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The growing concerns over the use of drugs in sports today

Personal use only; commercial use is strictly prohibited. For some substances, like alcohol abuse, certain groups of athletes may be particularly at-risk relative to peers who are not athletes.

For other substances, participating in athletics may serve as a protective factor. Unique considerations are associated with understanding alcohol abuse and drug use in sport. These include performance considerations e. Fortunately, there are several effective strategies for preventing and reducing alcohol abuse and drug use, some of which have been tested specifically among athlete populations.

If such strategies were widely disseminated, they would have the potential to make a significant impact on problems associated with alcohol abuse and drug use in sport and athletics.

These links include issues such as ubiquitous alcohol advertising and sponsorship in many sports, frequent scandals involving performance-enhancing drugs e. Scholarship on alcohol abuse, drug use, and sport has increased substantially, providing a more complete understanding of the phenomenon. Alcohol use among athletes has received more attention in the research literature than use of other substances, which is not surprising considering that it is abused more than drugs like marijuana, cocaine, and amphetamines.

Three primary topics related to alcohol and other drug use are discussed in this article. First, rates of alcohol abuse and drug use among different groups of athletes are addressed. When possible, comparisons with relevant nonathletes norms are discussed. Second, several unique considerations associated with understanding alcohol abuse and drug use specifically among athletes are presented.

Third, prevention and intervention strategies that have promise for reducing alcohol abuse and drug use in sport are explored. Finally, suggestions are provided for future directions among scholars and practitioners interested in this topic. Prevalence of Substance Abuse in Sport Alcohol Although few studies have examined prevalence rates of alcohol abuse or other formal alcohol use disorders among athletes, several studies have examined rates of binge drinking or other indicators of at-risk alcohol consumption.

College athletes were also more likely than nonathletes to report a host of academic, legal, and interpersonal difficulties associated with their alcohol use. Together, the existing research suggests that, in general, those who participate in sport are at-risk for excessive alcohol use and related negative consequences. A meta-analysis of 17 studies examining drug use among adolescents found that those participating in sport were significantly less likely than those not participating in sport to report cannabis use Diehl et al.

Alcohol Abuse and Drug Use in Sport and Performance

Another systematic review of longitudinal studies among adolescents found that athletic participation was inversely associated with the use of drugs other than cannabis Kwan et al. Research among college athletes in the United States has also found that athletes were less likely than nonathletes to report marijuana use Wechsler et al.

Performance-Enhancing Drugs Drug use in sport is often most associated with a variety of substances designed to improve athletic performance e. Several high-profile incidents have involved athletes being punished for the use of the substances, such as Ben Johnson losing the 100-meter track gold medal in the 1988 Olympics for steroid use, Lance Armstrong being stripped of seven Tour de France cycling titles for performance-enhancing drug use, and a number of top athletes in United States receiving suspensions for steroid or other performance-enhancing drug use.

Such incidents may create the impression that performance-enhancing drug use is rampant in athletics, but the research evidence is equivocal.

A meta-analysis of nine studies found an overall positive association between adolescent sports participation and anabolic steroid use Diehl et al. A 2013 study of approximately 21,000 college athletes in the United States indicated that only 0. In comparison, a national study of college students reported an annual prevalence rate of 0.

Rates of performance-enhancing drug use may be higher among elite athletes, where the stakes and incentives for optimal performance are quite high.

Doping in sport: What is it and how is it being tackled?

These estimates are consistent with several anecdotal reports in the popular press estimating that performance-enhancing drug use rates are relatively high among elite adult athletes, particular in certain sports e. This finding extends to prevalence rates of some substances e.

Yet, for other substances e. Such contradictory findings illustrate the importance of understanding the roles various sport-related factors play in either promoting or inhibiting alcohol abuse and drug use. It is also important to explore such factors considering the ethical issues inherent in the use of some substances in sport i.

Several factors that are somewhat unique to the sporting context are discussed. The Cultural Context of Alcohol and Sport Despite the potential negative effects of alcohol use on athletic performance Barnes, 2014in many countries alcohol and sport are inextricably linked. There are several mechanisms by which these associations might translate to individual drinking behavior.

One involves an indirect association: A second is a more direct association, where athletes receive free or discounted alcohol products due to sponsorship from a beverage company. Another cultural aspect of sport that may relate to drinking behavior involves popularity and prestige. At the adolescent and collegiate level, successful athletes may find that they are regularly invited to social gatherings where alcohol or other drugs are provided. Athletes old enough to go to bars, clubs, and other public establishments may find that other patrons are eager to socialize with them, including purchasing their drinks.

Additionally, a club or bar owner may provide free drinks to athletes of a certain stature to encourage their patronage. Thus, athletes who may be at-risk for developing a substance abuse problem may often find it relatively easy to be in social settings where alcohol and drugs are readily available.

Performance-Related Considerations Athletes have clear incentives to perform at an optimal level in their sport. Thus, some athletes will be tempted to use substances that have the potential to make them stronger and faster, thereby improving their athletic performance.

Drug abuse in athletes

Conversely, concerns about the impacts certain substances can have on athletic performance may serve as an important deterrent among athletes. Addressing the role certain substances can play in inhibiting athletic performance could be a potentially useful component of interventions designed to prevent and reduce drug use among athletes. Although many athletes train year-round, they have defined periods when their athletic performance is more salient and relevant.

For example, the formal competitive season for a college football player in the United States runs from August the start of official practice through December or January depending upon the date of the final game. These athletes may have other obligations throughout the year, such as spring practice and off-season workouts, but they are not participating in formal competitions. Athletes who limit alcohol and drug use due to performance-related concerns may choose to increase their use outside of these formal competitive seasons.

Several research studies have shown that transitioning from in- to off-season serves as a risk factor for heavy drinking among athletes. Another study of professional Australian Football League players showed a dramatic increase in risky drinking between pre-season and in-season time periods versus the off season Dietze et al. Elite athletes at the international level are regularly tested for both performance-enhancing and illicit drug use, as are athletes in many major professional sports leagues and major amateur organizations e.

However, one study among adolescents in the United States showed that randomized testing reduced drug use but increased other risk factors for use, such as perceived norms and less risky beliefs about drug use Goldberg et al.

Further, if athletes are aware of their testing schedule, they may be able to organize their use around times when it would not trigger a positive test. Fear of a positive drug test almost certainly inhibits short-term drug use for some athletes, but the degree to which drug testing provides a more general impact on the substance use habits of athletes is more difficult to determine. Ethical Considerations A final sport-related contextual factor to address when considering substance use among athletes is ethical issues related to performance-enhancing drug use.

Performance-enhancing drugs and harm

This consideration is almost wholly unique to the athletic environment, as it is one of the only arenas where an individual may be incentivized to take a substance that would allow him or her to be physically superior to a specified opponent. Health or societal concerns regarding substance use can be applied across almost any group, but sport is unique in that use of certain substances may undermine the core foundation of the entity.

Virtually all sports are based on the notion that each competitor agrees to a specified set of rules and regulations, which in many instances involve the types of drugs and other performance-enhancing techniques that are allowable. For example, in many professional sports leagues, athletes are allowed to take certain narcotic painkillers, but cannot take anabolic steroids or human growth hormone.

The growing concerns over the use of drugs in sports today organizations are motivated to ensure that athletes do not use drugs that are banned by their governing body, as it is important that they convey to the public that they are attempting to enforce the ideal of all athletes playing by the same rules.

Further, sporting organizations are also motivated for their athletes to be perceived as living up to some sort of ideal e. Many athletes therefore find themselves in situations regarding drug use that seem arbitrary, and at times hypocritical, in terms of the substances they can ingest. For example, they may be suspended for using a substance legal in several countries and states in the United States cannabisbut they are allowed to use narcotic painkillers in an effort to facilitate their return to the practice or competitive arena.

Intervention and Prevention Strategies for Alcohol Abuse and Drug Use A number of effective intervention and prevention strategies for alcohol abuse and drug use have been identified. This section of the chapter will address those strategies that have been well-studied and have the strongest empirical support. When possible, research that has examined these approaches specifically among athletes is presented here.

Most of these studies focus on alcohol use, but in some cases their findings may translate to other substances. Motivational interviewing-based approaches are designed to help individuals identify their own reasons for change and support specific efforts toward change. A common feature of motivational enhancement interventions is personalized feedback, where the individual receives personalized information about the behavior in question. Theoretically, this feedback helps increase internal discrepancies in the individual that subsequently result in behavior change.

  1. Studies have shown that many nutritional supplements purchased online and in retail stores are contaminated with banned steroids and stimulants. For other substances, participating in athletics may serve as a protective factor.
  2. There are five classes of banned drugs, the most common of which are stimulants and hormones. The former German Democratic Republic substantiated these suspicions.
  3. Contingency Management One of the most efficacious strategies for intervening with individuals experiencing alcohol and drug disorders is contingency management, with one meta-analysis indicating that it had the strongest effects of any psychosocial intervention in terms of treating substance use disorders Dutra et al.
  4. So, if our objection to drugs is that they create an unfair advantage, consistency demands we apply the same standard to many other aspects of athletic competition. Research among college athletes in the United States has also found that athletes were less likely than nonathletes to report marijuana use Wechsler et al.
  5. Narcotics are used to decrease pain while practicing or playing.

Popular components of this feedback include personalized social norms information i. Overall, there is considerable empirical support for the efficacy of motivational enhancement interventions.

Further, interventions that provide personalized feedback in the absence of individual clinician contact have also been shown the growing concerns over the use of drugs in sports today be efficacious at impacting substance use Miller et al. A handful of studies have examined the efficacy of motivational enhancing interventions specifically among athletes, with promising results.

For example, in one study, Martens and colleagues 2010 found that a personalized feedback-only intervention was effective among a sample of college athletes at reducing peak blood alcohol concentration.

Another study by Doumas et al. Finally, a recent study by Cimini et al. Together, these findings suggest that brief, motivational enhancement interventions have considerable potential in reducing harmful alcohol consumption among athletes. Alcohol and Drug Skills Training Programs Another class of interventions involve those designed to teach individuals specific skills and strategies that are used to reduce alcohol and drug use and limit the likelihood of experiencing substance-related problems.

Only a few studies have examined the efficacy of alcohol skills programs specifically among athletes. This study was limited by factors such as a low sample size and high dropout rate. Contingency Management One of the most efficacious strategies for intervening with individuals experiencing alcohol and drug disorders is contingency management, with one meta-analysis indicating that it had the strongest effects of any psychosocial intervention in terms of treating substance use disorders Dutra et al.

Contingency management interventions are based on basic operant behavior principles, where target behavior is reinforced and therefore likely to increase. For example, patients in a contingency management program for a drug-use disorder may receive a cash payment or voucher each time they provide a negative urine sample.

Theoretically, the individual will initially engage in the behavior e. Over time, the individual will begin to experience other reinforcers that naturally occur due to decreased substance use, such as better relationships and job performance.

Matthew P. Martens

Ideally, these reinforcers will be powerful enough to cause the individual to continue to engage in the target behavior even after the contingency management intervention has ended. For example, an athlete in a contingency management program whose sport performance improves after ceasing drug use may be likely to continue to refrain from drug use even when he or she no longer receives the financial incentives associated with the program.

To date no studies have been published that examined the efficacy of contingency management interventions specifically among athletes. Due to the fact that many sporting organizations already routinely test athletes for various substances, implementing such a program in certain athletic settings may be somewhat easier than the typical outpatient or inpatient clinic. Indeed, many organizations already have a punishment-related system affiliated with drug testing e.

Such a program would likely be most appropriate for athletes who have been experiencing fairly significant alcohol and drug problems and are attempting to eliminate their use of the substances.

Twelve-Step Programs Twelve-step programs are likely the mode of alcohol and drug abuse intervention most familiar to the general public. AA or NA programs have historically been the most common route for individuals to engage in a 12-step program, but there are examples of individual interventions designed to facilitate the 12-step process e.

Twelve-step programs conceptualize addiction as a disease, and therefore complete abstinence is the desired outcome.