Do we have to Hit Rock Bottom to Recover?

There has been much recent debate about whether a person has to hit rock bottom in under to surrender and start recovering, whether one has to go to the bitter end before surrendering to the recover process.

My own experience shows  that we have to concede to our inner selves that we are alcoholic and that we need help from others.

For me it was a “last gasper” rock bottom for many it was a low bottom, I had lost practically everything and for some they had lost little compared to me but they had seen the road ahead and realised it was not going to get any better without accepting help.

This shows there is more to alcoholism than alcohol, that these people realised their negative behaviours and their consequences were causing them as much distress as their drinking. They did not like who they were becoming or the effect it was having on others around them , their loved ones, families and friends and employers.

I maintain also that there are also many different variables that contribute not only to one’s alcoholism and it s severity but also in one’s chances of getting into recovery sooner rather than later. Environmental factors such  as ethnicity, income, place in society, class can often play a role and social and therapeutic support networks. One of the most startling parts of this study was the lingering question that given that 85.1% of AA members in the US are White shouldn’t AA members be reaching out to non-white communities? 

Environment  is a factor in the progression of addiction but should it play such a huge role in the starting and progression of recovery too!? I have also noticed that many AAs in the groups I have intended are White and middle class. It always bugs me that there is not more non white and working class or blue collar alcoholics in recovery,  in my part of the world anyway.

In fact, the working class, and sometimes non-white alcoholics I know have come to AA via Treatment facilities.  Do cultural issues get in the way of access to recovery? The other startling point is that many more alcoholics who seem to have stopped drinking before losing what was important to them are motivated to pursue recovery than those who lost nearly everything, including health, family, friends, and jobs.

Individuals are accessing treatment via support networks much earlier in their drinking and may not have to experience the multitude of physiological, mental, emotional, financial, legal relationship and other problems low bottom alcoholics frequently do. This for me begs the question of whether AA is doing enough for the low bottom alcoholic who still suffers?

Anyway check this study (1) out – it signals the start of many blogs on why and how AA and other 12 works. Also this study shows a very interesting statistic which is that a majority of recovering alcoholics in this study have sought additional professional help. This shows that Bill Wilson’s “Lets be friendly with our friends” appears to be becoming a reality for many. It is our intention, via our research blogs, to continue this desire, to demonstrate how 12 step and other recovery models can work together and even compliment each other.

“The concept of hitting bottom persists within Alcoholics Anonymous (AA) even though the backgrounds, addiction experiences, and therapeutic options of AA members are now radically different than they were at the group’s founding. Understanding what AA members now mean by hitting bottom is important because the experience describes the point at which they become willing to seek help—professional treatment, AA, or both.

The concept of the alcoholic bottom evolved from the illness model of addiction. By popularizing the illness model (later reconceptualized as a disease model), AA revolutionized addiction treatment, and its 12-step approach remains the most popular and accessible route to recovery (Gross, 2010; Kurtz, 2002).

Among the most controversial aspects of AA is the idea that alcoholics will seek help only when their “illness” has led to “pitiful and incomprehensible demoralization” (AA, 2001, p. 30). Those words originally appeared in the 1939 first edition of Alcoholics Anonymous, but by the time of the publication of the 1953 commentary, Twelve Steps and Twelve Traditions (AA, 1953), the idea had changed in contradictory ways. The instance of help seeking received a name (“hitting bottom”) that suggested an objectively fixed point.

On the other hand, the experiences of those entering AA demonstrated that such a point is relative, and not fixed. AA was helping “people who were scarcely more than potential alcoholics” so it was “necessary to raise the bottom” (AA, 1953, p. 23). The meaning of “hitting bottom” remains problematic (for some). Denzin (1987) provided the succinct definition used in this article: “Bottom: Confronting one’s alcoholic situation, finding it intolerable and surrendering to alcoholism. Accompanied by collapse and sincerely reaching out for help; may be high or low” (p. 134).

The hitting bottom concept originally reflected the experience and outlook of AA’s founders and pioneers in the 1930s. They shared a common background (professional White men), the common “low-bottom” experience of institutionalization for their alcoholism, and commitment to peer-facilitated spiritual growth (Kurtz, 1988). In refining the disease concept of alcoholism,Jellinek (1946) surveyed these early AA members and identified the bottoming-out phenomenon, which he subsequently developed into the Jellinek curve (Jellinek, 1960). jellinek_lg   Since the founding of AA, the membership has become much more diverse and the rise of professional treatment has provided multiple alternatives to institutionalization of alcoholics (Robertson, 1988; Stolberg, 2006). Yet despite the variable backgrounds and experiences of AA members today, they continue to rely on the hitting bottom concept and terminology. Although hitting bottom entails the crucial decision to seek help, no research has been conducted to determine any commonality among AA members regarding the meaning and implications of the term. The purpose of this exploratory study, therefore, is to determine how AA members perceive their alcoholic bottom (high, middle, or low)…

Participants were asked, “Which description best fits the ‘bottom’ you hit as an alcoholic?” This categorical variable had three potential values: high, middle, or low. Although Denzin (1987) reported a bottom could be high or low, the middle category was added so that participants would not be forced to select a more extreme option if they believed their bottom was neither high nor low. AA literature represents bottom levels in terms of loss, such that high-bottom alcoholics, “still had their health, their families, their jobs, and even two cars in the garage” (AA, 1953, p. 23). In keeping with this understanding, loose definitions were provided to participants in their answer choices:
High bottom: I stopped drinking before I lost what was important to me.
Middle bottom: I suffered serious consequences but did not lose everything.
Low bottom: I lost nearly everything, including health, family, friends, and jobs.

The study found that Whites, religious people, and episodic drinkers were less likely to be low bottoms when they began recovering. Alcohol-related problems were most clearly associated with level of bottom, supporting recent findings that problems increase the odds that an alcoholic will perceive the need for help and will seek help (Grella et al., 2009). Findings were – high bottom (36.1%), middle bottom (44.5%), and low bottom (19.4%).

A fundamental tenet of AA is that alcoholism is progressive, so that alcoholics “get worse, never better” (AA, 2001, p. 30). Supportive of this progressive framework is the finding that problems distinguish high bottoms from low bottoms. The difference was most clear in the categories of social and physical problems, indicating that early identification of these problems could signal a need for intervention, particularly if the individual drinks constantly or uses drugs other than alcohol.

The finding that hitting bottom remains salient for AA members holds implications for addiction professionals treating those members. Professionals have struggled with the idea that addiction must render an individual demoralized before treatment can be initiated. Some reject the bottom concept outright, whereas others have attempted to integrate hitting bottom into standard practice.

Nearly 50 years ago, the family intervention was developed to “raise the bottom” by confronting alcoholics with ultimatums to guide them into treatment (Jay & Jay, 2000; Johnson, 1986; Liepman, Nirenberg, & Begin, 1989). In recent decades, the legal system likewise has coerced offenders into treatment initiation and compliance (Sullivan et al., 2008). Although such confrontational and coercive strategies ostensibly are in the alcoholic’s best interest, they have drawn criticism for their manipulative tactics and for inconclusive reports of effectiveness (Broadstock, Brinson, & Weston, 2008;Loneck, Garrett, & Banks, 1996; W. R. Miller, Meyers, & Tonigan, 1999; Perry et al., 2006).

Researchers and practitioners have expressed concerns about the alcoholic’s loss of agency when the only options are hitting bottom or being manipulated into perceiving that the bottom is immanent. Their concerns include both the ethics and efficacy of the alcoholic bottom (Smith, 1999; White & Miller, 2007). Effective alternatives designed to facilitate treatment entry without an alcoholic bottom include motivational interviewing and harm reduction (Logan & Marlatt, 2010; Lundahl & Burke, 2009). With these approaches, which are now widely used by professional therapists, the alcoholic is encouraged to determine whether treatment is desirable and, if so, how intensive that treatment should be.
Although the concept of surrendering at the alcoholic bottom seems incompatible with the more agentive therapeutic frameworks now popular in professional counseling, the evidence suggests that many recovering alcoholics rely on a combination of professional treatment and mutual-help groups to sustain their abstinence (Patterson & Nochaski, 2010;VanderWaal et al., 2008).
AA estimates a third of its members enter AA through a treatment center, and 63% of its members receive some form of treatment or counseling before entering AA and the same proportion do so after entering the fellowship (AA, 2001). Evidence suggests combining AA with professional services is associated with significantly greater abstinence over time (Gossop, Stewart, & Marsden, 2008; Kelly, Stout, Zywiak, & Schneider, 2006; McKellar, Stewart, & Humphreys, 2003;Moos & Moos, 2005).
Given that the majority of AA members (a) understand their addiction in terms of hitting bottom, and (b) are helped by a combination of both AA and professional treatment, professionals treating AA members should therefore understand the bottom concept and be prepared to address it during patient interactions.
Whites and those introduced to AA by an AA member were significantly less likely to hit a low bottom. Given that 85.1% of AA members are White, it is possible that non-White alcoholics are less likely to enter AA at a high-bottom stage because their social network includes fewer AA members who could take them to a meeting (AA, 2008).
The finding that alcoholics who enter AA via court order are far less likely to be high bottoms indicates that mandated referral can work, but it seems to be more of a last resort than other modes of entry. This finding supports the research that endorses the effectiveness of coercion, for at least some alcoholics (Gregoire & Burke, 2004; N. S. Miller & Flaherty, 2000). A recent study by Field, Duncan, Washington, and Adinoff (2007) reported an inverse relationship between motivation to change and alcoholic problem severity, suggesting low-bottom alcoholics might be less motivated than high-bottom alcoholics to pursue recovery.”
The salutatory lesson from this for me from this study is that we should never pronounce when another addict or alcoholic has had enough! That quite clearly is for them to decide not us!  It appears almost counter intuitive for some, if not many,  that many more alcoholics, who seem to have stopped drinking before losing what was important to them, are motivated to pursue recovery than those who lost nearly everything, including health, family, friends, and jobs. This is very noteworthy as it runs contrary to AA experience in the early days when most alcoholics seeking recovery were low bottom.
This would suggest that widespread societal awareness that there is a solution has had a profound effect on alcoholics seeking help for their illness much earlier than in the early decades of AA.
This has profound effects on earlier intervention as these individuals can access treatment via support networks and may not have to experience the multitude of physiological, mental, emotional, financial, legal, relationship, family and other problems low bottom alcoholics frequently do.
If we can alleviate suffering we should also seek to do so and help others to do so as early as possible.
You do not appear to have lost everything in order to surrender to 12 step programs of recovery. For me there is  a real message of hope in this study, that alcoholics can seek help earlier without having to experience the various hardships of low bottom.
Obviously this also begs another very important and pertinent question. Why do so many low bottom people not seek recovery or treatment? Why do I sit in AA rooms and rarely see a beat up low bottom alcoholic walk into the room like I did a number of years ago?
Is AA doing enough for the low bottom alcoholic who still suffers? 
The type of alcoholic who co-founded AA in the first place?
References
1. Young, L. B. (2011). Hitting bottom: Help seeking among Alcoholics Anonymous members. Journal of Social Work Practice in the Addictions, 11(4), 321-335.

One comment

  1. alcoholicsguide · July 15, 2016

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