So then we must ask why 12 step treatment programs are so insistent on people "hitting bottom". Is this because people with the fewest resources become the most fanatical or AA converts? Because people who have a life have better things to do? Is going to AA just a new addiction to substitute for the old addiction?
Conventional 12 step treatment programs merely assure people that they are "free of addiction" when they walk out the door and give clients no tools at all to deal with the reality that most of them will relapse and use drugs or alcohol again. Tons of heroin addicts leave 12 step treatment and try to shoot up their old dose and die of overdose because they were never warned how severely their tolerance had dropped while they were drying out. Warning people about tolerance drop would seem like a minimal harm reduction intervention to save lives. But the folks who love consequences would surely call it "enabling" and sooner see people dead than be "enabled."
Whatever may be the case--the truth seems to be that the best way to help people get a handle on drug or alcohol problems is to help them keep the consequences under control and not to encourage them to "hit bottom". Because "Dead addicts don't recover".
Peele S, Brodsky A. (1991). AA Abuse. Reason. 34-39.