The Myth of the Gateway Drug
Spoiler alert: Those D.A.R.E. officers didn't know what they were talking about.
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If you were a kid in the 80’s and 90’s, there is a very good chance you remember the D.A.R.E (Drug Abuse Resistance Education) program—designed to “keep kids off drugs.” I have a hazy memory of a police officer coming to my fifth-grade classroom to explain that peer pressure is bad and that marijuana is a “gateway” drug—if you do it, you’ll end up addicted to even worse drugs. Or something. Honestly, all I remember is thinking it was weird for a police officer to be in my classroom if no one was in trouble.
As you may have gathered from what I’ve revealed about myself in this newsletter, the D.A.R.E. program totally worked, and I reached middle age without ever touching alcohol or weed. Just kidding, like the vast majority of kids who were exposed to the program, it had precisely zero impact on my behavior. (Some studies have found that it may have actually increased rates of substance use by making kids curious about the drugs mentioned.)
So why am I talking about this old, ineffective program? Because it was very effective in one thing: promulgating the “gateway drug” narrative. A study published in 1975 found that “very few youths progress to other illicit drugs without prior experience with marijuana.” Thus, according to DARE officers and Nancy Reagan, if kids could just say no to cannabis (and also alcohol and cigarettes), they could be spared their otherwise inevitable descent into “hard” drugs.
I thought we had moved on from the “gateway drug” conversation; among addiction researchers, it’s widely accepted that the gateway drug theory makes the mistake of conflating correlation with causation, and there are too many other variables among adolescent use (access, genetics, stressors, etc.) to substantiate the theory. But the term caught my eye in a story published on Fox News’s website a few days ago.
This story claimed, “A vast majority of American adults say they have consumed alcohol at some point—experts warn that alcoholic beverages could be a ‘gateway drug’ to more harmful substances.” If the phrase “gateway drug” wasn’t enough, this is the moment I realized I was officially hate-reading the story.
Of the classes of commonly misused substances (alcohol, tobacco, opiates, cannabis, psychedelics, cocaine, methamphetamine, benzodiazepines, etc.), few, if any, are associated with more harm than alcohol. It is the most used substance in the United States and, on both a societal and individual level, is associated with profound harm.
If this makes you bristle, let me assure you, I’m not suggesting that because something is associated with harm, you should stop doing it. Unless you want to stop drinking or think you need to stop drinking, I’m not particularly interested in your drinking habits. Plenty of people use alcohol in ways that minimize harm to themselves and others, and we all take varying degrees of risk (substance-related or otherwise) every day.
But the phrases “gateway drug” and “hard drugs” are red flags in my book. They’re unspecific and overly moralistic. Both phrases imply that substance use outcomes are more a product of what drug is used as opposed to how it’s used.
For example, in college, I distinctly remember telling myself (and others, I’m sure) that I didn’t have a substance use problem because I didn’t do “hard drugs.” In college, plenty of my friends did coke or LSD—none of which I had any interest in. This allowed me to regularly drink myself into a blackout and still feel morally superior (or, at the very least, not morally inferior) to people who occasionally dropped acid. In retrospect, that’s bananas. But being able to strut around knowing I didn’t do “hard drugs” gave me a false sense of stability when I was very clearly unraveling.
In the Fox story, the phrase “hard drugs” is used interchangeably with “harmful” drugs, but harm is something that’s (at least theoretically) quantifiable. Drunk driving, cancer, violence—these are all known and quantifiable harms of alcohol use. What we consider “hard drugs” or even “gateway drugs” changes over time.
‘Gateway drug’ used to be synonymous with marijuana, but we now know that there’s no evidence to support that assertion. What’s more, cannabis may help people reduce their use of other, more potentially harmful drugs, like opioids. We’ve known this for decades, and yet, also for decades, people who oppose marijuana legalization have effectively used ‘gateway drug’ as a scare tactic to keep it illegal at the federal level.
David Tzall, a Brooklyn-based psychologist and addiction specialist, calls the notion of gateway drugs “really outdated.”
Nonetheless, the Fox story quotes the medical director of a “luxury rehab and addiction treatment center” who claims he’s seen the alcohol to other drugs pipeline firsthand. He says, "I personally have seen the ravages of this — hungover victims turn to meth, cocaine, and other drugs for the ‘pick me up’ they feel they need."
Listen. I don’t want to paint with too broad a brush, but if you wake up with a hangover and turn to meth to feel better, I’m going to go out on a limb and say there’s more going on than just the fact that you got drunk the night before.
“The question is whether or not what people call ‘gateway effects’ are the effects of the person or the drug,” says Dr. Michael Ostracher, a psychiatry and Behavioral Sciences professor at Stanford Medicine. We want a simple way to inoculate ourselves and others from harm. But the reality, he adds, is “so complicated sociologically, economically, and biologically.”
To truly understand addiction, we have to embrace the complexity underpinning it. For decades, people struggling with substance use were stigmatized as weak-willed moral failures. Drugs that had the potential to help people in the right context were demonized. Recognizing that substances affect people differently—that environment, biology, and society are all part of how and why we use substances—is how we help people heal.
But your D.A.R.E. officer was never going to tell you that.
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I’m not a doctor or mental health professional, so my advice shouldn’t be construed as medical or therapeutic. You are free to take or leave it.
DARE Officer: A lot of kids take drugs because they want to fit in and be cool
Me: (nods to self, cool kids do drugs, got it)
Thank you for this honest assessment of these so called gateway drugs. Very informative! Thank you!!