The Prevalence of Substance Misuse and Addiction in Sports

Jessica Joiner, LCSW, LAC, has over a decade of experience working with those suffering from addiction, complex trauma, and co-occurring disorders. She uses her experience along with the extensive skills gained to address the many issues that arise for athletes.

In her workshop hosted by Harmony Foundation, Joiner discussed the prevalence of substance misuse among athletes, various ways of identifying “red flags,” and evidence-based interventions that can be helpful in combating the misuse of drugs and alcohol.

As Joiner explained, there are three main reasons athletes misuse substances: pain resulting from injuries, stress from incessant pressure to win, and the desire to enhance performance artificially. Over the years and decades, these reasons have stayed the same but the drugs involved are now more sophisticated than ever, with more options.

The statistics paint a grim picture. Substance misuse is prevalent in high school: approximately 19 percent of males and 14 percent of females binge drink in high school. 21 percent of teens use marijuana and up to 6.6 percent have used performance-enhancing drugs (PEDs).

It gets worse in college where 42 percent of students admit to binge drinking, 28 percent use cannabis, and around 11,000 NCAA athletes admit to taking PEDs. There is a strong correlation between concussions and alcohol use. “Having a concussion is actually predictive for alcohol use,” said Joiner. “If a high school student is entering college with a history of concussion, and we know about the correlation, we could put some measure in place to intervene before things get out of control. We don’t want them to get overwhelmed by the pressure of performing and the grades required to continue.” It’s much better to support them on the front end before things get out of hand.

Should players get drafted into the National Football League, the pain from injuries, the pressure to win, and the temptation to use PEDs get even worse. In the NFL, 51 percent of players use opioids and 71 percent of those athletes admit to misusing them. Many of the pills are not prescribed by medical doctors: 68 percent say they got them from other sources.

It takes only a few days to get addicted to opioids, Joiner warned, and professional athletes have easy access. Professional athletes tend to play through the pain and then “fix it” with opioids and other substances after the game, putting themselves at risk for greater injury and addiction.

Joiner then went over the possible consequences of such risky behavior, which include the impact on performance, health, relationships, and career—and in the worst-case scenario, death.

While substances were initially taken to enhance or maintain performance, escalating use will eventually compromise performance and wreak havoc with the athlete’s health. As is the case for all people with substance use disorder, addiction has “a definite negative impact on relationships.” If there is no intervention and treatment, players may end up with legal problems, a league suspension, or just get kicked off their team.

There are many examples of athletes falling into this trap. Former Boston Celtic Chris Herren struggled with substance misuse for much of his NBA career. While playing for the Celtics, Herren started to use opioid painkillers. In December 2007, he was charged with possession of heroin in Rhode Island and in the following June, Herren overdosed on heroin in Fall River, Massachusetts. According to the attending paramedics, he was clinically dead for 30 seconds.

Abby Wambach—widely considered the best female soccer player ever—was arrested for driving under the influence in 2016. Following the incident, Wambach published an autobiography revealing that she had misused prescription drugs and alcohol for many years.

After going into recovery, Herren started raising awareness of drug addiction and has now spoken to over one million students, athletes, and community members, promoting frank discussions about substance use disorder and wellness.

In the webinar, Joiner, too, stressed the importance of prevention and early intervention to attack this problem. Prevention should include educating everybody involved to raise awareness of mental health issues that often drive substance misuse, so parents, teachers, and coaches learn to recognize red flags. “From the outside, it often looks like they have everything”, explained Joiner. That’s why depression and anxiety disorders are often overlooked. Testing, screening and other interventions should be used in a supportive, not punitive way.

“We should stop just being reactive and be more proactive,” Joiner said. Coaches and trainers of athletes should not wait for a crisis to unfold and athletic programs should provide adequate mental health services for players (and other students). Treatment should not be perceived as punishment for bad behavior but as a concerted effort to heal psychological problems. “We need effective collaboration between therapists, doctors, school departments, and the community that facilitates integrated care,” Joiner said. Currently, too many people fall through the cracks because many athletic departments don’t provide nearly enough mental health professionals. Ultimately, a culture shift is required: our society’s approach to athletic injuries and mental illness needs to change significantly and we need more trauma-informed and stigma-free care—and not only for athletes.

Harmony Foundation Responds to the Opioid Epidemic with HOPE

by Christopher Reveley, MD, and Annie Peters, PhD, LP

The Opioid Epidemic

According to the National Institute on Drug Abuse (NIDA), nearly 100 people die from opioid overdose in the United States every day, and 2.6 million Americans struggle with opioid addiction. The prescribing of opioid pain relievers became much more common in the late 1990s, and it soon became evident that these medications were powerfully addictive. Opioid overdose deaths have increased significantly in the years since. Many of those addicted to heroin started with the abuse of prescription opioids.

Overdose along with the spread of HIV, hepatitis C, and withdrawal syndromes in babies born to addicted mothers constitute a nationwide crisis that has overwhelmed the resources of state and local health care delivery services. Recently, the White House identified the opioid epidemic as a national public health emergency.

How is Harmony Responding to Opioid Epidemic?

Harmony Foundation in Estes Park, CO, has been treating addiction for 48 years and has fostered a generation of long-term recovery support for individuals and families. Harmony’s mission is to provide the foundation for sustained recovery from the diseases of drug and alcohol addiction. Harmony staff is committed to continuous improvement and closely monitors a client experience, treatment response, and the research literature on addiction treatment. In the field of opioid addiction research, advances in behavioral treatment, neurobiology, and brain imaging have given treatment programs guidance in developing better services. Harmony now offers HOPE – Harmony’s Opioid Programming Experience. HOPE is offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

HOPE: Medical and Clinical Approaches

HOPE begins with thorough medical and psychological evaluations. Collaboration with the client, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly Opiate Support Groups led by a professional addiction counselor. This group addresses the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid rapid relapse. In this setting, clients support each other and are educated about the process of recovery.

Harmony has provided all clients with medication-assisted treatment (MAT) for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce craving, and give the individual time to heal from the psychological, social, and spiritual wounds of addiction.

HOPE clients may choose to avoid medications altogether or use only sleep and anxiety-reducing medications during the acute withdrawal period. For others, naltrexone, an opioid receptor blocker, can prevent the euphoria of opioid use and help control cravings, thereby changing the client’s drive to use illicit opioids after treatment.


This partial opioid agonist, administered in a tapering protocol, may be chosen by the treatment team and client to ease symptoms of severe opioid withdrawal during detoxification. On an individual basis, this medication may be continued during early recovery, most commonly for those with severe and persistent opioid addiction. Care following residential treatment may include ongoing buprenorphine to provide a craving-free foundation for the client as they rebuild damaged interpersonal and work relationships and regain physical and emotional health. The ultimate goal with all treatment approaches is complete abstinence from all opioids.

While some may question how an opioid medication (buprenorphine) can help someone recover from opioid addiction, this treatment approach is supported by organizations such as the World Health Organization, the American Society of Addiction Medicine, the Substance Abuse and Mental Health Services Administration, NIDA, the Veterans’ Administration, NAADAC – the Association for Addiction Professionals, and the National Association of Addiction Treatment Professionals. Due to the number and quality of research studies that have been completed on the use of buprenorphine in treating opioid use disorders, the level of evidence for the effectiveness of buprenorphine treatment is considered to be high (Thomas et al., 2014). Positive outcomes typically include improving retention in treatment and reducing illicit opioid use.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opiate addiction and needs help right away, Harmony is here to help. Call us at 866-686-7867 and one of our admissions specialists can discuss next steps.


Center for Behavioral Health Statistics and Quality (CBHSQ), 2016. 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Thomas, CP, Fullerton, CA, Montejano, L, Lyman, DR, Dougherty, RH, Daniels, HS, Ghose, SS, & Delphin-Rittmon, ME. Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatric services, 65(2), 158-170.

Bipartisan Focus on Opioid Overdose Deaths

The rise in drug overdose deaths in America has legislators from both sides turning their attention to the insidious problem. Senate Majority Leader Mitch McConnell of Kentucky (R), and Senator Ed Markey of Massachusetts (D) have called upon the Department of Health and Human Services (HHS) to urge the Surgeon General to issue a report on the problem opioid overdose deaths plaguing the country, The Hill reports.

Since 1999, deaths caused by prescription opioids quadrupled, the article reports. In 2013 alone, 44,000 people lost their lives to opioid overdoses – more than firearms or car crash related deaths.

Addiction to opioids and the overdoses related to abuse does not discriminate, people from all walks of life, both red and blue, have lost their lives to prescription drugs and heroin. Senator Markey says the issue “has to be bipartisan,” according to the article.

“Whether it’s Lexington, Massachusetts or Lexington, Kentucky, this epidemic knows no boundaries,” said Markey. “Senator McConnell and I believed that our response should know no political boundaries.”

Recently, McConnell and Senator Bob Casey of Pennsylvania (D), introduced legislation to the HHS for the development of a plan focusing on neonatal abstinence syndrome (NAS). Pregnant women who use opioids put the baby at risk of developing NAS, which requires weeks of intensive medical attention for several weeks after birth.

“This is a bipartisan issue that members of both parties have come together to fight head on,” McConnell said in a statement to The Hill.

Even democratic presidential candidate Hillary Clinton has set her sights on addressing the problem. In Iowa, Clinton spoke about the issue:

“When I started running, when I started thinking about this campaign, I did not believe I would be standing in your living room talking about the drug abuse problem, the mental health problem, and the suicide problem,” said Clinton. “But I’m now convinced I have to talk about it. I have to do everything I can in this campaign to raise it, to end the stigma against talking about it.”
Addiction and recovery news provided by Harmony Foundation

Generic Vicodin Prescibed More Than Any Other Drug

In the United States, pain management is an important need, as well as a major problem. Patients complaining of pain are entitled to appropriate medications for treatment. Unfortunately, far too often medications, such as OxyContin ® (oxycodone) and Vicodin ® (hydrocodone), are misused and abused which ultimately can lead to addiction. Chronic over prescribing of opioid medications and gaps in screening, has led to a prescription drug epidemic in America.

In 2013, more Medicare beneficiaries received a prescription for generic Vicodin ®, known as hydrocodone acetaminophen, than any other prescription drug, The Wall Street Journal reports. In the same year, nearly two million Americans either abused or were dependent on opioids, according to the Centers for Disease Control and Prevention.

“It’s striking that the drug prescribed to the most beneficiaries is a narcotic painkiller that can be addictive,” said Walid Gellad, an associate professor at the University of Pittsburgh School of Medicine.

The findings come from an analysis of Medicare’s prescription drug program, according to the article. The data indicated that some doctors prescribe the drug much more often than others, and a group of about 200 doctors gave the drug to more than half of the beneficiaries to whom they prescribed. Despite hydrocodone’s high potential for dependence, about 691,000 providers prescribed the drug in 2013.

The data showed that approximately 8.09 million Medicare beneficiaries were prescribed hydrocodone acetaminophen. Interestingly, the drug prescribed the most after generic Vicodin ® was the cholesterol drug simvastatin, with 7.03 million prescriptions.

Pain management is not an easy task, partly due to the fact that pain is subjective. However, it is clear that doctors should turn to prescription opioids as a last resort. Simply handing out Vicodin ® for minor pain complaints only fuels the prescription drug epidemic plaguing America.

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How Addiction Impacts The Family

Addiction unravels the life of the individual in its grasp. As circumstances in the individual’s life began to spiral downward, those around the addict begin to suffer as well. Addiction is a family disease. This includes not only immediate family members, but also coworkers and friends that are involved in the addict’s life. As addiction takes a toll on the quality of life of the addict, negative consequences of their disease begin to creep into the lives of those around them.

The addiction and its consequences instill an atmosphere of negativity around the addict. Whenever anyone is around them they are often surrounded by an aura of negative emotions. These emotions can include anger, sadness, confusion, and anxiety.

These emotions are related to common situations that impact families during addiction. First, money will often be a factor that impedes upon the family dynamic during the addiction process. As the addiction grows the addict needs more of the substance to achieve the same result. When they can no longer afford to support their addiction, they must lie, cheat, borrow, or manipulate their way to gaining the funds necessary to get the substance they need. Those closest to the addict will typically suffer first, and the hardest. The addict will try to borrow money from friends and family. They may manipulate those close to them to get money from them. This can include concocting untrue and elaborate stories or circumstances that explain why they need money. Those involved in the addict’s life will feel used and hurt when they find out the truth, and may chose to stay away from the addict altogether.

Another common way addiction impacts family and work relations is when the addict starts not showing up – emotionally or physically. The addicted individual will likely not pull his or her own weight at work or in the family. They may show up late or not at all. Even when they do show up their work, be it helping around the home, with the kids or on the job, is sub par. This leaves family members and coworkers resentful because they have to compensate for the addict’s lack of involvement or production.

Being in addiction can also cause inconsistent boundaries at home. The addict may seem to get away with a lot of negative behaviors because they are chalked up to their disease. Meanwhile, other family members are not granted the same leniency, leading them to resent the addict. Or the parents or spouse of the addict may develop a problem with co-dependency. This essentially means they place such a high priority on taking care of the addict that they stop sufficiently taking care of themselves. Those close to the addict may go another route by denying the fact that there is a problem or even enabling their behavior by turning a blind eye or supporting them financially or emotionally.

Because there are many situations that can arise from addiction that will cause negative emotions and circumstances for those involved in the addict’s life, these feelings don’t go away when the addict gets sober  or enters addiction treatment. That is why Harmony Foundation places the utmost importance on the recovery of the family alongside the addict. We believe through education and communication the family can recover. For more information about our family program, click here.

Marijuana Abuse & Depression

A recent study revealed that marijuana abuse could inhibit the brain’s reaction to dopamine – revealing that marijuana abusers may be more prone to depression.

The U.S. National Institute on Drug Abuse conducted the study by looking at the brains of 24 marijuana abusers after giving them Ritalin, which increases the amount of dopamine in the brain. The 24 subjects in the study smoked an average of 5 joints per day, 5 days a week for 10 years. Compared to the control group, they had a significantly dulled behavioral, cardiovascular and brain responses to dopamine – the “feel good” chemical of the brain. Overall their heart rate and blood pressure were lower and they reported feeling anxious and restless rather than elated.

The study concluded that marijuana abuse can diminish one’s reaction to dopamine and can impact the brain’s reward processing. In short, what normally causes feelings of euphoria in people may not for the marijuana abuser. The study suggests that their weaker response to dopamine may indicate that the area of the brain responsible for processing reward may be damaged; “Cannabis users may experience less reward from things others generally find pleasurable and, contrary to popular stereotypes, that they generally feel more irritable, stressed, and just plain crummy,” says Raul Gonzalez a neuropsychologist at Florida International University.

Often, those that are vulnerable to addiction feel “crummy” before abusing drugs anyway and often overindulge in order to self medicate. The study may not have accounted for the fact that the 24 abusers may have been prone to depression before abusing marijuana. This study also reveals information about marijuana abusers rather that the recreational marijuana user. However, now that marijuana is legal in Colorado, recreational use may lead to higher rates of abuse.


Is Addiction Inherited?

Robert Downey Jr. has been in the news recently, not because of Iron Man or his past drug problems, but because of his son – 20-year-old Indigo – who is reportedly in rehab.

Robert Downey Jr. had a very public battle with addiction when he was in and out of jails and institutions while trying to salvage his career. People watched as the extremely talented actor struggled with addiction to heroin, alcohol and cocaine and now praise him as a hero – not only because he is Iron Man, but for having overcome his powerful addiction to drugs and alcohol – he has been sober since 2003.

His son apparently went to treatment for trouble with prescription pills. His mother – Downey’s ex wife Deborah Falconer reportedly said, “He was never addicted. He was taking one pill a day” and now  “He’s doing great. He’ll be back playing music and going better soon.”

Indigo, who plays in a band called The Seems (who just got a record deal with Warner Brothers) seems to have inherited creativity from his father, is it possible he inherited addictive tendencies as well? Robert Downey said that he was influenced by his own father’s drug use and began using marijuana at 6 years old after seeing his dad use it.

In the field of addiction treatment there are arguments for both nature and nurture when determining whether or not addiction can be inherited. To date, there is not one specific “addiction gene” but biological characteristics that make people either more or less vulnerable to addictive substances. For example, genes play a role in people having difficulty quitting once they start or experiencing greater withdrawal symptoms from substances once they stop. But scientists say that someone’s genetic makeup will not inevitably doom them to a life of addiction.

What do you think? Is it nurture or nature that puts one at greater risk for addiction?