So, I decided to watch Monday night football yesterday. After trying Channel 7, I remembered Monday night football was on ESPN. I spent about three hours watching the Miami Dolphins and the New York Jets butt helmets. It was not a pretty game except for a cornerback, Revis, a few throws by Sanchez and a couple of catches by the visiting teams ends. When the final whistle blew, the Jets had won 24-6.  I made a mental note not to watch a coach’s post game interview,   if  it followed a game played by a couple of teams who had no ability to play well – especially of neither team was my team. It might be dangerous to my mental health.

For some reason, certainly not logical, I stayed in my chair and watched Rex Ryan come before the media to give his reaction to the game. What he decribed was mind bending. He noted that his team played well – yes they had started slow – but took off and was very pleased with their performance. Let me repeat, the Jets, who Mr. Ryan had crowned as Super Bowl winners, had just beaten a very poor team who had lost their starting quarterback. Now, either Rex needs a better optical perscription, he is using some kind of substance that creates hallucinations, he is struggling with a mental disorder or he is a liar. By the way, more than one causation can be true at the same time.   It’s only fair to give Rex Ryan a break – his team had lost the last three games. Maybe just winning one game made him drunk and delirious.

As he was talking, I wondered if I had to much to drink when I was watching the game. I checked my mug – herbal tea. I drank a pot of peppermint herbal tea. Wow, that stuff is sure powerful. We know that politicians are the great spin doctors. Rex should run for President. If he lost, he would still move his stuff into the White House. By the way, I know this article is focusing on one coach. But, I’ve seen so many make me feel nuts.

How is distorting the view of a football game by a team’s coach helpful to his players and to the audience that is watching and listening? Maybe it helps the coaches with their concussion symtoms. The previous day, I had watched a tape of two coaches getting into a fight with each other after the game was over. Maybe the coaches need to be side lined and examined. I know players are checked for drugs. What about the coaches? I suggest random testing of coaches for drugs, alcohol, psychological testing. If they don’t pass, please stop them from giving post game interviews.

The use of drugs and alcohol by professional athletes has become an all too common occurrence. A lthough attempts are made to help the individual receive treatment, often they fall short of their mark and the athlete is allowed to continue down the path of addiction. Intervention needs to be taken seriously by family members, friends and the professional organization in order for it to be effective. However, the “win at all costs” mentality often results in people turning the other way when faced with obvious signs of substance (click here for an article on identification). This is often referred to as enabling and can be quite damaging to the individual since the earlier treatment is received, the grater the chance of maintaining a substance free life-style. While the motivations for drug use vary from athlete to athlete, the pattern of enabling needs to be stopped before treatment can begin.

Case Illustrations

Daryl Strawberry played right field for the New York Mets. He was part of the World Championship team in 1986. His talents were impossible to ignore. The only questions seemed to be how many records he would break over the course of his playing career. He and his teammate, Dwight Gooden (pitcher), were going to be the foundation of a dynasty. Not long after the Championship season both players got seriously involved with substance abuse. Daryl, Dwight, and the Mets began to spiral into the darkness of addiction. To date, Daryl’s life has almost completely fallen apart. He is presently behind bars for violating parole. He has been in and out of various rehabilitation programs. Finally, he decided that the only way he could stop using was to be in jail. His story is filled with anecdotal information that shows how difficult it is to break clear of the vicious cycle of abuse. Especially obvious, in his case, is the role of family in supporting addictive behavior. Not one of his family stepped in and confronted Daryl because he was taking care of everyone. Addiction is often spoken of as a family disease … not only the biological family but also the family of a sports team that enable an athlete to continue using.

John Daly is a professional golfer. He could hit a tee shot further than anyone. He broke upon the PGA tour with great fanfare. Early victories made him an instant celebrity. It looked for a moment as if no one and nothing could possibly beat him. John had won a major tournament which qualified him to play in the three other majors for that year. He seemed invincible. But, everyone was wrong. Alcohol was beating him. Before you could even join his fan club, he had entered a rehab. During his treatment stay, he missed out on one major and was banned from another. In addition to alcohol, he was a totally devoted cigarette smoker. You would almost never see him hitting a golf ball without one in his mouth. He was very over weight and clearly had a problem with over eating also. As long as John could hit a golf ball so far, everyone over-looked his various addictions. He was like a cult figure. Crowds would cheer. But, he was killing himself. He is back on tour today and it is unclear whether he has broken with the substance abuse history. It is a problem that just doesn’t completely go away. It is a life time commitment to change one’s life. Regardless of whether your statue in life, substance abuse problems is like gravity … no one is so powerful that they can just will away the effects, specially when management and fans are enabling them.

A couple of weeks ago, Bob Hayes died as a result of prolonged alcohol and drug abuse. Readers may not remember him but back in the 1960′s, he was designated as “the world’s fastest human.” This honor was given to the man who could win the 60 and 100 yard dash in the Olympics. Bob did just that. He was then drafted by the Dallas Cowboys as a wide receiver. No one thought he could make the transition from tack and field to football. But, he did and did it big time. Football teams were forced to create different defenses in order to stop him. Once he caught the ball, there was no stopping him from getting to the end zone. There was only one thing that did stop Bob from his goals in life … substance abuse. His feelings of invincibleness got the better of him. Also, everyone around him thought he was invincible. They needed to believe in someone who could be so powerful and enabled him to continue his use.

These three examples clearly show that enabling behavior form individuals in an athlete’s life can have a significant negative impact on the individual’s problem. Once an athlete has been identified as having a substance-abuse problem, treatment steps should be taken immediately. This is necessary to increase the likelihood of success. Although friends, family, and professional organizations believe that they are doing the right thing letting the individual try to help himself, they are just prolonging his or her pain. Established treatments can make a significant change in an individual’s life and can in the long run be more “cost-effective” then simply letting the problem continue.

Treatment

&nbspThe goals of this initial phase are for the athlete to acknowledge the possibility of having this problem. Different types of treatment approaches are discussed and the impacts upon family, athletic career and team should be discussed. If severe enough, it is often necessary for an athlete who has substance abuse problems to be removed from the environment so that the recovery process can begin. If detoxification is necessary, inpatient programs provide the environment to monitor withdrawal symptoms and medical assistance. These programs last between 4 – 6 weeks while the person is participating in group and individual psychotherapy. Alcoholics Anonymous is often introduced during the in-patient stay. Family members are usually involved in the treatment process by attending family treatment and education on the important issues of alcohol and drug abuse. Sometimes, recommendations are made to attend Al-Anon meetings – a 12 step program for the addict’s significant others.

When an athlete is released from in-patient treatment, the aftercare phase of treatment begins. Most people think that since the athlete has been clean for a month that the addiction problem has been resolved. The fact of the matter is that the hardest part is now coming. All too often, the athlete is returned to the same environment that contributed to the cycle of substance abuse. Specifically, the athlete returns to the competition that created pressures and stress that motivated the abuse. The aftercare phase of treatment usually lasts between 3 months and 2 years. Serious consideration should be given to keeping the athlete out of participation in sport competition for a good deal of this time. Everyone is going to be under pressure to get the athlete back performing earlier rather than later. The focus of aftercare is get a person re-adjusted to contact with the family, social network, occupation and the team. Attention should be given to teammates who may not know how to respond to the returning athlete. Facilitation of normal communications and honest disclosure can be taught by the coach.

It is suggested that outpatient treatment be continued indefinitely. This can occur while participation in the athlete participates in sports, family and personal pursuits. This type of treatment is only successful if the person stays clear of all alcohol and drug abuse. It needs to be understood at the deepest level possible that substance abuse involves distorted thinking and an intolerance of emotions. Just because the athlete is not using does not mean the thinking is corrected and emotions are being handled effectively. In fact, it is often quite the contrary. The same painful thinking and emotions are operating, but, now, there is no substance to numb them out. It takes great courage and persistence to deal with this aspect of treatment. If this does not occur, there is a great likelihood of going back to alcohol and drug abuse. Just ask Daryl Strawberry and John Daly! It’s too late to ask Bob Hayes.

&nbspThere are a number of specific factors that should be considered by the therapist and client in the treatment of a substance-abusing athlete. The effect of the clash of self-images between that of the healthy athlete and the sick patient should be explored. The impact of public exposure on the treatment process should be kept in the forefront of everyone’s mind. Also, the effect of organization policy on treatment needs to be assessed. Exercise can either hamper or enhance treatment outcome for an athlete.

Conclusion

&nbspA couple of days ago it was revealed by a sports reporter that one of the Mets minor league players was video taped smoking marijuana. The Mets organization might light of it and tried to smooth over the story. The reporter was concerned that the entire team could be infected with this problem. He was on a track that makes perfect sense. It would have sent a more productive message to the athletes if the organization did respond with concern for the teammates instead of enabling him. Even after Daryl’s demise, it could be asked what has the Mets organization learned? They maybe more concerned about the team’s image than the health of their athletes. It doesn’t make much sense – even from a monetary point of view. They invest tremendous amounts of money developing athletes. It wouldn’t take much more money to protect their investment. This problem doesn’t just go away by wishing, denying, or acting dumb. Knowledge and sensitivity can bring us all to a healthy way of interceding.

Illicit drug use is a huge problem in communities all over the United States. Although sports usually works as a protective factor from the initiation into drug use, even athletes can fall under their dark spell. Coaches, agents. team-mates, friends and family members must be educated in the signs and symptoms of addiction because the longer that use is allowed to continue, the more difficult it is to break the habit.

Communication regarding the use of substances by families, schools, and teams is key in preventing the initiation of drug use. However, since substance use goes hand in hand with hiding and lying, the people around the athlete need to be sensitive to various aspects of an athlete’s life. Surprisingly, studies have shown that coaches and parents often lack knowledge about their players’ attitudes and feelings regarding substance use.

Although parents and coaches alike exert a powerful influence in athlete’s lives, they are sometimes hesitant to touch upon certain subjects – like drugs. As a first line of defense, it is important that they be aware of the warning signs that suggest illicit drug use by athletes. Essentially, the warning signs of drug use can be broken down into four categories: physical, behavioral, emotional, and cognitive. You should intervene when you notice significant changes in some or all of these areas. It is important to examine each one of these more closely, so let’s focus on the signs of abuse!

Physical Signs

The phrase “a picture is worth a thousand words” is specially true when it comes to discerning substance use. Believe what you see – not what you hear. Looking at athletes with a critical eye can tell you a lot about who is involved in illicit drug use. Below are some thigns that you should make note of when you see your athletes.

Four out of the five senses offer tell tale signs of substance abuse. Drugs can create a significant reactivity to touch, smell, sound, and light. Go ahead, touch them and listen for complaints. Don’t be shy about it. Are they complaining about things that you simply do not smell? Are they listening to music at a volume that is too loud? Too soft? Remember that the eyes are the gateway into the mind, so look into their eyes. Do you see bloodshot eyes? Are the white parts clear? Are there dark circles underneath? Are the pupils normal in size? If they appear dilated, ask.

Another indicator of drug or alcohol addictions is frequent complaints of being too hot or too cold when others feel comfortable. Athletes under the influence cannot maintain normal body temperature. “I’m freezing my butt off.” “It’s so hot in here, I can’t stop sweating!” Certain types of drugs effect metabolism such that under minor exertion, individuals sweat profusely. Watch athletes in the locker room for signs that an athlete may be perspiring heavily.

Finally, chronic fatigue is another side effect of certain illicit drug use. Unusually large amounts of sleep, yawning, nodding out in class, lateness to school, etc. are behaviors not to be ignored. Although there may be other reasons for this, such as illness, persistent chronic fatigue with no other rational explanation can be a warning sign of illicit drug use.

Behavioral Signs

What you are looking for here are actions, both verbal and non-verbal. At times these are readily obvious, others they are more subtle. Many of them are intertwined so it is important to take a step back and get a general picture. Look at the forest not the trees.

First and foremost, drug users engage in irresponsible actions that let others down. Promises that are made are not kept. Chores go undone. Notes from school don’t get passed onto the parents. Showing up late or not at all for practice. Borrowing money and delaying paying it back or not paying it back at all. This last one is particularly important because drug and alcohol use is expensive. Basic bills may go unpaid resulting in shut off of utility services, memberships are cancelled, refrigerators are empty. Highly motivated students demonstrate significant disinterest in their classes when substance abuse is activated and as a result grades may drop substantially

Secretive behaviors that don’t make sense on the surface are another warning sign. Doors may be closed or locked when they are usually open. Phone calls occur out of parents’ ear shot or sight. Names are left out of social activities. Even though teenagers can be normally secretive, very general descriptions of day and evening activities without details are offered by substance abusers. “Do I have to tell you everything?” is a response offered by many substance using individuals.

Lack of social contact with others is also common for a variety of reasons. The athlete finds himself isolated from team-mates, friends, and family members. Long-term friendships are dropped. The athlete may get into more conflicts with significant people in his life. These incidents lead quickly to verbal aggression and violence. Perhaps they are unable to participate in certain activities due to the costs that are involved. Friends may assume that things are fine and that the athlete is simply busy with other responsibilities. “Out of sight, out of mind,” is a very dangerous tendency that we all have. New friends may appear. Due to social pressures, the new group effects changes of clothing, hair, and language. Because drug and alcohol use reduces anxiety, inhibitions are removed and the result is a greater frequency of high-risk taking behaviors.

Emotional Signs

Some athletes have a low tolerance for certain emotions. Drugs and alcohol may be used as a way of coping with the pressure that they feel on the field and off. Substances are used as a buffer. This is referred to as self-medication since drugs are used for their numbing effect. Another problem is that the substances themselves may result in certain emotions. The athlete exhibits large mood swings such that small events trigger large emotional reactions. In short, they are irritable, edgy and impatient. Episodes of depression are frequent and unexplainable. Although normally affectionate, supportive and empathetic people, they become insensitive to the needs of others. This can be observed in coldness shown towards teammates, coaches, siblings, and the media. They appear to be indifferent to the need for cooperation in-group activities. When trying to communicate with an athlete under the influence, you may feel like there is no one “home.” He or she is unmoved by serious performance problems and there is less tolerance for a coach trying to provide instruction.

Cognitive Signs

The thoughts that an individual is having provides valuable information about their mental state. It is so important to push an athlete who you suspect is taking substances to discuss what they are thinking. By doing this you will gain valuable insight into how their mind is working. If you can’t follow the conversation, do not think it is your problem. It may be that the athlete is not able to string logical thoughts together. This could be a sign of disordered thinking that goes along with substance abuse. Simple instructions or communications don’t seem to be understood by an athlete under the influence. They may also be forgetful. It could be that the memory part of the brain is not functioning properly or because of the short attention span created by substances. Finally, denial of a problem may continue even after you present information to the contrary. They may exhibit paranoia, “You’re out to get me!” Typically, this is communicated with hostility.

Summary

Rarely do athletes who are struggling with substance abuse admit, without coaxing, that they are in trouble. It takes great alertness, knowledge, caring and courage by significant others to bring the issue into the light. The longer that the problem is allowed to go on, the more difficult it becomes to stop using. Substance abuse problems create an ever- widening circle of negative impact on groups and individuals. Information can help break through our desire to deny there is problem going on in the people we care about and are dependent on. Physical, behavioral, emotional, and cognitive signs can tip us off about individuals who are using substances. Once a change is noticed, action must be taken immediately. We can either become part of the problem or the solution.

This article will review drugs sometimes used by athletes. Most sports officials’ voice a consistent negative attitude towards the use of performance enhancing and recreational drugs and have developed policies to ban their use. When violations have been discovered, however, punishment is randomly handed out. Some of the reasons behind this inconsistency are societal values of “the ends justify the means” and an obsessive drive to have an edge over competition. Subsequent articles will attend to the identification of drug problems, the motivation of drug usage and treatment options.

The International Olympic Committee refers to the use of banned drugs as “doping.” The Committee defines doping as “administrations or use of substances in abnormal amounts with abnormal methods by healthy persons with the exclusive aim of attaining an artificial and unfair increase of performance in competition.”

The same Committee has created five different doping categories that are banned from athletic competition: anabolic androgen steroids, stimulants, narcotic analgesics, beta-adrenergic blockers, and diuretics. Substances that sedate the central nervous system and serve to reduce anxiety (alcohol, barbiturates and sedative hypnotics), local anesthetics, anti-inflammatory drugs that relieve pain are not on the IOC list but are tested for in selected competitions. Specifically, alcohol, nicotine, diet regimens, amino acids and vitamins are not banned because they don’t enhance performance.

Before going on to the specific impact of the drugs mentioned above, it is important to understand the concept of addiction. It is characterized by an inability on the part of the athlete to control his/her chemical use. Therefore, addiction to a drug is characterized by chemical and psychological dependence on the substance to maintain an experience of normality. There can be a withdrawal syndrome during which physiological and psychological functioning are impaired. Chemical tolerance is thought of as a state where the drug needs to be taken in larger amounts to get the same effect.

Banned Substances

Anabolic Steroids. Many athletes use steroids to increase their strength and power. Steroids increase the male hormone androgen and decrease the female hormone estrogen. This has a masculinizing effect (increased masculine bulk and strength, increased facial and body hair, lowered voice, and interference with reproductive functioning). Long term usage of steroids can cause heightened aggression, domestic violence, child abuse, attempted murder, self-injury, suicide, cancer of the liver and lymphatic system, and premature heart disease. Other negative side effects include the possibility of addiction, decreased production of testosterone, which causes shrinking of testes, low sperm count and infertility.

Steroids only improve athletic performance when strength is a primary component of the sport and when the drug is combined with an intensified training program. Steroids work because they aid in the synthesis of proteins that help build skeletal muscle tissue. There is an increased risk in injuries because tendons and ligaments do not strengthen at the same rate as that muscle tissue develops.

Stimulants. The biological consequences of stimulant usage are to increase the rate and capacity of the heart, central nervous and respiratory systems. This category of drugs is divided into three groups:

1. Psychomotor (cocaine, diet suppressants, amphetamines)
2. Sympathomimetic amines which mostly effect the sympathetic and autonomic nervous system. These drugs seem to improve athletic performance by enhancing alertness and by reducing both mental and physical exhaustion. Stimulants are extremely dangerous (cocaine can cause death due to seizures, heart damage and strokes).
3. Hallucinogens (marijuana, LSD, PCP, and cocaine) are often called recreational, mind-altering, or street drugs. These drugs effect or distort the perception of incoming stimuli, inhibit response and decision making time. Usually, the drugs that make up the hallucinogenic group inhibit as opposed to enhance athletic performance.

Narcotic Analgesics.Narcotic Analgesics (codeine, heroin, morphine, and opium) are often referred to as anti-inflammatory drugs. They are most often used by athletes to reduce pain, reduce inflammations of tissue, and create a sense of psychological well being and a sense that no one can beat them. So, athletes can continue playing even though they have sustained muscles and tissue damage. But, there is often an actual reduction in performance because one side effect is sedation. Other negative impacts of narcotic analgesics include physical and psychological dependency/addiction depressed respiration, and gastrointestinal disturbances.

Beta-Adrenergic Blockers. This classification of drugs is mostly used to lower blood pressure and treat heart disease. It should be noted that they do not induce dependency. The IOC bans them because they can positively effect performances in sports that require a steady hand (rifle and pistol shooting, archery, bowling and golf). Their negative effects include infertility, CNS disturbances, and bronchial problems.

Diuretics help the body get rid of water and salts by leaving as urine. When weight is a critical issue in a sport, athletes may try to reach required amounts by using these drugs. For example, wrestlers, jockeys, and boxers have strict weight requirements in their sports that may result in these individuals engaging in the use of diuretics. In addition, athletes who must take a drug test often use the use of diuretics. Diuretics will get the banned substances to pass through their system faster. The problem with this approach is that too rapid loss of fluids and potassium can cause heart arrhythmia, nausea, heat exhaustion, blood clotting, muscle cramps and reduced blood volume.

Depressants. These drugs were designed to relieve tension/ anxiety, steady the nervous system of the fearful athlete. There are many problems in using this method to relax include impaired reaction time, poor hand eye coordination, and loss of balance and erratic judgment. In addition, prolonged usage can result in tolerance of the drug, need to use higher levels, and addiction.

Ergogenic Aid refers to any technique that enhances athletic performance beyond what would be possible through natural ability and training. There are five categories of sports ergogenic aids:

1. Nutritional (vitamins and amino acids)
2. Pharmacological (anabolic acids, anti-inflammatory agents, caffeine)
3. Physiological (blood doping and creatine)
4. Psychological (mental skills for emotional control, anxiety management, optimal arousal)
5. Bio-mechanical (sports equipment)

Each athlete, coach and trainer should consider four questions in the decision to use ergogenic aids. Is the substance legal? Is it ethical? Is it safe? Is it effective? The failure to consider each of these questions carefully could lead to problems when the athlete goes into competition.

Creatine. Mark McGuire, first baseman for the St. Louis Cardinals, admitted using Creatine during the 1998 season when he hit 70 home runs. The function of Creatine is to increase muscular strength and speed. There is a significant increase in usage of this substance by athletes because it is not considered an anabolic steroid, not unsafe in reasonable amounts and legally available. Creatine phosphate is not a very important energy source for prolonged exercise. It is most effective in those activities that require repetitive high-intensity, very short- term tasks with brief recovery periods. Although the research focusing on the use of creatine is inconclusive, overuse of any substance can lead to negative and unwanted side effects.

Blood Doping. The process of blood doping involves the removing of one liter of the athlete’s blood one to two months prior to competition, freezing and storing it. The red blood cells of the stored blood are put back into his system just before competition. This produces more red blood cells and hemoglobin. The impact increases oxygen uptake and improves aerobic functioning. Of concern is that bloods can be mislabeled and contaminated. The results could be catastrophic.

In summary, this review of drugs often used by athletes will provide you with a technical understanding to build an appreciation for the motivations for their use. It will help those parents, athletes, coaches and trainers to make positive decisions, identify and intervene when destructive behaviors are present. In upcoming issues of Psyched look for articles focusing on the identification of substance abuse by athletes and treatment alternatives when substance abuse is discovered.