Cross addiction, also known as addiction interaction disorder, is when a person has two or more addictions.1 Such addictions may extend well beyond alcohol and other substances of abuse, including compulsive behaviors such as hair pulling, skin picking, gambling and excessive shopping are also addictions.1 The addictions may occur simultaneously or one addiction may replace another.
Comprehensive forms of treatment for cross addiction extend beyond abstinence and focus on correcting maladaptive thoughts, emotions, and behaviors.
What Are Cross Addictions?
Cross addictions occur in several ways. First, in the absence of a preferred substance, an individual might begin using another substance. For example, someone using opioids might try to replace that substance with cannabis.
Second, an individual might become addicted to a substance of abuse while concurrently engaging in compulsive, maladaptive behavioral patterns (medically referred to as behavioral or process addictions). In this case, the person could be addicted to alcohol and simultaneously have a shopping addiction. Third, an addictive behavior may precede a chemical addiction or vice versa.
This article will focus on cross-addiction as replacing one addiction to drugs with another that is behavioral in nature (i.e., sex, gambling, food, masturbation, porn, plastic surgery, etc.), especially during or after a long period of recovery.
Symptoms of addiction (chemical or behavioral) include:
- Active use longer than expected
- Desire and/or 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 fulfil important responsibilities
- Recurrent social and/or interpersonal problems caused by or exacerbated by use
- Reduction in social, occupational, and/or recreational activities that were previously enjoyable
- Using despite the high risk and adverse consequences
- Continued use despite harmful physical and mental consequences
- Tolerance as defined by a need to increase use to receive the desired effect
- Signs and symptoms of withdrawal when individual stops using
What’s the Difference Between Chemical & Behavioral Addictions?
A key difference between chemical and behavioral addictions is that chemical substances lead toward a physiological dependence, meaning that the individual will experience physical withdrawal symptoms when they reduce their usage or quit altogether. Addictive behaviors contribute to the addiction process. Addiction is a pervasive repetitive behavior that continues despite serious physical, mental, emotional, and social consequences. It also continues despite one’s desire or continued attempts to stop.2
Such problematic behaviors extend to many things, which is why some individuals refer to themselves as having “addictive personalities.”
Although gambling disorder is the only behavioral addiction included in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, other common behaviors fitting similar criteria have been defined and are currently under study. The repetitive engagement in these behaviors ultimately interferes with functioning in other domains, similar to diagnosable substance use disorders.3
6 Common Categories of Behavioral Addiction
Given the criteria for what defines a behavioral addiction, many behaviors could ultimately become problematic. However, the most common behaviors are those that trigger the reward (pleasure) pathway. People have an innate preference to do what makes them feel good, which is why behaviors that increase “happy” neurotransmitters, such as dopamine, are increasingly more addictive.
To classify the most common behavioral addictions, researchers have identified several broader categories. Addictions within, between, or among any of these categories may yield potentially severe physical, mental, emotional, social, financial, and/or legal issues.
The six categories of behavioral addiction are:4
- Sex addiction
- Work addiction
- Love addiction
- Internet addiction
- Technological addiction
- Exercise addiction
Cross Addictions Before, During, & After Recovery
Cross addiction presents differently depending on where one is along the recovery continuum (i.e., before, during, after). With any addiction—regardless of whether it is substance-based or behavioral/procedural—it is important to note the similarities. In either case, there is a problematic internal process consisting of maladaptive thoughts, emotions, and behaviors.
Prior to any recovery effort, individuals struggling with cross addiction may not even recognize it as a problem. Given the severity of chemical addictions, symptoms may serve as the primary focus while thoughts, emotions, and behaviors associated with the secondary addiction (behavioral/process) are overlooked, increasing the intensity of the behavioral addiction.
During recovery, assuming that one is abstaining from the substance, the process may be complicated by associated thoughts, emotions, and behaviors specific to the secondary condition. Therefore, unless addressed during recovery, the cross-addiction may arise or resurface during aftercare. This is typically gradual—beginning with something seemingly healthy, such as exercise—exacerbating into something, once again, harmful.
Cross Addictions vs. Co-occurring Disorders
It’s important to denote the difference between cross addiction and co-occurring disorders. Co-occurring disorders refer to having a diagnosis of a substance use disorder and the presence of one or more mental health disorders. This isn’t to say that individuals with cross addiction may not also have a co-occurring disorder. In fact, there is an increased likelihood of cross addiction occurring in said circumstance.5
Common diagnosable mental health conditions in this respect are:6
- Attention deficit/hyperactivity disorder (ADHD)
- Bipolar disorder
- Borderline personality disorder (BPD)
- Eating disorders
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
Why Does Cross Addiction Happen?
Cross-addiction often begins accidentally, but because addiction itself is defined by the internal process rather than physical dependence, those who struggle with chemical addiction are at increased risk of developing cross addictions.5 This piece of the equation is often hardest to treat because even if the substance is removed, someone can still be afflicted by the addiction process.
For example, a client is prescribed opioids for a sports-related injury. While taking the opioid prescription, they develop 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 no longer have access to the opioid prescription, and as a result, begin seeking ways to continue taking the medication or replace it with another addiction.
This may include returning to exercise in hopes of numbing the pain. With heightened pain reduction and euphoria, exercise can be undertaken at an extreme level, leaving them now addicted to exercise.
5 Examples of Cross Addictions
It’s unlikely that anyone enters an addiction intentionally. Rather, it’s a vicious progression whereby those impacted don’t recognize the problem until it is too late. As with any addiction, pathways toward cross addiction vary—in some cases quite significantly.
People who are at particular risk of developing a cross addiction include those who experience trauma, are raised around addiction, have a genetic predisposition, experience “black or white” thinking, or have diagnosable mental health disorders.1
Here are five examples of cross addictions:
1. Alcohol
Alcohol is relatively socially acceptable and readily accessible. Especially when a person is of legal drinking age, they have easy access to it at restaurants, bars, social events, grocery stores, gas stations, and even religious ceremonies. This, among other factors, is why alcohol use disorders are so common.
2. Exercise
Exercise is commonly perceived as good. However, this seeming win-win approach may become problematic when one exercises to excess, ultimately building up lactic acid and other toxins while contributing toward atrophy of bone, muscle, and other tissues. Again, even the best of intentions here may lead toward exercise addiction.
3. Acquiring an Illegal Substance
For many individuals struggling with addiction, the thrill goes beyond use itself. Some individuals explain how the thrill or “high” of purchasing an illegal substance and any associated dangers (e.g., being robbed, injured, or even killed) is as exciting as the euphoric sensation gained from use.
Even while in recovery and actively abstaining from use, some will reenact the process of acquiring a substance in the absence of actual use.
4. Gambling
A cross-addiction involving gambling serves a similar purpose as the example above in that there is a thrill to it. There’s a lot of risk involved 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 even having a loan shark seeking debt repayment.
5. Sex
Sex naturally leads to arousal. While, for many, this arousal requires an attraction toward or connection with another, there are cases in which sexual gratification in any form is enough for pleasure. There are potential risks with sex addiction as well. Said risks may include sexually transmitted diseases, physical and/or emotional harm to self or others, or angering a third party should infidelity be involved.
How to Avoid Cross Addiction
Fortunately, there are many ways to avoid cross addiction. It is important that such attempts are individualized and personally resonate with the individual. The better aligned any actions are to the needs and preferences of the individual, the better the likelihood of success. What works for one person may not work for another. If a strategy falls short, it’s important to continue trying other strategies.
Here are seven ways to avoid cross addictions:
- Have an awareness of self: By continually checking in with oneself, individuals may become aware as to whether a potential problem exists. Here it is important to consider problematic thoughts, emotions, and behaviors—particularly those that have a sudden onset and/or are growing in intensity.
- 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 one might find in personal reflection
- Become educated on addiction: The more informed one is on the addiction pathway, what addiction is, associated symptoms, and useful recovery resources and strategies, the better they’re equipped to reduce symptoms or prevent cross-addiction from occurring.
- Regulate potentially addictive substances and behaviors/processes: Depending on one’s addiction potential, it is important to minimize or completely avoid use of recreational substances while also moderating potentially addictive behaviors/processes. For example, if someone likes to gamble but tends to max out their account, a more appropriate plan would be to commit to gambling minimally and only on rare occasions.
- Become involved in prosocial activities: When there are more people involved, there are more individuals to help with accountability. Those activities that are more fulfilling, such as volunteer work, satisfy one’s need for belonging, which may minimize a desire to engage in addictive processes.
- Quit everything at once: Though challenging, it helps to quit all addictions at once. Doing this alleviates the risk of trading one addiction for another as the focus is on addiction in general.
- Speak with a professional: The best recommendation when struggling with any type of addiction is to speak with a professional. Even if curious as to whether one has cross-addiction or not, taking preventative caution or participating in early intervention by honestly speaking with a therapist can reduce the likelihood of it becoming more serious.
Treatment for Cross Addiction
The best treatment for cross-addiction depends on the individual and the severity of their condition. The more severe it is, the more invasive and restrictive treatment should be. Inpatient/residential stays, which typically last around 30-90 days, are often reserved for severe cases. For less severe cases or for those who have had past successful recovery attempts, outpatient therapy and support groups are helpful.
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)
A successful recovery effort greatly depends on the individual. The more motivated, consistent, and intentional they are, the greater likelihood of success. Choosing the right therapist and facility can make all the difference. To search for different therapists based on location, expertise, cost, and more, review our therapist directory.
How to Help a Loved One With Cross Addiction
When attempting to help a friend or loved one, it’s important to become as informed as possible. In addition to learning about the addiction and considering applicable treatment options, try to become knowledgeable about helpful ways to approach the topic with love, support, and personal boundaries. Our article on how to help a friend with an addiction provides some additional guidance.
Cross Addiction Statistics
Statistics on cross addiction are rather limited. In 2014, the Columbia University Medical Center conducted an extensive study on the theory. Of those invited, 34,653 completed the interview.5
Here are notable statistics on cross addiction:5
- In a large nationally representative sample of adults with SUDs, approximately 1 in 5 had developed a new-onset SUD during the course of the 3-year follow-up
- Individuals who remitted from a SUD had less than half the risk of developing a new SUD than those who did not remit from any SUD
- In univariate analyses, remission from drug use disorders was associated with increased odds of a new-onset SUD5
This information is specific to those who cross over from one substance of abuse to another. Additional research will need to be conducted to assess the prevalence and frequency of cross addiction where a substance use disorder crosses over into a behavioral addiction.
Final Thoughts on Cross Addictions
Despite any debate regarding whether cross-addiction exists or not, the reality is that a lot of people are struggling with it. Although the individual struggle may be unique, you are not alone. Speaking with a professional and having the right social support can make all the difference. If there’s any thought whatsoever that cross-addiction is occurring, the time to act is now.
For Further Reading
- SAMHSA’s National Helpline: (800) 662-HELP (4357)
- Hazelden Betty Ford Foundation
- American Addiction Centers (866) 460-6405
- MentalHealth.gov
- Best Movies About Addiction
