Addiction, relapse and Capitalism: Why it isn’t just your fault

Criticism of Egypt’s addiction treatment system usually stops at bureaucracy. The debate centers on tighter laws, stricter licensing, and higher professional standards; measures meant to guarantee “the best treatment for the disease of addiction.”

None of this is irrational. Oversight can matter, and unregulated institutions can cause real harm. But focusing almost entirely on regulation avoids a harder reckoning. Even when treatment “works,” the system itself shows clear limits that individual recovery stories cannot explain.

Before arguing over licensing and compliance lies a more basic question: Is addiction really a disease?

Side effects of modernity

That question, controversial as it may sound in Egypt, sits at the center of “Evaluating the Brain Disease Model of Addiction,” a 2022 book by the Addiction Theory Network. The volume is part of a growing body of work challenging the idea that addiction can be fully explained—or effectively treated—as a medical disease.

The disease model narrows addiction down to biology and psychology, stripping away the social and political conditions that shape how substance use takes hold. In doing so, it distorts history, treating the most destructive forms of drug use as if they were the only natural relationship between humans and mood-altering substances.

Historians of addiction, including Bruce K. Alexander, point out that the pattern most people now recognize as addiction—compulsive use organized around a single substance—has not always existed. It is largely a modern phenomenon, closely tied to social disruption and economic change.

If addiction were a “biological disease,” why did it emerge in this specific form, at this moment in history? And why does it appear so unevenly across societies?

Despite this extensive debate in the West, the disease model of addiction in Egypt has remained axiomatic, even among critics from within the system itself. Their focus is typically on unlicensed rehab centers, administrative violations, or the lack of qualified staff.

The core question, meanwhile, goes unasked: Are these institutions—licensed and unlicensed—even capable of dealing with addiction as a complex social phenomenon, rather than a defect located solely in the individual’s “brain”?

The therapeutic community

I am one of those who recovered inside a rehab center. But my personal experience has taught me that what helped me move beyond addiction was not what I learned inside the institution as much as the social and personal advantages my class position and specific circumstances gave me.

That is what makes it so hard to generalize my experience to others.

The sharpest contradiction in rehab centers appears in the “therapeutic community” model. Inside, we shed our individual identities—our jobs, our possessions, and the pressures of daily life—and live a collective life that resembles a primitive form of human solidarity.

For many people, that environment can feel transformative. It offers a sense of warmth, mutual recognition, and the possibility that a different way of living might exist, at least for a time.

That collective life, however, ends when treatment does. When people leave rehab, they return to the same social and economic conditions that shaped their drug use in the first place. The structure falls away, but the pressures remain.

Criticism of the system has been boxed into the binary of “licensed vs. unlicensed rehab centers,” as if legal status alone can produce real treatment.

Meanwhile, the bigger questions are ignored: Is addiction a disease in the first place? Is the individual alone responsible for it? What role does society play in producing addiction and in making recovery possible? Do we need “social recovery,” not just individual recovery? What is the relationship between addiction and capitalism, inequality, isolation, and punitive policies?

Disease capitalism

Many rehab centers frame addiction as a malfunction in the brain—an explanation that sounds objective and scientific. But that framing also underpins a growing treatment industry, one that depends on a steady flow of patients.

Rehab facilities operate as businesses. Their survival depends on demand, which leaves little incentive to pursue approaches that might reduce the need for treatment altogether. Instead, fear and urgency, often felt most acutely by families, are converted into monthly fees, exchanged for programs that carry the legitimacy of state licensing and official recognition.

The irony is that failure does not threaten this system; it reinforces it. Relapse brings people back through the door, creating demand for additional sessions, new treatment plans, and extended programs.

Addiction is routinely described as a condition “prone to relapse,” a framing that normalizes repeated returns to treatment. In practice, it also helps sustain the market. What counts as failure for the patient becomes, quietly, a measure of success for the system built around them.

Inside rehab centers, the person with addiction is reshaped through a disciplinary model. To earn basic privileges, or permission to leave, residents must master the discourse of recovery and perform their role “positively.”

Positivity here is not a feeling as much as it is compliance with a prescribed performance—like the performance of an ideal employee.

Just as a compliant employee is rewarded in a company, a compliant person in recovery is rewarded in the rehab center. This is less treatment than training in discipline, making the individual fit to return to the same social system they previously tried to escape.

But is discipline alone enough? Research on “recovery capital” suggests that long-term stability depends less on behavior during treatment than on what comes after: access to housing, income, social support, legal protections, and a livable environment.

Rehab centers do not provide those conditions, and individuals cannot manufacture them on their own. When people relapse, it is often because the circumstances of their lives have not materially changed.

Today, addiction sits within a wider context: a society defined by burnout. Individuals are pushed to drive themselves hard and maximize productivity, polish their emotions, market their identity, and manage their fears.

In that context, a common piece of advice like “work on yourself,” meaning learn new skills and refine old ones, can become a form of self-abuse rather than healing. Many relapses may be attempts to escape this constant pressure.

The Canadian psychologist Bruce Alexander offers one way to make sense of this pattern. His dislocation theory argues that addiction is less a biological disease than a response to social breakdown. When people lose stable bonds, to community, work, or shared purpose, drug use can become a way to cope with that loss.

In this view, addiction reflects not a defect in the individual, but the strain of living in societies where connection has eroded and security is unevenly distributed.

The American model

Politics cannot be separated from the push to treat addiction as a disease. During the Cold War, the United States needed a narrative that absolved white men as drug use spread in the middle class.

The “brain disease” model offered an ideal solution: no blame on society, no critique of economic and political conditions. It was simply an illness that required treatment.

To understand the roots of this model more clearly, we can go back to the 1970s. Neuroscience rose with a discourse promising to end suffering by focusing on the brain. At the same time, Nixon declared the war on drugs.

That merger of science and politics produced a narrative that looks scientific but serves a security agenda. Decades later, it became clear the war on drugs was not simply a war on substances. It was a war on people, and many of neuroscience’s promises were overstated.

Even so, the dominant narrative keeps reproducing itself. We fight addiction as if it were the cause, and we neglect the conditions that produced it.

We reduce recovery to returning to “before addiction,” without criticizing the conditions the person could not adapt to in the first place.

In Egypt—especially in the 1970s, with Sadat’s open-door economic policy and the drive to imitate the American model—we imported the same disease model.

With it came a discourse that denies the social dimension of the problem, turning addiction into an individual malfunction that can be repaired inside a closed institution.

We cling to the disease model as if it were final scientific truth, despite the fierce criticism it has faced in the West, including specialists challenging Nora Volkow, director of the National Institute on Drug Abuse in the United States, and challenging the brain model itself, as organizations call for human sciences that acknowledge social and psychological complexity.

Today, people with addiction often reflect the pressures of the society they live in. The American philosopher Kent Dunnington has described them as “messengers,” arguing that their suffering points to deeper problems in the contemporary social order.

Yet instead of treating that suffering as information—something worth listening to—the response is often procedural. The treatment system absorbs criticism, adjusts its language, and continues largely unchanged.

The novelist J.G. Ballard once argued that the American dream no longer produces shared aspirations, but shared nightmares. One of those nightmares is the insistence on explaining addiction primarily as a brain disease, even as its drivers remain rooted in political choices, economic inequality, and cultural pressure.

If meaningful change is the goal, addiction has to be understood in that broader context: societies shaped by instability, dislocation, and uneven access to dignity and security.

Recovery cannot be confined to the walls of rehabilitation centers. It depends on whether people can return to lives that are stable enough to sustain them—housing they can keep, work that does not break them, and communities that offer more than surveillance and punishment.

The unanswered question, then, is not how to perfect treatment inside rehab, but how to build a society people do not need to escape in order to survive.