What Is a Gateway Drug?

Gateway drugs generally refer to nicotine, cannabis, and alcohol. These are often the drugs people first
start experimenting with, and they are the most common substances used in adolescence or early
adulthood. These drugs are stereotyped as milder, but the notion is that using them may increase one’s
vulnerability to experimenting with other substances.

What Is the Gateway Drug Theory?

The theory of gateway drugs dates back to the early 1970s when the National Institute on Drug Abuse
gave Dr. Denise Kandel, a professor at Columbia, funding to study cannabis as a gateway drug. Dr.
Kandel found a sequence that young people with addiction had histories of experimenting with
cigarettes, beer, and wine first. She theorized that nicotine, in particular, can prime the brain for
addiction.

Why Is the Gateway Drug Theory Controversial?

It’s impossible to test whether using certain drugs causes someone to then use other drugs. Causation
refers to the idea of one effect causing another. Correlation, on the other hand, refers to a relationship
between two effects. Just because two effects correlate does not mean one inherently causes the other.

While research shows that people with substance use disorders are more likely to have experimented
with certain drugs first, it’s important to consider whether other variables, such as one’s mental health,
trauma, and family history may play more of a role. In addition, many people who use gateway drugs do
not later develop substance use disorders. It is also important to consider that people who have a low
threshold for using gateway drugs might similarly have a low threshold for using other drugs.

What Substances Are Considered Gateway Drugs?

Gateway drugs aren’t an official term, but they generally refer to nicotine, alcohol, and marijuana. With
marijuana, some health experts have concerns that legalization could increase use and cause it to more
frequently lead to the slippery slope of trying more highly addictive and dangerous drugs. Some health
professionals also consider prescription drugs, such as Adderall, particularly in children, as gateway
drugs.

Substances considered to be gateway drugs include:

Alcohol

Alcohol has long been considered a gateway drug. It’s legal, easily accessible, socially acceptable, and
research shows that the average age of first consumption is around 15-16 years old. Some research
shows that students who use alcohol during high school had a greater chance of using both legal and
illicit substances in adulthood.

That said, alcohol use is prevalent among high school and college campuses. Binge drinking represents a
significant problem, with over one-third of college students reporting patterns of it. Some of these
students do meet the criteria for an alcohol use disorder, but others ‘grow out’ of these habits as they
evolve into adulthood.
Tobacco/Nicotine

Tobacco and nicotine have always been a problem, but the rise of vaping has added more complications.
Research shows that about 14% of high school students use e-cigarettes. There is also a high correlation
between having a substance use disorder and abusing nicotine. In fact, many people who achieve full
sobriety from mood-altering substances report struggling to quit nicotine.

Marijuana

Marijuana is also considered a gateway drug, with some research suggesting that it precedes the use of
other substances. Marijuana use is also connected to other substance use disorders, including nicotine.
Some animal studies show that early cannabis exposure diminishes dopamine reward centers in
adulthood, which could explain one’s susceptibility to addiction.

Prescription Drugs

Many children are prescribed stimulants for ADHD treatment. Some research shows that ADHD
medications do not increase the risk of substance use. In fact, some studies indicate that those who took
ADHD medication were less likely to develop substance use disorders. But the effect of taking stimulants
as study drugs or party enhancers may increase vulnerability to addiction.

Risk Factors for Substance Abuse

It’s probable that some variables may increase the likelihood of someone moving from experimentation
into more problematic substance use. That said, substance use disorders are multifaceted and complex,
and researchers are still examining why some people are more prone to such conditions than others.
The combination of several factors likely plays a role in the gateway drug effect.

Factors that can increase the risk of misusing substances include:

Mental health issues: People with comorbid mental health issues, including anxiety and depression, tend
to have higher rates of substance use. Likewise, many people with substance use disorders also meet
the criteria for a mental health disorder.

Genetics: It’s estimated that genetics play a role in who develops an addiction.

Trauma: Research shows that trauma is a significant risk factor for all mental health issues and
substance use disorders.

Family history: People with addictions often cite having at least one first-degree relative with past or
current addiction problems.

Environment: Certain cultures and geographical locations have higher rates of substance use disorders.
In addition, when substance use is normalized and even glamorized, people are at a greater risk of
experimenting with drugs and alcohol.

9 Myths About Gateway Drugs

Drug abuse is complicated, and we’re still learning more about the individual factors contributing to
addiction. It’s unhelpful to assume that any one variable causes addiction. Moreover, using gateway
drugs does not automatically mean someone will struggle with a substance use disorder.
Common facts and myths about gateway drugs include:

Using a Gateway Drug Always Leads to Abusing Other Drugs

Many people use certain drugs without moving on to other drugs. Likewise, some people can and do
recreationally take particular substances without building a tolerance to them. Using drugs does not
inherently mean abusing drugs. It’s important to consider the intensity and frequency of substance use
as well as how drugs impact overall functioning.

Gateway Drugs Are Harmless

Although nicotine and alcohol are often considered harmless, they’re among the deadliest drugs. In the
US, smoking is responsible for nearly half a million deaths each year (1300 deaths each day). In addition,
a person dies every 52 minutes from a drunk driving accident. Because these substances are normalized
and legal, many people underestimate their harmful effects.

Gateway Drugs Lead to Addiction for Those Without Self-Control

Addiction should not be conceptualized as a willpower problem. Rather, it’s a chronic disease that
fundamentally impacts neurochemistry. Cravings, tolerance, and withdrawal represent very real physical
and psychological effects. Most people with substance use problems desperately want to stop drinking
or using drugs, but overcoming addiction is incredibly challenging.

There’s No Connection Between Gateway Drugs and Other Drugs

Research does show a connection between gateway drugs and other drugs. However, it’s impossible to
discern if this connection is causal. That said, some people with substance use issues did not start with
conventional gateway drugs. Furthermore, others may use gateway drugs for many months or years
without experiencing addiction problems.

Teaching Abstinence Is Best for Managing the Gateway Drug Problem

While abstinence is effective, teaching that as the only method isn’t. The reality is that many people will
experiment with drugs and alcohol, and it’s more important to open up ongoing dialogue about knowing
the risks and staying safe. People also need to be aware of the signs of addiction and their potential
treatment options.

Using Gateway Drugs Is a Normal Part of Growing Up

Although young people use drugs and alcohol, it’s untrue to assume that it’s a rite of passage. Parents
and teachers should not act as if a child is “doomed” to experiment with substances. Instead, they
should openly talk about the situation. They should also strive to empower children to recognize the
effects of peer pressure and make healthy decisions for themselves.

It’s Bad or Dangerous to Use Gateway Drugs

All substances have inherent risks, including health consequences, relationship issues, and the potential
of addiction. That said, using certain substances isn’t inherently bad. Many people use various
substances, such as cannabis or prescribed medications for medicinal purposes. It’s dangerous to make
blanket statements indicating that all substance use is problematic.

Using Gateway Drugs Requires Treatment

Professional intervention may be recommended if someone struggles with signs of a substance use
disorder. With that, it’s important for individuals and loved ones to be aware of both the risk factors and
signs of addiction. However, simply using gateway drugs does not automatically mean someone needs
mental health treatment.

Gateway Drugs Are Safer Than Other Drugs

As mentioned, nicotine and alcohol are among some of the most dangerous drugs in the world. People
should not assume that gateway drugs are inherently milder or safer. For instance, people overdose on
alcohol and make reckless decisions while under the influence everyday.

Is Trauma the Real Gateway Drug?

In recent years, experts have been closely examining the role of trauma and addiction. Trauma,
especially when it happens early in life, can impact all areas of functioning and may stunt emotional
development. Many people turn to substances to cope with trauma-related symptoms or to self-
medicate symptoms of depression or anxiety.

Studies show that people with adverse childhood experiences (ACEs) are more likely to have mental
health issues and substance use problems. More serious ACEs exposure may yield higher rates of drug
addiction. For example, people with ACE scores greater than five are 7-10x more likely to report illicit
drug addiction.9

Preventing Drug Abuse & Addiction

There isn’t a single method guaranteed to prevent drug abuse. It’s important to understand that anyone
can be vulnerable to addiction. Early preventative methods should include increased education about
substance use and learning how to regulate emotions in adaptive ways. Parents should also be aware of
their child’s friends, establish clear boundaries at home, and aim to be good role models.

Treatment for Substance Abuse & Addiction

The treatment process for substance use is often multifaceted and can include either inpatient or
outpatient services (or both). It may also include a combination of therapy, medication, and other
lifestyle changes. While moderate or severe addictions generally require detox, some people can start
their treatment process with either in-person or online therapy options.

Group Therapy and Support Groups

Groups provide a sense of camaraderie and accountability for addiction treatment. There are numerous
group therapy options and support groups available to people of all ages. Therapists or trained
facilitators lead the majority of these groups. Support groups may be peer-led and can include well-
known addiction treatment models, including Alcoholics Anonymous and Narcotics Anonymous.
Individual Therapy

Working with an individual therapist specializing in addiction can help with every stage of the recovery
process. Therapy provides structure, tools, and guidance. You can start your search by looking into a
professional therapist directory to find a therapist who meets your needs.

Therapy options for addressing substance abuse and addiction include:

Cognitive behavioral therapy (CBT): CBT helps people challenge negative thoughts about themselves and
others, which can improve emotions and behavioral responses.

Dialectical behavior therapy (DBT): DBT implements concepts of mindfulness, emotion regulation, and
distress tolerance, which can help with addiction recovery.

Eye movement desensitization and reprocessing (EMDR): EMDR can help people recover from trauma,
which is often part of addiction recovery.

Motivational interviewing (MI): MI helps people experiencing ambivalence about change, which often
applies to people attempting to recover from an addiction.

Interpersonal therapy (IPT): IPT focuses on improving interpersonal distress and strengthening social
support, which is often a core struggle for people experiencing addiction.

Intensive Outpatient Treatment

Intensive outpatient treatment (IOP) refers to a highly-structured treatment program. People at this
level of care receive clinical services, but they still live at home and often maintain their work and school
responsibilities. IOP schedules vary, but most clients attend treatment services for anywhere from 10-25
hours per week for anywhere between 1-12 months. Costs vary based on the treatment facility and
insurance reimbursements (if applicable).
Author: Nicole Arzt, LMFT

Medical Reviewer: Heidi Moawad, MD

Published: July 3, 2023

https://www.choosingtherapy.com/gateway-drug/