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Substance Abuse in Student Athletes

By: Jamie Legner, MS, LAT, ATC

Drug abuse occurs for many reasons and across many levels of sports participation. Reasons for drug abuse can include performance enhancement, pain relief, stress management, and as a way to cope with poor performance or pressure to succeed. Drug abuse in athletes can include not only prescription or illegal drugs, but also the use of dietary supplements to gain a competitive advantage. The contents of many dietary supplements are not regulated. This means that the manufacturer may not be required to include all of the ingredients, or the amount of each ingredient, on the supplement label. Alcohol can be another substance abused. One study, by Donohue et al., shows that as many as 36 percent of high school athletes reported the use of alcohol compared to only 21 percent of their non-athlete peers.

The use of performance enhancing drugs can lead to devastating outcomes for an athlete and his or her family. These effects can be short or long-term and vary based on the substance used. It is imperative that clinicians are aware of warning signs that may indicate the use of illegal substances and that we educate our young athletes on the effects of these harmful materials before it is too late.

Warning Signs

Warning signs will vary depending on the substance that is being used, but things to watch for include personality changes, aggressiveness toward others, needle marks, slurred speech or rapidly increasing muscle mass. Any changes in consciousness would be a severe sign that something is wrong. If you’re able to rule out other causes for loss of consciousness, a drug test may be indicated. It is important to forge healthy relationships with athletes so that we are able to recognize changes in their demeanor or mood.

Signs and Symptoms of Substances Commonly Used by Athletes

Alcohol - Sedation, decreased concentration and coordination, disinhibition, slurred speech, vomiting

Anabolic Steroids - Acne, rapid muscle gain, irritability, gynecomastia and hair loss in males, deepening of voice and facial hair in females, visible injection sites and cysts

Cannabinoids - Bloodshot eyes, increased appetite, slowed responses, cough, lack of motivation, paranoia

Opiates - Constricted pupils, sedation, slowed responses, slurred speech, constipation

Stimulants - Dilated pupils, anxiety, jitters, increased heart rate and blood pressure, loss of appetite, tics

Treatment Options for Drug Abuse

Education about the harmful effects of these substances is the first step in treatment. By making the athlete aware of what the material is doing to his or her body, we may be able to shut down the use before any long-term effects are felt. Another step to treatment includes behavioral therapy to modify or replace the harmful behaviors. Athletes may also benefit from techniques such as goal setting and motivational enhancement therapy. If you are unsure of what to do about suspected substance abuse, reach out to a school guidance counselor, mental health professional or physician who may be able to direct you to the next step.


  • Reardon CL, Creado S. Drug abuse in athletes. Subst Abuse and Rehabil. 2014; 5: 95-105.
  • Donohue B, Pitts M, Gavrilova Y, Ayarza A, Cintron KI. A culturally sensitive approach to treating substance abuse in athletes using evidence-supported methods. J Clin Sport Psychol. 2013; 7: 98-119.
  • Diseases and Conditions: Drug Addiction. Mayo Clinic Web site. Published December 5, 2014. Accessed September 23, 2016.
  • John Wiley & Sons. Adapted with permission from Morse ED. Substance use in athletes. In: Baron DA, Reardon CL, Baron SH, editors. Clinical Sports Psychiatry: An International Perspective. Oxford, UK: Wiley; 2013.8,13 (Reardon, 2014)

About CHKD Sports Medicine

About CHKD Sports Medicine  CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.