Nicotine dependence in elite sport

Abstract

We were interested to read in Addiction the recent World Anti-Doping Agency (WADA) review of cannabis and its prohibited status [1]. Its prohibition brings other currently permissible and recreationally consumed substances into focus (e.g. nicotine, alcohol and caffeine). We are examining nicotine use and dependence in professional English football (soccer), from a position that tobacco-free nicotine products and nicotine dependence may have implications for player performance/health, with further evidence required to inform policy and practice in this space. Nicotine is an in-competition stimulant on WADA's Monitoring Program for potential misuse since 2012 [2], but it is not prohibited. Stated motivations for nicotine use by athletes include relaxation, seeking peer approval, cognitive enhancement, appetite suppression, pain management and smoking cessation [3-5]. Nicotine can improve cognitive function in sports involving motor skills and attention [6-8].In higher doses, nicotine also effects a relaxing sensation in the user [9] that could be used to mitigate performance related anxiety [4].Prevalence studies demonstrate that nicotine use is common across different sporting disciplines including events where these effects are not germane (e.g. recreationally rather than performance orientated use) [10]. Nicotine can be consumed from heated tobacco products (e.g. cigarettes), smokeless tobacco products (e.g. chewing tobacco) and tobacco-free nicotine products (e.g. electronic cigarettes). Certain UK