I agree 100 percent with the rest of your comment, and you put it really well….I made need to quote you!

Depending on their length of use, drug of choice, and other health issues, so many addicts are incredibly decompensated in their ability to make rational decisions concerning tapering and withdrawal. Too many family members have been inundated by “black and white” thinking that their approach has got to receive the 12-step stamp of approval or it’s flat out “enabling” and thus should be discarded as faulty. That either/or thinking stymies potential problem-solving approaches.

One size doesn’t fit all addicts, nor does a singular approach only fit just one addict for life. Addiction recovery is recursive in nature, and there needs to be flexibility to reach the addict at his point of need and especially at his greatest point of need.

Bottom-only approaches can be deadly. There seems to justifiably be a right and proper place for various harm-reduction approaches.

I’m so thankful I found this site!

The stages of change theory of behavior change points out that people need to move from pre-contemplation (lack of sufficient awareness and focus on the need to change) to contemplation (sufficient awareness and focus on the need to change) as a precursor to any actual shift in behavior.

Pain can precipitate this shift. So can a profound experience. So can an intervention. So can counseling, especially using motivational interviewing techniques.

It’s a romantic and beautiful thought that the look in a mother’s eyes, or holding your newborn child in your arms for the first time would be enough to magically wipe away addiction. But the truth is it can at best create a strong desire for change.

If the other conditions for behavior change are also in place, recovery may begin in that moment and continue uninterrupted from that point forward.

But if the other conditions for behavior change are not in place, a person who feels the power of the profound experience deeply and sincerely will not experience instant and perfect recovery from that moment forward.

It’s worth noticing how many opiate dependent people already have a strong desire to change.

Many opiate dependent people who are supposedly “in denial” or “need to hit bottom” are already beyond the need for a shift in focus. They already have a desire for change.

But the shift from pre-contemplation to contemplation is often not enough to ensure a change in behavior. It is just a necessary first step.

Other factors have to be addressed too. The person has to see a path to recovery, and have some sense that if they follow the path they will succeed. Any barriers to recovery have to be identified and removed.

Some people will realize the need for change, identify a path to recovery, and follow that path successfully. It may seem like all it took was getting to the point where they “felt” the need for change, or “wanted it bad enough.”

But other people will feel the need to change with the same intensity, but be blocked by barriers to recovery. They often need support in overcoming these barriers.

Over 90 percent of the people who use the syringe exchange program at my workplace (part of comprehensive approach to helping people transition from current injection drug use to recovery) have already identified that their use is problematic.

Their opiate use has long since passed from recreation or experimentation to nightmare.

Most have tried repeatedly to stop using. Most have detoxed repeatedly. Many have been to residential treatment multiple times.

The problem is they have not yet found a path to sustainable recovery that has worked for them. And many have lost the sense that recovery is possible for them.

Some are gathering strength to try again.

This is why hitting bottom is a destructive concept. Because it isn’t necessary for recovery, and it often isn’t enough for recovery.

Yet it is presented by many people who should know better as something that is both necessary and sufficient for recovery to begin.

Even worse, it is often presented as the recovery itself. It is presented as necessary and enough to instantly and permanently end opiate use by an opiate dependent person.

There is another thing that bothers me about the hitting bottom idea. It often damages the opiate dependent person’s sense of self-efficacy (sense that they can succeed) and self-esteem.

It leaves them with the feeling that they are so depraved and beyond hope that even losing custody of their child, or going to jail, or surviving an overdose is not enough to “make” them stop using.

That is a horrible feeling. And the family members and other people around them are left with the same horrible feeling.

The reality is not that they are depraved or beyond hope. Or that the really bad thing wasn’t bad enough. It’s just that experiencing really bad things is not enough to enable them to change.