Stress addiction in athletes:
Are you addicted to (training) stress?

Alan Couzens, MS (Sports Science)

April 29th, 2016

“When athletes clearly know better but cannot bring themselves to reduce their training, they threaten to become arousal addicts. Arousal addicts need their daily runner’s high (or ‘fix’) to feel good about themselves, which actually is the physical and mental state of not feeling bad due to the biochemistry of arousal. They are no longer in pursuit of excellence but rather in need of counseling and professional help. The coach might hear rationalizations from an athlete such as: “Coach, I need to train harder to improve…I don’t need or want to take (recovery) time off.” However, the grim reality is that the coach is listening to a running junkie pleading for his or her next fix.”
- ‘Distance Running’ Robert Lyden.

The above paragraph from one of my favorite books on running sums up something that has been on my mind of late: Stress addiction in athletes.

More specifically, when does the therapeutic dose of regular sports training turn into something more damaging? And, more importantly, what can we do to prevent this & keep an athlete's relationship with sport 'healthy'?

First, a little background on the biochemical basis for addiction that will show how the physical training of sport fits in…

Dopamine is a neurotransmitter in the brain that serves an important role in reinforcing behavior. It can be thought of as the ‘wanting’ neurotransmitter. Low levels of dopamine lead to craving & 'seeking' behaviors. Low levels of dopamine have been implicated in the development of ADHD (Wu et al., 2012) and more significantly to our purposes, drug addiction, particularly addiction to stimulants such as cocaine or amphetamines….

“When people addicted to stimulants go through withdrawal, they do not experience the physical suffering associated with alcohol withdrawal or withdrawal from opiates, instead they experience craving, an intense desire for the drug characterized by irritability, restlessness and other arousal symptoms”
- ‘The clinical neurobiology of drug craving’ Sinha (2013)

Sound familiar?

I don’t mean to take a light hearted tone here. This is serious stuff. While, admittedly not as immediately serious as an addiction to crystal meth, a general stress hormone addiction of any kind can lead to some pretty deleterious effects on your health further down the road.

The issue is in that word above – general. Dopamine doesn’t know or particularly care about what behavior it’s rewarding. Whether that behavior is considered positive (e.g. exercise) or negative (e.g. gambling or snorting a line of cocaine). The effect on the neurochemical reward centers, while perhaps different in magnitude is very similar in mechanism and end result.

So, what is the end result of continually stimulating dopamine secretion? The same result as any transmitter-response coupling: Habituation, i.e. to get the same response, you want more!

This is chemical, not psychological. It is the same mechanism that is responsible for insulin resistance in Type II diabetics. The uptake cells eventually become resistant to the messenger so you need to send more ‘messengers’ to get the message across.

What does this mean for an athlete? Bigger. Harder. Faster. More!

Actually, the ‘harder’ and ‘faster’ should be underlined when it comes to addiction to the stimulation of stress hormones. The effect of exercise on stress hormone release is specific to the intensity of exercise, with a marked increase in sympathetic nervous system activity and an exponential increase in stress hormone release as exercise intensity increases beyond the aerobic threshold (Christensen et al., 1979) In fact, at low levels of exercise intensity, the stress hormone cortisol can actually decrease below resting levels – something we’ll revisit when we look at ‘treatment strategies’. But, for now, put plainly, an athlete addicted to exercise isn’t going to get their fix from those easy aerobic sessions. They want to go hard… all the time… throughout the year.

Additionally, and unsurprisingly, stress addicts are also going to have a hard time with ‘down time’ e.g. transition periods between seasons. They are going to crave training to the point of feeling ‘not good’ during periods of extended recovery. This effect becomes more pronounced the higher the training status of the athlete. (Crossman et al., 1987 ) In fact, the former U.S.S.R. was so well aware of this phenomenon that they planned a specific ‘de-tox’ detraining protocol for their high performance athletes after retiring as they transitioned back to normal life. Yes, the Eastern Bloc had more than a few problems in the way they treated their athletes, but the American system could take a leaf or 2 from this book in preventing the all too common post-career depression we see among retiring professional athletes.

During periods of reduced training, in the absence of a ‘de-tox’ plan, the generality of the dopamine reward pathways is likely to come into play, i.e. athletes will seek their stress stimulants from non athletic sources. While maybe not extending to regular visits to ‘the other side of the tracks’, in the modern age, stimulation of the stress hormones is not hard to come by. Maybe during periods of reduced training you throw yourself into work projects in the name of ‘catching up’? Maybe you find yourself out late partying with friends to 'blow off steam'...

Or maybe you just fire your coach and find one who’ll ‘give you what you need’? Just one fix? :-)

So, what’s the solution?

Well, ‘hair of the dog’ certainly isn’t it. Perpetually pumping stress hormones into your blood stream is only going to result in one thing – tired (or dead) adrenals. This has particular implications on the widespread use of stimulants to treat ADHD but that’s another conversation. Irrespective, when it comes to stress addiction of any sort, we need a better solution than more or differing stress….

Before we get to some useful strategies for athletes dealing with addiction to stress, first, a little cold, hard truth: If your reward centers are deeply tied to stress then (perhaps paradoxically) removing stressors from your life is initially going to suck!

For example, it is not uncommon for hyper-stressed individuals who begin a regular meditation program to feel sad to the point of tears in their initial exposures. A reduction in sympathetic stimulation is, initially, not going to be pleasant.

Persisting through this period of ‘withdrawal’ is dependent on staving off these depressive tendencies. To that end, we call on another neurotransmitter...

The flipside of dopamine is serotonin. Serotonin is a satisfaction neurotransmitter. Where dopamine’s theme song may be “I can’t get no satisfaction”, Serotonin’s is “don’t worry be happy”. It is not surprising then that anti-depressant medication tends to focus on keeping more of this around by selectively limiting serotonin’s uptake from the synaptic cleft (i.e. selective serotonin reuptake inhibitors - SSRI's).

Well supported, practical advice then: When going through the depression of ‘dopamine withdrawal’, a good coping strategy is to boost the serotonin….

In fact, this is precisely the pharmacological strategy employed in addiction therapy when detoxing from amphetamines, an emphasis is placed on shifting the patient's neurochemistry from craving and wanting to satisfaction.

But ideally, we don't want to reach for the SSRI medication, at least not as the first port of call. There are other, better, healthier, options...

• Get outdoors in the sun! – head to a sunny locale during periods of reduced training intensity. Studies have shown a direct relationship between the serotonin metabolite 5HIAA and exposure to bright sunlight (Ferrano & Steger, 1990)


• Focus on longer duration exercise with high metabolic demand, i.e. get 'happy tired' with base training. Long duration activity that is metabolically challenging results in high levels of plasma tryptophan which, presumably leads to that ‘sleepy tired’ feeling that long easy training brings with it (as opposed to the ‘tired but wired’ feeling that accompanies high intensity training) Tryptophan is an important biochemical precursor to serotonin.


• Change your diet. The tryptophan mentioned above is an amino acid. Therefore, protein intake becomes important in the development of our satisfaction friend, serotonin. Studies that have looked at the relationship between milk intake (containing the tryptophan rich protein – alpha-Lactalbumin) & mood showed significant improvements in mood and cognition in stressed and depressed subjects with an increase in protein in the diet. (Booij et al., 2006, Markus et al., 2002). Additionally, high sugar diets will activate that dopaminergic stress system that we're trying to 'detox' from. Put plainly: Donut 'rewards' do not help the detox :-)


• Meditate! Bujatti et al, (1976) showed a significant increase in 5HIAA – the main metabolite of serotonin along with a reduction in catecholamine release following a protocol of transcendental meditation.I have personally seen significant reduction in activation of the high stress 'fight or flight' sympathetic nervous system (via HRV measurement) in athletes following a period of consistent (daily) meditative practice


• Cognitive-behavioral therapy. Yes, you have a problem. It's called trying to fit in to an irrational & fundamentally unhealthy society. E.g. "Yes, of course you should come home from a 10hr day at the office and bust out a 2x20 set at FTP on the trainer before your standard 6 hours of 'quality' sleep. You are committed aren't you?" Maybe you should be! :-/ You see, unhealthy stress in the modern world (including the athletic world) is a socially legitimized, if not endorsed, habit. A habit that needs to be broken! In ‘traditional’ stimulant addiction the 2 most effective treatment plans for ‘breaking the habit’ are contingency management (i.e. discovering and rewarding healthier options) and cognitive-behavioral therapy, i.e. addressing (& decreasing) maladaptive habitual thoughts and actions, or in our case, maladaptive (damaging) training decisions.

Ultimately, sport, even at a high level/volume of training, has the potential to greatly enrich your health (& your life!) by balancing out some of the typical forms of stress encountered in modern society. However, particularly at high intensities, it can quickly become ‘just another stressor’ that adds to the challenges we face in keeping a healthy balance in modern life.

For the sake of your long term health....

Train smart,

AC

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