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).
Risk and enabling environments in sport: Systematic doping as harm reduction
Glucocorticoids are sometimes used by athletes in an attempt to enhance performance because of their anti-inflammatory and analgesic properties.12 However, there is minimal research to show any performance benefits of this class of drugs. Selective androgen receptor modulators are not approved for use in humans in any country, but athletes are able to obtain these substances on the Internet.32 No studies were found looking at the effects of selective androgen receptor modulators on muscle strength or mass in humans. Androgens include exogenous testosterone, synthetic androgens (eg, danazol, nandrolone, stanozolol), androgen precursors (eg, androstenedione, dehydroepiandrosterone), selective androgen receptor modulators, and other forms of androgen stimulation.
Why the war on drugs in sport will never be won
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. 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.
Study Selection
Each of these positions has its strengths and weaknesses, but we need to determine which model ensures sports’ integrity the most, which one delivers the best outcomes for players and athletes, and which one offers the opportunity for sports’ other stakeholders to also benefit. However, these policy options are difficult to precisely evaluate, since subjectivity and bias inevitably get in the way of an impartial analysis, even where a lot of objective evidence has been compiled. Zero tolerance is likely to deliver lower levels of use, but it will impact on a player’s civil liberties, and the overall harms to the athletes may not necessarily be lowered since banned substance use presents only one of many catalysts for harm to occur in and through sport.
Anabolic steroids are available over-the-counter in some countries such as Thailand and Mexico. There is a research base demonstrating that many doping agents are in fact performance-enhancing. However, some substances (eg, selective androgen receptor modulators, antiestrogens, and aromatase inhibitors), used in an effort to enhance performance, have little data to back up their effectiveness for such a purpose. Note that the studies cited in this paper are chosen as being historically important or representative of the bulk of the research on the topic, and the broad overview provided in this paper does not aim to cite all evidence on the effects of these substances.
Doping risk and enabling environments
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). Other ways of cheating that change the body without using foreign substances include injecting one’s own red blood cells as done with doping at the Tour de France, treating blood with UV light or the use of a hyperbaric chamber (not currently banned), and, potentially, gene doping. Performance and image enhancing drugs (PIEDs) are substances taken by people with the intention of changing their physical appearance and to enhance their sporting performance.
“But everyone else is doing it” might not be an argument a teenager is going to win with a parent, but in the case of professional athletes and PEDs, the argument is one that the sporting world should accept. The Council of Europe says it first appeared in sport at the Berlin Olympics in 1936.[42] It was produced in 1887 and the derivative, Benzedrine, was isolated in the U.S. in 1934 by Gordon Alles. Amphetamine was also used legally as an aid to slimming and also as a thymoleptic before being phased out by the appearance of newer agents in the 1950s.
We conclude with a comparison of sport and non-sport responses to drug use and the potential outcomes of each approach. In a multisite, randomized controlled study, the rate of successful outcomes after 12 months with suboxone was under 50% and had a relapse rate of 57% whereas those treated with vivitrol had a relapse rate of 65% [45]. All these treatments still have plenty of room for improvement, only offer limited disorders assistance and do not even begin to explore the athletic population and their specific needs. This is coupled by the fact that athletes do not typically like to take medications as they tend to be young and healthy and are quite fearful of side effects. Other substances outside of nicotine have even less data supporting any type of medication treatment including stimulants, cannabis and cocaine amongst others.
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. 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).
Six other teams pulled out in protest including Dutch team TVM who left the tour still being questioned by the police. The Festina scandal overshadowed cyclist Marco Pantani’s how long does weed stay in your system tour win, but he himself later failed a test. The infamous “Pot Belge” or “Belgian mix” has a decades-long history in pro cycling, among both riders and support staff.
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. 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.
The current conversation around the practice can be traced back to the revelation of steroid use in MLB players back in the late 90s to early 2000s. More than 24 MLB suspensions have been related to performance-enhancing drugs since 2005; on the NFL side, hundreds of games have been missed due to temporary suspensions related to doping. Experts at the event concluded that sport can present an opportunity to model healthy lifestyles for youth, increase prevention potential from risky behaviours including substance use, and develop important alcohol drug wikipedia life skills such as critical thinking and resisting negative peer pressure. 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.
- To speculate in the absence of evidence, it is also possible that some athletes employ higher dosages of normally banned substances while permitted to do so under the umbrella a therapeutic exemption.
- Athletes who had received doping sanctions were sometimes taking these sanctions, with their lawyers, to civil courts and sometimes were successful in having the sanctions overturned.
- An autopsy later revealed the presence of amphetamines and a drug called nicotinyl tartrate in his system.
- There is no reason to believe these techniques and variations of such would not be successful in athletes but more studies are needed.
These values have been conflated into the initial WADA slogan of ‘play-true’ and its current mantra of ‘drug-free’ sport. If a drug meets two of the above three criteria, it will be listed as a banned substance. Our writers and reviewers are experienced professionals in medicine, addiction treatment, and healthcare.
Using drugs to improve performance in sport may lead to an athlete being banned and may also harm their health. Trainers, coaches, and health care providers should provide evidence-based, safe alternatives to PED use, including optimal nutrition, weight-training strategies, and psychological approaches to improving performance, all of which may help with athletes’ confidence in their natural abilities. Athletes take human growth hormone, also called somatotropin, to build more muscle and do better at their sports. But studies don’t clearly prove that human growth hormone boosts strength or helps people exercise longer.
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. Quite a few drugs, including steroids and growth hormone, that are regularly banned by sports organizations are useful medical treatments, especially for sports injury recovery.
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). chronic relapsing disease 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.
Erythropoietin (EPO) is largely taken by endurance athletes who seek a higher level of red blood cells, which leads to more oxygenated blood, and a higher VO2 max. An athlete’s VO2 max is highly correlated with success within endurance sports such as swimming, long-distance running, cycling, rowing, and cross-country skiing. EPO has recently become prevalent amongst endurance athletes due to its potency and low degree of detectability when compared to other methods of doping such as blood transfusion. While EPO is believed to have been widely used by athletes in the 1990s, there was not a way to directly test for the drug until 2002 as there was no specific screening process to test athletes . Athletes at the Olympic Games are tested for EPO through blood and urine tests.
Such mixed messages become compounded when we assume that using an over-the-counter drug with significant side effects is acceptable, but the use of an illicit drug with no greater side effect is not only taboo but also indicative of a moral failing. The message can be further confused when officials, journalists, and fans not only demand that athletes always perform at their best but also remind them that failure will be publically scrutinised. In analysing a series of case studies, Carstairs exposed the complex and often contradictory responses to doping expressed through the popular media, message boards, and polls [37]. Athletes who have failed drug tests can receive sympathy and condemnation simultaneously. Though there is a notion that a relatively large percentage of athletes use anabolic steroids, studies have shown it to be rare, and under 6% of professional athletes. However, information from an Iranian study showed an interesting difference with a value of 36.2% among athletes.
Some commentators maintain that, as outright prevention of doping is an impossibility, all doping should be legalised. However, most disagree with this, pointing out the claimed harmful long-term effects of many doping agents. Opponents claim that with doping legal, all competitive athletes would be compelled to use drugs, and the net effect would be a level playing field but with widespread health consequences. A common rebuttal to this argument asserts that anti-doping efforts have been largely ineffective due to both testing limitations and lack of enforcement, and so sanctioned steroid use would not be markedly different from the situation already in existence.