BACKGROUND AND AIMS: Elite athletes may use psychotropic substances for recreational reasons, (perceived) performance enhancement or self-medication. Causes can overlap. For athletes, substance use may be associated with various medical and social risks. Psychoactive substances include alcohol and nicotine, illicit and various prescription drugs, which all have a potential for abuse and dependence. This paper reviews the existing literature on the use of psychoactive substances and associated substance use disorders among elite athletes in terms of prevalence, patterns of use, as well as underlying causes and risk factors.METHODS: Due to the heterogeneous and partially fragmentary study data, a narrative approach with selection of applicable publications of a Medline search was chosen.
RESULTS:The most commonly used psychoactive substances among elite athletes were alcohol, nicotine, cannabis, stimulants and (prescription) opioids. Overall consumption rates are lower in professional sports than in the general population, but use of several substances (smokeless tobacco products, prescription opioids, stimulants) have high prevalence in specific sports and athlete groups. Substance use is subject to multiple risk factors and varies by substance class, sport discipline, country and gender, among other factors. CONCLUSION: Knowledge on the underlying causes and patterns of substance use, as well as the prevalence of substance use disorders in professional sports, is still limited. High prevalence of various substances (i.e., nicotine, prescription opioids) may indicate potentially harmful patterns of use, requiring further research. Specific preventive and therapeutic concepts for the treatment of substance use disorders in elite athletes should be developed.
Background: Primary and secondary negative symptoms (NS) are core features of schizophrenia (SCZ) and can also be observed in bipolar-disorder-I (BD-I) patients. Secondary NS, due to other clinical factors, are frequently reported in clinical practice, yet systematic investigations into these symptoms remain sparse. In this study, we characterized potential sources of secondary NS as well as the association between NS and working memory (WM) capacity within the SCZ-BD spectrum. Methods: We included 50 outpatients with SCZ and 49 with BD-I and assessed NS domains using SANS global scores for avolition-apathy, anhedonia-asociality, alogia and blunted affect. To identify clinical factors as potential sources of NS we applied multiple regression analyses including positive symptoms, disorganization, depressive symptoms, antipsychotic and mood stabilizer intake. We quantified their relative importance as sources for secondary NS through dominance analyses. Lastly, we used multiple regression to assess the relationship between NS domains and WM. Results: Across SCZ and BD-I, disorganization was associated with avolition-apathy and anhedonia-asociality and depressive symptoms additionally predicted anhedonia-asociality. Antipsychotic dose was associated with blunted affect while group differences only predicted alogia. Avolition-apathy predicted impaired WM transdiagnostically and in BD-I higher anhedonia-asociality was associated with better WM capacity. Conclusion: Secondary NS are prevalent across the SCZ-BD spectrum, with disorganization reflecting an important factor for avolition-apathy and anhedonia-asociality. Avolition-apathy emerged as a transdiagnostic predictor of WM impairment, while anhedonia-asociality was linked to better WM in BD-I. Altogether, these findings support the clinical relevance and need for future research of secondary NS across the SCZ-BD spectrum.
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