There’s a prevailing narrative in addiction treatment that says a person only seeks help for their substance misuse once they’ve hit rock bottom. The narrative is so common, in fact, that it’s often seen as a necessary step for a person to change.

This belief can be traced back as early as 1953, the year Alcoholics Anonymous’ foundational text, Twelve Steps and Twelve Traditions, was published. In it, the author states:

“…Few people will sincerely try to practice the A.A. program unless they have hit bottom. For practicing A.A.’s remaining eleven Steps means the adoption of attitudes and actions that almost no alcoholic who is still drinking can dream of taking. Who wishes to be rigorously honest and tolerant? Who wants to confess his faults to another and make restitution for harm done? Who cares anything about a Higher Power, let alone meditation and prayer? Who wants to sacrifice time and energy in trying to carry A.A.’s message to the next sufferer? No, the average alcoholic, self-centered in the extreme, doesn’t care for this prospect–unless he has to do these things in order to stay alive himself.”1

As journalist Maia Szalavitz describes in her book Unbroken Brain: A Revolutionary Way of Understanding Addiction, this belief gave rise to a burgeoning of “therapies” designed to “demolish the ego.” Foremost in this trend was a program known as Synanon, which relied on tactics such as sleep and food deprivation, isolation and dressing clients in diapers to provoke the kind of “submission” deemed necessary for recovery.2

Such approaches have since been debunked as not only ineffective, but also psychologically damaging. Nevertheless, Szalavitz says that “even today, virtually every publicly funded inpatient addiction program in the United States that calls itself a ‘therapeutic community’ has its roots in Synanon.”3

T. knows first-hand what it’s like to hit rock bottom. She was 19 when she started using cocaine. A year later, she began sneaking her husband’s painkillers whenever he was out of town. “We both got addicted,” she told Skywood Recovery in this interview. Next came heroin. “It was cheaper.”

For the next six years, T. used daily. The result was devastating. “I started losing jobs, lost my home, all three cars and everything we worked hard for.” Pretty soon, she turned to stealing to support her addiction. “I was a completely different person.”

She wasn’t the only one. Her husband–a man she’d been with for seven years–started beating and cheating on her.

It was at this point she decided to seek help. She entered a methadone clinic, where she said the theme of “hitting rock bottom” was omnipresent. “A lot of people I know had to lose everything or get arrested before they changed.” The reason, she said, goes back to the very nature of addiction. “When you’re in the addict mindset, you’re selfish–all that matters is the high.” That said, T. isn’t convinced that it has to be like that. “I think if there were better resources for addicts, they wouldn’t need to hit rock bottom first.” Among the resources she listed were accessible therapy, as well as systems in place to help those with addiction regain losses before they snowball.

And then there is the issue of stigmatization. When a person with addiction feels discriminated against, they are more likely to hit rock bottom, T. explained. “They feel alone.” For this to change, T. believes a new understanding of the very nature of addiction is needed. Specifically, she wishes more people would understand addiction as a disease and that “not all addicts are bad people.” Doing so would mean those living with it would not be under the same kind of social pressure to hide, either from family and friends or those with the training to help.

J. was 18 when she started drinking. Marijuana followed, and finally cocaine. Very quickly, she sensed she wanted out. But without any dramatic bottoming out, she struggled to get people to take her calls for help seriously.

“Sometimes I would say to my family ‘I’m done with this,’ but it was like no one believed me,” she said in this interview with Skywood Recovery.

Meanwhile, J. and her family watched her older brother descend deeper and deeper into an addiction of his own. Finally, he ended up in jail, where he suffered a battery of abuse. “And he got out, and I remember my mom almost praising the change she saw in him.”

Soon after he was released, J.’s brother died as a result of his addiction.

Deprived of a friend and family ally, J. withdrew into an abusive relationship, eventually ending up in the hospital and then the streets before clawing her way back to a life of love and stability.

Whether or not J.’s story would have taken a different turn had her family heeded her early calls for help is impossible to say. What is clear, however, is that by emphasizing the need to hit rock bottom, society exposes those with addiction to incredible—and sometimes fatal—risk.4

J. admits she’s cynical about the myth of “rock bottom” losing its grip on the addiction recovery process anytime soon. “Treatment centers don’t have any reason to encourage it. They make money off of recidivism.” What she does have hope for is people’s ability to come back, no matter how deep or dark their “rock bottom” is. As evidence, she needs to look no further than her own life.

“I still feel days of immense sadness for the years I lost, my brother, things that have happened to me, trauma.” But now, she said, “I feel healthy. I feel balanced.”

Check out more on how society currently views mental health illness and how we hope to shift this perspective in the future. Sam Webb shares his thoughts on Recovery Unscripted.


3. Ibid.

Written by Tamarra Kemsley