Drug addiction and substance use disorder

Drug addiction and substance use disorder are terms that are often used interchangeably, but they carry slightly different meanings. The distinction between them is worth understanding, because it shapes how we think about the condition and what kind of support is likely to help. 

Whether you’re concerned about your own drug use or trying to make sense of what’s happening to someone you care about, this guide explains what these conditions are, how they develop, what the signs look like, and what treatment involves.

What is substance use disorder?

Substance use disorder (SUD) is the clinical term used by mental health professionals and psychiatrists to describe a pattern of substance use that causes significant impairment or distress. The term comes from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and covers a wide range of substances, including alcohol, cannabis, stimulants, opioids, and sedatives.

What distinguishes substance use disorder from casual or recreational use is a cluster of specific criteria: things like craving, loss of control, continued use despite serious consequences, and physical withdrawal. The DSM-5 identifies 11 such criteria in total, and the severity of the disorder depends on how many a person meets:

• Mild SUD: 2 to 3 criteria met
• Moderate SUD: 4 to 5 criteria met
• Severe SUD: 6 or more criteria met

Severe substance use disorder corresponds to what is commonly called addiction. Understanding SUD as a spectrum, rather than a binary condition, helps explain why some people can pull back from harmful use with counselling and social support, while others require intensive clinical treatment to recover.

The difference between drug abuse and drug addiction

“Drug abuse” and “substance abuse” are older terms that predate the current clinical framework. Under the DSM-IV, the previous version of the manual used before 2013, clinicians distinguished between “substance abuse” (harmful use without full dependence) and “substance dependence” (more severe, compulsive use). The DSM-5 replaced these separate categories with a single spectrum diagnosis: substance use disorder.

The older terminology has fallen out of favour clinically, partly because the word “abuse” carries connotations of moral failure and personal choice that don’t accurately reflect the neuroscience of addiction. “Drug abuse” and “substance abuse” remain in widespread everyday use, however, and still appear in South African public health policy and media, so understanding what they refer to is useful.

The practical distinction is this: a person misusing drugs may still retain a degree of control over their use and may be able to stop with motivation, early intervention, or social support. 

A person with moderate to severe SUD has typically lost that ability to stop, not because of a lack of willpower, but because addiction alters the brain’s reward, motivation, and decision-making systems in ways that override normal self-regulation. 

The shift from harmful use to full addiction is gradual and not always visible from the outside. This distinction shapes what kind of intervention is appropriate. Early-stage harmful drug use may respond to brief counselling or outpatient support, while severe SUD generally requires a more intensive clinical approach.

Is drug addiction the same as alcoholism?

In clinical terms, yes. “Alcoholism” is not a formal diagnostic term, but refers to what is now classified as alcohol use disorder (AUD): a substance use disorder where the substance is alcohol. 

Drug addiction and alcoholism share the same underlying neurobiology, the same diagnostic framework, and the same general treatment principles. The brain’s response to compulsive alcohol use is not fundamentally different from its response to compulsive drug use.

That said, different substances carry different risks and require different clinical approaches. Alcohol withdrawal can be life-threatening without medical supervision, while cannabis withdrawal is typically uncomfortable but not medically dangerous. Opioid withdrawal sits closer to alcohol on this scale and requires careful clinical management. 

What remains consistent across substances is that severe SUD fundamentally changes how the brain functions, which is why willpower alone is rarely sufficient for recovery.

Houghton House treats both drug addiction and alcohol use disorder. You can read more about our alcohol rehabilitation programme and how treatment is tailored to the specific substance and individual.

Commonly abused substances in South Africa

South Africa has among the highest rates of substance use disorder in sub-Saharan Africa. A 2024 study published in the International Journal of Drug Policy found that illicit drug use in the country increased dramatically between 2002 and 2017. 

Usage rates rose from 1.5% to over 10% of the adult population, driven in part by urbanisation, unemployment, and the availability of low-cost, high-potency substances. 

The substances below are among those most commonly implicated in addiction in South Africa.

Cannabis

Cannabis is the most widely used illicit substance in South Africa. Its private use was decriminalised in 2018, and it is often perceived as low-risk. 

Cannabis use disorder is less physically dangerous than dependence on other substances. However, heavy, long-term use carries real risks: anxiety, depression, cognitive impairment, and in some cases, cannabis-induced psychosis. 

For people with an underlying vulnerability to psychotic illness, regular cannabis use can be a significant trigger.

Methamphetamine (tik)

Tik (crystal meth) is a form of methamphetamine that became widespread in South Africa in the early 2000s, particularly in the Western Cape. The drug produces an intense but short-lived euphoria followed by a sharp crash, which drives compulsive redosing. 

Tik addiction is associated with severe physical and psychological deterioration, including dramatic weight loss, dental decay, paranoia, hallucinations, and in some cases, violent behaviour. 

Crystal methamphetamine is highly addictive and very difficult to withdraw from without clinical support.

Cocaine

Cocaine and crack cocaine are central nervous system stimulants with a high potential for addiction. Using cocaine carries significant cardiovascular risks, including heart attack and stroke, even in otherwise healthy adults.

Crack cocaine, which is smoked rather than snorted, produces a more intense and faster-acting effect that accelerates the development of dependence or cocaine addiction.

Opioids

Opioids include both street drugs like heroin and prescription medications such as morphine, codeine, and tramadol. This drug class carries some of the highest risks of any substance group, including a significant risk of fatal overdose, particularly after a period of abstinence when tolerance has dropped. 

Opioid withdrawal is intensely uncomfortable and, in certain circumstances, carries a risk of serious complications. Medically supervised detox is strongly recommended for anyone dependent on opioids.

Mandrax

Mandrax (methaqualone) is a sedative-hypnotic that was widely prescribed in the 1960s and 1970s before being banned in most countries. South Africa remains one of the few countries where methaqualone is still commonly abused. 

Also known as “buttons”, mandrax is typically mixed with cannabis and smoked using a broken glass bottle neck. 

The drug produces intense sedation and euphoria, and suppresses the central nervous system in ways that can cause respiratory depression and loss of consciousness at higher doses. Smoking mandrax in combination with cannabis amplifies and prolongs these effects, increasing the risk of overdose. Methaqualone dependence develops quickly, and withdrawal can include seizures.

Nyaope and whoonga

Nyaope and whoonga are street names for a low-cost drug mixture unique to South Africa, predominantly used in townships and low-income communities. The composition varies, but typically includes heroin as the primary active ingredient, combined with cannabis and various adulterants. 

Nyaope is extremely addictive, and users face severe physical deterioration alongside the social and financial consequences of dependence. The drug’s low price and high addictive potential make it particularly devastating in the communities where it is prevalent.

Prescription drugs

Prescription drug misuse is also a significant and underreported problem in South Africa and does not fit neatly into the categories above. Commonly misused prescription medications include benzodiazepines, painkillers, sleeping tablets, stimulants, and antiretrovirals. If you’re concerned about dependence on a prescribed medication, our admissions team can help you understand your options.

Signs and symptoms of drug addiction

Recognising drug addiction, whether in yourself or in someone you care about, can be harder than it seems. Addiction is characterised by concealment and denial. 

People who are dependent on substances often go to considerable lengths to hide the extent of their use, and the signs tend to become clear only in retrospect. The pattern of signs also varies depending on the substance, the severity of the disorder, and the individual. 

The following are some of the most common indicators across substances.

Physical signs of drug addiction

The body often reveals what a person is working to conceal. Some physical signs are substance-specific: opioid users may have constricted pupils and injection marks, stimulant users tend to show dilated pupils and significant weight loss. 

Across substances, the following signs are common:

• Noticeable weight loss or changes in appetite
• Deterioration in personal hygiene and appearance
• Bloodshot or glazed eyes, or changes in pupil size
• Unusual smells on the breath, skin, or clothing
• Frequent sniffing or a persistent runny nose, particularly with cocaine and certain opioids
• Disrupted sleep patterns, including insomnia or sleeping at unusual times
• Tremors, slurred speech, or impaired coordination

Over time, the physical toll of addiction tends to become harder to conceal. Prolonged and heavy substance use affects virtually every system in the body.

Behavioural signs of drug addiction

Changes in behaviour are often the first thing families and friends notice. The central feature of addiction is a shift in priorities: the substance begins to take precedence over work, relationships, finances, and responsibilities. This shift shows up in recognisable patterns, such as:

• Becoming secretive, evasive, or unusually private about whereabouts and activities
• Borrowing money, selling possessions, or experiencing unexplained financial difficulties
• Declining performance at work or school, or frequent absences
• Withdrawing from family, friends, and activities that were previously important
• Legal problems, including arrests or incidents related to drug use
• Conversations that revolve around obtaining, using, or recovering from drug use

The behavioural changes associated with addiction tend to escalate over time. What begins as occasional lapses in reliability or unusual moodiness often develops into a pattern of deception that is difficult to ignore.

Emotional signs

The emotional signs of drug addiction are closely linked to the psychological experience of dependence. When the brain has become reliant on a substance to regulate mood and manage stress, emotional responses begin to reflect that reliance. 

Common emotional indicators of substance abuse include:

• Denial of the extent or impact of drug use, even when confronted with clear evidence
• Minimising the severity of the problem or deflecting concern from others
• Blaming other people or external circumstances for the consequences of drug use
• Irritability, defensiveness, or anger when the subject of drugs is raised
• Mood swings, anxiety, or depression during periods when the substance is unavailable
• Shame or hopelessness that makes the person reluctant to seek help

These emotional responses can be frustrating and confusing for the people around someone who is struggling. Understanding them as features of the addiction rather than character traits can make them somewhat easier to navigate.

Drug addiction and mental health

The relationship between drug addiction and mental health is well established in the research, and more complex than a simple cause-and-effect. Studies of South African populations consistently show that anxiety, depression, PTSD, and personality disorders occur at significantly higher rates in people with SUD than in the general population.

The relationship runs in both directions. Some people begin using substances to manage the symptoms of an underlying mental health condition and develop a dependence over time. Self-medicating anxiety, numbing the effects of trauma, or lifting the weight of depression are common examples. 

In other cases, prolonged substance use causes or worsens mental health problems. Often, both processes occur simultaneously, which makes it difficult to determine which came first.

This is the basis for dual diagnosis treatment: the simultaneous clinical management of a substance use disorder and a co-occurring mental health condition. Treating both conditions simultaneously is far more conducive to long-term recovery than treating either in isolation. 

At Houghton House, psychiatric care is fully integrated into our rehabilitation programme. Our on-site psychiatric team assesses and treats co-occurring conditions alongside the addiction, rather than referring patients elsewhere.

Drug addiction treatment

Recovering from drug addiction requires clinical support. Addiction changes the brain in measurable ways, and reversing those changes takes time, appropriate treatment, and ongoing support. Treatment for drug addiction typically involves several components, tailored to the individual’s substance of use, the severity of the disorder, and any co-occurring mental health conditions.

Medical detox

For many people, medically supervised detox is the first stage of addiction treatment. The medical detox process involves clearing the substance from the body under clinical supervision, with medication prescribed to manage withdrawal symptoms and reduce discomfort. 

For substances like opioids, alcohol, benzodiazepines, and mandrax, withdrawal without clinical support can be life-threatening.

Inpatient rehabilitation

Inpatient treatment provides the most intensive level of care, with patients residing at the facility for the duration of the programme, typically 30 to 42 days. Removing a person from the environment and social networks associated with drug use is a valuable part of recovery in itself. 

Our drug rehabilitation programme combines individual therapy, 12-step group sessions, psychiatric care where indicated, family involvement, and a daily routine designed to support the development of new coping skills.

Outpatient rehab

Not everyone who needs treatment for drug addiction requires residential care. Outpatient treatment suits people with a milder substance use disorder, or those whose circumstances make an inpatient rehab stay impossible. Sessions typically include individual therapy, group counselling, and psychoeducation, spread across several days a week while the person continues to live at home.

Outpatient rehab works best where the person has a stable, supportive home environment. It’s also commonly used as a step-down option after inpatient rehabilitation, providing ongoing support during the transition back to everyday life.

Aftercare and continuing care

Recovery continues after discharge. The period immediately after leaving a primary treatment programme carries a high relapse risk, and ongoing support significantly improves long-term outcomes. 

Houghton House offers a comprehensive aftercare programme, including options for halfway house placement for patients who need a supported transition back to independent living.

If you’d like to talk through treatment options for yourself or someone you care about, our admissions team is available around the clock. Call us on +27 79 770 7532 or get in touch online.

Does medical aid cover drug addiction treatment?

In most cases, yes. Under South African law, substance use disorders are prescribed minimum benefits (PMBs), which means all registered medical aids must fund addiction treatment. 

As a private psychiatric hospital, Houghton House is also qualified to claim for treatment of certain co-occurring conditions that are covered by psychiatric PMBs. 

The specifics depend on the individual’s medical scheme and plan. Speak to our admissions team to confirm what your cover includes before making a decision. You can find scheme-specific information on our medical aid rehab cover page, where you’ll also find links to pages about individual medical aid schemes.

Frequently asked questions about drug addiction

What is the difference between drug abuse and drug addiction?

“Drug abuse” refers to harmful or hazardous substance use that does not yet involve full dependence. “Drug addiction” refers to severe substance use disorder: compulsive use, loss of control, and continued use despite serious consequences. The two exist on a spectrum rather than as distinct, separate conditions.

What is substance use disorder (SUD)?

Substance use disorder is the clinical term for a pattern of substance use that causes significant impairment or distress. The DSM-5 defines SUD on a spectrum from mild to severe, based on 11 diagnostic criteria. Severe SUD corresponds to what is commonly called addiction.

What are the signs of drug addiction?

The signs of drug addiction fall into three broad categories: physical (weight loss, deterioration in appearance, changes in pupil size), behavioural (secrecy, financial difficulties, declining performance at work or school), and emotional (denial, irritability, mood swings). The specific signs vary depending on the substance and the individual.

Is drug addiction a mental illness?

Yes. Drug addiction or substance use disorder is specifically classified as a mental health condition in the DSM-5. Like other mental health conditions, SUD involves measurable changes in brain function and responds to clinical treatment. Addiction frequently co-occurs with other mental health conditions, including anxiety, depression, and PTSD.

What is the difference between drug addiction and alcoholism?

“Alcoholism” is an informal term for alcohol use disorder, which is a substance use disorder where the substance is alcohol. In clinical terms, drug addiction and alcoholism are the same type of condition: both involve compulsive use, loss of control, and dependence. The substances and withdrawal profiles differ, but the underlying disorder and the broad treatment approach are comparable.

Can drug addiction be treated?

Yes. Drug addiction is a treatable condition. Effective treatment typically combines medically supervised detox, inpatient or outpatient rehabilitation, individual and group therapy, and aftercare support. The most effective programmes address both the substance use disorder and any co-occurring mental health conditions simultaneously. Recovery is possible, and many people go on to live full and healthy lives after treatment.

Get in touch

Taking the first step can feel daunting, especially when you’re in the middle of a crisis or watching someone you love struggle. Our admissions team is here to help you make sense of the options, without pressure and without judgement. We’re available around the clock.

Call us on +27 11 787 9142 or our 24-hour helpline +27 79 770 7532, or contact us online, for a free, confidential assessment. We’ll help you understand what level of care is appropriate, whether medical detox is needed, and how your medical aid cover applies.