Addictive and Unhealthy Behaviors

1. chapter 20 Addictive and Unhealthy Behaviors

2. Session Outline • 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 Eating Disorders (continued)

3. 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)

4. 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)

5. Session Outline (continued) Compulsive Gambling • Prevalence of Sports Gambling • Characteristics of Compulsive Gamblers • Signs of Compulsive Gambling • Gamblers Anonymous 20 Questions

6. 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.

7. 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)

8. 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.

9. 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.

10. Understanding Bulimia • Condition is severe but less severe than anorexia. • Bulimia can lead to anorexia. • Bulimic individuals are aware that they have a problem.

11. 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)

12. Prevalence of Eating Disordersin 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

13. Research on the Prevalenceof 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)

14. Research on the Prevalenceof 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 sport-specific prevalence (e.g., among wrestlers vs. archers). (continued)

15. Research on the Prevalenceof 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.

16. Predisposing Factors • Weight restrictions and standards • Coach and peer pressure • Sociocultural factors • Performance demands • Judging criteria

17. Recognition and Referralof 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.

18. 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.

19. Physical Signs of Eating Disorders • Weight too low • Considerable weight loss • Extreme fluctuations in weight • Bloating • Swollen salivary glands • Amenorrhea (continued)

20. 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)

21. 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.)

22. Psychological–Behavioral Signsof 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)

23. Psychological–Behavioral Signsof 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)

24. Psychological–Behavioral Signsof Eating Disorders (continued) • Evidence of self-induced vomiting • Use of drugs such as diet pills, laxatives, and diuretics to control weight

25. Dos and Don’ts for DealingWith 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)

26. Dos and Don’ts for DealingWith Eating Disorders (continued) • Do emphasize the importance of long-term good nutrition. • Do provide information about eating disorders. (continued)

27. Dos and Don’ts for DealingWith 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)

28. Dos and Don’ts for DealingWith 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.

29. Preventing Eating Disordersin Athletes and Coaches • Promote proper nutritional practices. • Focus on fitness, not body weight. • Be sensitive to weight issues. • Promote healthy management of weight.

30. 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.

31. 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.

32. 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.

33. Prevalence of Substance Abusein Sports Accurate assessment is difficult to achieve because of the sensitive and personal nature of the problem.

34. Prevalence of Substance Abusein 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.

35. 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)

36. 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.

37. Why Athletes and ExercisersTake Drugs Physical reasons include wanting to • enhance performance, • rehabilitate injury, • look better, and • control appetite and lose weight.

38. Why Athletes and ExercisersTake Drugs Psychological reasons include wanting to • escape from unpleasant emotions or stress, • build confidence or enhance self-esteem, and • seek thrills.

39. Why Athletes and ExercisersTake Drugs Social reasons include • peer pressure and • emulating athletic heroes.

40. Major Categoriesof 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.)

41. Common Side Effectsof 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.)

42. Preventing and DetectingSubstance Abuse Key Only specially trained professionals work in drug treatment programs. However, fitness professionals play a major role in prevention and detection.

43. Reducing the Probabilityof 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)

44. Reducing the Probabilityof 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

45. Reducing the Probabilityof 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 performance-enhancing drugs amount to cheating and unfair competition to enhance athletes’ morality. (continued)

46. Reducing the Probabilityof Substance Abuse (Prevention) (continued) • Set good examples. • Teach coping skills.

47. 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

48. 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 self-esteem) • Health concerns (negative side effects)

49. 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)

50. 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)