Dr. Shinderman went to medical school at the University of Illinois. He currently operates methadone-based treatment programs in both Chicago and Portland, Maine.

I am a psychiatrist. I was the head of a committee of a mental health facility back in the 70’s and they had a methadone maintenance program attached. I was exposed to methadone directly through that job. Prior to that and concurrent with it, I was a consultant with the Illinois Drug Abuse Program and was involved in treatment of adolescents and other people in drug free treatment settings.

Q: How would you describe addiction?

Addiction is usually described as an activity which gives some sort of reward in the brain and for some individuals, they will pursue that reward to their detriment or in spite of negative consequences. Attempts to stop that behavior are unsuccessful and generally result in what we call relapse. That’s it. That’s more or less it.

Q: Is there a big problem of addiction in Illinois, in the United States?

There are people with various kinds of addiction. Addiction can have very negative consequences. There is enough of it in Chicago, where I would consider it a serious problem, whether it is addiction to cigarettes or alcohol or gambling. Addiction- the pursuit of something despite negative consequences- where it exists, it’s a problem. I don’t think anyone can be unaware of the devastating effects of alcohol, tobacco or even opiate, cocaine, gambling, stimulant addiction. It’s everywhere.

Q: Is there a difference between addiction as it exists in Chicago and Maine?

I would say that addiction is pretty much the same disease wherever you find it. The variables, I would say have to do with access to treatment, and the lack of it, and the effectiveness of available treatments. If the pool of people in a given area have a greater or lesser exposure to diseases, such as Hepatitis C or HIV, because of the fact that there is more of it in a given community, or less access to education or clean injection equipment, the consequences can be more serious in one given locale than another. There is little Hep C or HIV in Maine compared to Chicago. Those are kind of local problems which are secondary consequences of addiction, people getting sick because of dependence, in Chicago. Other than that, each individual is pretty much the same. That’s pretty much it.

The reason we went to Maine is because we were aware of a huge problem of substance abuse there. With substance abuse being in general about a 50% genetically determined disease, and with the relatively homogenous gene pool in a place like Maine, compared to the diversity which you might have in major cities- places with lots of population, immigration- if there is an inclination toward substance abuse, it might be expressed in a larger proportion of the population- theoretically. What we did know, was that alcohol abuse was severe in Maine, and existed alongside opiate use. Which got worse in the late 90’s. I think in general that prescription opiates, that the prevalence of the problem, and the demand for treatment, seemed to mushroom in Maine.