Are Transfer Addiction and Cross Addiction Supported by Medical Research?

Sometimes, information seems to take on a life of its own, particularly if it’s found on the internet. A seemingly reputable (and perhaps well-intentioned) source puts out info, someone else sees it and creates similar content, everyone assumes it’s true (because multiple sources are talking about it), and away we go into the Land of Misinformation—or at minimum, the Realm of Uncertainty.

Transfer addiction, cross addiction, replacement addiction, and even cross dependence seem to have at least partially fallen down this rabbit hole. Poke around on the internet for these concepts and you’ll find plenty of blogs covering topics from “What is transfer addiction?” and “What is cross dependence?” to “How do cross addiction and cross dependence differ?”.

So let’s take a quick but revealing dive into these terms, which are often used to describe the notion of transferring addictions, i.e., replacing one addiction with another.

Valid Research About Transfer Addiction, Cross Addiction, and Other Addiction Transfer Terms

Addiction is a chronic relapsing disorder involving the brain. So it’s a condition like heart disease or diabetes.¹ As such, healthcare and addiction professionals abide by rigorous scientific standards to identify and treat addiction, and they look to widely accepted medical research to inform their decisions.

When it comes to this medical research, however, some forms are better than others. Meta-analysis and systematic reviews are the crème de la crème. A meta-analysis is a formal, quantitative, epidemiological study used to systematically assess previous research studies and to then develop conclusions about that research.² Meanwhile, a systematic review attempts to acquire all evidence to address a specific research question and to then summarize and synthesize evidence from multiple studies to answer this question.³

By their nature, meta-analysis and systemic reviews pull data from a wide variety of studies and involve a similarly wide range of audiences. Plus, via the combined sample groups of the various studies, these top-tier research methods offer insights based on a large number of study participants.

Meanwhile, case studies, cohort studies, and the like typically offer valid insights using proven research methods. But they’re not based on a broad body of existing research. Rather, they offer data specific only to their select sample size, which can literally include only a few individuals over a minimal period of time.² In effect, they offer valid info on a specific situation rather than broad insights on an entire topic.

So what does this have to do with cross addiction, transfer addiction, replacement addiction, et. al?

Minimal if any meta-analysis and systematic reviews exist to support the idea that those with a substance use disorder face a significant risk of replacing one addiction with another. Rather, the idea that one addiction can lead to another is based almost exclusively on case studies and anecdotal evidence.

In fact, one of the largest studies with a nationally representative sample, Testing the Drug Substitution Switching-Addictions Hypothesis, concludes that transfer addiction is less likely among those in recovery. Specifically, it indicates that those who achieve recovery are significantly less likely to develop another substance use disorder compared to those who don’t address their SUD. To put it another way, treatment and recovery are associated with a lower risk of a new-onset SUD.⁴

So is Transfer Addiction (or Cross Addiction) a Thing?

A quick internet search reveals multiple blogs that define cross addiction, discuss addiction transfer, and more. The mere fact that everybody seems to be using a different term to communicate the idea of trading one addiction for another—or that one substance use disorder increases the risk for another—proves the waters are muddy at best.

In fact, some sites go so far as to confuse co-occurring disorders (previously known as dual diagnosis) with the idea of cross addiction. While both topics concern addiction, they mean entirely different things. To be clear, a co-occurring disorder is when a person has both a substance use disorder and a mental health disorder such as anxiety, depression, or bipolar disorder.⁵

As described above, the existence of cross addiction, transfer addiction, addition replacement, and more aren’t supported by meta-analysis and systemic reviews. And you won’t find these terms discussed on websites for reputable addiction-industry organizations, such as the National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA). In fact, some addiction professionals have never even heard of these terms, and they wouldn’t approve the use of them in the context of an evidence-based treatment program.

All of that said, some people will point to anecdotal evidence of instances where a person in recovery from a SUD for one substance went on to seemingly replace that addiction with a SUD to a different substance. In this same vein, there’s anecdotal evidence for people replacing SUD-related behaviors with healthier alternatives (e.g., exercising, adhering to a strict diet, developing a hyper focus on work or hobbies, etc.) and/or with unhealthy coping behaviors (e.g., gambling, excessive shopping, eating issues, etc.).

But again, anecdotal evidence isn’t the same as the aforementioned reviews and analysis. To prove the point, consider anecdotal claims about carrots. Just because some people claim carrots improved their vision doesn’t mean it’s true for everyone—or at all.

Bottom line: Anecdotal evidence exists that suggests some people might trade one addiction for another and that some people in recovery might choose healthy or unhealthy behaviors to replace previous behaviors or coping strategies associated with substance misuse. However, given the dearth of meta-analysis and systematic reviews as of this time, use of terms such as cross addition, addiction transfer, et al. isn’t commonplace among evidence-based addiction-treatment professionals nor organizations.

Getting Help for Addiction

If you or someone you love struggles with a substance use disorder, American Addiction Centers can help. Providing evidence-based care at multiple accredited facilities, AAC can help you take your first steps toward recovery today. Reach out to connect with a knowledgeable admissions navigator, who can answer your questions, explain your options, even verify your insurance.