There has been a huge amount of academic, policy, and public debate over the years about doping in sport (i.e. the use of banned performance enhancing substances or drugs and other prohibited practices), and significant resources devoted to addressing it.
Doping is a complex issue – we are still striving to understand how and why it happens, and how to prevent it. But despite the attention doping in sport has received, there is still significant public disagreement about how best to respond to this problem.
Public discussions on doping usually break down - sometimes because of the way we argue about such issues, and often due to inconsistent reasoning. If you want evidence of this take a look at the online comments pages on sports doping articles, or start your own debate with friends and see how far it goes.
Greater clarity is needed on how people think and argue about doping in sport. In this piece I look at the common positions people take on doping, what these commit us to, and the consequences of mixed messages going unchallenged.
Why people dope
Assuming you care about doping in the first place (some people don’t), a key issue to clarify is your theory about why people dope. Your position here is important for discussing the doping issue because, whether you realise it or not, this informs your views on what should be done about it.
Some people believe the doping decision simply comes down to the individual’s desire to win or gain advantages of some type. To them, doping is mostly determined by individual psychological factors, and should therefore be addressed as an issue of personal responsibility and culpability.
Others believe doping choices are driven by a mix of psychological, social, cultural, and systemic factors, rather than individual traits alone. In this view, doping occurs due to the interaction of individual factors (e.g. the desire for winning, improvement, pain management, recovery, career longevity, economic gains, and belonging), and wider socio-cultural and systemic factors (e.g. social background and experiences, team/club/sport culture, sport governance systems, perceived efficacy of anti-doping system, and so on).
Against doping in sport
The question of whether you are for or against doping in sport is also clearly important. If you are against doping in sport, as most people are, there are a number of arguments you might run here.
For example, you may think doping is wrong because:
- It is against the defined rules and laws governing sport.
- It is unfair and goes against the level playing field ideal.
- It represents a health risk and is harmful to the individual.
- It harms the athletes who choose not to dope (e.g. they exit sport early, or their career is impacted from being cheated out of results and earnings).
- It contravenes other values defined as the ‘spirit of sport’ (e.g. fair play and honesty; health; character and education; fun and joy; teamwork; respect for self and others; courage; community and solidarity).
- It sends an unacceptable message about the place and impact of sport in society.
The important thing to note here is that anti-doping advocates vary in their relative emphasis on the above arguments. For some, it is all about the rules of sport, and related ethics and integrity requirements. While for others, the health risk and harm issue is paramount.
For doping in sport
Some people in academic circles argue that doping should be permitted in sport – either in an open free for all as it used to be, under medical supervision, or under the framework of regulated decriminalisation.
The proponents of these more liberal positions on doping commonly argue the following:
- The level playing field ideal is a myth - there are numerous legal performance enhancing strategies that are unequally available across sports and countries (e.g. expensive training facilities and programs, technologically superior equipment, nutritional, medicinal and other aids etc).
- Current banned drugs and substances are not inherently harmful, nor the biggest sources of risk and harm when you consider injury rates and long-term physical outcomes in some sport.
- The true spirit of elite sporting competition is closer to the Athenian ideal of superhuman effort at any cost (including risks and injuries), and doping is consistent with that.
- Supervised regulated use of performance enhancing drugs and substances, and other banned practices (e.g. blood transfusions) would reduce health risks and harms.
- Prohibition policies and punitive measures create hidden, uninformed, and riskier doping which exacerbates health and other harms.
Again, people who argue for doping in sport may place different weight on some of the above arguments over others. Further, belief in one or other of these arguments doesn’t commit you to all of them.
Doping prevention approaches
If you are opposed to doping, you should also have a position on how to prevent or reduce it – your discussions on the topic won’t get far if you’re against doping but have nothing to say on what to do about it.
On doping prevention you could take a zero tolerance stance, where you favour restrictive surveillance and testing protocols, and punitive responses for even minor doping transgressions. Implicit in this stance is the belief that because the individual chooses to break known rules by doping, they should take responsibility and be punished accordingly if caught or if they confess, or make later admissions.
Zero tolerance advocates might also believe that doping in sport can ultimately be eradicated. But this is not a necessary belief for this position - for example zero tolerance proponents might simply favour the strong public message in sports doping policy that includes punitive responses.
Alternatively, you could adopt a prevention stance based on harm minimisation principles. Implicit in this position is the belief that doping will always exist in sport, and so the pragmatic aim of prevention is to reduce doping harm (to dopers, other athletes, spectators, sport generally), rather than total eradication of the behaviour.
Harm reduction proponents emphasise an athlete health and welfare focus over harsh punitive measures (i.e. criminalisation specifically). People here are less concerned with upholding individual responsibility as far as punishment goes. They believe doping prevention is better achieved through a focus on broader social, cultural, and systemic factors (e.g. team/club/sport culture, sport governance systems, ethics and integrity culture and systems, etc) rather than individual factors alone.
Punishing dopers doesn’t work
People who argue for harm minimisation approaches believe punitive measures alone will be ineffective in reducing or preventing doping in sport. As above, one reason for this is they believe doping behaviour is driven by a range of factors, and so doping prevention too must take a broad focus (beyond individual behaviour and psychology) to achieve widespread and lasting change.
Another claim made here is that penalties for doping such as fines, suspensions, and even lifetime bans are unlikely to deter doping, and will not eradicate it. The analogy often cited here this is the case of death penalties for murder not halting murder rates, or harsh criminal penalties for illicit drug possession, supply and use failing to reduce or eliminate those proscribed behaviours.
People who are unconvinced about the effect of punitive measures might also point out that even the severest doping penalties are unlikely to work in most cases, because under the current system athletes would challenge such penalties legally to uphold their right to compete, or preserve their rights for future earnings.
Finally, many people against punitive responses to sports doping also place a high value on forgiveness and redemption – a chance to start again with a clean slate. What often comes with this position is the view that the punishment and public humiliations suffered by some dopers (and their families) can be wrongly disproportionate to their original doping offence.
Punitive measures have a place
Supporters of punitive measures do not accept the analogy made between doping and criminal behaviour. They would argue the social, cultural and individual factors (including psychological determinants) of doping in sport are very different to those for murder and illicit drug use. As such, they also claim the thinking behind doping prevention approaches, including the expected impact of severe sanctions (not necessarily criminal), should be different too.
Zero tolerance advocates believe that, if applied appropriately, punitive measures can achieve desired sports doping prevention outcomes (i.e. reduced doping behaviour, reduced harm, or complete eradication). The view here is if doping policy is to include punitive measures (as per the current anti-doping framework), then these should be implemented competently and consistently in accordance with the defined policy aims and processes; and with clear and consistent public messages from sports governing bodies giving unambiguous support.
Supporters of punitive measures might also argue that it is not the current anti-doping policy framework that has failed, but rather the inadequate implementation of this framework by sports governing bodies and systems weakened by inconsistent practices, ineffective leadership, and ambiguous public messages about high profile doping cases.
Middle ground or mixed messages?
Doping in sport debates are often framed around the two ‘sides’ of harm minimisation and zero tolerance. At first glance, such positions appear distinct. In reality, people commonly shift between positions or argue a mix of both.
For example, you might believe that doping requires social determinants focused education and prevention programs (including capacity building in ethics and integrity, athlete culture and health and welfare and so on), AND progressively severe punitive measures in certain circumstances (e.g. for repeat doping offences, systematic team-based doping, related fraud and criminal activity).
A significant challenge for the doping in sport debate is predicting how people will think about and respond to doping cases. Ideally, careful reasoning based on the types of beliefs and positions summarised in this article would lead us to consistent responses, but that is not what often happens.
We see this with the sport of cycling - for example, compare most people’s strident opinions and responses about the Lance Armstrong case, to the relatively muted reactions about other cyclists who have doped (e.g. David Millar, Jan Ullrich, Erik Zabel, George Hincapie, Tyler Hamilton, Stuart O'Grady, Matt White, Neil Stephens, Alberto Contador, Alejandro Valverde, Danilo Di Luca etc).
We also see this in the responses from governments, sports governing bodies, and the sport itself. Again, the official reactions to the above cases in cycling have been markedly different - take a moment to reflect on where each of these riders are currently.
Most sports governing bodies and officials would claim they occupy a middle position between ‘crime and punishment’ and ‘education and prevention’ thinking and approaches. At face value, this seems like a sensible space for doping policy - the best of both worlds. However, this middle space can also be a fertile ground for mixed public messages and inconsistencies on doping that can undermine prevention efforts - as I have argued before in this Column (here and here).
By trying to occupy the middle ground on doping between zero tolerance and harm minimisation - trying to have it both ways - sports governing bodies run the risk of subsequently failing to implement either aspect of their doping prevention policies competently and consistently. Again, take a look at the recent criticisms made about the International Cycling Union.
Doping prevention efforts in all sports are undermined when mixed messages emerge from inconsistent thinking and action around doping policy - and especially when they continue unchallenged in public discussion and debates (e.g. ‘say no to doping’ but ‘say yes to ex-dopers in coaching positions’; ‘our sport is anti-doping’ but ‘ex-dopers manage our pro teams’; ‘strong doping prevention messages are needed’ but ‘ex-dopers are sponsoring elite teams, sports blogs, and working in sports media’).
What does your position on doping in sport commit you to? What should be done to prevent doping? What should we say about the mixed messages that exist about doping in sport?
Further reading: There is of a large academic literature, and a growing research evidence base, underpinning many of the points made in this article. If you are interested in further reading, a reasonable coverage of the issues can be seen at the Wikipedia doping in sport site, and Routledge have published a number of excellent academic books on this topic by some of the leading thinkers in this area.
This article provides a brief overview of the history of the introduction of the performance enhancing drug, anabolic steroids, into American sport. Performance enhancing substances/drugs are discussed in terms of the method of use, the performance enhancing properties and effects of the substance, and the adverse effects of the substance. Particular attention is given to steroids, creatine, ephedrine, and androstenedione. Guidelines for coaches, athletic administrators and other related professionals are provided for the recognition, intervention, and prevention of steroid use, following those proposed by Johnson and Van de Loo (2002).
Keywords Androstenedione; Creatine; Dianabol; Drug Abuse; Ephedrine; Dietary Supplements; Performance Enhancing Drugs/Supplements; Pyramiding; Stacking; Steroids; Testosterone
The history of the use of performance enhancing drugs in sport as a means to improve athletic performance extends beyond a time frame that most would think possible. Athletes have been using performance enhancing substances for over 3000 years (Prokop, 1970), yet not until 1935 was testosterone isolated and determined to be a means to increase muscle tissue size (Berning, Adams, & Stamford, 2004). In 1954 Dr. John Ziegler, physician with the United States Weightlifting team, learned about the use of testosterone by Soviet athletes at the world championships. Dr. Ziegler returned to the United States and worked with a pharmaceutical company on the development of a synthetic testosterone which was released in 1958 (Goldman, Klutz, & Goldman, 1987). Athletes began trying the synthetic Dianabol without much information on the possible side effects of the substance (Berning, Adams, & Stamford, 2004), but as the increase in muscular strength of these athletes grew at exponential rates, more and more athletes began taking the drug privately. Dianabol usage was not illegal at this time, but athletes who were users kept their use private and the general public believed Dianabol usage to be limited; that these athletes had too much to lose and would not risk being caught (Berning, Adams, & Stamford, 2004).
The stripping of Ben Johnson's Olympic medal and world record at the Seoul Olympic Games in 1988 after he tested positive for anabolic steroids brought the use of steroids by elite level athletes into mainstream America (Berning, Adams, & Stamford, 2004). As a result, anti-doping measures were strengthened for the 2000 and subsequent Olympic Games. However, the subsequent revelations of ongoing performance enhancing drug use by athletes such as Olympic sprinter Marion Jones and Tour de France winner Lance Armstrong, who were never detected as drug users through ordinary sport-related testing, have created concerns that the use of performance enhancing drugs could be much more widespread than indicated by official test results (Dimeo & Taylor, 2013), and that official testing agencies may never be able to keep up with new means of artificially enhancing performance and ways to mask the use of banned drugs . This brief overview of the history of how performance enhancing drugs infiltrated International and American sport provides the necessary background to discuss and explore the prevalence, use, and types of substances that are currently used by adolescent athletes in the United States.
“It is easy for coaches and athletic administrators to say, ‘That does not happen here’ when it comes to a discussion on student athlete performance enhancing drug supplement use. The increased availability of these products on the Internet, by mail order, or from nutritional supplement retailers and illegal vendors, allows student athletes access to a wide variety of performance enhancing drugs and supplements that are highly marketed in fitness and strength training magazines with promises, endorsed by faulty research claims, of extraordinary weight loss, explosive power, or tremendous strength gains. Athletes consume these substances in addition to their normal diet because of the belief that these products will live up to the claims. Unfortunately, supplements are not regulated by the Food and Drug Administration (FDA) and, therefore, may include undisclosed ingredients have negative side effects, may be harmful when combined with other substances, or are impure and may be potentially unsafe or harmful to the consumer” (“Nutritional Supplements, ¶ 1).
Use of Performance Enhancing Drugs by Adolescents
The focus of this article is the adolescent use of performance enhancing drugs/substances. In a survey conducted by the Blue Cross Blue Shield Association's Healthy Competition Foundation, 1002 adults and 785 youths between the ages of 10-17 years were surveyed to assess the prevalence of performance enhancing substance use and knowledge about the potential harmful effects of these substances. The survey revealed that one in five American youths know someone who is using a performance enhancing drug and approximately 96% of American youth are aware that there are potential health hazards of using (Alcoholism & Drug Abuse Weekly, 2001). However, only 70% of the youth and 50% of the adults surveyed could specifically identify the potential effects of performance enhancing drug/substance use (Alcoholism & Drug Abuse Weekly, 2001). The Healthy Competition Foundation study also found that the top performance enhancing substances being used by youth were creatine followed by anabolic steroids (Alcoholism & Drug Abuse Weekly, 2001). Another study conducted by the Community Anti-Drug Coalitions of America (CADCA) in 2003 revealed that 1 in 30 student athletes was using a performance enhancing substance or steroids with 2.1 percent of 12th graders and 1.4 percent of 8th graders reporting steroid use in the previous year (Alcoholism & Drug Abuse Weekly, 2004).
A 2011 survey by Lorang and colleagues found that although the rate of use of anabolic steroids by high school students is low (1.4%), rates of use were high among males, recreational drug users, and those participating in school sports. In addition, many students believed that steroid use improved athletic performance (49%) and/or appearance (38%). Research conducted by Buckley and his colleagues (1988) indicated that of high school anabolic steroid users, approximately 65% were student athletes, suggesting the need to educate student athletes about the risks involved with steroid use and the need for future research to monitor changes in steroid use. Adolescent student athletes who have reported using steroids cite the desire to improve their athletic performance with the highest rates of use in football, wrestling, and track and field (Bahrke et al., 2000). Hodge, Hargreaves, Gerrard, and Lonsdale (2013) found that moral disengagement was a predictor of the use of performance-enhancing drugs among elite athletes.
Anabolic steroids are comprised of synthetic testosterone and mimic some aspects of the androgenic effects and most of the anabolic effects that natural testosterone has on the male body (Johnson & Van de Loo, 2002). The androgenic effects of testosterone are development of the sex characteristics including the development of the male reproductive tract and secondary sexual characteristics such as pubic and facial hair growth, increase in penis size, and development of prostate gland and scrotum (Johnson & Van de Loo, 2002). The anabolic effects of testosterone include increases in skeletal and muscular strength, growth of the long bones, thickening of vocal cords, increase in protein synthesis, decreased body fat, enlargement of the larynx, and development of the libido (Johnson & Van de Loo, 2002). The production and development of synthetic steroids has allowed manufacturers to minimize as many of the androgenic effects as possible to decrease these unwanted side effects (Johnson & Van de Loo, 2002). Steroid use aids individuals in improving their muscular strength and size; however there are some conditions that contribute to these improvements. Steroids may be taken orally or through injections, with injectable steroids being more slowly absorbed. Different types of synthetic steroids produce varying levels of androgenic effects (Johnson & Van de Loo, 2002).
Medicinal Uses of Steroids
Steroids may be used for several medicinal purposes including, for example, hormone replacement therapy, the stimulation of pubertal development, osteoporosis in women, to treat Turner syndrome, and late stage breast cancer (Johnson & Van de Loo, 2002). However, non-medicinal use focuses on the development of muscular strength in size. Muscular improvements occur when individuals
• "Intensely train in weight lifting immediately before using anabolic steroids and continue intensive weight lifting during the steroid regimen,
• Maintain a high-protein, high-calorie diet, and
• Measure their strength improvement using the same single repetition, maximal weight technique (i.e., bench press) they used in training" (Johnson & Van De Loo, 2002).
Steroid usage differs for endurance athletes seeking to slow the protein breakdown process during training versus athletes who seek power and explosiveness through increased strength (Johnson & Van de Loo, 2002). Steroids may also be taken using different patterns with the goal of decreasing the unwanted side effects and androgenic effects (Johnson & Van de Loo, 2002). These patterns include stacking, using more than one steroid at a time and pyramiding, starting steroid use at low doses and then increasing the dose gradually and then tapering off (Johnson & Van de Loo, 2002). While the improvements in muscular strength and size are the desired effects of steroid use, there are many unwanted and unhealthy physiological, cardiovascular, dermatologic, and psychological side effects of...