Nicotine Gateway Effects on Adolescent Substance Use

Abstract

Given the rise in teenage use of electronic nicotine delivery systems ("vaping") in congruence with the increasing numbers of drug-related emergencies, it is critical to expand the knowledge of the physical and behavioral risks associated with developmental nicotine exposure. A further understanding of the molecular and neurochemical underpinnings of nicotine's gateway effects allows emergency clinicians to advise patients and families and adjust treatment accordingly, which may minimize the use of tobacco, nicotine, and future substances. Currently, the growing use of tobacco products and electronic cigarettes among teenagers represents a major public health concern. Adolescent exposure to tobacco or nicotine can lead to subsequent abuse of nicotine and other substances, which is known as the gateway hypothesis. Adolescence is a developmentally sensitive time period when risktaking behaviors, such as sensation seeking and drug experimentation, often begin. These hallmark behaviors of adolescence are largely due to maturational changes in the brain. The developing brain is particularly vulnerable to the harmful effects of drugs of abuse, including tobacco and nicotine products, which activate nicotinic acetylcholine receptors (nAChRs). Disruption of nAChR development with early nicotine use may influence the function and pharmacology of the receptor subunits and alter the release of reward-related neurotransmitters, including acetylcholine, dopamine, GABA, serotonin, and glutamate. In this review, we emphasize that the effects of nicotine are highly dependent on timing of exposure, with a dynamic interaction of nAChRs with dopaminergic, endocannabinoid, and opioidergic systems to enhance general drug reward and reinforcement. We analyzed available literature regarding adolescent substance use and nicotine's impact on the developing brain and behavior using the electronic databases of PubMed and Google Scholar for articles published in English between January 1968 and November 2018. We present a large collection of clinical and preclinical evidence that adolescent nicotine exposure influences long-term molecular, biochemical, and functional changes in the brain that encourage subsequent drug abuse. [West J Emerg Med. 2019;20(5)696-709.] examined in a recent study (2015), which reported that 38.8 percent of adolescents initiate nicotine before alcohol and/ or marijuana, while 21.3 percent use alcohol prior to nicotine and/or marijuana, and 8.6 percent use marijuana before nicotine and/or alcohol. 23 Although previous reports highlight that the rates of cigarette smoking are decreasing in the United States (U.S.), from 20.9 percent in 2005 to 15.5 percent in 2016, current trends in teen use of electronic nicotine delivery systems (e.g., e-cigarettes, vaporizers, hookah pens) are rapidly increasing. 24-26 In particular, the rate of current e-cigarette use in high school students jumped from 1.5 percent in 2011

E-Cigarette-Only and Dual Use among Adolescents in Ireland: Emerging Behaviours with Different Risk Profiles

“…If e-cigarettes are being used in settings where smoking is prohibited, this may increase cumulative nicotine exposure and the associated adverse effects. It is possible that dual-use may represent a transition to tobacco product use, a process known as the gateway effect, and longitudinal evidence for this effect is mounting [ 36 , 37 ].…”

Bullying and Substance Use in Early Adolescence: Investigating the Longitudinal and Reciprocal Effects Over 3 Years Using the Random Intercept Cross-Lagged Panel Model

“…Another common health-risk behavior is substance use, which includes cigarette smoking, alcohol consumption, and other forms of illicit drug use (e.g., cannabis, ecstasy, cocaine). Several studies ( Radliff et al, 2012 ; Durand et al, 2013 ) indicated that substance use normally begins in adolescence, with cigarette smoking and alcohol consumption as the gateway to other forms of illicit drug use in subsequent years ( Ren and Lotfipour, 2019 ). The Health Behavior in School-aged Children study on substance use ( Inchley et al, 2020 ) reported a prevalence of alcohol consumption of 20% in boys and 18% in girls and a prevalence of cigarette smoking of 7% in both genders, when assessed for the last 30 days.…”

Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study

“… 15 16 A major concern regarding e-cigarettes is that they also seem to appeal to non-smoking teenagers 17 18 and might serve as a gateway to initiation of tobacco smoking as well as other drugs. 11 17 19 However, another explanation for the association between e-cigarette use and tobacco smoking may be that these behaviours share many risk factors such as social disadvantage, addictive behaviours, low academic achievement, and having family members or friends that smoke. 20–24 These shared characteristics may serve as a common liability for any tobacco or nicotine product, 25 26 which implies that the sequential order of product initiation is of less importance.…”