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The Cycle of Addiction: Evaluating the Legitimacy of Gateway Theory

“If you use marijuana, you will end up using more dangerous drugs.”

This is a phrase commonly heard when people talk about substance use problems and how they develop. The notion that the use of a substance viewed as less harmful will lead to the use of harder, more addictive substances is known as the Gateway Theory or the Gateway Effect. Caffeine, nicotine, marijuana, and alcohol are among those most commonly labeled as “gateway drugs.”

The Gateway Theory does have merit overall, but substance abuse issues are complicated, varying with each individual. There are contradictions to the theory, such as persons who have difficulty with prescription opiates, but who have never had smoking or drinking problems. Also, many people use caffeine, nicotine, alcohol, THC (the active component in marijuana), and prescription medications and never develop problems or progress to more potent substances.

Is it possible to avoid substance abuse problems by avoiding gateway drugs? Unfortunately, it’s not that simple. It’s not the drug that matters so much as the effect that the drug has on a person, what the person believes about that effect, and how their decision-making is influenced by their beliefs. People are also influenced by social and cultural beliefs instilled through families, friends, and schools, etc., that tell them how to behave in order to be accepted.

Decision-making plays an important role. One approach proposes decision-making as an “inside job” influenced by our beliefs, and posits that we constantly revise our beliefs to fit with what our experiences telling us. For example, humans have an inherent need to be “part of” something – to share experiences. It’s the basic “herding instinct” we possess that motivates us to seek interactions and relationships with other humans. So, if someone believes that using alcohol will help them fit in with a particular group of people, then that belief influences that person’s decision-making when they are with that group of people. It doesn’t matter if the belief is accurate or not: It will be acted upon until sufficiently proven wrong. Furthermore, if that person feels accepted into the group, whether it had to do with drinking or not, the idea that they were accepted because of drinking may become solidified and have an even more pronounced effect on future decision-making.

It’s also about brain chemistry. Nicotine, for instance, promotes the release of dopamine, a neurotransmitter released with activities related to survival (e.g., eating and sex). Dopamine is powerful motivation for the continuation of nicotine use because it calms and stimulates simultaneously. Through this experience, one might say, “When I smoke, I am calm, focused, and alert and I get a lot done.” The person might combine this belief with a common social belief that success is measured through accomplishment. This pairing creates a strong influence on whether that person makes the decision to continue using nicotine or not. Also, when nicotine is processed through the body, the result is a feeling of lethargy combined with restlessness – a not so desirable outcome. Eventually, the person may start to believe they cannot function properly without nicotine because it continually takes higher doses of nicotine to induce the desired effect. The person might say to him/herself, “Nicotine isn’t working like it used to any longer. I need something stronger.” The person’s decision-making is different than it was before because it is skewed by the new beliefs that nicotine has saddled them with, not to mention the physical need felt through the withdrawal from it. That person might then make the decision to seek out a more powerful substance.

The assumption is that this process could lead to experimentation with marijuana as a replacement, for example. Marijuana contains THC, which releases a higher amount of dopamine in the brain, creating euphoria in the user. The person again revises their beliefs followed by new decision-making patterns that could lead to trying even more powerful substances.

Any abusable substance or behavior could be plugged into this process – things such as exercise, food, sex, thrill-seeking, gaming, or even work – because everything we do elicits a chemical response in our brains.

Avoiding “gateway drugs” is not a bad idea, but it is even more important to avoid “gateway beliefs.” One needs to pay attention to the underlying motivations that influence the decision to use substances in the first place.

Couples & Family Therapy

RTCC counselors can provide Fort Collins mental health services to address communication issues and conflict management with couples and families. Emotionally Focused techniques, the theory of Virginia Satir, Structural Family Theory, Adlerian, and Gottman Method Couple’s Therapy are employed by our counselors to help clients through their difficulties. For most people in a relationship, conflict is an expected part of the dynamics between two people as their relationship evolves. Examining communication patterns which work, as well as those that do not work or harm the relationship can be essential to the survival of the couple. Managing conflict is one of the keys to a successful relationship as is recognition of destructive influences. Exploration of the couple’s communication patterns, working towards mutual goals, and creating a shared meaning are all essential to the health of the relationship. RTCC counselors have experience in working with couples who are non-traditional as well as traditional and we welcome couples from any nationality or orientation.


Recovery from trauma is a complicated process which can cause many people to feel overwhelmed, disconnected, isolated and helpless as they try to come to terms with their traumatic experience. For some, hyper-vigilance, flashbacks, nightmares, and avoidance of certain situations are a direct result of the trauma. Recovery can be even more complex if the traumatic experience happened in childhood. It is imperative that clients have a safe, trusting and supportive environment in which to work through their trauma. RTCC counselors endeavor to create optimally therapeutic relationships with their clients and employ a variety of techniques to instill hope for the client and to empower him or her on the path to recovery.  Our counselors utilize a comprehensive array of approaches such as Cognitive Behavioral Therapy, emotion regulation, stress management techniques, self-soothing, grounding, and mindfulness, to help clients with the healing and recovery process.


For clients who experience anxiety, life can be a troublesome and turmoil-filled experience. Anxiety can be experienced in a number of ways: Generalized Anxiety (constant fears or worries as you go through the day), Panic Attacks (an unexpected occurrence), Phobias (an unrealistic fear of an activity, situation, or object), Social Anxiety (unease about being in social situations or what others might be thinking about you), and Post-traumatic Stress Disorder (PTSD). PTSD occurs in the wake of traumatic or life-threatening event and can often include flashbacks or night terrors. People who suffer from PTSD often fall prey to substance use disorders in order to cope with their symptoms.

An anxiety attack can be a traumatizing experience in itself, causing worry or apprehension of the next attack. RTCC counselors will compassionately assist clients with their anxiety and encourage them to utilize relaxation and stress management techniques, recognize the importance of self-care, build confidence and self-esteem, and practice mindfulness and emotional regulation. Exploration of the roots of the anxiety will also be incorporated into treatment in order raise awareness and, hopefully, normalize the presenting situation. The counseling approach will be to focus on the ability to utilize coping skills in the moment to manage the symptoms of the anxiety.


According to recent National Institute of Mental Health statistics, 17% of the population will experience major depression during their life time. For many people, depression is situational and can be addressed with brief therapy; however, for others it can be an ongoing struggle requiring longer term care and support. RTCC counselors utilize a holistic approach to address a client’s struggle with depression, whether it is situational or clinical, including discussions about meaning making, gender issues, societal influences, diet and exercise, supplements, spirituality, and family of origin concerns.

Persons who are prescribed medications for depression are often saddled with the task of monitoring the continued effectiveness of those medications. The patience and persistence required of a depressed person as they go through the process of finding the right medication with their psychiatrist or doctor can, and often does, exacerbate the depression. RTTC can provide support and encouragement as the person endeavors to address their depression with the correct medication.

Aftercare Support

RTCC counselors recognize that clients who have completed a Residential Treatment Program or Intensive Outpatient Program for substance abuse issues are extremely vulnerable to relapse. Clients will benefit with support to create a comprehensive support system including recovery support groups, referrals to other medical and community services, and individual therapy with a therapist familiar with addiction and recovery. With this in mind, RTCC counselors provide a comprehensive program of services to assist the client with the transition back into “everyday life.” Entering a new life after treatment can be frightening and overwhelming. When a person is in a fearful state, he/she is less likely to make recovery sustaining decisions. We will look at things from a “challenge vs. support” lens to help the client learn to hold themselves accountable, to utilize the coping strategies they have learned from their treatment experience, and also add “tools” to their tool box.

The family system is highly valuable to the client in recovery as their inner circle of support. RTCC counselors provide family and couple therapy specific to clients seeking recovery to help those close to the client to tease out the subtle differences between supportive and enabling behaviors. Clients are encouraged to continue to build a circle of support outside of the family which is also an important part of the process of recovery.

Co-occurring Disorders

Many clients who face difficulties with substance use also have an underlying mental health concern such as depression, anxiety, bi-polar disorder, trauma, or ADHD. RTCC counselors recognize the importance of assessing each client for these underlying concerns and treating the issues concurrently. With compassion and encouragement, we utilize a strengths based, cognitive behavioral perspective to explore how thinking patterns can get in the way of recovery from depression and anxiety as well as cause people to utilize substances as a way to manage their symptoms.

Substance Abuse

RTCC counselors utilize Motivational Interviewing and strengths-based techniques to serve our clients with substance abuse issues. We provide a safe, supportive environment in which our clients can talk about their substance concerns and explore their willingness to make change from a biopsychosocial perspective. We recognize that each person’s path through the change process is unique and we will draw from other perspectives such as Cognitive Behavioral Therapy, Narrative Therapy, Reality Therapy, Solution Focused Brief Therapy, and Dialectical Behavior Therapy as needed to assist our clients with their goals.

Often times, substance abuse issues are experienced with an array of other co-occurring disorders such as anxiety, depression, trauma, and/or grief and loss. Our counselors are well equipped to create a positive therapeutic alliance with our clients in order to provide treatment to the “whole” person.

R-BIBSI Biopsychosocial Assessment

The purpose of this mixed-methods applied study was to develop a reliable, valid, and clinically useful brief integrative biopsychosocial assessment screening instrument (R-BIBSI) to investigate influences of alcohol abuse and dependence in college age students. The R-BIBSI is a 30-item, non-diagnostic, brief screening tool developed to aid drug and alcohol treatment professionals in treatment planning for persons experiencing substance abuse or dependence. The R-BIBSI is easily be scored by clinical or non-clinical staff to assess six constructs of alcohol use influence: Biological Influence, Psychological Internally Expressed Influence, Psychological Externally Expressed Influence, Social Family Influence, Social Peer/Work Environmental Influence, and Social Cultural Influence. Item reduction processes included a think-aloud form of cognitive interviewing, predictive validity testing utilizing independent samples t-test, and exploratory factor analysis. Validation and reliability testing for the BIBSI field-test utilized a convenience sample of 63 college age students.

Biopsychosocial Assessment

The R-BIBSI can be an extremely useful tool, especially for raising awareness of a client’s biopsychosocial influences to help guide the therapeutic conversation. The R-BIBSI can also be utilized as a valuable method for addiction counselor training.

Please contact me for more information on access and utilization of the R-BIBSI.