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Playing through pain

By Alex Piazza

Jake was the starting running back for his high school football team.

His success on the field earned him plenty of attention from college coaches.

But midway through his senior season, a linebacker tackled Jake near his knee, tearing his MCL.

A local physician prescribed him Vicodin to dull the pain, but it was the last time Jake ever played competitive football. He grew dependent on the powerful painkiller and lost all motivation for sports.

Philip Veliz has heard hundreds of these stories.

A young athlete suffers an injury, and then turns to drugs or alcohol to dull the pain. Or for many athletes, drugs and alcohol are simply vices to cope with the daily stressors of being a local star.

Veliz, a research assistant professor at the University of Michigan’s Institute for Research on Women and Gender (IRWG), and his colleagues study the connection between young athletes and substance use in an effort to curb this dangerous trend.

“The reason why I focus on young athletes so much is because they make up about 75 percent of the adolescent population,” he said. “That’s why I’m so adamant about studying the connection between drugs, alcohol and sports. This is a major public health concern that very few people are talking about. I love sports, but we need to address certain issues so that we can improve the overall experience for athletes, especially at a young age.”

Firsthand experience

Veliz can certainly relate to his research subjects.

The Ohio native was a standout wrestler in high school.

And with success came pressure to live up to lofty expectations.

“What happens if I lose? Will my scholarships disappear? Will my friends start to avoid me?”

Sure, wrestling taught Veliz discipline and increased his confidence. It encouraged him to wake up every morning and head to school. And it also helped him make friends.

"If we know that substance use is more closely associated with contact sports, we have to do a better job of monitoring these particular sports."

But those same friends were the ones who introduced Veliz to drugs and alcohol.

“All the people I used to wrestle with, they drank quite a bit, much more than people in other sports,” he said. “It was this sort of risky behavior that we embraced in high school for some reason.”

But was his experience unique? That question inspired Veliz study substance use among adolescent athletes.

Take alcohol for example. Veliz teamed with U-M colleagues Carol Boyd and Sean McCabe to see whether high-school boys who played sports were more prone to binge drink.

Their findings, published this month in The American Journal on Addictions, show that 20 percent of high-school boys who play at least one sport say they have binge drunk. The percentage is even higher among high-school boys who play more than one sport.

And during high school, Veliz noticed that his classmates who participated in contact sports were more prone to consume drugs or alcohol than those who played noncontact sports.

Veliz, Boyd and McCabe reviewed sample data from thousands of students in grades 8, 10 and 12, and their findings confirmed their assumption. Young athletes who participate in contact sports like football and wrestling are more likely to engage in binge drinking, marijuana use, nonmedical use of prescription painkillers and stimulants, as compared to athletes who play sports like tennis and golf.

“Contact sports participants view their body as an instrument that can be easily gambled with, even if it means permanent damage,” Veliz said. “If we know that substance use is more closely associated with contact sports, we have to do a better job of monitoring these particular sports.”

Fixing the problem

The pros far outweigh the cons in terms of youth sports.

There are a number of academic studies that show sports help students excel in the classroom and improve their health. And teens that participate in sports are less likely to engage in criminal behavior, research shows.

But stress and peer pressure weigh heavily on many athletes, prompting some to engage in substance use. McCabe participated in sports throughout his childhood, and into college, where he was a seven-time All-American tight end at Kenyon College.

"My main concern is how many of these youth are being prescribed opioids for their injuries."

“I was aware of substance use before I started participating in sports at a young age, but substance use became widespread during secondary school and throughout college, both inside and outside of sports,” said McCabe, a research professor in IRWG who studies substance use during the transition from adolescence to adulthood.

The 2014 NCAA Student-Athlete Substance Use Study shows that binge drinking is down significantly among student-athletes, and that student-athletes are much less likely to engage in social drug use than other college students.

That said, according to the NCAA study, six percent of student-athletes reported using pain medication without a prescription.

Boyd has nearly 40 years experience in the health care industry and has worked with her fair share of prescription drug abusers. She wasn’t aware of its prevalence in sports, though, until she took a closer look at the amount of injuries among young athletes.

“I follow the drugs, so when I see all these sports injuries, I realized there has to be some sort of connection here,” said Boyd, Deborah J. Oakley Collegiate Professor of Nursing.  “My main concern is how many of these youth are being prescribed opioids for their injuries. We know from prior research that about 15 percent of people who are given an opioid like it enough to take a lot of it.”

Prescription drug abuse can prove deadly, Boyd said, so it’s important to increase public awareness around the issue of substance use in youth sports.

“We ultimately need to address the availability problem,” she said. “This means coaches and parents need to step up and keep a closer eye on this issue. When injured athletes get a prescription, their parents should monitor how that drug is stored, how it’s used and whether others can get their hands on it.”

Veliz and McCabe agree. They also support the development of local forums where student-athletes can voice their concerns in a safe, secure environment.

“When you play sports, you’re not supposed to be scared—you’re supposed to always be in control,” Veliz said. “For a teenager, that’s not easy and it takes a toll on you emotionally. There are not many formal outlets where athletes can go to vent their problems, and that’s problematic because some may turn to alcohol or drugs to cope with these daily stressors.”