Youth Drug Prevention: Challenges and Opportunities Related to the Decriminalization of Marijuana in Uruguay

Background: In 2013, Uruguay became the first country in the world to decriminalize  marijuana. While it is too soon to know the full impact on adolescents’ drug use when a country decriminalizes  marijuana, some early national statistics indicate increases in use of marijuana, particularly in Montevideo region, the country’s capital. According to Uruguay’s 2014 national annual drug use survey of adolescent aged 13-17, almost 2/3 of adolescent have consumed some type of substance in the past 12 months. Marijuana is the third most commonly used substance and according to The Organization of American States (OAS, 2015), marijuana use among adolescents in Uruguay doubled from 8.4% in 2003 to 17% in 2004. The Montevideo region has the highest adolescent marijuana use in the country, 20.3%.  For Uruguayan adolescents, marijuana is the most offered and easily available drug – over half report it is easy to obtain. Because experimental marijuana use begins around ages 14-15, it is important to deliver culturally-grounded prevention intervention specifically tailored to those under age 15. As a result of these factors, a linguistically adapted version of keepin’ it REAL, a SAMHSA model program, was pilot tested in two private middle schools in Montevideo, Uruguay. keepin’ it REAL teaches youth culturally grounded drug resistance strategies (Refuse-Explain-Avoid-Leave), enabling them to successfully respond to substance offers in the US. This paper examines the short-term changes in substance use following the implementation of keepin’ it REAL in Uruguay.

Methods:  Students in two charter middle schools in the neighborhood with the lowest SES in Montevideo, Uruguay were recruited and randomized into a treatment (N=58) and control (N=96) condition (e.g. those receiving keepin’ it REAL compared to those receiving no substance use prevention programming). Students (mean age = 12.4) in both conditions completed a pre-test prior to implementation and short-term post-test after the last lesson was delivered. Marijuana measures were 30-day amount and frequency.  Within-condition paired t-tests and Cohen’s d effect sizes were examined.

Results:  Students in the control group significantly increased in marijuana amount (t(74)=1.98, p=.052)) and frequency of marijuana use ((t(74)=1.89, p=.063)).  The students receiving keepin’ it REAL completely stopped using marijuana at the post-tests – both marijuana amount and frequency had a mean =0 at post-test.  The mean difference in marijuana use between the treatment and control group, indicate small to medium effect sizes (Marijuana Amount: d=-.32; Marijuana Frequency: d=-.31).

Conclusions: This pilot study provides support for the global applicability of efficacious substance use prevention programs originally developed in one country, but also the importance of assessing for cultural fit to achieve maximum efficacy. The results indicate that keepin’ it REAL can be an effective tool in teaching drug resistance strategies and reducing marijuana use among adolescents living in a country where marijuana use is legal. Although these results cannot be generalized due to the small sample size and the unique characteristics of the schools and neighborhood, they provide sufficient evidence to continue with translational research efforts.