Alcohol, nicotine, and marijuana are often called gateway drugs. The idea is that early use of these substances might lead to later use of harder drugs. But is alcohol a first step toward other drug use? Or are other factors involved?
What is the gateway drug theory?
The gateway drug theory suggests that using legal substances like alcohol or nicotine can lead to the use of illegal drugs later on.
It describes a sequence—starting with alcohol, then moving to tobacco or marijuana, and eventually to harder substances like cocaine or opioids.
Evidence supporting the theory: gateway drug statistics
Several studies suggest a strong link between early alcohol use and later drug use. These findings support the idea that alcohol might serve as an entry point to other substances.
Epidemiological studies
Epidemiological studies look at health and behavior patterns across large groups of people. In the case of substance use, they help identify trends in when and how people begin using drugs.
Various studies have been able to demonstrate that alcohol is a gateway drug and that many people who use illicit drugs started with alcohol.
This pattern begins early in adolescence and continues into later substance use.
- Alcohol was the most common starting point for U.S. 12th graders who later used tobacco, marijuana, or other illicit substances.
- Studies show that students who drank alcohol were more likely to use both legal and illegal drugs later.
- Youth who began drinking in sixth grade had higher rates of lifetime and frequent use of illicit drugs than those who started in ninth grade or later.
Evidence challenging the gateway hypothesis
Not all research agrees that alcohol leads directly to other drug use. Some studies, especially those using animals, suggest a more complicated picture.
Animal model studies
A 2016 study showed that rats exposed to alcohol did not later crave or use more cocaine. These results suggest that shared risk factors—like genetics or brain chemistry—might explain why some people use more than one drug.
Another study found that mice exposed to nicotine and alcohol didn’t respond as strongly to amphetamines.
Why the gateway theory isn’t always applicable
The gateway theory helps explain how substance use may begin, but it doesn’t tell the whole story. While alcohol often comes before other drugs, that doesn’t mean it directly causes people to use them.
Correlation is not causation
- Family history, peer pressure, and mental health often shape a person’s substance use.
- Some people may be more open to trying substances regardless of which one comes first.
- Just because alcohol use happens first doesn’t mean it starts a chain reaction.
Alcohol use may point to other problems
Drinking at a young age doesn’t always lead to drug use, but it often signals other concerns:
- Young drinkers may take more risks or act out in other areas of life.
- Alcohol use can be a sign of stress at home, challenges at school, or emotional distress.
- Teens who drink early are often part of social groups where drug use is more common.
Substance use follows no single path
There is no single reason why someone moves from one substance to another. Many factors shape this path.
- Personal experiences, social influences, and biology all shape how and why someone uses substances. Each person’s journey with substance use is different.
- Brain development plays a role—teens often focus more on rewards and have a harder time weighing risks.
- Access also matters. What’s available in the home, school, or community—and how it’s viewed—can affect choices.
Risks of alcohol abuse
Alcohol use can affect a person’s health, behavior, and decision-making. These risks can appear quickly or build over time, especially when drinking starts early.
Short-term risks
Even a single episode of drinking can lead to harmful effects, especially when large amounts are involved:
- Accidents and injuries: Slower reaction time and poor coordination increase the risk of falls, crashes, or other injuries.
- Poor decisions: Drinking can lead to risky choices like unprotected sex, fights, or driving under the influence.
- Alcohol poisoning: Too much alcohol too quickly can cause a life-threatening medical emergency.
- Aggression: Alcohol may increase impulsive or aggressive behavior, leading to conflict or violence.
Long-term risks
The longer someone uses alcohol, especially starting young, the more likely serious health problems become:
- Brain changes: Alcohol affects brain areas tied to memory, judgment, and learning.
- Addiction: Early use raises the risk of developing alcohol dependence later.
- Mental health issues: Long-term use is linked to anxiety, depression, and emotional struggles.
- Sleep disruption: Alcohol can lead to poor-quality sleep and chronic fatigue.
- Liver damage: Over time, alcohol harms the liver and may cause disease.
- Heart risks: Alcohol use raises blood pressure and the risk of heart disease.
- Weaker immune system: Frequent drinking lowers the body’s ability to fight illness.
- Suicide risk: Heavy drinking combined with mental health issues can increase the risk of suicide.
Social and academic problems
Alcohol use also affects school, relationships, and daily life:
- School trouble: Linked to lower grades, missed classes, and disciplinary action.
- Strained relationships: Alcohol can lead to conflict with family and friends.
- Legal consequences: Underage drinking or drunk driving can bring fines, suspensions, or arrest.
- Isolation: Teens who drink often may pull away from social and school activities.
- Broken trust: Ongoing alcohol use can damage trust with parents, teachers, and peers
Other gateway substances
Alcohol isn’t the only substance linked to later drug use. Other commonly used drugs may also play a gateway role:
- Nicotine: Often one of the first substances tried, nicotine use—primarily through vaping—is linked to later alcohol, marijuana, and other drug use.
- Marijuana: Some teens use marijuana before trying alcohol or tobacco. Its early use may also increase the risk of using stronger drugs later.
- Prescription drugs: Misusing medications like painkillers or ADHD drugs at an early age can increase the chances of later substance problems.
Treatment options for alcohol use disorder (AUD)
Treatment for AUD often combines medical and behavioral approaches. Some people benefit from inpatient or alcohol rehab programs, while others do well with outpatient care or telehealth support. Common options include:
- Therapy: Group and individual therapy help people explore behavior, identify risk factors, and build coping strategies.
- Medical support: Some may receive medication to manage withdrawal symptoms or reduce cravings. This is important for those with strong physical dependence or who may develop a substance problem with other drugs, like prescription opioids.
- Family involvement: Family sessions strengthen home support and help loved ones understand addiction as a mental health disorder.
- Dual-diagnosis treatment: Many people with AUD also face mental health conditions like anxiety or depression. Addressing these together improves long-term outcomes.
- Aftercare planning: Support with jobs, school, and housing is important, especially if someone develops addictive patterns or relapses later in life.
Modern Recovery’s alcohol addiction treatment program
Modern Recovery offers a flexible, private, and supportive telehealth program for teens and adults dealing with alcohol use. It’s designed to fit real lives while providing real help.
- Accessible anywhere: Join sessions from home using a phone, tablet, or computer
- Small group format: Build lasting support with others going through similar challenges
- Recovery coaching: Stay connected with trained mentors who have overcome addiction themselves
- Family support: Sessions and tools to help families heal and grow together
- Master’s-level therapists: Weekly therapy with experienced professionals
- Mental health support: Address underlying mental health concerns that often go with AUD
We’re in-network and accept insurance
Online therapy covered by insurance does exist. Modern Recovery works with leading insurance providers across the United States to bring you quality mental health treatment that’s both accessible and affordable.
Final thoughts
Many studies have linked alcohol use to later drug use. But calling alcohol a gateway drug doesn’t explain the full picture.
Early alcohol use may signal deeper issues like stress, peer pressure, or mental health struggles.
While there’s a clear link between alcohol and other substances, that link depends on many factors—not just the order in which substances are used.
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Sources
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2. Jordan A, Salen P, Wojda TR, Cohen MS, Hasani A, Luster J, et al. Exploring the association between initial serum alcohol concentration and polysubstance use: More than a simple “gateway drug” effect? Indian J Crit Care Med. 2018 Oct-Dec;8(4):201-206. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311963/
3. Kirby T, Barry AE. Alcohol as a Gateway Drug: A Study of US 12th Graders. J Sch Health. 2012 Aug;82(8):371-9. Available from: https://doi.org/10.1111/j.1746-1561.2012.00712.x
4. Keyes KM, Schulenberg JE, Hamilton JM, Patrick ME, Cerqueira MT, Terry-McElrath YM, O’Malley PM. Marijuana as a gateway drug: Testing the hypothesis of sequence using longitudinal data from the National Survey on Drug Use and Health. Drug Alcohol Depend. 2019 Jan 1;194:1-9. Available from: https://doi.org/10.1016/j.drugalcdep.2018.10.004
5. Fredriksson I, Adhikary S, Steensland P, Vendruscolo LF, Bonci A, Shaham Y, Bossert JM. Prior Exposure to Alcohol Has No Effect on Cocaine Self-Administration and Relapse in Rats: Evidence from a Rat Model that Does Not Support the Gateway Hypothesis. Neuropsychopharmacology. 2017 Apr;42(5):1001-1011. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506787/