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.
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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