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Performance-enhancing drugs in athletics: Research roundup

2015 roundup of research on the use of performance-enhancing drugs in athletics and academics as well as their potential health effects.

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by Leighton Walter Kille, The Journalist's Resource June 9, 2015

This <a target="_blank" href="https://journalistsresource.org/health/athletic-academic-performance-enhancing-drugs-research-roundup/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

Performance-enhancing drugs have a long history in sports, of course, but pharmacological research has led to a surge in the number of substances available, each with its own potential for misuse.

Given the potential financial rewards of athletic success, it’s no surprise that we’ve been witness to a seemingly endless procession of allegations and scandals. Sluggers Barry Bonds (steroids) and Alex Rodriguez (human growth hormone); cyclists Lance Armstrong (EPO),  Floyd Landis (testosterone) and Alberto Contador (clenbuterol); runners Tyson Gay (steroids) and Justin Gatlin (testosterone); and golfer Vijay Singh (IGF-1) are only some of the more prominent professionals implicated in such behavior. The complicity of medical professionals and shadowy labs is often involved, and a 2015 report from the International Cycling Union (UCI) found the sport’s own governing body bore significant responsibility.

Not surprisingly, hard numbers on rates of usage are difficult to come by, but anecdotal evidence isn’t lacking and anonymous surveys have provided some insight. Questionable use of medications and supplements have also been reported in the U.S. armed forces , fire and police departments , amateur athletics , and even high schools .

Below is a selection of studies on a range of issues related to performance-enhancing drugs. It has sections on their potential economic impacts, prevalence , health effects and athletes’ attitudes . For additional studies on these topics, you can search PubMed , which is the federal clearinghouse for all medical research. At bottom, we have also included some studies relating to cognitive-enhancing drugs and the related academic dimensions of this issue.

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“The Economics of Corruption in Sports: The Special Case of Doping” Dimant, Eugen; Deutscher, Christian. Edmond J. Safra Working Papers, No. 55, January 2015.

Abstract: “Corruption in general and doping in particular are ubiquitous in both amateur and professional sports and have taken the character of a systemic threat. In creating unfair advantages, doping distorts the level playing field in sporting competition. With higher stakes involved, such distortions create negative externalities not only on the individual level (lasting health damages, for example) but also frictions on the aggregate level (such as loss of media interest) and erode the principle of sports. In this paper, we provide a comprehensive literature overview of the individual’s incentive to dope, the concomitant detrimental effects and respective countermeasures. In explaining the athlete’s motivation to use performance enhancing drugs, we enrich the discussion by adapting insights from behavioral economics. These insights help to understand such an athlete’s decision beyond a clear-cut rationale but rather as a product of the interaction with the underlying environment. We stress that in order to ensure clean sports and fair competition, more sophisticated measurement methods have to be formulated, and the respective data made publicly available in order to facilitate more extensive studies in the future. So far, the lack of data is alarming, especially in the area of elite sports where the stakes are high and doping has a substantial influence.”

“The Frequency of Doping in Elite Sport: Results of a Replication Study” Pitsch, Werner; Emrich, Eike. International Review for the Sociology of Sport , October 2012, Vol. 47, No. 5, 559-580. doi: 10.1177/1012690211413969.

Abstract: “The difficulty of measuring the prevalence of doping in elite sport is a recurring topic in the scientific literature on doping. The Randomized Response Technique is a method for asking such embarrassing or even threatening questions while allowing the respondents to answer honestly. It was used to measure the prevalence of doping among German squad athletes by Pitsch et al. (2005, 2007). In a replication study with better sampling control, it was possible to replicate the general trend of the data from the 2005 study…. The paper-based survey resulted in a rate of 10.2% ‘honest dopers,’ irrespective of the disciplines, obtained with the question: ‘Have you ever knowingly used illicit drugs or methods in order to enhance your performance?’ By adding the rate of cheaters (24.7%), whose behaviour the researchers know nothing about, one can calculate the interval (10.2%, 34.9%), which should include the true rate of dopers throughout their career among German elite athletes. In contrast, this means that the larger proportion of athletes, namely, 65.2%, represents ‘honest non-dopers.’ In the 2008 season, this figure was 65%.”

“Growth Hormone Doping in Sports: A Critical Review of Use and Detection Strategies” Baumann, Gerhard P. Endocrine Reviews , April 2012, Vol. 33, No. 2 155-186. doi: 10.1210/er.2011-1035.

Abstract: “[Growth hormone] is believed to be widely employed in sports as a performance-enhancing substance. Its use in athletic competition is banned by the World Anti-Doping Agency, and athletes are required to submit to testing for GH exposure…. The scientific evidence for the [performance-enhancing characteristics] of GH is weak, a fact that is not widely appreciated in athletic circles or by the general public. Also insufficiently appreciated is the risk of serious health consequences associated with high-dose, prolonged GH use. This review discusses the GH biology relevant to GH doping; the virtues and limitations of detection tests in blood, urine, and saliva; secretagogue efficacy; IGF-I doping; and information about the effectiveness of GH as a performance-enhancing agent.”

“Supplements in Top-Level Track and Field Athletes” Tscholl, Philippe; Alonso, Juan M.; Dollé, Gabriel; Junge, Astrid; Dvorak, Jiri. American Journal of Sports Medicine , January 2010, Vol. 38, No. 1, 133-140. doi: 10.1177/0363546509344071.

Abstract: “Analysis of 3,887 doping control forms undertaken during 12 International Association of Athletics Federations World Championships and one out-of-competitions season in track and field. Results: There were 6,523 nutritional supplements (1.7 per athlete) and 3,237 medications (0.8 per athlete) reported. Nonsteroidal anti-inflammatory drugs (NSAIDs; 0.27 per athlete, n = 884), respiratory drugs (0.21 per athlete, n = 682), and alternative analgesics (0.13, n = 423) were used most frequently. Medication use increased with age (0.33 to 0.87 per athlete) and decreased with increasing duration of the event (from sprints to endurance events; 1.0 to 0.63 per athlete). African and Asian track and field athletes reported using significantly fewer supplements (0.85 vs. 1.93 per athlete) and medications (0.41 vs. 0.96 per athlete) than athletes from other continents. The final ranking in the championships was unrelated to the quantity of reported medications or supplements taken. Compared with middle-distance and long-distance runners, athletes in power and sprint disciplines reported using more NSAIDs, creatine, and amino acids, and fewer antimicrobial agents. Conclusion: The use of NSAIDs in track and field is less than that reported for team-sport events. However, nutritional supplements are used more than twice as often as they are in soccer and other multisport events; this inadvertently increases the risk of positive results of doping tests.”

“Alcohol, Tobacco, Illicit Drugs and Performance Enhancers: A Comparison of Use by College Student Athletes and Nonathletes” Yusko, David A.; et al. American Journal of Sports Medicine, August 2010. doi: 10.3200/JACH.57.3.281-290.

Abstract: Compares the prevalence and pattern of substance use in undergraduate student athletes and nonathletes from 2005-2006. Data was collected using questionnaires from male (n = 418) and female (n = 475) student athletes and nonathletes from 2005-2006 to assess prevalence, quantity, and frequency of alcohol and drug use, and to determine patterns of student athletes’ alcohol and drug use during their athletic season versus out of season. Male student athletes were found to be at high risk for heavy drinking and performance-enhancing drug use. Considerable in-season versus out-of-season substance use fluctuations were identified in male and female student athletes. Additional, and possibly alternative, factors are involved in a student athlete’s decision-making process regarding drug and alcohol use, which suggests that the development of prevention programs that are specifically designed to meet the unique needs of the college student athlete may be beneficial.”

Health effects

“Performance Enhancing Drug Abuse and Cardiovascular Risk in Athletes” Angell, Peter J.; Chester, Neil; Sculthorpe, Nick; Whyte, Greg; George, Keith; Somauroo, John. British Journal of Sports Medicine , July 2012. doi:10.1136/bjsports-2012-091186.

Abstract: “Despite continuing methodological developments to detect drug use and associated punishments for positive dope tests, there are still many athletes who choose to use performance- and image-enhancing drugs. Of primary concern to this review are the health consequences of drug use by athletes…. We will address current knowledge, controversies and emerging evidence in relation to cardiovascular (CV) health of athletes taking drugs. Further, we delimit our discussion to the CV consequences of anabolic steroids and stimulant (including amphetamines and cocaine) use. These drugs are reported in the majority of adverse findings in athlete drug screenings and thus are more likely to be relevant to the healthcare professionals responsible for the well-being of athletes.”

“Illicit Anabolic-Androgenic Steroid Use” Kanayama, Gen; Hudson, James I.; Pope Jr., Harrison G. Hormones and Behavior , Volume 58, Issue 1, June 2010, Pages 111-121. doi: 10.1016/j.yhbeh.2009.09.006.

Abstract: “The anabolic-androgenic steroids (AAS) are a family of hormones that includes testosterone and its derivatives. These substances have been used by elite athletes since the 1950s, but they did not become widespread drugs of abuse in the general population until the 1980s. Thus, knowledge of the medical and behavioral effects of illicit AAS use is still evolving. Surveys suggest that many millions of boys and men, primarily in Western countries, have abused AAS to enhance athletic performance or personal appearance. AAS use among girls and women is much less common. Taken in supraphysiologic doses, AAS show various long-term adverse medical effects, especially cardiovascular toxicity. Behavioral effects of AAS include hypomanic or manic symptoms, sometimes accompanied by aggression or violence, which usually occur while taking AAS, and depressive symptoms occurring during AAS withdrawal. However, these symptoms are idiosyncratic and afflict only a minority of illicit users; the mechanism of these idiosyncratic responses remains unclear. AAS users may also ingest a range of other illicit drugs, including both “body image” drugs to enhance physical appearance or performance, and classical drugs of abuse. In particular, AAS users appear particularly prone to opioid use. There may well be a biological basis for this association, since both human and animal data suggest that AAS and opioids may share similar brain mechanisms. Finally, AAS may cause a dependence syndrome in a substantial minority of users. AAS dependence may pose a growing public health problem in future years but remains little studied.”

“Adverse Health Effects of Anabolic-Androgenic Steroids” Van Amsterdama, Jan; Opperhuizena, Antoon; Hartgensb, Fred. Regulatory Toxicology and Pharmacology , Volume 57, Issue 1, June 2010, Pages 117-123. doi: 10.1016/j.yrtph.2010.02.001.

Abstract: “Anabolic-androgenic steroids (AAS) are synthetic drugs derived from testosterone. Illegally, these drugs are regularly self-administered by body builders and power lifters to enhance their sportive performance. Adverse side effects of AAS include sexual dysfunction, alterations of the cardiovascular system, psyche and behavior, and liver toxicity. However, severe side effects appear only following prolonged use of AAS at high dose and their occurrence is limited…. The overwhelming stereotype about AAS is that these compounds cause aggressive behavior in males. However, the underlying personality traits of a specific subgroup of the AAS abusers, who show aggression and hostility, may be relevant, as well. Use of AAS in combination with alcohol largely increases the risk of violence and aggression. The dependence liability of AAS is very low, and withdrawal effects are relatively mild. Based on the scores for acute and chronic adverse health effects, the prevalence of use, social harm and criminality, AAS were ranked among 19 illicit drugs as a group of drugs with a relatively low harm.”

“Effects of Growth Hormone Therapy on Exercise Performance in Men” Triay, Jessica M.; Ahmad, Bushra N. Trends in Urology & Men’s Health , July/August 2012, Vol. 3, Issue 4, 23-26. doi: 10.1002/tre.274.

Conclusions: “In the athletic arena, [growth hormone] doping is considered to be widespread and used in combination with other agents, and regimens vary depending on individual preferences and cost implications…. It must be recognised that the effects of GH administration in adults with a normal GH/IGF-1 axis are not comparable to those in GH deficiency and that the complexity of processes influencing GH release and peripheral actions means that overall performance should be considered as opposed to isolated effects. Although studies to date have been small in both subject numbers and treatment times, they have demonstrated measurable changes in GH and IGF-1 levels, as well as possible deleterious effects on exercise performance that should be taken seriously.”

“Performance-Enhancing Drugs on the Web: A Growing Public-Health Issue” Brennan, Brian P.; Kanayama, Gen; Pope Jr., Harrison G. American Journal on Addictions , March-April 2013, Vol. 22, Issue 2, 158-161. doi: 10.1111/j.1521-0391.2013.00311.x.

Abstract: “Today’s Internet provides extensive “underground” guidelines for obtaining and using illicit substances, including especially anabolic-androgenic steroids (AAS) and other appearance- and performance-enhancing drugs (APEDs). We attempted to qualitatively characterize APED-related Internet sites. We used relevant Internet search terms [and] found thousands of sites involving AAS and other APEDs. Most sites presented an unabashedly pro-drug position, often openly questioning the qualifications and motivations of mainstream medical practitioners. Offers of AAS and other APEDs for sale, together with medical advice of varying legitimacy, was widespread across sites. Importantly, many sites provided detailed guidelines for exotic forms of APED use, some likely associated with serious health risks, which are probably unknown to most practicing clinicians.”

“Doping in Sport: A Review of Elite Athletes’ Attitudes, Beliefs and Knowledge” Morente-Sánchez, Jaime; Zabala, Mikel. Sports Medicine , March 2013. doi: 10.1007/s40279-013-0037-x.

Abstract: “Although most athletes acknowledge that doping is cheating, unhealthy and risky because of sanctions, its effectiveness is also widely recognized. There is a general belief about the inefficacy of anti-doping programmes, and athletes criticise the way tests are carried out. Most athletes consider the severity of punishment is appropriate or not severe enough. There are some differences between sports, as team-based sports and sports requiring motor skills could be less influenced by doping practices than individual self-paced sports. However, anti-doping controls are less exhaustive in team sports. The use of banned substance also differs according to the demand of the specific sport. Coaches appear to be the main influence and source of information for athletes, whereas doctors and other specialists do not seem to act as principal advisors. Athletes are becoming increasingly familiar with anti-doping rules, but there is still a lack of knowledge that should be remedied using appropriate educational programmes. There is also a lack of information on dietary supplements and the side effects of [performance-enhancing substances].”

“Age and Gender Specific Variations in Attitudes to Performance Enhancing Drugs and Methods” Singhammer, John. Sport Science Review , December 2012. doi: 10.2478/v10237-012-0017-3.

Abstract: “Using a population-based cross-sectional sample of 1,703 Danish men and women aged 15-60 years, the present study examined age and gender variation in attitudes to performance enhancing drugs and methods…. Overall, participants held negative attitudes to drugs and methods enhancing predominantly cognitive-abilities-enhancing performance drugs and to appearance-modifying methods, but were positive to drugs for restoring physical functioning conditions. However, attitudes varied nonlinearly across age. Lenient attitudes peaked at around age 25 and subsequently decreased. Lenient attitudes to use of drugs against common disorders decreased in a linear fashion. No gender differences were observed and attitude did not vary with level of education, self-reported health or weekly hours of physical activity.”

“Drugs, Sweat and Gears: An Organizational Analysis of Performance Enhancing Drug Use in the 2010 Tour De France” Palmer, Donald; Yenkey, Christopher. University of California, Davis; University of Chicago. March 2013.

Abstract: “This paper seeks a more comprehensive explanation of wrongdoing in organizations by theorizing two under-explored causes: the criticality of a person’s role in their organization’s strategy-based structure, and social ties to known deviants within their organization and industry. We investigate how these factors might have influenced wrongdoing in the context of professional cyclists’ use of banned performance enhancing drugs (PEDs) in advance of the 2010 Tour de France….. We find substantial support for our prediction that actors who are more critical to the organization’s strategy-based structure are more likely to engage in wrongdoing. Further, we find that while undifferentiated social ties to known wrongdoers did not increase the likelihood of wrongdoing, ties to unpunished offenders increased the probability of wrongdoing and ties to severely punished offenders decreased it. These effects were robust to consideration of other known causes of wrongdoing: weak governance regimes and permissive cultural contexts, performance strain, and individual propensities to engage in wrongdoing.”

“Elite Athletes’ Estimates of the Prevalence of Illicit Drug Use: Evidence for the False Consensus Effect” Dunn, Matthew; Thomas, Johanna O.; Swift, Wendy; Burns, Lucinda. Drug and Alcohol Review , January 2012, Vol. 31, Issue 1, 27-32. doi: 10.1111/j.1465-3362.2011.00307.x.

Abstract: “The false consensus effect (FCE) is the tendency for people to assume that others share their attitudes and behaviours to a greater extent than they actually do…. The FCE was investigated among 974 elite Australian athletes who were classified according to their drug use history. Participants tended to report that there was a higher prevalence of drug use among athletes in general compared with athletes in their sport, and these estimates appeared to be influenced by participants’ drug-use history. While overestimation of drug use by participants was not common, this overestimation also appeared to be influenced by athletes’ drug use history.”

“The Role of Sports Physicians in Doping: A Note on Incentives” Korn, Evelyn; Robeck, Volker. Philipps-Universitat, Marburg, March 2013.

Abstract: “How to ban the fraudulent use of performance-enhancing drugs is an issue in all professional — and increasingly in amateur — sports. The main effort in enforcing a ‘clean sport’ has concentrated on proving an abuse of performance-enhancing drugs and on imposing sanctions on teams and athletes. An investigation started by Freiburg university hospital against two of its employees who had been working as physicians for a professional cycling team has drawn attention to another group of actors: physicians. It reveals a multi-layered contractual relations between sports teams, physicians, hospitals, and sports associations that provided string incentives for the two doctors to support the use performance-enhancing drugs. This paper argues that these misled incentives are not singular but a structural part of modern sports caused by cross effects between the labor market for sports medicine specialists (especially if they are researchers) and for professional athletes.”

“Socio-economic Determinants of Adolescent Use of Performance Enhancing Drugs” Humphreys, Brad R.; Ruseski, Jane E. Journal of Socio-Economics , April 2011, Vol. 40, Issue 2, 208-216. doi: 10.1016/j.socec.2011.01.008.

Abstract: “Evidence indicates that adolescents (athletes and non-athletes use performance enhancing drugs. We posit that adolescent athletes have different socio-economic incentives to use steroids than non-athletes. We examine adolescent steroid use using data from the Youth Risk Behavior Surveillance System. Multi-sport upperclassmen and black males have a higher probability of steroid use. Steroid use is associated with motivations to change physical appearance and experimentation with illicit substances. These results suggest there are different socio-economic motivations for adolescent steroid use and that steroid use is an important component of overall adolescent drug use.”

Cognitive-enhancing drugs

“Randomized Response Estimates for the 12-Month Prevalence of Cognitive-Enhancing Drug Use in University Students” Dietz, Pavel; et al. Pharmacotherapy , January 2013, Vol. 33, Issue 1, 44-50. doi: 10.1002/phar.1166.

Results: “An anonymous, specialized questionnaire that used the randomized response technique was distributed to students at the beginning of classes and was collected afterward. From the responses, we calculated the prevalence of students taking drugs only to improve their cognitive performance and not to treat underlying mental disorders such as attention-deficit-hyperactivity disorder, depression, and sleep disorders. The estimated 12-month prevalence of using cognitive-enhancing drugs was 20%. Prevalence varied by sex (male 23.7%, female 17.0%), field of study (highest in students studying sports-related fields, 25.4%), and semester (first semester 24.3%, beyond first semester 16.7%).”

“The Diversion and Misuse of Pharmaceutical Stimulants: What Do We Know and Why Should We Care?” Kaye, Sharlene; Darke, Shane. Addiction , February 2012, Vol. 107, Issue 3, 467-477. doi: 10.1111/j.1360-0443.2011.03720.x.

Results: “The evidence to date suggests that the prevalence of diversion and misuse of pharmaceutical stimulants varies across adolescent and young adult student populations, but is higher than that among the general population, with the highest prevalence found among adults with attention deficit-hyperactive disorder (ADHD) and users of other illicit drugs. Concerns that these practices have become more prevalent as a result of increased prescribing are not supported by large-scale population surveys…. Despite recognition of the abuse liability of these medications, there is a paucity of data on the prevalence, patterns and harms of diversion and misuse among populations where problematic use and abuse may be most likely to occur (e.g. adolescents, young adults, illicit drug users). Comprehensive investigations of diversion and misuse among these populations should be a major research priority, as should the assessment of abuse and dependence criteria among those identified as regular users.”

“Adderall Abuse on College Campuses: A Comprehensive Literature Review” Varga, Matthew D. Journal of Evidence-Based Social Work , 2012, Vol. 9, Issue 3. doi: 10.1080/15433714.2010.525402.

Abstract: “Prescription stimulant abuse has dramatically increased over the past 10 years, but the amount of research regarding college students and illicit prescription stimulant use is still very limited. This has important implications for college mental health professionals and higher education administrators. In this comprehensive literature review the author explores factors contributing to illicit use, self-medication, and recreational use of controlled prescription stimulants; discusses the potential consequences for those students abusing stimulants; and provides recommendations for educating, combating, and assisting students who illicitly use prescription stimulants on college campuses.”

“A Comparison of Attitudes Toward Cognitive Enhancement and Legalized Doping in Sport in a Community Sample of Australian Adults” Partridge, Brad; Lucke, Jayne; Hall, Wayne. AJOB Primary Research , November 2012. doi: 10.1080/21507716.2012.720639.

Abstract: “This article compares public attitudes toward the use of prescription drugs for cognitive enhancement with the use of performance enhancing drugs in sport. We explore attitudes toward the acceptability of both practices; the extent to which familiarity with cognitive enhancement is related to its perceived acceptability; and relationships between the acceptability of cognitive enhancement and legalized doping in sport. Of 1,265 [survey] participants, 7% agreed that cognitive enhancement is acceptable; 2.4% of the total sample said they had taken prescription drugs to enhance their concentration or alertness in the absence of a diagnosed disorder, and a further 8% said they knew someone who had done so. These participants were twice as likely to think cognitive enhancement was acceptable. Only 3.6% of participants agreed that people who play professional sport should be allowed to use performance-enhancing drugs if they wanted to. Participants who found cognitive enhancement acceptable were 9.5 times more likely to agree with legalized doping.”

Keywords: drugs, youth, sports, cheating, higher education, corruption, ADHD, research roundup

About The Author

Leighton Walter Kille

The Enhanced Games: letting athletes use drugs could lead to worse problems than cheating

Senior Lecturer in Ethics, Department of Sport and Exercise Sciences, Swansea University

Disclosure statement

John William Devine does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Swansea University provides funding as a member of The Conversation UK.

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What would sport be like if performance-enhancing drugs were allowed? How fast could the fastest athletes run? How high could they jump? How heavy could they lift? The Enhanced Games seeks to answer these questions by removing all restrictions on doping.

In lifting the ban on performance-enhancing drugs, the Enhanced Games challenges a core tenet of modern sports ethics – that sport should be doping-free .

When the first Enhanced Games takes place in December 2024, athletes in its five categories of competition – track and field, swimming, weightlifting, gymnastics, and combat sports – will be allowed to ingest whatever substance they wish to improve their performance.

There will be no tests, no bans, no limits. For some, including the games’ founder Aron D’Souza, the Enhanced Games is the next step in sport’s evolution, but for others, it is a moral stain on the sporting landscape.

Advocates of “enhanced sport” contend that permitting athletes to use whatever drugs they choose will allow sport to test the limits of human potential , to respect athletes’ bodily autonomy, and to escape the unending cycle of cheating scandals generated by a failing anti-doping system.

However, it is far from clear that enhanced sport will open new horizons of sports performance, support athlete autonomy, or promote fair competition.

Peak performance?

Anti-doping rules limit the substances that athletes can use to reach peak performance. Anabolic steroids can help weightlifters to lift heavier and erythropoietin can help distance runners to run faster. So the prohibition of these substances appears to place a ceiling on the pursuit of sporting achievement.

Athletic excellence is not, however, reducible to outcomes.

A sprinter who runs with a tailwind, a marathon runner who rides the subway , or a high jumper who uses a trampoline are not better placed to explore the limits of human potential in their respective sports.

In each case, an extraneous aid (that is, the tailwind, subway and trampoline) assists the athlete to reach the desired outcome more efficiently but without demonstrating any further athletic skill or ability. These supposed “enhancements” obscure rather than cultivate athletic excellence .

The use of performance-enhancing drugs may, in a range of cases, more closely resemble running with a tailwind than mastering a new athletic skill .

In evaluating any sports performance, the outcome cannot be detached from the means of its achievement. More work needs to be done by philosophers and sport scientists to determine when, if ever, drug-assisted performance truly extends the limits of human performance, as envisaged by the organisers of the Enhanced Games.

Furthermore, sports are designed to test a specific cluster of skills and capacities, including physical, psychological, tactical and technical abilities. Performance-enhancing drugs elevate the importance of certain physical attributes, such as strength and stamina.

Lifting the ban on drugs would alter the nature of sports by increasing the significance of this sub-set of physical attributes at the expense of other physical attributes , such as coordination and agility, as well as non-physical attributes such as strategic skill, mental resilience, and technical proficiency.

A second argument advanced by advocates of the Enhanced Games is that lifting the ban affords athletes more extensive control over their bodies. “ My body, my choice ,” as D’Souza, puts it. Allowing athletes to use whatever substances they wish better respects their autonomy – so the argument goes.

However, lifting the doping ban would allow – perhaps even incentivise – athletes to ingest dangerous or untested drugs. Supporters of enhanced sport suggest that this presents no moral concern, provided that athletes give free and informed consent .

Even charitably assuming that such consent eliminates any moral concern, the removal of the ban will expose unwilling and uninformed athletes to pressure from coaches, parents, sponsors and governments to use dangerous and experimental drugs that could pose a serious risk to their health. Lifting the ban on doping invites the proliferation of coerced doping.

Time to abandon a failed system?

The Enhanced Games may find reluctant support from those who oppose the use of performance-enhancing drugs in principle but have become disillusioned by the failure in practice of the World Anti-Doping Agency and national anti-doping agencies to contain the problem.

If sport is replete with cheating by doping and attempts to address this problem impose burdensome bureaucratic and testing obligations on athletes, perhaps the best solution is to lift the ban, both to close off this avenue for cheating and to remove the burdens of anti-doping on athletes.

However, lifting the doping ban would grant further competitive advantage to athletes who represent economic superpowers such as the US and China. These governments could invest huge sums into drug research and development for the benefit of their athletes. They could provide expert medical supervision, not available to athletes from less wealthy states, to ensure that drugs are used in ways that minimise harm and maximise their effect.

In a sporting world in which inequality of opportunity is already rampant, the removal of the doping ban would only deepen an existing moral failing.

Recent doping scandals and persistent rumours that doping remains prevalent among elite athletes provide reason for pessimism about the prospect of doping-free sport, but lifting the ban is not the answer. Doping is a problem that needs to be managed, not side-stepped. Competitions that allow it will increase the risk to athletes’ health, render competition even more unfair and threaten to undermine the fundamental purpose of sport.

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Drug abuse in athletes

Claudia l reardon.

Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Shane Creado

Drug abuse occurs in all sports and at most levels of competition. Athletic life may lead to drug abuse for a number of reasons, including for performance enhancement, to self-treat otherwise untreated mental illness, and to deal with stressors, such as pressure to perform, injuries, physical pain, and retirement from sport. This review examines the history of doping in athletes, the effects of different classes of substances used for doping, side effects of doping, the role of anti-doping organizations, and treatment of affected athletes. Doping goes back to ancient times, prior to the development of organized sports. Performance-enhancing drugs have continued to evolve, with “advances” in doping strategies driven by improved drug testing detection methods and advances in scientific research that can lead to the discovery and use of substances that may later be banned. Many sports organizations have come to ban the use of performance-enhancing drugs and have very strict consequences for people caught using them. There is variable evidence for the performance-enhancing effects and side effects of the various substances that are used for doping. Drug abuse in athletes should be addressed with preventive measures, education, motivational interviewing, and, when indicated, pharmacologic interventions.

Introduction

Doping, defined as use of drugs or other substances for performance enhancement, has become an important topic in virtually every sport 1 and has been discovered in athletes of all ages and at every level of competition. 2 – 4 See Table 1 for rates of use of a variety of substances, whether doping agents or recreational substances, among different populations of athletes as reported in various recent research studies. 5 – 10 Of note, self-reports are generally felt likely to yield under-reported figures. 5 Importantly, performance-enhancing drugs (PEDs) are not restricted to illegal drugs or prescription medications, such as anabolic steroids. 11 They include dietary supplements and a variety of compounds that are available at grocery and health food stores and online. 12

Substance use rates among different populations of athletes as reported in various recent research studies

Abbreviation: WADA, World Anti-Doping Agency.

Drug abuse in the athlete population may involve doping in an effort to gain a competitive advantage. Alternatively, it may involve use of substances such as alcohol or marijuana without the intent of performance enhancement, since athletes may develop substance use disorders just as any nonathlete may.

Athletes may turn to substances to cope with numerous stressors, including pressure to perform, injuries, physical pain, and retirement from a life of sport (which happens much earlier than retirement from most other careers). 13 Additionally, athletes may be significantly less likely to receive treatment for underlying mental illnesses such as depression. 14 Athletes receive comprehensive treatment and rehabilitation for physical injuries, but this may be less often the case for mental illness, because of their sometimes viewing mental illness as a sign of weakness. 14 Untreated mental illness is often associated with substance use, perhaps in an effort to self-treat. Alternatively, substances of abuse may cause mental illness. 15

We will especially focus on doping in this review, which specifically aims to serve as a single paper that provides a broad overview of the history of doping in athletes, the effects of different classes of drugs used for doping, side effects of doping, the role of anti-doping organizations, and the treatment of affected athletes.

Materials and methods

For this review, we identified studies through a MEDLINE search. Search terms included the following, individually and in combination: “doping”, “athletes”, “steroids”, “drug abuse”, “mental illness”, “drug testing”, “anti-doping”, “psychiatry”, “sports”, “depression”, “substance abuse”, “substance dependence”, “addiction”, “history”, “side effects”, “drug testing”, “treatment”, “androgens”, “testosterone”, “growth hormone”, “growth factors”, “stimulants”, “supplements”, “erythropoietin”, “alcohol”, “marijuana”, “narcotics”, “nicotine”, “Beta agonists”, “Beta blockers”, “diuretics”, “masking agents”, “gene doping”, “National Collegiate Athletic Association”, and “World Anti-Doping Agency”. We restricted results to the English language and used no date restrictions. We retrieved all papers discussing drug abuse in athletes. We reviewed the findings of each article, and reviewed the references of each paper for additional papers that had been missed in the initial search and that might include findings relevant to the scope of our review. Ultimately, 67 manuscripts or chapters were felt relevant and representative for inclusion among those referenced in this paper.

History of doping in athletes

The belief that doping is only a recent phenomenon that has arisen solely from increasing financial rewards offered to modern day elite athletes is incorrect. 16 In fact, doping is older than organized sports. Ancient Greek Olympic athletes dating back to the third century BC used various brandy and wine concoctions and ate hallucinogenic mushrooms and sesame seeds to enhance performance. Various plants were used to improve speed and endurance, while others were taken to mask pain, allowing injured athletes to continue competing. 17 – 19 Yet, even in ancient times, doping was considered unethical. In ancient Greece, for example, identified cheaters were sold into slavery. 1

The modern era of doping dates to the early 1900s, with the illegal drugging of racehorses. Its use in the Olympics was first reported in 1904. Up until the 1920s, mixtures of strychnine, heroin, cocaine, and caffeine were not uncommonly used by higher level athletes. 16

By 1930, use of PEDs in the Tour de France was an accepted practice, and when the race changed to national teams that were to be paid by the organizers, the rule book distributed to riders by the organizer reminded them that drugs were not among items with which they would be provided. 20

In the 1950s, the Soviet Olympic team began experimenting with testosterone supplementation to increase strength and power. 16 This was part of a government-sponsored program of performance enhancement by national team trainers and sports medicine doctors without knowledge of the short-term or long-term negative consequences. Additionally, when the Berlin Wall fell, the East German government’s program of giving PEDs to young elite athletes was made public. 1 Many in the sporting world had long questioned the remarkable success of the East German athletes, particularly the females, and their rapid rise to dominance in the Olympics. Young female athletes experienced more performance enhancement than did male athletes. Unfortunately, they also suffered significant and delayed side effects, including reports of early death in three athletes. 19

The specific substances used to illegally enhance performance have continued to evolve. 21 The “advances” in doping strategies have been driven, in part, by improved drug testing detection methods. 21 To avoid detection, various parties have developed ever more complicated doping techniques. 21 Further, new doping strategies may result from advances in scientific research that can lead to the discovery and use of substances that may later be banned. Over the past 150 years, no sport has had more high-profile doping allegations than cycling. 16 However, few sports have been without athletes found to be doping.

Many sports organizations have come to ban the use of PEDs and have very strict rules and consequences for people who are caught using them. The International Association of Athletics Federations was the first international governing body of sport to take the situation seriously. 22 In 1928, they banned participants from doping, 22 but with little in the way of testing available, they had to rely on the word of athletes that they were not doping. It was not until 1966 that the Federation Internationale de Football Association and Union Cycliste Internationale joined the International Association of Athletics Federations in the fight against drugs, closely followed by the International Olympic Committee (IOC) the following year. 23

The first actual drug testing of athletes occurred at the 1966 European Championships, and 2 years later the IOC implemented their first drug tests at both the Summer and Winter Olympics. 24 Anabolic steroids became even more prevalent during the 1970s, and after a method of detection was found, they were added to the IOC’s prohibited substances list in 1976. This resulted in a marked increase in the number of doping-related disqualifications in the late 1970s, 24 notably in strength-related sports, such as throwing events and weightlifting.

While the fight against stimulants and steroids was producing results, 24 the main front in the anti-doping war was rapidly shifting to blood doping. 25 This removal and subsequent reinfusion of an athlete’s blood in order to increase the level of oxygen-carrying hemoglobin has been practiced since the 1970s. 25 The IOC banned blood doping in 1986. 25 Other ways of increasing the level of hemoglobin were being tried, however. One of these was erythropoietin. 25 Erythropoietin was included in the IOC’s list of prohibited substances in 1990, but the fight against erythropoietin was long hampered by the lack of a reliable testing method. An erythropoietin detection test was first implemented at the 2000 Olympic Games. 25

In the 1970s and 1980s, there were suspicions of state-sponsored doping practices in some countries. The former German Democratic Republic substantiated these suspicions. 25 The most prominent doping case of the 1980s concerned Ben Johnson, the 100 meter dash champion who tested positive for the anabolic steroid stanozolol at the 1988 Olympic Games in Seoul. 25 In the 1990s, there was a noticeable correlation between more effective test methods and a drop in top results in some sports. 25

In 1998, police found a large number of prohibited substances, including ampoules of erythropoietin, in a raid during the Tour de France. 25 , 26 The scandal led to a major reappraisal of the role of public authorities in anti-doping affairs. As early as 1963, France had been the first country to enact anti-doping legislation. Other countries followed suit, but international cooperation in anti-doping affairs was long restricted to the Council of Europe. In the 1980s, there was a marked increase in cooperation between international sports authorities and various governmental agencies. Before 1998, debate was still taking place in several discrete forums (IOC, sports federations, individual governments), resulting in differing definitions, policies, and sanctions. Athletes who had received doping sanctions were sometimes taking these sanctions, with their lawyers, to civil courts and sometimes were successful in having the sanctions overturned. The Tour de France scandal highlighted the need for an independent, nonjudicial international agency that would set unified standards for anti-doping work and coordinate the efforts of sports organizations and public authorities. The IOC took the initiative and convened the First World Conference on Doping in Sport in Lausanne in February 1999. Following the proposal of the Conference, the World Anti-Doping Agency (WADA) was established later in 1999.

Performance-enhancing effects of substances used by athletes

There is a research base demonstrating that many doping agents are in fact performance-enhancing. However, some substances (eg, selective androgen receptor modulators, antiestrogens, and aromatase inhibitors), used in an effort to enhance performance, have little data to back up their effectiveness for such a purpose. Note that the studies cited in this paper are chosen as being historically important or representative of the bulk of the research on the topic, and the broad overview provided in this paper does not aim to cite all evidence on the effects of these substances. Additionally, research on this topic is limited by the difficulty in performing ethical studies due to the high doses of doping agents used, potential side effects, and lack of information on actual practice.

Androgens include exogenous testosterone, synthetic androgens (eg, danazol, nandrolone, stanozolol), androgen precursors (eg, androstenedione, dehydroepiandrosterone), selective androgen receptor modulators, and other forms of androgen stimulation. The latter categories of substances have been used by athletes in an attempt to increase endogenous testosterone in a way that may circumvent the ban enforced on natural or synthetic androgens by WADA.

Amounts of testosterone above those normally found in the human body have been shown to increase muscle strength and mass. For example, a representative randomized, double-blind study involved 43 men being randomized to four different groups: testosterone enanthate 600 mg once per week with strength training exercise; placebo with strength training exercise; testosterone enanthate 600 mg once per week with no exercise; and placebo with no exercise. This was a critical study in demonstrating that administration of testosterone increased muscle strength and fat-free mass in all recipients, and even moreso in those who exercised. 27 A second study from the same investigators 5 years later further demonstrated a dose–response relationship between testosterone and strength. 28 Another double-blind trial of exogenous testosterone involved 61 males randomized to five different doses of testosterone enanthate, ranging from 25 mg to 600 mg, along with treatment with a gonadotropin-releasing hormone agonist to suppress endogenous testosterone secretion. That study demonstrated findings similar to the previous one, in showing a dose-dependent increase in leg power and leg press strength, which correlated with serum total testosterone concentrations. 29

Androgen precursors include androstenedione and dehydroepiandrosterone (DHEA). We found no evidence that androstenedione increases muscle strength. 30 DHEA is available as a nutritional supplement that is widely advertised in body building magazines as a substance that will improve strength. However, results from placebo-controlled studies of DHEA in males have been mixed. 30 , 31 One study involved 40 trained males being given DHEA 100 mg per day, androstenedione, or placebo, with no resulting differences in muscle mass or fat-free mass between groups. 30 A second study involved nine males and ten females randomized to receive DHEA 100 mg daily or placebo for 6 months, who were then crossed over to the other group for a further 6 months. The males but not females showed increased knee and lumbar back strength during DHEA treatment. 31

Selective androgen receptor modulators are not approved for use in humans in any country, but athletes are able to obtain these substances on the Internet. 32 No studies were found looking at the effects of selective androgen receptor modulators on muscle strength or mass in humans.

Other forms of androgen stimulation include exogenous human chorionic gonadotropin, antiestrogens such as tamoxifen, clomiphene, and raloxifene, and aromatase inhibitors such as testolactone, letrozole, and anastrozole. These substances may result in increased serum testosterone. 33 However, we found minimal research demonstrating an effect on muscle strength. 34 While androgens of different forms have been shown to improve muscle strength and mass, they have not been shown to improve whole body endurance per se. 35

Growth hormone and growth factors

Growth hormone and growth factors are also banned by WADA. Research shows recombinant human growth hormone to increase muscle mass and decrease adipose tissue. One representative study randomized male recreational athletes to growth hormone 2 mg/day subcutaneously, testosterone 250 mg weekly intramuscularly, a combination of the two treatments, or placebo. 36 Female recreational athletes were randomized to growth hormone 2 mg daily or placebo. In both males and females, growth hormone was associated with significantly decreased fat mass, increased lean body mass, and improved sprint capacity (although with no change in strength, power, or endurance). Sprint capacity improvement was even greater when growth hormone and testosterone were coadministered to males.

Growth factors include insulin-like growth factor and insulin. They are presumed to have similar effects to growth hormone, but have not been studied in athletes. 37 Athletes use these substances because of their apparent anabolic effect on muscle. 37

Stimulants include amphetamine, D-methamphetamine, methylphenidate, ephedrine, pseudoephedrine, caffeine, dimethylamylamine, cocaine, fenfluramine, pemoline, selegiline, sibutramine, strychnine, and modafinil. Research has shown stimulants to improve endurance, increase anaerobic performance, decrease feelings of fatigue, improve reaction time, increase alertness, and cause weight loss. 38 Of note, while WADA bans stimulants as a class, it does allow use of caffeine. Energy beverages now often include a variety of stimulants and other additives including not only caffeine, but also the amino acids taurine and L-carnitine, glucuronolactone, ginkgo biloba, ginseng, and others. 39 Caffeine content can be up to 500 mg per can or bottle. The potential performance benefits of the other ingredients in energy beverages are unclear. For example, taurine may improve exercise capacity by attenuating exercise-induced DNA damage, but the amounts found in popular beverages are probably far below the amounts needed to be of performance-enhancing benefit. 39

Of note, the number of athletes, especially at top levels of competition, reported to be using stimulant medications has markedly increased in recent years. In the USA, the National Collegiate Athletic Association acknowledged that the number of student athletes testing positive for stimulant medications has increased three-fold in recent years. 40 There has also been concern about inappropriate use of stimulants in major league baseball in the USA. According to a report released in January 2009, 106 players representing 8% of major league baseline players obtained therapeutic use exemptions for stimulants in 2008, which was a large increase from 28 players in 2006. 41 Therapeutic use exemptions allow athletes to take otherwise banned and performance-enhancing substances if their physician attests that they should for medical reasons.

Nutritional supplements

Nutritional supplements include vitamins, minerals, herbs, extracts, and metabolites. 39 Importantly, the purity of these substances cannot be guaranteed, such that they may contain banned substances without the athlete or manufacturer being aware. Studies have shown that many nutritional supplements purchased online and in retail stores are contaminated with banned steroids and stimulants. 42 Thus, athletes could end up failing doping tests without intentionally having ingested banned substances. 42 Creatine is not currently on the WADA banned list and is the most popular nutritional supplement for performance enhancement. 3 Studies demonstrate increased maximum power output and lean body mass from creatine. 43 , 44 As such, some allowable nutritional supplements may have ergogenic effects, but may have insufficient evidence supporting their ergogenic properties to rise to the level of being banned.

Methods to increase oxygen transport

Substances athletes use to increase oxygen transport include blood transfusions, erythropoiesis-stimulating agents such as recombinant human erythropoietin and darbepoetin alfa, hypoxia mimetics that stimulate endogenous erythropoietin production such as desferrioxamine and cobalt, and artificial oxygen carriers. Transfusions and erythropoiesis-stimulating agents have been shown to increase aerobic power and physical exercise tolerance. 45 However, the ergogenic effects of the other agents are debatable. 45

Other recreational drugs

Other recreational drugs that may be used in an attempt to enhance performance include alcohol, cannabinoids, narcotics, and nicotine. 13 WADA does not currently ban nicotine but bans cannabinoids and narcotics. Alcohol is banned in six sports during competition only. All of these substances may be used by athletes to reduce anxiety, which may be a form of performance enhancement, but we found little research looking at actual performance enhancement from these agents. Narcotics are used to decrease pain while practicing or playing. Nicotine may enhance weight loss and improve attention. 46

Beta agonists

There is debate as to whether beta-2 adrenergic agonists, for example, albuterol, formoterol, and salmeterol, are ergogenic. 47 There is anecdotal evidence of improvements in swimmers who use these substances prior to racing. 48 Additionally, oral beta agonists may increase skeletal muscle, inhibit breakdown of protein, and decrease body fat. 48 However, there is some evidence suggesting that swimmers may have a relatively high prevalence of airway hyperresponsiveness due to hours spent breathing byproducts of chlorine, such that beta agonists may be needed to restore normal, not enhanced, lung function. 49

Beta blockers

Beta blockers such as propranolol result in a decreased heart rate, reduction in hand tremor, and anxiolysis. These effects may be performance-enhancing in sports in which it is beneficial to have increased steadiness, such as archery, shooting, and billiards. 48

Other prescription drugs

Diuretics and other masking agents may be used as doping agents. 12 Diuretics can result in rapid weight loss such that they may be used for a performance advantage in sports with weight classes, such as wrestling and boxing. 12 Diuretics may also be used to hasten urinary excretion of other PEDs, thereby decreasing the chances that athletes will test positive for other banned substances that they may be using. 12 Masking agents in general conceal prohibited substances in urine or other body samples, and include diuretics, epitestosterone (to normalize urine testosterone to epitestosterone ratios), probenecid, 5-alpha reductase inhibitors, and plasma expanders (eg, glycerol, intravenous administration of albumin, dextra, and mannitol). 50

Glucocorticoids are sometimes used by athletes in an attempt to enhance performance because of their anti-inflammatory and analgesic properties. 12 However, there is minimal research to show any performance benefits of this class of drugs.

Athletes may also use phosphodiesterase-5 inhibitors in an attempt to attain increased oxygenation and exercise capacity, since they have vasodilatory effects. 51 However, again, little research exists to support a performance benefit from these substances.

Psychiatric medications, including antidepressants, anxiolytics, antipsychotics, and anticonvulsants, are generally not on the WADA banned list. 14 Bupropion is an antidepressant that is on the WADA 2014 monitoring list, meaning WADA is monitoring for any concerning trends of inappropriate use. One small study of nine males suggested that bupropion, when used acutely in warm environments, may allow athletes to push themselves to higher body temperature and heart rates without perceiving greater effort. 52 Otherwise, there is very minimal evidence that any of these classes of psychiatric medications enhance performance. 14

Nondrug performance-enhancing measures

Gene doping is a concerning potential method of nondrug performance enhancement and is banned by WADA. The potential to directly affect strength and endurance through gene manipulation has been demonstrated in laboratory mice, but no human athletes thus far have been found to be using this method. 16

Additionally, athletes may legally attempt to improve physical performance in a number of nondrug ways. 53 These have varying degrees of research into their effectiveness and safety, and include hypoxia induction techniques. 53 For example, athletes may train at high altitudes, which can result in erythrocytosis. Some studies suggest that a high–low method of sleeping at high altitude followed by training at low altitude is a better training strategy than training or sleeping at either high or low altitudes alone. 54 Some athletes have tried sleeping at simulated high altitude by using low oxygen tents. Athletes may also make dietary changes to try to increase hemoglobin levels. 55 , 56

Side effects of substances used by athletes

It is presumed that most if not all doping agents have potential short-term and/or long-term side effects. Unfortunately, given the high doses of these agents used by athletes, it is difficult to confirm such effects. It would be unethical to give dosages as high as those used by athletes for performance enhancement effects to participants in research studies. 16 Knowledge about side effects may be gleaned from empirical observation, reports of admitted users, and effects in patients prescribed such agents for medical conditions. Table 2 lists the potential side effects of various forms of doping. 57 – 59

Potential side effects of different substances and methods of doping

Note: Copyright © 2013. John Wiley & Sons. Adapted with permission from Baron DA, Reardon CL, Baron SH. Doping in sport. In: Baron DA, Reardon CL, Baron SH, editors. Clinical Sports Psychiatry: An International Perspective . Oxford, UK: Wiley; 2013. 16

Anti-doping organizations, drug testing in athletes, and rules

Drug testing typically occurs only in organized, competitive sports. At the college level, organizations such as the National Collegiate Athletic Association 60 and individual member institutions conduct standard drug testing programs and enforce penalties for positive tests.

Elite athletes competing at international and national levels are subject to standardized anti-doping guidelines under the auspices of WADA and related national organizations. WADA is the international independent agency that publishes the World Anti-Doping Code, which is the document harmonizing anti-doping policies in all sports and all countries. 61 The Code was first adopted in 2003 and became effective in 2004. The Code sets forth specific anti-doping rules and principles that are to be followed by the anti-doping organizations responsible for adopting, implementing, or enforcing anti-doping rules within their authority, including the IOC, International Paralympic Committee, international sport federations (for example, the International Cycling Union), major event organizations, and national anti-doping organizations (for example, the US Anti-Doping Agency).

WADA revises and publishes its list of banned substances approximately annually. It specifies those banned substances and methods that are prohibited at all times (both in-competition and out-of-competition) because of their potential to enhance performance in future competitions or their masking potential, and those substances and methods that are prohibited in-competition only. The list may be expanded by WADA for a particular sport.

WADA has also taken the lead in the development of the athlete biological passport concept. 61 WADA’s athlete biological passport operating guidelines took effect in 2009. The fundamental principle of the athlete biological passport is based on the monitoring of selected parameters over time that indirectly reveal the effect of doping, as opposed to the traditional direct detection of doping by analytical means. This concept gained momentum as a result of questions raised during the 2006 Olympic Winter Games surrounding suspensions of athletes by their federations following health checks that reported high hemoglobin levels. An athlete’s passport purports to establish individual baseline hormone/blood levels, which are monitored over time for significant changes. A positive test result would consist of too dramatic a change from the established individual baseline. This approach is intended to protect athletes from false-positive tests resulting from naturally occurring high levels of endogenous substances, while catching those attempting to cheat by using naturally occurring substances.

In the event that an athlete and his or her medical providers feel it necessary, for documented medical reasons, that he or she continue to take a banned substance, WADA may consider granting a therapeutic use exemption, a concept mentioned earlier. A therapeutic use exemption must be on file before an athlete tests positive for the substance allowed by that therapeutic use exemption.

Treatment of affected athletes, including counseling and psychiatric support

The first level of addressing the problem of drug abuse by athletes is prevention. 13 Drug screening is used in higher-level athletics both to deter athletes from using drugs and to punish and offer opportunities for rehabilitation to those who are found to have done so. Didactic education is another method aimed at prevention. 62 On the one hand, some authors and clinicians feel that among the most effective preventive strategies for drug abuse in sports is frequent, accurate, very closely observed, truly random urine drug testing. 13 , 63 However, some view drug testing as ineffective at preventing use of PEDs. 64 The argument for the latter is that these interventions target doping behavior rather than athlete attitudes. Athletes ultimately focus on their performance, and thus may view doping as rational behavior. 63 Moreover, knowledge of the potentially dangerous consequences from doping imparted via didactic education does not necessarily dissuade athletes. For example, in 1997, Bamberger and Yaeger surveyed 198 Olympic athletes. When asked if they would use PEDs under the hypothetical conditions of knowing they would not be caught and knowing their use would result in victory, 195 of 198 responded “yes”. Moreover, if the caveat was added that they would die within 5 years, 61% of the athletes still said they would use them. 65

There is little research available to guide counseling and psychiatric approaches to treatment of athletes who abuse drugs. 64 However, motivational interviewing approaches have been suggested for athletes with drug abuse or doping problems, since athletes may often present in the precontemplation stage of change. 13 , 64 Important elements of motivational interviewing include: 64

• Clinician empathy
• Developing discrepancies between where the athlete wants to go in life after sport and the impact that continued use of the substance might have on those goals. During this process, the provider helps athletes to clarify conflict among their values, motives, interest, and behaviors.
• Rolling with resistance. When resistance inevitably occurs, providers should avoid arguing with athletes, as that can exacerbate resistance to change. The provider may “agree to disagree” on certain points with some athletes. Providers may propose or “wonder about” certain alternative viewpoints or actions, but they do not impose or insist upon them.
• Encouragement of self-efficacy. Athletes may need to shift their viewpoint from one of being willing to do whatever it takes to win, to acknowledging that they would use PEDs only if ultimately incapable of succeeding without them (with the hope that athletes will never get to that point). If an athlete is physically dependent on a drug, then additional strategies may be needed. These may include pharmacologic interventions such as naltrexone, acamprosate, or disulfiram for alcohol dependence, or buprenorphine for opiate dependence. 13 Additionally, providers should assess for comorbid mental illness, since co-occurrence of physical dependence and mental illness is commonplace. 13 Any underlying mental illness should be treated. 13 A recent review paper on the epidemiology of mental illness in athletes noted that some mental illnesses such as depression are probably as common in athletes as nonathletes. 14 Twelve-step facilitation, cognitive behavioral therapy, and network therapy are also approaches that may be helpful for athletes who are abusing drugs, although studies are preliminary. 10 , 13 , 66

Conclusion and suggestions

Drug abuse in athletes is a significant problem that has many potential underlying causes. The drive to be the best in sport dates to ancient times, as does the use of performance-enhancing substances. With the ever-mounting pressures faced by athletes, it is not surprising that drug abuse by athletes exists across essentially all sports and age groups.

Suggestions for those undertaking research and clinical work with athletes include:

• If providers become aware of an athlete using PEDs, they should educate the athlete about the potential risks of continued use, regardless of any evidence that suggests this may not be influential for all athletes. Providers should encourage discontinuation of the abused substance(s).
• There is great variance in drug testing programs in different sports and at different levels of competition. 13 More high-quality, prospective, randomized trials should be undertaken to determine the deterrent efficacy of various types of PED screening programs, and changes should be made to those types of screening programs found to be ineffective. 8

Common signs and symptoms of substances relatively commonly used by athletes

Note: Copyright © 2013. John Wiley & Sons. Adapted with permission from Morse ED. Substance use in athletes. In: Baron DA, Reardon CL, Baron SH, editors. Clinical Sports Psychiatry: An International Perspective . Oxford, UK: Wiley; 2013. 8 , 13

• The efficacy of education about PED use as a preventative measure needs further study. Early integration of well designed prevention curricula into sports programs may be beneficial. 8 However, as alluded to earlier, at least one preliminary study suggests that educational programs that solely emphasize the negative effects of PEDs may be ineffective for young athletes. 67
• Mental health professionals should be included in the network of team doctors and other health care providers readily available to athletes. Psychiatrists are often helpful in developing strong drug prevention policies that emphasize education and treatment and not just sanctions. 13 Mental health care professionals should have a year-round presence with the athletes and teams with whom they are working so as to build trust. 13
• Screening for and treatment of underlying mental illnesses such as depression that may contribute to self-treatment with drugs by athletes should be increased. The effectiveness of this screening should be studied.
• Athletes who are using drugs are often skeptical of the medical field. This may be partly with good reason, as many health care professionals are unfamiliar with the mentality of athletes or common drug abuse patterns in this population. Accordingly, referral networks or team assistance programs consisting of health care professionals familiar with these issues should be established for athletes and teams. 62 The effectiveness of these models should be studied.
• Research should examine differences in treatment approaches that may be needed for athletes who have been using drugs for a shorter versus longer period of time.

Trainers, coaches, and health care providers should provide evidence-based, safe alternatives to PED use, including optimal nutrition, weight-training strategies, and psychological approaches to improving performance, all of which may help with athletes’ confidence in their natural abilities.

The authors report no conflicts of interest in this work.

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Exploring Topics in Sports: Why Do Athletes Risk Using Performance Enhancing Drugs?

How prevalent is drug use in sports.

In 2005, Major League Baseball introduced a new, stricter drug policy that significantly increased the severity of penalties for steroid and amphetamine use, signaling the end of the so-called “steroid era.” In order to accurately judge the prevalence of drug use in sports, the graphics below use this new policy as a benchmark date and summarizes ten years’ worth of suspension data across the National Football League and Major League Baseball , which have much higher incidence rates than any other sports.

In Major League Baseball, 47 players  have been suspended for using banned substances (including steroids, HGH, testosterone, and amphetamines) since 2005, with penalties ranging from ten-day suspensions to 162 games (or the entire regular season) in the case of famed infielder Alex Rodriguez. Of the 47 suspensions, 12 were for a mere ten days, while 19 were for 50 games; only three were for 100 games or more.

Notice that roughly half of these suspensions are attributed to “undisclosed” substances. Under Section 5.C of the MLB’s drug policy , the Commissioner’s Office may issue a statement announcing the suspension of a player that includes the length of the suspension and the specific substances(s) and the category of prohibited substance that the player tested positive for or used, possessed, sold, or distributed. For first offenses, the Commissioner’s Office often keeps the substance involved undisclosed, putting the onus on the player to withhold or share that information with fans.

Meanwhile, in the NFL , teams vary widely in the amount of drug-related suspensions enforced by the team. By comparison, only 3 games have been missed by Pittsburgh Steelers players due to suspension, while the Indianapolis Colts dwarf that number with 54 games missed. Suspensions related to substance abuse saw a sharp uptick in the NFL beginning in 2012, jumping to 82 suspensions in 2012 from 21 suspensions in 2011. Note that, in the map below, ‘third strikes’ are calculated as 16-game bans. This represents the minimum term for a third offense under the NFL’s old policy , which was replaced in 2014 .

While undisclosed substances make up the vast majority of violations, it’s interesting to note that alcohol and marijuana are not far behind when it comes to substance abuse suspensions. However, alcohol-related suspensions are on the decline since 2006, while marijuana-related suspensions have remained fairly constant over the last ten years.

It’s also important to remember that the data reflects positive tests — not violations committed. As Gwen Knapp at Sports on Earth argues , “even now, drug testing is a sieve. It is in every sport. The tests are probably useful in skimming off the worst abuse, requiring juiced athletes to moderate their doses — a pretty valuable effect, if you think about this clearly. The tests may even scare off some potential users, but they won't clean up a sport.”

Drug-related suspensions, performance enhancing or otherwise, have become commonplace throughout the past ten years. But what physical advantages make the risk of suspension so tempting to athletes?

The Effects of Drugs on Athletic Performance

Simply put, many of the drugs athletes take illegally are designed to increase their athletic performance.

For example, steroids and related hormones (such as testosterone) are used to increase muscle mass and strength by promoting testosterone production. Steroids can also aid with recovery from workouts by reducing and helping heal the damage to muscles that occurs during workout sessions, enabling an athlete to work out harder and more often while minimizing the risk of overtraining. Some athletes may also value the aggressive feelings that steroid use can lead to, casually referred to as “roid rage.”

Marijuana provides an interesting case for the leagues. The leagues tend to treat marijuana as a recreational drug; athletes, however, have cited it as a substance that helps with recovery and pain management. With the athletes’ perspectives in mind, marijuana is grouped with amphetamines, anabolic agents, and other PEDs in the graphic below.

However, steroids and its related hormones have visible side effects, especially when taken at higher than medically safe doses. Men may experience prominent breasts, baldness, shrunken testicles, infertility, and impotence, as well as acne, an increased risk of tendinitis, liver abnormalities, high blood pressure, aggressive behaviors, psychiatric disorders, and more.

To combat these side effects of anabolic steroid use, many athletes turn to anti-estrogens , which mask many of the telltale signs of steroid use. Anti-estrogens block the body’s estrogen receptors, allowing athletes to protect their physique while engaging in steroid use.

One murky area of today’s drug landscape concerns Adderall and related drugs . Adderall is typically prescribed for ADHD and other related conditions as a way to help the patient focus, remain calm, and maintain concentration. However, studies have shown that Adderall and related drugs can help improve hand-eye coordination, acceleration, and strength, which athletes could benefit from in addition to improved focus and concentration.

Currently, Adderall is allowed with the proper exemptions and with a doctor’s note; otherwise, it’s banned by every major sporting drug policy, and it frequently causes positive results for amphetamine testing. Controversy surrounds Adderall because there’s no official lab test to diagnose ADD and ADHD, meaning athletes can obtain it legally without much effort. In fact, as Seattle Seahawks cornerback Richard Sherman once famously proclaimed, “about half the league takes [Adderall].”

While the goals of taking drugs — improving performance or recovery time — are largely the same across sports, the policies of major sports all vary considerably regarding their testing methods and penalties.

How Policies Compare Across the Major Sports

The NFL’s drug policy differs from the MLB’s, which differs from the NBA’s, and so on, although the leagues’ different drug policies do have some common elements. For the major sporting leagues in the United States, the drug policy is generally determined by the league and negotiated during collective bargaining ( the NCAA , interestingly, relies principally on the testing programs at their affiliated institutions, which vary widely; however, the NCAA typically makes several visits throughout the year to ensure policies are being upheld). Here’s a glimpse at how drug policies stack up across major sports.

Banned Substances

In general, all major sporting leagues conduct urine tests for the following:

• Steroids and related hormones
• Anti-estrogens and masking agents
• Oxygen-transfer enhancers

The NFL and MLB also test for “drugs of abuse” (recreational drugs, i.e., marijuana, cocaine, etc) and the NBA, similarly, tests for cocaine, opiates, PCP, LSD and marijuana.

Testing Policies

Prior to entering the league, only the NFL requires pre-employment testing for all players, although in the MLB, all players are subjected to testing within five days of reporting for spring training. The NBA, NHL, NCAA, and all other professional leagues do not require pre-employment testing.

The frequency with which players are tested also varies greatly among professional leagues. In the NFL, all players are tested at least once per year, and the policy allows for targeted testing. Ten players per team are randomly tested each week, which continues during the playoffs for teams in the postseason. There may also be up to six offseason tests per player.

In the NBA, all players are subject to four random tests per season, and the league conducts reasonable-cause testing. Similarly, in the NFL, players are tested up to three times per year at random. Surprisingly, in the MLB, players are only subject to the test within five days of reporting for spring training and one other test on a randomly selected date, in addition to random tests in and out of season.

Violations and Penalties

If a player in any professional sport violates the league’s drug policy, they are immediately suspended, and the length of suspension (or ban) depends on how many times the player has violated the drug policy.

In the NFL, a first violation leads to a minimum four-game suspension, while a third violation calls for a minimum 12-month suspension as well as disqualification from the Pro Bowl and other honors for the year.

In the NBA , the first positive result for PEDs earns a 10-game suspension; the fourth violation results in disqualification from the league. If a first-year player tests positive for drugs of abuse, he earns a one year suspension with a chance of reinstatement after one year; all other players are suspended for at least two years. However, as we’ll discuss more below, players who come forward with a drug abuse problem receive league-paid treatment.

In the MLB, which strengthened its drug penalties in 2005, a player’s first PED violation leads to a 50 game suspension without pay. A second violation leads to a 100 game suspension without pay, and a third violation leads to a lifetime ban. However, violations of drugs of abuse are treated clinically first, rather than through suspension.

Substance Abuse Programs

The professional leagues’ approaches to their substance abuse programs vary as well. In the NFL, upon testing positive for a banned PED, the player is notified and the sample (which is split in half during the original phase of testing) is re-tested. Mandatory physical examinations are conducted to rule out naturally occurring high levels of chemicals (such as testosterone), and psychological examinations may also be conducted in case of suspected addition. The burden of proof is placed on the league during an appeals process.

In the NBA, meanwhile, the approach is much more recovery-focused. Players who come forward with their drug problems receive league-funded counseling from the Life Extension Institute , a 24-hour counseling center funded jointly by the NBA and the NBPA.

The MLB’s approach takes a middle ground. Any player testing positive for a drug of abuse or found to possess such a drug must submit to an initial evaluation by medical personnel, who then determine whether or not a treatment program is necessary. The treatment program is agreed upon by medical personnel and the player, who can complete treatment as either an inpatient or an outpatient. Players who refuse to comply with the treatment program or who test positive for drugs of abuse after their evaluation and commitment to the treatment board may find themselves suspended or subject to other discipline.

How Policies Have Changed Over Time

Out of the major professional sports,  the MLB has perhaps the most interesting history of drug policies. In January of 2005, under pressure from Congress, the MLB and its players announced a new drug agreement, in which first offenses earned a 10-day suspension and fourth violations earned a one-year ban.

However, later that year, players and owners revised that agreement to say that first violations resulted in a 50-game suspension, second violations resulted in 100-game bans, and third violations earned lifetime bans. In 2011, players and owners agreed to have blood testing for HGH during spring training in 2012, and blood testing has since been implemented during the regular season.

In March of 2014, players and owners announced that PED penalties would increase to 80 games for a first violation and 162 games (or a full season, including the postseason) for a second violation; all suspensions are without pay.

In 2007, the NFL announced stricter anti-doping policies, increasing the number of players tested and the number of random off-season tests; four years later, the NFL became the first major American sports league to approve blood testing for HGH, a policy which was finally implemented in 2014.

The NBA’s drug policy has remained relatively constant over the years. The NHL first instituted a drug-testing policy for PEDs in 2005.

What causes an athlete to assume the risk of taking drugs? For an NBA player, maybe it’s knowing that he can always come clean, so to speak, and get free treatment. For an NFL wide receiver, maybe it’s the possibility that an easily obtained Adderall prescription could improve his reflexes. For an MLB player, maybe it’s the fact that random tests are few and far between. Whatever the case, it’s clear that positive drug tests are much more prevalent in today’s sports than they were even ten years ago.

Many sports fans tend to take the black-and-white view of athletes and PEDs: professional athletes who take PEDs are labeled as poor decision makers, while athletes who reject PEDs are supporting the purity of the sport. However, athletes and PEDs actually lie more in a grey area. Given the profound effects that PEDs can have on your body, and the fact that marginal improvements in performance can be rewarded with multi-million dollar contracts, professional athletes who take PEDs might be more accurately labeled as calculated risk-takers — especially if their sport’s drug testing policies are lax.

It’s easy to ask (and answer) the question of why so many athletes get caught using PEDs. Instead, maybe we should begin asking ourselves — why so few?

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Article contents

Alcohol abuse and drug use in sport and performance.

• Matthew P. Martens Matthew P. Martens University of Missouri
• https://doi.org/10.1093/acrefore/9780190236557.013.168
• Published online: 28 June 2017

Issues associated with athletics, alcohol abuse, and drug use continue to be salient aspects of popular culture. These issues include high-profile athletes experiencing public incidents as a direct or indirect result of alcohol and/or drug use, the role that performance-enhancing drugs play in impacting outcomes across a variety of professional and amateur contests, and the public-health effects alcohol abuse and drug use can have among athletes at all competitive levels. For some substances, like alcohol abuse, certain groups of athletes may be particularly at-risk relative to peers who are not athletes. For other substances, participating in athletics may serve as a protective factor. Unique considerations are associated with understanding alcohol abuse and drug use in sport. These include performance considerations (e.g., choosing to use or not use a certain substance due to concerns about its impact on athletic ability), the cultural context of different types of sporting environments that might facilitate or inhibit alcohol and/or drug use, and various internal personality characteristics and traits that may draw one toward both athletic activity and substance use. Fortunately, there are several effective strategies for preventing and reducing alcohol abuse and drug use, some of which have been tested specifically among athlete populations. If such strategies were widely disseminated, they would have the potential to make a significant impact on problems associated with alcohol abuse and drug use in sport and athletics.

Introduction

Alcohol and drugs are a pervasive part of many sports, and in many ways they are inextricably linked. These links include issues such as ubiquitous alcohol advertising and sponsorship in many sports, frequent scandals involving performance-enhancing drugs (e.g., anabolic steroids and human growth hormone), and high-profile incidents among nationally known athletes that involve excessive alcohol and/or drug use. Scholarship on alcohol abuse, drug use, and sport has increased substantially, providing a more complete understanding of the phenomenon. Alcohol use among athletes has received more attention in the research literature than use of other substances, which is not surprising considering that it is abused more than drugs like marijuana, cocaine, and amphetamines. Three primary topics related to alcohol and other drug use are discussed in this article. First, rates of alcohol abuse and drug use among different groups of athletes are addressed. When possible, comparisons with relevant nonathletes norms are discussed. Second, several unique considerations associated with understanding alcohol abuse and drug use specifically among athletes are presented. Third, prevention and intervention strategies that have promise for reducing alcohol abuse and drug use in sport are explored. Finally, suggestions are provided for future directions among scholars and practitioners interested in this topic.

Prevalence of Substance Abuse in Sport

Although few studies have examined prevalence rates of alcohol abuse or other formal alcohol use disorders among athletes, several studies have examined rates of binge drinking or other indicators of at-risk alcohol consumption. Research has generally shown that younger adolescents participating in sport are more likely than those not participating in sport to report excessive alcohol use (Kwan, Bobko, Faulkner, Donnelly, & Cairney, 2014 ), although this relationship may differ depending upon other contextual factors. For example, one study of more than 8,000 high school students in the United States found that participating in sports was associated with an overall increase in problematic alcohol use over time, but only for adolescents who did not participate in other extracurricular activities like academic or music clubs (Mays, DePadilla, Thompson, Kushner, & Windle, 2010 ). Another study of more than 3,000 Norwegian adolescents found that sports participation was associated with increased likelihood of future alcohol intoxication, but only for those participating in team sports (Wichstrøm & Wichstrøm, 2009 ). Several large studies from the 1990s and early 2000s showed that college athletes in the United States were more likely than those not participating in formal athletics to report high-risk drinking and experience alcohol-related problems (Leichliter, Meilman, Presley, & Cashin, 1998 ; Nelson & Wechsler, 2001 ; Wechsler, Davenport, Dowdall, Grossman, & Zanakos, 1997 ). In these studies, more than 50% of college athletes reported at least one binge-drinking episode (typically defined as five or more drinks for men and four or more drinks for women in a single sitting) and more than 25% reported three or more binge-drinking episodes in the preceding two weeks. Comparison rates for those not participating in formal athletics were 38%–43% for at least one binge-drinking episode and 16%–21% for at least three binge-drinking episodes. College athletes were also more likely than nonathletes to report a host of academic, legal, and interpersonal difficulties associated with their alcohol use. A more recent study showed that college athletes at all competitive levels (intramural, club, and varsity) engaged in binge-drinking episodes more frequently than nonathletes (Barry, Howell, Riplinger, & Piazza-Gardner, 2015 ). Comparatively fewer studies have been conducted among older adults participating in organized sports, although evidence suggests both amateur and elite adult athletes in certain sports may drink more than the general adult population and/or at hazardous levels (Dietze, Fitzgerald, & Jenkinson, 2008 ; Kerry S O’Brien, Blackie, & Hunter, 2005 ; O’Farrell, Allwright, Kenny, Roddy, & Eldin, 2010 ). Together, the existing research suggests that, in general, those who participate in sport are at-risk for excessive alcohol use and related negative consequences.

Recreational Drugs

In contrast to the literature on alcohol abuse, research on recreational drug use and sport suggests that those participating in athletics may be less likely than others to use a variety of substances (Lisha & Sussman, 2010 ). A meta-analysis of 17 studies examining drug use among adolescents found that those participating in sport were significantly less likely than those not participating in sport to report cannabis use (Diehl et al., 2012 ). Another systematic review of longitudinal studies among adolescents found that athletic participation was inversely associated with the use of drugs other than cannabis (Kwan et al., 2014 ). Research among college athletes in the United States has also found that athletes were less likely than nonathletes to report marijuana use (Wechsler et al., 1997 ), and rates of other drug use among this group are generally lower than population norms (Johnston, O’Malley, Bachman, Schulenberg, & Miech, 2015 ; Rexroat, 2014 ). Finally, the limited research on illicit drug use among elite athletes at both the adult and adolescent level also suggests lower prevalence rates relative to the general adult population (Dunn, Thomas, Swift, & Burns, 2011 ; Peretti-Watel et al., 2003 ).

Performance-Enhancing Drugs

Drug use in sport is often most associated with a variety of substances designed to improve athletic performance (e.g., anabolic steroids, human growth hormone). Many of these substances are illegal without a prescription and/or banned by sporting agencies. Several high-profile incidents have involved athletes being punished for the use of the substances, such as Ben Johnson losing the 100-meter track gold medal in the 1988 Olympics for steroid use, Lance Armstrong being stripped of seven Tour de France cycling titles for performance-enhancing drug use, and a number of top athletes in United States receiving suspensions for steroid or other performance-enhancing drug use. Such incidents may create the impression that performance-enhancing drug use is rampant in athletics, but the research evidence is equivocal. A meta-analysis of nine studies found an overall positive association between adolescent sports participation and anabolic steroid use (Diehl et al., 2012 ). In contrast, a study of more than 16,000 high school students in the United States reported no differences in steroid use between those who did and did not participate in athletics (Miller, Barnes, Sabo, Melnick, & Farrell, 2002 ). A 2013 study of approximately 21,000 college athletes in the United States indicated that only 0.4% of the sample used anabolic steroids in the preceding 12 months (Rexroat, 2014 ). In comparison, a national study of college students reported an annual prevalence rate of 0.5% (Johnston et al., 2015 ).

Rates of performance-enhancing drug use may be higher among elite athletes, where the stakes and incentives for optimal performance are quite high. A recent review of the literature concluded that the “doping” rate among elite athletes was between 14% and 39%, although there was considerable variation among different types of sports and hard data on the question is lacking (de Hon, Kuipers, & van Bottenburg, 2015 ). These estimates are consistent with several anecdotal reports in the popular press estimating that performance-enhancing drug use rates are relatively high among elite adult athletes, particular in certain sports (e.g., American football or track and field).

The Sporting Context, Alcohol Abuse, and Drug Use

Research has generally shown that, particularly among adolescents, sport participation is associated with positive psychosocial outcomes (Clark, Camiré, Wade, & Cairney, 2015 ). This finding extends to prevalence rates of some substances (e.g., cannabis and other illicit drugs), where sport participation has been shown to be a protective factor. Yet, for other substances (e.g., alcohol) sport participation serves as a risk factor. Such contradictory findings illustrate the importance of understanding the roles various sport-related factors play in either promoting or inhibiting alcohol abuse and drug use. It is also important to explore such factors considering the ethical issues inherent in the use of some substances in sport (i.e., performance-enhancing drugs) and the degree to which the use of other substances can lead to unique negative consequences for athletes (e.g., failed drug tests, negative publicity, poor sporting performance). Several factors that are somewhat unique to the sporting context are discussed.

The Cultural Context of Alcohol and Sport

Despite the potential negative effects of alcohol use on athletic performance (Barnes, 2014 ), in many countries alcohol and sport are inextricably linked. Alcohol beverage companies throughout the world serve as major sponsors for leagues, teams, and in some cases even individual athletes (Collins & Vamplew, 2002 ). There are several mechanisms by which these associations might translate to individual drinking behavior. One involves an indirect association: athletes, most of whom have likely been following sport from a young age, have strongly ingrained ideas associating athletic participation with alcohol consumption. A second is a more direct association, where athletes receive free or discounted alcohol products due to sponsorship from a beverage company. Two studies of athletes in Australia and New Zealand, ranging from club to national level, revealed positive associations between alcohol sponsorship and individual alcohol consumption (O’Brien & Kypri, 2008 ; O’Brien, Miller, Kolt, Martens, & Webber, 2011 ).

Another cultural aspect of sport that may relate to drinking behavior involves popularity and prestige. Athletes, particularly those who are successful and well-known, are often afforded higher social status than their peers, which can lead to significant social opportunities (Holland & Andre, 1994 ; Tricker, Cook, & McGuire, 1989 ). At the adolescent and collegiate level, successful athletes may find that they are regularly invited to social gatherings where alcohol or other drugs are provided. Athletes old enough to go to bars, clubs, and other public establishments may find that other patrons are eager to socialize with them, including purchasing their drinks. Additionally, a club or bar owner may provide free drinks to athletes of a certain stature to encourage their patronage. Basic behavioral economics principles indicate that the likelihood of substance use will increase with lower price and greater availability (Murphy, Correia, & Barnett, 2007 ). Thus, athletes who may be at-risk for developing a substance abuse problem may often find it relatively easy to be in social settings where alcohol and drugs are readily available.

Performance-Related Considerations

Athletes have clear incentives to perform at an optimal level in their sport. The reward value of such incentives generally increase as athletes progress to more elite competitive levels, culminating in major awards, international recognition, educational opportunities in the form of university scholarships, and the opportunity to make one’s (often well-compensated) livelihood in sport. Thus, some athletes will be tempted to use substances that have the potential to make them stronger and faster, thereby improving their athletic performance. Indeed several studies among athletes at varying competitive levels have shown that the primary reason athletes choose to use performance-enhancing substances is to improve their athletic performance (Miller, Barnes, Sabo, Melnick, & Farrell, 2002 ; Rexroat, 2014 ). Conversely, concerns about the impacts certain substances can have on athletic performance may serve as an important deterrent among athletes. Research among college students in the United States suggests that concerns about athletic performance is an important reason they choose not to use certain substances, although factors such as health-related concerns and lack of desire to experience the substance’s effects seem to be more salient factors (Rexroat, 2014 ). Addressing the role certain substances can play in inhibiting athletic performance could be a potentially useful component of interventions designed to prevent and reduce drug use among athletes.

Seasonal Effects

A unique aspect of many athletes’ lives involves the yearly rhythms surrounding their competitive season. Although many athletes train year-round, they have defined periods when their athletic performance is more salient and relevant. For example, the formal competitive season for a college football player in the United States runs from August (the start of official practice) through December or January (depending upon the date of the final game). These athletes may have other obligations throughout the year, such as spring practice and off-season workouts, but they are not participating in formal competitions. Athletes who limit alcohol and drug use due to performance-related concerns may choose to increase their use outside of these formal competitive seasons. Several research studies have shown that transitioning from in- to off-season serves as a risk factor for heavy drinking among athletes. Studies among college athletes in the United States found heavier alcohol consumption outside of their athletic season, including one longitudinal study that reported average drinking rates doubled during the off season (Bower & Martin, 1999 ; Martens, Dams-O’Connor, & Duffy-Paiement, 2006 ; Thombs, 2000 ). Another study of professional Australian Football League players showed a dramatic increase in risky drinking between pre-season and in-season time periods versus the off season (Dietze et al., 2008 ). The use of other substances may follow a similar pattern, and suggests the need for targeted intervention/prevention efforts for athletes transitioning out of their competitive seasons.

Drug Testing

Formal testing for the presence of certain drugs, particularly during an athlete’s competitive season, is another factor that almost certainly impacts drug use among these groups. Elite athletes at the international level are regularly tested for both performance-enhancing and illicit drug use, as are athletes in many major professional sports leagues and major amateur organizations (e.g., college athletes at National Collegiate Athletic Association member institutions). Several studies have shown that drug testing serves as a deterrent to banned substances (Coombs & Ryan, 1990 ; Dunn, Thomas, Swift, Burns, & Mattick, 2010 ), and may partially account for relatively low prevalence rates of certain illegal drugs. However, one study among adolescents in the United States showed that randomized testing reduced drug use but increased other risk factors for use, such as perceived norms and less risky beliefs about drug use (Goldberg et al., 2003 ). Further, if athletes are aware of their testing schedule, they may be able to organize their use around times when it would not trigger a positive test. Fear of a positive drug test almost certainly inhibits short-term drug use for some athletes, but the degree to which drug testing provides a more general impact on the substance use habits of athletes is more difficult to determine.

Ethical Considerations

A final sport-related contextual factor to address when considering substance use among athletes is ethical issues related to performance-enhancing drug use. This consideration is almost wholly unique to the athletic environment, as it is one of the only arenas where an individual may be incentivized to take a substance that would allow him or her to be physically superior to a specified opponent. Health or societal concerns regarding substance use can be applied across almost any group, but sport is unique in that use of certain substances may undermine the core foundation of the entity. Virtually all sports are based on the notion that each competitor agrees to a specified set of rules and regulations, which in many instances involve the types of drugs and other performance-enhancing techniques that are allowable. For example, in many professional sports leagues, athletes are allowed to take certain narcotic painkillers, but cannot take anabolic steroids or human growth hormone. Sporting organizations are motivated to ensure that athletes do not use drugs that are banned by their governing body, as it is important that they convey to the public that they are attempting to enforce the ideal of all athletes playing by the same rules. Further, sporting organizations are also motivated for their athletes to be perceived as living up to some sort of ideal (e.g., serving as a “role model” for children), which is why use of certain substances that have no performance benefits still results in suspension and other punishments. Many athletes therefore find themselves in situations regarding drug use that seem arbitrary, and at times hypocritical, in terms of the substances they can ingest. For example, they may be suspended for using a substance legal in several countries and states in the United States (cannabis), but they are allowed to use narcotic painkillers in an effort to facilitate their return to the practice or competitive arena.

Intervention and Prevention Strategies for Alcohol Abuse and Drug Use

A number of effective intervention and prevention strategies for alcohol abuse and drug use have been identified. This section of the chapter will address those strategies that have been well-studied and have the strongest empirical support. When possible, research that has examined these approaches specifically among athletes is presented here. Most of these studies focus on alcohol use, but in some cases their findings may translate to other substances.

Motivational Enhancement Interventions

The term “motivational enhancement” refers to a group of interventions, often sharing similar characteristics, which are designed to enhance an individual’s motivation to change a target behavior(s). Most of these interventions are founded in motivational interviewing, which is a theoretical and therapeutic approach that helps clients resolve ambiguity about behavior change (Miller & Rose, 2009 ). Motivational interviewing-based approaches are designed to help individuals identify their own reasons for change and support specific efforts toward change. A common feature of motivational enhancement interventions is personalized feedback, where the individual receives personalized information about the behavior in question. Theoretically, this feedback helps increase internal discrepancies in the individual that subsequently result in behavior change. Popular components of this feedback include personalized social norms information (i.e., how the individual’s drinking behavior and perception of “typical” drinking among a specific reference groups compares to actual drinking norms), typical drinking levels (e.g., estimated blood alcohol concentration on a heavy drinking occasion) and risks associated with such levels, and a summary of problems associated with the behavior in question (e.g., specific negative consequences experienced over the past 30 days as a result of alcohol consumption). These interventions also sometimes include an alcohol skills training component (Dimeff, Baer, Kivlahan, & Marlatt, 1999 ).

Overall, there is considerable empirical support for the efficacy of motivational enhancement interventions. Several meta-analyses have shown that brief (1–2 sessions) in-person interventions are effective at reducing at-risk alcohol and drug use (Burke, Arkowitz, & Menchola, 2003 ; Jensen et al., 2011 ; Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010 ). Further, interventions that provide personalized feedback in the absence of individual clinician contact have also been shown to be efficacious at impacting substance use (Miller et al., 2013 ). A handful of studies have examined the efficacy of motivational enhancing interventions specifically among athletes, with promising results. For example, in one study, Martens and colleagues ( 2010 ) found that a personalized feedback-only intervention was effective among a sample of college athletes at reducing peak blood alcohol concentration. Another study by Doumas et al. ( 2010 ) found that a feedback-only intervention was effective among high-risk drinkers at reducing average weekly drinking, drinking to intoxication, and peak number of drinks consumed on a single occasion. Finally, a recent study by Cimini et al. ( 2015 ) provided similar support for the efficacy of a single-session in-person motivational enhancement intervention. Together, these findings suggest that brief, motivational enhancement interventions have considerable potential in reducing harmful alcohol consumption among athletes.

Alcohol and Drug Skills Training Programs

Another class of interventions involve those designed to teach individuals specific skills and strategies that are used to reduce alcohol and drug use and limit the likelihood of experiencing substance-related problems. Most of these programs have focused on alcohol use, and their specific content can vary widely and include both alcohol-specific topics and general lifestyle factors (Larimer & Cronce, 2007 ). The delivery of these types of programs can also vary considerably, including individually in the context of a motivational interviewing-based session (Martens, Smith, & Murphy, 2013 ), in a group format (Fromme & Corbin, 2004 ), or via a computer without personal contact (Carey, Henson, Carey, & Maisto, 2009 ). Overall, empirical support for these types of programs has been mixed, which is not surprising considering the diversity of approaches (Cronce & Larimer, 2011 ).

Only a few studies have examined the efficacy of alcohol skills programs specifically among athletes. One early study found no effects for a single session program delivered in a group setting that included general educational information about alcohol and other drugs, stress management, and strategies to alleviate peer pressure associated with substance use (Marcello, Danish, & Stolberg, 1989 ). This study was limited by factors such as a low sample size and high dropout rate. Other skills programs are presented in the literature, but they have either not been formally evaluated (Curry & Maniar, 2004 ; Meilman & Fleming, 1990 ) or have not been subjected to peer review (Wyrick et al., 2009 ). Considering that many sporting entities mandate that their athletes receive some degree of education/training on alcohol and drug-related issues, implementing skills-based programs that have shown evidence of efficacy in the general population could have a significant impact on the alcohol and drug use habits of athletes at a variety of competitive levels.

Contingency Management

One of the most efficacious strategies for intervening with individuals experiencing alcohol and drug disorders is contingency management, with one meta-analysis indicating that it had the strongest effects of any psychosocial intervention in terms of treating substance use disorders (Dutra et al., 2008 ). Contingency management interventions are based on basic operant behavior principles, where target behavior is reinforced and therefore likely to increase. For example, patients in a contingency management program for a drug-use disorder may receive a cash payment or voucher each time they provide a negative urine sample. The level of reinforcement often increases over time, with consecutive instances of the target behavior yielding escalating rewards (Budney, Moore, Rocha, & Higgins, 2006 ). Theoretically, the individual will initially engage in the behavior (e.g., being abstinent from alcohol or drugs) to receive the tangible reward associated with the intervention. Over time, the individual will begin to experience other reinforcers that naturally occur due to decreased substance use, such as better relationships and job performance. Ideally, these reinforcers will be powerful enough to cause the individual to continue to engage in the target behavior even after the contingency management intervention has ended. For example, an athlete in a contingency management program whose sport performance improves after ceasing drug use may be likely to continue to refrain from drug use even when he or she no longer receives the financial incentives associated with the program.

To date no studies have been published that examined the efficacy of contingency management interventions specifically among athletes. Due to the fact that many sporting organizations already routinely test athletes for various substances, implementing such a program in certain athletic settings may be somewhat easier than the typical outpatient or inpatient clinic. Indeed, many organizations already have a punishment-related system affiliated with drug testing (e.g., suspensions for positive drug tests); a contingency management system would involve the reverse of this, where athletes received incentives for negative drug tests. Such a program would likely be most appropriate for athletes who have been experiencing fairly significant alcohol and drug problems and are attempting to eliminate their use of the substances.

Twelve-Step Programs

Twelve-step programs are likely the mode of alcohol and drug abuse intervention most familiar to the general public. They are most frequently affiliated with Alcoholics Anonymous or Narcotics Anonymous (AA/NA). AA or NA programs have historically been the most common route for individuals to engage in a 12-step program, but there are examples of individual interventions designed to facilitate the 12-step process (e.g., Project MATCH Research Group, 1997 ). Twelve-step programs conceptualize addiction as a disease, and therefore complete abstinence is the desired outcome. “Working” a 12-step program involves a series of steps, which include behaviors such as admitting that one is powerless over addiction (Step 1), asking God or a higher power to remove shortcomings (Step 7), and carrying the 12-step message to other alcoholics/addicts (Step 12).

There is evidence to suggest that 12-step programs are as efficacious as other interventions/treatments (Ouimette, Finney, & Moos, 1997 ; Project MATCH Research Group, 1997 ). However, it can be difficult to examine the efficacy of individual 12-step programs; by definition, they are usually anonymous and assignment to appropriate control conditions is logistically challenging. No published studies have examined the efficacy of 12-step programs among athletes, although numerous athletes have undoubtedly participated in such programs. If an athlete has a significant alcohol abuse and/or drug use problem and is open to abstinence as a treatment goal, then encouraging them to consider a 12-step program would be appropriate.

Environmental Interventions

Environmental interventions to refer to a broad class of interventions designed to impact behavior by changing the external environment in such a way as to inhibit alcohol and drug use. The interventions addressed thus far in this chapter are individual interventions, in that they are designed to change thoughts, behaviors, and emotions of specific individuals who receive the intervention. In contrast, environmental interventions are not necessarily targeted to specific individuals but are designed to create a context that disincentivizes alcohol and drug use among all of those in the environment. Most of these interventions have focused on alcohol use because it is a legal substance readily available in most communities. An example of a well-known environmental intervention involved raising the drinking age in the United States from 18 to 21, which resulted in a decrease in alcohol consumption and traffic crashes (Wagenaar & Toomey, 2002 ).

Many environmental interventions involve attempts to create policies or rules that limit access to alcohol, such as restricting times when alcohol can be sold or outlawing drink discounts or other specials that might encourage heavy alcohol use (Toomey, Lenk, & Wagenaar, 2007 ). Other interventions focus on creating, publicizing, and enforcing rules against alcohol and drug use (e.g., alcohol-free dormitories on college campuses). A number of studies have shown that environmental interventions can be efficacious at impacting the target behavior (see Middleton et al., 2010 ; Task Force on Community Preventive Services, 2010 ; Toomey et al., 2007 ), but they can also pose unique challenges. Implementing environmental interventions often requires considerable coordination among a variety of parties, some of whom actually benefit from substance use. For example, if a group of bar owners believed that drink specials yielded more patrons and greater profits, it might be challenging to convince them to outlaw such specials in an attempt to limit heavy drinking.

Another means of conceptualizing environmental interventions for alcohol and drug abuse is behavioral economics theory, which posits that the decision to use substances is related to availability and price of both the substances themselves and alternative sources of reinforcement (Vuchinich & Tucker, 1988 ). For example, all else being equal, adolescent alcohol use would theoretically be lower in a community that had numerous alcohol-free social activities available that were reinforcing to young people than a community that did not have such alternative activities. Behavioral economic theory also posits that alcohol and drug use will be lower when individuals are orientated toward future rewards incompatible with substance use, such as successful educational and vocational outcomes (Murphy & Dennhardt, 2016 ). Therefore, environmental interventions that promote such a future-based orientation may result in diminished desire to obtain short-term reinforcement from alcohol and drug use.

To date, only one large controlled trial has examined the efficacy of an environmental alcohol intervention among athletes. In this study, the researchers evaluated the efficacy of the Good Sports program (Rowland, Allen, & Toumbourou, 2012 ), which was implemented at community football clubs in Australia. This program includes a variety of environmental interventions grouped across three accreditation levels. An example of a level 1 intervention strategy is serving alcoholic drinks only in standard drink amounts, an example of a level 2 strategy is not serving shots of liquor, and an example of a level 3 is having and distributing a written alcohol policy to club members. An initial study showed that clubs with higher accreditation levels reported less alcohol use than clubs with lower accreditation levels (Rowland et al., 2012 ). Subsequently, researchers conducted a trial where 88 football clubs were randomized to the intervention or control condition. After the intervention, participants in the intervention condition reported less risky alcohol use than those in the control condition (Kingsland et al., 2015 ).

Considering these promising findings, as well as the overall support for different types of environmental interventions in other populations, athletic organizations should consider contextual strategies designed to limit alcohol and other drug use. Many large organizations have clear rules and policies built into their larger systems, such as suspensions for positive drug tests or alcohol-related arrests. Individual teams, clubs, or schools/universities could build more specific, targeted policies into their systems. For example, a high school or adolescent sporting club might ask team members to sign a pledge to refrain from alcohol and drug use, whereas a collegiate or adult club might ask team members to pledge to limit their alcohol consumption in some way. Consistent with behavioral economic theories, organizations could also promote social activities that do not involve substance use. Such strategies may be particularly useful among adolescents and young adults, and they could involve activities such as regular team social outings and partnerships with local community organizations that offer substance-free activities.

Conclusion and Future Directions

Research has convincingly established that for some substances, particularly alcohol, athletes have higher levels of at-risk use than individuals not participating in athletics. Conversely, rates of use for many other types of drugs are lower among athletes than nonathletes. Nonetheless, it is important to focus on understanding and limiting drug use among athletes, considering the myriad negative effects of such use on this population at all competitive levels. Research in the general population has established several effective individual and environmental intervention strategies, and there is emerging evidence for the efficacy of many of these interventions specifically among athletes. One recommendation for future research is to examine strategies for disseminating different types of empirically supported interventions to athletes, particularly those that are low cost (e.g., personalized feedback interventions delivered electronically). A second research direction could involve examining the efficacy of environmental interventions at more local levels, such as team-specific strategies designed to limit alcohol and drug use. A third direction involves more research focused on substances besides alcohol, particularly in terms of intervention studies. Finally, researchers could consider exploring strategies for targeting/tailoring existing interventions to be more efficacious specifically among athletes. For example, one study found that personalized feedback tailored specifically for college athletes was more effective than feedback applicable to a general student population at reducing high-risk drinking (Martens, Kilmer, Beck, & Zamboanga, 2010 ). Tailoring other types of existing interventions may also yield enhanced effects among athletes.

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Drug Abuse in Sports

The essay will examine the issue of drug abuse in the sports world, exploring how performance-enhancing and recreational drug use affects athletes, the integrity of sports, and the measures taken to combat this problem. On PapersOwl, there’s also a selection of free essay templates associated with Drug Abuse.

How it works

Drug abuse occurs in all sports and at most levels of competition. Athletic life may lead to drug abuse for a number of reasons,, to self-treat injuries, and retirement from sport. Most sport organizations ban the use of any drug that can help your ability to excel in any sport. Using enhancing drugs, always have side effects like easy to anger, depression, and even death. Today people may know that athletes use steroids and performance-enhancing drugs, but it is only the people who get caught that they dislike and punish, they don’t drug test them until suspicions arise.

These athletes are also usually the ones who set the amazing records such as many famous athletes ( like Alex Rodriguez).

Also during seasons the teams usually get drug tested if the players seems juiced. Juiced is a term used for somebody on drug that enhance their abilities to perform in a game. Some of the athletes use marajuana, as a enhancing drug because it makes you feel less when your on it, allowing harder workouts. Also, if some teenagers take performance drugs they are making them better than everyone else giving themselves an advantage over everyone else which is cheating, so why should they get money for using drugs to win, how do we know they aren’t actually good

at the sport. Performance drugs in sport should not be tolerated and should be illegal. Stores shouldn’t give teenagers drugs that way they can do well in a sport. Many store managers however have been called into court to make their statement “why they did give the athletes the enhancing drugs”?

Another claim made here is that penalties for using drugs such as fines, suspensions, and even lifetime bans. The simularities often cited here this is the case of death penalties for using illegal drugs or being a drug supplier can result in penalties not as far as death. If you use or start to use the illegal drugs then you will have to keep taking them. If you stop you start to have erratic behaviour. Many people who use this drugs can’t get off them because they are addictive. Just like many other drugs that make you feel great, such as weed and other psychedelic drugs.

Many think drug enhancers are okay because they allow people to get fit, especially when off season. But many people don’t understand that when your on off season, your still owned by the team and company. The company then can fire them, or release a fine for a good amount of money. Usually the fines are above 2 million dollars.Now according to the FDA anyone with drugs or taking them will be suspended and fined because its a violation the the rules. Now if someone isn’t caught until they are retired or later on after taking it, they still will get fined. And maybe they even go to court for illegal drug use, they can still lose their rings or trophies for illegal enhancement , if they win the World Series.

• “Abuse of Drugs to Enhance Sports Performance: Winning at Any Cost.” Nationwide Children’s Hospital, www.nationwidechildrens.org/specialties/sports-medicine/sports-medicine-articles/abuse-of-drugs-to-enhance-sports-performance-winning-at-any-cost.
• “Guide to Addiction and Treatment for Athletes.” American Addiction Centers, americanaddictioncenters.org/athletes.
• Rpowell. “Mind, Body and Sport: Substance Use and Abuse.” NCAA.org – The Official Site of the NCAA, 18 July 2017, www.ncaa.org/sport-science-institute/mind-body-and-sport-substance-use-and-abuse.

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Top 10 Pro & Con Arguments

Anabolic Steroids

Blood-Doping and Erythropoietin (EPO)

Human Growth Hormone (HGH)

Techno-Doping

Gene-Doping

Criminalization

Therapeutic Use Exemptions (TUEs)

Baseball Hall of Fame

1. Anabolic Steroids

Anabolic steroids mimic our bodies natural hormones, specifically male sex hormones, and have legitimate medical uses to treat anemia, asthma, bone pain from osteoporosis, muscle loss, and postmenopausal symptoms, among other ailments. Athletes use the drugs illicitly to achieve endurance increases, fat loss, muscle recovery increases, and muscular size and strength increases. However, the drugs carry serious side effects including but not limited to: abnormal menstrual cycles, aggressiveness, brain tissue damage, depression, hypertension, impotence, liver dysfunction, mania, and testicular shrinkage or atrophy

Proponents of allowing athletes to use anabolic steroids argue that athletes are going to dope regardless of the rules so steroids should be allowed, that allowing steroids could reinvigorate boring or languishing sports, and that athletes using steroids doesn’t lessen, but may increase, the entertainment value.

Opponents of allowing athletes to use anabolic steroids argue that anabolic steroid use is dangerous and can cause serious side effects (including addiction and death), that steroid use is not setting a good example for youth sports, and that sports should encourage clean play for the fairness and spirit of the game.

Read More about This Debate:

Should Anabolic Steroid Use Be Accepted in Sports?

Maryville University, “Understanding and Preventing Steroid Abuse in Sports,” online.maryville.edu, Apr. 14, 2021 ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Should Anabolic Steroid Use Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021

2. Blood-Doping and Erythropoietin (EPO)

Blood-doping refers to any method, including using the enhancement drug erythropoietin (EPO), to increase red blood cells. EPO can be used medically to treat anemia, among other applications. Athletes use blood-doping illicitly to increase endurance and reduce fatigue. However, blood-doping has been found to “thicken” blood, increasing the chances of hypertension, blood clots, stroke, and heart attacks.

Proponents of allowing athletes to blood-dope argue that blood-doping is already so prevalent that banning it now would lessen the sport, that the methods are safe for athletes, and that the same effects can be achieved by working out at high altitudes.

Opponents of allowing athletes to blood-dope argue that blood doping is dangerous and can lead to athletes’ deaths, that normalizing blood-doping is asking athletes to risk their lives to play a sport, and sport doesn’t need more athletes that break the rules.

Should Blood Doping and Erythropoietin (EPO) Use Be Accepted in Sports?

ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Should Doping and Erythropoietin (EPO) Use Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021 Elizabeth Quinn, “Erythropoietin (EPO) and Blood Doping in Sports,” verywellfit.com, Mar. 26, 2020

3. Stimulants

Stimulants are drugs that speed up parts of the body and brain, directly affect the central nervous system, and increase heart rate, blood pressure, metabolism, and body temperature. Medical uses include the treatment of allergies, asthma, ADHD (attention deficit hyperactivity disorder), common colds, headaches, and nasal congestion. Athletes use the drugs illicitly to increase alertness, competitiveness, responsiveness, and weight loss. However, side-effects of the drugs include addiction, aggression, anxiety, hypertension, brain hemorrhage, coma, convulsions, dehydration, heart attacks, insomnia, stroke, tremors, and even death.

Proponents of allowing athletes to use stimulants argue that Air Force pilots, long haul truckers, and others use stimulants without stigma, and that their use does not lessen the integrity of the game.

Opponents of allowing athletes to use stimulants argue stimulants are dangerous, can result in death, and do nothing to promote the health of the athlete, and that the cultural acceptance of stimulant use should change.

Should Stimulants Use Be Accepted in Sports?

Australian Academy of Science “Stimulants in Sport,” science.org.au (accessed on Apr. 19, 2021) ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Should Stimulants Use Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021

4. Human Growth Hormone (HGH)

Human growth hormone (HGH) is naturally produced by humans to control how the body grows into adulthood. Medical uses for children include growth hormone deficiency, Prader-Willi syndrome, Turner syndrome, idiopathic short stature, and growth deficiency. Medical uses for adults include hormone deficiency, radiation therapy, or trauma. Off-label uses on HGH are illegal and can result in felony convictions in the United States, but athletes use the drug illicitly to improve muscle mass and performance. However, side effects of HGH include joint pain, muscle weakness, diabetes, carpal tunnel syndrome, enlarged heart, and hypertension.

Proponents of allowing athletes to use HGH argue that HGH can be used safely by athletes to repair injuries and that adult athletes should be able to make their own choices about their bodies.

Opponents of allowing athletes to use HGH argue that any doping is cheating and doping allows a culture of coercion, bribery, unsafe medical practice, and unsportsmanlike conduct.

Should Human Growth Hormone (HGH) Use Be Accepted in Sports?

Mayo Clinic, “Performance-Enhancing Drugs: Know the Risks,” mayoclinic.org, Dec. 4, 2020 ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Should Human Growth Hormone (HGH) Use Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021 USADA, “Growth Hormone in Sport: What Athletes Should Know,” usada.org, Feb. 13, 2019

5. Techno-Doping

Techno-Doping as a technological augmentation that confers an advantage to the athlete, be it a specially designed shoe, a bike motor, or limb protheses that specifically offers an advantage over other athletes in the same competition. While the issue currently revolves around athletes who are otherwise impaired (including Oscar Pistorius who wears “cheetah” prosthetic legs, future iterations of the debate could involved able-bodied athletes who otherwise augment their bodies and athletes who improve their equipment, such as bicycles.

Proponents of allowing athletes to techo-dope argue that the advancements could push the sports and athletes in interesting ways, and that audiences not only don’t oppose new technology, but will be excited to see sports and athletes play a reinvigorated game.

Opponents of allowing athletes to techno-dope argue that doping is doping and all doping is unfair, that the advancements disadvantage athletes who refuse to dope, and that tech moves sport too far away from the accomplishments of the human body.

Should Techno-Doping Be Accepted in Sports?

ProCon.org, “Should Techno-Doping Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021

6. Gene-Doping

Gene-doping is a still-experimental manipulation of cells or genes to improve athletic performance. Gene therapy came about in the 1990s and entered popular culture via “Schwarzenegger mice,” which had been treated for muscle wasting conditions and ended up with twice the normal amount of muscle after gene manipulation. While currently more science fiction than reality, WADA has already banned the practice in athletes. The benefits and drawbacks medically are still hypothetical.

Proponents of allowing athletes to gene-dope argue that the enhancements could breathe new life into boring sports, could allow more categories of participation, and could be finely tuned to help athletes with specific issues such as muscle twitches.

Opponents of allowing athletes to gene-dope argue that doping is doping and all doping is unfair, and that gene-doping is basically science fiction that has numerous and serious ethical concerns such as parents altering fetuses in vitro to produce super athletes.

Should Gene-Doping Be Accepted in Sports?

Nick Busca, “Should Athletes Be Allowed to Enhance Their Genes?,” onezero.medium.com, Apr. 29, 2019 ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Should Gene-Doping Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021

7. Marijuana

Marijuana is frequently banned by sports organizations, yet the drug’s status as performance-enhancing is questioned. Further complicating the issue is that marijuana, as a medical or recreational drug is legal in most US states. Athletes take the drug illicitly to reduce anxiety, pain, and reliance on opioids. Side effects include appetite increase, balance and coordination impairment, concentration loss, drowsiness, motivation loss, panic attacks, and weight gain. If smoked (rather than consumed via edible), side effects can include bronchitis and cancer of the lung, throat, mouth, and tongue.

Proponents of allowing athletes to consume marijuana argue that the benefits for athletes are well-documented, that the drug is better than opioids, and that the ban is a continuation of an unjust drug war.

Opponents of allowing athletes to consume marijuana argue that all athletes should not play under the influence of any drug, that marijuana is not legal everywhere the players play, and the benefits are questionable.

Should Marijuana Use Be Accepted in Sports? Is Marijuana a Performance-Enhancing Drug?

ProCon.org, “Banned Performance Enhancing Substances & Methods,” sportsanddrugs.procon.org, Apr. 9, 2021 ProCon.org, “Legal Recreational Marijuana States and DC,” marijuana.procon.org, Apr. 12, 2021 ProCon.org, “Should Marijuana Use Be Accepted in Sports?,” sportsanddrugs.procon.org, May 10, 2021

8. Criminalization

Doping was partially criminalized in the United States by the Rodchenkov Anti-Doping Act of 2019. The Act penalizes participants in international sports (in which at least one American athlete and three athletes from other countries are participants) who engage in a doping scheme. The Act does not penalize athletes who have been caught doping. The Act also does not apply to American sports such as the NFL or NBA.

Proponents of criminalizing doping argue that doping is generally linked to other crimes such as money laundering and corruption, and clean athletes are being literally robbed of endorsement deals and other financial gains when doped athletes win.

Opponents of criminalizing doping argue that the governing bodies of sports (such as WADA and USADA) should be all the enforcement needed for doping, and criminalization could cause major political and diplomatic rifts between countries.

Should Doping Be Criminalized?

ProCon.org, “Should Doping Be Criminalized?,” sportsanddrugs.procon.org, May 10, 2021 US Congress, “H.R.835 – Rodchenkov Anti-Doping Act of 2019,” congress.gov, Mar. 11, 2020

9. Therapeutic Use Exemptions (TUEs)

A therapeutic use exemption (TUE) is a waiver for an athlete to use a banned drug when that drug is medically necessary, such an athlete with ADHD taking Ritalin, which is a banned stimulant.

Proponents of therapeutic use exemptions argue that athletes need medical attention just like everyone else and the TUE is approved by the governing body, lessening the risk of illegitimate TUEs.

Opponents of therapeutic use exemptions argue that the athletes with TUEs are abusing the system and only taking the drugs to gain an advantage, and that clean play must be the same clean play for everyone.

Should Therapeutic Use Exemptions (TUE) Be Allowed for Injured or Ill Athletes?

ProCon.org, “Should Therapeutic Use Exemptions (TUE) Be Allowed for Injured or Ill Athletes?,” sportsanddrugs.procon.org, May 10, 2021 USADA, “Therapeutic Use Exemptions (TUEs),” usada.org, Apr. 26, 2021

10. Baseball Hall of Fame

As of May 12, 2021, no baseball player who has been publicly accused of using PEDs has been allowed entry into the National Baseball Hall of Fame. The debate over whether to allow such players into the Hall of Fame has raged since the “Steroid Era” of baseball, from the late 1980s through the late 2000s, when a number of players were caught and accused of using steroids.

Proponents of allowing players accused of steroid use into the hall of fame argue that it’s impossible to determine who used and who did not use steroids, that even with steroid use the players being excluded are some of the greatest to ever play the game, and the morality argument is hollow when known abusers and other law-breakers are in the hall of fame.

Opponents of allowing players accused of steroid use into the hall of fame argue that cheaters should not be honored with the sport’s highest award available, the accused players’ statistics are overblown and dishonor the clean players’ performances, and a standard should be set for clean play not only for current players but for generations of baseball players to come.

Should Baseball Players Who Have Used Banned Substances Be Voted into the Hall of Fame?

ProCon.org, “Should Baseball Players Who Have Used Banned Substances Be Voted into the Hall of Fame?,” sportsanddrugs.procon.org, May 10, 2021

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Drugs and Dopping Issues in Sports Essay

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Introduction

Works cited.

Doping is the hot issue that’s gaining worldwide attention of policy makers, legal agencies, regulatory bodies, medical associations, sports bugs and everyone associated with sports of any kind at any level. Be it the World Cup, The Olympics, Tour de France or any other globally celebrated sporting event, ‘genetically transformed athletes’ have been stirring up storms in the media from quite a past few years now.

A North Korean shooter along with a Vietnamese gymnast was caught for doping at the recent Beijing Olympics. International Olympic Committee spokeswoman Giselle Davies says the North Korean shooter Kim Jong-Su who won a silver and bronze medal, tested positive for beta blockers which help steady athletes’ hands. (ABC International).

True, ‘non-traditional’ or ‘elitist’ sport-the form of sports characterized by bigger, stronger and faster ‘genetically transformed’ athletes/players- offers entertainment as could neither be experienced nor imagined in the case of traditional or natural sports. The trend of doping (oral or intravenous) has transformed the concept of this form of entertainment and has raised numerous ethical concerns among the masses.

On the one hand, doping or introducing any such element that did not previously exist in one’s body is in itself a harmful practice and must be avoided regardless of the purpose or intentions behind the action. This questions the pressure under which athletes feel the need to dope to gain artificial strength and unnatural bodies. The billion-dollar sports industry and the fanfare, the glamour, the fame and sometimes worse- fascist nationalism, pull the athletes into the destructive chase for constant glory. This is one of the most disturbing aspects of 21 st century’s materialist trends and this can be seen in the showbiz and other popular industries. Where athletes inject harmful steroids into their bloodstream that put their bodies into an ultimate hyper state, models in the fashion industry starve themselves to achieve that perfect stick figure. Such tendencies call forth the attention of regulatory bodies to intervene and associate legal ramifications to such harmful behavior (Garnier). Aside from medical implications, doping raises many issues as to the value of victory and honesty in sports. The view contends that victorious athletes destroy the very phenomenon of competition and the integrity of the sport itself. From the Utilitarian perspective, doping reduces the overall social utility of entertainment gained thru such sport competition where players put in and win through effort and strength which was never theirs to begin with.

A very strong perspective suggests that its skills that make up a good athlete and not strength and muscles. Gaining muscle mass through steroids and anabolic supplement definitely give athletes a body that performs better and withstands more pain but it’s always constant practice and proper training that creates winning performers. And sport ultimately aims at how one utilizes their bodily faculties and excels at exercising strength. Strength, from a biological perspective, is a characteristic of one’s genes something virtually nobody has a control on. Hence it seems pointless to get enrolled in a competition which is based on biology and science- stuff we don’t have any control on. Victory, in sports, then should not be based on natural strength, rather on the skill and tact or better, the art of utilizing the strength (natural or artificially enhanced) in the best possible way. Also, today when every facility and every field of specialization is enhanced through modern technology, then why not accept doping as a modern tool for better training and superior performance? If it does poses risk to the athletes health then why not appreciate the ambitious athlete who’s willing to take (a reasonable) risk in order to compete and perform better? (Tamburrini and Tannsjo, 204) Kantian theory of free choice suggests everyone has their right to choose freely what they want to do and that people shouldn’t be robbed of their free will, if it doesn’t pose harm to others. A few suggest that doping challenges the concept of level playing field and the doped athlete gains an unfair advantage over the clean athlete which is unfair. In reality, however all high performance, extreme sport today is plagued by inequalities and unfairness. The unequal distribution of resources and unequal access to modern training facilities across countries already destroys the possibility of level field play (Play the Game). In fact, lifting the ban on doping can give the disadvantaged an opportunity to gain a competitive edge in this regard. And then prohibiting the use of something that is virtually out of control only adds to the waste of economic resources and effort. A Steroid Chemist Dr Carl contends that we are slowly moving toward tolerating if not totally legalizing drug practice in sports (Lewis, 2007).

In sum, then the issue revolves around the question of the extent to which we should allow sports be the source of pure entertainment and display of powers beyond human capabilities; or keep it natural and simple and subject to luck and chances.

Though I concede that doping might rob sports of the originality and the humanness of the competition but I am willing to accept the change as part of cultural evolution and the value we attach to extreme action and dramatic entertainment. Although some might object by saying that sports in future be the practicing field of drug advisers and junkies, I reply by saying that the industry needs to have a balanced board of advisor to it. Medical intervention by doctors should be made compulsory to see players have access to what drugs and those that are absolutely harmful should be banned whereas drug advisors just like coaches should help players select drugs and hormones suitable for them.

ABC International. “Two athletes caught for doping at Beijing Olympics”. Radio Australia. 2008. Web.

Garnier, A. “Letter to the Editor: An Open Letter to Those Promoting Medical Supervision of Doping”. 2008. Web.

Tannsjo, T and Tamburrini, C. Values in Sports. London. Publishers: Taylor and Francis. (1999). Page Numbers: 16, 17, 18, 204, 2055, 206. Web.

Play the Game. “What is wrong with Doping?” Play the Game Magazine. 2008. Web.

Lewis, D. “Athletes and steroids: Will tomorrow’s game involve drug advisers?” San Francisco Chronicle. 2008. Web.

Saletan,W. “The nonsense of Olympic doping rules.” Washington Post. Newsweek Interactive Co. LLC. 2008. Web.

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Use Of Drugs In Sports Argumentative Essay Example

Type of paper: Argumentative Essay

Topic: Sports , Drugs , Athletes , Doping , Performance , Olympics , Health , Control

Words: 1800

Published: 02/20/2023

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Introduction

In the contemporary times, the use of drugs by athletes has emerged as a rather acute problem in professional sports. The immediate solution to this problem entails the resolution of a chain of related issues: how to improve the system of drugs controls, which drugs are to be prohibited, what measures shall be made against those athletes who violated anti-drug rules. Whereas many regard the use of drugs in sports as beneficial and helpful for the athlete, others believe the drug usage by sportsmen as extremely detrimental and destructive. As far as my opinion is concerned, performance-enhancing drugs must not be allowed in sports as they impose a harmful effect on the health of the sportsmen in the long run.

This debate can be better understood by having a glimpse over the history. It is believed by many historians that the use of performance-enhancing drugs began with the first Olympic Games held in 776 BC. Later, participants started to take hallucinogenic and analgesic extracts from mushrooms, wine and various herbs. The proponents of PEDs assert that even though these products would be prohibited today, athletes were not banned from using drugs that would help them to win in ancient times. By the time the first modern Olympic Games took place in 1896, athletes already had a wide arsenal of pharmacological aid. For instance, sportsmen actively used powerful stimulants as codeine and strychnine (Pampel, 2007, p.160). The 1940s witnessed the start of use of steroids. John Ziegler, a renowned psychologist, created modified synthetic testosterone with increased anabolic characteristics. These steroids were specifically created for the US weightlifting national team. It was the first artificial anabolic steroid – methandrostenolone (trade name Dianabol) (Porterfield, 2007, p.28). Soon, Dianabol became widely available and compulsory for weightlifters, football players, runners and other athletes. Its use increased protein synthesis, and helped muscles to recover faster after heavy workouts. This drug increases the nervous excitement resulting in more powerful muscle contractions. In actual fact, it became the basis for higher speeds and better reaction among athletes who used this drug (Porterfield, 2007, pp.28-29). Sportsmen continued to freely consume enhancing drugs until 1968 after which the International Olympic Committee introduced a procedure for compulsory urine tests to detect doping among athletes (Porterfield, 2007, p.31). At the same time, there is another argument offered by the advocates of drugs’ utilization in sports. They assert that the pharmacology makes life of the athletes much easier by protecting sportsmen`s health to a certain extent. As an athlete is constantly exposed to powerful loads and exhausting exercises, he must not dispense with extra medical substances that help the body to recover. Advocates acknowledging the effectiveness of performance enhancing drugs bicker that the devastating effects of these drugs on health are overstated pointlessly. They believe that it is the sole decision of an athlete whether or not to take drugs or if the drugs are harmful. They also argue that the use of drugs in sports in a contemporary requirement of the evolving sports industry just like superior technologies and techniques that are employed for training. On the other hand, I strongly oppose the use of PEDs due to their harmfulness and potential fatality. In fact, the athletes using them acquire an unmerited advantage due to which it is absolutely justified to consider them cheaters. In my opinion, no athlete associated with any sport has the right of violating the competitions’ spirit. In addition, doping offers an erroneous example to the youngsters. Furthermore, the users of performance-enhancers adopt an unfair means to weaken the significant accomplishments of clean athletes. Since the introduction of urine tests to check doping levels in sports, the athletes have been using various drugs that also have a profound effect on human body. These biologically-active medication substances are used to increase the physical and emotional capabilities of sportsmen in an artificial manner. The list of prohibited drugs in sports is updated on a regular basis. Currently, it contains more or less ten thousand items. The official list of prohibited pharmacological substances, approved by the Medical Commission of the Olympic Committee in 1988, is divided into several main classes (Thieme & Hemmersbach, 2009, p.40): - Doping substances, - Stimulants (central nervous system stimulants, sympatho-mimetic drugs, analeptics), - Narcotic analgesics, - Anabolic steroids and other hormonal anabolic agents, - Doping methods (various manipulations with blood and urine), - Alcohol, - Local anesthetics, and - Corticosteroids Stimulants affect the central and peripheral nervous system. These include amphetamine, ephedrine, pseudoephedrine, caffeine, strychnine, fenotropil, and mesocarb. Stimulants can cause (Reardon and Creado, 2014, “Drug abuse in athletes”):

• Increase in blood pressure and accelerated heart activity;

• Violation of thermoregulation and heat stroke, followed by collapse of health and death; • The occurrence of dependence on drugs and mental disorders. The most commonly used stimulant is caffeine. Currently, there is no ban on it because it is a part most drinks including coffee and tea. Stimulants are prohibited only during competition (Reardon and Creado, 2014, “Drug abuse in athletes”). Similarly, painkillers, or narcotic analgesics, decrease sensitivity to pain, regardless of its nature and causes. Athletes resort to them to shorten the recovery period after injuries and traumas. Their use is prohibited only during competition. Non-steroidal analgesics are not on the list of prohibited drugs (Reardon and Creado, 2014, “Drug abuse in athletes”). Anabolic-androgenic steroids (anabolic steroids) are among the most popular groups of doping agents. These are synthetic derivatives of the natural male sex hormone – testosterone. On the one hand, anabolic-androgenic steroids promote the absorption of protein, muscle building, development of the male body as well as the development of male sexual characteristics (androgenic effect, or masculinization) (Thieme & Hemmersbach, 2009, p.63). The most fundamental characteristic of anabolic steroids is their ability to enhance the synthesis of nucleic acids and proteins, as well as structural elements of the body cells and, hence, to activate repair processes in bone and muscle tissues. They stimulate amino acid absorption in the intestine, activate the production of erythropoietin (a substance that stimulates the process of hematopoiesis), and anabolic processes in the bone marrow. Anabolic steroids promote the fixation of calcium in human bones (Thieme & Hemmersbach, 2009, p.64). Whereas all the above-mentioned qualities of drugs are considered beneficial for the sportsmen, it is no secret that the uncontrolled use of anabolic steroids can cause mental disorders, liver failure, and development of tumors in liver and lung, thrombosis sclerosis and other dysfunctions of human body (Pope et al., 2013). Furosemide, chlorthalidone, amiloride, and acetazolamide are several diuretics and are used for three reasons. They help in the quick reduction of body weight. In addition, they help athletes improve their appearance (particularly gymnasts, figure skaters). Intense urination provoked by diuretics helps in getting rid of the other dopes or masks their application due to a significant decrease in urine density (Thieme & Hemmersbach, 2009, p.68). Almost all the doping agents are used as medicines. They are used under medical supervision. The patient is not subjected to physical stress, takes protective drugs and special diet – under such conditions it is not considered to be doping among sportsmen. After discussing drugs that are most widely used by sportsmen, it is necessary to consider issues that arise with the use of forbidden drugs. To prevent the use of such drugs, the world of sports has doping control – an essential part of a comprehensive program of measures aimed at preventing the use of banned doping substances by athletes. To put more simply, doping control procedure involves selection of biological samples for analysis, physico-chemical study of the samples, the verdict, and the imposition of sanctions on violators (Wilson & Derse, 2001, p.31). During the competition, an athlete is notified that he must pass a drug test (according to the rules). The mandatory drug tests are for winners (taking 1st, 2nd and 3rd places) as well as for one of the few athletes who did not win anything. This particular athlete is chosen randomly considering the decision of the commission. These athletes proceed to the special room of doping control where their urine is taken and tested for the presence of banned medical substances. Rejection of an athlete to undergo a doping control or attempt to falsify its results is considered the recognition of the fact that he took performance-enhancing drugs with all the ensuing consequences (Wilson & Derse, 2001, p.32). In recent past, doping control was necessary for only qualified athletes and only during critical international and domestic competitions. But today this control is carried out not only in the competitive period, but also during training sessions. Moreover, doping testing is required for all persons involved in sports, regardless of his or her sports chosen.

The problem of the use of drugs in sports is one of the most complex issues of the modern sport. The use of performance-enhancing drugs by athletes is not only detrimental to their own health, but also undermines the ideological foundations of the sport as a phenomenon. Proponents of drug utilization in sports need to understand that this issue also contains a moral aspect. Doping leads to inequality of conditions for competitors and this inequality does not stem from the level of preparedness. Instead, it is determined with the level of development of the pharmaceutical industry, medical science and economic opportunities of their attraction in the sports field. Athletes are regarded as role models for the youngsters and involvement in doping sets a wrong example for the followers. Therefore, it is excessively important to realize and understand the negative impacts of drugs and performance-enhancers as a means to achieve success.

Pampel, F. (2007). Drugs and Sports. Infobase Publishing. Print. Pope, H., Wood, R., Rogol, A., Nyberg, F., Bowers, L., and Shalender Bhasin. (17 Dec. 2013). “Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement”. NCBI. Retrieved 12 Mar. 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026349/ Porterfield, J. (2007). Doping: Athletes and Drugs. The Rosen Publishing Group. Print. Reardon, C., and Shane Creado. (14 Aug. 2014). “Drug abuse in athletes”. NCBI. Retrieved 12 Mar. 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140700/ Thieme, D., and Peter Hemmersbach. (2009). Doping in Sports. Springer Science & Business Media. Print. Wilson, W., and Ed Derse. (2001). Doping in Elite Sport: The Politics of Drugs in the Olympic Movement. Human Kinetics. Print.

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Home — Essay Samples — Life — Doping — The Rise of Using Performance Enhancing Drugs in Today’s Sports

The Rise of Using Performance Enhancing Drugs in Today's Sports

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