Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Wellness and Recovery in the Addiction Profession Part Two: Substance Use to Exercise: Are We Moving from One Addiction to Another? Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES

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Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 1 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

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Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 2 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Training Presenter • Duston Morris, PhD, MS, CHES • University of Central Arkansas

Training Presenter • Stephanie F. Rose, DSW, LCSW, AADC, CS • University of Central Arkansas

Substance Use to Exercise: Are We Moving From One Addiction to Another?

STEPHANIE ROSE, DSW, LCSW, AADC, CS, DCC, ASSISTANT PROFESSOR DUSTON MORRIS, PHD, MS, CHES, ASSOCIATE PROFESSOR

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 3 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Study overview

 Very little evidence addresses the relationship between substance use and exercise addiction among college students. A phenomenon referred to as “switching addictions” or substitute addictions is the substitution of one addictive behavioral pattern for another.

 A total of 824 college students completed a 36-item survey regarding substance use and views of exercise.

Physical activity and recovery

 Substance abuse disorders are among those with the highest mortality rates (Franko, Dorer, Keel, Jackson, Manzo, & Herzog, 2005).

 For chronic abusers, their health has generally taken a back seat to their addiction. Therefore, many treatment facilities also address nutrition and physical activity.

 Physical activity is often promoted in treatment for alcohol use disorder not only because it is at little cost, but it does not need insurance approval or a trained provider (Read, Brown, Marcus, Kahler, Ramsey, Dubreuil, Jakicic, & Francione, 2001).

POLL QUESTION #1

Which of the 1. Exercise can effectively following are increase the abstinence accurate rate statements 2. Exercise can ease concerning the withdrawal symptoms relationship 3. Exercise can reduce between physical anxiety and depression exercise and 4. All the above substance abuse?

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 4 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

What are the concerns?

 Possible benefits from physical activity as part of recovery include, achieving a pleasurable state without use of drugs, improving mood, increasing self-efficacy, participating in group activity and social support, providing a positive non-drinking alternative, decreasing stress reactivity and improving coping skills (Read JP, Brown RA, 2003).

 While this sounds promising, there is little research evaluating if individuals in treatment for substance abuse, who are susceptible to addiction, are potentially being lead to another addiction. 13

Making the connection

Similarities Societal norms Linked behaviors Individuals that are For example, individuals addicted to physical addicted to exercise and activity and exercise have individuals addicted to some characteristics drugs and/or alcohol similar to individuals that generally have low self- have a substance abuse esteem and both use disorder. either exercise or a chemical as a way of “managing and/or manipulating psychological states”

Substitute addictions

 Substitute addictions can involve a transition from a chemical addiction to a behavioral or process addiction. In some situations when an individual is able to terminate one addictive behavior, such as alcohol abuse, they may engage in a pattern of addictive eating, exercise, or sexual behaviors.

 The process of substitute or “switching addictions” involves process-overlaps between obtaining pleasure and distorted rewards, while experiencing withdrawal symptoms (Sussman S, Black, DS, 2008). Ultimately, switching from one addition to another leads to similar negative health outcomes. 15

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 5 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

POLL QUESTION #2

Researchers 1. Chemicals released that believe that in create a since of part, exercise pleasure or reward addiction may be 2. Specific positive exercise based on? attitudes 3. A family history of exercise addiction 4. Coping mechanism for other behaviors

Alcohol use and physical activity

 There is an association between alcohol use and increased physical activity (Dodge & Clarke, 2018). Among college students, for example, a correlation exists between risk for exercise addiction and alcohol use. Some research also demonstrated a link between problematic alcohol use and those considered at risk for exercise addiction.

Exercise addiction

 Exercise addiction involves psychophysiological symptoms that can manifest in compulsive and/or dependent behaviors (Yong-Seok, Eun, 2018).

 Exercise addiction renders consequential behaviors, similar to other addictive behaviors, including a lack of control despite negative consequences.

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 6 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Additional consequences of exercise addiction

 Musculoskeletal injuries and weakened immune systems (Yong-Seok & Eun, 2018).

 Similar to other addictions, including, alcohol abuse and gambling, an individual with exercise addiction presents with psychological inflexibility.

 Obligatory exercise is a compulsive pattern of exercise behavior where thoughts of needing to exercise or actual exercise behavior begins to dominate daily life requirements, and where the lack of exercise begins to produce withdrawal symptoms (Rodgers, Blanchard, & Munroe, 2001).

 Individuals recovering from alcohol or drug addiction may perceive obligatory exercise as a healthy alternative due to the general social acceptance surrounding excessive exercise; however this is not always the case.

Griffiths (1997) six components of exercise addiction

 Salience

 Mood modification

 Tolerance

 Withdrawal

 Conflict

 Relapse

POLL QUESTION #3

It is estimated that 1. 5% _____% of people who are addicted 2. 10% to exercise might also be addicted 3. 15% to tobacco, alcohol, and 4. 20% other drugs.

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 7 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Exercise addiction contributors

 Feelings of guilt and shame are two primary emotions associated with personal motive for behavioral change concerning heavy alcohol consumption and a desire to engage in restorative- health efforts (Dodge & Clarke, 2018). In relation to guilt and shame, those struggling with exercise addiction also struggle with poor body image (Berczik, Szabo, Griffiths, Kurimay, Kun, Urban, & Demetrovics, 2012).

Association with social constructs

Social constructs The bellybutton challenge Exercise trends Exercise addiction is often Current social constructs that overlooked as a concern due to promote, sensationalize, and the positive view of physical glamorize only the fit images activity and sports within our as healthy people can make social construct. This extreme the average person feel guilty level of acceptance can result or shameful about their own in rationalizing dysfunctional exercise efforts and/or body behavior (Nogueira, Molinero, image. Salguerro, & Marquez, 2018), which can lead to the disruption of normal, healthy lifestyle patterns. 23

POLL QUESTION #4

Exercisers at high 1. True risk of exercise addiction 2. False reported the same level of support for exercise from relatives as those at low risk of exercise addiction.

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 8 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Other contributing factors

 Among undergraduate college students, more women reported increased weight as a concern in regard to alcohol consumption (Reilly, Dmochowski, Schaumberg, Earleywne, & Anderson, 2016). There is a high prevalence of co- occurring diagnoses with exercise addiction and eating disorders (Berczik, Szabo, Griffiths, Kurimay, Kun, Urban, & Demetrovics, 2012).  Furthermore, there is research that suggests that guilt related to drinking can be a mediator for increased exercise as a way to address the additional caloric consumption. Individuals who consume increased alcohol tend to increase exercise as a way to manage body-weight.  Among undergraduate college students, both men and women reported binge-drinking and increasing alcohol intake. More women reported that the motivation for increased alcohol use as an attempt to cope, while men reported that social engagement was the primary motivation for increased alcohol consumption (Reilly, et al., 2016).

Culture of sports

 Existing research has identified a perception of substance use acceptance as part of the culture of sports (de Grace, Knight, Rodgeres, & Clark, 2017).

 Endurance sports are associated with the most risk for addiction(Nogueira, Molinero, Salguerro, & Marquez, 2018).

 Associated celebration events, as well as, maladaptive attempts to cope with injuries and performance pressure are also identified triggers for increased substance use among athletes (de Grace, Knight, Rodgeres, & Clark, 2017).

 Competitive characteristics among athletes increases physical activity, while the same competitive nature also increases binging of illicit substances (NewsRx, 2017).

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 9 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

POLL QUESTION #5

The prevalence of 1. True substance abuse in some sports 2. False communities creates a greater risk of addictions for people already vulnerable to them.

Methods

 Convenient sample of college students enrolled in CHBS programs.

 Participants responded on a Likert-type scale to questions about frequency of substance abuse and views of exercise.

 Frequency was measured in the substance abuse section of the survey in a five point Likert- type scale where 1= “never” and 5= “daily or almost daily.”

 Participants were also asked to provide demographic data, such as age, sex, and race, which may influence the dependent variable.

Results

 There was a significant negative correlation (r = -.104, n = 815, p < .01) between drug use over the past thirty days and increased exercise volume per day.  There was a significant negative correlation (r = -.083, n = 814, p < .05) between drug use over the past thirty days and exercise importance.  There was a significant positive correlation (r = -.078, n = 820, p < .05) between binge drinking over the past two weeks and exercise importance.  There was a significant positive correlation (r = -.080, n = 815, p < .05) between binge drinking over the past two weeks and increased exercise volume per day.  There was a significant positive correlation (r = -.079, n = 815, p < .05) between alcohol use over the past thirty days and exercise euphoria.  There was a significant positive correlation (r = .110, n = 815, p < .01) between alcohol use over the past thirty days and exercise limits.

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 10 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

Implications for research

 Information that contributes to improved education about moderation for healthy limits of physical activity could further assist with treatment interventions.  Given the rationalizing behaviors associated with increased exercise to address increased caloric intake from alcohol consumption, exploration of the relationship between exercise addiction and eating disorders could be beneficial (Berczik, Szabo, Griffiths, Kurimay, Kun, Urban, & Demetrovics, 2012).

POLL QUESTION #6

Which of the 1. Extroversion following factors have been 2. Narcissism related to exercise 3. Exercise engagement addiction? and intensity

4. All the above

Recommendations and interventions

 Feelings regarding self-perception and body-image can assist to expand upon motivation for problematic exercise behaviors (Brown & Fry, 2014).

 The relationship between personality traits and both alcohol use, as well as, impulsive, reactive behaviors needs to be explored more in-depth (Fischer, Collins, Settles, Gunn, & Smith, 2012).

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 11 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

References

 Berczik K, Szabo A, Griffiths MD, Kurimay T, Kun B, Urban R, Demetrovics Z (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use & Misuse, 47(4), 403-417. https://www.ncbi.nlm.nih.gov/pubmed/22216780

 de Grace LA, Knight CJ, Rodgeres WM, Clark AM (2017). Exploring the role of sport in the development of substance addiction. Psychology of Sport & Exercise, 28, 46-57. https://www.sciencedirect.com/science/article/pii/S1469029216301819

 Dodge T, Clarke P (2018). Testing weight motives and guilt/shame as mediators of the relationship between alcohol use and physical activity. Addictive Behaviors, 77, 131-136. https://www.sciencedirect.com/science/article/abs/pii/S0306460317303659

 Fischer S, Collins B, Settles R, Gunn R, Smith GT (2012). The role of negative urgency and expectancies in problem drinking and disordered eating: testing a model of comorbidity in pathological and at-risk samples. Psychology of Addictive Behaviors, 26(1), 112-123. https://www.ncbi.nlm.nih.gov/pubmed/21604832

 Franko DL, Dorer DJ, Keel PK, Jackson S, Manzo MP, Herzog, DB (2005). How do eating disorders and alcohol use disorder influence each other? International Journal of Eating Disorders, 38, 200-207. https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.20178

 Griffiths M (1997). Exercise addiction: A case study. Addiction Research, 5(2), 161-168. https://www.academia.edu/429690/Griffiths_M.D._1997_._Exercise_addiction_A_case_study._Addiction_Research_5_161- 168

 NewsRx (2017). Study reveals surprising link between athletics and addiction. Obesity,Fitness & Wellness Week. https://www.sciencedaily.com/releases/2017/02/170213151321.htm

References

 Nogueira A, Molinero O, Salguerro A, Marquez, S (2018). Exercise addiction in practitioners of endurance sports. A literature review. Frontiers in Psychology, 9, 1484. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01484/full

 Read JP, Brown RA, Marcus BH, Kahler CW, Ramsey SE, Dubreuil ME, Jakicic JM, Francione, C (2001). Exercise attitudes and behaviors among persons in treatment for alcohol use disorders. Journal of Substance Abuse Treatment, 21, 199-206. https://www.sciencedirect.com/science/article/pii/S0740547201002033

 Reilly EE, Dmochowski S, Schaumberg K, Earleywne M, Anderson D (2016). Gender-moderated links between urgency, binge-drinking, and excessive exercise. Journal of American College Health, 64(2), 104-111. https://www.ncbi.nlm.nih.gov/pubmed/26629729

 Rodgers WM., CR, Blanchard CM, Munroe KJ (2001). Prediction of obligatory exercise by exercise-related imagery. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 15(2), 152-154. https://psycnet.apa.org/record/2001-06707-009

 Sussman S, Black, DS (2008). Substitute addiction: A concern for researchers and Practitioners. Journal of Drug Education, 38(2), 167-180. https://www.researchgate.net/publication/23191439_Substitute_Addiction_A_Concern_for_Researchers_and_Practitioners

 Yong-Seok, J, Eun D (2018). Exercise Addiction and Psychophysiological Health in Korean Collegiate Students. International Journal of Mental Health Addiction, 16, 451-465. https://link.springer.com/article/10.1007/s11469-017-9802-7

Thank you! Any questions?

Duston Morris, PhD, MS, CHES Stephanie F. Rose, DSW, LCSW, AADC, CS 36 36

Presented by: Stephanie F. Rose, DSW, LCSW, AADC, CS and Duston Morris, PhD, MS, CHES 12 Substance Use to Exercise: Are We Moving 3/17/2021 from One Addiction to Another?

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