posted
I think both alcohol and marijuana have been discredited as gateway drugs. That doesn't leave much else.
Posts: 3275 | Registered: May 2007
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posted
I could certainly say that there is no consensus in the evidence-based medical world that the concept of "gateway drug" is particularly useful, or that alcohol is such a thing. Of course there will always be someone saying any given thing, but it is more the substance (or lack thereof) behind what is said that is most compelling. And there doesn't seem to be an evidence-based argument definitively supporting the idea of a "gateway drug."
It may or may not have been totally ruled out -- I don't know. It certainly hasn't been ruled in, as far as I can tell.
On the other hand, there is pretty clear consensus on the risk factors listed above.
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Edited to add: In a lit search, I see some people are still using the term, although it is very much decreased from the 90s usage of it. I know the continued use of it is both controversial and still decreasing.
quote:Originally posted by advice for robots: How come? Now I'm curious.
See above. Briefly, history of alcohol use in and of itself -- once you control for the other established risk factors -- doesn't make someone more likely to try other drugs. That is, there isn't support for it as a factor on its own.
In contrast, poor parental supervision does seem to be an independent risk factor, for example. But in kids who are otherwise similar with respect to such risk factors, alcohol doesn't seem to be a predisposing factor to other substance abuse. If it were a "gateway drug," then it would have to be something such that the use of it (even with all other things being held equal) would make other substance use more likely -- i.e., drinking or not drinking should therefore make a difference in the other rates. It doesn't.
Posts: 14017 | Registered: May 2000
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posted
This might be helpful, or at least interesting history:
In the 80s and early 90s, there was a lot of interest in taking very large national survey databases (10s of thousands of participants: National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Survey (YRBS), etc.)) and sifting through the data to see what you can find. The study afr linked is one of these.
There were limitations to these studies. Some of the data was "dirty" (i.e., multiple missing answers in the coding, internally inconsistent answer sets), the questions may have been poorly designed (and when you are mining a database, you can't ask the question you really directly want to answer -- you just have to pick out the questions closest to it that someone else had already asked, and that may be misleading), most of them were purely cross-sectional (only a snapshot glimpse at one moment in time), some were telephone interviews (which comes with its own set of problems), and so on. However, they are great for generating hypotheses.
The "gateway drug" concept was one of these hypotheses. However, "gateway" is a concept that only makes sense in a trajectory of time, which a cross-sectional study doesn't show. All a cross-sectional study can show is correlation.
So there was some interesting stuff that came out of the analyses of these databases, and people settled down to look more closely at causation. That means smaller studies but much more powerful and specific ones, ones that were directed toward specific questions and "trajectories of use," or the different common pathways of drug use over time. This concept of "trajectories of use" is the most currently used evidence-based approach in the literature. If you want to browse through current top research, that is a search term that may be helpful.
Different trajectories of use have been identified, particularly early-use, midrange-onset, and late-onset use (or words to that effect). There are somewhat overlapping but still different sets of risk factors and prognoses for these groups, both the trajectories for marijuana use and for alcohol use (the most commonly studied drugs, along with nicotine). There is also overlap between those groups (marijuana v. alcohol), but in some areas, marijuana use is increasing while alcohol use is decreasing. And there are other complicated patterns emerging.
All of this is being driven by the question, "what will change the outcomes?" Often in screening questionnaires -- such as used in an ER as part of the questions asked after a motor vehicle crash -- the number of questions is pretty limited. There isn't time or manpower to ask a lot of questions, so the most effective tools rely on the most useful questions to ask, usually 4-8 or so: questions that are more likely to minimize false positives and false negatives.
There followed a lot of research on which questions to ask that would help predict whether a given adolescent in front of you was more or less likely to have future problems with substance use, in order to make whatever interventions were available to help avoid that. Asking about alcohol use separately from other drug use just wasn't helpful in discriminating between those who would go on to have substance abuse problems and those who would not.
The CRAFFT (link is to pdf) is one of the screens that tests most accurately for adolescents. It is a set of six questions about drug use (alcohol or other) that seems to be a good predictor of future outcomes. But there isn't support in the research for separating out alcohol from other drugs, as it isn't predictive on its own. There isn't any usefulness in pulling out one as characteristically different than the others.
So research on trajectories of use is ongoing, and it is there where (when I last checked) people were studying what questions were best predictive for people in various trajectories. That is, they were looking at whether given factors (like alcohol use in particular, apart from overall drug use) was predictive [for certain subgroups of adolescents]. I honestly don't know where that went. But I do know that the evidence-based screening tools for adolescents in general do not find that to be a helpful distinction, and the term "gateway drug" has fallen out of favor as a useful concept.
Posts: 14017 | Registered: May 2000
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