For Many, Not Full Abstinence.
Sobriety became such a core part of Mr. Reed’s identity that he launched an online dating website called “Single & Sober,” but in 2020, Mr. Reed, a Navy veteran, said he found himself struggling as his sister, who had Down syndrome, was dying of cancer.
Mr. Reed, 43, began smoking marijuana. More recently, he went to a clinic for infusions of ketamine, and tried tiny doses of psychoactive mushrooms. Mr. Reed said those substances improved his mood — and he still regards himself as sober, because he remains alcohol free.
Not long ago, sobriety was broadly understood to mean abstaining from all intoxicating substances, and the term was often associated with people who had overcome severe forms of addiction. These days, it is used more expansively, including by people who have quit drinking alcohol but consume what they deem moderate amounts of other substances, including marijuana and mushrooms.
“Just because someone has a drinking problem doesn’t mean they have a problem with every single thing,” Mr. Reed said.
As some drugs come to be viewed as wellness boosters by those who use them, adherence to the full abstinence model favored by organizations like Alcoholics Anonymous is shifting. Some people call themselves “California sober,” a term popularized in a 2021 song by the pop star Demi Lovato, who later disavowed the idea, saying on social media that “sober sober is the only way to be.”
Approaches that might have once seemed ludicrous — like treating opioid addiction with psychedelics — have gained broader enthusiasm among doctors as drug overdoses kill tens of thousands of Americans each year.
“The abstinence-only model is very restrictive,” said Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital who specializes in medical cannabis and is a recovering opioid addict. “We really have to meet people where they are and have a broader recovery tent.”
It is impossible to know how many Americans consider themselves part of an increasingly malleable concept of sobriety, but there are indications of shifting views of acceptable substance use. (...)
Dr. Nora Volkow, a psychiatrist who since 2003 has led the National Institute on Drug Abuse, a division of the National Institutes of Health, said she was trained to think that “the only way out of an addiction is total and full sobriety.” Over the years, she said, she came to see that as unrealistic for some patients. Reduced use, or replacing highly addictive drugs like opioids with cannabis, may be a decent outcome for certain people, she said in an interview.
“You come to realize that there are people that are able to recover and yet they are not absolutely free of every substance,” Dr. Volkow said.
Weighing Risks
The concept is shaking up the field of addiction medicine.Adherents of the full-abstinence model, which include Narcotics Anonymous, follow a 12-step process that includes turning to a higher power to regain “sanity.” Members often celebrate sobriety milestones with tokens or coins to reflect how long they have abstained from using alcohol or drugs.
The danger of abusing opioids and alcohol has become increasingly clear in recent years. But questions remain in the medical community about the risks of some drugs now often touted as wellness enhancers rather than guilty pleasures — cannabis products as sleep aids, ketamine infusions to treat depression, and psychoactive mushrooms to ease anxiety.
Addiction treatment centers have responded with concern to the shifting definitions of sobriety.
Dr. Joseph Lee, the president of the Hazelden Betty Ford Foundation, the nation’s largest nonprofit addiction treatment provider, said that people with severe substance use problems are generally the least equipped to make wise decisions about drug use.
“One truth about risk in people is that we all do a very poor job of assessing our own risk,” he said. He added that he had grown concerned about claims from new cannabis and psychedelic ventures as they compete for business. “They know exactly who they are targeting, and those people who are being targeted are misassessing their risk,” he said. (...)
Individual Paths
Maya Richard-Craven, a journalist from Pasadena, Calif., said she has thought a lot about mitigating risk since she went to rehab in 2019 after her alcohol use became a problem.
She said she relapsed in 2020, consumed by anxiety early in the pandemic, and later turned to cannabis, regarding it as a healthier way to take the edge off. By 2021, she said she was smoking excessively, “to the point where I wanted to not feel anything.” That prompted her to “put down the pipe” and publish an essay warning about the risks of California sober.
More recently, Ms. Richard-Craven, 29, said she has resumed using marijuana but with greater restraint, typically smoking no more than half a joint at the end of the workday and the rest before bedtime. She credited cannabis with helping regulate her appetite, improving her sleep and, most of all, easing distress after a sexual assault. Still, Ms. Richard-Craven said she believed people with serious addictions should steer clear of all substances for at least their first year of recovery.
“That first year, you’re all over the place,” she said.
Others, like Connor Hunter-Kysor, 29, of Philadelphia, said that while he does not doubt that some people who have struggled with addiction can find a healthy approach to substance use, he has concluded that full abstinence is the right answer for him.
Addiction runs in his family, he said, and past efforts to consume drugs in moderation always failed.
“It’s a disease,” Mr. Hunter-Kysor said. “I know myself and I don’t want to play with fire any longer.”
Tiffany Fede, of Austin, Texas, once held similar views, but her outlook changed after her husband died in 2020.
Seeing him struggle with opioid addiction, Ms. Fede said she did what she had learned in the addiction recovery circles where their romance began years earlier: She watched him like a hawk, persuaded his dealer to stop supplying pills and balked when her husband suggested that taking psychoactive mushrooms might be helpful.
“I put my foot down,” said Ms. Fede, 43. “I was indoctrinated by this belief system that held that that would be harmful.”
Still, Ms. Fede said, her husband died of a methadone overdose.
Grieving, Ms. Fede said she began using magic mushrooms herself, an experience that led her to recalibrate her approach to mind-altering substances. Ms. Fede said she took three grams of psilocybin mushrooms, a trip that “helped me to not feel lonely for the first time.”
Ms. Fede said she no longer regards terms like sobriety useful and has ceased to think of herself as a recovering addict. (...)
Maya Richard-Craven, a journalist from Pasadena, Calif., said she has thought a lot about mitigating risk since she went to rehab in 2019 after her alcohol use became a problem.
She said she relapsed in 2020, consumed by anxiety early in the pandemic, and later turned to cannabis, regarding it as a healthier way to take the edge off. By 2021, she said she was smoking excessively, “to the point where I wanted to not feel anything.” That prompted her to “put down the pipe” and publish an essay warning about the risks of California sober.
More recently, Ms. Richard-Craven, 29, said she has resumed using marijuana but with greater restraint, typically smoking no more than half a joint at the end of the workday and the rest before bedtime. She credited cannabis with helping regulate her appetite, improving her sleep and, most of all, easing distress after a sexual assault. Still, Ms. Richard-Craven said she believed people with serious addictions should steer clear of all substances for at least their first year of recovery.
“That first year, you’re all over the place,” she said.
Others, like Connor Hunter-Kysor, 29, of Philadelphia, said that while he does not doubt that some people who have struggled with addiction can find a healthy approach to substance use, he has concluded that full abstinence is the right answer for him.
Addiction runs in his family, he said, and past efforts to consume drugs in moderation always failed.
“It’s a disease,” Mr. Hunter-Kysor said. “I know myself and I don’t want to play with fire any longer.”
Tiffany Fede, of Austin, Texas, once held similar views, but her outlook changed after her husband died in 2020.
Seeing him struggle with opioid addiction, Ms. Fede said she did what she had learned in the addiction recovery circles where their romance began years earlier: She watched him like a hawk, persuaded his dealer to stop supplying pills and balked when her husband suggested that taking psychoactive mushrooms might be helpful.
“I put my foot down,” said Ms. Fede, 43. “I was indoctrinated by this belief system that held that that would be harmful.”
Still, Ms. Fede said, her husband died of a methadone overdose.
Grieving, Ms. Fede said she began using magic mushrooms herself, an experience that led her to recalibrate her approach to mind-altering substances. Ms. Fede said she took three grams of psilocybin mushrooms, a trip that “helped me to not feel lonely for the first time.”
Ms. Fede said she no longer regards terms like sobriety useful and has ceased to think of herself as a recovering addict. (...)
Ms. Fede said she had stopped obsessing over the events that led to her husband’s death. One question, though, continues to tug at her: If she had indulged his desire to try treating his opioid addiction with magic mushrooms, would he still be alive?
by Ernesto Londoño, NY Times | Read more:
Image:Meridith Kohut for The New York Times
