Alcoholics in recovery often talk about the need to hit “rock bottom” before a commitment to treatment will have any possibility of success. Some treatment practitioners don’t really like this idea because they believe, understandably, that intervention should be possible before reaching this stage. What this dispute might show, however, is simply that “rock bottom” means something different to different people.
If we take the phrase at its literal meaning, I suppose it means when you reach the stage where nothing can get worse. Well, yes, but very unfortunately, and too often witnessed, that might mean exiting this world altogether – a point from which no return is possible.
Does it mean, instead, when you’ve lost everything – your job, material possessions, home and family? Sadly, many alcoholics and drug users find themselves ultimately in this position. This is what medical and treatment practitioners have in mind when they say, “it doesn’t have to be this way”.
Perhaps, instead, the sense of a personal rock bottom is just meant to signal the mix of circumstances when the alcoholic is ready or "triggered" to turn around. This might be understood as reaching a point at which there is a balance of pain against pleasure, when the alcoholic is ready to reach out or respond to the offer of help.
What do I mean by this? Consider the problem of memory and relapse. The mind plays funny tricks. When you’ve been through withdrawal and perhaps succeeded in a period of abstinence, something initiates the memory of what you previously deemed to be pleasurable. So you start to imagine that this time it will be different, that you can manage to drink in a controlled manner.
In this situation, it’s almost as though something is not sufficiently bad to provide a memory of pain to place against the memory of pleasure. Behaviourists have a way to look at this and to train us to behave differently. Memory plays a significant part in the formation of habit. We need to change the balance of risk and reward when acting impulsively. This is what countless studies have shown can be achieved in laboratory experiments.
In my case, it was that I didn’t really enjoy the experience of my first full-blown panic attack and tetany. I told the person tending to me that I was “going” and that is what I quite literally believed – that I was dying. That shock was sufficient to put me on the straight and narrow for about three years, with a lot of support and therapy, before I could control the panic attacks. But I still came back for more after five years of sobriety.
When the full- blown panic attacks returned, it meant that I couldn’t easily do the things that I took for granted in a normal life. I couldn’t easily answer the phone at work. I developed a fear of heights. I was uncomfortable in tall buildings and sitting by the window in aircraft. I even recall walking across a bridge and not being able to make it back again.
Finally I made the association between drinking to excess and my illness. After recovery, friends would comment on my sobriety – “we admire your strength in getting well and refusing to drink”. But it was not strength. It was fear. And I didn’t want to live with fear for the rest of my life.
I had reached my own “rock bottom” – the definition that worked for me and turned me around. Whenever I find reminders or people ask me why I don’t drink, I find it easy to answer – I don’t want to go back to that place and there is not a shadow of doubt in my mind that is where I would be headed.
Reaching “rock bottom” is like arriving at a crossroads or a potential turning point, when the alcoholic may reach out for help. We can think of turning around as a form of conversion. Theologians have a Greek term for conversion – metanoia – which has been taken up by psychologists. Interestingly, the literal translation of the word also implies repentance. But what is really going on in conversion is a “transformation” or “renewal” of the mind.
This turning around or conversion involves acceptance and confession in addition to repentance. The process, which needs to be ongoing, is cleansing and liberating. The transformation of the mind involves perceiving and acting in the world in a new way.
How can we help the process of conversion or transformation before it becomes too late? We can help alcoholics to anticipate “rock bottom” through providing teaching and insight. We can be ready to provide treatment, including psychotherapy and drug intervention, if useful. We can better train people to use memory and reasoning. We can try to identify triggers of behaviour and break the habit through Cognitive Behavioural Therapy (CBT), for example.
Most of all, we need to listen. We can use the “rock bottom” as an opportunity – there is openness in the alcoholic at this stage. This is openness to consider a changed attitude to life, perhaps using a spiritual dimension. This does not have to entail religion. Some philosophers would say, as I would, that it takes something like CBT back to its deeper roots in Stoic philosophy.
It’s probably controversial and frowned upon by the medical profession to say that an alcoholic has to reach “rock bottom". It implies inevitability. But it doesn’t mean you have to lose everything – it means that you need to reach a turning point, which will help you to gain everything instead!