Gateway drugs are drugs that are believed to lead to the use of more dangerous and addictive substances. There have been reports in the news about alcohol being the “real” gateway drug. This article will look at the science behind substance use to discover whether alcohol is a gateway drug.

Substance addiction is a complex disorder, and there are many factors that affect each person’s likelihood of being exposed to and becoming addicted to substances. These factors fall into two main types: genetic and environmental factors.

  • Environmental factors are things like:

    • How an individual was raised
    • Education level
    • History of abuse or trauma
    • History of mental health disorders
    • Socio-economic situation
    • Life situation
    • Personality

Exposure to a gateway drug is yet another environmental factor. Like other risk factors, it is not the only factor that decides whether someone will develop a substance addiction. Rather, it is part of the total sum of factors that influence an individual’s likelihood of developing addiction.

What Is a Gateway Drug?

A gateway drug is a psychoactive substance that tends to predispose those who use it to later use of other drugs. The three gateway drugs are nicotine, alcohol, and cannabis. The concept is based on the “gateway hypothesis,” which states that adolescents who experiment with these drugs are more likely to use other addictive drugs later in life.

Even though the gateway hypothesis has been around since the 1970s, more recent discoveries about the science of the brain and addiction support it. In particular, the brain does not finish developing until the mid-20s and is very susceptible to chemicals that disrupt that development.

Recent research has revealed that drugs of abuse– especially alcohol – cause an abnormal inflammation in the brain that disrupts the connections between brain cells (neurons). These disrupted brain connections lead to new connections that promote the development of addiction and other mental health disorders.

Is Alcohol a Gateway Drug?

The controversy and conflicting research can be confusing, but there are some conclusions that can still be made. Here’s a review of the scientific evidence of alcohol as a gateway drug:

  • Alcohol does increase the likelihood of other drug use, including the other gateway drugs (tobacco and cannabis)
  • Addiction is a complex disease – prior use of alcohol is simply another risk factor among many, and there is no single explanation for why someone becomes addicted
  • The interrelationships between the gateway drugs (tobacco, alcohol and cannabis) are complex
  • Targeting alcohol use in adolescents will likely have an impact on the development of other substance use disorders later in life.

Alcohol vs. Tobacco & Marijuana as a Gateway Drug

Overall, it would seem that alcohol is more dangerous as a gateway drug than tobacco or marijuana. However, the relationship between gateway drugs appears to be complex as well as closely interrelated.

  • Alcohol vs. Marijuana:

    Cannabis is not off the hook as a gateway drug. Another study based on the U.S. National Epidemiological Study of Alcohol Use and Related Disorders (NESARC) data set showed a strong association between cannabis use and other substance use disorders. The U.S. National Institute on Drug Abuse also considers cannabis to be a gateway drug for illicit drug use, based on a large amount of evidence.

    Another large study, using data from NESARC, suggested that cannabis is a gateway drug for the later development of alcohol use disorder.

    Another study, again using data from NESARC, showed a relationship between alcohol use, cannabis use and major depressive disorder (MDD). This demonstrates that there is a complex interrelationship between each gateway drug as well as between gateway drugs and mental health disorders.

    Further studies show that people who use alcohol and cannabis together have more adverse social consequences, higher rates of alcohol dependence and higher rates of depression than people who use either alone. As well, the use of alcohol and cannabis is associated with lower grades in college students and a higher likelihood of being arrested.

  • Alcohol vs. Nicotine:

    Alcohol and nicotine also have a complex interrelationship, where the use of one predisposes the use of the other. As well, their adverse health effects add together, meaning that cancer and other health risks are increased beyond those of either drug separately.

Statistics on Gateway Drugs

One recent study using data from the U.S. National Survey on Drug Use and Health found an association between gateway drugs and later drug abuse. Specifically, there was a link between prior alcohol, cigarette and cannabis use and the abuse of prescription opioids in people aged 18 to 25. The study found that 12% of the study subjects were currently abusing prescription opioids, and of those who were abusing them:

  • 57% had used alcohol prior to opioid use (men only)
  • 56% had used cigarettes (men only)
  • 34% had used cannabis (men and women)

Another study of American 12th-graders singled out alcohol as the No. 1 gateway drug. The study found that alcohol was the primary gateway to drug use, including cigarette and cannabis use. For the majority of 12th-graders, alcohol was the first gateway drug they had ever used. The study authors concluded that alcohol use should be the primary focus of high school drug use prevention policies.

The previously mentioned gateway hypothesis remains controversial, even among researchers. A recent animal study did not find that alcohol use in adolescent rats led to increased self-administration of cocaine later in life. However, another recent study found a strong association between prior alcohol consumption and later obsessive cocaine use in rats.

Another large study used data from the U.S. National Longitudinal Study of Adolescent to Adult study, which followed adolescents over a period of 14 years as they transitioned to adulthood. This study found that gateway drugs were significantly related to further illicit drug use in adolescence, but this relationship broke down as the study subjects progressed into adulthood. The study authors concluded that the factors that determine drug use in adulthood are far more complex than what the gateway hypothesis predicts.

Alcohol & The Adolescent Brain

Alcohol use is prevalent in adolescents. The 2018 Monitoring the Future survey conducted by the National Institutes of Health showed that 86% of 12th-graders find alcohol easy to obtain and that 30% of them had used alcohol in the last 30 days. Further, 59% had used alcohol by the time they finished high school.

Other research has shown that the adolescent brain is especially sensitive to the effects of alcohol in several ways. The adolescent brain is:

  • Less sensitive to the cues to limiting use, resulting in increased intake
  • More sensitive to the reward effect
  • More susceptible to escalated use
  • More sensitive to social cues for alcohol use

Other Considerations

There is a lot of disparity in the research evidence surrounding alcohol as a gateway drug, and there is a lot of knowledge missing. Because the issue involves finding ways to prevent young people from developing substance addictions later in life, one would think that there would be a lot of research into the subject.

However, there are a few problems that prevent effective research into gateway drugs and their effects on adolescents. First of all, the kind of studies that can establish a cause-and-effect relationship are unable to be done, due to ethical reasons. These studies are called randomized controlled trials (RCTs), and they cannot be done in adolescents because they involve feeding adolescents alcohol or placebos and seeing what happens.

That is why the RCT trials that can establish cause and effect are done in rats. Unfortunately, rats do not share the same complex mix of genetics and environmental factors that make up addiction risk in humans.

The only kinds of studies that can be done with alcohol in adolescent humans are observational studies, where different groups of people are compared to see what characteristics they have. These studies cannot determine a cause and effect relationship. For example, some observational studies look at whether people who are addicted to cocaine were exposed to alcohol as teens. However, these people were also exposed to things like soda, video games and comic books, and there is no way to rule those out as factors leading to addiction.

Gateway Drugs & Cocaine Use

A study involving more than 44,000 Americans between the ages of 12 and 25 found that gateway drugs predisposed cocaine use. The gateway drugs increased the opportunity for progressive drug use, rather than just because of brain changes. In addition, young people who used tobacco and alcohol were more likely to have opportunities to use marijuana, and they were more likely to use it when given the opportunity.

They also found that marijuana users were more likely to have opportunities to use cocaine and were more likely to use cocaine when given the opportunity. This further illustrates the complex relationships between the gateway drugs.

If you are affected by an addiction to alcohol or any other substance, The Recovery Village can help. Contact us today to speak with one of our representatives about how we can help you get your life back on track. 


Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.