Exploring the Progressive Use of Performance Enhancing Substances by High-Performance Athletes

Abstract

BackgroundGiven the implications associated with the use of performance-enhancing substances (PESs), a variety of stakeholders from clinicians to managers must remain informed about usage precipitants and be able to anticipate conditions signaling athlete vulnerability to increasingly hazardous exposures. ObjectivesTo gain deeper qualitative insight into athlete PES usage and explore the variables leading high-level athletes to escalate their PES use regimens. To reveal PES experiences of athletes during their careers and, unlike other studies, not to focus exclusively on 'doping' as measured by the use of WADA-banned substances. MethodsA macro life course-based framework from which the data could emerge through a thematic coding analysis was utilized. Sixteen narrative life course histories of retired highperformance athletes report on the factors impelling their escalation in PES use, including for some, the first use of banned PES. ResultsInformant reports, thematically coded, reveal performance maximization urgency to be a central factor in escalating PES use, driven by four variables: Requirements, Opportunities, Influencers and Outcomes. These variables each comprise two key components that stimulate an urgency ecosystem affecting an athlete's proximity to an escalation threshold. Conclusions/ImportanceSuch a comprehensive investigation of PES use precipitants has not previously been undertaken. Advances in PES use were instantiated by a substantive, sometimes radical and often sudden increase in urgency to improve performance related to output requirements, specific demands, knowledge and access, timing windows, the competitive landscape, loyalty to coaches, efficiency expectations and likelihood of detection. This study informs incremental models of doping, the use of which is encouraged in order to analyze life course narratives to better understand athlete behaviors.

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“…The potential of moral disengagement to facilitate this process is supported by research that has demonstrated its use to justify and rationalize prohibited performance enhancement practices and maintain a positive self-view Boardley et al, , 2015Boardley et al, , 2017. Further, life history accounts of recently retired high-performance athletes have shown that progression in performance enhancing substance use can be driven by situational factors (e.g., urgency for improved performance, coaches, peers; Smith and Stavros, 2020).…”

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“…The year 2020 has been unprecedented and exceptionally complex, also in the context of anti-doping efforts in situations of considerable restrictions, lockdowns, reduced options for training and competition, and collection and analysis of anti-doping samples. Probably more than ever, understanding an athlete's attitude towards doping, [1][2][3] the susceptibility and motivation(s) to cheat, identifying factors that influence or predict an athlete's (anti-)doping position and behavior, [4][5][6][7][8] and approaches that support strengthening and consolidating highest levels of sportspersonship as well as harm reduction strategies, 9 have been required to effectively limit intentional anti-doping rule violations (ADRVs).…”

“…ence or predict an athlete's (anti-)doping position and behavior, [4][5][6][7][8] and approaches that support strengthening and consolidating highest levels of sportspersonship as well as harm reduction strategies, 9 have been required to effectively limit intentional anti-doping rule violations (ADRVs).…”