Redefining sobriety: shaking up the field of addiction medicine

Mike Reed, a musician and Uber driver in Arizona, said he quit drinking more than a decade ago when his roommates got so fed up with his unruly behavior that they threatened to kick him out.

Sobriety has become 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 struggles like his sister, who had Down syndrome. , she was dying of cancer.

Mr. Reed, 43, started smoking marijuana. He recently went to a clinic for ketamine infusions and tried small doses of psychoactive mushrooms. Mr Reed said the substances lifted his spirits – and he is still considered sober, staying alcohol-free.

The notions of what constitutes sobriety and problematic substance use have become more flexible in recent years as younger Americans have increasingly shunned alcohol while embracing cannabis and psychedelics — a phenomenon that worries some addiction experts.

Not so long ago, sobriety was widely understood as abstinence from all intoxicating substances, and this term was often associated with people who had overcome severe forms of addiction. Today, it is used more and more, including by people who have stopped drinking alcohol but consume what they consider 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 are viewed as health enhancers by those who use them, adherence to the total abstinence model favored by organizations such as Alcoholics Anonymous is changing. Some people call themselves “California Sober,” a term popularized in the song from 2021 pop star Demi Lovato, who later rejected the idea, speaking on social media that the only way is to be sober.

Approaches that might once have seemed laughable — like treating opioid addiction with psychedelics — have gained wider enthusiasm among doctors as drug overdoses kill tens of thousands of Americans each year.

“The abstinence-only model is very restrictive,” said dr. Peter Grinspoona primary care physician at Massachusetts General Hospital who specialized in medical cannabis and a recovering opioid addict. “We really need to meet people where they are and have a wider recovery tent.”

It’s impossible to know how many Americans consider themselves part of an increasingly flexible concept of sobriety, but there are signs of changing views on acceptable substance use. Since 2000, alcohol use among younger Americans has declined significantly, according to a Gallup poll.

At the same time, the use of cannabis and psychedelics has increased as state laws and attitudes become more permissive, even though both remain illegal under federal law.

A survey found that 44 percent of adults aged 19 to 30 said in 2022 that they had used cannabis in the past year, a record. That year, 8 percent of adults in the same age group said they had used psychedelics, up from 3 percent a decade earlier.

dr. Nora Volkowpsychiatrist who has been leading since 2003 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 addiction is complete and utter sobriety.” Over the years, she said, she realized that was unrealistic for some patients. Reduced usageor replacing highly addictive drugs like opioids with cannabis, can be a decent outcome for certain people, she said in an interview.

“You realize that there are people who are able to recover and yet they are not completely free of every substance,” said Dr. Volkow.

The concept is shaking up the field of addiction medicine. Proponents of the total abstinence model, which includes Narcotics Anonymous, follow a 12-step process it involves turning to a higher power to regain “sanity”. Members often celebrate sobriety milestones with tokens or coins to reflect how long they have been abstinent from alcohol or drug use.

The dangers of opioid and alcohol abuse have become increasingly clear in recent years. But questions remain in the medical community about the risks of some drugs now often touted as health enhancers rather than guilty pleasures — cannabis products to aid sleep, ketamine infusions to treat depression and psychoactive mushrooms to ease anxiety.

Addiction experts say the legal status of cannabis and psychedelics has made it difficult to rigorously study their risks and medicinal potential, even as more people turn to them for self-medication. It brings risks. Some doctors note that cannabis can be addictive. Psychedelic trips can be psychologically destabilizingthey say, and in rare cases they triggered psychotic episodes.

NIDA has none began to support research research into whether psychedelic trips can be effective in treating addiction to other drugs. Dr. Volkow said that while recent clinical trials involving psychedelics are promising, she is concerned that the hype surrounding the therapeutic use of that class of drugs, along with medical cannabis, has outstripped the science.

“It’s clear that for some people the experience with some of these substances can be very revealing, but for others it can be very traumatizing,” she said.

Addiction treatment centers have responded with concern to the changing definitions of sobriety.

Dr. Joseph Leepresident of the Hazelden Betty Ford Foundation, the nation’s largest addiction treatment nonprofit, said people with severe substance use problems are generally the least equipped to make wise decisions about drug use.

“One truth about risk in humans is that we are all very poor at assessing our own risk,” he said. He added that he has become concerned about claims from new cannabis and psychedelic ventures as they compete for business. “They know exactly who they’re targeting, and those people who are being targeted misjudge their risk,” he said.

Maya Richard-Craven, a journalist of Pasadena, Calif., said she’s been thinking a lot about mitigating her risks since entering rehab in 2019 after her alcohol use became a problem.

She said she relapsed in 2020, consumed by anxiety at the start of the pandemic, and later turned to cannabis, seeing it as a healthier way to relieve herself. By 2021, she said she was smoking excessively, “to the point where I wanted to feel nothing.” This prompted her to “down the pipe” and post an essay alert on the risks of California sobriety.

Recently, Ms. Richard-Craven, 29, said she continued to use marijuana, but with greater restraint, usually smoking no more than half a joint at the end of the work day and the rest before bed. She credited cannabis with helping to regulate appetite, improve sleep and, above all, relieve stress after a sexual assault. However, Ms Richard-Craven said she believed people with serious addictions should stay away from all substances for at least the 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 doesn’t doubt that some people who have struggled with addiction can find a healthy approach to substance use, he decided total abstinence was the right answer for him.

Addiction runs in his family, he said, and previous attempts to use drugs in moderation have always failed.

“It’s a disease,” Mr Hunter-Kysor said. “I know myself and I don’t want to play with fire anymore.”

Tiffany Fede, from Austin, Texas, used to hold similar views, but her views changed after 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 had begun years earlier: She watched him like a hawk, convinced his dealer to stop supplying the pills and refused when her husband suggested that taking psychoactive mushrooms might help.

“I put my foot down,” said Ms. Fede, 43. “I was indoctrinated with this belief system that thought it would be harmful.”

Still, Mrs. Fede said, her husband died of a methadone overdose.

Grief-stricken, 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 not feel alone for the first time”.

Ms. Fede said she no longer finds terms like sobriety useful and has stopped thinking of herself as a recovering addict. These days, she said, her use of mushrooms and other mind-altering compounds is deliberate and often ritualistic. They eased her grief, brought her joy and made her a better parent, she said.

“These deep journeys have made me more patient, kinder and more graceful with myself,” she said.

Mrs. Fede said she stopped dwelling on the events that led to her husband’s death. One question still haunts her, however: If she had granted his wish to try curing his opioid addiction with magic mushrooms, would he still be alive?

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