Addiction: Why We Keep Doing Things That Hurt Us

Why do people keep doing things they know are harming them?

If addiction was simply a matter of willpower, nobody would smoke, gamble away their savings, drink themselves into hospital, or spend hours scrolling through videos they don’t even enjoy.

In this episode, I explore the science of addiction, the role of dopamine, why craving is often different from pleasure, and why the debate between personal responsibility and the disease model is far more complicated than either side wants to admit.

We talk about alcohol, food, gambling, smartphones, trauma, recovery, and the uncomfortable reality that modern life may be making addiction easier than ever before.

Most importantly, we ask a difficult question: At what point does a choice stop feeling like a choice?

If you or someone you know is struggling with addiction

If this episode resonated with you and you feel you may be struggling with addiction, help is available.

• NHS Addiction Support
• NHS Find a Drug and Alcohol Service
• Alcoholics Anonymous UK
• Narcotics Anonymous UK
• Gamblers Anonymous UK
• GamCare (gambling support)
• FRANK (drug information and support)
• Smoking and Nicotine Support (NHS Better Health)
• Mind - Useful contacts for drug and alcohol addiction

Healthcare Professionals

If you’re a doctor, nurse, paramedic, pharmacist, or other healthcare professional struggling with addiction, confidential support is available:

• NHS Practitioner Health
• Doctors in Distress

Crisis Support

If you feel at immediate risk of harming yourself or others, contact emergency services (999 in the UK) or attend your nearest Emergency Department.

For urgent mental health support in the UK:

• Call NHS 111 and select the mental health option where available.
• Samaritans (call 116 123, available 24/7)

If you’re struggling with addiction, please don’t try to face it alone. Speak to your GP, a trusted friend or family member, or one of the organisations above. Recovery is possible, and asking for help is often the hardest step.

Thank you for listening!
email: adoctorsview@gmail.com
instagram: @adoctorsview
X: @DrPolyvios

Transcript

The Science of Addiction

Hello everyone and welcome to A Doctor’s View. I’m Dr Polyvios.

In today’s episode, I want to talk about addiction. But, before I begin, this podcast is called “A Doctor’s View” and the doctor giving that view is me. I’m not an expert by any means in addiction psychology or anything like that. I just enjoy thinking about life and the way everyday challenges and medical problems affect us all and I love sharing my opinion and point of view with anyone who is interested in hearing them. It’s like a ranting diary for me. And my opinions are just that. Opinions. And whilst I will always do my very best to provide accurate medical information when I’m talking about something like how a drug works, a lot of my topics are about my observations in life and in hospital life and are very much open to debate which I absolutely encourage and I enjoy being proven wrong albeit not quite as much, as much as being told I’m correct. for So please, if I say something that doesn’t sit well with you, please know that I might be wrong.

So anyway, Addiction.

Addiction is one of those words we use quite often without really thinking about what it means. We say we’re addicted to coffee, our phones, sugar, and so on, pretty much anything that gives us something we want at the time and usually makes us feel slightly worse or guilty afterwards.

And because the word is used more flippantly now, it has become diluted. If someone says they’re addicted to chocolate, we don’t usually imagine a serious medical condition. We imagine someone opening a second KitKat and pretending it does not count because they had a stressful day. And most of us can relate to some form of that.

Of course, not every unhealthy behaviour is addiction. Human beings can be gluttonous, and pleasure-seeking without having a medical disorder. Sometimes people simply over-consume because they enjoy something without showing too much will-power.

But real addiction is much deeper than just liking something a lot. It is not always a case of simply being greedy, weak, or irresponsible, or any of the other lazy labels we’ve historically attached to it.

Addiction is usually understood as compulsive substance use or behaviour, with impaired control and continued use despite harm. As addiction develops, substances or behaviours begin to alter brain systems involved in reward, learning, stress and decision-making. Gradually, something that started as a choice can begin to feel less like one.

That does not mean people have no responsibility at all. And this is where there is often debate. Some people talk about addiction as if it’s purely a brain disease and the person is completely passive. Others talk about it as if it is simply a moral failing and the answer is to pull yourself together. As usual, the truth is more complicated and more human than either of these extremes.

There has long been debate about whether addiction is best understood as a disease, or a behavioural disorder or a maladaptive learned behaviour. Modern medicine generally classifies addiction as a chronic disorder or disease involving changes in brain circuits related to reward, motivation and self-control. But addiction also involves learning, habit, environment, and social conditions.

Addiction in a way is fascinating as it sits in that strange middle ground between biology and behaviour. It is biological, absolutely. It changes the brain. It changes stress responses. It changes what normal feels like. But it is also behavioural. It is shaped by environment, trauma, boredom, and opportunity. It is a relationship between a vulnerable brain, a rewarding stimulus and a world that often provides endless access to things.

And I think this is why addiction matters now. For most of human history, addictive substances and behaviours were limited by friction. You had to go somewhere. You had to find something. You had to wait. But modern life has removed many of those boundaries.

Alcohol can arrive at your door. Gambling can happen from your phone. Pornography is infinite. Food is engineered to be hyper-palatable. And your phone can deliver reward, distraction, validation, and escape almost instantly.

So when we talk about addiction, we are not just talking about heroin in a dark alley. We are talking about a broader question. What happens when the human brain, evolved for scarcity, is placed inside a world of abundance, stimulation and engineered temptation? What happens when reward becomes frictionless or when every uncomfortable emotion can be interrupted by something that changes how we feel?

That is what I want to explore in this episode.

At its simplest, addiction is a pattern where a person continues to use a substance or engage in a behaviour despite harmful consequences. Repetition alone is not addiction. Pleasure alone is not addiction. The key issue is loss of control and continued use despite harm.

For example, someone might drink every weekend and not be addicted. Another person might drink less often but be unable to stop once they start. The volume matters, but the pattern matters too.

Medically, we often talk about substance use disorders rather than simply addiction. That language is useful because it allows severity: mild, moderate or severe. It is not a switch where one day you are fine and the next day you are an addict. It is often gradual.

That gradual quality is part of what makes addiction so dangerous. It rarely announces itself at the beginning. Nobody starts drinking socially and thinks, in ten years I will be hiding bottles in the garage. It starts because it works.

That is the uncomfortable truth about addiction. Addictive things usually do something useful at the beginning. They relieve anxiety. They create pleasure. They numb pain. They reduce loneliness. They increase confidence. They help someone stay awake or help someone sleep. And if something works, even temporarily, the brain remembers.

This is where dopamine comes in.

Dopamine has become a social media buzzword. People talk about dopamine detoxes, dopamine hits and dopamine addiction. And like most things online, there is a grain of truth surrounded by a large amount of nonsense. Dopamine is not simply the pleasure chemical. That phrase is too simplistic. Dopamine is one important neurotransmitter that essentially helps the brain learn what matters, what to approach, what to repeat and what might be worth pursuing again.

A better way to think about dopamine is not just pleasure, but wanting. It is not only the enjoyment of the thing. It is the drive towards the thing. The feeling that says, go and get that. Open the app. Pour the drink. Watch one more video.

This distinction between liking and wanting is really important. In addiction, people may continue to want something long after they stop properly liking it. For example, a smoker may not even enjoy smoking a cigarette anymore. The craving remains.

The brain is a learning organ. If a stressful day is followed by alcohol and alcohol gives relief, the brain learns that alcohol is a solution. If anxiety is followed by gambling and gambling gives excitement, the brain learns that placing a bet is a solution. And if sadness is followed by food and food gives comfort, the brain learns that food is a solution. So over time, the cue becomes powerful.

This is why telling someone to just stop often fails so badly. The behaviour is not existing in isolation. It is embedded in cues, routines, emotions and learned associations. If you remove the substance but leave every trigger untouched, the brain continues to ask for the old solution.

And many addictive drugs can produce dopamine signalling that is more intense or more direct than natural rewards.

Reward tells you something matters. Memory tells you how you got it. Emotion gives it meaning. The prefrontal cortex is supposed to help you pause and weigh consequences. In addiction, those systems become imbalanced.

So the person is not just choosing pleasure over responsibility in some simple moral sense. Their brain has become biased towards the addictive behaviour.

This is also why addiction is not just about euphoria. Over time, the motivation often shifts from positive reinforcement to negative reinforcement. At the start, someone may use or do something because it feels good. Later, they use because not using feels unbearable. The drug or behaviour is no longer adding joy. It is removing distress. It is bringing them back to baseline, or what feels like baseline.

Withdrawal is another reason addiction becomes so powerful. As we’ve discussed, in many addictions, the person eventually stops using not to feel good, but to stop feeling bad.

Withdrawal is different to tolerance. Tolerance means that over time, the same amount produces a smaller effect, or a larger amount is needed to produce the same effect. So you can see how addictions can spiral; if using a substance that once made you high just makes you feel normal, you then need more and more to get the same high over time. This is true for behaviours too not just drugs.

Withdrawal is what happens when the substance is reduced or stopped and the adapted brain is suddenly left without it.

And depending on the substance, withdrawal can involve anxiety, sweating, shaking, insomnia, nausea, and many other physical symptoms, sometimes even potentially life-threatening complications. This is why some addictions need medical support to stop safely. It is not always safe to simply go cold turkey.

Even where withdrawal is not medically dangerous, it can be psychologically brutal. It can look like irritability, restlessness, emptiness, inability to concentrate, or a sense that the world has become grey.

As some researchers put it: “Addiction is not a disease of pleasure, it is a disease of learning, motivation and stress.” I like that because it captures the broader picture. It is not just that people chase pleasure. It is that the brain learns a powerful association, reorganises priorities and then experiences distress when that pathway is blocked.

And that brings us to one of the biggest misconceptions: the idea that addiction is about willpower.

Willpower exists. People can make choices. People can change and recover. But willpower is not a magical infinite resource that floats above biology. It is affected by sleep, stress, environment, etc. If you put someone in a state of withdrawal, shame, loneliness and constant cue exposure, and then say use willpower, you are asking a lot.

It is a bit like telling someone with severe asthma to just breathe better. Breathing is under some voluntary control, yes. But when the physiology is against you, instruction alone is not enough. You need treatment.

That does not mean we remove responsibility. It means we make responsibility realistic. Recovery is not helped by pretending addiction is entirely voluntary. But recovery is also not helped by telling people they are powerless forever. The useful position is somewhere in between. The brain can change in addiction, and the brain can change in recovery.

We can’t talk about addiction without mentioning smartphones.

We are addicted to our phones, but by calling it an addiction we do somewhat risk over-medicalising ordinary behaviour. But we cannot pretend the relationship many of us have with our phones is healthy. People reach for them automatically. They check them without deciding to. They cannot sit in silence. They cannot queue, eat, travel, watch a film or lie in bed without stimulation. And I am as guilty as anyone.

The phone is powerful because it is not one addiction. It is a portal to many rewards: social validation, novelty, outrage, gambling, news, work, reassurance. Because it is arguably a necessary device for modern life, abstinence is unrealistic. You cannot simply never use a phone. My phone helps me all the time at work for example, be it to look up guidelines or to calculate doses and so on. So the challenge becomes control rather than elimination.

Food is another difficult one because we need food to live. You cannot abstain from eating. And food addiction as a concept is debated. But what is not really debatable is that modern ultra-processed foods are often engineered to be highly rewarding. If you’ve listened to my obesity podcasts you’ll know that even though I’m not a fan of the “fat acceptance movement” and the “healthy at any size” nonsense. I do appreciate that hunger, stress, hormones, environment, etc all matter. What I actually take issue with is having the laws of thermodynamics being completely ignored in the name of political correctness and whilst the simple phrase “eat less, move more and you’ll lose weight,” is in the context of addiction, a simplistic one, it doesn’t make it any less true. Burn more calories then you consume and you’ll lose weight. I also take issue with hearing that you can be obese and healthy and that someone saying otherwise is bigoted or prejudice and that they have the problem. I appreciate very much it’s difficult, I appreciate very much that many overweight individuals have massive struggles and as I’ve said many times, I take no issue with self-confidence and ignoring hurtful comments which are absolutely uncalled for. But we must also accept responsibility for our own actions. Even if in the modern world, our weaknesses are exploited.

We live in a world where industries profit from repeated consumption. Alcohol companies do not make money when people drink once a year. Betting companies do not thrive on people placing one harmless bet and walking away. Social media platforms do not profit when people use them for five minutes and then feel satisfied. The business model often depends on attention, repetition and dependence.

That does not mean every company is evil or every consumer is helpless. But we should be honest about incentives. If a product is free, convenient, rewarding and heavily optimised, your self-control is not competing against nothing. It is competing against design, data and money.

This is where the conversation becomes culturally uncomfortable. We tell individuals to take responsibility, which they should. But we are strangely reluctant to ask whether society is creating more addictive conditions. We put betting adverts around sport, then act surprised when gambling harms rise. We build apps around variable reward, then tell people to put their phones down.

It is a bit like cycling into a strong headwind. Some people are facing a much stronger wind than others. That is unfair. But you still have to pedal.

So I don’t believe everyone is helpless. People can make choices and set boundaries. People can recover. But the more addictive the environment becomes, the more effort is required to live normally. And I appreciate that that effort is not evenly distributed. Some people have more stress, trauma, poverty, loneliness, and less support.

However, people must not use an environmental factor as an excuse to start or continue an addiction or bad habit - easier said than done - I am guilty of many bad habits that I can very easily blame on a lot of different things but ultimately everyone will have a time in their lives where they will be tested to the highest degree. The worst day or time that you can possibly fathom. Acknowledge the external influence yes. But acknowledge that you can also do something about it. For example it’s very easy to blame a drug addiction on a drug dealer. Sure, of course they are part of something destructive. However it’s also a person’s choice whether to purchase anything from them.

This truth is hard. Especially when you hear some of the reasons people got into their addictions.

So who becomes addicted?

One thing I have learned from medicine is that addiction does not respect status or discriminate. You can understand physiology and still smoke. You can know the risks of alcohol and still drink too much. Knowledge helps, but it does not make you invincible.

It affects doctors, teachers, teenagers, parents, athletes, wealthy people, homeless people, and even disciplined people. Even intelligence does not protect you. In fact, intelligent people can sometimes build more elaborate justifications. They can rationalise, compartmentalise and hide things.

There are risk factors of course but risk is not destiny. Many people with risk factors do not become addicted. Many people without obvious risk factors do.

When I qualified as a doctor I worked in AAU - acute assessment unit. It was a bit like an extension of A&E. We used to get a fair few patients who would admit their alcohol use to me when I would take their histories. I rightly or wrongly would on occasion ask quite bluntly, out of genuine curiosity and in no way to be judgmental, “What made you start drinking so much?” What amazed me was how open they were. They would tell me straight. It was usually a trauma in life including someone’s wife passing away on Christmas Day and alcohol was a way of suppressing that memory. And one thing I noticed was how pleasant and normal they were when they were talking to me.

That does not make the addiction healthy of course but it does sometime  make it understandable.

Understanding is often mistaken for excuse-making. It is not. Understanding is how you treat the problem. If someone is drinking because they are physically dependent, they need one kind of help. If they are drinking because they are lonely, they need another. If they are gambling because they are in debt and chasing losses, another. You cannot treat the behaviour properly if you do not understand its function.

This is why shame is such a poor treatment strategy. Shame may occasionally jolt someone into awareness, but chronic shame usually drives secrecy. And secrecy protects addiction.

So what does recovery actually involve?

Well firstly, recovery is possible.

I think that’s important to say because addiction creates hopelessness. People relapse. They promise to stop and then don’t. Other people lose faith in them and eventually they lose faith in themselves. But recovery does happen. All the time.

But recovery is rarely as simple as just “stop doing the thing.”

Because if alcohol, gambling, drugs, food, scrolling, whatever it is, has become your way of coping with stress or trauma or loneliness or anxiety, then removing it leaves a hole behind. And if you leave the hole empty, the old behaviour has a habit of creeping back in.

That’s why recovery is often less about removing something and more about rebuilding something.

And sometimes medical treatment is genuinely needed. Alcohol withdrawal can be dangerous. Some people benefit from medications that reduce cravings or stabilise withdrawal. Therapy can help. Support groups can help. Honest friendships can help.

And I don’t think we should become snobbish about recovery pathways either. Some people recover through therapy. Some through medication. Some through religion. Some through exercise and so on. The best recovery method is the one that actually helps someone build a stable life again.

Relapse is also not necessarily proof that somebody is hopeless. It can be part of the process. Painful, dangerous, destructive sometimes, yes. But still part of the process.

And I think one of the most important ideas in recovery is understanding that a craving is not an instruction.

It feels urgent. It feels like something that must be acted upon immediately. But cravings rise, peak and fall. Creating even a small gap between urge and action can completely change outcomes.

Environment matters massively too.

If you’re trying to stop drinking while keeping bottles of alcohol around the house, you’re making life harder for yourself. If gambling is the problem, keeping betting apps on your phone is probably not a brilliant idea either. Recovery often means creating friction between yourself and the behaviour.

And connection matters as well because addiction loves secrecy. It thrives in isolation. Recovery usually involves at least one person knowing the truth.

And real recovery is often not dramatic.

Films love the big breakthrough moment. The emotional speech and the triumphant transformation. But real recovery is usually much less cinematic than that. It’s choosing not to buy the bottle on a random Tuesday. It’s surviving a craving. It’s deleting an app. Going to bed. Turning up to appointments. Telling the truth repeatedly until eventually your life stops revolving around the addictive thing.

People also talk a lot about having an “addictive personality.”

And maybe there’s a grain of truth in that. Some people are more impulsive or novelty-seeking or prone to excess. But I personally don’t think it’s helpful when people start treating addiction like it’s their identity. Like they are fundamentally broken in some permanent way.

Because people can change.

And language matters here as well. The word “addict” helps some people because it creates honesty and community. For other people it becomes pure shame. And addiction already comes with enough shame attached to it.

One of the cruellest things about addiction is how it distorts priorities.

The immediate relief becomes emotionally louder than the long-term consequences. The next drink feels more real than tomorrow morning. The next bet feels more real than the debt. The next scroll feels more real than the wasted hour.

And despite how addiction is sometimes glamorised in films and music and culture, it usually doesn’t make life bigger.

It makes life smaller.

More and more of someone’s time and emotion starts revolving around the addictive thing.

Recovery, by contrast, slowly makes the world bigger again.

So what can people actually do?

Honestly, I think the first step is just brutal honesty with yourself.

Do I actually control this?

Or does it control me?

Is this making my life bigger?

Or smaller?

And then practical things matter too. Reduce access. Increase friction. Replace the coping mechanism with something healthier where possible. Involve other people. Stop trying to fight everything completely alone.

Because ultimately addiction reveals something uncomfortable about human beings.

We are not purely rational creatures. We are emotional creatures with habits and reward systems and vulnerabilities. And modern life constantly offers us instant relief from discomfort.

But the same brain that learns addiction can also learn recovery.

And I think that’s probably the hopeful part.

And maybe that is where I want to bring this together.

Addiction is not simply about bad substances or bad people. It is about the brain’s capacity to learn relief and repeat it. It is about reward pathways being hijacked by substances, behaviours and industries that deliver reward without natural limits. It is about pain, escape, wanting without liking, and the narrowing of life around a solution that eventually becomes its own problem.

And if there is one thing I want people to take from this episode, it is that I believe addiction is both more medical and more human than we often allow.

More medical, because it involves real changes in brain circuits and stress systems.

And more human, because it often begins with understandable needs: relief, confidence, sleep, connection, numbness, escape and even finding meaning.

So we need compassion, yes. But compassion should not become passivity. We need responsibility, yes. But responsibility should not become cruelty. We need honesty without humiliation.

And perhaps we also need to look at the world we have built.

Because we cannot keep designing everything to be addictive and then act shocked when people become addicted. We cannot monetise attention, engineer food, normalise alcohol, advertise gambling, remove boredom, and isolate people and then place the entire burden on individual willpower.

That is not a serious society. That is a society outsourcing the consequences of its own incentives.

It is a bit like flooding a room and then blaming people for getting wet. The environment clearly matters.

But at some point we also have to ask whether people are making any attempt to move towards the door.

because as individuals, we still have choices. We can notice what is pulling us. We can create friction. We can ask for help. We can stop laughing off dependence as personality. We can ask whether our comforts are still comforting us or quietly controlling us.

Because freedom is not having unlimited access to everything you want. Sometimes freedom is being able to say no to the thing that keeps promising relief and delivering regret.

And with that, I’ll leave you.

As always, Please look after yourself.

I’m Dr Polyvios. Goodbye.