Does a Loved One Have to Hit Bottom?
Does a loved one have to “hit bottom” before they can successfully treat their alcoholism or other drug addiction?
The short answer, “NO!”
But before I continue, please know language to describe alcoholism or drug addiction has changed greatly in recent years, falling under the umbrella term, “substance use disorder.” Alcohol abuse and alcoholism are referred to as alcohol use disorder and marijuana abuse and addiction are referred to as marijuana use disorder, as examples. I still use the more common terms. This article explains this changed language. And this is another great one, “The Words We Use Matter.”
And, now, to answer the question, “Does a loved one have to hit bottom?” please see the following excerpt from my book, 10th Anniversary Edition If You Loved Me, You’d Stop! What you really need to know when your loved on drinks too much, pages 108 – 116 (outgoing links have been added to this post). Note: this book is equally applicable for those whose loved one is grappling with other types of drug use disorders.
They Don’t Have to Hit Bottom
“Hit bottom” is an expression used to describe the point at which a person with alcoholism may have finally run out of money, friends, family, their home – or illusions of control – and at long last admit they have a problem controlling their drinking. This old notion that a person has to hit bottom before they can be helped is wrong, wrong, wrong. In fact, the earlier the progression of the disease is interrupted – treated – the better.
A person with a drinking or drug use problem does not have to “hit bottom.”
Think of it this way, if your loved one had ANY other socially “acceptable” disease, like cancer, you would be researching every treatment option you could find, leaving no stone unturned. And it’s likely they would too. You would probably be talking and working together to identify and evaluate treatment options. And you would no doubt be talking to your close friends and family members, as well, and maybe even telling your boss why you’re under stress. Heck, your friends and neighbors might be bringing you dinners, picking up your children after school while you and your loved one meet with treatment providers, and taking your children for a Saturday afternoon so you could take a nap and regroup. That’s what they’d be doing if your loved one had cancer. Unfortunately, it’s the nature of alcoholism and the secrecy and shame that surrounds it that makes it difficult to bring your loved one and others who can help into the discussion about diagnosis and treatment.
Having said all this, the decision to seek treatment is still your loved one’s. You can’t make them. At the same time, trying to blame or shame a person into treatment doesn’t work either.
One of the best ways to help your loved one “raise their bottom,” however, is to get help for yourself in order to take that all important first step, stopping the denial. You’ll understand why and how as you continue reading this chapter and those that follow. Now, to continue, here are some other suggestions that can help you sort this out. [But before I go on, you may be interested in reading, “Why Can’t an Alcoholic Have Just One Drink?”]
To Understand Why They Don’t Have to Hit Bottom…
Accept That You – and They – Are Powerless Over Alcohol
You may have heard the expression that someone is “powerless over alcohol.” If you are a person who doesn’t have a problem controlling how much you drink, this makes no sense. But if you think of it this way, it might make more sense: They are powerless over their brain; therefore, they are powerless over their behaviors, if they drink any amount of alcohol, period. And, if they are powerless over their brain if they drink, then you are certainly powerless over it too. Therefore, you are also powerless over their behaviors when they drink. I know this idea may be hard for you to accept right now, however you will save yourself a lot of struggle and grief if you try to accept the truth of it.
Focus on the Drinking Behaviors Not the Person
Only talk with they’ve not been drinking. Don’t accuse or throw labels about. Instead, speak from your heart about behaviors they exhibit while drinking.
Instead of zeroing in on, “You’re an alcoholic,” stick with talking about their behaviors – how they act and what happens when they drink. As importantly, don’t try to talk about their drinking behaviors when they are actively drinking because you are not talking to a brain that can “reason.” Here are a couple suggestions for how to start the conversation when they are sober:
- I don’t know if you’re aware how much your behaviors change when you drink, but last night, for example ____________. I’ve been doing some research as to why this happens and have found resources that explain so much. I’d really appreciate if you’d read ______ so we can talk about it. I’m not sure what to do next, but I do know your drinking behaviors are not going away if you continue to drink.
- I’ve been doing some searches online trying to figure out if I should say anything about how you behave when you drink too much and found this great website, NIAAA’s Rethinking Drinking. I’d really like you to do their anonymous, online assessment and take a look at the other information on the site and then let’s talk about it.
Pay Particular Attention to Trauma | ACEs (Adverse Childhood Experiences)
Experiencing childhood trauma (Adverse Childhood Experiences) is one of the key risk factors for developing a drinking problem.
Time and again when I speak before audiences or talk one-on-one with individuals or engage in conversations with therapists and other medical professionals, I ask, “Have you heard of the CDC-Kaiser ACE Study?” Time and time again, the answer I receive is “No.” This lack of awareness continues to shock and sadden me because the ACE Study was conducted in the late 1990s. Yet, using this study’s findings and treating a person’s ACEs as part of their treatment plan can have a profound impact on their recovery success – because childhood trauma is one of the key risk factors for developing alcoholism. This is why I included that separate section on ACEs and the ACE Study in Chapter 6.
v It was hearing Lisa’s presentation on the neurobiology of addiction – especially the part about Adverse Childhood Experiences – that I practically jumped out of my seat screaming, “YES!” – that’s me! It’s a much longer story, but basically, I got the right kind of therapeutic help for my ACEs and that paved the way for me finally being able to succeed in doing the other things that also helped me succeed in my recovery.
Know It Must Be Treated Like Any Other Chronic Disease
As previously explained, disease by its simplest definition is something that changes cells in a negative way. When cells change in a body organ, the health and functioning of that organ changes. In the case of lung cancer, for example, cancer cells in the lungs change the health and functioning of the lungs. Alcohol addiction – alcoholism – changes cells in the brain, which in turn changes the health and functioning of the brain.
But it is a disease, and like other chronic diseases, it is treatable. And like other chronic diseases, treatment requires the 3-stage disease management approach:[i]
- Stage 1: detox/stabilization
- Stage 2: acute care/rehab
- Stage 3: long-term continuing care.
Again, putting it in terms of other diseases, consider heart disease. If someone presents with a heart attack in the emergency room, Stage 1 – detox/stabilization – is implemented immediately – no questions. The intervention at this stage is all about getting the heart pumping and stabilizing all vital signs while the next course of action is determined. These next steps could be running tests, getting MRIs, etc., and of course taking a complete medical history.
When a course of care is decided, Stage 2 – acute care/rehab – begins. With this stage, the person may have surgery – a triple bypass, for example (acute care). This acute care is followed by rehab. In this case, rehab would be a stay in the hospital. During this rehab period, the patient’s body accepts the surgical changes and the person gains knowledge and tools for living with what’s happened and information about what they need to change in order to protect their heart health.
Stage 3 – long-term continuing care – is also fully expected and accepted when treating heart disease. This involves a long-term continuing care plan, which may include diet changes, medications, heart health improving exercises, stress-reducing practices, therapy to cope with what happened and how to get over the fear of it happening again. All of these would be offered in increments to coincide with the healing of the heart. AND, it would include regular follow-ups with the medical team to be sure all was going as planned. If it weren’t, changes to care would be implemented. Most importantly, at no point along the way is the person who presented with a heart attack blamed or shamed if they have another heart attack!
Sadly, understanding the importance of Stage 3 for the success of alcoholism treatment and recovery is sorely missing.[ii]
Note: The above example of the treatment for a chronic condition like heart disease is not to suggest there are specific timeframes for each stage, nor that every person needs to go through all three stages separately when treating alcoholism. In other words, when dealing with alcoholism, a 30-day residential treatment program might also provide detox, thereby addressing stages 1 and 2.
Know What Is Needed to Treat This Disease
As you just read, we must accept that this disease cannot be completely treated in 30 days any more than we would dream it is possible to completely treat cancer in 30 days. (Check out the American Cancer Society’s treatment timeline for cancer for comparison.) It is going to take time. It took time to wire and map the brain to develop the disease, thus it will take time to unwire, remap, and heal the brain of this disease.
Unlike the story I shared in Chapter 1 of my mom’s success with her speedy breast cancer diagnosis and treatment after finding a lump, it is rare that you can just take your loved one to the doctor to talk about alcohol use disorder symptoms and/or request a referral for a more in-depth evaluation. Nor can you simply go to the doctor yourself to get that information or referrals for your loved one. Again, this is changing, but in the meantime, I’m sharing some suggestions about what is needed to treat this disease – whether treatment involves a residential, inpatient program, or an intensive outpatient program, or a self-directed program.
These suggestions are taken from an excellent, online resource created by the National Institute on Drug Abuse (NIDA). One is for adults, titled: Principles of Drug [and Alcohol] Addiction Treatment: A Research Based Guide (Third Edition). A second online resource is also used. It is created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and is titled: NIAAA Alcohol Treatment Navigator.
Descriptions of What Helps With Treatment
Please understand the following list of suggestions about treatment is not meant to overwhelm you. Rather it’s to share the complexity of issues involved in treating this disease for some people. Take time to consider these recommendations and determine the ones that apply in your loved one’s situation. That can greatly help a person find the right treatment for them and thereby succeed in their recovery.
- No single treatment is appropriate for everyone, nor must it be a residential treatment program. Treatment varies depending on the specific factors that contributed to an individual developing alcoholism (or other drug addictions) and/or the level of their commitment to do whatever it takes.
- Effective treatment attends to multiple needs of the individual, not just their alcohol use disorder, such as any associated medical, psychological, social, vocational, and legal problems that could be triggers to drink during the treatment and recovery process.
- Remaining in treatment for an adequate period of time is critical. In other words, that adequate period of time must incorporate long-term continuing care in the treatment/recovery process.The appropriate duration for an individual depends on the type and degree of their problems and needs. As with other chronic illnesses, relapse can occur and should signal a need for treatment to be reinstated or modified, NOT as a sign the person didn’t want recovery badly enough. We certainly don’t look at a person whose breast cancer returns as not wanting to be breast cancer free badly enough.
- Behavioral therapies—including individual, family, or group counseling—are commonly used forms of treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change; providing incentives for abstinence; building skills to resist drinking; replacing drinking-involved activities with constructive and rewarding activities; improving problem-solving skills; and facilitating better interpersonal relationships.
- Anti-craving medications can be an important element of treatment for many with alcoholism, especially when combined with counseling and other behavioral therapies. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol cravings, which helps people stabilize their lives. In other words, these medications enable them to live through the craving and carry on with their efforts to wire new, healthy, alcohol-free coping skills. Think of these medications as bridges between neurons until the brain re-establishes its natural neurotransmitter/receptor connections.
Note: if a person uses anti-craving medications, they should also be involved in counseling and other behavioral therapies. This is known as Medically-Assisted Treatment (MAT).
- Many individuals with alcoholism also have other mental disorders (also referred to as mental illnesses). Because alcoholism often co-occurs with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both at the same time.
- Of note: if the person is an adolescent, treatment is different. This is due to the brain developmental processes under way during adolescence (explained in Chapters 4 and 6). If this is the case, check out the National Institute on Drug Abuse (NIDA)’s Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. You can find this online.
- Of additional note: some people seek a diagnosis or help from a physician who is certified in addiction medicine by the American Board of Addiction Medicine (ABAM). These physicians cross a range of specialties, including psychiatry, family medicine, pediatrics, and emergency medicine. The ABAM certification is to assure the American public that the physician has the knowledge and skills to prevent, recognize, and treat addiction. Visit their website at ABAM.net to learn more or to find a physician with an ABAM certification.
How to Use This Information
Understanding what can help a person seek help before they hit bottom helps with finding the right treatment.
Use the information contained in these resources, so you/your loved one can make a list of the questions you/they will ask a treatment provider (if you are looking for outpatient or residential treatment or behavioral therapy options, for example). Getting answers to those questions will help confirm whether the provider can meet your loved one’s treatment needs. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a free, anonymous, online treatment provider search tool you can also use. It can be found by searching this phrase, FindTreatment.SAMHSA.gov.
It’s possible your loved one may structure their treatment/recovery based on this information, as well. Again, it doesn’t have to be a residential treatment program. For example, your loved one may elect to have naltrexone injections for cravings; participate in SMART Recovery for peer support; engage in cognitive behavioral therapy with a therapist specializing in addiction and childhood trauma; practice yoga for mindfulness; incorporate diet changes to add more nutrient-rich foods to repair neurotransmitter damage; or commit to daily running for aerobic exercise. They might also get physical therapy to improve nerve pain – for example if they had problems in their shoulder caused by an old injury (for which they found drinking helped ease the pain). In other words, there are many ways to do this. The point is for your loved one to find ways that work for them, and if one way doesn’t work, then to try another.
To order my book
Written to provide key information about alcohol use disorders and their impacts on families.
For a more complete picture of what happens to the person with a drinking problem and those who love them, please consider reading my book. This is the link to the Amazon version, 10th Anniversary Edition If You Loved Me, You’d Stop! What you really need to know when your loved on drinks too much. It’s available in both Kindle or paperback.
________________________________________
[i] Galater, M.D., Marc and Herbert D. Kleber, M.C., The American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fourth Edition, Washington, D.C.: American Psychiatric Publishing, Inc., 2008, pgs. 95-97.
[ii] McKay, James R., Ph.D. and Hiller-Sturmhöfel, Susanne, Ph.D., “Treating Alcoholism As a Chronic Disease: Approaches to Long-Term Continuing Care,” Alcohol Research Current Reviews, 2011; 33(4): 356-370, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625994/ (accessed 5.25.19).
Lisa Frederiksen
Latest posts by Lisa Frederiksen (see all)
- Does a Loved One Have to Hit Bottom? - November 20, 2022
- Resources for Parents of Children with Substance Use and Mental Disorders - October 18, 2022
- 4 Things to Support Brain Health and Function for Recovery - August 30, 2022
I enjoy reading your work.
That’s wonderful to hear – thank you!