Understanding addiction

Addiction is not a moral failure or a lack of willpower. It is a health condition — described clinically as a substance use disorder — where someone keeps using a drug despite harm, often with strong cravings, loss of control, and withdrawal when they stop. It develops through a mix of biology, mental health, trauma, environment and circumstance.

Most people who try a drug never develop a problem. Drug use ranges across:

• Experimentation — usually short-lived.
• Non-dependent use — much like social drinking.
• Regulated use — within personal or cultural rules.
• Dependence — impaired control, craving, withdrawal.
• Habituated / addictive use — drug use becomes the automatic response to life.

Roughly 8–15% of people who use drugs will develop a problem with their use, depending on the substance.

Harm reduction is a practical, evidence-based approach. It works alongside people who use drugs to reduce health, social and legal harm — without requiring them to stop first. It is grounded in human rights and public health, and any positive change counts.

It includes things like:

• Sterile needles and syringes for people who inject.
• Opioid agonist therapy (methadone, buprenorphine).
• Naloxone to reverse opioid overdose.
• Safer-use information, HIV/HCV testing, mental-health support.

South African policy supports harm reduction through the National Drug Master Plan (2019–2024), the National Strategic Plan on HIV, TB and STIs, and the National Hepatitis Action Plan.

Stigma keeps people away from clinics, away from testing, and away from treatment that works. Words matter: "person who uses drugs" instead of "addict"; "in recovery" instead of "clean". Discrimination by health workers, police harassment, and laws that criminalise people who use drugs all increase harm. Treating people with respect is not optional — it is part of the care.