In Brief: Alcohol use among adolescent athletes is fairly high, but the problem is complex. Young athletes may be more likely to abuse alcohol than their non-athlete peers and more likely to suffer behavioral and psychosocial consequences as a result of drinking. They are also more prone to binge drinking. Education and prevention strategies should focus on physiological, behavioral and psychosocial consequences. At this juncture, these problems must be confronted in an immediate fashion. They must in all instances be well documented, including first time episodes.
The problem of alcohol use among competitive athletes is complex, partly because of their high visibility. For years the media have regularly reported incidents involving high level athletes and their use of alcohol. Although some athletes have demonstrated that treatment and rehabilitation can be successful, too often alcohol use among athletes ends in tragedy.
Unfortunately, the consequences of alcohol use also extend to younger, less visible athletes, particularly to high school athletes who abuse alcohol through chronic overuse or heavy episodic drinking HED (five or more drinks at one sitting for men and women). Many high school coaches have had an unfortunate amount of experience with team cohesion and athletic relationships divided by alcohol use, resulting in less-than-optimal performance due to decreased interest and diminished team commitment. Others have had to deal with tragedies such as automobile accidents and other alcohol-related injuries and deaths.
In a survey of 215 high school athletic directors, 59% reported having personally encountered intoxicated student-athletes. They considered alcohol use to be a bigger problem among their players than the use of other drugs.
A review of alcohol use among high school and college athletes, as well as the clinical, physiological, psychosocial, and behavioral effects in these groups, can provide help in assessing the efficacy of education and prevention efforts and provide to team physicians, coaches, and athletic directors practical strategies for dealing with individual athletes.
In New York State the use of alcohol by student athletes has been well recorded by the American Athletic Institute. It begins at onset in 7th grade with 14.1% reporting alcohol consumption during the school year. This use progresses to 58.5% by 12th grade. It is understandably of concern that the use is associated with increasing amounts throughout high school, although the number of occasions per month remains relatively constant at five drinking episodes per month, which leads us to believe that it is for most once per week on the weekend. Nonetheless, this activity is against the law and dangerous, as alcohol has been linked to nearly all high risk behaviors and health crisis. When we combine this alcohol use with high risk behaviors normally experienced by youth, we greatly magnify the propensity for disaster and watch our young adolescents enter the ten most dangerous years of life, ages 14-24.
The “just do it” generation has been marketed to and it has indeed worked. Today’s athlete has assumed the adventurer/risk takers stance on how far to push their luck. Athletes have always portrayed the assumption of risk as behavior as usual. The recent onset of increases in pack mentality has certainly increased the problems and behaviors of concern we presently see. Even non risk takers boldly portray themselves as risk takers to fulfill a “wan-a-bee” identity.
The ripple effect of use spills over into all aspects of a young athlete’s life including social, personal, psychological, education al and legal.
Patterns and Prevention:
Below is a recap of points made on the nature and magnitude of alcohol use among high school and college athletes and how best to approach the problem.
Alcohol remains the most used and abused drug in America. Unfortunately, many of the users and abusers are high school students. According to AAI Surveys, 80+% of NY high school students, grades 9-12, indicate they have had at least one drink of alcohol during their lifetime. Results from the same survey indicate 52% reported having at least one drink in the last thirty days and 37% consumed five or more drinks in a row during the last thirty days!
Many national studies have reported that high school student-athletes drink alcohol at about the same rate as other high school students and some studies report slightly higher use by student-athletes. The latest AAI survey indicates 58.5% of NY high school student-athletes, grade 12, drank during the past year.
There are many reasons why student-athletes choose not to drink alcohol. Among those reasons are the values taught by their parents, the positive influence of their coaches and teammates, the possible negative effects on athletic performance, and the possibilities of penalties/sanctions if they're caught.
More than any other group of adolescents, we have a compelling reason for athletes not to drink, health and performance. Alcohol, a metabolic poison has only negative effects on all physiological parameters. This can be our initial rationale for non-use.
The following are some of the additional benefits for student-athletes who choose not to drink alcohol:
Billions of dollars are spent annually on alcohol marketing. Student-athletes receive many messages promoting their use of alcohol. Many of these messages are subtle hints that alcohol use will improve athletic ability, increase their chances of being successful in life, and make them more sexually attractive. It is impossible to stop this kind of advertising or to protect youth from it. It is possible for adults to counteract the promotion of alcohol by setting positive examples, using teachable moments, consistently enforcing rules, and learning how to respond when concerned about a student-athletes' behavior. All these efforts will greatly assist student-athletes in making difficult choices about the nonuse of alcohol.
A five year high school program to confront chemical health issues and impact the problems that face today’s athlete.
Why focus on the athlete?
High school sports do matter! High school athletics are an integral part of many communities throughout the United States. The local sports teams are the focal point of community life: it’s a source of pride, a spot for social gathering, and where initial perception of a community begins; because of this performance matters; the performance of the athletes as well as their behavior. The choice by student-athletes to use drugs greatly affects both of these domains. The athletes are usually the leaders in the school and the way the athletes go the school goes.
-Year #1 Pre Season Meetings for Entry Level Athletes and Parents
How school districts can establish mandatory seasonal meetings to discuss conditions for involvement, expectations, philosophy and what it means to be an athlete. This program allows you to impact the majority of your entire student body and most importantly the parents. Athletics is the largest target population that exists in any school.
-Year #2 Athletic Codes of Conduct Conditions for Involvement
The #1 issue reported by high school Athletic Directors is the problem of enforcing Codes of Conduct. This program helps schools to understand what a code is for, what it can impact and how to rewrite them for today’s athlete and the dilemmas they face. This program includes strategies for controlling adult fan/stakeholder behaviors of concern, parental issues, and the seven non-negotiable conditions for involvement to partake in high school sports. It also addresses the problem of modern day codes, which are reactive punishment based documents. Codes are re-written as proactive character based documents, taking us to a valuable paradigm shift, supporting our young athletes by telling them what we want them to do and our rationale for why, rather than telling them what we don’t want and what we will do to them, if they do.
The Life of an Athlete
Pure Performance; The Way to Success.
“The Proactive Approach to the Greatest Threat” document produced by AAI has presented a clear view of the effect of alcohol and marijuana on high school athletes. It has become widely viewed as an understandable and useful educational tool for coaches, parents and administrators to address the social drug issues with athletes concerning the detrimental effects on performance and health. It is important to realize that our concern for our athletes cannot be entirely focused on them, rather that all stakeholders must assume some level of concern, vigilance and responsibility if any prevention strategy is to impact their decisions. This is evident in our survey to parents and athletes in New York high schools which revealed that parents might not know as much about their own children as they think. We asked on matched sets of surveys to parents “does your son or daughter (athlete) drink alcohol?” 82% responded no… We then asked their child “have you consumed alcohol during this school year?” 52% responded yes. This information is shared to parents also in hopes that they might become concerned and more vigilant. The “greatest threat document” is widely accepted by parents as a useful starting point to address alcohol use.
While this information offers good reasons for young student-athletes to choose not to drink alcohol or use marijuana, the most compelling arguments against the use of alcohol by young people may come from parents, coaches, and other significant adult role models. Established relationships, mentoring and connecting with an adult has been shown to greatly influence the values and lifestyle development of adolescents.
AAI has researched this effect and the bullets are listed below:
Proven Scientific Facts:
(Up to 96 hours)
for hormone catalytic/conversion actions
Alcohol is a metabolic poison that crosses all barriers and affects all systems of the human physiology simultaneously
Education and Prevention Models and Theories
A variety of prevention and education models have been suggested to address alcohol abuse in adolescents, athletes and non-athletes a like (17). No one model has significant empirical data to support its exclusive use. Alternative approaches might be effective for different athletes.
Models based on social learning theory support a team approach to education and prevention that involves friends, other individuals, families, small groups, and communities providing positive and negative reinforcement for avoiding the hazards of drinking. These models also support the use of peers in media ads.
Cognitive dissonance theory emphasizes eliminating incongruence between adolescents' attitudes and behavior regarding alcohol use. Models based on this theory suggest using oral or written "inoculations" to establish or strengthen beliefs and attitudes about resisting drinking, which may be in conflict with another, more desirable goal. This may involve making a public commitment or private contract with friends to abstain from drinking. This approach is nearly universal on the high school level, where students and parent/guardians sign documents agreeing to certain behavioral standards.
Behavioral intention theory suggests that attitudes and beliefs predict behavior and emphasizes the need to disconnect perceived social norms in alcohol use from individual behavior. This approach makes use of data noted above suggesting that inflated perceptions of alcohol consumption by others may lead to increases in personal intake. The social norms theory in the athlete world is quite frankly a dead end, as research supports the fact that athlete use rates are rampant and non users are in the minority. In NY State for instance we might say 41.5% of student athletes don’t report use of alcohol during the school year. That statistic certainly would not portray a valuable positive social norm, rather it signals as young people often perceive most athletes party.
The health behavior approach to education and prevention combines information on the physical, psychological, social, and personal risks of alcohol use into a single program.
Finally, of particular importance in reducing alcohol use among athletes is the need for programs to account for the concept of thrill-seeking, in which athletes need new and stimulating experiences that can border on the dangerous or excessive, apparently for an adrenaline release.
All of these theories have been incorporated in various ways into pilot educational programs designed to reduce alcohol use among adolescents. Most have shown some benefit compared with historical controls although this approach to study design is methodologically weak. Some research has suggested that success can depend as much as anything on the name and face recognition and credibility of the staff responsible for counseling and educating, as well as their visibility at practice, in the locker room, and at events. We know quite well that the first established impact with this athlete populations is credibility, what have you done in sport. Quite simply athletes require that you walk the walk as well as talk the talk.
There are, however, problems with preventive approaches taken to date. While prevention efforts educate athletes about the hazards of alcohol use, the message may be diluted or contradicted in other ways. For example, drug testing programs in high schools (11% nationwide) or in NCAA universities may focus more on drugs such as marijuana, even though most athletic trainers believe that alcohol is the most abused drug. Random or mandatory testing is probably not helpful but deserves further, more controlled study, with a focus on the nature of follow-up and how positive tests are handled as well as examining the purpose of such testing. Is it to find student athletes who need help or as a deterrent for drug use. It is widely believed in athletics that at best drug testing is a mild deterrent.
Education versus Advertising
In addition, educational programs compete directly—and often unsuccessfully—with the association of sports and alcohol seen in advertising. A study by Slater et al provides an example of the influence of sports imagery on alcohol advertising. A sample of 157 white male public school junior and senior high students viewed 72 television advertisements and 24 television excerpts that highlighted the use of beer or another product, with or without sports involvement. The students responded more positively to beer ads with sports content than without sports content, as well as to non-beer ads with sports involvement. To think that the association between alcohol intake and sports is not influenced by alcohol advertising is naive.
The Life of an Athlete was developed by John Underwood, for initial use by the New York State Public High School Athletic Association. We have carried out extensive pilot work since 1999 in the area of student athletes and substance abuse.
This program evolved as a result of the frustration of utilizing an existing program that was based on pure prevention and had very little connection to athletics. Such programs were used for many years and had not evolved to even incorporate modern day prevention strategies.
This new approach “The Life of an Athlete”, initiated in 2002 targets male and female adolescent athletes, coaches, parents, athletic directors and communities. It is based on the realization that in order for an Interscholastic Athletic program to function, all stakeholders must take an active and vigilant role. The program itself begins at the beginning, working with modified age athletes (7th & 8th graders) and establishes a sound basis for participation in athletics, by setting the foundation for ownership, focus, dedication, purpose, goals, collective and personal responsibility. Establishing knowledge of athlete lifestyle is paramount in this program. Using a TEAM centered design to provide an atmosphere of normative expectations and subsequent personal and collective responsibility, Life of an Athlete, uses a highly scripted program that can be implemented through schools, recreation centers, community youth sport organizations for adolescent athletes. The content addresses etiologies and risks of substance use by young athletes and emphasizes both, the impact on personal and team performance as well as goals. The realization that “this is it” and that less than 2% of high school athletes go on to NCAA athletics, helps athletes stay focused. It also takes into consideration that less than 35% of high school athletes are concerned primarily with performance. (non-homogeneous population). The most significant role this program plays is that it focuses on the “many messengers with the same message approach” drawing in all stakeholders to take an active and vigilant part, collectively.
The Prevention Basis to Athlete Programs and Team Effectiveness
Social ecology theories begin with the premise that these assumptions are inherently false. Such theories postulate that instead of looking for causes within the individual, or even in the individual's way of interacting socially, we should focus on the social system itself and how that system affects individuals.
Clearly, some causes of substance abuse lie within the individual, and these should not be ignored. Social ecology theory, however, seeks causes primarily in the social environment. Consequently, efforts to modify use must focus on changing the person's environment rather than the person. For the central tenet of social ecology is that individual behaviors are mainly the result of socialization; to change the behavior, we must change the social institutions that shape it. (HANSEN)
When applied to alcohol and drug abuse, social ecology theory shifts attention to a different set of variables from those that most program developers typically deal with. Of particular interest from this perspective are variables like team culture, traditions, rituals, inter-team relationships (including power relationships), team value systems, and team social norms. Of lesser interest are variables such as personal belief, perception of risk, and intra-personal skills.
The strongest predictors of alcohol and drug abuse among high school or college athletes are social. Among high school and college athletes, for example, the social group dominates as the best predictor of substance use…
(other than previous drug use).
Athletes who take drugs usually do so in a social context of one kind or another. From such data, we may conclude that athletes use drugs primarily as a function of the social group with whom they interact. This principle applies directly to casual and experimental use and indirectly to addictive use of substances. Obviously, at some point in an addict's history, physiological and psychological effects drive use. (HANSEN) Adapted UNDERWOOD
If we hope to change a particular behavior (e.g., excessive use of alcohol), we must change the social context-the institution or group-that shapes the behavior. In other words, we must address the effects of social influence, within the team on the members of that team. (HANSEN) Adapted UNDERWOOD
The power of being on a team has a magnitude far greater than most peer associations, in that the amount of time spent in such close relationships, compounded by the pack mentality and goal cohesion exerts a pressure to follow social group norms despite personal values that may be in conflict with such decisions.
Within any team lies the power for good and bad…or positive or negative norms, behaviors and lifestyles. For example, positive team or individual values like focus, dedication and commitment, are components associated with team and individual effectiveness and both goal and social cohesion.
Looking for the positive lifestyle both on and off the field has been overlooked far too long. Today’s athlete must begin to think about what they are doing off the field that ruins what they are trying to do on the field. A four to six year window of opportunity in high school can pass by with the individual failingto realize their full athletic, academic or social potential due to the use of alcohol and other drugs.
It is specifically within the social group, then, that we can expect to find the causes of social alcohol and drug use. It is quite well established that groups have traditionally had a powerful influence on the behavior of their members…Especially teams. It is also quite well established that time spent in close association with peers has profound impact on group behaviors, especially when there is a strongly established pack mentality.
We first connect the traditional benefits of sport: commitment, focus, dedication, team work, loyalty, goals, to success beyond the playing field.
We then show athletes a picture of what is optimal performance.
This is accomplished by an educational component of physiologically based learning objectives, concerning high performance. We then establish clear goals for individuals and the collective group (team). Knowledge understanding and agreement of clear and consistent boundaries or social cohesion is controlled by a serious and well written code of conduct with seven non-negotiable standards.
These standards are universal and consequences for violations are immediate.
Finally, we show the physiological data that has been collected on the negative impact of social drug use on team and individual performance.
Dealing with Alcohol Abuse
Most athletes who abuse alcohol do not come to the attention of team physicians and/or athletic trainers, because of physiological or medical problems. At best, those who observe them on a day to day basis, i.e. coaches and teammates, are better positioned to recognize changes in behavior, appearance, attitude, temper, among other indicators of alcohol abuse. These red flags/alerts are often overlooked or dismissed in lieu of superior play or performance. Only when the change/event is of great magnitude i.e. criminal arrest, alcohol poisoning, assault, vandalism, etc. is the problem addressed. This is the failing of a system that both rationalizes and turns a blind eye to the suspicion of possible abuse and use itself.
Confronting the Behavior of Concern
There is a well-accepted approach to intervention that is similar for all alcohol abusers, athletes or not. The person who confronts the athlete should explain the motivation for doing so, be specific, describe the problems that have been observed, share personal reactions to the observed problems, listen to the athlete's explanation (which will almost certainly include significant denial and rationalization), and explain the desired behaviors and the potential consequences of noncompliance, being specific about the official sanctions involved.
A simple way to assess the depth of an athlete's alcohol problem is to ask him or her to compare the importance of sports involvement to the importance of alcohol. If he or she expresses any hesitation about being able to give up alcohol, even temporarily, or if alcohol comes close to sport in importance, achieving positive behavior change will likely be a significant problem.
Renewing Prevention Efforts
Alcohol use by high school and college athletes receives little attention compared with the use of other illicit drugs and performance enhancing drugs. Given the nature and magnitude of the problem, it deserves close attention and intervention where possible by physicians, trainers, counselors/ mental health specialists, coaches, and athletic directors.
Setting Positive Examples
Adults can set positive examples about alcohol use or nonuse by choosing not to use or setting personal guidelines for responsible use, such as using in moderation and when it is appropriate, and legal to do so. Approximately 1/3 of all adults abstain from the use of alcohol completely. By demonstrating abstinence as a choice, adults send the message that choosing not to use is an acceptable choice one can make throughout his or her life. Another 40% of adults use alcohol appropriately, moderately, and legally. These adults experience no problems through their use of alcohol. By making this choice they send the message that, if one does choose to drink, it should be done at the appropriate time and place, using moderate amounts safely, and legally.
No adult should use any drug while associated with any athletic venue.
Teachable moments are opportunities for coaches and other adults to use everyday situations and current events to teach adolescents positive messages about alcohol use or nonuse. When using teachable moments, remember, sixty one-minute messages are much more effective than one, sixty minute lecture!
The following are examples of teachable moments: 1) discussing how to celebrate victories without the use of alcohol, 2) reinforce the positive choices student-athletes make by not going to the parties where alcohol is present, 3) discuss the breaking of team rules and the effect it has on the entire team, 4) discuss some of the real consequences of alcohol use and also some of the reasons people choose to use.
Effective Codes of Conduct
The reason for developing a school's code of conduct is not to punish those who break the rules. A code of conduct, which is well thought out, clearly written, and effectively communicated in a variety of ways, sets behavioral standards to assist youth in making good decisions. It also sets the clear and consistent boundaries for your programs. The five essential elements to effective codes of conduct are:
Responding to Concerns
Coaches may choose not to become involved when concerned about a young person's behavior for a variety of reasons. Those reasons usually include:
When a significant adult fails to respond to a student-athlete's inappropriate behaviors that lack of response is often interpreted as a lack of caring or an acceptance of the behaviors.
In order to respond effectively when concerned about a student-athlete's behavior, a coach should observe and identify behaviors of concern, share concerns with the young person, uphold team expectations and rules, provide support by letting the person know you care about them, and know where to refer the person so they can receive the appropriate help.
The most successful approach is to ask individuals to buy into a group decision. This social ecology approach has helped this non-homogeneous high school population realize that social cohesion is the only way to both individual or team effectiveness. The Life of an Athlete program in NY State has started a five year pilot program. It is based on the premise that rather than attempting to control a group of individuals, ex. 40 football players, with 40 social workers, it is more effective to get the group to buy into a social norms agreement, i.e. “it is the same for all of us… it is what we agreed to and we are bound to it.”