Gateway drug

Gateway drug theory (alternatively, stepping-stone theory, escalation hypothesis, or

progression hypothesis) is a comprehensive catchphrase for the theory that the use of a
psychoactive drug can be coupled to an increased probability of the use of further drugs.
Possible causes are biological alterations in the brain due to the earlier drug and similar
attitudes of users across different drugs (common liability to addiction). Scientific investigation
of the possible causes is considered important for health policy concerning education and law
making.

General concept

The concept of gateway drug is based on observations that the sequence of first-time use of
different drugs is not random but shows trends. On the basis of established techniques of
longitudinal studies such trends can be described precisely in terms of statistical probability. As
to the interpretation of the observed trends, it is important to note the difference between
sequence and causation. Both may – but need not – be coupled, a question which is subject of
further research, e.g., by physiological experiments.

Examples of trends

From a sample of 6,624 people who had not used other illegal drugs before their cannabis
consumption the overall probability of later use of other illegal drugs was estimated to be
44.7%. Subgroup analyses showed that personal and social conditions, such as gender, age,
marital status, mental disorders, family history of substance abuse, overlapping illegal drug
distribution channels, alcohol use disorder, nicotine dependence, ethnicity, urbanicity, and
educational attainment influenced the height of probability.

A study of drug use of 14,577 US 12th graders showed that alcohol consumption was associated
with an increased probability of later use of tobacco, cannabis, and other illegal drugs.
Adolescents who smoked cigarettes before age 15 were up to 80 times more likely to use illegal
drugs.

Large-scale longitudinal studies in the UK and New Zealand from 2015 and 2017 showed an
association between cannabis use and an increased probability of later disorders in the use of
other drugs.
Because a sequence of first-time use can only indicate the possibility – but not the fact – of an
underlying causal relation, different theories concerning the observed trends were developed.
The scientific discussion (state of 2016) is dominated by two concepts, which appear to cover
almost all possible causal connections if appropriately combined. These are the theories of
biological alterations in the brain due to an earlier drug use and the theory of similar attitudes
across different drugs.

Alterations in the brain

Rats repeatedly injected with tetrahydrocannabinol - earlier in life - increased the self-
administration of heroin (results based on 11 male rats), morphine (study based on 12 male
rats) and also nicotine (34 rats). There were direct indications that the alteration consisted of
lasting anatomical changes in the reward system of the brain. The importance of these findings
for the reward system in the human brain in relation to the liability to the use of further drugs
has been pointed out in several reviews.

In mice nicotine increased the probability of later consumption of cocaine and the experiments
permitted concrete conclusions on the underlying molecular biological alteration in the brain.
The biological changes in mice correspond to the epidemiological observations in humans that
nicotine consumption is coupled to an increased probability of later use of cannabis and
cocaine.

Personal, social and genetic factors

According to the concept of similar attitudes across different drugs (common liability to
addiction), a number of personal, social, genetic and environmental factors can lead to a
generally increased interest in various drugs. The sequence of first-time use would then depend
on these factors. Violations of the typical sequence of first-time drug usage give credit to this
theory. For example, in Japan, where cannabis use is uncommon, 83.2% of the users of illicit
drugs did not use cannabis first. The concept received additional support from a large-scale
genetic analysis that showed a genetic basis for the connection of the prevalence of cigarette
smoking and cannabis use during the life of a person.

The results of a twin study presented indications that familial genetic and familial
environmental factors do not fully explain these associations, and are possibly only relevant for
sequences of some drugs. In 219 same-sex Dutch identical and non-identical twin pairs, one co-
twin had reported cannabis use before the age of 18 whereas the other had not. In the
cannabis group the lifetime prevalence of later reported use of party drugs was four times
higher and the lifetime prevalence of later reported use of hard drugs was seven times higher
than in the non-cannabis group. The authors concluded that at least family influences – both
genetic and social ones – could not explain the differences. The study noted that, besides a
potential causal role of cannabis use, non shared environment factors could play a role in the
association such as differing peer affiliations that preceded the cannabis use.

Another twin study (of 510 same sex twin pairs) also examined the association of earlier
cannabis use and later hard drug use. Like other studies it examined later drug use differences
between siblings where one sibling had used cannabis early and the other had not. The study
examined identical twins (who share approximately 100% of their genes) and non-identical
twins (who share approximately 50% of their genes) separately and adjusted for additional
confounders such as peer drug use. It found, after confounder adjustment, that the
associations with later hard drug use existed only for non-identical twins. This suggests a
significant genetic factor in the likelihood of later hard drug usage. The study suggested that a
causal role of cannabis use in later hard drug usage is minimal, if it exists at all, and that
cannabis use and hard drug use share the same influencing factors such as genetics and
environment.

While the phrase gateway drug was first popularized by anti-drug activists such as Robert
DuPont in the 1980s, the underlying ideas had already been discussed since the 1930s by using
the phrases stepping-stone theory, escalation hypothesis, or progression hypothesis.

The scientific and political discussion has intensified since 1975 afuter the publications of
several longitudinal studies by Denise Kandel and others.
 Mini
Project
In
MAPEH

Princess P. Morales. Mr. Jayson Herrera

8-Mater Inviolata. Feb. 26, 2019