Athletes and Substance Misuse

Athletes may use or misuse prescription and illicit drugs for various reasons. Some may want to improve their performance on the court or field, while some may want to reduce stress. While underlying reasons may change, the consequences of drug misuse in sports remain the same. In addition to severe adverse health effects, drug misuse can lead to legal trouble, suspensions from sports, and even a fatal overdose.

Why Do Athletes Use Drugs?

Athletes may use drugs for several reasons, and not all constitute misuse. There are circumstances where an athlete may be prescribed a drug for a specific reason. But, if an athlete uses a drug in a dose or way other than prescribed (e.g., snorting) or if they use another person’s prescription, it would be considered misuse. A few reasons why athletes may misuse prescription or illicit drugs are to:^{2, 3}

• Improve athletic performance. Athletes may turn to drugs such as steroids to gain an edge in the competition. This is known as doping and is widespread across different sports, ages, and levels of competition.
• Cope with mental illness. Athletes often receive treatment for physical injuries. But they are less likely to receive mental health treatment. Some athletes may use drugs and alcohol to self-medicate.
• Deal with pressure. Athletes often face a significant amount of pressure on and off the field. They may face pressure to win, improve their performance, or quickly recover from an injury. To cope with this pressure, some athletes may take drugs.
• Treat physical injuries. Athletes who suffer physical injuries may use drugs such as prescription opioids and marijuana, to deal with pain. For some athletes, addiction starts when they are prescribed painkillers for an injury. Over time, they may begin to misuse their prescriptions, eventually becoming both physically and psychologically dependent on these medications.
• Cope with retirement. Athletes may be faced with retirement much earlier than other careers. Leaving the game can be a difficult transition for athletes who are not prepared to retire and miss the thrill of competition. Drugs and alcohol may be a way of managing this stress.
• Peer pressure. Athlete substance abuse is common, with an estimated 67% of bodybuilders using steroids, 52% of professional football players using opioids, and up to 93% of college athletes using alcohol.

Drugs Misused by Athletes

Athletes may use a variety of drugs, such as performance-enhancing drugs, stimulants, and prescription and non-prescription opioids, to improve their performance, manage pain or injury, and deal with the stress of athletics.

Performance-Enhancing Drug Use in Sports

• Anabolic steroids. The human body naturally produces anabolic steroids in the form of testosterone, which aids muscle-building. Athletes may use high doses of anabolic steroids to increase muscle size, work out harder, and recover more quickly from workouts.⁴
• Androstenedione (Andro). Andro is a prescription drug that can be used illegally by athletes hoping to increase certain male sex characteristics.⁴
• Human growth hormone (HGH). Athletes may use HGH to increase muscle mass and improve performance. The injectable drug is only available as a prescription but is regularly bought and sold illegally, or misused.⁵
• Diuretics. Athletes may use drugs to lose weight or to pass a drug test.² Diuretics work by altering the body’s fluid and electrolyte levels. They are popular among sports that support strict weight control, such as boxing and wrestling.
• Erythropoietin. This drug increases the production of red blood cells (erythrocytes) and hemoglobin, which can increase oxygen delivery to the muscles. Athletes may take erythropoietin to increase endurance and aerobic power.⁶

Painkillers and Prescription Drug Use in Sports

• Prescription opioids, such as oxycodone and hydrocodone, are painkillers intended for use in managing relatively severe pain. In large enough doses, users may experience a high that includes euphoria and relaxation in addition to pain relief.^{1, 7}
• Although some athletes may begin taking opioid painkillers with a prescription, many others use them non-medically—either more than their prescribed instructions or without a prescription at all. Even those taking them according to prescribed instructions can develop tolerance or physiological dependence.
• Tolerance occurs when a person doesn’t feel the same effects they did when first taking the drug, leading them to use more or in higher doses. Dependence is when a person experiences withdrawal symptoms if they stop using a substance or drastically reduce the dose.⁸

Athletes Using Stimulant Drugs

Stimulants can be prescription or illicit and are known for speeding up systems within the body.⁹ Prescription stimulants are often prescribed to treat conditions like attention-deficit hyperactivity disorder (ADHD).¹⁰ People often take stimulants to improve performance, stay alert, feel exhilarated, or stay awake longer.⁹

• Amphetamines and methamphetamine. Athletes may use amphetamines, including the illegal drug methamphetamine, to enhance alertness and performance. Amphetamines can make users feel energized, experience an increase in self-confidence, and decrease appetite. Because of this latter effect, some athletes, such as boxers or wrestlers, may use amphetamines to lose weight.^{5, 9}
• Adderall. Adderall is a prescription stimulant used to treat attention-deficit hyperactivity disorder. Research suggests it may improve alertness, focus, and reaction time.^{2, 10} Like other stimulants, athletes may use Adderall to enhance performance, control fatigue, and lose weight.

Other Drug Use in Sports

• Alcohol. A significant number of athletes drink alcohol.² Perhaps surprisingly, some athletes drink alcohol before a game or competition to reduce anxiety and thereby enhance performance. There is little evidence that this works, however. Consistent alcohol use is more likely to lead to other issues that hinder performance.
• Marijuana. Athletes may use marijuana for euphoria and relaxation. Some athletes may also turn to marijuana to treat pain.³
• Cocaine. Like other stimulants, athletes may use cocaine to improve their endurance and performance, increase focus, decrease fatigue, and lose weight.² Cocaine causes users to experience a brief euphoria, followed by a crash. Users may “binge” on the drug repeatedly to prolong the high.¹

Effects of Misusing Drugs in Sports

Misusing drugs can have dangerous and even life-threatening consequences.¹ The adverse health effects of using drugs in sports vary depending on the substance but may include an increased risk of:^1-6

• Cardiovascular problems (e.g., heart attack, stroke).
• Respiratory problems (e.g., pulmonary hypertension).
• Cognitive problems (e.g., memory loss).
• Digestive problems (e.g., bowel obstruction, constipation).
• Mental health problems (e.g., anxiety, depression).

As mentioned, different substances of misuse have different adverse health effects. For example, human growth hormone (HGH) is associated with multiple health risks, including heart problems while excessive diuretic use can lead to severe health issues, including dehydration and muscle cramps.

In addition to adverse health effects, drug misuse impairs performance, potentially forcing athletes into early retirement due to diminished abilities and withdrawal symptoms. Finally, violating anti-drug rules in professional sports can lead to bans, suspensions, and the loss of previous awards or titles. Notable athletes like Lance Armstrong and Brett Favre have faced these consequences.

Recovery Programs for Athletes

Athletes who struggle with addiction issues may seek the help of several different types of recovery programs:¹¹

• Inpatient treatment programs are those in which a person lives in a facility for the duration of treatment. The length of treatment depends on the level of care.
• Outpatient treatment programs offer therapy for several hours per week, with participants returning to their own homes or other residences during non-treatment hours. The intensity of therapy depends on the specific program.
• Twelve-step programs can help people develop connections with other people in recovery and find support throughout the recovery process. Some 12-step programs are based on the 12 steps of Alcoholics Anonymous, while others offer 12-step facilitation that isn’t part of an anon- group.

Addiction treatment programs typically offer various types of behavioral therapies that can be effective in helping athletes recover from substance use disorders:¹²

• Cognitive behavioral therapy (CBT) helps people identify and change negative behaviors and thoughts that contribute to substance misuse.
• Motivational interviewing helps people in early recovery work through their ambivalence about change. Athletes may come to treatment with conflicting feelings about their drug use.

Co-Occurring Disorders

Athletes with substance use issues may also struggle with co-occurring mental health conditions, such as anxiety, depression, or other mental health issues. Drugs and alcohol may be a way of coping with a pre-existing mental health condition. Co-occurring disorder treatment programs are available to help people struggling with such dual diagnosis issues. These programs offer both addiction- and mental health-targeted therapeutic interventions, including counseling, psychiatric medications, and support groups led by trained professionals.¹³

Finding Addiction Programs for Athletes

If you’re ready to find an addiction rehab for athletes, use our rehab directory to find qualified treatment providers today.