Transfer addiction: effects, signs, causes, and treatment

Transfer addiction is a situation where someone recovering from an addiction switches to a different compulsive behavior or substance. This often happens during recovery, as people replace their original addiction with something new.

Signs of transfer addiction include intense preoccupation with a new activity, neglect of responsibilities, changes in mood and behavior, compulsion and loss of control, tolerance and withdrawal, isolation and secrecy, and replacement of healthy activities.

Causes of transfer addiction encompass unresolved underlying issues, craving and the brain’s reward system, lack of coping strategies, and genetic and biological factors.

Treatment of transfer addiction consists of integrated behavioral therapy, cognitive-behavioral therapy (CBT), medication-assisted treatment (MAT), motivational interviewing (MI), 12-step programs, relapse prevention strategies, and mindfulness-based therapy (MBT).

What is transfer addiction?

Transfer addiction refers to the substitution of one addictive behavior with another. This phenomenon includes both substance-related dependencies, such as alcohol or drug addiction, and behavioral addictions, such as compulsive gambling, shopping, or eating disorders. Individuals exhibit multiple addictions concurrently or sequentially, with one addiction often taking the place of the previous one.

The article “Cross-Addiction Risk Profile Associations with COVID-19 Anxiety: a Preliminary Exploratory Study” authored by Brendan Dowd et al. and published in the International Journal of Mental Health and Addiction in 2022, examines the factors contributing to cross-addiction, such as forced abstinence, harm reduction strategies, and relapse prevention efforts. Although short-term substitution temporarily relieves symptoms, it often impedes long-term recovery by preventing individuals from addressing the underlying psychological causes of their addiction.

What is the other name for transfer addiction?

The other names for transfer addiction are cross addiction, addiction substitution, switching addictions, substance substitution, substitute dependency, addiction hopping, compensatory addiction, addiction replacement, or addiction interaction disorder. In the chapter “Addiction Interaction Disorder” authored by Patrick J. Carnes et al. published in the Handbook of Addictive Disorders in 2004, the complexity of multiple addictions and the necessity of addressing them collectively for effective recovery is explored. Carnes proposed the term “Addiction Interaction Disorder” to describe how addictions work together as a system. Treating them as a whole package, rather than separate issues, leads to better recovery outcomes.

What are the effects of transfer addiction?

The effects of transfer addiction are listed below.

• Continued struggle with addictive behaviors: Even when the original addiction is under control, individuals often face compulsive behaviors in a new form. The article “Unravelling the Web of Addictions: A Network Analysis Approach” by Daniel Zarate et al. published in the journal Addictive Behaviors Reports in 2022, highlights that individuals with one addiction are more likely to develop another. The study uses network analysis to illustrate how various addictive behaviors are interconnected, increasing the likelihood of addiction transfer or the emergence of new compulsive behaviors. For instance, someone shifting from alcohol abuse to gambling, enduring severe consequences like financial ruin or damaged relationships. Similarly, a person recovering from sex addiction continues seeking new partners or consuming pornography, endangering existing relationships. These new compulsions have significant repercussions, such as disrupting healthy relationships and harming self-esteem. Despite recognizing a misalignment between their actions and values, individuals struggle to resist these urges.
• Impaired daily functioning: Transfer addiction affects a person’s ability to function in daily life, similar to the original addiction. This includes issues with work, relationships, and general well-being.
• Financial problems: Like other addictions, transfer addictions lead to significant financial strain due to spending on the new addictive behavior. The article “Pathological Gambling: A Critical Review” published in the National Academies Press (US) in 1999, examines the financial implications of gambling addiction including issues such as bad credit, legal difficulties, and eventual bankruptcy, and compares it to other forms of addiction like alcoholism and substance abuse, illustrating the significant financial strain that results from addiction transfer.
• Interpersonal issues: Transfer addiction often disrupts relationships as the new addiction takes precedence over existing connections. The compulsive nature of the new behavior erodes trust, as individuals engage in deceitful or secretive actions, leading to broken trust with loved ones. Additionally, responsibilities such as financial obligations and emotional support are frequently neglected, causing further strain. As the individual prioritizes their new addiction, conflicts arise and emotional distance grows, resulting in a significant impact on relationship stability and overall interpersonal dynamics.
• Relapse risk: Transfer addiction increases the likelihood of returning to the original addiction, especially if the new behavior is used as a coping mechanism. When the new addiction is employed to manage stress or emotional pain, it often fails to address the root causes of the original addiction. This results in a dual struggle with both the new and old addictions. Additionally, the stress and emotional turmoil caused by the new addiction heightens vulnerability to relapse, as the individual turns back to the original addiction for relief or comfort. Thus, rather than resolving the issues, the new addiction complicates recovery and increases the risk of falling back into old habits.
• Deterioration in physical health: Transfer addiction often deteriorates physical health. When individuals replace substance abuse with behavioral addictions such as excessive gaming or social media, they unwittingly adopt sedentary lifestyles, increasing their vulnerability to obesity and heart disease. Additionally, neglecting sleep and nutrition weakens the immune system, while chronic stress raises cortisol levels, causing high blood pressure and digestive problems.

What are the signs of transfer addiction?

The signs of transfer addiction are listed below.

• Intense preoccupation with a new activity : A hallmark of transfer addiction is a constant preoccupation with the new behavior or substance. This includes continually thinking about, planning for, or seeking out opportunities to engage in the latest addiction, such as obsessively planning exercise routines or shopping sprees.
• Neglect of responsibilities: People with transfer addiction often neglect personal, professional, or social responsibilities in favor of their new behavior or substance. This involves missing work, skipping important family events, or failing to meet obligations because they are preoccupied with their new addiction.
• Changes in mood and behavior: Transfer addiction leads to strong emotional reactions when the new behavior is interrupted. This includes mood swings, irritability, or even feelings of euphoria similar to the original addiction.
• Compulsion and loss of control: Transfer addiction leads to a feeling of powerlessness over the new behavior. People struggle to control how frequently or intensely they engage in it, even if it has negative consequences. The latest activity becomes all-consuming. Individuals devote an excessive amount of time to it, neglecting other important aspects of life.
• Tolerance and withdrawal: Developing a tolerance to the new behavior or substance is common, meaning individuals need more of it to achieve the same effect. They experience withdrawal symptoms when unable to engage in it, such as needing to shop or gamble more frequently to feel satisfied.
• Isolation and secrecy: Transfer addiction often leads to withdrawal from social activities and increased secrecy. Individuals isolate themselves and hide their new behaviors due to shame or fear of judgment. This includes lying about their activities or whereabouts and behaving with uncharacteristic impulsivity, recklessness, or aggression.
• Replacement of healthy activities: Healthy hobbies or activities are replaced by the new addictive behavior. For instance, someone skips workouts or social gatherings to engage in their new addiction, indicating that the new behavior is taking over their life in an unhealthy way.

What are the causes of transfer addiction?

The causes of transfer addiction are listed below.

• Unresolved underlying issues: Transfer addiction often arises from unaddressed emotional or psychological problems that initially fueled the addiction. When individuals struggle with unresolved emotional issues, such as trauma, stress, or mental health disorders, their initial addiction serves as a coping mechanism or a way to escape from these difficulties.
• Craving and the brain’s reward system: They play significant roles in transfer addiction. The brain’s reward system, initially activated by the original addiction, contributes to the development of new addictions. Research by Howard Barry Moss et al. in the article “Early Adolescent Patterns of Alcohol, Cigarettes, and Marijuana Polysubstance Use and Young Adult Substance Use Outcomes” published in the journal Drug and Alcohol Dependence in 2014, suggests that adolescents who begin using one class of drug, such as alcohol or tobacco, which is socially acceptable but illegal for their age group, are at higher risk of progressing to other illicit substances like cannabis, methamphetamine, or cocaine. This progression highlights the concept of cross-addiction, where the initial addiction triggers similar cravings or activates the brain’s reward system in a way that perpetuates the cycle of addiction.
• Lack of coping strategies: Lack of coping strategies is a significant factor contributing to transfer addiction. When individuals use food to manage difficult emotions or stress, it becomes their primary coping mechanism. However, when this coping strategy is removed, such as through bariatric surgery that restricts food intake, individuals often need to find new ways to handle their emotional and psychological stress. Research by Sandra Jumbe in “Psychological Aspects of Bariatric Surgery as a Treatment for Obesity” published in Current Obesity Reports in 2017, shows that, in the absence of food as a coping mechanism, individuals frequently develop new compulsive behaviors. These behaviors serve as substitutes for the emotional relief that food previously provided.
• Genetic and biological factors: Genetic and biological factors influence addiction transfer, where individuals with a genetic predisposition to addiction are more susceptible to developing multiple substance use disorders. The article “Multiple Substance Use Disorders May Share Inherited Genetic Signature” by Julia Evangelou Strait, published by Washington University School of Medicine in St. Louis in 2023, suggests that a common set of genes increase a person’s vulnerability to developing various addictions, regardless of the addictive substance.

Is transfer addiction relevant to bariatric surgery?

Yes, transfer addiction is relevant to bariatric surgery as individuals who undergo bariatric surgery are at risk of developing transfer addiction. After surgery, patients often experience significant changes in their relationship with food, which leads them to substitute eating with other compulsive behaviors.

In the research article “Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery” by Afton M. Koball et al. published in the journal of Surgical Clinics of North America in 2021, reward deficiency syndrome is proposed as a possible explanation for addiction transfer after bariatric surgery. The theory suggests that compulsive overeating and obesity serve as protective factors against the addictive qualities of substances like alcohol. The article further highlights that over 80% of patients identified transfer addiction or substitution as a reason for developing substance use problems after bariatric surgery.

How common is transfer addiction after bariatric surgery?

Transfer addiction accounts for up to 30% of patients who have undergone bariatric surgery. Bariatric surgery contributes to an additional 2,000 cases of alcohol addiction annually in the United States alone.

The article “Cross-Addiction in Bariatric Surgery Candidates” by Meral Özkan and Mustafa Kavak, published in The Journal for Nurse Practitioners in 2022, discusses how individuals with obesity seeking bariatric surgery often experience food addiction, with pre-surgery prevalence ranging from 14% to 58%. The literature suggests that by surgically eliminating food addiction, another impulsive behavior arises. When bariatric surgery patients are unable to overeat as they did preoperatively, they substitute with other maladaptive coping mechanisms, such as alcohol abuse. The article highlights a concerning trend of “cross-addiction” or “addiction transfer” following bariatric surgery, noting that 34.3% to 89.5% of patients begin using substances after the procedure.

Are alcoholics more prone to transfer addiction after bariatric surgery?

Yes, alcoholics are more prone to transfer addiction after bariatric surgery. The research study “Bariatric surgery and alcohol and substance abuse disorder: A systematic review” by Giovanni Cerón-Solano et al. published in the journal Cirugía Española in 2021, found that bariatric surgery is associated with an increase in the prevalence of alcohol abuse in the preoperative period. Additionally, the study revealed that people who had undergone Roux-en-Ygastric bypass (RYGB) surgery were particularly likely to struggle with alcoholic misuse compared to those who had other types of weight-loss surgery.

Another research study titled “Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery” by Wendy C. King et al. published in the journal JAMA in 2012, found that the rate of alcohol use disorders (AUDs) increased from 7.6% to 9.6% among alcoholics who underwent bariatric surgery. This rise is attributed to changes in alcohol metabolism and the psychological impact of losing food as a coping mechanism.

What are the different ways that addictions can be transferred?

The different ways that addictions can be transferred are listed below.

• Behavioral substitution: Behavioral substitution involves individuals shifting their focus from substance addiction to behavioral addiction or vice versa. For instance, someone shifts from abusing drugs or alcohol to developing a compulsive gambling habit, or they become addicted to eating, sex, video games, or excessive internet use after quitting substance use. A research study titled “Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa” by Deborah Louise Sinclair et al. published in the International Journal of Environmental Research and Public Health in 2021, found that patients recovering from substance abuse disorders sometimes develop new behavioral addictions, such as compulsive work, gambling, meditation and prayer or over involvement in religious practices.
• Pharmacological substitution: Pharmacological substitution refers to transferring from one prescribed medication with another that carries a risk of addiction. This occurs when a person completes treatment for addiction to a medication such as benzodiazepines (benzos) but then starts using a different substance or medication that has the potential for abuse.
• Emotional substitution: Emotional substitution occurs when individuals replace substance use with other addictive behaviors that provide similar emotional relief. Individuals recovering from alcohol addiction develop workaholism, shopping, or excessive exercise as a new coping mechanism as evidenced in the research study titled “Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa” by Deborah Louise Sinclair et al. published in the International journal of environmental research and public health in 2021.
• Social and environmental influences: Changes in social environments lead to new addictive behaviors. A research study titled “Role of Social Context in Addiction Etiology and Recovery” authored by Justin C. Strickland and Samuel F. Acuff published in the journal Pharmacology Biochemistry and Behavior in 2023 found that negative social environments, especially those with drug-using peers, increases the risk of starting and continuing drug use.

What are the treatments for transfer addiction?

The treatments for transfer addiction are listed below.

• Integrated behavioral therapy: Integrated behavioral therapy combines approaches to address multiple addictions simultaneously. The research article “Behavioral Therapies for Drug Abuse” by Kathleen M. Carroll and Lisa S. Onken, published in The American Journal of Psychiatry in 2005, shows that behavioral therapies effectively reduce substance use and associated behaviors by targeting the underlying issues common to various addictions. The study further highlights that addressing these core issues, helps prevent the transfer of addictions and promote long-term recovery.
• Cognitive-behavioral therapy (CBT): CBT helps individuals identify and change maladaptive thought patterns and behaviors associated with addiction. The research “Cognitive–Behavioral Therapy for Pathological Gamblers” by Nancy Petry et al. published in the Journal of Consulting and Clinical Psychology in 2006, provides evidence of CBT’s effectiveness in treating both substance use disorders and behavioral addictions such as gambling. The study found that CBT helped individuals reduce their gambling behavior and substance use, demonstrating its applicability to transfer addictions.
• Medication-assisted treatment (MAT): MAT involves using medications to help manage withdrawal symptoms and cravings while combining with behavioral therapies. For instance, medication like naltrexone is effective for opioid and alcohol use disorders, reducing the likelihood of developing new substance dependencies.
• Motivational interviewing (MI): MI is a patient-centered approach that enhances motivation to change by exploring and resolving ambivalence. It is effective in treating both substance and behavioral addictions by increasing individuals’ readiness to engage in treatment.
• 12-Step programs: 12-step programs like alcoholics anonymous (AA) or narcotics anonymous (NA) provide peer support and a structured approach to recovery. These programs are beneficial for individuals with multiple addictions by fostering a supportive community and reinforcing commitment to sobriety.
• Relapse prevention strategies: Relapse prevention strategies focus on identifying triggers and developing coping skills to manage cravings and high-risk situations. This approach has been effective in reducing relapse rates and preventing the development of new addictions.
• Mindfulness-based therapy (MBT): Mindfulness involves becoming more aware of the present moment. MBT aids in treating transfer addiction by enhancing self-awareness and emotional regulation, helping individuals recognize and manage cravings for both the original and newly acquired substances. By fostering a non-judgmental awareness of thoughts and feelings, MBT reduces the intensity of cravings, lowers stress, and promotes healthier coping strategies.