While alcohol and other drugs are recognized by most as "legitimate" addictions, cross addictions, or "other" addictions—such as those to food, sex, gaming, spending, work, or gambling—often receive scorn by those "in the rooms" of Twelve Step recovery. This unique stigma and shame leaves people feeling isolated and hopeless. Brenda Iliff specializes in these "other addictions," along with many other recovery-related topics. Brenda is the executive director of the Hazelden Betty Ford Foundation's campus in Naples, Florida and the author of the book A Woman's Guide to Recovery . In part one of this two-part Q-and-A, Brenda answered questions about the nature and stigma of these other addictions. Now, in part two, she answers questions about several of these specific addictions. In addition to alcohol and other drugs, what kinds of activities or substances can become addictive? With any substance or behavior, the more that it is necessary for survival, such as food or sex, and the stronger the "zing" or the dopamine rush of that sensory effect, the more likely it is to be addictive. That's why food and sex can become such core addictions for people. In addition, addictions can be even more powerful when the three A's are involved. The three A's are "anonymous," "available," and "affordable." An example might be cyber sex, or cheap junk food. The cost is low. It's always there. And nobody ever has to know. How do technology and the internet contribute to the growth of these other addictions? We can learn a lot from the internet, including finding helpful recovery resources. But the internet can become a powerful addiction in and of itself, in addition to contributing to a wide variety of addictive behaviors. The internet can provide a trance for people where they actually lose track of time. We ask people: How many hours a day would you say you're on the internet? An even better question might be: How many hours are you thinking about getting on the internet? The people at highest risk for technology addiction are adolescents and young adults. Any time a young, developing brain is exposed to a powerful source of dopamine release, it's more likely to become addicted. People of any age can become more and more preoccupied with seeking more stimulation. They give the technology more time, have less interaction with others, and withdrawal from other activities. Can gambling be an addiction for some? Gambling addiction is now listed in the DSM-5. Few gamblers seek treatment until their consequences are dire. One element of gambling addiction is called "chasing the loss." We have a win, and then we get a loss. Then we chase that loss, thinking we'll make it up. One of the things that is so difficult about gambling addiction is that when a gambler has a near miss, the brain interprets that as a win. Even though there's no money coming in with it, the brain feels good, and it just encourages that ongoing chasing the loss. Gambling is a very secretive addiction. The suicide rate for gamblers is higher, and a lot of that has to do with the massive debt involved. Male gamblers tend to be more into active, fast-paced gambling, while women seek out the escape, the relief, the trance of gambling. What about smoking? Is it worthwhile to try to kick a smoking addiction at the same time as trying to quit other substances? We used to say, even at the Hazelden Betty Ford Foundation, let's just quit one substance at a time. I was part of that philosophy. But some nicotine studies got our attention, and we changed our approach. We know those leaving treatment nicotine-free have greater recovery rates from other substances. Why? Nicotine is a non-intoxicating substance, but it triggers the brain to release that dopamine. Any time you're triggering the brain, even just a little bit, the brain will say, in effect, this feels good but I know what would feel better. And then the brain will push to go back to its chemical of choice. What is food addiction? Food meets all of the criteria to become addictive. It is necessary for survival and provides a strong sensory experience that releases dopamine in the brain. In addition, in most places, food is available in abundance, can be consumed in secret, and costs very little, especially for junk foods. Food addiction is still highly stigmatized in our society. Those who are obese or overly thin can experience the powerful shame that contributes to secrecy and continued self-destruction. Food addiction can be as destructive as any other addiction, impacting physical health, emotional wellbeing, social and professional interactions, as well as our sex and financial lives. The most common foods that people tend to struggle with are the sugars and the more refined carbs. However, for some it's the fats they just can't stop eating. For others, it might be the flours or the wheat. It varies person to person. Others are volume addicted, meaning they simply can't get enough food to feel satisfied. Can work be an addiction? Workaholism and financial obsession can absolutely become addictive and require some amount of assisted treatment to overcome. What about sex addiction? Just like food and money, sex is also a topic we don't talk about much, let alone sex addiction. Sex addiction is very different from sexual offending and sexual compulsion. Just because someone is a sex offender does not mean they are a sex addict. Sex addiction may be strongly associated with substances. We call this "fusion." Many of those in the addiction world are used to hearing about the cocaine-sex connection or the meth-sex connection. With sex addiction, it's really about progression, and this can move very rapidly. There is loss of control, lots of secrets and shame, and it may be associated with power. It may be about fantasy. It may be fueled by the internet. I call the internet "the crack cocaine of sex addiction." Remember the three A's: It's available. It's affordable. It's anonymous. The average age people are exposed to cyber sex is around age 11. Unfortunately, that's right during the developing of the sexual template. What we're seeing with younger folks is that it distorts what is sexually acceptable and normal, which creates all kinds of problems as they enter into real-life relationships. Can the Twelve Step model be helpful with these kinds of other addictions? Absolutely. Twelve Step programs clearly provide help for people. It goes way beyond the substance or the process. They provide identification. They provide caring, growth, and enhanced compassion for self and others. A food addict, for instance, will be much more open with another food addict, releasing those secrets and finding support and a model for a way through their addiction with other people who have been there.