There is a long-held belief in the field of addiction services that people need to “bottom out” before treatment can and will help. The idea assumes that, unless someone “hits rock bottom,” then he or she will never experience the life-altering realization needed to change. Like many of the phrases and slogans borrowed in addiction treatment, the notion that someone must hit rock bottom to change lacks merit. While undoubtedly, some people will stop after a near catastrophic event in their lives – an overdose, a car accident, the loss of a marriage, a career.
For most, though, such events can undermine motivation to change, and actually limit the likelihood of a successful treatment outcome.1 If rock bottom ends with the loss of the only person that someone has ever trusted, who will help manage the panic that often derails rehab admissions? Or if rock bottom ends with a serious injury and chronic pain, why would someone stop using the pills and alcohol that provides them relief?
The problem with the rock bottom approach is that, sometimes, a lot of the time, people end up without a reason to change. Damage or deprive someone to an extreme, and what will serve as their motivation? What will be left to strive for? Keep in mind, as well, that the longer the delay in seeking treatment, the greater someone will cognitively and physically deteriorate, to the point that change becomes even more challenging to achieve.
Like many of the canons in the field of addiction treatment, the “rock bottom” explanation gives license to providers, to avoid their own helplessness in treating addictions. The concept of rock bottom enables a clinician to cast blame solely on the so-called addict when a treatment episode flounders. It’s not that the provider failed to use the right interventions, or to aptly facilitate those interventions, treatment failed simply because someone needs to suffer more, until he or she can admit that they need help. It’s a rather archaic approach to treatment that stems from the pre-modern practice of repentance.
Repentance – as the antecedent to the word penitentiary – prescribes misery as the only remedy to moral failings. In a nutshell, then, the concept of rock bottom concludes that those with addictions must suffer, must be punished, they must atone to be saved. It’s a conclusion that assumes a harsh life lesson will help shape a morally correct choice. It’s a conclusion very much at odds with current research into addictive disorders. It’s the type of conclusion that continues to stall the evolution of addiction treatment in this country.
Kevin Murphy, Psy.D
AToN Center 888-535-1516