When Prochaska et al did their extensive research on the change process they did not find evidence that a dramatic and traumatic event such as AA’s notion of “hitting bottom” caused people to change their behaviors. What they found instead was that change occurred in six distinct stages:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
In precontemplation people are not even thinking about making a change. In contemplation mode people are thinking about making a change. A trigger is needed to move people from precontemplation to contemplation–we will call this trigger the “tipping point.” However, this tipping point does not have to be something huge and dramatic like AA’s conception of “hitting bottom”; it can be an accumulation of small things or even just one non-dramatic incident. My tipping point for deciding to quit cigarettes was my 5 year old adopted nephew’s insistence that I quit so that I didn’t die like his grandmother had.
Then why does AA talk about the need to “hit bottom”? “Hitting bottom” is a very useful tool when we look at the process of Religious Conversion. Religions with a tradition of intense proselytization such as the Hare Krishnas or the Unification Church (Moonies) seek out people when they are at their most vulnerable, because this is when people are ripe for religious conversion. For example, the Cult Hotline and Clinic tells us that, “Everyone has the potential to be susceptible to cult recruitment and coercion at particularly vulnerable points of their life.
Transitional times tend to increase vulnerability:
- During a vacation
- First year away at school
- A year “off” or after graduation
- A job change or loss
- After suffering any loss
- Upon reaching new life stages
- Following the break-up of a relationship
- Soon after moving to another city or country
- During a search for meaning, or to “find oneself.”
- Lonely, without, or away from friends or family”
http://www.cultclinic.org/qa6.html
Religious proselytization in AA is known as “doing 12th step work.” The 12th step says, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” In fact, the “Big Book” essentially says that proselytizing others is necessary to avoid an alcoholic death: “Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail.” (Big Book p. 89) AA finds ripe grounds for converts by battening on people who have lost wives, or jobs, or who are in prison or hospitals due to their drinking. Since vulnerability makes one ripe for religious conversion it is no wonder that so many AA members speak of how they affiliated with AA after another AA member approached them when they had “hit bottom.”
Can a dramatic and traumatic event such as “hitting bottom” trigger change in the absence of an AA recruiter who fastens onto the vulnerable person? Yes it is possible that the “tipping point” can be triggered by a dramatic and traumatic event. However, it is far more likely that such an event will lead to increased drinking or drug use than it will to stopping drinking or drug use. “Tough Love” approaches which seek to traumatize people in order to make them “hit bottom” are more likely to lead to increased drinking and drugging than to reform. The evidence shows that the more resources which people have intact and the less they are traumatized, the better their chances of recovery. A harm reduction approach which minimizes the damages caused by drugs and alcohol will have far more success in leading people to recovery than will torture therapy. Torture therapy is practiced by sadists and not by the compassionate–they have been with us to prey on the weak, vulnerable, and socially rejected in every generation from the concentration camps of Nazi Germany to the Tough Love camps of the American addiction treatment system. The evidence shows that the normal outcome of addiction is spontaneous remission; torture therapy camps prevent spontaneous remission and lead to greater drug and alcohol use than no treatment at all.
In conclusion, “hitting bottom” is great for leading people to religious conversion and affiliation with AA; however, hitting bottom is not necessary for changing an addiction and may actually lead to deeper addiction instead. AA itself often becomes the new substitute addiction for those who “hit bottom.” By way of contrast, harm reduction enables recovery from addiction.
REFERENCES:
Denning P, Little J. (2011). Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions. The Guilford Press.
NIAAA (2009). Alcoholism Isn’t What It Used To Be. NIAAA Spectrum. Vol 1, Number 1, p 1-3. http://www.spectrum.niaaa.nih.gov/media/pdf/NIAAA_Spectrum_Sept_09_tagged.pdf
Prochaska JO, Norcross JC, Diclemente CC. (1994). Changing for good. New York, Avon Books.
Wilson, W. (1939, 1976). Alcoholics Anonymous. New York: Alcoholics Anonymous World Services.
Wilson, W. (1953). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services.
Copyright © 2012, The HAMS Harm Reduction Network
The Alcohol Harm Reduction Blog 