Denial is more than just a river in Egypt

I ask all patients about their use of things like tobacco, alcohol, and drugs. I was tipped off that this patient may have issues in the area when it took 3 visits to his room to even find him because he was constantly out smoking.

When I asked about his alcohol use, he said, "I just have one a day."
"One what?" I asked.
"One, you know, one thing of vodka."
"One shot of vodka?"
"No. You know those glasses that some people put their beer in?"
"A pint glass?"
"Yeah, one of those."
"So you drink a pint of vodka a day?"
"Well, that's with dinner, but most days if I'm not sleepy at bedtime, I'll pour myself another one to help me sleep."
"Any other alcohol use?"
"No...well, beer doesn't count, does it?"
"Actually, yes it does."
"Oh, well then I have one can of beer with dinner too."
"Okay. When is the last day that you did not drink any alcoholic beverage?"
"Oh gosh, doc, I couldn't tell you. I can't remember the last time I didn't have one."
"So has your alcohol use ever caused a disruption in your daily life?"
"Oh no, I don't think so...well, what do you mean by that?"
"I mean, has your alcohol use ever caused you to lose a job or a relationship or get in legal trouble?"
"Oh no, nothing like that....well wait, there was this one time..."
"Tell me about that..."
"Well, this one time, I had a little too much to drink and then got in a bar fight and went to jail. But since I had some outstanding warrants, I stayed in jail a while. So I lost my job, and my wife left me and took everything. So when I got out of jail, I had nothing, and I was living under a bridge for about 6 months. But other than that, no, the alcohol has not caused any disruptions in my life."
"Well, I think that qualifies as a pretty big disruption in your life."

Never underestimate the power of denial.