Substance Use among College Student-Athletes

Alcohol and drug use are common among student-athletes (White & Rabiner, 2011). Underage drinking, drinking and driving, binge drinking (i.e., five drinks in a row per occasion for a male and four per occasion for a female), illicit drug use or misuse of prescription drugs increase the risk of adverse consequences for athletes, teammates, friends, roommates, universities, sports teams, and in some instances innocent bystanders.  

High-risk drinking and drug use increase the risk of injuries, vehicle crashes, altercations, fights and assaults, sexual abuse, unsafe sex, academic problems, mental health problems, vandalism, property damage, and involvement with police. Additional consequences are loss of athletic scholarships, suspension or dismissal from an athletic team, loss of a starting position, and decreased likelihood of a career as a professional athlete.

A study by the National College Athletic Association (NCAA) found that student-athletes are much less likely than college students to use cigarettes, marijuana, stimulants, and synthetic marijuana (Burnsed, 2014). This study also found that binge drinking is down significantly among student-athletes since 2005—from 63 percent to 44 percent—although the percent of athletes who drink is the same as nonathletes (Burnsed, 2014). Substance use is higher among males than females, and the highest among athletes attending Division III schools.

For many years I provided clinical services to college athletes. Services for student-athletes included evaluation, individual counseling, group education and awareness, referral for psychiatric consultation, and collaboration with the athletic department. Following is a summary of a review of 150 case records by a research associate and myself, results of written evaluations of a group education and awareness program by 278 athletes, which included involvement by athletic department staff members who had been student-athletes. There are several effective interventions that reduce harmful effects of substance use on athletes and other college students (White & Rabiner, 2011).  

The primary goal of the service to athletes was to evaluate and address the substance use problem leading to a referral by a coach or trainer—less than 5 percent were self-referrals. Most athletes (78 percent) were male, 37 percent were freshmen, 26 percent were sophomores, 22 percent were juniors, and 15 percent were senior or graduate students. 

Athletes were referred for two main reasons:

1. They were involved in underage drinking, drinking in the dorm or while at a competition at another university, drinking during a “dry” season, receiving medical care after getting intoxicated or injured, fighting after drinking, getting arrested while intoxicated or coming to practice smelling of alcohol. Forty-six percent of referrals had an alcohol incident that varied from mild to severe. Among these, 6 percent reported drug use within the past ninety days (mainly marijuana).
2. They tested positive for drugs (49 percent), mainly marijuana. Drug use patterns varied from infrequently to daily. Less than 5 percent tested positive for opioids, stimulants or other drugs. Among this group of drug users, half reported binge drinking within the past ninety days.  

Most athletes (71.5 percent) presented with a problem that was mild to moderate in severity. The others had no substance problem (e.g., some were referred for violating the “dry” season rule of a team) or a severe problem. The latter included greater frequency or quantity of substance use, more negative effects, meeting criteria for substance dependence or those in need of a rehabilitation or intensive outpatient program. Less than 10 percent met this criteria, and most had cannabis use disorders.

Athletes with mental health problems were referred by the athletic department to other services. Some with substance use problems also had issues with anxiety, depression, attention deficit disorder, domestic violence or temper control. A psychiatrist was consulted to address mental health problems among these athletes. 

Athletes with no substance problem or a mild problem attended up to four sessions for education and monitoring. Those with moderate problems attended up to eight sessions spread over two semesters, and those with a more severe problem attended sessions for as long as needed, and/or were referred for rehab, IOP or AA or NA meetings. Athletes referred for a positive drug test received random drug testing from the athletic department. Athletes who failed to show for individual sessions were usually rescheduled within a few days or a week. A team trainer was contacted if athletes failed to show a second time to reschedule an appointment.

Athletes kept 80 percent of their scheduled sessions; 20 percent failed to show or rescheduled. Text messaging was the most effective way of reminding athletes who missed sessions to reschedule immediately to avoid the athletic department being contacted. The average number of sessions attended was 6.75 with 33 percent attending up to four sessions; 51 percent attending five to nine sessions; and 16 percent attending ten or more sessions. Athletes attending ten or more sessions had more severe problems. Some requested additional sessions or were recommended by myself or the athletic department to attend more than the initial requirement.

Over half (52 percent) had “excellent” outcomes. Athletes referred for a positive drug test had an excellent outcome if they did not have any future positive drugs tests or did not show or report any episodes of drug use or alcohol intoxication. Athletes referred for an alcohol incident had excellent outcomes if they set the goal of not drinking and adhered to it, did not report any episodes of intoxication or did not report an episode of heavy drinking. Twenty percent of athletes had a “good” outcome with limited episodes of intoxication or heavy drinking during the past ninety days (less than one per month). Some occasionally drank excessively after the season ended or during breaks when they went home. Nine percent of athletes had a “moderate” outcome with more than one episode of heavy drinking per month. Nineteen percent had unknown or poor outcomes. Some quit or were removed from the team and left school so we did not have follow up information about them, and some continued to show problems with substance use—seven percent were referred two or more times to the program as a result of positive drug tests or alcohol incidents (months or years could lapse between these incidents).

Individual sessions focused on any concern or problem that athletes had in addition to alcohol or drug use. Issues addressed included: 

• Managing anger, anxiety, boredom or depression
• Dealing with relationship problems
• Addressing high-risk behaviors related to sex or physical altercations
• Improving organizational skills and study habits
• Spending more time on academics and less on video games
• Future goals  

We provided interactive self-awareness sessions with small groups of athletes. We recently conducted nineteen sessions with 278 athletes from various sports teams. In this session, we used their experiences to discuss why athletes use substances; the effects of substances on their emotions, judgment, and behaviors; and the relationship between substance use and sexual behaviors or interpersonal violence. Athletes completed brief written tasks to identify effects of their substance use and determine their highest blood alcohol level based on the most drinks consumed during a drinking episode in the past six months. Finally, we conducted roleplays to illustrate common situations involving alcohol or drugs that athletes encounter. At the end of this program, each athlete completed a brief questionnaire. Results showed that:

• Almost all athletes (96.5 percent) believed small group sessions were a good or great idea to convey content and raise awareness of substance issues
• The majority (81.3 percent) learned a good or great amount of information; less than 3 percent said they did not learn much
• The majority found the written activities (80.5 percent) and the roleplays (77.1 percent) to be useful or very useful in raising awareness and learning

For open-ended questions, 190 identified something specific they liked or found helpful about the session (e.g., “openness,” “hearing personal stories,” “answering questions about myself,” “learning I could have fun without getting drunk”). When asked what they liked least or did not find helpful, 110 athletes made positive comments or said there was nothing they disliked; 79 gave examples of what they liked least (e.g., “didn’t apply to me as I don’t drink,” “I already knew this information,” “I didn’t like completing the questionnaire”). When asked how we could improve this session, ninety-four made positive or neutral comments and thirty-eight gave suggestions (e.g., “more roleplays,” “more stories,” “more focus on violence”).

My experience with student-athletes and the results presented earlier show that most respond favorably to brief interventions when they have an alcohol or drug issue that comes to the attention of the athletic department. Most athletes are compliant with the required sessions, complete assignments and make significant progress in stopping or reducing substance use. While a few athletes have a severe substance problem, most present with mild or moderate problems that respond to brief interventions and close oversight by the athletic department. Close collaboration with trainers of the sports teams was essential to catching problems early, monitoring progress and participation, and intervening when problems worsened. Providing education about substance use issues is most effective when it engages athletes in interactive discussions and self-awareness activities.  

Burnsed, B. (2014). Rates of excessive drinking among student-athletes falling. Retrieved from http://www.ncaa.org/about/resources/media-center/news/rates-excessive-drinking-among-student-athletes-falling 

White, H. R., & Rabiner, D. L. (Eds.). (2011). College drinking and drug use. New York, NY: Guilford Press.