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Possible effectiveness of a novel multimodal school-based program, EMPATHY, to reduce substance misuse in youth: A mixed methods intervention Open Access


Other title
brief intervention
substance misuse
Type of item
Degree grantor
University of Alberta
Author or creator
Hamza, Deena M
Supervisor and department
Greenshaw, Andy (Psychiatry)
Silverstone, Peter (Psychiatry)
Examining committee member and department
Pullin, Wendy (Psychology)
Winship, Ian (Neuroscience)
Pazderka, Hannah (Psychiatry)
Department of Psychiatry

Date accepted
Graduation date
2017-06:Spring 2017
Doctor of Philosophy
Degree level
Substance misuse in Canada is a major individual and public health issue, with evidence suggesting that in many cases it starts during youth. Reducing rates of misuse is therefore important. In 2013, an estimated 3.1 million Canadians over the age of 15 used at least one of 6 illicit substances (cocaine/crack, cannabis, heroin, hallucinogens, ecstasy, or speed) during the past year. When cannabis is excluded from analysis of substance use rates, 2% of Canadians over the age of 15 reported use of at least one of the remaining 5 illicit substances; however, the rate of use by youth 15 – 19 years of age (5% of total population of this age group), and young adults between the ages of 20 – 24 years (6% of total population of this age group) was substantially higher than use reported by adults (1% of total adult population). Further, youth and young adults reported more harms associated with their own illicit drug use at a higher rate than adults (8%, 8%, and 2%, respectively). According to these statistics, harms associated with youth substance misuse has resulted in 4 times the consequences of those observed in the population of individuals 25 years and older. Alcohol continues to be the most prevalent substance used with 21.9 million Canadians (76%) reporting use in the past year. In youth between the ages of 15 – 19, a total of 60% reported past year use and this rate increased with age to 83% of 20 – 24 year olds. Although a decrease is noted with the transition from youth to adult, a relatively high rate of use continues to be observed with 77% of Canadian adults over the age of 25 reporting use in the past 12 months. Canada’s Low-Risk Drinking Guideline has recommended a maximum of 2 drinks per day (10 per week) for women, and 3 drinks per day for men (15 per week) to reduce potential health risks by managing consumption of alcohol. Despite these limits for safe use of alcohol, 21% of Canadians exceeded safe consumption and were at risk of chronic health consequences, while an additional 15% were at risk of acute health consequences. Further, youth between the ages of 20 – 24 exhibit the highest prevalence of over-consumption of alcohol in 2013, followed by those 15-19 years of age, and adults over the age of 25. There is evidence suggesting substance use problems in adulthood stem from age of first use, meaning substance use in youth may be a predictor of future substance use disorder development. In addition, prolonging abstinence from alcohol until at least 18 years of age decreases future risk of alcohol-related problems in adulthood both on an individual and general population level. Interestingly, up until the mid-1980s, youth engaging in risky substance use were often treated with existing adult models despite awareness since the mid-1950s of the difference in treatment needs of youth. Often, these methods were confrontational and aggressive as a way to counter ambivalence to change or resistance to treatment. Although widespread awareness of differences in substance use between youth and adults began in the 1980s, most of these age-specific programs did not actualize until the mid-1990s. Evidence to date has not found methods to reduce youth use of alcohol and drugs that can be administered to large populations. Therefore, there remains a compelling need for a program to reduce these rates. The primary goal of this PhD program is to examine if a novel school-based approach in a large population of youth (more than 6,000) is effective. It is based on the Empowering a Multimodal Pathway towards Healthy Youth (EMPATHY) program, and examines a novel form of screening, brief intervention, and referral to treatment (SBIRT). To fully understand the context of treatments for substance misuse it is necessary to briefly review similarities and differences between adult and adolescent treatments which introduces the need for novel solutions for youth. This is then followed by an examination of long standing approaches to determine what has been effective in the past. The most studied approaches are those used with adults with alcohol use disorder
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Hamza DM, Silverstone PH (2015). In the Treatment of Alcohol Abuse there are No Clear Differences in Outcomes between Inpatient Treatment and Outpatient Programs. Journal of Addiction Prevention. 3(1): 9Hamza DM, Silverstone PH (2014). A Systematic Review of Treatment Modalities for Alcohol Use Disorder. Journal of Substance Abuse and Alcoholism 2(3): 1023Hamza, DM; Bercov, M; Suen VYM; Allen, A; Cribben, I; Goodrick, J.; Henry, S.; Pryce, C.; Langstraat, P.; Rittenbach, K.; Chakraborty, S.; Engles, RC; Greenshaw, AJ; McCabe, C; Silverstone, PH (2016). A Novel Multimodal School-Based Program, EMPATHY, Significantly Decreased Long-Term Drug and Alcohol Abuse as Measured by CRAFFT Scores in 6,227 Youth Aged 11 – 18. Submitted to PLoS One, August 2016

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