Chapter 24: Substance Abuse

1. Chapter 24: Substance Abuse

2. Substance abuse has no place in athletics • There is an increasing number of athletes engaging in substance abuse • Use and abuse of substances can have a profound effect on performance • Both positive and negative • Use of performance enhancing and street drug use occurs throughout athletics, on various levels

3. Performance Enhancing Drugs • Drug use designed to improve performance is known as doping • Doping • “Administration or use of substances in any form alien to the body, or of physiological substances in abnormal amounts and with abnormal methods by healthy persons with the exclusive aim of attaining an artificial and unfair increase in performance in sports.”

4. Stimulants • Used to increase alertness, reduce fatigue, increase competitiveness and hostility • Some respond with loss of judgment that may lead to personal injury or injury to others

5. Amphetamines • Extremely potent and dangerous • Injected, inhaled, taken as tablets • Most widely used for performance enhancement • Can produce euphoria w/ heightened mental status until fatigue sets in, accompanied by nervousness, insomnia, and anorexia • In high doses, will reduce mental activity and decrease performance • Athlete may become irrational • chronic use causing individual to become “hung up” in state of repetitious behavioral sequences

6. Can lead to amphetamine psychosis, manifesting in auditory and visual hallucinations and delusions • Physiologically, high doses can cause abnormal pupil dilation, increased blood pressure, hyperreflexia and hyperthermia • Athletes believe that it promotes quickness and endurance, delay fatigue, and increases confidence • Research indicates that it may increase the risk of injury, exhaustion and circulatory collapse

7. Caffeine • Found in coffee, tea, cocoa and cola • CNS stimulant, diuretic and stimulates gastric secretion • In moderation it will cause wakefulness and mental alertness • Large amounts will cause elevated blood pressure, changes in heart rate, increased plasma levels of epinephrine, norepinephrine and renin -- impacting coordination, sleep, mood, behavior and thinking processes

8. Habitual user that ceases use may go through withdrawal -- sufferer headache, drowsiness, lethargy, rhinorrhea, irritability, nervousness, depression and lost interest in work • Believed to act as ergogenic aid during prolonged activity • Also acts as a diuretic when hydration may be important

9. Narcotic Analgesic Drugs • Derived from opium or synthetic opiates • Morphine and codeine are examples • Used for management of moderate/severe pain • Risk physical and psychological dependency • Beta Blockers • Primarily used for hypertension and heart disease. • Used for sports requiring steadiness • Relax blood vessels, slows heart rate and decreases cardiac output

10. Diuretics • Used for variety of cardiovascular and respiratory conditions • In sports, misused for weight loss or to decrease a drug’s concentration in urine • Certain classes banned for ethical and health grounds

11. Anabolic Steroids • Synthetic chemical (structure resembles sex hormone, testosterone) • Androgenic effects • Growth, development and maintenance of reproductive tissues, masculinization • Anabolic effects • Protein synthesis - causing increased muscle mass and weight, general growth and bone maturation • Goal is to maximize this effect • Can have deleterious and irreversible effects causing major threats to health • Use most commonly seen in sports that involve strength and power

12. In prepubescent boys • Decrease in ultimate height, cessation of long bone growth, acne, deepening of the voice (hirsutism), and swelling of the breasts (gynecomastia) • Ingestion by females • Hirsutism • Increases in duration and dose increases the likelihood of androgen effects • Abuse may lead to liver and prostate cancer and heart disease

13. Human Growth Hormone (HGH) • Produced by anterior pituitary and released into circulatory system • Amount released varies with age • Can be produced synthetically • Results in increases muscle mass, skin thickness, connective tissue in muscle, organ weight • Can produce lax muscles and ligaments during periods of growth and alterations in bone growth

14. Can cause premature closing of growth plates, acromegaly which may also result in diabetes mellitus, cardiovascular disease, goiter, menstrual disorders, decreased sexual desire and impotence • No proof that increased HGH and weight training contributes to strength and muscle hypertrophy

15. Androstenedione • Weak androgen produced primarily in testes and in lesser amounts by adrenal cortex and ovaries • Increases testosterone in men and particularly women • Effects last a few hours • No scientific evidence to support or rebuke efficacy or safety of using this ergogenic aid

16. Blood Reinjection (Blood Doping, Packing or Boosting) • Endurance, acclimatization and altitude make increased metabolic demands for the body, requiring increased blood volume and RBC’s • Can replicate physiological responses by removing 900 ml of blood and reinfusing is after 6 weeks (allows time to replenish supply) • Can significantly improve performance • While unethical, it can also prove to be dangerous • Risks involve allergic reactions, kidney damage, fever, jaundice, infectious disease, blood overload (circulatory or metabolic shock)

17. Recreational Substance Abuse Among Athletes • It occurs among athletes • Desire to experiment, temporarily escape, be part of the group • Can be abused and habit forming • Drug used for non-medical reasons with the intent of getting high, or altering mood or behavior

18. Psychological vs. Physical Dependence • Psychological dependence is the drive to repeat the ingestion to produce pleasure or avoid discomfort • Physical dependence is the state of drug adaptation that manifests self in form of tolerance • Tolerance of a drug is the need to increase the dosage and create the effect that was obtained previously • When cease consumption abruptly unpleasant withdrawal occurs

19. Tobacco Use • Cigarettes, cigars & pipes are increasingly rare in athletics • Smokeless tobacco and passive exposure to others continues to be an ongoing problem • Cigarette smoking • Seriously impact performance for those that are highly sensitive • Associated with 4,700 different chemicals • 10 inhalations can cause average maximum decrease in airway conductance of 50% (secondhand also)

20. Cigarette Smoking (continued) • Reduces oxygen carrying capacity of blood • Aggravates and accelerates heart muscle cell stimulation through over-stimulation of sympathetic nervous system • Decreases lung capacity and maximum breathing capacity, also decreases pulmonary diffusion • Accelerates thrombolic tendency • Carcinogenic factor in lung cancer and contributes to heart disease

21. Nicotine is the addictive chemical in tobacco- one of the most toxic drugs • Causes elevated blood pressure, increased bowel activity, and antidiuretic action • Passive inhalation of cigarette smoke can reduce maximum aerobic power and endurance • Smokeless Tobacco • Loose leaf, moist, dry powder, and compressed • Posses serious health risk • Bad breath • Stained teeth • Tooth sensitivity to heat and cold • Cavities and gum recession • Tooth bone loss • Leukoplakia • Oral and throat cancer

22. Major substance ingested is N-Nitrosonornicotine • Absorbed through mucous membranes • More addictive habit w/out exposure to tar and carbon monoxide • Will increase heart rate but does not impact reaction time • Coaches, fitness professionals, healthcare providers and professional athletes should avoid use in order to present a positive role model

23. Alcohol • Most widely used and abused substance with athletes • Depresses CNS • Absorbed from digestive tract into bloodstream • Does not improve mental or physical abilities and should be avoided by athletes • Consumption on a large scale can result in development of a moderate degree of tolerance • No place in sports participation

24. Cocaine • CNS stimulant w/ short duration effects (intense) • Produces immediate feeling of euphoria, excitement, decreased fatigue and heightened sexual drive • Long term use results in psychological tolerance and dependence • Can be taken in many forms including snorted, intravenously, or smoked (freebased) • Overdose can lead to • Tachycardia, hypertension, extra heartbeats, coronary vasoconstriction, strokes, pulmonary edema, aortic rupture and sudden death

25. In form of crack (highly purified cocaine)- very short term rush, followed by depression • When cocaine is used recreationally, the athlete feels alert, self-satisfied, and powerful • Sudden stimulation w/ crack can cause cardiac or respiratory failure

26. Marijuana (carcinogenic drug) • Formerly most abused drug in Western society • Similar components and cellular changes as tobacco • Can lead to respiratory disease, asthma, bronchitis, lowered sperm count and testosterone levels, limited immune functioning and cell metabolism • Causes increased pulse rate and can cause decrease in strength • Psychologically causes diminution of self-awareness and judgment, slower thinking and short attention span

27. Has also been found to alter the anatomical structures suggesting irreversible brain damage • Contains cannabinoids (can store like fat cells) • May remain in the body and brain for weeks and months resulting in cumulative deleterious effects

28. Crystal Methamphetamine • Used by individuals of all ages and is gaining popularity • Colorless, odorless, highly addictive stimulant • Looks like small pieces of shiny, blue-white rocks, or glass • Long lasting euphoric effects • Higher purity level compared to methamphetamine • Up to 12 hours • May be smoked or injected

29. Physiologic effects include: • Rapid heart rate, increased BP • Can cause damage to blood vessels in the brain, leading to stroke • Overdose can cause increased temperature, convulsions, death • May experience periods of paranoia, anxiety, violent behavior, confusion and insomnia • Psychotic effects can last up to months or years after an individual stops using

30. Ecstasy • Most commonly used designer drug • Close derivative of methamphetamine • Found in table, capsule, or powder form • Consumed orally or injected • Typical Effects- • Euphoria, feelings of well-being, enhanced mental or emotional clarity, anxiety and paranoia • Heavier doses can cause: • Hallucinations, sensations of light-headedness, depression, paranoid thinking, violent & irrational behavior

31. Physical reactions • Loss of appetite, nausea, vomiting, blurred vision, increased heart rate, blood pressure increases, muscle tension, faintness, chills, sweating, tremors, insomnia, convulsions, and loss of control over voluntary movements • Some reactions have been noted to last up to 14 days

32. ADHD Medications • Typically used to treat attention deficit and hyperactivity disorder • More recently these medications are becoming abused in collegiate populations • Medications are usually amphetamines • Ritalin, Adderall, Dexedrine • Act as stimulants and help to decrease distractibility and facilitate concentration • Reasons for abuse • Improving attention, partying, reducing hyperactivity, improving grades

33. Common signs & symptoms of illegal use include • Shakiness • Rapid speech • Rapid movements • Difficulty sitting still • Difficulty concentrating • Lack of appetite • Sleep disturbances • Irritability

34. Drug Testing in Athletics • NCAA and USOC have established banned substances lists and testing programs • Banned substances list have not been set at the high school level • Choice is left up to the individual schools • Testing at the high school level is on the rise • Guidelines are available for programs that want to institute a drug-testing program

35. Drug testing in high schools • Started in mid 1970’s • Performed infrequently with varying degrees of success • Most commonly screen for amphetamines, marijuana, cocaine, opiates and PCP • Leaves out alcohol, tobacco, and steroids