The “Hitting Rock Bottom” Myth
Misinformation and myths surrounding addiction are incredibly problematic in the world of substance misuse, addiction, and recovery. Misinformation and myths can result in missed opportunities for treatment, worsening conditions, and significant injury.
The “rock bottom” myth generally states that someone who is misusing alcohol or other drugs will not seek out or benefit from treatment until they “hit rock bottom.” This suggests that everyone, including the person using alcohol and drugs, is powerless to assist the substance user until they have arrived at “rock bottom.”
This myth can have serious repercussions, in that it can significantly influence the perceptions and behaviors of family members and treatment professionals toward the addicted person. Also, it can affect the expectations of the user toward themselves and others. Believing this myth can propel a counterproductive course of action and may discourage any action at all.
What Is “Rock Bottom”?
The concept of “hitting bottom” has been around for more than 50 years, with the term first mentioned in a research paper on alcohol addiction treatment in 1965.1 The paper indicated that individuals must “hit rock bottom” before they could change their drinking behavior.1
While certain research has found that “hitting rock bottom” is an important factor in an individual entering treatment and has been associated with greater treatment compliance, the concept is problematic, since there is no concrete definition for “rock bottom.”1 It will not be consistent from person to person, and it may lack consistency for an individual. A person may have thought that they reached the bottom, only to fall even further.
Hitting rock bottom remains a relevant concept for many individuals, but it has never been operationally defined.1 Language used in 12-Step programs (the Alcoholics Anonymous Big Book for instance) states that most individuals “have to be pretty badly mangled before they really commence to solve their alcohol problems.”1 Generally, “rock bottom” means the lowest point that a person can fall due to substance use and addiction.
A significant factor in the discussion of “rock bottom” is resource loss. “Rock bottom” seems to signify losses commonly associated with addiction. Individuals struggling with substance abuse and addiction risk losing or damaging multiple resources, including:
- Supportive relationships.
- Financial security.
- Housing and safety.
- Physical health.
- Mental health.
Hitting “rock bottom” would imply that treatment will not be effective until most or all of these resources are damaged or lost completely. The rock bottom myth paints a devastating picture—only someone who has lost it all (e.g. someone who’s homeless, unemployed, and sick) can truly benefit from getting help.
Issues With the “Rock Bottom” Myth
The problem with the “rock bottom” myth is that it leads to many dangerous outcomes that would never be suggested in other fields. An oncologist would not suggest waiting until the cancer has metastasized before beginning treatment, so why would someone with an addiction wait until “rock bottom” to receive treatment?
Delayed response leads to an increased likelihood of harmful physical and mental consequences.
Physical Health Risks
Ill effects from substance use can happen at any time, but the longer that alcohol and drugs are used for, the greater the risk of damage to physical health becomes. This takes place either through the exacerbation of short-term problems or the creation of new, long-term problems like:2,3
- Damage to major organs like the liver (e.g. from alcohol use or abuse of acetaminophen-containing drugs).
- Malnutrition/weight loss.
- Stress on the heart (e.g. from stimulant use).
- Transmission of blood borne diseases like HIV and hepatitis from injection use.
- Dental and skin deterioration (common among methamphetamine users).
- Respiratory depression (common to users of depressants like alcohol and opioids).
- Harm to the reproductive system and—in the case of pregnancy—the developing fetus.
- Sexual dysfunction.
Continued use also puts the user at an almost constant risk of overdose and death. Waiting to hit an undefined rock bottom can do irreparable damage.
Mental Health Risks
The mental health of someone addicted to drugs or alcohol is just as vulnerable as their physical health. Many substances overstimulate the release of a neurotransmitter called dopamine. Over time, excessive amounts released due to the use of substances leads to decreased natural production, resulting in decreased happiness and excitement.
Mental health issues that will vary according to the individual may include:2,3,4
- Cognitive impairment.
- Mood swings.
- Paranoia, psychosis, and delusional thinking.
- Suicidal thoughts.
- Violent behaviors.
Finding a Better Way: Raising the Bottom
As discussed above, there is some truth to the “rock bottom” myth. Some research has shown that resource loss is a good predictor of treatment completion.1,5 The difference is that resource loss does not have to be catastrophic to be impactful. This is the concept behind “raising the bottom.” If the person misusing substances can respond to minor changes in their life, they will not need to experience “rock bottom.”
Supporters of the person using substances can aid in “raising the bottom” by avoiding the risk of enabling current use. By allowing natural, negative consequences to occur, the probability of the addicted individual seeing the need for treatment can increase. For example, clearly stating the consequences of continuing use or not getting treatment—such as no longer receiving money for rent—may provide the person with the motivation they need to enter a drug rehab program. This creates a crisis point that builds motivation, as opposed to waiting until the individual “loses it all.”
At the same time, the bottom can be raised by encouraging healthy behaviors. To do so, a friend or family member can:
- Allow the addicted individual to resolve his or her own personal conflicts.
- Practice consistency when setting limits and boundaries.
- Discuss and support treatment options.
- Provide transportation to doctor or therapy appointments.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has identified several factors that are opportunities to increase the motivation of someone addicted to drugs or alcohol to seek treatment. These factors include:6
- Distress levels. Someone experiencing high levels of distress from a situational stressor will be more likely to seek a change.
- Critical life events. Something like a death, a prevalent health issue, or another major life event can trigger interest in treatment.
- Cognitive evaluation and appraisal. This involves the individual analyzing their status in life. A negative appraisal can lead to change.
- Recognizing negative consequences. This is the ability to accept the cause-and-effect relationship between substance use and unwanted outcomes.
- Positive and external incentives. Not all factors have to be negative. If someone sees enough positive reinforcement associated with ending use, they will be more likely to do so.
These factors increase motivation. Motivation is a key agent of change associated with substance use disorders. If enough motivation is present, the recovery process has a greater chance of success. Previous views of motivation saw it as unchangeable unless the person was confronted with a major crisis.
The “rock bottom” concept supports a way of thinking that may stigmatize the addicted person by equating their continued use with a lack of desire to quit using drugs or alcohol. If treatment was unsuccessful, it is often perceived as the fault of the client, and other factors such as the quality of treatment may be ignored. In reality, addiction is described as a chronic condition that is associated with periods of recovery and relapse, so resistance, continued use, and poor outcomes are likely during the process.7
Presently, the concept of motivation is changing. According to SAMHSA, motivation is:6
- The center aspect of change.
- Fluid and changing constantly.
- Impacted by the social environment.
- Affected by the style of the treatment professional.
Based on this information, a lack of success does not speak to a total lack of motivation from the client. Rather, it indicates a momentary lack of motivation that can be easily corrected in a short amount of time through the individual:
- Reevaluating their position.
- Recognizing the negative consequences.
- Receiving motivating incentives for returning to treatment and sobriety.
This contrasts the rock bottom myth and indicates that effective treatment can be initiated at any time. It is true that events associated with resource loss can boost motivation, but motivation can be increased through other methods, such as self-appraisal and a different social environment.
Involuntary Treatment Can Work
Although motivation is an important element of treatment, it is not essential. Another false myth of recovery is that it must be voluntary. The National Institute on Drug Abuse has found that treatment can be successful even when it is court-ordered or mandated by family. Once treatment has started, the individual has the opportunity to experience the benefits.7
Addiction Treatment Options
Certain therapeutic styles focus on helping to influence motivation to get and stay sober. 2 such treatment methods are contingency management and motivational interviewing. Contingency management (CM) is a behavioral therapy that has been tested and proven to improve treatment success among people misusing:
CM works by rewarding individuals in treatment for activities that are congruent with recovery, such as:
- Attending therapy.
- Participating in support group meetings.
- Providing drug-free urine screens.
- Maintaining healthy coping skills like working.
For each positive activity, the client will receive immediate, tangible rewards or the opportunity to be rewarded with a lottery system. These positive incentives work to negate the perceived positives associated with substance use.
Motivational interviewing (MI), sometimes called motivational enhancement, is a form of talk therapy where the therapist works to increase the client’s intrinsic desire to begin or maintain recovery—rather than depending on the therapist to provide continual motivation. MI can be used alone to treat substance use or in collaboration with other methods like cognitive behavioral therapy (CBT) to treat addictions to substances like:
A drug and alcohol addiction treatment program can be started at any time—without waiting for “rock bottom.” Treatments can help build healthy coping and communication skills to avoid drug and alcohol use and triggers of use. There will be a focus in reinvesting time and energy in productive actions and positive people.
If you are interested in learning more about effective treatment options for any stage of addiction or recovery, consider calling American Addiction Centers (AAC). You can contact us free at at any time, day or night. You can also verify your health insurance coverage now. Remember, waiting can result in greater damage to your physical and mental health. Recovery does not have to be put on hold.