1. The Dangers of Nicotine: Pathway to Addiction? Module 9 Assignment ADC 655 Wade A. Wilkins Aspen University December 21, 2015

2. Some cold, hard facts about Nicotine. According to the World Health Organization over one billion people world wide use nicotine in some form (Tobacco 2015) According to a United Nations Report 246 million people world wide have used an illicit drug with 27 million of them being problem users (United Nations Office on Drugs and Crime 2015). World wide there were six million deaths attributed to nicotine in a years time (Tobacco2015) where there were only 187,100 drug-related deaths (United Nations Office on Drugs and Crime 2015).

3. Gateway Drug Theory? States that use of less deleterious drugs precedes, and can lead to, future use of more dangerous hard drugs. (Gateway Drug Theory 2015) Less dangerous> > > >More Dangerous

4. Those that oppose this theory point out these weaknesses. Does not specify mechanistic connections between “stages” Does not extend to the risks for addictions (Vanyukov, etal 2012)

5. Some points of opposition to this theory. Examples of Alternative Causal Pathways Social LearningSocial Exposure Genetics

6. The argument. If you have a cause there must be an effect to prove that a substance was a gateway. If you reverse this you should come to a reverse conclusion that the effect had a cause. The argument is that many times the effect does not have the same cause.

7. What those that support Gateway Theory have to say. “[t]he notion of developmental stages in drug behavior does not imply, however, that these stages are either obligatory or universal, nor that all persons must progress through each in turn” (Vanyukov, etal 2012 p. S5)

8. What the Studies Show Youth that used alcohol and tobacco both progressed to harder drugs. Youth using tobacco alone progressed to harder drugs. Depression in youth may be cause of tobacco use (Torabi, etal 2010)

9. Studies show link between smoking and drinking Animal studies show a link between nicotine use and alcohol abuse. Nicotine and Alcohol effect the same area of the reward circuits of the brain (Lea˜o etal 2014)

10. Link Between Nicotine and Cocaine Animal studies show that the same areas of the reward system of the brain are activated by both Nicotine and Cocaine. (Kandel & Kandel 2014)

11. Other Animal Studies Study done by Mao etal Changes noticed in reward center of brain due to nicotine. Noted that “Our findings are consistent with the reported synaptic changes associated with cocaine exposure.”

12. More Studies Nicotine has been found to lead to stimulant addiction. (Weinberger and Sofuoglu 2014) Nicotine use has been associated with greater severity of cocaine use which is associated with greater neuropsychological impairments Human studies examining the effect of administered nicotine on cocaine variables have suggested that nicotine may increase cravings for cocaine

13. Summary Whether you are an opponent or a proponent of Gateway Theory there is still something both sides can learn from it if an open mind is kept. From this theory have come new implications for treatment of addictions. If it is continued to be built upon it will lead to future directions in treatment.

14. Conclusions Early exposure to nicotine influences the development of stimulant addiction and smokers with co-morbid drug use have more severe stimulant use and may be more treatment resistant.

15. References Gateway Drug Theory. (2015, October 30). Retrieved November 29, 2015, from https://en.wikipedia.org/wiki/Gateway_drug_theory Kandel, E. R., & Kandel, D. B. (2014). Shattuck lecture: A molecular basis for nicotine as a gateway drug. The New England Journal of Medicine, 371(10), 932-43. Retrieved from http://search.proquest.com/docview/1560163714?accountid=34574 Leao, R., Cruz, F., Vendruscolo, L., Guglielmo, G., Logrip, M., Planeta, C.,... George, O. (2015). Chronic Nicotine Activates Stress/Reward-Related Brain Regions and Facilitates the Transition to Compulsive Alcohol Drinking. Journal of Neuroscience, 6241-6253. Li, H., Bu, Q., Chen, B., Shao, X., Hu, Z., Deng, P.,... Cen, X. (2014). Mechanisms of metabonomic for a gateway drug: Nicotine priming enhances behavioral response to cocaine with modification in energy metabolism andneurotransmitter level. PLoS One, 9(1) doi:http://dx.doi.org/10.1371/journal.pone.0087040

16. References Continued Mao, D., Gallagher, K., & Mcgehee, D. (2011). Nicotine Potentiation of Excitatory Inputs to Ventral Tegmental Area Dopamine Neurons. Journal of Neuroscience, 6710-6720. Phillips, C. V. (2015). Gateway effects: Why the cited evidence does not support their existence for low-risk tobacco products (and what evidence would). International Journal of Environmental Research and Public Health, 12(5), 5439-5464. Retrieved from http://search.proquest.com/docview/1686488911?accountid=34574 Tobacco. (2015, July 6). Retrieved November 29, 2015, from http://www.who.int/mediacentre/factsheets/fs339/en/ Torabi, M. R., Jun, M. K., Nowicke, C., de Martinez, B. S., & Gassman, R. (2010). Tobacco, the common enemy and a gateway drug: Policy implications. The ICHPER-SD Journal of Research In Health, Physical Education, Recreation, Sport & Dance, 5(1), 37-44. Retrieved from http://search.proquest.com/docview/814389661?accountid=34574

17. References Continued United Nations Office on Drugs and Crime. (2015, June 26). Retrieved November 29, 2015, from https://www.unodc.org/unodc/en/frontpage/2015/June/2015-world-drug-report-finds-drug-use-stable--access-to- drug-and-hiv-treatment-still-low.html University of Chicago Medical Center. (2011, May 4). Nicotine and cocaine leave similar mark on brain after first contact. ScienceDaily. Retrieved November 14, 2015 from www.sciencedaily.com/releases/2011/05/110503171745.htm Vanyukov, M. M., Tarter, R. E., Kirillova, G. P., Kirisci, L., Reynolds, M. D., Kreek, M. J., …Ridenour, T. A. (2012). Common liability to addiction and “gateway hypothesis”: Theoretical, empirical and evolutionary perspective. Drug and Alcohol Dependence, 123(Suppl 1), S3–17. http://doi.org/10.1016/j.drugalcdep.2011.12.018 Weinberger, A. H., & Sofuoglu, M. (2009). The impact of cigarette smoking on stimulant addiction. The American Journal of Drug and Alcohol Abuse, 35(1), 12. Retrieved from http://search.proquest.com/docview/219366494?accountid=34574