Everything You Need to Know About Gateway Drugs

Hank’s doctor prescribed painkillers after his biking accident. Two years later, his life revolved around an addiction to heroin.

Kim was introduced to cigarettes as a teenager. Now she smokes crack cocaine on a regular basis.

Did these addictions begin with the “gateway drugs” of nicotine and prescription pills? Or did Hank and Kim start using illicit substances for other reasons?

The theory of gateway drugs emerged decades ago…and it’s still up for debate today.

Let’s talk about it.

What is a Gateway Drug?

Gateway drugs are substances “whose use is thought to lead to the use of and dependence on a harder drug.” In other words, they open the gate to the world of drugs. While this isn’t a medical term, it expresses the idea that using some substances leads to future drug abuse.

There’s no official list of gateway drugs, but alcohol, nicotine, marijuana, and certain prescription medications are the substances most often named.

Common Gateway Drugs

Nicotine

Nicotine is a highly addictive stimulant that can lead to tobacco dependency. This substance is the main psychoactive ingredient in tobacco products. In 2020, 57.3 million Americans age 12 or older reported using tobacco products in the past 30 days.

Certain statistics from the Centers for Disease Control (CDC) support the idea that nicotine acts as a gateway to illicit drug use. Self-reports of past-month cocaine use, heroin use, marijuana use, binge drinking, and non-medicinal use of prescriptions drugs are all higher for smokers than nonsmokers.

For example, the percentage of people who reported past-month cocaine use was nine times higher for smokers than nonsmokers.

Marijuana

Some research suggests that marijuana is a gateway drug. A 25‑year longitudinal study published in Addiction indicated that early marijuana use “was strongly associated with later and more frequent drug use and abuse.”

Another study in the International Journal of Drug Policy reported a 44.7 percent chance that people who used cannabis would use other drugs.

The National Institute on Drug Abuse (NIH) reports that 30 percent of people who use marijuana may have some degree of marijuana use disorder. As of 2015, roughly four million people in the US met the diagnostic criteria for marijuana use disorder.

Alcohol

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2015 that 15.7 million people over the age of 12 had an alcohol use disorder.

Some statistics indicate that drinking alcohol could lead to other drug use:

54 percent of 12^th graders who reported they used alcohol, tobacco, and marijuana reported using alcohol first.
Students who reported alcohol use in 6^th grade had higher rates of lifetime illicit substance use than those who didn’t use alcohol until they were older.

Alcohol is one of the most visible and easiest to obtain substances. It’s also the most socially acceptable gateway drug.

Prescription Pills

Strong pain medications (opioids) are often prescribed by doctors or found in the family medicine cabinet. Common prescriptions include oxycodone, hydrocodone, and codeine.

Data gathered from 2002 to 2012 showed the incidence of heroin use was 19 times higher among people who reported prior abuse of opioid pain relievers.

The Mayo clinic reports that anyone who takes opioids is at risk of developing addiction. This is partly because tolerance can develop quickly. So people have to take more and more of the drug to achieve the same effect. And this leads to physical and psychological dependence.

The Department of Health and Human Services reports that 9.7 million people misused prescription pain relievers in 2019. Today, these drugs are responsible for the majority of overdose deaths in the United States.

Other Common Gateway Drugs

Caffeine: Daily consumption in adolescents correlates with increased risky behaviors and greater sensitivity to stimulant drugs.
Inhalants: Common household products produce vapors that can damage brain regions controlling thinking and movement.
Over‑the‑Counter Medications: Misusing DXM cough suppressants, sleep aids, and antihistamines lowers the barrier to stronger substances.
Synthetic Cannabinoids (K2, Spice): Often associated with early exposure, these unpredictable substances may act as a gateway to more dangerous drugs.

Do Gateway Drugs Really Lead to Other Drug Use?

There seems to be evidence supporting the “gateway drug” concept. But the idea is not accepted by all. And there’s also evidence against it.

One study published by the Department of Health and Human Services (HHS) suggests “gateway drugs aren’t the only entry point to harder substance use and addiction. Instead, there are numerous factors such as poverty, aggressive crime, and social environment that play a major role.”

As this study suggests, the main argument against the idea of gateway drugs is that other factors are also important to consider. Perhaps it’s social interactions, or socioeconomic status, or something else that pushes a person to move on to harder drugs.

The key to keep in mind is that there seems to be a correlation (relationship) between use of these gateway drugs and future drug use. But causation (the reason for a future event) has not been proven. In other words, just because a person uses one of these gateway drugs doesn’t guarantee they will move on to other drug use or develop an addiction.

But it’s absolutely possible that use of gateway drugs puts them at an increased risk.

How Do I Know if Someone Has an Addiction?

Recognizing addiction, especially in early stages, but here are some key behavioral, physical and psychological signs you can watch for:

Behavioral Signs:

Loss of control: The inability to stop using substances, even when they want to.
Neglecting responsibilities: Neglecting work, school, and/or family obligations.
Secretive behavior: Hiding, lying and becoming defensive.
Change in social circles: Spending time with a new group that share the behavior.
Risk-taking: Using substances in dangerous situations, like driving under the influence.
Increased tolerance: Needing more substances to achieve the same effect.

Physical Signs:

Changes in appearance: Weight changes, poor hygiene, bloodshot eyes, or unusual smells.
Withdrawal symptoms: Shaking, sweating, nausea, irritability, and/or insomnia when not using.
Sleep Issues: Sleeping too much, or too little.

Psychological Signs:

Mood swings: Irritability, aggression, or sudden emotional shifts.
Anxiety or depression can occur if these worsen without the substance.
Loss of interest: No longer enjoying activities and hobbies.
Denial: Refusing to acknowledge an obvious problem.

Where Can I Find Information About Substance Abuse Treatment?

You can find trusted and up-date information for substance abuse treatment from the following:

Substance Abuse and Mental Health Services Administration (SAMHSA) website, under Treatment Locater, or the helpline at 1-800-662-4357. Helpline information is in English and Spanish.
National Institute on Drug Abuse (NIDA).
Local resources such as state and county health departments, community health clinics, and hospitals.
Crisis & support services: National Alliance on Mental Health (NAMI); Crisis text line at text HOME to 741741 (24 hour support); Alcoholics Anonymous (AA); Narcotics Anonymous (NA).

What Are The Treatment Options for Drug Addiction?

Detoxification (Detox) for safely managing withdrawal symptoms in a hospital or detox center, with medical supervision.
Inpatient residential treatment with 24/7 care in a structured environment. Length of stay can be 30, 60,90 days, which includes therapy, education and support groups.
Outpatient treatment where someone can attend therapy session several times a week, while living at home.
Medication-Assisted Treatment (MAT) is used to treat opioid, alcohol or nicotine addictions with medication.
Support and peer support groups, such as AA, NA, Smart Recovery (a science-based alternative to the 12 steps), with ongoing peer support and accountability.

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-914-7089 (Sponsored) today.