Preaddiction Intervention Could Save Lives

"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. In the early 1970s, I encountered this idea as a medical student."

The mistaken belief that people with substance use disorders (SUDs) must 'hit rock bottom' has governed addiction care for decades. Medicine typically manages chronic illnesses with early detection and proactive treatment, but addiction care often waits for maximum despair or life-changing events before intervening. Moving the 'bottom' upward and applying preaddiction logic can reduce SUD-related suffering, illness, and mortality. Stigma and fears of system gaming, along with institutional austerity, contribute to denial of early diagnosis and treatment. Emergency departments historically refused overdose admissions, while physicians receive structured early intervention and monitoring through physicians' health programs, which produce strong return-to-work outcomes.

Read at Psychology Today