The Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health, Madison, WI, recently published a review discussing drug abuse in athletes. Drug abuse occurs in almost all sports and at most levels of teen and adult competition. Doping, defined as use of drugs or other substances for performance enhancement, has become an important topic in sports.

Athletic life may lead to drug abuse for many reasons. Often first experimented with in high school or college for performance enhancement, athletes later continue use to deal with stressors, such as pressure to perform, injuries, physical pain, and retirement from sports.

Performance-enhancing drugs (PEDs) are not restricted to illegal drugs or prescription medications, such as anabolic steroids. They include questionable dietary supplements and a variety of compounds that are available at grocery and health food stores and online. These substances may negatively affect hemoglobin, glucose and kidneys if misused, and evidence of actual performance enhancement is questionable.

Most if not all doping agents have potential short-term and long-term side effects. Unfortunately, given the high doses of the substances often used by athletes, it is difficult to confirm such effects. It would be unethical to give dosages as high as those used by athletes to participants in research studies. Information about side effects has come from empirical observation, reports of admitted users, and effects in patients prescribed specific medications for medical conditions. Research on this topic is extremely limited.

Athletes may receive comprehensive treatment and rehabilitation for physical injuries, but less often for mental illness, such as anxiety or depression due to extreme stress, possibly because of social views of mental illness as a sign of weakness. Untreated mental illness is often associated with substance use, perhaps in an effort to self-treat. Alternatively, substances of abuse may cause mental illness. This can certainly be true of performance enhancing drugs.

Athletes who use drugs are often skeptical of discussing this fact with their doctors. This may be partly with good reason, as many health care professionals are unfamiliar with the mentality of athletes or common drug abuse patterns in this population. Athletes also try to hide their drug abuse. Referral networks or team assistance programs consisting of health care professionals familiar with these issues should be established for the benefit of athletes, teams, trainers and coaches.

Co-occurrence of physical dependence and mental illness is commonplace.  The first level of addressing the problem of drug abuse by athletes should be prevention. Providers should assess for co-occurring mental illness and drug abuse in athletes with preventive measures, education, motivational interviewing, and other evidence-based interventions.

No athlete should ever have to consider PED use to succeed in sport. Simply put, PEDs have the potential to harm the human body and biological functions. These drugs can be extremely dangerous and, in certain situations, deadly. No matter how you look at it, using performance-enhancing drugs is risky business that does not benefit the sport, the athletes or the fans. Remember the film “The Wrestler?” That’s the true end result of PED use.

There are 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. It’s time we stop sullying athletic accomplishment with PED abuse. Talk to a professional for more information on substance use or addiction treatment options.