Case 3: Ms. Jones

Provider

History

Ms. Jones is a 19–year–old college student who was drinking in her dorm room with friends. She tripped and hit her head on the bathroom sink. She sustained a laceration over her right eye. Her friends state that there was no loss of consciousness. They insisted that she go to the ED. Ms. Jones is in good health and takes no medications.

Physical Exam

The smell of alcohol on her breath is unmistakable. She has a 2 cm laceration over her right eye that needs sutures. The rest of her exam is normal.

Alcohol Screen

She drinks 1–2 days per week, mostly on Friday and Saturday

She drinks beer 4–6 per evening

Physician Advice

You would like her to agree to no more than 3 drinks on any one occasion.

You would like her to follow–up with student health services, and suture removal in 5 days.

Patient: Ms. Jones

History

You are a 19–year–old college student. You were drinking in your dorm room with friends. You went to the bathroom, slipped, and hit your head on the sink. You cut your forehead, and although it bled a lot, you want to put a band–aid on it and go to bed. You don’t know what the big deal is, and what you are doing at the ED.

Negotiation

You are aggravated with having to speak to the doctor about your drinking. You see no association between your alcohol use and tripping in the bathroom. The floor was wet. You drink 4–6 beers on the weekends. You choose a 1. You do not think you have a problem.

You think your drinking would become a problem if you were doing badly in school or had black outs. You consider yourself responsible and never drink and drive. In a discussion you do admit to sometimes doing things that you might not have if you had not had so much to drink (You have a flashback of that jerk you went home with one night, but you do not say this in the interview.) You agree that more than 5 beers, and you get “spacey.”

Your Goal

In the end you agree to think about a 3 beer limit but the best that you will agree to at the present time is setting an upper limit of 5 beers. After that you really feel it. You never drive while drinking.