In the final episode of Demo Lovato’s docuseries, Dancing with the Devil, the singer reveals she isn’t completely sober following her near-fatal 2018 overdose. She said she still drinks alcohol and uses marijuana in moderation and has referred to herself as “California Sober,” a controversial and somewhat fluid colloquialism to describe people who abstain from most substances.

Harm reduction is typically thought of in the context of formalized programs—methadone clinics and syringe service programs—but experts say the way Lovato speaks about her own moderation could fall under the umbrella of harm reduction. Lovato says she no longer uses heroin, which qualifies as a harm reduction strategy.

Collin Reiff, MD, addiction psychiatrist and clinical assistant professor in the Department of Psychiatry at NYU Langone Health, who isn’t involved in Lovato’s treatment plan, said harm reduction is a broad term that can be thought of as a spectrum, with the far end being abstinence.

Dr. Reiff says his work is to meet the patient where they are. “Individuals in recovery often learn what works and what doesn’t in small steps,” says Dr. Reiff. But he is skeptical of moderation as a long-term strategy, noting that moderation management may work for a small subgroup of people who struggle with only alcohol use disorder, but a lot of research is needed to make any claim that it is effective or safe for people who have severe alcohol use disorder, a history of alcohol dependence, or other substance use disorders including opiate use disorder or dependence.

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