Which Came First? Understanding Cross-Addiction

Have you ever wondered why an individual who chooses to discontinue one addictive substance often picks up another? Maybe a recovering alcoholic now drinks an increased amount of coffee or energy drinks?

Or a former smoker finds himself with an intense desire to eat…and eat…and eat?

Or maybe overeating was the initial issue, and once that was well managed, the person has developed a smoking or drinking habit? Fear not! There is science to support this trend and it’s something you can share with your clients to help them understand that alternatives exist to help them succeed!

When an individual becomes addicted to a substance, whether it be an illicit drug, nicotine, alcohol or perhaps even food, the brain releases the chemical dopamine as a reward.

Dopamine is the “feel good” chemical, and it is released in large quantities directly into the brain when consuming an addictive substance.

Over time, the receptors in the brain get used to these huge releases of dopamine and it takes more of the substances to create the initial “high” felt in the beginning. This time is where tolerance and the true addiction kicks in. When the substance is removed, the dopamine receptors are now seeking an alternative means to get that “boost” they previously received.

The brain seeks out any source it can find to boost dopamine, often fulfilling the need with another addictive substance that will increase the chemical levels in a similar way.

True Recovery

So now lets look at recovery – how can our clients truly enter recovery if they replace one addictive behavior with another? Yes, our client has kicked the primary habit – hooray! But now what? What has he done to replace the addiction (the primary coping tool) so he can manage day to day stress?

Well, if clients have not been working through a system of developing techniques to cope with emotions, anxiety, etc. in healthy ways, cross-addiction has most likely slipped in. Perhaps now they are struggling with the new addiction because they didn’t participate in therapy to address the core issues in the beginning of the recovery process.

What can you offer, as a therapist, as a means to learning healthy alternatives to managing the stress, anxiety, etc., to help the client stay on track in his/her recovery?

Addictive thinking often drives the behaviors and feelings that lead to thoughts of relapse or seeking alternative means of filling a perceived void. Ever heard the saying “you go with what you know?”

Lacking support and understanding in recognizing substance abuse as a coping skill (albeit unhealthy) lessens the ability to seek alternate, healthier options such as meditation or exercise in the face of crisis (Intense emotions = painful feelings that are difficult to face = resort back to use of substances to decrease pain/increase dopamine).

A Forgotten Roadblock

Focus on helping clients identify healthy habits to incorporate into his/her daily life that will become so ingrained into their mindsets as to become their “go to” coping skills in their toolbox as opposed to relapse or cross-addiction.

Remember, helping our recovering clients learn to change their thinking patterns is an on-going process. The goal is to guide them in recognizing their strengths and abilities beyond what they currently view in their struggles.

There will be setbacks and stumbling blocks along the way, but the choice to get back up and continue will always be there. Addictive thinking is not only a habit that has been learned, but it is also ingrained into the core chemical makeup of an individual. It takes practice, ongoing support, and possible mistakes and struggles to overcome personal, mental, and sometimes physical barriers that get in the way.

Cross-Addiction is a sometimes forgotten roadblock in the recovery process, as it is not often recognized as a trigger to relapse in and of itself. The nature of an individual seeking to fulfill the need left void by the substance of choice will often lead the person to seek these alternative means of soothing cravings, such that cross-addiction occurs quickly and often with little warning, as it can many times appear harmless (an extra coffee here, an energy drink there, etc.).

With appropriate support and guidance in identifying healthy coping tools that can replace the need for these faulty dopamine-supplementing agents, the brain can heal itself over time to a point that the connections can re-establish in healthy ways and good communication within the brain can happen once again.

Binge eating photo available from Shutterstock

Which Came First? Understanding Cross-Addiction

Amanda Dutton, MS, LAPC

Amanda Dutton, MS, LAPC is a clinical therapist in Georgia providing therapy and support for pre- and post-bariatric patients in her private practice. Her practice focus is on this group of clients because of her own experience with bariatric surgery. Mrs. Dutton documents her story within her professional counseling blog at


APA Reference
Dutton, A. (2015). Which Came First? Understanding Cross-Addiction. Psych Central. Retrieved on August 13, 2020, from


Scientifically Reviewed
Last updated: 17 Sep 2015
Last reviewed: By John M. Grohol, Psy.D. on 17 Sep 2015
Published on All rights reserved.