Addiction and Dual Diagnosis Counselling

Most people don't set out to become dependent on anything. Alcohol, a substance or a habit usually begins as a way of coping: with stress, pain, loneliness, anxiety, or simply with how life feels. For a while it works. Then, often slowly, it starts to take more than it gives, and the thing that once helped becomes the problem.

If that sounds familiar, for you or for someone you love, you are not alone, and it is not a moral failing. It is something that can be understood and worked with.

What I help with

• Substance addictions: alcohol, drugs, and prescription medication
• Process addictions: gambling, disordered eating, pornography, social media, and extreme behaviours
• Dual diagnosis: addiction alongside anxiety, depression, trauma or another mental health condition
• Relapse prevention and aftercare when you leave a clinic or rehab centre
• Support for families and loved ones

What “dual diagnosis” means

Addiction rarely travels alone. Many people who struggle with alcohol, substances or compulsive behaviours are also living with anxiety, depression, trauma, grief or another mental health condition. Sometimes the addiction began as a way of managing those feelings; sometimes it made them worse. Often it is hard to tell which came first.

This is called dual diagnosis, or co-occurring conditions. What matters is that both sides receive attention. Working only on the drinking, using or behaviour, while the anxiety or trauma underneath remains untouched, tends to leave the door open to relapse.

Formal diagnosis is the work of a psychiatrist or psychologist. Where a diagnosis, medication or a medical assessment is needed, I will help you find the right person, and with your consent we can work alongside them.

My experience

Addiction and dual diagnosis have been at the centre of much of my career. I worked as senior counsellor and program manager in the dual diagnosis programme at Kenilworth Clinic (Akeso) in Cape Town; as a counsellor, group therapist and psychoeducation lecturer at Rustenburg Momentum Mental Health Care Clinic; and as a trauma and addictions counsellor, group therapist and lecturer at Affect2U Clinic in Belgium.

I was also invited by the Psychological Society of South Africa (PsySSA) to join a podcast on the rising levels of alcohol and substance abuse, and addiction, in South Africa.

That clinic work taught me that recovery is rarely a straight line, and that lasting change comes from understanding the person, not only the substance or the behaviour.

My understanding of addiction is not only professional. I have been through my own process, first with an addiction to extreme sport, and later, after a paragliding accident in my early thirties, with a dependence on prescription pain medication that I had to overcome. The consequences of that accident changed the course of my life, including my studies and my career. I know from the inside what it takes, and how little shame and judgement help. It is the reason working with people who struggle with addiction is so close to my heart.

How I work

My approach is shaped by your needs and circumstances, not by a fixed model. I don't work from the disease model, a strict 12-step programme, or the idea that you are powerless. Fear, guilt and judgement have no place in the treatment of addiction. Some people find 12-step groups such as AA or NA helpful, and others don't; I have no expectations either way.

The work runs on three tracks at once. The first is practical: understanding your patterns, what triggers them, and what you can do differently, starting now. The second goes deeper: what the drinking, using or behaviour has been doing for you, and what it has been protecting you from.

The third is existential: the meaning of the suffering that addiction brings, and how that experience can be turned into a process of growth. Life after active addiction is not about constantly looking back over your shoulder at the past. It is motivated by intent, connection, purpose, love and change, working towards outcomes we have identified together as the ones you want.

In practice, that draws on:

• An honest, non-judgemental relationship. Mixed feelings about change are normal. You don't need to be sure you want to stop before you come.
• Understanding the beliefs behind the behaviour, using REBT, for example “I can't cope without it”, “one won't hurt” or “I'm a bad person”.
• Mindfulness, learning to notice cravings, urges and emotions as they arise, and to create a pause before reacting.
• Psychoeducation, understanding what addiction does to the brain, body and relationships, so that what happens makes sense.
• Relapse prevention, recognising early warning signs, planning for high-risk situations, and knowing what to do if you slip.
• The six dimensions of daily living, rebuilding physical health, relationships, structure, work and meaning, so that recovery rests on a full life.

Abstinence or harm reduction

There is no single right goal for everyone. For some people, stopping completely is what is needed; for others, reducing the harm is the right place to start. We decide together which is indicated. If we choose harm reduction, we agree ahead of time on the signs that it isn't working, and on what happens next.

Wherever you are in the process

• Wondering whether you have a problem. We can look at it together, honestly and without labels.
• Preparing for treatment. I can help you think through your options, including in-patient care.
• Leaving a clinic or rehab centre. Aftercare is an essential part of treatment, and the weeks after discharge are often the hardest. I offer ongoing counselling to support that transition.
• Staying well, or starting again after a relapse. A slip is not the end of recovery. It is information we can learn from.

Do I need to go to a rehab centre or clinic?

Not necessarily. Many people work through addiction with therapy and counselling alone, while living at home and carrying on with work and family life. A rehab centre or clinic is one option, not a requirement. Together we look honestly at whether counselling can give you the support you need, or whether broader safety and support, such as a medical detox or an in-patient programme, is indicated.

Counselling is not a substitute for medical care. Stopping some substances suddenly, alcohol and certain medications in particular, can be dangerous without medical supervision, and disordered eating can affect physical health in ways that need a doctor's involvement. Where a medical detox, medical care or an in-patient programme is the safer route, I will say so and help you find it, and we can continue working together alongside or afterwards.

For families and loved ones

Addiction affects everyone close to it. Partners, parents and adult children often carry worry, anger, guilt and exhaustion, and may lose sight of their own needs. I offer support to family members in their own right, whether or not the person with the addiction is ready to seek help.

Sessions

Sessions take place in person at my practice in Stellenbosch, or online by Zoom, in English or Afrikaans. Sessions are fifty minutes, R800 in South Africa and $65 internationally. Answers to other common questions are on the FAQ page.

Taking the first step

Reaching out is often the hardest part. You don't need the right words, or to have decided anything yet. Send me a message by email, WhatsApp or the contact form, and we can talk about what is happening.

← Return to Approach