Episode #117

People have to hit rock bottom before they can get sober. It’s a really good thing that this isn’t true. If people had to find the very bottom before they could get clean, there would be so much more misery. People get sober at all different times of their lives and for all different reasons. It’s hard to tell what might be the thing that turns on the lightbulb for someone or that gives them the strength they need to find recovery. Sometimes it IS a big event. Sometimes though, its a small, quiet voice telling them that they need to turn around. Today we’ll talk about why it matters that we debunk this myth.


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

 Welcome back to the All Things Substance Podcast. This is episode 117. A quick shout out to everyone who attended the Analyzing Alcohol Webinar. I really love being able to present information in a live format, 

I hope that the information was helpful for you in your practice. I always wanna give you research backed and useful information. Thank you so much for choosing to spend your time with.  I am so thankful for all of my listeners. It’s truly a joy to be able to do this every week. 

Today we’re gonna be talking about an addiction myth,  one that I think gets repeated quite a bit and it’s just not accurate. We’re gonna talk about the idea that a person has to hit bottom before they can get sober.  What people mean by that is that they have to crash and burn, that they have to make a giant disaster of their life before they can get clean. 

Sometimes it’s used to explain why a person made a giant mess of their life. Sometimes it’s used to explain why someone hasn’t gotten sober yet. Sometimes it’s a statement made with understanding in the tone of voice, and sometimes there’s some disdain, some frustration, some bitterness.

Addiction is confusing to say the least. Seemingly intelligent good people can end up doing really bad things when they’re using and become someone that their loved ones don’t even recognize. Everyone swears that it’s not gonna happen to them, that they’re not gonna wind up being an addict or an alcoholic, and that they can control whatever’s happening in their life.

It’s very common for people to compare themselves to. IV users who are using needles look down on people who aren’t using IV because for them, that feels like a lack of commitment. People who don’t use IV needles yet look down on people who are shooting up because they feel like that’s true junky territory.

And if they stay away from needles that somehow they’re in a different class and they haven’t totally lost it. People have lost everything to addiction from money and homes and jobs to relationships, family members, partners, their health, their wellbeing, their mental health, even as far as losing limbs. And people lose their lives to this disease all the time. So why don’t people stop; even in the face of tremendous consequences? Why don’t they stop?

The idea that they haven’t hit bottom yet is one that often gets brought up. And it’s possible that that’s the truth, is that they haven’t hit bottom yet, but the insinuation there is  that hitting bottom will be the thing that brings them back up. And sometimes that’s true, but not all the time.

Where does this idea come from that somebody has to hit bottom?  That they have to wreck their lives before they can get clean. In the early days of aa, so Alcoholics Anonymous, there were story after story of at the time, mostly men who were involved in the movement and how they had lost things in their life. Their marriages, contact with their children, their jobs, their social standing, and were miserable drunks by themselves. And these were true stories, and that did indeed happen.

One of the things that the big book says is, the blue book that is the handbook for AA that has been revised over the years. And in AA circles it’s just called the Big Book. In the Big Book of aa, there is a line that reads that they got sick and tired of being sick and tired. It’s easy to translate that as  they were down and out at the bottom ready to turn their life around.  We see stories, and we watch movies where the main characters hit terrible consequences and then they start to turn their life around.

I think that Hollywood, with the movie industry and also in the TV industry, has given us the idea that things turn about when somebody is faced with the reality of what their life is and could be. This past Christmas we ended up watching the movie Spirited It stars Ryan Reynolds, who I adore and Will Ferrell, and it’s a retelling of the classic Dickens story, a Christmas Carol. With the three ghosts of Christmas, past, present in future.

It is a lovely movie and I recommend that you see it. The idea is that they’re supposed to see that their future would look bleak and grim, and they’re giving them a chance to change before the bottom comes for them. The idea is that they’re bringing the floor to the person, and that is what changes them. Fear of that future. 

The belief that you have to hit bottom is very persistent and very common. Even in recovery circles and even in treatment programs. It’s a myth because for those people who don’t get sober when they hit bottom, it’s very confusing. They wonder why they can’t turn it around. if all they had to do was hit the worst point in their life, they hit that a couple different times and they find themselves wondering how fucking far is the bottom And they feel defective. That somehow reached the bottom that they weren’t ready to quit. 

The reason that it matters  that we address the myth is that getting clean or getting sober or getting into recovery is different for everyone. What gets a person sober is extremely unique. There are some commonalities, and we’ll talk about that in a little bit. But the reason that it matters is that if the idea is that they’ll quit when they hit bottom, that does a couple things. 

One is that it invites a lot of misery. Perhaps someone is considering whether or not they have a problem with a substance. Let’s just pick alcohol. There are a lot of folks that I have heard that actually Googled, do I have a drinking problem?  and the consensus is if you Google, do I have a drinking problem? You probably have a drinking problem. 

Now, this isn’t necessarily alcoholism yet. It’s likely a gray area drinking problem. This gray area, drinking constitutes the middle ground between moderate recreational drinking and alcoholic drinking or addiction.

Believing that they would quit because they hit bottom sometimes makes people feel like they have time. Like they haven’t gotten that bad yet, and so it’s okay and they don’t have to worry.  And that feels like potentially the wrong message, people can get off of this rollercoaster early. They don’t need to wait until they get to the bottom. But I can’t tell you the number of folks that I have heard over the years waiting for the bottom, waiting for this to be enough.  And when it’s not, they figure, well, must not be bottom yet might as well go out and keep using. Which is kind of bizarre, but it is the way that addict thinking works.

I think the idea that people have to hit bottom gives people an opportunity to close the door on trying to make someone get clean or even trying to help them get clean. The idea that it’s out of their hands and it’s not in their control, and that person just has to hit bottom and they’re not there yet. Because it is so confusing and maddening and hurtful and frustrating and all sorts of things. Watching someone that you love continue in substance use. 

Additionally, it’s like people are waiting for the person to hit bottom, to intervene, to say something. They’re trying to bring the floor up. This is what’s behind  things like the show intervention. The idea is that they’ll bring the bottom to the person. 

Where they pull them in front of their family and friends who usually they’re pretty estranged from. They’ll attempt to force the person to listen to the ways that they’ve hurt their family. I understand the drive for this kind of action.

I understand families feeling desperate and wanting to hold up a mirror for their family members of what it’s like to be on the outside. There are some problems with this though.  I just don’t think that interventions are super effective. I think that in that moment you might get someone to agree to go to treatment, and getting into treatment is actually really difficult, which is why intervention has to do a lot of work on the back end.

They gotta foot the bill. There’s a whole bunch of stuff that goes into getting someone into treatment and oftentimes it’s not immediate. What you’ll see on the show, which is actually very true, is that when someone’s ready to seek help, they do need to get help very quickly because the motivation for this drops almost as fast as it rises.

So someone’s in an intervention and they’re sitting in this room and they’re listening to their family and friends telling them how much they’ve been hurt and how worried they’ve been. I think part of what the person ends up feeling is there’s some guilt, I think, but there’s also a heap of shame and shame isn’t a great motivator for change. It is a great motivator to make something stop. That in that moment, you want whatever’s causing the shame to end. You either wanna get out, you want people to stop talking, whatever. Shame makes you want to make it stop.

But once the shame is stopped, once the onslaught of shame has gone away, the reality of what they’re looking for is extremely complicated and I have not found shame to be enough to get people sober. Shame, after all, is paralyzing. Guilt can be motivating. The guilt part is something that I think can be useful.

The idea that person has fucked. They’ve hurt people in their life and they wanna do better. The shame though, that just makes people wanna hide and it makes people wanna continue in whatever behavior was getting them the relief from all of life. And so they wanna numb out. 

You see on the show intervention that they end up having to get the person that moment to go to treatment. That absolutely does not stop anywhere. The bags are already packed. They can’t do anything else. They can’t get away from the people and that there is someone accompanying them on the plane all the way until they are in the door and checked into treatment. Because what they know is that the system can fail at any given point; because shame is not a motivator for change.

Shame it wears off and it stops feeling as powerful when you can get away from it.  The idea is to get the identified person to treatment so quickly that they don’t have time to change their mind. And that once they’re in treatment, that it’s the treatment staff’s job to try to keep them.

Sometimes that’s a super short window. Somebody comes in, they start doing an intake the person gets offended by something that a nurse asks or a counselor asks, and they’re like, fuck this, I’m out. Seen that happen. Sometimes it’s the withdrawal and they’re there for a day and they just can’t take it anymore.

Sometimes they stay through the withdrawal and then they think they’re fine and they can move along their way,  and sometimes they do stay for the duration of an inpatient treatment. 

Addiction is so tricky that it is hard to know how to intervene, and I think that that is behind some of the comments of they haven’t hit bottom yet. Because worrying about what’s gonna get someone sober is exhausting.

There are plenty of stories where people have hit a bottom that brought them to being sober. I’ve shared some of those stories here on the podcast. I’ve shared a story  of a man who ended up in prison at a very young age, finding himself facing felonies, and with the prospect of being able to use drugs in prison.

However, the consequences for using drugs in this particular facility, We’re dire. And for him, he decided that that was enough. So people might think that the bottom was going to prison, but that wasn’t actually the bottom. It was a bottom certainly. It was the farthest that things had gone, the most severe of the consequences. But that’s not what got him sober. What got him sober was not wanting to go through it again, not wanting it to be worse, wanting to get out of prison. It was avoidance of other consequences that got him sober.

We heard a story of a woman whose sobriety came over time as she started to realize what was happening in her life.  That she wasn’t going to be able to keep using pills and living the life she wanted to live.  She’d been kicked out of her master’s in social work program, and that was a bottom certainly. It was one of the most severe consequences she experienced, but that wasn’t the thing that got her sober. 

In fact, it was hearing other people’s stories about addiction and trauma that helped her come to the realization that she had.  It was a much more quiet moment. There are people, of course, who have gotten sober because of a bottom. Years ago there was a woman that visited the treatment center where I worked and she would share her story and her story had a bottom and there were significant things that could have brought her to sobriety if we were looking for the bottom. 

What it ended up being for her is that she was in treatment and trying to find something to shoot into her veins and decided to use Tide. And as you can imagine shooting Tide is, , unwise. And that was her bottom. She realized how desperate she must have been to try to shoot liquid Tide into her veins, and that was the thing that made her realize that she needed to get sober.

Every single story, there is a moment where somebody realizes that things are gonna go bad. Or that things are bad and for every single person it’s super different. There are some common themes that I think probably hold true as things that could potentially help someone get to sobriety. One of ’em is legal consequences. As humans, and as Americans sort of obsessed with freedom, we don’t like the idea that anyone can tell us where to go or what to do or how to do it.

And if you have legal consequences, certainly there are lots of people who have control over you. If you’re incarcerated, they tell you when to sleep. They tell you when to eat. They tell you when to exercise, when to shower. They tell you who you can be around, when you can see the sky, and basically anything else they have control over.

Legal consequences on the outside as opposed to being on the inside are restrictions of your license. In this part of the country, not being able to hunt deer or whatever is a big deal because as a felon, you can’t own a gun. You can bow hunt, but you’re not allowed to use a gun or own a gun. And that is a restriction that people don’t want.  

 Legal consequences as well coming from child protection. People are terrified that they’re gonna get their kids taken.  When child protection does get involved, then they’re terrified they’re gonna lose their rights. And sometimes those are enough to put people on a path towards recovery.  

Another thing that I’ve seen push people towards recovery is the idea of losing a relationship. That perhaps for them it is when somebody gives them an ultimatum that either you quit using or I’m out. Or it could be that their children are no longer gonna be able to see them or don’t want to speak to. 

For other people,  perhaps it’s medical consequences that they don’t wanna have to have a liver transplant. That they don’t want to lose all their teeth. Consequences are important  in terms of addiction and people getting into recovery because consequences make things uncomfortable 

Sometimes those consequences are natural consequences, meaning that they occur no matter where the person is.

They could live in a cabin on the top of a mountain by themselves, and there would still be consequences. For instance, someone could be drinking by themselves every day and they are going to have physical consequences. Getting COPD or emphysema is a natural consequence from smoking. Doesn’t matter who is around, it’s still going to happen 

Sometimes consequences are logical consequences that are enacted by others. So those are given by the police, the court system, an employer or some other form of authority for that person. 

Logical consequences are. This is what the person did, and this is usually legal, but also it could be when it comes to a job, could be put on probation, being put on a performance improvement plan or being fired altogether.

And then there are social consequences, and those are things that are part of our relationships. Whether it’s losing a partner, getting a divorce, children distancing themselves, friends not calling anymore. Whether it’s overt or. A little more hidden. Those are also consequences that can push someone towards recovery.

A lot of times when people are feeling desperate for their loved one to get into recovery, they wanna find a way to make consequences happen cuz they’re hoping to find this kind of magical space where it clicks for their person so that the person can find recovery. I don’t know that this is necessarily a bad thing, but it can be a little bit crazy making. Trying to figure out how to manufacture consequences so that the person will stop doing what they’re doing. And very often people are surprised at what addicts and alcoholics will be willing to put up with in order to keep using. 

The idea that people have to hit bottom is based on the idea that addiction is a choice, and that is a problem because addiction is not a choice. And if you aren’t sure why I would say that . I would encourage you to go to episodes six through 10 of the podcast and listen to me talk about brain science and what contributes to addiction.

Let me be super clear here though, that yes, people choose to use. They absolutely choose to. They don’t choose to get addicted. There are lots of people who have used drugs and alcohol in their lifetime and never got addicted. Is that because they’re smarter? Is that because they were super careful? I don’t think so.

There are lots of people who used to excess and yet it didn’t hook.  What we know is that when addiction gets triggered, there are biological changes in the brain, visible on scans that have changed this person’s biology, making addiction easier to set in, and making it harder to recover from.

This doesn’t even account things that are consequences from the drug itself that also make it more difficult to get sober. For instance, when someone is using meth, in the beginning you can still sleep, you can still eat, you can still do all sorts of normal things, and it doesn’t seem like it’s really doing you any damage. And when you’re high, it feels fucking amazing. Literally six times more powerful and more pleasurable, than anything we could come up with on our own. The best sex of your life doesn’t compare to meth. The happiest, most natural high isn’t even in the same league as what meth is able to create in your body.

This beginning stage where people can still function leads them to wrongly assume that they’re always going to be there, and that they will know when to stop it. What they don’t know that’s happening in the background is that their dopamine receptors are dying. Dopamine receptors exist to raise dopamine levels and if they don’t need to produce dopamine anymore, then they die because they’re not needed. So when someone is flooding their system with dopamine to the point that the dopamine receptors don’t have to function,  then they’re gonna go away.

So then when the person is not high on meth, there isn’t any dopamine production happening and everything feels way worse. It feels gray, and the only thing that brings them any kind of relief is the drug. It’s part of what makes recovering from meth so fucking hard. 

So what is it then? What is my point? What do I want you to come away with?  Here’s what it is. People don’t have to hit bottom. People can get off of this elevator whenever they’re ready. Think about addiction as being an elevator  and the elevator is going down and it’s heading to destruction to death. And I know that sounds dramatic. People either quit or they die. 

Once the addiction has set in and it’s no longer a gray area or recreational or risky or misuse, and we’re now in the addiction realm, they either are going to quit or they’re going to die because there isn’t any other way. People who are in addiction cannot moderate.

They try, but it’s not something they’re able to do, and they have to figure that out for themselves sometimes. And sometimes what was enough to get them sober isn’t going to be enough this time because they still are trying to see if there’s a way for them to use normally. We don’t like not being able to have something. It makes it forbidden and it makes us want it even more. But moderation in people who have addiction, 99.9% of the time does not work.

There are other people who are not in that place who probably can moderate. There are plenty of people who do. I would just submit that they’re not addicts and alcoholics.

Instead of thinking about hitting bottom, I want us to think about it in terms of being on an elevator that people can get off at different floors and then find their way back to where they wanna be. They don’t have to, once they get in the elevator, ride it all the way down. They don’t have to find more misery. They don’t have to find more consequences.  They just have to get off at a different floor. For some people, they are very lucky.  

I count myself as one of those people who was very lucky to get off at an earlier floor. There were many moments in my use history where I could have hit bottom, so to speak. There are events and situations that I was in that were really bad and that I could have been like, fuck this shit, I’m done.  It was a moment no one was even present for. I wasn’t even high at that moment when I decided that I had to get clean.

I was alone in my car, and I was driving around the northern suburbs of Chicago by myself, chain smoking cigarettes and having it out with the God of my understanding, because I was fucking pissed that I felt like he’d been sitting on his hands. That was the night where I started to see that I could get off of the elevator.

Not that it was some cosmic moment where I had an epiphany of some kind. I just was ready. I was ready to see what it would be like to get off at that. . If I had not gotten off on that floor, I absolutely would have kept riding the elevator down. The addiction switch had already been flipped, and so that was a thing that had happened.

Moderation was not going to be something that was possible for me. I am very lucky that I was able to get off at that floor. And I’m not smarter or more clever or  have more wisdom than anyone who didn’t get off at an earlier floor. It was just a circumstance and things were apparently in line to the point that I was able to take that step when those doors opened.

Last month I interviewed a woman named Andrea Owen, and she and I talked a little bit about this . She talked about how she was able to get off at an earlier floor. She absolutely had all the makings of someone who could have been a raging alcoholic. She had the impulsivity, the drive, the novelty, seeking the desire  to quiet the thing in her head that, for her, ended up being about codependency.  Alcohol is effective  when you’re trying to numb out feelings of loneliness and rejection. I’m not saying it’s adaptive, I’m just saying it’s effective. Well, until it’s not, of course.

We heard from my friend Jean McCarthy last September in her recovery story, where she realized that things were going to get really bad and that she needed to do something in order to manage. She tried for years to stop drinking.

She would tell you that every morning she had hope that today would be the day. Now she was able to quit before she lost her husband, her children, and her career. And if you asked her, she would tell you that she’s not special. It wasn’t some sort of. It wasn’t some sort of talent she had to be able to get off at that floor. She just was able to.

Sometimes I wonder if it’s a number of factors, the things that we find, say on the Adverse Childhood Experiences. I wonder if the higher the ACE score, the harder it is to get off earlier. Certainly that’s not something we can necessarily decide or know for sure, but it is something that I just wonder about because I wish I knew the combination to help people exit that elevator before things get really bad.

I feel the desperation. I totally get why people want to bring the floor to.  and my advice for family members is not about what to do to get their person sober. My advice for family members is to protect themselves. Sometimes those boundaries that people have to put up do encourage people to consider their use and why someone is making those boundaries. 

If they’re no longer allowed at a particular place unless they’re sober, that can sometimes lead them to reflection. Or if somebody doesn’t feel that they’re a safe babysitter for their children anymore, that might be something.  I want people to set boundaries because I want them to protect themselves from the chaos of addiction as well as they can.

There’s no chance that addiction doesn’t affect everyone in the family. It does in some way, shape or form. How much destruction it leaves on the rest of everyone’s life that’s the thing I’m trying to prevent. 

 So what does this mean for us? I don’t expect that most of you are gonna specialize in substance use.

Most of you are not here because you’re specialists. I am trying to convince all of my fellow therapists that we can step into substance use pretty far without specializing. This puts us working with people in the middle. People who haven’t necessarily gone to the addiction place and they have a chance to get off at an earlier floor. What matters here is readiness to change. 

How ready are they to change? What signs are you seeing that they might be thinking about it? Because changing isn’t about that day that you make the choice Changing is the whole setup beforehand where they first become aware that this is some shit, and they don’t like it, and they wanna figure out a way around it. And they’re in that contemplation stage, and that’s when a lot of work can get done. 

What are the pros of continuing whatever the behavior is, what is the benefit? What’s the negative side of continuing that behavior? What’s gonna happen potentially down the road even? But then also looking at what’s the negative of quitting that behavior? Because secondary gain is a real thing. Something is holding that behavior up. They’re getting to avoid something.

They’re getting to not have to feel feelings. To put up with things that they shouldn’t put up with. Whatever the case is, there’s gonna be some fallout from stopping a behavior and we wanna be really honest about that. This is the area, though, where we have a lot of chances to really work with people to help them take a look to see what is possible.

People don’t have to hit bottom in order to get sober.  They don’t have to be ready to give it up totally. They just have to be ready to make some changes and to consider what it might be like to do things differently.

If you haven’t listened to the Stages of Change episode, head over to betsy byler.com/podcast and check it out. The Stages of Change are incredibly important when it comes to changing any kind of behavior, and it really does help not get ahead of our clients when we can pay attention to what stage they’re in and make sure that  we are in step with our clients.  Next week on the podcast, we’re gonna be hearing  from a fellow She Recovers member.

She is a relationship coach and is going to be sharing her recovery story with us. I’m excited to share Duffylyn’s story with you, and I hope you’ll join me for that podcast. And until then, have a great week 

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links