How Common is Drug Abuse Among Athletes and Do They Seek Treatment?

Athletes are no less immune to drug abuse and addiction than anyone else, and their risks may be heightened by the intense pressure to perform. Athletes may be driven to use drugs to enhance their athletic performance, cope with the stress of high-pressure situations such as playoffs or finals, manage sports-related pain, recover more quickly from (or simply cover up) injuries, or even to self-treat mental health issues. Some may also turn to drugs for emotional relief after having to retire, which may happen sooner than expected due to injury.¹

Some of the world’s most famous athletes have spoken openly about their own battle with addiction and mental health problems, including Michael Phelps, Lamar Odom, and Andre Agassi.

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Surprisingly Common: Addiction and Athletes

For many people, participating in sports can be incredibly positive—benefitting the mind and body in numerous ways. People who are athletically gifted can use their physical talents to gain success, recognition, riches, and fame. However, the intense pressure to push harder, go faster, and keep playing through pain can push some athletes over the edge. Combine those pressures with everyday responsibilities such as caring for children and, in some cases, dealing with physical or mental health issues, and it’s clear that athletes are under a unique combination of stressors. This, in turn, can lead an athlete down a path of drug use and addiction.

Although it seems contradictory, playing sports can lead an athlete to engage in harmful behaviors that can negatively impact their athletic performance and overall health. In addition, playing sports may give athletes increased access to certain substances—especially opioid painkillers.²

Young sports players are not immune. Research has found that adolescent athletes may be more susceptible to binge drinking, using tobacco, drinking alcohol, and abusing performance enhancing drugs (PEDs).³ A 2017 study found that high school students who engaged in high-contact sports such as ice hockey, football, lacrosse, and wrestling were 1.8x more likely to binge drink and smoke marijuana compared to their non-athlete peers.² According to the NCAA, student-athletes have higher rates of binge drinking—defined as 4 or more drinks for women and 5 or more for men—than non-athlete students, and 1 in 5 male student-athletes report that when they are out drinking they have 10 or more drinks.⁴ Among student-athletes, the most commonly reported substances used are alcohol and marijuana; however, there is growing concern about the abuse of prescription stimulants and opioid painkillers in this population.⁴

Researchers are finding that some individuals may be at greater risk of developing an addiction to drugs compared to their teammates. One study found that it’s not the specific sport played that influences the pathway to addiction but rather the social acceptance and normalization of drug use, as well as role models who turn a blind eye to substance abuse, that have a greater influence on a person’s likelihood to use.⁵ However, individual athletes will have different reasons for beginning to use, some of which will be explored below.

Doing “Whatever It Takes”

A player’s identity and self-esteem can be shaped through sports. When athletics play such a powerful role in a person’s life, they may be willing to risk long-term health problems for short-term gains in strength, power, or endurance. The culture of playing through pain only encourages the mindset of putting competition above all else.⁶ Athletes who play high-contact sports are more likely to be exposed to norms surrounding risk-taking, hiding pain and injuries, and putting winning above all else.²

In 1999, given the high rates of drug abuse in sports, the World Anti?Doping Agency (WADA) began to control substance abuse among athletes and to “promote, coordinate, and monitor the fight against doping in sport in all its forms.”⁷ WADA publishes a monitoring list every year which details all of the substances that are banned in play. These substances are banned on the grounds that they meet any of the following criteria: they enhance performance, pose a health risk to the player, and/or violate the spirit of the game.⁸

According to a survey conducted by WADA, 38% of athletes used an over-the-counter substance that was listed on the WADA monitoring list during the prior 12 months.⁹ Using performance-enhancing drugs to get a competitive edge over the opponent occurs at virtually every level of competition.¹

PEDs include:⁸

• Anabolic steroids.
• Hormone and metabolic modulators.
• Growth hormones.
• Beta-2 agonists.
• Glucocorticoids.
• Beta-blockers.

Anabolic Steroids

The most talked-about PEDs are anabolic steroids, which can significantly increase muscle mass and strength but are tied to a host of scary side effects, including extreme aggression (‘roid rage) and hormonal problems that lead to effects like breast development in men and loss of periods in women.

Steroid users are likely to be:¹⁰

• Male.
• Users of tobacco, alcohol, or illicit drugs.
• Athletes (often, football players, wrestlers, weightlifters, or bodybuilders).

Many people use anabolic steroids without any idea of the dangers associated with these drugs. Below is a list of physical and psychological dangers of abuse. While some of the effects are reversible, many of them are not.¹¹

Adverse physical effects (both males and females):¹¹

• Mood swings
• Mania
• Depression
• Delusions
• Aggression
• Acne
• High cholesterol
• Nosebleeds
• Hair loss/balding
• Fertility problems
• Retention of fluids and swelling
• Elevated blood pressure
• Cardiovascular problems (e.g., enlargement of the heart, heart attack, and blood clotting)
• Liver tumors
• Liver cancer
• Issues stemming from injection use (e.g., skin infections, HIV transmission, and hepatitis).

Effects in males:

• Frequent erections
• Shrinkage of the testicles
• Cancer of the prostate
• Decreased sexual desire

Effects in females:

• Decreased breast size
• Deepening of the voice
• Facial or body hair growth
• Menstrual irregularities
• Clitoral enlargement
• Problems with fetal development during pregnancy

Athletics play such a powerful role in a person’s life, they may be willing to risk long-term health problems for short-term gains in strength, power, or endurance. Young, promising athletes may be especially vulnerable to steroid use. They might be influenced by professional role models and chase dreams of a better body, faster mile time, or higher batting average. They may feel the need to go to extremes to enhance their performance (to earn sports scholarships or make it to professional drafts), making them easy targets for illegal drug dealers who are prowling on the internet. There are hundreds of message boards, YouTube videos, testimonials, and even Facebook groups dedicated to finding steroids on the internet. Online sellers don’t have to look far to find young athletes willing to spend a significant amount of money for easily accessible steroids. Young steroid buyers may not have a full awareness of what steroids do to the body, their side effects, or in what conditions the steroids are manufactured.

In 2015, the DEA seized 16 underground labs, 134,000 steroid dosage units, 636 kilograms of raw steroid powder, 8,200 liters of injectable steroids, and over $2 million dollars during a crackdown on the underground trade of anabolic steroids. The majority of the PEDs were manufactured and trafficked from underground labs in China. The operation, called “Cyber Juice,” led to the arrest of more than 90 people, and DEA agents found huge amounts of raw steroids being mixed in sinks and bathtubs. Given that these substances are produced in often extremely unsanitary conditions and the manufacturers don’t put any effort into properly labeling them, they can cause an unsuspecting buyer harm above and beyond the “normal” harm associated with anabolic steroids.¹²

Patterns of Steroid Use

There are different patterns of steroid abuse, including:¹¹

• Cycling: alternating between periods of high doses of steroids and periods of either low or no doses.
• Stacking: using 2 or more steroids together.
• Stacking the pyramid: a stacking method where the user progressively increases the dose used during the first part of the cycle and gradually reduces the dose in the second half of the cycle.

Among NFL players, the rate of reported steroid use is high. In a study of 2,552 retired NFL players, 9.1% reported using steroids during their NFL careers. Approximately 16% of offensive linemen and 15% of defensive line players reported a history of steroid use. Players who had suffered an injury such as a herniated disc, knee injury, elbow injury, neck injury, spine injury, or foot injury were more likely to report using the drugs.¹³

The level of competition and expectations of professional sports like the NFL may make players feel like they do not have a choice when it comes to getting hurt—either medicate their injuries or risk sitting on the sidelines for an entire season.

Artificial Energy

If there’s one thing that is constantly needed by athletes, it’s energy. Unfortunately, maintaining the kind of energy needed to play sports at a high level can be extremely difficult, and some athletes may turn to drugs—namely stimulants—to do so.

Stimulants may provide the energy boost many athletes are seeking, but they may also cause weight loss, an effect sought after by many people looking to increase their performance. Stimulants include:¹⁴

• Amphetamine.
• Ephedrine.
• Caffeine.
• Cocaine.
• Methylphenidate.
• D-methamphetamine.

Stimulants may lead to a short-term increase in energy and endurance; however, high doses and long-term use can carry serious health risks for conditions such as tremors, hypertension, cardiac arrest, and death.¹⁴

Amphetamines

Adderall—one of the most popular amphetamines—is prescribed for ADHD (and permitted with a valid prescription/doctor’s note) but banned like all other amphetamines if there is no legitimate reason for the player to have it.¹⁵

The use of Adderall among athletes appears to be high. Richard Sherman, the cornerback for the Seattle Seahawks, is quoted saying that, “about half the league takes [Adderall].” Athletes may use amphetamines to:¹⁴

• Stimulate metabolism.
• Improve reaction time.
• Increase acceleration.
• Improve endurance.
• Increase strength.
• Raise lactic acid levels.

The appeal of increased endurance, strength, and metabolism may lead many athletes to ignore the dangerous side effects that using these drugs without medical need and/or in high doses can cause. These side effects include:¹⁴

• Aggression.
• Anxiety.
• Headaches.
• Insomnia.
• Heatstroke.
• Reduced perception of injury, leading to exacerbation of the issue.
• Cardiac arrest.
• Death.

Cocaine

Cocaine decreases fatigue but, unlike amphetamines, it has very limited medical use. The overwhelming majority of cocaine in this country is non-pharmaceutical as well as illicitly manufactured and distributed. It is a very addictive recreational drug. When athletes use cocaine, they may perceive an increase in their performance and strength, but studies show that cocaine has no benefit on a person’s running time and it actually reduces endurance. In fact, an animal study found that when rats were given cocaine it accelerated glycogen degradation and accumulation of lactate during exercise, causing fatigue.¹⁶ What’s more, taking cocaine and participating in physical activity can compound some of the already-serious side effects (such as increased blood pressure, tachycardia), with potentially lethal results (e.g., stroke, heart attack).

Adding alcohol to the mix is particularly dangerous. When players mix alcohol and cocaine, it can also lead to cardiac arrest, seizures, respiratory arrest, and/or sudden death. ¹⁶

Ephedra

Ephedra (ma huang) is an herb native to China. Traditionally, ephedra was used in ancient Chinese medicine to treat lung problems such as asthma or congestion.¹⁷ As ephedra made its way to the United States, companies marketed it as a weight loss and energy supplement.¹⁸ Ephedrine, an alkaloid of ephedra, is a popular ingredient in weight loss products like Hydroxycut. Ephedrine is marketed as a way to enhance energy and is often used alone or in combination with other drugs to stimulate weight loss. Given the widespread availability of ephedrine products, many people have a misconception that they are healthy and safe to use. However, these drugs can be dangerous; according to the Food and Drug Administration, they are often involved in reports of adverse events, including death. Side effects can occur at low doses and may include:¹⁹

• Tremors.
• Headaches.
• Anxiety.
• Insomnia.
• Increased heart rate.
• Increased blood pressure.
• Seizures.
• Hepatitis.
• Psychosis.
• Stroke.
• Injury of the heart muscle.
• Intracranial hemorrhage.

Someone with an underlying heart condition, high blood pressure, or diabetes is more at risk for experiencing the more severe consequences of ephedrine use. Physical exercise and dehydration can heighten the toxic effects of ephedrine, increasing the chances of serious health problems or death.¹⁹

Although the drug is perceived to enhance athletic performance, studies find no consistent data to support this belief.¹⁹

From Injury to Addiction

The misuse of prescription opioids is a huge public health problem, and given that athletes are at greater risk for injury and related pain, they may be even more vulnerable to developing opioid abuse issues. A study of NFL players found that as many as 68% of NFL players are injured in any given year. In a survey of retired NFL players, 52% reported using opioids during their career, and 71% of those reported misusing those opioids; this represents a rate that is 2.9x higher than the general population of individuals at a comparable age. Use of opioids in the NFL is likely exacerbated by the common experience among players of injury and chronic pain—81% of players report their pain to be moderate to severe.²⁰

Young athletes may be particularly vulnerable to opioid misuse. The association between opioid misuse and athletics may begin at a young age. The intensity of sports and increased risk of injury, even in school-age kids, can result in an opioid prescription being written and, in some cases, subsequent misuse of those opioids.

Sports such as wrestling and football have the highest rates of severe injury among high school athletes, and one study found that football or wrestling high school athletes had higher odds of using opioids compared to their peers. They also had higher odds of misusing opioid medications or taking too much in the past year, as well as higher odds of using them merely to get high. However, in the study, the association between organized sports participation and increased opioid use/misuse only appeared to apply to males, not females. This may be due to several factors, including the higher likelihood of becoming severely injured, as well as the reliance on sports among many males as a way to maintain social status and male identity.⁶

Another study, conducted with middle and high school students, found that by the time high school athletes became seniors, male athletes had 2x the odds of being prescribed painkillers during the past year and were 4x more likely to misuse painkillers compared to males who did not participate in competitive sports.⁶

Athletes, too, can fall prey to the temptation to turn to heroin after abusing painkillers. In recent years, there has been a lot of concern about the transition from painkiller abuse to heroin use and addiction. The prescription opioid abuse epidemic has been named a major contributor to the rising numbers of heroin users, especially among populations not typically associated with high rates of heroin use.

Athletes, too, can fall prey to the temptation to turn to heroin after abusing painkillers.

In 2015, Sports Illustrated ran a story about young athletes turning to heroin after first abusing opioid painkillers like OxyContin, Percocet, and Vicodin. Due to the pharmacologic similarity of opioid painkillers to heroin, some individuals who abuse these pills may eventually turn to heroin. A 2003 study found that among Ohio heroin users aged 18-33, 50% reported having previously abused painkillers like OxyContin.²⁴

The reasons for some prescription opioid abusers’ transition to heroin include low cost and increased accessibility. On the street or internet, opioids can cost as much as $30 a pill. Because heroin produces a similar but stronger high, and is often obtainable at a much cheaper price (as low as $5 a bag), people may be tempted to use it instead of painkillers.²⁵ The jump from painkillers to heroin is a dangerous one. Heroin today is commonly adulterated with extremely potent synthetic opioids like fentanyl that greatly increase the likelihood of overdose.

Drug Use and Abuse Among Famous Athletes

Some of the most famous athletes in the world have battled addiction. Once a famous athlete is caught abusing drugs, it’s hard for them to shake off the label of being a drug user or cheater. Below are a number of athletes who have been caught using substances during their athletic career:

Signs of an Emerging Addiction in an Athlete

Oftentimes, signs of abuse will include changes in behavior, such as lying or secrecy. Below are some signs to watch out for if you think one of your teammates is having difficulties with alcohol or drugs:

• They talk about stopping their substance use but don’t follow through.
• They lie about their substance use.
• They are regularly getting drunk or using drugs.
• They are becoming increasingly isolated and/or using drugs alone.
• Most of their social activities involve drinking or using drugs.
• They engage in unsafe sex or high-risk activities while using drugs.
• They have poor academic or work performance.
• They are missing practices and/or games.
• Their performance appears to be suffering.
• They are spending less time with their close friends.
• They’re spending time with teammates or others known to be drug users.
• They are losing interest in the things they once enjoyed.
• They are experiencing memory loss or blackouts due to substance use and have a hard time remembering what happened the night before.
• They seem increasingly irritable or depressed.
• They are spending a significant amount of time recovering from the effects of drugs or alcohol.
• They are driving while intoxicated.
• They have an increased tolerance for alcohol or drugs.
• They are unable to moderate their drug use.
• They withdraw abnormally large sums of money from their account/ATM.
• They use anti-estrogens to hide signs of steroid use.

If you are a coach, trainer, friend, parent, or fellow athlete, and you suspect that someone close to you is struggling with addiction, you may be in a good position to help them seek treatment. Doing nothing or ignoring their problem will not help them, and silence only contributes to a worsening issue.

Family members can be a powerful tool in getting an athlete the help they need, as the majority of student-athletes say they talk to their family about their stress or mental health issues. If you are noticing changes in your child or sibling’s behavior and you are concerned about their wellbeing, you can take action by contacting their coach or athletic director.

The NCAA 2016 Student-Athlete Social Environment Study that surveyed student-athletes across all divisions and sports found that 66% of men and 83% of women said they often or sometimes turn to family members for help dealing with stress or other mental health issues.³⁸

There are numerous programs and resources available to help athletes recover from substance abuse, including:

• 360Proof: This tool was created for student-athletes and coaches using evidence-based strategies. In order to begin, you will need to sign up and enter the portal using this link.
• APPLE Training Institute: These conferences were developed by the NCAA and provide resources to student-athletes, coaches, athletic trainers, and administrators. The conferences train student-athletes to work with campus administrators in order to reduce substance abuse on campus.
• Step UP! Bystander Intervention Program: This training program is designed to help student-athletes learn the skills in order to step up and say something if they see a teammate engaging in unhealthy behavior. The training walks students through scenarios such as, “How can drinking games get out of control considering how competitive student-athletes are? What are some things you could do to diminish this?” and “94% of student-athletes report that they have seen someone whose health or safety was in danger from drinking too much. What has your experience been?”

Treatment Options

Treatment can be an extremely positive force in the life of an athlete suffering from drug abuse and addiction. Particularly among young athletes, combining cognitive behavioral therapy with education can be very successful. Social influence plays a major role in a young athlete’s life, so preparing them for peer pressure they are likely to encounter and how to maneuver past those triggers or urges to use will help them resist the pressure to use.¹⁰ Other treatment approaches include focusing on nutrition and strength training, as well as harm reduction strategies.

If you are using drugs and/or alcohol and you are worried that you might have a problem, it’s important that you take a look at your behaviors and the effects of your substance use—especially if you are reaching a level of use that is causing harm to yourself or others. If you’re ready to seek treatment, there are options including:

• Detox: Depending on the length and severity of your dependence and/or addiction, your body will likely need to detox from the toxic substance(s). During detox, you will slowly taper off of substances to ensure that your body and health remain stable. You can detox in an inpatient or outpatient setting, depending on what fits your treatment needs.
• Therapy: After completing detox, you may enter an inpatient or outpatient setting for treatment. A large component of rehab is therapy—either in a one-on-one setting with a counselor or in a group setting. Therapy will help you understand the underlying reasons for your drug use and may help you work through issues related to body image, nutrition, stress, anxiety, and various other factors. Many programs use cognitive behavioral therapy, which helps you recognize various triggers and cues that lead to your drug use.
• Medications: Your doctor may prescribe certain drugs to help you manage withdrawal and cravings. He or she may also prescribe medications to help with depression, headaches, and muscle/joint pains.³⁹
• Aftercare: Aftercare is an extremely important phase in maintaining your drug-free lifestyle. Individual aftercare plans will vary considerably.

Remember, you are not alone, and there are athletes all over the country, in every level of the game, that are struggling with similar issues as the ones you’re facing right now. Whenever you are ready to stop using substances, get healthy, and start living a drug-free lifestyle, you can begin your journey to recovery. Many athletes look back and wish that they hadn’t put their bodies through so much—for sport, or fame, or to uphold expectations. You can break the cycle of addiction at any time, even if it feels like it’s impossible right now.

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