Start with clinical risk, not marketing. If you or a family member has severe withdrawal histories (seizures, delirium tremens, abrupt benzodiazepine or alcohol dependence), pregnancy, uncontrolled medical problems, suicidal ideation, or heavy poly-substance use, you need a medically supervised detox with 24/7 nursing and medical cover. If the physical withdrawal is low-risk but psychosocial problems are severe — homelessness, active criminal charges, no sober support — an inpatient programme that provides structure and case management is usually safer than outpatient alone. Day clinics (partial hospitalisation) are a middle ground when you can sleep at home but need intensive therapy and medical oversight during the day. Outpatient counselling works when motivation is intact, supports are available, work/school can continue, and the substance use is mild-to-moderate. In Johannesburg you also have to factor in transport safety, work leave, and whether your medical scheme will authorise admission. Ask providers for their intake assessment tools (AUDIT/ASSIST, PHQ‑9, suicide screen), their on-site medical capacity, and whether they offer a written clinical rationale for level-of-care placement before you sign anything.
Families in SA often carry the treatment load alone; that’s a clinical problem, not a moral failing. Look for services that offer structured family intervention and skills training, not just a weekend “family day.” Effective options include clinicians who run multi-family therapy, attachment-based family work, and practical case management with clear boundary-setting coaching. In Johannesburg, SANCA centres, specialised private rehabs, and some NGOs offer family programmes; FAMSA and Al‑Anon groups provide ongoing peer support. A useful first step is a family assessment with a social worker who can map legal risks (child custody, domestic violence), explain safety steps (removing credit cards, securing medication), and produce a clear contract for boundaries and consequences that everyone signs. If the provider only invites the family for a glossy brochure session, walk away — you need hard tools, not platitudes.
Public and NGO services can be good, but the quality is uneven. Start at your nearest public clinic or hospital emergency department for acute needs; they can triage and admit for detox where necessary. For ongoing care, look to established NGOs (SANCA, community mental-health teams, province-run rehab centres) and harm-reduction programmes — needle exchange, opioid substitution therapy where available, and naloxone distribution for opioid users. Ask any public/NGO service whether they provide structured psychosocial interventions (CBT, relapse prevention), psychiatric review when needed, and a documented aftercare plan. If funding is the barrier, explore referral letters for social work-funded placements, application to Department of Social Development programmes, and whether your medical scheme has a chronic care programme or aid for partial funding. Do not accept sleeping shelters or unstructured “recovery houses” as substitutes for clinical care when there are withdrawal risks or mental-health comorbidity.
Ask for names and qualifications of the clinical team (medical doctor/psychiatrist, psychologists, social workers, registered nurses) and verify HPCSA or relevant registration. Request a copy of a typical weekly programme schedule, the ratio of staff to clients, and their incident/medical emergency protocol. Demand outcomes data: what percentage of discharged clients complete the programme, what follow-up contact is offered at 3 and 6 months, and whether they measure relapse or functional outcomes. Check whether they provide evidence-based therapies (CBT, motivational interviewing, trauma-informed care), whether opioid substitution or medication-assisted treatments are used where indicated, and how they handle dual diagnosis. Be blunt: ask to speak to an independent former client or a referring clinician. If they shy away from any of these questions or give vague answers, they are selling an image, not treatment.
Integrated care is non-negotiable for dual diagnosis. Look for programmes that provide simultaneous psychiatric assessment and addiction treatment under one coordinated plan: psychiatrist for medication management, psychologist for trauma-focused therapies (EMDR or CPT when clinically appropriate), and addiction clinicians for relapse prevention and craving management. Immediate priorities are medical stabilisation and safe detox; trauma processing should generally begin after withdrawal is under control and there’s some emotional regulation in place. Ask whether the centre does standardised mental-health screening on intake (PHQ‑9, GAD‑7, PTSD screen), has regular psychiatric review, and whether the treatment plan includes both trauma work and addiction-specific strategies. If a facility funnels you to external psychiatry with no coordination, keep looking — fragmentation kills outcomes, especially when PTSD and substance use reinforce each other.
