Alcohol Abuse in Sport

Hazardous alcohol use is a significant health problem that affects many people. In the United States, almost 10% of the population will meet past-year diagnostic criteria for either alcohol abuse or alcohol  dependence,  with  the  highest  rates  occurring among  college  students  and  other  young  adults. Alcohol use disorders co-occur with mental health problems   like   depression,   anxiety,   and   other substance  use  disorders,  and  can  cause  a  variety  of  physical  ailments.  According  to  Bouchery, Harwood,  Sacks,  Simon,  and  Brewer  (2011),  the economic  cost  of  alcohol  use  disorders  in  the United  States  is  approximately  $223.5  billion each year.

Despite  the  fact  that  alcohol  use  is  known  to be  harmful  toward  athletic  performance,  rates  of alcohol use are relatively high among some groups of  athletes.  This  entry  compares  rates  of  alcohol use  between  athletes  and  non-athletes,  discusses sport-related factors that might impact alcohol use among  athletes,  and  highlights  effective  intervention and prevention strategies.

Rates of Alcohol Use Among Athletes

A  number  of  studies  across  several  countries have  shown  adolescent  athletes  consume  alcohol at  rates  similar  to  or  higher  than  peers.  Findings from  several  recent  studies,  though,  suggest  the relationship between sport participation and alcohol  use  among  adolescents  is  impacted  by  other factors.  One  national  study  of  U.S.  adolescents found  self-reported  rates  of  heavy  drinking  and drinking  and  driving  in  the  past  30  days  were higher  for  male  athletes  versus  male  non-athletes. In  contrast,  female  athletes  reported  lower  rates of  ever  using  alcohol  or  use  within  the  past  30 days versus female non-athletes. Another national, longitudinal  study  found  that  adolescents  within the  United  States  whose  extracurricular  activities included only sports display accelerated rates of  alcohol  use  and  alcohol-related  problems.  In contrast,  involvement  in  sports  and  extracurricular  academic  activities  was  associated  with  a deceleration in alcohol use and related problems. Additionally, a national study of Norwegian high school  students  found  participation  in  collaborative  team  sports  like  soccer  was  associated  with an increase in alcohol intoxication over time, but participation in endurance sports like running was associated with a decrease in alcohol intoxication over time. Thus, the answer to the degree to which sports  participation  among  adolescents  is  a  risk or protective factor for alcohol use is not a simple one, but is instead often contingent upon a variety of factors.

Research  examining  the  relationship  between sport participation and alcohol use among college athletes in the United States has provided clear evidence that athletes tend to consume more alcohol than  non-athletes.  For  example,  in  three  national studies with sample sizes ranging from 12,777 to

51,483, the researchers reported past 2-week binge drinking rates of 57% to 62% and 48% to 50% among  male  and  female  college  athletes,  respectively.  These  percentages  were  approximately  15 points higher than corresponding rates for non-athletes. Similar patterns emerged for other measures of alcohol use, such as frequent binge drinking and average number of drinks per week. As one might expect  given  these  differences  in  heavy  drinking rates,  college  athletes  were  also  more  likely  than other students to experience problems from alcohol  like  impaired  academics,  trouble  with  the authorities,  and  participation  in  behaviors  later regretted.  There  is  also  evidence  to  suggest  that college students who engage in recreational sports like  club  teams  and  intramurals  are  more  at  risk for excessive alcohol use than other students.

Relatively  few  studies  have  examined  rates  of alcohol consumption among professional or other elite  athletes,  particularly  in  terms  of  comparing them with relevant non-athlete groups. Those that have  been  conducted  suggest  rates  of  alcohol  use among adult elite athletes are higher than general population rates. Research is also lacking on rates of alcohol use disorders among athletes. However, it is likely that rates of alcohol abuse and dependence are particularly high among some groups of athletes,  especially  those  where  evidence  suggests they  experience  more  alcohol-related  problems than others (e.g., college athletes).

Sport-Related Factors and Alcohol Use

Researchers  have  identified  numerous  factors that  increase  the  likelihood  of  hazardous  alcohol use  in  the  general  population,  including  demographic  characteristics,  genetic  factors,  personality  variables,  environmental  factors,  and  a  host of other individual, interpersonal, and contextual variables.  The  impact  of  such  factors  is  presumably  consistent  between  athletes  and  non-athletes, but researchers have also identified several sport related factors that may increase the likelihood of heavy drinking among athletes.

There  is  a  clear  cultural  link  between  athletics and alcohol use in many countries. Alcohol beverage  companies  advertise  heavily  during  televised sporting  events  and  provide  key  sponsorship  for many sporting leagues. In some countries, alcohol companies  even  provide  direct  sponsorship  for individual teams and players. Research has shown that  athletes  receiving  alcohol  industry  sponsorship report higher rates of hazardous drinking than those who do not receive such sponsorship. Other research  has  documented  an  association  between exposure  to  alcohol  advertising  and  subsequent alcohol  consumption.  It  is  therefore  possible  that athletes  are  more  likely  than  others  to  be  influenced by the advertising or sponsorship efforts of alcohol beverage companies.

A second set of factors that may be associated with  heavy  alcohol  use  among  athletes  is  a  particular  susceptibility  to  the  positive  and  negative reinforcing  aspects  of  alcohol.  For  example,  the personality  trait  of  sensation  seeking  has  been shown  to  be  positively  associated  with  alcohol consumption, and several studies have shown that athletes are more likely than others to report high levels  of  this  trait.  Similarly,  a  number  of  writers have suggested that some groups of athletes experience  especially  high  levels  of  stress  and  other pressures,  such  as  college  athletes  attempting  to balance  the  demands  of  athletics  and  academics. Such  individuals  are  thought  to  be  particularly prone  to  using  alcohol  as  a  negative  reinforcing coping  strategy  (e.g.,  reducing  stress,  distracting from  life’s  problems),  although  research  studies have not provided convincing support that this is in  fact  the  case.  There  may  be  other  factors  that are associated with both the likelihood of participating in athletics and the likelihood of engaging in at-risk alcohol use.

Increased access to alcohol may also account for heavier drinking rates among athletes in comparison with the general population. Athletes at many competitive levels often have more social opportunities involving alcohol than others. For example, college athletes are usually among the most popular students on campus, and therefore have ample opportunities to attend parties or other gatherings where  they  will  be  provided  alcohol.  Similarly, many athletes socializing in public establishments, particularly  those  who  are  recognizable  in  their communities,  will  experience  the  phenomenon  of others  wishing  to  buy  them  drinks  or  otherwise supply  them  with  alcohol.  Thus,  heavy  drinking among  some  athletes  may  be  partially  explained by relatively easy access to a supply of free or low-cost  alcoholic  beverages,  which  would  be  consistent with basic behavioral economics theories.

A  final  factor  that  may  impact  at-risk  drinking  among  athletes  involves  their  seasonal  calendar cycle. Research suggests athletes tend to limit alcohol  use  during  their  competitive  seasons,  but drinking  rates  increase  in  the  off-season.  Some athletes  may  engage  in  particularly  heavy  drinking during the off-season believing (a) they are not harming their athletic performance since they are not  in-season;  and  (b)  they  have  to  take  advantage of a limited timeframe that does not involve regular  practices,  games,  and  accountability  to coaches.  Such  a  spike  in  heavy  drinking  can  lead to increased likelihood of a host of severe alcohol related consequences.

Interventions for Hazardous Drinking Among Athletes

Unlike both recreational and performance enhancing  drugs,  regular  testing  for  the  presence  of  a substance  is  not  a  logistically  feasible  deterrent for alcohol use among athletes. Thus, it is particularly important to explore alternative strategies for preventing  harmful  alcohol  use  among  athletes. Several  effective  treatments  have  been  identified for individuals experiencing alcohol use disorders, including cognitive behavioral therapy, twelve-step facilitation therapy, and behavioral family therapy. Athletes  experiencing  significant  problems  with alcohol should be referred to settings where intensive treatment could be provided.

It is also important to provide interventions to those  who  may  be  at  risk  for  experiencing  alcohol-related  problems  but  whose  current  alcohol use  habits  do  not  necessarily  warrant  extensive treatments.  Over  the  past  10  to  15  years,  clinical researchers  have  examined  the  efficacy  of  brief interventions in reducing harmful alcohol use. One of  the  most  popular  and  efficacious  approaches involves a single-session model where the clinician uses  a  motivational  interviewing-based  style  and provides personalized feedback about one’s drinking  habits.  Motivational  interviewing  is  designed to  increase  an  individual’s  motivation  to  change behavior  by  exploring  and  resolving  ambivalence regarding  change,  and  this  process  can  be  facilitated  by  receiving  personalized  information  on one’s  drinking  habits.  Commonly  included  pieces of  personalized  feedback  include  social  norms information  (how  one’s  own  alcohol  use  and perceived  typical  alcohol  use  among  others  compares to actual population norms), a summary of alcohol-related risks or problems experienced, and possible  genetic  risk  for  an  alcohol  use  disorder. More  recently,  researchers  have  explored  the  efficacy  of  personalized  feedback-only  interventions where  the  feedback  is  provided  without  one-onone clinician contact. Three studies have examined the effects of these interventions specifically among athletes,  all  of  which  showed  positive  effects  in terms  of  reducing  alcohol  consumption  relative to control conditions. One of the studies included feedback that was targeted specifically for athletes (e.g.,  the  impact  of  alcohol  use  on  one’s  athletic performance), which was shown to be more effective than personalized feedback that did not include the  athlete-targeted  information.  Other  studies have  provided  promising  support  for  interventions focusing exclusively on correcting misperceptions of drinking norms, although they have been limited by the lack of proper control conditions.

An  important  gap  in  the  literature  on  the efficacy  of  alcohol-related  interventions  among athletes  is  that  the  effectiveness  of  interventions delivered  via  sporting  organizations  themselves has not been examined. There are, though, potentially promising avenues that could be explored in this area. For example, research has supported the efficacy  of  brief  advice  interventions  delivered  by physicians  and  parent-based  interventions,  both of  which  could  be  modified  to  be  delivered  by athletic  organization  personnel  like  coaches  and team doctors. It may also be possible to integrate alcohol interventions into the context of a team’s sports  medicine  staff,  which  would  be  advantageous  given  the  degree  to  which  athletic  trainers and other sports medicine staff are often the ones working most closely with athletes on a variety of health-related issues.

Conclusion

Some groups of athletes are particularly at risk for excessive alcohol use that can lead to a variety of negative or harmful outcomes, including impaired athletic  performance.  Researchers  and  theorists have  explored  several  sport-related  factors  that might  serve  to  heighten  the  risk  of  heavy  drinking among athletes, although the specific ways in which  many  of  these  factors  impact  alcohol  use are  not  well  understood.  Fortunately,  a  number of  interventions  exist  that  can  either  reduce  or prevent  problematic  alcohol  use,  including  brief models that have been shown to be efficacious specifically among athletes.

References:

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