I happened across a recent discussion on cross addiction. A blog article had cited some new research to portray it as a ‘myth’ to which patients were wrongly subjected while in treatment.

For the sake of clarity, the study’s conclusion was that patients in the initial period of sobriety weren’t more likely to develop another addiction. They were actually less likely to do so.

Which makes sense, if you think about it: Those who’ve put in the hard work to achieve recovery would be naturally cautious of other substances. Unless of course they set out to find a substitute drug, which is not exactly uncommon, either.

As for the term ‘cross-addiction,’ I’ve heard that since the 70’s, but with varying meanings. I don’t think it’s a term borrowed from science, unlike cross-tolerance, which comes directly from pharmacology.

I suspect the idea of cross addiction grew from the appearance in treatment of patients who’d been through rehab before but showed up months or years later with a second (or third) substance addiction. Some real-life illustrations:

  • Wanda, who developed a problem with alcohol in her 20’s, gave it up in her 40’s with help from Antabuse, but returned two years later severely dependent on Librium and Halcion.
  • Dennis, a Vietnam vet who had used heroin for a decade after his return, then went on methadone maintenance and developed alcoholism resulting in three DWI arrests.

When patients such as these tell their stories in group, it leaves an impression. Everyone’s question:  “Why?” Back in the era of psychoanalysis, it was commonly attributed to underlying personality disorder. But like much of psychodynamic theory, that was never very easy to demonstrate. Counselors began referring to cross addiction, which seemed to have several meanings in practice. The most common was that a history of one addiction would put you at risk to develop others.

Cross-tolerance is much easier to understand. That’s a verifiable phenomenon where tolerance to one drug can result in tolerance to another drug with similar pharmacological actions. It’s the basis of substitution, a principle of both medical detox and long-term maintenance. Valium and methadone are similar enough to alcohol and heroin to permit substitution without painful withdrawal, and that’s exactly what’s done.

Cross-addiction, on the other hand, is notion peculiar to addiction treatment, and not widely used elsewhere. There are many concepts in clinical psychology that are not science-based, but are nonetheless still of use in therapy. Cross-addiction is one of them.

As to the deeper question of what causes someone who has successfully dealt with one addiction to develop another: It happens, but clinicians explain it in different ways– some behavioral, some physiological. It’s really a matter of clinician preference.

As a personal note: It makes perfect sense to me to warn patients in treatment to take precautions to avoid developing another addiction. It makes equal sense to advise someone in recovery who is, for instance, seeking relief from chronic pain, to make darn certain their physician is aware of their history and also knowledgeable about addictions– especially given the vast number of physicians who are neither.

But it shouldn’t be used an opportunity to “scare someone straight”. That doesn’t work. And there’s plenty of research to back me up on that one.