The term “California sober” gained attention after Demi Lovato’s interview on CBS Sunday Morning in March. At the time, the singer said that stopping short of complete sobriety worked well for them in the aftermath of their near-fatal opioid overdose in July 2018.
In the March interview at Lovato’s Los Angeles home, they told CBS's correspondent Tracy Smith, “I think the term that I best identify with is 'California sober.' I really don’t feel comfortable explaining the parameters of my recovery to people, because I don’t want anyone to look at my parameters of safety and think that’s what works for them, because it might not.” They continued, “I am cautious to say that, just like I feel the complete abstinent method isn’t a one-size-fits-all solution for everybody, I don’t think that this journey of moderation is a one-size-fits-all solution for everybody.”
Now, however, Lovato sees things differently. They posted on their Instagram story in December to disavow their "'California sober' ways.” They went on to say, “Sober sober is the only way to be.”
The California Sober Lifestyle
While traditional sobriety is defined as abstaining from any drug or alcohol, the California sober approach is about using certain drugs in moderation.
“In the case of Demi Lovato, [they were] substituting [their] drug of choice, opioids, with other substances, like alcohol and cannabis,” says Patrick Cronin, an addiction specialist at Ark Behavioral Health, which runs rehab facilities in Massachusetts.
Cronin makes a distinction between this approach and the philosophy of harm reduction, which is when someone uses strategies to manage their usage and reduce the harmful or life-threatening consequences of drug or alcohol use.
“By most definitions California sober is not harm reduction,” he says, emphasizing that this approach is more about replacing one drug with another than about minimizing usage.
The term is often attributed to Michelle Lhooq, a writer who published an article on Vice.com in 2019 about streamlining her substance use to improve her health. Lhooq quit all drugs except marijuana and certain psychedelics when she moved from New York to California (one of the states that had legalized marijuana use at the time, hence the name “California sober”). The term “Cali sober,” Lhooq wrote, is also commonly used by people who abstain from all substances except marijuana.
While California sober may be a new colloquial term, people all over have been trying to manage addiction using this approach for years, says Cronin. Cronin himself is in long-term recovery from a history of opioid use disorder; he said he tried the California sober approach numerous times while trying to get clean. “It failed miserably. It always led to relapse.”
Brian Couey, PsyD, director of outpatient services for the Betty Ford Center in San Diego and Los Angeles, says it makes sense that patients with addiction — including people with opioid use disorder — avoid all intoxicants instead of trying to substitute one substance with another or use them in moderation.
All addiction is neurophysiological, Dr. Couey says. This means that addiction does not have as much to do with which substances people use as it does with the person’s biology, psychology, and genetics. It’s more about how a person’s brain reacts to chemicals, such as having tolerance, urges, and cravings, than it is about the specific chemical ingested.
“For people who truly have addiction, complete abstinence works the best for the most,” Couey says. “'California Sober,' or using in moderation, may not produce the results a person is looking for.”
Given the way substances affect mental and physical health, is California sober a recommended approach for some people?
“I like hearing 'moderation' as a specialist,” says Timothy K. Brennan, MD, the director clinical services at the Addiction Institute at Mount Sinai in New York City. Too much of anything can be problematic health-wise, he adds. For example, if you find yourself drinking more than usual, as many people have during the pandemic, reducing your intake is always a good idea. He cautions that for someone with a substance use disorder, treatment is not as simple as replacing one substance with another. “If taking substances like cannabis was a cure for opioid use disorder, we wouldn’t have opioid treatment programs.”
Couey says that some people with a substance use disorder may have a predisposed vulnerability to mind- and mood-altering substances, resulting in other unhealthy behaviors.
“This is why we say that addiction is about people, not any particular drug,” Couey says. “We know that the same brain structures involved in chemical addiction are also at play with other types of disordered behaviors. It’s about the neurophysiology of the brain.”
Gambling addiction is a great example of a nonchemical addiction, which can produce harmful addictive behaviors in those who are most vulnerable, Couey explains. “Behavioral addictions, such as addiction to food, gambling, sex, internet, [and others] are all contingent upon capturing the same neural networks in the brain that chemical addiction does. In fact, a lot of businesses, such as social media companies and fast-food chains, rely on knowledge of these psychological and behavioral principals to ensure that people use their products addictively.”
How Addiction Affects the Brain
Why might using another substance in moderation hamper efforts toward recovery for an addicted individual? One of the reasons is the complex way addiction affects the brain.
“Dopamine is the brain’s main pleasure hormone,” explains Dr. Brennan. “A stimulating conversation, food, drink, sex, or substance use can all lead the brain to release dopamine.” But different substances don’t release the same amount of dopamine. While a person may experience a small burst of the hormone while drinking a glass of wine, substances like opioids lead to extreme surges, hundreds to thousands of times greater, he says.
How does this affect the brain? Brain imaging research has helped scientists map the circuits of neurons involved in relapsing patterns of addictive behaviors. According to a study published in April 2018 in the American Journal of Psychiatry, during intoxication, the drug stimulates large bursts of dopamine, and drug-taking behavior is reinforced by this physiological reward.
For a person suffering from addiction, these dopamine bursts diminish over time, and they need more of the substance to feel the same effects. The circuits controlling the desire for a drug, usually held in check by the prefrontal cortex, which supports rational, healthy decision-making, are also disrupted. This explains why it’s harder for an addicted individual to resist using.
For someone adopting the California sober approach, substituting one substance for another will still hit the brain’s dopamine receptors, says Cronin, but the dopamine release will likely be reduced. For someone with a substance use disorder, this could potentially incite relapse, since the brain craves a stronger reward and healthy decision-making is impaired, he explains.
Am I Addicted? Mild, Moderate, and Severe Substance Use Disorder
“There is no blood test, X-ray, or tissue biopsy for diagnosing a substance use disorder,” says Brennan. Instead, if you’re concerned you have a substance problem, your doctor will ask you some questions drawn from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This uses 10 to 11 diagnostic criteria, or symptoms, to classify a substance use disorder. Symptoms fall into four categories:
- Impaired control, like taking the substance in larger amounts or over a longer period than was intended
- Social problems, like neglecting responsibilities and relationships
- Risky use, like continued use despite known problems
- Physical dependence, like needing more of the substance to get the effect you want (tolerance) or the development of withdrawal symptoms, which can be relieved by taking more of the substance
Those who have two or three symptoms are considered to have a “mild” disorder; four to five symptoms is considered “moderate”; and six or more is considered a “severe” substance use disorder — commonly called addiction.
Could the California sober approach be recommended for someone with a mild or moderate substance use disorder as opposed to a severe disorder?
“I would say absolutely not,” says Cronin. “With my experience and expertise, offering someone to drink alcohol or smoke marijuana to subside another mild addiction makes no sense. There are many different forms of recovery and or treatment. California sober is not something I have seen any facts around or science proving otherwise.”
Brennan strongly cautions against this approach as well, regardless of the severity of someone’s disorder. “I would not recommend this approach to anyone under any circumstance,” he says.
Couey emphasizes that decades of research support evidence-based addiction interventions such as U.S. Food and Drug Administration (FDA)–approved medications, feedback informed treatment, 12-step programs, and cognitive behavioral therapy.
“There is always an appetite to find an 'easier, softer way' to deal with addiction, and this can often lead people down a frustrating path and, for some, using unproven approaches can have very serious consequences,” Couey cautions.
Even if you still feel drawn to Lovato’s previous endorsement of 'California sober' and their sense that there’s no one-size-fits-all solution with a problem as complex as addiction, Cronin recommends that if you’re concerned, talking to your primary physician is always a step toward effective treatment.
“Talk to your doctor and be honest,” he says. “With California sober, relapse is a matter of time.”
And if your thinking shifts over time, as Lovato’s did, don’t beat yourself up, Couey says. “By its very nature, recovery from addiction often entails numerous efforts to self-modulate or moderate one’s use, and many who ultimately abstain do so because those efforts were unsuccessful,” Couey notes. “I do think it’s important to not be dogmatic about sobriety, because each individual is truly unique and needs to make choices that are realistic for them. Nonetheless, I think the endpoint on the continuum of risks associated with 'California sober' — if you’re someone who has addiction — is that a person could end up as a tragic statistic.”
Additional reporting by Lisa Rapaport.