Positive change can start at rock bottom

Mental health issues and addiction often go hand in hand

Tuesday, July 12 2022

When difficulties with mental health, substance use disorders or other forms of addiction lead a person to a crisis in their work or family life, a low point such as this can become a starting point for healing and recovery.

“For a person who is struggling with deep seated trauma and emotional issues, it can seem that drinking, getting high or any other form of ‘escape’ offers a short term solution or coping strategy,” says John Ralphs, an occupational therapist in the COPE therapy team at Netcare Akeso Stepping Stones mental health facility in Cape Town.

“All too often, when someone does not receive the professional help they need after hitting ‘rock bottom’, the dangerous combination of a psychiatric condition and substance use disorder can cause their lives to spiral even further out of control.

“At first one area of the person’s life may begin to suffer, such as the loss of a job or a significant relationship. Tragically, there is always a new, worse ‘rock bottom’ situation that a person can find themselves in, when mental health disorders and addiction remain unaddressed.”
According to Ralphs, the stigma attached to addiction leads many people to conceal their habits even from those closest to them for as long as possible, and many are unwilling to admit they have a problem.

“Denial is the hallmark of addiction. With some types of substance use, such as crystal meth or heroin, the signs of addiction are often clear. It is not so easy to identify when a person has a gambling or sex addiction or is abusing medication, however these too can be very damaging to a person’s life.

“A person who has anxiety or depression, for example, might find alcohol dependence goes unnoticed for some time, particularly if the nature of their work involves drinking alcohol and entertaining, it may be seen as socially acceptable.  

“In many cases, people are reluctant to disclose they have a problem with some form of addiction, and this may only come out at a later stage when their mental health is significantly deteriorating. The dual diagnosis approach acknowledges that mental health and addiction disorders are most often interlinked, and when treatment is integrated the prospects of lasting recovery and progress are more likely.”

The dual diagnosis unit at Netcare Akeso Stepping Stones runs an inpatient programme to assist individuals with various types of substance use or behavioural addictions together with a psychiatric condition such as depression, anxiety, bipolar disorder or post traumatic stress disorder (PTSD), among others. The multidisciplinary team includes psychologists, psychiatrists, occupational therapists, addiction counsellors and general practitioners who work closely together to provide comprehensive treatment which is supported by experienced nursing staff.

“A person who might have been very reluctant to accept help may pause to reflect when they reach a new low – such as being evicted from their home or receiving a warning for poor work performance. For concerned loved ones, the person may be more open to accepting help when they get to a low point where they realise their quality of life is seriously impacted.”

Ralphs points out that people who begin treatment with voluntary admission to an inpatient facility, such as Netcare Akeso facilities’ dual diagnosis units, tend to progress quicker. “Treatment outcomes don’t differ so significantly for involuntary admissions, when a family obtains a court order with the support of a social worker to secure treatment for a loved one whose decisions are endangering themselves or others.

“While the likelihood of successful recovery is similar to voluntary clients, the length of stay required to achieve this may be longer. For families with limited resources, the timing of an intervention is therefore crucial to make the most of the 21 days’ admission covered by medical schemes. Those who are unwillingly participating in treatment may take longer to reach the point where they are ready to change,” says Ralphs.

“Some people have preconceived ideas about recovery groups and rehabilitation. We introduce clients to some of the tools available, including the 12 Step Programme, but there are also more modern approaches that are less doctrinal. Dialectical Behaviour Therapy [DBT], which is evidence based psychotherapy that is often used in building distress tolerance and the treatment of personality disorders and interpersonal conflicts, is one of many approaches that we use,” he says.

The Netcare Akeso Stepping Stones dual diagnosis team also includes recovery assistants, people who are themselves in recovery from addiction and who speak from their own experiences. “The recovery assistants are crucial in connecting with clients from a place of empathy and demonstrating that progress is possible, although recovery truly is an ongoing process,” Ralphs says.

For information about mental health and rehabilitation services, and accessing care, Netcare Akeso is here to help. In the event of a psychological crisis, individuals can phone the Netcare Akeso crisis helpline on 0861 435 787, 24 hours a day, to talk to an experienced counsellor.

Fellowships such as Alcoholics Anonymous and Narcotics Anonymous are also valuable options for assistance.


About Netcare Akeso
Netcare Akeso operates a network of private inpatient mental health facilities and is part of the Netcare Group. Netcare Akeso provides individual, integrated and family oriented treatment in specialised inpatient treatment facilities, as well as certain outpatient services, for a range of psychiatric, psychological and substance use conditions. Please visit or contact [email protected] for further information. The COPE Therapy website also contains many useful blog posts on various issues and tips relating to mental health.
In the event of a psychological crisis, call 0861 435 787, 24 hours a day for emergency support. Psychiatrist consultations can be made through Netcare appointmed™, online at or by calling 0861 555 565. Outpatient psychologist and occupational therapist consultations can be booked via
For more information on this media release, contact MNA at the contact details listed below.

Issued by:            MNA on behalf of Netcare Akeso
Contact:    Martina Nicholson, Meggan Saville, Estene Lotriet-Vorster and Clementine Forsthofer
Telephone:    (011) 469 3016
Email:    [email protected], [email protected], [email protected] [email protected] or [email protected]