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Review
, 123 Suppl 1 (Suppl 1), S3-17

Common Liability to Addiction and "Gateway Hypothesis": Theoretical, Empirical and Evolutionary Perspective

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Review

Common Liability to Addiction and "Gateway Hypothesis": Theoretical, Empirical and Evolutionary Perspective

Michael M Vanyukov et al. Drug Alcohol Depend.

Abstract

Background: Two competing concepts address the development of involvement with psychoactive substances: the "gateway hypothesis" (GH) and common liability to addiction (CLA).

Method: The literature on theoretical foundations and empirical findings related to both concepts is reviewed.

Results: The 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.

Conclusions: Whereas 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.

Figures

Fig. 1
Fig. 1
A hypothetical individual developmental trajectory of the CLA phenotype. The outset phenotype (Pi) is formed at conception. Genetic and environmental factors, acting as vectors (v1, v2, . . .) whose salience changes over time, projected on the liability dimension, form a resultant vector (R) determining the phenotype location at each time point. When connected, these phenotypes comprise a trajectory leading to a resultant phenotype (Pr) at the time when a diagnosis can be made.

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