chapter
20
Addictive
and Unhealthy
Behaviors
Session Outline
Eating Disorders
• Defining and Understanding Eating
Disorders
• Prevalence of Eating Disorders in Sport
• Predisposing Factors
• Recognition and Referral of an Athlete With
Eating Problems
• Dos and Don’ts for Dealing With Eating
Disorders
• Preventing Eating Disorders in Athletes and
Coaches
(continued)
Session Outline (continued)
Substance Abuse
•
•
•
•
•
Substance Abuse
Prevalence of Substance Abuse in Sport
Why Athletes and Exercisers Take Drugs
Major Drug Categories and Their Effects
Preventing and Detecting Substance Abuse
(continued)
Session Outline (continued)
Addiction to Exercise
•
•
•
•
•
Defining Exercise Addiction
Positive Addiction to Exercise
Negative Addiction to Exercise
Symptoms of Negative Addiction to Exercise
Preventing Negative Addiction to Exercise
(continued)
Session Outline (continued)
Compulsive Gambling
•
•
•
•
Prevalence of Sports Gambling
Characteristics of Compulsive Gamblers
Signs of Compulsive Gambling
Gamblers Anonymous 20 Questions
Defining and Understanding Eating
Disorders
Anorexia nervosa
A psychological disease characterized by an
intense fear of becoming obese, a disturbed
body image, a significant weight loss, the
refusal to maintain normal body weight, and
amenorrhea.
Characteristics of Anorexia Nervosa
• Weight loss to 15% below normal
• Intense fear of gaining weight or being fat,
despite being underweight
• Disturbance in one’s experience of body
weight, size, and shape
• Females: absence of at least three
consecutive expected menstrual cycles
(APA, 1994)
Understanding Anorexia Nervosa
• Anorexia is potentially deadly; it can lead to
starvation and other medical complications
such as heart disease.
• Affected individuals don’t see themselves
as abnormal.
Defining and Understanding Eating
Disorders
Bulimia
An episodic eating pattern of uncontrollable
food bingeing followed by purging,
characterized by an awareness that the
pattern is abnormal, fear of being unable to
stop eating voluntarily, depressed mood, and
self-deprecation.
Understanding Bulimia
• Condition is severe but less severe than
anorexia.
• Bulimia can lead to anorexia.
• Bulimic individuals are aware that they have
a problem.
Characteristics of Bulimia
• Recurrent binge eating
• A sense of lacking control over eating behavior
during the binges
• Engaging in regular self-induced vomiting, use
of laxatives or diuretics, strict dieting or
fasting, or vigorous exercise in order to prevent
weight gain
• Average minimum of two binge-eating episodes
a week for three months
• Persistent overconcern with body shape and
weight
(APA, 1994)
Prevalence of Eating Disorders
in Sport
Accurate assessment is difficult to achieve for
a variety of reasons:
• Fear of being dropped from program
• Questionable accuracy of studies
(assessment problem) and data must be
viewed with caution
Research on the Prevalence
of Eating Disorders in Sport
• Athletes appear to have a greater
occurrence of eating-related problems
(disordered eating) than does the general
population.
• Female athletes, in general, report higher
rates of eating disorders than male athletes,
which is similar to rates for the general
population.
• Athletes and nonathletes have similar
eating-related symptoms.
(continued)
Research on the Prevalence
of Eating Disorders in Sport
(continued)
• A significant percentage of athletes engage
in pathogenic eating or weight loss
behaviors (e.g., bingeing, fasting), although
subclinical in intensity.
• Eating disorders and pathogenic weight
loss techniques tend to have a sportspecific prevalence (e.g., among wrestlers
vs. archers).
(continued)
Research on the Prevalence
of Eating Disorders in Sport
(continued)
• Up to 66% of female athletes may be
amenorrheic as compared to 2% to 5% of
nonathletes.
• Although anorexia and bulimia are of
special concern in sports emphasizing form
(e.g., gymnastics, diving, and figure skating)
or weight (e.g., wrestling), athletes with
eating disorders have been found in a wide
array of sports.
Predisposing Factors
•
•
•
•
•
Weight restrictions and standards
Coach and peer pressure
Sociocultural factors
Performance demands
Judging criteria
Recognition and Referral
of an Athlete With Eating Problems
• Be able to recognize the physical and
psychological signs and symptoms of these
conditions.
• If you suspect an eating disorder, make a
referral to a specialist in the area.
Making Referrals
• A person who has a rapport with the
individual should schedule a private
meeting to discuss the matter.
• Emphasize feelings rather than directly
focusing on eating behaviors.
• Be supportive and keep all information
confidential.
• Make a referral to a specific clinic or person.
Physical Signs of Eating Disorders
•
•
•
•
•
•
Weight too low
Considerable weight loss
Extreme fluctuations in weight
Bloating
Swollen salivary glands
Amenorrhea
(continued)
Physical Signs of Eating Disorders
(continued)
• Carotinemia—yellowish palms or soles of
feet
• Sores or calluses on knuckles or back or
hand from inducing vomiting
• Hypoglycemia (low blood sugar)
• Muscle cramps
• Stomach complaints
(continued)
Physical Signs of Eating Disorders
(continued)
• Headaches, dizziness, or weakness from
electrolyte disturbances
• Numbness and tingling in limbs from
electrolyte disturbances
• Stress fractures
(See “Physical and Psychological-Behavioral Signs
of Eating Disorders” on p. 465 of text.)
Psychological–Behavioral Signs
of Eating Disorders
• Excessive dieting
• Excessive eating without weight gain
• Excessive exercise that is not part of
normal training program
• Guilt about eating
• Claims of feeling fat at normal weight
despite reassurance from others
(continued)
Psychological–Behavioral Signs
of Eating Disorders (continued)
• Preoccupation with food
• Avoidance of eating in public and denial of
hunger
• Hoarding food
• Disappearing after meals
• Frequent weighing
• Binge eating
(continued)
Psychological–Behavioral Signs
of Eating Disorders (continued)
• Evidence of self-induced vomiting
• Use of drugs such as diet pills, laxatives,
and diuretics to control weight
Dos and Don’ts for Dealing
With Eating Disorders
• Do get help and advice from a specialist.
• Do be supportive and empathetic.
• Do express concern about general feelings,
not specifically about weight.
• Do make referrals to a specific person and,
when possible, make appointments for the
individual.
(continued)
Dos and Don’ts for Dealing
With Eating Disorders (continued)
• Do emphasize the importance of long-term
good nutrition.
• Do provide information about eating
disorders.
(continued)
Dos and Don’ts for Dealing
With Eating Disorders
• Don’t ask the athlete to leave team or curtail
participation, unless so instructed by a
specialist.
• Don’t recommend weight loss or gain.
• Don’t hold team weigh-ins.
• Don’t single out or treat the individual
differently from other participants.
(continued)
Dos and Don’ts for Dealing
With Eating Disorders (continued)
• Don’t talk about the problem with
nonprofessionals who are not directly
involved.
• Don’t demand that the problem be stopped
immediately.
• Don’t make insensitive remarks or tease
individuals regarding their weight.
Preventing Eating Disorders
in Athletes and Coaches
•
•
•
•
Promote proper nutritional practices.
Focus on fitness, not body weight.
Be sensitive to weight issues.
Promote healthy management of weight.
Substance Abuse
• 98% of elite athletes said they would take a
banned performance-enhancing substance
with two guarantees—they would not be
caught and they would win.
• 60% said they would do so even if it meant
they would die from the side effects.
Defining Substance Abuse
Substance abuse
A maladaptive pattern of psychoactive substance use
indicated by one of two patterns of use: continued
use despite knowledge of having a persistent or
recurring social, occupational, psychological, or
physical problem that is caused or exacerbated by
use of the psychoactive substance; or recurrent use
in situations in which the use is physically hazardous
(e.g., driving). Some symptoms of the disturbance
have persisted for at least one month or have
occurred repeatedly over a longer period.
Defining Drug Addiction
Drug addiction
A state in which either discontinuing or
continual use of a drug create an
overwhelming desire, need, and craving for
more of the substance.
Prevalence of Substance Abuse
in Sports
Accurate assessment is difficult to achieve
because of the sensitive and personal nature
of the problem.
Prevalence of Substance Abuse
in Sports
Most studies have focused on alcohol and
steroid use:
• Alcohol use: 55% to 92% of high school
athletes; 87% to 88% of college athletes.
• Performance-enhancing drugs: reported
use by 5% of high school and college
athletes (40 to 60% among elite athletes).
• A 2003 CDC study: 1 in 16 high school
students used steroids.
Girls’ Steroid Use
• Traditionally, the use of performanceenhancing drugs such as steroids has been
seen as predominantly a male domain.
• However, recent research has revealed that
young girls (some as young as 9 years old)
are using bodybuilding steroids—not
necessarily to get an edge on the playing
field but to get the toned, sculpted look of
models and movie stars.
(continued)
Girls’ Steroid Use (continued)
• About 5% of high school girls and 7% of middle
school girls admit to trying anabolic steroids at
least once with the use of the drugs rising steadily
since 1991.
• In teenage girls, the side effects from taking male
sex hormones can include severe acne, smaller
breasts, deeper voice, excessive facial and body
hair, irregular periods, depression, paranoia, and
fits of anger dubbed "roid rage." Steroids also carry
higher risks of heart attack, stroke, and some forms
of cancer.
Why Athletes and Exercisers
Take Drugs
Physical reasons include wanting to
•
•
•
•
enhance performance,
rehabilitate injury,
look better, and
control appetite and lose weight.
Why Athletes and Exercisers
Take Drugs
Psychological reasons include wanting to
• escape from unpleasant emotions or stress,
• build confidence or enhance self-esteem,
and
• seek thrills.
Why Athletes and Exercisers
Take Drugs
Social reasons include
• peer pressure and
• emulating athletic heroes.
Major Categories
of Performance-Enhancing Drugs
There are six major categories:
1. Stimulants
2. Narcotic analgesics
3. Anabolic steroids
4. Beta-blockers
5. Diuretics
6. Peptide hormones and analogues
(See table 20.1 on p. 478 of text.)
Common Side Effects
of Recreational Drugs
•
•
•
•
Mood swings
Distorted vision
Decreased reaction time
Changes in blood pressure
(See Common Recreational Drugs and Their Side
Effects on p. 479 of text.)
Preventing and Detecting
Substance Abuse
Key
Only specially trained professionals work in
drug treatment programs. However, fitness
professionals play a major role in prevention
and detection.
Reducing the Probability
of Substance Abuse (Prevention)
Be aware of the warning signs of substance
abuse:
• Change in behavior (lack of motivation,
tardiness, absenteeism)
• Change in peer group
• Major change in personality
• Major change in performance (academic or
athletic)
(continued)
Reducing the Probability
of Substance Abuse (Detection)
(continued)
Be aware of the warning signs of substance
abuse:
•
•
•
•
•
•
Apathetic or listless behavior
Impaired judgment
Poor coordination
Poor hygiene and grooming
Profuse sweating
Muscular twitches or tremors
Reducing the Probability
of Substance Abuse (Prevention)
• Provide a supportive environment (address
the reasons that individuals take drugs).
• Educate participants about the effects of
drug use.
• Inform participants that performanceenhancing drugs amount to cheating and
unfair competition to enhance athletes’
morality.
(continued)
Reducing the Probability
of Substance Abuse (Prevention)
(continued)
• Set good examples.
• Teach coping skills.
Drugs in Sport Decision Model (DSDM)
• The DSDM states that individuals conduct a
cost–benefit analysis of the consequences
of lawbreaking behavior before deciding to
break a law.
• The DSDM consists of three major
components:
1. The costs of a decision to use
2. The benefits associated with using
3. Specific situational factors that may
affect the cost–benefit analysis of using
Drugs in Sport Decision Model (DSDM)
Costs
• Legal sanctions (fines, suspensions, jail
time
• Social sanctions (disapproval, criticism by
important others, material loss)
• Self-imposed sanctions (guilt, reduced selfesteem)
• Health concerns (negative side effects)
Drugs in Sport Decision Model (DSDM)
Benefits
• Material (prize money, sponsorship,
endorsements, contracts)
• Social (prestige, glory, acknowledgment by
important others)
• Internalized (satisfaction of high
achievement)
Drugs in Sport Decision Model (DSDM)
Situational variables
• Perceptions of prevalence (how frequently others
use this drug)
• Experience with punishment and punishment
avoidance
• Professional status (how much money and status
might be lost)
• Perception of authority legitimacy (can the agency
enforce the law?)
• Type of drug (its effects and side effects)
Addiction to Exercise
• Exercise addiction: A psychological or
physiological dependence on a regular regimen of
exercise that is characterized by withdrawal
symptoms after 24 to 36 hours without exercise
• Positive addiction to exercise: A condition in which
exercise is viewed as important in one’s life but is
successfully integrated with other aspects of life
(healthy habit)
• Negative addiction to exercise: A condition in which
life becomes structured around exercise to such an
extent that home and work responsibilities suffer
Symptoms of Negative Addiction
to Exercise
• Stereotyped pattern of exercise with a
regular schedule of once or more daily
• Giving increased priority, over other
activities, to maintaining the pattern of
exercise
• Increased tolerance to the amount of
exercise performed
• Withdrawal symptoms related to mood
disorder after cessation of the exercise
(continued)
Symptoms of Negative Addiction
to Exercise (continued)
• Relief of withdrawal symptoms by further
exercise
• Subjective awareness of a compulsion to
exercise
• Rapid reinstatement of the previous pattern
of exercise and withdrawal symptoms after
a period of abstinence
Preventing Negative Addiction
to Exercise
• Schedule rest days.
• Work out regularly with a slower partner.
• If you’re injured, stop exercising until
healed.
• Train hard–easy: Mix in low intensity and
less distance with days of harder training.
• If interested in health aspect, exercise three
or four times a week for 30 minutes.
• Set realistic short- and long-term goals.
Compulsive Gambling
• Compulsive gambling, despite its long
history in competitive sport, is only now
getting public attention.
• Gambling on sporting events is widespread.
Prevalence of Compulsive Gambling
• 72% of NCAA Division I football and
basketball athletes engage in some form of
gambling.
• 12% of male and 3% of female college
athletes have problematic/pathological
gambling problems.
• 6% to 8% of college students are
compulsive gamblers.
Prevalence of Compulsive Gambling
• A 2003 NCAA study showed that 35% of
male athletes and 10% of female athletes
bet on college sports, and approximately
60% of NCAA Division I and 40% of Division
III athletes did not know the NCAA rules
about gambling.
• 6% to 8% of college students are
compulsive gamblers.
• Gambling by high school students is
thought to be widespread.
Typical Parental Reactions
to Teenage Gambling
• Feel fear; imagine organized crime is
involved
• Think they can handle it (most common
reaction)
• Think, Thank God, it’s not drugs.
Characteristics
of Compulsive Gamblers
•
•
•
•
•
Boastfulness
Arrogance
Optimism
External competitiveness
Intelligence
Signs of Compulsive Gambling
Keys
• Identification is next to impossible.
• Use the following Gamblers Anonymous 20
Questions for self-identification.
• Sport psychology professionals should
make referrals when negative
consequences appear.
Gamblers Anonymous 20 Questions
1. Did you ever lose time from work or school
due to gambling?
2. Has gambling ever made your home life
unhappy?
3. Did gambling affect your reputation?
4. Have you ever felt remorse after gambling?
5. Did you ever gamble to get money with
which to pay debts or otherwise solve
financial difficulties?
(continued)
Gamblers Anonymous 20 Questions
(continued)
6. Did gambling cause a decrease in your
ambition or efficiency?
7. After losing, did you feel you must return
as soon as possible and win back your
losses?
8. After a win, did you have a strong urge to
return and win more?
9. Did you often gamble until your last dollar
was gone?
(continued)
Gamblers Anonymous 20 Questions
(continued)
10. Did you ever borrow to finance your
gambling?
11. Have you ever sold anything to finance
gambling?
12. Were you reluctant to use “gambling
money” for normal expenditures?
13. Did gambling make you careless of the
welfare of yourself or your family?
14. Did you ever gamble longer than you had
planned?
(continued)
Gamblers Anonymous 20 Questions
(continued)
15. Have you ever gambled to escape worry
or trouble?
16. Have you ever committed, or considered
committing, an illegal act to finance your
gambling?
17. Did gambling cause you to have difficulty
in sleeping?
(continued)
Gamblers Anonymous 20 Questions
(continued)
18. Did arguments, disappointments, or
frustrations create within you an urge to
gamble?
19. Did you ever have an urge to celebrate
any good fortune with a few hours of
gambling?
20. Have you ever considered selfdestruction as a result of your gambling?