Yulia Efimova had just won a silver medal at the Rio Olympics. This should have been one of the happiest moments of the 24-year-old swimmer’s life. Yet here she was sobbing into the arms of her coach, visibly upset by what was going on around her. Far from celebrating her achievements, the crowd had booed loudly every time she entered the aquatics arena.
In March, Efimova had tested positive for the banned substance meldonium - the same drug tennis star Maria Sharapova was caught using earlier this year. Her main rival, the American Lilly King (who won the gold) was incensed that she’d been allowed to swim at all. She had gone out of her way to publicly condemn the Russian swimmer at every stage of the competition. In their post-race press conference, as Efimova struggled to hold back her tears, King hammered home the point again: “I’m just happy [...] to know I am competing clean and doing what is right."
In actual fact Efimova’s case was slightly more complicated than either King or the booing crowds gave her credit for. The swimmer, who lives in the US, wasn’t a part of the state-sponsored doping program which led to over a hundred of her compatriots (including all bar one of the Russian track & field team) being banned from the Olympics. The meldonium she’d tested positive for, it was reckoned, might have been taken perfectly legally. The substance was only banned in January and the traces they found in March may have predated the ban.
“If it’s not fame or fortune that amateur dopers are seeking, then what is it?"
But even if Efimova was innocent, her harsh treatment is understandable. Her story fitted neatly into the narrative of “the cheating Russians," and for someone with a dodgy past when it came to performance enhancers (she’d served a previous drug-related ban) she was on shaky ground even before the positive meldonium test. At best, she’d been very careless but many people refused to give her the benefit of the doubt. They assumed that she was just the latest in a long line of elite sportspeople to be tempted by an easy route to riches.
The appeal of performance enhancing substances to professional athletes like Efimova certainly seems obvious: Money, medals and the trappings of success are all strong motivating factors. Increasingly however, it’s not just the pros who are using performance enhancers, but amateurs too. People who stand to gain nothing either financially or in career terms.
UK Anti-Doping (UKAD), the body which polices sport in this country, has noticed an “increase in the number cases relating to amateurs using performance enhancing substances" recently according to Sophie Ashcroft, a spokesperson. In July this year, the same month that the official report into Russian doping was published, UKAD announced a three-year ban for a young amateur cyclist named Gabriel Evans for taking the hormone EPO. A few days later, they sanctioned Luke Graham, a 28-year-old amateur boxer. Andrew Hastings, another amateur cyclist, was found guilty of using steroids last December.
None of these three stood to gain financially from doping. Hastings competed at national level, but in the masters category (for 35 to 39-year-olds) so it wasn’t as if he had his eye on a future professional career. All obviously took their hobbies seriously (apparently too seriously) but they were competing in races and bouts that only their families and fellow enthusiasts would be watching. So why do it? If it’s not fame or fortune that dopers like this are seeking, then what is it?
“I think quite often with amateur athletes, self-esteem can become entwined with their performance within their sport," says Dr Ian Boardley a sports psychologist from the University of Birmingham, who studies the mental processes which lead to doping. His interviews with drug takers have revealed interesting similarities between professionals and amateurs across a range of different sports.
“A bodybuilder's self esteem might be strongly linked to their appearance and how they think people view them, [and] it's the same with endurance athletes. They think that people are judging them based on their performance in their sport, and that their self-esteem is very strongly influenced by their performance in their sport. Therefore they will consider any means to perform well." Dr Boardley believes this need to be perceived as successful can be an important motivator whatever level you’re competing at - something that’s borne out by anecdotal evidence.
“I think that it's an accepted fact that at the ‘elite’ amateur level (people that are competing for state championships and masters) that a significant percentage of the top athletes are experimenting or doping," says Peter Flax, a journalist who has investigated several cases of amateur doping among cyclists in California. “You go to these masters races and people have tens of thousands of dollars of equipment, and they have soigneurs and massage therapists and vans. The whole thing is people throwing an unreasonable amount of resource at this hobby."
Stereotypically, he says “these are guys who wear suits Monday through Friday, drive nice cars and sort of have an identity of succeeding in life. A lot of them really love cycling and train really hard but also some of them at the end of the day want to have something to show for all they've put into the sport. I think it's pretty easy for them to get blinded by the possibility of succeeding at a higher level."
“You go to these races and people have tens of thousands of dollars of equipment. They want something to show for it and they get blinded."
It’s a characterisation Dr Boardley recognises. Although his research hasn't looked into it specifically, he says "there are a number of plausible personality characteristics and certainly a competitive trait would be one of them."
What’s interesting about the amateurs - and indeed the professionals - that Boardley has interviewed however, is that: “Their self-esteem is more influenced by how others view them than how they view themselves." Even though they know their results are artificially improved, “what is more important to them than the means by which they're achieving their performances is how other people are viewing them".
This tendency certainly helps explain one of the most interesting cases of amateur doping exposed in recent years - that of Nicholas Brandt-Sorenson. Having been busted and banned from competitive cycling, Brandt-Sorenson took to Strava using the pseudonym Thorfinn-Sassquatch and proceeded to post seemingly impossible times up many of the famous climbs around his Los Angeles home. Peter Flax pieced together his identity partly through his boastful posts on Instagram. The story sent shockwaves through the California cycling scene before being picked up by the LA Times and other mainstream outlets.
“The idea that this guy was cheating at Strava really inflamed a lot of people," Flax says, when I ask why the story resonated. “It just felt like a line had been moved. It was like: ‘Alright, we're used to people cheating at actual elite sports but now someone's cheating at this virtual, video game version of cycling’. It just felt like an even more inconsequential thing to cheat at, which disturbed a lot of people."
But perhaps cheating on social media, an environment where other people’s perceptions are everything, is merely the ultimate expression of the phenomenon Dr Boardley identified? As Flax investigated, the picture of Brandt-Sorenson which emerged was of a man whose whole identity was tied up with bike racing. Having been banned from competing in real life he was getting his validation from the virtual world - with every new KOM, Strava follower, or Instagram ‘like’ a boost to his self-esteem.
Could the rise of apps like Strava help explain the rise in amateur doping? “I can certainly see strong potential for that," says Dr Boardley. “Certainly the upsurge in social media has made people competitive in every situation. And there's a lot of research in sports psychology that links judging your competence relative to other people - rather than to yourself - with lower levels of morality and a greater likelihood of cheating."
Of course, as Flax points out, you can’t blame the apps themselves for people’s stupid behaviour. But “it does create this whole new world where people can express how they think they're great, and cheat. The technology gives them a platform".
Technology has contributed to the rise of performance enhancing drug use in amateur sport in other ways too. “[We’ve] seen an increase in these substances becoming freely available over the internet," says Sophie Ashcroft of UKAD. “Athletes and members of the public may purchase these products on the internet with no idea or understanding of what’s in the product, what the side effects are, or where it’s come from."
“The idea that the guy was cheating at Strava - this virtual, video game version of cycling - really disturbed people."
This is a problem that Dr Natalya Kennedy knows all too well. A keen amateur sportswoman herself, she works in acute medicine and A&E in a hospital in the East Midlands*, where she’s treated multiple patients who’ve taken performance-enhancing substances. “The people I've come across tend to be young men who've been admitted with pancreatitis, which is a horrible, horrible condition which can happen as a result of steroid use," she says. Pancreatitis can lead to organ failure and is potentially fatal. Even those who survive it can end up diabetic and it “can have all sorts of implications for your quality of life afterwards".
Yet most of the patients Dr Kennedy has treated profess to be surprised that their steroid use is to blame. “I think in terms of recreational athletes people take an awful lot on word of mouth and on the culture of the club that they train in. They don't necessarily fully look into the potential side effects." Often, she says, they don’t even know exactly what it is they’re taking.
They are “young men who go to a gym, who enjoy working out, feeling good, building muscle. [They] went down the protein shakes route, saw good improvement and then someone at the gym would say: 'Have you considered this? It would improve your performance, it would improve your muscle bulk.' And they might not necessarily look too hard [at the label]."
This route into taking banned substances - stepping up from legal supplements to illegal drugs - is one that Dr Boardley has come across before. In fact, he tells me, he’s just won a grant from the World Anti-Doping Agency (WADA) to research it further. “We've got a project starting in the next couple of months looking at the effects of supplement use - nutritional supplements and medications - and whether they can lead to the use of performance enhancing drugs. It's referred to as the gateway hypothesis."
He explains that the pathway people take into using banned substances affects not only the kinds of drugs they use, but also, crucially how they justify the use to themselves. “The endurance athletes that we interviewed initially took performance enhancers to come back from injury, but then once they experienced the performance enhancing benefits, they then found other ways of justifying and rationalising their continued use after the injury recovery period."
Others who were introduced to steroids through their gym “found needles in the locker room. Then that allowed them to believe that more athletes were using performance enhancing drugs. Once they'd started using them they convinced themselves that this was something that was more pervasive in their sport and they could justify using performance enhancers."
Because here’s the crucial thing about the people who use performance enhancing drugs, whether they’re pros or amateurs: They don’t believe they are cheating. Or rather, they find ways to convince themselves that they are not - to “justify and rationalise the behaviour", as Dr Boardley puts it. It’s the exploration of the psychological processes that make this justification possible which lies at the heart of his research.
“The theory that I work with suggests that we're all influenced by personal and social influences," he says. When you have a situation where the personal influences are stronger than the social ones then a psychological process known as “moral disengagement" can come into play. “Moral disengagement [allows] people to justify and rationalise things that they shouldn't."
“If you cheat by hitting another player or you dive to try and fool the referee then that's something that it's quite easy to observe." You have to be able to justify your actions to your peers, which especially in amateur competition, can be a strong disincentive - no-one wants to be known as a cheat. Drug-taking however, can be kept private. “You have to justify and rationalise it to yourself, but you don't necessarily have to rationalise it to others," says Dr Boardley. “So moral disengagement is probably most influential with performance enhancing drug use, because we don't need to justify our behaviours socially. It's only personal influences that would justify it."
This means athletes may find it far easier to cheat by taking drugs than they would by blatant cheating on the field of play. “They’d [tell themselves] that it was just allowing them to come back from injury," says Dr Boardley, “[Or they] would argue: 'Well, lots of others are doing it'. Their arguments can be quite contradictory and often they are arguments that you could challenge quite easily. But because they're not making these arguments in a social context, they're not open to that challenge. They're just convincing themselves."
“Someone at the gym would say: 'Have you considered this? It would improve your performance, it would improve your muscle bulk.'"
If moral disengagement is a mechanism for convincing yourself that you’re in the right, it’s a pernicious one. When you’re able to persuade yourself that you’ve done nothing wrong by cheating, it can affect other areas of your life. “Once you've learned the mechanisms [for moral disengagement] they can be quite easily transferred to other contexts," says Dr Boardley. “So it's likely that you would develop the ability to morally disengage in other contexts." His research has shown a correlation between student athletes who cheat on the sports field and those who cheat in their exams for example.
Fascinated by the idea that cheating by doping is a process of psychological justification, I decide to put it to the test myself. “There are two main forms of doping" from a medical point of view, according to Dr Kennedy. “One is about building the physical muscles, so the machinery you're operating is more powerful. That's where you use the anabolic steroids. The other is improving the capacity of your body to deliver oxygen to the tissues, which is what things like meldonium and EPO do."
Finding either kind of performance enhancing drugs online, it turns out, is very easy. In fact, as Sophie Ashcroft of UKAD points out, it’s all too easy. Dr Boardley’s studies show that dopers often keep their drug use a secret from their friends and families, but online people seem strangely willing to discuss it. I find hundreds of forum threads dedicated to which substances to take, and in what quantities.
As a man whose main forms of exercise are running and cycling, I decide (after some shopping around) that meldonium - the drug taken by Efimova, Sharapova and many of the Russian track & field team - is my best option. “It acts on receptors similar to the ones that adrenaline acts on, to increase the diameter of the vessels and increase blood flow," explains Dr Kennedy, when I ask her, hypothetically, how Meldonium might affect me. “It would improve endurance, it would aid recovery time and it would allow you to work your muscles harder in training and build your muscles with less time needed for recovery."
Meldonium, or Mildronate as it’s known in pill form, is also very easy to buy despite not being sold in the UK. It may be banned by WADA but it’s perfectly legal in Russia, where it’s sold over the counter without a prescription. A quick Google search and a willingness to type my credit card details into a dodgy-looking Russian website are all it takes to procure myself a supply from a Russian online pharmacy willing to ship to the UK.
“A quick Google search and a willingness to type my credit card details into a dodgy-looking Russian website are all it takes to procure a supply of meldonium."
The first exercise I try after taking the pills is a group mountain bike ride in Wales. It’s too early for the drugs to have properly taken effect (like most performance enhancing drug users I’m getting my advice online, and I’ve learned there’s a “load" period). But I’m more interested in what it does to me mentally. I’m not necessarily quicker up the climbs, but I can’t help but feel like the vibe in our group has changed subtly. I can see some of the others chatting about it as I reach the crest of a hill. There’s nothing malicious about it, but I can’t help feeling that any impressive climbs I now do are less valid in their eyes, which makes them less valid in my eyes too.
A short while later, I go for a run on one of my regular routes. I’m still technically in the “load" period so the drugs won’t be working to full effect. But I swallow the pills 40 minutes before exercise (as the online advice told me to do during competitions) and I’ve taken enough chemicals, both prescribed and proscribed, to know that they’re having a bit of an effect as I set off. The run feels fast. When I finish I find out I’m within three seconds of my quickest time for the route. At this stage, the effect may still be psychosomatic. Perhaps I’ve run faster because I was expecting to. What is definitely noticeable however, is that I seem to catch my breath far quicker than usual - my recovery time seems to have improved.
It’s when I run with the full force of meldonium in my body that I really feel the difference. Or rather, I don’t - and that’s the beauty of it. I’m pushing myself faster than I normally would, but I don’t feel especially out of breath. When I check my stats I find I’ve smashed my record for the 4 mile (6.7km) route by nearly a minute and a half. It seems the drugs have allowed me to get more out of my body than normal, while feeling roughly the same in terms of effort expended.
Of course, these tests are anything but foolproof. There are too many variables involved in my running - from the number of people I have to dodge on the canal towpath to the amount of sleep I’ve had the night before - for them to ever withstand proper scientific scrutiny. But even if you discount all of that, the fact that I had taken performance enhancing drugs definitely had an effect on me psychologically.
In the first instance, on the mountain bike ride with my friends fully aware of what I’d done, I felt like I was cheating, even if the drugs had little discernable effect. By the time I did that final run, however, I felt different about it. I felt like I worked bloody hard for that PB. I certainly pushed myself as much as I had for any of my other quickest times over the distance. Yes the meldonium might have helped, and my recovery time was certainly quicker, but it was still me that did it right? Right?
Except, of course, it wasn’t me, and therein lies the crux of the problem. As unscientific as my experiment was, it illustrated perfectly what Dr Boardley had told me, and helped me understand something fundamental about the mental processes involved in performance enhancing drug use: I had started convincing myself that it was OK, that somehow I’d deserved that quicker time.
Of course there’s a huge difference between cheating your own stopwatch and cheating in competition. I wasn’t beating anyone or earning any esteem from my peers (I never post my running times on social media, not least because even with the help of performance enhancing drugs, they’re awful). But whether I was fully “morally disengaged" as Dr Boardley might put it, is kind of a moot point. Like Efimova, Sharapova, or any of the Russians who’ve been banned from next week’s Paralympics, I’d started rationalising my dabbling. When it was me in the dock and my performances on trial, I found myself justifying them.
“They don’t believe they are cheating. Or rather, they find ways to convince themselves that they are not."
It’s easy to condemn drug cheats outright. But what’s interesting is the closer you get to the subject, the more you realise that it’s not as simple as that. It might seem black and white but the reality is more like a Bridget Riley painting - the closer you look at it, the more the black and white seem to swirl around and merge, creating something altogether more confusing.
Even from a medical point of view things aren’t clear cut. As both Boardley and Kennedy point out, the line between legal supplements and illegal drugs can be a fine one. “And then you've got altitude training or sleeping in an oxygen deprived atmosphere which achieves essentially the same thing as EPO but it's perfectly legal," says Dr Kennedy. Arguably the practise, which sees athletes use artificially sealed chambers to simulate altitude, is just as unnatural. “That for me is where the grey area exists," says Kennedy, “because you're achieving the same end result, but in one instance you're taking a drug whereas in another you're sleeping in an oxygen deprived atmosphere. It's interesting where we choose to draw that line morally."
Of course, as Dr Kennedy is keen to point out, there has to be a line drawn somewhere. Quite apart from the potentially horrendous physical consequences of abusing performance enhancers - whether it’s pancreatitis caused by steroids or blood clots caused by EPO - there are the mental consequences. The danger that moral disengagement might start affecting other areas of your life. The psychological damage that living dishonestly can wreak on work and relationships. Dr Boardley cites a cases where an amateur athlete’s secret doping secretly nearly ended their marriage.
At a professional level, doping can turn the viewing public off a sport altogether, ruining it for everyone involved. At an amateur level, it seems even more self-defeating. Sport is, after all, about testing yourself physically within a set of (usually fairly arbitrary) rules. By breaking those rules, you’re undermining the whole point of doing it in the first place. This is something, according to Dr Boardley, that the cheats themselves come to understand in the end. “Often we interviewed people that had stopped [taking performance enhancing drugs] because they were getting less from their sport. They just didn't feel right, they couldn't trust their performances."
“It might seem black and white, but like a Bridget Riley painting, the more you look into it the more the two seem merge."
But if taking performance enhancing drugs at any level of sport is contemptible - not to mention stupid - it’s also when understandable. When you look at individual case studies and the psychological processes behind them, it's easy to see how it can happen. Publicly shaming people or calling for lifelong bans - as King did for Efimova - might feel like the right thing to do, but it’s a very simplistic solution. If you really want to fight the problem in the long run, then perhaps a better understanding of exactly how and why people get into doping would be more helpful.
*Full disclosure, she is also my sister.