While not always the case, for the most part, drug use doesn’t usually start with “hard” drugs such as meth or intravenous heroin. Typically, experimentation with substances starts with substances far more accessible and socially acceptable. This can be beer, liquor, cigarettes, or prescription medications. On the surface, these substances are considered socially acceptable and less harmful than illegal drugs. But in reality, they can sometimes act as gateway drugs.
A gateway drug is a weaker drug that can “introduce” people to drugs and make them crave a more intense high. Because these first substances seem more “safe,” people might be more inclined to explore more powerful (and often more dangerous) substances later on. Over time, this can lead to dependency on harder substances, requiring professional support such as heroin addiction treatment to break the cycle and begin recovery.
What is a Gateway Drug?
The term “gateway drug” refers to a substance that the use of which may increase the likelihood of a person progressing to harder or more addictive substances. These drugs are usually easier to access than drugs considered more dangerous, as well as more socially accepted. They may even be legal for recreational use, which can lower the perceived risk of using them.
The theory behind the concept of a gateway drug is that someone will be exposed to one of these “socially acceptable” substances and, as a result, will become desensitized to the risks associated with drug or alcohol use. The idea is that they may then begin to experiment with “harder,” less socially acceptable, or illegal substances.
An example of this is a teenager who drinks alcohol at a party or another social gathering where others are doing it. After trying alcohol and not having a negative reaction, they may then decide they want to continue experimenting with other substances. Over time, they may continue to progress with their experimentation, eventually trying harder drugs such as powder cocaine or ecstasy. As their body continues to build a tolerance to certain substances, they may have to turn to harder drugs to replicate the feelings they used to get from alcohol or other substances.
While this is an extreme example, it’s also important to note that this is not the norm. One sip of alcohol won’t result in a full-blown substance use disorder or a desire to use a very hard drug. But experimentation with these types of substances, especially at a young age, can increase the risk of a substance problem developing later in life.
Examples of Gateway Drugs
While any drug can technically be a “gateway” drug if it leads to further use and experimentation, certain substances are more commonly considered to be gateway drugs.
Nicotine
Found in cigarettes, vapes, and other smokeless vaping products, nicotine is often one of the first substances young people experiment with. Nicotine is highly addictive and has well-documented effects on the brain, especially during adolescence. The normalization of nicotine use, especially through flavored vapes and other measures aimed at attracting younger people to smoking, can downplay the dangers of addiction. This can increase the chance of further experimentation.
Nicotine can alter the brain’s reward system, which may make the person more open to trying other addictive substances. It also often co-occurs with other drug use. For example, a person who vapes may also be more likely to use alcohol, cannabis, or even stimulants in different settings.
Alcohol
Alcohol is one of the most socially accepted intoxicating substances in the world. It’s legal, widely available, and deeply integrated into many social activities across cultures. That’s why, for many, drinking alcohol is a common first drug, especially among teens and young adults.
While it is socially acceptable and easily accessible to use it, alcohol impairs judgment and lowers inhibitions. As a result, when drinking, people are more likely to make risky decisions or do things they may not normally do when they are sober. This may include experimenting with drugs. Alcohol also increases dopamine levels in the brain’s reward system, which can encourage users to seek that same chemical reward through “harder,” more potent drugs.
Cannabis
Cannabis, also known as marijuana, is another frequently cited gateway drug. As legalization spreads across the U.S., access and social acceptance have skyrocketed. While cannabis is considered less dangerous than many illicit drugs and even has medical applications, it’s not without risk. Cannabis can affect areas of the brain related to memory, judgment, and impulse control, which can impair decision-making. This is especially true for young people, as cannabis use before age 21 has been tied to damage to the developing brain.
Prescription Drugs
Prescription drugs, especially opioids, benzodiazepines (like Xanax), and stimulants (like Adderall), are casually considered “safer” drugs because they’re prescribed by doctors. However, when misused, they can be just as dangerous as illegal drugs. They may be considered gateway drugs because people may turn to harder drugs to achieve similar effects. Many people who develop a heroin addiction, for example, begin by misusing prescription painkillers. The body builds up tolerance to the effects of the opioids over time. When refills run out or the pills become too expensive, individuals may turn to illegal alternatives that offer a similar effect.
Is Someone “Doomed” After Trying a Gateway Drug?
Absolutely not. Trying a substance that may be considered a gateway drug doesn’t mean that someone is automatically going to become addicted. Many people who try alcohol or experiment with drugs at a young age go on to live a life free of addiction to drugs and/or alcohol.
Addiction is a complex, multifaceted disease. It depends on a wide range of factors, including:
- Genetics: Some people are more genetically predisposed to addiction.
- Mental health: Individuals with anxiety disorders, depression, or who have trauma are more at risk.
- Environment: Peer pressure, family dynamics, and exposure to drug use can influence behavior.
- Access to drugs: Availability of substances increases the chance of repeated use.
- Coping mechanisms: People who use drugs to escape stress or emotional pain are more likely to seek out stronger highs.
Signs of Drug or Alcohol Addiction
It’s also important to note that, even in the event that experimental drug or alcohol use does lead to substance abuse or addiction, it won’t happen overnight. Addiction often begins subtly, with behavioral changes and emotional shifts that grow over time.
If you are concerned that you or a loved one is suffering from an addiction, here are common signs to look for:
Behavioral
- Using drugs even when there are negative consequences in doing so
- Risky behaviors, such as driving under the influence or unprotected sex
- “Doctor shopping,” or visiting multiple providers to obtain prescriptions
- Frequent lying or manipulation to cover up substance use
- Erratic or impulsive decision-making
- Repeated failed attempts to stop or cut back on drug or alcohol use
Physical
- Frequent illnesses or infections due to a weakened immune system
- Tremors or shaking, especially in the hands
- Slurred speech or difficulty with coordination
- Changes in sleep patterns, such as insomnia or excessive sleeping
- Unusual body odor or bad breath
- Chronic fatigue or lethargy, even after rest
- Unexplained bruises or injuries from blackouts or falls
- Frequent nosebleeds or sniffles (common with snorted drugs)
- Track marks on arms, legs, or extremities from injections
Emotional
- Heightened irritability or outbursts of anger
- Feelings of hopelessness or despair
- Sudden personality changes
- Paranoia or hallucinations
- Low self-esteem or shame related to substance use
- Loss of interest in personal relationships or life goals
Cognitive
- Memory lapses or frequent blackouts
- Trouble concentrating or completing tasks
- Disorientation or confusion, even when sober
- Decline in academic or job performance
Social
- Isolation from family and friends
- Frequent conflicts or arguments with loved ones
- Loss of job or academic standing due to substance-related issues
- Neglecting children, pets, or family responsibilities
- Associating primarily with others who use drugs or alcohol
- Legal trouble, such as arrests for possession or DUI
Receive Help for Addiction at First Steps Recovery
Understanding the concept of gateway drugs can help you better recognize how casual or early drug use can sometimes evolve into something more serious. But even more important is knowing that addiction, at any stage, is treatable.
At First Steps Recovery, we provide compassionate, evidence-based care for individuals facing substance use disorders, including those whose journey began with gateway drugs like alcohol, cannabis, or prescription medications.
Don’t let a gateway drug open the door to long-term addiction. If you or a loved one is struggling, it’s never too early or too late to ask for help. Contact us today to learn more about our treatment options and how we can help you start on the road to recovery.
Dr. Curl is the Medical Director and primary on-site provider for First Steps Recovery. He is a Board Certified Internist and Addiction Medicine Specialist having attended the David Geffen School of Medicine at UCLA and completing his residency at Mount Auburn Hospital with Harvard Medical School. Following several years work as an internist and physiatrist (physical medicine and rehabilitation). Dr. Curl completed the Addiction Medicine Fellowship at Howard University in Washington DC and participated as a RAM Scholar (Research in Addiction Medicine). While part of the fellowship, Dr. Curl pursued research investigating the barriers to expanding and improving medication for opioid use disorder. Following his fellowship, Dr. Curl spearheaded the Opiate Use Disorder outpatient clinic and worked in the Department of Psychiatry and Behavioral Sciences within the Howard University Hospital. In 2023, Dr. Curl completed his Board Certification in Addiction Medicine.
