When Sam Thomas was 15 years old, he learned the word “bulimia” by reading an advice column in the paper. The person who had written in seeking help was a single mother who binged and purged after her children went to bed. While Thomas didn’t relate to her situation, he immediately recognized the behavior. He hadn’t known before that moment that what he was doing had a name.
“I thought it was something that I’d invented, something unique to me,” Thomas, who lives in the U.K., told HuffPost.
Thomas traces his eating disorder to the homophobic bullying that he endured at school, which left him with “low self-esteem, no confidence, no sense of self.” He did attempt to get help a couple of times during his adolescence, but found that the topic of male eating disorders was so shrouded in silence that providers were reluctant to connect him with the treatment he needed.
Without professional help, Thomas managed to leave bulimia behind as a young adult. He moved from Liverpool to Brighton and started volunteering for LGBTQ+ and mental health causes.
He didn’t start drinking until he was 23. He set up a charity for men with eating disorders, and traveled throughout Europe speaking at conferences, “but actually in the behind-the-scenes, this new addiction was sort of manifesting.”
Thomas said he initially didn’t realize alcohol was becoming a problem for him, and then he was simply in denial about it. Following his mother’s death, his drinking escalated. He went through detox four times.
“At that point, I was really beginning to realize that actually, I’m recovering from many different things, and not just from the alcohol or just from eating disorders,” Thomas said. “More important than anything else is the trauma [that] needs to be addressed at the core.”
A couple of years ago, he was diagnosed with post-traumatic stress disorder, which he views as the root of his struggles. “If you pick up a weed by the leaf, it’s just going to grow back because the roots are still there,” he said. “So it’s exactly the same ― unless you address things at the roots, there’s every chance that it can manifest in all sorts of ways that you don’t necessarily expect.”
Thomas is now 38, and has been sober since 2019. In sobriety, he’s found a couple of behaviors that sustain him: exercise and writing. He’s “hyperaware,” however, that exercise can also tip into addiction, and he carefully sticks to a planned workout schedule.
Thomas’ story is familiar to many people who find that on their way to recovery from one addiction, they fall into another ― a phenomenon known as addiction transference. We typically think of addiction in terms of drugs and alcohol, but there are a wide variety of behaviors that can become addictive.
“Addictions are anything that we consume or anything that we do we can’t stop, even though we want to, despite the consequences,” Fiona Dowman, a licensed psychologist who specializes in helping people recover from addiction, told HuffPost.
Addiction transference, sometimes called cross addiction, is common, according to Shane Kraus, a professor of psychology at the University of Nevada, Las Vegas. “You kind of trade one addiction for the other.”
This might involve swapping drugs for alcohol, for example. Or a person might substitute a substance for a behavior, or a behavior for a substance, as Harris did with bulimia and alcohol. Likewise, someone might substitute one behavior for another, such as gaming instead of gambling.
The common thread among addictive substances and behaviors is that they activate the dopamine reward system in the brain, Vanessa Kennedy, a clinical psychologist and director of psychology at Driftwood Recovery, told HuffPost.
“Dopamine is a neurotransmitter that we make naturally in our brain, but when we are using drugs or alcohol, we get a dopamine rush, or a release of a much higher amount of dopamine in our brains that lights up our reward system and gives us a lot of pleasure,” she said.
Unfortunately, our dopamine levels fall below normal after using the substance. “The natural levels get altered drastically in the brain,” Kennedy explained, leading to cravings, mood swings, depression and a desire to return to the substance in order to feel that dopamine rush again.
“Through that process, our brain is learning not to make as much dopamine,” she continued. We don’t “have as much dopamine available to us naturally, so we’re not able to experience some of the natural joys or pleasures of things that occur day to day.” The addiction, chasing down that dopamine rush, can quickly overtake a person’s life.
And when someone stops using a substance, they may turn to another substance or behavior that will provide that same dopamine rush — leading back into the same cycle.
“More important than anything else is the trauma [that] needs to be addressed at the core.”
– Sam Thomas
What does addiction transference look like?
It can be difficult to recognize that you’re headed toward another addiction — especially when it’s a behavior generally considered healthy, such as exercise.
Signs that a behavior is becoming a problem include looking for more opportunities to engage in that behavior than might be considered healthy, or engaging in the behavior at the expense of other activities, Kennedy said.
“When the amount and frequency of a behavior starts to affect other areas of functioning, like socializing, [or] other types of responsibilities, like work obligations or parenting or getting enough sleep,” she said, “that’s when it starts to pose a risk.”
With a substance like alcohol, you can try abstaining if you’re concerned that you’re developing a problem. (Though if you’ve developed a dependence, you may experience withdrawal symptoms and will need a professional to guide your detox.) The same strategy works with something like gambling.
But other behaviors, like exercise or shopping, may not be ones that you want to give up entirely. And a behavior like eating can’t be abandoned, so the goal is to learn to engage in it with healthy moderation.
If you’re concerned that a particular behavior is awakening your addictive tendencies, Kennedy suggests you ask yourself: “Is this starting to affect you in ways that may be unhealthy?”
These consequences may not be as obvious as physical symptoms, Dowman said. “It might be that people in your life are starting to mention that there’s difficulties in relationships [or] finances.” This can get tricky in a partnership if one person sees a problem but the other does not.
If you’re trying to figure out if something is an addiction, Dowman said, “it’s the inability to stop despite the negative consequences that’s really the key. If you can take it or leave it, then it probably isn’t addictive.”
“By being more aware of the feelings that come up right before you might decide to do the addictive thing… you can be more responsive, rather than reactive.”
– Fiona Dowman, clinical psychologist
What does treatment look like?
Addiction treatment varies depending on the substance or behavior in question. Alcohol and drug addictions may require treatment for withdrawal and include medications prescribed by a doctor, for instance. Support group meetings are a staple of addiction treatment, and are free and widely available. Individual therapy is helpful to many people as well.
In some cases, it may make sense to tolerate a new addiction for a time in the name of harm reduction, as in the case of someone who quits using a drug but continues to smoke cigarettes. In this case, Dowman said, a key would be to assess what the person’s goals are.
Kennedy said that if you’re concerned a behavior is negatively affecting your life, you can ask: “Are there ways that we can structure a routine or create some consistency in our schedule to create balance around this behavior so that it stays at a healthy level?”
Setting a time limit for yourself is one strategy. You might schedule certain days and times to go to the gym, for example, or designate a certain hour for your online shopping, and refrain from those behaviors at other times. Overall, having structure and sticking to a schedule when it comes to eating and sleeping is helpful for anyone recovering from an addiction, Kennedy said.
She also suggested engaging your support network by “having a group of individuals or another individual that you trust to help hold you accountable, [and] help you talk about what thoughts or feelings come up for you prior to the behavior.” This will allow you to “bounce your thoughts and ideas, your emotions, off of another person and check in with the support network about whether the behavior is healthy and beneficial.”
Dowman recommended mindfulness as a way to learn your triggers and prevent yourself from engaging in an unhealthy behavior. “By being more aware of the feelings that come up right before you might decide to do the addictive thing… you can be more responsive, rather than reactive,” she said. It’s about “noticing how you feel, and then making more of a choice about what to do next.”
As Thomas found, however, it’s important to treat any underlying trauma or mental health issue that may fuel addiction.
“I think cross addictions happen because people aren’t treating the underlying issue,” Kraus said, mentioning that he works with many veterans who have been diagnosed with PTSD. Unless the underlying trauma is addressed, the person will likely continue their addictions in some form or another.
With any addictive behavior, Kraus said, first you have to ask “‘Why do you do it?’ And then, ‘How do you replace it with something that’s healthy and meaningful?’”
He gave the example of someone he treated for a gambling addiction, “a young guy who felt like he was no one.”
“He didn’t have a job, but when he went in a casino, people called him sir, they were nice to him,” Kraus said. The young man explained that when he was in the casino, he felt like he was someone.
“That’s what I got to work on, right?” Kraus said. “That’s what we’re treating, is that you don’t feel like you’re someone.”
This kind of insight can make treatment effective, Kraus said, and it can help prevent someone from simply transferring one addiction for another.
“If you’re leaning on something more than you probably should, and you start to recognize that and see that, then it’s an opportunity to make some changes,” he said.
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
If you’re struggling with an eating disorder, call or text 988 or chat 988lifeline.org for support.