Psychiatry - July 2008 - (Page 59)

who works with PGA players while on tour and is familiar with this issue, I find it noteworthy that in early June, 2007, Dick Pound, former president of the World Anti-Doping Agency (WADA) stated in an article that the PGA Tour Commissioner, Tim Finchem, told him that there is no drug problem in golf.2 Mr. Finchem correctly reversed his opinion several weeks later.3 Now for the first time I am hearing the PGA Tour golfers complain, “Have things gone overboard with drug testing?” The reality is that performanceenhancement drugs can insidiously infiltrate the sport of golf and have the serious potential to threaten the integrity of almost all professional sports. ENHANCING PERFORMANCE OR RESTORING NORMATIVE FUNCTION? Most of the issues involving the definition of performance-enhancing drugs in the past have been relatively clear cut. However, with the continuing advancement of medicine and particularly the application of psychotropic medicines, the sports psychiatrist will need to become an integral player in this complex social, moral, and medical drama. Psychiatrists who work with professional athletes will be faced with unique challenges that must be identified, acknowledged, and acted upon in agreement within the sport to ensure the integrity of the profession. The stated mission of the United States Association of Drug Agencies (USADA), the official antidoping agency for America’s Olympic athletes, is to preserve “the wellbeing of Olympic sport, the integrity of competition, and the ensuring health of athletes.”4 A primary example that has often required the policing of USADA is use of erythropoietin (EPO), which provides performance enhancement in endurance sports like cycling.5 This protein is produced by the kidneys and accelerates erythrocyte production, thereby increasing the oxygen-carrying capacity of an individual’s blood. The 59 use of EPO clearly violates the USADA objective of preventing an unfair advantage to fellow competitors. The World Anti-Doping Agency (WADA) was organized under the 1999 initiative from the International Olympic Committee (IOC) and defines the term therapeutic exemption as the use of a drug for restoration of normal health.6 But one of the central problems in defining a therapeutic exemption lies in understanding the evolving power of medical science. Medicine historically has focused on restoring normative health for those with pathologic conditions. As medical science advances, however, the focus of treatment transcends the longstanding goal of normalizing pathologic conditions and extends into the concept of wellness and helping individuals feel better than they have ever felt. The emerging questions are the following: (i) “What does the restoration of normal function mean?” (ii) “Who should define its characteristics?” Perhaps the most important question stated from a medical therapeutic perspective is, “Where does situations.7 Conversely, in an endurance sport like cycling or longdistance running, beta blockers adversely affect performance8 and would not necessarily be prohibited. An interesting recent doping violation comes from the Canadian snowboarder Ross Rebagliati, who had to return his Olympic Gold medal due to testing positive for marijuana, only to have it later returned for a variety of reasons. This situation raises the unexpected question of whether marijuana is a performanceenhancing drug. Another interesting question to consider is whether athletes with adult attention deficit hyperactivity disorder (ADHD) are better athletes when treated with stimulants? It has been reported9 that some athletes actually perform better when their ADHD symptoms are not treated with medication. For example, a basketball point guard who has symptomatic ADHD may actually be more spontaneous or unpredictable for the opponent. In contrast, the center player with ADHD who has difficulty disciplining him- or herself to stay near the basket may find that he or she is often out of position unless his or her Although no well-controlled scientific studies conclusively support claims that stimulants provide ballplayers with an unfair performance-enhancement advantage, these chemicals have long been thought to do so because of their physiologic and psychoactive properties. The question then arises, “If an individual truly has adult ADHD, is the use of stimulants actually providing a performance-enhancement edge or simply providing a restorative function?” restoration of normative function end and the beginning of performance enhancement start?” Further complicating these critical issues are the subtle ways in which performance-enhancement drugs are sport specific. For example, in sports like golf, archery, or pistol shooting, where a steady hand is critical, beta blockers provide a performanceenhancing function that combats the normal physiologic tremor that is exacerbated in high-pressure ADHD symptoms are treated with medication.9 The most controversial current policy issue has occurred in baseball, where stimulant abuse has plagued the sport for decades.10 Although no well-controlled scientific studies conclusively support claims that stimulants provide ballplayers with an unfair performance-enhancement advantage, these chemicals have long been thought to do so because of their physiologic and psychoactive [JULY] Psychiatry 2008 59

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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