Drug use and abuse, including alcohol abuse, are considerable public health problems. One societal domain where this problem has received particular attention is in the realm of sports. This attention is due, in part, to numerous alcohol- and drug-related incidents involving well-known sports figures, and the problem encompasses both performance-enhancing and recreational drug use. Scholars have conducted numerous studies on the prevalence rates and reasons for drug abuse among athletes at various competitive levels, although many important questions remain unanswered.
Performance-enhancing drugs are substances that give an athlete some type of competitive advantage and are deemed illegal by a sport’s governing body or state or federal law. Examples of commonly used performance-enhancing drugs include steroids, human growth hormone, amphetamines, and painkillers. These drugs are generally used to increase strength and speed, provide extra energy for practice and competitions, allow an athlete to train harder and recover more quickly from training, and enable an athlete to compete when hurt or injured.
The use of drugs for enhancing athletic performance is not a new phenomenon, as historians have uncovered evidence of stimulant use among ancient Greek athletes for competitive advantages. Steroid use to increase strength was documented among Olympic, professional, and intercollegiate athletes in the 1960s and 1970s, and the first Olympic drug-related suspensions occurred during the 1968 Summer Olympics. The first most notable performance-enhancing drug suspension involved Canadian sprinter Ben Johnson being stripped of his 100-meter gold medal at the 1988 Summer Olympics, although throughout the 1990s and into the 21st century a number of Olympic and professional athletes continued to be suspended for performance-enhancing drug abuse. In 2007, Marion Jones—the first woman to win five medals at one Olympics (in Sydney, Australia, in 2000)—admitted to using steroids and was stripped of her medals. No comprehensive studies, however, have been conducted among professional or other elite athletes to gauge the overall prevalence rate of performance-enhancing drug use among this population, although the 2007 Mitchell Report revealed that some professional baseball athletes had used illegal performance-enhancing substances. Recent studies among college and high school athletes have found that 1 to 4 percent of athletes in these groups reported steroid use or amphetamine use for performance-enhancing purposes.
The most obvious reasons for performance-enhancing drug use among athletes are self-evident: to become a better athlete and have enhanced sport-related outcomes. Athletes also report that they use such substances to recover from and prevent injuries, to improve their appearance, and in some cases in response to pressures from coaches. Stimulants may be used for energy purposes or as a weight loss aid, the latter reason being particularly relevant for sports where appearance can be judged (e.g., gymnastics) or where weight requirements exist (e.g., wrestling). Athletes may abuse painkillers in an effort to conform to a cultural norm that suggests being injured is explicitly or implicitly met with disapproval and playing through pain or injury is rewarded.
Abuse of performance-enhancing drugs can have multiple negative impacts on an athlete’s health. Some substances, such as painkillers and amphetamines, can result in physiological and psychological dependence. Steroid use has been linked with a number of physical and psychological problems, including cardiovascular disease, genital shrinkage (among men), development of masculine physical characteristics (among women), and increased mania and rage. It should be noted, however, that most of the research on the long-term effects of steroid use comes from case reports and not well-designed, comprehensive studies.
Aside from the potential negative health impacts, performance-enhancing drug use compromises fundamental assumptions associated with athletic contests. One of the most important assumptions of competitive sport is that all participants are adhering to a standard set of rules and laws. Individuals who intentionally violate these rules in an effort to gain a competitive advantage compromise the integrity and fabric of the activity in which they participate. If those who participate in and are fans of a sport cannot be certain that the competitions are “clean,” the resulting decline in credibility could have a considerable negative impact on the sport’s popularity and acceptability within the larger culture.
Unlike substances such as steroids, there are generally no physiological performance-related advantages to using recreational substances like alcohol, marijuana, or cocaine. Nonetheless, recreational drug use, especially alcohol use, has long been linked with athletics. In Europe a formal relationship between the alcohol industry and athletics goes back several hundred years, and today alcohol companies are among the most important commercial sponsors of organized sports. Additionally, there have been several high-profile athlete deaths involving recreational drug use, including cocaine overdoses and auto accidents when driving while intoxicated.
A number of research studies have found those who participate in athletics consume more alcohol and engage in more high-risk drinking than those who do not. Several national research studies on college students in the United States have found that intercollegiate athletes are considerably more likely than other students to engage in heavy drinking. Not surprisingly, these studies have also found that college athletes are more likely than non-athletes to experience negative health, social, and legal consequences as a result of their drinking. Studies among youth, high school, professional, and recreational athletes are not as comprehensive, but most indicate that those who participate in athletics consume more alcohol than those who do not. Others studies have shown that sports fans drink more heavily than do non-fans. In contrast, research seems to indicate that participating in sports serves as somewhat of a protective factor against other recreational drug use, as studies have shown that youth and college-aged individuals participating in sport are less likely than others to use substances such as marijuana and cocaine.
There are several theoretical explanations as to why athletes tend to drink more than non-athletes. These include athletes being under more pressure than non-athletes (e.g., balancing academics and athletics), athletes having high levels of personality traits associated with alcohol use (e.g., impulsivity), the larger cultural link between alcohol and sport, athletes having more social opportunities than other individuals, and a perceived norm regarding the social behaviors expected of athletes. Few research studies have explored these possibilities, however, so the exact reasons athletes tend to drink more than non-athletes remain unknown.
The reasons that athletes seem to use drugs (other than alcohol) less often than non-athletes do are also largely unknown. Many professional and collegiate sporting organizations engage in random drug testing that could serve as a deterrent, although comprehensive research studies on the effects of drug testing programs in sports are lacking. Some research indicates that one of the common reasons college athletes report not using recreational drugs is concern for their health, so it is possible that the negative health effects of substances like cocaine and marijuana are salient for those participating in athletics. Finally, it is possible that the overall culture of athletics, while somewhat permissive regarding alcohol use, implicitly and explicitly discourages the use of other recreational drugs.
Preventing Substance Use Among Athletes
Over the past 10 years research studies have shown that brief, individualized interventions are effective in the general population at reducing alcohol and other drug use, especially those that utilize the motivational interviewing framework or alcohol and drug skills training. Motivational interviewing is a nondi-rective approach, often incorporating personalized feedback regarding one’s behaviors, which is designed to enhance one’s desire to change his or her behaviors. Alcohol and drug skills training programs are designed to help the individual develop specific strategies for reducing his or her substance use. Research studies have shown that many athletes are exposed to education-based substance abuse prevention programs, but these education-only programs generally have been shown to be ineffective at reducing substance use. However, a handful of recent studies have provided promising support for using motivational interviewing or skills training programs to reduce substance use, specifically among athletes. Adaptations of these types of programs that address considerations unique to athletes, such as the impact of substance use on an athlete’s sport performance, may prove to be particularly effective.
- Damm, John and Patricia Murray. 2002. “Alcohol and Other Drug Use among College Student-Athletes.” Pp. 185-220 in Counseling College Student-Athletes: Issues and Interventions, 2nd ed., edited by E. F. Etzel, A. P. Ferrante, and J. W. Pinkney. Morgantown, WV: Fitness Information Technology.
- Elliot, Diane L., Esther L. Moe, Linn Goldberg, Carol A. DeFrancesco, Melissa B. Durham, and Hollie Hix-Small. 2006. “Definition and Outcome of Curriculum to Prevent Disordered Eating and Body-Shaping Drug Use.” Journal of School Health 76:67-73.
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- National Collegiate Athletic Association. 2001. “NCAA Study of Substance Use Habits of College Student-Athletes.” Retrieved March 29, 2017 (https://www.ncbi.nlm.nih.gov/pubmed/11176146).
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- Stainback, Robert D. 1997. Alcohol and Sport. Champaign, IL: Human Kinetics.
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