Who is Dr. Herbert Kleber?
10/09/19: Addiction RecoveryDr. Herbert Kleber is one of the big names in psychiatry, especially in regard to drug addiction recovery and treatment. He is responsible for revolutionizing the way we view addiction and changing the way we treat it, focusing on the needs of the individual through evidence-based practice. Dr. Kleber was recently celebrated by way of a Google Doodle on Tuesday, October 1, the 23rd anniversary of his election to the National Academy of Medicine.
The BeginningDr. Herbert Kleber was born in Pittsburgh, Pennsylvania on June 19, 1934. He attended Dartmouth College and received medical training at the Sidney Kimmel Medical College in Philadelphia. According to an interview with Kleber, an anatomy professor at the medical college was addressing the class as he was illustrating a particular nerve or muscle and its importance to all the students except “Mr. Kleber, who is going into psychiatry, which raises the question of why he is even here.” Kleber ran into this attitude frequently throughout his time in medical school. Psychiatry was not thought of as a medical pursuit, but rather something based on a lack of morals in an individual. After this, he did his residency at Yale-New Haven Hospital before entering into the U.S. Public Health Service in 1964. His first real experience with people with substance abuse disorder was during his time at the government-run prison health service hospital in Lexington, Kentucky where many of the patients were in addiction recovery treatment. He ended up there due to the fact that, at the time, doctors were being drafted out of residency programs to go to Vietnam. However, they were being allowed to finish their psychiatric or medical training if they signed up for the military or the Public Health Service, so Kleber decided he would reach out to them, and was placed at the prison in Kentucky. In a twist of fate, this was one of the only places in the country where one was able to learn more about addiction. The treatments they were receiving at this time were “work” and group therapy, which weren’t very effective for most of the patients at the prison, and Kleber noted that up to 90% of them relapsed shortly after their release. Originally, this wasn’t the path he wanted to take, but because of the experience he gathered in Kentucky, he found that he was in-demand for addiction treatment upon returning to Yale.
Obstacles in the FieldAside from addiction being viewed as the result of a moral failing, Kleber ran into other obstacles during his time in the field. One such example is Yale’s resistance to him implementing a community-based addiction treatment program. His department acting chair at the time didn’t hold the belief that the Department of Psychiatry should even be treating addicts in the first place, and told Kleber that if he wanted to do so, he should join the School of Public Health. Despite this, the chair was outvoted and Kleber was able to apply for the necessary grant. In addition, the concept of using methadone as an integral element of the addiction recovery process was highly controversial. Some believed that “giving drugs to drug addicts” was akin to “treating rapists by giving them women and bank robbers by giving them stolen money.” Many saw it as a way to maintain the drug problem as opposed to solving it. Therapeutic communities at the time were very much in opposition to its use in substance abuse treatment. Also, The Black Panthers would often protest the use of methadone in black and poor communities, as they were also of the belief that it did nothing to address the root problem of racism and poverty in the ghettos. Despite obstacles and setbacks, Kleber was able to maintain and grow a highly successful career, which allowed him to change many lives.
Changing the Way We Treat AddictionIt was his time in the prison working with drug-addicted inmates that raised his awareness about the lack of effective treatment options for substance abuse disorder. He also felt that there were a lot of misconceptions and flaws in the way that society viewed addiction. His belief was that addiction was a medical condition that could be treated and cured, as opposed to a moral failure. Before then, addiction was commonly regarded as a choice that people made because they were inherently “bad”. Dr. Kleber understood that this wasn’t the case at all, and in fact, addiction could happen to anyone regardless of their gender, age, ethnicity, socioeconomic status, moral standing, etc. He began promoting the use of “evidence-based treatment.” Instead of punishing or shaming his patients (as had often been done before), he stressed the importance of supporting and nurturing the individual through the process. Before, addiction treatment often involved punishing or shaming patients. However, since the main goal of Dr. Kleber’s practice was to help keep all of his patients on the road to recovery and avoid relapse, he did not believe that creating a negative experience was conducive to true recovery. Instead, he focused on the careful use of medication combined with involvement in therapeutic communities. He was also responsible for spreading knowledge on the importance and effectiveness of the substitute-drug methadone — which was highly controversial at the time — in helping addicted people wean off of harmful substances.
Rising to Prominence in the CommunityIn 1964, Kleber took a faculty position at the Yale University School of Psychiatry, eventually founding the Drug Dependence Unit in 1968 and served as the unit’s head for over twenty years. In 1989, seeing all of the transformative work Kleber was doing, George H.W. Bush appointed him to serve as deputy director for Demand Reduction at the Office of National Drug Control Policy. He and his then-wife Dr. Marian W. Fischman established America’s leading research program on substance abuse at the Columbia University College of Physicians and Surgeons. Throughout his 50-year-long career, Kleber authored hundreds of articles and books and mentored many other medical professionals in the field of addiction treatment.
In ConclusionWhen asked if he was an optimist, Kleber said: “Of course I’m an optimist. How else do I work with addicts for 40 years?” He acknowledged the extreme difficulty of treating patients with substance abuse disorders, but unlike his predecessors, he recognized why they were so difficult to treat. Addiction is complex and multi-layered, and requires holistic, individualized, evidence-based treatment to properly address. Not to mention, people with addiction at this time were made to feel as if their problem was based on a moral failing of their own fault. But Dr. Kleber altered the landscape of addiction treatment in such a way that allowed patients to be diagnosed and treated rather than shamed, punished, and shunned, saving countless lives over the course of his career.
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