From your perspective – they're at rock bottom. Their addiction has cost them their career, friendships, home – anything and everything that they ever valued. You can't understand why, at this extremely low point, they still refuse help – they may even still refuse to recognize that they have a problem. But the difficult reality is that, for any number of reasons, they probably have not yet reached rock bottom.

What is "rock bottom"?  It is very likely that the description mentioned above – loss of career, friendships, home – is part of your definition of rock bottom. But these tangible manifestations of the destructive trajectory of addiction are easier to justify in the mind of an addict than you may initially understand. Certainly the loss of all of these defining aspects of identity contributes to an increasingly poor self-esteem on the part of the addict. Indeed, the addict is very aware that they are approaching the bottom: a metaphorically low place. But career success, healthy relationships, homes – none of these is actually required for what the addict is still able to achieve: existence, no matter how bad it may seem to you. The problem is complicated by the mind-altering substance that is controlling them, which replaces these other aspects of the addict's identity. In all likelihood, they are unable to think outside the substance. In other words, the substance has given them a worry-free, or at the very least – a numb – existence, so that what outsiders perceive to have value – like careers, relationships, and homes – has little to no value to the addict, only insofar as it helps them continue their abusive and addictive behaviors. So while the addict is approaching or at the bottom, they have not yet reached rock bottom. Unlike the bottom, which you can see very easily from your perspective, rock bottom is a metaphoric place in the addict's mind where life is not simply less than desirable, but impossible to continue under the current circumstances. In other words, continuing the current lifestyle is so hard that, even if they want to, they can't.

How does an addict reach rock bottom? If an addict is able to successfully continue their addiction, they have no reason to stop – at least in their minds. Because substances can mask the pain that may have led them to experiment with a substance in the first place as well as the losses they may have experienced after the addiction took hold – the only thing that the addict knows or values is that substance. In many cases, addicts don’t reach rock bottom because family, friends, co-workers, neighbors, and others with good intentions enable them to continue their addiction. By cushioning the fall to the rock bottom or hard place, these individuals unintentionally prolong the period before the addict is forced by difficult circumstances to make a decision about their life. Before an addict can break the cycle, the cycle itself must break. That is, something must make the living a life of addiction impossible. In many cases, this means that family and friends must remove themselves (including financial and other support) from their lives.

Is rock bottom the answer to stopping an addiction? Maybe. Some addicts wake up and realize that their current lifestyle is leading nowhere – that they don't want to be spending their days seeking the drug for the rest of their lives. But not all addicts who reach rock bottom have happy endings like an epiphany that makes them resolve to change their behavior. Some feel so low that they attempt to find solace in an extremely high dose of the drug, resulting in an accidental overdose that causes long-term physical or mental damage, or death. Others consider suicide. As mentioned earlier, addicts often have a poor sense of self-esteem. In the same way that other aspects have lost value for them, addicts often believe that they too have lost value. Perhaps the better option is for family and friends to intervene and remind the addict of their value (and to offer a way out) while simultaneously withdrawing any support that would promote or encourage the addiction. Throughout the process, it is important to remember that the addict is not a bad person - addicts are sick people who need help. No matter how frustrated you are or how much they hurt you, in the end, your love and insistence might be what ultimately saves them.

See also:

• Are you an Enabler?
• How Addicts Think
• Who Becomes an Addict?