Reflection
Cross-Addiction: A Different Cabin on the Titanic
The image I use for this is a different cabin on the Titanic.
You have moved. The move required effort, it involved packing, and it feels like you have done something. You have also not left the ship, and the water is still coming in at the same rate.
That is cross-addiction, and it is one of the most common things I see in people who have been treated once already and consider themselves recovered.
What it looks like
The classic version, and the one I saw repeatedly during my years working inside residential treatment: someone stops cocaine, completes a programme, does well. Two or three years later they are back, and the presenting problem is alcohol.
They will tell you, often quite sincerely, that this is a separate matter. Alcohol was never their thing. They were a cocaine user, and that is finished.
It does not have to be another drug. Very often the substitute is a behaviour: sexual compulsion, pornography, spending, gambling, work, or food. And it can begin as something perfectly healthy. A hobby, taken up in early recovery on good advice, which quietly stops being a hobby — training that grows from three times a week to twice a day and cannot be interrupted, a diet that becomes a rule, a business that becomes the only place the person feels real.
The behaviour changes. The mechanism does not.
Emotional crutches
The second image is simpler. Addictions are emotional crutches.
If a person cannot bear their own weight — cannot yet tolerate what they feel without something to take the edge off — and you remove the crutch, they do not suddenly walk. They find another crutch and put it under the same arm. Take away the cocaine and it becomes weed, or drinking, or compulsive masturbation.
And here is the crucial part: it works. For a while. That is not a small point, and it is why the person is so often unpersuadable in the early stages. The substitute genuinely does the job at first, which looks, from inside, like proof that the new thing is not a problem.
The energy of the god
Underneath both images is the thing I actually think is going on.
Addiction is not fundamentally a chemical event. It is an intensity — an energy, and a very large one. It is the energy of the god, and it belongs to the person whether or not they have anywhere to put it.
Jung put this precisely. Writing in 1929, he observed that “the gods have become diseases” — the point being that the energy which once went into worship, ritual and meaning did not evaporate when we stopped believing. It went into the body, and into the symptom, and it now turns up in the consulting room wearing clinical clothes.
If that is right, then a treatment that consists only of removing outlets is attempting to get rid of something that cannot be got rid of. The energy is not the pathology. Being unchannelled is the pathology.
This is also why the pious version of recovery fails so reliably. A life scrubbed of all intensity, in which nothing is ever wanted very much, is not a life this particular person will stay inside. They will leave it, and the leaving will look like relapse, and everyone will discuss their motivation. The problem was the design.
I have written elsewhere about the thirst for oneness that Jung described to Bill Wilson, and about whether there is such a thing as an addictive personality. This is the practical end of the same argument.
The loop back
The pattern I most want people to recognise is the one that closes.
Someone used heroin. They stopped. They were never a drinker — genuinely, that was never the problem — so when they start drinking socially, the logic is sound. I never had a problem with alcohol.
Then the drinking increases, because it is doing a job. They put on weight. They stop recognising themselves, and the self-disgust arrives, which is its own reason to want relief. And one night they are drunk, and being drunk has removed the judgement that was the last barrier standing between them and the original drug.
The substitute did not merely fail to protect them. It became the route back.
That is why I take a new drink in a former opiate user more seriously than the person expects me to, and why the response is so often that I am overreacting.
What the evidence shows, honestly
There is one place where this has been studied under something close to experimental conditions, and it sits exactly where my two specialisms meet.
After bariatric surgery, the capacity to overeat is removed surgically. If cross-addiction is real, this is where you would expect to see it — and you do. Alcohol use disorder is roughly twice as prevalent more than two years after surgery, with one review finding a six- to sevenfold higher risk compared with people with obesity who did not have surgery. Gastric bypass carries the highest risk of the procedures. The Swedish Obese Subjects study found elevated rates of non-alcohol substance use disorder too.
Now the honest part, because this field is contested and I would rather say so than present it as settled.
The “addiction transfer” explanation has been challenged. Alcohol is absorbed differently after gastric bypass — faster, and to higher peak concentrations — so some of the increased risk is pharmacological rather than psychological. And critics point out that the alcohol problems typically appear years afterwards rather than immediately, which they argue is inconsistent with simple substitution.
That second objection is the one I would push back on, as a clinician rather than a researcher. A delay of two to three years is not evidence against transfer. It is the exact timeline I see in cross-addiction generally: the cocaine user who returns for alcohol three years later, the person who does well for two years and then does not. Substitution does not happen the week the first behaviour stops. It happens once the initial effort is exhausted and life has become ordinary again. The delay that is treated as an argument against transfer is, in my experience, one of its most characteristic features.
Both mechanisms can be true at once. The pharmacology and the psychology are not competing for the same slot.
Worth noting alongside this: GLP-1 medications appear to be associated with reduced rather than increased addiction risk, which is an interesting asymmetry, and one I have touched on in writing about Ozempic and eating disorders.
Why nobody catches it
Three reasons, and they compound.
The delay. By the time the new behaviour appears, the old problem is closed business. Nobody, including the clinician, is looking for a connection to something that was resolved three years ago.
The respectability gradient. Swapping heroin for alcohol looks like an improvement. Swapping alcohol for the gym looks like recovery. Swapping cocaine for eighty-hour weeks looks like ambition, and gets rewarded. The more socially acceptable the substitute, the longer it runs unchallenged — which is why the eating disorder that appears after the drinking stops is so routinely missed, sometimes for years.
And the sincerity. The person is not lying when they say the new thing is different. They experience it as different. The continuity is only visible from outside, or afterwards.
What treatment has to do instead
If the intensity is not going anywhere, the work cannot only be subtraction.
It means treating what sits underneath rather than the current behaviour alone: what the addiction has been managing, what it makes bearable, what would have to change for that state to be liveable without it. It is the same argument I make about what happens after detox and about the dry drunk — remove the substance and leave the person unchanged, and you have not finished, you have started.
It means naming the pattern early, and asking about the other channels rather than only the one the person came in about. In practice that means asking a cocaine user about their drinking, a drinker about their eating, and anyone in the first years of recovery about training, work, spending and sex. Not as suspicion, but because these are the places the energy goes.
And it means building a life with enough real intensity in it. Not a smaller, safer, more careful life — that is precisely the design that fails. Something demanding enough to hold the energy that used to go into the addiction: work that matters, relationships with real stakes, something creative, something bigger than oneself. Jung’s point, translated into practice, is that you do not defeat a god. You give it somewhere to live.
Otherwise you produce a person who is abstinent from a lengthening list of things and no better than when they started — still on the ship, with a fine view from the new cabin.
The clinical descriptions in this article are composites, drawn from how this material is commonly described in consulting-room work. They are not accounts of any individual.
Dr Philippe Jacquet is a UKCP registered psychotherapist, Jungian analyst and Hazelden-trained addiction specialist, with a Doctorate of Professional Practice from the University of Essex on male eating disorders. He worked inside private residential addiction treatment for nine years and supervises clinical teams in residential addiction treatment and a private psychiatric hospital. He treats addiction and eating disorders in central London and online.
If you have stopped one thing and are uneasy about another, a first conversation is a discussion about what is actually happening, not an assessment against criteria.
