What does being sober mean? For many, not full abstinence

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

Sobriety became such a core part of Reed's identity that he launched an online dating website called Single & Sober, but in 2020, Reed, a Navy veteran, said he found himself struggling as his sister, who had Down syndrome, was dying of cancer.

Reed, 43, began smoking marijuana. More recently, he went to a clinic for infusions of ketamine and tried tiny doses of psychoactive mushrooms. Reed said those substances improved his mood — and he still regards himself as sober, because he remains alcohol-free.

Notions of what constitutes sobriety and problematic substance use have grown more flexible in recent years as younger Americans have shunned alcohol in increasing numbers while embracing cannabis and psychedelics — a phenomenon that alarms some addiction experts.

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.

“Just because someone has a drinking problem doesn't mean they have a problem with every single thing,” 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 is shifting. Some people call themselves “California sober,” a term popularized in a 2021 song by 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. 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.