1.Overtraining can be characterized by fatigue,
depression, restlessness, and increased resting
heart rate to name a few (Sachtleben, 2003).
2.Mood disturbance is one of the key characteristics of
the overtraining syndrome, and therefore monitoring
of an athlete’s mood during increased stress may also
be helpful (Sachtleben, 2003). Additionally, athletes
who participate in multiple sports and endurance ath-
letes (e.g., marathoners) should be monitored for
signs of overtraining due to the nature of their sport
behavior (Sachtleben, 2003).ALCOHOL USE, ABUSE,
AND DEPENDENCE
- The most common substance abused by athletes is
alcohol (Green and Nattiv, 2003). In a survey of
21,000 college student athletes by the National
Collegiate Athletic Association (NCAA) regarding
substance abuse habits, 79.5% reported using alcohol
in the preceding 12 months. Regarding frequency of
alcohol consumption, 69% reported drinking 1–2
times during a typical week. Additionally, 39%
reported consuming 3–5 drinks in a sitting, and 30%
reported consuming 6–9 drinks in one sitting (NCAA,
1997). Twenty percent also reported that alcohol had
a negative effect on their athletic performance. - The Diagnostic and Statistical Manual of mental
Disorders-Fourth Edition-Text Revision (DSM-IV-TR)
delineates criteria for whether substance abuse (see
Table 74-1) or substance dependence (see Table 74-2) exist. For a diagnosis of alcohol dependence to be
made criteria for alcohol withdrawal must be met (see
Table 74-3). A helpful screening tool in determining
whether the athlete is a recreational drinker or has a
more significant problem with alcohol is the CAGE
questionnaire (Fleming and Barry, 1992):- Have you ever felt you ought to Cut down on your
drinking? - Have people Annoyed you by criticizing your
drinking? - Have you ever felt bad or Guilty about your drink-
ing? - Have you ever had a drink first thing in the morn-
ing to steady your nerves or get rid of a hangover
(Eye-opener)?
- Have you ever felt you ought to Cut down on your
- One or more positive answers are indicative of haz-
ardous drinking behavior. Two or more positive
answers indicate the probability of alcohol abuse and
possible dependence. Referral for further assessment
and treatment should be made for these individuals. - The absence of a clinical level of drinking behavior
does not diminish the importance of addressing the
impact of alcohol use on current sport performance
448 SECTION 5 • PRINCIPLES OF REHABILITATION
TABLE 74-1 DSM-IV-TR (2000) Criteria for Substance
Abuse
- A maladaptive pattern of substance use leading to clinically
significant impairment or distress, as manifested by one or more of
the following, occurring within a 12-month period:
a. Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, or home (e.g., repeated absences or
poor work performance related to substance use; substance-related
absences, suspensions, or expulsions from school; neglect of
children or household).
b.Recurrent substance use in situations in which it is physically
hazardous (e.g., driving an automobile or operating a machine
when impaired by substance use).
c. Recurrent substance-related legal problems (e.g., arrests for
substance-related disorderly conduct).
d. Continued substance use despite having persistent or recurrent
social or interpersonal problems caused by or exacerbated by the
effects of the substance (e.g., arguments with spouse about
consequences of intoxication, physical fights). - The symptoms have never met the criteria for Substance Dependence
for this class of substance.
SOURCE:APA: Diagnostic and Statistical Manual of Mental Disorders,
4th ed. Text Revision, Washington, DC, American Psychiatric
Association, 2000.
TABLE 74-2 DSM-IV-TR (2000) Criteria for Substance
Dependence
A maladaptive pattern of substance use, leading to clinically significant
impairment or distress, as manifested by three or more of the
following, occurring at any time in the same 12-month period:- Tolerance, as defined by either of the following:
a. Need for markedly increased amounts of the substance to
achieve intoxication or desired effect.
b.Markedly diminished effect with continued use of the same
amount of the substance. - Withdrawal as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance (refer
to Criteria A and B of the criteria sets for Withdrawal from the
specific substances)
b.The same (or a closely related) substance is taken to relieve or
avoid withdrawal. - The substance is often taken in larger amounts or over a longer
period than was intended. - A persistent desire exists to cut down or control substance use
along with many unsuccessful attempts to do so. - A great deal of time is spent in activities necessary to obtain the
substance (e.g., driving long distances), use the substance, or
recover from its effects. - Important social, occupational, or recreational activities are given
up or reduced because of substance use. - The substance use is continued despite knowledge of having a
persistent or recurrent physical or psychologic problem that is
likely to have been caused or exacerbated by the substance (e.g.,
continued drinking despite recognition that an ulcer was made
worse by alcohol consumption).
SOURCE: APA: Diagnostic and Statistical Manual of Mental Disorders,
4th ed. Text Revision, Washington, DC, American Psychiatric
Association, 2000.