As you read (in chapter 6) the materials on the use of performance enhancing substances by athletes, it is important to know about the history of substance use in sports. This section deals with the history of substance use among athletes and with a brief history of drug testing in international sports.

Evidence indicates that athletes have sought and used performance-enhancing drugs for centuries. Athletes in Greece and Rome used a variety of potions and substances, including hallucinogenic mushrooms, believed to improve physical performance. Strychnine and brandy was the potion of choice among European distance skaters in the 1700s and distance runners during the 1800s (strychnine is a dangerous "upper" used to stimulate the nervous system). Heroin was used as a painkiller by boxers before 1900, and as early as 1886 a cyclist died after using a mixture of heroin and cocaine. Many athletes in different sports used this mixture, called a speedball, in the late 1800s. Other drugs, including opium, alcohol, caffeine, strychnine, ethyl ether, and nitroglycerine, also were used during this period. Cyclists in the 1930s and British soccer players in the 1950s used amphetamines in combination with cocaine.

This brief review is not intended to give the impression that all athletes through history have been drug users. Most athletes have not used performance-enhancing drugs, although many at elite levels of competition have experimented with and used a wide variety of different substances believed to enhance performance. But the use of these substances is not new; this is important to remember as we try to explain why athletes use them today.

Historical evidence also shows an increase in the use of performance-enhancing drugs in the 1950s. This was due to two factors: (1) the development and official use of amphetamines in the military during World War II, and (2) advances in biology and medicine that led to the laboratory isolation of human hormones and the development of synthetic hormones, especially hormones fostering physical growth and development.

Experiences with amphetamines during the war alerted many physically active young men to the possible use of these drugs in other settings, including sports. Athletes in the 1950s and 1960s fondly referred to amphetamines as "bennies" (slang for benzedrine, a potent "upper"). Research on the use of synthetic hormones in sport had been done as early as the 1920s, but it wasn’t until the 1950s that testosterone, steroids, and growth hormones from both humans and animals became more widely available. They didn’t become very widely used, however, until weight training and strength conditioning programs were emphasized in certain sports. When athletes realized that muscle growth and lean body mass could be extended significantly, they became increasingly interested in specialized weight training programs, planned diets, vitamin supplements, and a variety of newly developed chemical substances. As might be expected, the growth of bodybuilding also has been closely connected with substance use, especially the use of hormones and hormone derivatives.

When Harold Connelly, the 1956 Olympic hammer-throw champion, testified before a U.S. Senate committee in 1973 that the majority of athletes he had known "would do anything, and take anything, short of killing themselves to improve athletic performance," he was probably describing what many athletes through history would have done. The reason drug use has increased so much since the 1950s is not that sports or athletes have changed but that drugs believed and known to enhance physical performance have become so widely available. If today’s drugs had been available in past centuries, it is likely that athletes would have used them as much as athletes do today. This makes it difficult to blame all drug use on the profit motive, commercial interests, television, or the erosion of traditional values.

This substance availability hypothesis must be examined more closely, but it clearly fits with the model of positive deviance presented in this chapter. The use of drugs and other substances by athletes is generally not the result of defective socialization or lack of moral character. After all, users are often the most dedicated and committed athletes in sports! Nor are the users helpless victims of coaches and trainers who lack moral character, although coaches and trainers who push the sport ethic without question may indirectly encourage the use of performance-enhancing substances. Instead, most substance use and abuse is clearly tied to an overcommitment to the sport ethic itself. It is grounded in overconformity-the same type of overconformity that occurs when injured distance runners continue training even when training may cause serious injuries, when young female gymnasts cut their food intake to dangerous levels, and when American football players risk their already injured bodies week after painful week in the NFL.

Apparently, many athletes enjoy playing their sports so much that they will do whatever it takes to stay involved and live up to the expectations of their athlete peers. Of course, being winners helps them avoid cuts or elimination, but winning is usually secondary to just playing and being accepted as an athlete. And as long as even a few athletes are willing to take performance-enhancing substances to gain the edge they need to continue playing at their level of participation, others will conclude that they also must use similar substances to stay competitive, even if it’s against their better judgment. These dynamics, all connected with overconformity to the sport ethic, seem to operate at various levels of sports, from the local gyms of bodybuilding to the locker rooms of professional sport teams, and among both women and men across a wide variety of sport events, from the shot put to the 100-meter sprint.

The implications of the drug availability hypothesis and the positive deviance model become especially clear when we examine efforts to define, test for, and control the use of performance-enhancing substances and other forms of positive deviance.

The creation and enforcement of rules regulating drug use among athletes has always been the responsibility of individual sport associations, federations, leagues, and conferences. And every organization has a different drug control policy history.

The IOC, for example, first defined and banned doping in 1967. The first drug tests in international sport were administered at the 1968 Olympic Games in Mexico City, but they were done for research purposes and no athlete was punished for testing positive. In 1968 there were no accurate tests for detecting anabolic steroids; few sports leaders were aware of how many athletes were using steroids, and most medical experts naively claimed that steroids had no significant effect on performance. These first regulatory drug tests were prompted by suspicions about drug-related deaths among cyclists and soccer players and by rumors about widespread drug use among athletes in Eastern Europe.

The absence of tests for steroids opened the door for rapid increases in the number of athletes using them. According to an unofficial poll taken by Jay Sylvester, a member of the U.S. track team in 1972, 68 percent of all track and field athletes used some form of anabolic steroid in preparing for the 1972 Games in Munich. Accurate tests to detect steroid use were developed in 1973, and they were first administered on an experimental basis at the 1974 Commonwealth Games. No athletes were punished, even though about 20 percent of the competitors in the sample tested positive.

During the 1976 Olympic Games in Montreal, 8 out of 275 athletes tested positive for steroids, but at that time many already had switched from synthetic steroids to pure testosterone. This was ironic, since anabolic steroids originally were developed and used in medical treatment because they were safer than testosterone. However, because testosterone is a natural substance in the human body, it created detection problems for the testers. According to the policy used then in Olympic sports, a positive test for testosterone meant that an athlete’s urine contained more than a 6:1 ratio of testosterone to epitestosterone ("T/E ratio" or "tet/epitet ratio"), both of which are naturally occurring hormones in men and women (normal T/E ratios are about 2:1 or less). Many athletes manipulated their use of hormones so that they would not surpass this ratio.

Drug tests done in 1980 indicated that over 20 percent of the U.S. athletes who would have competed in the Moscow Olympic Games (if there had been no boycott) tested positive for the use of exogenous (not "naturally" produced) testosterone, according to the T/E ratio definition of doping. In 1982 the IOC added testosterone to its list of banned substances. During the next year, fifteen male athletes from the United States tested positive for steroids at the Pan American Games in Caracas, and a dozen others packed up and returned home before competing in their events when they heard about the testing. This attracted attention and led to numerous investigations of drugs in sport by sport organizations, journalists, and others. The popular press was full of drug reports. The investigations suggested that drug use existed among many athletes in a wide range of amateur and professional sports.

The USOC stepped up its testing efforts during the 1984 Olympic trials, although there were no punishments for eighty-six athletes who tested positive. But the athletes used the test results to learn more about how to avoid detection, and many steroid users turned to unbanned masking drugs, switched to the use of human growth hormone (hGH), or controlled their testosterone use more carefully. The reason for the switch to hGH was that growth hormone could not be detected through standard testing methods. Testosterone was allowed as long as the T/E ratio was not beyond 6:1. However, both hGH and testosterone are more dangerous and powerful than anabolic steroids. Additional rumors in the mid-1980s suggested a few athletes may have even experimented with "monkey juice," the growth hormones of monkeys and apes. During the Los Angeles Games in 1984, a number of positive drug tests were never made public, and the records of these tests were mysteriously shredded when discovered by the press. Also, tests were not done for testosterone or caffeine, blood boosting policy was kept unclear, and athletes routinely used cleverly evasive methods of providing testers with "clean urine". Overall, the testing in 1984 was a sham that may have been influenced by an interest in selling the games to image-conscious corporations. Of course, the sale of the games has continued at a record pace!

The outcomes of the drug-testing programs for the 1988, 1992, and 1996 Summer Olympic Games in Seoul, Barcelona, and Atlanta followed similar patterns: only a few athletes tested positive amid rumors of widespread use. Evidence suggests that the rumors are at least partially true. Testing done after the completion of the Seoul Games revealed at least fifty men using anabolic steroids and twenty positive drug tests that were never made public; after the Barcelona Games, hundreds of athlete urine samples were found to contain evidence of drug use. Athletes probably are using various forms of anabolic steroids, other hormones, and substances such as EPO in a wider range of events than ever before; usage is no longer limited to weight lifting and other so-called strength sports.

Many people believe that the relatively small number of positive tests in recent Olympic Games has been due not only to cover-ups, but also to the use of masking drugs to distort test results, a more careful and knowledgeable determination of usage cycles and dose amounts among athletes, the use of customized "designer drugs" that escape detection in the tests, and the use of hGH, EPO, and other substances that can’t be accurately detected by the tests. Also, some athletes have now become so experienced in the use of testosterone that they take it in doses that keep the detectable amount below allowable limits, which have occasionally been raised to a 10:1 T/E ratio-over 500 percent of what is normal in the human body! In order to stay close to but not exceed the 6:1 ratio, some athletes, especially women, now take strength- and speed-boosting doses of testosterone through skin patches and via skin cream. As long as they stay under 6:1, they do not test positive.

Other sport organizations have different histories of drug testing from that of the IOC. Every organization has its own policies, procedures, and "banned substances list." And each organization’s policy is influenced by unique sets of internal political issues and external factors, such as the policy positions of players’ associations, the availability of money to conduct tests, and the legal limits of testing in certain situations.

The effectiveness of drug testing in high-profile power and performance sports such as those in the Olympic Games is compromised because people associated with these sports like the benefit of performance-enhancing drugs. Charles Yeselis, a drug expert and professor of health policy at Penn State University, explains that these drugs give sports "world records, bigger-than-life human beings with tremendous physical capacities they could not attain without drugs. That sells television minutes and endorsements". And as we saw in the Atlanta Games and have seen in other events since then, television and commercial endorsements shape sports in dramatic ways; while they may not cause the taking of drugs, they do impact the enforcement of drug policies.

In 1999 there were hundreds of track and field athletes who tested positive for the steroid nandrolone. All these athletes denied taking any steroid. However, the "nutritional supplements" that they and many of their fellow athletes were taking contained the steroid even though it was not listed among the "contents" on the supplement bottle. They claimed they were taking "natural" substances, and that they assumed that "natural" was automatically acceptable. Others tested positive for ephedrine because they used "supplements" or sports "energy bars" that contained "ma huang." They assumed that ma huang was a natural herb. However, ma huang is also known as "ephedra" which is a chemical equivalent to ephedrine. My guess is that some of these athletes were unaware of the full chemical content of the substances they were taking and that others were aware but thought they would escape positive tests.

I did not put this information in the current edition of Sport in Society because some athletes change nutritional supplements as often as they change the brand of socks they wear. Part of the problem faced by athletes is that the U.S. government classifies chemical compounds and "dietary supplements" in a different category than "drugs." Drugs are regulated by many rules and they must be thoroughly tested by the FDA. Compounds and supplements are governed by few rules, and the corporations that manufacture and sell them can do just about whatever they want to make money. Until this issue is addressed, many athletes will continue to spend hundreds of dollars every month to buy untested supplements in an effort to give them the edge they need to maintain their status and identities as elite athletes.