Adjustment Disorder and Addiction
Adjustment Disorder is one of those psychiatric labels that sounds harmless until you see what it looks like in real life. People hear “adjustment” and think it means you’re simply struggling to adapt, like you need a better attitude or a few motivational quotes. In practice, Adjustment Disorder can be the doorway into heavy drinking, pills, cocaine, gambling, compulsive scrolling, and a full collapse of routine. Not because the person is weak, but because the nervous system has been overloaded and the coping system has failed.
In South Africa we don’t have the luxury of pretending stress is optional. People are dealing with job losses, financial pressure, divorce, family conflict, crime trauma, medical diagnoses, relocation, immigration issues, caregiving, grief, and a constant feeling that the ground shifts under your feet. Most people manage. Some people don’t, and when they don’t, they often get judged as “dramatic” or “lazy” rather than recognised as someone whose mental health has tipped into a clinically significant reaction.
Adjustment Disorder is essentially this, a person experiences a stressor, and their emotional or behavioural reaction is out of proportion to what we’d expect, or it disrupts their ability to function. That reaction might look like depression, anxiety, irritability, anger, reckless behaviour, sleep disruption, or withdrawing from everything. It can also look like substance use suddenly becoming non-negotiable.
Why people underestimate Adjustment Disorder
People underestimate it because it’s linked to something “normal,” a life event. They assume if the trigger is ordinary, the reaction should be manageable. That assumption ignores one crucial truth, the same event hits different people differently depending on their history, their support system, their personality, their biology, and what else is happening behind the scenes.
A breakup might be a sad chapter for one person and a total identity collapse for another. A retrenchment might be a temporary setback for one person and the end of stability for someone already carrying shame, debt, and fear. A move to a new city might be exciting for one person and deeply destabilising for someone who relies on familiar routines to stay emotionally regulated.
What makes Adjustment Disorder dangerous is that it often looks like “not coping,” and people respond by shaming the person into coping harder. That usually backfires. Shame adds pressure. Pressure increases anxiety and low mood. Low mood increases avoidance. Avoidance increases substance use. And then the person’s behaviour is judged even more harshly.
The symptoms people miss because they look like personality
Adjustment Disorder symptoms often get misread as attitude problems. The person becomes irritable, snappy, withdrawn, or “difficult.” They might stop answering calls. They might start missing work. They might be tearful, anxious, or angry. They might become reckless, driving fast, spending money, drinking hard, sleeping around, or taking risks. Families often respond with, “Pull yourself together,” because they don’t recognise the internal distress.
Sleep is often one of the first things to break. The person lies awake replaying the stressor. They wake up with dread. They feel exhausted. Exhaustion reduces self-control. Reduced self-control increases impulsive coping. Then the person feels ashamed and tries to hide the struggle, which increases isolation.
Isolation is a major problem in Adjustment Disorder. People often withdraw because they don’t want to be a burden, or because they feel embarrassed that they “can’t handle life.” That withdrawal removes support at the exact moment they need it most. Then substances become a private coping tool, and private coping tools are where addiction grows.
The lie of “it will pass” and why waiting can be dangerous
Some Adjustment Disorder reactions do pass with time, especially if the person has good support and healthy coping. But waiting is risky if the person is self-medicating. Alcohol and drugs don’t wait politely. They build tolerance. They change sleep patterns. They increase anxiety. They disrupt mood stability. They create conflict. They create financial harm. They change the brain’s reward system.
People often say, “Let them calm down first, then they’ll stop.” That’s not how addiction works. The behaviour becomes the way they calm down. The more they repeat it, the more their brain relies on it. That’s how a stress reaction turns into dependency.
This is why early intervention matters. If someone is using substances or compulsive behaviours to cope with a life stressor, don’t treat it like a phase. Treat it like a risk factor that needs management.
What treatment focuses on
At Changes Rehab in Johannesburg, when someone comes in with a stress-triggered collapse, we don’t only look at the substance. We look at the stressor, the person’s coping style, their support system, their thinking patterns, and the behaviours that have started spiralling. The goal is stabilisation first. Sleep. Structure. Physical health. Reduced chaos. Emotional regulation tools that aren’t chemical.
Then we address the deeper layer, what does the person believe about themselves in the face of this stressor. Do they believe they are a failure. Do they believe they have no future. Do they believe they are trapped. Do they believe they can’t cope without substances. Those beliefs drive behaviour. If you don’t address them, the person returns to the same stress environment and repeats the same coping.
Treatment also looks at practical reality. If the stressor is financial, we look at planning, structure, and support. If the stressor is relational, we look at boundaries and communication. If the stressor is grief, we look at processing rather than avoidance. If the stressor is relocation or identity change, we look at rebuilding routine and belonging.
The controversial truth
People hate this truth because it sounds like an excuse, but it’s not. Many addictions start as understandable coping. The person isn’t trying to destroy their life. They are trying to survive their feelings. The problem is that the coping tool becomes destructive, and once it becomes destructive, intention doesn’t matter, outcomes do.
If you are using alcohol, pills, or anything else to get through a life change, don’t wait until it becomes a full dependency before you take it seriously. If your sleep is broken, if your mood is unstable, if you’re withdrawing, if you’re drinking more, if you can’t stop when you plan to, those are early warning signs.
Adjustment Disorder isn’t a soft diagnosis when it’s driving destructive coping. It’s a red light that says, your current coping system can’t carry what you’re going through. That can be fixed, but not by pretending it’s fine.
A firm and realistic call to action
If you recognise yourself here, stop telling yourself you’re just “going through a tough time” if your coping has turned chemical or compulsive. Life stress is normal. Losing control isn’t. Get help early. Talk to a professional. Put structure in place. Tell someone the truth before secrecy becomes the habit. The sooner you stabilise, the less damage you have to repair.
If you’re a family member, don’t wait for rock bottom. Don’t negotiate with denial. Encourage assessment and treatment before the stress reaction becomes a long-term addiction. Compassion and firmness can exist together. Support the person, but don’t protect the addiction.
