Reason Magazine - Topics > Addiction

R.J.'s Law

dweigel@reason.com (David Weigel) — Tue, 13 May 2008 12:00:00 EDT

Sixteen years ago, R.J. Feild was born to a heroin-addicted welfare mother in Southern California. Brought into the world underweight and premature, he has trouble walking, and his bad eyesight makes it hard for him to read. He was, however, able to enter an essay contest sponsored by Assemblyman John Benoit (R-Palm Desert) called “There Oughta Be a Law,” in which the winner’s proposed bill would be brought to the floor of the California legislature. Feild’s essay suggested giving random drug tests to welfare recipients and stripping benefits from people who tested positive.

He won the contest. “You can’t make up this story,” says Assemblyman Benoit. “The beauty of this bill is that it comes from a real-life, lovable young man who’ll the suffer rest of his life for mistakes of his mother. When you see him make this argument, you can’t help be sympathetic to it.”

“R.J.’s Law,” as submitted by Benoit, is actually a little less strict than what the 16-year old proposed. It offers people who fail the drug test a choice between losing their benefits and entering rehab, although if they test positive in rehab they’ll be out of luck. “I live in a political world,” Benoit explains. “We should give these people a chance to walk down the right path. Of course, if they walk off that path, then we can’t help them.”

Benoit’s detractors point out that welfare program managers are already empowered to test recipients if they suspect they’re using drugs. Benoit doesn’t think that’s enough. “The average lady behind a counter is not trained to recognize the symptoms of drug addiction,” he says. “You need occasional random sampling. It works for professional baseball players, it works for the clerks at Wal-Mart, and it will work here.”

R.J.’s Law might not pass the Democrat-dominated legislature, but Benoit is optimistic. He is pondering another “There Oughta be a Law” contest this fall, when kids return to school.

They Try to Make Me Go to Rehab

info@reason.com (Damon W. Root) — Tue, 06 May 2008 13:53:00 EDT

Will the troubles of poor Amy Winehouse never cease? First, a leading UK daily releases a video that allegedly shows her smoking crack. Then another calls for the British government to forcibly commit her to drug treatment ("The State's actions could save a great talent"). Now Variety brings word that she won't be recording the theme song for the latest James Bond flick:

Mark Ronson, who produced much of Winehouse's Grammy-winning "Back to Black," said the soul diva is "not ready to record any music."

Ronson said the two started work on the track for the upcoming Bond movie "Quantum of Solace" but it would take "some miracle of science" to finish it, he said in an interview with Sky News.

reason, of course, has long championed the right to use those "miracles of science" that keep landing Winehouse in such trouble. Read all about it here, here, and here.

Self-Refuting Drug Warriors

jsullum@reason.com (Jacob Sullum) — Fri, 18 Apr 2008 19:02:00 EDT

A new analysis of data from the National Survey on Drug Use and Health once again confirms a point I emphasize in my book Saying Yes: The vast majority of illegal drug users do not fit the stereotype of addiction and degradation promoted by the government and the news media. Based on data from the 2004, 20005, and 2006 surveys, the Substance Abuse and Mental Health Services Administration (SAMHSA) calculated the percentage of people who became "dependent" on various drugs within two years of trying them. Here are the dependence rates, in ascending order:

Inhalants: 0.9%

Tranquilizers (nonmedical use): 1.2%

Psychedelics: 1.9%

Sedatives (nonmedical use): 2.4%

Painkillers (nonmedical use): 3.1%

Alcohol: 3.2%

Cocaine Powder: 3.7%

Stimulants (nonmedical use): 4.7%

Marijuana: 5.8%

Crack Cocaine: 9.2%

Heroin: 13.4%

In some ways these results track conventional wisdom. Heroin comes out on top, which conforms to traditional thinking if not to more recent scare mongering about crack and methamphetamine, each of which was said to be at least as addictive, if not more so. But even in the case of heroin, a large majority of users were not deemed "dependent," and most (69 percent) had not even used the drug in the previous year. Likewise, crack looks more addictive than cocaine powder, but 76 percent of the people who tried crack were not using it at all a year later, quite a feat with a drug that's said to be instantly addictive. The comparable rate for cocaine powder was 58 percent, which could mean that a) people find it more appealing than crack, b) people find it easier to integrate into their lives because the experience is less intense, or c) people find it more appealing because it's easier to integrate into their lives. I think most people would be surprised to see that "stimulants," which included methamphetamine, rate lower on this addiction scale than heroin, crack, and even marijuana, and that narcotic painkillers, described as overwhelming and irresistible in press coverage of the OxyContin "epidemic," look no more addictive than alcohol.

A few notes of caution:

1. SAMHSA measures drug dependence through questions based on the American Psychiatric Association's diagnostic criteria, which require three or more of seven indicators: 1) tolerance, 2)withdrawal, 3) taking the drug in larger amounts or over a longer period than intended, 4) a persistent desire or unsuccessful efforts to cut back, 5) a lot of time spent getting, using, or recovering from the effects of the drug, 6) disruption of important social occupational, or recreational activities, and 7) persistent use despite serious drug-related physical or psychological problems. To qualify for the label, a patient is supposed to be suffering from a "maladaptive pattern of substance use" that leads to "clinically significant impairment or distress," which is difficult to assess at a distance through a survey. But the major line of criticism I've seen indicates that, if anything, applying the "clinically significant" criterion would generate lower rates of substance dependence.

2. This particular analysis covers just a few years, and serious drug problems may take longer to develop (although that's certainly not the impression left by the government's anti-drug propaganda). Studies covering longer periods, such as the National Comorbidity Survey (which I cite in my book), do find higher addiction rates. But they still indicate that addiction is not a typical result of drug use.

3. It's risky to assume that the addiction rate associated with a substance has to do with its inherent properties, as opposed to the sort of people who like to use it. It seems plausible that people who are attracted to an extreme, notorious practice like heroin injection, for example, are different from people who aren't in ways (tastes, preferences, personality traits, circumstances) that affect their likelihood of using the drug heavily.

[via the Drug War Chronicle]

Casual Pot Addicts

jsullum@reason.com (Jacob Sullum) — Thu, 27 Mar 2008 16:39:00 EDT

NORML's Paul Armentano notes that, according to the government's own data, one-third of the people admitted to treatment for marijuana "dependency" in the U.S. have not smoked pot in the previous month. How is that possible? See if you can guess.

Hooked on the Myth of Instantly Addictive Cigarettes

jsullum@reason.com (Jacob Sullum) — Wed, 13 Feb 2008 14:02:00 EST

Digging through a pile of medical journals, New York Times health reporter Jane Brody discovers that cigarettes are instantly addictive:

Dire warning to all adolescents: You can get "hooked from the first cigarette."

Brody is quoting an article (available for $10) from the December Journal of Family Practice in which tobacco researcher Joseph R. DiFranza warns that "one cigarette may be all it takes to get hooked." But DiFranza immediately back-pedals:

Hooked from the first cigarette?
You bet.
Very soon after that first cigarette, adolescents can experience a loss of autonomy over tobacco, and recent research indicates that this loss of autonomy may play a key role in nicotine addiction.

Notice how the claim of instant addiction quickly becomes a claim that some time after the first cigarette (possibly after the 10th or 100th?) smokers may begin to experience "loss of autonomy," which ultimately could play a role in addiction. And how is this "loss of autonomy" measured? With a 10-point checklist:

Have you ever tried to quit smoking, but couldn't?

Do you smoke now because it is really hard to quit?

Have you ever felt like you were addicted to tobacco?

Do you ever have strong cravings to smoke?

Have you ever felt like you really needed a cigarette?

Is it hard to keep from smoking in places where you are not supposed to, like school?

When you tried to stop smoking (or, when you haven't used tobacco for a while):

Did you find it hard to concentrate because you couldn't smoke?

Did you feel more irritable because you couldn't smoke?

Did you feel a strong need or urge to smoke?

10.

Did you feel nervous, restless, or anxious because you couldn't smoke?

If you answer yes to one or more of these questions, according to DiFranza, you have experienced "loss of autonomy" and are well on your way to a cigarette habit that will give you lung cancer when you're 65. In a sentence that Brody quotes, DiFranza says "three New Zealand national surveys involving 25,722 adolescent smokers who used this checklist revealed a loss of autonomy in 25% to 30% of young people who had smoked their one and only cigarette during the preceding month." How plausible is it that someone who has smoked exactly one cigarette in his life has tried to quit smoking but couldn't, or feels strong cravings for a cigarette, or gets irritable and has trouble concentrating when he can't smoke? Maybe teenagers who have tried cigarettes sometimes say such things because they believe that's what a smoker would say, and they are experimenting with that identity. Or maybe they are just screwing with the people conducting the survey.

Neither DiFranza nor Brody considers these possibilities. Brody is so eager to believe in the overwhelming power of nicotine that she does not even notice how she contradicts herself. After quoting a tobacco researcher who notes that "the vast majority of teenagers who try one or two cigarettes don't go on to become smokers," Brody blithely asserts that "smoking by youngsters...typically leads to a lifetime of smoking."

This sort of misrepresentation reinforces the myth that nicotine is irresistible and inescapable, which is counterproductive for at least two reasons that DiFranza and Brody should be able to appreciate. Teenagers who experiment with tobacco or observe peers who do so will quickly discover that addiction takes more than a single cigarette. Having seen through the scare tactics aimed at stopping them from taking that first puff, they may be inclined to dismiss better-grounded concerns about, say, the long-term health consequences of a pack-a-day habit or the difficulty of giving up cigarettes once you've come to depend on them as a way of relieving stress. And if they do eventually become regular smokers, exaggerating the enslaving power of nicotine will discourage them from trying to quit and from persisting in the attempt.

I commented on earlier attempts to portray cigarettes as instantly addictive here and here.

Nonaddictive Morphine?

jsullum@reason.com (Jacob Sullum) — Thu, 31 Jan 2008 13:18:00 EST

University of California at San Francisco researchers say they've genetically engineered mice that can receive morphine on a regular basis without developing tolerance or physical dependence. They believe the success of their genetic manipulation may point the way to developing a strong painkiller that patients can take over an extended period without increasing the dose to maintain effectiveness or worrying about withdrawal symptoms. Those certainly would be welcome improvements for patients in pain, but it would not, contrary to the UCSF press release about the research, "block dependency" or eliminate the possibility of addiction.

Both the university press office and the researchers themselves seem to be equating addiction with tolerance (the need for escalating doses to achieve the same effect) and physical dependence (the adaptation that results in withdrawal symptoms when a drug is suddenly withdrawn). Anyone who takes narcotics long enough and regularly enough will develop tolerance and physical dependence, but addiction requires a persistent desire to use the drug for its psychoactive effects. According to the American Psychiatric Association, tolerance and withdrawal are neither necessary nor sufficient for a diagnosis of drug dependence, and this is one of the rare occasions when I agree with the APA.

Otherwise, we'd have to say that everyone who regularly uses narcotics for pain becomes addicted to them, even though only a small percentage end up using such drugs for nonmedical reasons. We'd also have to go back to saying that drugs such as nicotine and cocaine (use of which does not lead to the clear, predictable tolerance and withdrawal associated with narcotics) are not truly addictive but merely habit-forming, a distinction without a difference. And if addiction were defined as tolerance plus withdrawal, it would not be meaningful to speak of addiction to things other than drugs that provide pleasure or relieve stress, such as gambling, sex, or shopping. Addiction is a pattern of behavior, not a chemical reaction; in the case of drugs, it resides in the person's relationship with the substance, not the substance itself.

Still, it's true that you don't often hear of addiction to aspirin or ibuprofen. If a drug company could produce a painkiller as strong as morphine that had no psychoactive effects, it would not be attractive to people seeking to get high or soothe their unhappiness. Then it would make sense to call the drug nonaddictive.

[Thanks to CK for the tip.]

Where Have All the Pot Smokers Gone?

jsullum@reason.com (Jacob Sullum) — Wed, 02 Jan 2008 15:14:00 EST

Given the fact that most American adults born after World War II have used illegal drugs (typically marijuana), can we expect public discussions of this subject to become more honest, or less so? In an op-ed piece The Wall Street Journal ran on Monday, addiction expert (and occasional reason contributor) Stanton Peele defends Barack Obama against the argument that it's irresponsible for politicians to discuss their youthful drug use:

Perhaps it can be good for young people to learn that as they mature they can, and will, straighten out and fly right?
This is the opposite of the approach of nearly all school drug education programs. Here the logic is to troop in people who have ruined their lives by their drug use and drinking, as object lessons in the evils of sin. But there are reasons to believe that kids reject negative messages from figures like these, and that purely scare tactics don't work. Research on effective drug resistance programs finds that the best ways to prevent substance abuse are for kids to develop skills, feel good about themselves, have positive peers, and look forward to their futures.

Peele, whose latest book is Addiction-Proof Your Child, notes that survey data from the year Obama turned 18 indicate that two-thirds of high school seniors had tried illegal drugs. Drug education cannot be credible if it denies or ignores the reality that the vast majority of them nevertheless turned out OK.

The Buck Keeps Moving

jsullum@reason.com (Jacob Sullum) — Wed, 02 Jan 2008 06:57:00 EST

Critics of OxyContin manufacturer Purdue Pharma blame it for promoting abuse of the painkiller by encouraging family doctors to prescribe it. "As a result of the expanded access," said a recent New York Times story, summarizing the rap against the company, "OxyContin wound up in the high schools and street corners of rural America, where curious teenagers crushed the pill, defeating the time-release formula, and ended up addicts or, in some cases, dead."

Miraculous as OxyContin may seem to people suffering from severe chronic pain, it does not have the ability to crush itself and leap up the noses of innocent bystanders. No one "ends up" an addict without repeatedly choosing to seek out and consume a drug for the pleasure or emotional relief it provides. Drug treatment data indicate that regular OxyContin users are typically experienced illicit drug consumers who have undergone treatment before, not "curious teenagers."

Purdue Pharma, which pleaded guilty in May to "misbranding," may have misled doctors by telling them OxyContin was less subject to abuse than other opioids. But depicting OxyContin addicts as innocent victims of corporate greed is equally misleading, ignoring the decisions by which they determined their own fates.

There was no shortage of such responsibility-deflecting narratives in 2007. A few more highlights:

Kentucky Fried Lawsuit. Arthur Hoyte, a retired physician from Rockville, Maryland, sued KFC after discovering what he portrayed as the fast food chain's deadly secret: It fried its chicken in partially hydrogenated vegetable oil. (It has since switched to a trans-fat-free oil.) "If I had known that KFC uses an unnatural frying oil, and that the food was so high in trans fat, I would have reconsidered my choices," Hoyte said.

But the evidence Hoyte cited to back up his class action, which was supported by the Center for Science in the Public Interest, consisted largely of information KFC itself disseminated through its website and point-of-sale posters. In May a federal judge dismissed the suit.

Deadly Drinking. Last spring, after a fraternity initiation rite, Gary DeVercelly Jr., an 18-year-old freshman at Rider University in Lawrenceville, New Jersey, was pronounced dead at a Trenton hospital. He had a blood alcohol concentration of 0.43 percent. In August local prosecutors responded by charging three students and two university officials with "aggravated hazing," which carries a penalty of up to 18 months in prison.

Unless the administrators were at DeVercelly's side shouting "drink, drink," charging them seems like a stretch, even if you accept the premise that anyone should be held criminally liable for an adult's decision to consume three-quarters of a bottle of vodka in less than half an hour. Although the charges against the Rider officials were later dropped, last week DeVercelly's parents sued the university.

San Francisco Tiger. So far the story about the fatal Christmas Day attack at the San Francisco Zoo has focused primarily on the question of what the zoo should have done to prevent the tiger from escaping, the main criticism being that the wall around the enclosure was not tall enough. But the experts seem to agree that a Siberian tiger does not leap a 33-foot moat and scale a 12½-foot wall without provocation. "There had to have been a tremendous stimulus that made the tiger react the way she did," one told the San Francisco Chronicle.

The teenager who was killed, Carlos Sousa Jr., reportedly saved his friends, 19-year-old Amritpal Dhaliwal and his 23-year-old brother, Kulbir, by luring the tiger away from them. The brothers were hostile to the police, at first refusing even to give their names, and have yet to provide a public account of what happened.

Police found a shoeprint on top of the railing outside the enclosure, and the Chronicle reported that "pinecones and sticks that were found in the moat might have been thrown at the animal." Whatever role the Dhaliwal brothers played in the attack, you can be sure it will be further obscured by their inevitable lawsuit.

Scratch-Off Tickets: The Smokable Version of Lotteries

jsullum@reason.com (Jacob Sullum) — Thu, 27 Dec 2007 15:45:00 EST

Although I'm against state lotteries because they're unjustified government monopolies (that, not coincidentally, offer crappy odds), I have a hard time sympathizing with their most conspicuous critics, who are motivated by a combination of paternalism and moralism. "Scratch-off tickets are to the lottery what crack is to cocaine," a Texas state legislator tells The New York Times. He and other "urban liberal Democratic politicians" have allied themselves with religious conservatives who oppose all forms of gambling. The "liberals" are worried by "evidence that blacks and Hispanics individually spend much more than whites on the lottery."

This concern reminds me of anti-smoking activists who criticize tobacco companies for "targeting vulnerable populations"—i.e., children, women, blacks, and Hispanics, who apparently are on a par when it comes to making risky decisions, and in any event less savvy than white men. The Times reports that a 2006 Texas survey found "the typical black player spent $70 a month on the lottery, compared with $47 for Hispanics and $20 for whites." Why is that more troubling than the reverse situation would be? If the issue were simply income (a question of who is better able to afford lottery tickets) or education (a question of who is better prepared to assess the costs and benefits of playing the lottery), why bring up race at all? Are blacks and Hispanics constitutionally less capable of deciding how to spend their money?

Ernest L. Passailaigue, director of the South Carolina lottery and president of the North American Association of State and Provincial Lotteries, manages to discuss the demographics of his customers without sounding racist:

Mr. Passailaigue...does not dispute that certain games appeal more to minorities and low-income people, but he said these groups were not being singled out and the trend should not worry state lottery officials.
"It's more cultural in nature," he said. "Some people think it's O.K. to go and play golf and bet on each hole."
While golfers might have more disposable income than many scratch-off bettors, Mr. Passailaigue argued the reality was, "Culturally, people have experienced different ways not only to amuse themselves but to gamble. It's been that way for a long time in this country."

The Addict's Veto

jsullum@reason.com (Jacob Sullum) — Wed, 21 Nov 2007 06:52:00 EST

Annie Duke, who testified at a recent House Judiciary Committee hearing on Internet gambling, is not a typical poker player. A professional for 13 years, she is the biggest female money winner in the history of tournament poker.

Gregory J. Hogan Jr. is not a typical poker player either. As his father, the pastor of the First Baptist Church in Barberton, Ohio, explained at a House Financial Services Committee hearing last summer, "Gregory Jr. is currently in prison for a robbery he committed to feed his online gambling addiction."

While Annie Duke recognizes that most Americans who play poker do it for fun, not for a living, Pastor Hogan tends to overgeneralize from his son's equally extreme experience with the game, which involved losing hundreds of dollars a day while playing 12 hours at a time. Hogan demands an addict's veto over Internet gambling: Because his son robbed a bank, he thinks, no one should be allowed to play poker online.

"I oppose any effort to legalize or even give credibility to Internet gambling," Hogan said. He called last year's passage of the Unlawful Internet Gambling Enforcement Act, which effectively requires American financial institutions to shun transactions related to online wagers, "an answer to my prayers that other families would not have to suffer as my family has."

Hogan's argument is a fine illustration of prohibitionist logic, which says anything that can be done to excess should be illegal. But as Duke noted, "If the government is going to ban every activity that can lead to harmful compulsion, the government is going to have to ban nearly every activity. Shopping, day trading, sex, [eating] chocolate, even drinking water—these and myriad other activities, most of which are part of everyday life, have been linked to harmful compulsions."

According to a survey reported in the October 2006 American Journal of Psychiatry, about 6 percent of shoppers experience "compulsive buying." Data from the federal government indicate that the rate of alcohol abuse or dependence among past-year drinkers is something like 13 percent.

By comparison, a 2007 government-sponsored survey in the U.K., where Internet wagering is legal, found that 6 percent of people who had placed sports bets online and 7.4 percent of people who had placed other kinds of online bets in the previous year qualified as "problem gamblers" based on American Psychiatric Association criteria. That does not mean they were robbing banks; it means they acknowledged at least three of 10 gambling-related problems, such as "chasing losses," "a preoccupation with gambling," "a need to gamble with increasing amounts of money," and "being restless or irritable when trying to stop gambling."

The prevalence of problem gambling among all past-year gamblers (excluding lottery ticket buyers) was 1.3 percent. Does that mean "gambling online is several times more addictive" than other forms of gambling, as Thomas McClusky of the Family Research Council claimed at the House Judiciary Committee hearing?

Not necessarily. It could simply be that people who are inclined to gamble heavily are especially attracted to online gambling. Notably, the overall rate of problem gambling in the U.K. remained unchanged between 1999 and 2007, despite the rise (and legalization) of Internet wagering.

In any case, it's plain that one cannot safely draw any conclusions about the usual experience of online gamblers from the story of the minister's son who robbed a bank to support his poker habit. According to Duke, the average online poker player spends about $10 a week, in exchange for which he has some fun and sharpens his skills.

"For the majority of Americans, playing poker is a hobby," Duke told the House Judiciary Committee. "They should have a right to choose how to spend their discretionary income, whether it be on poker or anything else." They do not expect to become poker champions, and they should not be treated like bank robbers.

Tough Love Hurts

jsullum@reason.com (Jacob Sullum) — Thu, 11 Oct 2007 10:41:00 EDT

In a new report, the Government Accountability Office cites "thousands of allegations of abuse, some of which involved death," in "residential treatment programs" for "troubled youth." The report was released yesterday at a House hearing where the parents of Aaron Bacon, a teenager who died at a Utah boot camp in 1994, testified. According to The New York Times, "His parents said they saw Northstar as a place that would distance Aaron from negative influences at his high school, where he had begun dabbling in drugs." The staff there starved him, forced him on long hikes, and beat him, according to the GAO, "from the top of his head to the tip of his toes." Northstar's owner and four employees pleaded guilty to negligent homicide in 1994, but none served any time in prison.

While Northstar was shut down, other abusive "tough love" programs continue to operate, as Maia Szalavitz showed in an appalling reason exposé earlier this year. In addition to criminally negligent managers and incompetent or sadistic staff members, lax state regulators and excessively trusting parents bear a share of the blame for this situation. But as Szalavitz's piece makes clear, the problem would not be nearly as big or as persistent were it not for the anti-drug hysteria that drives panicked parents to send their children to places like Northstar. Aaron Bacon is no longer "dabbling in drugs," and in that sense, I suppose, his "treatment" was a success.

In follow-ups to her reason feature, Szalavitz has noted Mitt Romney's ties to "tough love" camps and highlighted attempts to squelch criticism of such programs. Her book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids is available here.

Thank the Higher Power for the First Amendment

jsullum@reason.com (Jacob Sullum) — Wed, 12 Sep 2007 12:14:00 EDT

Last week the U.S. Court of Appeals for the 9th Circuit joined several other federal and state courts in ruling that compulsory A.A. attendance runs afoul of the Establishment Clause. The case involved Ricky Inouye, a meth addict on parole in Hawaii who was ordered to attend Alcoholics Anonymous/Narcotics Anonymous meetings and was sent back to prison because he refused, saying the program clashed with his Buddhist beliefs. "For the government to coerce someone to participate in religious activities strikes at the core of the Establishment Clause," the unanimous three-judge panel said, noting that "reverence for 'a higher power' is a substantial component of the AA/NA program." (A.A., which insists "we're not religious but spiritual," took no position on the ruling.) Not only were Inouye's rights violated, the 9th Circuit said, but his parole officer, Mark Nanamori, did not deserve qualified immunity for his role in returning Inouye to prison, since "the vastly overwhelming weight of authority on the precise question in this case held at the time of Nanamori's actions that coercing participation in programs of this kind is unconstitutional."

A PDF of the 9th Circuit decision is available here. The addiction expert (and lawyer) Stanton Peele, who discussed the First Amendment implications of coerced A.A. participation in reason back in 2001 (the same year Inouye's parole was revoked), notes that "compulsory 12-step participation is still standard practice around the country."

Are Addicts Sick, Bad, Both, or Neither?

jsullum@reason.com (Jacob Sullum) — Wed, 29 Aug 2007 13:39:00 EDT

reason contributor Maia Szalavitz had an interesting essay in yesterday's Washington Post contemplating the essence of addiction, drawing on her own experiences as a cocaine and heroin injector as well as research and expert opinion. Her opening frames the issue this way:

Is addiction a disease? A moral weakness? A disorder caused by drug or alcohol use, or a compulsive behavior that can also occur in relation to sex, food and maybe even video games?

Yes, she more or less concludes:

So is addiction disease or learned behavior? Given its complexity, some experts say, what probably matters most is which view best yields compassionate and effective treatment.

This position seems backward to me. If you've already decided that "compassionate and effective treatment" is the appropriate response to addiction, that pretty decisively tilts your perspective toward the disease model. But as Maia notes, even people who claim to champion a disease model seem ambivalent about it: Can you think of any other disease for which the most widely accepted treatment involves asking the patient to surrender himself to a "higher power" and make amends for the wrongs he's done as a result of his illness?

My own view (which I think is similar to Maia's) is that addiction is a learned behavior that, like many other things in life, is influenced by various genetic and environmental factors. Viewing it this way neither requires nor precludes compassion for addicts. As with anyone in trouble, the moral evaluation hinges on the specifics of the individual's situation, including disadvantages that are beyond his control and the extent to which he has hurt other people. Drug addiction should be seen as part of the continuum of human behavior, not as a special case in which all-powerful chemicals take control of people and dictate their actions.

[Thanks to Jeff Schaler for the link.]