Substitute Addictions in Persons with Substance Use Disorders: A Scoping Review

Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa

“…While a universally agreed-upon definition remains elusive [ 2 ], there is a longstanding recognition that other behaviors or addictions may arise while abstaining from a primary substance [ 2 , 3 , 4 , 5 , 6 ], particularly during early recovery (1–12 months) [ 7 , 8 , 9 ]. A recent scoping review in which substitute addictions were defined as the “immediate or gradual functional replacement of an addiction or set of addictions that have been terminated”, underscores that substitute behaviors may become addictions and display key characteristics of addictive behaviors ([ 10 ], p. 692). Consequently, substitute behaviors are part of a continuum where behaviors have the potential to progress to addictive levels over time and which vary in severity.…”

“…Consequently, substitute behaviors are part of a continuum where behaviors have the potential to progress to addictive levels over time and which vary in severity. When these behaviors are a purposeful component of treatment (e.g., nicotine replacement therapy; methadone maintenance treatment) these should not be regarded as substitute addictions [ 10 ].…”

“…The extant literature on substitute behaviors in persons with SUDs demonstrates varying conceptions of its onset (e.g., during or after treatment), nature (e.g., substance or behavior), function (e.g., relapse prevention), and duration (e.g., short- or long-term) [ 10 ]. The primary focus lays on substance-to-substance substitution [ 10 ], but substance-to-behavior substitutions, encompassing DSM-5-listed disorders as well as behaviors subjectively experienced as addictions without diagnostic criteria (e.g., compulsive sex, shopping, and exercise [ 27 ]), have rarely been examined. Behavioral substitutes for alcohol that have been reported include compulsive work, hobbies, gambling; mystical belief, prayer, and meditation; increased involvement with religion and Alcoholics Anonymous [ 8 , 19 ].…”

“…Behavioral substitutes for alcohol that have been reported include compulsive work, hobbies, gambling; mystical belief, prayer, and meditation; increased involvement with religion and Alcoholics Anonymous [ 8 , 19 ]. Based on a recent scoping review, the prevalence of substitution in substance use treatment samples is estimated between 7% and 92% (despite differences in conceptualization, operationalization, and sample size [ 10 ]). Correlates of substitute behaviors include greater severity and duration of substance use, comorbid mental health problems, younger age, and male gender [ 28 , 29 ].…”

“…To our knowledge, this is also the first study to empirically examine substitute behaviors in a LMIC context, i.e., South Africa. Considering the high rates of SUDs and related harm, low treatment entry, and high post-treatment relapse in this country [ 40 , 41 , 42 ], knowledge on the prevalence of substitute addictions and associated personal and contextual factors is essential to optimize the organization of treatment and recovery-oriented support [ 9 , 10 , 25 ].…”