A patient of mine once told me the story of when he "hit bottom" and stopped drinking.  He had promised his wife he would stop drinking but they were headed towards a party and he felt panicked.  He asked her to stop at a grocery store on the way to pick something up, ran in to the store, and searched frantically for anything with a screw top.  As he sat in the bathroom of the grocery store downing a bottle of cheap booze he thought to himself with disgust, "What the hell am I doing here?"  That was the last time he took a drink.

That man didn't need to destroy his marriage

, lose his job, get arrested, or make headlines to come to the realization that he couldn't keep doing what he was doing; but others are not so fortunate.  Charlie Sheen just entered rehab for the third time in the past 12 months and his behavior over the course of the last year has included extreme substance abuse, destruction of property, tens of thousands of dollars spent on prostitutes and porn stars, and loss of his marriage, just to name a few.  Is this the end of substance abuse and sex addiction for him?  Only he has the answer for that; we can hope for him but it may not be.

In 12-step programs, "hitting bottom" is defined as the moment when someone becomes "sick and tired of being sick and tired."  In other words, the pain accrued from continuing the behavior outweighs the pain anticipated from stopping the behavior.  Sometimes family members, therapists, friends, or others will try to "raise the bottom" for an addict by intervening in some way, calling attention to the self-destructive (life-destructive, relationship-destructive) nature of their behaviors.  This can have some success and is certainly worth the effort.  However, repeatedly trying to intervene often leads to frustration and despair, or to a cycle of codependency.  People in an addict's life need to accept that for an addict, just like for anyone under any circumstances, change has to ultimately be internally motivated. 

Change is hard.  There is no way around that.  It takes great courage and usually perseverance.  So as much as any one of us would like to, we can't force someone to get tired enough to "stop digging the hole they are standing in."  And in truth, any moment can be that "bottom."  It could be (and for some, needs to be) a painful, life-changing event; but it could also just be a simple moment of waking up to the reality of your life.

And of course, "hitting bottom" and getting into recovery is only the first step on a long road of every day making a choice to live a different kind of life - a life for which you are fully present and conscious.

Photo by Riccardo S. Savi/Getty Images

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