Do I Really Need Treatment in a Rehab?

Not all hangovers are the same. If someone using alcohol or benzodiazepines develops severe tremors, profuse sweating, high fever, visual or tactile hallucinations, confusion (delirium), vomiting that prevents fluid intake, or a seizure — treat that as an emergency. Those are signs of complicated withdrawal (delirium tremens or withdrawal seizures) and can kill without monitored medical treatment. Even heavy stimulant or opioid withdrawal can produce severe dehydration, suicidal thoughts or collapse. In Johannesburg you don’t manage severe withdrawal at home: ring your GP or go to the nearest emergency unit for a medical detox protocol, electrolyte and thiamine replacement, and monitoring. Trying to “ride it out” or taper without medical oversight is dangerous.

We make that call on risk and stability, not on moral judgment. Inpatient care is recommended when there are multiple, interacting problems: repeated failed attempts to cut down, physical dependence with risky withdrawal potential, current suicidal or violent behaviour, inability to meet basic needs (housing, food, child care), severe psychiatric symptoms (psychosis, uncontrollable depression) or ongoing legal and workplace collapse. If the person has stable housing, some sober supports, and manageable withdrawal risk, outpatient or intensive day programmes can work. If several red flags coexist — for example someone is drinking to the point of blackouts, lost their job, assaults their partner and can’t stop — that combination scores high for admission. A clinical assessment (AUDIT/DUDIT screening, psychiatric evaluation, social appraisal) determines the level of care; don’t let stigma delay that assessment.

Repeated antisocial behaviour like theft, school or work collapse, chronic secretive use, mood swings and withdrawal from family activities is a behavioural pattern, not mere teenage rebellion. When those behaviours are driven by substance use — escalating tolerance, cravings, using despite clear harm, and withdrawal when they try to stop — they meet clinical criteria for a substance use disorder and need specialised treatment. Punishment without treatment commonly makes things worse: the underlying physical dependence and often coexisting anxiety, depression or trauma won’t be fixed by scolding. For children and adolescents, seek a clinician who does family-based interventions and adolescent pharmacotherapy where indicated; for adults, prioritise a dual-diagnosis assessment and a programme that includes social stabilisation, skills training and relapse prevention. If the person is putting children at risk or is homeless and unwell, involve social services and medical emergency teams immediately.

Relapse is not moral failure; it’s feedback. Repeated lapses usually mean the treatment plan isn’t addressing a key driver — untreated psychiatric illness, inadequate intensity of care, ongoing trauma exposure, poor social supports, or biological factors such as high physical dependence. Clinically, that triggers a reassessment: consider medication‑assisted options (for example opioid substitution or evidence‑based medications for alcohol dependence where available), a longer residential admission, structured outpatient with daily monitoring, or a focused psychotherapy modality that wasn’t tried before (CBT, MET, trauma therapy). Also check for triggers like withdrawal symptoms, medication interactions, or active mental illness. If multiple relapses occur, escalate care rather than blame the patient — that’s when a different level or type of professional help is usually required.

Start with safety. Remove children and vulnerable people from the environment and call emergency services if there’s imminent violence or medical collapse. If someone is medically unwell from intoxication or withdrawal, take them to emergency care — hospitals can admit for medical detox and psychiatric assessment. If there’s ongoing danger to others or the person lacks capacity and refuses help, consult a medical practitioner about invoking the appropriate sections of the Mental Health Care Act so admission can be arranged lawfully; do not try to restrain or forcibly detox at home. Document incidents (dates, threats, injuries), contact your family doctor or a local addiction clinician to arrange urgent assessment, and ask about social work involvement to protect children. Practical, immediate steps — protect people, secure medical help, and get a clinical assessment — will prevent harm and open the door to professional treatment options.