. Of course we all want to prevent before the trouble even begins but it is like once it begings we just want to let it run its course and then allow the person to heit bottom before we help them get back on their feet again. Why not approach addictions with the same fervor that we do cancer and other illnesses and work on treatment every step of the way?

  • amyhop

    amyhop

    June 24th, 2008 at 3:22 AM

    I have never thought about addiction in this way either, and it surprises me that more people haven’t especially since most of us now recognize that this is indeed a disease rather than just another lifestyle choice.

  • Austin

    Austin

    June 25th, 2008 at 9:55 AM

    Well there are times though when the people who go through these addictions should be lucid enough to start picking up the pieces of their own lives without someone constantly having to watch over them. With addicts it is like there is a need for the whole house to come crumbling down and I do not get this reasoning. Maybe the drugs take away any hope of reasoning for them.

  • Margo

    Margo

    June 26th, 2008 at 3:11 AM

    I agree that it takes away their ability to be rational but I still do not think they are in any state to just pick up and change things. Everyone needs help at certain points in their lives and I think addicts should be handled just as kindly as others struggling with a disease and hoping to get well again.

  • Ed Wilson

    Ed Wilson

    June 26th, 2008 at 12:19 PM

    It’s always interesting to consider the comments our articles elicit, and we are very appreciative of them.

    It always strikes us how “addictions” occupy an ill-defined limbo land, without any real status as a real disease or psychilogical disorder or anything else. We have, however, always taken a non-pathologizing approach because it fits the research and it works, while other stratagies, quite frankly, don’t even match the “natural remission” rate.

    The hardest part for people involved with a problem person to manage is to manage their own disengagement – to allow the natural consequences to accumulate. To often people wait until too late because they have been protected from the early warning signs.

    The myth of “bottoming out” like most 12-Step mythology simply comes from generalizing from a tiny number of intractable cases without ever even looking at the overwhelming number of exceptions to these cases – exceptions who turn out to be the rule. Of course the myths generate self-fulfilling prophecies.

    We frequently remind clients that millions of people have quit smoking without any bottom having been reached and that tobacco is far more addictive than alcohol, herion, or cocaine. Why? Because they chose to.

    What are the best predictors of success in eliminating addictive behaviors? 1) believing that you can; 2) having a supportive spouse; and 3) seeking help that does not believe in either the “disease model” or “powerlessness.”

    Thanks to all of you for the comments and interest.

    Ed & Mary Ellen

  • Jeanette

    Jeanette

    June 28th, 2008 at 2:56 PM

    Smoking is one thing but how about alcohol and much harder drugs? I really do think that it takes more than just a supportive family to get you through that. There are too many people who are just too far gone on that to make the rational decision that they believe they can stop on their own. For them there has to be a more aggressive treatment plan than that which you suggest.

  • Ed Wilson

    Ed Wilson

    June 28th, 2008 at 4:03 PM

    Talk to anyone who has ever quit smoking and any other drug – they’ll tell you, as I will, that cigarettes are far harder. But that rather misses the point, which is that the longer one waits the tougher it gets. So why wait?

    Most spouses and families wait because they hope the problem will just go away – and sometimes it does. Other times spouses like the other person being the designated problem (wives do, after all, usually divorce husbands who quit drinking and marry another active drunk) and they like looking good in comparison. There are any number of reasons for conditions becoming whatever they become.

    None the less, people who actually want to change a behavior – and not just placate someone else – usually do so and the two things we can do as counselors is to help them figure out waht all needs to change, and to then get out of their way. That is exactly the opposite of what traditional drug and alcohol “programs” do and why they have “success rates” that are essentially 0 over 5 years – the traditional time line for considering a “disease” to have been cured.

    Are there people too far gone for less drastic measures? Of course there are, just as there are with any condition. That still doesn’t mean we avoid treatment before some one reaches that point, much less that we claim that no one should be btreated until they are terminal. What kind of sense does that make?

    Besides, alcohol abuse is rarely progressive. It tends to remain at a constant level for decades even though the consequences are building, same as smoking. Why wouldn’t one wish to stop before one’s body shuts down?

    Ed

  • Jeanette

    Jeanette

    June 29th, 2008 at 10:56 AM

    Because I think that so many of them no longer believe that they have any amount of control over the situation. And then they begin to resent others who are still rational and tend not to listen to them. I think you have some very valid points but I am not sure that the best thing is to let them do it on their own. There are some great programs residenhtial and otherwise which can help get them back on their feet and to a point where they can believe in their ability to stop the negative behavior.

  • Ashley

    Ashley

    June 30th, 2008 at 9:55 AM

    I find it a bit concerning that so many overlook addiction as just a choice that someone makes rather than the terrible disease that it really is. Why is there such a stigma still attached to things like addiction and mental illness?

  • Ed Wilson

    Ed Wilson

    July 1st, 2008 at 8:10 AM

    Your point is well taken, but I would despute the idea that there are any great residential programs available in the U.S. In 25 years of looking for places to refer people I have yet to find a single program with a 5 year “success” rate that exceeds the 5% spontanious remission rate that all addictive behaviors have. Actually, I’ve never found one that was even that effective.

  • Ed Wilson

    Ed Wilson

    July 2nd, 2008 at 3:27 AM

    Quite possibly because there isn’t a shred of research to support the “disease” concept and a ton of research to support it as a choice? Regardless of the onset of the addiction, maintaining it is certainly a choice, as 20,000,000 ex-smokers can attest… Frankly, the primary benefit of the pathologizing of addictive behaviors has been the provision of an excuse to maintain the behavior.

  • upstatesc

    upstatesc

    July 15th, 2008 at 2:42 PM

    I tend to agree with you. It is like we have given those with a problem in this area the perfect excuse to continue with the negative behavior and labeling it ias a disease. It gives them a feeling that they have to continue with what they are doiung because it cannot be helped. That is bull. We all have to remember that we fully have control ober our own behaviors and that we have the reason and will to stop and start at any time we choose. Will it be hard? Of course, but that still does not mean that we do not even have to try to improve.

  • Maddie

    Maddie

    July 25th, 2008 at 10:02 AM

    Personally I think it is impossible for addicts to know how bad they are until they hit bottom. It is only then that they realize just what kind of bad shape they are in and the damage that they are doing not only in their own lives but in the lives of others as well. I do think that it is fine to try intervention along the way- any responsible adult would. But that does not always mean that it will be effective unless the addict has made the decision for himself that he wants to or needs to quit the harmful behavior he is engaging in. And I am not really sure that they will ever feel that way until there is some real scare in their lives.

  • Ed

    Ed

    July 25th, 2008 at 5:08 PM

    It’s one of those areas were converging myths make things worse for everyone – most peoploe with alcohol/drug abuse and dependence never come close to “hitting bottom” though they may wait to if they also believe the “progressive disease” myth. Or people avoid early intervention for fear of being labeled, or diagnosed with a “life-long diease” requiring forever “recovery.” So pervasive have these myths become that nearly everyone who hasn’t bothered to read the research thinks they’re true. But it’s precisely these closely held, but erronious, beliefs that prevent people from getting help early on when the abuse and dependance are still symptomatic rather than causative.

    So, please, let’s stop spreading the mythology? Let’s help more people reverse their use while that’s not only possible, but probable.

  • Jack

    Jack

    October 14th, 2008 at 6:37 AM

    I often marvel at how people first prop up so-called ‘myths” in order to then decry and denounce whichever they’ve chosen to banner. THAT is the very phenomena of ‘myth making’ right there.

    For instance, Alcoholics Anonymous, which appears to be the primary source reference for this ersatz myth exercise, has ALWAYS explicitly both explained what the reality of “hitting bottom” means AND plainly addressed the matter that any number of people won’t and don’t “have to” either. So where’s this ‘myth’ being batted around here?

    Seems to me that any such myth-making must be coming from elsewhere. And that elsewhere usually turns out to be ‘the treatment industry’ … which is mainly a cul-de-sac of the social work/therapy business — which generally tries to usurp and subsume everything else into it’s context.

    I’ve rarely, if ever, met anyone that actually is ‘waiting to hit bottom’ before doing anything, at all as a conscious intention. So it’s very unclear what all this dialogue bemoaning such a thing could be about, or for whom.

    Same thing with the ‘disease concept’. Again, AA for instance, only uses the word ‘disease’ exactly ONCE in the infamous ‘164 pages’. And THAT is specifically as a ‘spiritual disease’. All the rest of the notion again comes to us from the Disease Makers — the conceptual disease makers, which are psychiatry and ‘clinical’ psychology.

    I couldn’t agree more that these ‘disciplines’ do us all a great disservice in both misleading everyone about such matters and misguiding us to the various ‘solutions’ also pinned onto the very ‘problems’ they spawn.

  • Ed

    Ed

    October 14th, 2008 at 2:25 PM

    Okay – I can appreciate the points, and psychotherapy of all sorts has it’s share of “disease” making. That said, it’s hard to get more pathology, and mythology, based than to label oneself an “alcoholic” or to claim “powerlessness.” And certainly, over the past 25 years, I have known countless individuals who have avoided changing their behavior with the phase “… but at least I’m not as bad as…..” Pretty much referring to an ever descending bottom.

    All of that said, and allowing that we can certainly differ on details, it is true that no one “solution” be it AA or being “born again” or Grahm crackers, works for more than 4 or 5% of those who try it. To date no 12 -step based “treatment” has even a 5% recovery rate over 5 years, which is less than the spontanious recovery rate.

    Our real point is that it would be nice if those seeking help had a lot of choices with some chance of finding the right one

  • Alyssa

    Alyssa

    November 6th, 2008 at 3:45 PM

    I personally don’t think it’s a good idea to “hit bottom”. On some occasions this can be too late for some people. I believe in getting help as soon as you realize you have a problem.. Thing is, some people don’t realize they need help until they hit bottom and I think this is where we get the saying you have to “hit rock bottom”.

  • Friend of Bill

    Friend of Bill

    December 28th, 2008 at 7:04 PM

    I understand what you are trying to say, but it is misleading. I will try to explain. First, I would suggest you read “Beyond the Influence” by Katerine Ketcham, or even the DSM-IV-TR and revise your statement “Let’s look at alcoholism as if actually were a disease” as there is in those texts scientific and medical proof that it is.
    “Hitting bottom” is not a term originating out of any 12 step program, it is a term that comes from treatment centers. The only phrase close to that found in 12 step literature is “He will not be able to imagine life with or without alcohol, he will be at the jumping off place- he will wish for the end.” (Alcoholics Anonymous, p. 152) You describe a bottom as being something material- a dui, a divorce. It is none of these, they are simply consequences. The reason that many of the original members were at such “low bottoms” or had so many consequences was that after each consequence, they may resolve to quit for good, and enter a hospital for detoxification, but invariably drink again. No, you don’t have to do that today, because there are 12 step programs and hospital programs that offer more than detox, but without hitting a point of emotional bankruptcy, what desire is there to stop drinking? For the alcoholic, alcohol is a coping mechanism, sometimes the only one they know, so until it stops working why would you want to seek out a healthier one?

  • Ed

    Ed

    December 29th, 2008 at 6:46 AM

    Thanks for the comments which are well taken. None the less, there really isn’t any research supporting the “disease model,” quite the contrary. George Valient, M.D. has spent 50 years and taken half a million AA dollars in his quest to prove the disease theory and has only succeeded in doing the opposite, for example. As for the DSM, it’s always been a political guide, not a medical one – remember that until recently it listed homosexuality as a disease, for example.

    That said, alcohol abuse doesn’t even act like a disease. How many diseases can you list which improve a person’s health when you have them in moderation? How many go into remission at greater rates when untreated than when given the standard AA based treatement? Name one that responds to dozens of different approaches, none of them medical? Or one where at least a third of those who suffer from it return to healthful levels of it?

    It’s very easy to get confused by marketing hype and mis-information. That’s how we came to have a treatment industry dominated by an approach which has no demonstrated efficacy. Let’s not continue down that dead end road. Please?

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