When Normalcy Fades, The Body's Symphony Becomes Discordant

The word “disease” does two things to people. It calms some down because it makes the problem feel medical and treatable. It infuriates others because they think it sounds like an excuse, like a way to dodge responsibility. That’s why the addiction as a disease conversation never dies, it sits right at the intersection of science, morality, family trauma, and public anger.

And in South Africa, where addiction is often handled with judgement, gossip, and punishment before it is handled with proper treatment, this debate matters. Not because words are magical, but because labels shape what families do next. If you believe addiction is simply bad behaviour, your plan is shame, threats, and control. If you believe it is a disease, your plan becomes assessment, boundaries, treatment, and long term management. One approach tends to escalate conflict. The other tends to create a real chance of change, while still holding the person accountable for behaviour.

So let’s cut through the fluffy version. Calling addiction a disease does not mean the person is helpless. It means the condition is real, progressive, and predictable in the way it damages the brain, behaviour, and relationships, and it needs a structured response, not just family speeches and Sunday promises.

What “Disease” Actually Means

A disease is a condition that disrupts normal functioning and causes harm. That can be physical harm, mental harm, behavioural harm, or all three. Disease is not a synonym for “innocent”. It’s a category that tells you something important, the body or brain is no longer operating normally, and without proper intervention the damage tends to progress.

We accept this logic easily with diabetes, asthma, high blood pressure, depression, and many other conditions. Nobody says to a diabetic, “Just produce insulin harder.” Nobody tells someone with chronic asthma to stop being dramatic and breathe properly. But with addiction, people still talk like the person is choosing to be sick every day, as if they wake up and select destruction on a menu.

Addiction complicates this because it shows up as behaviour. Lying. Stealing. Manipulation. Neglect. Rage. Disappearing. Broken trust. And families experience those behaviours as personal betrayal. That experience is real. It is also possible that the behaviour is driven by a brain that has been rewired by repeated substance exposure and habit loops, and that is where the disease concept becomes useful.

The Real Reason People Hate the Disease Model

People don’t reject the disease model because they love science. They reject it because they have been hurt. They’ve watched an addicted person destroy a home and then apologise like it was a bad day. They’ve covered up and rescued and tried everything, only to be lied to again. So when someone says “It’s a disease,” families hear “Stop being angry” or “It’s not their fault.”

That is not what the disease model says. It says the addiction is the problem, and the behaviour is part of how the condition operates. It also says the person is responsible for getting help and changing behaviour, even if the condition makes that difficult. Disease is not a free pass. It is a diagnosis that changes strategy.

This is why we talk about addiction as a primary disease. Not because it is the only thing going on in a person’s life, but because it becomes a standalone condition that needs direct treatment, not just a side effect that will vanish if the person “sorts themselves out.”

Addiction as a Primary Disease

When clinicians call addiction a primary disease, they mean it can exist on its own, it is not always merely a symptom of something else, and it can drive its own progression. If someone has a primary alcohol addiction, treating anxiety alone will not magically stop the drinking. If someone has a primary meth addiction, treating depression alone will not automatically end the compulsion. Those mental health issues might be present and important, but the addiction itself has its own momentum.

This matters because families often cling to the comforting idea that if they can just fix the “real reason” the person uses, the using will stop. Sometimes there is a clear trigger. Trauma. Loss. Abuse. Stress. But addiction can outlive the trigger. It becomes its own engine. That’s why people can keep using even when life is going well, or keep drinking long after the original pain has passed.

Primary disease framing says, treat the addiction directly, and do not wait for a perfect explanation before you act.

Acute vs Chronic

A lot of the public conversation about addiction is confused because people expect short term problems to behave like long term ones, and vice versa. In medicine, we distinguish between acute and chronic conditions. Acute conditions come on fast and can sometimes resolve with immediate intervention. Chronic conditions develop over time and usually require ongoing management.

Addiction often behaves like a chronic condition. It develops gradually. It escalates. It relapses. It impacts multiple systems, physical, psychological, social, legal, financial. It does not usually vanish because the person had a heartfelt conversation or a frightening scare. The idea that a single crisis will “wake them up” is one of the most damaging myths families cling to, because it keeps them waiting for the magic moment when the person changes without a structured plan.

Can addiction appear rapidly after a specific event. Yes. Can someone have a period of intense misuse that is short lived. Yes. But once dependence and compulsive patterns take hold, the condition tends to be long term and requires ongoing support and monitoring, much like other chronic illnesses.

This is where social media tends to split. One side says, “People relapse, so rehab doesn’t work.” The other says, “Relapse is part of it, so nothing matters.” Both are wrong. Chronic conditions relapse when management fails or stress overwhelms the plan. That doesn’t mean treatment is pointless. It means the plan needs to be stronger and more realistic.

The Complication That Makes Treatment Trickier

Secondary addiction is when substance use grows out of another issue. Someone starts drinking to numb anxiety. Someone uses pills to sleep. Someone uses stimulants to cope with depression and fatigue. Someone uses cannabis to suppress trauma symptoms. It begins as self medication and then becomes dependence.

This is where families get stuck because it feels like the substance is the symptom. They focus only on the underlying problem and ignore the addiction that has developed. In reality, both now require attention. Treating the mental health issue matters, but treating the addiction as a separate condition matters too, because the addiction changes the brain and behaviour in ways that persist even when the original trigger is addressed.

Secondary addiction also matters because it can hide in plain sight. People excuse the drinking because the person is stressed. They excuse the pills because the person can’t sleep. They excuse the stimulant use because the person is “trying to cope.” Then months pass, tolerance builds, withdrawal appears, and suddenly the family realises they are no longer dealing with coping, they are dealing with dependence.

The Brain Disease Part

Calling addiction a brain disease doesn’t mean the brain is permanently broken. It means repeated substance exposure and repeated behaviour loops change brain circuits related to reward, motivation, memory, stress response, and impulse control. The brain starts prioritising the substance, and the person’s decision making becomes distorted. They chase relief. They chase numbness. They chase energy. They chase escape. And they keep chasing it even when the consequences are brutal.

This is why addicted people often look irrational to families. They can love their children and still vanish for days. They can want to keep their job and still show up intoxicated. They can beg for another chance and still relapse within weeks. Families interpret this as not caring. Sometimes it is not a lack of care, it is a hijacked priority system.

None of this removes accountability. It explains why the behaviour is so resistant to guilt and threats. It explains why “just stop” advice fails. It explains why treatment needs structure and repetition rather than speeches.

The Dangerous Misuse of the Disease Model

Here’s the part people don’t like hearing. Some addicted people use the disease model as a weapon, “I have a disease, so you can’t judge me, you must support me, you must forgive me, you must keep paying.” That is not treatment thinking. That is manipulation. Families are allowed to set boundaries. Families are allowed to say no. Families are allowed to protect children and finances and their own sanity.

Chronic disease management includes boundaries too. If someone with epilepsy refuses medication and keeps driving, we remove keys. If someone with uncontrolled diabetes refuses care and keeps collapsing, we intervene. We don’t call that cruelty. We call it safety. Addiction is the same. Disease framing should lead to better care, not endless tolerance of harmful behaviour.

The Point of Calling It a Disease

Calling addiction a primary disease helps remove pointless moralising and replaces it with strategy. It frames addiction as something that needs treatment, monitoring, and long term planning, while still requiring personal responsibility and behavioural change. It helps families stop waiting for willpower to appear and start insisting on care. It helps society move away from punishment as the first response and toward treatment as the first response.

And if this topic lights up your social feed with angry comments, good. It should. Because the real question is not whether addiction deserves a label people like. The real question is whether we want people to keep dying and families to keep breaking, or whether we want to treat addiction like the chronic, destructive condition it is, with the seriousness, boundaries, and professional support that actually gives people a chance.