Adolescent Substance Use Prevention: Challenges and Opportunities Related to the Decriminalization of Marijuana in Uruguay

In 2013, Uruguay became the first country to decriminalize marijuana and involve the national government in marijuana cultivation (certifying growers), distribution (through pharmacies) and adult user registration. Critics argued that decriminalization will normalize drug use for children and adults, erode norms discouraging drug use, undermine social cohe­sion, and lead to greater marijuana experimentation and use among adolescents. 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 adolescents aged 13-17, almost two-thirds of adolescents have consumed some type of substance in the past 12 months. Piloting a culturally-grounded substance use prevention in a country that recently decriminalized marijuana may be the first step in understanding how to prevent or reduce adolescent marijuana use in this globally expanding decriminalized/legalized context. To accomplish this, a linguistically adapted version of the U.S.-based keepin’ it REAL (kiR) substance use prevention program was pilot tested in two middle schools in Montevideo, Uruguay. Randomized into a treatment, kiR, (N=58) and control (N=96) condition, students (mean age = 12.4) completed a pre-test prior to implementation and post-test immediately after. Changes in marijuana measures (last 30-day amounts and frequency) were examined with paired t-tests, baseline adjusted regression models with full information maximum likelihood adjustments for attrition, and Cohen’s d effect sizes.  Students in the control group reported significant increases in amount and frequency of marijuana use from pretest to post-test while these measures declined among students receiving kiR. Differences between the control and intervention schools were statistically significant, and achieved medium effect sizes (d=.31, .32).  The results indicate that kiR can be an effective tool in teaching drug resistance strategies and reducing marijuana use among adolescents in a country where marijuana use is decriminalized. 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 exploring the impact of decriminalization, marijuana use, and the impact kiR can make.