In the last episode of Demi Lovato’s documentaries “Dancing with the devil,” The singer reveals that she’s not completely sober after her near-fatal overdose in 2018. Lovato said she still drinks alcohol and uses marijuana in moderation and has referred to herself as “California Sober” a controversial and somewhat fluent colloquial language to describe people who do without most substances.
“I know I’m done with the stuff that will kill me,” she said, but completely renouncing alcohol and marijuana is just “preparing to fail”.
The prevailing narrative about addiction is that substance use in moderation is incompatible with long-term recovery. However, some experts argue that addiction understandings in this area are evolving to make room for less rigid, didactic approaches.
“Recovery is a process of change through which people improve their health and wellbeing, lead self-directed lives, and strive to reach their full potential.” according to the Administration for Substance Abuse and Mental Health.
Elizabeth Burden, Senior Advisor to the National Behavioral Health Council, notes that the definition does not mention abstinence anywhere.
“Many experts would agree that there are many routes to recovery and that there are many elements or components of them,” she said. “In some settings, such as 12-step community traditions, abstinence is a key component, but that is not the only definition of recovery.”
“Recovery is not a one-size-fits-all solution”
Lovato said she hesitated to share her substance use out of fear of being criticized and out of concern that someone would make a decision about her own recovery based on hers.
“I also don’t want people to hear that and think they can go out and try to have a drink or smoke a joint, you know?” She said. “Because it’s not for everyone. Restoration is not a one-size-fits-all solution.”
In the documentaries, some people in Lovato’s support system said they understood their desire to explore boundaries while others were concerned about their approach.
Singer Elton John, an outspoken proponent of the AA model, which emphasizes abstinence, has been recovering for more than three decades. He was right in his disapproval.
“Moderation doesn’t work,” he said. “Sorry. If you drink you will drink more. If you take one pill, you take another. You either do or you don’t.”
But some experts say what is true of John may not be true of others.
“If we believe recovery is a self-directed process … then one person’s definition may not fit another person,” said Burden.
Carly Larson is the Opioid Response Coordinator for Rocky Mountain Crisis Partners in Colorado and identifies as a “non-abstinent person in recovery.”
Larson said John’s perspective is the predominant one, although it might reflect bias.
“He probably doesn’t see any success stories because if people successfully moderate their usage, they won’t be in AA anymore,” she said.
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A meta-analysis on the effectiveness of Abstinence versus controlled drinking concluded that “the available evidence does not support abstinence as the only approach to treating alcohol use disorders. Controlled drinking, particularly when supported by specific psychotherapy, appears to be a viable option when an abstinence-oriented approach is not applicable . “
Larson said there is little formalized support for people wanting to try moderation, which often means that people who research can get by on their own.
“Recovery is about living a better, fuller, more meaningful life,” she said. “This can be with or without substances for me. And if you make decisions and make progress in building connections, stabilizing your life, and creating a life worth living, you won’t want to escape that either. You won’t need whatever the void there is with substances. “
Harm reduction as a way to save lives
Harm reduction is a strategy that helps people who use drugs stay healthy and alive. There is often talk of overdosing or preventing HIV and hepatitis C in intravenous drug users.
Harm reduction is usually viewed in the context of formalized programs – methadone clinics and syringe service programs. However, experts say the way Lovato talks about her own moderation could fall under the harm reduction umbrella. Lovato says she stopped using heroin, which is considered a harm reduction strategy.
Collin Reiff, an addiction psychiatrist at NYU Langone Health who specializes in drug abuse treatment, said harm reduction is a broad term that could be viewed as a spectrum, with the other end being abstinence.
“I see it as the long-term goal when the patient is ready. But if I said to every patient I’ve met, ‘Hey, we’re going to be long-term abstinence,’ they’d say, ‘I’m not They don’t want to align with my goals, so I don’t want to get into this treatment, “he said.
Reiff said his job is to meet a patient where he is. People in recovery, he said, often learn in small steps what works and what doesn’t. But he is skeptical of moderation as a long-term strategy and notes it Moderation management can work for a small subset of people who are only struggling with alcohol use disordersHowever, much more research is needed to claim that it is effective or safe for people with a severe alcohol use disorder, a history of alcohol dependence, or other substance use disorders, including an opiate use disorder or addiction.
“There’s a fantasy that goes, ‘Hey, I can get this under control.’ And so these people are often … reasonably, I understand, they are eager to try moderation management. “Let me see if I can control how much I drink or how much cocaine or how much heroin I use.” And that doesn’t work for most people, “he said. “But when you do, the important thing is to really keep track and be honest with yourself and whoever you are working with about your substance use.”
Lovato’s recovery is still full of strangers
Lovato’s disclosure has been praised by mental health professionals, although not all of them agree with her publicly stated approach.
“She is very brave and courageous to find out about her substance use disorder and be public about it,” Reiff said. “I give her a lot of credit.”
But much is unknown about Lovato’s recovery journey, Reiff said. Viewers only see what she has revealed, including her use of Vivitrol, which he thinks reduces the alcohol’s euphoria. Your experience may not be comparable to someone trying to regulate alcohol consumption without it.
“This is her life, this is her experience,” he said. “We don’t know all of the pros and cons of her substance use disorder. We don’t know all the details of her recovery. She is at a certain point in time and I suspect she will move in one direction or the other. Where she is now, it won’t be where it stays. “