Think Locally, Act Globally


Washington College Researchers Work Alongside Zambian Leaders Implementing a Novel Substance Use Intervention Curriculum in Africa

The research team for the clinical manuscript together in a virtual meeting

There is an African parable that states, "If you want to go far, go together". This is a fitting description of the journey of three Washington College researchers and two Zambian professionals taking on the clinical study of a curriculum delivering sustainable, locally-owned and accessible care for people diagnosed with substance use disorders in Zambia.

The idea began in 2014, when Melissa Davis Stuebing, founder of CoLaborers International – a non-profit organization helping women and children reached by indigenous-led organizations around the world - became aware of homeless youth coming to the center in Zambia under the influence of drugs. After seeking out local resources, it became apparent that treatment options were very limited, largely due to the stigma associated with substance abuse.

Stuebing – who was also lead counselor with Kent County’s Crisis Program at the A.F. Whitsitt Center – was at the time pursuing her Master’s degree in psychology at Washington College, and discussed these findings with her graduate program advisor, Lauren Littlefield, Professor of Psychology. Recognizing Stuebing’s initiative, Littlefield encouraged her to research the issue by designing a culturally appropriate intervention as her Master’s thesis. Stuebing was already working alongside Zambian community leaders, including Chipo Nambeye, a childcare worker who is a co-author on the latest research article.

Having used expressive arts informally as an adjunct to treatment in the US and abroad, it seemed natural for Stuebing to turn to cultural art forms in Zambia as a therapeutic metaphor to apply cognitive behavioral, rational emotive behavioral, and 12 Step principles. She delved into art forms such as gourd art, drumming, call-and-response singing, painting, games, horticulture, weaving, and story-telling to develop what came to be called the "Literacy-Free 12 Step Expressive Arts Therapy" curriculum.

Incorporating creative processes like visual arts, music, and performances are methods that can engage clients who might not respond to traditional talk therapies. "Arts have a way of speaking to the soul, past the cognitive mind, past the behavioral defenses that arise when we only talk about things overtly,” said Stuebing. “I hoped activities would engage people, even while under the influence of substances.”

Group photo post-training in Ndola

PHOTO: Zambian professionals trained in "Literacy-Free 12 Step Expressive Arts Therapy" to deliver in their own communities. This picture is post-training in Ndola. Another group of professionals was trained in Lusaka.

Hjordis Lorenz ’16, became involved with the project in the fall of 2015 – her senior undergraduate year -- when she completed a year-long placement at Kent County Crisis Program as a Psychology intern. Getting paired with Stuebing for this internship was actually by design, as Littlefield, advisor to both women, recognized their shared interest and the opportunity for them to work together.

“We joke that she’s our matchmaker,” said Lorenz. “It says a lot about Washington College professors that they know you so well. They don’t just match you with your research interests, but also with personalities who have similar drive and motivation.”

Lorenz and Stuebing conducted a clinical study of the US version of the curriculum at A.F. Whitsitt Center in 2015. Data showed that the curriculum improved client attitudes toward recovery. Additionally, inpatients who were exposed to the curriculum experienced more positive outcomes than those who did not experience it (Alcoholism Treatment Quarterly, volume 38, 2020).

In 2016, Washington College’s Cater Society funded a research grant for Lorenz to field test the Zambian version of the curriculum with homeless youth in Zambia. Lorenz’s field work, facilitated by CoLaborers International, was supervised by Stuebing and Littlefield.

Stuebing shared research findings with Zambia's Ministry of Health, and as a result they endorsed a large-scale training of Zambian organizations in the curriculum. This is when Gabriel Lungu – psychiatric nurse and mental health officer for the Ministry of Health – became an integral part of the research team. Bringing the local connection full circle, funding for the training was provided by the Chestertown Rotary Club and Rotary International Foundation. Then in 2018, Stuebing, Lorenz, Nambeye, and several others trained 100 Zambian professionals, representing over 40 nonprofits, in the curriculum. The Zambian professionals subsequently carried the curriculum into their communities, expanding treatment accessibility.

The Zambian work was published in a peer-reviewed journal called Addictive Behaviors Reports in June 2022. Training in the curriculum helped Zambian providers to place higher value on treating people who abuse substances. Post-training, Zambian professionals used the curriculum at their respective facilities where data for 200 clients was collected. Curriculum-based treatment increased client participation while simultaneously decreasing frequency of substance use.

Throughout this journey, Zambia has been expanding its substance use provisions, aiming to emphasize addiction as a mental health problem and to increase awareness. In the meantime, Nambeye and Lungu are still working in Zambia, advocating for this population.  Stuebing has continued as Chief Executive Officer of CoLaborers International, and Lorenz has earned her Ph.D. in Experimental Psychology from the University of Oxford, UK.  Littlefield remains dedicated to her teachings at Washington College, and to supporting as many students as possible in similarly innovative and meaningful endeavors.

“It was a literal journey to Zambia for them but also an emotional journey of these brilliant and selfless individuals coming into their own as researchers,” said Littlefield. “I am so proud of Melissa and Hjördis and of what we were able to accomplish together!”

To read their open access paper, click here or listen to them tell their own story in this short video:

Top Photo: The research team for the 2022 clinical manuscript collaborated across three continents. Pictured are co-authors Melissa Stuebing, Chipego Nambeye, and Hjördis Lorenz (top row); and Lauren Littlefield and Gabriel Lungu (bottom).