Why Quitting is So Hard: Understanding Addiction

Addiction affects millions of people, yet stigma and misunderstanding often prevent people from seeking help. In this episode of Health Matters, host Courtney Allison speaks with Dr. Jonathan Avery, an addiction psychiatrist at NewYork-Presbyterian and Weill Cornell Medicine, about the realities of addiction and recovery. Dr. Avery explains that addiction is more than a problem of willpower. Drawing on research and clinical experience, he discusses how genetics, mental health, trauma, social factors, and brain chemistry all play a role in the development of substance use disorders and behavioral addictions. The conversation examines how addictive behaviors, from alcohol use and opioid dependence to gambling and social media use, affect the brain's reward system and why quitting can be so difficult. Dr. Avery also shares how newer treatments, including medications and emerging research on GLP-1 medications, are changing the landscape of addiction care. Finally, Dr. Avery discusses the importance of reducing stigma, building supportive communities, and recognizing that recovery is possible. He offers practical advice for people who may be struggling themselves as well as guidance for supporting loved ones with compassion and understanding. Chapters 00:00 – What Is Addiction? Why addiction is more than a substance, the role of trauma and mental health, and what happens in the brain 05:05 – Gambling, Screens, and Modern Addictions How behavioral addictions affect the brain and why smartphones have changed the landscape 09:00 – Treatment, Recovery, and New Hope Available therapies, medications, emerging GLP-1 research, and why most people do get better 11:30 – Breaking Stigma and Supporting Recovery Why connection matters, how addiction overlaps with mental health, and ways to support loved ones Key Topics Covered Addiction Recovery Substance use disorders Alcohol use disorder Opioid addiction Fentanyl epidemic Behavioral addictions Gambling addiction Social media addiction Gaming addiction Nicotine and vaping Dopamine and reward pathways Withdrawal Mental health and addiction Trauma and addiction Addiction stigma Recovery support Community and connection Addiction treatment Medication-assisted treatment GLP-1 medications Self-medication hypothesis Depression and addiction Anxiety and addiction Addiction psychiatry Key Takeaway Addiction is a complex health condition influenced by brain biology, mental health, life experiences, and environment, not simply a lack of willpower. While quitting can be challenging, effective treatments, supportive communities, and growing understanding of addiction are helping more people achieve lasting recovery. Reaching out for help is often the first and most important step.   Bio: Jonathan Avery, M.D., is an addiction psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center and vice chair of addiction psychiatry, a professor of clinical psychiatry, and the Stephen P. Tobin and Dr. Arnold M. Cooper Professor in Consultation-Liaison Psychiatry at Weill Cornell Medicine. He is the program director for the addiction psychiatry fellowship at NewYork-Presbyterian and Weill Cornell Medicine. He also serves as the medical director of the NBA’s Anti-Drug Program. Dr. Avery graduated from the New York University School of Medicine and completed his psychiatry residency at New York-Presbyterian/Weill Cornell Medical Center. During residency, he was selected as a Group for the Advancement of Psychiatry Fellow, served as co-chief resident in his final year, and received several awards for his clinical and academic work. He then completed a fellowship in addiction psychiatry at the New York University School of Medicine before joining the faculty at Weill Cornell Medicine. Dr. Avery has published widely in addiction psychiatry, with work spanning clinician attitudes toward patients with addiction, treatment approaches for substance use disorders, and the intersection of mental illness and addiction. He is the founder of the NewYork-Presbyterian and Weill Cornell Medicine Program for Substance Use and Stigma of Addiction, and his research on stigma has been supported by multiple national grants and awards. He has served on the editorial board for the DSM-5 Clinical Cases book and is the editor and author of more than 10 books, including Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatmen