“Hitting rock bottom” during the throes of substance abuse means different things to people. Often, rock bottom is associated with descending to levels of financial, ethical, or moral bankruptcy. While some people may, unfortunately, encounter these circumstances, others experience a simple knowing: this simply isn’t how their lives should be.
What’s more important than the definition of rock bottom with substance use disorder (SUD) is upending the concept that you can only experience the absolute worst suffering before you accept help. Nothing could be further from the truth.
Why Someone Might—and Might Not—Consider Treatment
Since certain signals indicate SUD requires professional help—such as inpatient rehabilitation treatment or extensive outpatient care—there are many factors to consider. Some people acknowledge the need for treatment because they:
- Went against their inherent values by abusing drugs or alcohol.
- Caused emotional, physical, mental, legal, or financial difficulties for themselves or others.
- Lost self-esteem or self-worth because of an unhealthy relationship and/or co-occurring disorders.
- Realized this particular way of existing was no longer suitable or sustainable.
Other people might deny they need help to overcome SUD because they haven’t hit rock bottom yet. In an article for Psychology Today, Professor Peg O’Conner said, “Too often I have heard people moving down the continuum of substance use disorders say, ‘Well, I never got a DUI. I still have my family and friends. I haven’t lost all that, so therefore I am not an alcoholic or an addict.’ This person rationalizes his use by comparing himself to a standard of terribly debilitating or devastating losses that only seems objective and factual. He might tell himself he can’t sober up yet because he hasn’t reached that bottom.”
She also points to a factor many people won’t accept: when they use the stereotype of rock bottom before helping a family member or friend seek treatment, they’re actually enabling someone indirectly by finding excuses for behavior. They won’t stage an intervention or encourage sobriety in any other way because they think losing everything is the only catalyst for positive change.
What’s the “Misery Threshold?”
O’Conner has a theory: instead of focusing on rock bottom, think more about a “misery threshold.” It’s a concept developed by William James, a philosopher, physician, and psychologist. He believed that similar to how each individual has a different physical pain threshold—while one person needs medication right away for a headache, for example, another might simply ignore it—every one of us has a different misery threshold. There simply comes a point when we no longer accept certain circumstances.
Bill Wilson, a co-founder of the 12-Step program Alcoholics Anonymous, followed James’ work closely in the early 1900s, and considered it instrumental in his recovery.
O’Conner explains more of James’ approach to this theory in her book, Life on the Rocks: Finding Meaning in Addiction and Recovery.
Along these lines, Dr. Nora Volkow expands on the structure of addiction as a brain disease by stating that it’s also “a disease of free will.” In an article for the National Institute on Drug Abuse, Volkow points out that because of addiction, “a person’s brain is no longer able to produce something needed for our functioning and that healthy people take for granted—free will.”
She explains that since surges of dopamine affect the brain’s pleasure center, as well as decision making, judgment, and self-control, continued substance use prompts receptor downregulation. The result is that ordinary healthy things in our lives—all the pleasurable social and physical behaviors necessary for our survival (which are rewarded by small bursts of dopamine throughout the day)—no longer are enough to motivate a person. “The person needs the big surge of dopamine from the drug just to feel temporarily okay…and they must continually repeat this, in an endless vicious cycle,” Volkow said.
Because every individual has a different response to receptor downregulation—a misery threshold, perhaps—their definition of “rock bottom” won’t be the same, either.
Making the Change
The motivation for change is also individualistic and inherent. The first step a person takes toward recovery is often the most difficult because frankly, positive change is hard, and often takes much longer than we’d like.
So how do you grasp the understanding that now is the best time for a change? Fred Muench, president for the Center on Addiction, said he started his sobriety journey by shifting his mindset. “Essentially,” he said in an interview with The Washington Post, “it was making a conscious choice to reject immediate gratification for the promise of tomorrow.”
What does this mean for you? If you’ve read this far, you’re likely curious about your behavior, so take that first step. The American Society of Addiction Medicine provides free and confidential online assessments that allow private exploration of your current situation. The results of these assessments provide talking points with a healthcare provider.
Another way to understand how to make a positive change is to understand the psychological and emotional barriers. In their book Changing to Thrive, authors and psychologists James and Janice Prochaska tell the story of David, who felt he needed to drink to socialize at work functions.
It’s described in the Greater Good Magazine. “Though he may have worried about the effects on his body of drinking, he was also concerned about how stopping drinking might impact his work relationships. Taking these concerns seriously and creating alternative plans for addressing them—rather than believing that David has to ‘hit bottom’ to change—is a much more compassionate as well as productive means of helping him.”
We Meet You Where You Are
By considering there might be a problem with drugs or alcohol, you’ve already made an important decision to change your life for the better. Answer these key questions, and then reach out to us. We’re available 24 hours a day, every day, to help you.