On Being a “Teacher”: Thoughts as I Prepare to Depart from South Africa

I first answered Africa’s siren song in 1992, when I spent half of my junior year in college in Kenya and Tanzania. In 2008, I returned to Namibia, Botswana, and Zambia, where I started writing my doctoral dissertation in a tent on quiet afternoons. This year, I was invited to South Africa, to Cape Town and Durban, to share my expertise in addiction research with physicians and psychotherapists. I came as a teacher and like all good teachers, I find that I am also a student.

There is no doubt that South Africa is a magical country. Twenty years after the end of apartheid and only a short time since Mandela’s passing, I find myself in a country that has made incredible advances with regard to racial equality and a land that remains troubled by its past. One of the ways in which these troubles are manifest is this nation’s almost-out-of-control turn toward substance abuse. According to the South African Central Drug Authority, substance abuse in South Africa is double that of the global average and South Africa is ranked among the top 10 countries with regard to the amount of alcohol consumed annually. The use of drugs like cocaine and “tik” is twice as much in South Africa as compared with other nations around the world. The economic cost of alcohol abuse in South Africa is estimated at 130 billion rand each year. It is also estimated that 7,000 people in South Africa die annually from drunk driving. All this in a nation of 52 to 53 million people. These are staggering figures.

Current research on addiction and addiction recovery

Given this climate, I have a great deal to offer in terms of fluency with the current research on addiction and addiction recovery. My work as Director of Addiction Research for Cliffside Malibu is to advance the field by drawing attention to the latest scientific findings in a variety of subjects and to use those findings to improve the quality and efficacy of addiction treatment. I am humbled by the scope of the addiction problem in the USA, South Africa, and so many other nations around the world, because each statistic signifies a human life, a human life devastated by suffering. This suffering is not unique to the addict, but experienced to some degree by the addict’s family, friends, and community. At the same time, I am also honored that Cliffside has made a solid commitment to both research and education. I know of no other treatment center that keeps a full time researcher on staff and supports annual attendance at multiple international conferences. This commitment allows me to move the discussion around addiction treatment forward with clinicians who in some cases have limited or no resources, other than their dedication and training. They work with people in desperate need in areas which have seen devastation of a type most Americans cannot imagine. Cliffside sends me to these places, to work with these professionals knowing that we’ll never see a client from our efforts. In my opinion (and admittedly, I am biased!), Cliffside’s commitment to helping addicts recover is truly exemplary in the field.

Improve treatment outcomes

And yet, as I teach, I also learn. At the Lentegeur Hospital near Cape Town, South Africa, I met with an incredible crew of dedicated physicians, psychiatrists, nurses, social workers, and students. Their smiles belie the overwhelming nature of their work, the almost incomprehensible need in the communities they serve. As professionals, we collaborated, having animated discussions about how we might “think outside the box” and use the limited resources available to improve treatment outcomes as much as possible. For example, if one-on-one psychotherapy is precluded because of lack of psychotherapists to meet the need, how can we re-group individuals or re-imagine group therapy to help the greatest number of clients? We discussed positive psychology, looking at the strengths and assets individuals bring to treatment. We imagined ways to connect community programs that are currently administered in a disjointed way. There is so much work to be done! Yet there was a sense in the group of progress and of hope.

After my wonderful experience in Cape Town, I flew to Durban to attend the World Congress for Psychotherapy. In my presentation, I was scheduled to cover new neuroscientific understandings of addiction, both how addiction develops and how it might be treated in imaginative ways to improve treatment outcomes. This group was most interested in the relationship between addiction and co-occurring psychological disorders, such as depression. According to other conference participants, the World Health Organization projects that depression will be the world’s leading illness by 2020. Having suffered from depression myself, I wanted to shout, “Why are we so hopeless?” when I heard this, for in addition to its biochemical components, depression is in large part a manifestation of hopelessness, social isolation and/or grief. So I re-focused my presentation not only on the neuroscience of addiction, but also the relationship between addiction and depression. After my presentation and for the remainder of the day, I was flooded with requests to pass along the research studies I had cited. How does the brain change in response to addiction and how are addiction and depression treated concurrently? What role does aftercare play in treating co-occurring disorders and again, where psychotherapists are not to be found, what other programs or therapies might we use to help improve the quality of individual’s lives? These are the topics we discussed that led to exhilarating ideas for all involved.

How do we provide care when resources are scant?

How do we care for those who suffer, not only from addiction or mental illness, but from all sorts of issues? How do we provide care when resources are scant? These are the questions we have asked here in South Africa over the past two weeks. My only hope is that I have taught at least half as much as I have learned.



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