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Performance Enhancing Drugs for Musicians?

Is the scourge of the professional athletic world rearing its ugly head in the music industry?

by Drew McManus
September 27, 2004

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This summer’s Olympics games were marked by several high profile performance enhancing drug scandals. Several high profile athletes tested positive for banned substances, most notably several previously successful Greek and American competitors.
These banned substances allow athletes who use them to perform at levels beyond normal human ability and help them achieve record breaking levels of performance. The drug of choice in the spotlight this year is a designer steroid named tetrahydrogestrinone (THD).
The motive behind banning such substances is obvious; everyone deserves to perform on the level playing field of natural ability and training. However, given the competitive nature of professional athletics, it’s no surprise to discover that there are always competitors eager to obtain an artificial edge.
And professional musicians are very similar to professional athletes; they are constantly searching for ways to improve their performance ability. But unlike their athlete cousins, professional musicians can rarely benefit from artificially increased physical ability.
But there are other ways for musicians to improve their performance; by reducing performance related anxiety.
It’s nothing new for musicians to suffer from performance anxiety, otherwise known as “stage fright”. And up until the past few decades, classical musicians haven’t dabbled in performance enhancing drugs (the legal ones at least).
Performance anxiety is an issue that’s typically treated as a mental challenge, something more like “mind over matter”. Almost every professional musician has a technique or trick they use to help them remain calm and focused during performances.
David Lockington, music director for the Grand Rapids Symphony Orchestra, espouses a technique he refers to as visualization, which helps him establish triggers to relax during performances; and for David it works well.
He says, “I visualize walking on stage, seeing the lights, and using all of those as triggers to relax instead of adding to the pressures.”
But some musicians have significantly more trouble obtaining those levels of relaxation and focus using mental exercises. 
Stage fright is an inherently individual condition which some individuals are naturally better equipped to deal with than others. So what does a musician do when they can perform at a level equal to the best of the best when they are in their private practice studio but fall apart due to performance anxiety when they step onto the stage?

Decades ago, musicians typically found their answers in a bottle; bourbon, scotch, vodka, gin, take your pick.  Alcohol has always been an easily accessible means to artificially lessen the rate of vital physiological activities.
But the pitfalls associated with that choice of action are obvious.  Alcohol not only deadens a musician’s synaptic responses (which are at the heart of performance anxiety) but they also slow down cognitive and physical ability. Then there’s that pesky addictive side effect to deal with.
Better living through pharmaceuticals
In 1965 Wyeth Laboratories developed Inderal, the brand name for propranolol, which is an antianginal, antiarrhythmic, antihypersensative, antimigraine drug, and beta blocker.
In English, that means it helps treat the effects of anxiety or nervous tension, aggressive behavior, angina, high blood pressure, migraine, headaches, panic attack, phobias, schizophrenia, tremors, and to help prevent second heart attacks.
Inderal is not habit forming, may be taken for months or even years, and proper dosage must be determined and prescribed by a physician.
It’s obvious to see why many musicians have found this drug to be extraordinarily useful if fighting the symptoms of performance anxiety.
Some musicians who use this drug have experienced significant reductions in their level of performance anxiety which, in turn, allows them to reach much high levels of consistency in their performing. Best of all, it isn’t habit forming and side effects are rare and usually minor in character.
A question of ethics
If you ask a group of musicians (especially a string player) about their feelings regarding Inderal and you’ll likely get an ear full.  Some players find it to be a god send which allows them to consistently perform at their best while others see it as an artificial crutch that eliminates a level playing field.
For example, two of the most stressful situations in the classical music industry are solo performing and taking auditions. Both are directly connected to how successful a musician is throughout their career.
Opponents of Inderal use claim that the drug provides an artificial edge to audition candidates, allowing them to win a position over a competitor that may otherwise deserve to win the job. They go on to point out that professional soloists that use Inderal create an artificial product that is not representative of their natural ability.
Proponents state that Inderal allows them to demonstrate the absolute best of the natural ability and results of their years of hard work. They claim the drug doesn’t enhance their ability to play their instrument, it merely allows them to display their natural ability.
One professional cellist I spoke with, who wishes to remain anonymous, swears that without Inderal their career would have never gotten off the ground.  They said “Without Inderal I never would have reached my full potential.  I’ve practiced just as long and just as hard as my colleagues.  The only difference is they don’t suffer from the gripping fear I do when I pick up my bow in front of other people.”
Individual choice
Arguably, when compared to physical issues the world of medical science is only just beginning to learn about physiological disorders. Are they more alike than different?  Are they a disease to be treated with physical and pharmaceutical solutions or should they remain in the realm of “mind over matter”.
It’s difficult to come to any sort of definitive conclusion. As of now, the issue of Inderal use among musicians is filled away under “personal choice”. 
But some of the potential dangers lurking in today’s world are the ease with which anyone can order prescription drugs without first seeing their physician.
And although Inderal is not nearly as harmful as other performance enhancing drugs such as anabolic steroids, it has been a prescribed medication for the past 39 years.
Since ethics is an issue usually left as an academic afterthought in the music industry, one has to wonder if we’ll all pick up a newspaper one day reporting that a conservatory student was found dead in their dorm room due to an improper usage of Inderal.
For now, Inderal will have to remain a topic that is limited to venues of personal debate and personal choice.
To learn more about Inderal and other forms of propranolol, visit PSYweb.com and Wyeth Laboratories.

Comments (8)

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Scott Cole from Ashland, OR writes:
October 12, 2004
I found the attempt to connect steroids and Inderal weak. As a violinist with years of solo and audition experience, I've taken Inderal often over the years. Is it an unfair advantage? No more so than being lucky enough to have a fine 18th century violin to play on. The experience with Inderal may be a personal one, but I never found it to decrease anxiety levels. It doesn't give one faster fingers, or better rhythm, more convincing phrasing, or a better sense of style. It simply prevents the type of physical reactions that can get in the way, such as shaking, sweaty hands, or a fast heart beat. Steroids can make an athlete faster or stronger, but Inderal doesn't make you a better musician. Preparation does.

At the doses musicians use -- about 10 mg., it's a harmless drug, no worse than coffee. And as for the possibility of conservatory students dropping dead from using it -- simply ridiculous.

Drew McManus from Baltimore writes:
October 12, 2004
Thanks for the response Scott, I believe we agree on the issue that Inderal isn't a performance enhancing drug, I say exactly that in the article.

But I don't know if there's a necessarily weak connection between how some people perceive its effect on musicians much like they do with steroids. Some people believe that anything beyond natural ability is performance enhancing and that's the issue at hand really.

As for college students (or anyone for that matter) dropping dead: I don't think it's terribly responsible to completely disregard it out of hand. the drug has some very real, very severe consequences if not properly prescribed by a physician or psychologist. It isn't an addictive drug but it is a drug with very real side effects that can also result in death if abused.

Thanks again for taking the time to write in.

Steven Yafet from New Jersey writes:
October 26, 2004
Heard most of the show. I am one of those who took another job. (Most of my eggs were not in the world's greatest virtuoso basket.) In my experience, the nerves correlate with an incomplete technique. When the ideal is to far from the attainable real, you have nerves.

Musicians, in particular, inhabit a world of their own construction, removed from the physical environment you might say. In performance they must bring the two together with the lights, noise, and fellow humanity around them. A wonder then that anyone can perform in the manner they have prepared.

Reconciling the two is most difficult when the performance goal is a little too high to reach... In Horowitz' case presumably because of the standards he set himself for legato, clarity, etc - perfect unattainable 100's in all categories. In Glen Gould's case, a similarly extreme goal that ends up sounding misguided because he misses by so much.

Never having used inderol, I can only guess that it affects the musical goal between practice session and performance. Maybe someone who has used it can enlighten us about this.

Estelle Schecter from Westchester County, NY writes:
October 26, 2004
In the l970's an excellent article about the benefit of Inderal was published in Lancet, a British publication. It focussed on the use of Inderal for managing performance anxiety, whether by musician or anyone else who suffers disabling performance anxiet. The Brits were quite concerned about well trained young musicians who did poorly in auditions. One of the young musicians had been using Inderal (propanalol) for hypertension and did well on audition. Experimentally and with physician guidance those musicians who had succumbed to performance anxiety on audition took 10 mg. of Inderal on the morning of an audition and one hour before the performance. It was very effective.

A colleague of mine in those days developed aphonia in public speaking. This symptom disappeared with the help of Inderal. In due course, if he forgot to take Inderal his performance was nonetheless fluid and excellent.

There is no contraindication for this aid.

Musicians can sing tunefully with good management of their breathing, actors can speak their lines and instrument musicians can play at the level of their mastery. One need not give up a performance career.

Karen McGale from Gilbert, Arizona writes:
September 6, 2005
I have just discovered Drew McManus' column and The Partial Observer, so I apologize for commenting on this article almost a year after it was first published.

I am a professional (French) horn player and teacher who holds a Doctor of Musical Arts degree in Performance. Throughout my career it has become obvious that performance anxiety affects musicians in different ways.

Some experience dry-mouth. Some get sweaty palms. Some find they can't breathe as well. Some shake a little or a lot.

Do those who bring a glass of water, or slice of lemon, on stage with them to counteract dry-mouth have an unfair advantage? Is it a crutch to use a towel to wipe off those sweaty palms? Are breathing accessories, such as tubes or inhalation monitor devices, creating an unlevel playing field by those who utilitze them before a performance? Are musicians who engage in mental and physical relaxation techniques to calm their shakey limbs cheaters? Does wearing a lucky bow tie or hiding a talisman in a tux pocket misrepresent one's natural ability?

My answer to all of these questions is a resounding No!. However, for many years I considered the use of beta-blockers fundamentally wrong. I had never tried beta-blockers and had never met anyone who used them -- or at least no one who would admit to using them. I was never presented with a logical argument in favour of beta-blockers to consider.

Then one day I read a statement submitted to a very active internet discussion forum for horn players by an internationally renowned soloist and pedagogue. He explained that he experiences varying degrees of performance anxiety and occasionally uses beta-blockers to manage extreme symptoms that could negatively effect his ability to perform well. Why accept the possibility of a mediocre performance resulting from the physical side effects of anxiety if they can be easily and safely treated with medication?

I thought about this confession often as my career developed, and began to encounter other highly respected musicians who openly discussed the benefits and relief they received through the occasional use of beta-blockers. I began to view beta-blockers not as an evil secret weapon, but a practical medical alternative when other options fail.

If I have a sore throat, I take a lozenge.

If I experience painful gas, I take an antacid.

If I get a headache, I take two Advil.

Does the audience have any idea that I have treated these symptoms beforehand in order to ensure my performance in not negatively effected? Nope. Would they care if I told them? Nope. Would another musician accuse me of enhancing my performance by treating these symptoms with medication? Nope.

So why is it okay to treat *some* physical symptoms with medication but not others? Would opponents of beta-blockers argue that musicians who are prescribed propranolol to treat high blood pressure or angina have an unfair advantage in an audition or other competitive scenario?

Would an audience feel cheated if I admitted that I took a beta-blocker before the performance for which they just gave me a standing ovation? Extremely doubtful. Would a musical colleague have any clue that I'd taken a beta-blocker before a performance? That has not been my experience. But they sure can tell if I *haven't* taken one when I should have!

Yes indeed, I have used beta-blockers (prescribed by my doctor) a handful of times over the past few years with great success. In each case, beta-blockers offered no opportunity for a competitive edge as the events were not competitive in nature. Rather, the performances were public recitals presented purely for entertainment. The only people that could have been cheated were the audience and myself if I had *not* taken advantage of beta-blockers' ability to minimize the physical effects of performance anxiety I sometimes cannot control on my own. It's not enhancement, it's normalization.

Yann COIRAULT from Lyon (France) writes:
March 27, 2006
Very interesting article which confirms for me needs for musicians in help skills for managing their anxiety. I'm working as a personal and team coach in business world. I've encountered the musical world for some years and thought the methods used in business coaching for many many years could be applied. Mental training, NLP (Neuro Longuistic Programmation) or others relaxation skills are already used by some musicians who have discovered these types of soft ans safety approach. Mihai CEICU, NLP Master and Tai-Chi specialist, in Deutschland is an example of that (www.musicoach.de). So, we propose in France, Deutschland and Romania, working with musicians to help them in their anxiety control or other type of problematics (internal conflicts, personal relationship with success, audition preparation,...). We are convinced by usefull and efficacy of these methods applied in the musical environment.

I apologize for my English language faults.


Adam from Atlanta, Georgia, USA writes:
July 6, 2007
Any "magic pill" is merely an attempt to adress what needs to be addressed during preparation. The visualization, and mental training of preparing and presenting a confident and poised performance. The Audition Mastery Guide has proven to be highly successful. Learn more at www.craneclassical.com

Steve from Cincinnati writes:
September 6, 2007
I must say that I have taken inderal on several, but not many occasions, depending upon the difficulty of the music involved or if gigging with a major US orchestra, upon need. It has, without exception, been most helpful. I have three performance degrees, none of which involved or needed inderal. As a semi-retired organist, I have had to play extremely difficult music for very famous, hugely big-named choral conductors (David Willcocks/Durufle Requiem) and I feel my playing was very much enabled by a small amount of inderal, taken only an hour before the hard to play stuff. I'm gigging this weekend with the local major US orchestra, and I've gotten my inderal through my physician.
These are simply my thoughts and experience.

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