Hit Bottom. Is it necessary for the addict to want to get help?
They have to hit bottom, or at least that’s the common belief when it comes to a drug addict or alcoholic seeking / getting help. Is this true?
Short answer, “No” — they don’t. Now this may surprise you. It certainly surprised me as I’d always heard they (the person with the drug or alcohol addiction) needed to hit bottom before they could be helped. It was also alleged that when a person relapsed (went back to their drinking or drug use), they just didn’t want it (recovery) badly enough.
It’s commonly believed that a person has to hit bottom before they can get help. Addiction (whether to drugs or alcohol) is a developmental disease and can be interrupted at any point along the way. Family members and friends are encouraged to take a stand early — it is not okay to be drunk or drugged and do the things you do when substancing.
Fortunately, new brain and addiction-related research is explaining that neither of these assumptions is true. This research is possible in large part to advances in imaging technologies of the past 10-15-20 years that is allowing neuroscientists and medical professionals to study the live human brain in action, over time and under the influence.
This research is providing the science to explain the fact that addiction is a chronic, often relapsing brain disease. It also explains why successful treatment of this brain disease requires a disease model of treatment (described below). When properly treated, relapse has a better chance of being avoided; however, relapse is not an indication of a person not wanting recovery badly enough.
This is a lot to declare, I know, so here is a bit of the science of why and what understanding this science can do.
Development of the Disease
Addiction is also a developmental disease; a person is not born an alcoholic or drug addict. The development of the disease starts with substance abuse, which causes chemical and structural changes in the brain. These brain changes make a person more susceptible to their key risk factors for developing the disease. These key risk factors are:
- genetics (such as higher or lower levels of neurotransmitters, receptors or enzymes that break down alcohol);
- mental illness (such as ADHD, depression, anxiety which also cause brain changes);
- childhood trauma (such as verbal, physical or emotional abuse, which also cause brain changes);
- social environment (such as a home or school environment where heavy drinking is viewed as normal and therefore modeled – a drinking pattern that may not work in a person’s brain); and
- early use (heavy drinkin
My latest book (2019) shares current research on how a person develops and treats an alcohol (or other drug) use disorder. It’s now available at book stores, libraries, and online retailers – click here for the Amazon link.
g during the brain developmental years of ages 12 through early 20s, when the brain is wiring neural networks related to puberty, cerebral cortex development and the strengthening and pruning process).
Understanding these risk factors can help family members and/or the person with the substance misuse problem recognize that what’s at stake may be more than a drinking or drug use problem. This understanding may prompt the substance misuser to seek a professional evaluation with an addiction’s specialist sooner rather than later, or prompt the family member to seek help for how better to cope with the drinking or drug misuse behaviors (the fights about the drinking, the verbal, physical or emotional abuse, the broken promises to stop or cut down). One and/or both changes can make a world of difference — check out “The Dance” – Addiction is a Family Disease for a more complete explanation. Most importantly, the drug addict or alcoholic does not have to hit bottom.
Treatment of the Disease
The disease model for treating a disease (including the disease of addiction) is threefold: 1) detox and stabilization; 2) rehab or acute care; 3) continuing care or aftercare – the kind of care where we reassess how it is going, make adjustments to the treatment plan as necessary, provide support and education to treat and change contributing risk factors and the like.
How does this apply to addiction treatment? A disease by its simplest definition is something that changes cells in a negative way. The nature of the disease of addiction is that it changes cells in the brain. Thus treating this brain disease means we are healing the brain of the structural, chemical and functional changes caused by the disease, itself. But what is most often missing when treating addiction is phase 3 – continuing care or after care.
Think of it this way – we allow months to heal a heart after a heart attack or a body after the diagnosis of breast cancer. The same is true of treating the brain. Thus giving it the amount of time and the kind of treatment it needs is the least we can do and support given the brain is the organ that controls everything we think, feel, say and do.
These are exciting times in our understanding and treatment of this brain disease!
Lisa Frederiksen
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Hi Lisa,
This is great information as I’m sure many have believed that an alcoholic or drug addict needed to hit bottom before they would consider receiving help. There are key times when family intervention has the potential to help someone consider recovery, and knowing the risk factors is important information for helping your loved one.
Thanks so much for your comment, Cathy! I agree — there definitely are times when family intervention has the potential to help someone seek the help they need. As you said, understanding the risk factors (and the nature of this brain disease) will hopefully help them appreciate the problem will not go away and that the early they intervene, the better for all concerned. Take care and thanks, again!