Meta-Ask: Define Rock Bottom Addiction December 18, 2005 9:09 PM   Subscribe

meta-ask: Are there any scientific studies suggesting the need for addicted people to "hit rock bottom" before getting better?

I've noticed in a lot of AskMe threads dealing with addiction in a loved-one that people say that the addicted person needs to hit "rock bottom" before they can start to get better. Now obviously in retrospect every former addict will have some low point that they can look back on as their lowest, but often the advice given also states that people should avoid helping their loved-one, in a sort of effort to accelerate their decent, like the quicker they hit the bottom the quicker they can get better.

I'm just wondering, why do people think this is true? Are there any studies that actually state this? It seems like a really important thing to be just guessing about.

posted by delmoi to MetaFilter-Related at 9:09 PM (38 comments total)

Also: would this have been better posted to ask or here? It's certainly mefi-related, but's also very askish.
posted by delmoi at 9:10 PM on December 18, 2005

We need a MetaAsk for this one.
posted by shoos at 9:15 PM on December 18, 2005

"Certainly mefi-related"? So, how much does a rock cost, anyway?
posted by Gyan at 9:16 PM on December 18, 2005

I don't know what the statistics are, or whether there are any peer-reviewed studies on it, but given the extremely high relapse- or recidivism rates, the idea is that until it gets really bad, the motivation to get better just isn't there- this is obviously an extremely subjective metric, as what's 'bad' for one isn't at all for another. Some people try and try to get clean and sober, and they just need to keep losing things; money, possessions, self-respect, &c.

The Twelve-Step modality is based on very strong anecdotal and [again, subjective] empirical evidence that this is the case. They say that addiction, if not 'arrested', ends up in three things; jail, institutions, and death. Hopefully, it gets bad enough before those things happen, and even then, there are plenty of people that never 'get' it.
posted by exlotuseater at 9:16 PM on December 18, 2005

While this thread is open...

A relevant article:

"Many people find it hard to abandon crack cocaine once they have tried it a few times, but when they do, they do not appear to become physically ill, as they would with heroin—or indeed nicotine or caffeine. “Heroin is a true addiction, with a recovery rate of 40-50%,” explains Giel van Brussel, who has been head of Amsterdam's addiction care department for many years. “With cocaine, the recovery rate is around 90%, so we don't see it as such an enormous problem.” That is rare sanity from a policymaker, but then Dutch policymakers are saner than most."
posted by Gyan at 9:19 PM on December 18, 2005

. . . avoid helping their loved-one, in a sort of effort to accelerate their decent, like the quicker they hit the bottom the quicker they can get better.

My take on this is not to enable the addict to continue. . . not so much to accelerate, but addicts can be extremely manipulative- the idea is to keep from allowing them to continue doing what they're doing easily. Think 'tough love'.
posted by exlotuseater at 9:19 PM on December 18, 2005

I don't know what the statistics are, or whether there are any peer-reviewed studies on it, but given the extremely high relapse- or recidivism rates, the idea is that until it gets really bad, the motivation to get better just isn't there

Sure, I understand the theory, but I wonder if the theory actually holds in real life. One could also argue that having the care and support of family can help motivate someone as well. Common sense isn't always an indicator of truth :P
posted by delmoi at 9:22 PM on December 18, 2005

Personally I think that "they have to hit rock bottom" doctrine is a bunch of crap. I did not have to become unable to climb one flight of stairs before I quit smoking, for example; "rock bottom" for smokers would be taking out a cancerous lung, wouldn't it? None of the problem drinkers I've known had to "hit rock bottom" before they quit, and those that got that low often stayed there -- or kept falling off the wagon so often you'd say s/he "got up on the wagon" instead.

And by the way, why are so many people in 12-step groups because they got busted doing something illegal? Has every kid arrested for jaywalking with a joint in his pocket "hit rock bottom"? If not, why are they being forced to "seek help" if "you have to hit rock bottom" before it'll do any good?

As far as helping someone, I wish people would try to do something besides parrot a Christian cult's goofy propaganda. First, it seems to me you'd want to reach them while they're still capable of making rational, informed decisions, before their brains have turned to oatmeal. Unless of course the point is to make converts, not to help anybody.
posted by davy at 9:27 PM on December 18, 2005

Maybe its because people are usually in denial about their problems, and become aware of it ONLY whey they do hit the rock bottom? That only then they THEMSELVES realize that things are fucked up and they need to do something about it.
posted by c13 at 9:35 PM on December 18, 2005

why are so many people in 12-step groups because they got busted doing something illegal

The answer is that of all the treatment modalities, 12-Step evidently works the best in terms of lowest relapse rates.

Of course, if you really do have a problem, but don't want to get help or aren't ready to receive help, there's no point in going to 12 Step programs.

But those people that administer 'correction' in this country are largely idiots, and if you have a joint, as far as they are concerned, you are in desperate need of help.
posted by exlotuseater at 9:40 PM on December 18, 2005

It's a great question. Real "rock bottom", not something induced or suggested or managed by someone else, is self-defined which is extremely significant. Wherever it happens, the important thing is the person themselves defined it as such. Point being: it may be understood to be the first thing they've decided in a long time that makes sense, a turning point which they've picked on their own and therefor buy into.
posted by scheptech at 9:45 PM on December 18, 2005

I was going to write something, but scheptech put it very well before I had the chance.
posted by clevershark at 9:51 PM on December 18, 2005

It's odd to hear "rock" bottom. As I remember it the idea was each person had to hit their own personal "bottom." Which, by definition, is the lowest point he or she went before starting recovery. To quote another one of those favorite phrases: "They have to be sick and tired of being sick and tired."

Personally, I think every addiction thread should begin and end with..."Don't wait. Consult your addictions clinic, but first realize no one decides to stay clean by force."
posted by ?! at 9:58 PM on December 18, 2005

Yeah, this should be an AskMe thread.

Last time I saw this issue raised, KevinSkomsvold had some great things to say. I'd jumped in with a "let them hit rock bottom" comment based on my experience that it's impossible to help an addict who doesn't want any help, but I really liked his reminder that rock bottom means different things to different folks. And his advice: "Your job is to raise her bottom." Making the addict feel like they're already at rock bottom (rather than allowing them to extend rock bottom for months or years, or commit suicide), seems like a better solution, even if it means lots of effort and heartache for someone who may never appreciate what you're trying to do.

Anyway, try some searches in academic journals that deal with addiction if you want the latest research results. But don't expect too much precision.
posted by mediareport at 10:01 PM on December 18, 2005

I think a lot of responders are motivated more by a desire to keep the asker's expectations realistic.

Dealing with addiction is very tough and there are no easy solutions. Addicts will lie, they'll steal from you, they'll relapse. And no addict ever quit because someone told him to, however well intentioned they may be. "Gee, you mean drinking a fifth a night is bad for me. Golly, I'll quit right this minute." Trust me, they know. They've read all the same pamphlets.

What those of us who've dealt with addicts realize from our experience is that there's nothing you can do to get them to quit until they convince themselves they need to. For many (most? but certainly not all) it takes a kind of negative epiphany, a rock-bottom landing to be convinced.

Unfortunately, a lot of askers haven't come to the same realization; they still think they're going to read something on the Internet that's going to make everything OK. That isn't going to happen and telling them to wait for rock-bottom is one way of making it clear that a lot of people seem to understand.
posted by TimeFactor at 10:11 PM on December 18, 2005

There are as many ways to deal with addiction as there are people who are addicted. While it may be the case that a great number of people who overcome their addictions demonstrate similar patterns, each person's experience will be their own and what is helpful will vary from person to person.

Some people hit rock bottom, some people don't. Some people get better when they hit rock bottom, some don't.
posted by spaghetti at 10:12 PM on December 18, 2005

addicts will indulge the addiction until the pain of staying the same exceeds the pain of change. misguided attempts to 'help' only serve to enable.
posted by quonsar at 10:40 PM on December 18, 2005

very well put, quonsar
posted by Iamtherealme at 10:47 PM on December 18, 2005

Are there any studies that actually state this? It seems like a really important thing to be just guessing about.

Why do you assume people are guessing and not speaking from personal experience with addicts?
posted by vacapinta at 10:55 PM on December 18, 2005

Since "rock-bottom" isn't a very well defined term, this is a vague question to try to answer.

The core of what you're asking seems to be whether:

people should avoid helping their loved-one

That I don't know. I have my anecdotes and experiences to draw on but I think there are people out there with the right education to try to answer this. I'm pretty sure that general love and support is a good thing. As for directed help with overcoming the addiction itself, well, don't come between a dog and his bone. Or something like that.
posted by scarabic at 10:59 PM on December 18, 2005

Rock bottom is the lowest point on the curve. It's also relative. I mean, it's always worse before it gets better, right?

"The answer is that of all the treatment modalities, 12-Step evidently works the best in terms of lowest relapse rates."

This is absolutely and patently false. They have about a 5% success rate; the same as the success rate of those quitting on their own. So many people are in 12-step because it is often required of them; to keep their job or as part of a court sentence. 12-step is a religious organization, and its point is to make you feel worthless so you have to give up control of your life to God. This is antithetical to what I believe; to quit you need to realize you are the only one in control of your life. The idea behind 12-step is keeping people servile rather than having them admit that their own choices can lead them out just as they led them in.
posted by Eideteker at 11:11 PM on December 18, 2005

(12-step has an interest in making you feel you've hit "rock bottom," by the way, as it helps them make you feel worthless. Just in case that wasn't clear.)
posted by Eideteker at 11:14 PM on December 18, 2005

Here are a couple of paragraphs from this interview of Stanton Peele:

Well, it is interesting that we have been talking about how people see drugs and how the national view on drugs, despite its own evidence, claims that people become eradicably addicted to different substances. The idea of addiction and its inescapableness is really a big part of the drug war. People go around and they say, “Well look, if you ever try any of these drugs – cocaine, heroin, crack, or marijuana – you are going to get addicted. And that’s why we have to prevent them from entering the country.” Of course, the government’s own research again shows this: of all the people who have ever taken heroin, crack, or cocaine in their lives, only 6% of each of those people have taken those drugs in the last month. What it tells us is that people will try a lot of things over their lifetimes, but in general if they have a good enough life to lead, if they have enough things going for them, then they are not going to give their lives over to drugs. That’s the small, hard secret of the problem...

People quit drinking or smoking at all points in their lives. To say you have to hit rock bottom, of course, is just preordaining for them that they have the worst life possible. What really causes people to quit – and I describe how to do this – is when they can clearly see that their behavior is challenging critical values that they hold more important to them than the desire to continue to be high or intoxicated. People can do that in a variety of different ways, but one way to do that is to list the most important things in your life – your health, your family, your image of yourself, your sense that you are in control of your life – and match that in your mind against every habit you have. When you can do that, and you see that perhaps your behavior is leading in the wrong direction, then you don’t have to be told by other people to quit or to cut something back, you’ll be driven on your own to do that. It’ll be something created – not something created from the outside, it’ll be something driven by yourself.

see also his Theories of Addiction, the third chapter in his book The Meaning of Addiction - Compulsive Experience and Its Interpretation

The Concept of Addiction therefrom is good as well.

Since narcotic addiction has been, for better or worse, our primary model for understanding other addictions, the analysis of prevailing ideas about addiction and their shortcomings involves us in the history of narcotics, particularly in the United States in the last hundred years. This history shows that styles of opiate use and our very conception of opiate addiction are historically and culturally determined. Data revealing regular nonaddictive narcotic use have consistently complicated the effort to define addiction, as have revelations of the addictive use of nonnarcotic drugs...

One final research and conceptual bias that has colored our ideas about heroin addiction has been that, more than with other drugs, our knowledge about heroin has come mainly from those users who cannot control their habits. These subjects make up the clinical populations on which prevailing notions of addiction have been based. Naturalistic studies reveal not only less harmful use but also more variation in the behavior of those who are addicted. It seems to be primarily those who report for treatment who have a lifetime of difficulty in overcoming their addictions. The same appears true for alcoholics: For example, an ability to shift to controlled drinking shows up regularly in field studies of alcoholics, although it is denied as a possibility by clinicians.

posted by y2karl at 12:02 AM on December 19, 2005

Remember that "rock bottom" is a figuration, albeit so stale that it no longer evokes someone crashing into the ground. Obviously, it cannot be quantified in a scientifically satisifying way. It's also an obvious hyperbole, as one can almost always (as many have pointed out) get worse. But in some sense, it's a tautology: just as a thrown rock always starts falling at the apex of its flight, so too one begins to recover at his or her worst.
posted by ori at 12:04 AM on December 19, 2005

I suspect there is at least a kernel of truth to the rock bottom idea. But I also suspect for many people, you stop when you hit rock bottom by definition. I mean, if you quit drinking, it's entirely possible that your worst days become your last drinking days quite by chance -- you could have perhaps gone much lower, but you didn't.

I think it's a somewhat useful shorthand for "you must want to change." I think it's dangerous to assume it's some unassailable truth that you can't quit until you've sunk to the very lowest of the low.
posted by teece at 1:47 AM on December 19, 2005

*cheers y2karl* That was fascinating.

I'm just chatting (!) now, but it's such an interesting thread... that I have to add that the tolerance level of the lover/friend/family member of the addict must also hit "rock bottom" before they give up trying to help, no matter what anyone says.

I know that I would never stop trying to help my husband if he had an addiction that wrecked him - yet I finally did leave my first husband... because at last he did something to finally make me hit rock bottom regarding him/us. It's logical in those cases of an overall pattern of dedicated self destruction that the addict will keep testing the boundaries of the loved one 'til they eventually hit on the proper camel-back-breaking straw to alienate even the most tenacious of would-be saviours.

In those cases, not only is the "rock bottom" bit true, but it has a dual role... For the addict bent on self-annihilation to hit rock bottom he or she must also, by default, force the ones who love them the most to enter a place of complete hopelessness.

But by no means do I think this is always the case... and even though I've had the whole rock bottom experience with a (multiple) addict, if faced with a whole 'nother addiction situation today, I wouldn't do anything differently (for the most part), and I would still desperately hold on and keep trying 'til the very last slender thread of hope was ripped away.
posted by taz at 2:47 AM on December 19, 2005

and its point is to make you feel worthless so you have to give up control of your life to God

You missed the point. The point is to free you from addiction. Try this: it's point is to make you feel empowered; paradoxically, by giving up trying to control things in your life that you cannot control (which is virtually everything outside oneself). It is primarily an admission that the only thing that one can control is their own choices. What are you giving up control to? "God" is a catchall word for anything that works for you. There are plenty of Atheists in 12 Step programs, and it works fine for them.

The 5% figure doesn't seem correct to me. Clinicians that I've spoken to seem to rate it higher than many other modalities.
posted by exlotuseater at 4:33 AM on December 19, 2005

Even if 12 steps is supposed to be some brainwashing god cult, the fact is it is the good kind. I've never seen anything closer to what Jesus was really talking about being practiced. Free gathering, people get together to share and help each other.

That said, I think forcing people into the 12 step programs to stay out of jail is a mistake. 12 steps really has no chance of working if you don't really want to commit to it.

I pretty much faked my way through 6 months of meetings because I had no other choice and I don't think that was fair to everyone else.

I don't think there have been any studies on the rock bottom thing, it's just one of those things people accept as true because they have heard it so much, also it often applies to their own lives.
posted by furiousxgeorge at 5:37 AM on December 19, 2005

Also, it is often the case that drug/alcohol abuse is a result of other psychological problems. It would be a better use of time to talk to a general therapist first to work out those issues, and tackle the addiction when you are ready.

If you have a family member you are worried about, try and get them into therapy, but lay off the addiction, people get really, really defensive about that, they are more likely to agree to therapy without a focus on that.
posted by furiousxgeorge at 5:44 AM on December 19, 2005

exlotuseater : "It is primarily an admission that the only thing that one can control is their own choices."

Of which consumption doesn't happen to be one?
posted by Gyan at 9:16 AM on December 19, 2005

If "rock bottom" is the point at which you've had enough and decide to change, then it's really a tautological idea. Which explains why some of you are saying it depends on the individual.
posted by i_am_joe's_spleen at 10:59 AM on December 19, 2005

What Eideteker said.

And thanks, y2karl.
posted by davy at 2:35 PM on December 19, 2005

From another site, here is a synopsis of Peele's thought:

The experiential, environmental approach leads to a range of radical ideas for approaching seemingly insoluble social problems concerning drugs, alcohol, and behavior. For example: a science of addiction geared towards brain mechanisms, irrespective of life problems and experiences, is barking up the wrong tree and is doomed to fail; self-cure is standard and occurs as people come to grips with the problems, people, and patterns in their lives; as they do so, formerly problem users frequently learn to use the substance moderately, or at least with fewer problems; treatment succeeds by helping people navigate their existence rather than by teaching them that they have an inbred, life-long malady; most drinking and other substance use are not pathological; how children learn to view substances largely determines whether they get stuck in drinking/drug use as a life-long destructive habit; a completely negative educational approach to alcohol, as well as drugs, increases the likelihood children will encounter substance use problems; the notion that substance use is a disease is simply the wrong way to prevent problems and to treat problems when these appear;
many activities which are correctly viewed as addictions - like compulsive shopping, gambling, sex - have incorrectly come to be treated as diseases; one wrongheaded result of the whole disease conception of addiction is that society now often excuses people for criminal behaviors that are labelled as addictions or diseases (e.g., PMS, post-traumatic shock, post-partum depression in addition to alcoholism); while it is correct instead to firmly punish drug- and alcohol-related misbehavior, the punishment of simple drug use - so-called "zero-tolerance" - is irrational and has been proven to be an expensive failure; non-moralistic policies, education, and treatment that recognize that people may sometimes use drugs or alcohol, but that engage people in productive activity and assist people to overcome difficulties in their lives, will succeed better - and certainly disrupt society and the lives of users less - than our current policies and treatments.

And this, from a capsule review of his new book--

7 Tools to Beat Addiction provides readers with these basic building blocks: values, motivation, rewards, resources, support, a mature identity, and higher goals. By carefully and clearly outlining this process, the book provides a road map to self-cure. What this book does not do is browbeat people into thinking that they are diseased, broken for life, and powerless.

--provides a Dr. Phil sized soundbite to his approach.

His website is down as I write but here is the Google cache of the page there for Chapter 1 of 7 Tools to Beat Addiction . It gives a fair sample of him in advice mode: concise and straightforward with no magic bullets.

Here is an interesting passage therefrom:

One group long noted for its distinctive drinking style is the Jews. In 2000 an exhibit entitled “Drink and Be Merry:Wine and Beer in Ancient Times” came to the Jewish Museum of New York . The exhibit pointed out that Jews had, since antiquity, developed a ritualistic, moderate approach to alcohol consumption that contrasted with the periodic, orgiastic use of alcohol by neighboring tribes.

When the claim is made that Jews have historically been moderate drinkers, objections are always raised that this is no longer true. For example, whenever I mention this fact to an AA member in Los Angeles or New York , the person starts listing Jewish alcoholics he or she knows who attend their AA group.

Two upstate New York researchers, Barry Glassner and Bruce Berg, heard the same claims—and believed them. Both reported that they personally knew an alcoholic Jew who hid his drinking. Both had read accounts that traditionally low Jewish alcoholism rates were rising. They consulted with experts, one of whom claimed that the Jewish alcoholism rate was growing alarmingly.

However, after conducting intensive interviews designed to elicit hidden alcohol problems, the researchers failed to uncover a single Jewish alcohol abuser among a random sample of Jewish respondents. Not one respondent they questioned had been intoxicated more than a few times. Only a quarter of the sample had even heard rumors of Jews with drinking problems—generally stories about distant relatives. The accuracy of these self-reports, ironically,was upheld by the very alcoholism expert who had issued an alarm on Jewish alcoholism to the investigators. The so-called expert on Jewish alcoholism reported that in a city of about ten thousand Jews, he knew of five Jewish alcoholics. Even this microscopic number was questioned by the other experts the researchers consulted, who said they knew at most of one or two Jews with a drinking problem.

All in all, the Jews and the Chinese are striking examples of how groups around the world determine behavior toward powerful intoxicants such as alcohol. And although it may be true that these groups do not hold sway over their members as they did in earlier decades in America , they nonetheless demonstrate how powerful, enduring, and decisive socialization by family, religious, and cultural groups can be in insulating people throughout their lives against addiction.

How do these groups teach the value of moderation? Glassner and Berg identified four factors or techniques that enabled Jews to avoid drinking problems (and which in fact closely resemble what we saw of Chinese American techniques):

Learning moderate drinking in childhood. Jews in the study usually had their first drink as children, “in the home as a part of religious ceremonies (Jewish tradition includes wine drinking at weekly Sabbath ceremonies and holidays, notably Passover) . . . only about 5% of the sample recalled their first drinks as (occurring) outside the family and later than childhood.”

Insulation by peers. As adults they associated almost exclusively with moderate drinkers, often other Jews. When they observed others drinking badly, they rejected those people. As one subject in the study said: “This one guy was making a real ass of himself. He’d had too much to drink and it made everyone uncomfortable. I guess our friends just are not heavy drinkers. . . . I think he eventually got the message, because he was one of the first to leave.”

Refusal skills. Jewish interviewees were “generally unafraid to offer an assertive ‘no’ when they are encouraged to drink more than they wish.”A typical respondent declared, “If everybody is drinking and I feel like having a drink I’ll have a drink. If everybody is drinking and I don’t want a drink, I don’t drink.”

Viewing alcoholics as outsiders. Jewish respondents associated heavy drinking and alcoholism with non-Jews.The authors noted that Jews commonly use the Yiddish expression shikker vie a goy (drunk as a Gentile). As one respondent claimed, “It sounds like a stupid generalization, but non-Jewish people drink more heavily than Jewish people. That’s a generalization I’ve been brought up with . . . and I still think it’s true.”

Combining Glassner and Berg’s research with studies of other low-alcoholism cultures, such as Chinese, Greek, Italian, and Spanish, we can extract the following values taught by low-alcoholism cultures and groups:

Drinking is accepted but is socially governed, and people are taught to behave within clear boundaries.

People are taught to identify good and bad styles of drinking, to place a high value on drinking properly, and to disapprove of bad drinking styles.

Alcohol is not seen to remove personal control, and the individual is held responsible for his or her alcohol consumption and behavior while drinking.

posted by y2karl at 3:49 PM on December 19, 2005

Part of the thing here, is that Alcoholism is accepted as a disease- the alcoholic can choose not to drink, but once they start, they cannot control their intake.

What y2karl just posted is very interesting, and doubles as anecdotal evidence that alcoholism is a genetically-influenced condition.

In addition, it is accepted in some circles as a physical condition, involved with particular markers. here.

Gyan:Of which consumption doesn't happen to be one?

Correct. You can consume, or not. But if you do, all bets are off.
posted by exlotuseater at 4:46 PM on December 19, 2005

oops. here.
posted by exlotuseater at 5:07 PM on December 19, 2005

So far no one has come up with any scientific evidence (other then anecdotal evidence) that withholding support from someone until they quit drinking hastens their recovery.

one doesn't withhold support in order to hasten anothers recovery, one withholds support in order to prudently preserve one's own resources, for they are sure to be squandered.
posted by quonsar at 8:42 PM on December 19, 2005

one doesn't withhold support in order to hasten anothers recovery, one withholds support in order to prudently preserve one's own resources, for they are sure to be squandered.

That's totaly resonable, but there's not much point in doing that if you're not poor.
posted by delmoi at 8:56 PM on December 19, 2005

Resources are not just money. Dealing with an addict is hard enough on one's emotions even if you're not actively and futilely trying to cure the addict.
posted by fred_ashmore at 2:09 AM on December 20, 2005 [1 favorite]

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