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Doping in sport: an analysis of sanctioned UK rugby union players between 2009 and 2015



To inform anti-doping policy and practice, it is important to understand the complexities of doping. The purpose of this study was to collate and systematically examine the reasoned decisions published by UK Anti-Doping for doping sanctions in rugby union in the UK since the introduction of the 2009 World Anti-Doping Code. Case files were content analysed to extract demographic information and details relating to the anti-doping rule violation (ADRV), including individuals' explanations for how/why the ADRV occurred. Between 2009 and 2015, 49 rugby union players and one coach from across the UK were sanctioned. Over 50% of the cases involved players under the age of 25, competing at sub-elite levels. Reasons in defence of the ADRV focused on functional use and lifestyle factors rather than performance enhancement. An a priori assessment of the "need", "risk" and "consequence" of using a substance was not commonplace; further strengthening calls for increasing the reach of anti-doping education. The findings also deconstruct the view that "doped" athletes are the same. Consequently, deepening understanding of the social and cultural conditions that encourage doping remains a priority.
Doping in sport: An analysis of sanctioned UK rugby union players between 2009 and
L. Whitaker & S. Backhouse
Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
Author Note
Correspondence concerning this article should be addressed to Dr Lisa Whitaker,
Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Headingley
Campus, Leeds, LS6 3QS, UK.
Telephone number: +44 (0)113 812 8651
Email address:
Additional author contact details:
Professor Susan Backhouse:
Telephone number: +44 (0)113 812 4684
Key words: anti-doping; WADA; anti-doping rule violations; rugby union
To inform anti-doping policy and practice, it is important to understand the
complexities of doping. The purpose of this study was to collate and systematically
examine the reasoned decisions published by UK Anti-Doping for doping sanctions in
rugby union in the UK since the introduction of the 2009 World Anti-Doping Code.
Case files were content analysed to extract demographic information and details
relating to the anti-doping rule violation (ADRV), including individuals’ explanations
for how/why the ADRV occurred. Between 2009 and 2015, 49 rugby union players
and one coach from across the UK were sanctioned. Over 50% of the cases involved
players under the age of 25, competing at sub-elite levels. Reasons in defence of the
ADRV focused on functional use and lifestyle factors rather than performance
enhancement. An a priori assessment of the ‘need’, ‘risk’ and ‘consequence’ of using
a substance was not commonplace; further strengthening calls for increasing the
reach of anti-doping education. The findings also deconstruct the view that ‘doped’
athletes are the same. Consequently, deepening understanding of the social and
cultural conditions that encourage doping remains a priority.
Key words: anti-doping; WADA; anti-doping rule violations; rugby union
Media headlines highlight that doping is omnipresent in sport, yet fail to
convey the complexities of the behaviour, which can perpetuate a naïve belief that
all ‘doped’ athletes are the same (Pluim, 2008). The World Anti-Doping Agency
(WADA) define doping as “the occurrence of one or more of the anti-doping rule
violations (ADRVs) set forth in Article 2.1 through Article 2.10 of the Code” (World
Anti-Doping Agency, 2015, p. 18). Taken together, the ten ADRV’s define a spectrum
of behaviours, ranging from the presence of a prohibited substance (or its
metabolites or markers) in an athlete’s sample (Article 2.1) to associating with any
athlete support personnel (e.g., coach, doctor, physiotherapist) who are serving an
ADRV or have been found guilty of a criminal or disciplinary offence that is
equivalent to an ADRV (Prohibited Association, Article 2.10). Moreover, because the
WADA enforces strict liability under Article 2.1 and 2.2 of the Code (World Anti-
Doping Agency, 2015; p.141), an ADRV can be established without an Anti-Doping
Organisation having to demonstrate “intent, Fault, negligence or knowing Use on the
Athlete’s part”. This cornerstone of the Code further extends the potential for
heterogeneity across doping cases.
These points notwithstanding, there is still a tendency to label athletes who
commit an ADRV as a ‘doper’ regardless of the context and circumstances leading to
that ADRV. For example, an athlete who unintentionally and unknowingly consumes
a banned substance by ingesting a nutritional supplement is often labelled a ‘doper’
in the same way as an athlete who has deliberately used an anabolic steroid to gain
an unfair advantage over others. Yet while both cases violate the anti-doping rules,
the former would not constitute ‘cheating’ as the athlete in question was not
intentionally seeking to gain an unfair advantage over others. Extending the
argument further, an athlete who deliberately uses a banned substance might not
be driven by a desire to outperform others in a sporting context. Instead, they may
be using chemical assistance to recover from injury, cope with stress and return to
play. In this instance use is defined by functionality rather than performance
enhancement (Petróczi, 2013). Indeed, many ADRVs do not involve individuals who
are deliberately trying to gain an unfair advantage over others - some involve the use
of recreational drugs or mistakenly ingesting a prohibited substance via medication
or nutritional supplements (Henning & Dimeo, 2015; Pluim, 2008). However, the
‘doper’ label still pervades. Consequently, there is a pressing need for research to
carefully deconstruct the ‘cheating narrative’ (Tamburrini, 2006) so that anti-doping
policy and practice can evolve as an evidence-based field.
One of the reasons for labelling athletes who commit an ADRV as ‘dopers’
might be associated with research traditions in the field. Typically, studies examine
the antecedents of prohibited substance use. With use and intention to use
prohibited substances driving the research agenda, a number of ‘critical incidents’
that could lead to doping have emerged. These include career transitions (Kirby,
Moran, & Guerin, 2011; Lentillon-Kaestner & Carstairs, 2010; Mazanov, Huybers, &
Connor, 2011), suffering an injury (Bloodworth & McNamee, 2010; Kirby, et al.,
2011; Whitaker, Long, Petróczi, & Backhouse, 2014), a desire to maintain current
standard of living (Bloodworth & McNamee, 2010) and experiencing a series of poor
performances (Kirby, et al., 2011) being identified. However, these critical incidents
are defined by the consumption of a substance included on the Prohibited List (the
list is updated annually by the WADA and contains information on any substance or
method that is prohibited at all times or in-competition only) (World Anti-Doping
Agency, 2016) and thus only apply to two of the 10 ADRVs. Yet if we are to
understand how/why individuals fail to comply with anti-doping policy, it is
important to deepen our understanding of the nature of the behaviour to be
changed (Michie, van Stralen, & West, 2011). In order to do so, we need to
investigate all the behaviours that constitute doping under the Code. This shift in
focus would also reflect policy changes brought into the 2015 WADA Code which
hold athlete support personnel (ASP) more accountable for their role in doping. It is
worth emphasising that not all ADRVs are committed by athletes. Infact, six of the 10
ADRVs also apply to ASP.
The sensitive and taboo nature of doping in sport presents real challenges for
furthering our understanding of this behaviour in context as it can be difficult to
recruit ‘dopers’ to participate in research. However, in fulfilling their policy
prescribed obligations, UK Anti-Doping (UKAD) publicly discloses the details of all the
hearings leading to a period of ineligibility. This source of information allows us to
explore the self-declared reasons for committing an ADRV within each case.
Although, it is important to be aware that these self-declared reasons may have
been derived by individuals (and their legal team) in an attempt to reduce a sanction
and thus may not be completely truthful, they do provide a unique opportunity to
extend our understanding of the complexity of doping in sport. Responding directly
to calls for research to be sport-specific (Mohamed, Bilard, & Hauw, 2013), the
objective of this study was to examine the reasoned decisions for individuals serving
a period of ineligibility from the sport of rugby union in the UK since the 2009 Code
came into effect. The decision to focus on rugby union was taken due to the
exponential increase in the number of individuals from rugby union within the UK
serving a ban for committing an ADRV (UK Anti-Doping, 2015). In addition, the
majority of those serving a period of ineligibility within rugby union have been
emerging from amateur level competition (UK Anti-Doping, 2015) where external
rewards are limited and the disseminated drivers for doping in sport (e.g., sport
sponsorship, financial rewards, contract renewal; Mazanov, et al., 2011; Whitaker, et
al., 2014) may not apply.
Following ethical approval from the University Research Ethics Committee,
this research adopts a case study approach focusing specifically on rugby union and
utilising sources available in the public domain only. In the UK, details of individuals
who have committed an ADRV and are serving a period of ineligibility are published
on the UKAD website with the exception of cases managed elsewhere (e.g., by World
Rugby). PDF files relating to each sanctioned case occurring between 2009 and 2015
were collected from the websites of UKAD, Rugby Football Union (RFU) or World
Rugby. We reviewed cases from 2009 onwards because those cases were subject to
the implementation of the second World Anti-Doping Code published in January
2009. Content analysis was then used to extract the following information from each
case: 1) player age, 2) playing level, 3) geographical location of the club being
represented, 4) violation committed, 5) period of ineligibility and 7) the individuals’
explanation recorded at the panel hearing. It should be noted that the amount of
information included in each case varies and where an individual did not contend the
ADRV, no information was provided to explain how/why the ADRV occurred. Equally,
some cases omitted demographic information (e.g., age or playing level at the time
of receiving the ADRV). Therefore, in a bid to obtain the missing data we also
conducted web searches using Google to identify media stories relating to each
player identified as currently serving (or having previously served) a sanction.
The information presented in this paper conveys the detail provided about
each case that is freely available in the public domain. Thus, we cannot be sure that
the cases represent the ‘truth’. For example, explanations provided by individuals
regarding how/why the ADRV could have occurred may not be accurate as the
accused may have offered an alternative explanation in an attempt to
change/reduce their sanction. Yet if individuals’ accounts have been constructed in
an attempt to influence sanctions imposed, this information can inform policymakers
about how successful (or unsuccessful) defence teams are in securing reduced
sanctions or indeed whether the anti-doping regulations are understood. Equally, it
is not possible to provide in-depth information about the circumstances surrounding
each case by analysing case reports alone because the reasoned decisions provide
insufficient information to do so. However, collating and analysing the available
information allows us to systematically review the sanction landscape of rugby union
and explore any patterns that may emerge between cases. Growing numbers of
ADRV’s associated with rugby union in the UK underscore the need to develop our
understanding of the circumstances leading to an ADRV so that we can tailor anti-
doping policy and practice accordingly. In turn, this evidence-based approach is
more likely to reduce the number of players committing ADRV’s as the behavioural
diagnosis will enable tailored intervention functions to emerge (Michie, et al., 2011).
In total, 50 male rugby union players received sanctions between 2009 and
2015 (2009, n= 1; 2010, n= 2; 2011, n= 4; 2012, n= 7; 2013 n= 13, 2014 n= 13, 2015
n= 10). However, in their 2014-2015 Anti-Doping report (Rugby Football Union,
2015), the RFU reported a further four cases were on-going and therefore could not
be commented on at the time of publication. Therefore, the number of sanctions
between 2009 and 2015 may increase from 50. Figure 1 highlights the geographical
distribution of the sanctioned cases and demonstrates the clustering of cases,
particularly in Wales. The age of players/coach at the time of receiving their sanction
ranged from under 18 to 38, with the majority being under 25 (Table 1).
-Insert figure 1 here-
-Insert table 1 here-
Playing level
Players received their sanctions whilst competing at a range of levels within
the English, Scottish and Welsh rugby union systems (Table 2). However, based on
the information presented it appears the majority of sanctioned players were
competing in lower leagues.
-Insert table 2 here-
ADRV committed
Thirty four players were sanctioned for the presence of a prohibited
substance (analytical finding) while 10 were sanctioned for use or attempted use of a
prohibited substance (non-analytical finding). Of those that were sanctioned for use
or attempted use, three were brought to hearing after ordering human growth
hormone or steroids online, five were found with needles and/or a prohibited
substance in their possession and two were uncovered by club coaches. Moreover,
three individuals were sanctioned for possession and trafficking, whilst three players
were sanctioned for refusing and failing to comply with testing procedures.
Substance(s) and length of sanction
Players were sanctioned for the presence of or attempted use of three
different types of drug; anabolic agents (n= 27), stimulants (n= 15) and hormone and
metabolic modulators (n= 6). Typically, individuals received standard bans for these
ADRVs: two year bans (n= 30) under the 2009 WADA Code and four year bans (n= 6)
after the introduction of the 2015 WADA Code (2015). However, if certain conditions
are met, it is possible for individuals to receive a ban reduction or suspension (as
detailed in Article 10 of the Code; World Anti-Doping Agency, 2015). In relation to
the presence of or attempted use of a prohibited substance, an individual can receive
a ban reduction or suspension if they can: 1) prove unintentional use, 2) prove no
significant fault or negligence (e.g., following use of a specified substance), 3)
provide substantial assistance in discovering/establishing other ADRVs or 4) make a
prompt admission of the ADRV.
Four adolescents received reduced bans: three following immediate
admissions (15 or 21 months) and one for unintentional use due to his dyslexia and
dyspraxia (2 years). Six individuals received reduced bans (between 3 and 6 months)
due to the presence of a specified substance (e.g., methylhexanaemine) and one
player received a one-year ban for exceptional mitigating circumstances following
the presence of benzoylecgonine (cocaine metabolite). In contrast, it is also possible
for individuals to receive lengthier bans for committing multiple ADRVs or for
committing more serious ADRVs (e.g., trafficking or administration of a prohibited
substance). Under the 2009 WADA Code, two players received increased bans (3
years or 3 years and 3 months) for the use of multiple anabolic agents and the
purchase of human growth hormone for personal use and family member supply. In
addition, two individuals received eight year bans for trafficking and possession of
anabolic agents where typical bans range from four years to lifetime ineligibility
depending on the severity of the ADRV (Table 3).
-Insert table 3 here-
Self-declared ADRV explanations
The explanatory information documented in each reasoned decision varied
considerably across those players contesting the charges. Further, there was no case
report available for three individuals and eight individuals chose not to contest the
charge, so their case did not go to a hearing. Consequently, these 11 cases were
precluded from further analysis.
Three cases involved trafficking and three involved refusing to provide a
sample. Explanations for the latter ADRV’s included one player with two failed
attempts at sample collection terminating the test due to a university exam and the
other players not submitting to doping control (stating work commitments/the use
of painkillers for back pain resulting in urinary retention in their reasoning). In
addition, one case involved the online purchase of human growth hormone for
personal use and supplying to a family member, while another involved the online
purchase of testosterone for bodybuilding purposes after quitting rugby due to
injury. The focus of the subsequent analysis will be on the 31 cases which provided
at least basic details on individuals’ explanations for how/why the ADRV occurred.
Through analysing the cases, it was possible to group them into five themes
with some cases overlapping more than one theme. The first four themes involved
use of a substance 1) to enhance recovery from injury, 2) to cope with work and
sports demands, 3) to aid weight management and 4) for personal reasons. The final
theme centred around the naïve use of nutritional supplements.
Enhance recovery from injury. Eight cases involved players who declared that
they had used a substance to help them to recover from an injury. Six of the players
were aware that the substance they were using was prohibited in rugby. However,
the other two players believed they were using permitted supplements that were
‘safe’ and did not contain a prohibited substance. One player claimed that he always
conducted research before using supplements and therefore believed that he tested
positive due to contamination of the product he was using during the manufacturing
process. In comparison, the other player conducted research after finding out he
had tested positive. This post-hoc research revealed he was using a product that
contained prohibited prohormones.
Cope with work and training demands. Three of the cases involved players
who were managing the dual-responsibilities of demanding occupational roles and
rugby playing commitments. Two of the individuals reported that they were
struggling to deal with the work and training demands placed on them and therefore
were becoming very fatigued. The other player testified that his occupational role
was being compromised because he had been asked to step in for the first team and
he found it difficult to cope with the increased training and competition demands at
that level. All three players reported that in order to fulfil their work and training
demands, they used nutritional supplements to reduce fatigue and enhance
recovery from training. Their explanations focused on being able to carry out their
jobs rather than enhance their rugby performance. According to the reasoned
decisions, none of the players were aware that the nutritional supplement they were
taking contained a prohibited substance. All three cases reported that players had
received little, if any, anti-doping education.
Weight management. Eight cases purportedly involved the use of a substance
for weight management purposes with three players looking to aid weight loss/burn
fat and four players looking to increase in size. Three of the cases relating to
increasing in size involved adolescent players who stated that they felt under
pressure to bulk up for rugby. In comparison, three of the cases relating to weight
reduction were for vanity reasons. Six players admitted that they knew the
substance they were using for weight management was prohibited for rugby. One
player said he only found this out though after he had undertaken a drugs test,
which prompted him to research the substance. It is unknown whether five of the
players had ever received anti-doping education but in three of the cases, it was
specifically reported at the hearing that no education had been received.
Personal reasons. Nine cases involved the use of a substance for personal
reasons that were not directly associated with playing rugby union. Two players
reported taking substances to deal with sexual dysfunction (one player reported
taking Klomen to help enhance his sex drive while another reported taking a number
of products including Test Propate to treat erectile dysfunction). A third player
reported using Anti-Esto to ameliorate the symptoms of gynaecomastia while
another player reasoned he had used some tablets given to him from a friend at a
time where he was feeling extremely low and vulnerable. Five players had used
cocaine, with four reporting use on a night out when they were not due to be
playing rugby. However, they stated that they received a last minute call to play the
following day. One player reported using cocaine once to deal with his personal
problems at the time.
Naïve use of nutritional supplements. Six cases involved players who had been
seemingly naïve and careless when using nutritional supplements. A professional
player stated he mistakenly drank from a bottle he believed to contain only water
but in fact contained Anabolic Nitro. This product was supplied to the club through a
sponsorship deal and consequently, six players were using the supplement. The club
briefly withdrew supply in 2010 following two positive cases in South Africa, but
reinstated supply in 2011. Following the player’s ADRV, his club requested Anabolic
Nitro to be tested for the stimulant methylhexanaemine and analysis confirmed the
presence of the specified substance in the batch. This case underscores the need to
follow risk minimisation protocols in order to prevent inadvertent doping and
safeguard players. The other five ADRV cases reported here involved players who
consciously chose to ingest the supplement that led to their ADRV. Two players did
not do any checks before ingesting Xtreme Mass and Jack3d. In addition, one player
reportedly did some basic checks before using Unstoppable but believed it was safe
because his team mates were using it. Two of these cases stated that the players had
not received any anti-doping education but while one was an inexperienced
adolescent player, the other was an experienced semi-professional who said he was
an ‘advocate for drug-free sport’. In the other cases, financial constraints led a
student to reduce his checks when using a housemates’ protein supplement, while
the final player was aware of the need to use batch-tested supplements, but
temporary retirement led to a drop in standards and the purchase of non-batch
tested products. An ADRV was subsequently recorded following doping control at an
international match.
Between 2009 and 2015, 49 rugby union players (two of which were also
ASP) and one coach were sanctioned for committing an ADRV. Of the 10 ADRVs set
out by the WADA, five were present in the 50 rugby union cases. Nevertheless, over
50% of the cases involved players under the age of 25, competing at sub-elite levels
and sanctioned for the ADRV’s involving the presence of a prohibited substance or
the use or attempted use of a prohibited substance. Commonplace across the cases
reviewed was a lack of awareness of the consequences of using the substance at the
point of ingestion, often due to the failure of players to do the necessary checks to
determine the associated risk of using a particular substance. As the concept of strict
liability defines current anti-doping policy and practice, it is vital that players become
habituated in ‘assessing the need, assessing the risk, and assessing the
consequences’ of using a substance a priori. This is particularly important for young
amateur players who may become reliant on chemical assistance and this could
serve as a gateway to the use of prohited substances (Backhouse, Whitaker, &
Petróczi, 2013; Ntoumanis, Ng, Barkoukis, & Backhouse, 2014; Petróczi, 2013).
Equally, the use of chemical assistance could compromise a users health and well-
being in the short, medium and long-term.
Explanations provided for using a substance were rarely associated with
attempts to outperform others or for the purpose of rugby performance
enhancement. Rather, defences built around functional use dominated, alongside
lifestyle factors. In nine of the 31 cases analysed in depth, individuals admitted to
knowing they were using a prohibited substance and their reasons included recovery
from injury and/or for weight management. Similarly, eight cases provided
explanations involving the functional use of nutritional supplements (three for
weight control, three for combatting fatigue and two for injury recovery) rather than
to gain an unfair advantage over others. These findings give weight to the proposal
that doping is a functional behaviour (Petróczi, 2013), driven by a desire to (1)
maximise personal athletic competence (2) cope with stress or (3) optimise physical
appearance. The explanations offered in the reasoned decisions provide insight into
how/why an ADRV may have occurred. With this knowledge, ASP could aid doping
prevention by creating supportive environments that foster positive behaviours to
help athletes deal with periods of instability. For example, providing players with
functional alternatives (e.g., individualised nutrition plans based on a food first
approach and strength training programmes) may prevent young players from
habitually using chemical assistance in order to achieve a ‘quick fix’.
Previous research analysing athletes’ defences against doping accusations
found that there were three general explanations offered: 1) imputed culpability
(crediting the ADRV to other people or circumstances, e.g., result of misinformation,
unwitting mistakes or personal hardship), 2) performance repentance (accepting
responsibility for actions and repenting whilst seeking empathy, e.g., acknowledge
ADRV but use lack of education as a reason for non-compliance) and 3) virility
defence (deny doping allegations on the basis they don’t need to dope to excel;
Henne, 2016). There are similarities between Henne’s (2016) research and the
present study in that imputed culpability and performance repentance are two
approaches evident within the reasoned decisions of the UK rugby union players. In
particular, cases are built on the contextual factors behind the sanction with the
majority of the reasoned decisions pleading innocence in some way (e.g., the use of
a contaminated supplement, lack of anti-doping education). Yet current policy
enforces strict liability and therefore being unaware that an action constitutes an
ADRV is often disregarded as a reason to reduce sanctions. In addition, strict liability
forces a focus on the individual athlete (holding them culpable and responsible for
what is in their body) whilst ignoring broader social relations (e.g., social and cultural
conditions that encourage doping). Thus negligence from clubs for example who fail
to protect their players from doping (e.g., through the delivery of education) is
Within the 31 reasoned decisions that provided at least basic details on
how/why the ADRV occurred, one third declared that they had never received anti-
doping education. If an individual has not received education and therefore lacks
sufficient knowledge to enable them to fully comply with anti-doping regulations, it
could be deemed as unfair for them to be sanctioned. However, strict liability
disregards this as an individual does not have to have intent to commit an ADRV.
Therefore, national governing bodies and clubs should have a responsibility to
ensure that their athletes (and ASP) are fully informed of anti-doping regulations so
that they are able to comply. Compulsory education delivered within rugby clubs
supported by the rugby union national governing bodies could be one way of
ensuring that players and ASP are not uninformed about anti-doping regulations. In
turn, this may lessen the potential for a lack of education and unwitting mistakes to
be used in defence of ADRVs and increase the confidence of the anti-doping panels
to challenge these claims.
Given that three of the cases involved ASP and one involved a possible future
ASP (sport and exercise science student), it is important that individuals are
cognisant of the implications of serving a period of ineligibility for their short- and
long-term sporting and career ambitions. The ASP who received sanctions were not
only prevented from playing rugby union, but also experienced detrimental effects
on their career (e.g., loss of job) because their sanction inhibits them from working
in a sport environment. Since the introduction of the 2015 WADA Code (World Anti-
Doping Agency, 2015) and the inclusion of complicity and in particular prohibited
association as ADRVs, it is essential that individuals are knowledgeable of anti-doping
to protect themselves from committing an ADRV and risking their own career. For
example, a university student committing an ADRV - whilst training to become a
sports coach - could thwart his/her career due to prohibited association. Raising
awareness of these implications may encourage individuals to take greater care and
consideration when making behavioural choices. Previous research has indicated
that ASP are unaware of their responsibilities under the Code, leaving themselves
(and their athletes) vulnerable to committing an ADRV (Backhouse & McKenna,
2011; Backhouse & McKenna, 2012; Mazanov, Backhouse, Connor, Hemphill, &
Quirk, 2014). In recognition of the importance of developing anti-doping knowledge
and understanding amongst ASP, employees of the English Institute of Sport
undertake the UKAD advisor course to ensure they are up-to speed on all anti-
doping matters. This model of practice could be adopted by the sport governing
bodies as part of their Code of Conduct, whereby all ASP working within rugby clubs
have to undertake the UKAD advisor course as a condition of their employment.
Rugby union players serving a period of ineligibility for committing an ADRV
span the length and breadth of the UK, map across the participation spectrum and
provide multiple explanations for the ADRV’s committed. Taken together, the
findings underline the complex and idiosyncratic nature of doping behaviour and
highlight players aged 18-25 years as a particularly ‘at-risk’ group. Although current
anti-doping regulations do not take into account knowledge and intention when
determining that an ADRV has occurred, it is important that well-being is at the
forefront of prevention. Ensuring that athletes and ASP are fully aware of the anti-
doping regulations not only equips individuals with the ability to conform, it will also
prevent defence cases being constructed around ‘innocence’. However, it is also
necessary to gain an understanding of the social and cultural conditions behind
prohibited substance use. An over-reliance on chemical assistance, particularly at a
young age may leave players vulnerable to committing an ADRV. Therefore, a deeper
understanding of the social and cultural conditions surrounding doping behaviour is
necessary for the development of tailored interventions designed to address the
rising tide of ADRV’s in the sport of rugby union.
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Figure 1: Geographical distribution of sanctioned cases (Scotland = 3, England = 27,
Wales = 20)
Table 1: Age of players at time of sanction
Age range Number of players
Under 18 5
18-25 22
26-33 10
34-41 4
42-49 0
50-57 1
Unknown 8
Total cases 50
Table 2: Level of players at time of sanction
Country Level of rugby competition Number of players
England (n= 27) Premiership/A league (1) 3/1
Championship (2) 2
National League One (3) 6
6 4
7 2
9 1
College 7
County U15-18 coach 1
Scotland (n= 3) Premiership (2) 2
5 1
Wales (n= 20) Wales development 7s (1) 1
Premiership (2) 6
Championship (3) 6
5 1
6 3
8 2
Lower levels 1
Table 3: Class of drug and length of bans
Class of drug Length of ban
Number of
Stimulants (e.g., methylhexanaemine,
3 months to 2 years 15
Hormone and metabolic modulators
(e.g., human growth hormone,
2 years to 3 years 3
Anabolic agents (e.g., testosterone,
dianabol, trenbolone, clenbuterol,
drostanolone, 19-norandrosterone)
15 months to 4 years 27
*Total is greater than 44 as some players used more than one type of drug
... Наразі канабіс входить до забороненого списку ВАДА. Сліди ТГК можна виявити в сечі навіть через кілька днів після вживання [18]. ...
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The article discloses the theoretical and applied provisions on the actual issues of combating doping in ofessional sports at the international and national levels, as well as a comparative analysis of combating doping by the World Anti-Doping Organization and the provisions of the national legislation of foreign countries, and offers a solution to effectively combating the use of doping in within the framework of domestic Ukrainian legislation.Among the many problems of modern professional sports, the problem of doping is gaining more and more relevance. It is extremely complex, as it includes closely interrelated medical, legal, political, moral, organizational, social and pedagogical aspects. The effectiveness of combating doping in sports largely depends on the system of its organization. However, it should be noted that the organizational foundations of the fight against doping were not seen by scientists. The main efforts of sports and medical science were aimed at studying the impact of doping on the body of a professional athlete, finding methods for its detection, biochemical components, as well as reducing the cost of doping control procedures and finding the simplest and most effective procedures. In this regard, the study of the organizational foundations of the fight against doping is relevant both from a theoretical and a practical point of view.Within the framework of this article, anti-doping legislation was investigated in order to determine a reasonable assessment of the existing system of combating doping in sports, identified the shortcomings and positive aspects of this system, its influence on the education of athletes, which allow to determine ways of increasing its effectiveness, forming an understanding of the role of combating doping in sports , the main trends of development and ways of increasing its effectiveness among athletes, trainers and specialists of the physical culture and sports movement.The relevance of the specified issue determines the need for its solution, as well as the application of research results in law enforcement practice and law-making activities.Based on the conducted research, the authors conclude that the humanistic mission of sports regarding anti-doping measures should be taken into account in the processes of combating doping. It is clear that the current fight against doping, which focuses on bans, is not working effectively. The new regulator of anti-doping measures must make decisions taking into account the specifics of each sport.
... In contrast, multiple studies including those using self-reported instances of doping have found a substantially higher prevalence with estimates between 14% to 57% for compet-to doping in sport relate to wider environmental, and political factors ( WADA, 2013 ). This is supported by various studies that suggest doping emerges from a complex web of interactions between sociodemographic, psychosocial, and broader situational and environmental factors ( Backhouse, Griffiths, & McKenna, 2018 ;Backhouse, Patterson, & McKenna, 2012 ;Whitaker & Backhouse, 2017 ). As such, anti-doping research that attempts to understand only the intrapersonal determinants of doping behaviours or develop sophisticated biological testing will invariably fall short of understanding the broader systemic factors influencing doping. ...
Doping remains an intractable issue in sport and occurs in a complex and dynamic environment comprising interactions between individual, situational, and environmental factors. Anti-doping efforts have previously predominantly focused on athlete behaviours and sophisticated detection methods, however, doping issues remain. As such, there is merit in exploring an alternative approach. The aim of this study was to apply a systems thinking approach to model the current anti-doping system for four football codes in Australia, using the Systems Theoretic Accident Model and Processes (STAMP). The STAMP control structure was developed and validated by eighteen subject matter experts across a five-phase validation process. Within the developed model, education was identified as a prominent approach anti-doping authorities use to combat doping. Further, the model suggests that a majority of existing controls are reactive, and hence that there is potential to employ leading indicators to proactively prevent doping and that new incident reporting systems could be developed to capture such information. It is our contention that anti-doping research and practice should consider a shift away from the current reactive and reductionist approach of detection and enforcement to a proactive and systemic approach focused on leading indicators. This will provide anti-doping agencies a new lens to look at doping in sport.
... The only criminally relevant aspect concerns the sale of drugs or substances prohibited by law, which is therefore prosecuted by the Dutch judiciary and investigative bodies 13 . The British approach is different, but also permissive, and is followed by independent bodies such as the United Kingdom Sports Council Doping Control Unit and the official anti-doping body UKAD United Kingdom Anti Doping 14 . The main weakness in the UK legislation lies in the nature of the institutions involved which are devoid of 'governmental' authority, but are rather based on a private type of relationship, hence unable to be effective enough in the role they were designed for, with an obvious level of inefficiency in combating the phenomenon in question 15 . ...
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The fight against doping in sport, formally started in 1960 with the constitution of the International Olympic Committee (IOC) and culminated in 1999 with the birth of the World Anti-Doping Agency (WADA), commissioned to chair various activities, including the publication of the annual list of prohibited substances and methods for doping. In Europe, as early as 1967, the Committee of Ministers of the Council of Europe adopted a resolution to stigmatise the intake of substances foreign to the body for the sole purpose of artificially and unfairly influencing sports performance. In 2002, the Council of Europe adopted an Additional Protocol to the 1989 Strasbourg Convention against Doping to ensure mutual recognition of doping controls and to strengthen the enforcement of the Convention. In Italy, the Law of 14 December 2000 n. 376 “Discipline of the health protection of sports activities and the fight against doping”, defines doping as “the administration or intake of drugs or biologically or pharmacologically active substances and the adoption or submission to medical practices not justified by pathological conditions and suitable to modify the psychophysical or biological conditions of the organism in order to alter the athletic performance of athletes”. The same law regulates the use of drugs or biologically or pharmacologically active substances and update an annual list in agreement with WADA. The article aims to analyse the legislation from a national perspective, offering as complete a view as possible of the current situation.
... This new provision provides extra protection to these individuals and is applicable if they are retaliated against for doing so. The term of the sentence might range from two years to a lifetime ban 13 . ...
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Doping is a major issue occurring mostly in elite sports where the champion gains fame and acceptability from society. To ensure equality in sports, fair play, and to protect the athletes' health status, organizations have been founded throughout history. The two main organizations fighting doping are the IOC (International Olympic Committee) and the WADA (World Anti-Doping Agency). IOC and WADA have let out a list including illegal substances and methods that can be used to enhance athletic performance, such as gene-doping, blood transfusion, and also performance-enhancing drugs (PEDs). The WADA Code published in 2002 justifies the regulations in this matter. Regarding the daily evolution of technology, it is almost impossible to eliminate doping in sports; however, the regulations and tests must be performed in order to reduce the possibility of doping. In this article, we reviewed the anti-doping policies and the alterations they have gone through, alongside exploring related cases.
... Not all supplement ADRV cases are necessarily unintentional doping. Some athletes may want to explain the presence of a prohibited substance in the doping sample by supplement use in an attempt to declare innocence and to avoid sanctions (Whitaker and Backhouse, 2017). In other cases, the athlete had deliberately used a supplement to increase physiological performance for example by trying to reduce body weight or increase exercise intensity. ...
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Dietary supplements encompass a large heterogenic group of products with a wide range of ingredients and declared effects used by athletes for a multitude of reasons. The high prevalence of use across all sports and level of competition, combined with the well-documented risks of such products containing prohibited substances have led to several doping cases globally. Despite being a considerable concern and persistent focus of sport organizations and anti-doping agencies, the magnitude of anti-doping rule violations associated with supplement use is not well-known. This study examines 18-years of doping controls of a national anti-doping program to determine the relationship between the presence of prohibited substances in athlete's doping samples and the use of dietary supplements. In 26% (n = 49) of all the analytical anti-doping rule violation cases in the period 2003–2020 (n = 192), the athlete claimed that a dietary supplement was the source of the prohibited substance causing an adverse analytical finding. Evidence supporting this claim was found in about half of these cases (n = 27, i.e., 14% of all analytical ADRV's). Stimulants were the most prevalent substance group linked to supplements (n = 24), of which methylhexanamine was associated with 16 cases. High risk products were predominantly multi-ingredient pre-workout supplements (n = 20) and fat-burning products (n = 4). Anti-doping organizations should develop strategies on how to assist athletes to assess the need, assess the risk and assess the consequences of using various dietary supplements.
... This new provision provides extra protection to these individuals and is applicable if they are retaliated against for doing so. The term of the sentence might range from two years to a lifetime ban 13 . ...
Conference Paper
Over the past decades, there has been an increase in the rules and protocols which help sportsmen play fair and make sure every athlete has an equal opportunity in the competitions. The International Olympic Committee (IOC) started to set rules against doping in 1961, by letting out a list of prohibited substances and methods during or out of the competitions, such as blood infusions, gene doping, and the use of performance-enhancing drugs (PEDs). In 1999 the World Anti-Doping Agency (WADA) was also created by the authorities, which later on, let out the World Anti-Doping Code to systemize the regulations against doping. The Code was first published in 2002. The two main reasons for the anti-doping policies are the health of the competitors, and to ensure that all the competitors are equal in sports events. Although eliminating doping in sports would be unreachable, the main goal should be to control the behavior. In this article, we intend to review the development of anti-doping policies and different approaches to doping in sports and also explore related cases.
... Gleaves et al.'s (2021) recent review, we extracted 27 studies for the time period 2016 -2019 (inclusive). Of these, eight studies utilise data from WADA-mandated doping testing and publicly reported Anti-doping Rule Violations(Aguilar et al., 2017; Aguilar-Navarro et al., 2019;Al Ghobain, 2017;Aubel et al., 2019;Marchand et al., 2017;Mazzeo et al., 2016;Mercado et al., 2019;Whitaker & Backhouse, 2017). We updated this list with five eligible studies that have been published since 2020 (Aguilar ...
Rugby Union is a sport where physical attributes such as strength, speed and power, are highly desirable. To this end, there have been suggestions that rugby players might use doping substances to fulfil these said demands. The present study comprises interviews with thirteen doped recreational Welsh Rugby Union players. The study examined: (i) perceived physical demands of rugby; (ii) motivations to lift weights and follow specific diets; and (iii) the motivating factors to use nutritional and doping substances. Participants detail novel insight into doping within recreational Welsh rugby and reaffirm the perception that size matters. Specific factors such as coach reinforcement, age group categories and level of competition, contribute to this perception. Notably, however, participants use/d doping substances for multiple reasons that were context-sensitive, each carrying different weight and influenced by temporal and developmental dimensions. Importantly, most players also referred to factors outside of rugby participation. These findings have important implications for the Welsh Rugby Union and National Anti-Doping Organisations. We recommend that the Welsh Rugby Union target these potentially doping-inducing perceptions, offering more non-elite focused education for both athletes and coaches, with a focus on safe and healthy weight and size gaining practices.
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Global anti-doping policy indicates that athlete support personnel (ASP, e.g. doctors, nutritionists) can play an important role in fostering supportive environments that protect against intentional and inadvertent doping. Yet, research into ASP anti-doping roles is limited and no study has examined how (if at all) different members of ASP work together. Therefore, this study investigated anti-doping roles of ASP in a single sports club environment via semi-structured interviews. Through inductive reflexive thematic analysis, three overarching themes were constructed: 1) Everyone has responsibility for anti-doping, but most of the work rests unevenly on a few shoulders, 2) Education is fundamental to doping prevention, and 3) (Preventing doping) It’s all about the way we work with players and each other. As the first study of its kind, the findings indicated that actions taken to prevent doping varied across ASP working together in the same environment. The nutritionist and medical staff were most active in anti-doping efforts and least active were strength and conditioning coaches. Factors underpinning anti-doping roles were individuals’ relevant expertise/training and overall job responsibilities (e.g. supplements, medications) related to risk of doping. Staff also connected their doping prevention efforts to the club’s person-centred philosophy, which prioritised ‘individualisation’ and supportive relationships. While the data indicates potential for anti-doping responsibilities to be shared amongst ASP who work well together and trust one another, it revealed that reliance on one or two ASP in any environment might allow other ASP to neglect their opportunity to have a positive influence on players’ doping-related decisions.
Understanding the attitudes and dispositions of athletes towards doping has been the subject of increasing research. Few studies, however, manage to capture these attitudes and dispositions from athletes who have committed anti-doping rule violations. According to UK Anti-Doping (2020) data, 10% of all sanctioned athletes came from recreational levels of Welsh rugby union. Although there are significant doping concerns within Welsh rugby, no research investigations exist that examine this specific population. Uniquely, the present research sheds light on “doped” athletes within recreational Welsh rugby union. Semi-structured interviews were conducted with (n = 13) “doped” recreational Welsh rugby players. Interviews revealed a wide range of factors, including motivations for doping, drug use patterns, perceived harms and athletes’ experiences and perceptions of Anti-Doping Policy and practice. This study focuses on interviews where participants reveal a substantial disregard of Anti-Doping policy and practice and concerns surface across three main themes: (1) perceived lack of frequency related to doping control tests; (2) perceived lack of testing efficacy; and (3) advanced warning of doping controls by coaches. Not only does this data raise serious concerns for the integrity of sport at recreational levels, but it also challenges the discourses around perceived legitimacy of anti-doping therein.
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Despite the growing research on doping in sport, there is little analysis of the sanctioning process. This article contributes to remedying this gap by examining anti-doping rule violation hearings heard before the California State Athletic Commission. Drawing upon qualitative fieldwork informed by socio-legal approaches, it explores how athletes articulate defenses against formal accusations of doping. Their performances reveal broader power relationships. Analysis of the interactions between participants in the hearings illustrates how relational aspects of the hearings are integral to understanding the anti-doping sanctioning process. In sum, this article reveals how attempts to adhere to seemingly objective, procedural protocols and intersectional forms of social difference converge, complicating the pursuit of the Commission’s mandate to protect the health of athletes under its jurisdiction.
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The focus of researchers, media and policy on doping in cycling is often limited to the professional level of the sport. However, anti-doping test results since 2001 demonstrate that banned substances are also used by US cyclists at lower levels of the sport, necessitating a broader view of the patterns and motivations of substance use within the sport. In this article, we describe and explain the doping culture that has emerged in domestic US cycling among amateur and semi-professionals. Through analysis of records from sports governing bodies and journalistic reports, we assess the range of violation types and discuss the detection and punishing of riders who were not proven to have intended to cheat but became “collateral damage” in the war on doping. We argue that the phenomenon of doping is more complex than what has been shown to occur in elite sport, as it includes a wider variety of behaviours, situations and motivations. We develop fresh insights by examining cases where doping has been accidental, intrinsically motivated, non-performance enhancing or the result of prescribed medical treatments banned by anti-doping authorities. Such trends call into question the fairness of anti-doping measures, and we discuss the possibility of developing localised solutions to testing and sanctioning amateur athletes.
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Evidence of a sport-specific hierarchy of protective factors against doping would thus be a powerful aid in adapting information and prevention campaigns to target the characteristics of specific athlete groups, and especially those athletes most vulnerable for doping control. The contents of phone calls to a free and anonymous national anti-doping service called 'ecoute dopage' were analysed (192 bodybuilders, 124 cyclists and 44 footballers). The results showed that the protective factors that emerged from analysis could be categorised into two groups. The first comprised 'Health concerns', 'Respect for the law' and 'Doping controls from the environment' and the second comprised 'Doubts about the effectiveness of illicit products, 'Thinking skills' and 'Doubts about doctors'. The ranking of the factors for the cyclists differed from that of the other athletes. The ordering of factors was 1) respect for the law, 2) doping controls from the environment, 3) health concerns 4) doubts about doctors, and 5) doubts about the effectiveness illicit products. The results are analysed in terms of the ranking in each athlete group and the consequences on the athletes' experience and relationship to doping. Specific prevention campaigns are proposed to limit doping behaviour in general and for each sport.
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Over two decades, the importance of coaches as potential agents in the prevention of drug use amongst athletes has been emphasised. This article examines the published evidence on coaches' knowledge, attitudes and beliefs towards doping in sport. A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and Jan 2011. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. Four studies met the inclusion criteria and were examined in detail. Samples reflected a range of coaches (n = 566) drawn from Norway, Italy, France and Hong Kong. The investigations varied with respect to outcome focus and quality of evidence. Despite the influential role that coaches might play in an athlete's life, few studies have examined their doping-related knowledge, attitudes and beliefs. While the existing empirical research posits support for the anti-doping movement, it also exposes a limited knowledge of doping effects or governance. The current evidence-base makes it difficult to plan targeted education to span coaching contexts. Addressing this situation in a more systematic and thorough fashion appears warranted.
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Background: There is a growing body of empirical evidence on demographic and psychosocial predictors of doping intentions and behaviors utilizing a variety of variables and conceptual models. However, to date there has been no attempt to quantitatively synthesize the available evidence and identify the strongest predictors of doping. Objectives: Using meta-analysis, we aimed to (i) determine effect sizes of psychological (e.g. attitudes) and social-contextual factors (e.g. social norms), and demographic (e.g. sex and age) variables on doping intentions and use; (ii) examine variables that moderate such effect sizes; and (iii) test a path analysis model, using the meta-analyzed effect sizes, based on variables from the theory of planned behavior (TPB). Data sources: Articles were identified from online databases, by contacting experts in the field, and searching the World Anti-Doping Agency website. Study eligibility criteria and participants: Studies that measured doping behaviors and/or doping intentions, and at least one other demographic, psychological, or social-contextual variable were included. We identified 63 independent datasets. Study appraisal and synthesis method: Study information was extracted by using predefined data fields and taking into account study quality indicators. A random effects meta-analysis was carried out, correcting for sampling and measurement error, and identifying moderator variables. Path analysis was conducted on a subset of studies that utilized the TPB. Results: Use of legal supplements, perceived social norms, and positive attitudes towards doping were the strongest positive correlates of doping intentions and behaviors. In contrast, morality and self-efficacy to refrain from doping had the strongest negative association with doping intentions and behaviors. Furthermore, path analysis suggested that attitudes, perceived norms, and self-efficacy to refrain from doping predicted intentions to dope and, indirectly, doping behaviors. Limitations: Various meta-analyzed effect sizes were based on a small number of studies, which were correlational in nature. This is a limitation of the extant literature. Conclusions: This review identifies a number of important correlates of doping intention and behavior, many of which were measured via self-reports and were drawn from an extended TPB framework. Future research might benefit from embracing other conceptual models of doping behavior and adopting experimental methodologies that will test some of the identified correlates in an effort to develop targeted anti-doping policies and programs.
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To enable preventive measures to be designed, it is important to identify modifiable distal and proximal factors underlying doping behavior. This study investigated aspects of the prototype willingness model in relation to doping. A cross-sectional study was conducted involving 729 competitive athletes. Following ethical approval, athletes (mean age = 28.8 ± 10.1 years; 63% male) completed an online questionnaire, which assessed doping-related attitudes, norms, prototype perceptions, outcome expectancies, and behavioral willingness. Using hierarchical multiple regression analysis, 54.4% of the total variance in willingness to dope was explained. Specifically, past doping, attitudes, and favorability of performance enhancing substance user prototypes were the strongest unique predictors of willingness to dope. Athletes appeared most willing to dope if they were to suffer an injury, a dip in performance, or think others are doping and getting away with it. National-level athletes displayed significantly greater willingness to dope (Kruskal-Wallis γ2 = 35.9, P < 0.001) and perceived themselves as significantly more similar to a doper (Kruskal-Wallis γ2 = 13.4, P = 0.004) than athletes competing at any other level. The findings highlight the importance of extending anti-doping provision beyond elite-level sport and the need to target athletes’ doping-related perceptions
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Athlete support personnel (ASP) failing to meet responsibilities under the World Anti-Doping Code risk sanction. It is unclear whether the poor knowledge of responsibilities seen in sports physicians and coaches applies to other ASP (e.g., administrators, chiropractors, family, nutritionists, physiotherapists, psychologists, and trainers). A purposive sample of Australian ASP (n = 292) responded to a survey on knowledge of anti-doping rules (35 true/false questions), ethical beliefs and practice, and attitudes toward performance enhancement. Some ASP declined to participate, claiming doping was irrelevant to their practice. Physicians were most knowledgeable (30.8/35), with family and trainers the least (26.0/35). ASP reported that improvements were needed to support anti-doping education (e.g., basis for anti-doping) and practice (e.g., rules). ASP also had a slightly negative attitude toward performance enhancement. Linear regression showed that being a sports physician, providing support at the elite level, and 15 years of experience influenced knowledge. The results confirm gaps in knowledge, suggesting that stronger engagement with ASP anti-doping education and practice is needed. Applying the principles of andragogy could help foster active engagement through emphasis on active inquiry, rather than passive reception of content. Future work on the context within which ASP experience anti-doping is needed, exploring acquisition and translation of knowledge into practice.
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The purpose of this study was to provide an ecologically valid account of the experiences of ‘admitted dopers’. In-depth interviews were conducted with five elite athletes from the sports of road cycling, mountain biking and weightlifting. The athletes had either tested positive for banned substances or had admitted to prior drug use after their retirement from competitive sport. Thematic analysis was used to extract meaning from the interview data. Individual psychological factors and contextual influences on the athletes' doping decisions were identified. The conflicting responses of these athletes make the identification of a psychological profile of athletes most at-risk for doping difficult, but morality was consistently cited as an important consideration. The culture of the athletes' team or training group and ‘critical incidents’ during the athletes' careers were often influential in precipitating drug use. Doping deterrents were also discussed, of which guilt and shame were predominant. The athletes outlined their perceived personal and social consequences of doping. Their future outlook for reducing the problem of doping in sport was generally optimistic. The findings have significant implications for the design of anti-doping research and education, and the implementation of anti-doping policy. (ecologically valid)(‘admitted dopers’), , , , , (‘critical incidents’), , , , 5····
Certain performance-enhancing substances and training methods are forbidden by the International Olympic Committee (IOC), the World Anti-Doping Agency (WADA) and other international sport organizations. The reasons usually given by ruling sports organizations to ban doping are: (i) doping is harmful to athletes' health; (ii) doping is unfair because athletes who are reluctant to use it do not have a fair chance when competing against doped athletes; (iii) doping runs counter to the ‘nature’ or the ‘spirit’ of sport, which is said to be to strive for victory by exhibiting natural physical skills and excellence of character without the help of any artificial products. In this essay, firstly, I will argue, contrary to (iii) above, that doping is not only compatible with, but also incarnates, the true spirit of modern competitive elite sports. Secondly, I will also argue, contrary to (ii) above, that, if the doping ban is kept, fairness (understood as equality of the relevant competitive conditions in a sport contest) demands more fine-tuned doping regulations and sanctions rather than increased standardization. This criticizes the IOC and WADA's current efforts to enforce general standards to punish doping violations, as their current policy fails to consider the social and sport-ethical particularities of the different communities from which dopers come.
Nutritional supplement (NS) use is widespread in sport. This study applied an integrated social cognitive approach to examine doping attitudes, beliefs, and self-reported doping use behavior across NS users (n = 96) and nonusers (n = 116). Following ethical approval, 212 competitive athletes (age mean = 21.4, s = 4.5; 137 males) completed self-reported measures of doping-related social cognitions and behaviors, presented in an online format where completion implied consent. Significantly more NS users (22.9%) reported doping compared with nonusers (6.0%; U = 4628.0, P < 0.05). NS users presented significantly more positive attitudes toward doping (U = 3152.0, P < 0.05) and expressed a significantly greater belief that doping is effective (U = 3152.0, P < 0.05). When presented with the scenario that performance-enhancing substances are effective and increase the possibility of winning, NS users were significantly more in favor of competing in situations that allow doping (U = 3504.5, P < 0.05). In sum, doping use is three-and-a-half times more prevalent in NS users compared with nonusers. This finding is accompanied by significant differences in doping attitudes, norms, and beliefs. Thus, this article offers support for the gateway hypothesis; athletes who engage in legal performance enhancement practices appear to embody an "at-risk" group for transition toward doping. Education should be appropriately targeted.