Drug Use And Control

Drugs are used for performance enhancement purposes  in  elite,  competitive,  and  amateur  sports. Unlike  heroin,  barbiturates,  hallucinogens,  and substances used for recreational purposes   in other  subcultures,  athletes  use  and  abuse  drugs presumed  to  enhance  athletic  ability  and  performance, known as ergogenic substances. The most common  performance-enhancing  drugs  include amphetamines and a range of substances thought to  increase  strength  and  muscle  mass  like  anabolic steroids. The use of performance enhancing drugs  is  considered  doping  practice  (see  note  at end  of  entry)  and  is  therefore  prohibited  by  the World  Anti-Doping  Agency  (WADA),  National Anti-Doping Organizations (NADOs), and sports governing  organizations.  However,  because  athletes  may  face  illnesses  or  health  conditions  that require  medication,  the  use  of  certain  prohibited substances  is  allowed  for  therapeutic  purposes (known as therapeutic use exemptions). This process  is  regulated  by  the  WADA’s  International Standard for Therapeutic Use Exemptions (ISTUE).

Health Consequences of Drug Use

Small   or   moderate   dosages   of   performance enhancing drugs are unlikely to result in noticeable changes  in  athletic  performance.  Therefore,  athletes aiming to significantly improve their performance tend to engage in systematic and excessive use of drugs, especially during periods of intensive training.  In  fact,  athletes  typically  self-administer drugs  at  much  greater  dosages  than  those  prescribed  for  the  treatment  of  medical  conditions. However,  abusing  large  doses  of  performance enhancing drugs is associated with a wide range of side effects, including possible death. One notable example  is  the  death  of  cyclist  Tom  Simpson  in the Tour de France in 1967 as a result of amphetamine  abuse.  Furthermore,  the  abuse  of  anabolic steroids  has  been  associated  with  various  physical  and  psychological  side  effects,  including  but not limited to, liver toxicity, hormonal imbalance, irritability,  increased  aggressiveness  (known  also as steroid or roid rage), mania, major depression, and  psychotic  symptoms.  Some  studies  have  also noted  that  anabolic  steroids  can  be  potentially addictive,  leading  to  withdrawal  and  dependence symptoms.

The Ethics of Drug Use

The spirit of sports is characterized by a range of ethical principles, such as fair play, ethics, honesty, health, character and education, respect for the self and other participants, to name just a few. Using prohibited  drugs  to  increase  athletic  performance defies  those  principles,  and,  consequently  hurts the  image  and  integrity  of  sports.  Furthermore, drug  use  gives  an  unfair  competitive  advantage to athletes who have the resources to secure drug supplementation, as compared to athletes without access to drugs, or who lack the financial resources needed to support drug supplementation.

Availability and Drug Use Patterns

Drugs  can  be  supplied  through  drug  trafficking networks  either  face-to-face  or  online.  In  many countries,  the  supplementation,  possession,  and trafficking  of  performance-enhancement  drugs, and  even  encouraging  someone  to  purchase  prohibited  ergogenic  drugs,  is  penalized  via  legal sanctions.  Common  patterns  of  drug  use  include cycling,  stacking,  array,  and  pyramiding.  Cycling refers  to  the  use  of  drugs  for  periods  between  8 and  12  weeks,  or  even  longer.  Stacking  describes the  concurrent  use  of  several  types  of  drugs  to achieve greater performance effects, whereas array refers  to  using  other  drugs  to  counter  the  side effects  of  steroids,  including  estrogen  blockers, masking  agents,  and  diuretics.  Finally,  pyramiding  is  the  gradual  increase  of  dosages,  from  relatively  low  doses  of  drugs  at  the  beginning  of  the cycling period, to higher doses toward the end of the cycle. Some athletes may also start with lower doses,  move  on  to  higher  doses,  and  then  return to lower doses of drug use at the end of the cycle. In many cases, the patterns of cycling, stacking, or pyramiding are based on arbitrary criteria and are not accompanied by the strict medical supervision that  oversees  therapeutic  drug  use.  This  is  even more so in amateur sports and fitness, where users base  their  drug  use  patterns  on  word-of-mouth, or on information provided by informal channels such as drug-related websites.

Social and Psychological Predictors of Drug Use

There  have  been  several  attempts  to  identify the  psychological  drivers  of  drug  use  in  sports. Relevant  studies  were  initiated  as  early  as  the 1980s and centered on athletes’ KAB (knowledge attitudes-behavior). Over the last decade, research on  drug  use  expanded  considerably  and  has moved from mere KAB surveys to studying deeper psychological  processes  involving  the  interplay between personal traits and dispositions, motivational  variables,  cognitions  and  normative  pressures,  and  behavioral  intentions.  Some  scientists also  focus  on  novel  ways  to  assess  social  desirability, or capture the implicit beliefs and attitudes of  athletes  and  exercisers  toward  performance enhancing  drugs.  Such  research  is  based  on  the premise that athletes may be reluctant to disclose their  preferences  and  beliefs  toward  prohibited drugs; therefore, studying their mental representations about the issue with unobtrusive and indirect methods  can  yield  more  reliable  findings.  Other researchers argue that a narrow focus on decision-making  processes  and  cognitive  functions  may undermine  broader  cultural  and  social  influences on  drug  use,  such  as  the  effects  of  use-reduction or  harm-minimization  policies,  and  macrolevel normative influences. It is noteworthy that social science research on performance-enhancing drugs has  been  supported  by  official  antidoping  organizations  like  WADA’s  Social  Science  Research Program, which was launched in 2005, and stimulated  research  on  the  psychological,  behavioral, and  social  factors  associated  with  drug  use.  The available  studies  suggest  that  doping  is  a  deliberate  process  that  requires  decision  making  and intention  formation.  Doping  intentions  are  likely to be influenced by doping-related attitudes, goal orientations,  motivational  variables,  and  social influences.

Drug Control

A  commonplace  drug  control  method  is  urine testing.  This  approach  is  based  on  a  detect-and-punish premise and assumes that drug traces may be  present  in  an  athlete’s  urine  during  drug  use and remain for some time after. Nevertheless, athletes can evade drug controls or tamper with their results  by  refusing  to  participate  in  drug  testing, failing  to  declare  whereabouts  (a  requirement  for elite athletes to state their location to official sporting associations and NADOs in order to facilitate unexpected drug controls), discontinuing drug use before competition so that the drug is cleared from the body, drinking excessive amounts of water, or taking  masking  agents  in  order  to  tamper  with or  invalidate  urine  tests.  Another  problem  with existing doping control methods is that drug testing  cannot  be  applied  to  the  entire  population  of professional  and  junior  athletes,  mainly  because of  the  high  administrative  and  financial  costs involved.  Also,  drug  controls  often  fail  to  detect new substances and are even less effective in capturing gene doping. Finally, the detect-and-punish approach  does  not  prevent  the  onset  of  drug  use among young people and early-career professional athletes.

Athletes’ Beliefs Toward Drug Control

Research on athletes’ beliefs toward drug control and  testing  is  still  limited.  Some  of  the  available studies have shown that collegiate athletes in the United  States  were  in  favor  of  mandatory  drug control if it was followed by systematic efforts and education programs aiming to increase awareness about  the  side  effects  of  drug  use.  Other  studies  have  shown  that  collegiate  athletes  lacked knowledge  and  awareness  of  the  standard  procedures  involved  in  drug  controls  and  displayed little  awareness  of  the  side  effects  of  prohibited performance  enhancement  drugs.  On  the  other hand, evidence from elite athletes is controversial; some athletes appear supportive of rigorous drug testing,  whereas  others  are  less  in  favor  of  drug controls, and even believe that existing procedures (e.g.,  urinating  in  public  to  supply  a  sample  for analysis) hurts their dignity and personal privacy.

Education and Prevention

An alternative approach to drug control in sports that  has  gained  momentum  in  the  recent  years  is concerned with the investigation of psychological and social risk factors. This approach suggests that drug use can be explained by the interplay between a  person’s  motivations,  cognitions  and  beliefs, and normative influences. Knowledge about these processes  can  be  used  to  inform  subsequent,  evidence-based  preventive  strategies  that  focus  on education,  awareness,  and  behavior  modification interventions.

The  ATLAS  (Adolescents  Training  and  Learning  to  Avoid  Steroids)  and  ATHENA  (Athletes Targeting  Healthy  Exercise  and  Nutrition  Alternatives) projects are based on these principles, and are  used  to  train  adolescent  and  junior  athletes, trainers and coaches, and team leaders about the effects of drug use. ATLAS and ATHENA provide knowledge about the side effects of drug use, build refusal  efficacy  skills,  and  inform  athletes  about alternative  and  safer  performance  enhancement methods. Empirical studies have shown that both ATLAS and ATHENA are effective in significantly reducing future use of steroids and related performance enhancement drugs among young athletes in both the short and long term.


Drug use is an ongoing issue in both competitive and  elite  sports  and  in  amateur,  nonprofessional sports and leisure time exercise. Anabolic steroids, amphetamines and stimulants, and other anabolic agents  are  used  by  athletes  to  enhance  performance. Users tend to self-administer high dosages of drugs and engage in unregulated and unsupervised  drug  use  patterns,  thus  endangering  their physical and mental health. Research on drug use in  sports  has  shown  that  athletes  engage  in  this practice  for  various  reasons,  including  motivational  and  dispositional  variables,  as  well  as  normative influences. Recent research trends focus on unobtrusive  methods  to  capture  athletes’  beliefs toward  drugs,  whereas  other  researchers  call  for studies  that  address  broader  sociocultural  influences such as policy making. So far, drug control approaches have focused largely on punitive methods, but more recent trends support education and awareness-raising  campaigns  that  tackle  the  psychosocial  processes  underlying  drug  use  in  sports and  exercise  and  contexts  and  prevent  future  use by young athletes. Still, it appears that the road to drug-free sports is still long, and much work has to be done in order to eradicate the seemingly well established  drug-based  performance  enhancement mentality.


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