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

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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, Anthony, James C., Bruffaerts, Ronny, de Girolamo, Giovanni, de Graaf, Ron, Gureje, Oye, Karam, Aimee N., Kostyuchenko, Stanislav, Lee, Sing, Lépine, Jean-Pierre, Levinson, Daphna, Nakamura, Yosikazu, Posada-Villa, Jose, Stein, Dan, Wells, J. Elisabeth, Kessler, Ronald C.·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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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)
Regione Emilia-Romagna (IT)
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: Degenhardt, Louisa
Dierker, Lisa
Chiu, Wai Tat
Neumark, Yehuda
Sampson, Nancy
Alonso, Jordi
Anthony, James C.
Bruffaerts, Ronny
de Girolamo, Giovanni
Gureje, Oye
Nakamura, Yosikazu
Stein, Dan
Kessler, Ronald C.
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: green
www.ncbi.nlm.nih.gov
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
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Youth, Drugs, and Violence
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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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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