The possibility that cigarette smoking acts as a priming agent for substance use later in life,[3,4,2] or that there are common liabilities to nicotine and other addictions,[6,7] gains greater salience with the advent of e-cigarettes.[7,9] There is a debate about whether e-cigarettes act as a gateway, causing those who might otherwise not have smoked tobacco to become addicted, or whether those same people would have experimented with cigarettes anyway.[9] Many of the risk factors for cigarette use overlap and interact with risk factors for other addictions, and for other risk-taking behaviour – making studying any direct association difficult.[9] A meta-analysis, for example, analysed potential uncorrected confounding variables, and concluded that only two out of the eleven studies included had comprehensively adjusted for confounding variables.[7]
References:
[1] Lynskey MT, Agrawal A. Denise Kandel’s classic work on the gateway sequence of drug acquisition. Addiction 2018; 113 (10): 1927–1932.
[2] Wagner FA, Anthony JC. Into the world of illegal drug use: exposure opportunity and other mechanisms linking the use of alcohol, tobacco, marijuana, and cocaine. Am J Epidemiol 2002; 155 (10): 918–925.
[3] Ren M, Lotfipour S. Nicotine gateway effects on adolescent substance use. West J Emerg Med 2019; 20 (5): 696–709.
[4] Kandel D, Kandel E. The gateway hypothesis of substance abuse: developmental, biological and societal perspectives. Acta Paediatr 2015; 104 (2): 130–137.
[5] Lloyd C. Risk factors for problem drug use: identifying vulnerable groups. Drugs (Abingdon Engl) 1998; 5 (3): 217–232.
[6] Vanyukov MM, Tarter RE, Kirillova GP, et al. Common liability to addiction and “gateway hypothesis”: theoretical, empirical and evolutionary perspective. Drug Alcohol Depend 2012; 123 (Suppl 1): S3–17.
[7] Chan GCK, Stjepanović D, Lim C, et al. Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation. Addiction 2021; 116 (4): 743–756.
[8] MacCoun RJ. What can we learn from the Dutch cannabis coffeeshop experience? RAND Drug Policy Research Center. 2010. Available at: https://www.rand.org/content/dam/rand/pubs/working_papers/2010/RAND_WR768.pdf.
[9] Taylor GMJ, Hartman-Boyce J. Commentary on Chan et al.: Urgent need for more sophisticated research designs to examine the association between adolescent e-cigarette use and future smoking initiation. Addiction 2021; 116 (4): 757–758.
