One Wrong Step

Welcome to "The Tuesday," a weekly newsletter about politics, language, culture, and, apparently, celebrity gossip. To subscribe to "The Tuesday," follow this link.

Some Varieties of Addiction

Because I am blessedly insulated from many aspects of pop culture, I know the name "Demi Lovato" only from a (typically) brilliant Remy parody. But now that I know her name, I have acquired another more interesting pair of words: "California sober."

Lovato, for those of you who are similarly insulated, is an American pop singer who found her way into the tabloid headlines after overdosing on a heroin-fentanyl cocktail in the summer of 2018. The overdose was horrifying, and she still cannot drive a car because of vision loss associated with brain damage. She has since sought treatment for her drug problem and describes herself as "California sober," a tongue-in-cheek term of recent coinage that entails abstinence from so-called hard drugs such as heroin and cocaine but the continued moderate use of marijuana and/or alcohol. "California sober" accords with an approach to substance abuse broadly known as "harm reduction," which focuses on preventing the worst kind of self-destructive behavior associated with drug use rather than the criterion of absolute abstinence.

Lovato has come under criticism for her use of the term, both from addiction professionals (by which I mean doctors and therapists, not the other kind of addiction professional) and from recovering addicts who protest that to speak of qualified sobriety is an "insult" to those who practice a more total form of abstinence. There is a certain kind of American who always is looking for something to be insulted about. Many of them have New York Times columns.

Addiction recovery exemplifies several American tendencies. One is our ability to make an ersatz religion out of practically anything (count me with David Foster Wallace among those who believe that Alcoholics Anonymous is pretty obviously a cult, albeit a largely benign and well-intentioned one). Another is our ability to make a business out of anything (turnover in the addiction business is estimated at $42 billion a year in the United States). And a third is our ability to make Kulturkampf out of anything.

Human beings are storytelling creatures, and the mandate to create a unifying, comprehensive narrative about drug addiction is no less powerful than the need to create a unifying, comprehensive narrative about politics, the economy, or anything else. For practitioners of AA-style recovery, "California sober" is not only an insult but heresy. Of course, reality is much more complex than our storytelling accounts for. The D.A.R.E. and Reefer Madness school of propaganda would have you believe otherwise, but the vast majority of people who try serious drugs, including opiates/opioids and cocaine, never develop a problem with them. Overdosing on LSD is practically impossible to do by accident; the drug it is not physically addictive. As Anthony Daniels (writing as Theodore Dalrymple) documents in his Romancing Opiates: Pharmaceutical Lies and the Addiction Bureaucracy, the popular understanding of heroin addiction is wildly exaggerated, and heroin withdrawal is a relatively minor medical issue, far less dangerous than alcohol withdrawal. There are people who develop a problem with cocaine or heroin who give up those drugs but continue to use alcohol or marijuana without a problem. But we do love our stories, especially when they include a bright moral line with our kind of people on one side and the wrong kind of people on the other.

One of the problems with "California sober" is its lumping in marijuana and alcohol together. There are a great many people who have serious drug problems who are able to put aside heroin or cocaine but continue to have lifelong problems with alcohol, and some who develop a problem with alcohol as a substitute after overcoming a problem with a different drug. There are many reasons to believe that alcohol is far more dangerous to someone with other addiction problems than marijuana is. Of course, most people who use alcohol use it responsibly, and there is a world of difference between someone who has a glass of Bordeaux a few times a week and the guy who was sitting on the curb in front of a 7-Eleven a few blocks from my house this morning nursing a tallboy at 8 a.m.

We have a long tradition associated with alcohol, which is intertwined with everything from ... READ MORE