The term “gateway drug” is used to describe a recreational substance that leads to the use of other substances, usually, ones that are more addictive, involve more risks, eg. they are illicit, or are more potent, so more dangerous to use. Alcohol is often labeled by addiction experts as a gateway drug, as are both tobacco and cannabis.
However, other medical experts, including clinicians and other professionals, refute the term.
In major part due to the COVID-19 pandemic, the phrase has received significantly more mainstream media attention recently – for example, in headlines such as “Remote School as the Gateway Drug to Social Media,” published by the New York Times, or this humorous offering from the highly satirical New Yorker: “Georgia Governor Declares Water a Gateway Drug That Leads to Voting.”
However, its use to describe those drugs, ie. alcohol, tobacco, and cannabis, that may lead to illicit drug use or substance addiction, actually came to the fore way back in the 1980s, in a concept known as the “Marijuana Gateway Drug Theory.” Back then, fear-based prevention programs were used, like the marijuana theory, simply to try to stop adolescents from using cannabis. They did this by claiming that a massive number of adults who end up as heroin addicts had used marijuana when they were younger.
As flawed as the official thinking behind these programs and this “theory” undoubtedly was, when you actually isolated the scientific evidence it was based on, the truth of the matter emerges:
- Firstly, the majority of people who use any “gateway drug” do not go on to use other, more potent, illicit substances, and
- Secondly, someone who is a user of virtually any addictive substance is at an increased risk – however significant or otherwise – of using and having problems with other addictive substances in the future.
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Is Alcohol a Gateway Drug? Yes or No?
Even though scientific evidence tells us alcohol does increase the likelihood of other drug use in the future, such as other gateway drugs, like tobacco and cannabis, and illicit drugs, like cocaine, alcohol use is not a predictor. It’s only a recognized factor, just like an unfortunately traumatic experience during your childhood, or your family genetics are recognized factors in the possibility of substance addiction later in life.
If you strip the theory right down to an increase in simple mathematical probability, it’s small – very small. It’s only the combination of other factors with this small increase that can magnify any probability.
For example, let’s take heroin and alcohol. It’s a fact that most heroin users drink alcohol, too. However, just because most people who have used heroin have previously drunk alcohol clearly doesn’t prove that most people who drink alcohol will go on to be heroin users in the future. There’s simply an increased chance, however infinitely small that may be.
As the scientific researchers agree, alcohol use, especially in children and adolescents, will increase the probability of other drug use in the future. On its own, however, it is in no way a predictor of alcoholism in later life.
Consider this. Perhaps it is the term “gateway drug” itself that is fundamentally flawed. It’s a poorly written example of a descriptive phrase. Look at it this way. A “gateway” is a possible route to be taken – presenting someone with a choice. You don’t have to follow the route, you certainly don’t have to see where it leads, and, in terms of hard, illicit drugs, most people categorically don’t.
Alternative “Gateways” to Substance Use & Addiction
Prior use of gateway drugs is an indication of possible advancement to the spectrum of substance use disorders, such as opioid use disorder (OUD), but no more. However, there are several other major indicators you could also describe as “gateways” to the future use of stronger substances, and the subsequent development of a disorder or an addiction.
These factors have been used in studies to develop a “common factor” model, which cannot discount the gateway theory but can provide a statistically evidenced alternative. These models use factors such as:
- Habitualization: Firstly, there’s the familiarization aspect. For example, if you’re used to drinking beer because you like the lightheaded feeling of being drunk, the step up to hard liquor is an obvious one – you’re just drinking something else. In other words, you’ve become habituated to a certain way of getting your “high.”
Another example – take smoking tobacco. If you’re used to rolling your substance in paper and then smoking it, you’re more likely to smoke other substances, eg. marijuana. In fact, the links between are clear – known as comorbidity, smoking one significantly increases your chances of smoking the other, especially when you’re young.
Additionally, you can apply the same familiarization angle to injecting drugs, known as “shooting up.” Once a drug user becomes habituated to the process of drug injection, eg. a benzo (benzodiazepine) like Valium, it’s not a massive jump to then inject heroin, cocaine, or methamphetamine, especially when the user is already high.
- Social Networks: The social networks you move around in – your friends, your peers, or others you are socially connected to, are also other potential gateways to riskier substance use. Taking recreational drugs is a social activity, and the use of certain drugs becomes more normal and more accepted when the rest of the network, especially your close friends, are using them.
For example, if you regularly hang around with friends and peers who use crack cocaine, it will raise the odds of you, firstly, being offered the drug at some point, and, secondly, of you accepting that offer.
- Poly Drug Use: Poly drug use describes using 2 or more drugs recreationally because of their combined effect, and it becomes a gateway especially in the situation where you are combining the effect of a new drug with one you already use.
An example of this in terms of heavy alcohol use is its combination with cocaine. Heavy drinkers users sometimes become cocaine users (and vice versa, too) because they find using both at the same time is particularly euphoric.
There’s a scientific reason for this. Alcohol and cocaine use together produces a unique chemical in the body called “cocaethylene.” Cocaethylene is produced when the body attempts to metabolize both toxic substances in the liver, and it’s a powerful substance in itself – far more powerful than either cocaine or alcohol.
Gateway Drugs & The Science: What We Do Know
Before we look at one particular research study (involving U.S. 12th Graders, no less), and its conclusions about the concept of gateway drugs, let’s look at what we already know as certainties:
- Substance use disorder (SUD) is a complex chronic disease, and there is no single or complete explanation as to why someone becomes addicted. The prior use of alcohol is simply another risk factor among many, as we have described previously
- The interrelationships between the accepted gateway drugs (tobacco, alcohol, and cannabis) are complex in themselves, even before introducing another drug into the equation
- Targeting adolescent alcohol use will likely have an impact on their possible development of SUDs later in life
Now, the science. A 2012 research study, entitled “Alcohol as a Gateway Drug: a Study of US 12th Graders,” analyzed the data of 12th graders from the 2008 Monitoring the Future study. Using a Guttman Scale*, the study analyzed the relationship between the identified gateway drug and the use of other substances.
*A Guttman Scale is a single ordinal scale for the assessment of a set of attributes and is used in the analysis of varying data so an accurate assessment of a particular attribute can be made.
The purpose of the study was to determine which drug – alcohol, tobacco, or marijuana – was the actual “gateway” drug that would lead to any other form of substance use – legal or otherwise – among a nationally representative sample of 12th graders.
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The final result? The findings indicated clearly that alcohol should be considered the “gateway” drug because it was far more likely to lead to the use of both tobacco and marijuana, and further progression to the use of illegal substances. Furthermore, those students who used alcohol showed a significantly increased likelihood of using both legal and illicit drugs.
The authors thus concluded that alcohol should “receive primary attention in school-based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use.”
Observational Studies: The Limits to Any Conclusion
However, there is a single prevailing caveat to any scientific research into what constitutes a “gateway drug” and how reliable the evidential findings actually are. Due to ethical considerations (ie. you can’t use children in the same way as you can lab rats by deliberately exposing them to illicit drugs like heroin), the only studies available are observational in nature, where different groups are compared by their characteristics. Importantly, these studies cannot determine a cause-and-effect relationship.
For example, some observational studies have analyzed whether cocaine addicts were exposed to alcohol as teenagers. However, these people were also exposed to many, many other things that could have been influential, eg. video games and graphic comics. It is therefore impossible to rule those out as factors as possible causes of cocaine use or addiction.
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- National Institute of Drug Abuse (NIDA): Marijuana Research Report: “Is marijuana a gateway drug?” (July 2020)
- RAND Corporation, Research Brief: “Using Marijuana May Not Raise the Risk of Using Harder Drugs” (2002)
- American Psychology Association (APA), Journal Article: “Types of cannabis and tobacco/nicotine co-use and associated outcomes in young adulthood” (2019)
- Journal of School Health: “Alcohol as a gateway drug: a study of US 12th graders” (August 2012)
- University of Washington, study archive: “United States Monitoring the Future Survey, 12th Grade Students 2008”