Substance use – recognising a problem, and getting help here
The line between heavy use and dependence is not about what you use. What the warning signs are, and what help exists in South Africa.
What actually marks the line
Dependence is not defined by which substance, how often, or whether it is legal. It is defined by loss of control and by continuing despite harm.
- Needing more for the same effect.
- Withdrawal symptoms when stopping — shakes, sweats, anxiety, nausea, poor sleep.
- Repeatedly using more, or for longer, than intended.
- Failed attempts to cut down.
- A lot of time spent obtaining, using or recovering.
- Giving up activities that used to matter.
- Continuing despite clear damage to health, work, money or relationships.
- Craving — the intrusive pull towards it.
Stopping safely
What treatment looks like
Treatment is not only rehab. Most people are helped by a combination of things that do not require residential admission.
- Medically supervised detox where withdrawal is risky.
- Counselling and structured psychological programmes.
- Medication: options exist to reduce craving for alcohol and to treat opioid dependence.
- Mutual support groups, which are free and widely available across South Africa.
- Treating what sits underneath — depression, anxiety, PTSD and ADHD are very common alongside substance problems, and treating only one usually fails.
Used in treating dependence, prescribed and supervised:
Naltrexone — Revia, Dependex
Alcohol dependence; opioid dependence (relapse prevention after detoxification)
Thiamine (Vitamin B1) — Betabion, Thiamine Lennon
Thiamine deficiency; Wernicke's encephalopathy (IV); alcohol use disorder supplementation
Diazepam — Valium, Pax, Diapin, Antenex
Acute anxiety; alcohol withdrawal; acute seizures; muscle spasm; status epilepticus
Public clinics can refer to substance-use services, SANCA operates nationally, and SADAG's line can point to what is available locally. Employee assistance programmes cover many workplaces and are confidential.
Relapse, and how to think about it
Relapse is common and is part of the pattern for many people rather than proof that treatment failed. What matters is how quickly someone returns to help afterwards, which is heavily influenced by how much shame is attached to it.
- Identify the specific situations, feelings and people that precede use, and plan for them in advance.
- Change what you can about the environment — routes, contacts, availability.
- Build something into the space it occupied. An empty evening is the highest-risk hour.
- Tell someone you trust, so a slip is not also a secret.
- If you relapse, get back to help within days rather than waiting until it is bad again.
Common questions
- Do I have to go to rehab?
- No. Residential rehab is one option among several and is not the right fit for everyone. Outpatient programmes, counselling, medication and support groups help many people, and public-sector services exist.
- Is cannabis a problem if it is legal?
- Legality for private adult use says nothing about dependence. Regular heavy use is associated with dependence, poorer educational and work outcomes, and mental health problems in those already vulnerable. The definition above applies to it as much as to anything else.
- How do I raise it with someone I am worried about?
- Pick a calm moment, describe specific things you have seen rather than labels, say you are worried rather than angry, and offer a concrete next step. Expect denial the first time and do not treat that as the end of it.
Sources
- Mental health support and crisis resourcesSouth African Depression and Anxiety Group (SADAG)
- National Mental Health Policy Framework and Strategic PlanNational Department of Health, South Africa
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
Last reviewed 4 August 2026.