The expression, “hit rock bottom,” was popularized by Alcoholics Anonymous and has become part of our common language. Usually it means that a person has reached a point where there is nothing else to lose. There is no lower place to fall to; you’ve reached the rock bottom.

The landing is so painful and jarring, we believe, that it just may be enough to motivate a person to change. Pain can be a powerful motivator, and clearly this is one trajectory that recovery may take.

But I worry about the way the expression makes it seem as if there is some objective standard for what counts as “hitting rock bottom.” Must it always involve the loss of family? Of everything? Of self-respect? Of the respect of other people? There's no one answer.

Furthermore, I worry that people assume that hitting this rock bottom is the only way that people will ever attempt to make significant changes. There’s a belief that hitting this bottom will necessarily prompt a change. This way of thinking may perversely and ironically keep a person from seeking help earlier, when the problem may not be as serious.

Too often I have heard people moving down the continuum of substance-use disorders say, “Well, I never got a DUI. I still have my family and friends. I haven’t lost all that, so therefore I am not an alcoholic or an addict.” This person rationalizes his use by comparing himself to a standard of terribly debilitating or devastating losses that only seems objective and factual. He might tell himself he can't sober up yet because he hasn't reached that bottom.

Just as frequently, I’ve heard friends and families of these same people say, "Well, he’s not hit rock bottom yet. He needs to hit rock bottom before he’ll do anything.” These people are enabling, in an indirect manner, by excusing his continued use. Here, too, is a belief that losing everything will necessarily cause a person to become willing to attempt to change.

If I had my way, I would replace the expression with the concept of “misery threshold,” developed by philosopher/psychologist William James in The Varieties of Religious Experience (1902). A misery threshold is akin to a physical pain threshold. Each person has a threshold for physical pain—some will pop painkillers at the slightest ache while others grit their teeth and refuse any medicine, even when in excruciating pain.

The same holds for misery.

Some people will always incline toward the sunnier side. They can be unhappy and miserable at times, but it takes a lot of emotional pain to push them over the misery line or keep them there. This is not to say that these people are living in some sort of willful ignorance or state of denial, but their optimism is what provides the ballast in their lives. Their equilibrium is restored once they are back on the sunnier side of their line.

A sunny-sider might find herself drinking more than she intends. She begins to move down the continuum of social use to abuse and suffers some consequences that are too painful for her. She sees the connection between her use and her misery, and that prompts her to change her actions.

William James was most interested in people who lived on the darker side. People who are most comfortable or familiar with the dark side suffer from what he calls “world sickness.” This world sickness is progressive, we would say now. People can move from experiencing a little joy in some particular things to no joy in those same things, to no joy about anything, to a growing angst, to abject fear and terror about the world. James understood himself as someone who suffered great despair and pathological melancholy when he was drained of hope, color, and life.

Addicts can experience any or all of these degrees of world sicknesses. There are innumerable forms of suffering connected to addiction; no one stage is emblematic for all. There is no one way or one speed at which addictions and world sickness progress. Some people can tolerate more suffering for longer, and their world sickness may progress at a slow and steady rate or may have bursts of acceleration. The use of some drugs, for example, may lead more quickly to a sort of abject terror and paranoia that is the most devastating form of world sickness.  

The different ways in which addictions progress make the concept of misery threshold more appealing than rock bottom. In response to some loss of hope, some people cross their misery threshold. As a consequence, they may become willing to transform themselves. Others can suffer a significant loss of hope and color in their lives but still stay somewhere in the comfort zone of their misery threshold. Others will need to feel total and complete misery and only then will they consider a different course of action.

Many of us stop our drug use well before we lose jobs, partners, families, and dreams. We crossed our misery thresholds too often or started to feel more comfortable there than we wanted. Instead of occasionally visiting the darker side of our misery thresholds, we started to dwell there. Not wanting to be miserable in these ways prompts us to be willing to change.

Does this mean we haven’t really hit rock bottom? Perhaps we are not really addicted? That’s a very, very dangerous way of thinking.

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