Serving Substance Abuse Professionals Since 1993 Last Update: 15.06.12


C O R K   O N L I N E
powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home


CORK Bibliography: Drug Use and Gateway Hypothesis



44 citations. 2005 to present

Prepared: June 2012



Agrawal A; Silberg JL; Lynskey MT; Maes HH; Eaves LJ. Mechanisms underlying the lifetime co-occurrence of tobacco and cannabis use in adolescent and young adult twins. Drug and Alcohol Dependence 108(1-2): 49-55, 2010. (66 refs.)

Using twins assessed during adolescence (Virginia Twin Study of Adolescent Behavioral Development: 8-17 years) and followed up in early adulthood (Young Adult Follow-Up, 18-27 years), we tested 13 genetically informative models of co-occurrence, adapted for the inclusion of covariates. Models were fit, in Mx, to data at both assessments allowing for a comparison of the mechanisms that underlie the lifetime co-occurrence of cannabis and tobacco use in adolescence and early adulthood. Both cannabis and tobacco use were influenced by additive genetic (38-81%) and non-shared environmental factors with the possible role of non-shared environment in the adolescent assessment only. Causation models, where liability to use cannabis exerted a causal influence on the liability to use tobacco fit the adolescent data best, while the reverse causation model (tobacco causes cannabis) fit the early adult data best. Both causation models (cannabis to tobacco and tobacco to cannabis) and the correlated liabilities model fit data from the adolescent and young adult assessments well. Genetic correlations (0.59-0.74) were moderate. Therefore, the relationship between cannabis and tobacco use is fairly similar during adolescence and early adulthood with reciprocal influences across the two psychoactive substances. However, our study could not exclude the possibility that 'gateways' and 'reverse gateways', particularly within a genetic context, exist, such that predisposition to using one substance (cannabis or tobacco) modifies predisposition to using the other. Given the high addictive potential of nicotine and the ubiquitous nature of cannabis use, this is a public health concern worthy of considerable attention.

Copyright 2010, Elsevier Science


Alter RJ; Lohrmann DK; Greene R. Substitution of marijuana for alcohol: The role of perceived access and harm. Journal of Drug Education 36(4): 335-355, 2006. (30 refs.)

Research has shown significant declines in gateway drug use among participants in a school/community substance abuse prevention intervention in a midwestem, suburban school district (Lohrmann, Alter, Greene, & Younoszai, 2005). Though still at or below national levels, student marijuana use was not impacted as positively. The current study investigated the possibility that efforts to prevent alcohol use resulted in an unintentional substitution effect thereby increasing marijuana use. Factors including perceived access to alcohol and marijuana, along with perceived harm associated with alcohol and marijuana use, were examined to determine their role in marijuana use. Findings revealed a relationship between perceived access to and perceptions of harm associated with marijuana and its use that depended on the level of perceived access to and harm associated with alcohol.

Copyright 2006, Baywood Publishing


Arabi Z. An epidemic that deserves more attention: Epidemiology, prevention, and treatment of smokeless tobacco. Southern Medical Journal 100(9): 890-894, 2007. (55 refs.)

Smokeless tobacco (ST) use is common, especially in southern and rural areas. It is expected to become more popular with the recent move to sell more ST in areas where indoor smoking is banned. ST use usually starts in adolescence, which places this group at high risk. Nicotine dependence occurs almost exclusively in people who start using ST in their adolescent years, so it is crucial to prevent the introduction of ST to this age group. The debate over whether ST is a gateway to smoking or a bridge to quitting has not been fully answered. ST should not replace smoking where indoor smoking is banned. ST is less harmful than smoking, but nicotine replacement therapy (NRT) is much safer than ST. NRT and bupropion are helpful in the treatment of ST dependence by decreasing withdrawal symptoms and preventing weight gain after cessation.

Copyright 2007, Lippincott, Williams & Wilkins


Bretteville-Jensen AL. To legalize or not to legalize? Economic approaches to the decriminalization of drugs. Substance Use & Misuse 41(4): 555-565, 2006. (32 refs.)

Drug legalization is gaining ever-widening support in most Western societies. A liberalization of current drug laws will most probably lead to a fall in drug prices. The present article focuses on recent economic studies examining the effects of a fall in prices on quantities consumed and recruitment. Estimates of price elasticities indicate that a substantial increase in consumption by current drug users should be expected if prices decrease, whereas estimates of participation elasticities suggest all increase in the number of users. Tests of the so-called gateway theory (i.e., whether the use of a less harmful drug increases the risk of future use of more harmful drugs) offers less unambiguous results.

Copyright 2006, Marcel Dekker, Inc.


Choo T; Roh S; Robinson M. Assessing the "gateway hypothesis" among middle and high school students in Tennessee. Journal of Drug Issues 38(2): 467-492, 2008. (61 refs.)

The current study examines the applicability of the "gateway hypothesis" to drug use patterns of secondary school students from a nonmetropolitan area in Tennessee. The data were collected from students in the 8(th), 10(th), and 12(th) grades at three secondary schools, using self-administered questionnaires under supervision of teachers. Although there is some support for the gateway hypothesis in our data, there is also evidence that what differentiates those who move from initial marijuana use to use of harder drugs are risk factors unique to individuals and their environments, consistent with the predictions of problem behavior theory and integrated systems theory. Implications for various interpretations of the gateway hypothesis are discussed.

Copyright 2008, Journal of Drug Issues, Inc.


Degenhardt L; Dierker L; Chiu WT; Medina-Mora ME; Neumark Y; Sampson N et al. Evaluating the drug use "gateway" theory using cross-national data: Consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug and Alcohol Dependence 108(1-2): 84-97, 2010. (32 refs.)

Background: It is unclear whether the normative sequence of drug use initiation, beginning with tobacco and alcohol, progressing to cannabis and then other illicit drugs, is due to causal effects of specific earlier drug use promoting progression, or to influences of other variables such as drug availability and attitudes. One way to investigate this is to see whether risk of later drug use in the sequence, conditional on use of drugs earlier in the sequence, changes according to time-space variation in use prevalence. We compared patterns and order of initiation of alcohol, tobacco, cannabis, and other illicit drug use across 17 countries with a wide range of drug use prevalence. Method: Analyses used data from World Health Organization (WHO) World Mental Health (WMH) Surveys, a series of parallel community epidemiological surveys using the same instruments and field procedures carried out in 17 countries throughout the world. Results: Initiation of "gateway" substances (i.e. alcohol, tobacco and cannabis) was differentially associated with subsequent onset of other illicit drug use based on background prevalence of gateway substance use. Cross-country differences in substance use prevalence also corresponded to differences in the likelihood of individuals reporting a non-normative sequence of substance initiation. Conclusion: These results suggest the "gateway" pattern at least partially reflects unmeasured common causes rather than causal effects of specific drugs on subsequent use of others. This implies that successful efforts to prevent use of specific "gateway" drugs may not in themselves lead to major reductions in the use of later drugs.

Copyright 2010, Elsevier Science


Ding K; Chang GA; Southerland R. Age of inhalant first time use and its association to the use of other drugs. Journal of Drug Education 39(3): 261-272, 2009. (24 refs.)

Inhalants are the 4th most commonly abused drugs after alcohol, tobacco, and marijuana. Although inhalants are often referred as Gateway Drugs this hypothesis is less examined. Using the 2003 National Survey on Drug Use and Health data, age of first time inhalant use was compared with the age of onset of other drugs among 6466 inhalant users who also used at least one of 14 other drugs. Findings indicated that only 4.2% multiple drug users who used inhalants prior to other drugs, especially alcohol, tobacco, and marijuana. Thus, the theory that inhalants are gateway drugs was not supported.

Copyright 2009, Baywood Publishing


Fergusson DM; Boden JM; Horwood LJ. Cannabis use and other illicit drug use: Testing the cannabis gateway hypothesis. Addiction 101(4): 556-569, 2006. (67 refs.)

Aim: To examine the associations between the frequency of cannabis use and the use of other illicit drugs. Design: A 25-year longitudinal study of the health, development and adjustment of a birth cohort of 1265 New Zealand children. Measurements: Annual assessments of the frequency of cannabis use were obtained for the period 14-25 years, together with measures of the use of other illicit drugs from the same time period. Findings: The frequency of cannabis use was associated significantly with the use of other illicit drugs, other illicit drug abuse/dependence and the use of a diversity of other drugs. This association was found to be particularly strong during adolescence but declined rapidly as age increased. Statistical control for confounding by both fixed and time dynamic factors using random- and fixed-effects regression models reduced the strength of association between frequency of cannabis use and other illicit drug use, but a strong association between frequency of cannabis use and other illicit drug use remained even after control for non-observed and time-dynamic sources of confounding. Conclusions: Regular or heavy cannabis use was associated with an increased risk of using other illicit drugs, abusing or becoming dependent upon other illicit drugs, and using a wider variety of other illicit drugs. The risks of use, abuse/dependence, and use of a diversity of other drugs declined with increasing age. The findings may support a general causal model such as the cannabis gateway hypothesis, but the actual causal mechanisms underlying such a gateway, and the extent to which these causal mechanisms are direct or indirect, remain unclear.

Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs


Fergusson DM; Boden JM; Horwood LJ. Testing the cannabis gateway hypothesis: Replies to Hall, Kandel et al. and Maccoun (2006) (editorial). Addiction 101(4): 474-476, 2006. (6 refs.)


Galanti MR; Rosendahl I; Wickholm S. The development of tobacco use in adolescence among "snus starters" and "cigarette starters": An analysis of the Swedish "BROMS" cohort. Nicotine & Tobacco Research 10(2): 315-323, 2008. (41 refs.)

Whether the use of smokeless tobacco can facilitate the transition to cigarette smoking and/or to prolonged tobacco use in adolescence is unclear. We analyzed data from a cohort of 2,938 Swedish adolescents, with six follow-up assessments of tobacco use between the ages of 11 and 18 years. The majority of tobacco users (70%) started by smoking cigarettes, 11% took up snus before smoking, and 19% used both tobacco types close in time. Ever users of tobacco at baseline had a higher risk of being current smokers and/or smokeless tobacco users at the end of follow-up compared with never users, with the highest excess relative risk for "mixed users." Adolescents who initiated tobacco use with cigarettes had a non-significantly increased probability to end up as current smokers compared with snus starters (adjusted OR=1.42; 95% CI 0.98-2.10) The OR of smoking for "mixed starters" was 2.54 (95% CI 1.68-3.91). The risk of becoming current user of any tobacco was also significantly enhanced for "mixed starters." Marked sex differences were observed in these associations, as initiation with cigarettes rather than with snus predicted current smoking or tobacco use only among females. Progression of tobacco use in adolescence is not predicted by onset with snus or cigarettes, but rather by initiation with both tobacco types close in time and/or at young age. The proportion of adolescent smoking prevalence attributable to a potential induction effect of snus is likely small.

Copyright 2008, Taylor & Francis


George S; Moselhy H. "Gateway hypothesis" -- a preliminary evaluation of variables predicting non-conformity. (letter). Addictive Disorders and Their Treatment 4(1): 39-40, 2005. (4 refs.)

This letter reports the results of an exploratory study to explore the "gateway hypothesis", specifically whether there are patient variables that discriminate those whose who follow the "gateway" -- i.e. their use of licit drugs, i.e. alcohol, nicotine, leads to the use of illicit drugs -- from those for whom this is not the case. Two groups were identified those, those whose drug use progressed from "soft" drugs to hard drugs or whether they started using "hard" drugs (a reversed gateway.) The first group (typical ''gateway'') had the following characteristics: 72 (68.8%) were male and 34 (31.2%) were female; 69 (65%) were whites and 20 (19%) were Pakistani; 57 (54%) were single; 87 (82%) were unemployed; 28 (26%) had a mental health consultation in the last 2 years; 57 (54%) had a family history of drug dependence, and the age of first presentation to drug treatment services was 25.1(66.9) years. The "reversed gateway" group had the following characteristics: 27 (79%) were male and 7 (21%) were female; 18 (54%) were white and 9 (26%) were Pakistani; 21(62%) were unemployed; 12 (34%) had a mental health consultation in the last 2 years; 21(62%) had a family history of drug dependence and the age of first presentationfto drug treatment services was 23.2 years. There were no statistically significant differences between the 2 groups on any of these variables.

Copyright 2005, Lippincott, Williams and Wilkins


Golub A; Johnson BD; Dunlap E. Subcultural evolution and illicit drug use. Addiction Research & Theory 13(3): 217-229, 2005. (84 refs.)

This article articulates a subcultural basis to the evolving popularity for different illicit drugs primarily based on empirical research in the United States, especially among inner-city populations. From this perspective, drug use emerges from a dialectic between drug subcultures with individual identity development. The prevailing culture and subcultures affect drugs' popularity by imparting significance to their use. Innovations, historical events, and individual choices can cause subcultures to emerge and change over time. This subcultural view provides insight into the widespread use of licit drug, the dynamics of drug eras (or epidemics), the formation of drug generations, and the apparent "gateway" phenomenon.

Copyright 2005, Taylor & Francis Ltd.


Grau LE; Dasgupta N; Harvey AP; Irwin K; Givens A; Kinzly ML; Heimer R. Illicit use of opioids: Is OxyContin (R) a "Gateway drug''? American Journal on Addictions 16(3): 166-173, 2007. (42 refs.)

This study examines whether individuals who engage in illicit, non-medical use of OxyContin((R)) are distinguishable from other non-medical users of opioids and whether OxyContin serves as a "gateway'' to heroin and/or injection drug use. The study sample included active non-medical users of opioids, who are 16 years or older and residents of Cumberland County, Maine. Possible associations between type of opioid used and behavioral and descriptive variables were assessed. The study sample was predominantly urban-dwelling, male, Caucasian, and economically disadvantaged. OxyContin users could only be distinguished from heroin users (non-heroin opioid users). Polyopioid use within the first year of initiation was associated with quicker progression to heroin and injection drug use.

Copyright 2007, Taylor & Francis


Hall W. Dissecting the causal anatomy of the link between cannabis and other illicit drugs. (editorial). Addiction 101(4): 472-473, 2006. (8 refs.)


Hall W; Solowij N. The adverse health and psychological consequences of cannabis dependence. IN: Roffman RA; Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. London: Cambridge University Press, 2006. pp. 106-132

This chapter considers morbidity associated with chronic marijuana use. Among the conidtions addressed are the respiratory risks of smoking marijuana, respiratory cancers associated with long term use, brain function and cognitivie impairment associated with chronic use, and the role of cannabis in accidental injury. The cardiovascular effects of cannabis use are reviewed. In addition psychological/behavioral related effects are addressed, such as the impact of different levels of marijuana use on school performance,the relationsip of cannabis use ato psychosis and schizophrenia, and the "gateway hypothesis", as well as special populations of cannabis-dependent persons.

Copyright 2006, Project Cork


Hall WD; Lynskey M. Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. (review). Drug and Alcohol Review 24(1): 39-48, 2005. (66 refs.)

We outline and evaluate competing explanations of three relationships that have consistently been found between cannabis use and the use of other illicit drugs, namely, (1) that cannabis use typically precedes the use of other illicit drugs; and that (2) the earlier cannabis is used, and (3) the more regularly it is used, the more likely a young person is to use other illicit drugs. We consider three major competing explanations of these patterns: (1) that the relationship is due to the fact that there is a shared illicit market for cannabis and other drugs which makes it more likely that other illicit drugs will be used if cannabis is used; (2) that they are explained by the characteristics of those who use cannabis; and (3) that they reflect a causal relationship in which the pharmacological effects of cannabis on brain function increase the likelihood of using other illicit drugs. These explanations are evaluated in the light of evidence from longitudinal epidemiological studies, simulation studies, discordant twin studies and animal studies. The available evidence indicates that the association reflects in part but is not wholly explained by: (1) the selective recruitment to heavy cannabis use of persons with pre-existing traits (that may be in part genetic) that predispose to the use of a variety of different drugs; (2) the affiliation of cannabis users with drug using peers in settings that provide more opportunities to use other illicit drugs at an earlier age; (3) supported by socialisation into an illicit drug subculture with favourable attitudes towards the use of other illicit drugs. Animal studies have raised the possibility that regular cannabis use may have pharmacological effects on brain function that increase the likelihood of using other drugs. We conclude with suggestions for the type of research studies that will enable a decision to be made about the relative contributions that social context, individual characteristics, and drug effects make to the relationship between cannabis use and the use of other drugs.

Copyright 2005, Australian Medical and Professional Society on Alcohol and Other Drugs


Kandel DB; Yamaguchi K; Klein LC. Testing the gateway hypothesis. (editorial). Addiction 101(4): 470-472, 2006. (11 refs.)


Klanecky AK; Salvi S; McChargue DE. Coerced childhood sexual abuse moderates the association between cigarette smoking initiation and college drug use frequency. American Journal on Addictions 18(5): 363-366, 2009. (30 refs.)

The current study examined childhood sexual abuse (CSA) as a potential moderator of the "gateway theory" association of cigarette use onset and college drug use. Covariate adjusted hierarchical regressions showed that CSA history interacted with age of first cigarette to predict total 12-month illicit drug use frequency (Delta R-2 = .048, F(10, 76) = 4.041, Mse = 8.812, p = .021). Simple effects revealed that age of first cigarette predicted drug use frequency in individuals with CSA histories (p = .045) rather than non-CSA individuals (p = .103). Exploratory analyses further revealed that the CSA moderation was carried primarily by those exposed to forced/coerced CSA events. Implications of the findings are discussed.

Copyright 2009, American Academy of Psychiatrists in Alcoholism and Addictions


Lee D. Residential mobility and gateway drug use among hispanic adolescents in the US: Evidence from a national survey. American Journal of Drug and Alcohol Abuse 33(6): 799-806, 2007. (22 refs.)

Residential mobility has been an important topic in public health for the past decades. More than 22 million Americans migrated from state to state in 2000, but characteristics of minority American movers are not well documented in the aspect of public health. Using the U. S. national survey, we examined the association between residential mobility and gateway drug use among Hispanic adolescents in the U. S. Frequent movers and never movers were compared in the study. The study results indicate that frequent movers ( moved more than 4 times for the past 5 years) were more likely than never movers to smoke and use marijuana. We also found that frequent residential relocation, females, and older teenagers (14-17) are risk factors of gateway drug use among Hispanic adolescents.

Copyright 2007, Taylor & Francis


Levine SB; Coupey SM. Nonmedical use of prescription medications: An emerging risk behavior among rural adolescents. Journal of Adolescent Health 44(4): 407-409, 2009. (10 refs.)

Little is known about prescription medication abuse by rural youth. We surveyed 849 rural high school students and found that 34% reported lifetime nonmedical use of prescription medication higher than the 12% reported nationally. Boys and marijuana users had higher odds of nonmedical use of prescription medication than did girls or marijuana nonusers (odds ratio 1.9 and 3.8, respectively).

Copyright 2009, Society for Adolescent Medicine


Levine SB; Coupey SM. Nonmedical use of prescription medications: An emerging risk behavior among rural adolescents. Journal of Adolescent Health 44(4): 407-409, 2009. (10 refs.)

Little is known about prescription medication abuse by rural youth. We surveyed 849 rural high school students and found that 34% reported lifetime nonmedical use of prescription medication higher than the 12% reported nationally. Boys and marijuana users had higher odds of nonmedical use of prescription medication than did girls or marijuana nonusers (odds ratio 1.9 and 3.8, respectively).

Copyright 2009, Society for Adolescent Medicine


Lynskey MT; Vink J; Boomsma D. Early onset cannabis use and progression to other drug use in a sample of Dutch twins. Behavior Genetics 36(2): 195-200, 2006. (32 refs.)

One possible explanation of the commonly reported associations between early onset cannabis use and elevated risks of other illicit drug use is that early onset cannabis use increases access and availability to other drugs. It was this argument that in part motivated policy changes in the Netherlands that led to the de facto legalization of cannabis there. This study examines, using a co-twin control design, whether previously observed associations between early onset cannabis use and elevated lifetime rates of other illicit drug use would also be observed in a sample of 219 same sex Dutch twin pairs discordant for cannabis use before age 18. After adjustment for covariates, rates of lifetime party drug use (OR=7.4, 95% CI=2.3-23.4), hard drug use (OR=16.5, 95% CI=2.4-111.3), but not regular cannabis use (OR=1.3, 95% CI=0.3-5.1) were significantly elevated in individuals who reported early onset cannabis use, relative to their co-twin who had not used cannabis by age 18. The elevated odds of subsequent illicit drug use in early cannabis users relative to their non early using co-twins suggests that this association could not be explained by common familial risk factors, either genetic or environmental, for which our co-twin methodology provided rigorous control.

Copyright 2006, Springer


Maccoun RJ. Competing accounts of the gateway effect: The field thins, but still no clear winner. (editorial). Addiction 101(4): 473-474, 2006. (12 refs.)


Makanjuola VA; Oladeji BD; Gureje O. The gateway hypothesis of substance abuse: An examination of its applicability in the Nigerian general population. Substance Use & Misuse 45(10): 1558-1571, 2010. (28 refs.)

The study aims to estimate the prevalence and predictors of not following the gateway theory. Respondents were selected from a multistage stratified clustered sampling of households in five of Nigeria's six geopolitical regions. Interviews were conducted between February 2002 and May 2003 using the CIDI-version. 3 with a total sample size (N) of 2,143. Cumulative incidence proportions of not following a gateway pattern were estimated with SUDAAN. Predictors of this were estimated using multivariate logistic regression models. The deviation from the normative sequence of drug use occurs albeit infrequently. The public health implications of this are discussed as well as the limitations of the findings.

Copyright 2010, Taylor & Francis


Maldonado-Molina MM; Lanza ST. A framework to examine gateway relations in drug use: An application of latent transition analysis. Journal of Drug Issues 40(4): 901-924, 2010. (33 refs.)

A progressive and hierarchical sequence of drug use suggests that a sequence of stages of drug use can describe the order by which adolescents try drugs. We propose an operational definition to test gateway relations by providing a framework with the aim of describing a set of conditions to guide the evaluation of whether a drug serves as a gateway for another drug. We used data from the National Longitudinal Study of Adolescent Health to demonstrate how using latent transition analysis we can estimate the odds of using a drug at a later time conditional on having used a gateway drug at an earlier time. We provide three empirical demonstrations for testing the gateway relations using a national and longitudinal data of adolescents (e.g., gateway relation between cigarettes and marijuana, alcohol and marijuana, and alcohol and cigarettes).

Copyright 2010, Journal of Drug Issues Inc.


Mayet A; Legleye S; Chau N; Falissard B. The mediation role of licit drugs in the influence of socializing on cannabis use among adolescents: A quantitative approach. Addictive Behaviors 35(10): 890-895, 2010. (48 refs.)

Licit substance use could be an early stage leading on to cannabis use. The aim of the study was to test a hypothetical sequential process leading from socializing to cannabis use so as to evaluate the mediator role of tobacco and alcohol. Data was derived from a French nationwide survey carried out in 2005 involving 29,393 teenagers aged 17. The analysis used structural equation modelling. The sequence tested was: socializing with friends-tobacco/alcohol use-cannabis use-cannabis use disorders (CUD). Tobacco and alcohol consumptions appeared to be similarly influenced by the time spent with friends. However, tobacco mediation explained 57% of the sequence leading to cannabis use and 61% of the sequence leading to CUD, while the role of alcohol was weaker, at around 13%. Our results underline the effect of peer influence, in the course of night-out socializing, on substance use among adolescents, and the importance of tobacco mediation in the process leading to cannabis use and misuse. This suggests that prevention in places frequented by adolescents should primarily target tobacco consumption, which explains the largest part of cannabis use variance. However, processes linking substance uses seem to be more complex, with the existence of reverse pathways from cannabis to licit drugs. Thus, the gateway effects of tobacco and alcohol require further exploration in relation to simultaneous polysubstance use.

Copyright 2010, Elsevier Science


Mayet A; Legleye S; Chau N; Falissard B. Transitions between tobacco and cannabis use among adolescents: A multi-state modeling of progression from onset to daily use. Addictive Behaviors 36(11): 1101-1105, 2011. (24 refs.)

Use of a given substance may follow a stage process leading from onset to regular use, and use of one substance can be strongly associated with use of another. The aim of this study was to describe the transitions between tobacco and cannabis use. Data was derived from a French nationwide survey involving 29,393 teenagers. A homogenous Markov multi-state model (MSM) was fitted. The substance use pattern modeled was: no lifetime use -> 1 (2) substance(s) initiation -> 1 (2) daily substance(s) use, with pathways between tobacco and cannabis. The likelihood of first initiating tobacco appeared 17.6 times greater than the likelihood of initiating cannabis. Once a subject has experimented with one substance, the risk of another substance experiment was much greater. Transition intensity from tobacco initiation to daily use was 4.8 times higher than that from cannabis. Our results are compatible with a process mixing the gateway theory, the reverse gateway theory and the route of administration model, but do not explore a common liability to addictions, which could be explored by using a MSM on a prospective cohort with initial collection of some explanatory factors.

Copyright 2011, Elsevier Science


Mayet A; Legleye S; Falissard B; Chau N. Cannabis use stages as predictors of subsequent initiation with other illicit drugs among French adolescents: Use of a multi-state model. Addictive Behaviors 37(2): 160-166, 2012. (46 refs.)

The aim of this study was to confirm the influence of cannabis use patterns on the probability of initiation with other illicit drugs (OID). A French nationwide retrospective cohort on drug use was reconstituted on 29,393 teenagers. A Markov multi-state model was fitted, modelling all possible pathways from initial abstinence to cannabis initiation, daily cannabis use and OID initiation. The model was adjusted for tobacco and alcohol use. The risk for OID initiation appeared 21 times higher among cannabis experimenters and 124 times higher among daily cannabis users than among non-users. Tobacco and alcohol use were associated with a greater risk of moving on to cannabis initiation (hazard ratio (HR) = 1.2 for tobacco initiation, HR = 2.6 for daily tobacco use and HR = 2.8 for drunkenness initiation). The results of this study provide a confirmation of a stage process in drug use, mediated by cannabis and liable to lead to OID experiment. This is compatible with the literature on the gateway theory, but goes further by modelling the entire sequence of use. OID experiment could be a consequence of initial opportunity to use the more accessible illicit drug, cannabis.

Copyright 2012, Elsevier Science


Melberg HO; Jones AM; Bretteville-Jensen AL. Is cannabis a gateway to hard drugs? Empirical Economics 38(3): 583-603, 2010. (25 refs.)

The gateway hypothesis proposes that use of cannabis directly increases the risk of consuming hard drugs. We test this controversial, but influential, hypothesis on a sample of cannabis users, exploiting a unique set of drug price data. A flexible approach is developed to identify the causal gateway effect using a bivariate survival model with shared frailty estimated using a latent class approach. The model suggests two distinct groups; a smaller group of "troubled youths" for whom there is a statistically significant gateway effect that more than doubles the hazard of starting to use hard drugs and a larger fraction of youths for whom previous cannabis use has less impact.

Copyright 2010, Physica-Verlag


Menendez RG. Chemical addiction experiences in Havana's Psychiatric Hospital. Addictive Disorders and Their Treatment 4(4): 139-144, 2005. (26 refs.)

To describe our experiences in the treatment of alcoholism and other addictions that affect behavior, the author addresses the significance of drugs within a system integrated by legal prescription and illegal misuse of substances, which also has important reciprocal potentialities of induction and reinforcement; thus, attention should begin with the prevention of legal drug use and misuse. This article is based on a 25-year working period in a unit at the Havana Psychiatric Hospital for the Rehabilitation of Cuban and Foreigner Alcoholics and Other Drug Addicts, an institution appointed as a National Reference Center in this subject. It comprises national criteria about anti-alcoholic and other drug programs where alcohol is considered both as a paradigmatic and as a gateway drug. A conceptual framework, basic principles, and organizing standards, as well as programmatic methods and resources used in Cuba, are discussed. The high requirement of spirituality, ethics, and humanism in this program is also stressed.

Copyright 2005, Lippincott, Williams & Wilkins


Natarajan M, ed. Drugs of Abuse: The International Scene. The Library of Drug Abuse and Crime, Volume I. Surrey UK: Ashgate, 2010. (Chapter refs.)

The chapters (previously published journal articles) highlight drug abuse as a worldwide problem, affecting countries in both the developed and developing worlds. The contains 28 articles which are divided into four parts. Most of the articles have been recently published and cover some aspect of the globalisation of drug abuse. Part I, "Drug Abuse in the Developing World," with 7 papers addresses drug abuse in the developing world, drawing upon the experiences in seven different countries, and involving different substances, from opiates to cocaine, to methamphetamine to ecstasy, routes of drug administration, and drug use patterns. Part II, "The Emergence of New Drugs and Polydrug use" has five articles. The "new" drugs reviewed include ecstasy, LSD and ketamine. The typical user (young people) is described and where these drugs tend to be used (in nightclubs and dance parties). The poly drug use papers include substances such as opioid, cocaine and methamphetamine use. Part III "The Normalization Thesis and Gateway Drugs," has four papers on each of these topics. The Normalization Thesis is used to explain how young people normalise social drug use, with cannabis and 'dance drugs' (LSD, ecstasy, etc.) being the primary drugs discussed. One interesting finding was the high number of abstainers who tolerate or approve of social drug use amongst their peers, particularly is the drug is cannabis. The gateway papers continue to investigate the sequential and developmental pathways of drug use. This pathway is described as alcohol/tobacco first, then cannabis, and then 'hard' drugs. Gender differences in this pathway are described as well as the impact of age on the gateway process. Part IV, "Methodological Developments in Researching Drug Abuse," has eight papers. Macro- and micro-level epidemiological studies are discussed, along with how to capture hidden drug use populations, limitations of sentinel data (arrests, treatment admissions), rapid assessment and response (RAR) methods, and capture-recapture models. These methods are evaluated and any epidemiological or longitudinal findings are discussed.

Copyright 2010, Project Cork


O'Brien MS; Comment LA; Liang KY; Anthony JC. Does cannabis onset trigger cocaine onset? A case-crossover approach. International Journal of Methods in Psychiatric Research 21(1): 66-75, 2012. (34 refs.)

Psychiatric researchers tend to select the discordant co-twin design when they seek to hold constant genetic influence while estimating exposure-associated disease risk. The epidemiologic case-crossover research design developed for the past two decades represents a viable alternative, not often seen in psychiatric studies. Here, we turn to the epidemiologic case-crossover approach to examine the idea that cannabis onset is a proximal trigger for cocaine use, with the power of subject-as-own-control research used to hold constant antecedent characteristics of the individual drug user, including genetic influence and other traits experienced up to the time of the observed hazard and control intervals. Data are from newly incident cocaine users identified in the 2002-2006 US National Surveys on Drug Use and Health. Among these cocaine users, 48 had both cannabis onset and cocaine onset in the same month-long hazard interval; the expected value is 30 users, based on the control interval we had pre-specified for case-crossover estimation (estimated relative risk, RR=1.6; exact mid-p=0.042). Within the framework of a subject-as-own-control design, the evidence is consistent with the hypothesis that cannabis onset is a proximal trigger for cocaine use, with genetic influences (and many environmental conditions and processes) held constant. Limitations are noted and implications are discussed.

Copyright 2012, Wiley-Blackwell


O'Cathail SM; O'Connell OJ; Long N; Morgan M; Eustace JA; Plant BJ et al. Association of cigarette smoking with drug use and risk taking behaviour in Irish teenagers. Addictive Behaviors 36(5): 547-550, 2011. (20 refs.)

Background: Cigarette smoking has been shown to act as a 'gateway' to cannabis use and further risk taking behaviours. This study aims to (1) establish the prevalence of cigarette smoking and cannabis use in Irish teenagers, (2) to quantify the strength and significance of the association of cigarette smoking and cannabis use and other high risk behaviours and (3) examine whether the above associations are independent of the extent of social networking. Methods: Adolescent students across five urban, non-fee paying schools completed an abridged European schools survey project on alcohol and other drugs (ESPAD) questionnaire. Results: 370/417 (88.7%) students completed the questionnaire. 228 (61.6%) were female, 349 (94.3%) were aged 15-16 years. 48.4% of those surveyed had smoked tobacco at some stage in their lifetime, 18.1% in the last 30 days. 15.1% have used cannabis with 5.7% using it in the last 30 days. 29.6% of cigarette smokers have used cannabis in comparison to 1.6% of non-smokers. On multivariate analysis lifetime cigarette smoking status was independently associated with hard drug use, adjusted OR = 6.0, p < 0.01: soft drug use, adjusted OR = 4.6, p < 0.01 and high risk sex practises, adjusted OR = 10.6, p < 0.05. Conclusions: Cigarette smoking prevalence remains high in Irish teenagers and is significantly associated with drug use and other risk taking behaviours. Specific teenage smoking cessation strategies need to be developed targeting these combined high risk health behaviours.

Copyright 2011, Elsevier Science


Plancherel B; Bolognini M; Stephan P; Laget J; Chinet L; Bernard M et al. Adolescents' beliefs about marijuana use: A comparison of regular users, past users and never/occasional users. Journal of Drug Education 35(2): 131-146, 2005. (32 refs.)

A questionnaire investigating adolescents' opinions and experiences regarding marijuana use was administered to 163 adolescents and young adults (96 boys and 67 girls) aged 13 to 20 (mean age = 16.8, s.d. = 1.5). Items referred to marijuana and other substances' dangerousness, representations regarding the positive and negative consequences of marijuana use. Responses were compared according to marijuana use status (classified into never/occasional use, current regular use and past regular use). Results show that adolescents' opinions differ according to their experience with marijuana use. Current regular users evaluate marijuana as less dangerous, but alcohol and heroin as more dangerous in comparison with never/occasional and past users. Current and past users are more likely to define marijuana as a medical drug and a plant used in agriculture, and less likely to define it as an illegal drug. Current and past users evaluate marijuana use as a way to cope with stress, to relax to a greater extent than do never/occasional users do. The latter attribute more negative consequences to marijuana use such as diminished driving ability and school performance and a pathway to hard drugs.

Copyright 2005, Baywood Publishing Co.


Rebellon CJ; Van Gundy K. Can social psychological delinquency theory explain the link between marijuana and other illicit drug use? A longitudinal analysis of the gateway hypothesis. Journal of Drug Issues 36(3): 387-411, 2006. (44 refs.)

Extensive research suggests that marijuana use tends to precede the use of other illicit substances among adolescents. At the same time, there remain two viable interpretations of such research. First, marijuana use may cause an increase in one's probability of using other drugs. Second, the correlation between marijuana use and other drug use may be spurious, reflecting the influence of one or more "third variables" that simultaneously cause both behaviors. The present paper provides an empirical assessment of each view using panel data from three waves of the National Youth Survey. Even after adjusting for the influence of variables derived from strain theory,use patterns/ social bonding theory and differential association theory a series of longitudinal logistic regression analyses fail to disconfirm the hypothesis that marijuana use exerts a causal influence on one's probability of using other illicit substances. A three-wave panel model adjusting for the influence of unmeasured variables yields similar results.

Copyright 2006, Journal of Drug Issues, Inc.


Reich MS; Dietrich MS; Martin PR. Temporal sequence of incident cigarette, coffee, and alcohol use among AA participants. (review). American Journal of Drug and Alcohol Abuse 37(1): 27-36, 2011. (48 refs.)

Background: Cigarettes and coffee are widely used psychoactive substances among alcoholics. Due to the devastating public health impact of alcohol use disorders, it is important to determine if using cigarettes or coffee may influence alcoholism. Previous studies indicate that cigarette smoking is associated with progression of alcohol dependence, but the effects of coffee drinking have yet to be investigated. Objectives: To retrospectively determine the temporal sequence of incident cigarette, coffee, and alcohol use and attributed subjective effects in AA participants. Methods: Volunteers at all Nashville open-AA meetings (n = 289 [126 women], completion rate = 94.1%) were administered a Lifetime Drinking History modified to also include lifetime cigarette and coffee consumption, as well as coffee consumption and effects questions, the Fagerstrom Test for Nicotine Dependence, and the Smoking Effects Questionnaire. Results: Average ages (years) at first regular use of alcohol, cigarettes, and coffee were 15.4 (IQR: 13.0-18.0), 16.7 (IQR: 13.0-18.5), and 18.5 (IQR: 14.0-23.5), respectively. In a subset who used all three substances (n = 236; 102 women) alcohol consumption preceded cigarette smoking (p < .001) and coffee drinking (p < .001), and cigarette smoking preceded coffee drinking (p < .001); these relationships did not differ by gender. Conclusions: Recovering alcoholics started regular alcohol consumption prior to cigarette smoking and coffee drinking. Scientific Significance: In AA participants, coffee does not precede initiation of regular smoking or alcohol drinking as might be anticipated for a gateway drug.

Copyright 2011, Informa Health


Reid LW; Elifson KW; Sterk CE. Ecstasy and gateway drugs: Initiating the use of ecstasy and other drugs. Annals of Epidemiology 17(1): 74-80, 2007. (46 refs.)

PURPOSE: The main purposes of this study are to examine whether and to what extent ecstasy use serves as a gateway to the use of such hard drugs as cocaine, heroin, and methamphetamine and compare ages of onset of alcohol and marijuana use and subsequent use of cocaine, heroin, and methamphetamine among young adult ecstasy users. METHODS: Face-to-face surveys were conducted with 268 young adult ecstasy users in Atlanta, GA. Subjects were solicited by using the community identification process, including targeted sampling and guided recruitment. Data analysis involved discrete-time event-history analysis. RESULTS: Results suggest that age of onset of ecstasy use influences the initiation of cocaine and methamphetamine use for our sample of active ecstasy users. In addition, alcohol and marijuana use precedes the initiation of cocaine and methamphetamine use, but only marijuana use influences the initiation of heroin use. CONCLUSIONS: The sequential progression of drug use proposed in the gateway literature is not immutable. Researchers must take into account the changing popularity of drugs over time, such as the emergence of ecstasy use, when identifying patterns of drug-use onset.

Copyright 2007, Elsevier Science


Riggs NR; Chou CP; Pentz MA. Preventing growth in amphetamine use: Long-term effects of the Midwestern Prevention Project (MPP) from early adolescence to early adulthood. Addiction 104(10): 1691-1699, 2009. (38 refs.)

Aim: The aim of the current study was to examine the long-term effect of an early adolescent substance abuse prevention program on trajectories and initiation of amphetamine use into early adulthood. Design: Eight middle schools were assigned randomly to a program or control condition. The randomized controlled trial followed participants through 15 waves of data, from ages 11-28 years. This longitudinal study design includes four separate periods of development from early adolescence to early adulthood. Setting: The intervention took place in middle schools. Participants: A total of 1002 adolescents from one large mid-western US city were the participants in the study. Intervention: The intervention was a multi-component community-based program delivered in early adolescence with a primary emphasis on tobacco, alcohol and marijuana use. Measures: At each wave of data collection participants completed a self-report survey that included questions about life-time amphetamine use. Findings: Compared to a control group, participants in the Midwestern Prevention Project (MPP) intervention condition had reduced growth (slope) in amphetamine use in emerging adulthood, a lower amphetamine use intercept at the commencement of the early adulthood and delayed amphetamine use initiation. Conclusions: The pattern of results suggests that the program worked first to prevent amphetamine use, and then to maintain the preventive effect into adulthood. Study findings suggest that early adolescent substance use prevention programs that focus initially on the 'gateway' drugs have utility for long-term prevention of amphetamine use.

Copyright 2009, Society for the Study of Addiction


Saddichha S; Sinha BNP; Khess CRJ. The role of gateway drugs and psychosocial factors in substance dependence in Eastern India. International Journal of Psychiatry in Medicine 37(3): 257-266, 2007. (39 refs.)

Objective: Western studies have identified the gateway patterns of substance use which lead the way from the so called "Soft Drugs" (like nicotine, etc.) to the "Hard Drugs" (like Opioids) [the Gateway hypothesis]. Nicotine and alcohol have been implicated as the most common initiating drugs in studies from different places, however, studies are lacking from this region. This study was designed to find the drugs of initiation and to understand the factors for initiation, maintenance, and relapse of these substances in persons dependent on them in Eastern India. Method: Seventy subjects with ICD 10 DCR diagnosis of substance dependence admitted consecutively in Center for Addiction Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, were taken up for the study after taking written informed consent. A semi-structured questionnaire including the substance use part of Mini International Neuropsychiatric Inventory (MINI) was administered. Results: Alcohol and opioids were the most common drugs of dependence but nicotine and alcohol were found to be the most common initiating drugs in both alcohol and opioid groups. Persons dependent on opioids presented earlier for treatment, with earlier development of withdrawal symptoms and having completed lesser years of formal education, and had higher monthly incomes as compared to those dependent on alcohol. The most common psychosocial factors determining initiation and maintenance were peer pressure or curiosity. Conclusions: If adolescents and youth can be motivated to stay away even from the "gateway drugs" by targeting common initiation factors, it may lead to delay in dependence or possibly avoidance of development of dependence.

Copyright 2007, Baywood Publishing


Tarter RE; Vanyukov M; Kirisci L; Reynolds M; Clark DB. Predictors of marijuana use in adolescents before and after licit drug use: Examination of the gateway hypothesis. American Journal of Psychiatry 163(12): 2134-2140, 2006. (33 refs.)

Objective: The authors investigated whether the transition from licit drug use to marijuana use is determined by particular risk factors, as specified by the gateway hypothesis. They also evaluated the accuracy of the "gateway sequence" (illicit drug use following licit drugs) for predicting a diagnosis of substance use disorder. Method: Boys who consumed licit drugs only (N = 99), boys who consumed licit drugs and then transitioned to marijuana use (gateway sequence) (N = 97), and boys who used marijuana before using licit substances (alternative sequence) (N = 28) were prospectively studied from ages 10 12 years through 22 years to determine whether specific factors were associated with each drug use pattern. The groups were compared on 35 variables measuring psychological, family, peer, school, and neighborhood characteristics. In addition, the utility of the gateway and alternative sequences in predicting substance use disorder was compared to assess their clinical informativeness. Results: Twenty-eight (22.4%) of the participants who used marijuana did not exhibit the gateway sequence, thereby demonstrating that this pattern is not invariant in drug-using youths. Among youths who did exhibit the gateway pattern, only delinquency was more strongly related to marijuana use than licit drug use. Specific risk factors associated with transition from licit to illicit drugs were not revealed. The alternative sequence had the same accuracy for predicting substance use disorder as the gateway sequence. Conclusions: Proneness to deviancy and drug availability in the neighborhood promote marijuana use. These findings support the common liability model of substance use behavior and substance use disorder.

Copyright 2006, American Psychiatric Association


Timberlake DS; Haberstick BC; Hopfer CJ; Bricker J; Sakai JT; Lessem JM et al. Progression from marijuana use to daily smoking and nicotine dependence in a national sample of US adolescents. Drug and Alcohol Dependence 88(2/3): 272-281, 2007. (41 refs.)

Background: While it has been demonstrated that smoking cigarettes in adolescence increases the likelihood of progressing to marijuana use, few studies have considered the reverse scenario in which early use of cannabis leads to greater tobacco smoking. Methods: Participants (n = 5963), who had never smoked cigarettes daily by wave I of the National Longitudinal Study of Adolescent Health, were followed 6 years (waves I-III) from adolescence into young adulthood. Measures of marijuana use (lifetime use, monthly use, age at first use), as assessed at wave I within 12-16 (n = 3712) and 17-21 (n = 2251) year-olds, were separately modeled as predictors of three tobacco-related outcomes: (1) age at onset of daily cigarette smoking, (2) lifetime nicotine dependence, (3) current nicotine dependence. Results: In the older cohort (17-21-year-olds at wave I), lifetime (> 10 times) and past-month marijuana use at wave I were predictive of an earlier initiation into daily cigarette smoking and a greater likelihood of developing nicotine dependence by wave III. Furthermore, age at first use of cannabis was negatively associated with risk of nicotine dependence in the older, but not younger cohort. Conclusion: After controlling for baseline measures of tobacco smoking and other demographic risk factors, the use of marijuana in adolescence was modestly associated with daily cigarette smoking and nicotine dependence in young adulthood.

Copyright 2007, Elsevier Science


Tomar SL; Fox BJ; Severson HH. Is smokeless tobacco use an appropriate public health strategy for reducing societal harm from cigarette smoking? (review). International Journal of Environmental Research and Public Health 6(1): 10-24, 2009. (84 refs.)

Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a "gateway" for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking.

Copyright 2009, Molecular Diversity Preservation


Van Gundy K; Rebellon CJ. A life-course perspective on the "gateway hypothesis". Journal of Health and Social Behavior 51(3): 244-259, 2010. (47 refs.)

Drawing on stress and life-course perspectives and using panel data from 1,286 south Florida young adults, we assess three critical questions regarding the role of marijuana in the "gateway hypothesis." First, does teen marijuana use independently (causally) affect subsequent use of more dangerous substances? Second, if so, does that effect apply to the abuse of other illicit substances, as defined by the DSM-IV, or only to the use of such substances? Finally, does any causal effect of teen marijuana use survive beyond adolescence, or is it a short-term effect that subsides as adolescents transition to adulthood? Our results indicate a moderate relation between early teen marijuana use and young adult abuse of other illicit substances; however, this association fades from statistical significance with adjustments for stress and life-course variables. Likewise, our findings show that any causal influence of teen marijuana use on other illicit substance use is contingent upon employment status and is short-term, subsiding entirely by the age of 21. In light of these findings, we urge U. S. drug control policymakers to consider stress and life-course approaches in their pursuit of solutions to the "drug problem."

Copyright 2010, Sage Publications


van Leeuwen AP; Verhulst FC; Reijneveld SA; Vollebergh WAM; Ormel J; Huizink AC. Can the gateway hypothesis, the common liability model and/or, the route of administration model predict initiation of cannabis use during adolescence? A survival analysis-The TRAILS Study. Journal of Adolescent Health 48(1): 73-78, 2011. (31 refs.)

Purpose: There is substantial research linking tobacco and alcohol use to subsequent cannabis use, yet the specificity of this relationship is still under debate. The aim of this study was to examine which substance use model-the gateway hypothesis, the common liability (CL) model and/or the route of administration model-best explains the relationship between early onset of tobacco and alcohol use and subsequent cannabis use initiation. Methods: We used data from 2,113 (51% female) Dutch adolescents who participated in three consecutive assessment waves (mean age: 11.09, 13.56, and 16.27 years, respectively) of the TRacking Adolescents' Individual Lives Survey study. (Pre) adolescent cannabis, tobacco and alcohol use was assessed using the Youth Self-Report and a TRacking Adolescents' Individual Lives Survey developed questionnaire. Results: We found that, during adolescence, early onset of tobacco use does not pose a significantly higher risk of initiating cannabis use than early onset alcohol use. Therefore, we can rule out the route of administration model. Moreover, we found that adolescents who reported early onset comorbid use of both tobacco and alcohol have a higher likelihood to initiate cannabis use than adolescents who have tried either tobacco or alcohol. The gateway hypothesis is not broad enough to explain this finding. Therefore, the CL model best predicts our findings. Conclusion: Future research on adolescent cannabis initiation should focus on testing the robustness of the CL model. Furthermore, identifying adolescents who use both tobacco and alcohol, before the age of 13, may help to curtail the onset of cannabis use.

Copyright 2011, Society for Adolescent Health and Medicine


van Ours JC. Cannabis use when it's legal. Addictive Behaviors 32(7): 1441-1450, 2007. (15 refs.)

This paper addresses the question of whether alcohol and tobacco are "gateways" for cannabis use. To investigate this the relationships between the starting rates in the use of alcohol, tobacco, and cannabis are analyzed. The starting rate for cannabis use appears to be higher for smokers and lower for users of alcohol. Indeed, tobacco use seems to be a gateway for cannabis use. The main policy conclusion is that measures that reduce smoking will also reduce the incidence of cannabis use.

Copyright 2007, Elsevier Science


Ward JT; Stogner J; Gibson CL; Akers RL. A new trick for an old dog: Applying developmental trajectories to inform drug use progression. Journal of Drug Issues 40(4): 755-782, 2010. (74 refs.)

The frequent criticisms of the "gateway hypothesis" have led scholars to note the importance of considering the role of intra-individual change for drug use progression. While studies employing drug use trajectories have added considerably to our understanding of drug use comorbidity, the extent to which trajectories inform drug use progression remains largely unknown despite the fact that there are several theoretical reasons to suspect that intra-individual change is important to the gateway phenomenon. The current study employs latent class growth models using a sample from the Boys Town study of adolescent drug and drinking behavior. The results demonstrate that knowing how gateway drug use changes over time provides important information above and beyond knowing frequency of gateway use for predicting harder drug use trajectories. Implications of the empirical findings and directions for future research are discussed.

Copyright 2010, Journal of Drug Issues Inc.


Wells JE; McGee MA. Violations of the usual sequence of drug initiation: Prevalence and associations with the development of dependence in the New Zealand Mental Health Survey. Journal of Studies on Alcohol and Drugs 69(6): 789-795, 2008. (32 refs.)

Objective: For 3 decades, studies have reported that the usual sequence of drug initiation is licit drugs, then cannabis, and then other illicit drugs. This article describes the prevalence of violations of this sequence, the predictors of violations, and the relationship between violations and the onset of alcohol or drug dependence. Method: The New Zealand Mental Health Survey is a nationally representative sample with 12,992 face-to-face interviews carried out in 2003-2004, The response rate was 73.3%. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used in the survey. Reports of the age at first use were obtained for alcohol and drugs but not for smoking. Results: Violations of the usual sequence of drug initiation were uncommon in the population (2.6%). Use of other illicit drugs before cannabis was the main violation, found in 2.3% of alcohol users, 3.0% of cannabis users, 8.6% of cocaine users, and 16.7% of those who had used other illicit drugs. Use of other illicit drugs before cannabis was more predominant in younger cohorts and those with more early-onset internalizing disorders. Violations had little association with the development of dependence in users when other important predictors such as age at onset of use and the number of illicit drugs used were taken into account. Internalizing disorders and early-onset bipolar disorder also predicted dependence. Conclusions: In New Zealand, violations of the gateway sequence are not common and they are not markers of progression to dependence.

Copyright 2008, Alcohol Research Documentation


Wodarz N; Kraus B; Kliegel P; Binder H; Johann M. Smoking in 9th graders is associated with higher alcohol and cannabis intake results from a representative questionnaire survey. Psychiatrische Praxis 34(Supplement 1): S73-S74, 2007. (8 refs.)

Objective: Cigarette smoking has been regarded as a gateway drug" for the use of other substances. This study aimed at elucidating the differences in consumption patterns between adolescent smokers and non-smokers. Methods: We surveyed a representative sample of 1580 9(th) graders by using a 26-item questionnaire. Results Students had a mean age of 15.3 years and had started smoking at a mean age of 12.3 years. 30 day-prevalence rate of smoking was 49.3% and lifetime prevalence was 77.3%. 30.8% of all students were daily smokers (girls 28.7%; boys 32.7%), 43% of them fulfilling the DSM-IV-criteria of tobacco dependence. 48% of the smokers had at least one smoking parent compared to 31% of non-smokers. In smokers, alcohol consumption and binge drinking were increased fourfold and threefold, respectively. Cannabis has been consumed by 40% of smokers compared to 6% of non-smokers. This percentage was even higher in students with a nicotine dependence. Conclusions: Primary prevention of tobacco smoking in adolescence might be an effective strategy in reducing the later consumption of alcohol and cannabis.

Copyright 2007, Georg Thieme Verlag


Wu ZH; Temple JR; Shokar NK; Nguyen-Oghalai TU; Graduatey JJ. Differential racial/ethnic patterns in substance use initiation among young, low-income women. American Journal of Drug and Alcohol Abuse 36(2): 123-129, 2010. (27 refs.)

Background: Accumulating research suggests that the gateway hypothesis of substance use may not apply equally across different race/ethnicity groups. Objectives: The current study examines racial and ethnic differences in patterns of initiation of licit and illicit substance use. Methods: A cross-sectional survey was conducted among 696 low-income women between the ages of 18 and 31 who sought gynecological care between December, 2001 and May, 2003 in southeast Texas. Results: Overall, White women fit the classic profile of drug use initiation patterns, with those initiating tobacco and beer/wine at earlier ages being more likely to use illicit drugs. Conversely, African-American and Hispanic women initiated tobacco and beer/wine at much later ages than White women, but they were as likely to use illicit drugs. Conclusions: To be optimally effective, prevention efforts may need to be tailored to fit the race/ethnicity of the audience. Further studies are suggested to investigate specific risk factors related to substance use initiation by race/ethnicity.

Copyright 2010, Taylor & Francis