Cigarette Smoking Initiation among Substance Abuse Treatment Population: How applicable is the Gateway Hypothesis?

Background: Cigarette smoking has been considered a gateway to subsequent, and often, co-occurring usage of other licit or illicit substances in the general population. However, significant deviations from this typical pattern of progression have been observed among substance abusers. Moreover, progression patterns may differ by demographics and substance abuse-related risk factors. Objectives: This research examines the patterns of cigarette smoking initiation among substance abusers; and explores the correlates of cigarette smoking with demographic and other substance abuse-related factors with different patterns of cigarette smoking initiation in the substance abuse treatment population. Methods: The sample was comprised of 1,179 substance abuse clients, who received publicly-funded treatment in Tennessee. Data were collected from the clients at intake and six-months post intake. Results: A significant proportion of clients reported cigarette smoking (82%). Only 34% clients reported typical progression patterns (i.e. cigarette as a gateway substance). Others reported deviations in smoking progression patterns with 48% atypical progression ? cigarette smoking initiated post substance use, and 18% reporting as neversmokers. African Americans and college-educated participants were more likely to be atypical progressors or never-smokers. Marijuana users were more likely to be atypical progressors. Also, those who initiated licit or illicit drug use at an earlier age were more likely to be either atypical progressors or never-smokers. Conclusions: While the Gateway Hypothesis (GH) still holds for about a third of this population, these results suggest that it is insufficient in explaining cigarette smoking initiation among problematic substance users. In addition, the high prevalence of cigarette smoking in this population suggests the need for tobacco cessation efforts, alongside substance abuse treatment. In addition, the development of tailored preventative programs for those at greatest risk is needed to ward off gateway substances preceding problematic illicit drug abuse.