Common liability to addiction and "gateway hypothesis": Theoretical, empirical and evolutionary perspective

Michael M. Vanyukov, Ralph E. Tarter, Galina P. Kirillova, Levent Kirisci, Maureen D. Reynolds, Mary Jeanne Kreek, Kevin P. Conway, Brion S. Maher, William G. Iacono, Laura Bierut, Michael C. Neale, Duncan B. Clark, Ty A. Ridenour

Research output: Contribution to journalReview articlepeer-review

201 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)S3-S17
JournalDrug and alcohol dependence
Issue numberSUPPL.1
StatePublished - Jun 2012


  • Drug abuse
  • Drug dependence
  • Evolution
  • Genetics
  • Phenotype

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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