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Substance abuse in athletes is both prevalent and dangerous, leading to its international recognition as a public health concern. In recent controlled trials, behavioral prevention programs have been shown to reduce alcohol use in collegiate student athletes who are at-risk for alcohol abuse, with outcomes appearing to be enhanced when family members are prescriptively involved. However, no interventions have been found to decrease alcohol or drug use frequency in controlled trials involving athletes who have been diagnosed with substance abuse, and no prescribed clinical interventions for substance abuse have been tailored to accommodate the unique needs of competitive athletes. As an initial step in this development, we review an evidenced-supported behavioral treatment program modified for use with athletes. Optimizing the support of significant others, this innovative treatment approach comprehensively targets multiple areas of mental health while emphasizing cultural enlightenment. Recommendations are offered, including the great need for controlled treatment outcome research specific to substance abuse in athletes.

Recruitment of participants into treatment outcome studies is an important and often challenging aspect of human research. Yet, there have been very few controlled trials that have examined methods of recruiting participants into clinical trials, particularly in populations that may be reluctant to pursue mental health intervention, such as athletes. In this study, 79 NCAA Division I, Club, and Intramural student-athletes volunteered to participate in a study to determine their interest in participating in one of two goal-oriented programs representing two arms in a clinical trial. These programs were aimed at reducing substance abuse and sexually transmitted infections, and improving mental health, relationships, and sport performance. The participants were randomly assigned to Standard Recruitment (SR) or Recruitment Engagement (RE). RE included a review of the aforementioned outcome study and implementation of strategies that were developed to motivate participants to engage in treatment. The SR condition involved a review of the aforementioned treatment outcome study only. After the recruitment interventions were implemented, participants were queried to report any negative consequences that may have occurred from their use of illicit drugs or alcohol. Participants who reported negative consequences were invited to participate in baseline assessment of the aforementioned outcome study. Results indicated that 11 (25.0%) of the participants in the RE condition provided their consent to participate, 9 (20.5%) of whom subsequently completed baseline assessment; only 2 (5.7%) of the SR participants provided their study consent and subsequently participated in baseline assessment for the clinical trial (p < .05). After the respective recruitment intervention was implemented, participants were administered psychometrically validated instruments to assess their overall psychiatric functioning and the extent to which their sport performance was negatively impacted by dysfunctional thoughts and stress. Participants in RE were more likely to report greater dysfunctional thoughts and stress interfering with their sport performance (and, to a lesser extent, greater psychiatric problems) than SR participants, suggesting RE may influence greater disclosure of problem behavior than SR, permitting the interviewers opportunities to empathize with the participants’ concerns. Results are discussed in light of their implications to treatment outcome research and clinical and counseling practice involving student-athletes.

Athletes experience unique stressors that have been indicated to compromise their mental wellness and sport performance, yet they underutilize mental health services. Indeed, very few mental health interventions for athletes have been developed to fit sport culture, and well-controlled mental health outcome research in athlete populations is warranted. In this randomized controlled trial, a sport specific optimization approach to concurrent mental health and sport performance (The Optimum Performance Program in Sports; TOPPS) was examined. Seventy-four collegiate athletes (NCAA = 42; club = 11; intramural = 21) formally assessed for mental health diagnostic severity were randomly assigned to TOPPS or campus counseling/psychological services as usual (SAU) after baseline. Dependent measures assessed general mental health, mood, mental health factors affecting sport performance in training, competition and life outside of sports, days using substances, sexual risk behaviors, happiness in relationships, relationships affecting sport performance, and contributions of relationship to sport performance. Intent to treat repeated measures analyses indicated that participants in TOPPS consistently demonstrated better outcomes than SAU up to 8-months post-randomization and for mental health/substance use measures, particularly when diagnostic criteria were most severe. Recommendations are provided in light of the results to assist sport-specific mental health intervention development and implementation within athlete populations.