The Truth About Gateway Drugs and Addiction

The gateway drug hypothesis indicates that consuming milder drugs like alcohol, tobacco and marijuana can open the door to experimentation and addiction to harder and more dangerous drugs.

What is a gateway drug? There’s no singular “gateway drug” definition. However, the theory of gateway drugs holds that persons who frequently use alcohol or drugs are at a heightened risk of graduating to other, “harder” substances, to which they may become addicted.

This suggests that such consumption may put a person at risk of trying more destructive drugs. Is the theory accurate?

Understanding Gateway Drugs

The gateway drug concept divides researchers. Some support the notion that milder drugs may increase the chances of trying harder substances while other researchers believe that multiple perspectives including psychological, socioeconomic, and even genetic ones better explain drug addiction.

What does the evidence say? A review by the Western Journal of Emergency Medicine found that individuals who smoke cigarettes at a young age had a greater chance of using drugs like marijuana, cocaine and heroin in the future. However, are the results from this study proof that cigarettes act as a gateway drug?

Statistics professors often explain that correlation does not imply causation. What they mean is that nicotine in this study is associated (correlated) with consuming other drugs but is not the cause of using them. So what’s causing people to use harder drugs?

A study by Oxford’s Nicotine and Tobacco Research Journal found that when researchers compared a potential getaway drug (electronic nicotine delivery systems) with personal risks (mental health and socioeconomic conditions) the risk factors better forecast the chances of smoking cigarettes in the future than the getaway drug. The drug had no predictive power in this investigation.

This suggests that progressing from a milder substance to a harder one may be better explained by a person’s family composition, living conditions, personality and mental health challenges.

Substance abuse is a complex phenomenon. An individual may begin their journey consuming the most readily available drugs (alcohol, cigarettes or marijuana) but the reason they become addicted or experiment with more damaging substances could be better explained by their personal circumstances rather than by a getaway substance.

Is Marijuana a Gateway Drug?

The war on drugs led by President Ronald Reagan in the 80s categorized marijuana as one of the most dangerous drugs because its consumption could lead to more damaging substances. Is weed a gateway drug?

More recently there’s been a shift in how clinicians and policymakers view cannabis consumption. CDC research indicates there’s limited evidence demonstrating marijuana’s role in promoting the usage of other drugs as most individuals who use it never try harder drugs.

Once again, the association between marijuana consumption and abusing other drugs may be better explained by shared risk factors instead of the gateway drug concept.

The common liability theory indicates the risks that could predispose a person to use marijuana are similar to the conditions and predispositions that influence consuming other drugs. This explains why some individuals do end up transitioning to harder drugs. So, what are these risk factors?

Some of the most common ones include:

• Family history of substance use
• Social determinants of health
• Mental health challenges
• Accessibility to drugs
• Peers who use drugs or encourage drug use

The lack of evidence supporting marijuana as a gateway drug does not mean anyone should try it. Its use can negatively affect young individuals whose brains are developing and cause changes that may make them more likely to develop addictions and mental health issues in the future. Even among adults, some individuals develop cannabis use disorder.

Is Alcohol a Gateway Drug?

Alcohol’s role as a gateway drug is an area of active investigation. An animal study by Columbia University indicates that early alcohol consumption may predispose the brain to become more susceptible to addiction to harder drugs (in their research this was cocaine).

Likewise, a report by The Journal of School Health suggests that minors who start drinking earlier may consume more illicit drugs later in life. However, this is only one factor to consider.

Early life alcohol consumption may increase one’s risk for developing a substance addiction but so does a family history of alcohol use or addiction, mental health problems, traumatic experiences, economic hardships and even genetic inheritance.

Is alcohol a gateway drug? The evidence does not support this conclusion. Addiction is better understood as a disease with biological, socioeconomic and psychological causes.

For instance, an article from Advances in Drug and Alcohol Research shows that adolescents who vape are almost seven times more likely to consume alcohol.

However researchers believe the reason for this is not the getaway theory but rather that these young individuals may share similar psychological traits (like heightened risk taking or sensation seeking personalities) and behavioral challenges (like childhood trauma or depression) that can promote substance consumption.

What Are Other Gateway Drugs?

Nicotine

Nicotine is primarily consumed via tobacco products and is another substance labeled as a gateway drug. Studies with adolescents showcase a robust association between nicotine, binge drinking and marijuana consumption.

Nicotine may affect how the brain experiences pleasure which could potentially prime it to be more receptive to the effects of other drugs.

This is particularly dangerous for adolescents as one study found that 20.8% of U.S. teens vape. Their developing brains are more susceptible to these changes and many individuals who develop a substance use disorder start consuming it during their teens.

Prescription Drugs 

Prescription medication for pain (opioids) and attention deficit hyperactivity disorder (ADHD) (stimulants) may be gateways to substance abuse.

Some people share their prescriptions for these drugs with friends or relatives which opens the door to misuse and abuse.

Individuals with mental health issues, previous substance use (including tobacco) and a family history of addiction are at an elevated risk of misusing prescription drugs which illustrates how multiple risk factors may better explain addiction.

Facts About Gateway Drugs

First Time Users Data

A survey from the Substance Abuse and Mental Health Services Administration found that the most common substances first used by individuals in the U.S. in 2023 included:

• Nicotine vaping (5.9 million)
• Alcohol (4.2 million)
• Cigars (2 million)
• Marijuana (3.5 million)

Marijuana Statistics

The same report shows that marijuana (used by 61.8 million individuals) is the most consumed illicit drug in the U.S., followed by hallucinogens (8.8 million), prescription pain relievers (8.6 million),and cocaine (5 million).

Using vaping products that contain marijuana can increase the risk of later smoking or vaping nicotine. In the same vein, vaping nicotine may raise the chances of later vaping marijuana.

In addition, nearly 40% of high school students who smoke electronic cigarettes also vape cannabis.

Risk Factors Statistics

The SAMHSA survey found that 39% of adolescents and 44% of adults who struggled with substance abuse disorders in 2023 had a co-occurring mental health challenge.

People who experience four or more traumatic experiences in their childhood are 500% more likely to struggle with alcohol abuse as an adult while individuals who survive more than five traumatic childhood events are seven to 10 times more likely to consume drugs.

Alcohol Statistics

The CDC estimates that 488 Americans die each day due to excessive drinking. In addition, they found that teens whose parents consume alcohol more than five days a month tend to drink more than teens whose parents never drink.

Nicotine Statistics

The CDC notes that smoking cigarettes is the leading cause of preventable disease, disability and death in the United States. Moreover, the Advances in Drug and Alcohol Research study found that vape users are three to four times more likely to transition to smoking conventional cigarettes.

Opioids Statistics

U.S. individuals consume more than 80% of all opioids that are produced worldwide. The SAMHSA survey found that 39.1% of individuals who misused prescription pain relievers in 2023 obtained them from a family member or a friend. The CDC also estimates that 14% of students misuse prescription opioids.

How Do I Know if Someone Has an Addiction?

Only a qualified professional can diagnose an addiction. If you suspect someone close to you may be struggling with addiction then there are physical, psychological and behavioral changes that people who abuse gateway drugs may show.

Physical Changes

• Their appetite and sleeping habits may change.
• They may lack energy, have a poor skin tone, have bloodshot eyes, lose weight, and look tired.
• They could need drugs to avoid feeling sick.

Psychological Changes

• They cannot stop using drugs, even if they want to.
• They may distance themselves from their usual friends and lose interest in things they used to love.
• They can be chronically worried, nervous, sad, more irritated than normal and present big mood swings.

Behavioral Changes

• They keep using drugs despite evident harm to their personal lives.
• They may get in trouble with the law, forget commitments, have poor work performance or decline their grades at school.
• They could wear dirty clothes and stop caring about cleaning their living spaces and personal hygiene.
• They may fight more with friends and family, avoid social activities and become secretive.
• They can struggle to pay bills and borrow money for daily expenses.

Where Can I Find Information About Substance Abuse Treatment?

Here is a list of resources if you or someone you love struggles with substance abuse and want help to recover.

• SAMHSA: The Substance Abuse and Mental Health Administration (SAMHSA) has a National Helpline at 1.800/662.4357 that is available 24/7 for you to access addiction treatment resources.
• Rehab.com: Rehab.com is the leading recovery hub for locating rehabilitation centers in the United States. On the website, you can access resources to understand how addiction works. You can also browse treatment centers to match with facilities that accept your insurance and adapt to your personal circumstances so you can start a new life on your own terms.
• 988: The 988 Suicide and Crisis Lifeline (chat at www.988lifeline.org) is available if you or someone close is having a substance or mental health crisis.
• Doctor: A doctor or trusted healthcare professional can help answer your questions about addiction and guide you to find local treatment resources.
• Narcotics Anonymous: Available at 800.683.0146 or online at their website, Narcotics Anonymous can help you find local support groups to fight substance abuse.

What Are the Treatment Options for Drug Addiction?

Recovery from addiction to gateway drugs and other substances is possible. Help is available, and here are some alternatives to consider.

Detox

The journey to recovery may start with detox. This is a clinical treatment that helps your body clean from substances. Detox can be done in specialized residential facilities or through outpatient treatment, depending on your needs and the severity of your symptoms.

In both settings, medical professionals will monitor you and may offer medications to manage symptoms and keep you safe.

Inpatient Treatment

Inpatient treatments are one of the best options for individuals who want to concentrate exclusively on their recovery and shield themselves from negative environments that may promote substance abuse.

These programs offer 24/7 clinical support, mental health assistance and connections with peers who are battling the same fight. They also offer you a safe haven to understand the causes of addiction, heal your body and mind and develop the skills to transform your life and become the person you always wanted to be.

Outpatient Treatment

Outpatient programs provide more flexible treatment protocols for individuals who may want to keep a job or continue living at home while working on their recovery.

In these programs, you will find specialized clinical care that may include prescription medications to reduce cravings and urges to drink or consume drugs. There may be meetings with peers who understand challenges, therapy to address mental health problems and other therapeutic activities to rebuild your life and start a new, healthier chapter.

Aftercare

A recovery program’s end marks the beginning of a lifelong commitment to a healthy life. Aftercare treatments equip you with the resources to succeed.

Aftercare plans include support groups, therapy sessions and carefully crafted life skills training for you to navigate life challenges and prevent relapses.

Addiction is a treatable disease that you can conquer with specialized support. Your best life is waiting on the other side of recovery. Take the first step today and seek help.