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Drug use patterns among high school athletes and nonathletes.

Drug use by athletes has made newspaper headlines, sport governing body rulebooks, and doctors' waiting rooms on a regular basis. Despite this, the relationship between drug use and participation in athletics is not yet a clear one. On one hand, it has been suggested that participation in athletics leads to a healthier lifestyle and wiser decisions about substance use (Anderson, Albrecht, McKeag, Hough, & McGrew, 1991; Shephard, 2000; Shields, 1995). Conversely, others have suggested that drug use is inherent in sport and its culture (Dyment, 1987; Wadler & Hainline, 1989). In between these two perspecfives, one is left wondering if there is any difference in the substance use patterns of athletes and the general public (Adams, 1992; Anshel, 1998).

One way to begin clarifying this issue is to differentiate between recreational substances and ergogenic aids. Recreational substances are typically used for intrinsic motivates, such as to achieve altered affective states. Examples of such drugs are alcohol, tobacco, marijuana, psychedelics, and cocaine. Ergogenic substances are used to augment performance in a given domain. In sport, such drugs are typically used to assist athletes in performing with more speed and strength, and to endure more pain than normal. Examples of ergogenic aids are creatine, androstenedione, anabolic steroids, major pain medication, barbiturates, and amphetamines. The categorization of specific substances is debatable in some cases (Adams, 1992). For instance, although marijuana is traditionally viewed as a recreational substance, it recently has been banned by the International Olympic Committee for its performance-enhancing potential (i.e., lowering of physiological arousal) (H. Davis, personal communication, October 4, 1999). Similarly, amphetamines have been used for recreational purposes. Nevertheless, the attempt to label substances as either recreational or ergogenic assists in clarifying differences between athletes and nonathletes in their drug use patterns.

Recreational Drugs

It has been traditionally believed that participation in athletics leads to a healthier lifestyle and less use of recreational drugs. Increased physical activity not only creates a physically healthier person, but also may lead to changes in overall lifestyle, highlighted by "a prudent diet and abstinence from cigarette smoking" (Shephard, 2000). Some research has supported the popular notion that substance use is negatively correlated with healthful activities. In the university setting, athletes have self-reported less alcohol and drug use than their peers (Anderson et al., 1991), providing further evidence that the high-level physical and mental demands of sport are incompatible with recreational drug use. Shields (1995) indicated that high school athletic directors perceived that students who participated in athletics were less likely to smoke cigarettes, consume alcohol, chew tobacco, and smoke marijuana than were students who did not participate in extracurricular athletic activities. These findings, w hile encouraging, ought to be verified through confidential self-reports of high school students themselves. Nonetheless, these findings offer support for the notion that participation in sport promotes health and wellness.

Conversely, Wadler and Hainline (1989) have suggested that athletes maybe more likely to experiment with recreational and ergogenic aids than individuals not participating in athletics. Physically, athletes might use recreational drugs to cope with the pain of injury rehabilitation. Mentally, stress (arising from the competitive demands of sport) and low self-confidence are issues that might lead athletes to recreational drug use. Furthermore, the "culture" of the particular sport might socialize athletes into drug use (e.g., baseball and smokeless tobacco) (Anshel, 1998). However, there is little evidence to suggest that recreational drug use is higher for athletes than nonathletes.

Ergogenic Aids

Unlike recreational substances, use of ergogenic aids is more likely in competitive athletic settings (Dyment, 1987). Wadler and Hainline (1989) have pointed out five instances that might lead athletes to utilize performance-enhancing pharmacological aids: (1) athletes who are at risk for not making a team or achieving the level of performance they desire; (2) athletes who are approaching the end of their career and are striving to continue to compete in their sport; (3) athletes who have weight problems and are seeking a means to increase or decrease weight; (4) athletes who are battling injuries and are trying to find ways to heal quicker; and (5) athletes who feel external pressure, such as from teammates, coaches, and parents, to use performance-enhancing drugs. Little research has contradicted the notion that those participating in sport are more disposed to use ergogenic aids. However, the findings of Anderson and colleagues (1991) did not support the notion that there is an anabolic steroid epidemic i n collegiate athletics. Although their study did not examine whether athletes more frequently use anabolic steroids than do nonathletes, Anderson et al. concluded that steroid use by intercollegiate athletes did not increase over a fouryear span. However, the prevalence of ergogenic aids a decade later has multiplied, with the advent of over-the-counter supplements (Hendrickson & Burton, 2000).

Educational Interventions

While the relationship between drug use and participation in organized athletics is still unclear, few disagree that early identification of, and education about, drug use is necessary. Andrews and Duncan (1998) have noted that cigarette smoking that begins during adolescence proceeds to more frequent use in the two years following high school. Furthermore, onset of drug use has been found to be a major determinant of adolescent morbidity and failure to perform age-related social roles (Grant & Dawson, 1998). In light of these facts, identification of substance use patterns during the high school years is important for preventing and curbing at-risk behaviors that might arise later in an individual's life.

Sport organizations have made it their mission to deter substance use by athletes. In 1986 the National Collegiate Athletic Association implemented a national drug education and drug-testing program for its member institutions (Anderson et al., 1991). Other organizations at various levels of sport have also adopted programs to monitor and police drug use behaviors in athletes (Shields, 1995). The Massachusetts Interscholastic Athletic Association (MIAA) has initiated one such program for high school athletic programs in the state (Massachusetts Interscholastic Athletic Association, 1999). The cornerstone of this intervention is the MIAA Chemical Health Eligibility Rule.

During the season of practice or play, a student shall not, regardless of the quantity, use or consume, possess, buy/sell or give away any beverage containing alcohol; any tobacco product; marijuana; steroids; or any controlled substance....The penalty for the first violation is that a student shall lose eligibility for the next two (2) consecutive interscholastic events or two (2) weeks of a season in which the student is a participant, whichever is greater. If a second or subsequent violation occurs, the student shall lose eligibility for the next twelve (12) consecutive interscholastic events or twelve (12) consecutive weeks, whichever is greater, in which the student is a participant.

It is the desire of the MIAA that this rule will not only be effective during the athletic season, but lead to an overall healthier lifestyle. High school coaches and athletic directors are responsible for implementing this rule and levying punishments as infractions occur. Adams (1992) found that students favored the eligibility rule and would like to see it strictly enforced. Furthermore, student athletes supported the notion of mandatory/random drug testing in high school athletics. Although drug intervention programs have been supported by both administrators and athletes, their efficacy must still be determined.

Purpose of the Present Study

The purpose of this study was to examine the incidence of drug use by interscholastic high school athletes, and to see if participation in interscholastic athletics is related to a healthier lifestyle, specifically decreased use of recreational drugs and ergogenic aids year-round. Exploring possible differences in drug use patterns between athletes and nonathletes was a central element. This study sought to replicate previous high school drug use and abuse surveys conducted in the state of Massachusetts (Adams, 1992; Gardner & Zaichkowsky, 1995).

Besides the desire to update the findings on substance use habits since 1991, two other issues motivated this research. First, drug use by athletes has received a great deal of media attention. For example, the supplement androstenedione came to wide public attention during the baseball season in which Mark McGwire broke the home run record. Second, the governing bodies of state high school athletics have instituted wellness programs, drug education, and specific rules to prevent drug use. This study examined descriptive data relating to the effectiveness of these rules and programs.

METHOD

Participants

One thousand five hundred fifteen students, representing fifteen high schools within the state of Massachusetts, were surveyed. Male students represented 51% of the sample (n = 773), while female students accounted for 49% (n = 742). Thirty-five percent were freshmen, 24.6% were sophomores, 23.4% were juniors, and 17% were in their senior year of high school. Seventy-four percent reported they had participated in one or more formally sanctioned interscholastic sports within the past twelve months.

The 150-item questionnaire used in this study was based on previous studies that have examined drug use patterns among high school students and student athletes (Adams, 1992; Anderson & McKeag, 1985; Johnston, O'Malley, & Bachman, 1999; Gardner & Zaichkowsky, 1995; Zaichkowsky, 1987). It included questions about students' drug use within the past twelve months, and made "nonuse" as stringent a classification as possible. Consistent with previous studies, both recreational and ergogenic substance use was self-reported. Recreational substances included alcohol, cigarettes, smokeless tobacco, marijuana, cocaine, and psychedelic drugs. Ergogenic aids included major pain medications, anabolic steroids, barbiturates, amphetamines, androstenedione, and creatine. A final section of the questionnaire asked students to address the effectiveness of the Massachusetts Interscholastic Athletic Association's substance use rules and educational interventions.

Procedure

Permission to conduct the study was obtained from the principals of fifteen randomly selected public high schools in Massachusetts. Each principal agreed to allow between 100 and 180 students participate in the study, and assigned a school athletic director or wellness coordinator to be the primary contact person for the researchers.

Each contact person was asked to select students who were representative of the school's gender, ethnic, and athletic demographics to participate in the study. Students were categorized as athletes if they participated on any state-sanctioned interscholastic athletic team. Upon creating the sample, the principal investigator and each school's contact person selected a class period and date in which to administer the questionnaire.

The principal investigator and two research assistants visited the fifteen schools over a period of a month and a half. Students were administered the questionnaire in the school auditorium or cafeteria. They were assured that they would remain anonymous, that their responses would be viewed only by researchers, and that all information would be kept confidential. The questionnaire took approximately thirty minutes to complete.

Data Analysis

The frequencies of all variables were calculated. Descriptive statistics and chi-square analyses were conducted using the Statistical Package for the Social Sciences (SPSS).

RESULTS

Athlete /Nonathlete Differences

Chi-square analyses indicated statistically significant differences between athletes and nonathletes in reported use of four of the twelve substances (see Table 1). In terms of recreational drugs, significantly more nonathletes than interscholastic athletes have smoked cigarettes, [chi square](1, N = 520) = 7.455, p < .01. Nonathletes also reported using cocaine, [chi square](1, N = 59) = 11.491, p <.01, and psychedelics, [chi square](1, N = 171) = 18.382, p < .001, with greater frequency. One ergogenic aid, creatine, was used significantly more by athletes than nonathletes, [chi square](1, N = 115) = 7.455, p < .01. Athletes were less likely to use marijuana, amphetamines, and barbiturates than were nonathletes, although the differences fell just short of being statistically significant.

Interscholastic Drug Intervention Feedback

The Massachusetts Interscholastic Athletic Association's Chemical Health Eligibility Rule seeks to discourage the use of recreational and ergogenic substances by high school athletes. Sixty-eight percent of the student athletes were aware of this rule (see Table 2). Thirty-eight percent reported having violated the rule; only 12% of these student athletes reported having been punished by school officials. Thirteen percent of those caught breaking the rule said they had not been punished. Seventy-one percent believed that some of their teammates had violated the Chemical Health Eligibility Rule.

Not only does the MIAA set drug use rules for student athletes, but it also seeks to implement intervention programs. Fifty-seven percent of the athletes stated that their coaches further this mission by discussing the issue of drug use and abuse. Thirty-one percent of the athletes expressed interest in drug education programs provided by the athletic department, while 48% stated that they would submit to random drug testing.

DISCUSSION

The results of this study appear to reflect current trends in substance use by high school students when compared with national averages (see Johnson et al., 1999). One encouraging finding was that cigarette smoking in Massachusetts was lower than national averages. Roughly 38% of the students surveyed here reported smoking at least one cigarette as compared with the lowest estimate of 51% of the adolescents surveyed by the National Institute on Drug Abuse (Johnston et al., 1999). Massachusetts has engaged in an aggressive anti-tobacco campaign over the last decade, which might account for this finding.

Previous research suggests three possible reasons for adolescent drug use: experimentation, social learning, and body image concerns (Anshel, 1998; Collins, 2000). Experimentation with drugs has been associated with boredom and is often supported by adolescents' belief that they are impervious to the harmful side effects of dangerous substances. Social leaning theory states that individuals will take their drug use cues from others in the environment. Modeling of parents' and friends' behavior is a prime example of social learning. Lastly, individuals have been found to use certain drugs to improve their appearance.

Recreational Substances

It has been suggested that recreational drug use does not differ for athletes and nonathletes (Adams, 1992; Anshel, 1998; Dyment, 1987; Wadler & Hainline, 1989). The results of the present study were mixed in regard to student athlete and nonathiete substance use differences. There were no significant differences for three of the six recreational drugs: alcohol, marijuana, and smokeless tobacco.

It is clear that alcohol use is socially accepted (Bailey & Rachal, 1993; Bush & Iannotti, 1992; Reifman et al., 1998), which might explain the high percentage of students who consumed alcohol and the lack of difference in alcohol use between athletes and nonathletes. Further, the media provide opportunities for high school students to model the drinking behaviors of their professional and collegiate counterparts (Collins, 2000). Although the peer group influences the use of most substances, the culture of sport has also promoted alcohol use.

Slightly over 37% of the athletes reported smoking marijuana in the last year as opposed to about 43% of the nonathletes. This is similar to the pattern for cigarette smoking, although the difference between athletes and nonathletes for marijuana was not significant (p <.052).

Even though marijuana and cigarettes are two different types of drugs, it seems that the athletes were more aware of the negative impact smoking any kind of substance has on athletic performance.

Conversely, the lack of conclusive difference in marijuana use may reflect the availability of marijuana, the rising social acceptability of the drug, and the desire to experiment (Johnston et al., 1999). In addition, athletes might not perceive marijuana as being as harmful as cocaine or psychedelics, and therefore may be more inclined to try the perceived lesser of two evils.

Marijuana has often been labeled a "gateway" drug to more addictive substances (Bush & lannotti, 1992), yet the present study does not support this contention. Perhaps participation in athletics acts as a barrier to the use of more addictive substances. The significantly lower use of cocaine and psychedelics by athletes can possibly be explained by the commitment necessary to participate in high school athletics. Seasons are year-round for some athletes, and others may be multi-sport athletes. After-school practices and weekend competitions leave student athletes with less time for drug use/experimentation and less time to recover. Thus, organized athletics might reduce the desire of youth to indulge in more addictive and socially unacceptable drugs.

Ergogenic Aids

There was no significant difference between athletes and nonathletes for most ergogenic aids (anabolic steroids, androstenedione, pain medication, barbiturates, and amphetamines), which is a positive finding. This suggests that the culture of high school athletics in Massachusetts does not encourage widespread use of these illicit substances. However, it should be noted that the lack of differences might reflect body image issues, specifically in regard to nonathletes who take steroids. Steroids increase an individual's muscle mass, thus increasing self-confidence (Anshel, 1998). Additionally, muscle-building substances provide the opportunity for individuals to live up to societal standards for physical appearance. Similarly, amphetamines may be used to lose weight and help an individual achieve the "ideal" figure. These substances may not necessarily be utilized to improve athletic performance, but rather to help students improve their body image (Anshel, 1998).

The lack of differences for most of the ergogenic aids might further be explained by the skill level of the typical high school athlete. Wadler and Hainline (1989) have pointed out that few adolescents compete at "elite" levels. In light of this fact, there is little need for illicit performance-enhancing substances in the average high school athlete's competitive endeavors. As the competitive demands get greater and the opposition tougher, one might expect the usage levels of ergogenic aids to increase (Wadler & Hainline, 1989).

The sole difference in the use of ergogenic aids by athletes and nonathletes was for creatine, a nutritional supplement. High school athletes were more than twice as likely to use creatine than were nonathletes. The legality and availability of creatine are perhaps the greatest reasons for the higher level of use among athletes, who are likely trying to gain a competitive edge (Dyment, 1987).

Intervention

Can the differences in illicit drug use behaviors between student athletes and nonathletes be explained by interscholastic chemical health programs? While it would appear that the eligibility rule has helped in policing the substance use of interscholastic athletes, many are still unaware of this rule or ignore it. Seventy-one percent of the athletes reported that teammates have violated the Chemical Health Eligibility Rule. Furthermore, almost 40% of the athletes admitted to having broken this rule, with 13% having not been penalized after being caught. These figures bring the effectiveness of the rule and its enforcement into question. Only 57% reported that their coaches addressed the issue of substance use and abuse, which indicates that this is an educational opportunity that needs to be strengthened.

Educating this population is not an easy feat. A majority of the students were not interested in any further drug interventions. Over half said they would not submit to voluntary random drug testing, and 69% were not interested in drug prevention programs provided by their athletic departments. These findings indicate a change in student attitudes over the last decade. Adams (1992) found that a majority of student athletes were receptive to the idea of random drug testing and additional substance abuse programming through their athletic departments. One reason for the change might be that students have been saturated with drug education. Alternatively, the fact that athletes generally used fewer illicit substances than nonathletes might suggest that athletes felt they had already acquired healthful behaviors. Furthermore, recent studies have suggested that drug education programming needs to begin early (Faigenbaum, Zaichkowsky, Gardner, & Micheli, 1998), and interventions aimed at high school athletes might be too late for high success rates.

CONCLUSION

Despite this study's large sample size, one must be cautious regarding generalization of the findings. The high school and sport cultures examined here might only be representative of Massachusetts or the northeastern United States. Because the social circumstances of adolescents and their athletic participation greatly influence their substance use behaviors, more must be done to understand the social climate of high school athletics.

Nevertheless, the present study suggests that participation in athletics is related to a healthier lifestyle. It also reveals that marijuana and alcohol are the two primary substances where more education and intervention are necessary. Furthermore, this study suggests that coaches and administrators must assess the efficacy of their drug prevention programs and their efforts to enforce rules and regulations.

Athletic activities provide many opportunities to promote healthful behaviors. Therefore, sport organizations ought to assess the needs of their athletes and provide effective interventions in a timely manner.
Table 1

Drug Use Patterns Among High School Athletes and Nonathletes

 Athletes Nonathletes Total
 (%) (%) (%)

Alcohol 68.8 68.4 68.7
Cigarettes (**) 36.1 44.0 38.4
Smokeless Tobacco 8.0 7.7 7.9
Marijuana 37.5 42.9 39.1
Cocaine (**) 3.1 7.2 4.3
Psychedelics (***) 9.8 18.1 12.3
Creatine (**) 10.4 4.4 8.6
Androstenedione 2.3 2.1 2.2
Anabolic Steroids 2.5 3.4 2.8
Pain Medication 29.3 31.9 30.1
Barbiturates 3.7 6.1 4.4
Amphetamines 6.8 9.6 7.6

(*) Significant difference between athletes and nonathletes at the .05
level.

(**) Significant difference between athletes and nonathletes at the .01
level.

(***) Significant difference between athletes and nonathletes at the
.001 level.
Table 2

Interscholastic Athletes' Perceptions of Drug Intervention Effectivenss

Topic Yes No

Do you know the Chemical Health Eligibility Rule? 68% 32%
Have you violated this rule during the season? 38% 62%
Have you received a penalty if you violated this rule? 12% 88%
Have you been caught and not been penalized? 13% 87%
Have any of your teammates violated this rule? 71% 29%
Does your coach discuss the issue of drugs? 57% 43%
Would you submit to voluntary random drug testing? 48% 52%
Are you interested in drug prevention programs from 31% 69%
 the athletic department?


REFERENCES

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Anderson, W. A., Albrecht, R. R., McKeag, D. B., Hough, D. 0., & McGrew, C. A. (1991). A national survey of alcohol and drug use by college athletes. The Physician and Sportsmedicine, 19, 91-104.

Anderson, W. A., & McKeag, D. B. (1985). The substance use and abuse habits of college student athletes (Report No. 2). Mission, KS: The National Collegiate Athletic Association.

Andrews, J. A., & Duncan, S. C. (1998). The effect of attitude on the development of adolescent cigarette use. Journal of Substance Abuse, 10, 1-7.

Anshel, M. H. (1998). Drug abuse in sports: Causes and cures. In J. M. Williams (Ed.), Applied sport psychology: Personal growth to peak performance (pp. 372-387). Mountain View, CA: Mayfield Publishing Company.

Bailey, S. L., & Rachal, J. V. (1993). Dimensions of adolescent problem drinking. Journal of Studies on Alcohol, 54, 555-565.

Bush, P. J., & Iannotti, R. J. (1992). Elementary schoolchildren's use of alcohol, cigarettes and marijuana and classmates' attribution of socialization. Drug and Alcohol Dependence, 30, 275-287.

Collins, G. B. (2000). Substance abuse and athletes. In D. Begel & R. W. Burton (Eds.), Sport psychiatry. New York: W. W. Norton & Company.

Dyment, P. G. (1987). The adolescent athlete and ergogenic aids. Journal of Adolescent Health Care, 8, 68-73.

Faigenbaum, A. D., Zaichkowsky, L. D., Gardner, D. E., & Micheli, L. J. (1998). Anabolic steroid use by male and female middle school students. Pediatrics, 101, p. e6.

Gardner, D. E., & Zaichkowsky, L. (1995). Substance use patterns in Massachusetts high school athletes and nonathletes. Unpublished manuscript.

Grant, B. F., & Dawson, D. A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse, 10, 163-173.

Hendrickson, T. P., & Burton, R. W. (2000). Athletes' use of performance-enhancing drugs. In D. Begel & R. W. Burton (Eds.), Sport psychiatry. New York: W. W. Norton & Company.

Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (1999). National survey results on drug use from the Monitoring the Future study, 1975-1998: Volume 1. Secondary school students (NIH Publication No. 99-4660). Rockville, MD: National Institute on Drug Abuse.

Massachusetts Interscholastic Athletic Association. (1999). Massachusetts Interscholastic Athletic Association wellness manual. Milford, Massachusetts.

Mayer, R. R., Forster, J. L., Murray, D. M., & Wagenaar, A. C. (1998). Social settings and situations of underage drinking. Journal of Studies on Alcohol, 59, 207-215.

Nurco, D. N. (1985). A discussion of validity. In B. A. Rouse, N. J. Kozel, & L. G. Richards (Eds.), Self-report methods of estimating drug use: Meeting current challenges to validity (NIDA Research Monograph No. 57, DHHS Publication No. ADM 85-1402). Washington, DC: U.S. Government Printing Office.

Reifman, A., Barnes, G. M., Dintscheff, B. A., Farrell, M. P., & Uhteg, L. (1998). Parental and peer influences on the onset of heavier drinking among adolescents. Journal of Studies on Alcohol, 59, 311-317.

Shephard, R. J. (2000). Importance of sport and exercise to quality of life and longevity. In L. Zaichkowsky & D. Mostofsky (Eds.), Medical and psychological aspects of sport and exercise. Morgantown, WV: FIT.

Shields, E. W., Jr. (1995). Sociodemographic analysis of drug use among adolescent athletes: Observations-perceptions of athletic directors-coaches. Adolescence, 30,849-861.

Wadler, G. I., & Hainline, B. (1989). Drugs and the athlete. Philadelphia: F. A. Davis Company.

Zaichkowsky, L. (1987). Drug use patterns in Massachusetts high school athletes and nonathletes. Unpublished manuscript.

The researchers would like to thank the Massachusetts Governor's Committee on Physical Fitness and Sports for the grant that supported this study, and Bill Gaine and the Massachusetts Interscholastic Athletic Association for their assistance and support.

Doug Gardner, ThinkSport [R] Consulting Services, Playa del Rey, California.

Len Zaicbkowsky, School of Education, Boston University.

Reprint requests to Adam H. Naylor, School of Education, Boston University, 605 Commonwealth Avenue, Boston, Massachusetts 02215. Electronic mail may be sent to adamnaylor@juno.com.
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Author:Naylor, Adam H.; Gardner, Doug; Zaichkowsky, Len
Publication:Adolescence
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Dec 22, 2001
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