Athletes and Substance Abuse

When people think about athletes in the United States an image of physical perfection and elite performance come to mind. According to Lui and Suen (2008), the United States have performed as a top ten medal winner in the Olympics since 1984. One reason for the success of the US in sports is likely due to high economic development allowing more money to be contributed to the development of sports and athletes (Lui &Suen, 2008). The United States produces highly competitive athletes in all facets of competitive sports. People do not associate drugs and alcohol abuse with sports and athletes. According to Green, Uryasz,, Petr, and Bray (2001), athletes do not follow the same illicit drug use patterns of their classmates. Degenhardt and Hall (2001) concluded that, illicit drug use is a substantial cause of premature mortality and morbidity (p. 64). Are athletes immune to the draws of such substances or perhaps are they more vulnerable? There may be something about athletes that makes them behave differently regarding illicit substances. This paper is going to demonstrate that athletes are no less susceptible to substance abuse than the general population, specific circumstances may be influencing substance abuse among athletes, and the scope of study regarding athletes needs to be broadened in order to further understand this topic.

To determine if drug use among athletes is a problem, first, some information regarding drug use across the whole population must be established. Specific drug use varied widely by region and information regarding drug use was more reliable in well developed areas (Degenhardt & Hall, 2012). In 2011, the United Nations Office on Drug and Crime (UNODC) reported that worldwide drug use was between 3.3% and 6.1% or 149-271 million people (Degenhardt & Hall, 2012). The study classified illicit drug use into four categories cannabis, amphetamines, cocaine, and opioids. Cannabis included any form of substance derived from the cannabis plant and was estimated at 2.8% – 4.5% (Degenhardt et al, 2012). Cannabis was most prevalent in North America, Europe, and Oceania (Degenhardt et al., 2012). Amphetamine use was estimated at 0.3% - 1.3% and highest usage was in Southeast Asia (Degenhardt et al, 2012). Cocaine use was rated at 0.3% - 0.5% with the most prevalence in North America, Europe, and South America (Degenhardt et al, 2012). Opioids use was similar to the use of cocaine at 0.3% - 0.5%, but highest levels of use were in Asia and near Afghanistan (Degenhardt et al, 2012).

In a study of college athletes of the NCAA to gather a more accurate picture of drug use among the population (Green et al., 2001). According to the Green et al. (2001), overall marijuana use was reported at 28.4%. Compared to the report by Degenhardt et al. (2012), this number is drastically higher than world wide use, but as stated earlier drug use was highest in North America and Europe. According to Degenhardt et al. (2012), cannabis use in North America alone was reported at 10.7% of the population. This number still shows a drastic difference among use of cannabis between the general population and college athletes.

According to Kopstein and Gfroerer (1990), cannabis use among the US population is skewed towards those younger in age stating that, drug use prevalence clearly decreasing with increasing age (p. 12). Illicit drug use was lower among the fully employed as compared to the partially employed and unemployed (Kopstein et al, 1990). This information helps to establish that drug use of marijuana is clearly higher at ages when most college athletes would be competing. While it is expected that younger people would be using marijuana at higher rates the numbers are still noticeably different. When looking at the rates of marijuana use for the lowest age group, 18 – 25, fully employed were 6.9%, partially employed were 14.2%, and unemployed people were 25.5% (Kopstein, 1990). While the rate gets a bit closer when looking solely at unemployed young people and college athletes there are other interesting demographics associated with illicit drug use which should be addressed as well.

According to Kopstein et al. (1990), use of marijuana among males is significantly higher than that of females. There is also a correlation between income and drug use showing that marijuana use rates increase as income decreases for males (Kopstein et al., 1990). When one thinks about college athletes this makes sense. Many students have very high workloads associated with school work, then when you add college sports on top of that the workload becomes even greater. Sussman, Lisha, and Griffiths (2011), stated that, student athletes are expected to balance full course loads, practice, workouts, and social life and that, the pressures associated with this multitude of obligations may be overwhelming (p. 2). College athletes typically have certain grade requirements they are required to meet to be eligible to play. This leaves very little time for work if any at all. It is possible that the stresses on a college athlete are very high and, to reduce those stresses an athlete could turn to the use of illicit substances. Based on this finding it can be discerned that the use of cannabis among athletes is perhaps a bit higher than the average population, if not it does confirm that athletes are at least no less susceptible. There are other variables which have not been researched regarding the influences on athletes use of substances and more information will need to be gathered to draw stronger conclusions.

When looking at the use of other illicit drug use, the data does not show a significant difference (Green et al., 2001). The study of NCAA student athletes showed an overall use of cocaine at 1.5% and an overall use of amphetamines at 3.1% (Green et al, 2001). Use of these substances were reported at 1.9% for cocaine and 1.1% for amphetamines according to the UNOCD (Degenhardt et al, 2012). Amphetamines show a slightly higher rate of use as compared to the general population, but this is one substance that would be potentially expected for higher use among athletes based on its performance enhancement abilities. This conclusion is reaffirmed by Jason Ford (2008), who conducted a study looking at the use of nonmedical prescription drug abuse among students and athletes and found that stimulant use was higher among athletes than nonathletes. Amphetamines would give an athlete in training and performance due to the nature of the drug and its effects. This is confirmed by Green et al. (2001), where the results of their study indicate that majority of students who used ephedrine were seeking performance enhancement.

When looking at the use of cocaine based on employment status and age the difference is quite apparent. For 18 – 25-year-old participants cocaine use was 14% for the fully employed, 10.8% for the partially employed, and 13.4% of the unemployed (Degenhardt et al, 2012). The use of cocaine among student athletes is much lower than that of the general population. This is most likely due to the expensive nature of this drug and this is likely why the study showed that fully employed individuals partook in cocaine more than the less employed. Athletes as stated before athletes have little time for work on top of their other responsibilities.

Ford (2008) found that athletes were less likely to report use of barbiturates (6% nonathlete vs 5% athlete), opioids (12.5% vs 10.6%), and tranquilizers (8.2% vs 6.2%) than were non-athlete's college students. While it may seem like a positive that athletes are using pain killers at lower rates these numbers are still higher overall in comparison to the general population use according to Degenhardt et al. (2012). The difference for these rates may not be so simple. One interesting consideration should be that the average college student does not need to worry about drug testing on a regular or random basis. According to Green et al. (2001), 75% of division one schools, 43% of division two schools, and 8% of division three schools conducted drug testing of athletes. The NCAA tests all three divisions at championship events, random testing of division one and two football, and division one track and field for both men and women (Green et al., 2001). This randomized drug testing may act as a deterrent for athletes to indulge in such activities, if not only while they are competing in their sport. This can be seen in the difference of use between division one and division two and three athletes (Green et al., 2001). Manchikanti, et al. (2006), conducted a study on the use of illicit drugs among those prescribed pain killers. Manchikanti et al. (2006), also investigated the effects of urine testing and adherence rates among those studied and found a significant reduction in illicit drug use when monitored and randomly drug tested. Manchikanti et al. (2006), note an association between chronic pain and illicit drug use as well. Susan Okie (2010) noted in her study that in Virginia that 50% of deaths associated with opioids had a history of chronic pain.

According to Hootman,, Dick, and Agel (2007), NCAA teams can expect to experience and injury one if every two games and one in every 5 practices. This information is relevant to athletes because pain killers are often prescribed following surgeries related to athletic injuries. Athletes are often involved in serious injuries, often life altering or sport career ending. Something as serious as this could cause many issues with the athlete and their identity or mental health. Most of these studies looking at athletes focus on those within the NCAA, but typically no longer track them once they have finished competing in their respective sports. Hootman et al. (2007), states that ankle sprains were the most common in their study at 14.8% and that, 23% of ankle sprains.resulted in sequelae over a 12-year period (p. 315). This information confirms the idea that injuries in sports can affect the athlete throughout life. It would be wise to further research the connection with sport injuries at a younger age, chronic pain associated with it later in life, mental health associated with athletic identity, and illicit drug use.

When it comes to illicit drug use, the numbers are varied marijuana/cannabis use is consistent with the general population even though it is assumed these substances would hinder performance (Green et al., 2001). Other substances such as cocaine and amphetamines do seem to be influenced in a way that most would expect as a result of sports and athletics as seen by the reason cited for their use being performance based (Green et al., 2001). These substances have something in common, they are currently illegal in the United States. Cannabis is the mostly widely used illicit substance used world-wide and in North America (Degenhardt et al., 2012). These substances could get anyone, not just athletes, into serious trouble regarding the law. There are several other substances which are legal to own and are also regarded as performance inhibitors.

Alcohol impairs cognitive and behavioral functions and tobacco is associated with decreased lung capacity and oxygen uptake (Degenhardt et al., 2012). If one wishes to perform optimally it would be best to avoid these substances or limit their use severely. Weekly alcohol consumption was given for the 18 – 25-year-old population among employed, partially employed, and unemployed at 41.6%, 40.6%, and 43.9% respectively (Degenhardt et al., 2012). Heavy alcohol use was reported at 11.2% for employed, 11.2% partially employed, and 10.9% for unemployed (Degenhardt et al., 2012). According to the NCAA overall alcohol use was reported at 80.5% of student athletes (Green et al., 2001). The NCAA study is looking at alcohol consumption within the last 12 months, but still it can be concluded that many student athletes are using alcohol. Anecdotal evidence also links college campuses with drinking and partying as a well-known association. While most other studies do not group tobacco with illicit drug use, it is interesting to note that 22.5% of student athletes are using smokeless tobacco (Green et al., 2001). This evidence shows that it may not simply be that athletes are deterred from avoiding these substances purely based off desire for optimal athletic performance.

If the use of these substances is not associated with athletic performance, then they must be used for another reason. According to Green et al. (2001), most responses for why any substance was used was recreational/social use at 54.1% tobacco, 83.4% for alcohol, 61.2% for marijuana, and 42.1% for cocaine. If you add in the responses for it makes them feel good you get roughly that 85% - 95% of responses for those substances. The only substance that was associated with performance was amphetamines at 50.8% (Green et al., 2001).

What makes the use of alcohol, tobacco, and marijuana interesting is that these substances are often precursors to harder illicit drug use especially when their use begins at a young age (Degenhardt et al., 2012). According to Degenhardt et al. (2012), the most influential factors associated with increased use are drug availability, alcohol and tobacco use at an early in life, and social norms for use. They also state in their study that the usual initiation into drug use is alcohol and tobacco, then marijuana, and then other illicit substances (Degenhardt et al., 2012). Ford (2008) states that the strongest predictor of nonmedical prescription drug abuse are marijuana use, poor physical health, and mental health problems. This information is important because while the illicit drug use among athletes may not be obviously higher that the general population the use of alcohol, tobacco, and marijuana are quite high, and these are considered predictors. As established earlier, athletes may have an inherent deterrent in the form of random drug testing (Manchikanti et al.,2006). This deterrent is either not a deterrent at all, or it is lowering the use of these substances among athletes bringing them down to normal levels. This indicates that more research needs to be done using athletes after they finish competing in their sports. It is possible that athletes may put off using said substances until after they are done sports

One issue with these comparisons is that the general population is being compared to the college athletic population, but athletes are not just those that participate in NCAA sports (Green et al., 2001). The reason these populations are picked is due to convenience. It is easy for reasearchers to gather information this way. Sports departments are centralized and can administer the questionnaires quickly and cover a wide base of different sports. While One can see the benefits to this style of data collection it leaves out many athletes from the data. Many athletes are unable to compete in college for various reasons. Those that used to compete, but no longer do would likely still consider themselves athletes. These individuals should not be left out of the data simply because they do not compete at high levels on college teams or don't participate in specific sports. Many continue to participate in athletics throughout their lives for the love of sport alone. Unfortunately, there are not many studies associating self-identified athletes and drug use, but Molero, Bakshi, and Gripenberg, (2017), conducted a study in Sweden regarding gym goers and drug use. Molero et al. (2017), reported slightly higher rates of illicit drug use among gym goers as compared to the general population. Cannabis was the highest reported illicit drug used followed by amphetamines (Molero et al., 2017). Gym goers are generally associated with the same kind of expected health behavior as athletes but show similar issues with illicit drug use. This study touches on the idea that athletes are not simply defined by athletic competition and certainly not only college students. This continued research into self-identified athletes is important to the knowledge of the subject because it may reveal information regarding the change of use when transitioning from competitive sports to out of sports.

An interesting area of study which was conducted by Sutker, Archer, and Allain (1978), in the Journal of Consulting and Clinical Psychology looked at the personality traits of known drug addicts to determine if there was an association between personality and drug abuse. Sutker (1978) states that high sensation seeking individuals were associated with more drug categories and earlier use, and curiosity of alcohol. High sensation seekers seem to be motivated to seek more external stimulation (Sutker, 1978). Backmand, Kaprio, Kujala, and Sarna (2001) conducted a study in regard to personality types of athletes. They noted that there were specific psychological traits associated with certain sports and that athletes were noticeably different from the general population (Backmand, 2001). The most notable predictors of associated sport were introversion/extroversion and neuroticism (Backmand, 2001). This information is useful in establishing that the personality traits of athletes are in fact different from that of the general population. While the association is not obvious it does confirm that the minds of athletes may lead to a different association with illicit drug use.

References

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9. Molero, Y., Bakshi, A. S., & Gripenberg, J. (2017). Illicit drug use among Gym-Goers: a cross-sectional study of Gym-Goers in Sweden. Sports medicine-open, 3(1), 31.
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12. Sutker, P. B., Archer, R. P., & Allain, A. N. (1978). Drug abuse patterns, personality characteristics, and relationships with sex, race, and sensation seeking. Journal of Consulting and Clinical Psychology, 46(6), 1374.

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