Do You Have to Hit Bottom to Get Help for Alcoholism?

Do You Have to Hit Bottom to Get Help for Alcoholism?

Does a person have to hit bottom to get help for alcoholism or …?

A reader recently commented on one of my blog posts stating she agreed that alcoholism is a non-choice but questioned whether the disease is to blame for a person not getting help. I thought it was an excellent question as it also addresses one of the common myths about alcoholism that a person has to hit bottom before they can get help. So I decided to expand on my reply to her in this post to address two questions, “If a person doesn’t choose to be an alcoholic, can they choose to get help?” or said another way, “Do you have to hit bottom to get help for alcoholism?” and “What, if anything, can a family member do to help them choose help?”

Alcoholism is a Developmental Disease and the Person With the Disease Does Not Have to Hit Bottom

Before I answer these questions, I wanted to comment on the point about whether alcoholism is a choice. The answer is a solid, “NO!”

"If a person doesn't choose to be an alcoholic, can they choose to get help?" or said another way, "Do you have to hit bottom to get help for alcoholism?" and "What, if anything, can a family member do to help them choose help?"

“If a person doesn’t choose to be an alcoholic, can they choose to get help?” or said another way, “Do you have to hit bottom to get help for alcoholism?”

No one chooses to become an alcoholic, rather alcoholism – one of the chronic, often relapsing brain diseases of addiction. It is a developmental disease, and it starts with alcohol misuse (aka alcohol abuse). It is the misusing of alcohol that starts the chemical and structural changes that make one person’s brain more susceptible to the five key risk factors for developing alcoholism than another person’s brain, even though both engage in similar drinking patterns.

The five key risk factors include: genetics, early use, social environment, mental illness and childhood trauma. This post explains, “Want to Prevent Addiction? Assess Your Risk Factors.”

To be clear, however, a person can stop the progression at any time – any time. They can also decide to stop the use of the alcohol to which they are addicted at any time – any time. Sadly, time and again, it’s the stigma and shame attached to “being an alcoholic” and the general belief that all you have to do is “just Stop!” Both are the result of the general societal lack of understanding about the brain disease of alcoholism, why relapse is a hallmark of the disease and what it takes to treat the disease – in other words, to heal / re-wire the brain.

This post addresses the point of the label, “Do You Have to Call Yourself an Alcoholic to Get Sober?” This short video explains the distinction, “Alcoholism is a Disease and It’s Not Alcohol Abuse.” And, this post covers 7 key concepts about alcoholism (one of the diseases of addiction) that are commonly misunderstood or not known, “7 Sound Bites to Update 2014 Conversations Around Addiction.”

What Can a Family Member Do to Raise a Person’s Bottom, in other words To Choose to Get Help

Getting help is a choice, and what helps a person with making that choice is if everyone in that person’s sphere gets on the same page about what it is they are dealing with and the decision to fight excuses with facts. However, it’s equally important to remember the person has a brain disease that confounds “thinking,” so the way to address it is to talk about the drinking behaviors when that person is sober. It’s critically important to recognize the person is still the person – even if they drink – but it’s the behaviors they exhibit when they drink that are the problem.

It’s also important the family member stop blaming, shaming and/or calling them an alcoholic because that’s like a family member calling a loved one a canceric because the family member has decided they have cancer or blaming or shaming a loved one with cancer for having cancer. Just stick with, “I’m really concerned about the behaviors you exhibit when you drink, for example __________(fill in the blank).”  You might request they get an evaluation by a qualified professional – the same way you’d want them evaluated [and so would they] if they had cancer. You might let them know you’ve been researching to learn more about what drinking behaviors are all about – what is it about drinking alcohol that makes a person change so much – and then ask they read some of what you’ve been learning, such as this post, for example, or the information I share next.

Another approach is for the family member to first read and then share with their loved one (when sober) the World Health Organization’s anonymous assessment, called the Alcohol Use Disorders Test (AUDIT), and ask if they’d answer the ten questions to see what they (the person exhibiting drinking behaviors) thinks. Or, they (the family member concerned) can do it themselves and then tell their loved one they’ve done it and based on it, they’re very concerned about their drinking pattern.

In the meantime, the concerned family member may want to assess treatment options to suggest in the event their loved one does ask for help, but one key part of that is whether their loved one has a co-occurring mental illness, in which case, that’s a whole other treatment process (check out this post, “Co-ocurring Disorders Require Co-ocurring Treatment) or unresolved / untreated trauma because these require their own treatment protocols, and if left untreated are often the reason a person relapses. These two resources can help with researching treatment options: NIDA’s “Principles of Effective Treatment” and SAMHSA’s Treatment Facility Locator.

Lastly, but as importantly, if not the most important part of this post, is to stress the importance of the family member getting their own help. Coping with a person’s drinking behaviors and alcoholism, something I refer to as Secondhand Drinking, can be crazy-making and eventually sets up The Dance of the Family Disease of Addiction.

Another tremendous resource for families is the recently released book, A Guide for Families, Beyond Addiction: How Science and Kindness Help People Change, written by Jeffrey Foote, Ph.D., Carrie Wilkens, Ph.D., and Nicole Kosanke, Ph.D. These authors are also Directors (and Foote and Wilkens, co-founders) of the Center for Motivation and Change, which offers Community Reinforcement and Family Training (CRAFT). CRAFT helps motivate the alcohol user to seek help and helps the family take care of their own needs and is especially effective because it aims for a healthier, better life for all that is sustainable over time, not just as a way to “get the alcoholic into rehab.”

Bottom Line

It’s complicated. A person does not choose to become an alcoholic, but it is still up to them to choose getting help. At the same time, those in their life don’t have to let them “hit bottom” – that bottom can be raised when all understand what’s going on and deal with it from a scientific, supportive place.

Please feel free to call me at 650-362-3026 or email me at (no charge) if you have further questions.

© 2014 Lisa Frederiksen

Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.
Lisa Frederiksen

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22 Responses to Do You Have to Hit Bottom to Get Help for Alcoholism?

  1. Beth Wilson says:


    I continue to be amazed by the way you button up these complicated issues. You see the depths and yet explain things like brain science in language understood by all.

    Our field is indebted to you, as am I.

    Also grateful to hang out in cyberspace with ya!

    Hugs to you!

  2. Susanne Johnson says:

    Excellent article about a very important question, Lisa. Thank you for posting this one. There is one dilemma, that every alcoholic (or addict) face at a certain point: It is the realization, that there is a problem. The thought might be ‘I can’t continue to drink, but I can’t stop drinking’ or he sits in front of a glass and think ‘I gets worse with it, but worse without it’. There is this ‘Now What???’ moment. But it is one of the hardest thing to come up with a conscious decision for an addict or alcoholic alone. He usually need some type of help or consequences from outside to make this happen. The pain of using and drinking has to seem bigger than the pain of giving it up.
    The realization that something needs to be done is an excellent point, where family or an interventionist can help, support and overcome fears. As an Interventionist I can meet the alcoholic or addict at any point of the addiction, hopefully before all is lost, family ties ruined, health suffers etc., the earlier the better.
    Give a helping hand to those who are stuck in this disease, often it needs just a little support to help someone to get out of this downward spiral. Recovery is a process, not an event, so are the decision and thoughts. Don’t give up on your loved ones, read books on how to support the process and if needed, get professional help. Family members are often emotional to involved in the addiction process to go through with consequences. Get help on this and be willing yourself to support the process. Recovery is possible at any point of addiction.
    My thoughts are with all those who still refuse help and their loving families. Recovery and sobriety look scary, but they are so rewarding and it is easier than you might think. Give it a try!
    Susanne Johnson, CAI
    Metropolis, IL

  3. mary says:

    My teenager is exhibiting addictive behaviors, I am worried as alcoholism and mental illness run in the family,what do you recommend?

    • Hi Mary – thank you for contacting me as it’s so important you act now. Please give me a call at 650-362-3026 or email me at – there’s no charge for this, BTW – we can then talk about what you’ve tried, how long, next steps, etc. So glad you reached out!!

    • Susanne Johnson says:

      Mary, it is so wonderful that you consider talking to an expert at an early stage or maybe even false alarm, especially since you know about history in your family. It is really important to have a close look to find out, what is going on. Call Lisa, she can tell you more about your concerns and worries and show you possibilities. Addiction discovered in an early age and stage can be treated successful and often without experiencing major consequences in life yet. I’m so glad you reached out and I like to encourage more parents to do the same, if they are not sure about certain behavior of their loved ones. Recovery is possible at any age, stage, drug of choice or process addiction. Don’t let any stigma discourage you to seek help and advise.

      Susanne Johnson, CAI
      Metropolis, IL

  4. […] Do You Have to Hit Bottom to Get Help for Alcoholism … […]

  5. Amy says:

    Hello I have tried to help my mother for the last several years with finding a place that can help her and will take her. She has been sent home twice from rehab centers for not being clear enough after a 3 day detox so they have said for her to go home and come back when clear. This has been two places now and both have been out of state so it was not easy to get her to them and then to bring her back in such short time was heart breaking for all involved. I have not heard of this before and really dont know what to do now.

  6. This is such an in depth explanation, Lisa. I was thinking about CRAFT as I read your discussion about family members and was happy to see you mention Beyond Addiction. The book has wonderful tools and strategies for parents as does The Parent’s 20 Minute Guide. I always appreciate reading your thorough information. Thank you for all that you do!

    • Thank you, Cathy – and for readers information – Cathy is trained in the CRAFT program by The Center for Motivation and Change – she’s a terrific resource for parents struggling with their child and his/her substance use.

  7. Kyczy Hawk says:

    This is such a frustrating aspect of the disease! I kind of think of it this way: I can’t make another person “SEE” the bottom, but I don’t have to make the landing softer each time they hit. I saw it with my mom, myself and my son. Removing consequences never helped. The point you make about the family member getting help for him / her/ themselves is hugely important. I didn’t know much as a child but I sure know more when my son faced his own addiction. I also knew enough when I stepped into recovery that my kids would need help and I sought it immediately. They had as much to recover from as I did and it was not of their making / their “choice”. I wanted them to have MORE CHOICES by learning about their responses and behaviors as much as about my disease. They have had a journey of wellness themselves.

    • This line describes it perfectly, Kyczy – “I can’t make another person “SEE” the bottom, but I don’t have to make the landing softer each time they hit.” And I absolutely agree with you, the family member has as much to recover from as the person with the disease. I’d no idea how my mom’s alcoholism had affected me, nor how that, in turn, affected my relationships with other alcoholics in my life, all of which in turn changed me radically, changes that in turn deeply affected my own daughters – in other words, I had a secondhand drinking impact on them independent of the impacts of the alcoholics in their lives. I did the same thing as you did and got my children help with their own addiction-specializing therapists – all three of us had our own – and then we slowly started to mend as we found our way to self and that in turn had a huge impact on our relationships with one another. As you described it, all three of us have had a journey of wellness, and it’s made ALL the difference in the qualities of our lives, today. Thanks so much for sharing your thoughts and experiences!

  8. Herby Bell says:


    I’d like to “second” Beth’s great words in how you “button up” what can be complicating and do it with your seemingly endless resources. Thank you.

    I’m also taken aback by how addiction falls prey to our sick care, “wait for ghastly symptoms–then act” approach. You offer very healthy and integrated suggestions for something different. Your much appreciated advice points toward a time when more of the symptom bearers, family members and communities affected by addiction can further assist in a well educated and early intervention scenario–hopefully not too far off in the future.

    Another keeper and thanks again.

    • Boy I’m with you there, Herby – “taken aback by how addiction falls prey to our sick care, ‘wait for ghastly symptoms-then act’ approach,” and admire the work you do to mainstream the concept that addiction recovery is wellness and wellness is a holistic approach to mind, body and spirit health. Thank you for adding your comment!

  9. You know, you pose a great question, Lisa. And you reason it out well. I, for one, don’t believe one has to hit bottom to get help for alcoholism. That comes from personal experience, actually. When I knocked it off some 30 years ago, things were certainly not going well; however, I don’t think I’d hit bottom – there was plenty more damage I could have done. Thing is, I decided I’d had enough – and didn’t want to face the consequences of continued drinking and associated behaviors. That was that, and that was that. And you know, I firmly agree with you – one doesn’t choose to become an alcoholic. I mean, I can tell you for sure it’s a matter of the genetic and environmental stars lining up, and off we go. You’re always bringing us thought-provoking information, Lisa. Thank you for continuing to help…

  10. Tammy Blyden says:

    After being married to an alcoholic, I learned the person must choose to get help – in other words, you can lead a horse to water but can’t make him drink it. The choice to drink alcohol takes precedence and I also discovered some people choose to never get help. My second husband was also married to an alcoholic and it recently lead to her death. He does not drink at all as a result and I am a social drinker with strict limits. It definitely has an impact on you life after you live with an alcoholic.

    • Thanks so much for adding your comment, Tammy, and you’re right, in spite of all the support, understanding and healthy boundaries set by those who love a person with this disease, it’s still up to that individual to seek/accept help. Hopefully in the process, the family member(s) also find the help they need to recover from the hugely significant impacts they’ve experienced while coping with their loved one’s drinking behaviors.

  11. Amy says:

    I really enjoyed this article. I found this article just by simply searching google. I am really enjoying clicking through all of the resources that are laid out on this website. Thank you!

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