For pro athletes battling addiction, their names can be the biggest obstacle

Left, Michael Phelps warms up prior to competing in the men's 400-meter freestyle preliminary race, and right, Cleveland Browns' Johnny Manziel (2) sits on the bench during the second half of an NFL football game against the Carolina Panthers in Charlotte, N.C. (AP)

Addiction is a disease that does not discriminate. Hollywood’s brightest, athletic champions and political leaders mingle with CEOs, academics and average moms, dads, sons and daughters amongst what the National Council on Alcoholism and Drug Dependence (NCADD) estimates are 17.6 million Americans who suffer from alcohol abuse and 20 million people who have used an illegal drug within the past 30 days.

Two standout athletes recently entered treatment facilities in hopes of salvaging their careers, but not before finding themselves under scrutiny for where their social habits led them: The NFL’s Johnny Manziel, who debuted as a rookie quarterback last season for the Cleveland Browns after a storied career at Texas A&M, and Michael Phelps, the 18-time Olympic gold medalist swimming champion.

Manziel’s hard-partying ways were well-documented on his social media accounts and in the tabloids as the 22-year-old drank poolside in Las Vegas, surrounding himself with bottles of high-priced alcohol and hit the club scene regularly – resulting in a questionable July 2014 photograph where he was seen rolling up a dollar bill in a bathroom. Phelps was handed his second drunken-driving arrest in September 2014, reportedly following an eight-hour gambling binge at a local casino. The 29-year-old Olympian was then handed a second suspension by USA Swimming – the first came in 2009 when he was photographed inhaling from a marijuana pipe and was subsequently dropped by major sponsors like Kellogg.

The trigger for treatment

For both men, it took being humiliated in multiple public instances before they sought treatment, which according to one expert is typically the case when dealing with a professional athlete.

“What will get them into treatment is something that happens, like they get arrested, or they get fired from the team, have some marital problems,” Dr. Louis Baxter, who did not treat either athlete, told FoxNews.com. Baxter, the director of the American Board of Addiction Medicine and president and CEO of the Professional Assistance Program of New Jersey, as well as the consulting medical director to the athlete's program at Behavioral Health of the Palm Beaches Inc., also serves as a substance abuse consultant to both the NFL and NBA.

“The major obstacle is the athlete’s competitive mindset,” Baxter said. “First of all, they don’t want to acknowledge that they have a problem, they don’t want to lose fame or a starting position, they may in fact hide injuries and hide difficulties they are having with substances.”

There’s another element of an athlete’s mind that plays against them, according to Sally Greer, a former professional tennis player who battled alcohol and pill addiction and is now a counselor.

“You have this entitled person who thinks they can control everything,” Greer, who also was not involved in the treatment of either athlete, told FoxNews.com. She added that because society often regards addiction as a weakness, it’s difficult for an athlete to admit a problem.

“It’s very difficult for an athlete to admit to themselves, number one, that they have a problem – but that happens to everybody,” she said. “What’s difficult for athletes is to get them to understand that it isn’t the weakness in character, it is something that needs to be treated as a disease.”

“What I find more often than not is that they tend to relapse a lot because they continue to think ‘I can do it, I can do it, I can do it,’ and the truth is, they can’t,” Greer said.

Even once an athlete completes treatment, the obstacles surrounding their own environments remain. Because of their fame, and the money that follows, it may be difficult for a player to weed out who is and isn’t supportive of their new lifestyle. The athlete and his friends think he’s “super human” and telling him that he can’t control his disease makes it especially difficult.

“When you’ve got people like Johnny Manziel, they have a lot of people around them that do a disservice,” Greer said. “They’re in an environment where they can easily have access to anything they want so with that attitude and the availability then it’s just really, really difficult for them to just give it up and just admit that they have a problem.”

Baxter said there are many places that an athlete may turn before they turn to the team for help. They may seek out a private physician to prescribe pain medication, or a find a friend who can provide it for them. In the instance of a substance abuse issue, it may be the athlete attempting to hide an injury, or chronic pain.

“The mind of an athlete, professional and otherwise, is that they are always looking for an edge, and they are really trying not to reveal if they are having injuries or if they are having substance problems,” he said. It poses a risk to the athlete for injury, because they are then able to perform beyond the pain, which is the body’s way of causing an athlete to slow down to avoid further injury, he said.

Seeking treatment

When an individual decides to be treated for his or her disease, doctors must first determine what the pain condition is, if medical or surgical intervention is necessary, and the severity of the addiction. Once it’s determined that they meet the criteria for dependence or addiction, a proper level of care must be selected whether it’s an outpatient, individual, group or residential setting.

“In my experience, I think that especially professional athletes do better in a residential setting because they’re taken from their star environment and placed in a more therapeutic environment,” Baxter said. Greer, who founded 1 ON 1 Addictions Counseling for Athletes, an individual counseling program, agrees. In her experience, she said, she found that even if an athlete entered a group in-patient treatment facility, they were still given star treatment by other patients who wanted autographs, or stories from the glory days.

The founders of Athlete’s Recovery, a facility outside Houston that is specifically geared toward athletes seeking treatment, also agree. Former NFL cornerback and Division 1 collegiate football coach Kenny Greene watched many of his teammates struggle with substance abuse. Together with his wife Tina, a health care professional, they opened the center in partnership with Summit BHC.  As a team they have also partnered with a performance sports facility so that while athletes seek recovery for their addictions, they may also continue their rehabilitation for an injury, or they may continue training in a state-of-the-art facility. Neither Phelps nor Manziel were treated at the Greene's facility.

“Athletes are so used to being around other athletes,” Tina Greene told FoxNews.com. “It gives them a comfort level that they would understand the other guys dealing with the other stressors and pressures they’ve been dealing with, it gives us that base,” she said of the athletes-only center. She added that another advantage is that the facility’s alumni network allows for a younger player to reach out to another player for support.

“We felt like there was a tremendous need, there’s a vast amount of current or former athletes that are struggling with addictions,” Kenny told FoxNews.com. “We want them to have a place where they can stay safe and know that their best interests are in our hearts.”

The basis of treatment at Athletes Recovery, which at any point has up to 30 professionals and staff and hundreds more in their network, revolves around the need of the athlete and what will be most beneficial to them, Kenny said. Their treatment plan revolves around addressing the pressures that they feel, whether it to be performance related, general stress or pain.

Tina said a major aspect of their facility’s mission is to provide the athletes with a team network of support, rather than focus on the clinical terms .An athlete is geared toward reaching goals, achieving titles and relying on coaches. Once the athlete takes the time to unveil and deal with the deep rooted issues in residential treatment and counseling, their recovery is much more likely to succeed, Tina said.

“Many times you go in [to treatment] and you don’t have anyone who has played a sport, and wouldn’t understand. All of our staff in some way can relate to sports,” she said. The treatment also involves family-based therapy, which includes both biological family members and team members. Often a coach, or teammates, agents and others will enter the plan for aftercare.

Returning to the game

A critical part in recovery is going from a contained environment back to the environment where the athlete himself is making the choices.

“We stay in contact and monitor any red flags that might come up, have they missed a meeting or is it the family saying, ‘Hey, I’m seeing things that are not appropriate,’” Kenny said. “Our position is, we don’t want them to relapse, we want to get it before it becomes a problem again.”

Following treatment, it is imperative that the athlete not return to their former hangouts with the crowds who encouraged their destructive habits, Greer said.

“The problem with family is if they’re not in recovery themselves, then they don’t understand what it’s like to be an addict or an alcoholic. They don’t understand why can’t you just have one, because it’s a disease.”

It remains to be seen what the future holds for both Manziel and Phelps. On Thursday, Phelps returned to the pool and bested fellow champion Ryan Lochte in the 100 fly, acknowledging that he has made mistakes but saying he is ready to return to the sport and has grown as a person since his time away. And after being seen for the first time since leaving rehab at a Texas Rangers game Tuesday night, Manziel issued an apology to the Browns organization and fans.

“When you’re in recovery, it’s up to you, it’s up to nobody else, nobody is putting a gun to your head, you have to take responsibility for everything,” Greer said.