Reviewing the social science of drugs in sport: Five years on

Summary

Whilst the concept of doping in sport first penetrated the broader public consciousness on a global scale more that two decades ago, the social sciences have been slow to enter the debate. However, a vision for prevention is emerging. In recent years there has been a growing investment in social science research by the World Anti-Doping Agency as the need to move beyond detection-deterrence approaches has been recognised. As such, social scientists now play a more participatory role in the field and this has led to a developing research landscape. Insofar as doping in sport can be seen as having a many faceted human element, this update to our 2007 review explores the contribution of the social sciences to our understanding of doping in sport and considers recent empirical research alongside prevention programming.

The review aims to build on the findings of our previous review by summarizing the current evidence. The review focuses on:

(i) psychosocial correlates and predictors of doping in sport

(ii) knowledge, attitudes, beliefs and behaviors towards (anti-) doping

(iii) efficacy and effectiveness of anti-doping education programmes

(iv) doping specific models and theories.

The new mixed studies synthesis provides researchers, policymakers and practitioners with a comprehensive summary of current progress in the field.

Methodology
The review was conducted in line with guidelines devised by the UK National Health Service Centre for Reviews and Dissemination. An extensive search of the literature was conducted using electronic resources. The search strategy employed keywords for drug use in sport: ‘doping’, ‘performance-enhancing drugs’, ‘performance-enhancing substances’ and ‘drugs AND sport’ combined with selected terms relating to specific areas of interest, such as: 1) ‘attitudes’, ‘beliefs’, ‘knowledge’, ‘perspectives’, ‘perceptions’, ‘opinions’, 2) ‘correlates’, ‘determinants’, ‘risk factors’, ‘predictors’ ‘precipitating factors’, and 3) ‘education’, ‘intervention’, ‘model’, ‘prevention’. The review was limited to peer-reviewed articles written in the English language and published from 1st January 2007 to 1st May 2015. 

Results
Using our inclusion criteria 212 peer-reviewed articles were considered. This equates to an annual average of 26 papers published each year, far exceeding the annual average of six papers per year in 2007. Thus the field has seen a rapid increase in the quantity and quality of studies examining the social psychology of doping. The majority of studies examined doping correlates, as well as the knowledge, attitudes and beliefs of athlete support personnel, athletes (adolescent, elite and competitive), gym users, and the general public. Signalling the emerging nature of this area of work, only a handful of studies have progressed to present either the outcomes of anti-doping education programmes or to develop specific anti-doping theory/models.

The review identified multiple forms of deductively and inductively derived evidence. However, the heterogeneity of the studies means that definitive conclusions regarding the prevention of doping in sport remain elusive at this time. Still, consistent support was found for five main themes: (a) sport doping exists in a complex web of sociodemographic and psychosocial correlates and predictors, (b) critical incidents, both within sport and beyond, increase doping vulnerability, (c) social context and the role of reference groups – such as the coach, family, or peers – can facilitate and/or inhibit doping, (d) there is a perception that the likelihood of doping detection is low; often this is combined with deep doubts about the legitimacy of the current detection-deterrence system, (e) athletes’ and athlete support personnels’ exposure to formal anti-doping education appears insufficient and knowledge of anti-doping is moderate at best

Studies examining the effects of anti-doping education programmes remain scarce; on average one study was published per year. The only anti-doping education programmes that continue to be monitored over an extended follow-up period are the US based programmes: ATLAS and ATHENA. Inevitably then, these data are limited to a US cultural context and focus on team-based sports. To-date, neither study has identified the most ‘active ingredients’ of the programmes in affecting specific outcome variables, particularly doping behaviour. Novel theoretical models have been proposed to explain doping initiation; these have placed a strong emphasis on integrative approaches that reflect the complexity of interactions between personal, situational and contextual factors. The capacity for field-testing of these new tenets and models has yet to be determined. 

Significance for Clean Sport
This review once again reveals a patchy landscape with many gaps and uncertainties, particularly in relation to intervention design, delivery and evaluation. With such an absence of evidence, the requirement for undertaking multiple forms of enquiry will remain fundamental to identifying potential intervention approaches that have yet to be tried and tested.

Policy developments to prevent and detect doping in sport have moved rapidly and in advance of scientific research. This is important because policy informed by robust evidence is likely to be more effective and sustainable than that built on assumptions or ‘common sense’. The lack of evidence on the effects of anti-doping interventions remains a concern and highlights a significant need for investment. Indeed, funding will remain a priority to maintain and heighten the quality and impact of the outputs.

Related Publications

Video: A review of anti-doping social science research