The Mental Health and Substance Abuse Treatment of Student-AthletesA Review of the LiteratureMorgan PfaffSaint Joseph’s UniversityAuthor NoteThis paper was prepared for Foundations of Addictions CRJ 619, Section OL2, taught by Dr. Blank.The Mental Health and Substance Abuse Treatment of Student-AthletesA Review of the LiteratureWhen you think of high performance athletes and drug use, performing enhancing drugs or doping may come to mind. Although doping does occur in numerous sports and at most levels, athletes abuse many different types of substances.
Reardon & Creado (2014) believe that an athletic life may lead to drug abuse for multiple reasons. Athletes may abuse drugs for the purpose of performance enhancement, to self-treat untreated mental illness, and to cope with common stressors experienced by many athletes. Stressors such as the pressure to perform, injuries, pain, and the retirement from their sport are only a few reasons that may attribute to athletes abusing drugs (Reardon & Creado, 2014). According to the National Collegiate Athletic Association (NCAA) (2007), approximately 400,000 student-athletes participate in 23 sports at 1,000 different colleges across the United States.
This specific population has been under researched regarding the use of substances and mental illness. It is important to understand the unique barriers student-athletes face in receiving mental health or substance abuse treatment in order to properly implement the most effective treatment plans. Substance Use among AthletesWhen measuring substance use rates among college athletes, alcohol was the most used substance by 80.5%, followed by marijuana at 28.4%, and smokeless tobacco at 22.5% (Green, Uryasz, Petr, & Bray, 2001). Most would assume that high profile Division I athletic programs would have the highest rate of substance use due to having more athletic scholarships, longer playing seasons, and more sports programs offered then Division II and Division III universities. However, Green et al. (2001), found that Division I athletes had the lowest percentage of substance use and Division III athletes had the highest rate of substance use for five of the eight drugs surveyed. Division III athletes were the most likely to use alcohol, amphetamines, marijuana, and psychedelics, as well as having a higher percentage use of cocaine. One of the reasons that may explain why Division III athletes have a higher percentage of drug use is due to the lack of funding for drug education programs and the lack of drug testing. In 1999, 582 universities participated in an NCAA survey regarding drug testing and education. It was found that 75% of Division I schools conduct some sort of drug testing program compared to 43% of Division II schools and only 8% of Division III schools (NCAA, 1999). The amount of times athletes are drug tested in season also varies by Division. All three Divisions are tested at championship events, and Division I and II football and Division I track and field athletes are tested year round. Division III athletes are only tested by the NCAA at championship events leaving many athletes untested for drug usage. Considering Division III athletes have the highest percentage of drug usage and are drug tested the least is concerning. Drug tests can be a useful tool in identifying substance use problems and addictions The same NCAA survey (1999), revealed that Division I universities have larger budgets for implementing drug and alcohol educational programs for their athletes. It was found that 76% of Division I schools had a program while 50% of Division II schools had programs and 41% of Division III schools had programs. From these results, we can see the need for Division II and III universities to implement more drug and alcohol education programs as well as the need to drug test their athletes more frequently as a preventative screening tool. Two studies done by Leitchiter, Meilman, Presley, & Cashin (1998) and Wechsler, Davenport, Dowdall, Grossman, & Zanakos (1997) found that college athletes consumed larger amounts of alcohol per week and participated in binge drinking more frequently than nonathletes. College athletes were also more likely to experience numerous negative consequences because of their alcohol consumption (Leitchliter et al., 1998). The study also indicated as the level of involvement increased from nonparticipant to participant to team leader, the number of alcoholic drinks consumed and binge drinking episodes also increased. Team leaders (majority males), were found to be poor role models and demonstrated a larger amount of alcohol use and substance abuse-related problems (Leithcer et al. 1998). Men holding leadership positions in athletics were also the most likely to report having negative experiences. These findings rarely occurred between women athletic leaders and team members. Another study done by Ford (2007), also found that college students involved in athletics are at a greater risk of binge drinking then nonathletes are. Ford (2007) offers an explanation of alcohol use being more normative among athletes due to the possibility of using alcohol to relieve tension from balancing hours of athletic and academic work.It is clear that the NCAA and healthcare providers need to better address the issue of drug and alcohol use among athletes. It is speculated that athletes experience a work hard, play hard ethic more than nonathletes and that athletes experience a large amount of pressure during their career. Student athletes are faced with managing their athletic performance, academic work, and other time commitments and may use alcohol as a way to relieve various pressures caused by collegiate athletics. Another point that was brought up by Leithcer et al. (1998), was that American society connects alcohol and sports through numerous TV commercials as well as alcohol being used as a traditional means of celebration.Mental Illness among AthletesStudent athletes have been found to be more susceptible to mental health issues due to the various demands from participating in athletics (Ryan, Gayles, & Bell, 2018). The four most common mental health issues that student athletes face are depression, anxiety, eating disorders, and substance abuse (Thompson & Sherman, 2007). In a study conducted by Yang et al (2007), 21% of student-athletes reported experiencing symptoms of depression and those who were female, freshman, or had self reported pain had significantly higher odds of experiencing depression symptoms. In addition, the athletes that reported having symptoms of depression were associated with having higher scores of anxiety. Over 85% of athletic trainers felt that anxiety was a major issue among student-athletes on their campuses according to an NCAA study (Brown, 2014). A study done by Wolanin, Hong, Marks, Panchoo, & Gross (2016), found an even higher prevalence of student athletes that reported clinically relevant levels of depression symptoms. In a sample of NCAA Division I athletes, they found that 23.7% of athletes reported experiencing depression symptoms. Female athletes were found to have a higher prevalence rate for depressive symptoms than males with 28.1% reporting depressive symptoms vs. 17.5% of male athletes. The NCAA (2016) stated that nearly a quarter of student athletes reported being exhausted from the mental demands of their sport. These reporting’s were even higher for Division I athletes and those who participated in football in all three divisions. These findings indicate that depressive symptoms are common in student athletes. Another study revealed that in a group of 262 athletes, 21% reported high alcohol use and problems associated with its use (Miller, Miller, Verhegge, Linville, & Pumariega, 2002). The reported alcohol abuse was found to be significantly correlated with reported symptoms of depression and other general psychiatric symptoms. Athletes that reported suffering from severe depression and other psychiatric symptom ratings had a higher rate of alcohol abuse than athletes who had low depression and low or mild symptoms (Miller et al., 2002). The finding that athletes who report higher rates of alcohol abuse have more psychiatric symptoms suggests that many student athletes may be suffering from co-occurring disorders. The term co-occurring disorder refers to an individual who is diagnosed with a substance use disorder as well as mental health disorders. It can also be referred to as duel disorders or a duel diagnosis. A study of 424 college students also found that major depressive disorder (MDD) has a strong association with alcohol abuse and that many times students developed MDD prior to using alcohol or drugs (Deykin, Levy, & Wells, 1987). This is another finding that suggests athletes may use alcohol as a coping mechanism or as a way to self-medicate. Eating disorders are another prevalent mental health issue among student-athletes. Eating disorders can include anorexia nervosa, bulimia, and binge eating. According to Chatterton & Petrie, (2013); Greeneaf et al., (2009); & Thompson & Sherman (2007), all student-athletes may have a higher risk of developing eating disorders when compared to nonathletes due to increased pressures of maintaining low body weight for certain sports. However, women athletes were found to be at a higher risk for eating disorders than males due to other reasons. Those reasons include allowing external influences like the media, family, and friends to influence their thoughts and feelings about their body appearance. There are also many societal pressures for females to be thin and successful in their sport which may easily influence their behaviors surrounding eating (Wells, Chin, Tacke, & Bunn, 2015). In fact, a study done by Greenleaf et al. (2009) had 25% of female participants report symptoms of disordered eating. This finding is concerning due to the link between disordered eating and physical injury (Ryan, Gayles, & Bell, 2018). The athletes that are most at risk for eating disorders are those that emphasize the importance of physical appearance and size. Rates of disordered eating were also found to be more prevalent in athletes that participate in sports that have more revealing uniforms such as swimming, wrestling, track and cross country (Brown, 2014). Barriers to Substance Abuse and Mental Health TreatmentThere are multiple different barriers that student-athletes face when seeking mental health treatment. Some of these barriers include a lack of time due to athletic and academic work (Beauchemin, 2014;Watson, 2005), a fear of judgment from coaches and athletic administration (Proctor & Boan-Lenzo, 2010), as well as a personal fear of experiencing discomfort (Watson, 2005). Student-athletes are taught to be strong and successful, making help seeking behavior appear as a weakness among athletes because of stigma. There are two types of stigma that may influence a student-athlete’s willingness to seek out mental health treatment. There is self-stigma, which is defined as having a negative attitude towards oneself for seeking help, and public stigma which is the negative attitudes others may have about someone that is seeking mental health counseling. Self-stigma and public stigma may occur due to the perception of student athletes having mental toughness. Mental toughness is defined by the Journal of Applied Sport Psychology as:Having a natural or developed psychological edge that enables you to: generally cope better with the many demands (competition, training, lifestyle) that sport places on a performer; specifically, be more consistent and better than your opponents in remaining determined, focused, confident, and in control under pressure (Jones, Hanton, & Connaughton, 2002, p.209).ReferencesBeauchemin, J. ( 2014). College studentathlete wellness: An integrative outreach model. College Student Journal, 48(2), 268″ 280.G. Brown (Ed.), ( 2014). Mind, body and sport: Understanding and supporting studentathlete mental wellness. Indianapolis, IN: National Collegiate Athletic Association.NCAA. (1999). NCAA Drug-Education and Drug-Testing Survey. Indianapolis, IN: National Collegiate Athletic Association.Thompson, R. A., & Sherman, R. T. (2007). Managing studentathletes mental health issues. National Collegiate Athletic Association. National Collegiate Athletic Association. ( 2016b). NCAA GOALS study of the studentathlete experience: Initial summary of findings, January 2016.Proctor, S. L., & BoanLenzo, C. ( 2010). Prevalence of depressive symptoms in male intercollegiate studentathletes and nonathletes. Journal of Clinical Sport Psychology, 4( 3), 204″ 220.Ryan, H., Gayles, G. J., & Bell, L. (2018). Student-Athletes and Mental Health Experiences. Special issue: Critical Issues for Student Athletes:Going behind the Invisible Wall, 2018(163), 67-79.Watson, J. C. ( 2005). College studentathletes attitudes toward helpseeking behavior and expectations of counseling services. Journal of College Student Development, 46,442″ 449.Wolanin, A., Hong, E., Marks, D., Panchoo, K., & Gross, M. (2016). Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender. British Journal of Sports Medicine, 50 (3).