Alcohol is often regarded as a gateway drug. Individuals who initiate substance use with cigarettes or alcohol are more likely to use other drugs, including cannabis, than people who never use alcohol or tobacco at all. But the research in this area has neglected to thoroughly examine the trends of various ethnic groups. Although this theory may hold true for European Americans (EA), it may not be true for African-Americans (AA), and women in particular. Therefore, Carolyn E. Sartor of the Department of Psychiatry at the Yale School of Medicine recently conducted a study comparing cannabis use and problems to alcohol use and problems in a sample of AA and EA women.
Sartor analyzed over 4,000 clinical interviews of women who were part of either a larger twin study or a family study aimed at high risk families. She assessed their level of use for cannabis and alcohol, any cannabis- or alcohol-related problems, and development of cannabis use disorder (CUD). She looked at childhood sexual abuse (CSA) as a risk factor, as well as psychiatric issues. She found that even after she controlled for ethnicity and psychiatric issues, the AA women were more likely to use cannabis before or instead of alcohol, while the EA women usually first tried alcohol. When she looked at the trajectory of use in both groups, Sartor found that women who used cannabis progressed at the same rate to problem use as the women who used alcohol. This finding suggests that the progression of use is not unique to alcohol use or cannabis use.
The study also revealed that the first substance used, cannabis for AAs and alcohol for EAs, was the substance that produced the most negative symptoms over time. Also, individuals who reported using only one substance had the fewest symptoms. This indicates that women who use more than one substance are at increased risk for negative outcomes. Finally, CSA was linked to cannabis use but not alcohol use as it related to eventual misuse. In conclusion, Sartor believes that the gateway theory may not be universal, and should be viewed in light of ethnic and cultural differences. She added, “Prevention programs should be tailored to the various patterns of cannabis use and relative contributions of risk factors to the development of cannabis-related problems in different ethnic groups.”
Sartor, C. E., et al. (2013). Cannabis or alcohol first? Differences by ethnicity and in risk for rapid progression to cannabis-related problems in women. Psychological Medicine 43.4 (2013): 813-23. ProQuest. Web.
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