Drug Use and Rehabilitation in Sports

There are some relations between the use of drugs by sports players with drug use by warriors and soldiers. Both go back through history, and perhaps prehistory. It appears that using substances, both natural and synthetic, in order to improve the senses and energy levels has been a consistent drive in humans. The desirability of performing better in a variety of situations — even the instinct to kill and survive combat — is a part of humanity as well.

This desire can be compared and contrasted with more common recreational drug use, alcoholism and hard drugs in terms of the motivations of users. A partier wants a designer drug or cocktail of substances mainly in an effort to ‘feel real good’ — for personal and social reasons. Drugs ingested for pleasure, mood-enhancement or even sexual prowess are in many cases rooted as a social high.

Athletes, on the other hand, have a different agenda than securing pleasure artificially. In actuality, endurance athletes are drawn to using drugs in order to help them take the pain or endure the privations involved with extreme sports or long-duration events (races over many days without rest). That motive may also include pleasure insofar as relief from intense physical stress is the thing desired.

The presence of hardship and a drive to mitigate it through using a substance, or mixture of substances, would also be involved with the addict of hard drugs. In many cases, hard drug users are seeking to assuage the symptoms of psychological disorders, physical pain or even drug-related ailments, in a vicious circle.

Sports players may be the most practical and straightforward in their attraction to performance-enhancing drugs and their approach to taking them. Yet, because the drugs they choose have some of the worst side-effects, athletes put the most on the line. There is a psychological fixation upon winning or besting personal goals, which becomes the basis for sacrificing other worthwhile experiences and even responsibilities, let alone basic bodily health.

To put one’s life on the line for the sake of satisfaction with physical prowess, a need to win, financial rewards, public image and vanity is itself a disorder of the mind, which users of sports-oriented drugs must confront in a successful rehabilitation.

Drug Use in Sports

Which drugs are most commonly used by sports players? The question should be approached in one of two ways: depending upon the kind of athleticism involved. Endurance sports require different drugs than non-endurance or strength-oriented sports, and competitors in each have their own favored drugs. Those are the two main ways to answer the question of which substances are most commonly used and abused.

Given the extreme nature of an endurance sport such as cycling (the Tour de France) or various many-day marathons that do not allow sleep, the negative effects of performance-enhancing pharmaceuticals or other means are in turn the most extreme examples in all sports. Athletes that engage in ‘doping’ and who become addicted to any advantages derived from it, despite the deleterious effects upon their bodies, risk death.

The drugs in this area of professional sports are always changing. The modern history of doping began during the Cold War, as America experimented with Russian weightlifters’ known (scientific) use of Testosterone. In the US, anabolic steroids were developed to reduce the side-effects of Testosterone, and yet they have introduced their own heavy drawbacks and negative symptoms (in part stemming from their relative safety).

Unlike weightlifters, who seek to build muscle mass and raw power, endurance athletes require bolstering of their existing physical compositions and then specific biological modifications and performance boosters tailored to their respective travails.

For example, a cyclist in the Tour de France needs to perform at a higher level for a longer period of time, with intense exertion of certain muscles (the legs being the largest muscles in the human body) and yet overall, all-body high exertion levels. An athlete with these requirements may opt for a blood-oriented agent, and could use a fairly dangerous drug to thin the blood, or help it carry more oxygen, red blood-cell count, and so on.

There are also purely biological methods for doping, such as blood transfusion, in which case the athlete’s blood supply is increased artificially (using pre-stored blood), thereby giving real physiological advantages. When top athletes in prime shape use such methods, it is often a winning edge, and, puts their bodies closest to their physical limits. It is not uncommon for them to collapse or perish during their actual competition performances.

Sports-Enhancing Drugs in the Body

How do drugs in sports affect an athlete’s body? Again, the question is best answered according to whether it is an endurance or non-endurance sport.

As already mentioned, endurance athletes commonly target their pulmonary and respiratory organs to receive modification from a drug. An example would be Belgian cyclists who use Erythropoietin (EPO), which increases red blood cell count, expanding riders’ VO2 Max thresholds.

This kind of drug, which promises the most advantages to long-distance runners and swimmers, marathon cyclists, rowers, and cross-country athletes like skiers, has become more accessible and more popular. It is used at the risk of death, because of the unnatural and excessive strain it puts on vital organs.

In the case of power-oriented sports like bodybuilding and weightlifting, the visual effects of steroids, for example, are the main reason they are used. For that reason, athletes must usually be sheltered by an in-group or by coaches to escape accusations of doping. Close observers would be able to pick up the following signs of usage and ongoing abuse:


  • male pattern baldness
  • acne
  • breast formation (gynecomastia)
  • erectile dysfunction
  • increase in estrogen
  • impaired liver function
  • increased sexual drive
  • impotency


  • hair loss
  • male pattern baldness
  • growth of male facial qualities
  • increased toughness of the skin
  • hypertrophy of the clitoris
  • increased sexual drive
  • inconsistent menstrual cycles
  • premature closure of the epiphysis

There are other effects to the user’s body, such as in the case of a long-distance runner, for example, who may experience hallucinations, disorientation, blackouts and impaired judgement during events. That becomes a bigger concern in the case of rough contact sports, which seem to mimic the intensity and aggression of man-to-man mortal combat on a battlefield (American Football).

Where the athlete is in direct contact with other players (boxing being the best instance) or in a position to commit errors while using equipment that could harm or crash others, then culpability for side-effects is more serious and could involve legal consequences.


If an athlete survives their dependence upon performance-enhancing drugs (especially in the case of extreme or endurance sports) then rehabilitation will most likely entail a stronger medical component during detox and rebuilding stages; an athlete would generally require close counseling and special coaching precautions after rehabilitation, as well. The pressures exerted by professional sports are on a grander scale than the stakes for ordinary addicts of recreational drugs, or, amateur, semi-professional, and minor league sports players.

In the case of endurance athletes, detox while monitoring any deep structural disorders (such as heart fatigue and vascular damage) will be necessary — otherwise these stages could be as dangerous as the original drug abuses.

In all cases of sports-drug addictions, the psychological and even spiritual aspects of treatment will be most important alongside careful medical attention. The entire rehabilitation process could take longer than for ordinary (non-famous) patients, given the need for the temporary removal of contact with exacerbating influences or professional demands, strengthened by ongoing counseling.

Since confrontation of one’s addiction is likely to face increased counter-forces and even extended self-denial by the idolized and perhaps arrogant patient, it may be best to treat such cases as essentially including a psychological disorder — this is referred to as a ‘dual diagnosis‘, and requires stronger doses of psychiatric, psychological and psychotherapeutic remedies. Intense public shame commonly complicates the rehabilitation process, and is sure to remain a challenge during reentry into society.

Fame Mixed with Addictions

There have been too many cases of famous athletes made even more famous by their dependence upon performance-enhancing drugs taken in a clandestine manner. Now, most of these drugs are outlawed by sports authorities, but during the mid-20th Century there had been a period of experimentation rather than regulation and banning. In many European sports scenes, like the annual Tour de France cycling event, doping has been ever-present historically — to the point of cliche.

From American Olympic body-builders in the ’40s to Lance Armstrong in the 21st Century (perhaps the world’s most famous abuser of drugs, and liar about it), we have plenty of cases from which to choose. That selection would be much wider still, if we knew all the professional athletes who are using drugs secretly, of course.

Pick any professional or Olympic sport, and therein will be ready examples of athletes who succumbed to pressures (often from coaches, teammates, rivals, or personal ambitions) and who used artificial means to dope and reap an unfair advantage.


Although the practicality of sports doping (its strategic and often medically-supervised nature) may distract from the underlying addictive quality of such behavior — mainly at the physiological and ego level — there is another dimension that makes it difficult to approach and treat. This dimension is social, wherein a star player is also a public hero, a national representative, and made rich by that status. Often, such an athlete is caught in a ring of deception made tighter by the outside adulation in which people want to deny the notion of their heros’ foul play.

Lance Armstrong does provide a ready and recent example of how long an athlete can endure lying about doping and yet is eventually caught, then stripped of the many achievements or records. Other scandals occur at every echelon of professional sports, even at relatively minor levels, as within local communities.


The mental and sociological dimensions of drug abuse and addiction by sports players and endurance athletes are heightened by fame, adulation, social and individual denial, trouble with regulatory authorities or the law, and, huge amounts of money and pride hanging in the balance. These can provide sufficient basis for avoiding treatment and evading detection among athletes and their coaches for longer periods than ordinary addicts.

The sacrifices as well as the dangers of using the strongest performance enhancing drugs, or forcibly affecting biological alterations (to the blood and metabolism, for instance), are the highest of any but the worst addictions to hard drugs, or ‘bathtub’ compounds like methamphetamine. Users risk death, let alone deep physical scarring and organ damage.