Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis

Journal article


Hurst, P., Schiphof-Godart, L., Kavussanu, M, Barkoukis, V., Petróczi, A and Ring, C. 2023. Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis. International Journal of Drug Policy. 117, p. 104077. https://doi.org/10.1016/j.drugpo.2023.104077
AuthorsHurst, P., Schiphof-Godart, L., Kavussanu, M, Barkoukis, V., Petróczi, A and Ring, C.
Abstract

In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users than non-users, and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping and, therefore, anti-doping policy should target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.

KeywordsAthlete health; Clean sport; Gateway hypothesis; Nutritional ergogenic aids; Safe sport; Sports supplements
Year2023
JournalInternational Journal of Drug Policy
Journal citation117, p. 104077
PublisherElsevier
ISSN0955-3959
Digital Object Identifier (DOI)https://doi.org/10.1016/j.drugpo.2023.104077
Official URLhttps://www.sciencedirect.com/science/article/pii/S0955395923001251
Publication dates
Online31 May 2023
Publication process dates
Accepted14 May 2023
Deposited15 May 2023
Accepted author manuscript
License
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Restricted
Publisher's version
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Supplemental file
File Access Level
Restricted
Output statusPublished
References

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Blood pressure and cardiac autonomic adaptations to isometric exercise training: A randomized sham-controlled study
De Caux, A., Edwards, J., Swift, H., Hurst, P., Wiles, J. and O'Driscoll, J. 2022. Blood pressure and cardiac autonomic adaptations to isometric exercise training: A randomized sham-controlled study. Physiological Reports. 10 (2), p. e15112.
Ego orientation is related to doping likelihood via sport supplement use and sport supplement beliefs
Hurst, P., Ring, Christopher and Kavussanu, Maria 2021. Ego orientation is related to doping likelihood via sport supplement use and sport supplement beliefs. European Journal of Sport Science. 22 (11), pp. 1734-1742. https://doi.org/10.1080/17461391.2021.1995509
Targeting personal morality in anti-doping education
Hurst, P. 2021. Targeting personal morality in anti-doping education . HED Matters. 4 (1), pp. 9-12.
A psychological intervention reduces doping likelihood in British and Greek athletes: A cluster randomized controlled trial
Maria Kavussanu, Vassilis Barkoukis, Phil Hurst, Mariya Yukhymenko-Lescroart, Lida Skoufa, Andrea Chirico, Fabio Lucidi and Christopher Ring 2021. A psychological intervention reduces doping likelihood in British and Greek athletes: A cluster randomized controlled trial. Psychology of Sport and Exercise. https://doi.org//10.1016/j.psychsport.2021.102099
Prefrontal cortex oxygenation during endurance performance: A systematic review of functional near-infrared spectroscopy studies.
De Wachter, Jonas, Proost, Matthias, Habay, Jelle, Verstraelen, Matthias, Díaz-García, Jesús, Hurst, Philip, Meeusen, Romain, Van Cutsem, Jeroen and Roelands, B. 2021. Prefrontal cortex oxygenation during endurance performance: A systematic review of functional near-infrared spectroscopy studies. Frontiers in Physiology. 12, p. 761232. https://doi.org/10.3389/fphys.2021.761232
A moral intervention reduces doping likelihood in British and Greek athletes: evidence from a cluster randomized control trial
Kavussanu, M. and Hurst, P. 2020. A moral intervention reduces doping likelihood in British and Greek athletes: evidence from a cluster randomized control trial. Journal of Sport and Exercise Psychology. https://doi.org/10.1123/jsep.2019-0313
Athletes using ergogenic and medical sport supplements report more favourable attitudes to doping than non-users
Hurst, P., Ring, C. and Kavussanu, M. 2020. Athletes using ergogenic and medical sport supplements report more favourable attitudes to doping than non-users. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2020.09.012
The placebo effect in sport: How practitioners can inject words to improve performance
Roelands, B. and Hurst, P. 2020. The placebo effect in sport: How practitioners can inject words to improve performance. International Journal of Sports Physiology and Performance. 15 (6), pp. 765-766. https://doi.org/10.1123/ijspp.2020-0358
Can taste be ergogenic?
Best, R., McDonald, K., Hurst, P. and Pickering, C. 2020. Can taste be ergogenic? European Journal of Nutrition. https://doi.org/10.1007/s00394-020-02274-5
Dual career: balancing success in sport and life
Howland, L., Papadimitriou, A., Minoudis, V. and Hurst, P. 2020. Dual career: balancing success in sport and life. in: Chatziefstathiou, D., Garcia, B. and Seguin, B. (ed.) Routledge Handbook of the Olympic and Paralympic Games Routledge. pp. 1-21
No differences between beetroot juice and placebo on competitive 5-km running performance: A double-blind, placebo-controlled trial
Hurst, P., Saunders, S. and Coleman, D. 2020. No differences between beetroot juice and placebo on competitive 5-km running performance: A double-blind, placebo-controlled trial. International Journal of Sports Nutrition and Exercise Metabolism. 30 (4), pp. 295-300. https://doi.org/10.1123/ijsnem.2020-0034
Who responds to a placebo? Factors associated with response to placebo during a double-blind randomised controlled trial
Hurst, P., Saunders, S. and Coleman, D. 2020. Who responds to a placebo? Factors associated with response to placebo during a double-blind randomised controlled trial. European Journal of Sport Science.
Emailed - Are Nike's Vaporfly trainers the emperor's new shoes?
Hurst, P. 2020. Emailed - Are Nike's Vaporfly trainers the emperor's new shoes? CCCU Expert Comment.
An evaluation of UK Athletics’ Clean Sport Programme in preventing doping in junior elite athletes
Hurst, P., Ring, C and Kavussanu, M. 2020. An evaluation of UK Athletics’ Clean Sport Programme in preventing doping in junior elite athletes. Performance Enhancement & Health. https://doi.org/10.1016/j.peh.2019.100155
An educational placebo effect intervention reduces the likelihood of athletes using performance enhancing drugs
Hurst, P., Foad, A., Coleman, D. and Beedie, C. 2018. An educational placebo effect intervention reduces the likelihood of athletes using performance enhancing drugs.
Psychological mechanisms underlying morality in sport
Hurst, P. 2019. Psychological mechanisms underlying morality in sport.
Fear of failure predicts doping likelihood in competitive athletes
Hurst, P. 2018. Fear of failure predicts doping likelihood in competitive athletes.
Sport supplement use predicts doping attitudes and likelihood via sport supplement beliefs
Hurst, P., Kavussanu, M., Boardley, I. and Ring, C. 2019. Sport supplement use predicts doping attitudes and likelihood via sport supplement beliefs. Journal of Sports Sciences. https://doi.org/10.1080/02640414.2019.1589920
Improved 1000-m running performance and pacing strategy with caffeine and placebo effect: a balanced placebo design study
Hurst, P., Schiphof-Godart, l., Hettinga, F., Roelands, B. and Beedie, C. 2019. Improved 1000-m running performance and pacing strategy with caffeine and placebo effect: a balanced placebo design study. International Journal of Sports Physiology and Performance. 15 (4), pp. 483-488. https://doi.org/10.1123/ijspp.2019-0230
The placebo and nocebo effect on sports performance: a systematic review
Hurst, P., Schiphof-Godart, l., Szabo, A., Raglin, J., Hettinga, F., Roelands, B., Lane, A., Foad, A., Coleman, D. and Beedie, C. 2019. The placebo and nocebo effect on sports performance: a systematic review. European Journal of Sport Science. https://doi.org/10.1080/17461391.2019.1655098
Notes and tips on surveys
Hurst, P. and Bird, S. 2019. Notes and tips on surveys. in: Bird, S. (ed.) Research Methods in Physical Activity and Health London and New York Routledge. pp. 102-108
Questionnaires
Hurst, P. and Bird, S. 2019. Questionnaires. in: Bird, S. (ed.) Research Methods in Physical Activity and Health London and New York Routledge. pp. 93-101
Evaluating the effectiveness of the VIRTUES and HEROES projects: qualitative evidence
Kavussanu, M., King, A., Hurst, P., Skloufa, L. and Barkoukis, V. 2018. Evaluating the effectiveness of the VIRTUES and HEROES projects: qualitative evidence.
Preventing doping in sport: the HEROES project
Kavussanu, M., Hurst, P., Hatzigeorgiadis, A., Elbe, A. and Ring, C. 2018. Preventing doping in sport: the HEROES project.
Preventing doping in sport: the VIRTUES project
Kavussanu, M., Hurst, P., Barkoukis, V., Skoufa, L., King, A. and Ring, C. 2018. Preventing doping in sport: the VIRTUES project.
The effects of moral disengagement on doping likelihood and guilt
Kavussanu, M., Ring, C. and Hurst, P. 2018. The effects of moral disengagement on doping likelihood and guilt.
Social cognitive predictors of doping intentions: a multi-national study
Kavussanu, M., Skoufa, L., Barkoukis, V., Hurst, P., Chirico, A., Lucidi, F. and Ring, C. 2018. Social cognitive predictors of doping intentions: a multi-national study.
Effects of personal and situational factors on self-referenced doping likelihood
Ring, C., Kavussanu, M., Lucidi, S. and Hurst, P. 2018. Effects of personal and situational factors on self-referenced doping likelihood. Psychology of Sport and Exercise. https://doi.org/10.1016/j.psychsport.2018.11.003
The effects of moral disengagement mechanisms on doping likelihood are mediated by guilt and moderated by moral traits
Ring, C. and Hurst, P. 2018. The effects of moral disengagement mechanisms on doping likelihood are mediated by guilt and moderated by moral traits. Psychology of Sport and Exercise. 40, pp. 33-41. https://doi.org/10.1016/j.psychsport.2018.09.001
The placebo and nocebo effect in sport: intentions, attitudes and beliefs towards sport supplements and banned performance enhancing substances
Hurst, P. 2018. The placebo and nocebo effect in sport: intentions, attitudes and beliefs towards sport supplements and banned performance enhancing substances. PhD Thesis Canterbury Christ Church University Faculty of Social and Applied Sciences
Consensus statement on placebo effects in sports and exercise: the need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms.
Beedie, C., Hurst, P., Coleman, D., Foad, A., Benedetti, F., Cohen, E., Davis, A., Elseworth-Edelsten, C., Flowers, E., Roelands, B., Hettinga, F., Raglin, J., Szabo, A., Camerone, E., Barbiani, D., Lane, A., Lindheimer, J., Schiphof-Godart, l. and Harvey, S. 2018. Consensus statement on placebo effects in sports and exercise: the need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms. European Journal of Sport Science. https://doi.org/10.1080/17461391.2018.1496144
Could placebos be putting lives at risk?
Hurst, P. and Beedie, C. 2018. Could placebos be putting lives at risk?
Caution, this treatment is a placebo. It might work, but it might not”: why emerging mechanistic evidence for placebo effects does not legitimise complementary and alternative medicines in sport
Beedie, C., Whyte, G., Coleman, D., Hurst, P., Cohen, E., Lane, A., Raglin, J. and Foad, A. 2017. Caution, this treatment is a placebo. It might work, but it might not”: why emerging mechanistic evidence for placebo effects does not legitimise complementary and alternative medicines in sport. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2017-097747
Is there a role for implicit and explicit information about placebo and nocebo effects in reducing the use of drugs in sport?
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2017. Is there a role for implicit and explicit information about placebo and nocebo effects in reducing the use of drugs in sport?
Is the intention to use sport supplements a predictor of placebo and nocebo responding among athletes?
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2017. Is the intention to use sport supplements a predictor of placebo and nocebo responding among athletes?
Athletes intending to use sports supplements are more likely to respond to a placebo
Hurst, P., Foad, A., Coleman, D. and Beedie, C. 2017. Athletes intending to use sports supplements are more likely to respond to a placebo. Medicine & Science in Sports & Exercise (MSSE). https://doi.org/10.1249/MSS.0000000000001297
Development and validation of the sports supplements beliefs scale [Conference paper abstract]
Hurst, P., Foad, A. and Coleman, D. 2015. Development and validation of the sports supplements beliefs scale [Conference paper abstract]. Journal of Sports Sciences. 33 (Sup1), pp. s72-s74. https://doi.org/10.1080/02640414.2015.1110330
Expectations, caffeine and pacing strategy: how positive and negative expectations can influence running performance
Hurst, P. 2014. Expectations, caffeine and pacing strategy: how positive and negative expectations can influence running performance. British Journal of Sports Medicine. 48 (A3). https://doi.org/10.1136/bjsports-2014-094245.8
Expectancy effects on competitive 5 km time-trial performance
Hurst, P. 2013. Expectancy effects on competitive 5 km time-trial performance. British Journal of Sports Medicine. 47 (17). https://doi.org/10.1136/bjsports-2013-093073.15
Reproducibility of outdoor 5 km running time-trial in a competitive environment
Hurst, P. 2013. Reproducibility of outdoor 5 km running time-trial in a competitive environment. British Journal of Sports Medicine. 47 (e4). https://doi.org/10.1136/bjsports-2013-093073.14
Development and validation of the Sports Supplements Beliefs Scale
Hurst, P., Foad, A., Coleman, D. and Beedie, C. 2016. Development and validation of the Sports Supplements Beliefs Scale. Performance Enhancement & Health. https://doi.org/10.1016/j.peh.2016.10.001
Reliability of 5-km running performance in a competitive environment
Hurst, P. and Board, L. 2016. Reliability of 5-km running performance in a competitive environment. Measurement in Physical Education and Exercise Science. https://doi.org/10.1080/1091367X.2016.1233421
Beliefs versus reality, or beliefs as reality? The placebo effect in sport and exercise
Hurst, P., Foad, A. and Beedie, C. 2016. Beliefs versus reality, or beliefs as reality? The placebo effect in sport and exercise. in: Lane, A. (ed.) Sport and Exercise Psychology London Routledge. pp. 325-344
Capitalizing on the placebo component of treatments
Beedie, C., Foad, A. and Hurst, P. 2015. Capitalizing on the placebo component of treatments. Current Sports Medicine Reports (CSMR). 14 (4), pp. 284-287. https://doi.org/10.1249/JSR.0000000000000172
Influence of acute dietary nitrate supplementation over 5 km
Hurst, P., Coleman, D. and Saunders, S. 2015. Influence of acute dietary nitrate supplementation over 5 km. British Journal of Sports Medicine: International Sports Science + Sports Medicine Conference 2015 Abstracts Newcastle Upon Tyne 8–10th September 2015. 49 (Sup. 2), pp. A6-A6. https://doi.org/10.1136/bjsports-2015-095576.17
Placebo and nocebo effects during repeat sprint performance
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2016. Placebo and nocebo effects during repeat sprint performance.
Knowledge and experience of placebo effects modifies athletes’ intentions to use sport supplements
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2016. Knowledge and experience of placebo effects modifies athletes’ intentions to use sport supplements.