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 you became 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, foundation interest, and a large, growing group of colleagues 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, with a wide range of outstanding people bringing 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 or the needs of teenagers who were already meeting dependence criteria.

Can you explain motivational interviewing and cognitive behavioral therapy?

Motivational interviewing is a style of interacting with a person, using a kinder, gentler approach that helps more easily engage in discussing personal problems and 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 to 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: self-examination and an interest in change. And then you try to 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 aimed at the changes the individual seeks. One of these changes would be related to how you think about your problems or their solutions.

Often, that means getting the client to be more positive, to think more proactively about real solutions rather than dwelling on 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 relatively new but is now quite popular.

One of the projects we have is teaching parents these two skills. We’re conducting a brief intervention study in which we’re teaching parents to teach these skills to their teenagers at 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 consisting of two or three sessions had reasonable engagement among teens. Perhaps when teenagers realized there were only going to be a few sessions, they didn’t feel concerned, shy away, or think it was too onerous to commit to a large-scale endeavor.

We were pretty successful in getting many families to sign up. We found that when we worked with both the teenager and the parent, we got slightly better results than when we counseled only the teenager. Although we still observed modest effects when only the counselor worked with the teenager.

Several other researchers have also found that it helps when parents are involved. It can help both by changing the parents’ behavior at home, which can promote the teenager’s better health, but we also found that it may have opened the parents’ eyes to the fact that more help is needed for 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 can still exert some influence 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 approach, where much of the counseling effort is to engage the teenager and where the counselor acts more like a coach or mentor, interest in self-exploration and in talking about their problems and possible solutions is promoted.

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

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

The Partnership to End Addiction will help us take our current manual, which is currently only in written form, and develop it into an easily usable web-based program.

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

Even short of that, just the basic message that when a teenager thinks there is at least one parent in the home, they can share a personal problem with or talk to that parent about it 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 to find a very good program or counselor that works with teenagers when the drug problem has progressed to dependence.  Most states have a central state agency that maintains a directory of local addiction treatment programs. And there are national datasets where you can click a state to 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 boards 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 Institutes 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).