"This study--the most comprehensive national assessment ever undertaken--reveals a consistent and powerful connection between the use of cigarettes and alcohol and the subsequent use of marijuana, and between the use of cigarettes, alcohol and marijuana and the subsequent use of cocaine and other illicit drugs," said Joseph A. Califano, Jr., CASA's president and former HEW secretary.
"An increasing number of American children and teens believe there is little risk in chugging a beer or smoking a tobacco or marijuana cigarette. With the recently reported rise in drinking and using marijuana by children and teenagers, this report is a wake-up call for parents to discourage their children from smoking and drinking and for governors and mayors to enforce the laws prohibiting the sale of cigarettes, beer, wine coolers and other alcoholic beverages to minors," he said.
The CASA study establishes a clear progression that begins with gateway drugs and leads to cocaine use: nearly 90 percent of people who have ever tried cocaine used all three gateway substances first. More than half followed a progression from cigarettes to alcohol to marijuana and then on to cocaine.
The CASA study also concludes that the earlier a child starts to use these gateway drugs, and the more frequently, the greater the likelihood of using hard drugs. For example, children who smoke daily are 13 times more likely to use heroin than children who smoke less often.
The study is the most comprehensive to date using national data that looks at both children and adults and all gateway substances. The research is based on the 1991 National Household Survey on Drug Abuse conducted by the National Institute on Drug Abuse.
"No matter how we looked at the numbers, whether the user was white, black, male or female, the statistical connection between smoking, drinking or using marijuana and subsequent illicit drug use is clear," said Califano.
CASA's analysis reveals:
The CASA study also links the use of gateway drugs by children with subsequent regular use of illicit substances as adults:
Califano noted that the study finds a far more compelling relationship between the use of gateway drugs and subsequent use of cocaine and other illicit drugs than the 1964 Surgeon General's report found between smoking and lung cancer, the 1968 Framingham study found between cholesterol and heart disease, and the 1981 Selikoff study found between asbestos and lung cancer. "Each of those studies led not only to major investments in biomedical research, but to major changes in personal conduct among millions of Americans," said Califano.
Despite the illegal status of cigarettes, alcohol and marijuana for children, use of these gateway drugs by underage youth is widespread. It has been estimated that 3,000 young people in the U.S. become regular smokers every day. In 1993, 19.0 percent of seniors, 14.2 percent of tenth-graders and 8.3 percent of eighth-graders smoked cigarettes daily, up from 17.2 percent, 12.3 percent and 7.0 percent respectively in 1992. Marijuana use increased from 11.2 percent in 1992 to 12.6 percent in 1993 among eighth-graders; from 21.4 percent to 24.4 percent among tenth-graders; and from 32.6 percent to 35.3 percent among seniors. Recent studies show that 67 percent of eighth-graders, 81 percent of tenth-graders and 87 percent of twelfth-graders have tired alcohol.
"Ultimately, prevention is our only hope for stemming the tide of new addicts. If we can keep our children and teens from smoking, drinking and using marijuana, then we can go a long way towards preventing the use of all dangerous drugs," said Califano.
The study was conducted under the direction of Jeffrey C. Merrill, vice president for policy and research.