ELEVENTH HOUR RESCUE –
Nov. 3, 2025 – The mistaken belief that people with substance use disorders (SUDs) must “hit rock bottom” has shaped addiction care for decades. This model contrasts with how medicine manages chronic illnesses, where early detection and proactive treatment are normal. The “bottom” in addiction is a moment of maximum despair and hopelessness. It also may be a life-changing event like getting fired, losing a relationship, or facing legal charges. It could mean a moment between considering changing one’s life or suicide.
For more than 30 years, I have proposed that addiction treatment must “move up the bottom” to reduce harm and have a better chance of working. Applying preaddiction logic holds promise for lowering SUD-related suffering, illness, and mortality. Denying early diagnosis and treatment may primarily stem from addiction stigma.
“Let them hit bottom” was (and is) the refrain in addiction care; suffering supposedly must crescendo before people with an SUD accept the need to stop using drugs. Whether arising from fear of people gaming the system and seeking opioids for fake injuries or the inherent austerity of public institutions, this belief still shapes policy and practice.
