Reframing Addiction: From Disease to Survival Strategy

The Definition That Controls Everything

The National Institute on Drug Abuse defines addiction as "a chronic, relapsing disorder characterized by compulsive drug seeking and use despite harmful consequences."

This isn't just an academic distinction. This definition shapes everything: how doctors diagnose, how insurance companies reimburse, how courts sentence, how families understand their loved ones, and how millions of people understand themselves. It determines whether someone gets treatment or incarceration, whether their behavior is seen as a medical condition or a moral failure, whether the response is compassion or contempt.

The disease model declares addiction a brain disorder—chronic, progressive, often fatal. Like diabetes or hypertension, it's framed as a condition requiring lifelong management. The brain has been fundamentally altered by substance use. The person has lost the ability to control their behavior. Relapse is expected, even inevitable, because the disease itself is incurable.

This framework became orthodoxy through institutional consensus. Medical organizations, treatment centers, and public health agencies adopted it. It offered a way to reduce stigma: if addiction is a disease, then it's not the person's fault. It justified medical intervention and insurance coverage. It gave the treatment industry a coherent narrative and a billable diagnosis code.

But there's a problem.

The disease model explains what happens—compulsive use, craving, escalation, continued use despite harm, relapse—but it doesn't explain why . It locates the pathology inside the individual's brain and stops asking questions. Why did this brain arrive at this state? What conditions made this adaptation necessary? What is the person's nervous system actually responding to?

When you ask those questions, a completely different picture emerges.

Important clarification: When I reference parasitic infections, I'm not talking only about intestinal worms. I'm talking about protozoa like Toxoplasma gondii and helminths like Taenia solium (which causes neurocysticercosis)—organisms that can cross the blood-brain barrier, form cysts in brain tissue, and directly alter neurotransmitter function. These neurotropic parasites are systematically denied as causes of psychiatric and neurological conditions in developed nations, despite mounting evidence of their prevalence and impact. For a detailed examination of how parasitic infections manifest as neurological conditions, see my article on Restless Leg Syndrome as a parasitic condition .

What Behaviors Are We Actually Trying to Explain?

Before we can reframe addiction, we need to be clear about what we're explaining. The behaviors the disease model attributes to "chronic brain disease" include:

• Compulsive use and drug-seeking: The person continues using despite wanting to stop, despite promises to quit, despite consequences piling up.
• Craving and preoccupation: Intense desire for the substance, difficulty thinking about anything else.
• Escalation and loss of control: Needing more to achieve the same effect, using more than intended, unable to moderate.
• Continued use despite harm: Physical damage, destroyed relationships, lost jobs, legal consequences—none of it stops the behavior.
• Relapse after abstinence: The person gets clean, sometimes for months or years, then returns to use.

The disease model says: this is brain pathology. The reward system has been hijacked. Dopamine pathways have been permanently altered. The person has lost voluntary control.

But the brain often is diseased—just not in the way the system describes it. The disease is the biological aftermath of severe trauma. Parasitic infection. Chronic neuroinflammation. Sometimes all three at once, feeding into each other in ways that are nearly impossible to untangle. All three are sustained attacks on the central nervous system.

A child experiences severe abuse or neglect—what researchers call Adverse Childhood Experiences, or ACEs. The chronic stress dysregulates their developing nervous system, weakens their immune function, potentially makes them more susceptible to parasitic infection. Years later, they could be living with unresolved trauma and a parasitic load that's been altering their neurotransmitter systems, driving chronic fatigue and pain.

Poly-substance users aren't choosing between drugs randomly. This severe subset of people using multiple substances with frequency makes perfect sense: stimulants for the fatigue, opioids for both the physical and psychological pain, alcohol for the stress and anxiety, tobacco for the parasitic infection itself.

Chronic fatigue doesn't appear out of nowhere. It results from unresolved trauma, parasitic infections, or both. Same with chronic pain. These aren't separate issues running on parallel tracks—they're interconnected biological and psychological crises that the person is trying to survive.

In that context, "compulsive use" isn't mysterious. You've found something that actually moves the needle when nothing else does. "Escalation" isn't loss of control—it's needing more because the underlying problems are worsening, not improving. "Continued use despite harm" isn't insanity—it's a brutal but often unconscious calculation: the harm from using might kill you eventually, but the harm from not using is unbearable right now.

And "relapse"? Relapse is what happens when treatment removes the substance but leaves the trauma unaddressed, ignores the parasitic infection, does nothing about the chronic neuroinflammation. The internal crisis is still running at full volume. Of course the behavior returns.

The system calls this moral failure. The addict internalizes it as moral failure. But the system set them up to fail from the beginning by treating the coping mechanism as the disease and leaving the actual diseases—trauma, infection, inflammation—completely untouched.

The next article in this series maps specific substances to specific underlying conditions—you'll see exactly how opioids address chronic pain, stimulants combat chronic fatigue, tobacco fights parasitic infection, and alcohol quiets trauma. But first, we need to understand the biological and psychological drivers that create these patterns.