Redefining Recovery: The Expanding Cannabis Landscape and Its Implications for the California Sober Approach in Addiction

Abstract

An emerging approach called California Sober (CS) has gained attention for promoting abstinence of all intoxicating substances except cannabis and potentially, psychedelics. Cannabis legalization and the expansion of cannabis products have introduced new complexities in addiction recovery, challenging traditional abstinence-based frameworks such as Alcoholics Anonymous (AA), which define sobriety as complete cessation of all intoxicating substances. The CS approach offers flexibility for individuals who choose not to pursue full sobriety, yet the lack of clear standards highlight the need for greater consistency in its use. The potential risks of developing cannabis use disorder and substituting one addiction for another, coupled with cannabis policy discrepancies, emphasize the necessity for careful consideration when incorporating CS into treatment strategies. Given the diversity of possible recovery paths, it is crucial to adopt personalized approaches to ensure both safety and effectiveness while aligning solutions with the evolving needs of patients in this dynamic field.

The term “California Sober” (CS) was first introduced in a 2019 Vice article (Lhooq, 2025) on the self-reported experience of an individual in California who quit alcohol and hard drugs while continuing to use cannabis and psychedelics. Since then, CS has gained traction through celebrities and social media influencers. (Mohammed, 2023) CS supporters typically view cannabis as a healthier alternative and believe one can remain “sober” even while using cannabis containing THC (tetrahydrocannabinol, a major intoxicating cannabinoid). CS is rooted in the harm reduction model (Hawk et al., 2017) and departs from traditional abstinence-based models, challenging conventional definitions of sobriety by framing cannabis as a therapeutic aid, in line with the longstanding medical cannabis tradition in many United States (U.S.) states. (Matei, 2024).

Today, more than 4 million individuals in the U.S. are registered medical cannabis users. (Baldwin et al., 2024) According to the U.S. Centers for Disease Control and Prevention (CDC) (2025), approximately 52.5 million people (19%) in the U.S. have used cannabis at least once in the past year. (CDC, 2025) As of February 2026, medical cannabis is legal in 40 states, 2 territories, and the District of Columbia (D.C.), whereas recreational cannabis is legal in 24 states, 2 territories, and D.C. (Boehnke et al., 2025) With expanding legalization, dispensaries now offer products far beyond traditional flower (dried cannabis buds that are typically smoked), including high-potency oncentrates, waxes, edibles, tinctures, and beverages. (Thrul & Vandrey, 2024) Flower potency has been increasing in the era of legal cannabis, and this phenomenon—along with the introduction of new types of high-potency products with which some consumers are unfamiliar—has raised safety concerns, particularly regarding therapeutic benefits versus risks of cannabis use disorder (CUD).

Traditional recovery frameworks like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other 12-Step Facilitation (TSF) programs emphasize total abstinence from all intoxicating substances, including cannabis and psychedelics, alongside spiritual growth. A Cochrane review of 35 studies suggests that AA and TSF can improve abstinence rates. (Kelly et al., 2020) However, findings are mixed, with critics arguing that its “one-size-fits-all” abstinence model may not be feasible for many individuals, suggesting a need for personalized treatment strategies. (Mendola et al., 2016)

In contrast, the harm reduction model is a public health-oriented framework, reducing negative consequences of substance use rather than defining recovery as abstinence. Harm reduction (Marlatt, 1996) challenges the assumption that drug use inherently equals harm and instead, targets negative consequences as the focus of intervention, rather than the use itself. (Hawk et al., 2017) Evidence shows that harm reduction strategies such as naloxone distribution, syringe service programs (SSPs), medications for opioid use disorder (MOUD), and free, anonymous drug-testing services can be highly effective in reducing overdose deaths and other drug-related harms. (Pridgen et al., 2025)

As more individuals adopt the CS approach amid an evolving landscape of cannabis products, critical questions about its implications for addiction recovery and prognosis are unknown.

The purpose of this commentary is to do the following:

1. Discuss the CS approach and how it differs from previous models of addiction recovery.

2. Examine how the expanding cannabis product landscape (with increasing product diversity and potency) may have implications for CS in terms of challenges, benefits, and risks.

3. Explore the clinical and policy implications of CS on the operationalization of “sobriety” and recovery in addiction.

California Sober (CS)

Sobriety has been defined as “abstinence from alcohol and all other nonprescribed drugs.” (Betty Ford Institute, 2007) In recovery contexts, sobriety is typically viewed as a lifestyle change of abstinence and behavior change to improve overall health and well-being. (Pettersen et al., 2023) The CS approach differs from abstinence-only models by allowing cannabis use (and potentially psychedelics) within the framework of “sobriety” while abstaining from alcohol and other intoxicating substances. (Friedman, 2022), (WHO, 2014) Despite the growing popularity of CS, empirical evidence on its outcomes remains limited. Proponents argue that CS offers a more personalized and realistic recovery pathway, and that cannabis may support mental health. (Allitt, 2025) Supporting this view, a recent randomized controlled trial with 157 adult subjects found that THC cannabis significantly reduced alcohol consumption and craving compared with placebo. (Metrik et al., 2025) In relation to opioid use, multiple studies (Mok et al., 2023),(Lo et al., 2023) describe cannabis as an effective Harm Reduction tool citing an ‘opioid sparing effect’ and ‘tapering effects’ with reported reductions in long-term opioid, stimulant, and other substance use. Critics of CS point to substantial evidence (Chandy et al., 2024) that document potential harms of cannabis use, including risk for CUD, with estimates suggesting that up to 1 in 5 users may develop CUD. (Skumlien et al., 2025) Lastly, a longitudinal study of residents in 48 abstinence-based sober living houses found that 19% (N= 107) reported cannabis use was associated with increased risk of alcohol and other drug use. (Subbaraman et al., 2024)

In sum, the CS approach reflects a hybrid recovery approach that blends harm reduction and traditional abstinence-based principles. It aligns with harm reduction by allowing the use of cannabis as a substitute for more harmful substances while maintaining abstinence from all other intoxicating drugs.

Comparison with Previous Models of Addiction Recovery

Table 1 below outlines the differences and similarities between the CS approach, harm reduction, and abstinence models (AA, NA, 12-step programs). AA, NA, and other 12-step programs represent some of the longest-standing and most widely implemented approaches to addiction recovery. (Kelly, 2017) In contrast to the CS approach, AA and NA maintain that any use of intoxicating substances including cannabis constitutes a return to substance use and is incompatible with sobriety. Rooted in abstinence-based principles, these programs conceptualize substance use disorders (SUDs) as chronic, progressive illnesses best managed through complete cessation of all intoxicating substances and engagement in group support. (Groh et al., 2008), (Donovan et al., 2013) Particularly, the 12-step model emphasizes acceptance of the disorder, surrender to a higher power, commitment to personal accountability, and participation in peer-led meetings as core mechanisms of change. (Donovan et al., 2013) Critics of abstinence-only approaches note that rigid abstinence expectations may exacerbate or contribute to higher likelihood of treatment disengagement, stigma, or relapse shame for individuals who struggle with complete cessation. (Lee & O’Malley, 2018).

Table 1.

Differences and similarities between the CS approach, harm reduction, and abstinence models

Model	California sober approach	Harm reduction model	12-step model
Core approach	Abstinence from substances perceived as most harmful while allowing cannabis and psychedelics	Reduce harms associated with substance use	Complete abstinence from substance use
Abstinence required?	Partial (except cannabis and psychedelics)	No	Yes

Conversely, the harm reduction model does not require abstinence and instead prioritizes minimizing the negative health, social, and legal consequences of substance use, particularly among individuals who continue to use or are at high risk of SUD. In contrast to CS, which typically involves intentional, substance-specific abstinence and self-imposed boundaries, harm reduction is agnostic to patterns or quantities of use and focuses on pragmatic strategies to reduce harm regardless of whether use changes.

Together, these models represent a spectrum of recovery philosophies that vary in rigidity, underlying assumptions, and suitability across populations and stages of change.

Expanding Cannabis Product and Landscape

Since the emergence of CS in 2019, the cannabis product landscape has expanded substantially alongside broader legalization across the U.S. (Sumner & Goldstein, 2022) Products have diversified across routes of administration, chemotypes, potency, and formulation complexity. (Nali et al., 2024) While flower remains the most frequently used form, the use of edibles, concentrates, and vapes have increased, along with newer routes such as suppositories, sublinguals, and troches. (Spindle et al., 2019) Chemotypic evolution now includes multi-cannabinoid blends, terpene-enhanced profiles, and products marketed for specific therapeutic effects (e.g. sleep, anxiety, pain). (Vigil et al., 2023).

The proliferation of synthetic cannabinoids (“spice” or “K2”), variable cannabidiol (CBD) and THC formulations, and products containing minor cannabinoids such as cannabinol (CBN) and cannabigerol (CBG) further complicate safety assessment, measurement standardization, and understanding health effects across product types. (Teixeira, 2024) The rapid commercialization of new cannabis and hemp products, especially compounds and derivatives of such, present challenges to ascertaining which products have intoxicating effects, which are intoxicating, and to what extent they are intoxicating (pending on dose, potency, and chemotype), let alone being able to ascertain how these fit within current understandings of sobriety and use disorders.

Zoning and direct access to cannabis products have expanded markedly since CS emergence. In many legalized jurisdictions, developments in state and local cannabis regulations, along with rapidly maturing and increasingly competitive markets, have increased the density and visibility of retail outlets, while online platforms, delivery services, and in some states, drive-through dispensaries have further enhanced accessibility. (Cantor et al., 2024)

To cloud things further, an unintended consequence of the 2018 Farm Bill was a socalled “loophole” that permitted the sale of intoxicating, hemp-derived THC products nationwide, even in states where recreational marijuana was illegal. (The Associated Press, 2025) Leveraging the 2018 Farm Bill’s removal of hemp (cannabis products with 0.3% or less delta-9 THC by volume) from the Controlled Substances Act (CSA), many intoxicating hemp products, including full-strength THC gummies and THC flower, are now sold in grocery stores alongside alcohol, yet remain outside state cannabis regulatory frameworks designed to protect youth and public safety. (Goldstein, 2026) As a result, a wide variety of cannabis products is also increasingly available in many states that have not legalized recreational or medical “cannabis” but where intoxicating THC cannabis products are permitted to be sold as “hemp.” For instance, a growing number of grocery stores, bars, and restaurants in states such as Minnesota, Florida, Texas, and North Carolina offer hemp-derived delta-9 THC beverages (Bowdring et al., 2025) as alternatives to alcoholic drinks.

Clinical Implications for Addiction Recovery

As cannabis use becomes increasingly normalized and cannabis products increasingly accessible, substantial implications for addiction recovery, addiction substitution, (Kim et al., 2021) and the definition of “sobriety” continue to evolve. Greater cannabis availability may encourage a shift towards CS or harm reduction–oriented models. However, critics argue that CS may pose challenges for individuals recovering from alcohol or tobacco use, as several longitudinal and cross-sectional studies have linked cannabis use to an increased risk of consuming these substances. (Roche et al., 2019) At the same time, the overall evidence base remains limited, and the strength of the association between cannabis use and other substance use is also uncertain. This raises concern that cannabis may exacerbate relapse risk or withdrawal rather than serve purely as a substitution tool. However, evidence in the context of opioid use suggests a potential “opioid-sparing” effect, with several studies (Lucas et al., 2021), (Okusanya et al., 2020) reporting reductions or cessation of opioid use among individuals concurrently using cannabis. Despite this, cannabis is not recommended by physicians as a first-line option for opioid use disorder in mainstream medical practice. (Jeddi et al., 2024)

An additional challenge within CS is defining which cannabis products are permissible under “sobriety.” For example, if an individual is trying to reduce alcohol drinking, would smoking THC flower be considered acceptable, versus using cannabis gummies or edibles? This distinction is critical given emerging evidence of route-specific risks. Data from the 2022 U.S. Behavioral Risk Factor Surveillance System showed that 80% of adult cannabis users smoked or vaped it. (Quader et al., 2022)The smoking route-specific risk profile is substantial: smoked cannabis exposes users to higher risk of airway inflammation and increases the risk of chronic respiratory symptoms. (Georgakopoulou et al., 2025) Yet the long-term health effects and differential risks across varying potencies, formulations, and routes of administration remain largely unknown. Overall, the absence of clear criteria for permissible cannabis use within CS creates ambiguity and may limit its effectiveness as a recovery approach without a set standard of clinical guidance.

Another important consideration in addiction recovery is that complete abstinence or “sobriety” may not be feasible or desirable for some individuals, (Pettersen et al. 2023) and that “recovery” may be better viewed along a continuum rather than a binary state. In this context, the CS approach offers a flexible pathway that emphasizes structured cannabis use within a harm reduction framework and ongoing monitoring rather than total abstinence. CS acknowledges the complexity of SUDs and prioritizes quality of life and reduction of immediate health risk. Conversely, for certain individuals, the 12-step model (Mendola et al., 2016) may remain the most appropriate and effective option, particularly for those who benefit from strict abstinence from all intoxicating substances, spiritual growth, and strong peer support.

CS remains an emerging concept, and current evidence is too limited to evaluate its safety or effectiveness as a harm reduction strategy. Early experimental studies show short-term substitution effects, but these findings do not speak to long-term outcomes, relapse risk, or mental health impacts, all of which require rigorous longitudinal research. Consequently, substantial empirical studies are needed before CS can be recommended within clinical or public health frameworks.

Ethical Considerations in the Evolving Cannabis Landscape

As cannabis availability increases and regulatory environments remain inconsistent, clinicians, policymakers, and recovery communities face new questions regarding patient safety, equity, informed decision-making, and the ethical responsibilities of health systems navigating a shifting substance-use environment. For treatment providers and recovery communities, incorporating cannabis into harm reduction-oriented models such as CS have the potential to raise certain ethical issues. Allowing cannabis use may help some individuals reduce immediate harms (e.g., alcohol-related morbidity), yet may complicate recovery for others by reintroducing use of another substance, reinforcing avoidance coping, or triggering cross-substance relapse. Indeed, the absence of consensus definitions of “sobriety” within CS further complicates ethical decision-making, as inconsistent guidance can lead to confusion, inappropriate product selection, or misalignment between patient goals and clinical recommendations. Furthermore, as clinicians cannot fully quantify risks across all cannabis product classes, providing ethically robust, evidence-based guidance becomes also increasingly difficult with the evolving cannabis market. This raises concern that patients may make decisions based on marketing claims from cannabis product marketing and labeling rather than science.

Even in the face of the challenging task to keep up with cannabis product development, it would also be disingenuous to deny that a large number of people consume cannabis and hemp regardless of its legal status and that even the federal government has recently recognized that it does not entirely lack medical benefits (unlike other Schedule I substances). The ultimate disservice to public health and evidence-based knowledge around cannabis and hemp is the lack of research and education. Further, and more particularly relevant, is a lack of research and consideration as to the relative negative health outcomes of cannabis use as compared to alcohol use. (Nutt, 2021), (Crépault et al. 2026) Fortunately, the prospect of further research is hopeful given the widespread support for cannabis research, which seems to be bipartisan, including support expressed by the presidential administration, by members of Congress, and by the scientific community including the National Academies of Sciences, Engineering, and Medicine. (National Academies of Sciences, Engineering, and Medicine, 2017) Accordingly, advancing informed clinical and public health guidance will require investment in rigorous research, standardization, and evidence-based education that can keep pace with the rapidly evolving cannabis landscape, its ethical considerations and challenges.

Policy Implications

The conflict between state and federal cannabis laws continues to create major contradictions in regulation, policy, and public health. Because cannabis remains a federally controlled Schedule I substance under the Controlled Substances Act, (Lampe et al., 2026) alongside heroin, while alcohol is not federally classified as a narcotic, this often places prevailing concepts of sobriety at odds with the legal framework. Federal government has initiated formal steps towards rescheduling: The Department of Health and Human Services (Department of Health and Human Services, 2023) recommended moving marijuana to Schedule III in August 2023 and the Department of Justice/Drug Enforcement Administration (Drug Enforcement Registration, 2024) issued a proposed rule to transfer marijuana from Schedule I to III in May 2024. On December 18th, 2025, the Attorney General issued an executive order to expedite that rulemaking. However, substantial legal ambiguity remains, particularly regarding taxation (Diaz, 2024) and banking, (Komyati & Mouzon, 2024), (Carpenter, 2023) research approvals, medical practice liability, 49 employment protections, and interstate commerce. (The White House, 2025), (Asebey & Faviero, 2025).

At the same time, U.S. and international drug policies continue to evolve as politically shaped patchworks that often lack grounding in scientific evidence. Rapid state-level legalization and expanding commercial cannabis markets have further contributed to a landscape in which the realities of cannabis use do not align with existing laws, regulatory structures, or the availability of evidence-based research. This misalignment is compounded by federal restrictions on cannabis research; for example, the Office of National Drug Control Policy is prohibited from funding cannabis research, though a recent congressional proposal aims to change this. (Cooper, 2025).

Institutional abstinence-based policies have also struggled to keep pace with rapid change in national and local regulatory circumstances and retail marketplaces. For example, even in states with legal medical cannabis, courts may prohibit cannabis use as a condition of probation, public housing authorities may exclude cannabis users while permitting alcohol use, and publicly funded treatment programs often require abstinence and discharge individuals who relapse. (PIH, 2019) Treatment centers that receive public funding, in general, similarly focus on (or require) abstinence and often administratively discharge patients that relapse. (White et al. 2005)

Further, in some jurisdictions, non-intoxicating components of the cannabis plant (e.g., CBD, CBG, CBN) may be treated the same as THC for legal purposes, despite their differing effects on intoxication levels and sobriety. Another major policy gap is the rapid expansion of intoxicating hemp and THC-infused beverages. (Karnowski, 2025) These products, about which there is a dearth of research or scientific data, flourish in some states and have been carried by some mainstream consumer distribution outlets. A national ban on intoxicating hemp products that was passed in U.S. Congress in 2025 and is set to take effect in November 2026, barring legislative change or compromise in the interim (a Presidential Executive Order calls for further work in this area) (The White House, 2025). Given the lack of research and regulation until now, little is known about health impacts of these products or how they would align with current beliefs or standards around sobriety. These inconsistencies highlight the urgent need for research to clarify how intoxicating versus non-intoxicating cannabis components intersect with sobriety and whether blanket abstinence from all cannabis products continues to serve underlying public health goals.

Conclusion

While CS may be an alternative for individuals who do not pursue complete sobriety, the absence of clear guidelines on cannabis product type, potency, and route of administration, underscores the need for clarity on its approach. Risks of developing CUD and addiction substitution, combined with policy inconsistencies warrant the need for additional research on its effectiveness. Recovery is not a one-size-fits-all, and individualized, evidenceinformed strategies are essential to ensure safety, efficacy, and alignment with patient goals in this rapidly changing landscape.