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Cited by 272Substance Abuse Treatment and OutcomesYouth, Drugs, and ViolenceSmoking Behavior and Cessation

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

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Degenhardt, Louisa, Dierker, Lisa, Chiu, Wai Tat, Medina-Mora, Maria Elena, Neumark, Yehuda, Sampson, Nancy, Alonso, Jordi, Angermeyer, Matthias +15 more·2010·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2009.12.001PMC PMC2835832
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Abstract

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.

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  • Epidemiological data suggest that tobacco acts as a 'gateway' to subsequent substance abuse.

    “Although epidemiological data suggest that tobacco acts as a ‘gateway’ to subsequent substance abuse (Kandel et al. 1992; Lai et al. 2000; Degenhardt et al. 2010), it is not clear from human studies whether this reflects social influences or a drug effect (Lindsay & Rainey, 1997; Anthony, 2012).”

    From <scp>N</scp> icotine and the adolescent brain (2015) · cites this paper as Degenhardt et al. 2010

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  1. Kandel DB Yamaguchi K Klein LC Testing the gteway hpothesis Addiction 2006 101 470 472 discussion 474-476 16548924

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Authors
Degenhardt, L., Dierker, L., Chiu, W. T., Medina-Mora, M. E., Neumark, Y., Sampson, N., Alonso, J., Angermeyer, M., Anthony, J. C., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., Karam, A. N., Kostyuchenko, S., Lee, S., Lépine, J.-P., Levinson, D., Nakamura, Y., Posada-Villa, J., Stein, D., Wells, J. E., & Kessler, R. C.
Affiliations
  • UNSW Sydney (AU)
  • Wesleyan University (US)
  • Harvard University (US)
  • Hebrew University of Jerusalem (IL)
  • Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
  • Michigan State University (US)
  • Universitair Ziekenhuis Leuven (BE)
  • University College Hospital, Ibadan (NG)
  • Chinese University of Hong Kong (HK)
  • Hôpital Fernand-Widal (FR)
  • Israel Ministry of Health (IL)
  • Jichi Medical University (JP)
  • University of Cape Town (ZA)
  • University of Otago (NZ)
Corresponding author
Degenhardt, Louisa
ORCID
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2010-04
Volume
108
Issue
1-2
Pages
84-97
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2009.12.001
PMC
PMC2835832
OpenAlex
W2167374867
Cited by
271
References
39
Citations by year
2026: 3 · 2025: 8 · 2024: 7 · 2023: 13 · 2022: 7 · 2021: 14 · 2020: 24 · 2019: 14 · 2018: 17 · 2017: 19 · 2016: 33 · 2015: 29 · 2014: 30 · 2013: 17 · 2012: 18
FWCI
12.37
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
Funders
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, R01MH059575, U13MH066849, U01MH060220, R01‐MH069864)
  • National Institute on Drug Abuse (DA010075, K01DA015454, K05DA015799, R01DA016558, DA024260, T32DA021129, DA15454, P50DA010075, R21DA024260)
  • Fogarty International Center (R01-TW006481, R03TW006481)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Demography › Youth, Drugs, and Violence
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
gateway theory, drug initiation, alcohol consumption, tobacco use, cannabis use, illicit drug use, cross-national comparison, substance use prevalence, substance use prevention
MeSH terms
Adolescent, Adult, Age Factors, Aged, Alcoholism, Mental Disorders, Female, Humans, Interview, Psychological, Male, Marijuana Smoking, Middle Aged, Smoking, World Health Organization, Cohort Studies, Databases, Factual, Diagnosis, Dual (Psychiatry), Disease Progression, Substance-Related Disorders, Young Adult

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