Addictive disorders

Addictive disorders include substance abuse, characterized by a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of a substance, and the more severe substance dependence, which is a cluster of cognitive, behavioral and physiological symptoms (incl tolerance and withdrawal symptoms) indicating the an individual continues use of a substance despite significant substance-related problems. In many cases, addictive disorders might represent conditions that are perpetuated by sports participation itself (e.g. stimulant and anabolic steroid abuse).

As in the general population, alcohol is the most frequently abused substance among athletes (…). Several studies have been published on the rates of substance use in different sports and levels of competition. Alcohol use among college athletes has been reported to be higher than in the general public (75-93% for men athletes and 71-93% for women athletes), with rates of alcohol use higher in swimming/diving, soccer and baseball/ Softball than basketball, volleyball and track and field.  In a very large retrospective NCAA study of 13 914 student athletes alcohol was the most widely used substance in the past year (used by 85% of athletes), followed by cannabis (28.4%) and smokeless tobacco (22.5%) (…).. Furthermore, the prevalence of alcohol, amphetamine, cannabis, psychedelic substance and cocaine use was highest in division 2 or 3 level athletes. The authors noted that a significantly higher percentage of division 1 programmes than lower division programmes conducted their own drug testing, which served as a deterrent to substance use. Additionally, men tended to use more substances than women, and White student athletes more than non-White student athletes in this study.

Alcohol

Overall, college athletes cited alcohol as the substance with the most apparent negative effects on performance and health, despite it being the substance most used. Consistent with students’ perceptions of alcohol use as detrimental to performance, O’Brien (…) reported that alcohol consumption in the 24 hours before athletic activity caused reduction in aerobic performance by 11.4%. Miller et al. (…) addressed the possible link between psychopathology and alcohol abuse in athletes. They surveyed 262 college athletes about alcohol abuse and psychiatric symptoms. Twenty one percent reported heavy alcohol use, with significant dose-dependent correlations between alcohol abuse and depressive symptoms, as well as general psychiatric symptoms. They could not determine causality.

Stimulants

Stimulant use is of particular importance in sport psychiatry. Athletes sometimes use stimulants for performance enhancement, but there can also be adverse effects of stimulant use on performance including anxiety, insomnia, tremulousness, irritability and weight loss. Athletes may use alcohol and sedatives to counteract the side effects of stimulant

Tobacco

Athletes use chewing tobacco for a variety of reasons. Among professional athletes, the most common reasons given for use are pre-game and post-game relaxation, improved concentration, boredom, increased energy, the need to have something in the mouth and performance improvement(…). College baseball players gave a different set of reasons including recreational or social reasons (48%), pleasure and stress relief; only 1.4% indicated performance enhancement (…).

Anabolic Steroids

Anabolic steroids are another important substance of abuse among athletes. In the US, the first Anabolic Steroid Control Act took effect in 1990 and promoted a shift from the use of illegal anabolic steroids to legal nutritional supplements (e.g. supplements containing testosterone precursors) (…).’ In the past few years, the Bay Area Laboratory Co-Operative steroid scandal in track and field and baseball has highlighted the strategies, such as so-called ‘designer steroids’, which some athletes may employ in order to test negative for steroids while using them. Steroid-abusing athletes report dramatic increases in training and faster recovery times.’^”‘ In addition to their strength effects, anabolic steroids have psychiatric side effects, including hostility, aggression, irritability and mood lability (…).In 1993, Su et al. were the first to conduct a prospective, placebo-controlled, double-blind study that examined the psychiatric effects of anabolic steroids. They found that methyltestosterone was significantly associated with increased positive mood symptoms (euphoria, energy, sexual arousal), negative mood symptoms (irritability, mood swings, violent feelings and hostility) and cognitive impairment (distractibility, forgetfulness and confusion). Pope and Katz (…) compared 88 athletes who used anabolic steroids to 68 non-users. They found that 23% of users reported major mood syndromes (mania, hypomania or major depression), including 12% with psychotic symptoms and 8% with other drug dependence. The large 2001 NCAA study also analysed steroid use(…). Self-report rates by men varied greatly by sport, ranging from 0.2% (swimming) to 5% (water polo). Use by women NCAA athletes was much lower, ranging from 0.0% (in several sports) to 1.6% (lacrosse).