Are Substitute Addictions an Inevitable Part of Recovery?

Some people who recover from one chemical addiction or compulsive behavior will develop a different addiction while in recovery from the first one. Simply put, substitute addictions, also known as cross addictions, occur when a person “replaces” one addiction with another. Why are some people more successful in recovery, while others may bounce from one addiction to another? And is there such thing as a healthy substitute addiction?

What Are Substitute Addictions?

Substitute addictions may take the form of drugs or alcohol or compulsive behaviors like gambling, exercise or sexual compulsions. For example, a person abusing alcohol stops drinking but starts binge eating, or a person addicted to heroin quits using opiates but abuses marijuana. Cross addictions don’t always occur in a straight line. A person can engage in several compulsions at once or bounce back and forth between the same destructive behaviors. This concept is known as Addiction Interaction Disorder, and was first introduced by Dr. Patrick Carnes, an internationally recognized expert on addiction and founder of the International Institute for Trauma and Addiction Professionals. Addiction Interaction Disorder postulates that addictions often occur in “packages.” People can be addicted to many things at one time and addictions interact, merge and reinforce one another. For example, a bulimic individual may also abuse alcohol and suffer from intimacy issues. Someone chemically dependent on alcohol may also abuse porn and engage in compulsive gambling behaviors. Further complicating matters are conditions like co-occurring mental health disorders and underlying issues like trauma that may simultaneously occur with and fuel these behaviors.

Are Some People At Greater Risk for Cross Addictions?

Dr. Susan Raeburn has helped people overcome addictions and mental health issues for over 20 years. She was a staff psychologist at Stanford Medical Center for nine years and worked at Kaiser Permanente’s chemical dependency program for over 20 years in addition to her work in private practice. Dr. Raeburn has authored a number of research papers on addiction and shame, as well as occupational stress in musicians, and is co-author of Creative Recovery: A Complete Addictions Recovery Program That Uses Your Natural Creativity. She describes some common situations that occur around substance misuse and unhealthy behaviors. Sometimes individuals struggling with addictions possess the characteristics that have traditionally been associated with substance use disorders and process addictions. These predictable risk factors include a genetic predisposition for addiction, co-occurring mental health disorders, and/or unhealthy attachment styles or past trauma. Their chemical dependency and/or process addiction is often a way to self-medicate symptoms that stem from these challenges. Other individuals may or may not have some of these predictable risk factors but they were fortunate enough to develop healthy resilience and self-regulation skills along the way. Oftentimes these people begin engaging in destructive behaviors through exposure. For example, a college student may be hyperconscious about her weight because her mother was constantly dieting. She’s exposed to a roommate with bulimia and starts binging and purging as a way to control her own weight. Another example that is becoming more prevalent is overexposure to porn, sometimes beginning at an early age. Maybe a person found their parent’s pornography as a young child and viewing porn became a regular part of their life. This may cause an otherwise sexually healthy individual to no longer be able to get aroused by a “regular” person or sexual encounter, which can perpetuate compulsive sexual behaviors. The difference between these routes to substance misuse or compulsive behaviors is that those people with deep-rooted underlying issues may have a harder time with recovery until they fully address the reasons behind their self-medicating behaviors, such as trauma, mental health disorders, attachment styles, etc. For instance, they may eliminate their cocaine use or binge-purge behaviors, but unless they’ve gotten a handle on the motivating factors, they may still chase that dopamine, numbing or self-soothing “fix” in an attempt to cope with these difficulties. People who are engaging in destructive behaviors because of exposure and not because of a traumatic past or mental health issues may have more success in recovery because they are likelier to reach the point where they realize their actions are hurting them. Dr. Raeburn says that this is likely because these people have not crossed over into the biology of an addiction, nor are they coming from a place of trauma. They’re not as hindered going into it. This makes the behavior easier to self-correct through education, therapy and more minor approaches. “For these folks, the behavior isn’t serving the same psychological need,” says Dr. Raeburn. “Their self-regulation skills are more intact and they may have had healthy enough families or other resources growing up so that they have the self-awareness to say, ‘This is kind of sucking now. Let me at least learn about it and see if there is another way.’”

Are All Substitute Addictions Bad?

Sometimes people replace destructive behaviors with “healthier” compulsions. For example, an obsession with running or a preoccupation with religion or calorie-counting won’t lead to a deadly overdose like a heroin addiction can. Dr. Raeburn says her measuring stick for these situations is whether an individual feels they have lost control over the behavior or if they are experiencing negative consequences as a result of the behavior. Are they straddling the line between health consciousness and anorexia? Are they blowing off their job, family or personal obligations to go to church or run? Are they getting injured or putting their health or safety at risk? Another indicator is whether they are engaging in these compulsions to avoid the work they need to do to address the underlying causes of their addictive patterns. In that case, a person might be constantly at risk for cross addictions, and potentially ones that are more harmful. Dr. Raeburn also considers the realities of early recovery. “Where a person’s life was once all about getting high, early in recovery, everything must revolve around sobriety in that same way.” If exercising twice a day is standing between shooting up or staying sober, so be it. The problem, Dr. Raeburn explains, is when people are deeper into their recovery and still using these types of behaviors to avoid the work they need to do to heal from shame, trauma and some of the other issues that propel addiction. That’s when it’s time to take a closer look at what’s really going on.

Can Cross Addictions Be Avoided?

While there are no guarantees in recovery, there are ways to strengthen a person’s sobriety muscles. Some research indicates that a longer continuum of care can help prevent relapse. This might be attributed to extended time addressing underlying issues and learning better coping skills rather than simply eliminating the behaviors. Dr. Raeburn says it’s also important to educate people in early recovery about the potential for cross addictions and the value in developing trusting relationships with people they can turn to if they feel they’re at risk of relapsing or developing a substitute addiction — whether that is a therapist, AA/NA sponsor, friend, family member or support group. Accurate diagnoses are important as well. An undiagnosed personality disorder or mood disorder can wreak havoc on recovery. Lastly, Dr. Raeburn says it’s important to remember that every person is different and sobriety can mean different things to different people. “I work with [clients] as unique individuals. I really try to connect with a person authentically and help them accept their full self, and heal the stuff that interferes with that.”

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