Addiction medicine is – in the grand scheme of things – a relatively new field. The transition from seeing use disorders as a choice or worse a sin, one commonly made by those with shortages in moral fiber for instance, to that of a disease can be traced to the middle of the 20th century.
The first Diagnostic and Statistical Manual of Mental Disorders or DSM treated substance use disorder (i.e., “drug addiction” and “alcoholism”) as most commonly arising from a primary personality disorder. As you can probably imagine, the previous action stigmatized addiction by listing it with other societally disapproved disorders. In 1965, the American Medical Association (1965) recognized alcoholism, declaring the condition a medical disorder. The DSM-II (1968) encouraged separate diagnoses for alcoholism and drug addiction, according to the US National Library of Medicine. The DSM would make several changes over the years regarding how scientists and the medical community conceptualized unhealthy relationships with drugs and alcohol.
- DSM-III (1980): adopted atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence.
- DSM-III-R (1987): included physiological and behavioral symptoms and reflected the substance dependence syndrome.
- DSM-IV (1994): the concept of dependence was unchanged, i.e., emphasis on biology.>/li.
- DSM-V (2013): declares that all substances taken in excess activate the brain reward system.
Pioneers In Addiction Medicine and Recovery
The criteria for addiction have evolved over the years and so have the modalities of treatment. Such changes are owed to the tireless work put in by several individuals, perhaps too many to list. In the 19th Century, an 1849 essay titled Alcoholismus Chronicus, by Swedish physician Magnus Huss gave birth to the disease model. Huss’ essay defines the characteristics of alcoholism (a brand-new term at the time) as disease-like in nature; one that causes severe physical harm and can be fatal. Another body of work of note is E.M. Jellinek’s The Disease Concept of Alcoholism, which splits alcohol addiction into several stages.
In the field of recovery and use disorder treatment, some people come to mind often. Bill Wilson is a notable name, being a co-founder of Alcoholics Anonymous in the 1930s; a program that relies on addressing the spiritual side of the disease. While 12 Step programs are not scientific, many treatment centers utilize them along with other forms of therapy, such as cognitive behavioral therapy (CBT). Nora Volkow is someone who is worth mentioning as she heads up the National Institute On Drug Abuse (NIDA). There are also other names that most people have not heard – even those who work in the field today – whose contributions to addiction medicine deserve mention.
Dr. Herbert D. Kleber is one person who deserves recognition, especially in light of his recent passing. It’s fair to say that most Americans are unfamiliar with Dr. Kleber, even those who have undergone treatment in centers that utilize evidence-based methods. A researcher in the pathology of addiction, Dr. Kleber worked to develop evidence-based techniques to ease the discomfort of withdrawal, The New York Times reports. He also focused on helping such people avoid relapse and achieve long-term recovery.
Evidence Based Therapy
Upon completing his medical residency, Kleber went on to volunteer for the United States Public Health Service. His service took him to Public Health Service Prison Hospital (PHSPH) at Lexington, Ky. in 1964, roughly a year before the AMA’s recognizing alcoholism as a medical disorder. The PHSPH was a jail treating addicts and alcoholics, as part of the Addiction Research Center, NIDA’s predecessor.
Dr. Kleber understood that people with use disorders did not deserve punishment, according to the article. He would instead take a scientific approach; the doctor was instrumental in making the study of addiction into a discipline.
He was at the vanguard of bringing scientific rigor to the area of addiction,” said Dr. Frances R. Levin, director of the division on substance use disorders at Columbia University Medical Center, a program started by Dr. Kleber.
Over the decades, Kleber would continue to influence the field; he started and oversaw the drug dependence unit at Yale, the article reports. With his wife, he founded the division on substance use disorder at Columbia. Kleber was also a co-founder of the National Center on Addiction and Substance Abuse, now the Center on Addiction. He served as deputy to the Nation’s first drug czar during the George H.W. Bush administration. However, his dismay with the “war on drugs” and the lack of funding going towards addiction treatment led to his resignation. At his confirmation, someone asked how he remained optimistic working with addicts; responding by quoting the Talmud he said:
The day is short. The task is difficult. It is not our duty to finish it, but we are forbidden not to try.”
In 2015, Dr. Kleber said, “the last thing in the world I wanted to do was to treat addiction.” It is hard to imagine what addiction medicine would be today if it were not for Dr. Herbert D. Kleber contributions to the field. The Gentleman of PACE would like to express our gratitude for Dr. Kleber.
We invite you to reach out to us if you are struggling with drugs or alcohol and desire to find a new way to live. At PACE, we specialize in the treatment of males affected by use disorders and coöccurring mental illness.