Lady crying with mirror with lines of cocaine and a syringe

What do Cross-Addiction and Cross-Dependence Mean?

Lady crying with mirror with lines of cocaine and a syringe


Cross addiction, or addiction transfer, occurs when a person is addicted to more than one substance or activity. Remember, addictive behaviors don’t only apply to substances. People can become addicted to gambling, sex, food, shopping, video games, work, and cell phones. 

A classic example of cross-addiction is when a person is addicted to alcohol and another substance. Alcohol use disorder and drug addiction are often seen together and can lead to negative consequences such as poor health, decreased productivity, and legal trouble. 

We know that those who abuse alcohol are at higher risk of using other substances, including prescription medications. They may also be at higher risk of becoming addicted to gambling. Alcohol impairs judgment. Why do you think the casinos in Las Vegas give free alcoholic drinks to those who gamble? 

teenagers drinking at a party

It is important to remember that people don’t become addicted to substances by choice. Addiction can occur for a variety of reasons. 

  • It may result due to peer pressure. 
  • Post-op patients may be prescribed a new substance for pain control and may obtain pleasurable feelings while using this substance. They may continue to use it even in the absence of pain. 
  • People with poor coping skills may use addictive substances to numb the pain of a lost job, relationship, or the death of a loved one. 
  • Patients with bipolar disorder and other mental health conditions may develop new habits while trying to self-medicate. 

When patients have a mental illness and abuse substances, we refer to them as dual-diagnosis patients.

multiple drugs of abuse pictured


Cross-dependence has three different meanings.

The first is the ability of one substance to prevent withdrawal symptoms of another substance.

A classic example is using methadone to avoid the withdrawal symptoms from heroin or other opiates.

As healthcare professionals, we use this to help keep opiate addicts from using heroin and other dangerous street drugs.

woman snorting cocaine

Another definition of cross-dependence is when a patient rapidly becomes dependent on a substance related to another drug to which the patient already has a tolerance or dependence. This can happen, for example, with two addictive drugs, both opiates. This can lead to a dangerous balancing act where the patient tries to get the desired effect of the substances without overdosing.

The third definition of cross-dependence is when the person simultaneously depends on more than one substance or activity. This is the concept of cross-addiction. 

The most common cross-addictions are drugs to alcohol and drugs or alcohol to gambling. 

The patient may also substitute one addiction for another. For example, a patient suffering from cocaine addiction may start playing video games to take their mind off their drug of choice. Video games can release dopamine from the brain, which leads to positive reinforcement and an increase in the time spent playing video games. What started as a coping mechanism to try to abstain from cocaine use could result in the development of a video game addiction.

Cross-addiction and cross-dependence are concepts that must be considered when treating patients with substance addiction. 

Many treatment centers are available to help those suffering from drug dependence and other addictions. The first step in recovery is admitting a problem and finding support groups to help or seeking inpatient treatment when necessary. 

Developing healthy coping skills BEFORE you need them is the key to preventing addiction. 

Other aspects include mental health issues, chronic pain, a family history of addiction, and environmental factors that may lead to compulsive behaviors and an increased risk of addiction.

We must all remember that mental health disorders are no different than other medical conditions. 

They involve a different organ. The brain is the most complex organ in our body, and there are many things we still don’t understand. 

What we do know is the average person can become a drug addict at any time. 

As a society, we are responsible for caring for our population’s poor and vulnerable members. This includes those with mental health issues. 

The only way to be sure not to become addicted to a substance is total abstinence. This is also true of the activities that people may become addicted to. I am not suggesting never to eat or have sex but being aware of your actions and what habits you are forming. 

I hope everyone reading this will develop coping skills to help weather the storms that life creates. 

Remember, if you are addicted to anything and want help, 

call 1-800-662-HELP (4357). 

This is the greatest gift you can give yourself if you are suffering from an addiction.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


How to Break the Addiction Cycle

Do you have an addiction that is affecting your life?
Would you like a more healthy lifestyle?
Do you know the different stages of drug addiction?

This post will help you break the cycle of addiction. Reading this blog post starts your first step in getting clean and taking back your life. Addictive behavior should not rob you of your happiness. So read on and break the vicious cycle of addiction for good!

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.


According to the National Center for Drug Abuse Statistics 1

  • 11.7% of Americans age 12 and overuse illegal drugs, and 31.9 million have used them within the last 30 days.
  • 139.8 million Americans 12 and over drink alcoholic beverages, and 14.8 million (10.6%) have an alcohol use disorder (AUD).
  • Less than 8% of those with an AUD receive treatment.
  • There have been 700,000 deaths due to drug overdoses in the United States since 2000.
  • 47% of America’s youth use an illicit drug before high school graduation.

Risk Factors and Protective Factors

Research has shown that drug addiction is multifactorial.

We know that most individuals do not begin using substances to become addicted. We also know that a risk factor for one person may not be a risk factor for another.

The more risk factors one is subjected to in childhood, the greater chance of addiction.

Timing is also essential. Peer pressure during middle and high school is usually more powerful than at other stages of life.

This is also true of protective factors. A robust parent-child bond can have a more significant effect during the Childs early years of life.

Environmental factors such as drug availability and anti-drug use policies are critical. It is impossible to start using drugs or alcohol if they are unavailable.

The table below shows important risk factors and protective factors regarding drug addiction.2

risk factors and protective factors regarding drug addiction

The Seven Stages of Addiction

The infographic below outlines the seven stages of drug addiction.

Unfortunately, it may take several years to progress through all stages. As a result, first-time drug users may not make it to stage 7.

In addition, each stage comes with a higher risk of negative consequences.

Remember, illicit drugs are not the only addictive substances. Prescription drugs can also be abused and are very dangerous if misused.

In 2017, prescription opiates caused 17,029 deaths.3

Ways to Break the Addiction Cycle

respect yourself note on cork board with heart

The Most Important Thing to Remember

If you are reading this post, please realize that you are worthy of happiness.

It doesn’t matter what has happened in your past; you have a gift to give humanity.

I believe the first step in the recovery process is learning how to love yourself. Low self-esteem is an emotional trigger for drug use.

Many of us try to use substances to escape daily life stressors or to numb recurring emotional pain. This might work initially, but it often leads to drug dependence. Remember, the first step is to learn to love yourself.

I am a firm believer in self-love.

Man and woman holding hands looking at ocean during sunset

Engage in Activities that Exclude Intoxicants

One of the easiest ways to break the addictive cycle is to limit activities to those that don’t involve intoxicants. Many forms of entertainment fit this category.

Some ideas are listed below:

  • Engage in a hobby such as scuba diving or photography.
  • Meet a friend and work out at your local gym.
  • Watch a movie.
  • Go on a bike ride.
  • Cook your favorite meal.
  • Go hiking.
  • Take a walk on the beach.
  • Go to church.
  • Attend a support group.
  • Meditate
  • Read a good book.
  • Play a round of golf.
  • Take a road trip.
Man shopping for a guitar

Develop a Reward System for Not Using

I will never forget things from my experience as Director of Pharmacy in a private psychiatric hospital during the late ’90s.

One of the psychiatrists would tell his patients to take half of the money they would spend on drugs and alcohol and buy something they enjoyed. This can be a powerful tool. Using drugs is expensive, and buying things you want with some of the money you would have spent on your habit can be a compelling deterrent.

You can reward yourself with a trip to the beach, the nail salon, or an expensive meal. A piece of artwork or even a new car!

Whatever it is that makes you happy.

Buy Anxiety Formula Here

Traffic sign that reads new skills ahead

Work on Coping Skills


Learning how to deal with stress is crucial if you expect to break the addiction cycle. Pressure can come from relationship problems, job loss, the death of a family member or pet, and even everyday life. Stress often leads to anxiety which can prompt drug or alcohol use. Please read my blog post “9-useful tools for anxiety relief.” for ideas on how to relieve anxiety symptoms. Here are some ideas to help reduce stress. Pick the activities that work best for you.

  • Practice deep breathing techniques.
  • Listen to your favorite music.
  • Try herbal supplements or drink herbal tea.
  • Take a warm bath.
  • Practice yoga.
  • Get a massage.
  • Spend time in your garden.

The good news is many other choices can help reduce stress. Doing what you enjoy and having a good time is what is important.

Stop the Negative Thinking

Thinking errors can lead to relapse. If you plan to break the addiction cycle, you must learn how to minimize these thoughts. Thinking errors come in many forms, but they can all be detrimental to mental health. Please see my blog post for a more detailed discussion on thinking errors.

Cognitive-behavioral therapy (CBT) is the best way to combat thinking errors. This therapy helps to identify unhealthy thoughts and learn to react to them positively. CBT is available as an outpatient or part of a good inpatient substance abuse treatment program.

I highly recommend the book “Feeling Good” by Dr. David D. Burns. This is a must-read for those suffering from substance dependence. I have read this book several times, and it does help with not only thinking errors but anxiety and depression.

Eat Healthily

I cannot overstate the importance of eating healthy

A good diet is not only good for your body, but it also helps your mood. One study showed an unhealthy, high-glycemic diet led to more depression symptoms and an increase in mood disturbances compared to a low-glycemic-load diet.4

A healthy diet can also improve sleep quality.

Be Grateful

Gratitude is an essential aspect of the recovery process.

When a person stops using drugs or alcohol, emotions begin to appear. Addicts often feel guilt, shame, and remorse. It is crucial to balance these negative emotions with positive ones.

We all have many reasons to be grateful. The secret is to focus on the positive aspects of our lives and not dwell on the negative.

For a more in-depth discussion on gratitude, read my blogpost Gratitude Unlocks the Fullness of Life

Bright neurons

Understand the Effects of Dopamine on Your Behavior

Dopamine is a neurotransmitter responsible for feelings of pleasure. The dopamine receptors in our brain bind to the dopamine, which leads to the feeling of pleasure. Many things lead to an increase in dopamine release, including:

  • Drugs
  • Sugar
  • Sex
  • Gambling
  • TV
  • Social Media

When we indulge in these behaviors that increase dopamine release, our brains adjust by decreasing the number of dopamine receptors available. When this happens, we need more dopamine to feel normal. If we stop participating in “dopamine-producing” activities, we begin to experience withdrawal symptoms. These symptoms include:

  • Insomnia
  • Dysphoria (dissatisfaction with life)
  • irritability
  • Anxiety
  • Craving

This often leads to the person engaging in whatever activity produced the dopamine surplus, to begin with. However, we can break this cycle. If we stop flooding our brains with dopamine long enough, we can return to a balanced state.

Group counseling session

Get Professional Treatment

It is critical to realize that drug addiction is a chronic disease process. For a treatment program to be successful, it must help the patient:

  • Cease the use of intoxicants.
  • Remain drug-free.
  • Become productive at work and in society.
  • Develop into a positive influence on family and friends.

The best treatment programs combine several treatment approaches to provide individualized healing. Drug treatment must provide for individualization. What works well for one patient may not be effective for another. The figure below outlines the principles of an effective drug treatment program according to the National Institute on Drug Abuse.

There are many outstanding treatment facilities available throughout the United States to choose from. A simple Google search for “drug and alcohol treatment near me” will give you a list of treatment centers in your area.


My Final Thoughts

Drug and alcohol addiction can rob us of happiness and joy. What begins to be an enjoyable activity can turn into a nightmare. Many people have a family history of addiction. If you fall into this category, you owe it to yourself and your family to start a new life.

  • A new life without drugs and alcohol.
  • A new life of happiness.
  • A new life where YOU are in control.


Take a minute to think of your life without intoxicants.


How do you feel?

What will you accomplish?

How will this affect the people around you?

There is no better time to start your recovery than right now! You deserve to be happy! You deserve a better life!

If you have any questions about this post or anything related to health and wellness, feel free to email me at [email protected].

Remember, it is up to you to live a happy, healthy life, and Sunshine Nutraceuticals can help!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Ethanolism – Why You Shouldn’t Drink Alcohol

I enjoy a few drinks with friends.

I deserve a drink to calm down after a hard day at work.

Everybody drinks, right?

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

I started Sunshine Nutraceuticals in July of 2019. My goal has always been to help my readers live a happy, healthy, healing lifestyle.

I know a lot, if not most, of my readers, drink alcohol.

Ethanolism – Why You Shouldn’t Drink Alcohol is not about judgment. It is not about right or wrong. This post is meant to give my readers the facts about alcohol. The first fact, and likely the most important is this:

Ethanol is a neurotoxin

 What this means is when you drink alcohol, you are consuming poison.

Is it worth it?

Like most of you reading this, I used to drink alcohol. When my second youngest child was born, I decided to stop. Not because I had to, but because I wanted to be more productive and was sick and tired of wasting money on alcohol. I wanted my kids to grow up in a home without alcohol.

My life today without ethanol is much better. I am in good shape, I think more clearly, my anxiety level has decreased, and I am saving money. 

I have seen hundreds of patients admitted to the hospital because of alcohol intoxication. The nurses in ICU will tell you these are some of the most challenging patients to manage. Alcohol withdrawal is no joke. It can kill you!

I have watched people die of liver failure due to ethanol. This is not a good way to go. Remember, your liver is the primary organ responsible for removing toxins from your body. Imagine living your final days with a body full of byproducts. We have dialysis to help with kidney disease, but if your liver fails, there isn’t much that can be done.

If you want to be healthy, ethanol will not help you achieve the goal.   

Sobering Statistics

It is estimated that 88,000 people die from alcohol-related causes each year.  1

This ranks third as the most preventable cause of death in the United States behind tobacco,  poor diet and physical inactivity. 2

In 2014, thirty-one percent of all driving fatalities (9,967 deaths), were attributed to alcohol impairment. 3

In 2017, 26.4 percent of people over eighteen years of age reported binge drinking and 6.7 percent reported heavy alcohol use in the past month:

Binge drinking: a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. 4

Heavy alcohol use: Binge drinking on 5 or more days in the past month.

Alcohol Use Disorder (AUD) in the United States: According to the 2017 National Survey on Drug Use and Health (NSDUH), 14.1 million adults ages 18 years and older have AUD. 5

Alcohol Use Disorder (AUD): AUD is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. The fourth edition of the Diagnostic and Statistical Manual (DSM–IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications. 6

Over ten percent of children in the United States live with a parent with alcohol problems, according to a study published in 2012. 7

Drinking alcohol increases the risk of contracting the following types of cancers:

  • Mouth
  • Esophageal
  • Pharynx
  • Larynx
  • Liver
  • Breast 


Why Do People Drink Ethanol?

We will now explore the reasons people drink alcohol. Again, no judgment here. I am merely pointing out why you might drink.

Alcohol Gives Me Confidence and Helps With Socialization at Parties.

What alcohol does is dull your sense of apprehension along with other mental capabilities. Our bodies have a method to combat fear, known as the “fight or flight” response. This is the body’s way of protecting us from dangerous situations. Alcohol has a depressant effect on the brain and suppresses this response.

When our “fight or flight” system is diminished or absent, it makes us vulnerable to dangerous situations. If there is a danger, we are less likely to notice and certainly not as able to respond to it. What do we call people who are drunk? Hammered, wasted, tanked, tipsy, plastered. These words describe someone who can quickly be taken advantage of or hurt. This world is full of individuals that can’t wait to take advantage of someone in a vulnerable state. 

As far as confidence goes, I would much rather spend time with a shy person than someone who is drunk and talks nonstop. Drinking to gain confidence can easily backfire, turning the person into a fool. You are much more likely to develop strong friendships if you appear as you are rather than who you are when drunk. 

Intoxicated people also have diminished impulse control. I explain this to my students in the following way:

Suppose someone has just made you very angry. You don’t like this person and think about punching them in the face. 

Most of us would not punch them. We know there are consequences to such actions. This is an example of impulse control. We stop ourselves from doing something that will undoubtedly have negative consequences. Alcohol removes some of this control. Remember, alcohol deadens all senses, good and bad. 

Why do you suppose there are so many fights in bars? 

Alcohol does not give you any special powers, and it takes away your body’s inherent protective mechanisms.

Another thing to consider is the fact that you have to get home from that party! 

Do you have a designated driver? 

How many times have you driven when you have had too many drinks?

I don’t have to tell you what happens if you get pulled over by the police on the way home.

The least you will lose is a night of freedom and a big pile of money. You could also lose your job or even your career in some cases.

Is it really worth it?

Drinking Alcohol Relaxes Me, and I Deserve That After a Rough Day at Work!

Does alcohol relax us? 

What is it doing? 

The truth is alcohol doesn’t remove stress at all. It merely enables us to ignore our body’s innate warning system. If we are genuinely “stressed,” maybe we are trying to accomplish too much. Our body is telling us to slow down.

In fact, alcohol is very good at causing stress. 

What happens when the alcohol wears off? 

We feel anxious. Most of us want more. 

Wanting more causes stress that is only relieved when we continue to drink. The next drink does induce some relaxation, but this is only due to decreasing the withdrawal symptoms caused by alcohol leaving our body.

What will happen is the more you drink, the more stress you will invite into your life. Secondly, any problems you were attempting to forget will still be there when the alcohol wears off.

Finally, if you end up drinking too much to relax, your next day will likely be worse.

Alcohol helps Me Sleep

Not a chance. It might make you think you are sleeping better, but the sleep quality is reduced. 

Ethanol is a typical “over-the-counter” sleep aid. It increases the quality and quantity of NREM sleep during the first half of the night in non-alcoholics, but REM sleep is disrupted later. The REM stage is where we dream and is considered a restful period as our muscle tone is decreased. Do not use alcohol as a sleep aid! There are many other products that work much better with fewer side effects.

Sleep quality in alcoholics is even worse. During drinking periods as well as abstinence, altered sleep architecture leads to profound insomnia and daytime sleepiness. 9 

Alcohol and Dementia Risk

As a Clinical Pharmacy Specialist in Psychiatry, I see the consequences of substance abuse often. This is one of the subjects I am most interested in and will be writing about regularly — the unit where I currently practice has geriatric psychiatric patients. 

A large percentage of these have dementia. There are four basic types of dementia. Alzheimer’s disease, Lewy body dementia, vascular dementia and frontal-temporal lobe dementia.  

We know that chronic alcohol use can lead to dementia. 

Vascular dementia occurs as a result of a stroke. Long-term ethanol use increases blood pressure, increasing stroke risk. Alcohol consumption also increases the risk of developing type II diabetes, obesity, and atrial fibrillation. All of these increase the risk of stroke.

Alcohol abuse has also been associated with Alzheimer’s dementia:

“Research from the University of Illinois at Chicago has found that some of the genes affected by alcohol and inflammation are also implicated in processes that clear amyloid beta — the protein that forms globs of plaques in the brain and which contributes to neuronal damage and the cognitive impairment associated with Alzheimer’s disease.” 10 

Alcohol is bad for the brain. I want nothing to do with any avoidable habit that may lead to dementia.

What Alcohol is Doing to Your Body

Ethanol has an effect on every organ in the body. 

Take a look at this short youtube video on how drinking negatively affects the body:


Life Without Ethanol

Here are a few positive benefits of an ethanol-free life. Some of these have already been described earlier but will be repeated for emphasis.

  • Fewer calories consumed, which may lead to weight loss: It is no secret that alcoholic drinks contain empty calories. Drinking too much can derail any diet plan.
  • Better sleep quality: As mentioned above, ethanol disrupts REM sleep. This often leads to daytime sleepiness. If you combine this with a hangover, it leads to an awful day! 
  • More money to do the things you enjoy: Drinking is expensive, especially if you go to a bar. I once worked with a psychiatrist who told his patients to take half of the money they spent on their addictive substance (alcohol in this case), and spend it on something they enjoyed.
  • Improved interpersonal communication with family, friends, and colleagues: Nobody wants to be around someone who drinks too much. 


Michael Brown pictured with Final Thought written

Alcoholism is a significant problem in the United States. This disease leads to lost productivity, broken families, increased medical costs, and unnecessary pain and suffering. People have lost jobs, been involved in accidents, and gone through a painful divorce because of alcohol abuse.

Many drink booze to “have fun.” Is this making the situation more fun? Maybe you are having a good time because you are surrounded by people you like? Why not try to live without alcohol and see how you feel?

Ethanol does not make you sleep better. It changes your sleep patterns and robs your brain of restful REM sleep.

Think about the positives and negatives of drinking alcohol. If you think about it, drinking poison doesn’t make sense. Take it from someone who has eliminated it. You will feel better!

 It is possible to stop drinking. If you have a problem with alcohol, the most critical thing you can do is get help. Being healthy feels much better than being addicted to ethanol. Click on the following link for more information.

This one-click may be the beginning of the healthiest thing you can do for your body! 

Don’t be shy.

You are in control of your life. 

You are responsible for your happiness, and only you can decide what goes into your body.

Eat right, exercise, get plenty of sleep, and do the things that make you happy!!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.