Lovato relapsed a month after celebrating six years of sobriety. While recalling a March 2018 concert featuring Kehlani and DJ Khaled, Lovato explained that it was following a photo shoot that she began to question her sobriety. She recalled wondering why she was sober, noting that she felt miserable. "I'm not happy. I have all this stuff that I'm dealing with," she said, recounting her thoughts at the time. "I picked up a bottle of red wine that night and it wasn't 30 minutes before I called someone who I knew had drugs on them. I'm surprised I didn't OD that night." The singer said she went on a "shopping spree" when reunited with her former drug dealer. Lovato revealed that she took drugs she hadn't done before, describing a binge in which she mixed meth with "molly, with coke, weed, alcohol, oxycontin. And that alone should've killed me."
Lovato became addicted to heroin and hid her drug use from family and friends. As the singer's younger sister Madison De La Garza noted, Lovato is very good at hiding what she doesn't want people to know. Lovato told her circle that she wanted to explore drinking again to test her limits. Unbeknownst to them, just two weeks after her relapse, Lovato was "introduced" to heroin and crack cocaine. Sirah Mitchell, Lovato's best friend and former sober companion, recalled a moment she realised was a red flag in hindsight. She caught Lovato high in her bathroom during a game night, holding tin foil and smoking "something." But when she grabbed Lovato to talk to her, "she didn't even notice I was there." Lovato explains that it wasn't until a trip to Bali that she realised she'd become "physically dependent" on heroin, and that led to her writing the 2018 single "Sober."