Dual Diagnosis and High Performing Athletes: The Reality of Addict

Let’s face it: even in this day and age, many people still believe that addiction is about a lack of willpower. But if that’s true, then why do we see disciplined, world-class athletes dealing with drug and alcohol addiction?

Sure, we might be able to rationalize the use of performance-enhancing drugs, but what about luminaries like Andre Agassi and Michael Phelps, whose drug problems ramped up after they’d won their gold medals and achieved incredible athletic success?

A Lack of Willpower Isn’t the Problem

Training as an elite athlete involves an incredible level of determination over the course of many years. A lack of willpower isn’t the problem. Clearly, something else is at play … and that something else is called dual diagnosis.

In this post, we’ll explore the real reason why high-performing athletes struggle with addiction. We’ll look at the dynamics of dual diagnosis and discuss the importance of true dual diagnosis addiction treatment.

What is Dual Diagnosis?

Dual diagnosis is the technical term for a substance addiction and a concurrent mental health concern.

For example, depression and alcoholism is a dual diagnosis, as is Post-Traumatic Stress Disorder (PTSD) and heroin addiction. Dual diagnosis is synonymous with “co-occurring disorders” or “comorbidity” in medical literature.

The important point to remember about dual diagnosis is this: It isn’t really about the substance use. The substance use is the byproduct of the mental health issue. Think of the substances as medication people use to try and numb out from feeling depressed, anxious, sad, and alone.

How Common Is Dual Diagnosis?

Some people can develop purely chemical addictions to drugs, and detox alone is sufficient to resolve those issues. But most people with an active addiction also have an ongoing mental health issue such as depression, anxiety, or trauma.

We now know that dual diagnosis is actually the norm in addiction. According to the National Institute on Drug Abuse’s September 2010 publication on Comorbidity:

“Data show that persons diagnosed with mood or anxiety disorders are about twice as likely to suffer also from a drug use disorder (abuse or dependence) compared with respondents in general …. Similarly, persons diagnosed with drug disorders are roughly twice as likely to suffer also from mood and anxiety disorders.”

Again, individuals with mental health issues use drugs in an attempt to self-medicate. They don’t know how to cope with their depression, anxiety, and trauma, so they use. But using compounds the problem, adding their experience of discouragement, isolation, and shame.

Why Addiction and Athletics Can Go Hand in Hand

Dual diagnosis helps explain how and why hardworking, disciplined, and gifted individuals struggle with addiction. In fact, we now know that star athletes face an even greater likelihood of addiction than the general population.

Often we envision them as stronger than the rest of us, so we’re surprised when we hear that they’re dealing with drug addiction. We think, “How could this happen? They have willpower, fame, money … they have it all!” But having it all comes with its own problems.

The lives of top athletes are filled with intense exercise, pressure-packed performances and repeat adrenaline rushes. In such circumstances, exercise itself can act like a drug, dulling mental and emotional pain.

The Chemical Rush of Performance

Then after a time, athletes’ bodies and minds come to expect those extreme highs. They experience them as normal and feel very “off” without them.

In The Fix article by Kristen McGuiness, Are Celebrities More Prone to Addiction?, McGuiness quotes Dr. Dale Archer, the medical director for psychiatric services at Lake Charles Memorial Hospital as saying:

“‘When we get an addictive rush, we are getting a dopamine spike. [People] … talk about the ‘high’ of performing. And many people who experience that high report that when they’re not performing, they don’t feel as well. All of which is a good setup for addiction.’”

When the competitions end and retirement begins, the unexpressed emotional pain comes back too. And that’s when individuals are most vulnerable to using drugs to numb out.

A Loss of Purpose

In the wake of his Olympic wins, Michael Phelps abused alcohol and marijuana and received two DUIs. He’d come to believe that his athletic prowess defined him, so when he retired, he struggled with depression, anxiety, and loss of purpose.

As Wayne Drehs wrote in his ESPN article, Michael Phelps’ Final Turn, “Eventually, Phelps realized that all the Olympic medals in the world couldn’t ease his pain — and instead made life more complicated. By 2014, he was … lost, with no identity beyond that of a champion swimmer. He self-medicated and wondered whether his was a life worth living.”

High-performance athletes like Phelps have willpower in spades, but if they stop performing without addressing their issues, they’re likely to engage in other addictive behaviors. And that’s when dual diagnosis treatment is a must.

True Dual Diagnosis Treatment

From a dual diagnosis perspective, addiction treatment isn’t just about getting clean. Rather, the way to treat addiction is to heal the underlying core issues that drive it.

True dual diagnosis treatment involves addressing and healing the issues that are causing the depression, anxiety, and self-loathing. Once you’ve done that, then you won’t need the substances to medicate from those intense negative feelings.

Getting to Know the Real You

Make no mistake, facing up to your underlying core issues is no picnic. It means going to the places within your psyche that you’ve been avoiding for years. But it’s also an amazing opportunity … a chance to get to know the real you.

As Michael Phelps himself said when he was interviewed for ESPN’s Michael Phelps’ Final Turn, “‘People kind of built me up as the all-American boy …. Perfect, no mistakes, this and that. But that wasn’t me, you know? I wanted people to get to know the real me.’”

We put our top performers on literal and figurative pedestals, but it’s getting in touch with their true, fully human selves that empowers them to heal.

Joe Koelzer is the co-founder and CEO of The Clearing, a 12 Step Alternative residential addiction treatment program especially for individuals with Dual Diagnosis. He has years of counseling experience and a master’s degree in Spiritual Psychology from the University of Santa Monica. In co-founding The Clearing, Joe realizes his dream of creating and sharing the innovative Spiritual Psychology approach with others in a structured clinical setting.

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