Cross-Addiction: Unveiling the Complex Interplay of Addictive Behaviours
Cross-addiction, also known as addiction interaction or multiple addiction, occurs when an individual replaces one addictive behaviour or substance for another, while maintaining addictive patterns. This complicated dance shows us the underlying vulnerabilities and shared neurobiological pathways that drive addictive behaviour. Cross-addiction is key to effective treatment and prevention strategies. It goes beyond just treating the primary addiction to address the whole spectrum of potential dependencies.
Defining Cross-Addiction: Understanding the Shift in Addictive Patterns

Cross-addiction occurs when an individual shifts from one addiction to another, often due to unaddressed psychological and neurobiological drivers of addiction. The shift can show up in many ways, such as replacing alcohol with excessive gambling, or substance abuse with compulsive shopping or internet use. The key is that the individual is using the new behaviour or substance to cope with emotional pain or to get a reward and gratification. This behaviour is the same as the primary addiction, including loss of control, preoccupation and continued use despite negative consequences.
The Neurobiological Basis of Cross-Addiction: Dopamine and Reward Pathways
The neurobiological basis of cross-addiction is in the brain’s reward system, primarily the mesolimbic dopamine system, but it also involves serotonin (mood regulation), glutamate (learning and memory) , and stress-related hormones like cortisol. Dopamine is a neurotransmitter that reinforces behaviours and feelings of pleasure and reward. Addictive substances and behaviours hijack this system and over stimulate dopamine release. Over time the brain adapts to this over stimulation and becomes less responsive to natural rewards.
Recent research shows dopamine release occurs not only in response to reward but in anticipation of it, reinforcing learned association and compulsive seeking behaviours. This anticipatory release drives the motivation to seek out the addictive substance or behaviour. When someone tries to quit their primary addiction the brain craves the dopamine hit it’s used to. This craving can lead to substituting another substance or behaviour that also stimulates dopamine release and cross-addiction. Addictive behaviours create positive memories, motivate people to overcome obstacles, stimulate purposeful movement and give meaning.
Psychological Factors Contributing to Cross-Addiction: Trauma and Maladaptive Coping Mechanisms

Psychological factors play a significant role in cross-addiction. Trauma, chronic stress and underlying mental health conditions like anxiety and depression often drive individuals to addictive behaviours as a coping mechanism. People will turn to substances or behaviours to self medicate and escape their emotional pain. However, addiction substitution isn’t necessarily driven by self-medication. Indeed, impulsivity, habit reinforcement and social conditioning also drive addiction behaviours, whereby if the underlying emotional cause isn’t addressed, and a coping mechanism (primary addiction) is taken away and the person will seek another to fill the void.
Maladaptive coping mechanisms like avoidance, denial and emotional suppression can also contribute to cross-addiction. These mechanisms prevent people from dealing with the root of their pain and they will seek temporary relief through addictive behaviour. The cognitive and behavioural patterns of the primary addiction can also transfer to the new addictive behaviour making it hard to break the cycle of addiction.
Common Cross-Addictive Patterns: Substance Use, Behavioural Addictions and Stressor-Related Disorders

Cross-addiction can show up in many ways, both substance use disorders and behavioural addictions. Here are some common patterns:
- Substance to Behavioural Addiction: Using alcohol or drugs instead of behaviours like gambling, sex addiction or compulsive internet use.
- Behavioural Addiction to Substance Use: Using substances to regulate the emotional or physical consequences of a behavioural addiction. For example, a compulsive gambler may use alcohol to numb financial stress.
- Substance to Substance: Switching from one substance to another, like from alcohol to prescription drugs or other illicit substances.
- Behavioural Addiction to Behavioural Addiction: Replacing one behavioural addiction with another, like from compulsive shopping to excessive gaming.
These patterns overlap and are influenced by individual vulnerabilities, environmental factors and availability of alternative addictive stimuli. Major life Stressors can contribute to cross-addiction as individuals seek alternative ways to manage distress.
Identifying Cross-Addiction: Recognising the Signs and Symptomatology
It’s important to be aware of the signs and symptoms of addictive behaviours to identify cross-addiction.
These are:
- Loss of Control: Can’t stop or limit the behaviour despite trying to.
- Preoccupation: Spend a lot of time thinking about the behaviour or planning to do it.
- Tolerance: Need to do the behaviour more frequently or more intensely to get the desired effect.
- Withdrawal Symptoms: Experiencing discomfort (physical or psychological) when trying to stop the behaviour. This can manifest as anxiety, irritability, or physiological changes like cravings or insomnia.
- Continuing Despite Consequences: Persisting in the behaviour despite relationship problems, financial issues, or health complications. Neglecting Responsibilities: Neglect work, school or family obligations because of the behaviou.
- Secrecy and Deception: Hide the behaviour from others or lie about how much you’re involved.
Knowing these signs and symptoms is key to early intervention and stopping cross-addiction.
Assessment and Diagnosis of Cross-Addiction: Clinical Evaluation and Tools

Assessment and diagnosis of cross-addiction involves a full clinical evaluation. This evaluation includes:
- Detailed History: Gathering info on the individual’s substance use history, behavioural patterns, mental health history and any past trauma or stressors.
- Clinical Interview: A structured or unstructured interview to assess symptoms, behaviours and motivations.
- Standardised Assessment Tools: Using validated questionnaires and assessment scales to measure addiction severity, mental health symptoms and functional impairment.
- Psychological Testing: Administering psychological tests to assess personality traits, cognitive functioning and emotional regulation.
The findings from these assessments will help to determine the presence of cross-addiction, identify co-occurring mental health conditions, and inform the development of a personalised treatment plan.
Therapeutic Approaches to Cross-Addiction: Addressing Root Causes and Promoting Recovery
Therapy approaches for cross-addiction involve addressing the psychological and neurobiological underpinnings of addictive behaviours. This can involve:
- Individual Therapy: A safe and supportive space to work through emotions, address past trauma and develop healthy coping mechanisms. Cognitive Behavioural Therapy (CBT) is great for identifying and changing negative thought patterns and behaviours.
- Group Therapy: A platform to share your experience, get support from others and learn from each other. Peer to peer with professional guidance can be super powerful and encouraging.
- Family Therapy: Involve the family in the process to improve communication, address relationship issues and create a supportive home environment.
- Biological Interventions: Focus on the biological side of recovery, including diet, exercise, and sleep hygiene. Stress management techniques such asyoga, meditation, personal training, massage, sauna and ice baths can help regulate the autonomic nervous system and reduce anxiety and cravings.
- Trauma Reprocessing: For individuals whose addiction stems from trauma, therapies like Eye Movement Desensitisation and Reprocessing (EMDR), Cognitive Processing Therapy, Prolonged Exposure Therapy can help individuals to process and heal from past trauma. For individuals whose addiction is more habit driven, behavioural interventions such as CBT may be more effective.
The specific therapy approach will depend on the individual’s unique needs, preferences and the nature of addiction. A tailored treatment plan is key to long term recovery.
Preventing Cross-Addiction: Building Resilience and Fostering Healthy Coping Strategies

Stopping cross-addiction requires building resilience and healthy coping mechanisms. This means:
- Education and Awareness: Educating yourself about addiction and cross-addiction.
- Healthy Coping Mechanisms: Learning to manage stress, regulate emotions and cope with difficult situations without substances or behaviours.
- Mental Health: Addressing any underlying mental health conditions and access to mental health services.
- Social Support: Building strong social connections and seeking support from family, friends or support groups.
- Lifestyle Changes: Healthy habits, exercise, balanced diet and sleep.
- Early Intervention: Identifying and addressing addictive behaviours early before they become addiction.
By practicing these strategies , individuals can reduce their risk of cross-addiction and build a healthier, more balanced life.
Highlands Recovery, located near Sydney in Australia is an Institute of Behavioural Medicine offering a full 4 phase recovery program. Phases 1 and 2 are done through our intensive residential program, individual and group therapy, diet, yoga, meditation, personal training, massage, sauna and ice baths. Phase 3 provides ongoing support with weekly individual and group virtual therapy sessions and regular wellbeing check ins. Highlands Recovery is dedicated to helping you build a recovery that lasts.
Reviewed by: Dr. Emma Bardsley

Dr Emma Bardsley is a neuroscientist with a PhD from Oxford and a post doctorate from Auckland University, along with an undergraduate degree in Pharmacology from King’s College London. She has lectured extensively on neuroscience, physiology, and pharmacological interventions, bridging foundational research and its clinical applications. With a strong record of publications in high-impact journals and extensive experience in scientific writing, editing, and peer review, she excels at translating complex research into practical insights. Based in New Zealand and collaborating internationally, Emma is dedicated to advancing understanding and treatment in the fields of trauma, addiction, and recovery.
References
Marich J. EMDR in the addiction continuing care process: Case study of a cross-addicted female’s treatment and recovery. Journal of EMDR Practice and Research. 2009 Apr 1;3(2):98.
McFadden KM. Cross-addiction: from morbid obesity to substance abuse. Bariatric Nursing and Surgical Patient Care. 2010 Jun 1;5(2):145-78.
Nower L, Anthony WL, Stanmyre JF. The intergenerational transmission of gambling and other addictive behaviors: Implications of the mediating effects of cross-addiction frequency and problems. Addictive Behaviors. 2022 Dec 1;135:107460.
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010 Jan;35(1):217-38.
Hyman SE. Addiction: a disease of learning and memory. American Journal of Psychiatry. 2005 Aug 1;162(8):1414-22.
Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: the role of reward-related learning and memory. Annu. Rev. Neurosci.. 2006 Jul 21;29(1):565-98.
Najavits LM, Hyman SM, Ruglass LM, Hien DA, Read JP. Substance use disorder and trauma. 2017