Cross Addiction

Cross addiction — a pattern of replacing one addiction with another that has similar effects — is a common risk for people addicted to a harmful substance or behavior. These can include addictions to multiple substances or pleasure-inducing behaviors such as eating, sex, shopping and gambling.

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Cross addictions often occur when people addicted to a specific substance cease or decrease use of that substance. These individuals then start using a new substance under the belief that it will not cause the same addiction problems. For example, someone who overcomes an opioid use disorder may start abusing alcohol because it has similar depressive effects on the body.

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Those with substance use disorders are at greater risk of developing cross addictions. Individuals battling alcohol addiction are 18 times more likely to report prescription drug abuse than those who do not drink, according to a study by researchers at the University of Michigan. Another study by researchers at Harvard Medical School examined 48 patients hospitalized for oxycodone addiction and found that 77 percent previously had a nonopioid substance use disorder.

Cross addictions do not always involve drug or alcohol use. Many individuals replace a substance use disorder with an impulse control disorder, which affects the reward pathway of the brain in the same way that substances of abuse do. People may develop addictions to sex, pornography, gambling, shopping, food or other impulsive behaviors.

Treatment is available for individuals with addictions to multiple substances or impulsive behaviors. Appropriate therapy can provide a balance that allows them to reach recovery.

Dopamine, Reward and Cross Addiction

Drug and alcohol abuse activate dopamine — the brain chemical responsible for reward response — which makes users feel high and reinforces the abusive behavior. Without this chemical brain reaction, people would feel no euphoric effects. A vast amount of research shows that dopamine-inducing behavior plays a massive role in substance and process addictions.

Dr. Kevin Wandler of Advanced Recovery Systems discusses the role dopamine plays in the development of alcohol or drug addiction.

Dopamine also plays a vital role in cross addiction development. When substance-addicted individuals decrease or abstain from their substance of choice, they often face a dopamine deficiency. Over time, the brain becomes dependent on the substance to produce the release of dopamine.

People may turn to a new substance that produces the dopamine-induced high they are lacking to prevent withdrawal or alleviate discomfort, even if they are determined to avoid using their problem substance.

Impulsive behaviors such as sex, watching pornography, gambling and eating also cause the brain to release dopamine, producing euphoria and reinforcing the behavior. The impulsive behavior often becomes the new drug for individuals who develop cross addictions because these behaviors activate the same brain pathway and produce effects similar to those produced by drugs or alcohol.

Common Cross Addictions

Cross addictions come in many different forms. People can become dependent on almost anything that causes dopamine activation in the brain. Using new drugs or engaging in impulsive behaviors can provide a dopamine fix.

Other Drugs

The most common cross addiction involves addiction to multiple substances. In fact, many treatment specialists say it is more common for people to have multiple addictions than one. Addiction to one substance, such as cocaine, can often lead an individual to develop an addiction to another drug, such as Adderall.

Those with cross addictions turn to new substances to fill the void left when they stop using a substance they have been abusing. Cross addictions such as marijuana and opioids, opioids and alcohol, and cocaine and ADHD medications are common among people with substance use disorders.


Approximately 1 percent of Americans have a pathological gambling problem, according to the Substance Abuse and Mental Health Services Administration. The rate of pathological gambling disorders is much higher among those with substance use disorders, as is the rate of substance use disorders among pathological gamblers.

Individuals with substance use disorders have rates of pathological gambling four to five times higher than those of the general population. Alcohol is the most commonly abused substance among pathological gamblers.

Common thoughts and behaviors among gamblers with substance addictions can also perpetuate the severity of cross addictions.

These unhealthy thoughts and actions may include:
  • Gambling is a way to fund drug use.
  • Gambling and drug use complement each other as a regular part of a broader lifestyle.
  • Gamblers use drugs to maintain energy and focus during play.
  • People may sell drugs to obtain gambling money.
  • Drug or alcohol use makes gambling more pleasurable, thereby reinforcing the behavior.
  • Gamblers use drugs or alcohol to celebrate winning money.

Triggers for substance abuse or gambling can send individuals with this cross addiction into a whirlwind of destructive drug or alcohol use and gambling.

Compulsive Sexual Behavior

Approximately 5 percent of the general population meets the criteria for a compulsive sexual disorder, according to researchers at the University of Minnesota. The rate of sexual addiction is even higher among those with substance use disorders.

Men typically outnumber women in terms of sexual disorders. States of hypersexuality can be brought on by substance abuse, mental health conditions and environmental triggers. Compulsive sexual behavior can also be used to replace substance abuse for individuals in recovery.

Addictive sexual disorders are characterized by continued sexual activity despite considerable negative consequences created by such behaviors. The pattern is similar to substance addiction. These sexually impulsive behaviors are often used as outlets to escape emotional or physical pain or to cope with stress. However, this creates a cycle of destructive behavior that is reinforced by the gratification of sexual acts.


Watching pornography and chronic masturbation are behaviors commonly linked to cross addiction. A survey by researchers at Indiana University found that about 9 percent of porn viewers reported an inability to stop watching pornography. Many people become addicted to pornography because it activates the release of dopamine in the brain in the same manner as drugs or alcohol.


Shopping is another behavior commonly associated with cross addiction. People may shop or overspend on items they do not need to combat mental health issues such as depression or anxiety. This behavior is similar to using drugs or alcohol to self-medicate.

Compulsive shopping often leads to growing financial debt and strain which can further exacerbate substance use disorders or co-occurring mental health disorders. Compulsive shoppers receive a high or rush when they purchase items, which is often the root cause of their addiction.


Food activates reward pathways in the brain in the same manner as drugs or alcohol and can cause addictions and eating disorders in some individuals. Sugar intake, for example, releases dopamine and natural opioid neurotransmitters, which can fuel addiction.

Cross Addiction Treatment

Cross addictions require specialized care. Professionals are best equipped to assist individuals struggling to overcome addiction, whether it is an impulsive behavior or a substance use disorder. Underlying mental health disorders can also cause multiple addictions and may require co-occurring disorder treatment.

Addressing the addiction and co-occurring disorder simultaneously through integrated treatment is generally the most effective way to help people recover from cross addiction. Reducing triggers for substance abuse and impulsive behaviors is a key focus of teaching people to live sober and avoid engaging in destructive behaviors.

Cognitive behavioral therapy in group and individual settings allows individuals to explore thought patterns and feelings that contribute to their substance use and compulsive behaviors. Additional counseling can teach people how to prevent addictive behaviors by recognizing signs of destructive behaviors or feelings.

If you or a loved one is suffering from multiple substance use disorders or compulsive behavior disorders, seek professional help. Treatment facilities are available to assist people in overcoming their addictions and living healthy and happy lives.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Trey Dyer
Content Writer,
Trey Dyer is a writer for and an advocate for substance abuse treatment. Trey is passionate about sharing his knowledge and tales about his own family’s struggle with drug addiction to help others overcome the challenges that face substance dependent individuals and their families. Trey has a degree in journalism from American University and has been writing professionally since 2011.

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