How Athletes are Affected by Mental Health and Substance Use Disorders

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Adolescents and young adults who play high school and college sports face unique stressors that can leave them vulnerable to developing substance use and mental health disorders. In this interview, Dominque JonesDominique Jones shares ways that parents, coaches and professionals can support young athletes who are struggling or at risk.

Dominique is a primary mental health therapist at High Focus Centers in Sandy Springs, Georgia. A Licensed Associate Professional Counselor, she earned her master’s degree from Clayton State University.

Which behavioral health issues are most commonly seen in athletes?

There are particular stressors that come along with playing a sport and being an athlete that the average student doesn’t experience. Athletes are managing academics as well as sports practice, so they often have more on their plate. Common issues we see as behavioral healthcare professionals include anxiety and depression related to athletic performance. Maybe they’re not performing as well as they’d like to be, or maybe there are other influences at play, such as parents putting added pressure on them to perform.

I would say the most common issues would be anxiety and depression due to being overwhelmed with a lot of pressures that are coming from a lot of different moving parts.

Does becoming injured while playing sports put athletes at risk of developing opioid use disorder?

In my experience, very much so. Often there may be a disconnect in communication between our primary care doctors and their patients, especially if they’re overworked. There’s also some missing education in general on how dangerous prescribing opioids can be in these situations.

While opioids help with pain, they can start a domino effect because it’s so highly addictive. It’s a common story for an athlete to get injured while playing a sport, be prescribed an opioid for pain and then develop a tolerance that results in their provider having to increase their dosage over and over again. Eventually, it can become a gateway to using other substances, especially when the individual is exposed to other drug influences out in the world, whether at school or in the environment in which they live. It can be easy to fall into a pattern.

Are athletes less likely to seek treatment compared with the general population? What factors might prevent an athlete from seeking care?

There’s an influence for athletes to avoid seeking mental health or substance use services, particularly when they’re still able to function relatively normally within their sport. For example, they might avoid seeking treatment if they’re experiencing pain from an injury and opioids are allowing them to continue to play.

The athlete’s identity is often connected to the sport they play. This is especially true for promising, talented athletes or those who have a lot of external pressure on them to perform well at their sport. In these cases, they might be less likely to pursue professional treatment for their symptoms because their overall focus is on doing well in the sport and doing well in school so that they can continue to play the sport. Everything else gets pushed to the background.

What can parents, coaches, mentor figures, etc. do to help prevent young athletes from developing substance use disorders?

Awareness and understanding play a huge part in prevention. Just because the child has been prescribed opioids — for pain related to an injury, for instance — that doesn’t automatically mean that they’ll develop a substance use disorder. But it does increase the risk, even when they’re using those substances as prescribed by a physician.

Parents, coaches and other adults in young athletes’ lives need to have a general awareness of the possibility of dependence developing and be prepared to manage that. For example, let’s say an athlete who is injured finds that their pain medication isn’t working anymore. They’re still in pain, so their parent takes them to see the doctor, who increases the dosage. A parent who is aware that this scenario can lead to dependence and substance abuse might step in and inquire about alternative routes to pain management. Physical therapy, for instance.

The child also needs to be aware that there’s a possibility they could form a dependence. If they know what symptoms to look out for, then they can catch it early before it becomes serious enough that they’re using other substances or their life is in danger.

I would say that the best way to prevent substance use disorders from occurring is to be aware, ask questions and make sure there’s no judgment. It’s best to create a cohesive environment in which everybody is working together in the best interests of the athlete, rather than chastising them or placing blame.

In most cases, it’s not the athlete’s fault that they were injured. It’s not their fault that the doctor presented medication as the first or only option for pain relief. If the athlete feels trapped because the adults in their life are judging or chastising them, this could also contribute to negative mental health symptoms, like depression and anxiety. This might drive them to just focus on playing the sport and pretend like substance use isn’t an issue, creating a domino effect.

How do we accommodate the unique needs of athletes with substance use and mental health disorders at High Focus Centers?

For many people, mental health plays a huge role in their substance abuse. Maybe the athlete originally took the substance for pain but realized that they feel really good after taking a pill. They might be tempted to take the pill when they’re feeling depressed or sad in order to feel better. That’s one-way using substances can become a habit for coping with emotions and distress.

Our programs acknowledge the mental health side of substance abuse as well as the substance use disorder itself and I think this is really beneficial for the client. In the case of an athlete suffering from a substance use disorder after being prescribed opioids due to an injury, I think our programs provide structure from all sides, not just addressing the substance use, but the underlying issues that led to the substance use. We’re processing questions like, what is the substance helping you with? What is your fear? If you stop using the substance, what will happen? Clients also have access to an onsite nurse practitioner or psychiatrist who is able to help provide medication education and management.

We strive to build awareness and create resilience for our clients by approaching treatment from the mental health side as well as stopping the substance abuse and ensuring the client is safe. They’re developing coping skills to use in place of a substance.

Tell us about your role as a primary mental health therapist at High Focus Centers.

My main role is leading the structured IOP/OP groups for both adolescents and adults here at High Focus Centers. In groups, we focus on processing and mental health, developing coping skills and assessing safety as well as providing resources and medication management.

I also meet with clients individually and in family sessions. For adolescent clients, family sessions are especially important. Some factors within the family dynamic or in the environment that the child lives could be affecting their mental health and substance use, so that needs to be addressed.

Individual sessions provide a space where clients can communicate with a therapist one-on-one without the pressures of being in a group. Some things that they discuss individually, may not be comfortable discussing in a group.