Transcript SUBSTANCE ABUSE IN HEALTHCARE PROFESSIONALS

Alcohol-Related Problems in
Special Populations:
S. Pirzada Sattar, MD
Creighton School Of Medicine
Department of Psychiatry
Copyright ALCOHOL MEDICAL SCHOLARS
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Substance Use Disorders in
Special Populations
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Geriatric population
HIV+ , & Gay and lesbian groups
African Americans & other minorities
Immigrants
Psychiatric patients
Children & Youth
Women
Physicians
Incarceration
Homeless
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Athletes
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DEFINITIONS
Substance Use Disorders(SUDs)
 DEPENDENCE
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Tolerance
Withdrawal
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Inability to cut down/control use
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Considerable time spent using/obtaining/recovering
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Important activities given up/reduced
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Use despite negative consequences
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 ABUSE (less severe)
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Failure to fulfill role obligations
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Use in hazardous situations
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Recurrent, related legal problems
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SUBSTANCE USE DISORDERS IN
GERIATRIC PATIENTS
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Substance Use Disorders (SUDs) in Geriatric
Patients Are Often Overlooked
 Substance users stereotyped as young
 Physicians miss substance use
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Geriatric Patients with SUDs are Often
Evaluated by Physicians
 Frequent evaluation an opportunity to screen
 Higher rates of SUDs in medical facilities
 Substance use complicates medical illnesses
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Increased Substance Use Effects in Geriatric
Patients
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Increased BAC because:
•
Decreased lean body mass
•
Decreased total body water
•
Decreased gastric alcohol
dehydrogenase
Alcohol and drugs more intoxicating in
geriatric patients
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Description of Alcohol Use Disorders in
Geriatric Patients: Prevalence
 16% Men > 2 drinks per day, 15% Women >
1 drink per day
 Up to 31% men, 21% women > 3 drinks daily
in retirement communities
 Up to 21% alcohol dependence in medical
patients
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Alcohol Use Disorders (AUDs):
Early Onset (< Age 60)
 About 2/3 of geriatric AUDs
 Greater financial, legal and social problems
than later onset
 Heavier drinkers than later onset patients
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AUDs: Late Onset ( > Age 60)
 About 1/3 of geriatric AUDs
 Aging social drinkers more intoxicated with
same dose
 Cognitive disorder in heavy drinkers
 Social drinkers who increase drinking after
losses
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I. Medical Complications of Alcohol in
Geriatric Patients
 Cirrhosis: 60% 1 year death rate > age 60
vs. 7% in younger patients
 Heart Effects
• Women more susceptible
• Alcoholic women 4 X coronary artery disease vs. non-alcoholic
women
• Atrial fibrillation common, “holiday heart” increases risk
• Increased stroke risk
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II. Medical Complications
 Increase in cancers of liver, esophagus,
nasopharnx and colon
 Thrombocytopenia, macrocytosis
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III. Medical Complications
 Neurologic
• Increased dementia, Wernicke’s
encephalopathy, Korsakoff’s psychosis
 Psychiatric
• Alcohol-induced mood disorder
• Pseudodementia from mood disorder
• Suicide
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Other SUDs
 Less data than AUDs
 Low prevalence of illicit drug use
• Few IV drug users survive
• Reduced access to illicit substances
 High prevalence of prescription drug use disorders
• 25% using psychotropic medications
• This includes benzodiazepines and opioids
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Importance of Physician Screening
 Medical complications
 Doctors in an important position to intervene
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DSM-IV Criteria for Substance Dependence
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Maladaptive pattern and 3 or more of the following in a 12 month
period:
Tolerance (often reduced in geriatric patients).
Withdrawal (often delayed, with mental status changes in geriatric
patients).
Greater amount of use or longer duration than expected.
Unsuccessful efforts to reduce use.
Large amount of time obtaining, using and recovering from use.
Important activities reduced or given up.
Continued substance use despite its aggravation of physical or
psychological problem.
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DSM-IV Criteria for Substance Abuse
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Maladaptive use and 1 of the following in 12
month period:
Failure to fulfill obligations at work school or
home.
Recurrent use when physically hazardous.
Recurrent related legal problems.
Continued use despite recurrent social or legal
problems.
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State Markers that Suggest Alcoholism
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Gamma-glutamyl transferase (GGT): Sensitivity of 70% to
80% if 6-8 drinks per day consumed
Mean corpuscular volume (MCV) greater than 90 cubic
microns consistent with alcohol dependence
Carbohydrate deficient transferrin (CDT): Social over 14
units/liter and alcohol dependence over 20-30 units/liter
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Questionnaires that Raise Suspicion of
Alcohol Abuse or Dependence
• MAST-G is unique in that it is specific to
geriatric alcohol use disorders.
• AUDIT is comprehensive.
• CAGE and TWEAK are quick but have limited
sensitivity and specificity.
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Assessment of Drinking
2
2
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TWEAK:
- T (tolerance) “How many drinks can you hold?”
- W (worried) “Have close friends or relatives worried
or complained about your drinking in the past year?”
- E (eye opener) “Do you sometimes take a drink in
the morning when you first get up?”
- A (amnesia) “Has a friend or family member ever
told you about things you said or did while drinking
that you could not remember?”
- K (cut town) “Do you sometimes feel the need to
cut down on your drinking?”
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3 risky drinking
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Screening for SUDs other than AUDs
 Methods less developed than for AUDs
 Signs for concern (not specific) include:
• doctor shopping
• drug-seeking behavior
• decreased motivation
• trouble sleeping
• poor self care
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Treatment of SUDs
 Identification
 Intervention
 Detoxification
 Rehabilitation
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Identification
Doctor’s office, clinic and hospital
extremely important sites for identification
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Intervention in Geriatric patients
• Involve adult family members.
• Denial by family and peers.
• Reduced mobility.
• Losses and social isolation.
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Brief Intervention
• Two to three 10-15 minute counseling
sessions
• Identify problem, consequences and
formulate treatment plan.
• Non-confrontational and supportive.
• Tailored to individual needs and goals.
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I. Alcohol Detoxification Concerns in
Geriatric Patients
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Confusion (rather than tremor) early withdrawal sign
Duration of withdrawal/hallucinosis increased
Rule out DTs in confused elderly
Replace electrolytes and nutrients
Short acting benzodiazepines (lorazepam)
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II. Alcohol Detoxification Concerns in
Geriatric Patients
 Severe withdrawal or medical illness
managed inpatient
 Otherwise outpatient with family support
 Monitor symptomatology with Clinical Institute
Withdrawal Assessment for Alcohol (CIWAs)
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General Overview of Alcohol
Detoxification
 Supportive treatment
 Benzodiazepine taper
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Opioid Detox
 Supportive Treatment
 Medication
• Clonidine
• Methadone taper
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I. Rehabilitation Strategies for Geriatric
Patients
 Psychotherapy
• Individual for substance use and social
needs from losses and isolation
• Group, family and network therapy for
damage to family and peer relationships
from substance use.
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II. Rehabilitation Strategies for Geriatric
Patients
 Optimized by age-specific treatment
• Must fill the time formerly spent using
substances
• Senior centers often have alcoholics
anonymous (AA) groups and support
socialization
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Pharmacotherapy in Rehabilitation:
A Limited Role
 Naltrexone reduces alcohol reinforcing effects but
does not clearly promote abstinence, monitor liver
transaminases
 Disulfiram problematic with potential drug interactions
and co-morbid medical conditions
 Acamprosate may modestly increase abstinence
rates but GI upset, FDA approval pending
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Alcohol and Drug Misuse in
HIV+ and
Gay and Lesbian Populations
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Prevalence
 Approximately 1 million people have
contracted HIV since 2001
 Half have died
 >40% African American
 >20% Hispanics
 24% of HIV+ were IV drug users
 10% reported same sex practices
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Prevention requires:
 Greater tolerance, assessment,
testing
 Community resources & outreach
 Drug abuse treatment
 Harm reduction, e.g. Needle
exchange programs, methadone,
buprenorphine etc.
 Medical and psychiatric treatment
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Alcoholics Anonymous
 Most cities have gay/lesbian AA
meetings
 Clients may need to be reminded that
AA is not specifically focused on religion
 Extending the powerlessness over
alcohol concept to being powerless over
being gay may be helpful
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Recommendations
 Screen IV drug users & gay and lesbian
clients for alcohol abuse and
dependence
 HIV + may be referred to specific
treatment centers
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Substance Use Disorders
in
African Americans
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Goal of this section
Rare data
Policy/planning
Minorities and immigrants are different:
-traditional use of drugs in place
or culture of origin
-traumas suffered by Blacks and
other minorities
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Minorities discussed:
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African American
Native American
Hispanics
Asian Americans
Pacific Islanders
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Long history
Marijuana and south Sahara
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Exposure in the New World
 Patent medicine
Syringe development
Yet, use less common
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1940’s:
Heroin
Cough syrups
Prescription drugs
1960’s:
Marijuana

1990’s
Cocaine
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2000’s
Methamphetamine

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Major proportion of soldiers are from
minorities
Easy access to alcohol, ? Drugs
Bring experiences home, e.g. PTSD
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Racial integration (hallucinogens)
Widespread cocaine use
Gangs/crack
-interdiction
-combinations with alcohol and heroin
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Alcohol
White
Black
Hispanic
Any type of drug
White
Black
Hispanic
20.4
14.7
19.9
9.2
8.6
9.2
35+
65.6
49.6
49.8
66.0
55.7
50.6
54.3
42.0
44.0
17.0
15.7
10.9
8.8
Type of drug
Age group
26-34
12-17 18-25
2.9
3.8
1.5
10.6
5.7
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Age group
Type of drug 12-17 18-25
26-34
35+
Marijuana
White
Black
Hispanic
7.3
7.3
6.9
14.4
13.9
8.3
6.6
9.2
3.6
1.9
3.3
1.0
Cocaine
White
Black
Hispanic
0.5
1.1
1.1
2.3
3.1
2.1
1.3
0.6
1.4
0.4
0.6
0.6
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Education:
Family:
-Schooling was denied to Blacks
-Current education
-?cohesiveness
-Home supervision
-Minority youth/single household
Religion:
Role of Religion for minorities (then & now)
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Better screening and diagnosis
Coordination schools/local
organizations
Culturally sensitive programs
Involvement of religion and clergy
education
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Summary
 Discussion of historical and recent
patterns.
 Areas of probable vulnerabilities, e.g.
“acculturation stress”.
 Treatment options
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Substance Abuse
in Psychiatric
Patients
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Substance Abuse in
Psychiatric Patients
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Prevalence
Commonly abused substances
Increases morbidity and mortality
Treatment is available and effective
Long term approach required
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Alcohol-Related Problems in
Special Populations:
YOUTH and WOMEN
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Drinking Rates in Youth
12th Graders
100%
75%
50%
25%
0%
Ever
Drank
Been
Drunk
>5
Drinks
Daily
Drinking
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Features of Drinking in Youth
 Prognosis
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Drink < age 14:  risk of alcohol dependence
 Typical experimentation sequence:
Cigarettes
or
Alcohol
Marijuana
Other drugs
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Assessing Drinking in Youth
 Red flags:
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Change in peers
Family problems
Grades drop
Mood swings
 Common consequences:
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Accidents
“3-Ds”: driving, dating, & drug related problems
 Uncommon problems:
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Severe withdrawal symptoms
Liver problems
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Assessing Drinking in Youth
2
2
1
1
TWEAK:
- T (tolerance) “How many drinks can you hold?”
- W (worried) “Have close friends or relatives worried
or complained about your drinking in the past year?”
- E (eye opener) “Do you sometimes take a drink in
the morning when you first get up?”
- A (amnesia) “Has a friend or family member ever
told you about things you said or did while drinking
that you could not remember?”
- K (cut town) “Do you sometimes feel the need to
cut down on your drinking?”
1
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3 risky drinking
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Youth: Treatment
 Formats
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Multi-systemic treatments
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Minnesota model
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Therapeutic communities
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Cognitive-behavioral
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Groups
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Brief intervention
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Youth: Treatment
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Pathways to success
1.
Traditional routes
2.
Early individuation
3.
Family involvement
Outcome
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Treatment helps

Inpatient = Outpatient
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50-80% relapse in 1st year after treatment
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Women: Epidemiology
Women
Any alcohol in past year
62%
Men
83%
Has met Alcohol Abuse criteria
6% 13%
Has been Alcohol Dependent
8% 20%
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Women & Heavy Drinking
 Risk of health problems:
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Alcohol-related liver disease,
hepatitis, infections, anemia
STDs, UTIs, reproductive organ
problems, breast cancer
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Violence victimization risk
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Neurocognitive effects
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Alcohol & Pregnancy
 Prevalence
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16-35% of pregnant women drink
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4% drink frequently or heavily
 Fetal alcohol syndrome (FAS)
1.
Facial dysmorphia
2.
Growth deficiency
3.
CNS deficits
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Women: Detection
 Wide variability
 Social risk factors:
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Low vocational skills and education
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Substance use disordered partner
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Social isolation
 Screening tools:
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TWEAK

AUDIT-C
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Women: Treatment Issues
 Barriers
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External
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Internal
 Optimal treatment for women
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Reduce barriers
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Combine with obstetrics or other healthcare
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Women-only v. mixed setting
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SUBSTANCE USE
DISORDERS IN
PHYSICIANS
S. Pirzada Sattar, MD
School of Medicine
“WHY SHOULD I
STAY AWAKE?”
It might be my colleague
 It might be my patient
 It might be me
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KEY POINTS
 SUDs similar to the general population
 Benzodiazepines and opioids higher
 Identification is often difficult and delayed
 Treatment outcomes are often better
 Impaired Physician Programs are helpful
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EPIDEMIOLOGY
 VERY VARIABLE!!!!
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Population studied
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Methods used
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Terminology
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Diagnostic criteria
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Changes over time?
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Concern about anonymity
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EPIDEMIOLOGY
General
 Similar rates of SUDs to general population
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8-14%
 Less SUDs compared to other occupations
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Roofers, painters
 Increased rates of use & SUDs with:
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Benzodiazepines
Prescription opioids
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EPIDEMIOLOGY
Medical Students
 Use begins prior to medical school
 Types of drugs same as general pop.
 Alcohol use & dependence variable
 Drug use and dependence less
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EPIDEMIOLOGY
Residents
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Rates of dependence:10-14%
 Alcohol & illicit drug use begins prior
 Benzo & opioid use begins during
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Self-treatment
Self-prescribed
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EPIDEMIOLOGY
Practicing Physicians
 Prevalence of dependence: 8-14%
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Still means 60-75,000 affected M.D.s in U.S.!!!!
 Use & misuse of prescription opioids
& benzodiazepines up to 5Xs higher
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EPIDEMIOLOGY
By Specialty
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HIGHEST
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Emergency Medicine
Psychiatry
 LOWEST
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OB-GYN
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Pathology
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Radiology
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Pediatrics
Anesthesiology
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REASONS FOR USE
 Recreational
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Seen more in medical students
 Performance Enhancement
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Seen more in Emergency Medicine
 Self-medication (pain, anxiety, “stress”)
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Seen more in residents & attendings
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PROGRESSION
 Family
 Community
 Finances
 Spiritual/emotional
 Physical health
 Job performance

Often one of the last things affected
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CONTRIBUTING
FACTORS

Family History
 Personality characteristics
 Health/lifestyle
 Stress???
 Availability???
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IDENTIFICATION
 Urine drug screening
 Employment/school application
 Physician screening
 Impaired Physicians Programs
 Reporting
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“WARNING SIGNS”
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Isolation
Friction with colleagues
Disorganization
Inaccessibility
Frequent absences
Rounding on patients at odd hours
Inappropriate or forgotten orders
Slurred speech during off-hours calls
Prescriptions for family members
OD or suicide attempt
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WHY THE DELAY
IN DETECTION?
 Independence
 “Malignant denial”
 “I can take care of myself”
 “Knowledge is protective”
 Fear of consequences
 “Conspiracy of silence”
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“CONSPIRACY OF
SILENCE”
 Reputation
 Financial
 Fear & intimidation
 Professional pride
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REPORTING
 Ethical obligation
 Disabled Doctors Act
 Federal law
 Requirements vary by state
 Protection from law suit varies
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TREATMENT
THE GOOD NEWS!!!
 Variable data
 Most show better outcomes
 70-90% “success rate”
• little correlation with substance
• little correlation with specialty
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TREATMENT
Goals
 Abstinence
 Acceptance of chronic disease concept
 Identification of triggers
 Development of non-chemical coping
skills
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TREATMENT
Key Factors For Success
 Duration of aftercare
 Physician’s Health Program involvement
 Family involvement
 12-Step involvement
 Witnessed urinalysis
 Contingency contract
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TREATMENT
Stumbling Blocks
 Uniqueness
 Role-reversal
 Over-identification w/ performance
 Identification (by treatment provider)
 Medical knowledge
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TREATMENT
Physician-specific
 In-Patient

Talbott, Farley
 12-Step

“Caduceus meetings”
 Pros & Cons
 Combined approaches
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“RE-ENTRY”
 Most return to practicing medicine
 Change to a less high-risk specialty
 Imposed prescribing restrictions
 Altered work schedule
 Specialization in addictions
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“PREVENTION”
 Medical school policies
 Medical school education
 State Impaired Physicians Programs
• Protect the public
• Provide “rehabilitation” (vs punishment)
 JCAHO-mandated hospital programs
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KEY POINTS
A Review
 SUDs similar to the general population
 Benzodiazepines and opioids higher
 Identification is often difficult and delayed
 Treatment outcomes are often better
 Physician Rehab Programs are our friends
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WHERE TO GET HELP
State Agency
#
School Resources
#
Your email address
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NURSES
 Rates similar to general population
 Higher use of benzodiazepines & opioids

more parenteral use
 Higher in emergency room & critical care
 Especially difficult to monitor
 Watch for diversion
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DENTISTS
 Less good data
 More use of inhaled anesthetics
 Possibly higher opioid use and SUDs
 Related to higher suicide rate?
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PHARMACISTS
 Estimates of dependence: 10-18%
 Less parenteral use
 @ 50% have used CS w/o script
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@ 20% on regular basis
primarily self-medication
 @ 60% of students have used CS w/o script
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@ 40% on regular basis
primarily recreational
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VETERINARIANS
 Little good data
 More Ketamine use
 Other higher-potency opioids
 Inhaled anesthetics
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Substance Use In Athletes
S. Pirzada Sattar, MD
Developed for the Alcohol Medical Scholars Program
Copyright ALCOHOL MEDICAL SCHOLARS
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INTRODUCTION
 Major problems facing sport today
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Growing attention
Deaths of elite athletes
Increasing attention of media
 Contrary to the ethical principles of
athletic competition
 Wide spread among athletes
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DRUGS MISUSED BY ATHLETES
• Therapeutic drugs

OTCs, diuretics, opioids, beta-blockers,
etc.
 Performance enhancing drugs
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Amphetamines, ephedrine, caffeine,
anabolic steroids, growth hormone, etc.
 Drugs typically misused

Alcohol, nicotine, marihuana, cocaine, etc.
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GOALS
 Historical perspective
 Factors influencing athletes to use
drugs
 Types of drugs athletes useconsequences and myths
 Preventing and treating drug use in
athletes
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Historical perspective
 Ancient civilizations
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Mushrooms, herbs, liquor
 19th Century

Alcohol, caffeine, nitroglycerine, opium,
strychnine, trimethyl
 World War II

Amphetamines, testosterone
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Historical perspective
 Post war era
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Amphetamines continue
Anabolic steroids
 Newer agents
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Blood doping
Erythropoietin
Growth hormone
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Currently prohibited by IOC
 Drugs

Stimulants, opioids, anabolic agents, diuretics,
peptide hormones
 Methods

Blood doping, artificial oxygen administration,
plasma expanders, pharmacological, chemical
and physical manipulation
 In certain circumstances

Alcohol, cannabinoids, local anesthetics, 
blockers
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What factors influences athletes?
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Belief that competitors take drugs
Determination to do anything to win
Pressures from coaches, parents, peers
Community attitudes and expectations
Financial rewards
Media influence
Belief of enhanced performance
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THERAPEUTIC DRUGS
 OTCs
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NSAIDs, laxatives, ephedrine, analgesics,
weight loss meds, corticosteroids, local
anesthetics
Low potential for misuse
Increased risk of further injury, GI bleed,
anemia, eating disorders
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THERAPEUTIC DRUGS
 Diuretics
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Rapid weight loss
Boxing, wrestling, judo
Excretion or dilution of illegal substances
Overall negative impact on performance
Dehydration, hypotension, muscle cramps,
electrolyte imbalance
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THERAPEUTIC DRUGS
 Opioids
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Prescription pain killers most common
Allow performance while injured
75% used after injury only
Increased risk of further injury,
dependence, drowsiness, mental clouding;
in high doses: respiratory depression,
hypotension
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THERAPEUTIC DRUGS
 Beta-Blockers
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Anti-tremor, anxiolytic effect
Shooters, ski jumpers, archery
Negative effect on endurance
Depression, bronchospasm, fatigue
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PERFORMANCE ENHANCING DRUGS
 CNS Stimulants
 Amphetamines
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• Delay fatigue, increase alertness,
enhance speed, power, endurance,
concentration
Hypertension, angina, vomiting, abdominal
pain, cerebral hemorrhage, dependence,
death
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PERFORMANCE ENHANCING DRUGS
 CNS Stimulants
 Caffeine
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• Shortened reaction time, improved
concentration, diuresis
• Glycogen sparing leading to delayed fatigue
• > 12 ug/mL is a positive urine per IOC
Dyspepsia, cardiac damage, combination with
other stimulants (e.g. ephedrine) may be fatal
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PERFORMANCE ENHANCING DRUGS
 Systemic stimulants
 Adrenalin
• In local anesthetics
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Ephedrine and pseudoephedrine
• Cold and allergy remedies
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Phenylpropanolamine
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• Diet pills
Similar effects to the amphetamines in high doses
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PERFORMANCE ENHANCING DRUGS
 Anabolic androgenic steroids
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Derivatives of testosterone
First use generally later than other drugs
Drug and method sought for maximum anabolic
and minimum androgenic properties
Sprinting, weight lifting, body building
Acne, abnormal LFTs, feminization, virilization,
premature closure of the epiphysial plates,
behavioral changes “roid rage”, CVAs,
cardiomyopathy
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PERFORMANCE ENHANCING DRUGS
 Beta 2 agonists
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Isoproterenol, epinephrine, norepinephrine
Sympathomimetic amines, anabolic properties
Cardiac arrhythmias in overdose, headaches
 Peptide hormones: HCG
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Increases testosterone
Maintains testicular volume with anabolic steroid
use
Ovarian cysts
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PERFORMANCE ENHANCING DRUGS
 Pituitary and synthetic gonadotropins
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Increases testosterone, anti- estrogenic
Ovarian cysts
Corticotropins
Increase testosterone
Rare and related to excess corticosteroidspituitary suppression, ¯ immunity,
osteoporosis, hyperglycemia
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PERFORMANCE ENHANCING DRUGS
 Growth hormone
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Increase muscle mass & decrease fat
mass
Gigantism, acromegaly, hypothyroidism,
cardiac disease, myopathies, arthritis,
diabetes mellitus, impotence, osteoporosis
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PERFORMANCE ENHANCING DRUGS
 Erythropoietin (EPO)
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Stimulates RBC production
Increases oxygen carrying capacity
CVAs
 Blood doping
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RBC transfusion, artificial oxygen carriers
Increases oxygen carrying capacity
Allergic reactions, sludging of blood
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FOOD SUPPLEMENTS
 Viewed as legal means of gaining edge
 76-100% of athletes use vs. 50%
general population
 May or may not contribute to enhanced
performance
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Creatine, colostrum, antioxidants, sodium
bicarbonate, vitamins, proteins, amino
acids
Adverse effects not investigated
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TYPICAL DRUGS OF MISUSE
 Most common: marijuana, cocaine, alcohol
 Generally have negative effect on performance
 Substance misuse same in college athletes vs. nonathletes
 Decrease in use of marijuana, amphetamines and
cocaine, but increase in smokeless tobacco use,
1985-1996
 Most drugs first used in junior or senior high school
(for recreation not performance)
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TYPICAL DRUGS OF MISUSE
 Alcohol
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Most frequently used
Negative impact on reaction time, handeye coordination, balance, strength
Excessive heat production and dehydration
Cardiovascular and GI complications,
nutritional deficiencies, dependence
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TYPICAL DRUGS OF MISUSE
 Cocaine
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Minimal performance enhancing effect
Heightened arousal and increased
alertness with low doses
Over confidence leading to increased
risk of injury
MI, CVA, seizures, arrhythmias,
dependence
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TYPICAL DRUGS OF MISUSE
 Cannabinoids
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Most frequent illegal drug used in the US
Male athletes have higher incidence than nonathletic peers (opposite for females)
Initial use in high school
Psychomotor impairment, distorted perception,
amotivational syndrome; decreased
testosterone with long-term use
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TYPICAL DRUGS OF MISUSE
 Nicotine
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Majority use in form of smokeless tobacco
Males >> females
52% of baseball players, 26% of varsity football
players used smokeless tobacco (early 1990s California
college survey)
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Highest risk for baseball players
Cardiovascular and pulmonary disease, oral cancers,
dependence
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PREVENTION AND TREATMENT
 Drug testing
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Commonplace in amateur and professional
sports
65% of college athletes agree with testing
37% agreed that positive should result in
disqualification
67% of college athletes believe that drug
testing deters drug use
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DRUG PROGRAMS
 Administered by leagues and
associations (NCAA, NFL, NBA)
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Responsible for relevant events, fairness,
quality of competition, safety, image of their
athletes and events
Deter use by testing and discipline
Some include evaluation and treatment
Coaches can discourage use
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DRUG PROGRAMS
 Identify individuals with drug problem to
facilitate treatment
 Keys to successful drug program:
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Inclusion of all involved parties
Reliable and sensitive testing program
Consistent discipline
Evaluation of effectiveness
Confidentiality
Early prevention
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CHALLENGES
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Most drugs not prescribed
Viewed as essential for success
Easy access to drugs
Physician dilemma/role
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Monitoring side effects
Why?, discuss pro/cons, appraisal, explore
options
 Need for collaboration
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SUMMARY
 Substance use in athletes dates to ancient
times
 Multiple factors why athletes use drugs
 Types of drugs used range from therapeutic
and performance enhancing to typical drugs
of misuse
 Programs are in place to address drug use in
athletes
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