by Joanne L. Charnetski, Wexford University
There are many definitions of an elite athlete. Some common elements are that an elite athlete performs best in class, has the potential to turn professional and is prone to injury. Using the definition according to McGraw-Hill Concise Dictionary of Modern Medicine, an elite athlete (EA) is defined as an athlete with the potential for competing in the Olympics or as a professional athlete; elite athletes (EAs) are at an increased risk of injury, given the amount of training, for psychological abuse by coaches and parents, and self-abuse. It is estimated that about 80% of EAs suffer from minor depression (Schall et al. 2011). The purpose of this paper is to show how sport psychologists can help EAs battling addiction. Sport psychologists recognize the addictive nature of exercise, and how anxiety as well as burn out can lead to injuries, decreased immune functioning and psychological symptoms of depression (Greenspan et al., 1991). This leads to increased substance abuse as an attempt to gain control and enhance performance. The paper will define addiction and question whether it is a disease or set of extreme behaviors. It will highlight the primary areas of addictive tendencies amongst elite athletes and discuss root cause for the addiction. By using examples of real athletes, the paper will conclude by outlining various ways that a sport psychologist can help identify the addiction as well as design a program to help treat the addictive tendency.
Helping Athletes Battle Addiction: What is the Role of the Sport Psychologist?
What is addiction?
Addiction is a disorder derived from the ingestion of a substance or engagement of an activity that can initially be rewarding and lead to compulsive use that interferes with regular daily affairs including relationships, work and general well-being. Individuals may be unaware of their loss of control and unruly behavior hence, unable to realize its negative impact on their environment. Their locus of control is local (Heyman, 2009). Regardless of consequence, an addict will do whatever is necessary to get access to substance or activity (Lubman et el., 2004).
When first acknowledged, it was believed that addiction was a disease and hence, addicts were chronically sick (Dodes, 2011). In the 1930s, a neurobiological perspective was introduced and showed that addiction was a “chronic brain disease”. By accepting this model, addicts became less critical of themselves. This model also allowed people to be more forgiving and less judgmental of addicts. The model generated a great deal of emotional support and collective power.
Currently, many addiction specialists believe that the acceptance of this disease model, led to the disregard of some key facts (Dodes, 2011). If addiction is accepted as disease then, it may interfere with understanding the true nature of the addiction. Addiction is a set of behaviors. There is no infectious agent (as in tuberculosis), no pathological biological process (as in diabetes), and no biologically degenerative condition (as in Alzheimer’s disease).
Research indicates that 50% of addiction tendencies are attributed to genetic makeup. Addiction specialists believe that addiction is attributed by a combination of genetics, life experience and environment (Dodes, 2011). If one considers the almost obsessive or extreme behaviors of EAs, they may appear to have addictive personalities (Petroczi, 2007). They may be addicted to training, winning or an endorphin high. Hence, when performance or ability is in question, EAs become unbalanced, and may become addicted to a self-destructive or illegal behavior.
This understanding believes that addictive acts occur when precipitated by emotionally significant events, they can be prevented by understanding what makes these events so emotionally important, and they can be replaced by other emotionally meaningful actions or even other psychological symptoms that are not addictions (Dodes, 2011). Addictive behavior is a readily understandable symptom, not a disease. It is believed that this new explanation would empower addicts to believe that the addiction is a treatable obstruction.
In order for recovery to be possible, it is important to know how addiction works psychologically. Addiction is an extreme compulsive behavior (Lubman, et al., 2011). Recognizing addiction to be just a common psychological symptom opens the door to deal with the problem and re-stabilize the addict’s livelihood. It should be noted that there are physical as well as psychological aspects to addiction. Some substances may have stronger physical draw and therefore, recovery may require a chemical detoxification process; however, all addictions have a cognitive behavioral aspect that requires rehabilitation and professional support (Jaffe, 2010).
What are elite athletes’ addictive tendencies? Most EAs have something that differentiates them from regular people and thus makes them able to compete at a very high level (Bostick, 2012). EAs have three common characteristics that are three pillars of their beings: extreme self-confidence, low performance anxiety and high motivation (Orlick, T. & Partington, J., 1987). An EA who is highly motivated to succeed knows that he must be physically be prepared (Mahoney et al., 1987; Orlick, T. & Partington, J., 1988). He is motivated to practice at his best level of performance and master his skills. The EA is prepared and ready to conquer the demands of competition. He is confident and will be able manage his anxiety on the field because he knows that he has done everything to prepare himself (Murphy 1988). As in practice, he goes out and plays at his best level of performance. It is already assumed that EAs have extreme, borderline obsessive personalities hence, what happens when one of these three pillars begins to fragment or to fall? When an EA becomes less confident, anxious or unmotivated, they have a higher probability to incur injury as well as the potential to become addicted to performance enhancing substances and pain killers (Petroczi, 2007).
Some EAs are primarily extrinsically motivated and driven by their ego. It is about winning all the time and being the best. EA can be addicted to winning including the accompanying extraordinary contracts, fame and notoriety (D’Angelo & Tamburini, 2009). Addictions tempt athletes to maneuver outside legal and ethical boundaries. In the case of Lance Armstrong, the desire to win came at an unbelievable cost (Marlow, 2012). During his confession in January 2013, Armstrong stated he was told he was invincible, that he needed controlled outcomes, and all his peers were doping. He stated numerous times that he was doing his job and you needed to dope to win the Tour de France. He rationalized his use of doping (Marlow, 2012). Others believe that his addiction to winning led to his dependence or addiction to doping.
Armstrong is narcissistic in character. After he confessed in January 2012, his pursuit to conceal his behavior hurt many deeply, including his LiveStrong charity, individuals that he falsely sued, and his children who believed his lies. It is clear that there is a high that comes with winning and achieving a God like status. Other EAs join Armstrong such as, Alex Rodriguez (New York Yankee), Mary Jones (Olympic Gold Medalist), Roger Clemens (Boston Red Sox) and many more (Mango, K. 2013). When an athlete is using performance enhancing drugs the ethical lines become blurred and it’s easy for an athlete to think of doping as just one more sacrifice they make for their sport. The worst part is that in many cases coaches, doctors and professionals are enabling these addictions (Green, 2009). In a culture where everyone is striving to do their very best and stretch just a little farther than the next guy, it becomes an odd parallel to the drug culture where shunned behaviors become the norm, a toxic peer pressure that simultaneously insulates and infects (Greenspan, 2010). These performance enhancements may also give unrealistic impressions of what they can achieve. This unreal state causes them to push their natural limitations that may lead to chronic injury and ironically, another potential area of abuse via pain killers.
Sport injuries threaten EAs livelihood. Beyond the physical injury, EAs may feel a loss of one’s identity and challenged self-esteem. Overly ego-involved athletes may suffer ‘athletic neurosis’ which is bereavement for the loss of one’s self. Many athletes are willing to do whatever it takes to keep playing while injured by masking the pain with drugs (Stephens, 2013). The challenge here is that it is many coaches support these tactics, actually supplying players with endless amounts pain killers to numb their pain along with Human Growth Hormone (HGH) to help EAs recuperate faster from injury and physical abuse (Farmer, 2013). It is a common practice that starts as early as high school athletics ends in the professional leagues. Over the last four years, more scientific and professional attention has been paid to the issue and the need to minimize the abuse with EAs. In 2011, the first study of pain killer abuse in the National Football League (NFL) was published (Barr, 2012).
Starting in 2009 and sustaining for 18 months, on its Outside the Lines Program, the Entertaining and Sports Network (ESPN) examined the degree to which current and former NFL players’ use and misuse prescription pain medications. ESPN commissioned researchers at Washington University to complete the study. The study received funding from the National Institute on Drug Abuse (NIDA) and its results were published in the peer-reviewed, scientific journal Drug and Alcohol Dependence. For the first time in the history of the NFL, there was scientific data about the way former NFL players manage pain and the manner in which they use and misuse prescription. As noted by Barr (2012), the key findings of research were as follows: first, 52 percent of the retired players said they used prescription pain medication during their playing days. Of those, 71 percent said they misused the drugs then, and 15 percent of the misusers acknowledged misusing the medication within the past 30 days. Second, those who misused as prescribed while playing. Third, 63 percent of the retired players who used prescription painkillers while playing were three times more likely to misuse the drugs today than those who used the pain pills while playing and obtained the medications from a nonmedical source: a teammate, coach, trainer, family member, dealer or the Internet.
Dan Johnson, a former tight-end with the Miami Dolphins and a pro bowl player participated in the study. He stated he was taking approximately 1000 doses of Vicodan a month. When there was no more in the locker room, he would go to outside resources. He broke so many bones during his playing days that teammates called him “The King of Pain.” Ironically, on more than one occasion, his addiction to painkillers led him to debate suicide (Melnick, 2011). Johnson is not alone for he is joined by other well-known players such as Brett Faurve, Erik Ainge and many more (Cimini, 2011). After many years of therapy, challenges, arrests and life altering moments, a significant number of players have overcome their addictions. However, others have ruined their lives, are jail bound or dead. Given the wealth of these organizations and value of these human assets, a sport psychologist (SP) as well as other trained experts should have been actively involved to monitor the addictive tendencies and help design mental training programs to mitigate the risks of addiction.
How can sports psychologists minimize the onset of addiction? It is a given that EAs have addictive tendencies and it appears that the stakeholders of their organizations also enable their tendencies to become full addictions (Green, 2009). There are player unions and other professional associations that represent the interest of players. Given the addiction to winning, abuse of performance enhancement drugs and pain killers are still a systemic issue within the EAs’ environments (Baron, Martin, & Abol Magd, 2007). If we review the cases of Armstrong, Rodriguez, Marino and Ryan, we can hypothesize how a SP may have helped mitigate the risk of addiction. The author is well aware of the fact that most EAs know their strong mental health is essential to their success (Jones 2002). EAs also know mental health is important and they are still averse to employing their expertise in their training regimen (Carmen, Zerman and Blaine, 1968; Brewer and Petrie, 1996; Linder, D.E. et al., 1989). If the organization or union mandates the incorporation of mental training collectively, then collectively we may be able to identify a sustainable lifestyle for our EAs. In addition, a SP can educate players and coaches on symptoms as well as challenges of addiction. SPs can create programs to increase mental toughness and team cohesiveness (Jones 2007). SPs can work with stakeholders to establish realistic goals as well as plans to achieve them. Finally, SPs can set-up procedures and support networks for EAs who become addicts.
Using real case examples, sport psychologists (SPs) need to educate coaching staff and players on the causes, symptoms and aftermath of addiction. Working collectively, they need to develop a process for dealing with players at risk. This process needs to be adhered to like a contract with the players and organization. SP needs to ensure a relatively seamless process during a potentially emotional situation. Prior to the start of the season, they need to work with an addiction specialist and identify the most suitable assessment tools to verify the potential addictions. Building a relationship with addiction specialist, the SP can ensure that the addiction specialist becomes aware of industry as well as the character of EAs. Research has shown that an appropriate assessment instrument can make the difference between null and significant findings (Samet, Waxman, Hatzenbueler, & Hasin, 2007).
Included in the process, is a mental training program to help the player re-enter and minimize their inhibitions or fears as well as the confidence to stay drug-fear. Given that many addicts can be triggered by their environment (Siegel, 2005), the SP should work with organizational staff to change the player’s environment (location of locker, parking space, etc.).
In both the cases of Armstrong and Rodriguez, their achievement bar was continuously raised. Both the United States Postal Service and the New York Yankees should have recognized that the goals that were respectively set were not achievable. When EAs start doing things that seem impossible that has to be done to help EAs help themselves rather that to profit from their addictive acts (Anderson, Denson, Brewer, & Van Raalte, 1994.). After they are caught doping, they must be placed into a professional program with the assistance of their team sport psychologist who can work with them on various fronts including self-actualization, individual goals and action plans. This should also include discussions of long term goals so they can start to consider their life after retirement from their sport. It is the author belief that given Armstrong’s narcissistic nature he may also need the help of psychotherapy to deal with his personality disorder which is out of scope for the SP (Anderson, Denson, Brewer, & Van Raalte, 1994.). As EAs finish treatment and start to prepare for their return to field, the SP should start build their strengths within mind and body movement to help understand how the body reacts under pressure, stress and anxiety. Finally, working on their ability to use imagery to enhance performance and focus as well as calm their minds and nerves. They should also start to review tapes of games and practices so that they can see how they compete without the juice as well as sustain injury.
Many sport injuries are caused by anxiety, loss of focus, impaired concentration or fear (Hanin, 1980). Hence, SPs need to work with EAs to ensure that they have the mental ability to minimize the opportunity for physical injury. SPs must help athletes stay balanced; feel supported as well as in control (Smith, 1986). Current research has shown that mindfulness meditation enhances overall sports performance by increasing an athlete’s ability to function ‘in the zone’, by sharpening concentration and awareness and by improving accuracy and precision Bernier et al. (2009). SPs can help EAs learn to let negative thoughts or words go. Mindfulness Meditation does not try to alter negative mental experiences and believes that too much cognitive activity inhibits flow (Schwanhausser, 2009). It helps players accept whatever is going on in our minds, and refocus our attention on the task in hand. SPs need to work EAs to establish various meditations to help them realize thoughts and emotions as events where reaction is optional.
EAs need to be physical fit and mentally tough. By following a Neuro Linguistic Program (NPL), establish by Navy SEAL psychologist, SPs can work with EAs to ensure that they mentally prepared for every competition (Swanson, 2011). First, EAs must enter a stressful situation and focus on the immediate goal. Close- focused goal setting is paramount to peak performance (Swanson, 2011). Second, use imagery or visualization to ensure success by imagining what it looks, feels and smells like as well as the aspects of the environment. By repeating this process, the brain of EAs will experience success. Third, by managing self-talk to conquer negative thoughts by calling them out and replacing them with an encouraging refrain. Fourth, control arousal by breathing deeply and physically calming the body by giving brain more oxygen, lowering blood pressure and increasing ability to think clearly (Akil II, 2009).
As the Navy Seals believe, EAs have to repeat an action, any action, over and over, with the knowledge that you are “unlearning” the bad memory. Lieutenant Commander Eric Potterat, Ph.D., a Naval Special Warfare Command psychologist, associates this study and NLP program to sports and described the difference between winners and losers:
Physically, there’s very little difference between athletes who win Olympic gold and the rest of the field. It’s like the SEAL candidates we see here. Terrific hardware. Situps, pushups, running, swimming — off the charts, superhuman. But over at the Olympic center, the sports psychologists found that the difference between a medal and no medal is determined by an athlete’s mental ability. The elite athletes, the Tiger Woods, the Kobe Bryants, the Michael Jordans — this is what separates them from the competition. Knowing how to use information (Akil II, 2009).
Regardless, of EAs’ mental toughness, there will also be injuries in sport for there are many uncontrollable factors (Finch, 1996). For the injured athlete, the experience of sport-related trauma can be terrifying and mystifying. In order to minimize fear that may impede rehabilitation, SPs need to help EAs understand what expect physically and emotionally; decreases in performance associated with injury can be attributed to psychological factors more so than physical factors (Dunn, 1999). The sports medicine community has become aware of the integral role that psychosocial factors play in the injury occurrence and recovery processes (Brewer, Jeffers, Petitpas, & Van Raalte, 1994; Flint, 1998). SPs need to introduce athletes to the five stages of injury and empower them to see the future (Reynolds, 2005). Included in this process, if not already in place, injured EAs need inspiring retirement plan so that they can minimize their anxiety and uneasiness regarding their future (Russell, 1993). According to Forbes Magazine, Sports Illustrated magazine estimates that 78% of former National Football League players are bankrupt or under financial stress within two years of retirement. An estimated 60% percent of former National Basketball Association players are broke within five years of retirement (Laura, 2012). National Football League Players’ Association made a statement in 2012 expressing their deep concerns about retired athletes. Several players have suggested some kind of mandatory counseling as players approach the end of their career (Laura, 2012).
SPs must stay part of professional team, nurture mutually respectful relationships and offer continuous care for the overall well-being of EAs. When substance abuse becomes an issue, the respective protocol and processes must be in place and followed by all stakeholders.
With respect to the history and research, it is the author’s belief that professional organizations, universities/colleges, and unions must institute a zero tolerance campaign allowing every player one opportunity to clean up without retribution. They should consider working under the guidelines as the United States Anti-Doping Agency (USADA) to ensure consistency with EAs. They should also continue to nurture partnerships with groups such as Pain Alternative Solutions and Treatments (P.A.S.T.) for Retired Athletes:
My experience with P.A.S.T. just blows my mind! The doctors and the staff truly care they even call me all the time to see how I am feeling. They are a great support system for me and so many other guys. They are not just fixing my neck; they are also dealing with my depression, dependency, post-concussion problems, weight loss and all my other health issues at the same time. They have lifted me up out of a very dark place and I know because of P.A.S.T. I will once again be able to function and be a great husband and father. Their new E-Pro clinic has taken my health to a whole new level. With P.A.S.T. in my life I don’t feel like killing myself anymore. THERE IS NOW LIGHT AT THE END OF THE TUNNEL!” (Lucas, R., 2012)
Ray Lucas was addicted to pain medications while in the NFL. At his worst, he was taking 800 opioids per month. Many others have other types of substance abuse issues and the one thing they have in common is that they were enabled by coaches, physical trainers, and doctors. His addiction carried into his retirement and almost ruined every aspect of his life. Addiction is prevalent within sport. Substance abuse is a growing problem and is not age, gender or sport dependent.
It is the author’s perspective that SPs have a significant role to play in preventing and identifying addiction cases as well as managing the recovery process. As the USADA continues to improving testing and sharing research on new substance abuse issues, professional athletic organizations and unions can follow their precedent in testing protocol and procedure. Coaching staff and EAs can be more informed of the symptoms and degradation of addiction. EAs can be more at ease on the playing field, more strategically minded and mentally tough. SPs can work stakeholders to realistic collective and individual goals as well as plans to achieve them. SPs can work EAs to sustain life balance and natural feelings of control so that substance abuse is not an attractive course of action.
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