Most people have heard of “gateway drugs”, which are normally cited as things like nicotine, alcohol, and marijuana. Purportedly, using these drugs allows people to build habits around drug use and reliance, easing their opinion of the dangers of drugs, and opening the door to heavier drug use. However, as much as it’s seen as major problem, people are rarely documented moving to heavier drugs from alcohol or nicotine and communities with high marijuana usage actually have lower instances of using other kinds of drugs.
But, the gateway drug hypothesis is still important to be aware of, because using one drug can and does open doors to using others.
The original gateway drug theory stated that people using “soft” drugs like nicotine, alcohol, and marijuana come to rely on the increase in dopamine and serotonin in their brains. Eventually, as tolerance builds up, they start to look for something stronger, leading to heroin, meth, and other hard drugs.
Today, we know that it’s unlikely someone will escalate from cigarettes to heroin without many very unrelated steps in between. But, there’s still a lot you should know about the process including how vulnerabilities to substance addiction impact “soft” as well as “hard” drugs.
People who feel lonely, awkward, socially outcast, bullied, emotionally turbulent, depressed, or anxious are significantly more likely to abuse drugs of any kind than people who are emotionally stable. This means that many people who have emotional, social, or economic problems resulting in stress, depression, anxiety, or loneliness are very likely to lean on substances to feel good. That most-often starts with accessible drugs like cigarettes and alcohol.
This means that someone abusing cigarettes or alcohol is significantly more vulnerable to hard drug use and abuse because they have vulnerabilities that increase risk for them. Because they may lean on cigarettes first which might escalate to marijuana when they realize that marijuana does a better job of making them feel better, and then to harder drugs when they can access them, the “phenomenon” of a gateway drug can be visibly evident. However, in these cases, it’s highly likely that if that person first received a harder drug, they would lean on that and not on the softer drug.
This phenomenon is known as self-medicating and it can be a form of escapism.
The first time someone takes a drug, the body isn’t used to it. The effect of the drug is extremely strong. Over time, your body adapts to it, the effect reduces, and you need more and more of the drug to achieve the same effect. This “tolerance” theory is very real and it often results in escalating patterns of usage, where people use more and more of a substance over time.
The way around it is, of course, to have significant periods without the drug to reduce tolerance. But, for people using substances to self-medicate, putting a substance down for that long can be difficult. The gateway drug hypothesis suggests that this leads to people seeking stronger and stronger drugs. Yet, there’s no evidence for this. Instead, documentation shows that people continue to escalate usage of the thing they’re addicted to, unless something stronger is introduced independently.
Most drug addiction is a combination of physical addiction (chemical dependence) and behavioral addiction. It’s the behavioral addiction that normally requires rehab and therapy. Here, people often become psychologically reliant on a drug. For example, they see it as something they need to feel okay.
That’s a common process with prescription medications, like benzodiazepines. People are prescribed them to deal with short-term anxiety or panic attacks while going to therapy. They start taking the drug to prevent oncoming attacks. Then, they start to feel anxious without the drug, what if they don’t have it and they have an attack. They start taking the drug with them. Then they start taking the drug to prevent anxiety about having a panic attack if they don’t take the drug. Eventually, they can go to extremes to get more of it – even working themselves into panic attacks because they don’t or can’t use the drug.
This psychological reliance rarely happens without daily usage. However, it can happen in most types of soft drugs. For example, people rely on cigarettes to the point where they feel like they need a cigarette to destress or calm down – even preemptively smoking when something stressful is about to happen. That even extends to drugs that people don’t normally think of as drugs, like caffeine, where people can be in states of only being semi-awake before their cup of coffee – despite the fact that they have so much caffeine tolerance the drug barely affects them.
Most documented gateway drugs are prescription medications. However, it’s notable that people will often continue to seek out the same drugs they became addicted to, even when cheaper or more accessible options are available. Often, it’s only when they can’t get their drug of choice that people switch to a different drug.
For example, people who take pain medication are significantly likely to abuse that medication. Abuse rates range from 21-29% for opioids. Addiction rates range from 8 and 12% for those same drugs. When the U.S. introduced harm reduction programs to better control opioid usage after prescription, the country saw increases in heroin usage and then fentanyl usage, as people who no longer had access to prescription opioids looked for street alternatives.
It’s also interesting that gateway drugs work in reverse. People who use hard drugs are more likely to start using soft ones. And, people who go into rehab are considerably more likely to develop cigarette and sugary drink habits than they were before going into rehab.
Eventually, any reliance on a drug can result in reliance on another drug. Often, that’s because the vulnerabilities to addiction are there and that person is more likely to be chasing a high. However, it’s extremely likely that someone goes from getting a dopamine high from cigarettes to looking for something stronger without additional external factors coming into play. So, it’s never safe to abuse a drug. Even overdoing cigarettes can lead to cravings and being unable to put that drug down. Alcohol reliance is every bit as bad as heroin reliance. And, for many people, you’ll need rehab and treatment to drop habits for things like sugar and nicotine.
Asana Recovery offers detox, residential, and outpatient addiction treatment services at our center located in Orange County, California. Please contact us today to speak with one of our experienced addiction treatment team if you have any questions about our programs.