{
  "abstract": "Objective To systematically map and synthesise the scientific literature on substance use patterns among elite athletes, encompassing recreational substances, performance-enhancing drugs (PEDs) and polysubstance use.Design This study was a scoping review conducted in accordance with the Joanna Briggs Institute (JBI) methodological framework and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol was prospectively registered on the Open Science Framework.Data sources A comprehensive search was conducted in PubMed/MEDLINE, PsycINFO, Scopus and SportDiscus from inception to March 2025.Eligibility criteria for selecting studies Eligible studies were peer-reviewed original research articles examining substance use, misuse or substance use disorders among elite athletes, including collegiate, professional, Olympic, Paralympic or national-level competitors. Both recreational substances (eg, alcohol, cannabis, nicotine, prescription drugs) and PEDs were included.Results From 3292 unique records screened, 119 studies met inclusion criteria. Alcohol was the most extensively studied substance, particularly among National Collegiate Athletic Association collegiate athletes, with consistent evidence of heavy consumption in certain sports, especially those with strong social and team-based norms. PED studies revealed marked sport-specific patterns, largely informed by anti-doping surveillance data, but offered limited insight into psychosocial mechanisms. Research on other substances and polysubstance use was heterogeneous, fragmented, and methodologically variable. Across all domains, the literature was dominated by cross-sectional designs, self-reported data and Western populations.Conclusion The existing evidence base demonstrates substantial substance-related vulnerability among elite athletes but is characterised by significant conceptual, methodological and geographical gaps. Future research should prioritise longitudinal and theory-driven designs, broader representation of professional and non-Western athletes, integration of mental health frameworks and rigorous evaluation of prevention and intervention strategies.Trial registration number The review protocol was prospectively registered on the Open Science Framework (OSF) (DOI: 10.17605/OSF.IO/3PJDN) on 8 January 2025.",
  "authors": [
    {
      "affiliations": [
        "Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil",
        "Perdizes Institute (IPer), Clinics Hospital of the Medical School (HCFMUSP), University of São Paulo, São Paulo, SP, Brazil"
      ],
      "name": "João Mauricio Castaldelli-Maia"
    },
    {
      "affiliations": [
        "Medicina, Faculdade Pernambucana de Saude Curso de Medicina, Recife, Brazil"
      ],
      "name": "André Ayalla Rodrigues"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA",
        "Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA"
      ],
      "name": "Zachary L. Mannes"
    },
    {
      "affiliations": [
        "Department of Forensic Psychiatry, University of Bern, Bern, Switzerland"
      ],
      "name": "Alexander Smith"
    },
    {
      "affiliations": [
        "Department of Forensic Psychiatry, University of Bern, Bern, Switzerland"
      ],
      "name": "Michael Liebrenz"
    },
    {
      "affiliations": [
        "Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, Netherlands",
        "Section Sports Medicine, University of Pretoria, Pretoria, South Africa"
      ],
      "name": "Vincent Gouttebarge"
    },
    {
      "affiliations": [
        "NYU Grossman School of Medicine, New York, NY, USA"
      ],
      "name": "Brian Hainline"
    },
    {
      "affiliations": [
        "Department of Psychiatry, University of Wisconsin Madison, Madison, Wisconsin, USA"
      ],
      "name": "Claudia L. Reardon"
    },
    {
      "affiliations": [
        "Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "David McDuff"
    }
  ],
  "title": "Substance use patterns in elite athletes: a scoping review of alcohol, performance-enhancing drugs and other psychoactive substances",
  "uid": "514adb68-6aa1-59ec-87a1-b3265106dfb1"
}