SUMMARY
Over the past 30 years, we have been involved in the establishment of a number of national and international sports drug testing programs, the review of positive tests, and the medical treatment of substance-abusing athletes. It was expected that with educational programs, testing, and supportive medical treatment this substance-abusing behavior that could lead to deadly addictive disorders would decrease. Unfortunately, this has not been the case. In fact, new, more powerful, and undetectable performance-enhancing drugs are now abused by professional athletes, and sophisticated networks of distribution have developed. Professional athletes are often the role models of adolescent and young adult populations who at times mimic their behaviors, even the abuse of drugs. This review of performance enhancement in sports is to inform addiction treatment professionals of the historical basis of performance-enhancing drugs, its institutional nature, and its spread to vulnerable athletic and non-athletic populations.