Authors have described performance-enhancing drug use in sports as early as Ancient Greece, where athletes used substances such as hallucinogenic mushrooms, sesame seeds, and brandy and wine mixtures as a means to enhance performance.1 However, just as experts today don’t consider drug use in sports for performance enhancement “professional,” neither did Ancient Greeks of that time. If the Greeks identified an athlete as a cheater, the cheater was sold into slavery.
However, many experts consider the beginning of modern-era doping as the early 1900s.1 At this time, the illegally-drugged athletes weren’t human – they were horses. Racehorses were given a number of medications to enhance their speed.
Drug use in sports for performance-enhancement has often been a concern in one of athletics’ biggest stages: the Olympics. In the 1950s, the Soviet-sponsored government training programs experimented with steroids and testosterone as a way to increase strength and power.1 East Germany also had extensive doping programs, which affected an estimated 10,000 former East German athletes.2
However, testing for performance-enhancing drugs was not widely available until the mid-1960s, and even then doctors could not test for all the drugs that athletes were using.1
Unfortunately, coaches, trainers, and team doctors contributed to early doping use in baseball, including that of the stimulants Dexamyl and Dexedrine to enhance athletic performance.2
Cycling has proven one of the most controversial examples of drug use in sports.1 For example, athletes in the cycling world have had a history of using “blood doping,” which is the practice of removing and re-infusing an athlete’s blood as a means to enhance the amount of oxygen an athlete’s blood could carry. In 1998, the police raided a Tour de France cyclist team using blood doping, bringing more information to light about doping.1
One of the most famous doping scandals was that of Lance Armstrong, the cyclist who won seven Tour de France titles.1 Armstrong admitted to blood doping as a means to enhance performance and was later stripped of his titles.
Unfortunately, performance-enhancing drugs are still prevalent in cycling. According to Medscape, an estimated 90% of professional cyclists reportedly used performance-enhancing drugs at some point in their careers.
Across all sports, an estimated two percent of elite athletes have used banned substances within the past year, according to an article in the journal Substance Abuse and Rehabilitation.1
According to an article in the journal Substance Abuse and Rehabilitation, an estimated 75% to 93% of male college athletes have used alcohol in the past year.1 An estimated 93% of female athletes reported having used alcohol in the past year.1
Alcohol is not always banned in sports, but some sports may ban alcohol during sports competitions. However, most doctors don’t think that alcohol enhances performance.
An estimated 28% of college athletes have used cannabis over the past year, according to an article in the journal Substance Abuse and Rehabilitation.1
An estimated 52% of professional football players have used opiates in the past year, according to an article in the journal Substance Abuse and Rehabilitation. Of professional football players across their entire career, an estimated 71% have misused opiates.
An estimated 23% of college athletes report having used smokeless tobacco at some point in time over the past year, according to an article in the journal Substance Abuse and Rehabilitation.1 College baseball players use smokeless tobacco in especially high numbers, with an estimated 40% to 50% having used tobacco over the past year.1 An estimated 35% to 40% of professional baseball players and 20% to 30% of professional football players report using smokeless tobacco over the past year.1
An estimated three percent of college athletes have used stimulants over the past year, according to an article in the journal Substance Abuse and Rehabilitation.1 Stimulant drug use in sports enhances endurance and reduces overall feelings of fatigue. The number of athletes testing positive for stimulants has increased by three times in the past few years.1
There are a variety of reasons why athletes use drugs in sports, and sometimes there are multiple reasons that contribute to an athlete’s drug use in sports. These include:1
For performance enhancement
To self-treat untreated mental health issues
To deal with stress from early retirement
To deal with stress, such as the pressure to perform
To overcome injuries
To overcome physical pain
Athletes may use a variety of performance-enhancing drugs, or PEDs.1 Examples of these drug types include:
Diuretics to help lose weight quickly
Other health food compounds
As sports become increasingly competitive, some athletes turn to PEDs as an attempt to get ahead or simply feel competitive. Coaches and trainers have also been charged with providing substances to athletes, who may have known about or not known about, to enhance performance as well.
Athletic injuries can present a challenge from which to recover, and many athletes face tremendous pressure to recover as quickly as possible from their injuries. They may use drugs to mask the pain or improve performance during recovery.
Old injuries and aches and pains from the physical demands placed on the body can lead to chronic pain for some athletes. It’s not uncommon to become dependent upon or addicted to painkillers as a means to escape this chronic pain.
If an injury or other factors forced an athlete into early retirement, they may experience anxiety, depression, or other emotions related to their retirement. As a result, they may try to escape these emotions through drugs or alcohol.
Athletes experience mental health concerns just as the rest of the population does. Though they are asked to be mentally strong on the playing field or competition, they face pressures, demands, and defeat, which can lead to mental health concerns.
The side effects of drugs used for performance or abused by athletes vary based on what is abused. Some of the side effect examples include the following:
Cannabinoids: Affected alertness, slowed response times, anxiety, and psychosis or losing touch with reality
Painkillers: Addiction, nausea, constipation, poor concentration, and fatigue
Stimulants: Rapid heart rate, stroke, heatstroke, weight loss, muscle breakdown, nausea, tremors, anxiety attacks, high blood pressure, and psychosis
When athletes use performance-enhancing drugs, some of the signs they may be using them include:
Sudden weight gain or loss
Sudden, unexpected increase in athletic performance
Increasingly secretive behavior, such as withdrawing from social activities
Some of the ways to recognize that an athlete is using illegal drugs or abusing alcohol to excess may include:
Struggling to make early practices or having withdrawal symptoms, such as tremors, at early practices
Suddenly having an unkempt appearance
Increasingly secretive or withdrawn behaviors
Defensiveness or aggressiveness if someone asks about the person’s welfare
Asking others for prescriptions or medications
Some are very, very good at hiding they have a problem. However, there comes a time where the addiction or substance abuse becomes so severe that they lose control over how much or how often they use.
According to an article in the journal Substance Abuse and Rehabilitation, athletes reportedly experience mental health concerns such as depression at the same rates as non-athletes.1
A large-scale review of 52 studies that included more than 13,000 athletes from 71 sports published In the British Journal of Medicine found that mental illness affects an estimated 33% of athletes a year.4 Unfortunately, many do not seek help for their mental illnesses because they may not recognize them as a mental illness or because they are concerned about what others will think of them if they seek help.
Some additional barriers to seeking care the study found included:
Gender stereotypes, such as men being concerned they would not be viewed as tough
Personality traits, such as being an introverted person
According to the journal’s authors, “Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literacy about mental health.”4
The review article in the British Journal of Medicine found that coaches, trainers, and other people who have a leadership role in sports performance are vital to promoting either a positive or negative culture when it comes to mental health and substance abuse.4 Unfortunately, there are many of these authority figures who turn a blind eye to an athlete’s struggles because they are worried about performance only.
Ideally, athletic trainers and coaches will take steps to prevent addiction and doping from ever occurring in the first place. Examples include engaging in drug screening that deters athletes because they know drug abuse would keep them from being able to play. Performing random drug testing and testing before larger-scale performances is important.1
It’s important that psychiatric help is sought for anyone testing positive for illegal or performance-enhancing drugs. A therapist can help identify if mental illness or some other underlying reasons caused the use of the drug in the first place.
Other steps can include:
Group therapy individualized counseling
Providing education on mental illness and addiction can help athletes and their coaches recognize these concerns, ideally as quickly as possible so that a person can seek help.
Athletes represent the pinnacle of peak performance, idolized worldwide for their abilities, and the pressures to perform can be overwhelming. Educating athletes on mental illness and the importance of their safety in refraining from using PEDs and illegal drugs is vital. It’s important that athletes who become dependent on drugs or alcohol feel supported in seeking help from others.
New York Yankees pitchers Andy Pettitte (performance-enhancing drugs)
Tennis star Maria Sharapova (performance-enhancing drugs)
Basketball player Allen Iverson (alcohol)
Baseball player Darryl Strawberry (cocaine)
Soccer player George Best (alcohol)
Baseball player Manny Ramirez (performance-enhancing drugs)
Golfer John Daly (alcohol)
Football player Ricky Williams (marijuana)