Is It a Habit or an Addiction? SA’s Blurred Line

You’ve heard it at braais, in WhatsApp groups, on wellness podcasts: “I’m addicted to coffee.” “She’s addicted to her phone.” “He’s addicted to running.” The word addiction has become so overused in everyday conversation that it’s losing the ability to do its most important job — flag when someone actually needs help.

This matters deeply in South Africa. The South African Community Epidemiology Network on Drug Use (SACENDU), which monitors substance-use trends through the South African Medical Research Council (SAMRC), reported in 2023 that alcohol and methamphetamine remain the primary substances driving admissions to specialised treatment centres, with nyaope (a combination typically containing heroin, dagga, and other adulterants) a dominant driver in Gauteng and KwaZulu-Natal. Hundreds of thousands of South Africans live with substance-use disorder. When “addiction” means everything, it effectively means nothing — and real harm goes unrecognised.

What a habit actually is

A habit is a behaviour your brain has automated because it’s been repeated enough times in a consistent context. Neuroscientists describe this as a shift from the prefrontal cortex — the decision-making centre — to the basal ganglia, which runs routine actions with less conscious effort. That’s why you don’t think about brewing your morning rooibos; you just do it.

Habits can be unhelpful. Reaching for your phone every time you feel bored is a habit. Eating a packet of chips during load-shedding because there’s nothing else to do is a habit. These patterns can be stubborn and hard to shift. But crucially, if the context changes — if you decide to stop — you can stop. There’s no physical withdrawal. There’s no significant functional collapse if the behaviour is interrupted. Discomfort, yes. Dependence, no.

Where dependence enters the picture

Dependence is the bridge between habit and disorder. Your body adapts to a substance — alcohol, nicotine, opioids, benzodiazepines — and begins to function as though that substance is normal. Take it away and your physiology rebels. Alcohol withdrawal can cause seizures within 24–72 hours of the last drink, a medical emergency. Opioid withdrawal (relevant to nyaope users) produces severe physical symptoms: vomiting, muscle cramps, and intense dysphoria that can last days.

Physical dependence does not automatically mean addiction. A patient who has taken prescribed opioids after surgery may be physically dependent and need a supervised taper — but they don’t have a use disorder. This distinction is one reason the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) moved away from the old “dependence vs. abuse” framework entirely.

What the DSM-5 actually says

The DSM-5 uses the term substance-use disorder and defines it on a spectrum — mild, moderate, or severe — based on how many of 11 criteria a person meets in a 12-month period. Two or more criteria qualify as a disorder. Six or more is considered severe.

The criteria include:

1. Taking the substance in larger amounts or for longer than intended
2. Persistent desire or failed efforts to cut down
3. Spending a great deal of time obtaining, using, or recovering from the substance
4. Craving — a strong urge or compulsion to use
5. Failing to fulfil major obligations at work, school, or home because of use
6. Continuing to use despite social or interpersonal problems caused by it
7. Giving up important activities — hobbies, family time, sport — because of use
8. Recurrent use in physically hazardous situations
9. Continuing use despite knowing it worsens a physical or psychological problem
10. Tolerance — needing more of the substance for the same effect
11. Withdrawal symptoms when stopping or cutting down

The critical thing to notice: craving, compulsion, and loss of control over use are the core of this framework. A habit lacks those. If you can easily skip your evening glass of wine for a month without distress, you don’t have a use disorder — you have a habit. If the thought of skipping it triggers anxiety, planning, and sneaking, that’s a different matter entirely.

The wellness culture problem — and why it matters here

Here’s the distortion worth naming directly: the wellness industry, particularly since the mid-2010s, began applying addiction language to behaviours like social media use, sugar intake, and exercise. Some of this was rooted in real neuroscience — dopamine pathways are involved in all rewarding behaviour. But the leap from “dopamine is involved” to “this is an addiction equivalent to heroin” is not supported by current evidence.

The SAMRC and the South African Society of Psychiatrists (SASOP) both operate within the DSM-5 framework. No local or international clinical body currently classifies social-media use or sugar intake as a substance-use disorder. Gaming disorder was included in the ICD-11 but remains an area of active debate and requires impairment in daily functioning across multiple domains for at least 12 months.

Why does the overclaim matter? Because minimising real addiction (“I’m just addicted to Netflix, we’re all addicted to something”) creates a cultural environment where people with alcohol-use disorder or nyaope dependence delay seeking help, assuming what they’re experiencing is the same as everyone else’s little habit.

What this looks like in a South African context

Consider three scenarios.

Siphiwe scrolls social media for two hours a night. He sometimes wishes he did it less. He could stop if he decided to. That’s a habit, possibly an unhelpful one.

Nomsa drinks two glasses of wine every evening. She’s been doing it for years. If she skips a night, she feels irritable but gets through it. She might meet one or two DSM-5 criteria. A conversation with her GP would be worthwhile, but this is not a severe disorder.

Kgomotso drinks from the moment he wakes up. He’s been fired from two jobs. He tried to stop last year and was hospitalised with a seizure. He meets eight or nine DSM-5 criteria. He has severe alcohol-use disorder and needs specialist intervention.

South Africa’s burden of alcohol-use disorder is substantial. The Heart and Stroke Foundation SA notes that South Africa has one of the highest rates of alcohol-use disorder in Africa, and Statistics SA data links alcohol directly to injury, femicide, and road deaths that kill tens of thousands of people annually. The public health stakes of calling this a “habit” are serious.

Getting help: access in SA

Access to substance-use treatment is uneven, and that unevenness falls along familiar lines.

Public sector: Your first point of contact should be a community health centre (CHC) or primary care clinic. A nurse or doctor can screen using validated tools and refer you to a district hospital with a psychiatry or addiction unit. The National Department of Health lists SANCA (South African National Council on Alcoholism and Drug Dependence) centres across all nine provinces; many operate on a sliding-fee scale and some are free. Wait times vary, and load-shedding can complicate after-hours access to clinics in some areas — call ahead or ask a social worker to help coordinate.

Private sector: A consultation with a psychiatrist in private practice typically costs between R1,500 and R2,500 per session. An inpatient rehabilitation programme ranges from roughly R15,000 to R60,000 per month depending on the facility. These figures are beyond most South Africans without medical aid.

Medical aid: Substance-use disorder qualifies as a Prescribed Minimum Benefit (PMB) condition under the Medical Schemes Act. This means your scheme must fund diagnosis, treatment, and care — in principle. In practice, schemes often limit inpatient days or require pre-authorisation. Phone your scheme’s mental-health line before admission and document everything in writing.

Practical barrier: Many rural areas lack specialists entirely. The South African Depression and Anxiety Group (SADAG) maintains a helpline (0800 567 567) and can help you locate the nearest service, including SANCA centres and public psychiatric facilities.

When to seek help

See a doctor, psychiatrist, or addiction counsellor if you or someone you care about:

– Has tried to cut down on alcohol, nyaope, or another substance and couldn’t

– Has experienced withdrawal symptoms (shaking, sweating, seizures, severe anxiety)

– Is missing work, school, or important relationships because of substance use

– Is using in situations that are physically dangerous

>

You don’t need to be certain it’s “bad enough.” A GP assessment is a conversation, not a judgment.

>

SADAG: 0800 567 567 | Lifeline: 0861 322 322 | SANCA national helpline: 0800 127 843

—

The bottom line

• A habit is automated, context-driven, and interruptible without significant distress or impairment.
• Physical dependence means your body has adapted to a substance — it doesn’t automatically mean addiction or use disorder.
• The DSM-5 defines substance-use disorder by 11 criteria across a mild-to-severe spectrum; meeting two or more in a year qualifies.
• Calling everything an addiction dilutes a clinical term that tens of thousands of South Africans need others to take seriously.
• If you’re unsure where you or someone you love sits on that spectrum, ask a professional — not a wellness influencer.