Substance dependence is characterized by a maladaptive
pattern of substance use in which impairment,
distress, or clinically significant tolerance to the effects
of the substance is evident. Persons exhibiting substance
dependency may engage in a persistent desire or
unsuccessful efforts to control, curtail, or even cease
their use of the substance. Dependence is further associated
with withdrawal symptoms upon termination from
repeated exposure to the substance. Hiding one’s use of
the substance may be done to give the impression of
cessation of use.
According to the National Institute on Drug Abuse
(2016), it is important to distinguish between physical
and behavioral dependence. Physical dependence occurs
because the body adapts to regular exposure to the substance,
thereby resulting in tolerance after chronic use
and withdrawal when the substance is taken away.
Physical dependence may lead to craving the substance
in order to relieve the withdrawal symptoms (e.g., anxiety,
sweating, fatigue, irritability, nausea, vomiting).
Behavioral dependence refers to persistent use despite
negative physical (organ damage, hormone imbalance),
psychological (depressed mood, sleep disturbance),
social (job loss, suspension or expulsion from sports
teams), or legal (arrests, probation) consequences.
In 2013, the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5), no longer
used the terms substance abuse and substance dependence. These terms were combined into a single
category titled: ‘Substance Use Disorders,’ with levels
of severity defined as mild, moderate, or severe
(Substance Abuse and Mental Health Services
Administration, 2015). According to the DSM-5, a
diagnosis of substance use disorder is characterized by
clinically and significant impairment in daily life, such
as failure to meet major responsibilities at work, school,
or home. Regardless of the substance, the behaviors
related to a diagnosis of substance use disorder fall into
four main categories: (1) impaired control (e.g., spending
excessive time getting/using/recovering from the
drug use), (2) social impairment (e.g., spending less
time with family/friends or no longer engaging in an
activity such as golf), (3) risky use (e.g., using the substance
while driving a car), and (4) pharmacological
indicators (e.g., tolerance—increased amount of the
substance to achieve the desired effect; withdrawal—
body’s response to abrupt cessation of the substance)
(American Psychiatric Association, 2013).
Substance dependence occurs in all sports and at
most levels of competition (Morse, 2013). Athletes may
rely on substances to cope with the stressors of competition
and pressures to win at all cost as well as to
enhance their athletic performance (i.e., performance
enhancement drugs). To the contrary, athletes may use
substances such as alcohol or marijuana without the
intent of performance enhancement. In other words,
athletes may develop substance use disorders in the
same way as any nonathlete (Morse, 2013). Finally,
injuries and management of physical pain may play a
role in athletes’ substance use/dependence.
