Cross-Addiction: How to Avoid Replacing Alcohol With Another Addiction

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More than 700,000 Americans undergo treatment for alcohol addiction every day. Part of alcohol addiction recovery is replacing alcohol misuse with healthy coping skills. For some people, alcohol can accidentally can be replaced with other “bad habits” or addictions even when they become abstinent.¹

Alcohol Misuse and Addiction

The Center for Disease Control and Prevention (CDC) defines alcohol misuse as more than one drink per day for women and two drinks per day for men.¹ The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines alcohol misuse as any pattern of alcohol intake that leads to harm in one’s: ²

• Physical and mental health
• Relationships
• Professional life

NIAAA also defines “excessive drinking” as more than three drinks a day for women and four for men.²

Alcohol use disorder is a mental health condition that includes all of the behaviors commonly referred to as “addiction.” Alcohol use disorder is characterized by any pattern of intake that causes harm and its symptoms can range from mild to severe.

Mental health professionals diagnose alcohol use disorder by evaluating 11 criteria. If you have experienced 2-3 of the criteria, you may have mild alcohol use disorder. If you have experienced 4-5 of the criteria, you may have moderate alcohol use disorder. Severe alcohol use disorder is diagnosed if you have more than 6 of the criteria. ³

Cross-Addiction During Recovery

When recovering from alcohol use disorder, one of the goals is to find things to replace alcohol. In some cases, this can result in the undesirable phenomenon of “cross-addiction.” Cross-addiction is also known as:

• Substitute addiction
• Addiction transfer
• Addiction interaction disorder

Cross-addiction was once thought to be extremely common. However, a 2014 study of more than 34,000 adults with a substance use disorder revealed that only approximately 20% of the total sample developed a new-onset substance use disorder in recovery.⁵ The study did not draw conclusions about who may be more likely to develop cross-addiction.

Alcohol addiction often starts with alcohol misuse to cope with physical or emotional symptoms. When you stop using alcohol, you have a hole where that coping skill was. Individuals with alcohol use disorder often have a physical or psychological dependence on alcohol, which means they may rely on alcohol as a means of staying calm, sleeping, or performing other daily functions.

If you used alcohol to cope with physical symptoms—like chronic pain—you may have an increase in certain symptoms after detox. Treating these symptoms is critical to avoid finding things to replace alcohol as a pain reliever or sleep aid.

If you used alcohol to cope with mental or emotional symptoms—like feelings of anxiety or depression—these symptoms can also increase or change when you become sober. Some individuals are diagnosed with a mental health condition that was hidden by the symptoms of their alcohol addiction after they detox, such as attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), or obsessive compulsive disorder (OCD).

Cross-addiction can happen with any substance or compulsive pattern of behavior, including behavior that would otherwise be encouraged such as exercising or working.

Some possible alcohol addiction replacements are:⁴

• Illegal, legal recreational (e.g., weed), prescription, or over-the-counter substances, including mixing substances
• Nicotine, including cigarettes, chewing tobacco, e-cigarettes, nicotine gum or patches, and vape pens
• Gambling
• Disordered food behaviors, including binge eating or restricting
• Disordered exercise behaviors, including over-exercising to the point of illness or injury
• Overworking
• Excessive social media or internet usage, including obsessive viewing of adult materials
• Compulsive sexual behavior, which may include unsafe practices
• Compulsive behavior in relationships, including friendships and romantic relationships (e.g., extremely high amounts of internet dating)
• Shopping beyond your needs or means
• Risk-taking or adrenaline-seeking

Alternatives to Drinking Alcohol

Cross-addiction is not an inevitable part of alcohol addiction recovery. Formal addiction treatment, specialized therapy, and self-guided steps toward finding coping mechanisms that work in your sober life can help you avoid replacing alcohol with another substance or compulsive habit.

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Consider the Underlying Causes of Your Alcohol Misuse

Look within and ask yourself when you are most likely to reach for an alcoholic drink. Knowing your use patterns and how and why you use alcohol to cope will help you to recognize your triggers when they occur and choose healthier alternative coping skills when needed.

Cognitive-behavioral therapy (CBT) is a form of therapy where the goal is to recognize the thoughts, feelings, and situations—also called cues—that lead to drinking and develop coping skills to handle the triggers in alternative ways.^{6, 7} CBT is used in many alcohol addiction treatment programs.

Recognize the Difference Between a Habit and an Addiction

Habits and addictions can involve the same behaviors for different people. For example, eating is a requirement to survive, but compulsive behaviors around food and exercise can develop into eating disorders. Even though it is not defined as an addiction by mental health professionals, the peer support group Overeaters Anonymous (OA) even considers overeating to be a literal addiction just like alcohol use disorder.

Be honest with yourself about the nature of your behaviors. A therapist can help you examine the function that behaviors serve in your life.

Dialectical behavior therapy (DBT) is one type of therapy that may help with identifying potential cross-addiction. DBT focuses on validating a person’s complicated feelings as well. DBT focuses on becoming mindful of one’s thoughts, feelings, behaviors, and patterns, learning to regulate emotions, increasing distress tolerance, and generating new behaviors more aligned with one’s values.⁸

Develop New Daily Habits

Create a new routine filled with replacement habits that will positively contribute to your life. For example, if used to drink alcohol at a very specific time of day, consider replacing that alcoholic drink with a nonalcoholic drink, a snack, or with an activity like taking a walk with a friend.

You may also choose to replace behaviors you associate with alcohol use with daily meditation, exercise, creative expression, or another hobby of your choice. Making it a daily habit will help your brain to create new neural pathways, and over time, your cravings for alcohol will lessen, and you will start to feel rewarded for choosing your healthy habit.

For many people in Alcoholics Anonymous (AA), AA meetings, working the 12 Steps, or other AA literature—such as the Daily Reflections—can become part of this new daily routine.

Choose to Replace Addiction with a New Passion

Many people intentionally choose a new hobby, educational or professional pursuit, or passion while in recovery. You may find this new passion while in treatment. For example, some programs offer alternative therapies like animal-assisted therapy, art therapy, yoga, and music therapy that may guide you.

Consciously choose to channel the energy you put toward your alcohol misuse into a positive and creative outlet. Feeling purposeful and connected are considered critical parts of alcohol recovery.

Practice Mindfulness

Mindfulness is a practice of being fully present in the moment and consciously observing your thoughts, feelings, sensations, motivations, and behaviors from a nonjudgmental and curious perspective. Practicing mindfulness will help you increase your self-awareness to recognize addictive triggers better and identify your strengths to help you move forward and make healthier choices in the future.

Mindfulness is also used in many alcohol addiction programs. DBT teaches a specific type of mindfulness you may find helpful in recovery.

Seek Professional Counseling or Therapy

A variety of therapy techniques can help you identify and heal unresolved traumas and emotional wounds that may contribute to alcohol misuse or other addictive behaviors. These therapies can also help you identify and practice healthy coping skills that you can utilize instead of choosing to drink.

Some available therapies include:^6,7

• Motivational Interviewing—Motivational interviewing starts with developing a list of pros and cons of drinking, then you and your therapist will work on strengthening your motivation to remain abstinent and build your confidence so you can maintain your healthy choices long-term.
• Couples and Family Counseling—Often, alcohol misuse affects all relationships. In these situations, it can be helpful to seek couples therapy or family counseling to help repair, improve, and strengthen relationships that may have been harmed.
• Trauma Therapy—Trauma therapy, such as exposure therapy, can support alcohol addiction therapy since trauma is considered a risk factor for addiction and many individuals with addiction also have co-occurring trauma disorders.

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Seek Peer Support

A variety of peer support groups are available for people struggling with alcohol misuse. Alcoholics Anonymous (AA) is the most common nationwide and support group, but there are many other options so that you can find peer support that you find most helpful.

Peer supports including SMART Recovery, HAMS, Celebrate Recovery, LifeRing Secular Recovery, and Secular Organizations for Sobriety, as well as other secular, religious, and spiritual organizations.

Some peer support groups, like AA and its sister organizations like Narcotics Anonymous (NA), have a mentorship program. These sponsors are not mental health professionals, but rather a sober person in your support group who can personally reach out to you when you need support.

Enroll in a Relapse Prevention Program

Cross-addiction is sometimes referred to as “the back door to relapse.” While you may not necessarily relapse into alcohol use, you can still relapse by replacing alcohol with another addiction. Some individuals consider true recovery to be strict abstinence from any addictive substance or behavior, while others understand recovery to be finding freedom from “problem substances” through moderation, harm reduction, or abstinence.

A relapse prevention program can help you stay away from alcohol and help you develop and strengthen alternative coping skills to remain abstinent and avoid replacing alcohol with other substances and addictive behaviors. These programs may be part of transitioning out of formal treatment or may be available through other addiction treatment providers.

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Resources

1. Centers for Disease Control and Prevention. (2018). Alcohol & Substance Misuse.
2. National Institute on Alcohol Abuse and Alcoholism. (2021). Drinking Levels Defined.
3. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.
4. Sussman, S. & Black, D. (2008). Substitute Addiction: A Concern for Researchers and Practitioners. Journal of Drug Education, 38(2), 167-180.
5. Blanco,C., Okuda, M. & Wang, S. (2014). Testing the Drug Substitution-Switching Addictions Hypothesis: A Prospective Study in a Nationally Representative Sample. Journal of American Medical Association, Psychiatry, 71(11), 1246-1253.
6. S. National Library of Medicine. (2021). Alcohol Use Disorder (AUD) Treatment. MedlinePlus.
7. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for Alcohol Problems: Finding and Getting Help.
8. Dimeff, L. A. & Linehan, M. M. (2008). Dialectical Behavior Therapy for Substance Abusers. Addiction Science & Clinical Practice, 4(2), 39-47.