Franques, P., Auriacombe, M., & Tignol, J. (2001). Sports, use of performance enhancing drugs and addiction. A conceptual and epidemiological review. Annales de Medecine Interne, 152 Supplement 7, 37-49.

"BACKGROUND: Both the general public and non-sports medicine health professionals have recently been made aware of a large use of performance enhancing drugs among sports practicing subjects. It has been suggested that this behavior is similar to that of substance dependence. Also some have reported that practice of a sport could be in itself an addictive behavior. OBJECTIVE: The main objective was to address the following question: is performance enhancing drug use in sports an addictive behavior? METHODOLOGY. We first reviewed the definition of performance enhancing drug use in sports and the diagnostic criteria of substance dependence as they are currently accepted and attempted to determine a possible common factor. Secondly we reviewed epidemiological data from the literature according to three approaches: RESULTS: Use of performance enhancing drugs is an important and increasing phenomenon among adolescents. It is sometimes associated to risk taking behaviors for health (syringe use and sharing). Competition participants are at increased risk (up to 20% according to some authors) and some substances (anabolic steroids) are also used by non-sports practicing individuals. It has not been shown that sports practicing subjects were more at risk of using addictive substances compared to non-sports practicing subjects. It is not established that practice of a sport is by itself a risk factor for substance use. However, it could be that a sub-group of individuals that practice certain types of sports in an intensive way, that use both performance enhancing drugs and addictive substances and that engage in health risk taking behaviors have an increased risk for developing a dependence syndrome to both addictive and performance enhancing drugs. This sub-group is even more at risk because some performance enhancing drugs (anabolic steroids) could increase the risk for occurrence of a substance dependence syndrome through neurobiological actions. Yet, the few available clinical studies show that at most only half of regular users actually meet criteria for dependence. Also, one study has reported an overrepresentation of sports professionals among patients seeking treatment for heroin addiction. CONCLUSION: The large majority of sports practicing subjects have no dependence to either performance enhancing or addictive drugs. However, a subgroup of individuals that practice sports intensely and makes use of both addictive and performance enhancing drugs appear to be at increased risk for developing a substance dependence syndrome".

Implication. Serious elite athletes do not develop dependencies on supposed "performance-enhancing" or addictive drugs. If the hysteria about a drug-epidemic in sports perpetuated by the media and politicians were true, it is likely that dependencies would develop and be exhibited. A case could be made for the WADA-targeted elite athletes being an example of clean sportspeople rather than the villains hypothetically created to keep the ill-formed current anti-drugs-in-sport regime in place.

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