Rock Bottom in Addiction: What is it and how do you know if you’re there?
I’ve been a drug and alcohol counselor for a long time, but this work still interests me. One of the things I continue to find fascinating is the point at which my clients realize or decide they want help. This varies greatly, but often what brings people to my office is hitting “bottom” or “rock bottom.”
What is bottom?
The idea of rock bottom is that someone with an addiction needs to experience something horrible or have their life fall completely apart before they can accept they have a problem and need help. This is a very useful idea and is often what precedes someone with an addiction getting sober. But there are many common misconceptions about what bottom looks like.
First, bottom can look very different for different people. For many, their bottom is something big and very unpleasant: going to jail, getting a DWI, their marriage falling apart, etc. Sadly, for some addicts and alcoholics the bottom is death. Some people never get well despite increasingly negative consequences. I’ve had clients who’ve kept drinking or using despite losing access to their children, losing their drivers licenses, bankruptcy, losing their law or medical license, killing people while driving drunk, going to jail, or being homeless. Some addicts never get it.
Not all Bottoms Look the Same
The good news is that most people with addictions do eventually wake up as a result of consequences. Interestingly, some addicts experience bottom without something horrific happening. I’ve had clients whose bottom was something like embarrassing themselves at a party or simply realizing on their own that their relationship with alcohol or using was a problem. This is what people in recovery refer to as having a “high bottom.” Working in private practice with high-functioning clients who are often highly successful, many of my clients have fit this pattern.
Bringing bottom to the addict / alcoholic
I get calls and emails every day from loved ones of people with addictions wanting to know how to get them help. One of the most frequent problems in families of addicts is that loved ones enable. This always comes from a place of love, but it is a misunderstanding about how to lovingly support someone with an addiction. Generally, families of addicts and alcoholics – out of love and concern – try to shield their loved ones from consequences and suffering.
By the time someone with an addiction shows up in my practice, those around them – usually parents or spouses – have been protecting them from the natural consequences of their behavior for years. Anything we do that prevents an addict from experiencing consequences is enabling. Sometimes enabling is blatant: buying alcohol for the alcoholic, for example. But the kind of enabling I most often see takes the form of a spouse getting upset about the problematic drinking or using – even threatening to get divorced if it happens again – but not following through with this. By the time clients show up in my office, sometimes this pattern has been going on for years or even decades.
In the late 60s, Bill Milliken coined the term “tough love” in his book Tough Love. It introduced the idea that in order to help people, addicts, at-risk youth, our kids, we often have to be firm and boundaried rather than doing what is easy or what the addict wants. The idea was so well received that now Websters Dictionary defines tough love as the “promotion of a person's welfare, especially that of an addict, child, or criminal, by enforcing certain constraints on them, or requiring them to take responsibility for their actions.”
The more those around the addict or alcoholic can help them experience the consequences of their illness, as hard as this can be, the better. We can help an addict by bringing bottom to them: letting them experience the consequences of their illness.
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