Against Rock BottomThere is always further to fall.

Against Rock BottomThere is always further to fall.

Issue 33

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Arts & Culture

Stories about hitting rock bottom appeal to us from an early age. Ex-offenders and addicts are often enlisted to deliver cautionary talks to schoolchildren.

Few places suck readers in like a rock bottom. The media is full of stories of people waking up to find themselves without their job, their home, their family—potentially every marker of security and respect—and then clawing their way back. Why? We are not just voyeurs slowing down at a car crash but storytellers entranced by a strong dramatic arc. We are explorers who want to know what knowledge our fellow travelers have gleaned after crossing the abyss.

But not everyone is enamored with this trope. “The concept of ‘rock bottom’ should be retired from usage,” says Peg O’Connor, author of Life on the Rocks: Finding Meaning in Addiction and Recovery. The idea of “hitting bottom” is particularly entrenched in the fields of addiction psychology and treatment, and yet it is a common misperception that anyone with an addiction will need to experience the shock and estrangement of this metaphorical place before they can truly start on the path to recovery.

There are obvious pitfalls to this approach: One is that a person who hasn’t lost all these things can live in denial about their circumstances for a long time. Another is that the concept of a rock bottom implies there’s nowhere further to fall. “Many people assume there’s some objective ‘rock bottom’ or set of losses or consequences so severe that someone will have no choice but to quit,” says O’Connor. “Unfortunately too many people realize it’s untrue far too late.”

Part of the problem is that extreme stories reinforce the idea that rock bottom is a binary construct—you either are there or you aren’t. For example, people in Alcoholics Anonymous have to admit they are flawed; it’s stigmatizing. But current neuroscience is more inclined to support the idea of a spectrum; the biggest influence is not who we are but when we encounter a substance or activity, and what else is going on in our lives and brains at the time. In the DSM-5, the most recent edition of the psychiatrists’ handbook, for example, the term “alcoholism” is out and “alcohol-use disorder” is in, with subcategories of mild, moderate and severe.

In her book Unbroken Brain: A Revolutionary New Way of Understanding Addiction, the journalist Maia Szalavitz, writing from both expertise and experience, argues that the concept of rock bottom has infected addiction treatment, particularly in the US. Szalavitz calls it a pseudoscience, built up over decades by AA, where it’s seen as the catalyst to get people onto the 12 Steps.

The concept also echoes through other “tough love” treatment approaches, as well as the punitively inclined justice system; think of the way loved ones who offer material or emotional support are branded enablers. “If addiction were truly seen as a medical disorder, we’d see it as sick and twisted to try to ‘disable’ people who have it,” says Szalavitz. “If the concept of ‘enabling’ were accurate, then providing clean needles and prescribing heroin would make people stay addicted forever—in fact, these methods are both linked with faster recovery, not longer addiction.”

That’s not to guilt people who have had to cut off an addicted family member or friend—sometimes it’s the best way to keep yourself, and others in your life, safe. But empathy, support and community are approaches backed up by evidence.

The way forward, minus the detour to the bottom? “If we want to overcome any type of addiction, we need to start looking at why we engage in the behavior,” says Szalavitz. “It’s usually because of despair, trauma or mental illness. Once you look at and treat the source problem and teach people tools for avoiding relapse, recovery becomes possible.”

At a time when conversations about mental health are part of the mainstream, the stories we tell about ourselves and other people matter. The rock bottom trope features in some riveting, instructive and inspiring yarns. But it’s not the only tale in the sea.

Stories about hitting rock bottom appeal to us from an early age. Ex-offenders and addicts are often enlisted to deliver cautionary talks to schoolchildren.

You are reading a complimentary story from Issue 33

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