What does it mean to be an addict in Egypt? A reflection on medical model imperialism.

What may seem familiar in Western critical debates — the questioning of psychiatry’s authority, the exposure of its institutional violence — remains almost entirely absent in the Arab world. Oppression here doesn’t only silence speech; it sterilizes it. It leaves us with a form of discussion that can only repeat what power has already said.

This text was written for Egyptians who have lived through forced rehabilitation, shame, and the moral policing that comes disguised as care. I ask readers to approach it as one might approach a voice speaking such critique for the first time — because in Egypt, that’s still what it means to speak freely about mental suffering.

In Egypt, whenever the question of addiction treatment arises, one dominant discourse immediately takes the stage—a discourse that calls for more laws, more regulations, more certificates, more inspections, and more licenses. And when we speak specifically about addiction treatment centers, the conversation circles around professionalism, compliance, and institutional “best practices” for offering the most effective “treatment” for addiction—the “best cure for the disease of addiction.”

But is addiction a disease? There is real debate and disagreement among researchers over whether the term “disease” is even appropriate to describe the phenomenon. The problem with this description is not only theoretical—it carries material and political consequences. It reduces addiction to its psychological and biological dimensions alone, disregarding the social and political contexts that sustain it. It also creates a kind of historical distortion: the most destructive forms of drug use—use leading to death and social collapse—are normalized and generalized as if they were the only, or the “natural,” forms of human relationships with mood-altering substances. Historians of addiction have noted this as a misreading of history that erases any critical perspective capable of questioning the nature of this relationship and the social structures that produced it.

It is important to remember that the use of mind- and mood-altering substances has taken many shapes and meanings throughout history. Archaeological evidence shows that such substances were used long before written history—so the potential for misuse has always existed. Yet particular styles and patterns of use dominate each era, each culture, each society. Many scholars of addiction history argue that the modern form of addiction—one that centers life around the substance, turning the addict into its worshipper, repeating cycles of self-destruction—is a phenomenon unique to modernity. Thus, alongside individual work that addresses the immediate needs of those struggling with addiction, it is crucial to ask: why, in our historical moment, has this particular form of use proliferated?

Western academia has produced hundreds of papers and books—alongside popular works and bestsellers—critiquing the disease model of addiction. This critique often overlaps with broader critiques of the medicalization of human suffering, including what we call “mental illness.”

Yet in Egypt, such critique has not taken root. The disease model has been treated as an unquestionable truth, a starting point for all discussion. Consequently, what presents itself as radical critique here rarely goes beyond managerial or administrative criticism—it does not disturb the foundations upon which these institutions were built. These are the very institutions that, despite some individual success stories (and I am one of them), have largely failed to address addiction as a social phenomenon. But even for those of us who “recovered,” one must ask: do we owe our recovery to these institutions themselves? Were they truly the essential cause of our survival?

Or were there other, more decisive factors—factors that vary from person to person—some deeply personal, rooted in one’s own disposition, resources, and circumstances; others structural, shared by many, linked to class, society, and opportunity? I, for example, left a rehab eight years ago. What has kept me sober since then were things I contributed to, yes—but they were not products of what I learned inside those institutions. They were mostly privileges given to me by my social class and personal circumstances, things I can never generalize to others.

In my understanding today, recovery is not merely abstaining from drugs—it is withdrawing from an entire logic that turns one’s relation to life, to self, and to others into relations of use and exchange; thing-to-thing relationships defined by exploitation, interest, and demand. It is to end our objectifying mode of being—what Erich Fromm called the “having mode”—in which humans turn one another into consumable or exploitable objects. This kind of recovery—a recovery that requires building a life outside the very logic that shapes our world, one that also recognizes our social wounds—will not be offered by rehabs, licensed or unlicensed.

There is a deep contradiction inside treatment centers that must be addressed. We enter what is called the “therapeutic community,” where we are stripped of our external identities—our jobs, possessions, and habits—to experience a new kind of life: collective, communal, even quasi-socialist. This, I believe, is what makes life in these institutions bearable for many and perhaps gives some addicts a fleeting sense of warmth and hope—that life can still hold meaning. Yet that very longing for connection is exploited; what was once a space of warmth becomes a temporary simulation of community, one that dissolves the moment treatment ends. What follows is a return to coldness, to isolation, to relapse.

This is not a call to deny that some benefit may come from treatment centers in their various forms. Rather, it is an attempt to reveal the contradictions structuring the system itself, and to direct our gaze toward what remains unspoken—what concerns us all: addicts, those in recovery, and citizens alike.

Many people have also recovered in centers now facing legal and administrative scrutiny—unlicensed places that nevertheless saw real recoveries. But can we call these institutions legitimate simply because some people emerged sober from them?

This kind of administrative criticism—focused on licenses, procedures, or the “scientific” credentials of staff—ignores more fundamental questions: Is addiction truly a disease? Is it a purely individual responsibility? What role does society play in producing both addiction and recovery? Do we not need a social recovery that includes all aspects of human life—economic, political, emotional? How is addiction tied to capitalism, inequality, poverty, marginalization, social isolation, labor markets, punishment, law, and medicine? And what of existential despair—is it not something we share collectively? Does the addict really need only “professionals”? What promises do these professionals and institutions make—and are these promises ever fulfilled?

These questions shape how we deal with addiction as a phenomenon that touches us all. The addict, in this sense, carries a certain symbolism. How can it be that, amid such technological progress, people from vastly different classes, nations, and backgrounds converge on the same impulse—to destroy themselves, to withdraw not only from the system but from life itself? In his book Addiction and Virtue, Kent Dunnington compares addicts to prophets of the modern age—living messengers revealing something about the sickness of the societies that produced them. The addict becomes a living critique of the existing order.

Instead of listening to this critique, administrative reform works to repair and beautify the system, keeping it alive through cosmetic improvement. The result is a sterile binary: licensed vs. unlicensed. This kind of reform is absorptive—it allows the system to metabolize its own criticism, transforming dissent into an argument about who possesses the “legitimate” right to treat.

And so, the addict’s family takes him to a licensed facility that proudly claims professionalism and scientific rigor, promising recovery to both patient and family, addressing all conceivable “individual” and “family” dimensions—without ever questioning the world outside that created the suffering in the first place. The best-case scenario is that the addict completes his treatment and leaves—only to return to the same society, the same conditions, that once made drugs his only refuge.

The “brain-disease model of addiction” cannot be separated from the political economy that sustains it. The disease model is not a neutral scientific description—it is a framework that organizes an entire market: the addiction treatment industry.

Licensed rehabs present themselves as professional and scientific institutions. In reality, they are commercial enterprises that cannot allow science or ethics to interfere with profit. They sell reassurance to anxious families: “We treat your child’s disease.” Fear and despair are converted into monthly payments. Families pay not only for accommodation and medication, but for legitimacy itself—legitimacy that the clinic has purchased from the state.

Inside these places, addiction is stripped of its social and political dimensions and redefined as an individual defect of brain or soul. This absolves the state of responsibility for the conditions that breed addiction and hinder recovery. The burden of “fixing the brain” is placed squarely on the individual.

What’s most striking is that the system’s failure does not threaten it—it reinforces it. High relapse rates are not seen as evidence of structural dysfunction but as justification for further expansion—more “professional training,” more campaigns, more investment. Failure becomes the condition of the market’s survival. A treatment that promises success yet produces repeated failure guarantees its own continuity.

“Addiction is a relapsing disease”—what a perfect formula for perpetual demand! Even after multiple failures, nothing changes. At best, the addict moves from one rehab to another, each offering the same programs, the same narratives.

In most of these institutions, to regain certain basic rights—like phone calls, visits, short leaves, or even your own cellphone—you must follow the script: repeat prescribed phrases, perform “insight,” adopt the language of the program. Speaking in your own words is prohibited. The institution assumes that what made you an addict is precisely your inability to “express yourself correctly.” You are treated like a child—regardless of age or experience—who must obey and repeat. The “change” your counselors look for is linguistic conformity, accompanied by outwardly “positive” behavior deemed signs of recovery.

Positivity here means self-management according to institutional standards—standards that, paradoxically, mirror corporate logic. In rehab as in the office, you are not asked to be free or truthful about your suffering—you are asked to perform the role expected of you. As they say in the centers: “Commitment is the first step of recovery.” Attend meetings on time, obey rules, display enthusiasm, repeat recovery slogans. Just as a disciplined employee is rewarded with promotion, the “recovered” patient is rewarded with small privileges—or, ultimately, discharge. Success is measured not by inner transformation or genuine healing, but by conformity to pre-set norms. What happens is not therapy but training in obedience—the addict turned into the ideal employee of the recovery institution.

What, then, is the purpose of all this? Is what we normalize as “treatment” in fact a form of disciplining—a pedagogy of docility? Is the addict’s problem truly a lack of discipline? Have we examined every social factor that impedes human flourishing, only to conclude that the missing ingredient is obedience?

There is a concept known as Recovery Capital—used to measure the likelihood of relapse or long-term success after quitting drugs. This capital is not determined by personal discipline alone, but by psychological and material support, access to employment, respect, rights, and the environment one inhabits. Does the city one lives in support recovery—or drive one toward despair? These are social, not individual, determinants—and the most decisive ones.

We live in an era of what has been called the “burnout society”—an era of relentless self-exploitation, where individuals are urged to commodify every capacity in the pursuit of productivity, growth, and recognition. The self becomes a permanent project—constantly improving, optimizing, policing its emotions, suppressing its “negativity.” The result is a form of self-domination that requires no external master.

In what is today called “recovery”—and here I echo the familiar phrase used by counselors, “working on yourself”—this “work” becomes an endless loop of self-surveillance and self-extraction. I would not be surprised if many relapses are, at their core, attempts to escape this suffocating compulsion to self-control.

When we link all this to Bruce Alexander’s Dislocation Theory—a socio-psychological account of how individuals, severed from meaningful social bonds in postcolonial, hollowed-out societies, turn to addiction—we begin to see addiction in historical and structural terms. Addiction, in its contemporary form, is a response to specific social and historical conditions: to emptiness, to exhaustion, to the psychic void of life stripped of meaning, to the despair produced by neoliberal positivity and the self-help ideology that conceal the material and political roots of our collective dislocation.

We need to bring new considerations into the conversation—ones invisible from within the system itself. The first of these is the general human condition: how are we, as people, doing today? Do we still possess the social and material resources that historically helped humans endure suffering—security, family, community, education, dignity, intimacy?

Who benefits from the addiction treatment industry and from the “addiction is a disease” narrative? Do addicts benefit? Why does this narrative dominate? Is it truly because of science—or because of something else? A cultural reason rooted in the Cold War, which we then imported—an epistemic vacuum left by medical imperialism in our region, and a cultural dislocation that followed.

It may shock many in the fields of addiction treatment and psychology to hear that addiction might not be a disease. I understand the shock: such a conclusion requires viewing the phenomenon through a critical lens. Most practitioners are entangled in the disease model, materially and existentially—it provides their livelihood and shapes their professional and personal identities.

According to Bruce Alexander, the brain-disease model emerged in a particular Western context: the Cold War between the U.S. and the Soviet Union. Many scientific studies contradict this model, yet the dominant narrative remains intact. Politics and culture, not science, have sustained it.

Alexander links ideological battles between the Western and Eastern blocs—the struggle for global leadership—to the ways addiction was discussed and represented. In early twentieth-century America, addiction was mainly associated with racial minorities and immigrants, stigmatized as the vice of “outsiders.” But when it began spreading among the middle and upper classes, a neutral narrative became necessary. In a nation that claimed moral and scientific leadership of the world—the American Dream as the best of all possible worlds—addiction could no longer be a moral failure. It had to be a disease.

In Egypt, as we embraced the American model during the Infitah—the economic liberalization of the 1970s—we too paid the social price: addiction spread across classes, along with the disease model and a collective denial of its roots. Our specialists became even more dogmatic than their American counterparts—so much so that it became almost impossible to imagine addiction outside the medical framework. Meanwhile, in the West, many scholars and practitioners began openly debating figures like Nora Volkow, director of the U.S. National Institute on Drug Abuse, and resisting the biological determinism that underpins her model—calling instead for a human science capable of addressing social and existential complexity.

So how did it all begin? Let us return to the 1970s—and to the promise neuroscience made to humanity.

The neurosciences rose to prominence promising to solve human suffering by focusing on the biological level, heavily funded and politically endorsed. Around the same time, Nixon declared his infamous “War on Drugs.” The disease model framed addicts as weak and defective individuals who needed protection—from themselves and from others—by any means necessary. It was the perfect moral justification for a war that would later reveal itself to be, in truth, a war on the American people.

Decades later, the deception is clear. The war on drugs has left countless victims. Yet the disease model still reigns, along with the science that claims neutrality. We continue to “fight addiction” as though it were both the cause and the symptom—fighting, in truth, the part of ourselves we cannot bear to face. Recovery is reduced to a return to a pre-addiction state—to the same logic that broke us in the first place—while “treatment” becomes a technology of self-management aimed at reintegration into the very toxic society we once tried to escape. Any form of knowledge born from our survival, from our attempts to live differently, is disqualified in advance.

In short, we are struggling to survive at a time when the worst in us is laid bare. We no longer dream. The worst addict among us represents the brutal truth of our age more faithfully than any entrepreneur in Silicon Valley—the first intoxicated by his drug, the second by the last fumes of the American Dream.

So I ask those working in the fields of addiction and mental health in our part of the world: is there such a thing as an “Egyptian Dream”? If not, why do we keep importing the same solutions, repeating the same answers, as if they could fit all contexts equally?

The American Dream, as the novelist J. G. Ballard once wrote, has run out of fuel. The car has stopped. It no longer supplies the world with its images, its dreams, or its illusions. Not anymore—it now exports its nightmares.

The disease model of addiction is one of those American nightmares.

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Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own.