"Do they really have to hit "rock bottom"?"
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My son was in and out of treatment for a long time. According to him, he didn’t feel motivated to do whatever it took to stay sober until he hit what he calls his "moment of truth." I think one person's bottom is different from another. For my son, it was the clear realization that he was going to die, and realizing at that moment that he simply wanted to live. But he also has friends who have hit much lower points who did not have that "moment." Another mom told me that "people hit their bottoms when they stop digging." That made sense to me. Addicts can always go lower, so when there is a moment of clarity like my son had, it needs to be seized and followed up with a willingness to ask for help. Otherwise, the moment or "bottom" will pass and be forgotten only to be repeated again in an endless cycle.
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"Rock bottom" is a relative term. For some, their bottom may involve life-threatening situations. For others, it can simply be missing too much work. There is a saying in AA that is often quoted: "You do not have to take the elevator all the way down to the basement – you can get off at any floor." This is true, as bottoms usually involve a feeling of utter hopelessness and despair despite outside circumstances. There are things you can do to make it easier for your loved one to get to this point, such as not enabling them or making it easy for them to continue to live in addiction. The key is not to make his addiction comfortable; that way he has more of a chance to realize he needs help.
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