Is Alcohol a Gateway Drug?

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For decades now, some doctors (and often the media) have touted marijuana as the “gateway drug”—a substance that, once used, could lead a person to use “harder” drugs. But is this theory actually true? And, if so, is marijuana really the main culprit?

Many studies show a strong link between alcohol misuse and other addictions, particularly among younger people. If this is the case, could alcohol be the real gateway drug?

What Is a Gateway Drug?

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Before getting into whether alcohol is, in fact, a “gateway drug,” we should unpack what exactly this term means. Gateway drug theory is the idea that using one substance can lead an individual to use more “serious” drugs in the future Gateway drugs are often less dangerous and more easily accessible, providing a “stepping stone” of sorts into substance use.

Alcohol, marijuana, and tobacco are all examples of relatively accessible substances. Alcohol and tobacco are legal everywhere in the United States, and marijuana is legal for recreational or medical use in the majority of the states in the US. The fact that these substances are all so accessible begs the question: which one is a gateway drug? All of them?

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Alcohol Use: Concerning Statistics

Alcohol is the most frequently used and misused substance in the United States. It can be particularly problematic for younger people who engage in binge drinking—a behavior often seen as normal by high school and college-aged people.

In 2019, nearly 26 percent of people aged 18 and older reported engaging in binge drinking in the past month. Among the adult population at large, nearly 15 million people over age 12 had alcohol use disorder, including an estimated 414,000 adolescents (ages 12 to 17).

This is especially concerning given that young people who start drinking at an early age are at greater risk of using other dangerous substances. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the younger a person is when they begin drinking, the more likely they are to engage in risky and harmful behaviors. Binge drinking and other drug use also leads to poor educational performance and lower grades in school.

Is Alcohol Really a Gateway Drug?

So, does alcohol increase drug use? In some cases, drinking may have no impact on a person’s overall substance use. But, overall, there does appear to be a real connection.

Research shows that people with alcohol use disorder are 18 times more likely to use prescription drugs for non-medical purposes Other studies show that alcohol addiction and other substance use disorders often go hand-in-hand.

The risk seems especially high for younger people. A 2012 study reports that 12th grade students who used alcohol were significantly more likely to use illicit drugs. NIAAA research also shows that young individuals who binge drink frequently are more likely to use other drugs, such as marijuana and cocaine.

How Does Alcohol Act as a Gateway Drug?

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The research is not 100 percent clear on exactly why alcohol is linked with other types of drug use. But here are some possible explanations for why drinking might lead to broader substance issues, especially for younger drinkers:

Alcohol lowers inhibitions

Drinking alcohol increases levels of norepinephrine, a neurotransmitter that contributes to both arousal and impulsivity. The consequences of this are well-known: many people engage in risky and potentially dangerous behavior when intoxicated. This can apply to substance use as well. A person who is drunk might be willing to try drugs they would never consider when sober.

Drinking can expand your social circle

For young people in particular, drinking alcohol may be part of expanding their social life, or beginning to attend more parties and events. This isn’t always a bad thing, but these contexts may involve associating with others who are making poor decisions around alcohol and substance use. This can increase a person’s chance of being exposed to other substances in the context of lowered inhibitions.

Consuming alcohol can normalize substance use

Finally, alcohol itself is an intoxicating substance, and is technically illegal if consumed underage. If an adolescent starts drinking alcohol, and experiences no serious consequences, they may begin to question whether other illegal substances are really so bad. Being intoxicated in certain contexts may also start to feel more normal or socially acceptable, making substance use in general less taboo.

In summary, the more time younger people spend in contexts involving alcohol, the more likely they are to encounter other dangerous drugs. Lowered inhibitions, the normalization of substance use, and the influence of other acquaintances may, in fact, lead to further drug use for some people.

Alcohol Is Dangerous on Its Own

All discussion of gateway drugs aside, it’s important to remember that alcohol can be as dangerous as many illegal drugs, whether it leads to further substance use or not.

Approximately 95,000 people in the United States die each year from alcohol-related causes, making it the third-leading cause of preventable death in the nation. Alcohol played a role in more than 43 percent of liver disease deaths among adults in 2019, and research clearly shows that individuals who misuse alcohol have a greater risk of developing liver disease, heart disease, depression, stomach bleeding, and oral cancers.

As far as addiction is concerned, alcohol is certainly on par with many illegal drugs. Those with severe alcohol use disorder (AUD) often find it extremely hard to quit, and withdrawal symptoms can be severe enough to require hospitalization. More than 14.5 million people nationwide qualify as having AUD. So, while it’s certainly worth considering whether alcohol is a gateway drug, it’s important to remember that excessive drinking is a big enough issue on its own.

Whether you’re concerned that a loved one’s drinking will lead to further substance use, or feel your own drinking has reached a point where it’s unhealthy, there are new, more convenient ways to get help. Ria Health offers support for cutting back or quitting alcohol from a smartphone app. Our program includes weekly coaching support, prescription anti-craving medications, and handy digital tools—everything you need to establish a better relationship with alcohol.

Written By:
Rachael Goldstein
Philadelphia-based freelance writer specializing in law, mental health, psychology, and addiction.
Reviewed By:
Evan O'Donnell
Evan O’Donnell is an NYC-based content strategist with four years’ experience writing and editing in the recovery space. He has conducted research in sound, cognition, and community building, has a background in independent music marketing, and continues to work as a composer. Evan is a deep believer in fact-based, empathic communication—within business, arts, academia, or any space where words drive action or change lives.
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