ReviewDrug and alcohol dependence2012
Common liability to addiction and "gateway hypothesis": theoretical, empirical and evolutionary perspective.
Review in Drug and alcohol dependence, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 216 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
216 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review.Addiction (Abingdon, England) · 2025Pooled it
- Cannabis use among Arab students: a systematic review.Frontiers in psychiatry · 2025Pooled it
- A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes.Harm reduction journal · 2024Pooled it
- Cross-ancestry meta-analysis of opioid use disorder uncovers novel loci with predominant effects in brain regions associated with addiction.Nature neuroscience · 2022Pooled it
- A systematic review of gene-by-intervention studies of alcohol and other substance use.Development and psychopathology · 2021Pooled it
- Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: a systematic review and meta-analysis.BMC public health · 2021Pooled it
- Association of the OPRM1 Variant rs1799971 (A118G) with Non-Specific Liability to Substance Dependence in a Collaborative de novo Meta-Analysis of European-Ancestry Cohorts.Behavior genetics · 2016Pooled it
- The Efficacy of Primavera, a Prevention Programme on Alcohol and Tobacco Use among 10-12-Year-Old Schoolchildren: A Randomized Controlled Cluster Study.International journal of environmental research and public health · 2021Trial
- The social exigencies of the gateway progression to the use of illicit drugs from adolescence into adulthood.Addictive behaviors · 2017Trial
- Substance use involvement moderates the effect of cortisol response on white-matter microstructure longitudinally.Dialogues in clinical neuroscience · 2026Article
- Trends in waterpipe and e-cigarette use among young people in the European Union, 2012-2023: a repeated cross-sectional study.The Lancet regional health. Europe · 2026Article
- Co-Use of Some Substances Associated With Higher Doses in Adolescents: Findings From the Adolescent Brain Cognitive Development Study.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2026Article
- "Cannabis Green Wave" versus "Nicotine Freeze": the regulatory paradox of cannabis liberalization and nicotine prohibition.Harm reduction journal · 2026Article
- Association between substance use disorder and risky behavior among students in Indonesia: a cross-sectional study.Korean journal of family medicine · 2026Article
- Deconstructing Methodological Paradigms in Adolescent Gambling Research: a Critical Analysis and Future Directions.Journal of gambling studies · 2026Review
- Association between adverse childhood experiences and over-the-counter drug abuse in Japan: A nationwide population-based cross-sectional study.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Identifying risk profile for adolescent e-cigarette use: A sex-stratified machine learning analysis.Drug and alcohol dependence reports · 2026Article
- Dynamic and Baseline Multi-Task Learning for Predicting Substance Use Initiation in the ABCD Study.medRxiv : the preprint server for health sciences · 2026Article
- Longitudinal Bidirectional Associations Between Early Adolescents' Externalizing and Posttraumatic Stress Symptoms and Substance Use Patterns.Research on child and adolescent psychopathology · 2026Article
- Etiological Development of Alcohol Use and Dependence From Adolescence to Midlife in a Longitudinal Community Study of Twins.Alcohol, clinical & experimental research · 2026Article
156 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
backgroundTwo competing concepts address the development of involvement with psychoactive substances: the "gateway hypothesis" (GH) and common liability to addiction (CLA).
methodThe literature on theoretical foundations and empirical findings related to both concepts is reviewed.
resultsThe data suggest that drug use initiation sequencing, the core GH element, is variable and opportunistic rather than uniform and developmentally deterministic. The association between risks for use of different substances, if any, can be more readily explained by common underpinnings than by specific staging. In contrast, the CLA concept is grounded in genetic theory and supported by data identifying common sources of variation in the risk for specific addictions. This commonality has identifiable neurobiological substrate and plausible evolutionary explanations.
conclusionsWhereas the "gateway" hypothesis does not specify mechanistic connections between "stages", and does not extend to the risks for addictions, the concept of common liability to addictions incorporates sequencing of drug use initiation as well as extends to related addictions and their severity, provides a parsimonious explanation of substance use and addiction co-occurrence, and establishes a theoretical and empirical foundation to research in etiology, quantitative risk and severity measurement, as well as targeted non-drug-specific prevention and early intervention.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.