The drive to succeed, to perform at the highest attainable level, is a natural component of competitive athletics. Among certain athletes, this drive may culminate in the use of performance enhancing substances or devices (Catlin et al., 2008; Lippi et al., 2008a). Sports governing bodies, such as the World Anti-Doping Agency (WADA), are primarily concerned with athletic performances achieved with unfair of dangerous means--whether these be specific techniques, equipment, substances, or medications. Drug 'doping,' the chemical alteration of athletic performances by a substance or procedure, can be associated with deleterious effects on health (Davis and Summers, 2008; Dodge and Jaccard, 2008; Lage et al., 2002, Spedding and Spedding, 2008). The WADA characterizes a drug as "illegal" in competition if it satisfies two of the following three criteria: 1) enhances performance, 2) represents a risk to health, and 3) violates the "Spirit of the Sport" (Savulescu et al., 2004). Non pharmacological means of gaining unfair advantage, such as unsanctioned equipment modifications, typically fall under the jurisdiction of sports' individual governing bodies.
Despite potential health risks and penal repercussions (e.g., forfeiture of winnings, sport banishment) associated with doping and the use of other unsanctioned products/equipment, the use of banned performance enhancing products (PEPs) remains an issue in virtually all adult competitive sports (Lippi et al., 2008b; Noakes, 2004). In the empirical literature, the use of any substance (sanctioned or unsanctioned) to enhance performance in the face of perceived obstacles is generally defined as "doping behavior" (Johnson, 2000; Laure, 2000). Although ample evidence illustrates the dangers of doping and prevalence rates among athletes in different sports (Alaranta et al., 2006), research exploring the attitudes and beliefs that may contribute to use of unsanctioned substances/products are inconsistent. While some findings suggests that doping users and non-users may perceive health risks differently, the contributions of proposed demographic and psychological variables (e.g., self esteem, anxiety) are equivocal (Kirby et al., 2011; Laure and Binsinger, 2007; Laure et al., 2004; Mazanov et al., 2008). Despite uncertainty in the literature, it is generally understood that athletes' rationales for using PEPs likely include a desire to maximize performance/succeed (Anshel, 1991; Laure and Binsinger, 2005) and perceptions of risks to health (Lentillon-Kaestner et al., 2012).
A challenge in developing theoretically sound and applicable PEP use models is the complexity and heterogeneity in which these behaviors occur. It is well known in the social sciences literature that beliefs, motivations, attitudes and environmental factors play an important role in understanding and predicting behavior (Ajzen, 2001). Within the context of doping behaviors, this is perhaps best summarized in Backhouse's WADA manuscript on drug use attitudes and behaviors in sports (Backhouse et al., 2011). In this comprehensive literature review, the authors systematically highlight how doping appraisals and actions are largely dependent on contextual factors, including the type of sport (e.g., body building vs. cycling), level of competition (e.g., high school, college, professional competition), and the characteristics of the individual (e.g., athlete, coach, general population).
Existing models of doping behaviors attempt to account for the complexity of this phenomenon, and often incorporate key psychological and societal/environmental factors. For example, the Drugs in Sports Deterrence model (DSDM) highlights the role of decisional processes involved in performance enhancer use, as well as the contributions of other factors (e.g. affect, cognition) that may influence this cost-benefit analysis (Strelan and Boeckmann, 2003). Another conceptual framework, the Drug Compliance in Sports Model, presents eight factors believed to influence intentions towards drug use: threat appraisal; benefit appraisal; personal morality; legitimacy; personal self-esteem; reference group opinion; drug affordability; and drug availability (Donovan et al., 2002). While these and other promising theories exist (Petroczi and Aidman, 2008; Strelan and Boeckmann, 2003), further empirical derived models are need, as existing perspectives often fail to account for considerable amounts of variance in predicting doping behaviors and attitudes (Petroczi, 2007).
A challenge encountered by sports governing bodies is the reality that it is virtually impossible for laws/regulations/rules to keep up with the technological advances of doping, particularly as newer drugs mimic natural human processes (Savulescu et al., 2004). This challenge also falls on athletes; in pursuit of an advantage, a competitor may find a category of PEPs that is not explicitly listed as banned or non-banned. Legal/non-banned PEPs is a broad and subjective category, as an athlete may (correctly or incorrectly) perceive virtually anything as contributing to improved performance (e.g., equipment, dietary modifications, clothing, etc). Even among established guidelines, the ethics of PEPs use can be unclear, confusing, and contradictory. For example, while the use of technologically-constructed hypoxic environments are approved by many sports governing bodies, the mechanisms underlying their efficacy are similar to those of erythropoietin (EPO), a banned substance (Loland and Caplan, 2008). Another example is the well-publicized use of AOD-9604, an analogue of growth hormone releasing factor, by the Australian Essendon Football Club in 2012. This relatively new compound fell under the WADA's "S.O." category, and thus, should have been prohibited (Paton, 2013). Predictably, the ethics of "legal" and "illegal" performance enhancement have become increasingly blurred as recent studies illustrate that society has become more tolerant of doping over time (Vangrunderbeek and Tolleneer, 2011). Another potential concern lies in dietary supplements--frequently used by athletes as non-banned PEPs--which are not required to undergo testing to confirm efficacy or safety (Dodge and Jaccard, 2007). Unfortunately, our knowledge of effective anti-doping programs is still in its infancy; this outcome literature is narrowly focused in the realm of anabolic steroid use (Sjoqvist et al., 2008), and results suggest that education alone is likely insufficient to change behaviors (Backhouse et al., 2011).
To fully understand the complexity of doping/cheating drives among athletes, it is important to also understand the motivations and attitudes driving legal/non-banned PEP use. As most efforts to eradicate doping/cheating among elite cyclists have been ineffective (Lippi et al., 2008b), a greater understanding of the interplay between athletes attitudes and beliefs about PEPs and doping behaviors is essential. Thus, the aim of the present pilot study is to examine legal, ethical, and practical considerations in choosing to use legal/non-banned PEPs among a sample of competitive cyclists, and how these attitudes may influence sanctioned/banned PEP use behaviors. Additionally, we sought to examine the differential importance of World Anti-Doping Agency (WADA) and...