Abstract
To evaluate the consistency of the relationship between early drug use in adolescence and illegal drug use in adulthood as proposed in the “gateway theory” and to determine whether pre-existing depressive symptoms modifies this relationship. We used contractual data from the National Longitudinal Study of Adolescent to Adult health data spanning a 14 year period. We assessed the relationship between gateway drugs at baseline (age 11–20 years) and drug use in adulthood using generalized estimating equation (GEE) regression models. Gateways drugs used in early adolescence were significantly associated with marijuana use, illegal drugs and cocaine in older adolescence, but over time these relationships were not consistent in adulthood. Changes in the pattern of psychoactive drug use were important predictors of drug use in adulthood. A history of higher depressive symptoms was associated with higher frequencies of psychoactive drug use over time. Users of mental health services in adolescence were less likely to use drugs in older adolescence and in adulthood. Relationships between early drug use and later drug use in adulthood cannot be solely explained by the gateway hypothesis. Collectively, adolescent drug prevention and treatment programs should apply theory-based and evidence-proven multisectoral intervention strategies rather than providing a brief counseling on individual's behaviors. This evidence should include understanding that changes in behavior should involve broader analyses of the underlying social context for drug use and in particular the role of the community social norms in driving a group's behaviors.
Highlights
The concept of “gateway hypothesis” has been studied since the 1970s (Kandel, 1975; Kandel and Faust, 1975) as the theory suggests that an adolescent's early experimentation with alcohol or tobacco or cannabis escalates to more addictive illicit drugs later in adulthood (Lynskey et al, 2003)
The aim of this study is to evaluate the impact of early substance use on later illicit drug use while accounting for concurrent drug use over a relatively longer period among a cohort of adolescents transitioning to adulthood, and to determine the extent to which these relationships conform to the GH
We evaluated cohort-specific analysis to determine the relationship between initial drug intake and later illicit drug progression across different waves of data collection
Summary
The concept of “gateway hypothesis” has been studied since the 1970s (Kandel, 1975; Kandel and Faust, 1975) as the theory suggests that an adolescent's early experimentation with alcohol or tobacco or cannabis escalates to more addictive illicit drugs later in adulthood (Lynskey et al, 2003). An earlier series of studies (Kandel, 1975; Kandel and Faust, 1975; Kandel et al, 1992) among adolescents showed the existence of a significant and a clearly defined sequence of drug use onset starting with licit substances (alcohol, cigarette) and progression to illicit drugs (cocaine, marijuana, methamphetamine, and heroin) through adulthood.
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