Comment on “Recreational Athletes’ Use of Performance‑Enhancing Substances: Results from the First European Randomized Response Technique Survey”
Sports Medicine - Open volume 9, Article number: 36 (2023)
We read with interest the manuscript “Recreational Athletes’ Use of Performance‑Enhancing Substances: Results from the First European Randomized Response Technique Survey” by Christiansen et al. . We commend the authors’ effort to estimate the prevalence of doping use in recreational sport in Europe, but also observe important limitations, as follows.
Methodological Limitations in the Assessment of Doping Prevalence
The term “doping” is clearly defined by the World Anti-Doping Code (the ‘Code’)  and international conventions [3, 4]. Likewise, the Prohibited List  published by the World Anti-Doping Agency specifies the substances and methods that are prohibited to use by athletes that fall under the scope of the Code and relevant anti-doping rules. Christiansen et al.  rightly acknowledged that their survey methods and results reflected recreational athletes “own understanding of doping”, and the relevant RRT question left the term “prohibited” open to subjective interpretation. This presents the following methodological limitations:
Recreational athletes do not necessarily fall under the scope of the Code and related anti-doping rules; thus, the term “prohibited” becomes elusive.
Certain prohibited substances (e.g., Ostarine) can be purchased as nutritional supplements in some countries. Without a clear definition of “prohibited” it remains unclear what the reported prevalence estimates reflect.
Recreational athletes may underreport doping use for motivational reasons, such as self-deceptive denial, as documented in previous substance use research [6, 7]. Participants may unintentionally engage in self-deception to preserve their sense of self-integrity . John et al.  documented how these psychological processes lead to underreporting in RRT studies, and questioned the validity of resulting prevalence estimates.
Christiansen et al.  reported “extraordinarily high” (47%) instructional non-compliance – if almost half of the sample possibly did not understand the question, then the validity of the findings is seriously questioned.
Although a co-author of the Christiansen et al. duly acknowledged some of the abovementioned limitations in another publication using the same data , this was not the case in the said manuscript.
Misguided Implications for Anti-Doping Policy
Based on their findings, Christiansen et al.  argued that doping in recreational sport is a “myth” and national anti-doping organisations (NADOs) should “leave recreational athletes to themselves”. Given the aforementioned limitations and associated validity concerns, these statements do not proportionally reflect the insights of the study and are misleading. They also neglect the findings of large international studies (e.g., Sagoe et al., meta-analysis of 187 studies)  that assessed the use of (unequivocally defined) prohibited substances, such as androgenic anabolic steroids and growth hormone, which are the most commonly used doping substances in recreational sport settings [12, 13]. Additionally, Christiansen et al.  explicitly advised NADOs to disregard doping in recreational sport. The correspondence between this argument and the reported findings is, at best, tenuous for all the reasons discussed above. Most importantly, this argument fundamentally contradicts calls by the international scientific community (e.g., Kanayama et al., ; McVeigh & Begley, ) and policy organisations, like the Council of Europe (European Sports Charter; and the Resolution adopted at the 2022 Conference of Ministers responsible for Sport) [15, 16] to address doping in recreational sport as a public health issue.
Overall, we are concerned that, unless the methodological limitations and tenuous inferences about anti-doping policy that are made by Christiansen et al.  are contextualised and re-evaluated, they can mislead NADOs and other relevant stakeholders, and potentially undermine the health of recreational athletes.
Availability of Data and Material
National anti-doping organisation
Randomized response technique
Christiansen AV, Frenger M, Chirico A, Pitsch W. Recreational athletes’ use of performance-enhancing substances: results from the first European Randomized response technique survey. Sports Med Open. 2023;9(1):1–7.
World anti-doping agency. The world anti-doping code 2021. Montreal: world anti-doping agency; 2021.
Council of Europe. anti-doping convention. https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=135.
UNESCO. International convention against doping in sport. https://en.unesco.org/themes/sport-and-anti-doping/convention.
World anti-doping agency. The prohibited list 2023 international standard. montreal: world anti-doping agency; 2022.
Gopang M, Siyal AW, Umrani S. Seeing through rose-tinted glass: exploring forms of self-deception through students’ substance usage beliefs. J Human Values. 2022;28(3):247–58.
Martínez-González JM, López RV, Iglesias EB, Verdejo-García A. Self-deception as a mechanism for the maintenance of drug addiction. Psicothema. 2016;28(1):13–9.
Paulhus DL. Socially desirable responding: The evolution of a construct. In: Braun HI, Jackson DN, Wiley DE, editors. The role of constructs in psychological and educational measurement. Mahwah: NJ; Lawrence Erlbaum Associates; 2002. p. 49–69.
John KL, Loewestein G, Acquisti A, Vosgerau J. When and why randomized techniques (fail to) elicit the truth. Oganisational Behav Human Decis Process. 2018;148:101–23.
Werner P. Doping in recreational sport as a risk management strategy. J Risk Financ Manage. 2022;15:574.
Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol. 2014;24(5):383–98.
Kanayama G, Hudson JI, Pope HG Jr. Long-term psychiatric and medical consequences of anabolic–androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend. 2018;98(1–2):1–12.
Kanayama G, Pope HG Jr. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol. 2018;464:4–13.
McVeigh J, Begley E. Anabolic steroids in the UK: an increasing issue for public health. Drugs: Edu Prevent Policy 2017; 24(3):278–285.
Council of Europe. Revised European sport charter. 2021. https://rm.coe.int/recommendation-cm-rec-2021-5-on-the-revision-of-the-european-sport-cha/1680a43914. Accessed 20 Feb 2023.
Council of Europe. 17th council of Europe conference of ministers responsible for sport resolutions. 2022. https://rm.coe.int/recommendation-cm-rec-2021-5-on-the-revision-of-the-european-sport-cha/1680a43914. Accessed 20 Feb 2023.
No funding was received for the preparation or publication of this letter.
Ethics Approval and Consent to Participate
Consent for Publication
The authors declare they have no conflicts of interest relevant to the content of this letter.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Petrou, M., Lazuras, L. Comment on “Recreational Athletes’ Use of Performance‑Enhancing Substances: Results from the First European Randomized Response Technique Survey”. Sports Med - Open 9, 36 (2023). https://doi.org/10.1186/s40798-023-00581-9