Most people have heard the term “gateway drug”, which is synonymous with marijuana. The idea is that use of marijuana eventually leads to use of other, “harder” drugs. In my work I have seen this to be true the vast majority of the time. Still, this term is often misunderstood.
People often deny that there is any such thing as a gateway drug, emphasizing free will and our capacity to quit while we’re ahead. I think that for some people this is true, but I also know that substance use follows a typical progression, hence the reason why one drug may be a gateway to others. Many parents also take their child’s substance use lightly- whether it be drinking, smoking marijuana, or if they find some unidentified pills in their child’s clothes. This is probably because writing it off as normal teenage behavior is easier than taking the time to explore what’s going on. Or maybe smoking, drinking, or using marijuana occurs in the family and is not viewed as a problem. Or, perhaps the parents do say something, but they are too quick to believe their child’s stories/excuses. Whatever the situation, parents who discover that their child is smoking cigarettes or using any other substance should be aware that it may not stop there, and this is the perfect time to have conversations about drinking and drug use.
To understand the idea of gateway drugs I think you need to understand how we, as humans, make decisions about what we will or won’t do. When this involves something we know is wrong, illegal, or unhealthy, this often involves rationalization- coming up with reasons or excuses for why we will or why it is okay to do something. We do this when we experience conflict between knowing we shouldn’t do something, but part of us wants to do it anyway. So we search for a suitable reason (although sometimes a lame one) that can make us feel okay about what we want to do. We all do it to some degree. It might be whether or not to have that second cookie, whether we should snooze until the last minute before school or work, or whether or not to have one more beer or glass of wine than we know we should. It’s rationalization that often leads to poor habits, destructive behavior, and which also helps to fuel substance abuse and addiction.
So what are the gateway drugs and what should parents know? I would argue that any substance can be a gateway to another, as most people tend to have a hierarchy of drugs that we can think of and most people in their life have drawn a line in terms of what they would or would not be willing to try. Legal or socially acceptable substances- like alcohol or tobacco products, tend to be at the lower end as far as seriousness, dangerousness goes, or acceptability, while heroin or crack cocaine would be at the other end. Using one substance makes it easier to rationalize what may come next. For example, if you smoke cigarettes, it may not be that difficult to justify trying marijuana. After all, you have already smoked something- it can’t be that different, right? Or if you have used marijuana (usually a person’s first illegal drug), you may be more likely to try cocaine. You’ve already crossed the line into illegality, so what’s the difference, right? Though I’m sure it has happened, very few people go directly to shooting heroin or smoking crack cocaine. Surely they have used alcohol, marijuana, or prescription pain killers first. In fact, most heroin users today started out with prescription medications (opiates like Oxycontin, Percocet, or Vicodin), but eventually prescriptions run out, they can no longer afford the pills, or heroin is more available. A problem people have with the gateway drug concept is that they think people like myself are saying that use of marijuana guarantees use of other drugs. I’m not saying that at all- just that it becomes more likely, and the research demonstrates this. I have seen this in my work as well. To date I have probably done 200 substance abuse evaluations, and I can tell you that I have yet to meet a person who has used a “harder” drug but has never tried marijuana or alcohol.
An analogy I used in a group was stealing. A person who would steal a car (a serious crime, by the way) probably would have started smaller first- stealing a pack of gum from a convenience store or taking $5 from a friend or family member. For one thing drug use and stealing both involve a kind of thrill- with drugs it may be the feeling that you get from using them, but also there is the chance that you could be caught and in a lot of trouble. Taking risks can be exciting to people- and of course with teenagers there is a tendency to want to be rebellious or to try the things your parents and other adults have told you not to. There is also habituation. Doing one thing long enough leads to lost excitement, so it’s natural for people to want to try the next thing, one-upping the thing they did last- especially if they know others who are doing it. So it’s natural and we do this in all sorts of areas- not only with drugs or other risky behaviors. I think it’s important for parents to understand these factors so they can look for warning signs in their children’s behavior, start conversations with them about drugs, and so they can avoid the denial that their child “would never do that”. No matter how much you and your child talk, teenagers in particular are more influenced by their peers than by adults, and it is common for young people to experiment with use of substances. Of course teenagers are also influenced by celebrities, and they see musical artists, actors and actresses, and professional athletes all of the time who tend to make drinking or drug use seem really glamorous.
Lastly, I want to review a few of the gateway drugs that parents often don’t worry about or that don’t get as much attention, compared to some of the “more serious” drugs out there.
1) Tobacco products- Though smoking is less popular today than it was 10, 20, or 30 years ago, it hasn’t gone away, and kids continue to experiment with it- and become addicted very quickly, thanks to nicotine. Tobacco products are relatively easy to get- whether kids take them from their parents, get them from their friends, or know someone who is old enough to buy them. Tobacco products, like cigarettes, sometimes go hand-in-hand with drinking, and are frequently used by drug users, so I would say that young people smoking at least increases the chances that they will be exposed to other substances like alcohol and marijuana. At the very least, they could be struggling with a long-term addiction to nicotine.
2) Alcohol- Also easy to get, as most households contain at least some form of alcohol, even if the adults rarely drink it. Young people can take alcohol from their parents, they may be allowed to drink with their family on occasion (such as at a wedding, birthday, or on New Year’s Eve), or they can get alcohol from friends- who probably take it from their homes. Teens also may know someone who is 21, they may have a fake ID (this is getting more difficult, but still happens), or they may know of a place where they can purchase alcohol without their ID being checked. Not only is alcohol associated with use of drugs, but alcohol impairs judgment, so a person who is under the influence may become more likely to try another substance- even if he or she would not ordinarily. Also, since alcohol is legal, parents often do not seem to worry about their children experimenting with it- as long as they don’t drink and drive. Drinking under 21 is illegal, and furnishing alcohol to minors can lead to heavy penalties for adults, so perhaps parents need to rethink their approach to alcohol as well.
3. Marijuana- Marijuana, although illegal federally and in most states, is also easy to come by- easier than many parents think. And many people today do not regard marijuana as a drug, increasing the chances that someone else might try it. Even when it is viewed as a drug, many view it as “not that bad”, so it is perhaps the easiest drug for people to justify using. It doesn’t carry the same stigma as crack or methamphetamine, and most people know at least one person who uses it. Since marijuana is most people’s first illicit drug and the line between legal and illegal gets crossed, it becomes easy for people to rationalize trying another drug. Marijuana is also mind-altering, so use of marijuana could just lead to something else being used if one is under the influence. It’s important to note also that marijuana is addictive- not as much physiologically like many other substances, but psychologically. People often argue with this fact, but marijuana is difficult to stay away from when a person has been using it consistently. And often, despite negative effects (poor school performance, legal charges, probation or juvenile detention, lack of self-care), young people in particular will continue to use it, denying any connection between use of marijuana and their particular problems. Taking marijuana lightly, I believe, is particularly dangerous for parents.
4. Prescription medications- If your child is prescribed something like a pain killer (such as Oxycodone, Percocet, or Vicodin) or another medication that is prone to abuse (like anti-anxiety medications), you probably know. I would monitor use of the medication to watch for abuse. This may include taking more than is prescribed, medication “disappearing” (young people have been known to sell medications in school or to give them to their friends), or any significant change in behavior. If your child is not prescribed something, but you find some unknown pills, chances are your child is abusing or selling the medication. Prescription medications like opiates and benzodiazepines can be very dangerous in their own right, but again some- opiates in particular, can lead to use of other substances like heroin. Opiates are also highly addictive, and depending on the severity of use, could require a trip to detox and rehab. Opiate withdrawal can lead to severe illness or death if not medically monitored. Opiates and benzodiazepines, even when taken as prescribed, can be dangerous when taken with other substances like alcohol as well.
To close, regardless of your personal opinions on smoking, drinking, prescription medications, or use of marijuana, it’s important to know that use of one can easily lead to another. And if you have children, you might look out for signs that they are using any of these gateway drugs. This can include: being in possession of a substance or you finding it; smelling like smoke (tobacco or marijuana); appearing to be under the influence of something; or any noticeable change in behavior. If you have a relationship where your son or daughter comes to you and tells you they tried something- whether it was a positive or negative experience, that’s great. Your child obviously trusts you and probably cares about what you have to say about it. Even if you don’t have this kind of relationship, and you find out your child is using any substance, this is a perfect opportunity to start the conversation. I would encourage you to do so and to (calmly) talk about it. If your child feels comfortable talking to you, chances are he or she will- but if he thinks he’s just going to get in trouble, it’s likely he won’t tell you anything. Communication is key as far as parents being able to influence the behavior of their children, and healthy relationships help kids to make better choices.
If you are aware of your child having a substance abuse problem, or if you believe this may be the case, there are a number of things you can do. First, it is crucial to talk about it, but if you believe that professional help is needed, reach out.
1. If your child has a therapist, tell him or her about your concerns so that this can be discussed in therapy. Substance abuse counseling often involves at least some family sessions to discuss the issues and so that the therapist can provide the family with useful information. If there is reason to be concerned and the therapist is not skilled in substance abuse assessments, he or she can provide you with a referral.
2. Contact a therapist who specializes in substance abuse work (assessments and counseling) so your concerns can be addressed. He or she can assess your child and either start therapy around this issue, or a referral may be made to a treatment program (outpatient or inpatient, depending on your child’s needs).
3. If you believe your child is in immediate danger due to drugs or alcohol (is incoherent, unconscious, or behaving erratically), call 911 or go to the nearest emergency room.
(c) Jesse D. Matthews, Psy.D. 2013