By Ian Boardley

Introduction

The gateway hypothesis was originally developed in the context of recreation drugs, suggesting that use of softer drugs such as marijuana could act as a “gateway” to eventual use of harder drugs such as heroine. Subsequently, the gateway hypothesis has been applied in sport and exercise, suggesting that use of permitted forms of performance enhancement (e.g., nutritional supplements, some medicines, performance enhancing technologies) may facilitate athletes’ progression towards image and performance enhancing drugs (IPED) use. However, research testing this hypothesis is limited to cross-sectional research that has only tested the relationships between these different forms of enhancement at a single point in time. As such, the effects of permitted performance enhancement techniques on IPED use over time are yet to be tested. A more robust test of the gateway hypothesis would be to investigate whether use of permitted forms of performance enhancement are predictive of changes in known determinants of IPED use over time. Three likely indicators of IPED use are explicit attitudes towards IPED use (i.e., athletes’ positive evaluations of IPED use), automatic IPED preferences (i.e., a collection of self-relevant thoughts regarding IPED use instinctively retrieved from memory) and doping moral disengagement (six psychosocial mechanisms used to justify and rationalize IPED use). Importantly, mid-to-late adolescence is thought to represent a key transitional life stage during which athletes may be particularly susceptible to gateway influences on IPED use, as attitudes towards IPED use are likely to be still forming during this stage. Thus, given their life-stage university-student-athletes may be particularly susceptible to gateway influences on IPED use. As such, research testing the gateway hypothesis in university-student-athletes may be particularly informative. The aim of the current article is to provide a more detailed background to the gateway hypothesis, and also many of the conceptual arguments that underpin its main tenets. Once this is done, I will then describe a line of research that will commence this autumn designed to empirically test a number of these conceptual arguments.

Background Literature

The most widely used permitted form of performance enhancement is nutritional supplement use. Many athletes are known to use nutritional products such as protein supplements, caffeine and creatine monohydrate to supplement their diet in an attempt to facilitate the training effect. Importantly, researchers have demonstrated a positive link between nutritional supplementation and IPED use, therefore providing some support for the gateway hypothesis. For instance, qualitative work has shown IPED users believe once the performance benefits of nutritional supplementation plateau, athletes often look to IPEDs to facilitate further performance improvements (Boardley & Grix, 2014; Boardley et al., 2014, 2015). Similarly, quantitative research has demonstrated prevalence of IPED use is more than three times higher in athletes using nutritional supplements than it is in to athletes who do not, and that nutritional supplementation is a strong predictor of IPED use (Backhouse et al., 2013; Hildebrandt et al., 2012; Ntoumanis et al., 2014). As such, research evidence to date supports the possibility that nutritional supplementation could facilitate progression towards IPED use.

Another potential gateway to IPED use are off-label or over-the-counter medicines. Medicines are drugs or other preparations designed to prevent or treat illness or injury (e.g., painkillers, diuretics, decongestants; Mottram & Chester, 2015) that can be used to support athletic training and performance (Boardley et al., in press). Whilst some athletes take medicines to help cope with pre-existing conditions (e.g., asthma) or injury, there is strong evidence of inappropriate and excessive use of medicines in sport (e.g., Lazic et al., 2011; Tscholl et al., 2008a, 2008b). Although some medicines used by athletes may be permitted, the increased use of such substances may lead to a reliance on pharmaceuticals that could eventually lead to athletes experimenting with IPEDs (Donovan, 2009; Petróczi, 2013).

It has also been suggested that the use of performance enhancing technologies may also lead to IPED use. Performance enhancing technologies include equipment, clothing and oxygenation methods designed to facilitate performance and/or the training effect (Donovan, 2009), and the Incremental Model of Doping Behaviour (IMDB) suggests routine application of permitted practices such as these could lead to IPED use (Petróczi, 2013). Whilst not contravening the rules of sport, the ethics of applying such technologies has been questioned by some, especially when they enhance performance with no additional effort (Donovan, 2009; Miah, 2005). Thus, performance enhancing technology use may be another gateway influence of IPED use.

The IMDB also suggests mid-to-late adolescence may be of particular interest for researchers investigating the gateway hypothesis (Petróczi, 2013). More specifically, increased autonomy from parents and influence from peers mean this may be a period during which athletes are likely to further form and strengthen their attitudes towards IPEDs. One particular population that experiences a sudden increase in autonomy from parents and influence from peers during mid-to-late adolescence are university students. As such, university-student athletes may be a particularly interesting population to study in research investigating the gateway hypothesis.

Researchers often investigate key determinants of IPED use in lieu of reported use of IPEDs due to the difficulties involved in obtaining accurate data on IPED use (Morente-Sánchez & Zabala, 2013; Ntoumanis et al., 2014). One potential determinant of IPED use are explicit attitudes towards IPEDs, which represent positive evaluations of engagement in IPED use (Ntoumanis et al., 2014) and have been shown to be indicative of IPED use in athletes (Morente-Sánchez & Zabala, 2013). Further, a recent meta-analysis found positive attitudes towards IPEDs to be one of the strongest correlates of IPED use (Ntoumanis et al., 2014). Importantly, the IMDB suggests the doping mindset consists of both functional (i.e., whether IPED use is viewed as effective in enhancing performance) and moral (i.e., whether IPED use is viewed as morally right or wrong) attitudes, with IPED use being facilitated by increases in functional attitudes towards IPEDs.

The IMDB suggests to obtain a more complete picture of the mental processes governing IPED use, automatic doping preferences (i.e., assembled evaluations of self-relevant thoughts regarding IPEDs contextually retrieved from mental representations) should be investigated alongside explicit attitudes (Petróczi, 2013). Quite recently, researchers have started to investigate automatic doping preferences, and variants of the Implicit Attitude Test (IAT) have proved to be a promising approach to assessment (Brand, Heck, & Ziegler, 2014; Petróczi et al., 2010). Work using such approaches has found automatic doping preferences to be more positive in athletes who use IPEDs compared to non-users (Brand, Wolff, & Thieme, 2014; Petróczi et al., 2010). Importantly, it is generally assumed that IAT-based measures are less susceptible to socially desirable responses than explicit attitude measures. Thus, automatic doping preferences may constitute another useful indicator of IPED use for researchers looking to test the gateway hypothesis.

Moral Disengagement (MD) represents another key correlate of IPED use (Ntoumanis et al., 2014). MD is a collective term for a series of six psychosocial mechanisms that allow athletes to justify and rationalize IPED use (Bandura, 1991; Boardley & Grix, 2014). Importantly, quantitative (e.g., Hodge et al., 2013; Zelli et al., 2010) and qualitative (Boardley & Grix, 2014; Boardley et al., 2014, 2015) research has supported a positive link between MD and IPED use. With respect to the IMDB, tension between functional and moral attitudes to IPED use (i.e., IPED use is functional but against my moral beliefs) can lead to cognitive dissonance (i.e., uncomfortable feelings resulting from conflicting attitudes, beliefs or behaviours that motivate alteration in attitudes, beliefs or behaviours to reduce discomfort; Festinger, 1962). Thus, the incongruent functional and moral attitudes associated with the doping mindset may result in increased MD, as MD allows people to violate their moral standards without experiencing negative emotions (Bandura, 1991).

Despite permitted forms of performance enhancement being potential gateways to IPED use, the availability of performance enhancement alternatives is a situational factor that could also weaken positive attitudes towards IPEDs (Petróczi, 2013). Concordantly, effective anti-doping education programmes have been found to include presentation of alternatives to IPEDs (Backhouse et al., 2007). Further, exposure to information on functional foods as alternatives to IPEDs can have a desirable effect on beliefs regarding performance enhancement (James et al., 2010). Interestingly, if presented correctly, permitted forms of performance enhancement could act as a protective factor against – rather than a facilitator of – IPED use.

Upcoming Research

According to World Anti-Doping Agency (WADA) (2015), IPED use in sport is problematic because it (a) provides an unfair advantage over competitors, (b) potentially results in negative health consequences, and (c) contravenes the spirit of sport. The IMDB (Petróczi, 2013) and the gateway hypothesis of doping in sport (Backhouse et al., 2013) suggest IPED use evolves as part of routine application of permitted performance enhancement practices. However, researchers have not investigated the effects of nutritional supplementation and use of medicines and performance enhancing technologies on determinants of IPED use over time. As such, research is needed that tracks the influence of potential gateways to IPED use on key determinants of IPED use longitudinally. Also, research is needed to determine the effect of conflicting functional and moral attitudes on doping MD. Further, although permitted forms of performance enhancement have the potential to act as protective factors against IPED use, athletes often view them as precursors to it (Boardley & Grix, 2014; Boardley et al., 2014, 2015). Thus, there is a need for research that aids our understanding of how licit forms of performance enhancement can most effectively be presented as alternatives to – rather than precursors of – IPED use.

To investigate these issues, we have recently obtained funding from the WADA to fund a three-year research project with university-student-athletes that will utilise both qualitative and quantitative methodologies to further our understanding of the issues raised in this article. Further information on this project – including how people can potentially get involved – will be made available through the Human Enhancement Drug Network (HEDN) once the project commences in September 2016.

Further Reading

Boardley, I. D., & Grix, J. (2014). Doping in Bodybuilders: A Qualitative Investigation of Facilitative Psychosocial Processes. Qualitative Research in Sport, Exercise, & Health, 6, 422–439.

Boardley, I.D., Allen, N., Simmons, A., & Laws, H. (in press). Nutritional, Medicinal and Performance Enhancing Supplementation in Dance. Performance Enhancement & Health.

Boardley, I. D., Grix, J., & Dewar, A. (2014). Moral disengagement and associated processes in performance enhancing drug use: A national qualitative investigation. Journal of Sport Sciences, 32, 836–844.

Boardley, I. D., Grix, J., & Harkin, J. (2015). Doping in Team and Individual Sports: A Qualitative Investigation of Moral Disengagement and Associated Processes. Qualitative Research in Sport, Exercise, & Health, 7, 698–717.

Backhouse, S. H., Whitaker, L., & Petróczi, A. (2013). Gateway to doping? Supplement use in the context of preferred competitive situations, doping attitude, beliefs, and norms. Scandinavian Journal of Medicine and Science in Sports, 23, 244–252.

Hildebrandt, T., Harty, S., & Langenbucher, J. W. (2012). Fitness Supplements as a gateway substance for anabolic androgenic steroid use. Psychology of Additive Behaviors, 26, 955–962.

Ntoumanis, N., Ng, J. Y. Y., Barkoukis, V., & Backhouse, S. (2014). Personal and situational predictors of doping use in physical activity settings: A meta-analysis. Sports Medicine, 44, 1603-1624.

Petróczi, A. (2013). The doping mindset—Part I: Implications of the Functional Use Theory on mental representations of doping. Performance Enhancement & Health, 2(4), 153-163.