Question 1

Can someone have more than one substance use disorder?

Accepted Answer

Yes, an individual can have more than one, such as alcohol abuse disorder and opioid abuse disorder.

Question 2

What is the most common co-occurring disorder?

Accepted Answer

General Anxiety Disorder (GAD) – This disorder is also most associated with self-medicating behaviours.

Question 3

How can I prevent my risk for a co-occurring disorder?

Accepted Answer

Mental health and substance use disorders are both brain diseases, which means they cannot be cured. However, they can be managed by the following:

Being proactive by learning about your pre-dispositions.
Looking after your physical health.
Looking after your mental health, e.g., seeing a therapist.

Question 4

Why can’t we treat the drinking or drug use first and the depression later?

Accepted Answer

Because in most cases the problems feed each other. Substance use changes brain chemistry and behaviour in ways that can trigger, mask or worsen depression, anxiety, PTSD or bipolar symptoms — and untreated mental illness drives self-medication and relapse. In clinical practice we screen for both at intake (brief validated tools such as AUDIT/DUDIT and PHQ‑9/GAD‑7 are typical) and then treat them side by side. That might mean medical stabilisation for withdrawal, concurrent psychiatric assessment, starting or adjusting medication when safe, and psychotherapy aimed at both cravings and mood regulation. Separating them into two sequential programmes often leaves the underlying driver untouched and shortens the time someone stays well. For families in Johannesburg, that integrated approach also reduces repeat hospital visits and the constant cycle of crisis and expensive emergency care.

Question 5

How do psychiatrists safely prescribe when someone is detoxing or still using substances?

Accepted Answer

Prescribing in active use or withdrawal is cautious and practical. Clinicians consider current intoxication, withdrawal risk and drug interactions before starting antidepressants, mood stabilisers or antipsychotics. For example, benzodiazepines for withdrawal are used with strict monitoring because of misuse potential; some antipsychotics require cardiac and metabolic checks. We often stabilise with short-term medical detox or monitored withdrawal, then introduce longer-term psychiatric meds once acute risks are managed. A psychiatrist who understands addiction will dose more conservatively, plan for drug–drug interactions, watch for sedation that raises overdose risk, and coordinate with the addiction nurse or counsellor. If you’re paying through a medical aid in South Africa, ask upfront whether the facility provides on-site psychiatric review and how medication management is handled during and after admission.

Question 6

My family can’t afford private rehab — are there realistic integrated options in Johannesburg that don’t just send you back to the same streets?

Accepted Answer

Yes, but you must be strategic. Public hospitals and community mental health clinics offer integrated care, though capacity and waiting times vary. A practical plan is to secure a medical assessment at a public psychiatric unit or a community health centre and ask for a formal referral into a specialised programme — that referral can sometimes reduce waiting lists for NGO or government-supported beds. Look for day programmes that combine group therapy, psychiatric review and social work support; these can be more affordable than long residential stays. Local harm-reduction services and community-based support groups can also reduce immediate risk while you arrange longer-term care. Families should document risk (self-harm, overdose, criminal behaviour) to prioritise access, and they should ask clinics about social grants, disability applications, or work-reintegration services to stabilize housing and income — those social supports make clinical gains stick.

Question 7

How can I tell if a clinic truly treats “coexisting disorders” and isn’t just offering addiction counselling with a token psychiatric consult?

Accepted Answer

Ask for specific evidence: do they have a psychiatrist or registrars available for regular medication review, not just an occasional referral? Is there a formal integrated assessment on admission that documents both substance use and mental health diagnoses using validated tools? Are treatment plans multidisciplinary — involving psychiatry, psychology, addiction counselling, nursing and social work — and do they meet weekly? A real programme will provide medically supervised detox, documented medication protocols, trauma-focused therapy options (for PTSD), relapse-prevention skills taught with cognitive behavioural approaches, and a clear handover to outpatient psychiatric care. If the clinic can’t produce intake forms, treatment plans, or the names and qualifications of the clinicians who will manage medication and risk, that’s a red flag. For families in South Africa, also check whether they work with public hospitals or community resources for continuity after discharge.

Question 8

When a loved one relapses or refuses help, what concrete steps should family members take to manage safety and treatment without enabling?

Accepted Answer

Start with immediate safety: assess for overdose risk, violent behaviour, self-harm or severe withdrawal and get urgent medical or psychiatric attention if any are present. Don’t try to manage severe withdrawal at home. Next, set clear behavioural boundaries tied to help — for example: “You can stay here but we will not cover drug costs or conceal use, and we will insist on a psychiatric assessment.” Families should document episodes, collect collateral information (medication bottles, used substances) and arrange a clinical assessment; clinicians take documented history more seriously. Use harm-reduction measures if the person refuses abstinence: naloxone if opioids are involved, safer-use information, and insist on regular check-ins with a clinic. Finally, involve social services or a social worker to address housing, income and legal risks; these social fixes reduce the drivers of relapse. Avoid rescuing financially or covering for behaviour — that keeps the problem alive. If you are unsure what to do next, a single call to a public psychiatric unit or an addiction specialist clinic in Johannesburg can clarify whether urgent admission or outpatient integrated care is the right step.

What Is A Co-Occurring Disorder?

How Common Are Co-Occurring Disorders?

Signs of Co-Occurring Disorders

How to Treat a Co-Occurring Disorder

Our Co-Occurring Disorder Treatment in Johannesburg