Everything You Need To Know About Gateway Drugs

“Gateway drug” is a catchphrase used to describe legal mind-altering substances that are believed to increase the likelihood of using harder drugs. People may label any mind-altering substance as a gateway drug, even when scientific evidence does not confirm the connection. This is because the term is often used in a social context—to discourage use—rather than within the scientific community. Still, some researchers argue that the concept of gateway drugs deserves closer attention, while others believe the term is frequently misapplied. In this blog, we will explore the gateway drug hypothesis in detail so you can understand exactly what it entails. You’ll learn which substances are considered gateway or stepping-stone drugs, the studies that support or challenge the hypothesis, and the treatment options for addiction to these substances.

What is the Gateway Drug Hypothesis?

The gateway drug hypothesis suggests that the use of certain legal substances may increase the likelihood of later using illicit drugs.[1] For example, smoking cigarettes during adolescence has been linked to a higher risk of trying substances like crack cocaine. While this concept is discussed in the fields of addiction and brain disorders, it is not universally accepted. Gateway drugs, though legal, can be habit-forming. When used in an abusive manner, they may lead to dependency. People who misuse substances such as alcohol or prescription medications may become more willing to try more potent drugs, often dismissing warnings about their safety and well-being.[1] Prescription stimulants like Adderall, for instance, can produce a rush of euphoria, which is an effect that may appeal to individuals experiencing deep sadness or depression. Over time, repeated use can dull this high, prompting some to seek out illicit drugs in pursuit of the same or greater effects. Note: It’s important to remember that the gateway drug hypothesis remains a theory, not a universally accepted scientific fact.

What are the Four Common Gateway Drugs?

While many substances can be referred to as gateway drugs, four are often associated with the term. This includes alcohol, nicotine, marijuana, and caffeine. According to a study published on drug use and misuse by the Illinois Public Library, these four contain chemical agents capable of producing biological responses in the body.[2] These responses can be therapeutic, desirable, or adverse, undesirable.

Caffeine

According to PubMed Central, caffeine is the most widely consumed and easily accessible psychoactive drug in the world.[3] As a psychostimulant, it shares many pharmacological properties with traditional stimulants like amphetamine and cocaine. These substances increase motor activity and arouse by stimulating the central nervous system (CNS), which can intensify their effects on the user. A profile on caffeine published by StatPearls notes its addictive potential among regular users.[4] It shared that people who habitually consume caffeinated beverages — such as energy drinks, coffee, and tea — can develop physical, emotional, and psychological dependence and withdrawal. Withdrawal from caffeine may trigger uncomfortable symptoms, including headaches, insomnia, anxiety, depression, gastrointestinal distress, and even increased susceptibility to infections.[4] Because of its association with dependence and withdrawal, many researchers have considered caffeine within the framework of traditional addictions, leading to its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the “substance-related” category, but not as a recognized condition on its own.[5] However, individuals struggling to stop using caffeine may be diagnosed with caffeine withdrawal disorder (CUD), which is listed in the DSM-5. Despite the above, some experts argue that it should not be classified as an addictive substance in the DSM-5. They contend that caffeine dependence is generally less severe than that associated with other drugs of abuse and therefore warrants a lower priority..

Alcohol

The World Health Organization defines alcohol as any beverage containing ethanol, a psychoactive substance that is toxic to the body and can cause dependence[6]. Each year, alcohol use contributes to more than 2.6 million deaths worldwide.[4] Around 400 million people, or about 7 percent of those aged 15 and older, are affected by an alcohol use disorder.[6] This condition is marked by intense alcohol cravings, the inability to quit using despite the harm it causes, and withdrawal upon cessation.[7] Examples of alcohol include:

• Beer
• Wine
• Wine coolers
• Whiskey
• Bourbon
• Champagne

Alcohol use is often socially accepted as a way to celebrate occasions such as national holidays or birthdays. However, irresponsible use can lead to increased tolerance and eventual dependency. A person who becomes dependent on alcohol may experience alcohol withdrawal syndrome when attempting to quit.[8] This is a dangerous condition that can cause symptoms such as tremors, delirium, psychosis, and even seizures.[8]

Marijuana

Marijuana is a psychoactive drug derived from the dried leaves, flowers, and stems of the Cannabis sativa and Cannabis indica plants. According to the National Institute on Drug Abuse, cannabis contains numerous chemical compounds, including tetrahydrocannabinol (THC), the ingredient responsible for its mind-altering effects.[9] Experts disagree on whether cannabis should be classified as a gateway drug. The Centers for Disease Control and Prevention notes that while most cannabis users do not go on to use harder drugs, those who do face a higher risk of addiction and dependency.[10] This risk increases when cannabis use begins at a young age. Cannabis can be consumed in several ways, such as smoking marijuana cigarettes, vaping cannabis extract oil, eating edibles like baked goods, or using tinctures. Its use can cause rapid changes in mood, thought patterns, and perception of reality. Prolonged or heavy use may lead to dependence, making it difficult to stop. This condition is known as cannabis use disorder, or CUD.[11]

Nicotine

Nicotine is the addictive substance found in tobacco products such as snuff, cigars, and cigarettes. It is habit-forming, alters brain function, and causes regular users to develop strong cravings.[12] According to the U.S. Food and Drug Administration (FDA), all tobacco products contain nicotine, meaning any form of tobacco can lead to nicotine addiction.[12] A study published by the Columbia University Mailman School of Public Health found a strong correlation between vaping nicotine and risky behaviors such as binge drinking and cannabis use.[13] In a survey of more than 50,000 U.S. adults, researchers found that individuals who smoked nicotine products were 8 times more likely to use cannabis, those who vaped were 20 times more likely, and those who both smoked and vaped were 40 times more likely.[13] The study also revealed a connection between nicotine use and binge drinking. Individuals who used nicotine in the past 30 days were more likely to binge drink for at least two weeks, and those who both smoked and vaped were 36 times more likely to engage in binge drinking on 10 or more occasions.[13]  

What Causes People to Use Gateway Drugs?

There are several reasons why individuals choose to use gateway drugs. They are easily accessible and socially acceptable, as they are not classified as illicit substances like heroin or cocaine. Gateway drugs are also often glorified in modern culture, with many rappers, singers, and actors depicted using substances such as alcohol or marijuana in music videos, films, and photographs. Some of the main reasons people may turn to gateway drugs include:[14]

• Enhancing relaxation
• Seeking enjoyment
• Avoiding feeling left out in a group
• Experimenting with feelings of euphoria
• Rebelling against authority figures
• Celebrating holidays such as New Year’s
• Coping with physical or psychological pain
• Managing stressful situations
• Forgetting about problems
• Alleviating boredom

People who live in environments where gateway drugs are regularly used, or in families where use is common, may feel more comfortable trying them and are more likely to continue using them.

Are All Gateway Drugs Addictive?

Gateway drugs have a high potential for dependence and abuse, but not all of them are equally addictive.

• Nicotine: Found in tobacco, nicotine is highly addictive and carries a strong potential for dependence.
• Alcohol: Occasional alcohol use does not typically lead to alcoholism, but heavy or prolonged drinking can result in addiction and life-threatening withdrawal symptoms.
• Marijuana: Marijuana can alter brain function during use, but not everyone who uses it becomes addicted.
• Caffeine: Caffeinated beverages are habit-forming, though they rarely lead to severe addiction.

Prescription medications can also act as gateway drugs, particularly those classified as controlled substances. This includes prescription opioids, stimulants, and benzodiazepines, all of which are known to cause dependence and addiction.[15]

Is Polysubstance Use a Consequence of Using Gateway Drugs?

Polysubstance use refers to the sequential use of multiple psychoactive substances, including illicit drugs, prescription medications, and alcohol. This can involve combining substances from different categories, such as caffeine and marijuana, or from the same category, like alcohol and muscle relaxants. According to the Centers for Disease Control and Prevention, polysubstance use is common and can occur both intentionally and unintentionally.[16] An example of unintentional use is when someone smokes a marijuana cigarette believing it contains only marijuana, but it has been mixed with illicit substances such as cocaine or fentanyl. Similarly, a person may drink alcohol at a club, assuming it is pure, only to find it has been spiked with a drug like promethazine. While the gateway drug hypothesis is not universally accepted as a scientific fact, research is increasingly examining the link between gateway drugs and polysubstance use disorders, like the previously mentioned study by Columbia University, which found a correlation between nicotine use among adolescents and subsequent alcohol bingeing. Observational patterns, such as the tendency for coffee drinkers to also smoke cigarettes, suggest that individuals who use gateway drugs may be more likely to engage in polysubstance use.[17]

Are All Gateway Drugs Considered Controlled Substances?

The Controlled Substances Act classifies substances based on their potential for dependence, abuse, or misuse, placing them into schedules that reflect the likelihood of addiction. Some gateway drugs fall under these controlled substance categories.[15]

• Marijuana: Cannabis products are classified as Schedule I drugs, defined as having a high potential for abuse and no currently accepted medical use[15]. Other Schedule I substances include ecstasy and heroin.[15]
• Prescription drugs:[15] These are found across several schedules, reflecting their accepted medical uses but varying potential for abuse:
  • Schedule II: High potential for abuse; includes hydrocodone and Adderall.
  • Schedule III: Moderate potential for abuse; includes testosterone and Tylenol with codeine.
  • Schedule IV: Lower potential for abuse; includes Xanax, Ativan, and Ambien.
  • Schedule V: Lowest potential for abuse; includes Robitussin AC and Lyrica.
• Alcohol, nicotine, and caffeine are not listed in the U.S. DEA drug schedules.

What is the Treatment for Gateway Drug Abuse?

Anyone struggling with gateway drugs, such as prescription medications or alcohol, is at risk of life-threatening overdose. They may also develop dependence on other addictive substances, such as heroin or ecstasy, in an attempt to recreate the euphoria experienced when first using a gateway drug. Unfortunately, once dependency occurs, quitting on your own can be very difficult. Treatment programs that include talk therapy, behavioral therapy, and detoxification have proven successful in helping individuals overcome drug dependency and achieve lasting sobriety.[18] If you or a loved one is struggling to overcome gateway drug abuse, Southeast Addiction Center TN is here to help. We provide treatment in both inpatient and outpatient settings, offering evidence-based services such as medication-assisted treatment, trauma-informed care, and cognitive behavioral therapy. For help recovering, contact us by phone or fill out our online form, and a member of our team will reach out to you.