The use and abuse of drugs has been an omnipresent concept in our pop culture, history, politics, social culture, personal discovery, and more. Whether we’re talking about smoking a joint or having a “rager”, at the end of the discussion, we are all partaking in the ‘drug culture’. At least that is what it seems like to the general public.

As someone who has participated in the abuse of drugs during the peak rebellious years of anyone’s life; I can tell you that there is a huge difference between using and abusing drugs. The reason I began using drugs was for fun, to be included with college seniors, to feel young, and to feel like any other teen at my age. What began as a fun, once in a while thing turned into a defining factor of my social personality and inner personality too. My name was associated and influenced by drugs and so was my inner monologue. I found myself thinking and reminiscing about the craziness of the sessions and parties I attended. My reality, whether it was sitting in class or drinking with friends, became dulled down. Nothing brought me joy or even the slightest bit of excitement except the idea of doing drugs next. What I know now is that the main problem was the fact that my reason for doing drugs slowly shifted; what began as a fun thing became an escape. It became my safe haven, creating dependency and attachment rather than remaining as an occasional thing.This is where the issue begins; the reason behind why you are taking any drug.

The demonization and degradation of substances has surpassed unimagined levels which has begun overshadowing their potential and proven beneficial gifts to society. Over the years, the researchers, scientists, doctors, and theorists who have dared to experiment with substances in the treatment of certain mental illnesses and disorders have embarked on breakthrough journeys and realizations that have helped improve the aid that mental health professionals can provide to their patients.

But it has been extremely difficult to legalize or even normalize the use of such substances, and the term that we often hear about the least harmful drug – marijuana – is ‘gateway drug’. But, who decides such a general term on such a diverse individual experience? The stories that are woven around marijuana use are an amalgamation of fear, apprehension, joy, uncontrollable laughter, communityhood, friendships, and so much more.

The term ‘gateway drug’ has tinted and ruined the relationship marijuana has with society, but not the one it has with each individual. The ones who smoke know that the mental dependency is something to look out for, but the peace it brings along with it helps some maintain their ground.

But to truly understand how we perceive substances and how it affects our usage and ideas surrounding it, let’s talk about the gateway hypothesis.

The concept of “gateway hypothesis” has been studied since the 1970s as the theory suggests that an adolescent’s early experimentation with alcohol or tobacco or cannabis escalates to more addictive illicit drugs later in adulthood. Most commonly used illicit substances include heroin/opioids, cocaine and or amphetamines and their designer drug analogs, considered illegal by the criminal justice system in the United States and other jurisdictions. Early onset or drug experimentation has been elaborated and characterized in distinct pathways in the substance abuse and dependence literature. Overall, the theory has had mixed results showing both a link or sequence of licit drug use to illicit drug use and no association.

Although the concept has also been a subject of considerable scholarly and political discourse in western societies, a review of the literature often shows less consensus on research and policy relevance among investigators. 

An earlier series of studies among adolescents showed the existence of a significant and a clearly defined sequence of drug use onset starting with licit substances (alcohol, cigarette) and progression to illicit drugs (cocaine, marijuana, methamphetamine, and heroin) through adulthood. Recently, Kandel and Kandel, have demonstrated the GH with animal studies and their findings showed that use of one drug enhances effects of the other drugs — a process hypothesized as due to the priming of the neural circuitry of the brain. Fergusson et al. (2006) analyzed a population-based data on cannabis use and progression to other illicit drugs among a 25-year longitudinal study of 1265 birth cohorts from Christchurch, New Zealand. 

The investigators found strong evidence for a causal model of GH, in which earlier use of cannabis was hypothesized as causing increased use of other illicit drugs. In addition, numerous prior studies have failed to disconfirm causal links of gateway effects in human populations. 

However, a cross-country comparison of the GH by Degenhardt et al.found background prevalence of the gateway drugs or their availability as the major driving factor for drug use progression across countries analyzed. Another study analyzing a sample of adolescents from South Florida showed that marijuana gateway effect is contingent on the context of age.

In spite of these, it is still unclear the extent to which a cohort of adolescents at different developmental stages experience gateway drug use (tobacco, alcohol, marijuana) as determinants of later illicit drug use during and prior to adulthood.

While addressing the various causal effects of substances, we only address the choices that we choose to make. But what about the choices that we don’t choose? 

We often tend to ignore the fact that certain individuals are genetically predisposed to forming addiction and/or dependency and this is something that no one can control unless the right stimulus elicits the required response. 

To truly understand addiction, one needs to understand that no matter how much we might believe that we have complete voluntary control of our body and mind, sometimes it feels like we don’t. Especially in moments where one finds themselves going back to a habit or thing that they are trying to run away from.

Since everything is portrayed as a rational choice, it is very hard for people to accept that one does not choose addiction. It is a slow process that happens behind closed doors of your mind and gets you hooked until it’s too late for you to realize the sudden significance of that substance in your life.

Shame is a very common and troubling emotion that one feels while battling addiction; shame about the act, shame about their ‘weakness’, shame about the gossip, and the list goes on and on. This shame cages the individual and makes them too apprehensive to seek help which simply worsens their situation.

We need to work at subduing the presence of shame in open and honest conversations about addiction to let true emotions flow. To create a rapport, a safe space, a non-judgemental space, and a caring space to truly battle addiction.

The reason people tend to lapse is due to the simple fact that they have seen such beautiful moments in their life on substances that reality seems dull and unwanted. Their perception of reality is changed and dulled down, and well, nothing seems like a better escape than going back into the high.

Environmental variables, such as stress, appear to produce epigenetic alterations that can lead to the development of psychiatric illnesses and drug addiction, according to mounting research. Epigenetic modifications are gene expression regulations that do not require changes in the sequence of the genetic material (DNA). In practise, epigenetic modifications are information that is added to existing genetic material yet can influence gene expression. 

Most data reveals that early use of psychoactive substances is associated with increased likelihood of using further illicit substances during adolescent period, but effects of these substances on later illicit drug use are inconsistent. However, early use of marijuana also appears to more readily ‘open the gate’ towards later use of other illicit substances.

Now that we have analyzed and studied the data that has been presented to us via various sources and studies, we have to begin asking our own questions and building answers from the experiences that we encounter. A crucial piece of all this, that is most pertinent to therapist practitioners is holding space for trauma that is present underneath the ways in which drugs support or further exacerbate trauma experiences. While genetics can make and redesign our experience, our intergenerational environments are cause for our bodies and psyches to experience drugs in ways that help or devolve our sense of selves. Holding space for trauma sensitive work and working with trauma itself then becomes an important process of therapy.

Our aim as mental health professionals is to maintain a sense of honesty and clarity while presenting any information, and it needs to be informed by discourses that can hold space for people’s pain and center change that systems as a whole can make for us all.