Published in Swedish as “Förbättrade prestationer
och drogforskning”, Alkohol och Narkotika 96(1):16-18, 2002.
Performance
enhancement and drug research[1]
Centre for Social Research on
Alcohol and Drugs
In a context like today’s we
tend to emphasize the adverse effects of drugs, either on the consumer or on
others. But almost all drugs which
humans knowingly consume are at least some of the time and in some way
performance enhancing. I mean “performance
enhancing” in two main senses: in terms of an improvement on what the actor
could do without the enhancement, and also in the more social sense of how well
the actor performs in front of and with reference to others.
There are, of course, a
variety of aspects of being and acting in which humans seek to enhance their
performance. We seek ways to go farther
or faster, to be smarter or quicker, to be more attractive or sexier, to be
thinner or stronger, to be spaced out or alert, to be happier or less
depressed, to engage with others or to disengage -- this by no means exhausts
the ways in which we seek to enhance one or another
kind of performance.
Much of the discretionary spending in affluent
societies is on performance enhancement in this broad sense: we pay for a set
of wheels instead of relying on our feet, we subscribe to a gym to work out in,
and of course we take drugs like coffee and alcoholic beverages for various
purposes, including to be sociable and to affect our mood and alertness. To a considerable extent, the consumer
economy runs on our desires and beliefs about the ability of machines or
substances to enhance one or another of our various performances.
As the consumer economy began
to get under way about two centuries ago, the idea that the market for any
mechanical or chemical aid to performance should be left free came into
question. The classic temperance
movement’s fight against “inebriety” may be seen as the first great modern
attack on the idea that anything goes when it comes to marketing performance
enhancers. If we look at the arguments
for limiting or prohibiting alcohol which were marshalled by the temperance
thinkers of the 1800s, a primary argument was in terms of the effects of the
drinking on others around the drinker – on the family, on friends and on
bystanders. Often the drinker’s perceived enhancement of his or her own
performance was to the detriment of others.
A secondary theme was the long-term adverse effects on the drinker him-
or herself. A third theme was the
potential for adverse effects of alcohol consumption on societal efficiency or
the social fabric.
The initial impulse of the
temperance movement was to persuade the drinker rationally or emotionally to
give up drinking in view of the potential detriments to self or others. But some people did not respond to these appeals, or backslid from their response. The concept we now call “addiction” was put
forward as a way of understanding why this happened to drinkers, often
apparently against their own will.
Eventually, of course, the
temperance movement shifted its attention from the individual consumer to the
market, and pushed for total prohibition of alcohol sales.
While alcohol was the great
initial battleground for this argument about the operation of the free market,
by about 100 years ago the same arguments were being transferred to other
commodities. In particular, the
arguments were transferred to opiates and other psychoactive drugs.
Except among some religious
groups outside the mainstream, the argument never got extended to
caffeine. Here the performance
enhancement was judged to be socially useful, and any attendant harm to be
minor, so that the market was allowed to operate freely. With respect to alcohol, the 1922 referendum
in Sweden on national prohibition was narrowly defeated; unlike the U.S.,
Canada, Finland and Norway at the time, Sweden adopted and stuck to what would
be called in today’s terms a harm reduction approach, with a strong (though now
weakening) state control of the market to limit the damage from drinking. It can be argued that the more recent Swedish
approach to tobacco smoking also has elements of a harm reduction approach, in
the substitution of snus for cigarette smoking among teenage boys.
With respect to a selected
list of drugs – before 1971, the opiates, cocaine and cannabis – the decision
about the operation of the market was, as we all know, very different, both in
Sweden and internationally. The
international regime to manage the global market for opiates, attempting to
confine them to medical use, is one of the more ambitious attempts in human
history at a managed market. Starting in
1971, in part as a Swedish initiative, the effort to manage the market on a
global level was extended to nearly all psychoactive substances.
Even more recently, in 1999,
with the formation of the World Anti-Doping Agency, the effort to eliminate use
of performance-enhancing substances has extended in a new direction, to control
and indeed prohibit the use of substances capable of enhancing sports performance.
So, in the contemporary world,
we have two conflicting trends, with respect to the marketing of
performance-enhancing substances. On the one hand, the ideology of consumer
sovereignty and the unfettered market seems ever stronger for a wide variety of
performance-enhancing commodities. The
long-term Swedish prohibition of alcohol advertising, for instance, is under
threat from European Union court decisions.
Using the mechanism of trade disputes, the nations of the EU have also
successfully forced the weakening of alcohol controls elsewhere in the world,
in such countries as
It seems to me there are a
number of lessons to be learned from this history as we contemplate the present
and future of drug research:
1. There are conflicting trends in how different
drugs are defined and the extent and nature of controls on their marketing in
modern societies. The status of
particular substances in the market has changed radically over time in the last
century or so, and it should not be assumed that their present status is
“natural” or will necessarily continue.
In this circumstance, a major social function of drug research, it seems
to me, is to contribute to the policy debate on each substance a balanced and
quantified picture of positive and negative aspects of drug use and of societal
efforts at control.
2. The broad concept of performance enhancement
reminds us that for most users there are positive aspects to drug use at all
stages in the drug-using career. There
is a need for research
oriented to public health and prevention to pay attention to these positive
aspects, as they are experienced by the user.
A knowledge only of the negative consequences will cripple the efforts
of those planning prevention and intervention.
3. An important implication of the performance
enhancement concept is that it cannot be assumed that the user desires to be
rid of substance use. One problem with
addiction concepts, when loosely applied, is that they lead us too readily to
assume that a heavy drug user has the same motivation to “get better” as
someone with a broken leg or a debilitating infection.
In an era when there may be
the potential for genetic manipulation or other irreversible biological
interventions as forms of treatment for drug use, the fact that many users do
not wish to give up their drug use means that it is time for scientists and the
general public to initiate a dialogue on where the line should be drawn in
terms of human rights to decline treatment.
In the absence of such thoughtful dialogues, we risk falling again into
the comfortable arguments that the treatment is “for their own good” which marked the era of
sterilization operations.
4. There is a need to build a solid literature
for all performance-enhancing substances on the effects of different policy
interventions to control the market. At
the moment, much of our social policy on these substances is based on untested
beliefs. The alcohol field here provides
a good model to be emulated for other substances. The existence of state alcohol monopolies in
Nordic countries, along with the loosening of alcohol controls in the last 25
years, has allowed researchers in
[1]Presented at a seminar,
“Snillen spekulerar – drogforskningen i dag och i framtiden”, on the occasion
of the 100th anniversary of the Centralförbundet för Alkohol- och
Narkotikaupplysning.