Toward the Operationalization and Examination of “Hitting Bottom” for Problematic Alcohol Use: A Literature Review

Kirouac, Megan; Frohe, Tessa; Witkiewitz, Katie

doi:10.1080/07347324.2015.1050934

Cited by 17 publications

(13 citation statements)

References 59 publications

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“…(ii) Relapse. Quit attempts often occur when individuals hit "rock bottom" [44] and cannot avoid facing the most severe negative consequences of consumption [45][46][47]. Although medical management can ease the effects of withdrawal, it typically remains physically and psychologically painful to endure.…”

Section: Continued Consumption At the Expense Of Other Goods And Despmentioning

confidence: 99%

“Chasing the first high”: memory sampling in drug choice

Bornstein

Pickard

2020

Neuropsychopharmacol.

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Although vivid memories of drug experiences are prevalent within clinical contexts and addiction folklore ("chasing the first high"), little is known about the relevance of cognitive processes governing memory retrieval to substance use disorder. Drawing on recent work that identifies episodic memory's influence on decisions for reward, we propose a framework in which drug choices are biased by selective sampling of individual memories during two phases of addiction: (i) downward spiral into persistent use and (ii) relapse. Consideration of how memory retrieval influences the addiction process suggests novel treatment strategies. Rather than try to break learned associations between drug cues and drug rewards, treatment should aim to strengthen existing and/or create new associations between drug cues and drug-inconsistent rewards.

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Section: Continued Consumption At the Expense Of Other Goods And Despmentioning

confidence: 99%

“Chasing the first high”: memory sampling in drug choice

Bornstein

Pickard

2020

Neuropsychopharmacol.

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“…For instance, individuals who may be ambivalent about treatment may use a formal quantitative measure of hitting bottom to objectively evaluate whether or not their drinking warrants treatment. However, the construct of hitting bottom has yet to be defined operationally and has been studied primarily in qualitative surveys or by asking individuals retrospectively whether they had hit bottom or not (see review by Kirouac, Frohe, & Witkiewitz, 2015). This is particularly problematic as hitting bottom may be perceived as an individualized concept, and individuals may not view his or her “bottom” as warranting treatment.…”

Section: Introductionmentioning

confidence: 99%

“…For example, one individual may perceive his or her drinking as hitting bottom after losing his or her job, spouse, and home, whereas another individual’s hitting bottom may consist of experiencing serious physical problems caused or exacerbated by alcohol use (e.g., liver cirrhosis) that lead the individual to feel a need to change his or her drinking behavior. “Hitting bottom” is a term used to describe a multidimensional, individualized construct that can range from a “high bottom” to a “low bottom” and may be comprised of various components (see Kirouac et al, 2015 for narrative review of historical evolution of conceptualizations of “hitting bottom”). Such components may include: social networks; physical, mental, and emotional health problems; existential issues; situational and environmental factors; and cognitive appraisal (Kirouac et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…“Hitting bottom” is a term used to describe a multidimensional, individualized construct that can range from a “high bottom” to a “low bottom” and may be comprised of various components (see Kirouac et al, 2015 for narrative review of historical evolution of conceptualizations of “hitting bottom”). Such components may include: social networks; physical, mental, and emotional health problems; existential issues; situational and environmental factors; and cognitive appraisal (Kirouac et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

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Identifying “Hitting Bottom” Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR)

Kirouac

Witkiewitz

2017

Substance Use & Misuse

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Background: Alcohol use disorder (AUD) is a costly public health concern; yet, many individuals with AUD never receive formal treatment. Prior studies have identified that “hitting bottom” may be an important factor in seeking treatment for AUD) and the notion that “hitting bottom” is necessary for recovery is commonly portrayed in the popular media. Yet, “hitting bottom” has never been formally operationalized. Objectives: The present article aimed to operationalize “hitting bottom.” Methods: A multiphase process was used to develop a measure of hitting bottom among individuals experiencing alcohol problems: the Noteworthy Aspects of Drinking Important to Recovery (NADIR). Psychometric evaluation of the measure was conducted using online data collected from individuals who identified as moderate to heavy drinkers (N=597). Results: The NADIR included five lower-order dimensions and one higher-order dimension (“hitting bottom”), had strong concurrent validity with measures of alcohol use severity and alcohol-related problems, and was found to have excellent internal consistency reliability (α > 0.90). An overall summary score on the NADIR of 50+ (factor scores>0) differentiated individuals who had previously sought treatment for AUD and reported more excessive alcohol use compared to those with no treatment history and lower levels of alcohol use. Thus, the NADIR with a cutoff of 50 may be a good starting point for future researchers to test as a method to identify individuals who have hit bottom. Conclusions/Importance: The NADIR provides a viable operational definition of hitting bottom. Future research should evaluate the predictive validity of the NADIR.

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“…Alternatively, some individuals who already engage in problem drinking may decrease their alcohol consumption following a negative life event. The experience of “hitting bottom” is frequently a precipitating event that may lead one to pursue treatment for alcohol use (Kirouac, Frohe, & Witkiewitz, 2015, p. 313; Klingemann, 1991). This hitting-bottom event may be followed by developing a greater appreciation for life, greater sense of personal capability or self-efficacy, and identifying a new path for one’s life, referred to as posttraumatic growth (PTG; Tedeschi & Calhoun, 2004).…”

mentioning

confidence: 99%

Stressful life events influence transitions among latent classes of alcohol use.

Hoyland¹,

Latendresse²

2018

Psychology of Addictive Behaviors

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Stressful life events (SLEs) have been associated with an increased risk of heavy drinking, suggesting individuals may use alcohol to cope with negative life events. However, little research has explored the extent to which SLEs have different effects on later alcohol use based on one’s current alcohol use pattern. We replicated prototypical patterns of alcohol use via latent class analysis at Waves 2, 3, and 4 of the National Longitudinal Study of Adolescent to Adult Health (n = 4,569). Latent transition analysis was then used to examine the extent to which SLEs influenced the likelihood of stability or change in class membership from adolescence to early adulthood. Results suggested that adolescents were more likely to transition into different patterns of alcohol use as they entered early adulthood but were more likely to retain the same drinking pattern once in early adulthood. Among those who typically abstained, experiencing SLEs was associated with greater odds of transitioning to heavier drinking or problematic patterns of alcohol use. However, among those who had heavy or problematic alcohol use patterns, SLEs were associated with greater odds of decreasing alcohol use to either heavy or abstaining levels. Results suggest those who previously abstained may begin to use alcohol as a coping mechanism following stressful events, whereas those who drank heavily may decrease or abstain from alcohol use following life stress as a means of enacting positive life changes. The results encourage further study into factors that differentiate changes in alcohol use among light drinkers following SLEs.

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Toward the Operationalization and Examination of “Hitting Bottom” for Problematic Alcohol Use: A Literature Review

Cited by 17 publications

References 59 publications

“Chasing the first high”: memory sampling in drug choice

“Chasing the first high”: memory sampling in drug choice

Identifying “Hitting Bottom” Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR)

Stressful life events influence transitions among latent classes of alcohol use.

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