Resistance in a Lenient Alcohol Environment: Personal or National Drug Control Policy in Nicaragua, Central America?

Background: This exploratory study examines adolescent and young adult experiences and beliefs surrounding alcohol and other drug (AOD) use in Nicaragua, Central America. In Nicaragua, adult alcohol consumption appears pervasive, laws establishing a “legal drinking age” are non-existent, and policies regulating a “legal purchasing age” are not strictly enforced. This study explores adolescent responses to AOD offers and availability within this lenient drug control policy context.

Methods: Qualitative interviews were conducted in Spanish with adolescents ages 11-23 (M=15.6, SD=3.3) by a team of trained, native interviewers. Purposive sampling was used to recruit 32 participants (8 additional scheduled) across developmental and socioeconomic continua to provide diverse backgrounds and alcohol experiences. Interviews focused on participants’ family and peer relationships and experiences with AOD. Interviews were translated and transcribed by the Nicaraguan research team. English transcripts were analyzed using qualitative constant comparison techniques to examine 1) participants’ AOD use, 2) strategies used when presented with AOD offers and availability, and 3) beliefs about benefits and risks of alcohol consumption.

Results: Interview analysis and illustrative quotes support the following claims: 1) Younger participants report less frequent and varied use than older participants. 2) Stories of actual offers were resisted twice as frequently as accepted, with no gender differences observed. In resistance narratives, social considerations (family expectations, family history with alcohol abuse, peer reactions) and societal forces (religion, economics) were commonly mentioned by participants, while national drug control policy was not. 3) Participants did not report any benefits to alcohol use but cited getting drunk, losing control, and even death (from cirrhosis of the liver, drugged driving accidents, and violence) as common risks.

Conclusions:

• Findings suggest that adolescents do not consciously integrate national drug control policy into their decisions, which accords with studies in the U.S. where few adolescents cite legal concerns as a reason for resisting substance use.
• Instead, national policy creates an environment where more local social standards hold sway (e.g., family history and expectations; alcohol beliefs).
• Other non-policy societal factors (e.g., economics, religion) also impact use, which aligns with Central American studies showing illicit drug usage rates are higher for private schools than public, as private school youth are generally more affluent.
• Prevention messages in this lenient drug control policy context should focus on harm-reduction strategies by appealing to local social standards and realistic consequences.