Physician: It’s clear you’ve been feeling depressed, which may account for your insomnia and fatigue. Let me ask you a few more routine questions.

Ms. Martinez: OK.

Physician: Do you smoke cigarettes?

Ms. Martinez: Yes. Usually half a pack a day.

Physician: Do you drink beer, wine, or other alcoholic beverages?

Ms. Martinez: Well, yes, I drink wine.

Physician: How many times in the past year have you had 4 or more drinks in a day?

Ms. Martinez: Hmm… I’m not sure. Physician: Well, a bottle of wine contains 5 drinks.

Ms. Martinez: Oh, then, pretty often – probably every day.

Physician: OK. How much do you drink on a typical drinking day?

Ms. Martinez: More than I should. Physician: Meaning how much?

Ms. Martinez: I hate to even tell you – probably two bottles a day. Physician: Have you been concerned?

Ms. Martinez: Yes, I keep saying I’m not going to, but then I come home from work and then I just open the first bottle…

Physician: And then you keep going…

Ms. Martinez: Yes, I guess so – I guess I do – and then my whole night is shot – I used to do all sorts of things and I don’t do anything any more. I feel so isolated.

Physician: Mm-hmm. How long has this been going on?

Ms. Martinez: Quite a while – a couple of years I guess. I mean I used to always drink socially, but after the divorce, it just really picked up.

Physician: Did your insomnia and depression start after the drinking picked up?

Ms. Martinez: Why yes, I guess it did.

Physician: Have you ever had alcohol treatment?

Ms. Martinez: I went to an AA meeting once, but I felt uncomfortable and I didn’t go back.

Physician: It can be uncomfortable at first. Do you feel shaky or nervous if you don’t drink? Or do you drink in the morning to relieve discomfort?

Ms. Martinez: God no – I don’t drink in the morning. I do get a hangover, but I’ve never had the shakes.

Physician: Do you drink and drive?

Ms. Martinez: No – I really just drink at home.

Physician: Has your drinking caused problems at work or in your social life?

Ms. Martinez: What social life? No, I perform well at work. And really, nobody knows how much I drink.

Click here to return to Case 3