We appreciate Dr. Gold’s interest in our recently published article examining the
gateway effect of nicotine in an attention-deficit/hyperactivity disorder (ADHD) sample.
Dr. Gold raises an interesting question about the temporal ordering of tobacco use
and marijuana use in youth, citing his own research that shows marijuana to be a gateway
substance to tobacco use in college students. He regrets that we did not also consider
marijuana as a gateway substance to tobacco use in our analysis, in cases where marijuana
use begins either before or concurrently with tobacco use. However, in disagreement
with Dr. Gold’s premise and as stated in the methods of our paper, the temporal sequence
of use, essential to an assessment of the gateway hypothesis, cannot be determined
in subjects who report the initiation of smoking and substance use at the same age,
and these subjects should not be considered in an analysis of the gateway hypothesis.
In our data, only two and four ADHD and control subjects, respectively, began to use
tobacco and marijuana at the same age, and these subjects were excluded from our analysis.
We do not think that investigators can make assumptions about the direction of the
gateway effect in these temporally ambiguous subjects.
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Published online: July 31, 2006
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© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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- Regarding “Is Cigarette Smoking a Gateway to Alcohol and Illicit Drug Use Disorders? A Study of Youths with and without Attention Deficit Hyperactivity Disorder”Biological PsychiatryVol. 60Issue 10
- PreviewIt is with interest that we read Biederman et al’s (2006) “Is Cigarette Smoking a Gateway to Alcohol and Illicit Drug Use Disorders? A Study of Youths with and without Attention Deficit Hyperactivity Disorder.” We agree with their conclusions related to the importance of preventing smoking in children, in this case children with attention deficit hyperactivity disorder (ADHD). The authors determined the hazard ratio for tobacco smoking status and subsequent substance use while excluding those whose tobacco smoking and substance use began at the same age.
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