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Facts & Myths About Gateway Drugs

July 2, 2022

Table of Contents

A “gateway drug” is a colloquial term that refers to chemical substances (drugs) that are relatively not as harmful (and may even be legal) as more dangerous drugs that then “open the gate” for a person to use more dangerous substances in the future. 

People often believe that “gateway drugs” make it more likely that someone will progress to more dangerous drug use. For example, people often call marijuana a “gateway drug” that leads to more “serious” drug use, such as use of cocaine or opioids.  

“Gateway drug” is not a recognized medical term. There is no drug or substance in the United States that has any legal, medical, or scientific designation as a “gateway drug.” Nonetheless, the belief that some drugs will drive people to substance misuse persists, causing widespread impacts in public policy and legislation.[1] 

Myths About Gateway Drugs

Myths About Gateway Drugs

Myth 1: Using a gateway drug once will definitely lead to using cocaine or heroin in the future.

Truth: A “gateway drug” increases the possibility of future drug use, but it does not guarantee it.

Myth 2: Gateway drugs are instantly addictive.

Truth: So-called gateway drugs like alcohol, cannabis, or tobacco have addictive properties, but use of any of them does not guarantee an addiction.

Myth 3: Gateway drugs are harmless.

Truth: Even if a gateway drug does not immediately cause an “addiction” disorder, all drugs have risks. For example, even small amounts of nicotine can cause lung damage even in patients who are not “addicted” physiologically to cigarettes. All psychoactive substances carry risks even if the patient is not “addicted” or physiologically dependent on the drug. 

Myth 4: Using a gateway drug means a person has poor self-control.

Truth: Drug use is not about self-control. There are many reasons someone might use drugs — stress, depression, anxiety, peer pressure, environment, or genetic susceptibility. Using drugs is not a reflection of someone’s character or willpower.

Myth 5: There’s no connection between gateway drugs and more dangerous drugs.

Truth: Gateway drugs have in fact been connected to eventual use of more dangerous drugs, but there is no causal link between gateway drugs and more dangerous drugs. 

Facts About Gateway Drugs 

  • There is a correlation between people who use gateway drugs and misuse of more addictive drugs later in life, but it is not known if earlier drug use is “the cause” of later more serious drug use.
  • Even though the gateway drug hypothesis is not proven scientific fact, alcohol is considered to be much more of a gateway drug than cannabis or nicotine. Unlike cannabis or nicotine, alcohol is legal ( for those older than twenty one).
  • Consumption of a drug changes neural pathways in the brain particularly in younger individuals. Many researchers suspect that using alcohol, nicotine, or cannabis in teenage years likely make the brain more primed to respond to the chemical changes caused by more powerful drugs later on, although this has not been definitively proven. 
  • Even if there is no “gateway drug,” environment and genetics will not nullify the chemical effects of drugs. Even a person living in a healthy environment, with no family history of substance misuse, no mental health history, and no other obvious risk factors can still become addicted to alcohol and drugs, and often do. 
  • Animal testing on the subject of gateway drugs has found that early exposure to substances leads the animals to self-administer more drugs, but not all animal models of behavior can be generalized to human beings. 

Is Cannabis A Gateway Drug?

As the Institute of Medicine put it in 1999, cannabis is often the first illegal (or somewhat illegal, depending on the State) drug that most people encounter and use. Therefore, it is unsurprising that most of the people who use other illegal drugs have also used cannabis.[9] Cannabis has become more accessible and acceptable due to its legalization and decriminalization in many States. Believers in the gateway hypothesis fear that people experimenting with cannabis will seek out other drugs. That concern is not totally without justification: Cannabis use has been positively correlated with the use of more dangerous substances, like cocaine and methamphetamine (The New York Times).[7] However writers acknowledge that “not everyone who uses marijuana will transition to heroin or other drugs.” 

Is Nicotine A Gateway Drug?

Nicotine is legal and widely available for individuals over age 18 in the US. Thus, nicotine is sometimes considered a gateway drug because it is often one of the first drugs used by young adults. However, there remains no conclusive evidence that psychological or chemical effects of tobacco use have any causal connection to the later misuse of other drugs, especially more dangerous drugs. 

Is Alcohol a Gateway Drug?

Similar questions have been asked about the nature of alcohol as a gateway drug, with similar findings. Alcohol is often the first drug that many people are exposed to because it is legal in the US for those over age 21 [10] As with cannabis, there is no proven causal link between alcohol and use of more illicit drugs. 

In 2014, the Journal of Adolescent Health discovered a link between past alcohol, nicotine and cannabis use and subsequent misuse of prescription opioids, in people between the ages of 18 to 25.[11] Researchers noted that 12% of the study participants were misusing prescription opioids. Of that 12%, 34% of men and women had used cannabis before they moved to prescription opioids, 56% of men had used nicotine products and 57% of men had used alcohol. 

The Gateway Drug Hypothesis Explained

The gateway hypothesis is the hypothesis that early or initial use of legal or less harmful substances — alcohol, nicotine, and, in some jurisdictions, cannabis — is primary cause of progressing to the use of more dangerous substances, such as cocaine, heroin, methamphetamines, or others.[2] 

The idea originated in misunderstandings of epidemiological studies that detailed the natural history of substance misuse. However, the studies did not look at causality. They were interpreted as such and gave rise to immediate controversy that some degree of substance use will necessarily lead to a wider degree of substance use. One of the foundations of the gateway drug hypothesis is that drug use changes the brain’s neural pathways. Eventually, these pathways become standard channels of communication in the brain (becoming good at the language or the habit becoming second nature). This is where substance misuse and substance use disorder come in: Drugs change the brain’s chemical pathways, rewiring the connections so a person using the drugs associates the drug with feelings of pleasure, happiness, reward, and anticipation.[3]The gateway drug hypothesis is that once the brain’s neural pathways have been sufficiently altered by the use of drugs, this chemically normalizes the brain to seek out “harder” drugs to maintain those pathways. Some animal studies have found that the use of one drug made animals more likely to become dependent on other drugs. This has been connected to observational data that, in a similar way, people who use some drugs when they are younger go on to use other drugs when they are older.

However, we know that addiction is much more complicated than the simple “gateway hypothesis” might imply. Many other factors like genetic predisposition and environment likely play a much more significant role in SUD than simple prior use of a gateway drug.

Genetic Predisposition 

Genetic predisposition definitely matters in addiction, says the American Psychological Association. There is clear and consistent evidence that a person with family history of SUD is more likely to be at risk for developing their own SUD.[4] 

Environmental Factors 

Similarly, environment is also a risk factor for addiction. Living in close proximity to people who use drugs or alcohol, having easy access to drugs or alcohol, or living in economic depression and a culture of stress have all been connected with the likelihood of developing a SUD.[5] As the Nature journal points out, “the inheritance of addiction is a complicated affair,. 

Many feel that the gateway hypothesis is too simplistic and does not leave enough room for nuance when trying to determine the many factors that contribute to addiction.[6] It is impossible to attribute addiction to something as simple as the misuse of one or multiple “gateway drugs”. Addiction never has one sole determinant, it is a multifactorial problem that involves a combination of genetic and environmental factors. 

The Bottom Line

While substance misuse of any kind — whether it be alcohol, nicotine, or marijuana — does increase the likelihood of further drug use, attributing addiction disorders totally or even primarily to prior use of a gateway drug is likely a drastic oversimplification. Causes of substance use disorders are always multifactorial and complicated, and only by addressing the complexity of addiction can we begin to successfully treat it in those suffering from addiction.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Marijuana as a Gateway Drug: The Myth That Will Not Die. TIME. https://healthland.time.com/2010/10/29/marijuna-as-a-gateway-drug-the-myth-that-will-not-die/. October 2010. Accessed March 2022.
  2. Testing the Gateway Hypothesis. Neuropsychopharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506797/. April 2017. Accessed March 2022.
  3. Institute of Medicine (US) Committee on Opportunities in Drug Abuse Research. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington (DC): National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK232964/. 1996. Accessed March 2022.
  4. Genes Matter in Addiction. Monitor on Psychology. http://www.apa.org/monitor/2008/06/genes-addict. June 2008. Accessed March 2022.
  5. Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research. International Journal of Environmental Research and Public Health. https://pubmed.ncbi.nlm.nih.gov/27322303/. June 2016. Accessed March 2022.
  6. No More Addictive Personality. Nature. https://www.nature.com/articles/522S48a. June 2015. Accessed March 2022.
  7. Marijuana Has Proven to Be a Gateway Drug. The New York Times. https://www.nytimes.com/roomfordebate/2016/04/26/is-marijuana-a-gateway-drug/marijuana-has-proven-to-be-a-gateway-drug. April 2016. Accessed March 2022.
  8. Is Marijuana a Gateway Drug? Here's What the Research Says. Vox. https://www.vox.com/2016/4/29/11528410/cannabis-gateway-drug-theory. April 2016. Accessed March 2022.
  9. Marijuana and Medicine: Assessing the Science Base: A Summary of the 1999 Institute of Medicine Report. Archives of General Psychiatry. https://pubmed.ncbi.nlm.nih.gov/10839332/. June 2000. Accessed March 2022.
  10. Alcohol as a Gateway Drug: A study of US 12th Graders. Journal of School Health. https://pubmed.ncbi.nlm.nih.gov/22712674/. August 2012. Accessed March 2022.
  11. Previous Use of Alcohol, Cigarettes, and Marijuana and Subsequent Abuse of Prescription Opioids in Young Adults. Journal of Adolescent Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552239/. February 2013. Accessed March 2022.
  12. ‘Gateway Hypothesis’ and Early Drug Use: Additional Findings From Tracking a Population-Based Sample of Adolescents to Adulthood. Preventative Medicine Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929049/. May 2016. Accessed March 2022.

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