What Is Cross Addiction? Definition & Examples

What Are Cross Addictions?

Cross addiction, also known as addiction transfer or addiction interaction disorder, occurs in various ways. First, an individual may simultaneously engage in substance abuse and maladapative behavioral patterns (medically referred to as behavioral or process addictions). Second, a person may replace one addiction with another (i.e., substituting opioids with cannabis). Third, an addictive behavior may precede a chemical addiction or vice versa.^1,2

Symptoms of addiction (chemical or behavioral) include:

• Active use longer than expected
• Desire and unsuccessful attempts to stop
• Significant time and effort spent using and coming down
• Cravings or strong desire to use
• Recurrent use that impacts an ability to fulfill responsibilities
• Recurrent social and interpersonal problems caused by or exacerbated by use
• Reduction in social, occupational, or recreational activities that were previously enjoyable
• Using despite a high risk of adverse consequences
• Continued use despite harmful physical and mental consequences
• Tolerance or a need to increase consumption to receive desired effects
• Signs and symptoms of withdrawal when an individual stops using

Cross Addictions Vs. Co-occurring Disorders

Denoting the difference between cross addiction and co-occurring disorders is essential when determining the best course of treatment. Co-occurring disorders refer to having a substance use disorder alongside one or more mental health disorders. This isn’t to say that individuals with cross addiction may not also have a co-occurring disorder. There is an increased likelihood of cross addiction occurring in said circumstance.³

Chemical Vs. Behavioral Addictions

Both chemical and behavioral addictions include pervasive repetitive behaviors that continue despite serious physical, mental, emotional, and social consequences and attempts to stop.² A major difference between the two is that chemical substances lead to physiological dependence, meaning the individual will experience withdrawal symptoms when they reduce their consumption or quit.

Although the DSM-5 only formally recognizes gambling disorder as a behavioral addiction, researchers have identified and are studying other common behaviors fitting similar criteria. Repetitive engagement in these behaviors ultimately interferes with functioning in other domains, as seen in diagnosable substance use disorders.⁴

Common Behavioral Addictions

Many behaviors could ultimately become problematic. However, the most common addictive behaviors trigger the reward (pleasure) pathway, hinting that dopamine and addictions are strongly related. For example, behaviors that increase “happy” neurotransmitters like dopamine are increasingly more addictive because they make people feel good.

Common behavioral addictions include:⁵

• Sex addiction
• Work addiction
• Love addiction
• Internet addiction
• Technological addiction
• Exercise addiction

Why Does Cross Addiction Happen?

Cross-addiction often begins accidentally. However, those who struggle with chemical addiction are at increased risk of developing cross addictions.³  Because addiction stems from an internal process rather than physical dependence, even if a substance is removed, someone can still be afflicted by the addiction process.

For example, a client using prescription opioids for a sports-related injury develops physical dependence—a natural occurrence that may or may not lead to addiction. Because they are physically dependent on opioids, they experience withdrawal symptoms when they lose access to the opioid. As a result, they begin seeking ways to continue using or replace the opioid with another addiction.

Cross Addictions Before, During, & After Recovery

Cross addiction presents differently depending on the recovery continuum (i.e., before, during, or after). In any case, a problematic internal process of maladaptive thoughts, emotions, and behaviors persists.

Before any recovery effort, individuals struggling with cross addiction may not even recognize they have a problem. Given the severity of chemical addictions, substance-use-related symptoms may serve as the primary focus in treatment. Unfortunately, the thoughts, emotions, and behaviors associated with the secondary addiction (behavioral/process) are overlooked, increasing the intensity of the behavioral addiction.

During recovery, these overlooked secondary experiences may complicate substance abstinence. Therefore, cross addiction may arise or resurface during aftercare unless the behavioral addiction is addressed during recovery. Cross addictions are typically gradual—beginning with something seemingly healthy, such as exercise, before exacerbating into something harmful.

Examples of Cross Addictions

Individuals rarely, if ever, enter addiction intentionally. Instead, addiction is a vicious progression whereby those impacted fail to recognize the problem until it is too late. Regardless, pathways toward cross addiction vary—in some cases quite significantly.

Below are examples of cross addictions:

Alcohol

Alcohol is relatively socially acceptable and accessible. A person of legal drinking age can easily access alcohol at restaurants, bars, social events, grocery stores, gas stations, and even some religious ceremonies. Ease of access, among other factors, is why alcohol use disorders are so common.

Exercise

Exercise is commonly perceived as healthy and positive. However, this behavior may become problematic when an individual excessively exercises, ultimately building up lactic acid and other toxins while contributing to bone, muscle, and tissue atrophy. Again, even the best of intentions may lead to exercise addiction.

Acquiring an Illegal Substance

In some cases, the thrill goes beyond substance use, with some individuals explaining how the rush or “high” of purchasing an illegal substance and associated dangers (e.g., being robbed, injured, or even killed) is as exciting as the euphoric sensation gained from use. Some will reenact the process of acquiring a substance even while in recovery and actively abstaining from use.

Gambling

A cross addiction involving gambling also entails a sense of excitement. Gambling involves many risks in that one may win or lose money—in some cases, a lot of it. The consequence might be an inability to pay bills, save money, or fulfill debts.

Sex

Sex naturally leads to arousal. For many, arousal requires an attraction toward or connection with another, but sexual gratification in any form can create pleasure. Sex addiction poses risks, including sexually transmitted diseases, physical or emotional harm, or angering a third party if infidelity is involved.

How to Avoid Cross Addiction

Fortunately, cross addiction is avoidable. However, attempts to resist cross addiction should be individualized. The better the likelihood of success when actions align with individual needs and preferences. What works for one person may not suit another. Continue trying other strategies if one approach falls short.

Here are seven ways to avoid cross addictions:

1. Be aware of yourself: You can recognize problems with addiction if you continually check in with yourself. Consider problematic thoughts, emotions, and behaviors, particularly those with a sudden onset or growing intensity.
2. Check in with others: Many of us have blind spots where we struggle to see what is readily apparent to others. Check-in with friends, family members, co-workers, and others so they can share thoughts and observations that extend beyond what you might find in personal reflection.
3. Become educated on addiction: The more informed you are on the addiction pathway, what addiction is, associated symptoms, and recovery resources and strategies, the better equipped you are to reduce symptoms or prevent cross-addiction.
4. Regulate potentially addictive substances and behaviors: Depending on your addiction potential, minimize or avoid recreational substances while moderating potentially addictive behaviors. For example, if you like gambling but often max out your account, a more appropriate plan would be to gamble on rare occasions (or not at all).
5. Become involved in prosocial activities:  Fulfilling social activities, such as volunteer work, may satisfy your need for belonging and minimize a desire to engage in addictive processes.
6. Quit everything at once: Sometimes, quitting all addictive behaviors at once can help reduce the risk of cross addiction. Doing this also alleviates the likelihood of trading one addiction for another.
7. Speak with a professional: The best recommendation for addressing addiction is to seek professional support.

Treatment for Cross Addiction

The best treatment for cross-addiction depends on the individual and the severity of their condition. The more severe an addiction, the more invasive and restrictive treatment should be. Inpatient and residential stays are often reserved for severe cases. In other situations, outpatient therapy and support groups are helpful.

The more motivated, consistent, and intentional a person is, the greater the likelihood of success. Choosing the right therapist and facility can make all the difference. An online therapist directory allows you to search for therapists based on location, expertise, cost, and more.

Traditional forms of therapy used with cross-addiction include:¹

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Motivational interviewing (MI)
• Medically assisted treatment (MAT)

How to Help a Loved One With Cross Addiction

Becoming informed is important when attempting to help a friend or loved one struggling with addiction. Learn more about treatment modalities and helpful ways to approach the topic with love, support, and personal boundaries. Helping a friend with an addiction can be challenging, but help is available when the individual is ready and willing to seek recovery.

Final Thoughts

The reality is that many people struggle with cross addictions despite any debate regarding whether cross-addiction exists or not. Although your struggle may be unique, you are not alone. Speaking with a professional and having social support can make all the difference. If there’s any thought whatsoever that cross-addiction is occurring, the time to act is now.