- Singer Demi Lovato announced that she is “California sober.”
- “California sober” is an approach to recovery that includes drinking alcohol and smoking cannabis in moderation.
- While this approach is controversial, experts say that some people are able to manage their drug use through harm reduction strategies such as this one, rather than maintaining a completely sober lifestyle.
- However, this approach is not advised for people who have addictive substance use patterns.
In July 2018, singer Demi Lovato had a near-fatal overdose from heroin laced with fentanyl.
During a recent interview on “CBS Sunday Morning,” Lovato said she’s now “California sober,” which means she drinks alcohol and consumes cannabis in moderation.
In the interview, Lovato said she doesn’t believe her approach is the safest for everyone and is cautious about explaining it in detail.
We asked a few experts to share their thoughts on the “California sober” approach for people who have substance use disorders.
Here’s what they had to say.
Vanessa Kennedy, PhD, director of psychology at Driftwood Recovery, said complete abstinence from mind-altering substances that have the potential for addiction is the definition of “sobriety.”
However, she added that an alternative philosophy that Demi Lovato and others might ascribe to is called “harm reduction.”
In harm reduction, a person uses strategies to manage their substance use and reduce the negative or life threatening effects from drugs and alcohol.
“The term ‘California sober,’ i.e., using drugs perceived to be less life threatening than ‘harder’ drugs that could lead to overdose and death, seems to fit under the harm reduction umbrella,” Kennedy told Healthline.
While the approach is controversial, Kennedy said that some people are able to manage their drug use through harm reduction strategies.
Still, others can’t, especially people with addictive substance use patterns.
“Individuals with addiction difficulties usually find themselves unable to manage their substance use either because they are not able to ‘put the brakes on’ when using or because they have life-altering consequences from their use (e.g., overdose, medical problems, worsening mental health problems such as suicide attempts, relationship conflict, job loss, legal problems), hence the need to quit altogether,” she said.
Ernesto Lira de la Rosa, PhD, clinical psychologist and media adviser for the Hope for Depression Research Foundation, said that while treatments for substance misuse have historically been categorized into a one-size-fits-all approach — aka abstinence — other approaches, such as harm reduction, can be considered.
He describes harm reduction as a series of strategies, programming, and approaches with the goal of reducing substance use and the negative effects of substances, while allowing people to practice stable moderation or work toward abstinence.
Lira de la Rosa said that people need an approach that accounts for their own identities, medical history, mental health as well as goals for reducing or cutting back their substance use.
“For some, harm reduction can be one of the steps towards abstinence…[and] can be critical to ensuring that we are taking into account the complex and multifaceted phenomena of substance use,” Lira de la Rosa told Healthline.
Joseph R. Volpicelli, MD, PhD, founder and medical director of the Volpicelli Center and executive director of the Institute of Addiction Medicine, said he asks his patients to consider how stable they are in their recovery from other drugs before using alcohol or smoking cannabis.
For example, he said early in recovery, a person may be ambivalent about remaining abstinent.
“Alcohol intoxication can cloud one’s rational thinking, leading to poor impulsive choices such as drug relapse. Where marijuana is still illegal, its purchase can put one in contact with drug suppliers and easy access to other drugs,” Volpicelli told Healthline.
“Also, people who have a pattern of using alcohol or marijuana with other drugs may experience a craving for drugs when drinking or smoking marijuana,” he said.
If using a drug increases your desire to use more of it, this can create an unhealthy relationship with the substance. It may lead to harmful consequences typically associated with addiction, added Volpicelli.
“So, the use of alcohol or marijuana during recovery from other drugs depends on one’s individual circumstances. Rather than giving people simple answers to complicated issues, I often ask them to consider the consequences of their choices,” he said.
Volpicelli said he might ask patients the following:
- What if the use of alcohol or cannabis increases your risk of relapse, no matter how small?
- What do you stand to lose if you assume it’s safe to drink or use cannabis, and your assumption is wrong?
- If you assume it’s safe to drink or use cannabis and do not relapse, what have you gained?
- Is your relationship with alcohol or cannabis so important that you would risk your life to maintain that relationship?
Answers help him determine whether the patient’s relationship with substances is healthy or not.
However, Volpicelli said that while many people in the addiction community strongly object to the idea that it’s possible to drink or use cannabis with a history of addiction, this sentiment has consequences in compromising trust and discouraging people from starting and staying in treatment.
Kennedy said the circumstances and context regarding when someone misused substances determines whether they can drink or use cannabis in moderation.
She uses the following questions as a guide:
- Were they going through a stressful time and temporarily drank too much with some negative consequences?
- Were they able to moderate drinking appropriately when the stress abated?
- Did they develop a tolerance, have withdrawal symptoms, or have serious physical or mental health consequences as a result of their substance misuse?
- Did drinking or using cannabis lead to using different drugs?
- Does the substance misuse recur repeatedly despite consequences, or was it limited to a particular context, e.g., after a breakup or loss?
- Do friends and family who care about them agree that their substance misuse was temporary or did not lead to serious consequences?
Volpicelli believes that as more is understood about the pharmacology of drugs and alcohol, there is more evidence that addiction can be effectively treated.
For example, Volpicelli explained that a medication that blocks brain opioid receptors, naltrexone, also blocks the alcohol “high” and the cycle of use where one drink leads to another drink.
“Some of my patients who use naltrexone can even drink moderately without returning to problematic drinking. Patients stable in their recovery may use targeted naltrexone and take the pill only before high-risk situations, such as parties or weddings,” he said.
Lira de la Rosa said the best approach to recovery is to talk openly and honestly with a professional, friends, or family members about your concerns.
Find treatment programs, groups, or individual therapy, he said, and learn about substance use and its effects as well as about your cravings and triggers, and build healthier coping skills.
Lira de la Rosa stressed the importance of working with medical and mental health professionals to address substance use concerns “as addiction takes a toll on both physical and psychological well-being.”
Kennedy agrees, noting that outside support that teaches coping tools and predetermined strategies to manage situations when you might typically want to drink or use drugs are helpful.
If your drug or alcohol use constitutes an addiction, Kennedy said many programs offer support and encouragement to stay abstinent.
They include Smart Recovery, Recovery Dharma, and Alcoholics Anonymous or Narcotics Anonymous. There are also “Anonymous” groups for specific drugs, such as Cocaine Anonymous.
“Really good therapy can be very helpful to help you identify triggers, manage intense emotions, and process trauma. There are specific types of therapy used to manage certain issues, and finding the right type of therapy is important,” Kennedy said.