Athletes and Substance Use Disorder

Professional and elite athletes typically spend most of their lives perfecting their craft. Many of them begin their sport during early childhood, continuing to push their body’s limits through high school, college, and long into adulthood. When we think of professional and elite athletes, we assume they are the picture of health – hours in the gym improving their physical fitness, carefully chosen meals to maximize nutritional benefit, and ensuring that their bodies can operate at peak performance. After all, their bodies and health are their livelihoods.

However, with all of this comes years of pain and damage to the body’s muscles and joints, weeks or even years away from family and friends, and a lifestyle that prizes dedication, at almost obsession-like levels, to their sport. All of this can be a perfect storm, leading to a higher likelihood of substance use disorder and addiction.

Why Is Substance Use Disorder Common Among Athletes?

For many people, athletes and substance use disorder aren’t necessarily connected. However, statistics show that substance use disorder is common in athletes of all levels. Over 2% of elite athletes test positive for banned substances in any given year. Among college student athletes, over 85% report using alcohol, with a significant proportion demonstrating problem drinking behaviors. Anabolic steroids are used by 6.6% of high school athletes, 5% of male college athletes, 9% of professional football players, and 67% of competitive power lifters. Regarding opioid use, 52% of professional football players report using the medications over their career, and 71% of those athletes stated that they had misused opioids. Finally, 28% of college athletes report using cannabis over the past year and 3% stated that they abuse stimulants.

It’s clear that substance use is a common part of the athletic culture. Why is it that athletes turn to alcohol and drugs?

Performance Enhancement

One of the most common reasons that athletes abuse drugs is to gain a competitive edge. Performance-enhancing drugs, such as anabolic steroids, are often used in bodybuilding sports where increased muscle mass is important. However, sometimes, performance-enhancing drugs are used to increase endurance by boosting red blood cell counts and increasing the amount of oxygen delivered to the muscles.

Perhaps the most famous case of doping with performance-enhancing drugs is cyclist Lance Armstrong. He was stripped of his seven Tour de France titles and Olympic bronze medal after admitting to using erythropoietin, blood transfusions, corticosteroids, and testosterone to enhance his performance. His fall from grace led to calls to clean up the sport of cycling and end doping practices.

Self-Medication for Injuries

There is no doubt that years, and even decades, of practice and competing can cause a variety of injuries and chronic pain in athletes. For athletes with severe or chronic pain, opioid pain medication might be prescribed by a physician to help with the healing process. However, when the prescription runs out or when the pain cannot be controlled by the prescribed amount of medication, athletes might turn to illicit opioids, such as heroin, to dull the pain. They might also use their medications at a higher dose than prescribed or use pills from a family member or friend to cope with chronic pain.

Traumatic Brain Injuries

Traumatic brain injuries are, unfortunately, a common occurence in some sports, such as football, ice hockey, and boxing. Initially, substance use disorder following a TBI might be the result of self-medicating for the initial injury. Eventually, however, TBIs can lead to memory loss and depression, in addition to an increased risk of chronic traumatic encephalopathy (CTE). The mental health changes that can occur in the years to decades following TBIs can also increase the risk of alcohol and drug abuse.

Pressure to Perform

For many professional and elite athletes, and even athletes at the high school or college level, there is a tremendous pressure to be on top of their game always and perform to a high standard. Performing well can lead to idolization from fans, corporate sponsorships, college scholarships, multi-million dollar contracts, or being drafted to the top teams in the nation. When you’re in the spotlight, having an off-day doesn’t just affect you for that game. It can lead to outcries from fans, including social media bullying, lost medal hopes, and shattered expectations after years of training.

Athletes live with this high level of pressure, and while some athletes use it to their advantage, others crumble under the pressure, turning to drugs or alcohol to cope.

Meet Weight Requirements

Some athletes face tremendous pressure to maintain a certain body weight or size. This is especially true in among gymnasts, wrestlers, and figure skaters. Some of these athletes turn to diuretics to lower their body weight prior to competitions. While technically, diuretics are considered a masking agent and are banned by the Olympic games and other athletic organizations, because they do not remain in the urine long, their use is still, unfortunately, popular among athletes that are under pressure to maintain a lower body weight.

Side Effects of Substance Use in Athletes

While alcohol and drug use is relatively common among athletes, these substances are not often condusive for the high level of health and fitness that an athlete needs to perform. Many commonly used and abused substances can have detrimental effects on the body, sharply decreasing the athlete’s ability to perform.

Opioids in Athletes

Opioid use, both licit and illicit, can cause several important side effects that athletes should be aware of:

• hyperalgesia (hypersensitivity to pain)
• respiratory failure
• gastroparesis (delayed gastric emptying)
• heartburn
• gas
• bloating
• weight loss
• muscle rigidity
• involuntary muscle jerking or twitching
• hormonal imbalance
• amenorrhea or irregular menses
• reduced fertility
• suppressed immune system
• testosterone depletion
• lethargy and sedation
• vomiting
• dizziness
• constipation
• slowed breathing
• death from overdose

Signs of Alcohol in Athletes

Signs of alcohol use and abuse in athletes includes the following:

• blackouts
• memory loss
• irritability
• mood swings
• changes in appearance
• aggression
• impaired judgement
• excessive weight loss or weight gain
• missing practice or competitions
• decreased performance
• dry skin
• premature aging
• alcohol smell on the breath
• flushed face
• jaundice or yellowing eyes or skin

Drug Screening and Athletic Organizations

In an attempt to keep sporting events fair and to prevent substance use disorder among athletes, many athletic organizations conduct routine or random drug testing. In the National Football League, every athlete is tested at least once a year. The MLB, NBA, and NHL conduct random screenings several times a year. Each of these organizations use urine tests to screen for banned substances, which include steroids, masking agents such as diuretics, and stimulants. If an athlete tests positive, they face suspension or even a lifetime ban in the sport.

Random drug screening is also conducted in boxing, mixed martial arts, NASCAR, professional tennis, the PGA, and all high school and college sporting organizations, including the NCAA.

The Olympics also does both random blood and urine testing, looking for evidence of steroid, anti-estrogen agents, β-blockers, corticosteroids, stimulants, chemical and physical manipulation, oxygen-transfer enhancers, gene doping, diuretics, and a variety of performance-enhancing hormones. Any Olympic athlete who tests positive is banned from competition for life. There are some exceptions, however, if the athlete can prove medical necessity for a banned substance. One notable example is gymnast Simone Biles, who tested positive for stimulants and was able to provide proof from her physician of an ADHD diagnosis and stimulant prescription.

Because of these anti-doping practices, the number of athletes that abuse performance-enhancing drugs is decreasing. However, alcohol, opioids, and other addictive substances are not routinely tested for, making them more likely to be the drug of choice for athletes with addiction disorders.

Professional Athletes Who Battled Addiction

The unfortunate connection between athletes and drug abuse has significantly impacted the careers those athletes worked so hard to achieve. For some athletes, substance use disorder cost them their lives. For others, however, the story is one of recovery and hope.

Athletes Lost to Addiction

Tragically, several professional and elite athletes have lost their lives due to substance use disorder. One of the most devastating of these is professional wrestler Chris Benoit. In 2007, he killed his wife and seven-year-old son before ultimately dying by suicide. His autopsy and toxicology reports showed that he had high levels of testosterone in his system, in addition to steroids found in his home. This case illustrates the danger of performance-enhancing drugs to both the body and the user’s psychological state.

In 1986, the world lost young basketball player Len Bias. At the University of Maryland, he was a first-team All-American forward. He was drafted by the Boston Celtics as the second overall pick, only to die two days later, at the age of 22, from cardiac arrythmias caused by a cocaine overdose.

Unfortunately, these stories are not rare. The list of athletes lost in the prime of their careers is long, from 24 year old horse racing phenom Michael Carl Blaze, who died from cocaine and prescription drug abuse, to 28 year old hockey player Derek Boogaard, who died from alcohol and prescription drug addiction, to 25 year old golfer Erica Blasberg, also succombing to prescription drug abuse.

Finding Hope: Athletes Who Beat Addiction

There is hope for recovery, however. Many athletes facing addiction have gotten treatment and recovered, going on to have a successful and clean career. In 2014, decorated swimmer Michael Phelps sought treatment for alcohol abuse. After treatment, he went on to medal multiple times the 2016 Rio Olympic games.

Ohio State Buckeye and Minnesota Vikings football star Cris Carter sought treatment for ecstasy, marijuana, alcohol, and cocaine addiction. After overcoming his addictions, he enjoyed a victorious 12 year career with the Vikings, including eight consecutive Pro Bowl appearances. In 1996, he was ordained as a minister and dedicated his time to helping others overcome substance use disorder.

Fortunately, the list of athletes who have beaten their addiction is also long, including golfer John Daly, football player Maurice Clarette, basketball star Chris Mullin, baseball great Darryl Strawberry, and tennis legend Andre Agassi.

Winning the Fight Against Addiction

As an athlete, you already know that winning takes a lot of hard work and dedication. Overcoming your addiction will also take hard work, but with support and the right treatment, you can defeat your drug or alcohol abuse and get back to the game you’ve trained all your life for. If you are ready to take the first step in ending your addiction and living a clean and healthy life, give us a call. We are here to support you 24/7.