Exploring the Athletic Trainer's Role in Assisting Student-Athletes Presenting With Alcohol-Related Unintentional Injuries

Drinking Among Collegiate Student-Athletes

For decades, researchers^1,3,11,12 have repeatedly documented that varsity collegiate athletes are more likely to consume alcohol and drink in greater quantities than their nonathlete peers. Investigators also have demonstrated that as an individual's involvement or engagement in collegiate athletics increases, his or her drinking behaviors increase. Specifically, both male and female student-athletes in leadership positions (eg, team captains) consumed more drinks per week (8.25) than collegiate athletes who were not in leadership positions (7.34) and nearly twice the amount of nonparticipants (4.12).⁵ Hildebrand et al² noted similar trends when comparing athletic involvement in high school and college, reporting that as athletic involvement increased, the likelihood of being classified as a heavy drinker increased. Thus, student-athletes represent an at-risk group in particular need of programming aimed at reducing alcohol use.^13,14

Alcohol Use and Risk of Injury

Alcohol consumption represents a substantial risk factor for injury,^15,16 with the greatest likelihood of repeat injuries occurring among heavier drinkers.^17,18 Given that collegiate athletes represent one of the highest-risk drinking subgroups on college campuses, they are more likely to experience alcohol-related consequences, such as ARUIs, than their nonathlete peers.^4,5 An ARUI is particularly problematic for athletes because it represents not only a health risk but also a potential risk to their on-the-field performance and athletic careers. The National Collegiate Athletic Association found that 15.3% of student-athletes reported being either hurt or injured at least once during the year before the study because of use of alcohol or other substances.¹⁹ More recently, Brenner et al⁸ observed that nearly 18% of collegiate athletes reported having experienced an ARUI, with most of these happening in the off-season (53.2%) and in-season (30.5%).

Athletic Trainers' Confidence to Intervene

The National Athletic Trainers' Association has asserted that certified ATs have the capacity and responsibility to play active roles as integral members of the health care team.²⁰ Among the 8 content areas that students from accredited athletic training programs must demonstrate are Psychosocial Strategies and Referral and Prevention and Health Promotion.²¹ Per the fifth edition of the National Athletic Trainers' Association's Athletic Training Education Competencies, ATs must be able to “[i]dentify the symptoms and clinical signs of substance misuse/abuse, the psychological and sociocultural factors associated with such misuse/abuse, its impact on an individual's health and physical performance, and the need for proper referral to a healthcare professional.”^21(p27) Furthermore, the AT should “…develop and implement strategies and programs to prevent the incidence and/or severity of injuries and illnesses and optimize their client's/patient's overall health and quality of life.”^21(p12)

Skills within these content areas include a variety of behaviors, such as counseling skills, addressing referrals, maintaining a healthy lifestyle, and preventing chronic disease. Athletic trainers have identified psychosocial intervention as 1 role associated with their unique position, which allows them “to be approached by athletes with issues because of the special relationship that exists between athlete and athletic trainer.”^10(p150) Unfortunately, most ATs are not confident or do not believe they are effective in recognizing or confronting student-athletes presenting with health-risk behaviors, despite identifying these roles as part of their capacities as ATs.²² Although ATs reported that they were prepared to counsel student-athletes on injury rehabilitation and nutrition, they believed they were inadequately prepared to counsel on less common areas, such as ARUIs.^23,24

Action Items for Implementation

Whereas many researchers^25–29 have examined the effect of alcohol-related interventions for the general collegiate student population, few investigators^30–32 have focused on developing or evaluating alcohol-related intervention programs specifically for collegiate athletes. In the available studies, researchers have examined the effect of social-norms campaigns on athlete drinking,^31,32 but none have assessed ARUIs. Therefore, investigators have highlighted “the need to develop more efficacious interventions for heavy-drinking students and those who belong to other at-risk groups such as Greeks and athletes.”^33(p2488) Moreover, Larimer and Cronce³⁴ contended that “athletes appear [as] responsive to similar approaches as the broader [student] population.”^(p2459) Screening and brief interventions have been identified as the single most effective method for addressing alcohol use, particularly for those who are not seeking treatment.³⁵ Among a collegiate population treated with screening and brief intervention at a university emergency facility, 75% reported at a 3-month follow-up that the intervention was effective and their alcohol consumption had decreased. More recently, investigators examining effective prevention strategies among college students have suggested that brief, motivational interventions or skills-based interventions were most effective.^33,35–38 Simply stated, ATs need to be equipped with the knowledge and skills to provide face-to-face, brief interventions to student-athletes presenting with ARUIs and to evaluate the effect of their own involvement. To this end, action items for appropriate intervention should include (1) gaining an understanding of ATs' experience and confidence in and preparation for addressing ARUIs; (2) developing appropriate educational and skill-building programs for ATs on using screening and brief interventions with college athletes; and (3) for ATs, adopting and adapting appropriate screening and brief interventions as needed. Therefore, we offer specific initiatives to address the aforementioned actions:

• 1.

  To establish a baseline level of understanding, we must assess ATs' (a) experiences treating, evaluating, or referring athletes presenting with ARUIs; (b) confidence intervening with ARUI among athletes; (c) educational preparation to counsel athletes presenting with ARUIs; and (d) knowledge of the effects of alcohol on athletic performance.^9,10,37–40 For example, using aspects of the Screening, Brief Intervention, and Referral to Treatment (SBIRT)⁴¹ program would appropriately parallel the functions and roles of ATs when addressing an ARUI. Findings from these assessments can then be used to determine changes resulting from appropriate educational programs designed to equip ATs with appropriate knowledge, skills, and abilities.

• 2.

  Developing educational and skill-building programs that are designed to give ATs the requisite knowledge and abilities to intervene with collegiate athletes presenting with ARUIs.^9,10,37–40

• 3.

  For ATs, using aspects of the Brief Alcohol Screening Intervention for College Students²⁶ and the SBIRT⁴¹ programs could be beneficial in addressing alcohol-abuse concerns in student-athletes. The Brief Alcohol Screening Intervention for College Students program²⁶ is a nonconfrontational, nonjudgmental, and nonauthoritarian intervention program designed for young adults (age = 18–25 years) experiencing alcohol-related problems (eg, ARUIs). The SBIRT⁴¹ is an evidence-based practice approach for individuals who have (or are at risk of having) substance-use disorders and consists of an initial brief screening that can be based on a variety of models. For example, an AT could use sources such as AlcoholScreening.org, followed by brief interventions.⁴¹ These brief interventions can also use 1 or more of many readily available models, including motivational interviewing or referral to a specialist for cognitive behavioral therapy.⁴¹

These types of programs have been implemented successfully with college students and appear to be just as appropriate for athletes. Once ATs have been educated on applying screening and brief interventions, then they can implement these skills with their students and athletes. As with many initiatives, a follow-up assessment must be performed to examine the perceived usefulness of the approach, the outcomes of the program for the student-athlete and ATs, and any necessary changes or modifications necessary for future use.