Athletes and Alcohol

Athletic trainers can play a key role in new alcohol abuse prevention programs being developed across high school and college campuses.

By Sue Rochman

Sue Rochman is a freelance writer based in San Francisco. She is a regular contributor to Training & Conditioning.

Training & Conditioning, 10.7, October 2000,

Too many athletic trainers have seen the signs too often: student-athletes who are late for practice, who miss training room appointments, who are no longer performing well. Some have heard rumors about a student-athlete who really tied one on the night before, or listen to student-athletes joking about how plastered they got last weekend. These signs of alcohol abuse can be very troubling, but when they happen, what should an athletic trainer do? And what can be done to prevent them from occurring?
Alcohol use and abuse is a pervasive problem on many high school and college campuses. And student-athletes are in no way immune to the problem. In fact, when it comes to drinking—and binge drinking in particular—athletes who are team leaders are all too often ahead of their peers in this arena as well.
“I know students drink, because we see the aftermath in the training room,” says Maria Hutsick, ATC, Head Athletic Trainer at Boston University. “We see guys who have gotten into fights at parties. Even though there are specific teams—both male and female—that are known to binge drink, the fact is, kids on every team do it.”
Of course, not all athletes drink. But study after study has shown that far too many do—resulting in harm to themselves, to team members, and to other students on campus. In response, a plethora of alcohol education and prevention programs has been implemented over the years. Their effects, however, have generally been less than satisfactory. In response, many high schools and colleges are trying new educational programs that focus on such things as social marketing and peer education to get the message out about alcohol use and abuse.
By virtue of their close day-to-day interaction with many student-athletes, athletic trainers are in a unique position to help with these programs. Athletic trainers can have their strongest effect on alcohol abuse when they know what programs are offered at their school and how they work, since they vary in structure and approach. Regardless of the program, though, prevention starts with understanding the issues surrounding alcohol abuse, and then taking steps to address them.

Alcohol Use and Abuse
In many ways, alcohol has become synonymous with the culture of college life. The problem is not just that most college students are underage, but that when students drink, they often drink far more than they should. And problem drinking often doesn’t begin in college. Students with alcohol-related problems report that their drinking usually started during high school, and sometimes in junior high.
At the high school and college level, most students who drink are not “alcoholics.” Alcoholism is a medical disease with genetic as well as environmental and psychosocial causes. Alcohol abuse, in contrast—which is what tends to be seen among high school and college students—is the intentional overuse of alcohol, and it often takes the form of binge drinking.
Binge drinking is defined as five or more drinks in a row one or more times during a two-week period for men; and four or more drinks in a row one or more times during a two-week period for women. A drink is typically defined as 12 ounces of beer or wine cooler, a four-ounce glass of wine, or a shot of liquor, whether taken straight or in a mixed drink.
Because student-athletes have to sustain a high level of athletic performance, they do tend to drink less while in training and in season. But studies and anecdotal evidence make it clear that many don’t abstain even in the height of the competitive season and that many others easily make up for any decreased rate of drinking during the off-season.

Prevention Programs
Setting up programs for curtailing alcohol abuse is nothing new. The NCAA started handing out grant money to member schools to combat this problem through its CHOICES program back in 1991. But increased research on alcohol use and abuse on high school and college campuses has led athletic departments to realize their need to do much more.
There is no one program that works for every campus, and there are no studies to indicate which method is indeed “the best.” Instead, schools are experimenting with educational models based on different methods of encouraging behavioral changes. But while alcohol education programs come in all shapes and sizes, they all need to be able to change over time. Fort Hays State University, for example, used its CHOICES grant to revamp and change the direction of its alcohol education program. So far the results are promising.
In 1992, Fort Hays started an alcohol education program that had as its motto, “Don’t Drink.” But the program was far from effective. “Most of the kids we wanted to get involved would say, ‘I might go out and have a beer, and I’m not going to tell other students I don’t drink. I don’t want to be seen as a hypocrite,’” says Carolyn Bird, Senior Woman Administrator and Academic Coordinator at the school.
Now, Fort Hays has changed its tactics by promoting responsible drinking rather than trying to eradicate drinking on campus. “The message we’re trying to put out is, if you are going to drink, then drink responsibly, and don’t drive,” Bird says. “So, for example, at sporting events, we’re giving away reusable beverage cups that bear the slogan, ‘If you must drink, drink responsibly.’”
In addition, Bird has implemented a social marketing campaign designed to change perceptions about student-athlete drinking on campus. “Our campus survey showed us that students thought most students on campus binge drink, and that Greeks and athletes use more alcohol than other students,” she says. “But what the survey acually showed us was that our student-athletes are one of the most responsible groups on campus when it comes to alcohol use.”
This concept of social norming was also the theory behind a new program started by Dennis Thombs, PhD, Associate Professor of Health Promotion at Kent State University. Funded through a 2000 CHOICES grant, the campaign, called “Reality Check,” will use a series of ads featuring Kent State head coaches accompanied by statements designed to emphasize that, despite what many students believe, campus surveys show most students don’t misuse alcohol. The ads will appear throughout the school year in the student paper, inside buses, on bus shelters, and in other high-traffic areas. In conjunction with the advertising campaign, Thombs and others will work directly with student-athletes to develop drinking norms.
“We found that student-athletes don’t share expectations within teams or across teams about what is appropriate drinking behavior,” said Thombs. “Some coaches and teams are strict, while others are not. Our goal is to work with the team leaders who sit on the Student-Athlete Advisory Committee to generate shared norms for each team and then guide the teams through the process of writing policies for themselves. We want to focus on the advantages that shared norms can bring: greater team cohesion, a way to prevent bad PR, and the opportunity to increase competitiveness by reducing alcohol misuse.”
While some schools are using a social norming approach, others remain committed to the use of peer education programs as a means of deterring binge drinking. At New Mexico State University, Mike O’Larey, ATC, Assistant Athletic Director for Athletic Health Services and Head Athletic Trainer, served as the athletic representative on the group that received a 1998 CHOICES grant.
Over the past three years, in conjunction with their CHOICES program, O’Larey has helped recruit student-athletes to enroll in a three-credit peer education class. “I’ve gotten several student-athletes to take the class, which is open to all students,” says O’Larey. “And when they are done, they then speak to target populations throughout the campus community, which includes athletic teams.”
Georgia Tech also used its CHOICES grant to focus on peer education by expanding its Student-Athlete Mentors (SAM) chapter. SAM is designed to give freshman student-athletes the opportunity to build a strong relationship with older student-athletes who can help them understand the effects binge drinking can have on both their athletic and academic performance.
“Peers have much more of an effect on students than do coaches, doctors, or other adults,” says Larry New, Director of the Homer Rice Center for Sports Performance at the Georgia Institute of Technology. “They are going through or have been through the same experiences and stresses, so they can tell younger students how they’ve coped with the various pressures and what it took to help them succeed. Also, the program helps us educate older student-athletes about the obligation they have leadership-wise.”
At Boston University, which initiated a SAM peer education program with a CHOICES grant in 1999, Hutsick says she has seen that student-athletes really do rely on those who are in the program. “The team representatives who take part in the SAM program have become a real resource for students,” she says. “It’s easier for the students to talk to them, and they know what referrals to make and to whom. Also, it’s taught the team representatives how to open channels of communication [proactively].”
High school athletic departments also have an important opportunity to educate student-athletes and encourage appropriate behavior, and a number have implemented student-athlete peer education or social norming programs. These programs will be fighting an uphill battle, however, if the adults involved with high school athletics, including athletic trainers, don’t get behind them—in word and in action.
“When working at the secondary school level, one of the responsibilities athletic trainers have is to be good role models,” says Jon Almquist, ATC, Specialist, Fairfax County Public Schools. “In many cases, young athletic trainers who have just gotten out of college, where alcohol use is considered normal, attempt to befriend student-athletes, by talking to them—like they would college friends—about how wasted they got on Friday night. They think the kids want to hear that, but they have a responsibility to not portray that type of image. They need to step out of their college days and realize that they are talking to high school athletes.”
That professional responsibility also includes acting upon reports of alcohol use or misuse. “That’s where the education and counseling domain of athletic training comes in,” says Almquist. “Sometimes, when student-athletes confide in the athletic trainer about their drinking, the athletic trainer may see it as whistle-blowing if he or she brings the issue to the administration, because it will lead to the athlete being suspended. But it will also lead to the athlete becoming involved in an intervention program, and part of the responsibility of being in the athletic trainer’s role is to get the student assistance.”

Identifying Alcohol Abuse
Athletic trainers in all settings are indeed in the unique situation of working with a wide range of student-athletes one-on-one in a relatively non-competitive arena. And in this capacity, they have the opportunity, and some say the responsibility, to broach conversations about a possible drinking problem.
If a student-athlete comes to a practice or game inebriated, alcohol use will be easy to identify. More likely, however, the signs and symptoms will be more subtle. “Athletic trainers know the students well, and they may see changes that the students themselves may not see,” says Dean Blackburn, Coordinator of Substance Abuse Programs at the University of North Carolina, and a Certified Substance Abuse Counselor. “Some of those things include a performance decrease or a change in attitude. They may also see students who are less energetic, less motivated, or who are late for training appointments or workouts. All of these things can cause performance to decrease, lead grades to drop, and contribute to friction in the student’s relationships with his or her teammates.”
If a drinking problem is detected, how a concerned adult approaches a student is a key factor in whether or not he or she will feel safe to discuss his or her problems or seek help. “The most important thing is to talk to the student-athlete in a language that he or she understands, and that is the language of performance and success,” says Blackburn. “I recommend approaching the student-athlete and saying something like, ‘As part of this team, I am concerned about your physical health. In addition, your teammates and I are concerned about you and about your well being as well as the team’s well being. And this is what I suggest: Why don’t we set up a time for you to talk to someone about what’s going on?’”
Even though athletic trainers know student-athletes well, they may not be the best people to counsel them about alcohol use or misuse. “The benefits of talking to the student-athlete yourself is that you already have a relationship with him or her,” says Blackburn. “But the disadvantages far outweigh that, in part because each individual has his or her own understanding of what is appropriate consumption. That’s why having a trained individual with experience working with and knowledge about alcohol dependency and alcohol decision-making is important. People with this training know how to ask the right questions and how to get behind why the student-athlete is making the choice to use or misuse alcohol. And they know how to help the student make the choices that are in his or her best interest.”
In many ways, the referral to the trained counselor is equally, if not more, important than the counseling itself; without it, the student-athlete may never get the help he or she needs. This underscores the importance of everyone who comes in contact with that student-athlete doing his or her part. “Ultimately, alcohol and experimentation with alcohol by students is a social problem,” concludes Almquist. “It’s bigger than, and goes beyond, the athletic trainer and the athletic department. Even so, alcohol use and abuse is something athletic trainers must know how to address—because they are an important part of the solution.”

Portions of this article previously appeared in our sister magazine Athletic Management.

Sidebar: Resources for Responsible Alcohol Use

Athletic trainers interested in starting or being part of an alcohol management program on their campus should first contact their school’s health education or health services office. Many of these offices have trained substance abuse prevention and education counselors who can offer information and advice about how to establish such a program or about the ways in which existing programs can be tailored to fit the student-athlete community. There are also several resources for information and support off campus. Here are a few:

BACCHUS and GAMMA Peer Education Network is an
international association of college-based peer education programs focusing on alcohol abuse prevention and other student health issues.

The CORE Institute provides schools with surveys to determine the effectiveness of drug and alcohol education programs.

National Health and Awareness Services, Inc., is a private consulting firm specializing in alcohol and other drug prevention on college campuses.

The Higher Education Center for Alcohol and Other Drug Prevention supports institutions in their efforts to combat illegal alcohol and drug use and its consequences.