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Does Marijuana Use Cause the Use of Other Drugs?
Denise B. Kandel, PhD
JAMA. 2003;289:482-483.
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A developmental sequence of involvement in drugs is one of the best replicated findings in the epidemiology of drug use. Regular sequences and stages of progression in which the use of alcohol and cigarettes precedes the use of marijuana (cannabis), and, in turn, the use of marijuana precedes the use of other illicit drugs, has been observed in the United States as well as in other western societies.1 Very few individuals who have tried cocaine and heroin have not already used marijuana; the majority have previously used alcohol or tobacco. Such behavioral regularities are subsumed under the "gateway hypothesis." The gateway hypothesis implies 3 interrelated propositions about sequencing, association of initiation, and causation.1 Sequencing implies that there is a fixed relationship between 2 substances, such that one substance is regularly initiated before the other. Association implies that initiation of one substance increases the likelihood of initiation . . . [Full Text of this Article]
Author Affiliations: Department of Sociomedical Sciences, School of Public Health, and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York, NY.
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