Treatment of Substance Abuse Problems in Sport Penelope P. Ziegler, M.D. Williamsburg Place and The - PowerPoint PPT Presentation


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Treatment of Substance Abuse Problems in Sport Penelope P. Ziegler, M.D. Williamsburg Place and The


Levels of Sport Involved. Secondary schools. College athletics. Professional sports ' ... Sports medicine doctors. Physical therapists and trainers. Coaches ... – PowerPoint PPT presentation

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Title: Treatment of Substance Abuse Problems in Sport Penelope P. Ziegler, M.D. Williamsburg Place and The

Treatment of Substance Abuse Problems in
SportPenelope P. Ziegler, M.D.Williamsburg
Place and The William J. Farley
CenterWilliamsburg, VA
Substances of Concern
  • Legal substances and process addictions
  • Alcohol
  • Nicotine
  • Food
  • Gambling
  • Illicit drugs
  • Marijuana
  • Stimulants
  • Club drugs- ecstasy, GHB, ketamine, etc.
  • Heroin
  • Prescription drugs
  • Opioids
  • Sedatives
  • Stimulants- Ritalin, Adderal, etc.
  • Performance enhancing substances
  • Steroids
  • Other hormones and substances
  • Over-the-counter drugs

What Do They Have in Common?
  • All stimulate the midbrains reward system by
    increasing dopamine levels
  • Repeated overstimulation of this pathway in
    vulnerable individuals leads to permanent brain
    alterations addiction
  • Vulnerabilities
  • Genetic
  • Acquired

Genetic Vulnerabilities
  • Family history of addictive disorders
  • Alcoholism
  • Other drug addiction
  • Compulsive gambling
  • Eating disorders
  • Family history of bipolar disorder

Acquired Vulnerabilities
  • Exposure to drugs in utero
  • Early onset of drug use
  • Certain psychiatric disorders
  • Bipolar disorder
  • Attention deficit hyperactivity disorder
  • When untreated, greatly increases risk of
    developing addiction
  • Treatment reduces this risk
  • Post traumatic stress disorder

Levels of Sport Involved
  • Secondary schools
  • College athletics
  • Professional sports
  • Weekend warriors
  • Unofficial team sporting leagues and activities

Impact of Substance Use
  • Impaired academic function leading to
    ineligibility for sports participation
  • Impaired physical functioning leading to sports
  • Impaired adherence and participation in rehab
    leading to delayed healing
  • Impaired function on re-entry into sport leading
    to re-injury

Hierarchy of Problems
  • Curiosity and experimentation
  • Regular, non-problematic social use
  • Use in violation of rules of sport or law
  • Repeated use in situations which could cause
    danger to self or others (abuse)
  • Out of control use inability to cut down or stop
    use continued use despite adverse consequences
    development of tolerance and/or withdrawal
    impairment of social and occupational function
    due to use (addiction)

Development of Addiction
  • In vulnerable individuals, once drug use starts,
    progressive changes in brain function and
    structure lead to changes in behavior.
  • Drug taking moves from experimentation to regular
    use to compulsive, out of control use.
  • Without help, the addicted person is unable to
    stop or control use despite increasingly severe
    negative consequences, and despite his/her

Brain Circuits Involved in Drug Addiction

Primary Treatment (Prevention)
  • Studies show that most drug prevention efforts
    have been woefully ineffective
  • Exception is focusing on impact of substance use
    on participation and performance in sport
  • At elementary school level, using coaches and
    sport stars to educate kids about risks of
    substance use
  • At secondary and collegiate level, using sports
    pros in recovery sharing their stories
  • Using sports psychologists and athletic trainers
    to identify risks and train athletes in coping
    skills needed

Secondary Treatment(Early Intervention)
  • Working with athletes who are experimenting with
    or abusing drugs and/or performance-enhancing
    substances but not yet addicted
  • Using specialized approaches
  • Intensive education
  • Identification of specific risk factors
  • Peer group therapy
  • Attendance at open 12-Step meetings
  • Meeting young recovering athletes

Tertiary Treatment(Addiction Treatment)
  • Intensive treatment at level of care appropriate
    for individuals illness
  • Treatment providers (physicians, counselors,
    rehab centers) needs to work with sports system
  • Coach
  • Athletic trainer
  • Student assistance program, player assistance
    program that oversees athletes recovery
  • Family

Case 1
  • 19 year old single African American sophomore
    female on basketball scholarship to large
    midwestern university
  • At risk of ineligibility due to non-attendance at
    classes and practice
  • Minor ankle sprain leads to a routine, schedule
    appointment at sports medicine outpatient clinic
  • She arrived for appointment with alcohol on her

Red Flags
  • Change in behavior and performance
  • Non-attendance at classes
  • Non-attendance at practice
  • Alcohol on breath at a scheduled clinic

Case 1 (continued)
  • Evaluation showed alcohol abuse and history of
    anxiety and sleep disturbance since date rape
    freshman year
  • Referred for
  • Early alcohol intervention program
  • Individual sexual trauma counseling
  • Coaching on resistance to peer pressure
  • Continued on team with understanding that further
    missed practices or alcohol use would result in
    suspension and referral to higher level of care

Case 2
  • 20 year old white male junior running back at Ivy
    League college had car wreck following a game
    BAC was 0.18 in E.R. Urine drug screen positive
    for cocaine and methylphenydate (Ritalin).
  • Sustained a fractured wrist and dislocated
    shoulder in wreck.
  • Seen for consultation in hospital by addiction
    specialist diagnosis middle stage addiction
    to alcohol and stimulants.

Special Issue Prescription Stimulants
  • High school and college athletes use prescription
    stimulants for 3 reasons
  • Performance enhancement
  • Study aids
  • Euphoria, especially when snorted
  • These drugs are readily available
  • From peers
  • From family doctor
  • From student health center

Case 2 (continued)
  • Referred to a residential treatment program for
    addiction that was able to incorporated intensive
    physical rehab program.
  • Assisted in connecting with a sponsor who was
    a recovering pro NFL player.
  • Able to return to school in spring semester
    and return to team for fall season with ongoing
    outpatient treatment, support and monitoring
  • Decided on career in counseling rather than pro

Case 3
  • 40 year old, married Latino business owner
    admitted to an addiction rehab center for
    treatment of alcohol and opioid addiction.
  • In college, had been a star varsity soccer
    player until sustaining a knee injury rehab had
    been complicated by his drinking and unrecognized
    abuse of prescribed pain medication.
  • Never returned to the soccer team now has
    chronic pain in knee still taking opioids daily,
    and alcohol use has escalated out of control.
  • Chronic, low-level depression related to
    sedentary life style, obesity and self-hatred.

Missed Opportunities
  • Signs of problems following college injury
  • Drinking escalated following injury, drinking
    alone, drinking to self-medicate
  • Abuse of pain meds
  • Missing PT appointments, not showing interest in
    or motivation for rehab
  • Ways to intervene
  • Expressions of concern or caring
  • Arranging for visit by counselor or specialist
  • Dont diagnose or judge suggest assessment, help
  • Who can intervene
  • Sports medicine doctors
  • Physical therapists and trainers
  • Coaches
  • Peers

Case 3
  • During treatment, detoxified from alcohol and
    opioids and started on a pain management
    protocol, including PT and acupuncture.
  • Physical rehab and exercise improved physical
    conditioning, leading to weight loss and improved
    self esteem.
  • Began playing golf and swimming with peers while
    in treatment.
  • Now coaching sons soccer team and walking 5
    miles daily recently started long distance
    swimming competitions.