Stress, Anxiety, Binge Drinking, and Substance Use Among College Student-Athletes: A Cross-Sectional Analysis


  • Brandon A. Knettel Duke University School of Nursing and Duke Global Health Institute
  • Emily M. Cherenack Duke Global Health Institute and Duke University Department of Psychology and Neuroscience
  • Courtney Bianchi-Rossi Bethel University and Gustavus Adolphus College



alcohol use disorder, alcoholism, alcohol drinking, cannabis, risk-taking, sports, students, substance use, substance-related disorders


The immense pressure faced by college student-athletes to balance participation in sports with other responsibilities can contribute to unhealthy coping behaviors including alcohol and drug use. We administered online surveys to 188 college student-athletes to examine stress, athletics-related anxiety, and perceived control of stress as predictors of binge drinking, substance use, and associated risk behaviors. Participants rated athletics as the second greatest source of stress in their lives, trailing only academics. Athletics-related anxiety was a significant predictor of cannabis use and substance-related risk behaviors, and represents an understudied area in the literature. Reports of alcohol and drug use in our sample were comparable to national surveys of student-athletes, but opioid misuse was troublingly high. Participants over the age of 21 and males were more likely to report substance use and risk behaviors. Athletes are susceptible to orthopedic injury and associated pain, which may lead to early exposure to opioids with high potential for abuse. Interventions for this population must target social contributors to substance use among student-athletes, opioid prescription and misuse as a gateway to opioid use disorders, and untreated anxiety as a potential driver of substance use, including anxiety associated with athletic performance.


ACHA. (2016). Opioid Prescribing in College Health. American College Health Association.

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2018). WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638.

Benavides, O. (2019). Prevention and Treatment of Opioid Abuse in Collegiate Athletes. Board of Certification for the Athletic Trainer.

Buckman, J. F., Farris, S. G., & Yusko, D. A. (2013). A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug and Alcohol Dependence, 131(0), 50–55.

Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine, 158(16), 1789–1795.

CDC. (2018). Multiple Cause of Death, 1999-2018. Centers for Disease Control and Prevention National Center for Health Statistics.

de Grace, L. A., Knight, C. J., Rodgers, W. M., & Clark, A. M. (2017). Exploring the role of sport in the development of substance addiction. Psychology of Sport and Exercise, 28, 46–57.

Dijkstra, M. T. M., & Homan, A. C. (2016). Engaging in Rather than Disengaging from Stress: Effective Coping and Perceived Control. Frontiers in Psychology, 7.

Downey, R. G., & King, C. (1998). Missing data in Likert ratings: A comparison of replacement methods. The Journal of General Psychology, 125(2), 175–191.

Graupensperger, S. A., Benson, A. J., & Blair Evans, M. (2018). Everyone else is doing it: The association between social identity and susceptibility to peer influence in NCAA athletes. Journal of Sport & Exercise Psychology, 40(3), 117–127.

Hazelden Betty Ford Foundation. (2015). Youth Opioid Study: Attitudes and Usage Young Adults Ages 18 to 24 in the United States.

Johnson, T. P. (2014). Sources of Error in Substance Use Prevalence Surveys. International Scholarly Research Notices, 2014, 923290.

Judge, L. W., Bell, R. J., Theodore, R., Simon, L., & Bellar, D. (2012). An Exploratory Examination of Burnout in NCAA Division II Athletes. Journal of Intercollegiate Sport, 5(2), 230–240.

Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine, 156(6), 607–614.

Kowalski, K.C. (2000). Development and validation of the Coping Function Questionnaire for adolescents in sport. University of Saskatchewan.

Kowalski, Kent C., & Crocker, P. R. E. (2001). Development and validation of the Coping Function Questionnaire for adolescents in sport. Journal of Sport & Exercise Psychology, 23(2), 136–155.

Kutner, M., Nachtsheim, C., & Neter, J. (2013). Applied Linear Statistical Models (5th ed.). McGraw-Hill.

Kwan, M., Bobko, S., Faulkner, G., Donnelly, P., & Cairney, J. (2014). Sport participation and alcohol and illicit drug use in adolescents and young adults: A systematic review of longitudinal studies. Addictive Behaviors, 39(3), 497–506.

Lewis, T. F., Milroy, J., Wyrick, D., Hebard, S. P., & Lamberson, K. A. (2017). Binge-Drinking and Non-Binge-Drinking Student-Athletes: The Role of Proximal Norms, Negative Expectancies, and Selected Sociodemographic Variables. Journal of Child & Adolescent Substance Abuse, 26(2), 141–151.

Lisha, N. E., & Sussman, S. (2010). Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: A review. Addictive Behaviors, 35(5), 399–407.

Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30(2), 191–197.

National Institute on Drug Abuse. (2012). Resource Guide: Screening for Drug Use in General Medical Settings. National Institute on Drug Abuse.

National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse.

NCAA. (2018a). National Study on Substance Use Habits of College Student-Athletes. National Collegiate Athletics Association.

NCAA. (2018b). Summary of the NCAA Summit on Pain Management in College Athletes. National Collegiate Athletics Association.

NIAAA. (2020). College Drinking Fact Sheet. National Institute on Alcohol Abuse and Alcoholism.

NIDA. (2019). Drug Use Trends Among College-Age Adults (19-22): 2018 Monitoring the Future College Students and Young Adults Survey Results. National Institute on Drug Abuse.

Papanikolaou, Z., Nikolaidis, D., Patsiaouras, A., & Alexopoulos, P. (2003). Commentary: The freshman experience: High stress–low grades. Athletic Insight: The Online Journal of Sport Psychology, 5(4), No Pagination Specified-No Pagination Specified.

Phillips, E. L., & McDaniel, A. E. (2018). 2018 College Prescription Drug Study. Center for the Study of Student Life, The Ohio State University.

Reardon, C. L., & Creado, S. (2014). Drug abuse in athletes. Substance Abuse and Rehabilitation, 5, 95–105.

Rocha-Singh, I. A. (1994). Perceived stress among graduate students: Development and validation of the Graduate Stress Inventory. Educational and Psychological Measurement, 54(3), 714–727.

Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2019). Drug and Opioid-Involved Overdose Deaths—United States, 2013–2017. MMWR. Morbidity and Mortality Weekly Report, 67.

Shrive, F. M., Stuart, H., Quan, H., & Ghali, W. A. (2006). Dealing with missing data in a multi-question depression scale: A comparison of imputation methods. BMC Medical Research Methodology, 6(1), 57.

Smith, R. E., Smoll, F. L., Cumming, S. P., & Grossbard, J. R. (2006). Measurement of Multidimensional Sport Performance Anxiety in Children and Adults: The Sport Anxiety Scale-2. Journal of Sport & Exercise Psychology, 28(4), 479–501.

Veliz, P., Boyd, C. J., & McCabe, S. E. (2017). Nonmedical Use of Prescription Opioids and Heroin Use Among Adolescents Involved in Competitive Sports. Journal of Adolescent Health, 60(3), 346–349.




How to Cite

Knettel, B. A., Cherenack, E. M., & Bianchi-Rossi, C. (2021). Stress, Anxiety, Binge Drinking, and Substance Use Among College Student-Athletes: A Cross-Sectional Analysis. Journal of Intercollegiate Sport, 14(2).