conclusion for drugs in sports essay

Drugs in sports Essay

Introduction, drugs should be used in sports, drugs should not be allowed in sports.

Drug use in sports has gained momentum in the recent past. The drug is used for performance enhancing (Coe, p. 224). Different sports have set up laws that are used to curb drug doping. Sports personalities use drugs to gain an advantage over the others. Performance enhancing drugs have been used in the Olympics by different people. For example, Thomas Hicks won the marathon after using strychnine.

However, the use of stimulating substances was banned in 1928 by the International Amateur Athletic Federation (Hartgens, p. 513). Although the ban was instituted a long time ago, athletes still use drugs to enhance performance. In 1976, East Germany nearly won all the swimming gold medals after the players were given steroids (Longman, p. 124). There is a debate about whether to allow drugs to be used in sports or impose a total ban.

The proponents of this debate argue that drug use alone does not guarantee success in the field. A magnificent performance is a combination of proper nutrition and practice. However, this is not true because some drugs enhance the performance of an individual. Drug usage in sports should be banned because of its effects. These effects include; it provides an avenue for some athletes to cheat, it compromises the credibility and integrity of the results and it is illegal (Coe, p. 224).

A drug is a natural substance that is taken to alter the general body functions (Wilson, p. 180). Drugs are used for several purposes. The nature in which a drug is used depends on the purpose of the drug. It can be used for; curative, stimulating, performance enhancing or as food. People consider any substance to be a drug based on the existing culture or legislature. Some traditions consider some drugs as food.

Laws have been established about drugs based on the effects of the drug in the body. It is illegal to use a drug that has been prohibited by a government or any organization.

However, some drugs have been prohibited but can be used in the treatment of patients. Additionally, some drugs can be taken without the knowledge of an individual. In such a case, the drug is found in a substance that is taken as food. Using drugs to boost performance should be banned because it makes the sport lose its original intended meaning and it also causes several environmental and health problems (Hartgens, p. 513).

Performance enhancing drugs should be allowed to be used in sports. Drugs that enhance performance satisfy the expectation of spectators watching games. People expect to watch a unique ability in the sports personality. This is made possible through the use of drugs because it gives an athlete the ability to demonstrate sports creativity.

Many fans watch athletes with the expectation to watch unique traits in the athletes (Wannamethee, p. 163). This makes the sport to become interesting. It is difficult to display a unique trait that is different from the human traits without the influence of performance enhancing drugs (Longman, p. 124).

The major expectation of the fans is players to demonstrate creativity during the game. Therefore, many people consider a competition to be fair if all the players are allowed to use the drug. Here, all the players will have the same effect of the drug and the best will come out based on his creativity. It is upon the players to manipulate the drug through excellent training to obtain the best results (Wannamethee, p. 163).

Technology has been introduced into sports. All people around the globe are comfortable with the use of technology in sports and disregard drugs. Technology is a result of creativity in the sports. Since the genetic make up of athletes is the same, drugs would not provide an advantage over other players (Warburton, p. 78).

Performance enhancing drugs have been used in other aspects of the human life. For example, many classical musicians use drugs to enhance their performance on stage. An excellent classical presentation requires a proper control of the pulse rate and blood pressure (Russell, p. 442).

The musicians use the beta blockers to enhance the stage performance. A low pulse rate and blood pressure contributed by the beta blockers reduces the effects of stress and this gives the musician confidence to exhibit a sterling performance (Brantigan, p. 90). An outstanding stage performance is the expectation of the classical music fans. Using drugs to enhance a stage performance does not give the musician an advantage over others. It depends on the human creativity and practice (Brantigan, p. 90).

Drugs should not be allowed in sports because it provides an avenue for some athletes to cheat (Haugen, p. 67). The doping process for athletes is not accurate. This gives some athletes who use the drugs an added advantage over those who do not use the drugs (Haugen, p. 67). The doping process is not used in all games. Therefore, there is no level playing field for the players.

Consequently, a total ban on the use of drugs to enhance performance should be instituted to ensure that all the players have been given a level playing field. Players who use drugs and win competitions are not the genuine winners. Although other people argue that a level usage of drugs will make the players level in the field, the actual performance in the field does not reflect the potential of the player. A total ban on drugs in all sports gives a level playing field that reflects the exact potential of the players (Longman, p. 124).

Additionally, different players from different countries have varying abilities to access the drugs. Therefore, if the drugs should be allowed, athletes from developing countries will not access the best drugs. The only way to have a level playing field for all players is through a total ban on the drugs in sports.

Integrity in sports is the driving force behind the sports events. Using drugs by a section of players compromises the credibility and integrity of the results (Wilson, p. 214). To maintain credibility and integrity, drugs should be banned. Other players win after using drugs that have been prohibited. Here, the integrity of the results is compromised.

The results obtained as a result of using prohibited drugs are illegitimate (Warburton, p. 78). Also, they lack authenticity. The spirit of any competition is to allow for a level playing where every player is given an opportunity to express his ability. A winner in such a competition is accepted by all the fans around the globe. When a winner is declared after using drugs, the value of the sport is reduced.

Therefore, the value of the sport remains a major issue in any sport or competition. Additionally, good personalities are expected to be role models (Browne, p. 497). Using drugs is prohibited and illegal. Allowing athletes to use drugs is itself an act of breaking the law. Good role models should obtain success through hard work and determination as opposed to using drugs (Browne, p. 497).

In conclusion, drug use in sports should be based on the purpose of the drug. When the drug is used to enhance creativity, then it makes the sport interesting. However, these give the athletes a competitive advantage over the others. As such, the natural ability of the athletes is not properly rewarded.

Although drugs make sports interesting, it makes the sport’s lack integrity. Additionally, drugs make the results of a competition to lack integrity and lose value. Additionally, different players from different countries have varying abilities to access the drugs. Therefore, if the drugs should be allowed, athletes from developing countries will not access the best drugs. The only way to have a level playing field for all players is through a total ban on the drugs in sports. The best way to ban using drugs is through a global organization.

This institution should be equipped with excellent doping mechanisms to ensure that all the players are screened properly before participating in a competition. In addition, drug use in sports should be banned because of it adds a competitive advantage, and causes severe effects to the users. These effects include; it provides an avenue for some athletes to cheat, it compromises the credibility and integrity of the results and it is illegal.

Brantigan, C 2005, ‘Effect of beta blockade and beta stimulation on stage fright’, American Journal of Medicine, vol. 5. no. 72, pp. 88–94.

Browne, A 2009, ‘The ethics of blood testing as an element of doping control in sport’, Journal of Medical Science Sports, vol. 3. no. 31, pp. 497–501.

Coe, s 2004, ‘We cannot move from strict liability rule’, The Daily Telegraph, 25 Feb, p.21.

Hartgens, F 2004, ‘Effects of androgenic-anabolic steroids in athletes’, Sports Medical Journal, vol. 9. no. 34, pp. 513–554.

Haugen, K 2004, ‘The performance-enhancing drug game’, Journal of Sports Economics , vol. 4. no. 5, pp. 67–87.

Longman, J 2004, East German steroids’ toll: ‘they killed Heid , Oxford University Press, New York.

Russell, G 2002, ‘Effects of prolonged low doses of recombinant human erythropoietin during sub maximal and maximal exercise’, European Journal Applied Physiology , vol. 30. no. 86, pp. 442–449.

Wannamethee, G 2004, ‘Haematocrit, hypertension and risk of stroke’, J Intern Med, vol. 23. no. 235, pp. 163–168.

Warburton, C 2007, The Economic results of prohibition, Columbia University Press, New York.

Wilson, B 2004, Hall overcomes cancer, then red tape to reach Olympics , Associated Press, London.

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IvyPanda. (2019, November 29). Drugs in sports. https://ivypanda.com/essays/drugs-in-sports/

"Drugs in sports." IvyPanda , 29 Nov. 2019, ivypanda.com/essays/drugs-in-sports/.

IvyPanda . (2019) 'Drugs in sports'. 29 November.

IvyPanda . 2019. "Drugs in sports." November 29, 2019. https://ivypanda.com/essays/drugs-in-sports/.

1. IvyPanda . "Drugs in sports." November 29, 2019. https://ivypanda.com/essays/drugs-in-sports/.

Bibliography

IvyPanda . "Drugs in sports." November 29, 2019. https://ivypanda.com/essays/drugs-in-sports/.

• Performance-Enhancing Drugs and Substances Use in Sports
• Drugs and Dopping Issues in Sports
• The Doping Scandal Documentary Analysis
• Sports and Steroids: Society’s Acceptance or Rejection of Steroids in Sports
• Violence in Sports: When Life Is Dangerously Threatened
• Random Drug Testing for Collage Athletes
• Use of Performance Enhancing Drugs
• Should We Have Mandatory Drug Testing For Professional Athletes?

The Use of Performance-Enhancing Drugs

Our conclusion.

After critically looking at all aspects of performance-enhancing drug use, we have conclude, as a team, that doping is negatively affecting sports.  Performance-enhancing drugs are a bad thing for several reasons.  They have terrible side effects on athletes and destroy their bodies in the long run.  They give athletes an unfair advantage in sports which is a form of cheating in our opinion.  They also promote a do-anything-to-win attitude and an attitude that “ideal” bodies cannot be achieved through hard work and effort.

Most importantly, this topic is becoming a social issue because of the prevalence and the effect that it is having on our youth and teenagers.  Athletes using drugs are encouraging young people ,who view them as role models, to use these drugs to improve their performance and the looks of their bodies.

Science has created many drugs and made the population aware of the harm they can do.  They have promoted the use in the medical field to speed the healing of injuries.  They have in no way recommended the use of these drugs as performance-enhancing drugs in sports.  Science has played a huge role in the use of performance-enhancing drugs but they have not made them for this reason.

Doping should be banned in all sports leagues, and a no tolerance policy should be enforced.

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Doping in Sports: Essay Example

Doping in sports: essay introduction, doping in sports: essay main body, doping in sports: essay conclusion.

Recent years have seen major athletes being caught with doping. Use of performance enhancing drugs is considered as one of the major crimes in sports. This act is considered as cheating and as unethical in sports. Increase in the numbers of sportsmen being caught in anti-doping screening has raised debate on whether use steroids should continue to be prohibited.

Various sportsmen and other stakeholders in sports have made convincing arguments against prohibiting use steroids and other performance enhancing drugs. A lot of finances are being used in financing ant-doping screening. In some ways, anti- doping screenings are seen as campaign against sports and great sportsmen/women. Regulated use of steroids is okay and should be allowed.

The most used argument against the use of steroids in sports is that it is cheating. Use of steroid is considered to give an individual sportsperson using it an unfair advantage over other competitors. This is true, but it does not support the continuous use of prohibition as a way handling cheating in sports (Simon 77).

Fair competition grounds are very important in sports; they encourage competition since each every competitor knows that they have a chance of winning. However, use of anti-doping screening to control cheating has not been fully successful. In most cases offenders of anti-doping rules are only caught months or years after winning medals.

From such cases, it is evident that despite of anti–doping rules and implications set for offenders, many sportsmen/women are willing to risk use performance enhancing drugs. From this, it is imperative that prohibiting steroids have not been successful in creating fair competition grounds for all sportsmen. Instead of handling cheating use of steroids discourage sporting.

Prohibiting performance enhancing drugs in sports make it impossible to regulate their use. Steroids used by sportsmen/women are not regulated and no standard is set on the kind or amount to be used. Instead of prohibiting use of steroids in sports, it is more practical and cheaper to regulate their use.

Allowing steroids use in sports will enable sporting authorities to set standards and other regulation measures (Cashmore 56). Regulation has been seen to be successful in other areas. With regulation, the issue of cheating will be partially solved.

Sports men/women will not have to worry over being caught for use for use of steroids. Sporting authorities will be able to set standards and recommend certain types of steroids for use in sports (Simon 221). This will make performance enhancers to be equally available to all sportsmen/women who wish to use them.

Health risks involved with use of steroids are used to support their prohibitions in sports. There are evident health risks posed by use of performance enhancement drugs (Mottram 69). Despite of this, prohibiting steroids in sports on this ground is not strong enough.

Most sports are risky by themselves. In fact, the risk posed by steroids is only a fraction of risks involved in some sports (Irvin and Roy 123). For example, baseball players are usually at risk of fractures, and other major injuries such as head injuries that can lead to very severe effects.

Although some of such sports are know me to be dangerous, they are not prohibited. Thus, it is hypocritical to continue to prohibit use of steroids on health risk grounds. In fact, use of steroid would lead to stronger sportsmen/women leading to fewer injuries. Steroids also help in recovery from injuries and would be advantageous to sportsmen/women.

Use of steroids is not forced on sportsmen/ women. Decisions to use are made out of free conscience with knowledge of health risk involved (Cowart and Wright 77). Sportsmen/women who want to take the health risk for better performance should not be prohibited to do so. In other parts life, it is known that people make sacrifices to have competitive advantage against other people (Yesalis and Bahrke 77).

For example some ladies use diet drugs to enhance their outlook and have competitive advantage in their career progress. In sports such as football, players have to lift weights to increase their strength and have advantage over other players. As long as the sacrifice is not forced and health risk is not major, then the sacrifice should be allowed (Katz 1).

Unlike in earlier days when sports were used for fun, today sports are taken as a profession. Sports as a profession mean that players are required to participate in sports more frequently. Frequent and vigorous training and competitions requires a lot of energy from players and pose the player to injuries (Cahn and O’Reilly 45).

Thus, steroids should be allowed in professional sportsmen/women. Use of steroid would be advantageous to such sportsmen/women and also to their fans. Steroid would enhance performance, prevent injuries and also help in recovery from injuries.

On the overall, steroids use would lead to more entertaining sports that are more appealing to sporting fans. In additions, steroid use would lead to longer sporting period for professionals sportsmen/women making professional sporting more feasible and attractive.

Prohibiting steroids can be seen as motivated by fear of science. There have been general fears on science in many areas of life. However the fears in pharmaceuticals have been higher than in other areas. There is general preference of natural pharmaceuticals over synthetic (Yesalis 133).

These fears are not based on strong grounds since many synthetic pharmaceuticals have been found to have very positive effects to those how receive them. Thus, prohibiting steroid use on this ground is not right.

Allowing steroid use in sports would encourage innovations in sports. There is very large room for innovation in sports. Performance enhancers should be taken as part of sport medicine. Steroid use would lead to more innovations on ways of making sports more entertaining while at the same preventing injuries.

Anti- doping authorities in sports should review their stand on prohibiting steroids. Instead of encouraging sports, campaigns by anti-doping agencies are discouraging sports. The huge amount of money used in controlling steroid use could be used in other ways that would be advantageous to sports.

Regulating steroid use is the best approach to handling cheating in sports. This approach will enable standards that will protect sportsmen/women from negative health risks and enable a level ground to be created for competition.

Cahn, O’Reilly. Women and sports in the United States: a documentary reader :-Simon;- Fair play: the ethics of sport . New York: Westview Press, 2004.

Cashmore. Making sense of sports . New York: Routledge, 2005.

Cowart, V. and Wright, Joseph. Anabolic Steroids: Altered States . Pennsylvania: Cooper Publishing Group, 1990.

Irvin, R, and Roy, S. Sports medicine: prevention, evaluation, management, and  rehabilitation . New York: Prentice-Hall, 2008.

Katz:- Should we accept steroid use in sports . 2008.

Mottram, D. Drugs in sport . New York: Taylor & Francis, 2005.

Simon, R. Sports and social values. New York: Prentice-Hall, 1985.

Yesalis. Anabolic steroids in sport and exercise :-New York: Human Kinetics, 2000.

Yesalis, C., Bahrke, M.Performance-enhancing substances in sport and exercise. London: Human Kinetics, 2002.

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Conclusion: The Effect of Performance Enhancing Drug Use in Sports on American Society

Limitations

The main limitation with my topic isn't that there currently aren't any studies on the long-term effects of anabolic-androgenic steroids (AAS), but mainly in how the studies are conducted. Two studies on the long-term adverse effects of anabolics were done on oral compounds, which are known to have very different effects than the injectable compounds. Oral compounds are much faster acting, can potentially be hepatotoxic, and must be taken several times per day. Injectable compounds are injected directly into the muscle and have a much longer active life in your body. As a result of this, the muscle gains aren't as dramatic as oral compounds. This would be fine, but the study didn't state that. It just presented its findings as fact. Another limitation that I found is that studies on AAS don't indicate that different compounds effect people in different ways. For example, Winstrol, which is commonly used by bodybuilders for fat loss or “cutting” purposes, will have a profoundly different effect on someone than the use of Trenbolone, which is often used for “bulking” purposes.

Over ninety percent of the research that I've found on the adverse and long-term effects of performance enhancing drugs (PEDs) have been done on mice or other animals. The studies that were done on humans were being done on people with severe burns or underweight subjects with chronic obstructive pulmonary disease (COPD). These were interesting to read but offered little relevance to athletes cheating in sports. AAS affect athletes differently than people who are barely clinging to life.

One study on chromosome damage as a result of anabolic steroid use found that individuals who are weight training and taking AAS have a higher rate of cytotoxicity and chromosome damage compared to the two other groups that were tested. The study was done over a two-month period and compared the results of fifteen males weight training, fifteen males weight training and taking AAS, and twenty sedentary males. The problem that I have with this study is that in the discussion portion of the study, the researchers tried to take their short-term results and infer that there would be an almost linear progression of worsening effects if the study lasted one more second longer.

Currently, there aren't any studies done in which the participant is given a controlled dose of testosterone with all other variables controlled. This is mostly due to ethical reasons and that nobody will consent to doing long-term testing. The fact that the use of PEDs in sports is so taboo makes it difficult to find peer reviewed information on it, but the fact that it is so controversial makes it much more interesting to research. This could be considered a limitation or possibly a strength.

Contribution: Athletes who use steroids aren't bad people. They're just trying to do their jobs better.

“The only real solution for eliminating PEDs in sport is for the fans to stand up and say ‘we don’t want to see any more doping in sports.’ This hasn’t happened and probably won’t. What this is about, pure and simple, is entertainment. We like seeing 'bigger than life' people doing 'bigger than life' things. The fans have arguably created the market for these drugs” (Yesalis et al 1998). Fans like seeing world records broken every year and the revenue generated by sports teams reflects this.

PEDs aren't ruining sports or American culture as many people would like to believe. In reality, because PEDs in sports has become commonplace over the years, revenues have increased in the trillions of dollars (Adams et al 2004). The one thing that all the trillion plus dollar major sports have realized is that fans want to see larger than life people doing larger than life things. Fans want to see 40-yard dash times shattered each year at football combines. They want their linemen all to bench press over 500 pounds (Adams et al 2004).

In the future, I think that people will be more accepting toward PEDs because things are heading in that direction already. “Hormone replacement therapy” is just a fancy term for taking PEDs. There is reason to believe that there will be a new form of performance enhancement. Within the next several years, there will be a new trend among athletes called “gene doping.” There has already been conclusive testing in mice as well as in cows, and it’s only a matter of time before athletes get their hands on this technology (Riewald et al 2005).

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Expert Commentary

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.

Republish this article

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

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

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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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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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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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Essay on Doping in Sports

Introduction

The word doping is used to refer to the use of disallowed or prohibited drugs, medication or treatment which is intended to improve the performance of an individual athletically. The use of performance enhancement drugs is unethical and is not allowed by most international organizations that govern sports like the international Olympic committee. This practice has been carried out for centuries. however, high profile doping cases being covered by the media in the recent past has resulted in increased attention towards doping.

The most important reason for doping control is the is the health risk involved with this practice. Most of the substances used to enhance performance have a lot of long-lasting and harmful side effects that may include cardiovascular issues like elevated blood pressure and heart attacks, central nervous system side effects which may include anxiousness, psychosis, depression, and addiction. Other side effects of performance enhancement drugs include hormonal problems like low sex drive and infertility.

Another reason for doping control is that it is used to achieve an unjust advantage in sports. According to anti-doping organizations, performance enhancement significantly reduces the spirit of the competition. A drug-free competition provides equality in opportunities for all athletes and therefore the need for anti-doping campaigns.

There are various testing methods in doping which include urine tests, blood tests, and gas chromatography-combustion-IRMS. The urine test involves acquiring a sample of urine from an athlete which is then divided into samples A and B each in a sealed container that has a designation and a number that uniquely identifies the sample. When sample A tests positive for a disallowed substance, a test on sample B is requested to confirm the result. If this sample still tests positive, then the athlete is considered to have tested positive for the use prohibited substance. The process of confirmation is necessary for the safety of the athlete.

The blood test is used to illegal drugs used t enhance performance by measuring indicators that change when recombinant human erythropoietin is used. These indicators include hematocrit, levels of iron, and reticulocytes. When prohibited substances like erythropoietin are used, transport of oxygen gas into the muscles is enhanced through increasing the haemoglobin mass (blood volume and concentration of haemoglobin) which in turn leads to enhanced performance.

Another testing method involves the use of gas chromatography. This method is used to find isotopic variations in the composition of an organic substance when compared to a standard. When used, this technique can determine whether synthetic testosterone was used which in turn could lead to an increased and levels of testosterone that are not within the normal ranges. This method assumes that in nature, the majority of carbon atoms are carbon -12 while the remaining 1.1% are carbon-13. Therefore, the lower the ratio of the carbon -13 to carbon-12 the higher the probability that synthetic testosterone was used.

Other testing methods involve retesting samples and the use of athlete biological passport. Article 6.5 of the world Ant-Doping Code says that samples can be retested later for up to eight years. This allows the agency to take advantage of the new testing methods for detecting prohibited substances. Athlete biological passport on the other hand is a method that is used to trace locations of an athlete to control doping by monitoring the athletes and testing them for drugs wherever they are and comparing these results to previous tests that have already been done on them in the past.

Conclusion .

Many types of drugs have been used for enhancing performance by athletes. Despite doping being practised for many centuries, it is harmful to an athlete’s overall health to some extent and is also harmful to the spirit of the sport. The involvement of anti-doping agencies like the World Anti-Doping Agency, through their various doping testing methods, is important in combating this practice in the world of sport.

American College of Medical Toxicology. (January 25, 2017). What is “doping” and Athletes do this?

https://www.acmt.net/cgi/page.cgi/_zine.html/Ask_A_Toxicologist/What_is_doping_and_why_do_athletes_do_this_

McKennan J., Thurston M., Jonathan T. (2021). Doping. American Medical Society for Sports Medicine.

https://www.sportsmedtoday.com/doping-va-119.htm

World Anti-Doping Agency. (2015). World Anti-Doping Code

https://www.wada-ama.org/sites/default/files/resources/files/wada-2015-world-anti-doping-code.pdf

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Home — Essay Samples — Nursing & Health — Performance Enhancing Drugs — Performance Enhancing Drugs in Sports: the Steroid Debate

Performance Enhancing Drugs in Sports: The Steroid Debate

• Categories: Doping Performance Enhancing Drugs Steroids in Sports

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Published: May 24, 2022

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Works Cited

• Barry, A. (2013). The steroids era: Lessons from the game's most infamous era. Baseball Research Journal, 42(2), 71-77.
• Daneshvar, D. H., Baugh, C. M., Nowinski, C. J., McKee, A. C., Stern, R. A., & Cantu, R. C. (2011). Helmets and mouthguards: The role of personal equipment in preventing sport-related concussions. Clinics in Sports Medicine, 30(1), 145-163.
• Dimeo, P. (2007). A history of drug use in sport 1876-1976: Beyond good and evil. Routledge.
• Gurney, B. (2003). Steroids in sports: The end of baseball’s steroid era. Fordham Intellectual Property, Media & Entertainment Law Journal, 13(2), 735-757.
• Harvard University. (2012). Doping in sport: Understand the risks. Harvard Men's Health Watch, 17(2), 1-3.
• Karkazis, K., & Jordan-Young, R. (2018). Debating sex and gender in sports: Human rights and fairness. Science, 359(6378), 1011-1012.
• Sjöqvist, F. (2008). Anabolic steroids and doping in sports: A critical writer's view. Scandinavian Journal of Medicine & Science in Sports, 18(3), 278-279.
• Sports and Drugs. (n.d.). In National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/drugfacts/sports-drugs
• Tannenbaum, A., & Rasmussen, N. (2018). Anabolic-androgenic steroid use among Canadian high school students. Psychology of Sport and Exercise, 36, 29-35.
• World Anti-Doping Agency. (2021). The World Anti-Doping Code. Retrieved from https://www.wada-ama.org/en/what-we-do/the-code

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The Controversy Surrounding Barry Bonds and Steroids in Baseball

This essay about Barry Bonds and steroids in baseball delves into the controversy surrounding his career. Despite Bonds’ exceptional talent and record-breaking achievements, his legacy is overshadowed by allegations of performance-enhancing drug use, particularly during the Steroid Era. The essay explores Bonds’ connection to the BALCO scandal, the impact of steroid use on sports ethics, and the broader implications for athletic competition. It emphasizes the complexities of maintaining integrity in sports amidst advancements in performance enhancement methods, serving as a cautionary tale about the ethical dilemmas faced by athletes striving for greatness.

How it works

The intersection of performance-enhancing drugs (PEDs) and professional sports has long been a contentious issue, and few cases exemplify this more than that of Barry Bonds in baseball. Bonds, a legendary figure in the sport, is not only renowned for his extraordinary athletic abilities but also for the shadow cast over his career due to allegations of steroid use.

Barry Bonds’ career is a tale of two narratives: one of unparalleled success on the field and the other of suspicion and controversy off it.

Bonds, often hailed as one of the greatest baseball players of all time, holds numerous records, including the single-season and career home run records. However, these achievements are tarnished by the widespread belief that his accomplishments were artificially boosted by steroid use.

The use of performance-enhancing drugs in baseball came under intense scrutiny during the late 1990s and early 2000s, a period commonly referred to as the “Steroid Era.” This era saw a significant increase in player performance, characterized by inflated offensive statistics and an unprecedented number of home runs. While this era produced many remarkable moments and players, it also left a stain on the integrity of the game.

Barry Bonds’ involvement in the steroid controversy reached its peak during the BALCO scandal in the early 2000s. The Bay Area Laboratory Co-operative (BALCO) was at the center of a doping scandal that implicated numerous athletes across various sports, including Bonds. Bonds was accused of using performance-enhancing drugs supplied by BALCO, specifically the designer steroid tetrahydrogestrinone (THG), commonly known as “The Clear.”

Despite consistent denials and legal battles, Bonds’ association with PEDs has continued to overshadow his legacy. While he has never been convicted of steroid use, his connection to the BALCO scandal and the physical changes in his physique over the course of his career have fueled speculation and skepticism among fans and analysts alike.

The debate surrounding Barry Bonds and steroids extends beyond the confines of baseball. It raises broader questions about the ethics of using performance-enhancing drugs in sports, the responsibility of athletes as role models, and the integrity of athletic competition. Bonds’ case serves as a cautionary tale, highlighting the complexities and consequences of pursuing greatness at any cost.

In conclusion, the controversy surrounding Barry Bonds and steroids underscores the complex relationship between sports, ethics, and performance enhancement. While Bonds’ on-field achievements are undeniably remarkable, they are forever marred by allegations of steroid use. His legacy serves as a sobering reminder of the enduring impact of the Steroid Era on the game of baseball and the ongoing challenges faced in preserving the integrity of sports in the face of technological advancements and ethical dilemmas.

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