Substance Abuse Prevention

The year was 2000 and I was a junior in college, I was in the best shape of my life having completed football season and in the midst of a track season that would prove to be my best collegiate year of competition.  I was on top of the world, school was going great, sports were stellar and to top it all off I was a bachelor that lived alone!  I lived next door to a great girl that would always wave when we saw one another, and if given the chance she could talk for hours.  She seemed to have the perfect life, nice car, great style, plenty of friends, and what seemed to be a good boyfriend.  One evening, I got a knock on my door and my neighbor was standing in front of me crying.  I instinctively invited her in and tried to console her, but noticed immediately that something was not right.  Her speech was slowed, she was stumbling, and she seemed distant.  I didn’t think she was drunk, but still asked if she was drunk, she said no and I proceeded to ask what she had done immediately before coming to my apartment, and she nonchalantly answered “trying to end my life”…Thankfully, I was somewhat knowledgeable about how to handle a toxic agent being ingested or an overdose.  I immediately gave her milk to drink and sat her upright in a chair.  I grabbed the pill bottle she had ingested, and took her to the emergency room, where they pumped her stomach and checked her into the psychiatric ward of the hospital.  This story has a happy ending because she was released days later, and started receiving the help and attention that she needed and had been calling for, for so long.  She later told me that she suffered from depression, substance abuse (oxycotin), and Anorexia Nervosa.  To say the least I was utterly surprised!  I tell you this story, to help you understand that perceptions are not always reality, and as the old adage goes, you cannot always judge a book by its cover, so don’t be afraid to ask for help or offer help, we all need a ear, shoulder and kind heart from time-to-time.

Have you ever had a family member, friend or even neighbor that had issues with abusing drugs?  How about someone that had a body image disorder, anger management issues or the desire to end their life?  Well these are just a few of the topics that we covered the last two weekends with the APPLE Conference (1/21 -1/23 and 1/28 – 1/30.  The APPLE Conferences are led by the University of Virginia Gordie Center for Alcohol and Substance Education with assistance from the NCAA, Drug Free Sport, the Bacchus Network and the Gordie Foundation.  The great thing about the APPLE conferences is that they are focused solely on the student-athlete and the prevention of substance abuse and promoting health for student-athletes and athletics department administrators.  From the APPLE website,

“The goal of the APPLE conference is to assist colleges in promoting student athlete health and wellness by empowering teams of student- athletes and administrators to create an institution-specific action plan. “

There are individuals in our lives right now that could be experiencing or fighting and addiction, having trouble managing anger or image issues, and we could have no idea.  This is a problem, but we can do something to help, there are professionals at your schools, in your community and at the government level that can help you prevent substance abuse, but also recognize the signs of potential problems. 

I heard a number of wonderful presentations at the APPLE Conferences, and here are just a few of the professionals that spoke (power point presentations available to view here):

Linda Hancock is Director of the Wellness Resource Center at Virginia Commonwealth University (VCU) and a Family Nurse Practitioner.

Doug Everhart serves as the Manager of Alcohol Programs at the University of California-Irvine

Scott Goldman, Ph. D. is the clinical and performance psychologist for the University of Arizona's athletic department.

Matt Vogel works at the University of Wisconsin – La Crosse as a Health Educator and an adjunct Instructor for the Department of Health Education and Health Promotion. 

Erica Upshaw travels the country speaking to high school and college audiences and has reached more than 50,000 students with her program Keep Friendship Alive.

Craig Littlepage is in his eighth year as the Athletic Director of the University of Virginia.

Dr. Kelli Moran-Miller provides clinical and performance enhancement services at Virginia Tech, servicing the Athletic Department and Cook Counseling Center.

Resources:

Professional Organizations

American Academy of Pediatrics:  http://www.aap.org/  

American College of Sports Medicine:  http://www.acsm.org/  

American Dietetic Association:  http://www.eatright.org/  

American Society for Nutrition:  http://www.nutrition.org/about-asn/  

American Medical Association:  http://www.ama-assn.org/  

American Public Health Association:  http://www.apha.org/  

Institute of Medicine of the National Academies- Food and Nutrition Board:  http://www.iom.edu/About-IOM/Leadership-Staff/Boards/Food-and-Nutrition-Board.aspx  

Keep Friendship Alive:  http://www.keepfriendshipalive.com/

National Research Council:  http://sites.nationalacademies.org/nrc/index.htm  

National Institutes of Health:  http://www.nih.gov/  

National Library of Medicine:  http://www.nlm.nih.gov/  

National Eating Disorders Association: http://www.nationaleatingdisorders.org/

The National Center for Drug Free Sport Inc.:  http://www.drugfreesport.com/

College Drinking – Changing the Culture:  http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx

Consumer Lab (subscription needed):  http://www.consumerlab.com/

National Institute of Health:  http://www.nih.gov/  

Mayo Clinic:  http://www.mayoclinic.com/

myPlaybook:  http://myplaybook.drugfreesport.com/ 

Healthfinder:  http://www.healthfinder.gov/  

Partnership for a Drug-Free America:  http://www.drugfree.org/

The Resource Exchange Center:  http://www.drugfreesport.com/rec/

Supplement Safety Now:  http://www.supplementsafetynow.com/

The Cleveland Clinic:  http://my.clevelandclinic.org/default.aspx

Taylor Hooton Foundation:  http://taylorhooton.org/

Journals

American Journal of Clinical Nutrition:  http://www.jneb.org/  

American Journal of Sports Medicine:  http://ajs.sagepub.com/  

American Society for Nutritional Sciences:  http://www.nutrition.org/  

Journal of American College of Nutrition:  http://www.am-coll-nutr.org/  

Journal of Applied Physiology:  http://jap.physiology.org/  

Journal of Nutrition Education and Behavior:  http://www.jneb.org/

Journal of the American Dietetic Association:  http://www.adajournal.org/

Physician and Sports Medicine:  http://www.physsportsmed.com/   

Nutrition Action:  http://cspinet.org/nah/index.htm  

News Letters

Insight Newsletter:  http://www.drugfreesport.com/newsroom/insight.asp

Nutrition Action Health Letter:  http://www.cspinet.org/

Recognizing Disordered Eating

As mentioned in previous posts, it is important as a coach, athletic trainer, and teammate you are watching for signs of eating disorders. Most people will not admit they have a problem and will not seek help on their own. Because of the secretive nature of eating disorders such as anorexia and bulimia, it can be difficult to recognize when a student-athlete has a problem. However, if you are aware of some signals of disordered eating, you may be able to help an athlete before it develops into a full blown eating disorder. A short summary of some of the signs of disordered eating that you can watch for are listed below.

What they say: Someone may try to avoid eating a team meal or eating on the road by consistently saying “I already ate”, “I’m not hungry,” or “My stomach hurts.” If this avoidance becomes a pattern, consider talking with the athlete. The athlete may also be constantly talking about how they look or mentioning that they are fat or need to lose weight, even though they are at a normal or below normal weight.

How they act: Mood changes or social isolation can also be a sign of disordered eating. Watch for athletes who start to avoid hanging out with the group or who have gone from being generally happy to sad or seemingly depressed. Also be aware of whether or not student-athletes are skipping meal times or sneaking off right after a meal consistently.

How they look: Changes in weight can be another sign of disordered eating. If an athlete appears much thinner after a summer or winter break you may need to talk with them. Also, be on the lookout for hair loss, dry skin and hair, calluses on the palms of the hand, facial swelling, or brittle nails.

If you have an athlete you suspect has a problem, suggest they talk with health professionals on campus. Remember, disordered eating isn’t just a physical problem; it is a mental and behavioral issue as well. It is not as simple as increasing their caloric intake, they have to deal with their misperceptions about their body and food as well. Please encourage them to get help and use the resources below.

Academy for Eating Disorders
National Eating Disorders Foundation
NIMH Eating Disorders
Eating Disorders and Athletes
http://helpguide.org/mental/eating_disorder_treatment.htm

Bulimia Nervosa

Have ever had a friend who seemed to rush to the bathroom each time you finished having dinner with them? Or maybe you yourself have eaten a whole bag of cookies and then had the sudden urge to get rid of all the food you ingested. Bulimia nervosa is an eating disorder that involves a cycle of bingeing (eating a large amount of food) and purging (ridding the body of this food quickly). Unlike anorexia, individuals with bulimia appear to be close to their ideal body weight and do their best to keep their purging behavior secret.

Bulimia is characterized by:

• Recurring episodes of binge eating. Bing eating is characterized by eating, in a small amount of time, more than most people would eat and a sense of lack of control over the eating.
  
• Recurring inappropriate behavior to compensate for the binge eating to prevent weight gain. This includes self induced vomiting, use of diuretics or laxatives, fasting, or excessive exercise.
• These behaviors occur on average at least two times a week for three months.
  
• Distorted body image.

Physical Effects

• Brittle nails and dry skin and hair
• Facial swelling
• Jaundice
• Delayed wound healing
• Dehydration
• Fluid and electrolyte imbalances (This balance is very important to athletes and can impair performance)
• Abnormal heart rhythms
• Injury to the kidneys
• Urinary tract infections
• Irritation and infection of the esophagus, pharynx, and salivary glands
• Erosion of the teeth and cavities
• Rupture or tear in the stomach or esophagus
  

Psychological effects

• Anxiety
• Mood changes
• Personality changes
• Social isolation

How is it treated?

Treatment for bulimia requires a structured eating plan with nutrient dense foods to establish regular eating patterns. Steady maintenance of weight is the goal. There is also a need to work through the psychological and social issues the individual has towards food. They also have to work on the patient’s relationships with themselves and their body.

Most often, people with bulimia will not admit they have a problem. As a coach, trainer, teammate and friend, you need to watch out for some of the above changes and encourage someone who needs help to get it. Watch for behaviors such as eating in secret, disappearing after meals, excessive exercise beyond what is needed for their sport, or extreme focus on their body and weight. Below are some resources related to eating disorders.

Academy for Eating Disorders
National Eating Disorders Foundation
NIMH Eating Disorders
Eating Disorders and Athletes
http://helpguide.org/mental/eating_disorder_treatment.htm