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Substance Abuse Concerns for Athletes After Injury

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concerns for athletes and substance abuse post injury

Addiction does not discriminate. While the physical skill and discipline of athletes bring them praise, even they are not immune to the ravages of substance abuse. Whether an athlete’s status is student, professional, or even retiree, a drug problem can strike at any time. For this reason, public awareness cannot focus solely on professional athletes in their prime.

Prescription Addiction in Young Athletes

According to the National Council on Alcoholism and Drug Dependence, a study involving 2,300 high school students found that 12 percent of male teen athletes and eight percent of female teen athletes reported using prescription painkillers in the prior year. Compared to prior survey years, the abuse levels had increased. Further, it appears that substance abuse in general has a specific link with the high school athletic community as the study discovered that teen athletes abuse drugs more often than their classmates who did not participate in sports.1

This finding is surprising because it undermines the assumption that teen athletes are among the healthiest high schoolers. In fact, the demands of the sport, and the popularity it brings, could be factors that actually encourage drug abuse. Heightened awareness of prescription drug addiction in schools is paramount for the well-being of young players and the sports industry because the teen athletes of today are the parents, spouses, and professionals of tomorrow.

Prescription Addiction in Professional Athletes

Pro football playersIt may be surprising that athletes who prize their physical prowess and acumen can become addicted to drugs or alcohol. However, an understanding as to how athletes often start abusing substances reveals how uniquely vulnerable the athletic community is to addiction.

Addiction in athletes usually begins with a legitimate prescription for sports-related injuries. But even so, why don’t athletes just quit taking prescription pharmaceuticals when their injuries heal? Factors that may lead athletes to abuse prescriptions are the intensity and competitiveness of sports in general. Further, athletes may underreport pain to their doctors and not allow their injuries sufficient time to heal. Many athletes will forego their health and risk the negative side effects of substance use just to stay in the game.2

Erik Ainge, former backup quarterback for the New York Jets, sat out the entire 2010 football season as he recovered from a pain killer addiction that started after an injury.2

While Vicodin and OxyContin are among the most commonly abused prescription painkillers, athletes are also susceptible to stimulant abuse. Ritalin and Adderall are among the most commonly abused prescription stimulants. Some athletes will feign symptoms of attention deficit hyperactivity disorder (ADHD) to get prescriptions without understanding the dangers of stimulants or the strain these medications place on the heart. Although drug-seeking behavior is banned across the world of sports, a complete ban cannot be placed on stimulant amphetamine prescriptions because some players legitimately need these drugs.

One of the greatest challenges that prescription pill abuse poses, in general, is that these substances can have legitimate, therapeutic effects. The problem is that these prescriptions are often misused for their temporary effects.

While athletics are rewarding, many professional athletes are pressed into volatile and aggressive competition of the professional sports industry. There are several social and neurobiological factors at play which set up athletes to fall down the slippery slope of drug abuse, including:

  • Addiction to exercise. Exercise causes the release of the neurotransmitter dopamine in the brain, which can stimulate a pleasurable effect similar to that of drug use. The danger then becomes that when players leave sports, they begin to abuse drugs as a substitute for the excessive exercise during their careers.
  • Intense training. The tough training athletes endure may prime their brain for addiction. As the brain habituates to the pleasurable endorphins released during training, stopping the training can lead to withdrawal symptoms including anxiety and depression. The danger is that athletes may turn to drugs to cope with these symptoms.
  • Stress of the sport. Coaches, fans, family, friends, and the athlete often lay high expectations on performance. The pressure can result in depression and anxiety. The athlete may then seek relief in alcohol or illicit substances.
  • Primacy of the game. However illegal and unprofessional, inside reports on the sports industry suggest that sports organizations may not only look the other way on performance-enhancing drug abuse but encourage it. Athletes are often, regrettably, subject to the short-term win and profit goals of the sports world, which may not have the player’s health and long-term best interests at heart.2

In a hopeful future, research and awareness of prescription drug abuse and addiction will continue to grow, and information and resources may trickle down to prevent prescription drug abuse in teen, college, semi-professional, and even amateur athletes. As the media attaches to high-profile cases, more professional athletes may come forward to share their stories of addiction, and more light can be shed on this problem.

Prescription Addiction in Retired Athletes

Retired athletes potentially provide a wealth of first-hand knowledge of drug use in the sports industry because any code of silence that may have existed during their active years will likely be broken in their retirement. This group is also uniquely situated to illuminate the negative long-term effects and diminished quality of life which prescription drugs can have on elite athletes. Retirees who voice the dangers of the profession may help improve conditions for future generations of athletes.

In 2009, Sam Rayburn, former defensive tackle for the Philadelphia Eagles, was taken into police custody for committing fraud or forgery to illegally obtain a controlled substance. The arrest revealed that he had a painkiller addiction that at its height reached 100 Percocets per day.2

A Washington University, St. Louis study of 644 NFL players who retired between 1979 and 2006 tracked the players’ use of prescription drugs including oxycodone, codeine, and Vicodin. The study found that while approximately 52 percent of the retired NFL players reported using prescription painkillers during their careers, 71 percent of this group admitted they had misused those drugs. Further, 68 percent of those who had reported prescription drug use reported that they did not get these drugs from doctors, but unregulated sources such as coaches, trainers, fellow players, and the Internet.3

The study also found that abuse of prescription drugs during the active professional year disposed players to abuse pharmaceuticals in retirement. Approximately 15 percent of the NFL players who misused prescription medications while on the field kept up the practice in retirement. Overall, an NFL athlete who abused prescription drugs while active in the league was three times more likely to continuing doing so compared to players who had never partaken.3

Although prescription drugs may help athletes with pain management in the short term, research shows that pharmaceutical use can have the long-term effect of keeping the player hooked.

The physical wear and tear of athletic life can have a devastating impact not only on an athlete’s mental health, but also the brain itself. For instance, a growing body of neurological research supports that trauma to the brain – such as NFL concussions – can alter the structure of the brain and then predispose the player to depression, lack of focus and even suicide.4

Additional concerns about the mental health of athletes may occur when a player retires. Separation from career can trigger drug abuse, as retirees may experience a loss of identity, financial problems arising from a drop in income, and a lack of understanding as to how to manage life outside of the game. While all athletes retire at some point, it may impossible to take sports out of the athlete, which can understandably cause athletes serious emotional stress and suffering.

According to the Substance Abuse and Mental Health Services Administration, one in five adults faced mental illness in 2011.

Although athletes are accustomed to praise, athletes suffering from mental illness may face social stigma. The American Psychiatric Association, in an effort to address any stigma against mental illness in athletes, advises players and the public that:

  • Mental illness in athletes is no more common than in the population at large.
  • Getting help from qualified professionals can improve mental health.
  • Mental illness is not a matter of mental weakness, but is as important to health as any serious physical injury; for instance, people aren’t criticized for breaking an arm or having diabetes, similarly, they shouldn’t be faulted for suffering from disorders like depression.
  • The specific challenges and pressures of sports uniquely predispose athletes to mental health issues like depression and anxiety.5

“In the NFL, they will not tell you to stop playing if you get an injury, writes Ken W. for Heroes in Recovery. “It’s up to you to tell. If you do quit playing, you are liable to get cut. We, as athletes, go to any length to numb it, take whatever we can to get back out there on the field. I had over 15 concussions and seven surgeries in my nine years in the NFL. I had always that fear in me; it was a fear that killed me and a fear that drove me.

“…It got better for me. I needed people that had done it before me, who could show me how to do it, and show me how to apply it to my life. I have an accountability partner, a strong family, and a strong group of friends behind me today. My friends today are a group of solid people that share the same passions as I, and that is the love for recovery.”

Prescription Addiction Treatment in Athletes

RivitrolTreatment for painkiller addiction in the general population can be tailored to athletes. Intake usually begins with a sensitive and extensive intake process that includes diagnostics to determine the athlete’s specific level of addiction and overall state of health.

This assessment is important because the withdrawal phase from any drug can be acutely uncomfortable and trigger a relapse. For this reason, it is advisable that athletes seeking recovery have a medically supervised detox, overseen by consulting physicians, which can keep the addicted athlete on the track to recovery and safely treat withdrawals.

For instance, withdrawal symptoms from opioid painkillers substances may include:

  • Agitation
  • Strongly negative mood
  • Abdominal pain
  • Flu-like symptoms
  • Body aches
  • Enlarged pupils
  • Nausea and vomiting
  • Anxiety and panic

In some cases, athletes who have become dependent on opioid painkillers benefit from medication assistance during withdrawal. Treatments to ease pain and anxiety may help through this difficult phase. While not for everyone, some people use medications such as buprenorphine or naloxone to ward off withdrawal symptoms. Suboxone benefited 49 percent of participants in a study of 600 prescription opiate users.6

The abuse of prescription painkillers is 20 times more common than heroin abuse. Fifty percent more Americans seek help for a prescription drug addiction than for heroin addiction.6

As with recovery from many different types of drugs, psychotherapy is a critical component to prescription painkiller recovery and treatment. Licensed, dedicated programs like the program at Michael’s house will provide experienced and credentialed therapists who can help.

While some athletes in recovery also join a 12-Step program – a kind of group therapy – one-on-one counseling is also highly beneficial. There are different forms of psychotherapy in use in addiction treatment, including cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing therapy, and interpersonal therapy.

The individualized care of one-on-one counseling will help the athlete gain coping skills and strength. Once an addiction has begun, any athlete can benefit from the self-reflection and confidence re-building that therapy provides. Athletes may enjoy therapy and find that they:

  • Develop insight into specific problems and determine how these problems occurred and ways to successfully resolve them in the future without resorting to drug use
  • Review negative thought patterns and challenge them so that they don’t take center stage in the decision-making process
  • Understand how coping with stress and life situations through counterproductive actions is unhealthy and develop healthy new strategies for stress management
  • Use the healthy relationship developed with the therapist (and sometimes group therapy members) as a model for trust and stable communications in other relationships

Addiction does not have to signal an end of an athletic career. Treatment offers recovery, and also skills and tools to resume one’s sporting career with greater mindfulness. The goal is not only to avoid the pitfalls of addiction, but to avoid self-abuse in general.

Success in Recovery: The Ray Lucas Story

Ray Lucas, a former NFL quarterback, encountered financial ruin over an opioid addiction that hit a high of 800 pills per month when he was at his lowest. Lucas was a player known for exposing himself to hard tackles in the interest of the game. In fact, this tough behavior endeared him to New York fans when he played for the New York Jets. But the pain inflicted through his tough sportsmanship resulted in him taking prescription pain killers at increasingly alarming rates over his eight-year career in the NFL and then continuing to do so even after he retired.

After Lucas left the NFL and had his first back surgery, he assumed he could discontinue his use of prescription opioids. He was wrong. The withdrawal symptoms, which sent him to the ground sweating and shivering, caused him to relapse. Eventually, his out-of-pocket expenses for prescription opioids ran up to $2,500 per month, and Lucas lost his home, business, much of his body mass, and even his ability to look in the mirror. Although Lucas became a television sports analyst, his addiction continued, and he even contemplated suicide. Faced with an ultimatum from his wife (“go to rehab or get a divorce”), Lucas entered a 42-day program. Lucas has been drug-free since 2010, but says that he will always have to remain vigilant to stay clean.7

Anecdotal evidence of recovery is helpful to put a face and a story to painkiller addiction among athletes. Ray Lucas demonstrates that addiction does not have to start with an intention to abuse drugs. Further, though prescription opioids can instigate a downward spiral, recovery can provide a new lease on life that allows the athlete to choose the terms.

If you or an athlete in your life has been struggling with substance use, please give us a call at 760.548.4032. We work with athletes from all backgrounds, and our dedicated recovery professionals can help you get back in the game with a healthier outlook.


1 Denham, B. High School Sports Participation and Substance Use: Differences by Sport, Race, and Gender. Journal of Child & Adolescent Substance Abuse. Volume 23, Issue 3. May 2014.

2 Sack, D. "Are Athletes Primed for Prescription Drug Addiction?" PsychCentral. 23 Aug 2012.

3 Melnick, M. Study: Former NFL Players Are Popping Painkillers and in ‘Poor Health. Time. 28 Jan 2011.

4 Firestone, L. The Price of Being Strong: Risks to the Mental Health of Athletes. PsychAlive. Accessed 20 Jan 2018.

5 Clay, R. A New NFL Playbook: Enhancing Mental Health. American Psychological Association. 2017 Jan.

6 Bobinchock, A. Effective Treatment of Painkiller AddictionHarvard Gazette. 8 Nov 2011.

8 Jaslow, R. Former NFL quarterback Ray Lucas hopes story of painkiller addiction will lead others to get help. CBS News. 20 Aug 2013.