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Tuesday, May 19, 2020

The Myth of 'Rock Bottom' in Addiction Recovery


Often in the world of addiction and recovery, it is said that “you cannot make people change”. While this is true, there is a corresponding belief that therefore people must hit “rock bottom” before being ready to change and commit to treatment. 

Often this refers to extreme hardships as a result of drug use including eviction, loss of a job, strained relationships, even an overdose. While some have shared that an experience like this has brought a moment of clarity to realize they need help, many do not get that opportunity. 

Even more so, many others can and will seek some level of treatment before hitting their relative rock bottom. It is important for help to be made available for individuals wherever they are on their journey, to avoid rock bottom and still promote health, wellness, and recovery.

Do you have to hit rock bottom before entering treatment?

If we are to consider the disease model of addiction, then we must view recovery from it also as such. For other medical diseases, it would be dangerous to wait until “rock bottom” to start treatment. Instead, the medical model seeks to identify and treat illnesses at first detection and recommends preventative practices to avoid the continuation of the disease process. 

Even with chronic illness where a quick cure is not viable, there are still treatments to alleviate symptoms and slow down the progression of the disease. Similarly, substance use disorders are diseases that can increase in severity and cause harm to the individual, families, and communities. Therefore prevention efforts, or interventions that reduce the negative effects, are ideal from both a medical and public health perspective. This is known as the harm-reduction model.

Types of harm reduction treatment

The philosophy of the harm reduction model is to meet people where they stand in the progression of their addiction. This means treating those who struggle with addiction with respect, compassion, and attempt to limit the health, social, interpersonal, and economic consequences associated with drug use. 

This philosophy understands that regardless of efforts, some will continue to use substances, and rather than ignore or neglect these individuals, there are still beneficial interventions that can be put in place. 

This can be a therapeutic approach adopted by clinicians and treatment programs, or be the guiding principle for organizations and agencies. Harm-reduction strategies are not actually a novel idea. Both putting on sunscreen to avoid sunburn and having a designated driver or driving service available when drinking are also good examples of this philosophy at work. 

What does this look like in the community?

Some examples of programs and resources that embody the harm-reduction model are:
  • Medication-Assisted Treatment (MAT) - Also known as an opioid treatment program, these programs provide prescription medications to lower overall opioid use, overdose, and reduce cravings. These programs usually have group and individual counseling as well.
  • Safe injection sites - Facilities that provide medical supervision to prevent overdoses and provide education on safe injection practices, medical treatment, and therapy.
  • Needle exchange programs (NEP) - Community-based programs that offer sterile needles and syringes, and safe disposal. This reduces the risk of blood-borne pathogens and infections.
  • Harm reduction Abstinence Moderation Support (HAMS) Groups - A free, peer-led support group to discuss drinking habits and personal goals for lessening drinking.
  • Managed Alcohol Programs (MAPs) - Treatment facilities for people with chronic alcoholism experiencing homelessness. MAPs will offer small, regular doses of alcohol to prevent withdrawal, as well as provides housing, and seeks to lessen emergency room visits, hospital admissions, and potential lethal withdrawals

Other harm reduction efforts include administering medication to reduce cravings, aid withdrawals, and limit the effects of drugs if one uses.  

Advocacy and awareness efforts are also important, as some can hesitate to support or adopt this model for fear of encouraging use. However, studies show the harm reduction model is effective, safe, and does reduce multiple harmful consequences for individuals, communities, and families.

How you can help

If you have a loved one suffering from an addiction, there are ways you can help. Primarily, let them know you are there for them and seek ways to do so in a nonjudgmental and compassionate way

In keeping an open dialogue, it will be more likely that they can ask for help in the future if they are currently unwilling. Providing local resources can allow them to understand their options for safe use if they are not ready for treatment. 

While each relationship is different and sometimes boundaries and limits must be set, adopting a harm-reduction model can prevent rock bottom and limit negative consequences. It is always good to seek the advice of trained professionals who can address questions and concerns about substance use and explain the treatment options available. By treating those with addiction with respect and compassion, recovery is possible without the looming danger of rock bottom.

Recovery at The Haven

At The Haven, we ascribe to a harm-reduction philosophy. While we work to help our guests understand the costs of addiction, we place equal emphasis on understanding how their use of substances or addictive behaviors makes sense to them. Our goal is to help them see if anything else could make more sense.
Whether it’s seeking the support of our trained staff or seeking more information about the treatment options for your loved ones, give us a call today to learn more!