Doping as addiction: disorder and moral responsibility

Abstract

D’Angelo and Tamburrini invited readers to consider doping in sport as a health issue and dopers as potential addicts who need therapy rather than offenders who need punishing. The issue of addiction in sport is important and very much under researched. In this essay I explore the extent to which addiction can be justifiably used as an excuse for offending behaviour. The favoured argument is that addicts experience a craving or compulsion to use over which they have no control. I argue that there is insufficient evidence that addicts experience such compulsion. Although it seems science is unravelling some of the mysteries of addiction, it has not provided sufficient evidence that addictive consumption amounts to compulsive use. Nevertheless, it is clear that addicts do have difficulty with controlling their use and such difficulties ought to be considered in any judgements about moral responsibility. This does not mean that rules or laws including anti-doping legislation should be altered because not all those who fall foul are addicted. Moreover, accepting responsibility and punishment for the consequences of their actions (including anti-doping rules) is an important part of therapy for addicts.

Keywords:

• addiction
• moral responsibility
• compulsion
• doping

Acknowledgements

My thanks to John Russell and two anonymous reviewers for their comments and recommendations and to Nicholas Dixon and others at the IAPS 2013 conference for their valuable suggestions.

Notes

1. The DSM does not use the term addiction, but rather refers to Substance-related and addictive disorders. I will continue to use the term addiction in the paper.

2. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is largely responsible for defining or creating specific disorders. It has important cultural, medical and legal impact ‘…in shaping attitudes, standardising reimbursement for services by psychotherapists, and guiding the funding of research’ (Martin 2006, 8). Despite, or perhaps because of its powerful influence, the DSM can be problematic. Prior to 1973, homosexuality was included in the DSM and the way the DSM defines disorders makes expansion easy. Martin (2006, 23) argues that ‘At least in some instances, psychiatrists create, via their authoritative definitions, the illness they then cure’. Later in the paper, the status of ‘process addictions’ on the DSM is discussed.

3. Martin (2006, chapter 11) examines the arguments for whether ‘bigots are sick?’

4. The disease conception, as mentioned is not new. AA referred Alcoholism as a disease in 1939 and it appeared in the DSM in 1968.

5. The claims made by Heyman (2013) that most addicts quit by themselves are controversial to say the least. Dawson et al. (2006) found that for many alcoholics formal treatment and 12 step recovery programmes were necessary for recovery. A recent report by White (2012) which reviewed 415 scientific studies of recovery outcomes (in different populations and in different countries) found that around 50% of people who once met the criteria for substance misuse disorders no longer did so. The report paints a far more complex picture of addiction and recovery than the one offered here.

6. I recognise that there is a long list of PEDs which are banned by WADA – some may have psychoactive properties and users may become addicted to these directly just as with cocaine or heroin.

7. Recent figures in the UK show that there has been a dramatic rise in steroid users visiting needle exchanges which suggests the problem of steroid abuse is on the increase (at least in the UK) http://www.independent.co.uk/life-style/health-and-families/health-news/nice-needle-exchanges-should-supply-safe-equipment-to-under18-steroid-users-9247087.html accesses 9th of April 2014. van Amsterdam, Opperhuizen, and Hartgens (2010) argue that the dependence liability of anabolic steroids are very low.

8. –See Grant et al. (2010) for an extended discussion about how ‘obsessive disorders’ are distinguished from ‘impulsive control disorders’ and whether certain behavioural ‘addictions’ meet the DSM criteria for either/or both and/or whether they meet the criteria for substance.

9. This is too simplistic, but for an extended discussion of the comparison between addiction to psychoactive substances and addiction to behaviour see Smith (2012).

10. There are lots of other PEDs on WADA’s banned list. Whether the claim is equally plausible in each case is beyond the scope of this paper and doesn’t affect my overall argument.

11. In some cases there is co-morbidity with other issues such as low self-confidence, abuse, childhood disorder commonly associated with addiction (Pickard 2011a; van Amsterdam, Opperhuizen, and Hartgens 2010).

12. Tyson (2013) describes how he had a false penis made in order to circumvent doping control because he was a routine user of cocaine and marijuana before fights. According to a biography by Rendell (2006) the cyclist Marco Pantani was a regular user of performance enhancing substances like EPO and of cocaine.

13. Currently in the UK there is a preponderance of ‘legal highs’. They are substances which have similar psychoactive effects as illegal drugs. An individual who knowingly took a legal high might be judged differently to one who knowingly took heroin – the latter is likely to be acting in spite of well-known facts about heroin and its taboo status in our culture. The former might be excused for thinking that the legal high was not dangerous (acting in [reasonable] ignorance).

14. This seems to be a view espoused by Peter Hitchin in a recent British television debate with the American actor Matthew Perry. Hitchin intimated that addiction is a myth and addicts are in a grip of a deception not in the grip of a disease http://www.huffingtonpost.co.uk/2013/12/17/newsnight-matthew-perry_n_4457258.html accessed 28/03/2014.

15. In the UK, the National Institute for Health and Care Excellence (Nice) advised doctors not to blame obese patients http://www.telegraph.co.uk/health/healthnews/10382775/Dont-blame-obese-patients-for-being-fat-doctors-told.html accessed 28/06/2014 and there has been controversy about the possibility that the European Union may define obesity as a disability http://www.bbc.co.uk/news/world-europe-27809242 accessed 28/06/2014. The debate is characterised by what Martin (2006, 6) calls the problematic morality-therapy dichotomy. One is either sick (suffering from an illness) or bad (exhibiting a range of vices like sloth and gluttony.

Additional information

Notes on contributors

Carwyn Jones

Cardiff Metropolitan University, School of Sport, Cyncoed Rd, Cardiff, Cardiff, CF24 6XD United Kingdom. E-mail: [email protected].