Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 151 No. 0708 (2021)

Use of psychotropic substances among elite athletes – a narrative review

DOI
https://doi.org/10.4414/smw.2021.20412
Cite this as:
Swiss Med Wkly. 2021;151:w20412
Published
20.02.2021

Summary

BACKGROUND AND AIMS

Elite athletes may use psychotropic substances for recreational reasons, (perceived) performance enhancement or self-medication. Causes can overlap. For athletes, substance use may be associated with various medical and social risks. Psychoactive substances include alcohol and nicotine, illicit and various prescription drugs, which all have a potential for abuse and dependence. This paper reviews the existing literature on the use of psychoactive substances and associated substance use disorders among elite athletes in terms of prevalence, patterns of use, as well as underlying causes and risk factors.

METHODS

Due to the heterogeneous and partially fragmentary study data, a narrative approach with selection of applicable publications of a Medline search was chosen.

RESULTS

The most commonly used psychoactive substances among elite athletes were alcohol, nicotine, cannabis, stimulants and (prescription) opioids. Overall consumption rates are lower in professional sports than in the general population, but use of several substances (smokeless tobacco products, prescription opioids, stimulants) have high prevalence in specific sports and athlete groups. Substance use is subject to multiple risk factors and varies by substance class, sport discipline, country and gender, among other factors.

CONCLUSION

Knowledge on the underlying causes and patterns of substance use, as well as the prevalence of substance use disorders in professional sports, is still limited. High prevalence of various substances (i.e., nicotine, prescription opioids) may indicate potentially harmful patterns of use, requiring further research. Specific preventive and therapeutic concepts for the treatment of substance use disorders in elite athletes should be developed.

References

  1. Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53(11):667–99. doi:.https://doi.org/10.1136/bjsports-2019-100715
  2. Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Med. 2016;46(9):1333–53. doi:.https://doi.org/10.1007/s40279-016-0492-2
  3. Hughes L, Leavey G. Setting the bar: athletes and vulnerability to mental illness. Br J Psychiatry. 2012;200(2):95–6. doi:.https://doi.org/10.1192/bjp.bp.111.095976
  4. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–64. doi:.https://doi.org/10.1097/YCO.0b013e32816ebc8c
  5. Merikangas KR, McClair VL. Epidemiology of substance use disorders. Hum Genet. 2012;131(6):779–89. doi:.https://doi.org/10.1007/s00439-012-1168-0
  6. Buckman JF, Yusko DA, White HR, Pandina RJ. Risk profile of male college athletes who use performance-enhancing substances. J Stud Alcohol Drugs. 2009;70(6):919–23. doi:.https://doi.org/10.15288/jsad.2009.70.919
  7. Gil F, de Andrade AG, Castaldelli-Maia JM. Discussing prevalence, impacts, and treatment of substance use disorders in athletes. Int Rev Psychiatry. 2016;28(6):572–8. doi:.https://doi.org/10.1080/09540261.2016.1212821
  8. Reardon CL, Creado S. Drug abuse in athletes. Subst Abuse Rehabil. 2014;5:95–105. doi:.https://doi.org/10.2147/SAR.S53784
  9. Markser VZ. Sport psychiatry and psychotherapy. Mental strains and disorders in professional sports. Challenge and answer to societal changes. Eur Arch Psychiatry Clin Neurosci. 2011;261(Suppl 2):S182–5. doi:.https://doi.org/10.1007/s00406-011-0239-x
  10. Sarkar M, Fletcher D. Psychological resilience in sport performers: a review of stressors and protective factors. J Sports Sci. 2014;32(15):1419–34. doi:.https://doi.org/10.1080/02640414.2014.901551
  11. Arnold R, Fletcher D. A research synthesis and taxonomic classification of the organizational stressors encountered by sport performers. J Sport Exerc Psychol. 2012;34(3):397–429. doi:.https://doi.org/10.1123/jsep.34.3.397
  12. Kontro TK, Sarna S, Kaprio J, Kujala UM. Use of Alcohol and Alcohol-Related Morbidity in Finnish Former Elite Athletes. Med Sci Sports Exerc. 2017;49(3):492–9. doi:.https://doi.org/10.1249/MSS.0000000000001137
  13. Grossbard J, Hummer J, LaBrie J, Pederson E, Neighbors C. Is Substance Use a Team Sport? Attraction to Team, Perceived Norms, and Alcohol and Marijuana Use Among Male and Female Intercollegiate Athletes. J Appl Sport Psychol. 2009;21(3):247–61. doi:.https://doi.org/10.1080/10413200903019145
  14. Tamminen KA, Holt NL. Adolescent athletes’ learning about coping and the roles of parents and coaches. Psychol Sport Exerc. 2012;13(1):69–79. doi:.https://doi.org/10.1016/j.psychsport.2011.07.006
  15. World Anti-Doping Agency (WADA). 2019 WADA Prohibited List. Available at: https://www.wada-ama.org/sites/default/files/wada_2019_english_prohibited_list.pdf. Published 2019 [accessed 2020 May 2].
  16. World Anti-Doping Agency (WADA). 2017 Anti-Doping Testing Figures. Available at: https://www.wada-ama.org/sites/default/files/resources/files/2017_anti-doping_testing_figures_en_0.pdf. Published 2018 [accessed 2020 May 2].
  17. Benowitz NL. Nicotine addiction. N Engl J Med. 2010;362(24):2295–303. doi:.https://doi.org/10.1056/NEJMra0809890
  18. Severson HH, Forrester KK, Biglan A. Use of smokeless tobacco is a risk factor for cigarette smoking. Nicotine Tob Res. 2007;9(12):1331–7. doi:.https://doi.org/10.1080/14622200701705209
  19. Šaranović SĐ, Vićić J, Pešić I, Tomović M, Batinić Đ, Antić M, et al. The Influence of Tobacco Use on Pulmonary Function in Elite Athletes. Int J Environ Res Public Health. 2019;16(19):3515. doi:.https://doi.org/10.3390/ijerph16193515
  20. Severson HH, Klein K, Lichtensein E, Kaufman N, Orleans CT. Smokeless tobacco use among professional baseball players: survey results, 1998 to 2003. Tob Control. 2005;14(1):31–6. doi:.https://doi.org/10.1136/tc.2004.007781
  21. Alaranta A, Alaranta H, Patja K, Palmu P, Prättälä R, Martelin T, et al. Snuff use and smoking in Finnish olympic athletes. Int J Sports Med. 2006;27(7):581–6. doi:.https://doi.org/10.1055/s-2005-865826
  22. Martinsen M, Sundgot-Borgen J. Adolescent elite athletes’ cigarette smoking, use of snus, and alcohol. Scand J Med Sci Sports. 2014;24(2):439–46. doi:.https://doi.org/10.1111/j.1600-0838.2012.01505.x
  23. Marclay F, Saugy M. Determination of nicotine and nicotine metabolites in urine by hydrophilic interaction chromatography-tandem mass spectrometry: Potential use of smokeless tobacco products by ice hockey players. J Chromatogr A. 2010;1217(48):7528–38. doi:.https://doi.org/10.1016/j.chroma.2010.10.005
  24. Marclay F, Grata E, Perrenoud L, Saugy M. A one-year monitoring of nicotine use in sport: frontier between potential performance enhancement and addiction issues. Forensic Sci Int. 2011;213(1-3):73–84. doi:.https://doi.org/10.1016/j.forsciint.2011.05.026
  25. Mündel T. Nicotine: Sporting Friend or Foe? A Review of Athlete Use, Performance Consequences and Other Considerations. Sports Med. 2017;47(12):2497–506. doi:.https://doi.org/10.1007/s40279-017-0764-5
  26. Zandonai T, Chiamulera C, Mancabelli A, Falconieri D, Diana M. A Preliminary Investigation on Smokeless Tobacco Use and Its Cognitive Effects Among Athletes. Front Pharmacol. 2018;9:216. doi:.https://doi.org/10.3389/fphar.2018.00216
  27. Russell C, Rueda S, Room R, Tyndall M, Fischer B. Routes of administration for cannabis use - basic prevalence and related health outcomes: A scoping review and synthesis. Int J Drug Policy. 2018;52:87–96. doi:.https://doi.org/10.1016/j.drugpo.2017.11.008
  28. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456–73. doi:.https://doi.org/10.1001/jama.2015.6358
  29. Brisola-Santos MB, Gallinaro JG, Gil F, Sampaio-Junior B, Marin MC, de Andrade AG, et al. Prevalence and correlates of cannabis use among athletes-A systematic review. Am J Addict. 2016;25(7):518–28. doi:.https://doi.org/10.1111/ajad.12425
  30. Lisha NE, Sussman S. Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: a review. Addict Behav. 2010;35(5):399–407. doi:.https://doi.org/10.1016/j.addbeh.2009.12.032
  31. Yusko DA, Buckman JF, White HR, Pandina RJ. Alcohol, tobacco, illicit drugs, and performance enhancers: a comparison of use by college student athletes and nonathletes. J Am Coll Health. 2008;57(3):281–90. doi:.https://doi.org/10.3200/JACH.57.3.281-290
  32. Peretti-Watel P, Guagliardo V, Verger P, Pruvost J, Mignon P, Obadia Y. Sporting activity and drug use: Alcohol, cigarette and cannabis use among elite student athletes. Addiction. 2003;98(9):1249–56. doi:.https://doi.org/10.1046/j.1360-0443.2003.00490.x
  33. Buckman JF, Farris SG, Yusko DA. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug Alcohol Depend. 2013;131(1-2):50–5. doi:.https://doi.org/10.1016/j.drugalcdep.2013.04.023
  34. Kennedy MC. Cannabis: Exercise performance and sport. A systematic review. J Sci Med Sport. 2017;20(9):825–9. doi:.https://doi.org/10.1016/j.jsams.2017.03.012
  35. Ware MA, Jensen D, Barrette A, Vernec A, Derman W. Cannabis and the Health and Performance of the Elite Athlete. Clin J Sport Med. 2018;28(5):480–4. doi:.https://doi.org/10.1097/JSM.0000000000000650
  36. Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Cannabis use in active athletes: Behaviors related to subjective effects. PLoS One. 2019;14(6):e0218998. doi:.https://doi.org/10.1371/journal.pone.0218998
  37. Somogyi AA, Barratt DT, Coller JK. Pharmacogenetics of opioids. Clin Pharmacol Ther. 2007;81(3):429–44. doi:.https://doi.org/10.1038/sj.clpt.6100095
  38. Hainline B, Turner JA, Caneiro JP, Stewart M, Lorimer Moseley G. Pain in elite athletes-neurophysiological, biomechanical and psychosocial considerations: a narrative review. Br J Sports Med. 2017;51(17):1259–64. doi:.https://doi.org/10.1136/bjsports-2017-097890
  39. Warden SJ. Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes. Br J Sports Med. 2009;43(8):548–9. doi:.https://doi.org/10.1136/bjsm.2008.056697
  40. Zideman DA, Derman W, Hainline B, Moseley GL, Orchard J, Pluim BM, et al. Management of Pain in Elite Athletes: Identified Gaps in Knowledge and Future Research Directions. Clin J Sport Med. 2018;28(5):485–9. doi:.https://doi.org/10.1097/JSM.0000000000000618
  41. Baltazar-Martins JG, Plata MDM, Muñoz-Guerra J, Muñoz G, Carreras D, Del Coso J. Infographic. Tramadol: should it be banned in athletes while competing, particularly in road cycling? Br J Sports Med. 2020;54(2):120–1. doi:.https://doi.org/10.1136/bjsports-2018-100473
  42. Ford JA, Pomykacz C, Veliz P, McCabe SE, Boyd CJ. Sports involvement, injury history, and non-medical use of prescription opioids among college students: An analysis with a national sample. Am J Addict. 2018;27(1):15–22. doi:.https://doi.org/10.1111/ajad.12657
  43. Veliz P, Epstein-Ngo Q, Austic E, Boyd C, McCabe SE. Opioid use among interscholastic sports participants: an exploratory study from a sample of college students. Res Q Exerc Sport. 2015;86(2):205–11. doi:.https://doi.org/10.1080/02701367.2014.983219
  44. Dunne EM, Striley CW, Mannes ZL, Asken BM, Ennis N, Cottler LB. Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players. Clin J Sport Med. 2020;30(6):544–9. doi:.https://doi.org/10.1097/JSM.0000000000000628
  45. Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990-2013;2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015–35. doi:.https://doi.org/10.1016/S0140-6736(18)31310-2
  46. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2007;64(7):830–42. doi:.https://doi.org/10.1001/archpsyc.64.7.830
  47. Ford JA. Alcohol use among college students: a comparison of athletes and nonathletes. Subst Use Misuse. 2007;42(9):1367–77. doi:.https://doi.org/10.1080/10826080701212402
  48. Mastroleo NR, Barnett NP, Bowers KM. Association between sex, race/ethnicity, season, day of week, and alcohol use and related risks in college student athletes and nonathletes. J Am Coll Health. 2019;67(5):422–32. doi:.https://doi.org/10.1080/07448481.2018.1484367
  49. Martens MP, Dams-O’Connor K, Beck NC. A systematic review of college student-athlete drinking: Prevalence rates, sport-related factors, and interventions. J Subst Abuse Treat. 2006;31(3):305–16. doi:.https://doi.org/10.1016/j.jsat.2006.05.004
  50. Miller BE, Miller MN, Verhegge R, Linville HH, Pumariega AJ. Alcohol misuse among college athletes: self-medication for psychiatric symptoms? J Drug Educ. 2002;32(1):41–52. doi:.https://doi.org/10.2190/JDFM-AVAK-G9FV-0MYY
  51. O’Brien CP, Lyons F. Alcohol and the athlete. Sports Med. 2000;29(5):295–300. doi:.https://doi.org/10.2165/00007256-200029050-00001
  52. Gouttebarge V, Jonkers R, Moen M, Verhagen E, Wylleman P, Kerkhoffs G. The prevalence and risk indicators of symptoms of common mental disorders among current and former Dutch elite athletes. J Sports Sci. 2017;35(21):2148–56. doi:.https://doi.org/10.1080/02640414.2016.1258485
  53. Ciccarone D. Stimulant abuse: pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Prim Care. 2011;38(1):41–58. doi:.https://doi.org/10.1016/j.pop.2010.11.004
  54. Wilens TE, Spencer TJ. The stimulants revisited. Child Adolesc Psychiatr Clin N Am. 2000;9(3):573–603, viii. doi:.https://doi.org/10.1016/S1056-4993(18)30108-1
  55. Deventer K, Roels K, Delbeke FT, Van Eenoo P. Prevalence of legal and illegal stimulating agents in sports. Anal Bioanal Chem. 2011;401(2):421–32. doi:.https://doi.org/10.1007/s00216-011-4863-0
  56. Han DH, McDuff D, Thompson D, Hitchcock ME, Reardon CL, Hainline B. Attention-deficit/hyperactivity disorder in elite athletes: a narrative review. Br J Sports Med. 2019;53(12):741–5. doi:.https://doi.org/10.1136/bjsports-2019-100713
  57. Poysophon P, Rao AL. Neurocognitive Deficits Associated With ADHD in Athletes: A Systematic Review. Sports Health. 2018;10(4):317–26. doi:.https://doi.org/10.1177/1941738117751387
  58. Brunt TM, van Amsterdam JG, van den Brink W. GHB, GBL and 1,4-BD addiction. Curr Pharm Des. 2014;20(25):4076–85. doi:.https://doi.org/10.2174/13816128113199990624
  59. Taylor L, Chrismas BCR, Dascombe B, Chamari K, Fowler PM. Sleep Medication and Athletic Performance-The Evidence for Practitioners and Future Research Directions. Front Physiol. 2016;7:83. doi:.https://doi.org/10.3389/fphys.2016.00083
  60. Zandonai T, Lugoboni F, Zamboni L. A risk for athletes: when the desire to sleep becomes a nightmare. A brief case report on benzodiazepine addiction. Psychopharmacology (Berl). 2018;235(11):3359–60. doi:.https://doi.org/10.1007/s00213-018-5047-9
  61. Uvacsek M, Nepusz T, Naughton DP, Mazanov J, Ránky MZ, Petróczi A. Self-admitted behavior and perceived use of performance-enhancing vs psychoactive drugs among competitive athletes. Scand J Med Sci Sports. 2011;21(2):224–34. doi:.https://doi.org/10.1111/j.1600-0838.2009.01041.x
  62. Thomas JO, Dunn M, Swift W, Burns L. Elite athletes’ perceptions of the effects of illicit drug use on athletic performance. Clin J Sport Med. 2010;20(3):189–92. doi:.https://doi.org/10.1097/JSM.0b013e3181df5f87
  63. Castaldelli-Maia JM, Gallinaro JGME, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B, et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. Br J Sports Med. 2019;53(11):707–21. doi:.https://doi.org/10.1136/bjsports-2019-100710
  64. McDuff D, Stull T, Castaldelli-Maia JM, Hitchcock ME, Hainline B, Reardon CL. Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review. Br J Sports Med. 2019;53(12):754–60. doi:.https://doi.org/10.1136/bjsports-2019-100669

Most read articles by the same author(s)