Understand the cross, co-emerging and pairing addiction

Dr. Robert Weiss, LCSW, CSAT

Over the years, I have learned that treatment clients rarely deal with a separate issue. They might think that when they walk into the door of the therapist’s office they have only one problem, but after a small amount of assessment and conversation, it’s easy to see what they’re reporting (usually depression, anxiety, out-of-control sex, or alcohol and/or drug use that can’t quit smoking) is part of a larger, interconnected picture.

When a client is addicted in some way, this is especially likely regardless of whether they admit their addiction (or addiction). In fact, almost every addicted client I treat needs help with secondary illness, whether it’s another addiction or mental health issues like depression, bipolar disorder, or post-traumatic stress disorder (PTSD).

For the purposes of this article, I will limit the discussion of secondary issues to other addictions. Generally, these are divided into one of three categories:

1. Cross-addiction
2. Joint addiction
3. Pairing addiction

The individual with cross-addiction transitions from one addiction to another. Those who develop addictions at the same time engage in multiple addictions at the same time. Over time, people with paired addictions fuse multiple addictive behaviors into a single disease, so when they are involved in part of the addiction, they are also involved in another.

Often, people with cross, co-occurring and pairing addiction move seamlessly from one addictive substance to another addictive behavior, to the back and forth between another addictive substance and addictive behavior.

Cross-add:

• Alice has gained 35 pounds in three months after leaving treatment due to alcoholism, the first time in her life she struggled. She also found herself forcing a tour of social media sites to find people who want to have romantic or sexual chats.
• James revels after get off work and weekends. These behaviors last for days or even weeks at a time – until he feels regret and shame about his porn use and stops. But then he started drinking a lot. A few days or weeks later, when he felt bad about drinking, he stopped to go back to porn.

Colleagues addiction:

• Michelle uses alcohol and methamphetamine to inhibit himself. Unless she is drunk and tall, she cannot engage in the sexual acts that make her stand out. She needs alcohol and methamphetamine to overcome her fear and shame about sexual desire and overcome her low self-worth.
• Drug sales representative Allen constantly spends the evenings at hotel bars, looking for women (and sometimes men) who want to drink and hook. He promised himself several times that he would stop cheating on his wife, but then he had a cocktail – just to relax after get off work – and couldn’t stop himself.

Pairing/fusion addiction:

• Katy spends most of her time online, circling dating sites and apps, conducting sexual web chats, and watching porn. She did this all the time and she smoked. If she is not in “sex mode”, then she is not interested in the pot. Similarly, if she doesn’t smoke, she isn’t interested in sex.
• Diego combines cocaine with porn, strip clubs and prostitutes. If he is tall, he is chasing sex. If he is pursuing sex, he is also tall. Usually, he “lost” for three to five days when cocaine/sex occurs. He usually misses his job and doesn’t even call to get sick.

Cross, showing signs of both pairing addiction

Patrick Carnes, Robert Murray and Louis Charpentier list 11 off-road ways to co-emerge and pairwise addiction.[i]

1. Alternating cycles: Switching back and forth from one addiction to another, usually over the years (i.e., flipping between binge eating and sexual behavior)
2. Combined: Combining various addictive substances/behaviors to find the perfect high (i.e. mixing methylmethamphetamine with porn and then mixing the network)
3. Cross-tolerance: Tolerate another addiction in one addictive way (i.e. drunk or smoking to shame sexual behavior)
4. inhibition: Use an addiction to reduce the inhibition associated with a second addiction (i.e., getting higher before having sex with a stranger or a prostitute)
5. Fusion (also known as stacking): Use one addiction to amplify another (i.e. use cocaine or methamphetamine to enhance the pleasure of orgasm)
6. inhibition: Consider one addiction as a minority of two evils (i.e., smoking instead of watching porn all night)
7. masking: Hidden with one addiction (i.e., go to AA for alcoholism, but never see compulsive activities)
8. numbness: Use one addiction to make another feel ashamed (i.e., getting drunk or being high after cheating)
9. Alternatives: Replace one addiction with another (i.e., gambling reduces the use of connected apps for hours)
10. ceremony: Incorporate one addiction into another ritual phase (i.e., buying cocaine or methamphetamine before starting a search for a prostitute)
11. Abstinence and mediation: Use one addiction to stop another (i.e., forced shopping to stay away from sex clubs)

How common are cross-cutting, co-occurring and pairing addiction?

People who struggle with compulsive and romantic behaviors also tend to struggle with the addiction of crossing, co-occurring and pairing. A survey of more than 1,600 self-identified sex addicts found that 69% of heterosexual men, 79% of heterosexual women and 80% of homosexual men were admitted to receiving crosses, co-occurring or pairing addiction.[ii] Another study found that sex addicts often reported secondary or pairing problems with drug addiction (58%), compulsive spending (49%), eating disorders (47%), compulsive video games (37%), alcoholism (31%), and compulsive gambling (29%).[iii]

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If you or a loved one is struggling with sexual, pornography, or material/sex addiction, seeking integrity can help. In addition to residential rehabilitation, we offer low-cost online workgroups for both male addicts and male porn addicts, which is a new rehabilitation. Click here for information about our Sex Addiction Working Group. Click here for information about our Porn Addiction Working Group.

refer to

[i] Carnes, PJ, Murray, RE and Charpentier, L. (2005). Bargaining with confusion: Sexual Attractors and Addiction Disorders. Sex addiction and compulsive sex,,,,, 12(2-3), 79-120.

[ii] Carnes, PJ, Murray, RE and Charpentier, L. (2005). Bargaining with confusion: Sexual Attractors and Addiction Disorders. Sex addiction and compulsive sex,,,,, 12(2-3), 79-120.

[iii] Hall, P. (2013). Understanding and treating sexual addiction: A comprehensive guide for those who fight sexual addiction and those who want to help thempage 186. London: Routledge.