Addictive and Unhealthy Behaviors

Session Outline Eating Disorders Defining and Understanding Eating Disorders Prevalence of Eating Disorders in Sport Predisposing Factors Recognition and Referral of an Athlete With Eating Problems Dos and Don’ts for Dealing With Eating Disorders Preventing Eating Disorders in Athletes and Coaches (continued)

Session Outline (continued) Substance Abuse Prevalence of Substance Abuse in Sport Why Athletes and Exercisers Take Drugs Major Drug Categories and Their Effects Preventing and Detecting Substance Abuse (continued)

Session Outline (continued) Addiction to Exercise Defining Exercise Addiction Positive Addiction to Exercise Negative Addiction to Exercise Symptoms of Negative Addiction to Exercise Preventing Negative Addiction to Exercise (continued)

Session Outline (continued) Compulsive Gambling Prevalence of Sports Gambling Characteristics of Compulsive Gamblers Signs of Compulsive Gambling Gamblers Anonymous 20 Questions

Defining and Understanding Eating Disorders Anorexia nervosa A psychological disease characterized by an intense fear of becoming obese, a disturbed body image, a significant weight loss, the refusal to maintain normal body weight, and amenorrhea.

Characteristics of Anorexia Nervosa Weight loss to 15% below normal Intense fear of gaining weight or being fat, despite being underweight Disturbance in one’s experience of body weight, size, and shape Females: absence of at least three consecutive expected menstrual cycles (APA, 1994)

Understanding Anorexia Nervosa Anorexia is potentially deadly; it can lead to starvation and other medical complications such as heart disease. Affected individuals don’t see themselves as abnormal.

Defining and Understanding Eating Disorders Bulimia An episodic eating pattern of uncontrollable food bingeing followed by purging, characterized by an awareness that the pattern is abnormal, fear of being unable to stop eating voluntarily, depressed mood, and self-deprecation.

Understanding Bulimia Condition is severe but less severe than anorexia. Bulimia can lead to anorexia. Bulimic individuals are aware that they have a problem.

Characteristics of Bulimia Recurrent binge eating A sense of lacking control over eating behavior during the binges Engaging in regular self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain Average minimum of two binge-eating episodes a week for three months Persistent overconcern with body shape and weight (APA, 1994)

Prevalence of Eating Disorders in Sport Accurate assessment is difficult to achieve for a variety of reasons: Fear of being dropped from program Questionable accuracy of studies (assessment problem) and data must be viewed with caution

Research on the Prevalence of Eating Disorders in Sport Athletes appear to have a greater occurrence of eating-related problems (disordered eating) than does the general population. Female athletes, in general, report higher rates of eating disorders than male athletes, which is similar to rates for the general population. Athletes and nonathletes have similar eating-related symptoms. (continued)

Research on the Prevalence of Eating Disorders in Sport (continued) A significant percentage of athletes engage in pathogenic eating or weight loss behaviors (e.g., bingeing, fasting), although subclinical in intensity. Eating disorders and pathogenic weight loss techniques tend to have a sport- specific prevalence (e.g., among wrestlers vs. archers). (continued)

Research on the Prevalence of Eating Disorders in Sport (continued) Up to 66% of female athletes may be amenorrheic as compared to 2% to 5% of nonathletes. Although anorexia and bulimia are of special concern in sports emphasizing form (e.g., gymnastics, diving, and figure skating) or weight (e.g., wrestling), athletes with eating disorders have been found in a wide array of sports.

Predisposing Factors Weight restrictions and standards Coach and peer pressure Sociocultural factors Performance demands Judging criteria

Recognition and Referral of an Athlete With Eating Problems Be able to recognize the physical and psychological signs and symptoms of these conditions. If you suspect an eating disorder, make a referral to a specialist in the area.

Making Referrals A person who has a rapport with the individual should schedule a private meeting to discuss the matter. Emphasize feelings rather than directly focusing on eating behaviors. Be supportive and keep all information confidential. Make a referral to a specific clinic or person.

Physical Signs of Eating Disorders Weight too low Considerable weight loss Extreme fluctuations in weight Bloating Swollen salivary glands Amenorrhea (continued)

Physical Signs of Eating Disorders (continued) Carotinemia—yellowish palms or soles of feet Sores or calluses on knuckles or back or hand from inducing vomiting Hypoglycemia (low blood sugar) Muscle cramps Stomach complaints (continued)

Physical Signs of Eating Disorders (continued) Headaches, dizziness, or weakness from electrolyte disturbances Numbness and tingling in limbs from electrolyte disturbances Stress fractures (See “Physical and Psychological-Behavioral Signs of Eating Disorders” on p. 465 of text.)

Psychological–Behavioral Signs of Eating Disorders Excessive dieting Excessive eating without weight gain Excessive exercise that is not part of normal training program Guilt about eating Claims of feeling fat at normal weight despite reassurance from others (continued)

Psychological–Behavioral Signs of Eating Disorders (continued) Preoccupation with food Avoidance of eating in public and denial of hunger Hoarding food Disappearing after meals Frequent weighing Binge eating (continued)

Psychological–Behavioral Signs of Eating Disorders (continued) Evidence of self-induced vomiting Use of drugs such as diet pills, laxatives, and diuretics to control weight

Dos and Don’ts for Dealing With Eating Disorders Do get help and advice from a specialist. Do be supportive and empathetic. Do express concern about general feelings, not specifically about weight. Do make referrals to a specific person and, when possible, make appointments for the individual. (continued)

Dos and Don’ts for Dealing With Eating Disorders (continued) Do emphasize the importance of long-term good nutrition. Do provide information about eating disorders. (continued)

Dos and Don’ts for Dealing With Eating Disorders Don’t ask the athlete to leave team or curtail participation, unless so instructed by a specialist. Don’t recommend weight loss or gain. Don’t hold team weigh-ins. Don’t single out or treat the individual differently from other participants. (continued)

Dos and Don’ts for Dealing With Eating Disorders (continued) Don’t talk about the problem with nonprofessionals who are not directly involved. Don’t demand that the problem be stopped immediately. Don’t make insensitive remarks or tease individuals regarding their weight.

Preventing Eating Disorders in Athletes and Coaches Promote proper nutritional practices. Focus on fitness, not body weight. Be sensitive to weight issues. Promote healthy management of weight.

Substance Abuse 98% of elite athletes said they would take a banned performance-enhancing substance with two guarantees—they would not be caught and they would win. 60% said they would do so even if it meant they would die from the side effects.

Defining Substance Abuse Substance abuse A maladaptive pattern of psychoactive substance use indicated by one of two patterns of use: continued use despite knowledge of having a persistent or recurring social, occupational, psychological, or physical problem that is caused or exacerbated by use of the psychoactive substance; or recurrent use in situations in which the use is physically hazardous (e.g., driving). Some symptoms of the disturbance have persisted for at least one month or have occurred repeatedly over a longer period.

Defining Drug Addiction Drug addiction A state in which either discontinuing or continual use of a drug create an overwhelming desire, need, and craving for more of the substance.

Prevalence of Substance Abuse in Sports Accurate assessment is difficult to achieve because of the sensitive and personal nature of the problem.

Prevalence of Substance Abuse in Sports Most studies have focused on alcohol and steroid use: Alcohol use: 55% to 92% of high school athletes; 87% to 88% of college athletes. Performance-enhancing drugs: reported use by 5% of high school and college athletes (40 to 60% among elite athletes). A 2003 CDC study: 1 in 16 high school students used steroids.

Girls’ Steroid Use Traditionally, the use of performance- enhancing drugs such as steroids has been seen as predominantly a male domain. However, recent research has revealed that young girls (some as young as 9 years old) are using bodybuilding steroids—not necessarily to get an edge on the playing field but to get the toned, sculpted look of models and movie stars. (continued)

Girls’ Steroid Use (continued) About 5% of high school girls and 7% of middle school girls admit to trying anabolic steroids at least once with the use of the drugs rising steadily since In teenage girls, the side effects from taking male sex hormones can include severe acne, smaller breasts, deeper voice, excessive facial and body hair, irregular periods, depression, paranoia, and fits of anger dubbed "roid rage." Steroids also carry higher risks of heart attack, stroke, and some forms of cancer.

Why Athletes and Exercisers Take Drugs Physical reasons include wanting to enhance performance, rehabilitate injury, look better, and control appetite and lose weight.

Why Athletes and Exercisers Take Drugs Psychological reasons include wanting to escape from unpleasant emotions or stress, build confidence or enhance self-esteem, and seek thrills.

Why Athletes and Exercisers Take Drugs Social reasons include peer pressure and emulating athletic heroes.

Major Categories of Performance-Enhancing Drugs There are six major categories: 1. Stimulants 2. Narcotic analgesics 3. Anabolic steroids 4. Beta-blockers 5. Diuretics 6. Peptide hormones and analogues (See table 20.1 on p. 478 of text.)

Common Side Effects of Recreational Drugs Mood swings Distorted vision Decreased reaction time Changes in blood pressure (See Common Recreational Drugs and Their Side Effects on p. 479 of text.)

Preventing and Detecting Substance Abuse Key Only specially trained professionals work in drug treatment programs. However, fitness professionals play a major role in prevention and detection.

Reducing the Probability of Substance Abuse (Prevention) Change in behavior (lack of motivation, tardiness, absenteeism) Change in peer group Major change in personality Major change in performance (academic or athletic) Be aware of the warning signs of substance abuse: (continued)

Reducing the Probability of Substance Abuse (Detection) (continued) Apathetic or listless behavior Impaired judgment Poor coordination Poor hygiene and grooming Profuse sweating Muscular twitches or tremors Be aware of the warning signs of substance abuse:

Reducing the Probability of Substance Abuse (Prevention) Provide a supportive environment (address the reasons that individuals take drugs). Educate participants about the effects of drug use. Inform participants that performance- enhancing drugs amount to cheating and unfair competition to enhance athletes’ morality. (continued)

Reducing the Probability of Substance Abuse (Prevention) (continued) Set good examples. Teach coping skills.

Drugs in Sport Decision Model (DSDM) The DSDM states that individuals conduct a cost–benefit analysis of the consequences of lawbreaking behavior before deciding to break a law. The DSDM consists of three major components: 1. The costs of a decision to use 2. The benefits associated with using 3. Specific situational factors that may affect the cost–benefit analysis of using

Drugs in Sport Decision Model (DSDM) Costs Legal sanctions (fines, suspensions, jail time Social sanctions (disapproval, criticism by important others, material loss) Self-imposed sanctions (guilt, reduced self- esteem) Health concerns (negative side effects)

Drugs in Sport Decision Model (DSDM) Benefits Material (prize money, sponsorship, endorsements, contracts) Social (prestige, glory, acknowledgment by important others) Internalized (satisfaction of high achievement)

Drugs in Sport Decision Model (DSDM) Situational variables Perceptions of prevalence (how frequently others use this drug) Experience with punishment and punishment avoidance Professional status (how much money and status might be lost) Perception of authority legitimacy (can the agency enforce the law?) Type of drug (its effects and side effects)

Addiction to Exercise Exercise addiction: A psychological or physiological dependence on a regular regimen of exercise that is characterized by withdrawal symptoms after 24 to 36 hours without exercise Positive addiction to exercise: A condition in which exercise is viewed as important in one’s life but is successfully integrated with other aspects of life (healthy habit) Negative addiction to exercise: A condition in which life becomes structured around exercise to such an extent that home and work responsibilities suffer

Symptoms of Negative Addiction to Exercise Stereotyped pattern of exercise with a regular schedule of once or more daily Giving increased priority, over other activities, to maintaining the pattern of exercise Increased tolerance to the amount of exercise performed Withdrawal symptoms related to mood disorder after cessation of the exercise (continued)

Symptoms of Negative Addiction to Exercise (continued) Relief of withdrawal symptoms by further exercise Subjective awareness of a compulsion to exercise Rapid reinstatement of the previous pattern of exercise and withdrawal symptoms after a period of abstinence

Preventing Negative Addiction to Exercise Schedule rest days. Work out regularly with a slower partner. If you’re injured, stop exercising until healed. Train hard–easy: Mix in low intensity and less distance with days of harder training. If interested in health aspect, exercise three or four times a week for 30 minutes. Set realistic short- and long-term goals.

Compulsive Gambling Compulsive gambling, despite its long history in competitive sport, is only now getting public attention. Gambling on sporting events is widespread.

Prevalence of Compulsive Gambling 72% of NCAA Division I football and basketball athletes engage in some form of gambling. 12% of male and 3% of female college athletes have problematic/pathological gambling problems. 6% to 8% of college students are compulsive gamblers.

Prevalence of Compulsive Gambling A 2003 NCAA study showed that 35% of male athletes and 10% of female athletes bet on college sports, and approximately 60% of NCAA Division I and 40% of Division III athletes did not know the NCAA rules about gambling. 6% to 8% of college students are compulsive gamblers. Gambling by high school students is thought to be widespread.

Typical Parental Reactions to Teenage Gambling Feel fear; imagine organized crime is involved Think they can handle it (most common reaction) Think, Thank God, it’s not drugs.

Characteristics of Compulsive Gamblers Boastfulness Arrogance Optimism External competitiveness Intelligence

Signs of Compulsive Gambling Keys Identification is next to impossible. Use the following Gamblers Anonymous 20 Questions for self-identification. Sport psychology professionals should make referrals when negative consequences appear.

Gamblers Anonymous 20 Questions 1.Did you ever lose time from work or school due to gambling? 2.Has gambling ever made your home life unhappy? 3.Did gambling affect your reputation? 4.Have you ever felt remorse after gambling? 5.Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties? (continued)

Gamblers Anonymous 20 Questions (continued) 6.Did gambling cause a decrease in your ambition or efficiency? 7.After losing, did you feel you must return as soon as possible and win back your losses? 8.After a win, did you have a strong urge to return and win more? 9.Did you often gamble until your last dollar was gone? (continued)

Gamblers Anonymous 20 Questions (continued) 10.Did you ever borrow to finance your gambling? 11.Have you ever sold anything to finance gambling? 12.Were you reluctant to use “gambling money” for normal expenditures? 13.Did gambling make you careless of the welfare of yourself or your family? 14.Did you ever gamble longer than you had planned? (continued)

Gamblers Anonymous 20 Questions (continued) 15.Have you ever gambled to escape worry or trouble? 16.Have you ever committed, or considered committing, an illegal act to finance your gambling? 17.Did gambling cause you to have difficulty in sleeping? (continued)

Gamblers Anonymous 20 Questions (continued) 18.Did arguments, disappointments, or frustrations create within you an urge to gamble? 19.Did you ever have an urge to celebrate any good fortune with a few hours of gambling? 20.Have you ever considered self- destruction as a result of your gambling?