Psychoactive drug use among athletes: motives and risk factors beyond sports performance - A scoping review

Organised competitive sport represents a unique socio-cultural environment in which performance demands, social influences within sport and anti-doping frameworks shape athletes' substance use behaviours. In 2021, the World Anti-Doping Agency introduced a 'Substances of Abuse' category to address athletes' drug use outside the context of sport. Athletes may use psychoactive drugs, for example, to manage sports related pressure, stress and mental health challenges rather than to enhance performance. While doping in sport remains a widely studied phenomenon, less attention has been given to psychoactive drug use behaviours among athletes involved in organised sports that are driven by motives other than performance enhancement. This scoping review explored psychosocial motivations and associated risk factors for psychoactive drug use across varied athletic populations including young, professional, elite and retired athletes. A scoping review was conducted using a systematic search strategy in the Scopus, Web of Science and PsycINFO databases. The review followed JBI guidelines and the PRISMA-ScR framework. It focused on peer reviewed studies published between 2014 and 2024. Covidence software was utilised for researchers' independent screening processes and the Sport Drug Control Model guided the review's thematic analysis. 38 studies were included. Most studies were conducted in a North American context and were primarily focused on young athletes (55.3%). Cannabis was the most examined drug (68.4%). Athletes' motives for psychoactive drug use were related to benefit appraisal, especially perceived benefits for mood enhancement (for example, relaxation after a game or coping with injuries). Risk factors included young age, male gender, low perceived competence, mood disorders, peer use, contact sports, injuries and career transitions. The findings highlight the importance of ensuring that drug use prevention and harm reduction interventions reach at-risk athletic populations, particularly adolescent athletes, while also addressing sport specific risk factors.