Substance Use Research That Makes a Difference: Meet Dr. Ken Winters

I’m pleased to share my fascinating interview with Dr. Ken Winters, Director of the Center for Adolescent Substance Abuse Research (CASAR), regarding his recent trial with teens and their parents/caregivers.

This important new study demonstrates the effectiveness of brief interventions with adolescents to reduce their problem drug or alcohol use. Adding parent involvement in the intervention increased the positive results.

Please briefly tell us a little about yourself, and why did you become interested in Adolescent Substance Abuse Research?

I started out just being a generic clinical psychologist interested in applied research and fortunately I got appointed to a project that needed someone to help develop new assessment tools for identifying and referring teenagers who might have a problem with drugs.

Thus I did not have any grand scheme to be an addiction researcher. But it was a good time for someone to get involved in the general field of adolescent drug abuse research. It was the 1980’s and one could tell the whole area of drug abuse research was growing. It was a bull market in terms of federal dollars, interest by foundations, and a large growing group of colleagues that were developing skills in this area as well.

I was mentored by several senior colleagues who were also studying drug abuse. They helped shape my career. It was a small pond when I started out; now it is an interesting diverse, rich field, and there is a wide range of outstanding people that bring a lot of expertise to the table.

I was glad to jump into this field in its infancy. There was not a lot of rigorous science for adolescent clinical populations. Rather, most research work at that time was focused on prevention.  People hadn’t been looking as much at clinical populations and the needs of teenagers already meeting dependence criteria.

Can you explain motivational interviewing and cognitive behavioral therapy?

Motivational interviewing is really a style of interacting with a person with a kindler, gentler approach that seeks to more easily engage to discuss personal problems and seeks to convince the person to commit to behavior change. The individual is also encouraged to examine ways that they might want to change those habits.

With clinical populations, usually, we’re talking about bad habits, like drug use, risky behaviors, or poor health behaviors, but you can use it in any situation when you want to try and convince another person to look at something in a different way. You are using an interviewing or discourse style that is supposed to promote this kind of attitude, of self-examination and interest in change. And then you try and get the person to talk about how they might make those changes.

Cognitive-behavioral therapy is related, but it’s more about teaching specific skills that are aimed at the changes being sought by the individual. One of these changes would be related to how you think about your problems or think about solutions to your problems.

Often that means getting the client to be more positive, to more proactively think about real solutions as opposed to dwelling or pontificating about how bad their life might be. The counselor also works to get the client to make real behavioral changes in their life that promote health.

Cognitive-behavioral therapy has been around a long time but it has more recently been introduced to deal with addictions. The blending of motivational interviewing and cognitive behavioral therapy is also relatively new, but it is quite popular now.

One of the projects we have is that we are trying to teach parents about these two skills. We’re doing a brief intervention study where we are teaching parents to deliver these skills to their teenagers in the home. We think these skills are very teachable to a motivated parent.

What were some of the important findings from your trial that you conducted with the 315 adolescent and parent/caregiver pairs?

We found that a brief intervention that consists of two or three sessions had reasonable engagement by teens. Perhaps when teenagers realized there were only going to be a few sessions, they didn’t feel concerned or shy away or feel like it was too onerous to commit to a large scale endeavor.

We were pretty successful in getting a lot of families to sign up. We found that when we could work with both the teenager and the parent, we got slightly better results compared to when only the teenager was counseled. Although we still got some modest effects when just the counselor worked with the teenager.

Several other researchers have also found that it does help if the parents are involved. It can help both with changing the parent’s behavior in the home, which can promote the teenager getting better and getting healthier, but we also found it may have opened up the eyes of the parents that may be more help is needed with that teenager.  Thus many parents realized they should get some more services from my local community to keep the counseling process going.  And perhaps parents realized that even though their son or daughter is a teenager, they still can exert some impact as a parent.

Was there anything that surprised you in the results?

Two things.

The pleasant surprise was a lot of teenagers enjoyed the opportunity to have time with a counselor.  Many wanted more sessions even though the study only allowed two with the individual. That was a nice pleasant surprise and probably speaks to the good job our counselors were doing. Perhaps when teenagers are offered a motivational interviewing type approach where a lot of the counseling effort is to engage the teenager and where the counselor is more acting like a coach or a mentor, interest by the teenager to self explore and to talk about his problems and possible solutions is promoted.

Perhaps another surprise was that a certain percent of teenagers were interested in participating but they didn’t want their parents to know about their participation, or they didn’t want their parents to have the parent session. They might have been concerned that too much of the teenager’s private life would get disclosed in the parent’s session.

How can parents use your research findings to help their children avoid or reduce drug or alcohol use?

The Partnership For Drug-Free Kids is going to help us take our current manual that is just in written form and develop it into an easily usable web-based program.

Downstream, the vision is to have something that is very engaging and relatively easy to use by parents. Hopefully, we will have some support features to it if parents have questions or they want to go through a learning phase. We’re hopeful that it can move from our current version, which uses trainers and coaches and move it more towards a self-administered version.

Even short of that, just the basic message that when a teenager thinks that there is at least one parent in the home that they can share a personal problem with or talk to regarding a personal problem is helpful. When teenagers know that their parents would be disappointed if they went over the top with alcohol or other drug use or were violating family rules about the use of alcohol and other drugs, these are a huge plus in getting teenagers to avoid risky behaviors like drug use.

As you can imagine, parents can do all kinds of things on a daily basis to help promote those two principles, even if they don’t have a program like this.

I always encourage anyone to try and find a very good program or counselor that works with teenagers when the drug problem has progressed to dependence.  Most states have some kind of central state-based agency that has a directory of local addiction treatment programs. And there are national data sets where you can click on a state and see what’s available.

For example, a national listing of adolescent drug treatment programs across America is provided by SAMHSA(call 1-800-662-HELP).

Tell us your thoughts about this new research. How do you think this information could help your family?

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Ken Winters, Ph.D. is a Professor in the Department of Psychiatry at the University of Minnesota, director of the Center for Adolescent Substance Abuse Research, and a Senior Scientist with the Treatment Research Institute, Philadelphia, PA.  He received his B.A. from the University of Minnesota and a Ph.D. in Psychology (Clinical) from the State University of New York at Stony Brook.  His primary research interests are the assessment and treatment of addictions, including adolescent drug abuse and problem gambling.  He is on the editorial board of the Journal of Substance Abuse Treatment and the Journal of Child and Adolescent Substance Abuse and has received numerous research grants from the National Institute of Health and various foundations.  He was the 2008 recipient of the Research to Evidence-Based Practice Award from a national organization on effective treatment for adolescents (JMATE).  Dr. Winters is a frequent publisher, speaker, and trainer, and he is a consultant to many organizations, including the Hazelden Foundation, The Partnership at Drug Free.Org, National Center for Responsible Gaming, and the Mentor Foundation (an international drug abuse prevention organization).