What Are Gateway Drugs?
In This Article
For many people, addiction is a road that begins with seemingly harmless choices. What starts as a puff of a cigarette or sip of someone else's drink can quickly become substance use.
This substance can serve as a gateway drug, leading down a path of addiction and dangerous outcomes.
What are Gateway Drugs?
A gateway drug refers to a substance that is believed to increase the likelihood of progressing to the use of more potent and harmful drugs. They can be a precursor to other drugs or an entry point into a broader cycle of drug abuse.
Gateway drugs flood the brain with dopamine, changing neural pathways and making people more susceptible to addiction. The most common gateway drugs are:
- Nicotine
- Alcohol
- Marijuana
For decades, the gateway theory influenced assumptions around drug abuse. However, some experts have criticized this approach in recent years, arguing it’s incomplete.
History of Gateway Drugs
The idea of a progression in substance use from weaker to harder drugs goes back to the 1930s. Known as Stepping Stone Theory, it suggested an inevitable progression from marijuana to the use of harder drugs, such as heroin.
However, in 1975, Denise Kandel's Gateway Hypothesis challenged this idea. Unlike the Stepping Stone Theory, the Gateway Hypothesis suggests that gateway drugs don't always lead to more severe drug use.
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The Gateway Drug Hypothesis
While known under various names since the 1930s, Denise Kandel coined Gateway Hypothesis in 1975. Kandel noted in two studies that those who used dangerous substances such as opioids or amphetamines progressed through stages.
According to Kandel's research, 27% of young people who smoke marijuana first experimented with alcohol and tobacco products. Additionally, 26% of young adults who used marijuana later progressed to LSD, amphetamines, and heroin.
In other words, gateway drugs are a starting point for most people who turn to harder drugs.
Prescription Drugs and Gateway Drug Theory
Prescription painkillers are particularly dangerous, as they can lead to addiction and increased risk of overdose. This is particularly true when these drugs are obtained illegally.
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How Accurate is the Theory?
Controversy surrounds the legitimacy of the Gateway Theory, which fails to account for the causes of addiction sufficiently.
Critics argue that environmental factors, genetics, and mental health play a significant role in addiction. It’s important to note that not everyone who uses gateway drugs progresses to using more dangerous substances.
Common Gateway Drugs
Nicotine
Nicotine is one of the most common gateway drugs, followed by alcohol. It’s a stimulant that gives tobacco users a sense of mental alertness.
Nicotine is habit-forming and is considered by some to be as addictive as heroin. This is partly due to its high accessibility and ability to amplify pleasurable activities.
Prevalence of Nicotine Addiction
There’s a strong link between illicit drug use and tobacco products, especially by young people. According to a 2014 study, 87.9% of young adult cocaine users had smoked cigarettes.7
Marijuana
Marijuana is the most commonly used drug after nicotine and alcohol and the most frequently used illegal drug overall. It’s typically smoked, though users can also ingest it.
Marijuana acts upon the brain through the chemical THC, a psychoactive compound that produces euphoria and heightened sensory perception.
Illicit Substances Linked to Marijuana Use
Studies indicate that most crack-cocaine addicts are also prior marijuana users.
Alcohol
Like nicotine and cannabis, alcohol is a popular gateway drug. It’s a central nervous system depressant and the active ingredient in beer, wine, and spirits. It’s consumed primarily for recreation but also for cultural and religious reasons.
When consumed, the user feels a sense of euphoria, relaxation, and increased sociability. Alcohol is habit-forming, and excessive consumption induces physical dependency.
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How Gateway Drug Use Can Lead to Addiction
Studies are shedding light on the biological mechanism that drives addiction. It's been noted for a long time that there's a pattern in how people progress from experimenting with gateway drugs to more harmful substances.
Researchers have examined animal behavior and found that all drugs — including gateway drugs — activate the same neural pathway and cause structural and chemical changes in the brain. This makes individuals more susceptible to developing SUD.
The Role of Early Exposure in Gateway Drug Use
Early exposure to gateway drugs is a strong predictor of later SUD. Two factors that can increase the risk of early exposure are:
- The age at which a person first tries the drug: A person who tries a gateway drug at a young age is more likely to progress to other substances.
- The availability of the drug: Easy access to gateway drugs increases the likelihood of progression to more dangerous substances.
Risk Factors for Illicit Drug Use
Mental health disorders and substance use disorders are closely linked. Mental health issues, such as depression and anxiety, can increase the risk of substance abuse.
MAT combines buprenorphine, naltrexone, and methadone to reduce cravings, withdrawal symptoms, and relapse risk.
Finally, support from family and friends is invaluable for those seeking treatment for substance use disorder. Family therapy, support groups, and 12-step programs can also be part of a successful recovery plan.
What's Next?
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- “Excessive Alcohol Use.” Centers for Disease Control and Prevention, 2022.
- “Today’s Heroin Epidemic Infographics.” Centers for Disease Control and Prevention, 2015.
- Ellgren, Maria, et al. “Adolescent cannabis exposure alters opiate intake and opioid limbic neuronal populations in adult rats.” American College of Neuropsychopharmacology, 2007.
- Griffin, Edmund A., et al. “Prior alcohol use enhances vulnerability to compulsive cocaine self-administration by promoting degradation of HDAC4 and HDAC5” Science Advances, 2017.
- “Cigarette Smoking Gateway to Illegal Drug Use.” Johns Hopkins Bloomberg School of Public Health, 2000.
- Kandel, D. et al. “From Beer to Crack: Developmental Patterns of Drug Involvement.” American Journal of Public Health, 1993.
- Kandel, E.R., et all. “A Molecular Basis for Nicotine as a Gateway Drug.” The New England Journal of Medicine, 2014.https://www.nejm.org/doi/full/10.1056/NEJMsa1405092
- Kirby, Tristan, and Adam E. Barry. “Alcohol as a Gateway Drug: A Study of US 12th Graders.” Journal of School Health, n.d.
- “Understanding Alcohol Use Disorder.” National Institute on Alcohol Abuse and Alcoholism, 2020.
- “Is marijuana a gateway drug?” National Institute on Drug Abuse, 2021.
- Nkansah-Amankra, Stephen, et al. ““Gateway hypothesis” and early drug use: Additional findings from tracking a population-based sample of adolescents to adulthood.” Preventative Medicine Reports, 2016.
- Ren, Michelle, et al. “Nicotine Gateway Effects on Adolescent Substance Use.” The Western Journal of Emergency Medicine, 2019.
- Volkow, Nora. “Recent Research Sheds New Light on Why Nicotine is So Addictive.” Scientific American, 2018.
- Kirby T, Barry AE. “Alcohol as a gateway drug: a study of US 12th graders.” J Sch Health, 2012.
