Addiction, prescription painkillers and chronic pain management in pro wrestling
BY WAISMANN METHOD
Some wrestling fans and most of the general public don’t appreciate or can’t comprehend the lifestyle of a professional wrestler. It’s not just a few hours of television shows per week.There are house shows, media appearances and travel. Lots of travel.There’s little time to work out and stay in shape. And there’s even less time to relax. Sadly, unless a wrestler is an Undertaker or a Chris Jericho, they can’t take too much time off if they want to keep their spot on the card and in the story lines.
As for a vacation? That’s a foreign word to most wrestlers. To make it through the daily grind of bumps and bruises from in-ring competition, some professional wrestlers resort to illegal substances. Even the top stars are apparently immune, as shown with the recent 60-day suspension of WWE’s Randy Orton. Despite being one of the top faces in the industry, Orton now has two strikes against him in WWE’s Talent Wellness Program policy. One more, and Orton is gone from WWE for a year. WWE, to its credit, has taken steps to punish wrestlers who are not playing by the rules, and with the second strike against Orton, has showed it doesn’t play favorites. WWE also has a former talent rehabilitation program, which was launched in 2007 to assist former WWE wrestlers with substance abuse issues. Former WWE wrestler Maven, for example, reportedly recently completed a 50-day drug rehab program, paid for by WWE. “I owe the WWE my life for helping me through this situation,” Maven told TMZ.com. “I have the clarity and focus that comes with sobriety and will never let my family, friends, and fans down again.” As often as we hear of wrestlers dying due to drug use, we rarely hear about the success stories of overcoming addiction. And that’s a shame.
Many wrestlers deal with wellness and psychology issues, addiction, prescription painkillers, chronic pain management and concussions. Having read about these issues, I’m familiar with them. But to get the real story on what these hardships and injuries mean, I went to the experts. Let’s introduce our panel:
Clare Waismann is a Registered Addiction Specialist and administrative director of Waismann Method treatment, the pioneering treatment for opiate dependency. More information on Waismann’s work can be found at www.opiates.com.
Dr. Michael Lowenstein is a chronic pain management specialist and medical director for Waismann Method treatment. For more than 14 years, Dr. Lowenstein has safely, confidentially and humanely treated opiate dependency patients resulting in one of the industry’s highest success rates. More information on Lowenstein’s work can be found at www.opiates.com.
David M. Reiss is an M.D., Psychiatrist, who is based in San Diego.
Before we get started, I would like to thank my three panel members for taking the time to answer my questions for JAWBreaker.
Now, let’s ring the bell:
1. Talk about the difference between prescription drugs and the illegal drugs wrestlers use.
CLARE: “Often times, pro wrestlers start taking prescription painkillers to numb the discomfort of injuries and help them continue to compete without taking time off. This is how many drug addictions start, as prescription painkillers like Oxycodone and Percocet are highly addictive. Often times, addictions to prescription medications can spiral into uncontrollable situations where the individual will try any drug (legal or illegal) to satisfy their needs. It’s important to realize that any substance taken daily can turn into a dependency and/or addiction, and once a dependency forms, the lines between legal and illegal substances can disappear quickly.”
DAVID: “All legal drugs used to treat pain and/or emotional/psychiatric conditions have potential risks and side-effects, and can be very dangerous if over-used or misused. Even legal and general ‘safe’ drugs prescribed to treat certain medical conditions can have serious negative effects at time, including upon mood, cognition, memory and behavior (including some anti-inflammatories, anti-hypertensives, anti-convulsants, appropriate use of steroids – one example being use of Prednisone for asthma or Cortisone for muscular/skeletal injury). Prescription of any medication requires appropriate evaluation, diagnosis and monitoring of the use of the agent, without which, there can be significant danger.
“In my opinion, it can be quite reasonably argued that there are some illegal drugs that if legal, monitored and standardized would be no more dangerous or risky than using some of the legally prescribed agents. However, even leaving aside the purely legal aspect, the lack of standardization and monitoring makes use of those agents particularly dangerous.
“Additionally, there are some illegal agents which simply have no appropriate usage. The potential (or at times inevitable) risks far outweigh potential danger. Of course, there are some formerly-legal drugs that have been found to fall into that class and are now off the market – but that does not change the fact that there are some agents that are simply too dangerous to be able to be used effectively.
“Beyond the dangers of the drugs themselves, the other significant issue is that if any agent (even a legal medication) is being used without appropriate medical evaluation and supervision, it may be serving to ‘cover up’ a medical condition that potentially may then lead to increased danger of further injury, at times to the point that a treatable condition progresses to the point of being untreatable.”
2. In the WWE lifestyle of 300 days per year on the road and in the ring, explain why the use of painkillers are so prevalent?
MICHAEL: “If you look at the physiques of professional wrestlers, they are enormous muscular athletes who put their bodies through incredible physical workouts and frequently experience injuries. Wrestlers get paid to perform and compete, so they usually can’t afford the time that is necessary to allow their injuries to fully heal. Instead, many may use opiate painkillers to numb the pain from injuries sustained during training or in the ring in order to continue competing, which only aggravates their condition. When they are not competing, wrestlers are preparing for their next fight, so they never really have time to completely recover.”
DAVID: “Any ‘stressors’ will lead susceptible individuals to seek relief in unwise or counter-productive ways. Of course, how stress is perceived is very different from one person to another – one person may thrive on a very active schedule, another person may ‘burn-out’ quickly.
“Certainly in any physical endeavor – sport, entertainment, ‘regular’ physical labor – the more intensive the schedule, the more demanding on the body, the more frequent the ‘minor’ injuries – the greater the risk for ‘burn out’ or dysfunctional responses emotionally and behaviorally. Common sense dictates that few people can tolerate 300 days on the road subjecting their body to ‘bumps’ of any kind without experiencing a high degree of ‘stress.’ General guidelines to avoid ‘excessive’ stress would be helpful and can be based on reasonable study, history, research, etc. – but the issue is actually very much individualized, and any ‘guideline’ will be insufficient for some and unnecessarily restrictive for others.”
3. How could marijuana help, or hurt, a wrestler? Would it help chronic pain management (the bruises and bumps) of a wrestler?
MICHAEL: “There are those who claim that marijuana helps decrease pain, but it is not a widely accepted treatment for chronic pain management, and it is still illegal on the federal level.”
CLARE: “Marijuana is a depressant that can negatively affect mood, memory and reaction time, so it can be detrimental to any athlete, including pro wrestlers. This drug can also intensify depression, decrease energy levels and shorten one’s memory, creating a mental fog that can negatively affect a wrestler’s persona and career.”
DAVID: “The use of marijuana as a ‘medicinal’ agent is a very problematic subject. I personally did legal, pharmaceutical research on marijuana years ago (while working for Geigy – now Ciba-Geigy Pharmaceuticals – when the government still allowed and supported legitimate research).
“There is no doubt that marijuana does have some ‘medicinal’ effects; there is no doubt that marijuana has physiological side-effects. Of course the same could be said of almost any legal medication on the market, especially analgesics and psychotropic medications (medications for anxiety, depression, etc.).
“If marijuana were legal and controlled, and available in standardized dosages, the risk/benefit ratio for use would be different than they are currently. Of course just the fact that marijuana is illegal creates a tremendous ‘negative’ that by-and-large, outweighs the positives, especially for a functioning professional athlete.
“On a purely physiological basis (leaving aside legalities), some people might be able to tolerate using low-doses of marijuana to help with controlling pain or anxiety. Through my clinical work in California, I have seen some chronic pain patients who claim significant relief without any overt side-effects. However, in my experience, the percentage of those patients who return to productive functioning is extremely low. I doubt that is due only to the use of marijuana, but marijuana has a very long half-life – it stays in the body for an extended period of time. Any regular use of marijuana means that the amount being stored in areas of the body is constantly increasing. There is clear data that this can negatively impact thinking, concentration, motivation and judgment in the majority of people using it consistently. From a psychiatric point of view, I have seen any number of people who use marijuana to ‘treat’ anxiety or depression, and claim relief – but essentially without fail, they are then unable to effectively work on resolving the problems causing the emotional distress. The same can be said of certain legal medications, including high doses of certain anti-depressant medications and even low doses of certain anti-anxiety medications. Whether or not marijuana is ‘worse; than some legal agents is debatable – but coming from an open and neutral point of view, I have been consistently impressed that people using marijuana to try to ‘treat’ their problems end up not being able to effectively resolve their problems.
“If legal, I cannot definitively refute that infrequent and controlled use of marijuana might not carry any physical or mental health significant risk beyond that of having a drink or two – and might even provide some benefit. However, in my opinion, even if legal, consistent or regular use of marijuana has much more of a ‘down-side’ than ‘up-side’ and considering that it is not legal, controlled and standardized, the simple answer is that using it is foolish and should be avoided.
“To recap, the use of marijuana as part of a pain management program has more negatives than positives, and overall, I believe reduces the overall maintenance of well-being and productivity. Marijuana contains many different physiologically-active chemicals. Perhaps with appropriate research – which in my opinion, should be legalized – ways can be found to alter the chemical make-up of marijuana or separate out some of the therapeutic agents, such that the cannabis can be the source of safe and legal medicinal agents. However, unfortunately, (and more for political than medical reasons), we are not there yet.”
4. Even with a “Wellness Program” in place in WWE, why do wrestlers risk using knowing they could be caught?
CLARE: “When it comes to using illicit substances, fame and the resources that come with it are often key factors in why many pro athletes and celebrities risk taking drugs, even though they know they will face punishment if caught. More often than not, these individuals are able to pay those around them for access to whatever they want, enabling them to continue using prescription medications and illegal substances without consequence.”
DAVID: “There are as many reasons for irrational risk-taking behaviors as there are persons taking those risks. While programs that are cognitive-behavioral in focus, which includes ‘step programs’ can be helpful – and essential – in controlling addictive behaviors, rarely do they provide answers to the question, ‘Why?’
“There are multiple different potential reasons, following from different schools of thought and common sense. In most individuals, the reality lies in some combination of these general factors:
“Addiction: Once someone is addicted to a substance, there are physiological and psychological cravings that are difficult to control and which at the same time interfere with clear thinking, future-oriented thinking, common sense and even concern for self and loved ones. Without appropriate comprehensive intervention to contain the cravings, illogical and self-defeating behaviors can continue – regularly or intermittently.
“Physical pain: Acute and/or chronic physical pain can cloud judgment. A person may become so focused on gaining relief, that they do not consider the consequences of their behaviors. Judgment and decision making is altered directly by the pain, and also by secondary effects of the pain, such as lack of sleep, distraction, etc.
“Emotional pain: Whether in the form of depression, anxiety, fear, anger, loss of self-esteem, loneliness, boredom, worry, guilt, etc., sufficient emotional pain also causes impairment of judgment and (of) seeking of an immediate sense of relief, regardless of the consequences. At times relief is sought through any action or activity that provides a positive sense of relief, but paradoxically, in those who have self-defeating tendencies, certain types of emotional conflict and distress (anger, guilt, etc.) may be temporarily ‘relieved’ by the distraction of actually causing more pain, or practical problems that distract from the more deep-seated emotional conflicts.
“Inflated self-importance/narcissism: People can reach the point of such inflation of ego that they convince themselves that they will never be caught; that no one would dare punish them or hold them responsible for their actions – that they are ‘too big to fail.’ At times, the actions of others support and reinforce these beliefs – until reality gets in the way.
“Conscious or unconscious self-sabotage: At times, people are looking for a ‘ticket out’ of a situation. At times, this may be a calculated plan; more often, people are unable to face their true concerns, fears, or wish to change the personal or career path, and ‘getting in trouble’ takes the issue out of their hands.
“Stupidity: Does not require explanation, and is rarely the issue.”
5. What should a wrestler with an addiction problem do, especially if they think getting help for it could be a career risk since a wrestlers’ popularity changes by the day?
CLARE: “If a wrestler, or any other individual for that matter, believes they have an addiction, I recommend they seek help and not delay getting treatment. While it’s realistic to be concerned with privacy, the risks to their own health should outweigh those fears. For the last decade we have treated a large number of celebrities who suffered with substance abuse problems, yet because of our strict privacy guidelines the public never knew. As a professional, I believe confidentiality and respect for my patient’s condition is imperative to their success. Patients who experience added pressure and anxiety following treatment have a higher risk of relapse, so keeping all external stresses to a minimum is vital. Being in the public eye can be stressful, especially if the individual is being scrutinized for seeking substance abuse treatment. The health of the patient should always come first because without it they will not be able to maintain their status, which is why selecting the right treatment is a must regardless of everything else.”
DAVID: “On a clinical level, this is an ‘easy’ question in that with few expectations, ongoing addiction is going to escalate into a disaster sooner-or-later, and the sooner a person seeks and receives appropriate intervention, the better for self, family, etc.
“However, practically, this is not an easy question as there are very real immediate risks of acknowledging the problem, which can have long-term consequences. It would be wonderful if it could be said that the external world (fans, employers, promoters, sponsors) were consistently caring and compassionate, but it would be foolish to think that is true.
“From a therapeutic point of view, it is essential that anyone advising or trying to help the person takes a stance of very openly and honestly acknowledging the very real risks that are involved in admitting the problem and seeking help, does not try to provide unrealistic reassurance, and helps to devise a plan of action that attempts to minimize the risk as much as possible – while reinforcing that the long-term risks to self, health, family, etc. of continuing on a path of addiction are, in all likelihood, many magnitudes more serious and destructive than even the realistic risks of disclosure. If help is not available on an ‘open’ basis, there are often ways of seeking help that may be kept confidential. Those are options that should be realistically explored.”
6. Do you think WWE’s three strikes and you’re suspended for a year policy is appropriate in a sports entertainment business? Explain.
CLARE: “Yes, absolutely. Professional wrestlers have a responsibility not only to themselves and their own lives, but also their fans. From young children to adults who look up to them, pro athletes have a tremendous responsibility to serve as respectable role models and abide by the policies and guidelines of their sports organization.”
DAVID: “When approaching corporate ‘wellness’ strategies, it must be considered that there are different (and at times competing) interests: the long-term health of individual; issues of safety during performance; public relationships issues regarding the reputation of the corporation; financial concerns regarding negative media attention; pressures brought by sponsors, etc.
“From a clinical/psychiatric point of view, I cannot speak to the practical/financial pros and cons of this policy from a corporate standpoint. From a clinical point of view, in regards to whether the policy will actually help to reduce drug use, I do not have statistics that can prove or disprove effectiveness of a ‘three-strikes’ policy. Basic understanding of addictions and use of drugs suggests that for the true addict or ‘hard-core’ user and for the person with significant, deep-seated emotional problems, threats of ‘punishment’ usually are not particularly effective, and may even be perceived in an irrational way as a ‘dare’ or as an ‘insult’ to be rebelled against. On the other hand, for the more casual or ‘recreational’ user, such a policy likely will cause the person to consider the severity of the consequences of their behavior, and likely avoid taking such a severe risk.
“In that regard, overall, my perception is that probably, overall, the policy is helpful – but not uniformly and not for everyone – and any policy that is ‘one-size-fits-all’ at times will turn out be unfair or counter-productive.
7. Should a wrestler with “two strikes” in a three strikes and you’re out policy be a main-event star?
DAVID: “From a corporate/financial point of view, I cannot comment specifically upon the economic risks and benefits of reducing the profile of an ‘at-risk’ performer.
“From the point of view of the individual, it can cut both ways:
“If an athlete is clearly at risk and is subjected to what may not be a ‘disciplinary’ action but a ‘reasonable business decision,’ of course that might increase the person’s motivation to ‘stay clean’ and regain their status.
“On the other hand, depending upon the maturity and emotional stability of the person, being restricted in that manner might negatively impact their self-esteem, trigger anger and/or trigger guilt that are responded to in a dysfunctional manner, and actually hasten a decompensation or faster descent into a chemical ‘escape’ from reality.
“At the same time, if an athlete is clearly at risk, but is not subjected to some acknowledgement of the risk, it may counter-productively reinforce a narcissistic sense of being ‘too-big-to-fail’ and actually promote rather than prevent continuing risk-taking or inappropriate behaviors.”
8. Kindly elaborate on addiction in pro wrestling.
CLARE: “When it comes to addiction and pro wrestling, dependencies can often be intensified due to the environment wrestlers are surrounded by. Any individual with unlimited funds or resources lives in a reality where these drugs are accessible whenever they want them. In addition, the people around them may have difficulty saying no, and will actually help them feed their habits regardless of how dangerous it may be to their health and well-being.”
9. Any other comments on addiction?
CLARE: “Drug addiction and dependency are serious issues that affect millions of people nationwide. The CDC (Centers for Disease Control and Prevention) estimates that 100 people die every day in the U.S. from drug overdoses, and most of those deaths are caused by prescription painkillers. Historically, there has been a stigma associated with drug addiction that has caused many people to feel ashamed or degraded if they seek help. At Waismann Method treatment, we believe taking the step toward a drug-free life is an incredibly brave act and we acknowledge that addiction is a disease people do not choose for themselves, so we never make patients feel embarrassed or shameful of their condition.”
10. A former pro wrestler, Diamond Dallas Page, preaches yoga. And numerous wrestlers use it. What are some alternatives to addictive drugs that wrestlers can use for their hectic lifestyle?
MICHAEL: “Yoga is wonderful for preventing and reducing injuries, because it promotes flexibility and supple muscles. Other alternative therapies like acupuncture, massage, chiropractic work and physical therapy can also help lessen pain, but may not be able to completely resolve chronic pain issues. Just like non-athletes, wrestlers can also suffer from anxiety, stress or depression, and may use opiates to help to reduce these symptoms as well. The problem with this is that they can build a tolerance to prescription painkillers, so they’ll eventually need more of the drugs to achieve the same effect. Alternative therapies can help to address these mental issues as well, and do not have the same risks associated with opiates.”
DAVID: “Any practice that encourages relaxation, self-observation, participation with a support system – while avoiding the use of pharmaceuticals of any type – is a positive. Yoga, meditation, spiritual/religious involvement can all be very useful. Each person must find what works best for them – with the key being gaining the understanding and insight to be able to acknowledge when you are starting to feel physically and/or emotionally stressed, lonely, angry, depressed, etc. and to take appropriate and safe steps to protect yourself and reduce the level of physical and emotional stress.”
11. Is it safe to assume a wrestler’s chronic pain worsens each year? Explain. Some old-school wrestlers can still go at 50-plus years (Ric Flair, for example), while others can’t seem to make it more than a few years.
MICHAEL: “The progression of chronic pain really varies depending on a number of factors including genetics, training, and whether or not injuries are allowed to heal. Just as with any other pro athlete, genetics can play a role in determining how prone a wrestler is to injury. A large portion of how chronic pain advances is dependent on how well the individual takes care of their bodies, and if they properly address injuries and allow them to heal.”
DAVID: “Yes, it is safe to assume that generally, anyone involved in physically demanding activities will experiences the effects and ‘ravages’ of the years, both in regards to increasing injuries and decreasing ability of the body to fend off injuries and repair itself. However, again, everyone is a unique individual, with different tolerances. Physical tolerance and endurance differs from person-to-person based upon multiple known and unknown physiological factors. When it gets to dealing with chronic pain, that is even more complex, as the physiological factors, positive and negative, are complicated by emotional factors – basic constitutional personality structure and temperament; learned/acquired ways of coping with pain; social/family/cultural attitudes towards pain, etc.”
12. Feel free to elaborate on chronic pain management in pro wrestling.
MICHAEL: “Wrestlers are very strong and powerful athletes competing in a full-contact sport, which in and of itself makes them prone to injury. In addition, their schedules do not allow for them to take time off to heal or recover from injuries, which is why many of them experience chronic pain and turn to prescription painkillers. While it’s not unreasonable for these athletes to use opiate medications, it’s incredibly important that their use is closely monitored. Prescription pain pills are appropriate for acute injury, but issues of dependence and abuse tend to develop with chronic use. For minor injuries, muscle relaxants, topical preparations and anti-inflammatory drugs are more appropriate treatments for lessening pain.”
13. Any other comments on chronic pain management?
MICHAEL: “Opiate painkillers, like Vicodin, Percocet and Oxycontin, are some of the most common treatments for chronic pain, but they are extremely habit-forming and need to be prescribed and taken with great care. Any doctor prescribing opiates for pain needs to monitor the use of these medications. This can include an opiate agreement with the patient as well as random urine drug screening to ensure the substances are controlled and being taken appropriately. Often times, people may start taking prescription painkillers for an acute injury, but end up increasing their dosages if the pain persists, which is when the body can become physically dependent on the drugs. Many chronic pain sufferers who take prescription painkillers also develop hyperalgesia, which is a condition where patients experience a heightened sensitivity to discomfort coupled with a reduced tolerance for pain. There are many warning signs healthcare providers and loved ones can watch for that indicate an issue with opiate addiction, including taking more than the prescribed dose, “doctor shopping” or pursuing prescriptions from multiple physicians, interference with job performance or relationships, being arrested for substance related crimes and more.”
14. Do you think the actions of wrestler Chris Benoit spearheaded concussion safety forums in wrestling and the NFL and led to actual real testing in WWE?
DAVID: “Not having personally been involved in the discussions that occurred after that tragedy other than in the public arena, I cannot comment specifically – although there is no doubt that it was certainly a ‘wake-up call’ on some level, and that the Benoit situation as well as other tragic events (most recently, the suicide of Junior Seau) definitely have contributed to more serious considerations of all issues that might contribute to such horrible events (i.e., I have no personal information as to what specifically contributed to Junior Seau’s death, but the fact that people are looking more seriously at problems regarding depression, head injury, etc., and in the long-term, that is a positive result of a tragic situation).”
Again, I thank my panelists for their time in answering these questions.
WWE is currently weighing its options as it relates to the future of Randy Orton.
So, what do you think?
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