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Alcohol and Other Drugs Workshop for National Open Swimmers A guide to delivering a one hour alcohol and other drugs workshop to swimmers aged approximately 18 years and over. swimming.org.au 2 This resource has been developed on behalf of swimming Australia Limited to support the PowerPoint presentation titled “Alcohol and Other Drugs Workshop for National Open Swimmers (aged approximately 18 years old and over)”. Swimming Australia Limited. June 2013 Prepared by Karina Hickey and Annie Bleeker. Introduction: BEING A CLUB CHAMPION The Club Champions and Illicit Drugs in Sport Programs aim to enlist sporting organisations and sports people to reduce the levels of binge drinking and illicit drug use in the community. This resource provides information about the impact of alcohol and other drugs on the functioning of your body and mind and also your ability to train and compete at optimal level. Swimming Australia Limited (SAL) has a zero tolerance to illicit drug use policy as well as a dry team policy with regard to alcohol. This means that when the team is assembled to prepare for, attend and participate in an event, members are not allowed to drink alcohol or consume illicit or prohibited drugs. swimming.org.au 3 About this Presenter’s Guide This Presenter’s Guide is designed to accompany the PowerPoint presentation “Alcohol and Other Drugs Workshop for National Open Swimmers.” It has been produced to assist coaches, managers and others to facilitate training sessions to swimmers and stakeholders about alcohol and other drugs within their swimming clubs. This Presenter’s Guide combines edited content from two recent Commonwealth Government initiatives to educate Australian athletes about alcohol and other drugs (AOD); the ‘Club Champions’ and the ‘Illicit Drugs in Sport’ (IDiS) programs. Further information is also provided about the effects of alcohol and other drugs on sporting performance, statistical trends on alcohol and other drug use relevant to this age group, athlete wellbeing and safety, and where to get further help or information. Facilitation tips, suggested activities, knowledge quizzes and suggestions about audio-visual content are also provided in this Presenter’s Guide to increase the confidence of facilitators and to ensure workshops are interactive in order to maximise athlete engagement. This Presenter’s Guide has been developed by two experienced facilitators of the Club Champions and the Illicit Drugs in Sport (IDiS) programs with a background in alcohol and other drug research, training, education and curriculum and resource development. Anti-doping The focus of this package is on alcohol and illicit drugs and not on anti-doping or drug testing. Please consult the latest information on anti-doping or drug testing from ASADA and WADA available online: http://www.asada.gov.au/ http://www.wada-ama.org/ Target audience The target audience for this Presenter’s Guide is any coach, club manager or club stakeholder who wishes to facilitate an alcohol or other drug education session with swimmers aged approximately 18 years and over. Swimmers at any level of experience or skill can be targeted. How to use the Presenter’s Guide and PowerPoint presentation Before you start, familiarise yourself with the training materials, as well as the background information relating to the slides in the PowerPoint presentation. Decide how you wish to facilitate your session and which of the activities or optional extras will be appropriate for your athletes. The PowerPoint and accompanying activities are designed to run as a one hour (approximately) educational session. swimming.org.au 4 Background information on the Club Champions and Illicit Drugs in Sport programs Club Champions The Club Champions program is a $2 million initiative of the Commonwealth Government’s National Binge Drinking Strategy to equip sportspeople to promote responsible attitudes and practices towards alcohol. A National Alcohol Code of Conduct underpins the Club Champions Program. In 2009, seven sporting organisations signed up to the Code – the Australian Football League, the National Rugby League, the Australian Rugby Union, Cricket Australia, Football Federation Australia, Netball Australia and Swimming Australia. These seven sporting organisations participate in the Club Champions Program. To help educate sportspeople to be advocates for responsible drinking, those nominated by their sporting organisation or their club/team, including athletes/players, coaches, support personnel and officials, will take part in alcohol education sessions based around the key messages from the National Binge Drinking Strategy (short- and long-term harms associated with drinking to intoxication, the need for personal responsibility and the need to understand a standard drink size). Further Information about the Code of Conduct is available here: https://secure.ausport.gov.au/__data/assets/pdf_file/0020/335450/CodeOfConduct.pdf Illicit Drugs in Sport (IDiS) Illicit drugs can be harmful to athletes and bring sport into disrepute. There are many examples of how alcohol and other drug use and abuse can destroy the careers of successful young athletes. The use of illicit drugs in sport is particularly disappointing because so many young Australians look up to our athletes as role models. Through the IDiS Program, the Government is supporting national sporting organisations to ensure Australian athletes have the education and support they need to make the right choices when it comes to illicit drugs. The main aims of the IDiS program are to: • prevent illicit drug use in elite sport through education programs targeted at athletes, coaches and administrators; • harness the power of positive sporting role models to help deliver community education about the harms of illicit drug use; and • assist athletes identified with a drug problem in getting help. Further information about the IDiS program is available here: http://www.regional.gov.au/sport/programs/idis.aspx Further information about Swimming Australia’s roll-out and implementation of the program is available here: http://www.swimming.org.au/customdata/index.cfm?fuseaction=CustomItem&ItemID=48110 swimming.org.au 5 Participant outcomes and competencies At the end of the training, participants will have developed the following competencies: Skills and knowledge: > Know the categories that alcohol, cannabis and other illicit drugs fall into (e.g. depressants) > Understand the effects of alcohol and other illicit drugs on the body and brain > Understand the effects of alcohol and other drugs on sporting performance > Understand that irresponsible alcohol use or illegal drug use can affect an athlete’s physical health, career, reputation, and relationships (liver, livelihood, law and lover) > Understand Swimming Australia’s policies and views on alcohol and illicit drugs Attitudes: > Irresponsible alcohol use and illicit drug use can affect an athlete’s performance, team, future and character > Athletes are role models to other people involved in sport and to the wider community > In a tech-savvy age, smart phones and easy internet access can broadcast regrettable actions permanently Environment: > Irresponsible alcohol use and illicit drug use are not tolerated by teams, coaches, or administrators > If a swimmer, or a team mate, were in need of help or support, they could and would get it > What swimmers do outside the pool is also part of the club’s concern > Swimmers should not place themselves in environments where illicit drugs or binge drinking are likely to be present Room set-up and group numbers This session is best facilitated with a group of 15-30 swimmers to encourage an interactive environment with discussion and questions. The room can be set up in a horseshoe shape or with smaller groups of tables and chairs. This session can also be delivered to a larger group as a presentation, in which case any room set up may be used. Discussion questions should still be posed to a larger group and interaction encouraged where possible. Presentation requirements and what to bring on the day: • Room with projector and screen to play PowerPoint and laptop if needed • PowerPoint saved on USB and online as a backup. It is advised to save this in compatible format for 2003-2007 versions • Working speakers to play videos or pre-check that the training room has these facilities • Internet access to pre-loaded videos (or save them to a device such as a USB and play from there) • Pens for all participants • Printed feedback forms for all participants • Printed quizzes for all participants Introducing confidentiality Open this session by stating that you are talking about sensitive topics and pose that whatever is discussed in the room should remain confidential. Acknowledge that consuming alcohol before the age of 18 and consumption of substances such as cannabis, ecstasy and amphetamines is illegal, however research indicates that such consumption does occur; therefore participants should be encouraged to ask questions freely. State that you will not ask participants about their individual alcohol or other drug use. A useful way of avoiding direct disclosure about personal alcohol or other drug use is to suggest participants pose comments or questions as if they were talking about a friend’s experience, i.e. “Someone I know had this happen to them...” swimming.org.au 6 Facilitation Tip Avoid reading from the PowerPoint slides. Each slide contains a number of written points of information that the participants can read themselves and another two to three points of information, or a story, anecdote or discussion question presented by the facilitator. Facilitation Tip A note about self-disclosure from young athletes; if a participant is willing to share a story or ask a question this can be valuable to the group learning process. However, if it becomes apparent that a young person is about to incriminate themself, the facilitator should attempt to stop the young person from doing so and move the session forward. Triangulation of learning diagram In a well-facilitated workshop, participants learn from the facilitator, the facilitator learns from participants, and participants learn from each other. Trainer/Facilitator Participants Facilitation Tip Participants As coaches, senior swimmers, club managers or other stakeholders, you have probably seen first-hand the consequences of alcohol or illicit drug use and the impact on athletes. Perhaps you even have personal experience. Sharing your stories with the group will add credibility and depth to the session. There is however, no need for self-disclosure — you can speak in general terms or share stories on behalf of others. swimming.org.au 7 Notes to accompany PowerPoint slides Slides 1-2: Introduction – What is today about? Introduce yourself and the topics for the session, explain the workshop will run for approximately 60 minutes, will be interactive and include quizzes, video and activities. Attend to house-keeping issues (i.e. toilets, etc.), discuss confidentiality (see break out box) and answer any initial questions the group might have. You may also like to provide a background and rationale for the session i.e. what the Club Champions and Illicit Drugs in Sport Programs are about, why the Australian Government has chosen to invest in athletes and educate them about the harms of alcohol and other drugs in relation to swimming, and how athletes can make wiser choices. Slide 3: What do you already know? Alcohol and Other Drugs in Sport Quiz The Alcohol and Other Drugs in Sport Quiz is located in Appendix 1 and includes ten statements that participants are asked to mark as true, false, or unsure. You will need to print enough copies for the group beforehand. • Ask the group to fill in the Quiz and keep until the end of the session when you will go through the answers together • The answers to all quiz questions can be found in Appendix 2 – Answers to the Alcohol and Other Drugs in Sport Quiz If you prefer, you also have the option of completing a shortened version of this quiz orally, by selecting five questions from the Alcohol and Other Drugs in Sport Quiz that you think are most pertinent to the group. • Read the five questions aloud, seeking a group consensus on whether each statement is true or false Slides 4-5: Alcohol overview/who drinks what and how much? Alcohol is a central nervous system (CNS) depressant and falls into the depressant drug category. Clarify to the group that depressant drugs do not necessarily make people depressed, rather, they ‘depress’ or slow down the central nervous system. • Ask the group if they know what the CNS comprises? • Explain that the CNS consists of the brain and spinal cord. Alcohol slows down breathing and heart rate, induces relaxation and reduces inhibitions, which is often why it is consumed The statistics on alcohol use are from the National Drug Strategy Household Survey 2007. The full report is available here: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459906 Explain to the group that: • Some women tend to consume beverages with higher alcohol content per volume such as spirits and wine, over beer, therefore they are deemed to drink at riskier levels. They also tend to choose drinks with higher sugar content such as spirits mixed with juice or soft drink and thus generally consume more calories than men when drinking • Ask the group if they agree/disagree with these statistics (based on Australians aged 20-29 years old) and if they feel they are comparable to themselves as athletes? swimming.org.au 8 Slide: 6-7: Standard Drinks (SD) and Blood Alcohol Concentration (BAC) What is a standard drink? Alcohol differs in strength. Usually beers range from 1%-6% alcohol content; wines are between 12%-14%, and spirits (such as vodka, bourbon and Jägermeister) range between 20%-40% alcohol content. Alcohol is measured in ‘standard drinks’. A standard drink contains 10 grams of alcohol. All cans and bottles are required by law to list the number of standard drinks they contain. Remember, the drinks you purchase or pour for yourself generally contain more than one standard drink. As a guide: 100ml of wine (a small glass), 30ml of spirits (a shot) and a midi of beer (270ml small glass) are all one standard drink. Explain to the group that one standard drink includes: • Any alcoholic drink that contains 10 grams of alcohol • Middy (small pub glass) of full strength beer - 285 ml • Shot of spirits - 30ml • Small glass of wine or champagne - 100ml One standard drink will cause a person’s blood alcohol concentration (BAC) to reach approximately 0.01% to 0.03%, meaning that between 1% and 3% of a person’s blood stream is alcohol. One pre-mixed spirit, which is 1.5 SD, can take BAC to 0.05%. More information on standard drinks can be found here: http://www.dassa.sa.gov.au/site/page.cfm?u=121 Explain to the group that BAC is affected by the following: • Body size: A smaller person will have a higher BAC than a larger person, because the alcohol is concentrated in a smaller body mass • Empty stomach: Someone with an empty stomach will reach a higher BAC sooner than someone who has just eaten a meal. Food in the stomach slows down the rate at which alcohol passes into the bloodstream • Body fat: People with a lot of body fat tend to have higher BAC. Alcohol is not absorbed into fatty tissue, so the alcohol is concentrated in a smaller body mass • Gender: After consuming the same amount of alcohol, a female will almost always have a higher BAC than a male, due to having a higher percentage of body fat swimming.org.au 9 Driving and BAC: • A BAC of 0.00% is required for all Learner and Provisional drivers in Australia • A BAC of under 0.02% applies to drivers of public vehicles such as taxis and buses, as well as gross mass vehicles (e.g. trucks) in most states and territories • A BAC of under 0.05% applies to fully licensed drivers As a driver’s BAC rises, so does the risk of being involved in a crash. • 0.05% = double the risk • 0.08% = 7 times the risk • 0.15% = 25 times the risk For more information on BAC and driving click here: http://www.rta.nsw.gov.au/roadsafety/alcoholdrugs/index.html Sobering up Ask the group: • What have you heard about ways to lower BAC faster i.e. how might you be able to get rid of alcohol from your system? Myths include: • Drinking water, vomiting, eating greasy, fatty foods or bread, drinking coffee or electrolyte-based drinks, having a cold shower, doing exercise etc. NONE of these methods work to reduce a person’s BAC, as alcohol is mostly processed through the liver and this takes between 60-90 minutes per standard drink (particularly for women and those with liver conditions, etc.) • Some of these methods such as drinking water, may reduce or prevent the symptoms of a hangover but they will not eliminate alcohol from the blood stream faster SOBERING ALCOHOL FACTS • Each week 60 Australians die and 1500 people are hospitalised due to alcohol use • Alcohol is directly responsible for 70,000 assaults and 24,000 domestic violence cases per year • Alcohol is estimated to cost the Australian community about $36 billion per year Source: AERF (2010) for more information click here: http://alcoholireland.ie/wp-content/uploads/2009/04/alcohole28099s-harm-to-others-alcohol-education-and-rehabilitation-foundation-australia-2010.pdf swimming.org.au 10 Slide 8: 2009 Australian Alcohol Guidelines Explain to the group: That the Australian guidelines on alcohol were recently reviewed and changed by the National Health and Medical Research Council (NHMRC) in 2009. • “This guideline is based on evidence showing that the risks of accidents, injuries, violence and self-harm are high among drinkers aged under 18 years. Drinkers under 15 years of age are much more likely than older drinkers to experience risky or antisocial behaviour connected with their drinking, with the rates also somewhat elevated among drinkers aged 15-17 years. In addition, the evidence suggests that earlier initiation of drinking is related to more frequent and higher quantity alcohol consumption in adolescence, and these patterns are in turn related to the development of alcohol-related harms in adolescence and adulthood.” P.58 Source: NHMRC (2009) for more information click here: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf • Highlight to the group that the brain continues to grow and develop until the mid-20s and a range of studies have linked alcohol consumption to adverse brain development and alcohol-related problems later in life. Slide 9: Obligations under Swimming Australia’s policies Explain to the group that: • Swimming Australia Limited (SAL) has a zero tolerance dry team policy which makes it clear that when the team is assembled to prepare for, attend and participate in an event, members are not allowed to drink alcohol. SAL’s National Alcohol Code of Conduct states that: • Individuals cannot participate in sport if they are consuming or under the influence of alcohol • No alcohol at under-age sporting events • Clubs should support individuals seeking assistance • Athletes are role models, responsible for their own decisions and should not put themselves, their team mates or the public at risk • Athletes must assist team mates if they have had too much drink Remind the group: • That they are roles models and many people look up to them swimming.org.au 11 Slide 10: Alcohol and energy drinks Energy drinks contain stimulants such as caffeine and guarana which mask the sedative effects of alcohol when they are combined. This means that you don’t feel as drunk, tend to drink more and believe you are less impaired by the effects of alcohol than you actually are. Explain to the group that: • The main active ingredients in commonly available energy drinks are caffeine and guarana • Energy drinks delay the depressive effects of alcohol on the central nervous system, which can result in a higher consumption of alcohol Source: Ballistreri and Corradi-Webster (2008) for more information click here: http://www.scielo.br/pdf/rlae/v16nspe/09.pdf • Combined consumption of energy drinks and alcohol may affect an individual’s judgment by reducing the subjective sensation of intoxication. In other words, the individual may not feel as drunk as they actually are which can lead to increased risk of accidents, personal injury or health and social problems associated with impaired judgment Source: Ferreira et al. (2006) for more information click here: http://control.visionscape.com.au/SiteFiles/hunterlifeeducationorgau/200604_Ferreira_et_al.pdf • Caffeine and alcohol are both diuretics and drinking both in combination post-performance further inhibits rehydration and subsequently delays recovery for those who have been engaged in physical activity Slide 11: Women and alcohol Explain to the group that: • Women’s bodies generally have more fat and less fluid than men’s and alcohol does not absorb into fatty tissue, therefore there is less area for alcohol to ‘pool’ within the body and it becomes more highly concentrated within the blood. • It takes the body approximately 60 minutes to metabolise a standard drink and this varies depending on body size, presence of food in the stomach etc. For women, it is safest to leave approximately 90 minutes if driving, or if BAC needs to be 0.00%. • If a woman is menstruating she may feel the effects of alcohol more as it can take longer to metabolise (break down) alcohol due to hormonal influences. Source: Sutker, Goist Jr & King (1987) for more information on women’s menstrual cycles and alcohol click here http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.1987.tb01266.x/abstract. (Full text may not be available to all). swimming.org.au 12 Slide 12: Drink spiking Ask the group what the most common drug to be used when spiking someone’s drink is? Expected responses include Rohypnol, Gammahydroxy-butyrate (GHB) and Ketamine. While these drugs may be used in a small sample of drink spiking cases (although toxicology results in many cases don’t support these claims), alcohol is by far the most common drug and is used in the majority of drink spiking cases. This can mean adding extra alcohol to a drink already containing it, or adding alcohol to a non-alcoholic drink. The perpetrator can be known to the victim and may spike their drink as a ‘prank’, either out of curiosity or to ‘loosen them up’ or perhaps for sexual advantage. Ask the group: • Do you think it is reasonable to spike a friend’s drink and what could the consequences be? o For example, the victim could be planning on driving or may be taking medications that are contraindicated with alcohol, such as antibiotics, antidepressants, some pain killers and antihistamines When drugs other than alcohol are added to drinks they often change the taste or leave a chalky residue, negating the myth that drink spiking is a colourless, odourless and tasteless crime. GHB for example (see information in appendices) has a particularly strong, chemical taste. If someone suspects their drink has been spiked they should dispose of it immediately. Ask the group: • Ho w can you minimise the risks associated with drink spiking? • i.e. don’t leave your drink unattended, discard any unusual tasting drinks, don’t accept drinks from strangers unless you witness them being poured, keep an eye on your friends, etc. For a factsheet on drink spiking produced by NSW police click here: http://www.police.nsw.gov.au/__data/assets/pdf_file/0005/81374/fact_sheet_drink_spiking_myths.pdf For further information on drink spiking from The National Drug Strategy click here: http://www.aic.gov.au/documents/7/8/D/%7B78D26268-98C6-4508-8A9A-AA6BD2E34108%7D2004-11-drinkspiking.pdf swimming.org.au 13 Slide 13: Polydrug use = mixing alcohol with… Explain to the group that: • Consuming more than one drug at the same time is called polydrug use and it can have unpredictable effects. For example, mixing antibiotics with alcohol can increase the effects of the alcohol or decrease the effectiveness of the medication. It should be noted, however, that this usually only occurs with a few types of antibiotics that are prescribed for quite specific conditions, but it is usually a good idea to avoid alcohol if an infection is present For more information on mixing alcohol and antibiotics click here: http://theconversation.edu.au/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407 • Polydrug use caution also applies for over-the-counter medications e.g. taking aspirin thins the blood which can be dangerous if drinking, especially if someone becomes injured and starts bleeding • Considering that alcohol is a depressant drug which slows down the CNS, mixing it with stimulant drugs such as speed, is telling the CNS to both slow down and speed up at the same time. This confuses the brain and body and can make people feel sick or have more serious consequences including making someone pass out or experience heart problems. When consuming cocaine and alcohol simultaneously, a unique substance called cocaethylene is created in the body, which can increase the risk of experiencing heart palpitations and a heart attack • People who mix alcohol with cannabis are adding two depressant drugs into their system — doubling the effects on the CNS. Some people believe that if they do this in a particular order they will be less at risk. Regardless, however, mixing these drugs may cause unpredictable effects Remember to mention that: • Alcohol can make someone more likely to make the decision to try illicit drugs as it reduces inhibitions • Many people make decisions while sober to avoid illicit drug use, but when placed in a situation where drugs are present and they have consumed alcohol, their resolve weakens • Advise athletes to remove themselves from or avoid any situations they feel might put them at risk of illicit drug use Slides: 14-15: What are the good things about drinking alcohol? Ask the group and discuss: • What are some of the good things about drinking alcohol? Discuss with the group some of the good things about alcohol and the social and cultural roles it plays in Australian society. Alcohol is the most widely used drug in Australia – it has been consumed by 90% of the Australian population over the age of 14. Slide 16: What are some of the downsides to drinking alcohol? Ask the group and discuss: • What are some of the downsides to drinking alcohol? swimming.org.au 14 Slides 17-18: The bad and the ugly Discuss some of the negative effects of alcohol including: Liver: Alcohol affects the body, including the liver, and can cause the following: • Dehydration • Change in body composition (e.g. weight gain from excess calories in alcohol and associated eating) • Delayed injury recovery • Poor judgement and decision making Lover: Binge drinking may cause tension with partners, friends and family such as fights and saying things that are later regretted. Texting or Facebooking when drunk can cause embarrassment, regret and annoyance. Team mates can become disappointed and frustrated if fellow swimmers turn up to training or events hung-over as it could affect their own chances in team events or jeopardise the Club’s reputation. An intoxicated person is also vulnerable to losing their possessions such as their wallet, phone and keys and may also become a victim of assault. Livelihood: Alcohol and illicit drug use can affect an athlete’s career and reputation. Sportspeople, even at non-professional levels, are targets for media attention and are of public interest. Any small incident can be blown out of proportion or misinterpreted if ‘caught on film’. In the modern age of social media and smart phones it is important to stress to participants that everything they do has the potential to become public. Negative media can lead to loss of contracts, loss of sponsorship and tension with team mates. Law: Athletes are not immune to the legal consequences of illicit drug use or inappropriate alcohol use. Anti-doping controls exist under WADA and ASADA policies and athletes can be banned from competitions and fined, as well as be subjected to public scrutiny. If caught using illicit drugs, athletes can receive fines, cautions or even have to face court and potentially be imprisoned, depending on the seriousness of the offence/s. Receiving a criminal record for a minor drug offence can reduce opportunities for employment and international travel. Other consequences include loss of license if caught drink or drug driving, property damage charges, physical assault charges and sexual assault charges. Regrettable sexual activity, alcohol poisoning (see below) and serious injury or death are also possible when using alcohol or illicit drugs. For further Information about alcohol poisoning click here: http://darta.net.au/wordpress-content/uploads/2010/10/Factsheet-1.pdf Slides 19-20: Alcohol, drugs and sporting performance Use these slides to pose the question to the group. Consider as prompts both short- and long-term use of drugs. Ask the group (for example): • “If you were to have three shots of vodka right now and attempt to swim a short course freestyle event what would happen?” • “What about if you started smoking a few cones (cannabis) each morning before training?” • “How would going out for benders every weekend affect your training during the week?” Presenting this information in terms of the effects on the brain, body, nutrition and sleep can be beneficial. (See also Appendix 3: Additional information on illicit drugs). swimming.org.au 15 Slide 21: Psychomotor skills Explain to the group: • Even small to moderate amounts of alcohol have effects on psychomotor skills, for example reaction time, hand-eye coordination, accuracy and balance. Skills such as tracking (for example following the black line at the bottom of the pool) and visual search (such as finding Where’s Wally) can also be affected Source: Maughan (2006). For more information on how alcohol affects psychomotor skills click here http://www.ncbi.nlm.nih.gov/pubmed/16766502. (Full text may not be available to all). Slide: 22 Alcohol and the brain Explain to the group that: When the central nervous system slows down: • The brain takes longer to process information • Coordination is impaired • It takes longer for the muscles to react during a physical response Alcohol intake inhibits the hippocampus, an area in the brain responsible for memory. As such, alcohol intake may have a negative impact on sporting performance due to its effect on the formation of memories when trying to learn or execute new skills/plays. Source: Kuhn, Swartzwelder and Wilson (2000), Pumped: Straight Facts for Athletes about Drugs, Supplements, and Training. W.W Norton and Company. Alcohol intake can also affect rapid eye movement (REM) sleep which plays an important role in solidifying memories and consolidating new skills learned. While alcohol helps people fall into a light sleep, they can be awakened easily and can miss out on REM sleep and deeper, restorative sleep. For more information on alcohol and REM sleep click here to access information from the National Institute of Neurological Disorders and Stroke: http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm or this link to access information from the Australian Broadcasting Corporations Quantum program: http://www.abc.net.au/quantum/poison/alcohol/alcohol.htm Slides: 23-24 Where’s Wally These slides are an example of visual tracking and searching skills. Ask the group: • To find Wally as quickly as they can in slide 23, reveal the answer on slide 24. swimming.org.au 16 Slide: 25 Attention and concentration Ask the group: • Do you agree that alcohol affects brain and body activities for several days? Why might this be? Explain to the group: • Research indicates that brain and body activities can be affected for several days after consuming even small amounts of alcohol • This is likely due to that the flow-on effects of going to bed later than usual when out partying, not eating optimally both while intoxicated and the following day, and playing ‘catch up’ until an athlete is back in their regular routine of sleep and nutrition Discuss that impairment of brain and body functions are not just a result of regular drinking. Impairments have been found to be present after just a single heavy drinking session. For further information about how alcohol impairs brain and body functions click here: http://oade.nd.edu/educate-yourself-alcohol/alcohol-and-athletes/ Slide 26: Alcohol and the body Explain to the group how alcohol affects the body: Dehydration • Alcohol is a diuretic, meaning it increases urination, causing increased fluid loss from the body. This is because alcohol acts on the hypothalamus/pituitary gland to reduce the circulating levels of antidiuretic hormone (ADH). When ADH levels drop, the kidneys do not reabsorb as much water; consequently, the kidneys produce more urine • Dehydration delays recovery from performance and injury. Post-exercise alcohol consumption delays the return of plasma viscosity (thickness of the blood) and plasma fibrinogen (a coagulation factor) concentration to resting levels. This impairs injury and wound healing. Therefore alcohol is not recommended post training or performance Source: El-Sayed, Ali and El-Sayed (2005) for further information on the interaction between alcohol and exercise click here. http://www.ncbi.nlm.nih.gov/pubmed/15730339. (Full text may not be available to all) • More alcohol = more dehydration. The type of alcohol consumed is proportional to the level of dehydration, for example, drinking spirits will dehydrate someone more so than beer, as spirits have higher alcohol content by volume. Metabolic effects • Alcohol is metabolised (broken down) in the liver, a process that requires oxygen. Using oxygen to break down alcohol can cause oxygen deficiencies in other cells, thus indirectly affecting the body’s ability to synthesise adenosine triphosphate (ATP) • Glycogen (fuel) is not replaced properly when a person is drinking. Glucose from the liver is an important source of energy and replenishing the glycogen stores is essential after intensive training or competition. In particular, this will affect activities that require prolonged and moderate intensity outputs such as longer distance swims Source: Shirreffs and Maughan (2006) for further information click here: http://journals.lww.com/acsm-csmr/Abstract/2006/08000/The_Effect_of_Alcohol_on_Athletic_Performance.7.aspx. (Full text may not be available to all) swimming.org.au 17 Injury and recovery • Alcohol is a vasodilator – this means it dilates the blood vessels and can increase blood flow and bleeding, meaning it takes longer to recover • A new injury isn’t as noticeable when intoxicated (from alcohol or other drugs), similarly if an athlete is already injured and then consumes alcohol, they are less likely to feel pain. For example an athlete/player out dancing in a club might feel fine while drinking, but may actually worsen the injury during the night and experience ongoing problems through delayed recovery from their injury Aerobic function • The hangover phase is associated with increased heart rate, decreased left ventricular performance, and increased blood pressure Source: Maughan (2006) for further information on alcohol and exercise performance click here http://www.sportsoracle.com/uploads/2612.pdf • The left ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta via the aortic valve. Along with potential headaches, dehydration and restless sleep, even a single session of heavy consumption can cause brief cardiac arrhythmias (irregular heartbeat) Source: El-Sayed, Ali and El-Sayed (2005) for further information on the interaction between alcohol and exercise click here http://www.ncbi.nlm.nih.gov/pubmed/15730339. (Full text may not be available to all) • Previous research has indicated that the consumption of alcohol in the 24 hours prior to athletic activity significantly alters aerobic performance. This reduction of aerobic performance is reported to be of the order of 11.4% Source: O’Brien CP. (1993). Alcohol and sport: impact of social drinking on recreational and competitive sports performance. SportsMed, 15 (2): 71-7. Slide: 27 Alcohol and performance summary This slide summarises the effects of alcohol on sporting performance. You may choose to show this slide instead of going into the level of detail for slide 26. The data on increased risk of sporting injuries (54.8% likelihood in drinkers vs 23.5% in non-drinkers) is from O’Brien and Lyons (2000). For more information click here: http://adisonline.com/sportsmedicine/Abstract/2000/29050/Alcohol_and_the_Athlete.1.aspx. (Full text may not be available to all). For information about alcohol and testosterone see Valimaki et al. (1984). Abstract available here: http://www.ncbi. nlm.nih.gov/pubmed/6443186. swimming.org.au 18 Slide 28: Illicit drugs and the CNS This slide introduces basic information about alcohol and other drugs and the way that different substances affect the central nervous system (CNS). Information about cannabis and how it affects performance is included further below. Information about other illicit drugs is included in the appendices of this Discussion Guide. Stimulants: Stimulants increase the activity of the CNS. Some stimulants produce a sense of euphoria. Stimulants are used therapeutically to increase or maintain alertness, to counteract fatigue in situations where sleep is not practical (e.g. while operating vehicles), to counteract abnormal states that diminish alertness (such as in narcolepsy), to promote weight loss, as well as to enhance the ability to concentrate in people diagnosed with attentional disruptions (especially ADHD). Occasionally, they are also used to treat depression. Stimulants are sometimes used to boost endurance and productivity as well as to suppress appetite. Depressants: Many depressants acting on the CNS do so by increasing the activity of a particular neurotransmitter known as GABA (although others may be affected, depending on which drug is involved). GABA’s task is to calm the CNS and to promote sleep. Drugs that stimulate the activity of GABA slow brain function and cause a drowsy or calm feeling, and some depressant drugs are prescribed to relieve symptoms of anxiety or insomnia. Internal systems regulate the body’s production of GABA, but when a substance is taken that stimulates GABA action, it is possible to induce hazardously high levels, which can dangerously slow breathing and heart rate, and may result in death. Hallucinogens: Under the influence of hallucinogens, people may see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings. Hallucinogens cause their effects by disrupting the interaction of nerve cells and the neurotransmitter serotonin. Distributed throughout the brain and spinal cord, the serotonin system is involved in the control of behavioural, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behaviour, muscle control, and sensory perception. Ask the group: • What drugs have you heard of or what have you seen in recent media about drugs? Slides: 29-34 Illicit drugs and their effects These six slides contain visual images of the drugs, which was a request of athletes in previous workshops. Information on all these drugs is included in the appendices as well as links for further reading, and information about how each drug affects performance. Impart to the athletes that these drug are illegal, have unpredictable effects especially when mixed together or with alcohol, and they can cause serious health consequences. Despite this, their desired effects such as euphoria, increased self-confidence and increased energy is what attracts people to take them. You may like to discuss how each drug affects performance and recovery as you go along, or save the discussion for later in the workshop, combined with alcohol. See also Appendix 3: Additional Information about illicit drugs swimming.org.au 19 Slide 35: Short-term effects of illicit drug use – desirable Explain to the group: • Some of the desirable effects are listed on the slide • It is important to recognise that people take illicit drugs for many perceived positive benefits, just like alcohol • The athlete wellbeing approach to the IDiS and Club Champions programs focuses on helping athletes rather than shunning them or making them outcasts. Any athlete who is concerned about their own or someone else’s alcohol or other drug use should seek help from someone they feel comfortable with • See also the referral slide at the end of the presentation Slide 36: Short-term effects of illicit drug use – non desirable Some of the non-desirable effects of illicit drug use are listed on this slide. Explain to the group: • Stimulant drugs such as ecstasy/methamphetamines can result in teeth grinding, skin itching and jaw clenching • Anxiety and paranoia or experiencing a ‘drug induced psychosis’ can result from cannabis, methamphetamine or cocaine use For more information about cannabis induced psychosis click here: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/cannabis_and_psychosis?open • Aggression can result from too much methamphetamine and/or alcohol use • Nausea and vomiting, stomach cramps and muscle stiffness can result from ecstasy or from taking high doses of illicit drugs or mixing them with alcohol • Rapid irregular heart beat can be caused by stimulants, i.e. methamphetamine and cocaine • Possibility of coma, death, stroke, heart attack or overdose can result from consuming too much of any drug or combining drugs together • There are many risks associated with illicit drug use particularly because their manufacture is illegal and not regulated - meaning each time a person takes a drug it can cause a different experience and have unpredictable side effects Slide 37: Athlete consumption of illicit drugs • A recent survey (see below) of 974 elite Australian athletes was conducted to ascertain their knowledge of, attitudes towards and consumption of illicit drugs • Athletes had lower levels of illicit drug use than the rest of the population for all six drugs included in the survey • One third of the sample reported that they had had been offered or had the opportunity to use an illicit drug in the past year, however the majority of these athletes rejected offers or refrained from using • Sixteen per cent of athletes perceived there to be a ‘drug of concern’ in their sport, with ecstasy, cocaine and alcohol being named Source: Dunn et al. (2011) for more information about elite athletes and illicit drug use click here http://www.ncbi.nlm.nih.gov/pubmed/21219499. (Full text may not be available to all). swimming.org.au 20 Slide 38: Effects of illicit drugs on sporting performance Similarly to alcohol, illicit drugs can affect the brain, body, nutrition and sleep and have flow-on effects to training and competition. See Appendices 3 and 4 for further information and summaries. Slide 39: Video - Effects of Illicit drugs on your character This video is from the IDiS package and provides a good summary of the topic and models positive attitudes from athletes and coaches. This video file is 4.20 in length. Ideally it will be uploaded to YouTube or made publically accessible. Play the video: Effects of illicit drugs on your character. Ask the group: • What did they think of the video? • Did it make them think differently about illicit drugs? Slides 40-41: Strategies to help a mate These eight comprehensive tips can be read aloud to the group. Explain to the group: • Young people are often scared of being reprimanded or getting into trouble if something goes awry in an alcohol or other drug setting • Stress that getting medical help is more important than being reprimanded. According to NSW Ambulance service (personal communication 2012), an ambulance will not call police where illicit drugs are involved unless staff feel threatened or somebody dies • Young people should be encouraged to keep an eye on each other, have a plan to get home safely and extra money if needed to do so • Avoid giving an intoxicated person other drugs or leaving them alone in a shower • Cooperating with medical staff and providing them with information about what a friend has taken/consumed is in a young person’s best interests Slide 42: When to call an ambulance Explain to the group: • The vital signs of when they need to call an ambulance • Discuss that medical help should always be sought if there is concern for someone’s health or safety Slides 43-45: What did you learn today? Key messages Ask the group: • To think of a couple of new things they have learnt during the presentation and call upon individuals to answer — this will give you an idea as a facilitator what the group has retained and viewed as important • Move on to slide 44 as a general summary of the key messages Slide 46: Referral information Explain to the group: • That the focus of the Cub Champions and IDiS programs is on athlete wellbeing rather than punishment • Clubs want healthy, happy athletes and anyone with concerns should be encourage to seek help from someone they feel comfortable with within the club or from professional services Slide 47: Feedback Thank participants for coming along to the session and ask them if they have any further questions. Encourage them to fill in the feedback form which can be found in Appendix 5 – Participant Feedback Sheet. swimming.org.au 21 Appendix 1: Alcohol and Other Drugs in Sport Quiz Please circle or mark the response you think best matches each statement. If you are not sure please select UNSURE. Hold on to this page and your trainer will give you the answers at the end of today’s session. 1. Vomiting gets rid of alcohol from your system and reduces your blood alcohol content TRUEFALSEUNSURE 2. Taking GHB, although illegal, could increase my athletic performance TRUEFALSEUNSURE 3. Taking cocaine decreases the ability to feel pain TRUEFALSEUNSURE 4. Elite athletes are less likely to use illicit drugs TRUEFALSEUNSURE 5. Mixing alcohol with energy drinks keeps you more sober and alert TRUEFALSEUNSURE 6. Women’s bodies are proportionally made up of more fat and less muscle than men’s TRUEFALSEUNSURE 7. Being hung-over decreases aerobic performance TRUEFALSEUNSURE 8. Ketamine is the most common drug used for drink spiking TRUEFALSEUNSURE 9. All over-the-counter medications such as Panadol are OK to take with alcohol, but prescription drugs should never be used while drinking TRUEFALSEUNSURE 10. Wine/champagne contains more alcohol by volume than beer TRUEFALSEUNSURE swimming.org.au 22 Appendix 2 Alcohol and Other Drugs in Sport Quiz – Answers 1. Vomiting gets rid of alcohol from your system and reduces your blood alcohol content False. Most alcohol is processed through the liver and leaves the body in the urine, which takes around 60-90 minutes per standard drink. Vomiting will not get rid of alcohol from the bloodstream. The only way to sober up is time. 2. Taking GHB, although illegal, could increase my athletic performance False. GHB is a depressant drug that decreases coordination and causes lethargy and sleepiness. In higher does it can cause overdose, especially if mixed with alcohol. 3. Taking cocaine decreases the ability to feel pain True. Cocaine has anaesthetic properties meaning a user is less likely to feel pain. This can make someone more likely to injure themselves or exacerbate an existing injury. Alcohol acts in a similar way. 4. Elite athletes are less likely to use illicit drugs True. Research shows that although approximately one third of elite athletes have been offered illicit drugs in the past year or had an opportunity to take them; they generally consume them at rates less than the general population. Source: Dunn et al., (2011) available here http://www.ncbi.nlm.nih.gov/pubmed/21219499. (Full text may not be available to all). 5. Mixing alcohol with energy drinks keeps you more sober and alert False. People often feel more sober when mixing alcohol and energy drinks as the energy drinks can mask the sedative effects of alcohol, which can lead to someone drinking more than they normally would. People who mix these two drugs perform just as badly as those who are only consuming alcohol on tasks of motor performance and concentration. 6. Women’s bodies are proportionally made up of more fat and less muscle than men’s True. This means they tend to have higher blood alcohol concentrations than men as alcohol does not absorb into fatty tissue. 7. Being hung-over decreases aerobic performance True. One particular study calculated this to be a reduction in aerobic performance of 11.4%. Source: O’Brien CP. (1993). Alcohol and sport: impact of social drinking on recreational and competitive sports performance. SportsMed, 15 (2): 71-7. 8. Ketamine is the most common drug used for drink spiking False. Alcohol is used in the majority of cases rather than the perceived GHB, Rohypnol or Ketamine (although such drugs may occasionally be used). 9. All over-the-counter medications such as Panadol are OK to take with alcohol, but prescription drugs should never be used while drinking False. The concurrent use of alcohol and medicines can be dangerous. The effectiveness of some medicines can be increased or reduced by alcohol. Medicines can also increase the effects of alcohol in the body. 10. Wine/champagne contains more alcohol by volume than beer True. Champagne and wine are usually about 11-12% alcohol by volume and beer about 3-5%. swimming.org.au 23 Appendix 3 – Additional information about illicit drugs Cannabis • Cannabis is the most commonly used of the illicit drugs and around one in three adults in Australia have tried it • It is usually smoked in joints (such as hand rolled cigarettes) or in bongs (glass, plastic or homemade devices with water to cool the smoke so it can be inhaled more deeply) • Users can feel euphoric, relaxed, tired, uncoordinated, or have red eyes and a dry mouth and throat. They may get ‘the munchies’ and crave sugary or fatty foods • Smoking cannabis can lead to many of the same problems as smoking tobacco such as increased risk of respiratory problems and cancers • It is associated with an increased risk of mental health problems such as depression and anxiety and can double the risk of developing schizophrenia • It is completely illegal in all of Australia and getting caught can lead to a criminal record or large fine For further information on cannabis click here: http://ncpic.org.au/workforce/alcohol-and-other-drug-workers/cannabis-information/factsheets/ How does Cannabis affect sporting performance? Immediate effects of cannabis include slower reaction times, decreased cardiac stroke volume, lack of motivation and reduced hand-eye coordination, all of which would make swimming increasingly difficult. It can also interfere with appetite and potentially affect nutrition and body mass in the longer term. As it is commonly smoked, respiratory problems are also apparent and these can reduce the body’s effectiveness in absorbing oxygen. Ecstasy • Approximately 10% of the Australian population over the age of 14 have used ecstasy at some point in their lives • Because its manufacture is illegal, other substances such as sugar, caffeine and potentially more harmful chemicals are added as ‘cutting agents’ to decrease costs • Dehydration is a risk when taking ecstasy as it is often taken in hot nightclub settings while sweating and dancing. This can lead to headaches, nausea, and even passing out • It is a stimulant drug that can prevent sleep and reduce appetite for up to a few days • Street names include pills, pingers, xtc and disco biscuits • It is associated with three phases — coming up (waiting for the drug to take full effect), plateau/peak phase (up to 4-6 hours where the user will have lots of energy and feel euphoric) and the ‘come-down’ (feeling restless, lethargic and agitated and having trouble sleeping which can last up to a few days) How does Ecstasy affect sporting performance? Ecstasy can increase wakefulness and prevent sleep for up to a few days. It also decreases appetite and increases dehydration. Combined, this can reduce energy levels and prevent optimal training and recovery. swimming.org.au 24 Cocaine • Cocaine, or coke as it is commonly known, is a stimulant and has a similar effect to amphetamines such as Speed and Ice, but produces a more intense effect and shorter ‘high’ depending upon dosage • Cocaine produces an intense ‘rush’ and users feel a sense of euphoria, alertness, sexual arousal, and increased confidence • Cocaine is relatively expensive compared to other illicit drugs and is short acting, therefore more money can be spent than was intended • It is particularly dangerous when mixed with alcohol as this produces a substance in the body known as Cocaethylene, which puts additional strain on the heart • Crack cocaine is a crystallised form of the drug that when heated makes a crackling sound. A user inhales the vapours produced • Cocaine is often snorted which can lead to nasal and septum damage and transmission of blood borne viruses if implements are shared For further Information on cocaine click here: http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/cocaine How does Cocaine affect sporting performance? Reduced appetite and reduced ability to sleep will both have flow-on effects for training and competing. Cocaine has some anaesthetic properties meaning a user is less likely to feel pain and can acquire an injury or exacerbate an existing one. Amphetamines/methamphetamines • Amphetamines and methamphetamines are classified as stimulants as they increase alertness and wakefulness. Once consumed, amphetamines and methamphetamines convert into the same substance in the body • Speed, Base and Ice are all stimulant drugs in increasing levels of purity or strength. Speed is approximately 10% pure Amphetamine, Base is around 15-20% pure Amphetamine and Ice is approximately 80-90% pure Amphetamine. Therefore Ice will have a much stronger effect on the user • Users of highly potent stimulants such as Ice can feel invincible and put themselves in risky situations such as walking in front of cars or becoming aggressive and getting into fights • These drugs can increase libido and their propensity to reduce inhibitions can mean safe sex is less likely to be practised • Health promotion deterrent campaigns for these drugs often focus on aged faces of users with scabs or people scratching at bugs under their skin (formication) For further information on ice click here http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/ice For further information on speed click here http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/speed How do Amphetamines affect sporting performance? Similar to Ecstasy, stimulant-based drugs are dehydrating by nature and their associated activities. They prevent sleep, reduce appetite and can increase the risk of injury due to altered perceptions and increased confidence. swimming.org.au 25 Gamma-hydroxybutyrate (GHB) • GHB (Gamma-hydroxybutyrate) is a depressant drug often popular in the dance and nightclub scene due to its stimulating, euphoric and aphrodisiac qualities. Its manufacture is variable so each dose can be unpredictable in potency and effects • GHB is nicknamed Liquid Ecstasy although has no relation to Ecstasy. It is also referred to as Fantasy, Grievous bodily harm, and the date rape drug as it is sometimes reportedly used in drink spiking situations • GHB is chemical in flavour and can intoxicate quickly • It is particularly dangerous when mixed with alcohol or other depressant drugs as this doubles the depressant effects on the central nervous system Click here for information from the Australian Drugs Foundation: http://www.druginfo.adf.org.au/drug-facts/ghb How does GHB affect sporting performance? GHB increases sleepiness and dizziness and decreases coordination, therefore it would not benefit athletic performance. Considering the environment it is often taken in; nightclubs or at dance events, a user could end up staying awake longer than intended and experience interrupted sleep patterns. At higher doses, GHB can lead to vomiting, sweating, hallucinations and blackouts. Hallucinogens • Hallucinogens include substances such as Magic Mushrooms, LSD and Ketamine and can produce feelings of trance-like states, excitability, euphoria, increased heart rate, insomnia, hallucinations and paranoia • Ketamine has been used in medical and veterinary settings as a short-acting anaesthetic and pain killer. The danger of using it recreationally is that someone may hurt themselves and not realise, thus causing injury or making an existing injury worse • People who use Ketamine can ‘fall into a k-hole’. The experience of being in a k-hole varies but generally involves being socially detached, having hallucinations and experiencing a distorted sense of time and space • Psilocybin is a chemical with hallucinogenic properties that is found in certain species of mushrooms colloquially referred to as ‘magic mushrooms’. They typically contain less than 0.5% Psilocybin, as well as trace amounts of Psilocin, another hallucinogenic substance. When consumed, Psilocybin is metabolised by the body into Psilocin • LSD refers to Lysergic Acid Diethylamide and is one of the most potent mood and perception altering drugs. Synthesised from Lysergic Acid, LSD is initially a clear or white crystalline substance. It is also odourless and soluble in water. LSD is highly potent and only very small doses are required to produce a hallucinogenic effect For further information on Hallucinogens click here: http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/ content/other3 How do hallucinogens affect sporting performance? Hallucinogens can induce fear and paranoia and altered perceptions of reality and therefore would not be beneficial to sporting performance. During the time of intoxication, which for LSD can last up to 12 hours, an athlete would not be eating and sleeping optimally which would have flow-on effect on training and performance. swimming.org.au 26 Appendix 4 – Summary information about the effects of alcohol and/or illicit drugs on sporting performance Included below is some summary information on how both alcohol and/or illicit drugs can affect sporting performance. References pertaining to the information below may be found above. Sports performance • Increase likelihood of ignoring injury warning signs e.g. pain (alcohol, cocaine) • Suppress appetite, affecting energy levels and ability to recovery optimally (stimulant-based drugs) • Increase appetite, affecting management of weight (cannabis, alcohol) • Increase injury recovery time (alcohol, potentially other illicit drugs) • Increase dehydration (alcohol, stimulant-based drugs) • Decrease the likelihood of carrying out appropriate recovery strategies (all drugs) • Chronic sleep problems (cannabis, stimulant-based drugs) • Reduce sensitivity to pain, potentially exacerbating injury (alcohol, cocaine) • Reduce ability to focus – poor sleep quality, moodiness, depression and anxiety (many drugs including alcohol) • Decrease energy levels, feelings of lethargy or exhaustion (many drugs in hang over or comedown phase) • Illicit drugs could also potentially benefit sporting performance by increasing short-term concentration, alertness and reaction times. For example, Amphetamines such as Speed could benefit a swimmer mentally and physically if the correct dose was taken at the right time. For this reason such drugs are banned within sports for ethical and health reasons. You may prefer to break down the effects of alcohol and other drugs on sporting performance into the following four categories- brain, body, nutrition and sleep. Brain Psychomotor skills particularly affected by alcohol: • Impaired reaction time • Impaired hand-eye coordination • Reduced focus and attention • Reduced motivation • Reduced accuracy • Impaired balance • Slower visual tracking and visual search Body Bodily functions particularly affected by alcohol: • Reduced pain sensations • Existing injuries exacerbated • Reduced athletic performance by 11.4% if training with a hangover • Decreased endurance • Delayed recovery from injuries • Slowed recovery from training • Testosterone production affected • Glycogen production in the liver affected • Impeded production of adenosine triphosphate (ATP) Nutrition • Excessive high calorie food consumption – cannabis ‘munchies’, alcohol associated eating • Deficiency in calorie consumption due to low appetite - unable to replenish glucose stores or provide the body with an energy source for training – ecstasy or amphetamines • Body composition changes leading to weight gain or loss • Increased dehydration risk – stimulant drugs and alcohol Sleep • • • Rapid Eye Movement (REM) sleep stage impeded Regular sleep patterns interrupted - alcohol or stimulant drugs swimming.org.au Shallow and inefficient sleep patterns - cannabis and alcohol 27 Appendix 5 - Participant Feedback Sheet Please take a few moments to answer the following questions about this education session. Your feedback will help in planning of future sessions. Thank you! YOU DO NOT NEED TO PUT YOUR NAME ON THIS SHEET Date of Attendance: ____________ Age______________ 1. How useful/relevant was the information presented in this education session? 1 2 3 Not at all 4 5 6 Somewhat 7 Extremely 2. Did your knowledge increase as a result of attending this session? 1 2 3 Not at all 4 5 6 Somewhat 7 Extremely 3. How would you rate the overall presentation of this education session? 1 Very poor 2 3 4 5 Average 4. What’s the most important/relevant point you will take away today? 5. What aspect/s of this session did you like? 6. Is there anything you would change about this education session? 7. Are there any other comments/feedback? swimming.org.au 6 7 Very good