Download Chapter 29: Additional Health Conditions

Chapter 24: Substance Abuse
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• 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
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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.”
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• 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
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• 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
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– 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
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• 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
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– 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
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• 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
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• 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
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• 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
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– 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
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• 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
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– 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
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• 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
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• 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)
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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
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• 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
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• 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)
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– 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
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– Nicotine is the addictive chemical in tobaccoone 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
–
–
–
–
–
–
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Bad breath
Stained teeth
Tooth sensitivity to heat and cold
Cavities and gum recession
Tooth bone loss
Leukoplakia
Oral and throat cancer
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– Major substance ingested is NNitrosonornicotine
• 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
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• 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
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• 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
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– 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
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• 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 selfawareness and judgment, slower thinking
and short attention span
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– 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
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• 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
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– 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
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• 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
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– 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
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• 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
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• Common signs & symptoms of illegal use
include
– Shakiness
– Rapid speech
– Rapid movements
– Difficulty sitting still
– Difficulty concentrating
– Lack of appetite
– Sleep disturbances
– Irritability
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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
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• 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
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