"It Will Never Happen to Me"

Addiction and the Collegiate Female Athlete

by Claudia Black, Ph.D. and Priscilla Bolin, B.S.W., M.A.

Click here for a Chemical Dependency Questionnaire for the Female Athlete
Click here for Chemical Dependency Warning Signs

Young women have made great strides in participating and excelling in athletics. During the past two decades, since the enactment of Title IX,¹ female participation in high school sports has increased 723 percent.² Female athletes now make up one-third of all competitors in college sports -- up from 15 percent. The 1996 Summer Olympics was touted as the year of the woman.

Many opportunities now exist for women in professional athletics, including product endorsements, that heretofore were only available to men. Equally important is the role participation in athletics has played in the lives of women in a wide variety of professions. A survey of Fortune 500 companies reported 80 percent of its women leaders were "jocks" when they were growing up.

In spite of the advantages athletic abilities offer them, many of these young women get caught up in a destructive process of alcohol and food-related disorders.

As increased scrutiny has developed regarding the health and well being of female athletes, universities have realized the need to address eating disorders among these young women. A study by the Laureate Research Foundation in conjunction with the NCAA revealed more than 9 percent of female athletes suffer from a level of disturbed eating behavior sufficient to warrant clinical attention. Another 58 percent are at risk for developing an eating disorder. Addiction treatment professionals who work with eating disorders report a correlation between eating disorders and substance abuse.

To date, chemical dependency has not been given the same attention by the NCAA as eating disorders. Although educational films, workbooks, guidelines and resources regarding eating disorders are readily available, there is a lack of similar materials on chemical dependency in female athletes. This is significant considering alcohol abuse coexisted with eating-disordered behavior in 70 percent of the athletic cases referred to treatment by eating-disorder professionals.

Drinking, for both males and females on college campuses, has become normalized. It is difficult to see a young woman athlete's drinking behavior as anything but social. Nevertheless, our society continues to stigmatize addicted women more than men. Because of the increased stigma and the tendency of the woman alcoholic/addict to become sick more quickly, it is important that her family, friends and athletic support personnel close to her pool their concerns.

Vulnerabilities of the Female Athlete

"It Will Never Happen to Me" is a statement that we in the field of addictions associate with children of alcoholics. It is a statement made by children who are determined to have the strength their parents did not, and to rise beyond any vulnerability that might lead to addiction. However, it also is a statement that can generalize to other populations, such as elite athletes. A high-performance athlete cherishes, fine-tunes and respects her body. She is someone who seems physically invulnerable. "I can control myself. I am smarter and stronger than that. It will never happen to me." The addicted female athlete, in spite of being young, strong and capable in so many areas of her life, is nonetheless emotionally starved and spiritually void.

These are young women who, in their dedication to their sports, have often given up a great portion of their childhood. People frequently ignore the impact of this loss since these young women demonstrate incredible skill, initiative and commitment. Nevertheless, there are often large voids in their life experiences. Typically, play and socializing experiences offer children the opportunity to connect with others in ways besides just performing. These young women arrive at college with the strength and skill of an athlete, but without the confidence and other skills that develop during adolescence.

What tears at the heart of many of these young women is emotional abandonment. Emotional abandonment is defined as having to hide a part of yourself to earn acceptance, such as:

Having to hide mistakes. If an athlete makes a mistake, it is often the focal point of any attention. She has not just let herself down, she has let down a team, a coach, a department, a family, a university and possibly an entire community.
Inability to celebrate success (not being able to internalize accomplishment). These young people win silver and bronze medals, and we ask them how it feels to lose, what will you do next to be better? It is not good enough to win, now you need to break a record.
Individual needs not being met. When athletics become most competitive, they become winning-centered and not athlete-centered. Many young female athletes have had the experience of "needing to play" in spite of injury, pain or loss in their personal lives.
Living out their parents' dreams, not their own. This is the athlete that often says, "I never wanted to dance," "swimming wasn't my favorite sport, it was my mom's and my dad's," "I was the boy my father never had," etc.
Athletic"ism." Where alcohol is central to a chemically dependent family, athletics is the central focus of this family. The family has often lived and breathed their child's sports world. Their identity becomes centered around their daughter's athletic ability.
Verbal abuse. Many young athletes tell of being yelled at publicly and called derogatory names by spectators, fans and even by the coaching staff or the press.

We need to remember that, although these young women are elite athletes, they also are human. Many come from families that experience great stability; others grew up in families that may have struggled with chemical dependency, violence or abuse. The female athlete often becomes stereotyped as stronger than other females and not as vulnerable. In their humanness, alcohol and drugs can work for them in the same capacity it is used by others, to medicate their loneliness, numb their fear or anger and take away their pressure. These young women feel they can handle whatever comes their way. If they become addicted, they fall hard.

For the athlete who has spent most of her life in control of her body, performing and winning, experiencing a body where addiction begins to take control is both startling and confusing. The pressure of being a superb athlete by itself is not likely to create an eating disorder or chemical dependency. It is the combination of pressures, plus any genetic predisposition and strong environmental influences. Irrespective of the contributing factors, those who work with these women athletes need to be knowledgeable, concerned and trained to recognize problems and intervene as appropriate.

Enabling the Problem

Chemical dependency and eating disorders are often referred to as diseases of denial and isolation. The athlete, her coach and teammates may feel equally bewildered by her poor performance as her behavior becomes increasingly out of control. She may talk less openly about her experiences and isolate herself emotionally.

The athletic family, represented by the team, coach, athletic department and university, responds in the same manner as a traditional family. The "Don't Talk Rule" that helps the disease flourish in addictive families also exists in the athletic family. As a result, those who care often unknowingly perpetuate the addiction. They believe things will only get worse if they say something. The "family" continues to enable.

The combination of addiction and sports presents a special situation. Each athlete who is chemically dependent and/or has an eating disorder is unique and requires special approaches to management and treatment. The most effective and efficient management and treatment involves a cooperative effort between the athletic community and healthcare professionals who treat patients with addictive disorders. Unfortunately, these are often two separate worlds with little knowledge about each other. Consequently, athletes with problems do not get the appropriate treatment.

Proactive Strategies

Many athletic associations and universities across the nation are beginning to recognize the high risk of eating disorders among their female athletes. Several national associations have already taken actions they hope will reduce the risk. For example, the Women's Tennis Council has raised the age for full participation in international competition. The U.S. Gymnastics Federation has reported that the current Olympic gymnasts have higher body-fat content than in the past (approximately 16 percent). The Federation also is developing Four Star Clubs in which coaches will become certified when they meet certain criteria, including completion of educational courses on prevention of eating disorders.

Four years ago, the University of Tennessee (U.T.) developed a performance team (made up of the athletic coaches, strength and conditioning coaches, trainers, physicians, exercise physiologists and an addictions consultant) to address issues that hinder the performance of their female athletes. They have recognized eating disorders as a significant deterrent to the health and well being of their athletes and the sports programs. In addition to developing the performance team, the University of Tennessee has created a peer assistance program, ongoing continuing education, and a protocol for athletes at high risk for developing an eating disorder. Other universities continue to recognize the need to develop programs for the special needs of their athletes. But to date, few programs have been willing to develop protocol to recognize and intervene with the combination of food and chemical addictions. The suggested U.T. Women's Athletic Department Alcohol Policy is zero tolerance for women under the age of 21 (state law) and zero tolerance for those 21 and older during their competitive season. They recommend no one drink during the competitive season.

While it is not within the school's purview to know how to treat the individual, there is a responsibility to recognize the signs and symptoms and respond to the disease with appropriate referral.

Addiction Warning Signs

Unexplained poor performance.
Eye witnessed accounts (i.e. under 21 public consumption).
Identifiable sources of incidents (i.e. teammates, coaches, roommates).
Incidents with the law.
Signs and symptoms of hangovers.
Injuries/illness (unexplained or delayed healing).
Academics -- attendance, grades, attention problems, sleeping in class.
Change in body compositions.
Missed appointments.
Missed drug testing.
Other known chemical use in family.
Change in peers.

Recommendations

Addiction Professionals

Addiction professionals are in a unique position to offer timely services to this increasing population of elite female athletes and their respective collegiate and professional communities. Addiction professionals are often invited onto college campuses to address substance abuse through presentations and personal stories of recovery. For the female athletic population, the addictions professional should move beyond this initial involvement and participate in a more comprehensive program development that is a systemic response to problems associated with the addictive illness. Protocols need to be developed to identify, support and offer services to athletes at risk.

Because of the greater tendency toward eating disorders in this population and the frequent association of eating disorders and substance abuse, the addiction professional must bridge the gap between mental health, addiction and the athletic community. Mental health professionals on the campus or in the community are often trained in a non-addictive disease model. As a result, the coexisting disorders have not been recognized and therefore not treated in the most effective manner.

To be effective in the delivery of services to this population we recommend:

Awareness training in the sports culture and the history of women's athletics.
Training in eating disorders, with emphasis on eating disorders among female athletes.
Understanding the athletic department and university philosophy and infrastructure as it pertains to athletes and addictions.
Awareness training in women's health issues.

Athletic Communities

We suggest that athletic communities establish comprehensive models for the education, prevention, intervention, treatment and monitoring of chemical dependency among women athletes. Barring this all-inclusive approach, schools need to refer these problems to appropriate and identifiable professional resources. Further recommendations are:

In depth training to break the "No Talk Rule" and to create environments where athletes and their teammates can come forward without fear of losing careers, opportunities to compete, scholarships, etc.
Training that addresses the denial system of "It Will Never Happen to Me." (It will never happen to me, the athlete, ... me, my team, ... me, my department.)
Training in substance abuse and eating disorders should be mandatory for all coaches, athletic trainers and physicians within the athletic department. The training should be specific to women's issues.
Alcohol abuse should receive the same priority by NCAA, Women's Sports Foundation and athletic depart-ments as has the Female Athlete Triad.
The NCAA should work as diligently to develop materials for the female athlete and substance abuse as they have on eating disorders and the Female Athlete Triad.
The NCAA should acknowledge that alcohol is the number one drug of choice on college campuses.

Communities in Partnership

Partnering programs between athletic communities and addictions professionals have many advantages for the athletes, their communities, the universities and for the families.

Clearly, the problem is complex, yet each of us can play a constructive role. Without the assistance of addiction professionals, the opportunity for a higher education, as well as careers and lives may be lost. As a unified team, we have the potential to respond to the athlete at risk and to intervene as appropriate for the addicted athlete.

References

1. Title IX is federal legislation passed in 1972 to protect students from sex discrimination; Title IX was designed to prevent gender-based inequities in admission, treatment, employment, use of facilities and access to all extracurricular activities. The law stated that no person, on the basis of sex, could be excluded from participation in any educational program or activity that received federal funding.

2. Kessler, Lauren, "Full Court Press," A Dutton Book, (1997).

Claudia Black is a specialist in the addictions field, presently working with a number of collegiate athletic departments. She is the author of the book, "It Will Never Happen to Me."

Priscilla Bolin is the national coordinator for athletic and university programs at The Willough at Naples, Naples, Fla.

Chemical Dependency Questionnaire for the Female Athlete

Have you ever lied to cover up your use of drugs or alcohol?
Have your friends or teammates ever lied for you regarding your drinking or using?
Has your use of alcohol or drugs affected your athletic performance?
Do you reward yourself after a good performance with alcohol or drugs?
After a poor performance, do you use alcohol or drugs to lessen the painful feelings?
During the off season, do you find yourself drinking or using to fill in the empty space, in not training and performing?
Are you manipulating your schedule to accommodate partying and the use of alcohol or drugs?
Do you find yourself thinking ahead toward your next opportunity to drink or use?
Do you drink until you are drunk?
Do you avoid friends or certain teammates in order to use?
Have you acted in ways you regret while under the influence of alcohol or drugs?
Do you have any secrets about what occurred while you were under the influence?
Have you ever had a complete loss of memory as a result of drinking?
Have you ever participated in unwanted or unsafe sexual activity while under the influence of alcohol or drugs?
Have you ever been hit, pushed or shoved while under the influence of alcohol or drugs?
Have you ever needed medical attention due to being under the influence of alcohol or drugs?
Do you feel more confident, outgoing and appealing when under the influence of alcohol or drugs?
Is there a history of alcohol or drug abuse in your family?
Do you smoke cigarettes?
Are your activities with your significant other centered around drinking and using alcohol or drugs?
Have you progressed from never drinking or using before a practice or a game to drinking or using before a practice or a game?
Have you ever missed a practice or a game due to a hangover?
Has using alcohol or drugs interfered with meeting your public responsibilities?
Have you ever worn your team logo while you were under the influence of alcohol or drugs?
Have you ever reduced your food calories to offset alcohol calories?
Have you had changes in your body composition that concern your coach and/or trainer when changes in nutrition and training schedule have not helped?
Have you ever increased exercise to offset alcohol calories?
Do you ever binge and restrict your caloric intake or binge and purge on food?
Has anyone ever questioned your weight control behaviors?
Has anyone ever questioned you or told you they were concerned about your use of alcohol or drugs?

If you answered yes to more than six of these questions, the authors suggest a professional consultation with someone knowledgeable about addiction.

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