FW279 Addictive Behavior

Chapter 20: Addictive and Unhealthy Behaviors
20
AddictiveAddictive
and Unhealthyand Unhealthy
BehaviorsBehaviors
C H A P T E R

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)

• 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)

• 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
• Anorexia nervosa is a psychological
disease characterized by the following:
– An intense fear of becoming obese
– A disturbed body image
– A significant weight loss
– The refusal to maintain normal body weight
– 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, with a
mortality rate of 5%, the highest mortality
rate of any psychiatric condition. It can lead
to starvation and other medical
complications such as heart disease.
• The suicide risk of those affected is 50%
higher than that of the general population.
• Affected people don’t see themselves as
abnormal.

Defining and Understanding Eating
Disorders: Bulimia
• Bulimia is an episodic eating pattern of
uncontrollable food bingeing followed by
purging and is characterized by the
following:
– An awareness that the pattern is abnormal
– Fear of being unable to stop eating voluntarily
– Depressed mood
– Self-deprecation

Understanding Bulimia
• Condition is severe but less severe than
anorexia.
• Bulimia can lead to anorexia.
• Bulimic people 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
(continued)

Characteristics of Bulimia (continued)
• 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
and Disordered Eating 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) so 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)

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 sport-
specific prevalence (e.g., among wrestlers
versus archers).
(continued)

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
(continued)

Predisposing Factors (continued)
• Judging criteria
• Critical comments about body shape and
weight
• Genetic and biological factors
• Mediating factors

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
affected 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)

(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)

(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)

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)

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
person.
(continued)

with Eating Disorders (continued)
• Do emphasize the importance of long-term
good nutrition.
• Do provide information about eating
disorders.
(continued)

• Don’t ask the athlete to leave team or curtail
participation, unless instructed by a
specialist.
• Don’t recommend weight loss or gain.
• Don’t hold team weigh-ins.
• Don’t single out or treat the person
differently from other participants.
(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
athletes 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 is a maladaptive pattern of
psychoactive substance use indicated by
one of two patterns of use:
1. 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.
2. Recurrent use in situations in which the use is physically
hazardous. 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 is 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.
(continued)

Prevalence of Substance Abuse
in Sports (continued)
• 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
only 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 performance-
enhancing 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; use of the drugs has
risen steadily since 1991.
(continued)

Girls’ Steroid Use (continued)
• 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.
(continued)

Take Drugs (continued)
• Psychological reasons include wanting to
– escape from unpleasant emotions or stress,
– build confidence or enhance self-esteem, and
– seek thrills.
(continued)

Take Drugs (continued)
• Social reasons:
– Peer pressure
– Emulating athletic heroes

Six Major Categories
of Performance-Enhancing Drugs
1. Stimulants
2. Narcotic analgesics
3. Anabolic steroids
4. Beta-blockers
5. Diuretics
6. Peptide hormones and analogues
See table 20.1 on p. 480 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
• 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)

(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
(continued)

(continued)
• Provide a supportive environment (address
the reasons that people take drugs).
• Educate participants about the effects of
drug use.
• Inform participants that performance-
enhancing drugs amount to cheating and
unfair competition to enhance athletes’
morality.
(continued)

(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 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 (continued)

(DSDM) (continued)
• Costs
– Legal sanctions (fines, suspensions, jail time)
– Social sanctions (disapproval, criticism by important
others, material loss)
– Self-imposed sanctions (guilt, reduced self-esteem)
– Health concerns (negative side effects)
(continued)

(DSDM) (continued)
• Benefits
– Material (prize money, sponsorship, endorsements,
contracts)
– Social (prestige, glory, acknowledgment by
important others)
– Internalized (satisfaction of high achievement)
(continued)

(DSDM) (continued)
• 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)
(continued)

Addiction to Exercise (continued)
• 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.
(continued)

Preventing Negative Addiction
to Exercise (continued)
• 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 or pathological
gambling problems.
• 6% to 8% of college students are
compulsive gamblers.
(continued)

Prevalence of Compulsive Gambling
(continued)
• 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.
• 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
• Identification is next to impossible.
• Use the 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?
(continued)
Reprinted with permission from Gamblers Anonymous 2002.

(continued)
5. Did you ever gamble to get money with
which to pay debts or otherwise solve
financial difficulties?
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?
(continued)

(continued)
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?
10. Did you ever borrow to finance your
gambling?
11. Have you ever sold anything to finance
gambling? (continued)

(continued)
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?
15. Have you ever gambled to escape worry or
trouble?
(continued)

(continued)
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?
18. Did arguments, disappointments, or
frustrations create within you an urge to
gamble?
(continued)

(continued)
19. Did you ever have an urge to celebrate any
good fortune with a few hours of gambling?
20. Have you ever considered self-destruction
as a result of your gambling?

FW279 Addictive Behavior

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