Is Rock Bottom Necessary?

The theory of addiction recovery, especially in 12-step programs modeled after Alcoholics Anonymous, relies heavily on the “rock bottom” trope. This is the notion that until a person is literally lying in the gutter, she or he can’t truly be ready to make a course correction. According to this school of thought, an unbearably awful situation can be motivational when a person forms a resolve to never be in that particular situation again, and feels it so strongly that avoidance of that situation becomes life’s priority.

John McC, the recovering alcoholic who has written so much about the “lizard brain,” offers an insight about how it could work for some people. The base brain is monomaniacally dedicated to the pursuit of alcohol, cocaine, food, or some other thing that brings pleasure, to such an extent that only an enormous dose of pain can knock it off that track. If the world somehow delivers a sufficiently acute agony, the simple-minded lizard brain changes its identity from the pleasure-seeking machine, and switches over to become an entity whose single purpose and focus is pain avoidance.

In John McC’s own story, there was a vague awareness that life would probably end soon. Eviction and genuine street-level homelessness were not enough to nudge him into action, but when a doctor clearly laid out the two choices, “stop drinking or die,” somehow that made an impression.

Even then, the process was mysterious to him. He got on the waiting list for an outpatient treatment program, but hadn’t started to stop yet. One day, he ordered a beer with pizza and then, hardly even fully aware of what he was doing, changed the order to lemonade, and that was the start of the stopping.

Years later, he wrote, “I became convinced that my drinking days were over gradually,” and added:

I don’t really go along with the A.A. idea of “hitting rock bottom”. It seems like they just pick out one worst moment and call that “the bottom”. The reality is that people continue to drink as long as it is fun, and stop when it is more pain than pleasure. Of course people don’t quit drinking when things are good; they quit when things are bad. So however things were just before they quit gets called “the bottom”.

Some people who have experienced A.A. accuse the program of trying to “induce” rock bottom, especially when an intervention is involved. The idea, apparently, is to convince the alcoholic that rock bottom has been reached, which probably is futile because it is an emotional, not a logical, position. An online commenter spoke of resenting the idea that only a “broken shell” is worthy of turning his life around.

Rolf Ankermann, whose books portray A.A. as disempowering and dangerous, believes that death is the only rock bottom and says of A.A:

Many times they arrive because they have been “intervened” or threatened with divorce, the loss of their children in their lives or by a caring EAP program at work. When people are “forced” into rehab, the consequences can indeed be quite dire. It’s not hard to envision some folks coming out of that kind of coercive situation with an “I’ll show you attitude”.

In the realm of obesity caused by eating addiction, some of the people quoted by Childhood Obesity News experienced what might be called a soft rock bottom. For actor Corey Stoll, it was the realization that obesity would relegate him to “character” roles. One man realized that things had to change when he saw himself in his brother’s wedding photos.

Participants in online forums mention such incidents being unable to fit in an airplane seat, or having a chair collapse beneath them. None of those situations is comparable to lying drunk in a gutter, but in all cases, a life circumstance provided the motivation to move in a new direction.

Your responses and feedback are welcome!

Source: “Letters 330,”, 10/26/12
Source: “‘Glee’ Star Dead: Cory Monteith Dies At 31 Years Old,”, 07/15/13
Photo credit: Bob Ramsey via Visualhunt/CC BY-ND

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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