What Is Cross Addiction and Cross Dependence?

It’s been years since you’ve caught up with this friend, and as you sit across from them at dinner, you’re happy to see how much they’ve changed. The last time you spoke, they were struggling with a serious addiction to painkillers. Now they’re fresh out of rehab. You’re still laughing at one of their jokes when they flag down a server.

You’re surprised when they order a glass of wine — then another, and another. By the end of the meal, they’ve finished a bottle’s worth all by themselves. They never really drank before. Why would they start now?

Your friend might be experiencing a phenomenon called cross addiction. Let’s dive into this recovery obstacle, why it happens, and what we can do to stay on track.

What Is Cross Addiction?

Cross addiction, also called addiction transfer, transfer addiction, or addiction substitution, occurs after we’ve overcome one maladaptive behavior (such as substance misuse) and become reliant on a new substance or behavior. 

For example, although our friend overcame their opioid use disorder, they subsequently became dependent on alcohol. To understand why this happens, we need to unpack how addiction impacts the brain.

Chemistry of Addiction

Substance use disorder hijacks our reward system. Every time we consume an addictive substance, we experience a rush of dopamine — the chemical messenger associated with pleasure, learning, and motivation. In an attempt to reach equilibrium, the brain then slows its own dopamine production, expecting an artificial dosage through drug or alcohol use. These changes reinforce substance use, and, over time, our brain becomes dependent.

Even after we stop drinking or using drugs, we may crave that spike of feel-good neurotransmitters. A cross addiction develops when we replace our original addiction with a new source of dopamine. Sometimes, we begin using different substances. In most instances, however, we chase that high through physically or emotionally stimulating activities. These everyday dopamine-boosting behaviors can become compulsive and morph into behavioral addictions, also known as process addictions. Here are a few examples of common behaviors that can become compulsive:

• Gambling
• Having sex
• Stealing (kleptomania)
• Working
• Exercising
• Eating
• Shopping
• Watching pornography or television
• Scrolling social media
• Skin picking (dermatillomania)
• Playing video games

This is just a small sample of potentially addictive actions, and addiction transfer isn’t always the cause. Some people engage in compulsive behaviors due to obsessive-compulsive disorder (OCD). How do we know if we have a cross addiction or a dual diagnosis? Let’s read on to discover the difference.

Cross Addiction vs. Dual Diagnosis

Is “cross addiction” the same as “dual diagnosis”? we might wonder. The answer is no. Let’s compare the definitions to learn why.

• Cross addiction, or transfer addiction, is the transition from one addiction to another during the recovery process. This term focuses on the development of a brand-new dependence after overcoming an initial one. Think of a man who has stopped drinking, but now buys scratch-offs instead of beer at the bodega.
• Dual diagnosis means that we have two co-occurring conditions — for instance, a substance use disorder and a mental illness. Imagine someone who struggles with anxiety and alcohol misuse. These disorders may fuel one another; consuming alcohol can make this person more anxious, and anxiety could inspire them to grab a drink.

What About Cross Dependence?

Whereas addiction describes a mental and physical compulsion to perform a particular behavior such as substance use or gambling, dependence is a state of chemical and biological dependency on a substance. Cross dependence happens when we transfer one physical dependence to a new substance. 

Substances produce chemical changes in our body, making them addictive. The physiological effects of withdrawal from substances can produce tangible symptoms such as sweating, fever, shakes, nausea, pain, and headaches. When overcoming addiction, the withdrawal period may be more a mental game, but that form of withdrawal is just as real and powerful as physical symptoms. 

It’s possible to have an addiction and a dependency at the same time — in fact, many of us do. This adds another layer to the already complex process of maladaptive behaviors.

Now, let’s examine the factors that put us at risk for transfer behaviors that can fuel both addiction and dependence.

Risk Factors for Transfer Addiction

What makes us vulnerable to transfer addiction? A complex interplay of genetic vulnerabilities, mental health conditions, and social factors can potentially lead to new compulsions and affect our recovery.

1. Mental health conditions. Mental illnesses frequently co-occur with addictive behaviors. Often, one condition contributes to the other. These diagnoses can create a feedback loop: the more we drink, the more depressed we feel, so we drink more in an attempt to alleviate that depression.

2. Genetic predispositions. Our genetics may make us more vulnerable to substance use disorder and addictive behaviors than our peers. No single genetic allele controls this susceptibility; instead, the combined effects of several genes work together to determine how we’ll react to certain substances.

3. Unsupportive social circles. If our friends and family members don’t respect our sobriety, it can be difficult to stay on track, especially if our loved ones keep our temptations in the house or enthusiastically partake in front of us.

4. Poor coping skills. Life can hit us hard. Major events like losing a loved one, being fired, or moving across the country can be emotionally taxing, to say the least. If we don’t have a healthy way to cope with stress, we might just turn to a novel substance or behavior.

5. Cold-turkey, DIY quitting. When we quit without support, we may just stop drinking or using drugs. Because we haven’t processed the psychological and personal factors that drove us to substance use, we may not have learned important lessons that sustain healthier habits. We’re also less likely to question our actions if we begin spending hours on social media, smoking a lot of marijuana, or constantly betting on sports. Quitting without guidance can make us more likely to develop a cross addiction.

If we identify with one or more of these points, how can we prevent cross addiction from progressing? Fortunately, developing an understanding of transfer addiction can protect us from unwanted compulsions in the future.

How Addiction Transfer Begins

Often, cross addiction develops subtly. Consider the following example.

Imagine we’ve successfully overcome a reliance on opioid painkillers. Maybe we, like many people, also took those pills when we felt overwhelmed or stressed, which, come to think of it, we feel a lot now that we’re off our medication. Today, when we feel like we want to unwind, we decide to turn to a different substance instead. We pour a glass of wine. That works, so we decide that every time we really want to take an opioid, we’ll drink instead. In time, we may find ourselves dependent on alcohol. That’s cross addiction.

Why did we experience that addiction transfer? If you read the above paragraph carefully, you can spot some of the telltale signs:

1. We replaced painkillers with something similar.

First, we found a substitute for our previous addiction. By seeking out another substance that mimicked the effects of opioids, we found a way to relax and unwind. Just like opioid painkillers, alcohol is a depressant, and it affects the brain’s reward system in a similar way. We sought out a drug with a similar effect and have developed a similar dependence on it.

2. We used alcohol to cope.

Next, we used alcohol to control cravings, stress, and withdrawal symptoms. Many of us struggle to handle the physical and emotional challenges that come with recovery. We may not realize that the way we’re coping is unhealthy.

3. We didn’t address the root cause of our addiction.

Finally, we didn’t deal with the unresolved issues that contributed to our opioid use disorder. Why do we feel overwhelmed so often? What’s got us so stressed? Instead of digging into what upsets us, we’ve attempted to treat the symptoms — first with meds, then with booze.

But is there anything we can do to avoid this? Doesn’t this happen to everyone who gets sober?  

Is Cross Addiction a Natural Part of Recovery?

While anyone can experience transfer addiction, it isn’t considered a normal part of the recovery process. 

Recovery is more than just getting sober. In addition to stopping our alcohol use, we’ll need to make fundamental, lasting changes to our lifestyle, behaviors, and mindset. We might also seek professional help to address the issues behind our drinking. Without these reinforcements, we’ll be more vulnerable to future substance use disorders and process addictions.

If we build a solid foundation for our sobriety, however, we can successfully avoid cross addiction..

Avoiding Addiction Transfer in Alcohol Recovery

Putting down the booze is just the first step in our recovery journey. Once we quit drinking, we’ll need to avoid cross addiction by making sustainable, lasting changes. If you’re looking for direction in early recovery, we’ve put together eight tips just for you.

1. Address the root cause. To prevent future substance use disorders or behavioral addictions, it’s worth exploring why you began drinking in the first place. Therapy is a great way to unpack trauma, family history, or mental health conditions that may have impacted your relationship with alcohol.
  
2. Educate yourself about cross addiction. The more you know about cross addiction, the better equipped you’ll be to avoid it. Consider picking up some books from the library, consulting with experts, or doing online research to learn the warning signs of addiction transfer.
3. Build community. For many of us, social support is the biggest contributor to lasting recovery. Try connecting with fellow sober folks through online forums, group therapy sessions, or in-person meetings. Your peers can provide encouragement and accountability when you need it most.
4. Find new ways to cope. Many of us drink in an attempt to alleviate stress, depression, anxiety, and trauma. Replacing alcohol with healthy coping skills keeps us from filling that void with other addictive substances and behaviors. The next time you feel overwhelmed, try expressing yourself through a creative outlet, getting your jitters out by exercising, or calling a loved one.
5. Remember, it’s a lifestyle shift. Recovery is more than not drinking. It requires us to change our priorities at every level. We may need to develop new routines, stop seeing certain friends, and focus on our physical and mental wellness. With a little help, we can do it!
6. Seek professional help. If you find yourself replacing one addiction with another, there’s no shame in asking for help. Addiction treatment experts may recommend that you seek therapy or enroll in a rehab program that meets your needs. Also, tell your healthcare provider about your recovery journey, especially if they might prescribe medications with addictive potential. They need this information to make sound decisions about your treatment plan.
7. Steer clear of triggers. Certain people, places, and situations may make us crave the dopamine spike we associate with drinking. If you notice cravings or distress, consider removing those triggers from your daily life.
8. Dedicate yourself to recovery. Sobriety is a choice we make over and over again. That commitment isn’t always easy! Putting your recovery first helps you stick with your goals, even when you encounter temptation.

You Deserve a Lifetime of Happiness!

Let’s go back to that restaurant. Sitting across from your friend, you may have begun wondering about cross addictions of your own. Have you started smoking, shopping online, or doomscrolling after cutting back on alcohol? Are you worried about whether these behaviors are still within your control? If so, you may benefit from a sustainable alcohol cessation program — one rooted in scientific best practices.

Reframe offers the guidance you need to stop drinking (or drink less) while prioritizing your health and well-being. Our curriculum focuses on incremental, lasting change. We help you to unpack your relationship with alcohol while building safeguards against other potentially addictive behaviors. To learn more, visit the App Store or Google Play.