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Prognosis for Don Draper: Not Good

A study challenges the idea that “bottoming out” makes one more receptive to getting help for an addiction.
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Don Draper in Med Men. (PHOTO: COURTESY OF AMC)

Don Draper in Med Men. (PHOTO: COURTESY OF AMC)

As all Mad Men fans know by now, Don Draper hit rock bottom Sunday night, as the fifth season of the justifiably acclaimed television drama came to a close. His second wife walked out on him, perhaps for good, just before his partners at the ad agency forced him into taking an extended leave of absence.

Draper’s self-destructive behavior—including serial philandering, arrogance bordering on contempt for his colleagues and clients, and propensity to self-medicate to avoid feeling shame—has finally caught up with him. He has reluctantly admitted to himself that surreptitiously adding alcohol to one's morning orange juice is not sustainable behavior. So now he's ready to get help. Right?

Maybe not. A 2007 study published in the journal Drug and Alcohol Dependence questions the commonly held notion that “hitting bottom” is a potent catalyst for getting one’s act together.

“The notion of bottoming out implies that intervention should not interfere with the disease process in that experiencing negative consequences leads to increased motivation to change.”

“Our findings suggest that motivation to change was negatively, not positively, associated with greater emotional distress and problem severity,” writes a research team led by Craig Field of the University of Texas School of Public Health.

Field and his colleagues surveyed 200 veterans who requested substance-abuse treatment at the Dallas Veterans Medical Center. (The group was overwhelmingly male and mostly middle aged; 59 percent were diagnosed as alcohol dependent, while 23 percent were hooked on cocaine.) They answered a series of questions designed to measure their level of addiction, their assessment of their condition and prognosis, and their levels of anger, depression, and anxiety.

The results “do not support the bottoming out hypothesis,” the researchers write. They found “negative associations between motivation to change and current distress,” suggesting that addicts who are in the depths of despair are often unable to summon the will to make the necessary changes in their lives.

“The notion of bottoming out implies that intervention should not interfere with the disease process in that experiencing negative consequences leads to increased motivation to change,” they note. “In contrast, these data suggest that early intervention and reduction of problems associated with substance use may increase motivation to change.”

Well, it’s too late for “early intervention” for Draper. But the study does give him one bit of hope: The researchers found a positive association between “recent life events” and readiness to make a change. So if he takes action quickly, while the twin blows of losing his spouse and job are still fresh, he might be motivated to do the hard work required. If he waits, his odds of success decrease significantly.

If Draper does achieve sobriety, can he stay that way? A 2009 study suggests it won’t be easy. In the Journal of Substance Abuse Treatment, Alexandre Laudet and Virginia Stanick studied 250 substance abusers at the beginning and end of their outpatient treatment. They found that “among the strongest predictors of abstinence” are the level of confidence one has that he or she can can stay clean, along with the realization that a return to addiction threatens one’s health, job, and friendships.

Particularly problematic for Draper is their finding (echoed in other studies) that “the number of 12-step members in one’s social network” is an important factor in staying on the wagon. “Recovering persons consistently report that being around non-using peers is important to their recovery,” they write.

Does Draper have any non-using peers? He’d better find some.