Acute Alcohol Intoxication: Emergency Department Brief Intervention, Comprehensive Health Risk Education, Substance Use Screening and Multidisciplinary Support Referral for a University Student
Your Role — Nurse
Emergency Department
Your 22-year-old university student was brought to ED by ambulance after consuming approximately 15 units of alcohol over 2 hours and losing consciousness. The patient has had IV fluids and is now stable for discharge with a responsible adult. The patient reports drinking 6-8 pints on weekends and has experienced blackouts. Academic performance has declined this semester. The parents recently divorced. You are the ED nurse providing a comprehensive brief alcohol intervention including AUDIT-C screening, education about acute and chronic health risks, exploration of underlying stressors, harm reduction advice, and referral to university wellbeing services.
- •Confirm medical fitness for discharge. Assess the patient's current mental state and recall of events. Explore the circumstances of tonight's drinking without judgement.
- •Use motivational interviewing: assess readiness to change. Explore ambivalence — what does the patient enjoy about drinking versus what concerns them? Elicit their own reasons for change.
- •Provide education: explain acute risks (alcohol poisoning, aspiration, accidents) and chronic risks (liver disease, hypertension, brain damage, cancer). Use their AUDIT-C score to contextualise risk.
- •Explore underlying factors: stress, mental health, social pressures. The patient has mentioned parents divorcing and grades dropping. Link alcohol as a depressant that worsens stress.
- •Provide harm reduction advice: eating before drinking, pacing, alternating with water, setting limits, looking out for friends. Offer referral to university counselling service and local alcohol service. Provide written information.
The Interlocutor
Played by the actor / assessor
You are 22 years old and a university student. You were brought to ED after drinking heavily at a party and passing out. You do not remember much. You usually drink 6-8 pints on weekends and have had blackouts before.
- •Say you are embarrassed and do not remember what happened. Your friend said you passed out.
- •Say you drink 6-8 pints on weekends usually. You have blacked out a few times before.
- •Say your grades have dropped this semester. Your parents recently divorced and you have been drinking more to cope.
- •Say you do not think you are an alcoholic. You just drink to have fun and forget about stress.
- •Say you will take the card for the alcohol service. You will think about counselling.
Sample Role-play
How are you feeling now? That must have been quite a shock waking up in a hospital bed.
Honestly, really embarrassed. And I have a terrible headache. I just want to go home and forget this ever happened.
That is completely understandable — this is a very unusual and overwhelming experience for you. Do you have a clear memory of what happened tonight?
Not really. I remember being at a party, I did a few shots, and then the next thing I know I am waking up in hospital with a drip in my arm. My friend said I passed out and they called an ambulance.
I am very glad your friend was there and knew to call for help. What you experienced was serious — you consumed approximately fifteen units of alcohol in just two hours, which is enough to suppress the part of your brain that controls breathing and your gag reflex. That means you could have choked on your own vomit while you were unconscious without being able to protect your airway. I am not here to lecture you at all — I just want to make sure you understand exactly what happened so it never happens again. Would it be OK if I shared some important information with you?
How can I tell if my drinking is becoming a real problem?
A useful question to ask yourself is whether your drinking is affecting your health your studies or your relationships. If you are having blackouts drinking more than you intended or finding it hard to cut down these are signs it may be time to get some support.
What counts as a unit of alcohol?
Yeah, that is fine. I know I drank way too much.
Your body can only process about one unit of alcohol per hour. By drinking fifteen units in just two hours, your blood alcohol level rose far higher than your body could cope with. That is why you lost consciousness. Do you normally drink quite a lot on weekends?
I usually have about six to eight pints on a Friday or Saturday night. I have had a few blackouts in the past but nothing as bad as this before.
I appreciate you being honest with me. For context, one pint of beer contains about two and a half units of alcohol. So six to eight pints in one session is fifteen to twenty units — that is already more than the recommended weekly limit of fourteen units, consumed in a single night. Drinking at this level puts you at risk of immediate dangers like what happened tonight, and also long-term health problems including liver disease, high blood pressure, stroke, brain damage, and several types of cancer.
I did not realise a pint was that many units.
Most people do not. You also mentioned that your university grades have dropped this semester and that your parents recently divorced. Has your drinking increased since that happened?
Yes, I think it has. I have been drinking more to help me cope with the stress at home.
That is a very honest thing to share and I really appreciate you telling me. What many people do not realise is that alcohol is actually a depressant drug — it may make you feel relaxed for a short time, but it actually makes stress, anxiety, and low mood worse in the long run. There are much healthier ways to manage stress that actually work long-term, like regular exercise, talking to a trusted friend or family member, or seeing a professional counsellor.
I suppose I have been avoiding dealing with the situation at home by drinking.
That is a very insightful thing to say. I can refer you to your university counselling service or the local alcohol support service. They offer free, confidential support and can help you find better ways to cope with what is going on at home. Would you like me to arrange a referral?
I will think about the counselling. I am not sure I am ready for that yet.
I respect that completely. In the meantime, if you do choose to drink in future, here are some practical tips to keep yourself safe. Always eat a proper meal before you start drinking. Alternate every alcoholic drink with a full glass of water or soft drink. Decide how many drinks you will have before you go out and stick to that limit. And always look out for your friends and make sure they are looking out for you too. Here is a card with the local alcohol service contact details — take it with you, and it will be there if you ever change your mind or want to talk to someone.
Thank you. I really appreciate that you have not judged me. I thought you would just tell me off.
That is not how we help people. You have been through a frightening experience tonight. Please take care of yourself, and remember that number is there for you if you ever need it.
Useful Phrases
Clinical Background
Alcohol-related ED attendances are common. Brief interventions in ED have evidence for reducing harmful drinking. AUDIT-C: 3 questions (frequency, quantity, binge frequency). Score ≥5 indicates hazardous drinking. Nursing approach: non-judgemental, harm reduction focus, motivational interviewing. Safety net: ensure patient has safe transport home, understands signs of alcohol poisoning, and has emergency contact numbers.
Common Mistakes to Avoid
- ✕Being judgemental or dismissive — this creates defensiveness and reduces engagement.
- ✕Lecturing the patient rather than exploring their own motivation to change.
- ✕Missing the opportunity for brief intervention — even a short conversation can reduce future harm.