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From the Trenches: The Good and Bad of Substance Use Trends

Experts at a recent NCAA meeting warned that while testing and education efforts have helped curb steroid use, administrators and coaches must remain vigilant about the ever-changing dietary supplement market, the seemingly never-changing culture of alcohol consumption, and an alarming increase in prescription drug use.

NCAA Chief Medical Officer Brian Hainline convened a group of experts on April 23 to discuss the NCAA’s drug-testing and drug-education efforts and other best practices for college administrators to address student-athlete substance use on their campuses. Participants included representatives from the United States Anti-Doping Agency (USADA), the United States Olympic Committee and the NFL. 

Also attending were Mark Bockelman, director of NCAA drug-testing at the National Center for Drug Free Sport, and David Wyrick, who created the myPlaybook program that has helped dozens of schools reduce the negative consequences of student-athlete alcohol use. Their view from the trenches revealed some positive – and negative – insights about the culture of substance use on campuses today.

Drug Free Sport administers the NCAA’s drug-testing program and helps hundreds of NCAA colleges and universities conduct their own testing on campus. Bockelman, who has overseen much of the testing, says it has been the primary factor in stabilizing – if not reducing – the rate of steroid use among student-athletes. The NCAA’s most recent substance use study in 2013 shows usage of “ergogenic” or performance-enhancing drugs has declined since 2005. Particularly with anabolic steroids and ephedrine, usage has gone down in all three divisions (and it was low to begin with).

But Bockelman remains concerned about an unregulated and nebulous dietary supplement trade in which hidden or unlabeled ingredients can lead to a positive drug test.

“My biggest concern remains with supplement use – especially the fact that student-athletes don’t see it as a risk to their eligibility,” he said. “It’s cultural – there’s a pill for everything now. Watch any football game and track how many commercials are telling you to take this or drink that for an effect or to solve an issue.”

Bockelman also noted that student-athletes use these supplements to help with recovery, which they don’t perceive as cheating.

“They rationalize it by saying it’s not a competitive advantage, that it’s just helping them get back to 100 percent. But it’s also doing something to their body that isn’t natural to help them in that process, which is cheating,” he said.

Fortunately, a Drug Free Sport service called the Resource Exchange Center reviews dietary and other supplements for NCAA-banned ingredients. Unfortunately, student-athletes often think they know better.

“There’s still an overwhelming notion of: ‘If I can buy this stuff at a grocery store or at GNC, or if a doctor can prescribe it, it must be safe,’ ” Wyrick said. “Everyone is aware that drinking and driving is dangerous – that doesn’t mean people won’t do it, but they’re deciding at least from a different context. We’re not there yet with supplement use – there hasn’t been a cultural shift to say that using these is dangerous.”

Q&A with David Wyrick

What are you seeing now that is different from several years ago?
“We talk about how student-athletes are prone to higher-risk use of alcohol, which comes with increased negative consequences. While we’re not seeing a lot of decrease in alcohol use, there has been a decrease in self-reported negative consequences over time. Another win is that more athletics departments are hiring clinical counselors to deal with mental and emotional health issues, many of which stem from drug and alcohol use. There are more support/treatment options for student-athletes who are identified.”

What are your biggest concerns?
“Supplement use. There hasn’t been a cultural shift to say these are dangerous. There has to be a public acceptance similar to smoking is bad for your health, drinking and driving is dangerous, cocaine is addictive, etc. It still drives me crazy that student-athletes I work with, even after being hammered with information about the REC, they still go to GNC and buy this stuff without checking it out.”

What do we know now about how to address or even mitigate substance use that we didn’t know 10-20 years ago?
“We’ve finally distinguished between education and information dissemination. We’re all about education – after all, our institutions are higher education institutions. But we know now that information dissemination by itself is not effective. We know more about ‘prevention science.’ We know that there has to be some type of behavioral intervention. In the past, intervention meant ‘treatment.’ But now intervention is more accepted as a way to change behavior.”

Wyrick, a former basketball student-athlete at Elon College who’s now the faculty athletics representative at the University of North Carolina at Greensboro, is especially interested in student-athlete alcohol use. He developed myPlaybook in the mid-2000s not necessarily to reduce use but certainly to reduce the negative consequences of it. The web-based program has gained traction among NCAA colleges and universities as an effective resource for the student-athlete population.

In all the years of reviewing results, Wyrick says two things stand out.

“One is their normative perceptions,” he said. “Student-athletes perceive that more high-risk alcohol use is occurring than actually does, which puts them at risk. But even more alarmingly, they perceive that type of behavior is not only accepted, but expected.”

Such expectations face college students in general, not just student-athletes. In fact, the 2013 substance use study shows that student-athletes aren’t consuming alcohol more than their non-athlete peers, but their motivations for doing so are different. The general student tends to drink more for social purposes, but the student-athlete – particularly males – may be looking to blow off steam, which can lead to higher-risk use.

“Female student-athletes report alcohol use as a coping mechanism, while males report it as enhancing the event at hand (like a party or game, not the event they’re playing in) or blowing off steam,” Wyrick said. “Motivation for the general student population is almost always social.”

Those motivations may lead to different expectations – and consequences.

“Student-athletes have both positive and negative expectations,” Wyrick said. “Negative expectations are protective, and their positive expectations put them at risk. When we try to intervene to change those expectations, student-athletes often put a positive evaluation on what we would consider a negative, such as getting so drunk that you black out – we would say that’s a negative outcome, but they might say that was what they were after that particular night.

“So their evaluation of these expectations appears to be different than those of the general student population.”

Both Bockelman and Wyrick say the best news in all of this is that the educational effort is happening at all. More programs and methodologies are coming to light, and in time should help change the substance-use culture.

“The NCAA is well positioned to advise how to do this best in a higher-education environment,” Wyrick said. “No one else is as active in this area. But the challenge is how do you take these materials and resources to scale in order to accommodate a large and diverse membership with different goals and philosophies? It has to be gradual, sustainable and collaborative. You can’t just come in a say drop what you’re doing and use this program instead.”


NCAA testing could be strengthened

Meeting Attendees
  • Stevie Baker Watson, Director of Athletics, DePauw University
  • Mark Bockelman, Director of NCAA Drug Testing, The National Center for Drug Free Sport
  • Larry Bowers, Chief Science Officer, U.S. Anti-Doping Agency
  • Rob Cabry, Team Physician, Drexel University
  • Augusto Diana, Health Science Administrator, National Institute on Drug Abuse
  • Deborah Ford, President, University of Wisconsin-Parkside
  • Carolayne Henry, Senior Associate Commissioner, Mountain West Conference
  • Kayla Jones, NCAA Division II Student-Athlete Advisory Committee (Texas Woman’s University)
  • Tammy Loew, Health Advocacy Coordinator, Purdue University
  • John Lombardo, Director of NFL Drug Testing
  • Brad Maldanado, NCAA Division II Student-Athlete Advisory Committee (Lincoln Memorial University)
  • Andy Smith, Head Athletic Trainer, Canisius College
  • Frank Uryasz, President, The National Center for Drug Free Sport
  • David Wyrick, Faculty Athletics Representative, University of North Carolina at Greensboro; Author, myPlaybook

NCAA Chief Medical Officer Brian Hainline convened a group of experts in April to help the NCAA draft a plan for the future drug testing, drug deterrence and doping education, and to reduce performance-enhancing drug use and recreational drug use among student-athletes.

With more and more programs and awareness campaigns emerging, and with institutional resources devoted to drug testing at a premium, the group is looking for the most effective and efficient ways to enhance student-athlete well-being and protect the integrity of sport.

The NCAA adopted a drug-testing program at the 1986 Convention. It included testing for both performance-enhancing drugs and street drugs. The NCAA currently conducts a year-round program in Divisions I and II (summer testing was added in those two divisions in 2006 and 2007, respectively). Division III considered year-round testing but opted to devote more resources to alcohol education instead (the result is the new initiative called 360 Proof).

At least three-quarters of Divisions I and II schools have an institutional drug-testing program of their own (about 30 percent in Division III).

Hainline’s day-long meeting provided direction on several fronts:

Primarily, the group advocated a more robust year-round program that tests for performance-enhancing drugs, including stimulants. The group agreed that because anabolic steroids are used year-round, especially for training and recovery and not just to “gear up” for one particular event, testing should be year-round. Similarly with stimulants – if student-athletes are taking stimulants to train better, then year-round testing makes sense with these, too. However, the year-round testing program would not include testing for street drugs.

The group also wants to include testing at NCAA championships as part of the year-round testing program. That testing component would include street drugs, as is currently done, and add opiates.

Members also are interested in collaborating with conferences and institutions to standardize testing protocol and sanctions. They believe a uniform testing model is the best way to deter use, but they also acknowledge the challenges of expecting or implementing a standardized model within the large and diverse NCAA membership.

In addition, they want to partner with conferences and schools to enhance and standardize educational efforts and develop a best-practice model for drug-use deterrence, especially for performance-enhancing drugs, for which there currently are few, if any, effective educational programs available.

These recommendations and others will go to the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, which oversees NCAA drug-testing and drug-education programs.