NEW BLOG SERIES! – What is cross addiction, and does it really exist?

Cross-addiction is a phenomenon that has been unofficially observed for some time. It is defined as the instance when one compulsive behavior is exchanged for another compulsive behavior, and is also sometimes referred to as addiction transfer. Cross-addiction has been recognized by participants of 12-step programs, such Alcoholics Anonymous, Narcotics Anonymous, and Overeaters Anonymous for years.

The concept of cross-addiction had also been touched on in the media. A July 2006 article in the Wall Street Journal noted a trend of cross-addiction in bariatric surgery patients, from food to other compulsive substances or activities. The article also describes a disparity in the statistics—the president of the American Society for Metabolic and Bariatric Surgery (ASMBS) estimated only 5 percent of bariatric surgery patients develop a new addiction after surgery. The U.S. Bariatric institute estimated a whopping 20 percent of patients develop new compulsive behaviors, and estimates from psychologists in the ASMBS estimate up to a 30 percent rate of new addictions after surgery. A 2006 episode of Oprah, “Suddenly Skinny” cautioned that 30 percent of gastric bypass surgery patients transferred from what may have formerly been a “food addiction” to alcohol addiction. The divergence in these reports, along with, up until recently, a lack of scientific research, has made the existence of cross-addiction a controversial issue among healthcare professionals, researchers and patients.

While the numbers may not be consistent, there are numerous case studies supporting a model of cross-addiction. One article cites a few studies, including one of a 44-year-old woman with no prior known addictions asides from cigarettes. After bariatric surgery, she began to abuse prescription pain killers and mood stabilizers. The same article cites a 40-year-old woman who began to smoke tobacco and drink coffee excessively after bariatric surgery. A more positive example of post-surgery addiction transfer is of a 55-year-old man who has taken up running religiously after his surgery. There is an abundance of literature on other case studies relating to cross-addiction post bariatric surgery.

Supporting the theory of cross-addiction are brain imaging studies and other studies into the pathways of addiction. Brain scans of drug-addicted subjects show reduced levels of the neurotransmitter dopamine in reward-related brain regions. A similar study looked at the brains of individuals affected by excess weight or obesity. This study found a similar reduction in dopamine levels in reward-related brain areas. Thus, the data suggest that there is a common disruption in the reward circuits of those addicted to substances and those what are overeating and may be “addicted” in some ways to highly-palatable foods. Furthermore, the same study found that body mass index and dopamine levels are inversely related; the higher the BMI the lower the dopamine levels. This implies that lower dopamine levels in the areas of the brain that process reward may increase the amount of food needed to experience the reward.

The research indicating common D2 receptor deficiencies and neurotransmitters in both food addiction and substance addiction support the idea of a common neural pathway between them. Though once highly controversial, the theory of cross-addiction is gaining more traction as research into the subject expands. A common mechanism behind both food addiction and drug addiction makes addiction transference a much more easy and likely process than thought before. While some surgeons still believe that acquiring new compulsive behaviors after bariatric surgery is a coincidence, the majority of healthcare professionals recognize the risks of post-surgery cross-addiction occurrence. In fact, screening for bariatric surgery eligibility includes an extensive psychological evaluation examining, among other things, compulsive behavior in the patient. This is included in the evaluation not only because substance abuse could raise physiological concerns regarding the surgery, but also because of the anecdotal reports of cross-addiction known to healthcare providers of bariatric surgery patients for years.

So after reading this, what do you think? Do you think that cross-addiction might exist with food and other addictive behaviors? Do you think that patients who have undergone bariatric surgery might be at risk for other addictions? What has your personal journey of weight loss suggested about the rewarding aspects of food and how they may be similar, to some degree, to drugs like nicotine and alcohol?

*Thanks for Nisa Beceriklisoy for her assistance with the writing and development of this post.

About the Author:
Dr. Nicole Avena is a research neuroscientist/psychologist and expert in the fields of nutrition, diet and addiction. She has published over 60 scholarly journal articles, as well as several book chapters on topics related to food, addiction, obesity and eating disorders. She recently edited the book,
Animal Models of Eating Disorders (Springer/Humana Press, 2013), and she has a book Why Diets Fail (Ten Speed/Crown) available for preorder now and to be released in January, 2014. Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, the National Institute on Drug Abuse, and her research has been funded by the National Institutes of Health (NIH) and National Eating Disorders Association. You can learn more about her research at her website (, or follow her on Facebook and Twitter.

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Scientific information contained in this blog post has not been reviewed by the OAC National Board of Directors.

6 Comments for this Post
  • Karen Andry
    November 20, 2013 at 11:40 pm

    We need to educate on this topic and its relevance to bariatric surgery patients.

    • Nicole Avena, Ph.D.
      December 3, 2013 at 9:02 am

      I very much agree. I think this is an important topic and the information could be very useful to many. Any ideas on the best way to get this information to the people who need it?
      -Dr. Avena

      • V.
        October 21, 2015 at 9:51 pm

        I know this is an old post but I found it as I searched for info on transfer addiction. I myself had gastric bypass in 2013 and have suffered the horrible horrible grips of transfer addiction after. This is something that bariatric patients need to know about. I remember being warned about alcohol addiction but no one ever mentioned any other types of transfer addictions to me. The only way I can think to get the info out is to have someone stand up and tell their story. We are required to go to orientation, so make it apart of the requirements for a patient to get the surgery. I myself will stand up if I must because it is a very very big problem.

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  • Linda
    November 22, 2015 at 7:43 pm

    I’m 14 yrs post op rny. No one warned me about alcohol. Never had an issue with it before, but now I battle addiction. Had I been warned,like with sugar, I never would have started.

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