Stanton and Archie Brodsky tackle popular temperance messages in America whose goal is to discredit, disqualify, and discourage all consumption of all psychoactive substances--as though the issue were not self-evidently what, how, and by whom all such substances are used. And they will be used--both the legal and illegal ones! Facing this fundamental reality, distinguishing among types of use, and educating young people about these differences is exactly the opposite approach to the one taken by Joseph Califano's neoTemperance CASA and its supporters.

Published in Addiction Research, 5:419-426, 1998.
© 1998 Overseas Publishers Association.
Reprinted with permission from Gordon and Breach.

Stanton Peele
Lindesmith Center
New York City

Archie Brodsky
Department of Psychiatry
Harvard Medical School
Boston, MA

The "gateway" theory of drug use holds that exposure to "entry" drugs—notably alcohol, cigarettes, and marijuana—reliably predicts deeper and more severe drug involvements. U.S. drug czar Barry McCaffrey has incorporated the gateway theory as an integral part of the country's drug policy. However, although most heavier drug users undoubtedly were once lighter drug users, this association does not establish a causal connection. Few young people progress from lighter to heavier drug use; in fact, the dominant trend is for young people to reduce illicit drug use and to stabilize drinking with maturity. The gateway theory may actually be counterproductive if we consider that in non-temperance cultures that manage alcohol successfully, alcohol is generally introduced to young people at an early age. Other evidence suggests that moderate-drinking and drug-using young people, even when such behavior is illegal, are better off psychologically and are more likely to make a successful transition to adulthood than abstainers. Overriding all such profiles of moderate and abusive users of drugs and alcohol are social-epidemiologic models which indicate that the best predictors of abusive substance use are social, family, and psychological depredations that occur independent of supposed gateway linkages.

Keywords: Gateway drug; gateway behavior; stepping-stone drug; temperance; moderate drinking; problem-behavior theory; alcohol; marijuana; cigarette smoking; adolescent

The National Drug Control Strategy for 1997 unveiled by U.S. drug czar Gen. Barry R. McCaffrey (Office of National Drug Control Policy, 1997) adopts a "zero-tolerance" policy toward youthful alcohol, tobacco, and marijuana use. The strategy regards all of these as "gateway behaviors" leading to serious drug abuse. In support of this contention, the Strategy cites a report by the Center on Addiction and Substance Abuse (CASA, 1994) entitled Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use. The CASA report has been widely influential, in part because CASA president Joseph A. Califano, Jr., is a former Secretary of the U.S. Department of Health, Education, and Welfare.

Califano and CASA relied on data from a 1991 government survey to show that both adolescents and adults who have used cigarettes, alcohol, and marijuana are hundreds of times more likely to use cocaine than those who have never used any of the three substances. Califano's conclusion: The most critical step in stamping out dangerous drug abuse is to prevent young people from embarking on the road to perdition through the gateway of smoking, drinking, or using marijuana.

According to The National Drug Control Strategy, "Drug policy must be based on science, not ideology." This pronouncement is belied by the document's uncritical reliance on the "gateway" concept, whose enthusiastic acceptance by public officials and agencies has not been accompanied by any real scientific scrutiny. For example, the findings of the annual national surveys of high-school student drug use conducted at the University of Michigan over the past two decades offer little support for the gateway theory; instead, they show historical fluctuations in drug use. No one has shown a consistent pattern of youthful alcohol, marijuana, and cigarette use trends that presages cocaine and heroin use trends (Zimmer and Morgan, 1997).

The 1996 survey results (Johnston et al., 1997) continued a recent mild upward trend in use of marijuana, but not other illegal drugs. Along with a slight upturn in marijuana use among high school seniors, tobacco use was also up, while "binge" drinking (five or more drinks at one time within the past two weeks) remained at roughly the same level (30 percent of high school seniors) in 1996. Although the incidence of such drinking is lower than the highs of over 40 percent in the late seventies and early eighties, this does not signify a lessening of overall alcohol excess among young Americans. Researchers at the Harvard School of Public Health have labelled 44 percent of U.S. college students as binge drinkers (50 percent of men had 5+ drinks, 39 percent of women had 4+ drinks) (Wechsler et al., 1994). What lies in store for these young people as they mature?

When young people get away from home by going to college, their binge drinking rises; in time, however, their drinking declines (as does their drug use) as they assume adult roles (Bachman et al., in press). Given that so many young people ultimately do moderate their drinking, why are we failing so badly with the prohibitionist alcohol-education message in which Gen. McCaffrey places such confidence? This failure has more than temporary consequences. Unfortunately, despite the overall drop-off from early problem drinking, a higher than average percentage of those who display unhealthy early drinking will develop adult drinking problems (Schulenberg et al., 1996).