title: Common liability to addiction and "gateway hypothesis": theoretical, empirical and evolutionary perspective.
abstract: BACKGROUND
  Two competing concepts address the development of involvement with psychoactive substances: the "gateway hypothesis" (GH) and common liability to addiction (CLA).
  
  
  METHODS
  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.
authors.affiliation: Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA. mmv@pitt.edu
authors.forename: Michael M
authors.initials: MM
authors.lastname: Vanyukov
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Tarter
authors.forename: Galina P
authors.initials: GP
authors.lastname: Kirillova
authors.forename: Levent
authors.initials: L
authors.lastname: Kirisci
authors.forename: Maureen D
authors.initials: MD
authors.lastname: Reynolds
authors.forename: Mary Jeanne
authors.initials: MJ
authors.lastname: Kreek
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Conway
authors.forename: Brion S
authors.initials: BS
authors.lastname: Maher
authors.forename: William G
authors.initials: WG
authors.lastname: Iacono
authors.forename: Laura
authors.initials: L
authors.lastname: Bierut
authors.forename: Michael C
authors.initials: MC
authors.lastname: Neale
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Clark
authors.forename: Ty A
authors.initials: TA
authors.lastname: Ridenour
mesh_terms: D016739:Behavior, Addictive / Q000209:etiology*; D005075:Biological Evolution; D015984:Causality; D020022:Genetic Predisposition to Disease; D006801:Humans; D012306:Risk; D012931:Social Environment; D019966:Substance-Related Disorders / Q000209:etiology* / Q000503:physiopathology