Featured Articles: Understanding Addiction Transfer and Cross Addiction

By Meghan Vivo

You walk into an AA meeting and notice that everyone is smoking. Then you discover that your friend who just lost 100 pounds goes out drinking most nights, and has spent thousands of dollars on clothes to show off her new body. What’s going on here?

Psychologists call this phenomenon “addiction transfer.” People who struggle with compulsive behaviors (such as compulsive overeating, alcoholism, smoking, compulsive gambling or shopping, promiscuity, workaholism, Internet or video game addiction and drug addiction), often find that they overcome one addiction only to develop another months or even years later.

Recovering addicts and alcoholics may also struggle with “cross addiction,” which is an addiction to more than one drug. Just as these individuals break their addiction to one drug, they find themselves developing an addiction to another one, often from the same class of drugs.

Of the five primary drug categories, certain addictions are more likely to go hand in hand, explains Charles Graham, a program manager at Sober Living by the Sea, a renowned network of addiction treatment centers in Southern California. For example, the following addictions tend to go together:

• Central Nervous System (CNS) stimulants – methamphetamine, cocaine, Ritalin, caffeine, nicotine, sympathomimetrics, tricyclic antidepressants and selective serotonergic reuptake inhibitors (SSRIs).
• CNS depressants – alcohol, sedatives, hypnotics, minor tranquilizers, sleeping pills, benzodiazepines, GHB, Rohypnol, Xanax, Valium, Klonopin, Ativan, downers and reds
• Opiates – narcotics, analgesics, opium, morphine, heroin, codeine, methadone, Demerol, dilaudid, Percodan, Vicodin and Oxycontin
• Hallucinogens – psychedelics, psychotomimetics, LSD, psilocybin mushrooms, mescaline, Ketamine (Special K), Phencyclidine (PCP) and MDMA
• Cannabis – THC, marijuana, hashish, hemp, bhang, grass, pot or weed.

“When a person gets clean and sober from one drug and then encounters stress or anxiety, they will usually resort to a drug having the same general effect as the reward reinforcement pathway in the brain established by their drug of choice,” says Graham.

What Causes Addiction Transfer and Cross Addiction?

Psychologists originally developed the phrase “addiction transfer” because of a trend they observed: Drug addicts and alcoholics in substance abuse treatment recovered from an addiction to one form of drug only to swap it for another type of drug or other compulsive behavior. Because these patients still feel a void or haven’t fully addressed the underlying reasons for their addiction, they find new ways to escape or numb their emotions. For those who thought life would be perfect if only they could overcome an addiction, the reality sets in that life is still at times difficult, boring and hard to manage.

Addiction transfer also has a neurological basis. Research suggests that the same biochemical processes are at work in multiple types of impulse-control disorders, such as compulsive eating, alcoholism, smoking, compulsive gambling and drug addiction. Each of these behaviors triggers the same reward sites in the brain, resulting in cravings that are difficult to resist.

Addiction is a brain disease, and the brain is immensely complex. “The brain may be the most difficult puzzle in the universe,” says Graham. “The brain is hard to study, and it gives up its secrets slowly. This is the main reason that neurology and psychiatry have not necessarily kept pace with the progress of other areas of medicine.”

When it comes to handling difficult emotions, people tend to find something that works and stick with it.

“Addiction transfer is often a function of the deep need to repeat a known successful method of relieving physical and emotional stress and pain,” explains Graham. “In many cases, this occurs through the release of the neurochemical dopamine.”

Regardless of the type of drug – uppers or downers, strong or weak, legal or illegal – all drugs of abuse share one common feature: dopamine release in the midbrain. The “Dopamine Hypothesis” suggests that if a person has an addiction to one of these drugs, they are at increased risk of becoming addicted to any of the others, Graham reports.

For instance, cross addiction often involves alcohol and nicotine. Alcoholics and drug addicts frequently start smoking cigarettes in early recovery, and smokers often accelerate to chain smoking when they quit drugs and alcohol. If these smokers notice an increase in cravings, the Dopamine Hypothesis suggests this may be because the brain is responding to what it perceives as an insufficient dopamine release, explains Graham. As a result, the addict’s increased craving may put them at greater risk of relapse.

A common example of addiction transfer occurs after an individual undergoes bariatric surgery. Although the procedure may help patients lose weight and stop overeating, many end up struggling with new compulsive disorders such as alcoholism, gambling addiction or compulsive shopping. Because weight-loss surgery changes the way the body metabolizes alcohol, making the effects far more pronounced, many surgery patients develop a drinking problem.

Preventing Addiction Transfer and Cross Addiction

So does anyone ever become “free” from an addiction? People do learn to manage their addictions with appropriate treatment and self-care.

In order to break an addiction without transferring to another addiction, experts say intensive therapy and treatment are required. The first step is building self-awareness and an understanding of the nature of addiction.

“Individuals in recovery need to know that anything that is pleasurable could be manipulated into a method of coping with stress if taken to excess,” says Graham. “If the behaviors that are pleasurable are also those that release dopamine, such as food, sex, pornography, shopping, gambling, relationships or video games, the addict may succeed in decreasing their drinking or drug use only to increase their behavioral addictions.”

In addition, patients must learn new coping skills and practice using them in real-world situations in order to resist cravings in the future. The best addiction treatment programs will help put a relapse prevention plan in place so that the patient knows what to do when temptation strikes or life gets overwhelming.

It’s also important to continue talking through difficult emotions using individual therapy or support groups on an ongoing basis. Individuals in recovery need to realize that addiction is a lifelong battle, and their recovery is something that must be guarded and nurtured long term. Once these individuals achieve their goal of losing weight or putting an end to shopping, gambling, drug or alcohol addiction, they must set new goals and stay occupied in healthy pursuits.

“The key to recovery is to learn new constructive coping strategies to maintain a life in balance,” advises Graham.

The focus at Sober Living by the Sea is on good communication, group and individual therapy, exercise, nutrition, healthy boundaries and sober support networks. All of these components work together to frame a new lifestyle for the alcoholic or addict, says Graham.

Treatment for an addiction or compulsion is costly and time-consuming. By doing it right the first time, digging deep into the issues underlying the addiction and developing a thorough understanding of the disease of addiction, you’ll put yourself in the best position to avoid falling into the traps of cross addiction and addiction transfer.