Individual Characteristics And The Gateway Hypothesis Among Drug User Patient In Indonesia

Drug abuse has become severe not just in the world but also in Indonesia. To address this problem, public policies and researcher try to understand the drug use pattern. One of the famous concept in drug use pattern is gatheway hypothesis. The gateway hypothesis refers to the pattern of substance use initiate softer drug lead to the harder drug. However, many literature shows drug use pattern is not just gateway pattern, there is reversal pattern and using both gateway and reversal pattern. Many studies have discussed the relationship between drug use and individual characteristics. However, few of them are relatively link between individual characteristics and the sequential order in drug use. The purpose of this study is to evaluate how individual characteristics are associated with the gateway pattern and other pattern for different types of drugs. We use a secondary dataset of individual drug user patients from the Rehabilitation Center of National Narcotics Board aged 14–67 years assessed using the Addiction Severity Index (ASI), employing probit and multinominal logit model. Duration are associated with initial soft drug user with gateway pattern. While alcohol use and have high education level related with initial hard drug user with reversal pattern. Interestingly, duration and alcohol use correlated with initial intermediate drug user with all kind of pattern. Prevention and intervention efforts should be targeting high-risk characteristics of people at an initial stage of drug use and progression to the next stage.

EXAMINING THE GATEWAY HYPOTHESIS OF DRUG USE IN INDONESIA

Background: Drug misuse is a global threat, including in Indonesia. Solving issues of drug use is by understanding the drug patterns. One of the important concepts related to public policy in drug addiction is the gateway hypothesis. However, not all researchers support this theory as the initation of drug use is debatable in terms of how a person starts to consume tobacco and alcohol, marijuana, and then other drugs.Aim: This study identified a initiation sequence of drug use, particularly the gateway from soft to hard drugs and its reverse from hard to soft drug patterns.Methods: This study employed a dataset of drug user patients aged 14–67 years from the Rehabilitation Center of National Narcotics Board in 2014-2018. The dataset was assessed using the Addiction Severity Index (ASI). Purposive sampling was utilized in the sample selection. The dataset was divided into three subsamples to identify the pattern. The subsamples included regular soft-drug users, regular intermediate-drug users, and regular hard-drug users. This study used a quantitative method and cross-tabulation approach along with descriptive statistics.Results: Most of the drug users began consuming intermediate drugs and then soft drugs. Only early users followed the gateway pattern, while those in the intermediate and hard drug pattern mostly did not have the gateway pattern.Conclusion: A policy about prevention of soft drug use (marijuana) in early use may be effective to reduce harder drug use in the future.Keywords: drug use, gateway hypothesis, reversal pattern

Evidence for Causal Effects of Smoking Initiation and Alcohol Consumption on Substance Use Outcomes

Background and AimsThe ‘gateway’ hypothesis proposes that initial use of drugs such as tobacco and alcohol can lead to subsequent more problematic drug use. However, it is unclear whether true casual pathways exist, or whether there is instead a shared underlying risk factor. We used bidirectional Mendelian Randomisation (MR) to test these two competing hypotheses.MethodsWe conducted two-sample MR analyses, using genome-wide association data for smoking initiation, alcoholic drinks per week, cannabis use and dependence, cocaine and opioid dependence. We used several MR methods that rely on different assumptions: inverse-variance weighted (IVW), MR-Egger, weighted median, simple mode and weighted mode. Consistent results across these methods would support stronger inference.ResultsWe found evidence of causal effects from smoking initiation to increased drinks per week (IVW: β=0.06; 95% CI 0.03 to 0.09; p-value=9.44×10-06), cannabis use (IVW: OR=1.34; 95% CI 1.24 to 1.44; p-value=1.95×10-14), and cannabis dependence (IVW: OR=1.68; 95% CI 1.12 to 2.51; p-value=0.01). We also found evidence of an effect of cannabis use on increased likelihood of smoking initiation (IVW: OR=1.39; 95% CI=1.08 to 1.80; p-value=0.01). We did not find evidence of an effect of drinks per week on substance use outcomes, except for weak evidence of an effect on cannabis use. We also found evidence of an effect of opioid dependence on increased drinks per week (IVW: β=0.002; 95% CI=0.0005 to 0.003; p-value=8.61×10-03).ConclusionsOverall, we found evidence suggesting a causal pathway from smoking initiation to alcohol consumption, and both cannabis use and dependence, which may support the gateway hypothesis. However, we also found causal effects of cannabis use on smoking initiation, and opioid dependence on alcohol consumption, which suggests the existence of a shared risk factor. Further research should explore whether this is the case, and in particular the nature of any shared risk factors.

Testing the Role of Δ9-Tetrahydrocannabinol During Adolescence as a Gateway Drug: Behavioural, Brain Imaging and Transcriptomic Studies

ABSTRACTCannabis is widely consumed by adolescents, and is also a potential prior step leading to the use of other drugs later in life (Gateway Hypothesis); however, the evidence for this hypothesis is controversial. This work aimed to increase our understanding of the long-term consequences of adolescent exposure to Δ9-tetrahydrocannabinol (THC) and to test the Gateway Hypothesis, experimentally. We exposed rats of both sexes to THC and studied its effects on reward-related processes, brain morphology (MRI), metabolism (1H-MRS), function (PET) and the transcriptomic profiles of the nucleus accumbens (RNASeq). Lastly, we studied cocaine-induced cellular activation (c-Fos) and cocaine addiction-like behaviours. THC exposure increased Pavlovian to instrumental transfer in males, goal-tracking (regardless of the sex) and impulsivity, but did not affect habit formation. Adolescent THC reduced striatal volume (in females), commissural integrity and ventricular volume. Also, there were lower levels of choline compounds in the cortex of THC-exposed rats and cerebellar hypoactivation in THC-females. THC also modified some of the gene expression programs of the nucleus accumbens, which could contribute to the behavioural features observed. Lastly, THC exposure increased cocaine-induced c-Fos levels in cortical and hypothalamic areas and increased the motivation for cocaine, followed by a higher rebound of use in THC-females after reestablishing low-effort conditions. Critically, acquisition of cocaine self-administration, compulsive seeking, intake under extended access or the incubation of seeking were unaltered. These results suggest that adolescent THC exposure alters psychological and brain development and that the Gateway Hypothesis does not entirely pass the test of preclinical enquiry.