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In 1810, Benjamin Rush, a prominent physician, said that drunkards were addicted to alcohol. He described the progressive nature of the disease as episodic drinking with progressively shorter intervals between drinking bouts. As for loss of control, he stated, “When strongly urged by one of his friends to leave off drinking, an habitual drunkard said: were a keg of rum in one corner of the room, and were a cannon constantly discharging balls between me and it, I could not refrain from passing before the cannon, in order to get the rum.”

He seems to say two things. One is that drinkers have less time for activities and life interests because their time is consumed by getting, using, and recovering from drinking. The second notion is that as the time spent getting, and using drugs increases, the drinker is getting sicker, and will take risks in order to obtain alcohol.

Since alcohol is a legal drug, acquiring it is easy. However, obtaining other illegal drugs is a little more complex than going to a liquor store or a bar. The drug user needs to have some knowledge of the market, and the connections to make the purchase. Acquiring the money to purchase the drug including alcohol may entail criminal activity, especially if the daily habit is in the hundreds or thousands of dollars. Therefore, in order to satisfy his/her needs for alcohol or drugs, the addict must spend a considerable amount of time supporting the physical and psychological need for the drug. The time commitment increases, and will eventually preclude nearly all activities. This is the “narrowing of interest.”

According to E.M. Jellinek, researcher and founder of the Center for Alcohol Studies at Yale and Rutgers University, the “early stage” user (he spoke primarily of alcoholics, but the principle applies to all users) will live a fairly normal life but there may be some early warning signs of trouble ahead. They may drink for physical or psychological relief; develop tolerance, repeatedly drive while drunk; have blackouts; and suffer loss of control.

The “middle stage” is characterized by problems related to: jobs, family and friends, divorce, personal finances, and the law. Finally, the “late stage” develops over a 15-20 year period of drinking. This stage is characterized by a rapid deterioration of physical and mental health. As time passes, the user spends more daily time in pursuit of the drug(s). This is the “narrowing of interest.” The resulting behavior deterioration is exhibited in mood swings, maintenance of a rigid schedule, engagement in circular arguments, and perpetual defensiveness.

Think of the “narrowing of interest” concept as a funnel. A normal life is at the top of the funnel where it is broad. There is zest for life and the person is engaged in a wide range of activities. In contrast, an addict does not have the time for interests or activities. For an addict, the swirl gets to the bottom of the funnel where there is a narrow opening. That opening allows time for only one activity: drug use.

One of the goals of treatment is to turn the funnel upside-down. Without the pursuit of drugs and alcohol, a newly recovering person is left with a lot of unstructured time. To help relieve the boredom associated with the abundance of time, part of treatment is to help the person prepare and follow a daily schedule. As time passes, the person is encouraged to think of new sober activities that he/she may want to pursue. As the person progresses in recovery, life becomes more manageable and broadens within the confines of the funnel. The brain works better and recovery thought processes replace the compulsive thought processes of an addict.

Sober Talk is a monthly column by the Alcohol & Drug Council and runs in the Journal on the first Thursday of each month. Tom Lipa, MA, CASAC is a clinician at the Council.