Ask an Expert: Do People Have to Hit Bottom Before Getting Help?

By Rita Milios 02/19/15
Today's question is on whether there's a better way to urge a loved one to get treatment besides letting them hit bottom.

My best friend is alcoholic and way overweight and I think he is going to die any day even though he is barely pushing 30. He's a writer, which makes it hard to tell him anything. He'll go out at night and end up lying in the street after the bars close in the Village. I live nearby so I get calls from his drinking buds or sometimes from him to come get him and help him get home (my job lets out just before the bars close) or I will go check myself on him. I've talked blue in the face to him. Nothing. So what's your best ideas on how to deal with this? Let him hit bottom, the AAers I know tell me. But really there must be an alternative to that somewhere. - Chad.


Rita Milios:  This is truly a terrible situation, Chad…for both you and your friend. I know it is painful for you to watch your best friend behave in such a self-destructive manner, and you are rightly concerned for his life. The advice of the “AA people” is hard to take, but it comes from first-hand and hard-won experience. Is there an alternative? Perhaps.

You can (1) accept the reality that your friend has self-determination (as everyone does), and therefore only he can decide what he is willing to do and then take action based on that decision. That is the AA “let him hit bottom” choice. (2) You can continue to be available for calls and late-night rescues. But that sort of enabling only gives your friend the idea that he has “back up” available and therefore he can afford to take more risks, which actually encourages the self-destructive behavior - not what you intend, I’m sure. (3) Another possible option is to try to stage an Intervention. Does your friend have family who would be willing to do this with you?

An Intervention requires a number of people who care about the addicted person (and who he cares about) all getting together at the same time with him and each one in turn expressing to the addict in specific terms how his addiction is impacting their lives. Each person also states firmly that they are no longer willing to accommodate or enable the addictive behavior, and they strongly encourage the addict to go into rehab or seek other professional help to come clean. If the addict has sufficient motivation, and/or he desires to relieve the pain of his loved ones, such an Intervention can be a catalyst for positive change.

Beyond the above options, there is little else you can do. You must reconcile yourself with the fact that this is a situation that you are not in charge of. Each of us has the right to self-determination, even if means we decide to destroy ourselves. You cannot make choices for your friend, so please try to avoid assuming responsibility for his choices, and any consequent outcomes. Inappropriate guilt is a sad and unnecessary burden that helps no one.

I wish all the best for both you and your friend. 



Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training.”    Full Bio.

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