Table 3.

Selected Excerpts from Provider-Patient Conversations with Substance Use-Related Content

		Substance Use Endorsement (past 30 days)
	Age (years)	Alcohol Use	Tobacco Use	Drug Use
Participant 1	17.8	Denied	Denied	Denied
Excerpt	Provider: Ok. Before I look at you, do you have any questions? Anything you want to ask? Do you know what alcohol does to blood sugars? Patient: Lowers them. Provider: Right. Why is that? Patient: Because it takes longer for you to digest the alcohol. Provider: Well, not really, but the answer to your question is correct. The answer is that it can, you’re at risk for lows because what happens is the alcohol gets metabolized by the liver and the same pathway that the liver uses to break up stored glucose if you go low, you can’t do it so because it’s busy breaking down the alcohol, so if you don’t have carbohydrates when you drink, you can go low and can pass out. So I caution you, even though I should say that drinking is illegal under 21, I have to say that, if you do drink, you need to have carbs with it… Patient: No.
Participant 2	17.7	Denied	Denied	Denied
Excerpt	Provider: …So next question, any exposure to alcohol? Patient: No. Provider: Are you interested in trying? Not that I’m encouraging you. Patient: I mean, I want to know what it would do. Provider: Right. That’s the real question. So do you have any thoughts? Patient: I mean [name] told me that it lowers her blood sugar but I’m don’t -- Provider: Yes. It does. What it does, if you don’t have carbs with it, the alcohol uses the same pathway as glycogen to break down glucose. So if you go low and drink alcohol, it doesn’t get your blood sugar up because it’s too busy metabolizing the alcohol. So if you drink, and it is illegal under 21 -- Patient: I know. Provider: Actually under -- yeah, under 21, you’re putting yourself at risk for hypoglycemia. So what we tell our patients is that make sure you eat something if you’re going to drink. Well, I don’t recommend it.
Participant 3	19.6	Endorsed	Denied	Denied
Excerpt	Patient: I think that usually, because 12:00 AM, especially on the nights when I go out, that all comes back. My blood sugar might be a little high because when I do drink alcohol, I usually drink it with something that has sugar in it. Just because I’m still sort of trying to figure out the whole alcohol with my blood sugars. … Provider: So you can be in total control over this. So the way -- you could say it’s, okay, I need to be careful of the alcohol carbs and other carbs.
Participant 4	19.3	Endorsed	Denied	Denied
Excerpt	Provider: Well, so remember what happened -- did we talk about alcohol before you went to school? Patient: Yeah. Provider: So it’s hard to say exactly what happened. And alcohol, I know we talked about this last July, is tough. I mean what I would love to say to you is don’t drink. But you’re human, you know, so I don’t expect that you are going to not drink anything when you go to college… …Provider: …So I think, for you, the message or the takeaway is, are you going to drink? Probably. Do I love it? No. But am I realistic? Yes. You have to practice moderation.
Participant 5	19.4	Endorsed	Denied	Denied
Excerpt	Provider: And do you drink alcohol? Patient: No. Provider: Okay. Patient: I’d be too scared to have diabetes. I don’t want to mess with it. Provider: Well, that’s okay. If there ever comes a time when you feel like you’re ready to make that decision, let us know so we can teach you how to do it safely, okay? Patient: Yeah. Provider: Because you can do it safely. There’s a safe way to do it.