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.
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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.
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.
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