What are Gateway Drugs? Information and Prevention

The definition of a gateway drug is a habit forming drug, which may not be addictive itself, but could lead to the use of other, more addictive drugs. The theory that consuming softer drugs can lead to using stronger substances has existed for decades. Countless studies suggest that this transition is real. Educating youths and identifying treatment options can help avoid and overcome drug use.

Gateway Drugs

Gateway drugs are substances that when consumed give way to harder, more dangerous drugs. These milder substances, such as nicotine or alcohol, are believed to open the door to drugs such as meth, heroin and cocaine, which can lead to addiction.

Gateway drugs boost dopamine levels, which increases pleasure. Therefore, this class of drugs prepares the brain for a response to other substances, a process known as cross-sensitization. This heightens brain activity and could make users crave stronger substances.

History of Gateway Drugs

The idea that drug use can occur in stages took root in the mid-20th century. TV shows such as “The Terrible Truth” suggested marijuana use led to heroin addiction. Researchers began using the term “gateway drug” in the 1980s to describe substances that initiate these stages.

National anti-drug programs such as Drug Abuse Resistance Education (D.A.R.E.) specifically outline the consequences of three potential gateway drugs: marijuana, alcohol and tobacco.

Studies were conducted soon thereafter. In 1985, a report published in the Journal of Youth and Adolescence found alcohol to be a steppingstone to use of heavier drugs. Research on gateway drugs blossomed during the next three decades.

Since then, educators have warned students about the dangers of gateway drugs. National anti-drug programs such as Drug Abuse Resistance Education (D.A.R.E.) specifically outline the consequences of three potential gateway drugs: marijuana, alcohol and tobacco.

Through the years, middle school health educators have made gateway drugs a staple in their teachings. However, the controversy surrounding the concept has led some to reconsider using the term.

The Gateway Drug Hypothesis

For decades, supporters and critics have argued that certain substances, such as marijuana, are gateway drugs. Critics claim no evidence exists to support the claim. They also cite other risk factors that influence whether a person abuses illicit drugs:

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    History of abuse
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Certain reports support this argument. For example, the majority of marijuana users do not go on to use harder drugs, per the National Institute on Drug Abuse. In fact, most young users quit the drug upon entering adulthood.

The Center on Addiction and Substance Abuse at Columbia (CASA) found teens who use gateway drugs are 266 times more likely to develop a cocaine addiction than those who do not.

Supporters refer to ample research that strengthens the theory. For example, the Center on Addiction and Substance Abuse at Columbia (CASA) found teens who use gateway drugs are 266 times more likely to develop a cocaine addiction than those who do not.

The study, based on a survey by the NIDA, also found that nearly all cocaine users tried marijuana, cigarettes or alcohol first. Nearly 90 percent tried all three substances first.

Additional findings:

  • Children who use marijuana are 85 times more likely to use cocaine than non-marijuana users.
  • Children who drink are 50 times more likely to use cocaine than nondrinkers.
  • Adults who used marijuana as children are 17 times more likely to be regular cocaine users.
  • Adults who drank as children are six times more likely to be regular cocaine users.

Although no evidence confirms the gateway drugs theory, many trends lend credence to it.

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What Are Common Gateway Drugs?

Alcohol, marijuana and nicotine are commonly talked about as gateway drugs. In recent years, illicit opioids, prescription drugs and other common substances have joined the category.

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Alcohol is a central nervous system depressant that impairs brain function and motor skills. In 2014, nearly 88 percent of adults reported drinking alcohol at some point in their lives, and nearly 25 percent reported binge drinking in the past month.

Multiple studies suggest alcohol also is a gateway drug.

A University of Florida study found students who used alcohol were 16 times more likely to use illicit substances, such as cocaine and amphetamines, down the road. Many students began with socially acceptable substances such as alcohol or cigarettes before transitioning to marijuana, then harder drugs.

Adam E. Barry, who co-authored the study, told UF News the findings “add further credence to the literature identifying alcohol as the gateway drug to other substance use.”

Illicit substances linked to alcohol use include:

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  • heroin iconHeroin
  • opioids iconOpioids
  • marijuana iconMarijuana

Multiple studies reveal drinking at a young age affects drug use later in life. A 2016 study published in the Journal of School Health found sixth-graders went on to try nearly two illicit drugs later in life.

A Substance Abuse and Mental Health Services Administration survey revealed underage drinkers were more likely to use illicit drugs within two hours of alcohol use than legal drinkers. A majority of teen drinkers consumed illicit drugs, such as marijuana.

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Marijuana is a substance that alters a person’s attention, motivation, memory and ability to learn. More than 22 million people reported using marijuana in the past month in 2014, per NIDA, making it the most used illicit drug in the U.S.

Marijuana is commonly recognized as a gateway drug. However, its association to harder drugs has been widely debated.

Many believe marijuana builds a person’s tolerance to stronger drugs, and certain studies back up this idea. A study published in the International Journal of Drug Policy found nearly 45 percent of regular marijuana smokers used another illicit drug later in life.

One of those drugs is heroin. Studies suggest the majority of heroin users began with alcohol or marijuana. In fact, marijuana users are three times more likely to abuse heroin than nonusers, according to the Centers for Disease Control and Prevention.

Illicit substances linked to marijuana use include:

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  • heroin iconHeroin
  • ecstasy iconEcstasy
  • prescription drugs iconMarijuana

Adolescents who smoke marijuana are more likely to use harder drugs. According to a report by the U.S. Drug Enforcement Administration, teens who reported heavy marijuana use in the past month were:

  • 30 times more likely to use crack cocaine.
  • 20 times more likely to use ecstasy.
  • 15 times more likely to abuse prescription painkillers.
  • 14 times more likely to abuse over-the-counter medications.

Another study, by the Journal of the American Medical Association, found individuals who used marijuana by age 17 were two to five times more likely to experience substance abuse later in life than those who did not.

The study also found alternative factors, such as depression, social anxiety and parental conflicts, had a minimal impact on the results. This goes against the idea that environmental factors are the leading cause of substance abuse.

However, a report by the Journal of Health and Social Behavior found that marijuana’s influence as a gateway drug is contingent on factors such as employment status and other life events. It does suggest a moderate relationship between marijuana use and other illicit drug abuse.

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Prescription Drugs

Prescription drug abuse has exploded in popularity. About 52 million Americans 12 and older have used prescription drugs non-medically in their lifetime, per NIDA. Opioids are the most abused prescription drugs.

Prescription drugs are linked to heroin use. Heroin is a synthesized opioid that can be cut with other prescription drugs, such as Fentanyl, to achieve a more potent high. Many prescription drugs have similar effects to heroin, which has led to many opioid abusers transitioning to the substance.

Illicit substances linked to prescription drug use:

  • cocaine iconCocaine
  • heroin iconHeroin

Opioid users are 40 times more likely to abuse heroin than nonusers, per the CDC. In comparison, people addicted to alcohol were two times more likely to abuse heroin than nonusers. Marijuana users were three times more likely to abuse heroin.

Also, nearly half of young heroin users surveyed in three studies reported abusing prescription opioids first, according to NIDA. In fact, many opioid abusers switch to heroin because it is a cheaper option.

Ritalin, a prescription medication administered to children with ADHD, has been linked to cocaine use. Both drugs are stimulants, which increase alertness and productivity. Both have similar properties and increase dopamine levels. Consequentially, former Ritalin users are more susceptible to cocaine abuse, per Utah’s Genetics Science Learning Center.

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Researchers have long recognized tobacco products as gateway drugs. In 2011, scientists fed rats nicotine-laced water for seven consecutive days. The results, published in Science Translation Medicine, revealed the critters had an increased response to cocaine afterward.

Illicit substances widely linked to nicotine use include:

  • cocaine iconCocaine
  • heroin iconHeroin
  • prescription drugs iconMarijuana

The study also found nicotine increased levels of FosB, a gene in the brain linked to cocaine addiction. Researchers believe a similar effect can occur in humans, who share the gene. Studies suggest children are particularly at risk.

In 2013, teens who smoked cigarettes in the past month were 9 times more likely to use an illicit drug than those who did not, per SAMHSA. More than half of youths who smoked cigarettes also used an illicit drug.

Furthermore, children who smoke daily are 13 times more likely to use heroin than children who smoke less often, according to CASA. They are also 19 times more likely to use cocaine than nonsmokers.

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Other Gateway Drugs

Many substances, licit or illicit, can increase dopamine levels and potentially act as a gateway drug.


A 2008 report by the National Inhalant Prevention Coalition found that many 12- and 13-year-olds who abuse inhalants, such as shoe polish or glue, move on to illicit drugs. The findings revealed 21 percent of 593,000 inhalant users consumed marijuana or prescription painkillers the year prior.


A study published in Annals of Epidemiology revealed ecstasy may be a gateway drug to cocaine and methamphetamine. This is partly due to poly-drug use within the rave culture. Ecstasy use at a younger age increases the risk of using harder drugs later in life.

Anabolic Steroids

Individuals who use steroids risk an opioid addiction. A report published in the New England Journal of Medicine found that 9 percent of patients with an opioid addiction at a nearby treatment center had a history of steroid use. None of the patients had a drug addiction prior to steroid use.

Energy Drinks

Energy drinks contain high levels of caffeine, which increases energy and alertness. A study published in the Journal of Addiction Medicine revealed teens who consumed energy drinks were two to three times more likely to pick up an illicit drug than those who did not. Marijuana and amphetamines were common choices.

Gateway Drugs to Gateway Drugs

Sometimes harder drugs serve as the gateway to alternative ones. For example, many heroin users transition to prescription medications, such as methadone, to achieve a high. Many users of gateway drugs turn to other gateway drugs over time.

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Marijuana and Alcohol

Researchers say marijuana use could lead to an alcohol use disorder. A study published in Drug and Alcohol Dependence found adults who used marijuana for the first time to be five times more likely to develop an alcohol use disorder than nonusers.

Marijuana use also appears to increase the likelihood that an existing alcohol use disorder will continue over time.

Renee Goodwin, Ph.D., Associate Professor of Epidemiology at Columbia University

Another study, published in JAMA, used a larger sample size but found similar results: Adults who used pot for the first time were nearly three times more likely to abuse alcohol three years later.

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Nicotine, Alcohol and Marijuana

In 2013, teens who smoked cigarettes in the past month were 11 times more likely to use marijuana than those who did not smoke cigarettes, per SAMHSA. Those who drank alcohol and smoked cigarettes were 25 times more likely to use marijuana than those who did neither.

Furthermore, nearly half of binge drinkers — consuming five or more drinks on one occasion, one to four days a month — were marijuana users, according to the report.

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Prescription Drugs and Alcohol

Individuals who self-medicate have a tendency to combine prescription drugs with alcohol. Both substances have numbing agents and are dangerous when mixed together. Abusing either drug could lead to an addiction.

Those with an alcohol use disorder are 18 times more likely to use prescription drugs recreationally than nondrinkers, per a NIDA-funded study. The report also found that individuals with an alcohol use disorder represented 9 percent of the survey, yet constituted more than two-thirds of nonmedical prescription drug users.

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Marijuana and Prescription Drugs

Youth are vulnerable to pot, as their brains are still developing. A rise in dopamine levels can alter the way their brains react to other substances. Marijuana addiction at an early age has been linked to opioid abuse later in life.

Prevention and Treatment Options

Understanding the consequences of softer drugs could prevent the use of stronger ones. Educating teens about drug use is encouraged. Those who fall victim to soft or hard drugs should immediately seek treatment.

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Youth Prevention Education

Youths who use gateway drugs could pick up harder drugs later in life. In response, researchers have spent decades trying to identify effective approaches to prevent youth drug use.

Teaching drug prevention tactics to teens in a school setting has proven effective. Students learn the effects and dangers of drug use, how to avoid peer pressure and the benefits of a drug-free life. Many teachers include drug abuse prevention in their curriculum.

Health care professionals, community leaders and policymakers can also provide the education and funding needed to increase awareness among youth.

Successful school-based prevention approaches:

  • Make students aware of misconceptions and social pressures that exist.
  • Avoid fear-based tactics, which have proven ineffective.
  • Talk about the most effective ways to say no.
  • Include information on how to respond to media messages.
  • Use peer leaders, such as older students, to talk to students.


Each gateway drug presents a different set of treatment options. Treatment is always specific to each individual. Many rehab methods combine elements of medication, behavioral and group therapy, and moral support to help individual’s combat addiction.

Prescription drug addictions are often treated with medications, such as methadone, naltrexone and buprenorphine. These medications combat the effects of a drug, alleviate withdrawal symptoms and help prevent relapse.

Treatment for marijuana, the most controversial gateway drug, is unique. There are no FDA-approved medications to combat addiction, though other treatment options include:


Motivational incentives

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Contingency management

These methods aim to change a person’s behavior in an effort to avoid relapse.

The goal of treatment is to rid people of a substance, change their behaviors and steer them toward a drug-free life. If you or someone you know is suffering from an addiction, contact a drug and alcohol treatment center. Each facility is equipped with trained professionals who cater to an individual’s needs.

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