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.

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