substance abuseI’ve always been a bit ambivalent about the idea that sometimes, an alcohol or substance abuser needs to “hit bottom” before they can get well. For one thing, there aren’t that many people in our practice who have decided to stop drinking or using drugs as a result of a classic “hitting bottom” experience. For another thing, the whole idea of hitting bottom has, for a number of our patients, become a kind of perverse goal. If they are not going to get well until they hit bottom, and that means that they have to get really sick, then they can rationalize crazy substance use as all part of a process of getting well.

One of the people we’ve been working with closely, a young man with bipolar and some alcohol and marijuana problems, told me that he was trying to “hit bottom” so that he could then get well. I spent quite a bit of time trying to convince him that going in the opposite direction is rarely the best way of getting someplace.

That conversation, however, lead us to reexamine the idea of “hitting bottom.”

I was talking with him about what “hitting bottom” would mean for him, how would he know he had gotten there? And, in the middle of that discussion it occurred to me that, really, aside from the fact that hitting bottom is something that you do when you’re behaving badly, the key feature that defines “hitting bottom” is the fact that after that moment, the person decides to make a strong commitment to recovery. In other words, to do what it takes to get well.

What defines a moment as hitting bottom is not necessarily the severity of substance use, but rather the fact that the experience leads to a change in orientation. In other words, the evidence for the idea that it may be necessary to hit bottom before making a sustained recovery is circular. Hitting bottom means that you have a sudden change in orientation, so, of course, hitting bottom will lead to recovery for some people.

In that moment it occurred to us that the whole idea of hitting bottom is a different way of saying that, even in the very darkest moments, transformation is possible.

But if you are wrestling with problematic use of substances, the best way to make a positive change is to take small steps in that direction.

For every person who makes a sustained commitment to recovery after a serious binge, there are hundreds who don’t.

For more on the process of recovery see our interviews with Matt Tierney.