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. 2017 Oct 15;52(12):1602-1615.
doi: 10.1080/10826084.2017.1293104. Epub 2017 May 30.

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

Affiliations

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

Megan Kirouac et al. Subst Use Misuse. .

Abstract

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.

Keywords: Alcohol use disorder; hitting bottom; hitting rock bottom; recovery; treatment outcomes; treatment seeking.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Parallel analyses for the original 114-item NADIR and the reduced model tested via CFA.
Figure 2.
Figure 2.
Item Characteristic Curves (ICCs) from IRT analyses: left are the original, 114-item NADIR ICCs; right are the 60-item NADIR ICCs.
Figure 3.
Figure 3.
Visual representation of the final factor solution from CFA analyses and original item numbering (χ2 (245) = 6539.549, p < 0.001; RMSEA = 0.069 (90% CI: 0.067, 0.071; CFI = 0.962; TLI = 0.960).

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