Dr. Solomon Teferra Battling Substance Use Disorders

Substance use disorders are a significant public health concern in Ethiopia, mirroring a global trend. Complexities arising from political, social, and economic factors can push individuals into a cycle of addiction, making it difficult to break free without support. Social stigma and misunderstandings further impede help-seeking behaviour.

Despite the widespread nature of the problem, Ethiopia faces a shortage of rehabilitation facilities and qualified professionals to provide adequate treatment. While there has been a positive increase in mental health professionals in recent years, the gap in services remains substantial.

In a recent visit to Renascent Mental Health and Addiction Rehabilitation Centre, EBR’s Dr Brook Genene had the opportunity to speak with Solomon Teferra (MD,PhD), a leading figure in the field, a professor of addiction psychiatry at Addis Ababa University and the founder of Renascent to shed light on this critical issue.

Dr. Solomon Teferra’s dedication to this field stems from a personal tragedy. He lost his father at a young age due to complications from chronic alcohol abuse. This experience fueled his desire to become an addiction specialist. Solomon Teferra’s academic achievements are impressive. He earned his MD from Jimma University in 2000, followed by a residency in psychiatry at Addis Ababa University in 2005. His passion for knowledge led him to pursue a PhD in Psychiatry Epidemiology at Umeå University in Sweden, which he completed in just three years (2005-2008). Following a brief break in 2013, Dr. Solomon completed subspecialty training in Addiction Psychiatry at the University of Toronto, Canada.

A Lone Expert in a Vast Country

Dr. Solomon Teferra’s academic career has paralleled his work at Addis Ababa University since 2008. He rose to the rank of Professor in 2021. However, a critical challenge remains: He is currently the only addiction subspecialist in Ethiopia, a nation of over 120 million people facing significant socio-economic pressures that can contribute to substance use disorders.

Moved by the loss of his father and inspired by his commitment to helping people fight addiction, Dr Solomon founded Renascent Mental Health and Rehabilitation Center in 2023. With three psychiatrists, three psychiatric nurses, one psychologist, and a total staff of twenty, the Centre is contributing to the fight against substance use disorder.

The rehab Centre is located in Legetafo, on the outskirts of Addis Ababa, away from the hustle and noise of downtown. The area is surrounded by mountains, large trees, and new infrastructure that give off a peaceful vibe. The Centre has utilised its space well to accommodate the patients and provide the necessary care. It can host up to 25 inpatients and many more in the outpatient department.

To the right of the reception and near Professor Solomon’s office are board games like chess, where the patients sit around and compete head-to-head in a game of minds. The room also has a shelf filled with books and a TV with access to DSTV channels, which provide live sports and movies.

At the back of the building is the kitchen and a dining area with plenty of chairs to host patients. At the front is a green area decorated with flowers and grass that makes the area attractive. This refreshing place is where most patients start their day, chatting or sitting silently and enjoying the morning sun. If they want to be more active, they have football and table tennis nearby to occupy them.

“I call our rehab center Freedom House because people who arrive sad and ashamed leave with full of confidence. A person with substance use disorder is someone who has given up his freedom and can’t decide when to stop,” he says. The walls of the office are decorated with frames displaying his degrees. Among them is his Doctor of Medicine degree from Jimma University, where the journey started. He joined in 1993 and graduated in 2000 before working as a General Practitioner for four years.

“Psychiatry is the most social of the natural sciences and the most natural of the social sciences,” he states as he further explains why he was attracted to the field. He was the top student during his residency programme at Addis Ababa University and was determined to help people escape addiction and lead stable lives.

He explains that addiction is one of the most misunderstood issues in the country. “Renascent is a rehabilitation concept, and it means restoration of the former self,” he tells EBR. He explains that the primary goal of the treatment is to provide holistic recovery. “Even though there may be problems along the way, many of our patients have managed to lead successful lives after getting the necessary treatment.”

During his 11 years as an addiction psychiatrist and 20 years working in the mental health sector, he has witnessed stories of remarkable recoveries. His face brightens when he recounts the numerous patients who turned their lives around. “These people have managed to become successful in their personal, social, and economic lives,” he tells EBR.

The problem of addiction is increasing worldwide, and Ethiopia is no exception to this trend. Fifty per cent of adults consume alcohol, and 20% of men use alcohol in a damaging way. He states that the problem is increasing at an alarming rate. In addition to widespread issues such as alcohol, Khat, and cigarettes, many drugs are inappropriately used and even abused by the youth. “After Ethiopian Airlines started travelling to South America, cocaine has been entering the country via Bole airport,” Dr Solomon states. “The level of cannabis use has also increased, together with prescription drugs like Tramadol and Pethidine.”

The word “addiction” has been misused by many people. The term can erroneously be associated with various behavioural issues, such as gambling or excessive social media use. The Professor believes this public discourse will prevent people from getting help. “While the word for addiction comes from the Latin word ‘addiction,’ the word for addiction in Amharic is not a strong one that captures all the attributes. This will create a misunderstanding among the public,” he says.

In Ethiopia, alcohol and Khat are the most commonly used addictive substances. The Ethiopian Demographic and Health Survey (DHS) reported that 53% of men and 45% of women had a lifetime history of alcohol consumption. Increasing age and urban residence were associated with high levels of consumption. According to a 2015 study entitled “Magnitude and predictors of excessive alcohol use in Ethiopia” by

Theodros Getachew Zemedu (PhD) et al., the overall lifetime prevalence of alcohol use was 49.3%. Additionally, a report from Addis Ababa University showed that alcohol consumption was significantly associated with tobacco smoking. Theodros works at the Ethiopian Public Health Institute, Health System and Reproductive Health Research Directorate and has numerous years of experience.

As Ethiopia is believed to be the origin of Khat, the consumption of it is also at a high level. The overall prevalence of Khat chewing was found to be 15.8%. According to a 2015 study by Tekle et al., people living in Afar, Oromia, and Somali States and Hareri and Dire Dawa City Administration were significantly associated with the prevalent culture of Khat chewing. This is because Khat is predominantly cultivated in these regions and for cultural and religious reasons. Factors such as having less education, being in the lowest income range, and tobacco use were associated with Khat consumption.

In addition to the mental burden posed, substance addiction also leads to several illnesses. For instance, injecting drug use is a risk factor for HIV infection. In Ethiopia, drug injection is the second most common means of HIV transmission. People who inject drugs are also at higher risk for morbidity and mortality.

Ethiopia has been reported to have one of the lowest ratios of mental health professionals to population in the world. Around 2015, there were estimated to be only 0.08 psychiatrists per 100,000 population. In 2018, it was estimated that there were fewer than 100 psychiatrists across the entire country despite a population of over 100 million at the time. There has been recognition of a severe shortage and mal-distribution of mental health professionals, with most being concentrated in urban areas like Addis Ababa. These numbers indicate the magnitude of work that lies ahead in the fight against mental illness in general and addiction in particular.

Professor Solomon calls for the formation of an organisation that oversees the problem of substance use disorder in Ethiopia. Providing examples from other countries, he explains that different organisations work on control, prevention, and treatment. “It would be good to have an organisation that solely focuses on this area. There have been initiatives from the Ministry of Health, but that is not enough,” he says.

Another obstacle that stands in the way of treatment is stigma. There is still significant stigma surrounding addiction, which is viewed by many as a moral failing rather than a medical condition. This can hinder people who need treatment from seeking help. Furthermore, even after receiving treatment, there are very high rates of relapse, highlighting the importance of ongoing monitoring and care.

There is a global shortage of mental health professionals specifically trained in effective, evidence-based treatments for addiction. With the problem growing daily, professionals like Professor Solomon are essential in providing care and mentoring the next batch of professionals. EBR

12th Year • June 2024 • No. 130