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A Resource from the American College of Preventive Medicine

Stress, alcohol misuse and depression form a unique triad in primary care. Individually they are very common, but it is the interactions between them that are particularly challenging for clinicians. Stress contributes to excessive drinking, as well as susceptibility to depression; depression increases vulnerability to stress; alcohol is used to self medicate for depressive symptoms and anxiety, and to relieve stress, but excess alcohol accentuates the stress response and increases the risk of developing clinical depression. It is a vicious cycle that needs to be recognized and treated together, but the reality is that it is often not. Most patients feel unprepared to manage stress, and many clinicians feel unprepared to assist them. Few clinicians use a validated screening tool for alcohol use, and as many as half of depressed patients are not identified, even though brief screening tools are available. Time is a major factor in addressing the issues of stress, alcohol and depression in a coordinated fashion. An efficient approach is needed. 

The Stress, Alcohol and Depression Time Tool developed by the American College of Preventive Medicine is an innovative educational tool designed to assist the physician in a brief consult on these issues. It provides a guide to screening and counseling from a lifestyle perspective to address the root causes of stress, depression and alcohol misuse. The tool includes a practical approach for a clinical visit, along with a robust clinical reference document delineating the epidemiology, clinical evidence, guidelines and recommendations, along with additional tools and resources and a patient handout. 

This educational activity is intended for primary care physicians.

After completing this program, physician participants should be able to:

  • Screen for alcohol use disorders and depression

  • Discuss a strategy for controlling the response to stress

  • Explain alcohol use patterns that increase health risks

  • Diagnose and explain the nature of depression as a chronic condition

  • Discuss the relationships between stress, alcohol and depression

  • Understand the importance of assessing suicide risk in depressed patients 

  • Discuss why a healthy lifestyle is the foundation for problems with either stress, alcohol or depression

May 2009 through June 2011. Original release date: May 2009

These materials have been reviewed by the members of the American College of Preventive Medicine to ensure the continued scientific accuracy and medical relevance of information presented and its independence from commercial bias.

  • Ayanna V. Buckner, MD, MPH
    Morehouse School of Medicine
    Atlanta, Georgia

  • Thomas J. Craig, MD, MPH, FACPM
    American Psychiatric Association
    Springfield, Virginia

  • Brooke W. Rossheim, MD, MPH
    Public Health & General Preventive Medicine,
    Internal Medicine and Geriatric Medicine
    Williamsburg, Virginia

In the interest of providing an educational experience free of commercial bias, and as the accredited provider of CME for this activity, the American College of Preventive Medicine was responsible for decisions regarding educational content and allocation of funds.  All individuals involved in the planning, development, and delivery of educational activities are required to sign a conflict of interest statement in which they disclose any relevant financial interests or other affiliations with industry or other associations which may have direct and substantial interest in the subject matter of the CME activity. Such disclosure allows program participants to better evaluate the objectivity of the information presented in the program.

  • Ayanna V. Buckner, MD, MPH has disclosed no financial relationships.
  • Thomas J. Craig, MD, MPH has disclosed no financial relationships.
  • Brooke W. Rossheim, MD, MPH has disclosed no financial relationships.
  • Larry Mattson, Medical Writer, has disclosed no financial relationships.

These pages may be viewed using standard Internet browser applications (e.g. Internet Explorer). They may also be downloaded as PDFs and read using standard PDF reader applications (e.g. Adobe Acrobat Reader).

The American College of Preventive Medicine collects personal information from participants in this online activity for purposes of assigning CME credit only.  We will not share or sell your contact information, and your answers to quizzes and feedback forms will be kept confidential.

This material is copyright of the American College of Preventive Medicine.

If you have questions regarding this CME activity, please contact Haydee Barno at hbarno@acpm.org.

Stress, Alcohol and Depression Patient Guide




Copyright 2009 American College of Preventive Medicine. All Rights Reserved.

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