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The Myths of Hitting Bottom and Needing Residential Treatment

Stressed man presses glass of liquor to his foreheadEditor’s Note: The following article was written solely by the authors listed above. The views and opinions expressed here are not necessarily those of GoodTherapy.org. Questions and concerns regarding the article’s content can be directed to the authors or posted as a comment below. 

Last month, we wrote The Myths of Powerlessness and Disease, and this is a follow-up, offering two more myths that 12-step programs don’t want you to know. We believe that AA/12-step based programs, which make up 98% of U.S. treatment programs, are based on premises that both research and experience indicate are not only unfounded, but actually prevent you from getting over your problems and leave you with less than a 5% chance of recovery over five years.

Myth #3: A Person with Addiction Must Hit Bottom

The idea that you must “hit bottom” is a very destructive myth. Why would you wait until after you’ve lost you’ve everything to seek help? At that point, why would you bother to sober up?

Suppose for a moment that alcohol abuse actually were a disease. Then we’d be interested in prevention, regular checkups, early detection. Wait a minute—early detection? What happened to “hitting bottom?”

That’s the problem. With actual illnesses, we don’t wait until the patient is nearly dead before beginning treatment. Treatment is begun, good follow-up procedures maintain progress, and changes in the patient’s life are instituted that will sustain the recovery. That’s an effective model.

It shouldn’t be surprising that this same process 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 complete remission is possible, likely, and relatively straightforward.

How did that happen?

AA/12-step based programs make a common mistake—they generalize from themselves. And generalizing from a tiny number of terminal alcoholics to drinkers in general, simply doesn’t work. Not that it worked all that well for the AA originals either.

If you are thinking you could use a little help, 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. Get effective help early.

But be equally careful not to be sucked into the treatment industry, labeled a powerless, diseased alcoholic, and sentenced to a lifetime of recovery and senseless meetings that only reinforce drinking even more.

Yes, options do exist. Look for programs and counselors who offer real research-based solutions.

Myth #4: Residential Treatment Is Always Necessary

Now for the most expensive and least effective myth of all: “You need 30, 60, or 90 days of residential treatment!”

If you’ve been looking at treatment programs, you’ve probably found that they want you to spend a minimum of 30 days with them and that most are now pushing for 90 days. Why? Mostly because programs have found it easier to scare people into staying longer than they have to attract new clients. With a less than 5% success rate, that’s hardly surprising.

Regardless, even if they were effective, you’d find yourself asking, “Where am I going to find the time or the money to do 30 days of rehab, much less 60 or 90? And do so confidentially?”

Fortunately, you don’t have to. You may need a few days respite and sorting time, but you don’t need to waste your time and money, or suffer the disruption or exposure.

You’ve probably been told that the longer you stayed, the better your chances of success. It’s not true. Unless you buy the creative definitions of “success” 12-step based programs cough up. “Was not noticeably intoxicated while here,” is a common one. Stay three times as long and you’re automatically three times as successful, while you’re there!

Another aspect is their insistence that you fit yourself to “The Program.” Obviously, the more time they have to isolate you and indoctrinate you, the more apt you are to “fit.” This is not so different from military basic training—take a vulnerable person, confine him/her, and mold him/her. We don’t much like that model, especially for smart, creative, mature adults. We think you should develop your life, not convert to someone else’s religion.

“But everyone goes away to rehab, so it must be better than outpatient treatment—right?”

WRONG! We’re biased, of course, since we do outpatient, but we also do it because it’s usually far more effective, cheaper, less disruptive, and designed around you—not “The Program.”

Most of your time in a residential program will be spent on filler. Let’s take a quick look at a typical day:

  • Breakfast
  • Chores
  • 12-step meeting billed as “group counseling
  • An hour with your counselor (maybe)
  • Lunch
  • 12-Step meeting
  • Journaling and working on your “steps”
  • Recreation time
  • Quiet time
  • Dinner
  • Evening presentation on “the steps”
  • …and so on

One-on-one counseling (from someone whose only qualification, frequently, is that he or she can mostly stay sober while working at a treatment facility) probably won’t add up to more than an hour or two a week, if that. Not much to show for your $30 thousand to $200 thousand vacation from reality.

You’d be far better off planning your own vacation than going to residential rehab.

We are not so biased, however, that we don’t recognize that you may need some relief and protection and enough rest to sort your thoughts and options. Some people can do that in a few days, others need longer. Just choose your “retreat center” with care—and, yes, we know that can be extremely difficult to do when your world is crashing around you.

Still, the point is that your alcohol abuse exists within the context of your day-to-day life and ending it will happen within that context. Change the context, and the alcohol abuse goes away. Take a vacation from your life, and the context is still waiting when you return. It shouldn’t be a surprise that your drinking will return with you. It would be almost astonishing if it didn’t.

Treatment programs, consciously or not, are designed to create relapse. They reinforce all of the myths that encourage a return to abusing alcohol: powerlessness, disease, lifelong recovery, labels, and all of the usual secret-cult rituals: tokens, badges, and isolation from reality.
So please, be careful with yourself.

© Copyright 2009 by Edward Wilson, Ph.D., MAC. 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.

  • Leave a Comment
  • Eliza

    May 27th, 2009 at 1:11 PM

    I so agree with everything here! Waiting until you hit bottom to seek treatment is like waiting for the end to arrive before you even start thinking about the ways that you can change your life. You are hurting a whole lot of people in the process of waiting to hit bottom before seeking treatment including yourself. Wise up and get the help you need while you can still make a difference in your life and those of others around you. If you wait too long it may be too late to make those amends that AA and other 12 step programs are always encouraging you to make.

  • Patricia

    May 28th, 2009 at 9:05 AM

    But don’t you think that in some way people with addiction issues do not realize they have a problem until they hit proverbial problem?

  • Mary Ellen and Ed

    May 28th, 2009 at 12:53 PM

    While it’s always dangerous to generalize from ourselves, I also have the after-the-fact reports of a lot of clients over the years. Most agree with my experience of knowing full well what we were doing without ever admitting it to anyone else. I think real denial is much over-reported and is simply an excuse for not doing anything to fix the problem.

    Granted, there are people who are so emotionally infantile that their problems escape them, but they aren’t all that common and are fairly easy to recognize.

  • Pauline

    May 29th, 2009 at 5:45 AM

    There is hope that someone will take action before they hurt someone else in the process.

  • George

    May 30th, 2009 at 8:37 PM

    I am glad to read an article like this that actually blows away so many myths. However, I would say one thing in favour of a rehab clinic. When we go back to the environnemt for ex: our homes while receiving therapy, the temptation to get back to the bad habit happens more easily. a rehab centre helps by channelising energies and in relaxing the mind. It also helps by teaching the victim to stay distracted from giving in to addiction.

  • Mary Ellen & Ed

    May 30th, 2009 at 9:44 PM

    With regard to residential programs, the problem is that they insulate clients from the realities of home leaving people even more vulnerable when they return – hence the 95% post preatment relapse rate.

    The other problem we have is in the use of the term “victim” which falsely absolves clients from their responsibility for their behaviors, and therefore their recovery.

    Alcohol abuse is, after all, a choice. Recognizing that also frees people to make the choice to do something else. Responsibility equals power equals success as every bit of research demonstrates.

    Your point is well taken, but supportive training can more effectively, and affordably, be done in an intensive out-patient setting where clients aren’t simply fed filler in place of actual treatment.

  • Erica

    May 31st, 2009 at 8:08 PM

    My husband is an alcoholic. OUr family and friends have failed to get him to therapy for it. Even when we dont hold them responsible for it and try to coax them they dont want to get it over with. How does one get the horse to the water by saying they are not a victim and responsible for their alcohol abuse?

  • Olivia

    June 1st, 2009 at 5:45 AM

    Residential programs only make things harder for those who go there because they shield you from the real world and do not do an effective job at making you face the stressors that may cause you to drink and do drugs in the first place. Treatment should come in the real world, not take you away from it all. I agree with the therapists who wrote this article that no wonder those who go through residential treatment facilities continue to fail- they never are taught how to deal with the issues that got them there in the first place. I think that this kind of abuse is just like anything else. Until you are ready to face head on the things that scare and stress you there is no way you are going to get to the point where you can successfully overcome them.

  • Mary Ellen and Ed

    June 1st, 2009 at 6:25 AM

    You have stated precisely the problem with all AA/12 Step based mythology that actively supports NOT being responsible for one’s behavior.

    “I can’t help it,” they whine, “I’m the powerless victim of a disease.”

    It’s a wonderful way to keep on being totally irresponsible while holding everyone else hostage.

    But you don’t have to let that happen. Alcohol abuse is a choice, not a disease, and choices can be unmade or changed.

    If the drunk has elected to have their primary relationship with their bottle, you can choose to stop being a bit part player in their life and refocus your life around yourself and living healthily, happily, and productively.

    You can never force someone else to change, grow up, clean up, or anything else. But you’re not required to go down the drain with them.

    Sometime realizing that others are leaving their sinking ship encourages the alcohol abuser to change, but there are no guarentees.

    Please, take care of yourself.

  • Clark

    June 2nd, 2009 at 4:00 AM

    Unfortunately my dad never even realized hs boat was sinking even after the rest of us had jumped ship. He went down with it and never made it back.

  • Mary Ellen and Ed

    June 2nd, 2009 at 9:14 AM

    Sad to say, some people make that choice. Though I have never actually met anyone who didn’t know what they were doing. Admit it? No. But we all know what we’re doing unless we are either severly limited in ability or actually mentally ill. With alcohol abuse, either of these conditions is exceedingly rare.

    Our sympathy to you and your family.

  • Lea

    June 4th, 2009 at 3:06 AM

    Very good article on the myths. Maybe this will put some perspectives out there for others who need help before its too late.

  • Faye

    June 8th, 2009 at 12:03 PM

    Don’t think that people necessarily have to hit that mythological bottom but I do think that there are times when people need a real wake up call to get them out of their stupor and to realize that they need to make some real changes in their lives.

  • Mary Ellen and Ed

    June 8th, 2009 at 3:39 PM

    We have no arguement with that – and many people successfully answer that wake up call, whether from the doctor, judge, spouse, employer or other person capable of making a point.

    The other point is remembering that alcohol abuse is a choice, not some mysterious malady. It’s a lot easier (though not at all easy) to deliver that wake up call if you’re no longer being confused about her or his alcohol use.
    It’s a CHOICE!

    That said, don’t forget that you too can make choices. Don’t be held hostage by a “disease” or “the Program” or any of the other alcohol fixations abusers use to avoid intimacy and a real life…

  • Kelsi

    June 15th, 2009 at 2:35 AM

    Hitting bottom seems to me that it is too late. Hitting bottom for some people may mean depression that they can’t overcome or even suicide because they are tired of it. This article sets it straight.

  • Jeni

    June 23rd, 2009 at 2:36 AM

    I actually believe that alcohol starts out as a choice but becomes a disease.. Sure, it’s not a type of disease like cancer, but it in my mind is a disease once someone takes up the habit. Hitting bottom is definetly a myth because by then, alcoholics are more than likely to weak or so low they don’t even want to or know how to seek help

  • Jack McInroy, Ed.D.

    August 20th, 2009 at 8:29 PM

    I agree with most everything written in this article. I may add John Fleming, a well know psychiatrist believes its malpractice to not treat addictions with psychotropic medications. This is considered ridiculous by the treatment counselors who continue to tell everyone the only way to remain sober is the 12 steps and 90 in 90. Chad Emrick, Ph.D. has done the first scientific study on the effectiveness on AA and found approximately 34% of those who go to AA and do the 12 steps are successful. If a surgeon gave you those odds on a procedure would you proceed? I wouldn’t. It’s beyond time for addiction treatment to be individualized and scientific principles applied. We need to get rid of the folk lore and faith based treatments.

  • Arlene

    November 17th, 2014 at 3:22 PM

    “Yes, options do exist. Look for programs and counselors who offer real research-based solutions.”
    What are those programs, who are those counselors? How do I find them, what do I look for?

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