essay on drug use in sports

Drug Abuse in Sports

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

How it works

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

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

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

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

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

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

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

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Risk and enabling environments in sport: Systematic doping as harm reduction

April henning.

a Faculty of Health Sciences and Sport, University of Stirling, UK

Katherine McLean

b Administration of Justice, Penn State Greater Allegheny, US

Jesper Andreasson

c Department of Sport Science, Linnaeus University, Sweden

Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use drugs themselves. However, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments. Similar to non-sport contexts and drug use, it is important to analyse the environments in which doping occurs. This approach allows us to examine the dynamic interplay between risk and enabling factors, as the enabling environment shifts in response to changes produced in the risk environment, and vice versa. There are models of sport environments that have proven effective at both enabling doping by athletes and reducing harms to athletes: systematic doping. This article will use secondary literature in order to review and analyse known cases of systematic doping through the risk and enabling environment frameworks. We argue that these systems responded to anti-doping in ways that protected athletes from the risk factors established by anti-doping policy and that athletes suffered most when these systems were revealed, exposing athletes to the full range of doping harms. Further, we argue that risks within these systems (i.e. extortion, bullying) resulted from the broader prohibitive sport environment that forces doping underground and allows such abuses to occur.

Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use PEDs themselves ( Evans-Brown, 2012 ). There is a more or less clear separation in both public discourse and research on doping between the (elite) sport context and the use of PEDs in society, often connected to the gym and fitness enterprise. A second and even more distinct divide exists between PED use in sports and fitness and the use of illicit recreational drugs. This second distinction is partly related to the sporting context in which doping necessarily exists but is seen as unacceptable, as performance enhancing substances are viewed as a threat to the integrity of sport itself. The prohibition of sport doping is thus constituted in relation to a desire to ensure the value and spirit of modern sport, building on an ideal view of sport in which winners are crowned due to honest excellence in performance and nothing else ( Beamish & Ritchie, 2007 ). Consequently, it is taken for granted that the motives for doping in a sport context are connected mainly to performance enhancement, and so differ from use outside the sphere of modern sport. However, as Coomber (2014) has argued, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. Doping substances and methods are those that will improve or enhance performance within sport or fitness contexts. Indeed, doping can be understood as a contextually specific substance use practice.

There is an opportunity, then, to focus on the intersectional commonalities between the two types of use and contexts – sports doping and illicit drug use (from here doping and non-sport substance use) – and to apply frameworks from one field of research to the other. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments. Similar to non-sport contexts and drug use, it is important to analyse the environments in which doping occurs in order to understand: 1) how these environments shape use behaviours and produce risk; 2) how athlete risks are/can be mitigated. Crucially, this approach allows us to examine the dynamic interplay between risk and enabling factors, as the enabling environment shifts in response to changes produced in the risk environment, and vice versa.

There are models of sport environments that have, in some specific ways, proven effective at both enabling doping by athletes and reducing harms to athletes: systematic doping. Though it is not possible to eliminate all risks to athletes who engage in doping – or to their competitors – and it is still possible for athletes to be abused or harmed, organized doping can reduce some of the risks of PED use. We argue that these systems responded to anti-doping in ways that protected athletes from several of the risk factors established by anti-doping policy and that athletes suffered most when these systems were revealed, exposing athletes to the full range of doping harms. Further, we argue that risks within these systems (i.e. extortion, bullying) resulted from the broader prohibitive sport environment that forces doping underground and allows such abuses to occur. Of course, we cannot ignore the specific sport context in which doping occurs. The uncontested hegemony of anti-doping ( Lopez, 2017 ) and normative discourse around what sport is and meant to be have normalized very strict and prohibitive PED policies ( Jedlicka, 2014 ). We make no claims regarding the morality of either doping or anti-doping. We further acknowledge that athletes competing against athletes who engage in doping may be harmed in other ways. However, our goal is to take a critical view of how anti-doping constructs the environment in which doping and its related harms occur and to better understand how these effects are mitigated by athletes and other participants in systematic doping (sub)cultures, where PED use is managed and monitored.

This article will use secondary literature in order to review and analyse known cases of systematic doping through the risk and enabling environment frameworks. We begin with a background on doping and anti-doping, risk and enabling environments, and sport risk and enabling environments. We then present a theoretically explorative discussion on the specific anti-doping risk/doping enabling processes and environments, using known cases of systematic doping as illustration. We conclude with a comparison of sport and non-sport responses to drug use and the potential outcomes of each approach.

Doping and anti-doping

Anti-doping is a prohibitive, legalistic system of athlete-centred surveillance, testing, and sanctioning ( de Hon, 2016 ; Mazanov, 2013 ). Globally, anti-doping efforts are led by the World Anti-Doping Agency (WADA), the umbrella organisation responsible for policymaking and harmonisation ( WADA, 2019 ). Doping is commonly understood as the use of prohibited performance enhancing substances or methods in sport. The official definition accepted by most sport organisations and athletes is that doping is the violation of one of the anti-doping rules laid out in the World Anti-Doping Code. The WADA Code (2019) includes as its fundamental rationale the promotion of athlete health. In this view, health promotion is achieved by prohibiting athletes from using substances for which ‘medical or other scientific evidence, pharmacological effect or experience that the Use of the substance or method represents an actual or potential health risk to the Athlete’ ( WADA, 2019 , p.30). Ostensibly, this is related to the perceived health risks of doping substances, though it is also related to broader war on drugs style policies and politics ( Coomber, 2014 ; Dimeo, 2007 ). Indeed, the WADA Code identifies many illicit ‘recreational drugs’, such as cocaine, MDMA, heroin, and mephedrone, as substances prohibited in competition; the latter list includes controlled substances (namely cannabis, and opioid-substitution medications like buprenorphine) whose medical applications are increasingly recognized for purposes unrelated to performance enhancement ( Abuhasira, Shbiro, & Landschaft, 2018 ; Thomas et al., 2014 ).

Beyond health concerns, anti-doping is also supposed to ensure fair competition by preventing any athlete from gaining an unfair advantage. WADA indicates that its primary duty is really to protect non-doping athletes, as its central mission is keeping doping and doping athletes out of sport. This is primarily done through a system of testing biological samples from athletes collected both in and out of competition times and then banning athletes who test positive for doping. There are also indirect methods of detection, such as intelligence-led investigations into alleged doping. WADA takes a zero-tolerance approach under the principle of strict liability, which holds individual athletes responsible for any substance detected in a urine or blood sample regardless of how it got there ( WADA, 2019 ). Decisions regarding doping violations are made by sport governing bodies and appealed through the Court of Arbitration for Sport rather than through civil court systems. While this keeps athletes out of civil justice system, there is an automatic presumption of guilt if an athlete tests positive for a prohibited substance ( Lenskyj, 2018 ). Athletes who unknowingly or accidentally ingest a prohibited substance are held to the same standard as those who intentionally use doping substances and must demonstrate a lack of intent. First time Code violations are punishable by a competition ban lasting up to four years ( WADA, 2019 ).

The prevalence of doping is unclear, though there is a significant gap between prevalence estimated by researchers and the official testing results. WADA consistently returns a positive test rate of 1–2% per year – with exceptions for years in which retesting has occurred – while researchers using more sophisticated survey and modelling methods have estimated much higher rates, varying between 14 and 57% ( de Hon, Kuipers, & van Bottenburg, 2015 ; Elbe & Pitsch, 2018 ; Ulrich et al., 2018 ). It is difficult to determine the effect anti-doping policies have had on doping prevalence, as there were no baseline prevalence studies before WADA's founding. However, the discrepancy between the positive test rate and even the lowest prevalence estimates indicate that a large number of athletes who report engaging in doping are not being detected, potentially exacerbating PED-driven inequalities between athletes. In this way, anti-doping policies may mirror the limited effectiveness of recreational drug prohibition in deterring consumption or punishing violations, lessons best illustrated in the case of the United States. For example, the 2018 U.S. National Survey on Drug Use and Health estimated that roughly 53.2 million residents aged 12 and over had used illicit drugs in the past 12 months; that same year, the Federal Bureau of Investigation recorded less than 1.2 million arrests for possession of controlled substances, a capture rate just over 2% (likely inflated by the repeated arrest of certain individuals) ( United States Department of Health & Human Services, 2018 ; United States Department of Justice, 2018 ). Overall, it is increasingly accepted that the introduction of highly punitive prison terms for drug offenses in countries worldwide has done little to reduce drug use, decrease drug purity, or increase drug prices, a failure starkly evidenced by successive and concurrent opioid epidemics in Eastern Europe and the CIS, Southwest Asia, North America, and Australia ( Drug Policy Alliance, 2015 ; Pew Center, 2015 ; United States Sentencing Commission, 2017 ). Even within a far more circumscribed arena of enforcement – certain types of substance use within specific sporting competitions – it is unlikely doping-free sport ( WADA, 2020 ) will be achieved through a strategy of random or targeted testing and harsh sanctioning. It is possible that elite individuals or teams might still see the advantages of doping as exceeding the risk of detection even if athlete testing was expanded.

Though there is a range of motivations for engaging in doping ( Henning & Dimeo, 2014 ), a primary one at the elite level is winning. For elite and professional athletes, the monetary incentives to win can be huge and provide a reason for athletes to use prohibited substances ( Aubel & Ohl, 2014 ; Fincoeur, Cunningham & Ohl, 2018 ). However, the physical and social risks of doping are multiplied when individuals must secure their own supply, determine their own doses, minimise side effects, and prevent being caught through in or out of competition testing. One way of avoiding some of these issues is for athletes to collectively dope, thereby sharing the burden of risks and working together to minimize them. Systematic doping involves centrally organising doping for a group of athletes. This is often done by an entity above the individual, such as by a team or a state, which often stands to benefit from the cumulative boost in performance among its member athletes. While motivated by both shared and unique interests, systematic doping is similar to the phenomenon of Heroin Assisted Treatment (HAT), or the (tenuously) legal dispensing of pharmaceutical-grade heroin to individuals who have struggled with other modalities of opioid use treatment ( Kilmer et al., 2018 ). In both cases, the supply and use are centrally managed in order to manage the risks of substance use for individuals who would be otherwise incapable of doing this effectively on their own. Though systematic doping is often done for collective performance enhancement, related concerns include avoiding detection and ensuring athletes remain healthy enough to compete. As such, systematic doping may also be a way of managing risks (e.g. safe supply, dosing oversight, side effect management) that would be greater if each athlete were to undertake doping individually. Of course, both HAT and systematic doping as it currently exists are still limited by international/national prohibition policies.

Risk and enabling environments

As suggested by Rhodes (2009) drug harms are shaped by risk environments and a risk environment framework can therefore promote an improved understanding of harm, and harm reduction, as a matter of ‘contingent causation’ (p. 193). Risk environments can, broadly, be understood as the ‘space – whether social or physical – in which a variety of factors interact to increase the chances of drug related harms’ ( Rhodes, 2002 , p.91). Substance use research and policies have historically tended to focus on the individual and individual responsibility for risky behaviours ( Rhodes, 2009 ). This is a trend mirrored in sport doping research that focuses heavily on motives and prevention at the individual level. Taking an approach that understands substance use as socially (and spatially) situated, we can look more broadly at the interplay of physical, social, cultural, economic, and policy factors across levels (micro to macro) to understand how these influence use behaviours. There has been quite a bit of research attention given to risk environments in which social or recreational drug use occurs (see Duff, 2009 ; 2010 ; McLean, 2016 ; Rhodes et al., 2003 ). This has pushed forward understandings of how the context in which use occurs in many ways influences use behaviours.

Rhodes (2002 , 2009 ) saw the goal of understanding risk environments as the production of enabling environments in which harm reduction occurs. Enabling environments can be examined similarly to risk environments, as the interaction of various harm reducing factors across levels. As Duff (2010) observed, it is tempting to understand the two separately, or as the former leading to the latter. This, however, limits the extent to which we can understand how both risk and enabling factors and processes are intertwined with one another. Simply adding harm reducing strategies to a risk environment does not automatically make an enabling environment – introducing a service does not necessarily mean it will be, or can be, used. For example, a syringe exchange program that is installed without the explicit cooperation of law enforcement authorities may fail to attract participants if police officers are seen patrolling nearby; similarly, the success of policies that make naloxone (an opioid antagonist used to treat opioid overdose) available for sale without a prescription is contingent upon the drug's retail price point, the economic status of potential buyers, and the structure of health care and health insurance within the larger society. In sum, the processes of building enabling environments require simultaneously understanding the multi-layered risk environments that may limit their impact and effectiveness – or be shaped positively in turn. The evolution of drug policy in Vancouver, Canada may serve as an illustration of the latter movement, as the formal introduction of a supervised injection site in 2006 was followed by a shift toward ‘harm reduction policing’ (characterised by fewer drug violation arrests) and more recently, political interest in drug possession decriminalisation ( Landsberg et al., 2016 ).

Understanding risk and enabling environments together and as co-constituting also allows us to see the ways that enabling processes occur within risk environments even where higher-level changes (e.g. policy or economic) are unlikely or unable to happen. Few, if any, commentators anticipate the legalisation of heroin for recreational use in any nation; yet at least seven countries currently allow heroin-assisted treatment (HAT). These initiatives are founded upon the realisation that abstinence-based treatment, or other forms of opioid substitution therapy, may fail to attract and retain a significant subset of people who use opioids ( Fischer et al., 2002 , 2007 ). They additionally recognise that within the context of heroin prohibition on a national-level, a ‘safe supply’ of the drug cannot be guaranteed to those who buy from the illicit market – a particular concern in areas experiencing a surge in fentanyl-adulterated heroin and associated overdoses. Arguably, such harm reduction strategies (including HAT, syringe exchange, or take-home naloxone) represent adaptations that accept drug prohibition as an enduring, if not eternal, feature of the risk environment for people who use drugs ( Roe, 2005 ). It might additionally be noted that the roll-out of these once controversial services has often followed the recognition of a public health crisis, such as HIV/AIDS or accidental overdose, with potential to affect the ‘general’ non-using population – a historical precondition that does not necessarily apply to drug use in sport ( McLean, 2011 ). The politics and economics around doping are similarly unlikely to change and many of the public health concerns of recreational drug use also apply to PED use, such as unclear quality, labelling (dose and ingredients), and contaminated supplies (see Brennan, Wells, & Van Hout, 2017 ; Fincoeur, Van de Ven, & Mulrooney, 2015 ).

Doping risk and enabling environments

The sport risk environment is that in which various risk factors interact across micro and macro levels to increase the potential for harm to athletes engaging in doping ( Hanley Santos & Coomber, 2017 ; Rhodes, 2002 ). By shifting the focus from the individual athlete to the sporting context, we can see how harms to doping athletes are socially produced (c.f. Rhodes, 2002 ). Enabling environments are not well understood with regard to sport, as these are meant to be those physical or social spaces where barriers to harm reduction practices are removed ( Moore & Dietze, 2005 ) while anti-doping policies and discourses have led to a culture that largely does not consider harm reduction a viable option for sport. Such an approach seems more or less impossible to combine with the cultural beliefs and discourse around values of fair-play and sportsmanship in the elite sport context. This is contra the broader trends in approach to substance use. While harm reduction strategies and interventions for recreational drug use have flourished, sport has remained stubbornly bullish on a detect and punish approach ( Henning & Dimeo, 2018 ), not only in elite sport but also in recreational and non-competitive sport contexts. Amateurs and recreational athletes are included anti-doping's remit and they may be punished in the same way as elites for anti-doping rule violations, regardless of their athletic ambitions. This reflects an individual/athlete-centred view of doping that places the policy focus and responsibility squarely on the athlete ( Dimeo & Møller, 2018 ). Ignoring factors such as the level of competition or age of the athlete in question, further reinforces the potentially harm- and stigma-producing, punitive approach even in cases where the fair-play ideal is not really at stake. One example of this is Carl Grove, a 90 year old US cyclist who was given a public warning and stripped of an age group world record and national title – he was the only competitor in his age group – when he tested positive for a steroid, likely resulting from a contaminated piece of meat he consumed the day before he was tested ( USADA, 2018 ). While some types of recreational drug abuse are increasingly viewed as symptomatic of the ‘brain disease of addiction,’ which people who use drugs are unable to control, doping is largely seen as a rational and self-serving, if dangerous, practice, deserving of moral opprobrium – even within non-elite sporting contexts that lack significant material or symbolic rewards for performance. Of course, both of these discursive frameworks around drug use – as disease or deviance – locate pathology in the individual, not the environment.

Despite the growing research on a range of recreational drug risk and enabling environments, very little research has been done to similarly understand the environments in which doping occurs. One qualitative study with cyclists that has engaged with the risk environment framework looked specifically at the issues of employment and labour precariousness as factors that may lead to doping ( Aubel & Ohl, 2014 ). This study found that the structure of employment and working conditions could be addressed in ways to reduce risk as a preventative measure against doping. A second doping study surveyed Danish elite athletes about their views on PEDs and methods ( Overbye, 2018 ). Rather than focusing on the contours of a sport risk environment, this quantitative study took the risk environment as a jumping off point to argue that prohibited substances should be divided into those that produce social harms and those that produce individual harms ( Overbye, 2018 ). Although both studies have merits, neither gives a full picture of what a sport risk environment looks like across micro and macro levels, nor do they engage with enabling factors or delineate ways enabling environments may be produced within sport.

One in-depth analysis of a doping risk environment was by Hanley Santos and Coomber (2017) , in which the authors examined how anabolic steroid use was socially situated. The authors interviewed individuals who use steroids who accessed a safer injection facility and analysed how broader social, cultural, and political contexts were related to and impacted on their individual behaviours. They argued in favour of expanding harm reduction services and taking account of the range of contextual factors that impact use practices ( Hanley Santos & Coomber, 2017 ). For its consideration of harm reduction and service interventions, this does not directly examine the sport enabling environment. As such, we so far have little understanding of enabling factors in sport, how enabling environments are created and maintained, or how these environments are co-constituted with risk environments.

Harm reduction and doping

Researchers on doping policy have previously suggested harm reduction as an alternative approach to punitive anti-doping (e.g. Henning & Dimeo, 2018 ; Kayser & Broers, 2012 ; Kayser & Smith, 2008 ; Kayser, Mauron & Miah, 2007 ; Kirkwood, 2009 ; Lippi, Banfi, Franchini, & Guidi, 2008 , 2008 ; Smith & Stewart, 2008 , 2015 ). Though anti-doping is predicated on promoting athlete health, the current approach has been criticized as being paternalistic ( Kayser & Smith, 2008 ) or ignoring social and sport realities of substance use ( Smith & Stewart, 2015 ). Proposed models of doping harm reduction have focused on centring athlete health, though have differed in their overall approach. One liberalized approach by Savulescu, Foddy, & Clayton (2004) advocated health checks for athletes. Athletes would be allowed to use low risk substances and monitored for negative effects from higher risk substances, but only prevented from competing if they were deemed not healthy enough to compete. Similarly, others have suggested a public health-informed system of medically supervised doping to regulate use ( Kayser et al., 2007 ). Public health approaches to PED use, including needle and syringe exchange programs and other harm reducing measures, have had wide uptake among people who use steroids in the UK ( McVeigh & Begley, 2017 ). These models each offer benefits to athlete health, though they leave open many issues of implementation within the wider sport environment that has been saturated with anti-doping narratives of drug-free sport and zero tolerance for doping.

One model has called for a partial change to anti-doping by relaxing current rules to allow for harm reduction to be introduced. Kayser & Tolleneer (2017) proposed a step-change approach towards an anti-doping system that would reduce the number of banned substances to only those that present a high risk to health and include health monitoring, but that would retain a testing system to ensure athletes used PEDs only at defined levels. This model goes beyond the others to include several levels of ethical concern (self, other, play, display, humanity) and acknowledges the complex reality of implementing changes to the existing system. Another model that takes further account of context is that developed by Smith & Stewart (2008 , 2014 ) that considers a range of issues related to doping (e.g. technological, health, policy) and contextualizes sport's zero tolerance approach within a broader social context that accepts medical intervention and enhancement. These latter models offer specific recommendations for how sports policy may adapt to allow for harm reduction. Taking these into account, we next apply the risk environment framework to the current context to analyse how anti-doping policies have created an intolerant environment that drives doping into the shadows of sport, increasing various risks to athletes along the way. Following this, we examine how groups have organized systems of doping using strategies, similar to those outlined above, that work to reduce harm to athletes and enable safer use of PEDs.

Anti-Doping risk processes and environments

Applying the heuristic developed by Rhodes (2002 , 2009 ) to outline the factors and levels of environmental risk to the sport context illustrates several ways that sport and anti-doping policy create a risk environment that may produce doping behaviours (see Table 1 ). Anti-doping policies are underpinned by a sport culture in which doping is positioned as an issue of both morality and health. Much like other prohibitive substance use policies, these policies also create their own set of risks for athletes. Indeed, many studies have identified the criminalisation of drug possession for recreational use as among the most damaging features of those risk environments, not least because such policies often preclude or limit the formation of enabling environments. As a part of a broader ‘war on drugs’ climate ( Coomber, 2014 ; Henning & Dimeo, 2018 ), anti-doping policies tend to increase risk across categories for doping athletes.

Sport doping risk environment.

Table 1 outlines four risk factors (physical, social, economic, policy) at both micro and macro levels. We have populated the table with examples of factors at both levels that produce risk. The first factor identified by Rhodes are the physical risks of doping. Due to the high levels of intolerance for any kind of doping or doping-related behaviours, anti-doping policies and culture drive use underground (see Smith & Stewart, 2008 ; 2014 ). This increases the physical risks for athletes, as supply chains for high quality PEDs can be difficult to secure and maintain Fincoeur et al., (2015) . Further, due to their illicit nature, athletes may struggle to get quality advice on how to properly dose substances and turn to peer networks or online forums for information. One qualitative and netnographic study of an online doping forum looked at how people who use PEDs learn about and access these substances through social media and various internet forums for example. The study shows how the individuals in doing so became part of an ethnopharmacological do-it-yourself culture in which they could discuss their experiences of using the drugs and minimise the possibility of encounters with police while involved in criminalised activities ( Andreasson & Johansson, 2016 ). The authors also conclude that although users of the forum are aware of the possible risks and health costs associated with substance use to a certain degree, the potential physical gains through use and how to find information on it clearly dominated the discussions (see Smith & Stewart, 2012 ). This extends to the areas where PED use actually occurs – proper hygiene especially for injections or transfusions may be difficult to maintain if materials are difficult to acquire. There is also an inherent hazard resulting from information posted online from often anonymous individuals whose experiences and expertise are unknown or difficult to verify.

Social, economic, and policy risks – the three additional factors outlined by Rhodes – are bound together in significant ways. As shown in Table 1 , detection underpins many of these risks, which increase as anti-doping policies become stricter and testing more frequent. The main risk for athletes here is testing positive and receiving a sanction. This may result in further social and economic consequences, including being stigmatised as a doper or losing one's position on a team or sponsorship deal. At the same time, as athletes are pressured to perform from family, teams, and sponsors, there may be increased pressure to use PEDs to gain an edge over non-doping competitors. In sport groups or organisations where doping is accepted and employment is tenuous or performance based, PEDs may become a normal working condition ( Aubel & Ohl, 2014 ). This directly relates to economic risks, as income or sponsorships tied to performance present a fertile atmosphere for pushing doping boundaries. Similarly, athletes who receive support from public entities may feel the need to provide a return on that investment through medals or other victories, leading to a willingness to take more risks. Taken together, anti-doping policies and culture set up an anomic environment in which athletes are incentivized to dope while also being at risk of a range of negative outcomes if they are caught. It then becomes imperative that athletes avoid detection, a situation that can be tricky for an individual athlete to manage on their own.

Doping enabling processes and environments

There is a push/pull dynamic between risk and enabling factors. As sport and anti-doping drive harsher policies, more invasive surveillance techniques, and push the cultural narrative around ‘clean sport’, doping groups have responded with techniques for avoiding detection and keeping overall risk as low as possible. In order to understand how enabling environments are produced we must consider those instances where the environment has been altered in order to reduce the social, political, economic, and physical risks of doping. As noted above, online doping forums may be seen as a form of user-led, ‘grassroots’ harm reduction communities, although such venues may focus on the maximisation of physical or performance benefits. Nevertheless, these communities do provide a platform for diffusing extensive knowledge and information on dosages, post-cycle therapies, and how to avoid and treat unwanted side-effects from doping substances, all of which are part of a harm reducing ethnopharmacological culture ( Andreasson & Johansson, 2020 ; Monaghan, 2012 ). Moreover, the very nature of the doping risk environments may limit the ability of individuals to effect harm reduction through mere behavioural change. People who use drugs seeking advice from recreational drug forums such as Bluelight or Erowid encounter similar barriers to safer consumption – a digital network of geographically-disconnected and anonymous individuals can do little to ensure safe supplies, while their expertise may be restricted to personal experience.

As harm reduction is not recognized as an anti-doping policy approach, we have no formal interventions to consider or evaluate. This remains a paradox in sport: one of the rationales for anti-doping is athlete health but the approach largely excludes harm reduction. Though individual-orientated harm reduction services related to doping are largely absent from the sporting context, we do have examples of an environmental approach: systematic doping. In such systems care is taken to reduce as much risk as possible for those athletes who are using doping substances or methods. There is no guarantee that athletes will not still suffer some health harm related to use of PEDs as any use carries risks, a reality underscored by the implementation of medical monitoring of World and Professional Continental Teams by cycling's governing body the Union Cycliste Internationale ( UCI, 2019 ). This was developed partially to ensure cyclists were fit enough compete if using undetected doping methods. The cycling program is a rare example of a sport acknowledging that doping is potentially widespread and that athlete health may be at risk. However, most sports have not taken such a proactive approach. Instead, organized doping systems ensure athlete health in other ways.

Table 2 illustrates some ways organized doping groups may seek to change environmental factors to enable doping. For the first factor, athletes’ physical safety is looked after by doctors or other lay experts to ensure optimum use for getting desired enhancing effects without negatively impacting health or performance. Their social risks are managed by providing social support among the doping group who all share the same (secretive) use. Policy risks are reduced by anticipating anti-doping testing in order to circumvent a positive test. Similarly, economic risks, including loss of one's livelihood, are managed by avoiding positive tests and ensuring no disqualification, loss of prize money, or loss of sponsorships. Similar systems have also been reported in competitive bodybuilding where coaches support competitors doping practices through advising on what to take, how to acquire substances, proper dosing, and managing risks ( Andreasson & Johansson, 2020 ; Monaghan, 2001 ). By analysing known cases of systematic doping we can see how they employed strategies similar to those outlined in Table 2 .

Sport doping enabling environment via systematic doping.

During the 1990s, a number of doping sub-cultures emerged that illustrate the development of enabling environments for doping. The archetypal example is that of professional cycling. The organisation of doping in cycling was different from earlier doping systems such as that in East Germany, which was state-sponsored and led by doctors ( Hunt, 2011 ). Though not state sponsored, cyclists too obtained support from highly qualified doctors to support their doping practices, which advanced to include blood doping and micro-dosing; in response to a tightening policy environment (notably the creation of WADA in 1999), doping in cycling became highly organised and sophisticated, leading to not only fewer health risks, but technological innovations that supported the evasion of anti-doping sanctions for prolonged periods. The American cycling teams Discovery and US Postal are perhaps the most famous examples of systematic doping in cycling, and ones that additionally demonstrate its efficacy in reducing policy risks for athletes through the enforcement of omerta. Winning the Tour de France seven times with US Postal between 1999 and 2005, Lance Armstrong was highly protective of omerta – the code of silence around doping that all participants were expected to respect as mutual protection against suspicion – and in some cases pressured and bullied other cyclists and journalists who were raising concerns about doping ( Bell, Ten Have, & Lauchs, 2016 ). Through working closely with highly specialised doctors, the risks of getting caught were carefully managed: Armstrong ‘passed’ hundreds of doping controls over a decade. The success of Armstrong's team, and systematic doping scheme, was undoubtedly maintained through the coercive strategies that threatened to harm potential whistle blowers (and in the case of other cyclists, expose them to the risks they had previously avoided through systematic doping); yet, such tactics were arguably shaped by a policy environment whose severity had increased drastically compared to pre-WADA periods. Ultimately, however, this enabling environment was foreclosed in the early 2010′s, as evidence of systematic doping on Armstrong's teams came to light, leading to his lifetime ban from all sport ( USADA, 2012 ).

One important doping scandal since WADA's founding was revealed in 2015 when whistle-blowers provided evidence to news outlets that Russia had been engaged in a state-sponsored doping system that implicated the Russian Anti-Doping Agency ( McLaren, 2016a ). The system was directed by the head of Russia's anti-doping laboratory, Grigory Rodchenkov, who sourced and controlled the supply of substances and provided oversight of hundreds of Russian athletes’ dosing and use via the country's Sports Ministry. The effectiveness of the system was clear after Russia dominated the medals table at the 2010 Winter Olympics and then performed better than expected at the 2012 Summer Olympics, all while protecting most athletes from testing positive ( McLaren, 2016a ). Athletes in this system were well looked after; the quality of their doping substances and protection from reputational and economic ruin was improved as long as they remained within the system—a type of omerta. Rodchenkov described perfecting his protocol to maximise benefit, limit risk, and avoid detection, as well as his frustration at athletes who would use additional substances that put them at risk of testing positive ( Ruiz & Schwirtz, 2016 ). The reports on Russia also included evidence that athletes had been extorted by various members of the Russian sport apparatus in exchange for keeping their doping and/or positive anti-doping tests from becoming public ( McLaren, 2016b ).

The main harms to athletes came in response to the scandal. The International Association for Athletics Federations banned all Russian athletes from international competitions in 2016, including the Olympics. In 2018, the International Olympic Committee banned Team Russia from the Winter Olympics, allowing Russian athletes to compete independently under the neutral Olympic flag. Even athletes who were not part of the doping system suffered reputational and economic damages. Many of those who were implicated received competition bans up to four years.

The enabling processes and environments represented by systematic doping demonstrate a dynamic interplay with the multi-layered risk environment structured by anti-doping policies and cultural stigma. For example, where threshold values for banned substances have been set, athletes have ensured that they remain under the limit to avoid detection. Similarly, the introduction of the athlete biological passport meant that samples would be recorded over time to flag changes in biological values that might indicate doping not caught through testing single samples. Doping groups responded by introducing micro-dosing of PEDs that would show only minor variations in biological values while still giving athletes performance benefits. The social, economic, and policy risks to athletes in both cases are minimised through the harm reducing processes that ensure use remains undetected.

The restricted access to many doping substances due to both sport and non-sport legal prohibitions in many places means doping athletes may also find it difficult to secure a safe supply of PEDs. Because of these restrictions, athletes are vulnerable to both detection and physical harms from poor quality substances. Doping groups may respond to this by enlisting ‘doping doctors’ who can procure or prescribe higher quality substances, or by securing other trusted suppliers. This echoes sport harm reduction policy proposals for medically supervised doping ( Savulescu, Foddy, & Clayton, 2004 ; Kayser et al., 2007 ).

Due to the risks stemming from detection outlined above, there is a necessarily secretive element to systematic doping. Professional cycling provided a clear example of this, as the notion of omerta worked to protect cyclists from being found out. This silence required athletes to avoid discussing their own use and to deny knowledge of doping activities by anyone associated with their team. While omerta has been vilified within cycling and sport more generally, this cultural artefact actually explains some of the ways in which systematic doping can act as a form of harm reduction and produce (quasi)enabling environments. Many harm reducing programmes and interventions rely on trust between the service providers and the substance using clients. Clients must be confident they will not be turned over to authorities, that other clients will not report them, and that offered services will lessen their chances of harm. Similarly, athletes must trust that the doping managers and their teammates will similarly remain silent about doping in order to reduce physical risks related to supply and administration, as well as social, economic, and policy risks related to the consequences of detection. Russia exemplified such a system on a grand scale, protecting athletes across local, national, and international levels. Because all members of the team are in it together ( Johnson, 2016 ) one slip could cause the entire system to crumble such as when Floyd Landis became a whistle-blower and exposed the extent of the US Postal/Lance Armstrong doping system or Grigory Rodchenkov revealed the extent of Russian doping. In this way, omerta functions as a harm reducing strategy and enables safer doping to occur. Omerta also has implications for other stakeholders. Event organizers and sponsors may be led to believe teams are not doping and promote them as such, and though this may offer some plausible deniability it can also leave them open to criticism if the system is later revealed. Further, fans and supporters may feel betrayed if doping is revealed among the athletes or teams they support or have defended from allegations of doping.

Athletes did still suffer harms within these systems, often at the hands of central organising individuals or groups in the forms of bullying, coercion, and extortion. One reason athletes were vulnerable to such abuse is due to the nature of the risk environment in which these systems operated. Because of the risks that accompany doping revelations and the secretive nature of such systems, athletes had little recourse that did not necessarily out them as dopers or threaten their livelihoods, safety, or reputations. Much like individuals who are victimized as part of their use or sale of other controlled substances, doping athletes lack ‘access to law,’ an absence posited to fuel the apparently violent ‘nature’ of illicit drug markets at large ( Jacques, Rosenfeld, Wright, & van Gemert, 2016 ). Even as the systematic approach to doping did enable use and reduce multiple types of harms, it was unable to reduce all risks. These persistent social harms were able to flourish due to the competing risk derived from the anti-doping environment. Without the threat of exposure and accompanying harms, athletes may have been able to avoid some of these abuses. The policy response to this reality has been a shoring up of whistle-blower protections for athletes, though how effective those are remains to be tested.

By applying the risk environment framework to the sport context we have demonstrated many doping risks are socially produced through punitive anti-doping policies and approaches. Systematic doping is a response to these aimed at addressing the main risk factor produced by anti-doping: a positive doping test. By centralising doping and organising details to shield athletes from physical, social, economic, and policy risks, systematic doping necessarily includes harm reducing strategies. Cycling in the 2000s and the recent Russia scandal have shown how effective these well-organised and secretive systems can be. Despite anti-doping rules and increased testing and controls, in both cases the use environment shifted from one of great risk to one where use was enabled and supported. In many ways, these efforts mimic harm reductive approaches employed in the non-sport substance use context, as well as the harm reduction models proposed for sport (e.g. Kayser et al., 2007 ; Smith & Stewart, 2015 ), that tend to be based more on ideas around public health. Though some social harms (i.e. bullying, bribery) persisted even in the face of these efforts to reduce harm, many link back to the prohibitive and stigmatising factors arising from anti-doping itself. Armstrong would have been less able to bully members of his group and Russian officials less likely to coerce and extort athletes if those athletes did not fear the consequences of retaliation and revelations of their own doping.

Where systematic doping undertaken by national sports or private athlete teams has been roundly condemned (and harshly punished), there are widely accepted analogues within the recreational drug sphere, with both governments and non-profit organisations seeking to shape enabling environments for people who use diverse drugs. HAT is perhaps the starkest example of governments’ willingness to furnish individuals with the safe supply of a highly stigmatized drug, in order to ameliorate the multiple and varied risks associated with its unregulated use. Beyond enabling (a delimited population's) heroin use at the level of policy, HAT also molds the physical, social, and economic environments of use in ways that reduce acute and chronic harms. Delivered in hygienic and private spaces overseen by medical personnel, HAT removes the threat of arrest and stigmatisation that accompanies public use and precludes equipment sharing that may lead to disease transmission. In the countries that offer HAT, participants receive no-cost heroin of known purity, in doses and at intervals calibrated to their individual tolerance – effectively eliminating the hazards of on-site overdose, diluted or fake drugs, and possibly, other high-risk behaviours driven by withdrawal (such as acquisitive criminal activity) ( Kilmer et al., 2018 ).

While governments remain committed to drug policy approaches that emphasise prohibition, HAT stands out as a concession shaped by evidence, pragmatism, and humanism. Decades of draconian punishments have failed to eliminate, or even consistently lower levels of recreational drug use within the general population; there were more than a half million deaths related to illicit drug use in 2017 alone ( United Nations Office on Drugs & Crime, 2019 ). Much like the complex individual and structural strains that shape problematic drug use outside of sport contexts, the disproportionate material and symbolic rewards that drive some athletes’ interest in doping are likely to persist, and in turn inspire systematic doping schemes. Policy changes that seek to reduce harm among some athlete groups, such as recreational, youth, or elder sport participants, could provide a similar concession within the sport context. Harm reduction proposals for addressing doping have attempted to do so by advancing suggestions such as medically supervised doping, health checks, and threshold testing ( Kayser et al., 2007 ; Kayser & Tollneer, 2017 ; Smith & Stewart, 2015 ). Utilising such strategies in a policy context may begin to help foster sport enabling environments that are so far available only through illicit doping systems.

While far from aligning with hegemonic ideals of sport and anti-doping, systematic doping has provided a way of protecting athletes from the risks and harms produced by anti-doping within the sports environment. These efforts exist in tension with anti-doping, forming a responsive relationship between the two groups. As anti-doping policies and testing measures were put in place and enforcement increased, athletes, clubs, teams, and even countries responded by instituting systems underpinned by secrecy that would enable doping use to continue while simultaneously reducing the risk of harms to all involved. Anti-doping has responded with increased levels of athlete surveillance, increased penalties, and developing new methods of detecting doping.

It is unclear what will be the final outcome of doping war, but new questions and issues constantly present new challenges for both groups. For example, how each side will respond and adjust when unexpected outside forces – such as the current Covid-19 pandemic that has led to the postponement of World and Olympic level events – upset the tug of war. Future research on anti-doping policy and harm reduction may look more closely at the ways known doping systems have developed and their strategies for reducing various risk factors in order to enable doping. By considering these systems, sport researchers and policymakers may find new ways to incorporate harm reducing strategies to produce a less risky sport environment. It is possible, though, that the most effective doping systems for reducing harms may be the ones that have thus far avoided detection.

Ethical approval

This review was exempt from ethical approval as it involves no human subjects.

Declarations of Interest

Funding sources.

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Article contents

Alcohol abuse and drug use in sport and performance.

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

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

Introduction

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

Prevalence of Substance Abuse in Sport

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

Recreational Drugs

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

Performance-Enhancing Drugs

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

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

The Sporting Context, Alcohol Abuse, and Drug Use

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

The Cultural Context of Alcohol and Sport

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

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

Performance-Related Considerations

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

Seasonal Effects

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

Drug Testing

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

Ethical Considerations

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

Intervention and Prevention Strategies for Alcohol Abuse and Drug Use

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

Motivational Enhancement Interventions

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

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

Alcohol and Drug Skills Training Programs

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

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

Contingency Management

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

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

Twelve-Step Programs

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

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

Environmental Interventions

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

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

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

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

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

Conclusion and Future Directions

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

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• Performance Enhancing Drugs in Sports | Northwestern SPS

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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Top 10 Pro & Con Arguments

Anabolic Steroids

Blood-Doping and Erythropoietin (EPO)

Human Growth Hormone (HGH)

Techno-Doping

Gene-Doping

Criminalization

Therapeutic Use Exemptions (TUEs)

Baseball Hall of Fame

1. Anabolic Steroids

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

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

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

Read More about This Debate:

Should Anabolic Steroid Use Be Accepted in Sports?

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

2. Blood-Doping and Erythropoietin (EPO)

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

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

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

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

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

3. Stimulants

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

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

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

Should Stimulants Use Be Accepted in Sports?

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

4. Human Growth Hormone (HGH)

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

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

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

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

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

5. Techno-Doping

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

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

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

Should Techno-Doping Be Accepted in Sports?

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

6. Gene-Doping

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

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

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

Should Gene-Doping Be Accepted in Sports?

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

7. Marijuana

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

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

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

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

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

8. Criminalization

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

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

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

Should Doping Be Criminalized?

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

9. Therapeutic Use Exemptions (TUEs)

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

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

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

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

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

10. Baseball Hall of Fame

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

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

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

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

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

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The Implications of Drugs Used in Sports

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Ethical Issues With Performance Enhancing Drugs in Professional Sports Term Paper

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Introduction

Health issues, the spirit of sports.

Enhancement of human capacity has become possible following technological advancement in the field of health. Currently, scientists have the capacity to manipulate physical and physiological mechanism of the body to perform unusually. In sports, performance-enhancing drugs benefit sport professionals by improving the strength of the muscles, increasing degree of endurance, and efficiency in sporting. Despite these benefits, the uses of performance-enhancing drugs have serious ethical issues regarding health and sports.

The use of performance-enhancing drugs threatens physical and physiological health of sport professionals and distorts the sporting spirit. The spirit of sports emphasizes on the biological potential, fairness, and justice to the competitors; nevertheless, the use of performance enhancing-drugs undermines the same. The escalating cases of doping among sport professionals, casts great doubt on the preservation of health and ethical values in sports

With the advancing technology in health, scientists are now able to manipulate physiological mechanism of the body through various ways of human enhancement. Scientists have found out that human enhancement is possible in areas such as physical enhancement, life extension, cognitive enhancement and, personality enhancement amidst other emerging enhancements.

Physical enhancement is one of the ways of human enhancement that has found extensive application in professional sports. The use of performance enhancing drugs in professional sports has elicited a lot of debate and controversy concerning ethical, social, and legal implications in the society. The alarming increase in the use of performance-enhancing drugs pushed the former United States president, George Bush to voice his concerns on the same.

He said, “the use of performance enhancing drugs like steroids in baseball, football, and others sports is dangerous, and it sends the wrong message that there are shortcuts to accomplishment, and that performance is more important than character” (Schieffelin, 2007, p. 966). The escalating cases due to performance-enhancing drugs in professional sports have unforeseen negative effects to the society, hence ethical issues and concerns.

Although performance-enhancing drugs have health benefits of increasing muscle strength, endurance, and efficiency in sports, the use of performance enhancing drugs such as anabolic steroids has serious health repercussions. The Controlled Substance Act of the United States classifies anabolic steroids as illegal class of drugs that are very harmful to the health.

Scientific evidence demonstrates that, “steroids threaten the physical and physiological health of anyone who uses them for non-medical purposes … and pose even greater danger to adolescent individuals causing reproductive disorders, fluid retention, depression, and long-term physiological damage” (Schieffelin, 2008, p. 968).

In spite of the physical health benefits associated with performance enhancing drugs, the negative side effects of continued use of the drugs outweigh its benefits, thus generates ethical issues. Due to health concerns, it is not ethical to encourage the use of performance-enhancing drugs in or outside the sports.

Proponents who encourage the use of performance enhancing drugs cry foul that their critics have exaggerated the health risks posed by the drugs. The proponents argue that the harmful effects of these drugs “…have been overstated, that health risks are an athlete’s decision to make, that using drugs is part of the evolution of sports … and that efforts to keep athletes from using drugs are overzealous, unproductive, unfairly administered, and bound to fail” (Wyler, 2008, p. 3).

From their argument, the proponents of performance-enhancing drugs imply that they are not concerned about the health of the sport professionals; all they need is to enhance performance in sports. To argue that it is an individual’s decision to decide whether to use performance-enhancing drugs or not, contravenes the very core ethical values of the society. It is ethical to protect and advocate for preservation of the health conditions of sport professionals rather than leaving them at the mercy of their winning desires.

The exponential trend on the use of performance enhancing-drugs among youths is quite shocking. The statistical estimates released by The National Institute on Drug Abuse reveal that, “more than a half million eighth- and tenth-grade students are using steroids, and University of Michigan study showed that between 2000 and 2004, the Nation’s eighth-, tenth-, and twelfth-grade students experienced peak rates in annual anabolic steroid use” (Schieffelin, 2008, p. 970). This trend is setting a bad precedent to the young children who are aspiring to attain unrealistic achievements of their elders who are using performance-enhancing drugs.

The most important thing in the current society is to preserve and maintain ethical issues that will stand the test of time for the sake of physical and social health. Hence, if the use of performance-enhancing drugs is encouraged or goes unchecked in the light of the current trends, the physical and social health of the sport professionals would be irreparably damaged due to the bad culture of enhancing human performance.

According to World Anti-Doping Agency, its mandate is to ensure that sport professionals adhere to the sporting ethics that provide a level ground for healthy and fair competition in order to protect the sporting spirit.

Bostrom and Roache argue that, “athletes who use performance enhancing drugs are cheaters who gain an unfair advantage, violate the spirit of competition, send the wrong message to children, and unfairly diminish the historic achievements of clean athletes (2007, p. 8). It is unfair to rank sport professionals who use performance-enhancing drugs equally with those who do not use the same drugs.

Sport professionals who use performance-enhancing drugs have obvious advantage over the rest who do not use them thus negating the vital spirit of competition. For the spirit of competition to thrive well in sports, a level ground is prerequisite for just and fair competition, which is ethical; otherwise, unfair competition attributed to the use of performance-enhancing perverts sports.

Although it is plausible to level the ground of competition by encouraging all sport professionals to use performance-enhancing drugs, the spirit of sports measures sporting potential based on biological potential and not enhanced potential.

The spirit of sports is about preserving sporting ethics and values of ancient times, by testing biological strengths, and skills of the sport professionals. Bostrom and Roache assert that, “if biological potential is what the spirit of sport is about, then performance-enhancing drugs certainly go against it, since athletes can achieve things with the aid of drugs that they would be unable to achieve based on their natural potential alone” (2007, p. 9).

Therefore, the test of biological potential provides a level ground for competition, unlike the use of performance-enhancing drugs, which complicates the parameters of competition, since varied dose concentration, would give concomitant enhanced performance. Therefore, in performance enhancement, unequal dose of a given drug would result into unfair competition among competitors.

Since professional sports ultimately aim at making economical achievements, then the means of attaining economic gains matters. Despite the efforts of World Anti-Doping Agency to protect the spirit of competition, many sport professionals still use performance-enhancing drugs in order to edge their competitors and unfairly claim the prize. It is unethical for sport professionals to use unfair means to deny their competitors a chance of winning prizes they really deserve.

According to ethical theories of sports, “no person or group must be favored over another … not just whether to commit a strategic foul in terms of good consequences for one team, but the opposition and the good of the game” (Culbertson, McNamee, & Ryall, 2008, p. 6). Consequently, allowing or conspiring to win sport prizes by using performance-enhancing drugs is fraud and unethical for it robs of other competitors excellent opportunities of winning fairly.

Permitting the use of performance enhancing drugs in professional sports would distort the true spirit of sports. The main objective of the sport professionals is to win; no matter whether there is an improved performance or not.

Bostrom and Roache argue that, if people desire to see sport professionals perform superbly, “we can make humans using whatever means become available, then, we should actively promote performance-enhancing drugs, and expect to see competitors striving to become the first to discover the latest enhancements in order to beat their rivals” (2007, p. 10).

The use of performance-enhancing drugs would shift the focus of the sport professionals from winning the game into discovering the most effective performance-enhancing drug in the market. Eventually, sporting spirit of fairness and biological potential fades away and unfair spirit of competition in terms of money and effective drugs ensues.

The alarming trend in the use of performance-enhancing drugs in professional sports is raising great deal of ethical, social, and legal concerns.

Research studies claim that performance-enhancing drugs impair physiological and physical health of the sport professionals who indulge in their use. Adverse effects associated with performance-enhancing drugs pose critical issues of health. Moreover, doping is unethical in sports, and thus the World Anti-Doping Agency is putting up measures to ensure thorough screening of all sport professionals.

The aim of the World Anti-Doping Agency is to provide a level ground to all competitors, which will enhance the spirit of competition. Predictably, the continued use of performance enhancement drugs will lead into distortion of the sports’ spirit, as competitors will shift their focus from winning the game, into discovering a new performance-enhancing drug in the market. Ultimately, the loss of ethical issues regarding sports leads to the distortion of sports obliterating the sporting spirit; a core element within sporting circles.

Bostrom, N., & Roache, R. (2007). Ethical Issues in Human Enhancement. New Waves In Applied Ethics Journa l, 12, 1-27. Print.

Culbertson, L., McNamee, M., & Ryall, E. (2008). Resource Guide to the Philosophy of Sport and Ethics of Sport. Hospitality, Leisure, Sport and Tourism Network, 1-43. Web.

Schieffelin, N. (2007). Maintaining Educational and Athletic Integrity: How Will Schools Combat Performance Enhancing Drug Use? Suffolk University Law Review, 40(4): 959-979. Web.

Wyler, L. (2008). International Convention against Doping in Sport: Issues for Congress. Congressional Research Service, 1-6.

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• The Urgent Problem of Doping in Youth Sports: Solutions and Impact
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• Sports and Steroids: Society’s Acceptance or Rejection of Steroids in Sports
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• Random Drug Testing for Collage Athletes
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IvyPanda. (2019, February 20). Ethical Issues With Performance Enhancing Drugs in Professional Sports. https://ivypanda.com/essays/ethical-issues-with-performance-enhancing-drugs-in-professional-sports/

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Drug Use in Sports

Updated 26 July 2023

Subject Race and Ethnicity

Downloads 57

Category Health ,  Sports

Topic Drugs ,  Recreation and Sports ,  Doping

Athletes and sports workers frequently use drugs at almost all levels of competition. The goal of drug use in sports is to enhance performance or to help athletes cope with stressors like pressure to perform, injuries, physical discomfort, and worry about leaving their sport. (Reardon and Creado 95). However, professional athletes began to recognize the problem in the 1960s. Due to the Bay Area Laboratory Cooperative (BALCO) investigations involving former professional athletes and a 2007 report about drug use in professional baseball, the problem of drug use has recently received more attention. The issue was further enhanced by the scandal involving the Russian Olympic team in 2014 (CNN Library para.1). Therefore, as a result of the harmful effects and deceptive nature of drugs such as steroids in sports, athletes should not be permitted to access these drugs.

The history of drug use in sports can be traced back to ancient times even before organized sports had been developed. Since the discovery of sports, many professional athletes have engaged in the use of drugs to enhance their performance due to the competitive nature of many sports. During the ancient Olympics, many activities which are considered cheating in the modern day were acceptable except game fixing (Austin 3). As a result, these athletes would use experimental herbal medications to enhance their performance. Furthermore, drugs would be used to prevent fatigue and injury. For instance, in 100 AD, gladiator competitions and chariot racing were popular games in the Roman culture (Austin 4). Hence, gladiators would ingest stimulants such as strychnine to avoid fatigue and injury while improving the intensity of their fight (Austin 4). On the other hand, horses would be fed substances that would stimulate them to run faster in chariot races.

In the recent times, the most notable occurrence of drug use in sports is usually witnessed in Olympic Games especially in field and track events such as running. For instance, in 2014, the Russian Olympic team was involved in a major drug use scandal. According to Bishara (para.3), during the 2014 winter Olympics, a state-sponsored doping test was conducted in Russia and the government was in charge of the program. The revelation shows the extent to which countries go to ensure that they perform better in the Olympic Games. Following this scandal, the Russian track and field athletes were banned from participating in the summer Olympics which were to be held in Rio in 2016 (Bishara para.15).

Understanding of Opposition

Drug use among athlete is not wholly harmful and deceptive depending on the nature of the sport. In fact, the use of steroid among athletes is not harmful to their lives compared to other activities that people partake. Among some athletes, use of steroid is just a common behavior just like those people who engage in skiing and cliff diving. Criminalizing the use of steroid in sports because of the potential health risk to the athlete is not justifiable because there are other life behavior, legal drugs and activities which are more harmful. Among the list of drugs and diets which athletes are permitted to use, steroids are in the bottom of the list among those that can cause serious harm to the body (ProCon.org para.2). Hence, it is not justifiable to criminalize its use will allow the athletes to partake in some diets. Therefore, some steroid should be allowed to be used in controlled measures to ensure that the individuals using them are not harmed.

Furthermore, the claim that the use of steroid among athletes is deceptive to the nature of the sport cannot be justified. In a case, where steroid are allowed to be used by the athletes, many athletes will partake it to improve their performance. However, some athletes may decide not to use the drug. In such a case, the athletes should be allowed to declare whether they are using the drug or not publicly. As a result, an athlete will have informed the opponent about the type of drug they are using thus it will not be deceptive because the opponent will have details about the other person’s performance. Furthermore, steroids in some cases so not boost the performance of a person (ProCon.org para.4). For instance, in javelin games, a person might be high on steroids, but if they lack the technical ability to throw the javelin, then they will not be able to improve their performance. Therefore, the use of steroid can be allowed in cases where its use will not affect the overall outcome of the sport and in cases where the opponent is informed about the consumption of the drug.

Assert Position

In an athlete’s life, there are several that can lead to drug use. The primary reasons for drug use include enhancing their performance, to self-treat illnesses which they do not want the public to know and to deal with stressors such as fatigue and pressure to perform (Reardon and Creado 95). The continued use of this drugs is harmful to the life of the athlete because it may lead to drug addiction and drug abuse. An athlete may continue to face the stressor in life and the need to maintain performing better in games leading to an increase in the use of steroid by the athlete. The rise in drug use then results in drug addiction and in cases where steroids are unable to satisfy the needs of the athlete, the athlete may turn to substance abuse to cope with the numerous stressors (Reardon and Creado 96).

Moreover, although some individuals may claim that the use of steroids is not deceptive to the nature of the sport, its use may give an opponent a competitive advantage hence making the sport to be unfair. Steroid stimulates the muscles of a person and provides them with an increased supply of testosterone. As a result, the performance of such an individual in sports such as running will be improved. To maintain a fair competing ground, various sports organizations in the world have banned the use of any drug which is known to enhance the performance of a person. The first body to ban the use of PEDs was the International Association of Athletics Federation. These organizations have set strict rules for individuals who may be caught using drugs to enhance their performance. Therefore, the band of PEDs sets a level competing ground for all athletes.

Common Ground

The main aim for the use of drugs in many sports is to improve performance. Athletes use steroids to boost their energy supply so that they can be able to endure challenging circumstance and produce better performance. However, other better alternatives can improve an individual's performance which are legal and safe to the health of a person. For instance, instead of depending on drugs to boost their performance, athletes can train harder and observe a healthier diet. Having a healthy diet and engaging in consistent training will enable an athlete to achieve their best performance in the field.

To conclude, athletes should not be permitted to use steroid due to the deceptive nature and harmful effects of the drugs. The use of these drugs creates an unhealthy competing environment which is unfair and unsafe to the opponent. Although steroids appear to be harmless to the body, the overall and long-term effect of the continued use of these drugs is harmful as it may lead to substance abuse. In many sports, the governing bodies have illegalized the use of steroid to create a fair and equal competing ground. Therefore, athletes should desist from using steroid so that they can participate in sporting activities equally, safely, and fairly.

Works Cited

Austin, Jane. Drug Use and Abuse in Sport. U3asites.org.uk, October 2014. Web. 26 October 2017.

Bishara, Motez. Russian doping: ‘An unprecedented attack on the integrity of sport & the Olympic Games.’ CNN, 21 July 2016. Web. 26 October 2017.

CNN Library. Performance Enhancing Drugs in Sports Fast Facts. CNN, 28 May 2017. Web. 26 October 2017.

ProCon.org. Should Steroid be accepted in Sports? ProCon.ORG, n.d. Web. 26 October 2017.

Reardon, Claudia L., and Shane Creado. "Drug abuse in athletes." Substance abuse and rehabilitation 5 (2014): 95-105.

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What’s It Like to Be Drug-Tested? We Asked Three Olympic Runners.

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Late-night visitors armed with syringes and vials. Apps that track your location. Phone calls from mysterious numbers.

Ever wonder what drug testing entails for Olympic track and field athletes ? Consider the experiences of three runners — Ciara Mageean of Ireland, Emily Mackay of the United States and Olli Hoare of Australia — who are among those who have grown accustomed to one of the kookier parts of their shared profession.

“Nobody,” Mageean said, “will have poured urine into bottles on your own kitchen table as much as athletes.”

Ciara Mageean, Ireland

At this stage of her career, Mageean is intimately familiar with the various drug-testing protocols and the many minor inconveniences that they create.

For example, athletes must provide their “whereabouts” via a smartphone app to authorities like the World Anti-Doping Agency or, for Americans, the United States Anti-Doping Agency so that they can be tested without advance notice in an out-of-competition setting. That includes a one-hour window each day in which they must provide their exact locations in case a stranger needs to turn up to draw blood or (more uncomfortably) stand there while they urinate into a container.

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The World Anti-Doping Agency (WADA) says the U.S. Anti-Doping Agency (USADA) ran a rogue operation that turned athletes into "undercover agents."

"WADA did not sign off on this practice of permitting drug cheats to compete for years on the promise that they would try to obtain incriminating evidence against others," the organization said in a statement .

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This salvo from international anti-doping officials based in Montreal, Canada, comes after WADA itself faced growing criticism for its handling of positive drug tests involving 23 Chinese swimmers .

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USADA said in its statement athletes who worked undercover while still competing "provided intelligence" to U.S. federal law enforcement and anti-doping investigators that eventually led to criminal charges.

"When USADA and other anti-doping organizations obtain information about misconduct and potential violations," Tygart said, "it’s critical that we pursue the truth with all the resources at our disposal."

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Public Backs Athletes: 42% Say Recreational Drug Use Should Not Disqualify Olympians

Zinger key points.

• Survey shows 42% of Americans support Olympic athletes using recreational drugs, questioning current disqualification rules.
• Public backs revising policies to differentiate recreational from performance-enhancing drugs.

Recent controversies surrounding Olympic athletes like Sha'Carri Richardson and Shoko Miyata have sparked debate about drug policies within the international sporting community.

These high-profile cases have brought to light broader questions regarding the role of recreational drug use among Olympic athletes and whether current regulations are in step with public opinion.

See Also: Surprised To Hear Olympic Athletes Receive No Salary? – Well Here’s What They Get For Each Medal

A recent study conducted by Boca Recovery Center has provided fresh insights into American attitudes towards these issues. The survey, which included 1,000 respondents, revealed that a significant portion of the U.S. public believes recreational drug use should not automatically disqualify an athlete from competing in the Olympics.

Key Findings On Public Sentiment

The survey disclosed that 42% of Americans believe athletes should not be disqualified from Olympic competition solely based on recreational drug use. This sentiment is particularly strong among Millennials, 52% of whom support this stance, compared to 34% of Baby Boomers and Gen X respondents.

The study highlighted a clear distinction in public opinion between performance-enhancing drugs and recreational substances.

Over 80% of those surveyed asserted that Olympic drug policies should differentiate between these two categories. Furthermore, 53% of Americans believe that if a drug is legal in an athlete's home country, they should be permitted to use it and compete, provided it does not enhance performance.

Reactions To High-Profile Cases

Public disapproval of how recent cases were handled is also notable. A striking 84% of respondents disagreed with the decision to send Shoko Miyata home from the Paris Olympics after she was caught smoking cigarettes. Similarly, 70% opposed the ban on Sha'Carri Richardson from the Tokyo Olympics following her positive cannabis test.

Reasons cited for disagreeing with these sanctions included the belief that smoking is a personal choice (50%) and that the punishments were too severe (46%). On the flip side, some Americans agreed with these decisions, with 25% arguing it sets a bad example, particularly for young athletes, and 24% concerned about the potential impact on performance.

• Sha’Carri Richardson’s Olympic Return: The Cannabis Debate Amid US-WADA Tensions Over Doping Laws
• Sports On Steroids? Peter Thiel Invests In ‘Doping-Friendly’ Olympics Rival ‘Enhanced Games’

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Olympic officials address gender eligibility as boxers prepare to fight

PARIS – The case of two Olympic boxers has drawn attention to a thorny issue: Who and what determines which female athletes can compete.

Algerian boxer Imane Khelif and Lin Yu-ting of Taiwan both were disqualified from the 2023 women’s boxing world championships when they reportedly failed gender eligibility tests.

But this week, the International Olympic Committee confirmed the two boxers have been cleared to compete here at the Paris Games , as they both did at the Tokyo Games in 2021. The issues of so-called gender verification or sex testing have fueled discussion at the Olympics as the fighters prepare to enter the ring at North Paris Arena.

Khelif, a silver medalist at the 2022 world championships, is scheduled to fight Thursday against Angela Carini of Italy in the welterweight division at 146 pounds. Lin, a two-time world champion, is scheduled to fight Sitora Turdibekova of Uzbekistan in the featherweight division at 126 pounds.

“Yeah, it’s really tricky," Australian boxer Tiana Echegaray told reporters Tuesday when asked about the situation. "I don’t know exactly what their circumstances are."

IOC spokesman Mark Adams indicated Tuesday no personal information about the boxers' medical histories would be disclosed. "They've been competing in boxing for a very long time," Adams told reporters. “They've achieved all the eligibility requirements in terms of sex and age. We're following the rules in place in Tokyo."

Who's in charge of boxing?

At the Summer Olympics, when it comes to gender eligibility, the IOC defers to the international federations that govern each of the 32 sports.

The IOC does provide a framework to the international federations . But it's “nonbinding."

In other words, it’s not up to the IOC. And the situation has grown especially complicated with boxing.

Last year the IOC banished the International Boxing Association (IBA), long plagued with scandal and controversy that jeopardized the future of Olympic boxing. In fact, the IOC denied IBA the right to run Olympic boxing during the Tokyo Games in 2021 and instead turned over control to an ad-hoc unit.

Opinion: Olympic female boxers are being attacked. Let's just slow down and look at the facts

With that ad-hoc unit in charge, Kehlif and Lin both competed at the Tokyo Olympics. Neither won a medal.

But the IBA has maintained control of the world championships and gender eligibility rules. And after Lin won gold and Kehlif won bronze at the event in March 2023, officials announced the boxers had failed medical eligibility tests and stripped them of the medals.

IBA president Umar Kremlev said DNA tests “proved they had XY chromosomes and were thus excluded."

What's the eligibility criteria?

A passport could be key, based on comments from Adams, the IOC spokesman.

“I would just say that everyone competing in the women’s category is complying with the competition eligibility rules," he said. “They are women in their passports and it is stated that is the case.”

Thursday Adams added that the issues with the previous tests for the boxers "was not a transgender issue, there's been some misreporting on that in press. ... These women have been competing as women for many years.

"What I would say just quickly on testosterone is, the testosterone (test) is not a perfect test. Many women can have testosterone, even what would be called 'male levels' and still be women and still compete as women. So this is not a panacea − this idea that suddenly you test, do one test for testosterone. Each sport needs to deal with this issue but I think we agreed, I hope we're agreed, we're not going to go back to the bad old days of 'sex testing'. That would be a bad idea."

In the past, other eligibility standards have hinged on science.

Caster Semenya, a two-time Olympic gold medalist in track and field in 2012 and 2016, was forced to give up competing in the 800 meters because her testosterone levels were too high based on tests administered by World Athletics, the sport’s international federation previously known as the IAAF.

Semenya was assigned female at birth. She said she was told at age 18 that she has XY chromosomes and naturally had high levels of testosterone.

Khelif and Lin have not publicly addressed details of their medical histories regarding the tests.

The issue of eligibility surfaced as a source of controversy in the United States in 2022 when swimmer Lia Thomas became the first openly transgender athlete to win an NCAA championship.

At the time, the NCAA required transgender female athletes to have undergone one year of testosterone suppression treatment to be eligible to compete on a women's team in any sport. The NCAA has been under pressure to update its guidelines after the NAIA banned all transgender athletes from competing in women's sports.

The Court of Arbitration for Sport upheld a decision in June by World Aquatics, the international federation for swimming, that prevented Thomas from competing in elite competitions through World Aquatics or USA Swimming.

Who are these two boxers?

Lin, 28, has been fighting as an amateur for more than a decade, according to BoxRec, a widely regarded boxing site.

She made her official amateur debut about three months shy of her 18th birthday, winning at the 2013 AIBA World Women’s Championships. She won gold medals at the world championships in 2019 and 2022.

At 5-foot-9, she often has enjoyed a height advantage while amassing a record of 40-14 with one knockout. The record does not reflect the four fights she won at the 2023 world championships before her disqualification, which resulted in the outcome of the fights being changed to “no contest.’’

She lost her last fight – a split-decision defeat against Brazil’s Jucielen Cerqueira Romeu in April at the 2024 USA Boxing International Invitational in Pueblo, Colorado.

Khelif, 25, made her amateur debut at the 2018 Balkan Women's Tournament. She won a silver medal at the 2022 world championships.

At 5-foot-10, she also has enjoyed a height advantage while amassing a record of 36-9 with four knockouts, according to BoxRec. That does not include the three fights she won at the 2023 world championships before her disqualification resulted in the fights being changed to “no contest.’’

In one of those fights, Khelif stopped her opponent by TKO.

Contributing: Kim Hjelmgaard