Substance Related and Addictive Disorders

Addiction involves seeking out and consuming a substance (e.g. alcohol or drugs) or engaging in a behaviour (e.g. gambling, exercise, sex or computer gaming) compulsively, despite negative consequences. Typically the substance or behaviour serves a psychological need (e.g. to provide pleasure or relief from internal discomfort such as stress or anxiety) which the individual struggles to control. Symptoms of addiction include tolerance (increasing amounts required to achieve the desired effect), withdrawal (anxiety, irritability and sleeplessness in its absence), lack of control (unsuccessful attempts to cut down), significant investment in time, reduction in other activities, and continuing to take the substance or engage in the behaviour despite knowledge that it is causing problems. Addiction is considered to be a mental health problem and the collective term used is substance related and addictive disorders.

When a person is addicted to substances like alcohol or other drugs (clinically called a substance use disorder) there are physical symptoms directly related to ingesting chemicals that impact the brain and body. These include blackouts and memory loss, nausea and vomiting, organ damage, aggressive behaviour, loss of consciousness and hallucinations and are often substance specific. There are also physiological aspects to the substance use disorders as the substances directly affect the neurotransmitter systems of the brain.

When a person experiences a behavioural addiction (e.g. gambling disorder, one of the few behavioural addictions currently recognised in the major classification systems) the neurotransmitter systems of the brain are only indirectly affected but the addictive behaviour can serve as a reinforcer comparable to substances that directly affect these systems. Behavioural addictions share many of the same psychological causes and consequences as substance use disorders.

Addiction – Considerations for Elite Athletes

• The reasons for engaging in substance use or particular behaviours may be influenced by the elite sport environment (e.g. performance enhancement, numbing physical pain in games or through injury, dealing with stressors such as pressure to perform or media response, and retirement from sport), may relate to circumstances off the field, or to a combination of both.
• Sport specific examples include anabolic steroids used to increase muscle mass and body weight (while decreasing fat) and also increase aggression, with multiple side effects, including hormonal changes and strong withdrawal symptoms. Stimulants may be used to minimise fatigue, increase alertness, boost energy and mimic the intensity and adrenaline rush of games, with multiple psychological and physical side effects. Prescription pain medication has strong addictive qualities and may be used to numb pain going in to and following games as well as during injury, but may serve to numb feelings and experiences off the pitch. Alcohol and illicit drugs may be used to let off steam and manage post-match highs and lows and the peaks and troughs of the season. Behavioural addictions such as gambling or computer game addiction can serve to temporarily satiate the risk-taking, achievement oriented athlete’s wish to replicate the highs of winning, while alleviating boredom during off days. Athletes may become addicted to the process of exercising itself which can result in overtraining.
• Where substances used are performance enhancing and banned by the sporting body, there are typically strict consequences under anti-doping and sport integrity policies, which must be adhered to. The athlete may require psychological support and intervention similar to an athlete using non-banned substances or with a behavioural addiction.