Hitting rock bottom is a phrase I hear all the time when people talk about addiction. “She needs to hit rock bottom to stop drinking.” “Once he hits rock bottom, he will realize the damage that drugs have caused.” “After they hit rock bottom, they will understand how negatively addiction has affected their careers, finances, and families.” These are common phrases I hear when people talk about friends, family, or acquaintances with addiction.

Yet, what does it mean to hit rock bottom? Literally speaking, it means someone has fallen so far — perhaps off a cliff — that they have hit the ground. Metaphorically, hitting rock bottom describes a point in one’s life when they reach a definite low as a result of addiction problems. People generally see it as the lowest point possible, an epiphanic moment or process where one becomes cognizant of their addiction’s destructive nature. This point may be financial, emotional, physical, social, or spiritual.

For example, think about someone who recognizes that they have lost all their life savings because of a heroin addiction. Now they have no money for important milestones such as adult children going to college, or their own retirement. They do not even have money for more drugs. Others may hit rock bottom when they realize that they are diagnosed with cancer or another co-morbidity linked to their addiction. Further, there are those who experience their lowest point when they have lost important relationships in their lives.

There is a major cognitive component to hitting rock bottom. This involves realization. People must realize that they have hit a very low point in their lives. They must experience significant pain — a reaction to the loss of something important such as a marriage or career. Thus they have to judge the personal significance and importance of certain events, persons, or things.

Conversely, not everyone hits rock bottom. Addiction affects individuals in varying ways. Hitting rock bottom does not have a standard or universal marker. Think about hitting rock bottom as being on a continuum. One extreme looks at people who seek help and treatment well before addiction locks its deadly grasp. The other extreme hits a low point, as addiction’s tentacles adversely affect several aspects of their lives.

There are people who fall outside this continuum. There are people who experience cycles of sobriety or abstinence and relapse without falling all the way from the cliff. Some people hover above rock bottom, allowing their addiction to surpass critical levels without really embracing the full effects of loss, pain, and grief directly related to their addiction. These are the people whose rock bottom is death. It is dangerous for loved ones, friends, caregivers, and professionals to assume that those with addiction problems will realize the gravity of their situation when they hit rock bottom. Some people never get the chance to hit rock bottom. Rock bottom can mean death for those who are completely consumed by their addiction.

Is hitting rock bottom necessary if it means complete helplessness for some and death for others? Under the medical paradigm, addiction is a chronic brain disease. It develops over the long term and leads to several health-related complications such as a deteriorating immune system and liver failure.

If we think of addiction like other chronic illnesses, then we can approach it like other chronic illnesses. For instance, osteoporosis, a chronic condition characterized by the degeneration and progressive weakening of bone tissue, is fought well before it can render a person helpless. People do not wait until their bones are so brittle that they realize they have to seek help and treatment. Well before the disease has a stronghold in the body, people are restructuring their lifestyle choices such as nutrition and exercise and getting medical advice and help.

Perhaps addiction can be approached in the same manner, where preventative or management measures are applied before individuals hit rock bottom.