The barriers to illegal anabolic steroid use

Masculine enhancement as health or pathology: gender and optimisation discourses in health promotion materials on performance and image-enhancing drugs (PIEDs)

The consumption of performance and image-enhancing drugs (PIEDs) is commonly pathologised in public health discourse as stemming from an unhealthy relationship to masculinity, and is often framed as intrinsically 'risky' and fundamentally at odds with 'good health'. This article examines Australian health promotion materials on PIEDs to analyse their role in shaping notions of good health, normal gender and appropriate self-improvement. To do so, it draws on the work of Butler, Law and Latour to consider how these materials co-constitute men and their health, often in problematic ways. First, we examine the ways in which PIEDs are constituted via a politics of the 'natural', then consider how the health promotion materials on PIEDs participate in the regulation of appropriate, healthy masculinity, and conclude by examining how adolescent masculinity is co-constituted with PIEDs. We observe a key tension between health promotion's avowed interest in improvement and optimisation and its treatment of PIED consumers as aberrant, vulnerable and insecure subjects whose drive to enhance and optimise is characterised by pathology and addiction. We conclude by arguing that health promotion materials on PIEDs fail to acknowledge the exceedingly normative character of enhancement practices in contemporary society.

#Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram

This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.

Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access

BACKGROUND

Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS.

METHODS

A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered.

RESULTS

We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought.

DISCUSSION

AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals.

CONCLUSIONS

Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.

Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums

BACKGROUND

There is good evidence to suggest that performance and image enhancing drug (PIED) use is increasing in Australia and that there is an increase in those using PIEDs who have never used another illicit substance. Peers have always been an important source of information in this group, though the rise of the Internet, and the increased use of Internet forums amongst substance consumers to share harm reduction information, means that PIED users may have access to a large array of views and opinions. The aim of this study was to explore the type of information that PIED users seek and share on these forums.

METHODS

An online search was conducted to identify online forums that discussed PIED use. Three discussion forums were included in this study: aussiegymjunkies.com, bodybuildingforums.com.au, and brotherhoodofpain.com. The primary source of data for this study was the 'threads' from the online forums. Threads were thematically analysed for overall content, leading to the identification of themes.

RESULTS

One hundred thirty-four threads and 1716 individual posts from 450 unique avatars were included in this analysis. Two themes were identified: (1) personal experiences and advice and (2) referral to services and referral to the scientific literature.

CONCLUSIONS

Internet forums are an accessible way for members of the PIED community to seek and share information to reduce the harms associated with PIED use. Forum members show concern for both their own and others' use and, where they lack information, will recommend seeking information from medical professionals. Anecdotal evidence is given high credence though the findings from the scientific literature are used to support opinions. The engagement of health professionals within forums could prove a useful strategy for engaging with this population to provide harm reduction interventions, particularly as forum members are clearly seeking further reliable information, and peers may act as a conduit between users and the health and medical profession.

Adverse Effects, Health Service Engagement, and Service Satisfaction Among Anabolic Androgenic Steroid Users

There are a number of adverse health effects associated with the use of anabolic androgenic steroids (AAS), ranging from mood disturbances to gynecomastia and impaired sexual function. Despite the potentially serious nature of adverse effects, evidence suggests that users are reluctant to seek medical assistance. This study explores factors associated with health service engagement and treatments related to service satisfaction among a sample of AAS users. The analyses are based on a sample of 195 respondents from the Global Drug Survey 2015 who reported using steroids in the previous 12-month period and experiencing concerns about adverse health effects. The results indicate reluctance among AAS users to engage with health services, with only 35.23% reporting that they visited a doctor when experiencing concerns about adverse effects. Concern about sexual function increased the likelihood that users engaged with health services, while concern about changes in sexual organs decreased the odds of service engagement. Among AAS users who engaged with health services, individuals who received a mental health assessment or diabetes test rated the service as more helpful than those who did not; a finding that resonates with literature indicating a desire among AAS users to monitor the health impacts of their drug use and respond to issues as they arise. While more research is needed, the present results underscore a need for nonjudgmental health services aimed at assisting AAS users to monitor adverse effects and minimize harm through early intervention.

The Stigma of Anabolic Steroid Use

Little is known about the stigma of anabolic steroid use despite clear implications for treatment-seekers and for public policy development. We investigated the predictors of steroid stigma and contextualized the results by comparing steroids with marijuana. Undergraduates ( N = 304) completed measures of drug stigma, exposure to drug users, and history of drug use. Participants stigmatized steroid use more than marijuana use—a very large effect. Participants reported less exposure to steroid users. Nevertheless, 15% of participants reported having a steroid-using friend. History of drug use, but not exposure to steroid users, predicted lower steroid stigma. Drug use and exposure both predicted lower marijuana use stigma. The amount of stigma expressed toward steroids is commensurate with that of “hard” drugs, such as heroin, likely constituting a formidable barrier to treatment. The public’s difficulty empathizing with male body image insecurities may partially explain why exposure to steroid users did not predict lower stigmatization.

An exploratory study of image and performance enhancement drug use in a male British South Asian community

BACKGROUND

Consumerism of image and performance enhancement drugs (IPEDs) is a world-wide public health concern. Given anecdotal reporting of increased normalisation of IPED use and uptake of British South Asian male IPED users at UK needle and syringe exchange services, the study aimed to explore use of IPEDs among this under-researched ethnic group.

METHODS

20 in depth interviews were conducted with a purposive sample of British South Asian males attending harm reduction outreach in the North East of England. The interviews explored motives for use of IPEDs, sourcing routes, information seeking, injecting behaviours and cultural and community sensitivities around IPED use among this group. The data was collected and analysed using the Interpretative Phenomenological Analysis approach (IPA).

RESULTS

Motives for use centred on the achievement of enhanced definition and density of muscle, and improved recovery from training and injuries. All participants reported initial stimulation of interest and triggers to seek information on IPEDs due to social media, community and peer messages. Diverse forms of IPED use were described, with rational and moderated use common among older participants. In contrast younger participants adopted more excessive use in seeking short cuts to attaining muscle size. Sourcing of androgenic-anabolic steroids (AAS) and growth hormones from originating countries (Pakistan, India) was reported, along with diversification of entrepreneurial activity into IPED dealing networks. Sellers were generally reported to provide effective and reliable products and mentoring to inexperienced users. Group injecting practices were common. IPED use was observed by some as health promotion medium within religious contexts. Crime deterrence and drug abstinence occurred for some while involved in AAS cycles.

CONCLUSIONS

The study is intended to contribute to health policy and practice debate around the targeting of dedicated education, outreach and harm reduction for ethnic groups engaged in IPED use.

Understanding the public's health problems: applications of symbolic interaction to public health

Public health has typically investigated health issues using methods from the positivistic paradigm. Yet these approaches, although they are able to quantify the problem, may not be able to explain the social reasons of why the problem exists or the impact on those affected. This article will provide a brief overview of a sociological theory that provides methods and a theoretical framework that has proven useful in understanding public health problems and developing interventions.

The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research

Background

To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use.

Methods

We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines.

Results

A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation.

Conclusions

Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.

Judgments about illegal performance-enhancing substances: Reasoned, reactive, or both?

This study applied aspects of the Theory of Reasoned Action and the Prototype/Willingness model to understand cognitions associated with the use of illegal performance-enhancing substances. There were two study objectives. One was to investigate whether the illegal-is-effective heuristic (i.e. belief that illegal performance-enhancing substances are more effective than legal performance-enhancing substances) affects willingness to use illegal performance-enhancing substances. The second was to examine whether attitudes, norms, and prototypes influence the willingness and intentions to use illegal performance-enhancing substances. The illegal-is-effective heuristic was a significant predictor of willingness but was not a significant predictor of intentions. Implications for future research and prevention efforts are discussed.

A pilot study examining perceived rejection and secrecy in relation to illicit drug use and associated stigma

INTRODUCTION AND AIMS

Illicit drug use is a stigmatised behaviour; therefore, users tend to experience rejection and remain secretive about use. However, stigma-related rejection and secrecy can adversely affect those who reject abstinence. This study aimed to modify measures to assess these concepts with regard to illicit drug use and examine how they relate to use of various drugs and associated perception of public stigma.

DESIGN AND METHODS

An Internet-based convenience sample (n = 700) was surveyed to pilot items modified from previous scales in order to assess these concepts with regard to drug use. As perceived rejection and secrecy are related and potentially overlapping constructs, exploratory factor analysis was conducted to examine the underlying structure of items previously used to assess these concepts. These variables were examined in relation to sociodemographic characteristics, perceived public stigma and use of various drugs (marijuana, powder cocaine, ecstasy and nonmedical use of opioids and prescription stimulants).

RESULTS

After factor reduction, perceived rejection and secrecy loaded as two distinct, but related concepts. These modified measures had moderate to high internal consistency and both concepts were positively related to perceived public stigma and use of various drugs.

DISCUSSION AND CONCLUSIONS

This pilot study demonstrated validity evidence for these measures and results suggest that illicit drug use and associated stigma are related to increased feelings of rejection and secrecy in users. Research is needed to examine whether stigma towards users serves as a deterrent to use because rejection and secrecy are associated with adverse psychosocial outcomes.

Inside athletes' minds: preliminary results from a pilot study on mental representation of doping and potential implications for anti-doping

BACKGROUND

Despite the growing body of literature and putative links between the use of ergogenic nutritional supplements, doping and illicit drugs, it remains unclear whether, in athletes' minds, doping aligns with illicit behaviour or with functional use of chemical or natural preparations. To date, no attempt has been made to quantitatively explore athletes' mental representation of doping in relation to illegality and functionality.

METHODS

A convenience sample of student athletes from a large South-Eastern Australian university responded to an on-line survey. Competitive athletes (n = 46) were grouped based on self-reported use as follows: i) none used (30%), ii) supplement only (22%), iii) illicit only (26%) and iv) both supplements and illicit drug use (22%). Whereas no athlete reported doping, data provided on projected supplement-, doping- and drug use by the four user groups allowed evaluation of doping-related cognition in the context of self-reported supplement- and illicit drug taking behaviour; and comparison between these substances.

RESULTS

A significantly higher prevalence estimation was found for illicit drug use and a trend towards a biased social projection emerged for supplement use. Doping estimates by user groups showed mixed results, suggesting that doping had more in common with the ergogenic nutritional supplement domain than the illicit drug domain.

CONCLUSIONS

Assessing the behavioural domain to which doping belongs to in athletes' mind would greatly advance doping behaviour research toward prevention and intervention. Further investigation refining the peculiarity of the mental representation of doping with a larger study sample, controlling for knowledge of doping and other factors, is warranted.

Psychological drivers in doping: the life-cycle model of performance enhancement

BACKGROUND

Performance enhancement (PE) is a natural and essential ingredient of competitive sport. Except for nutritional supplement contamination, accidental use of doping is highly unlikely. It requires deliberation, planning and commitment; and is influenced by a host of protective and risk factors.

HYPOTHESIS

In the course of their career, athletes constantly set goals and make choices regarding the way these goals can be achieved. The cycle of choice - goal commitment - execution - feedback on goal attainment - goal evaluation/adjustment has numerous exit points, each providing an opportunity for behaviour change, which may or may not be related to the use of prohibited methods. The interplay between facilitating and inhibiting systemic and personality factors, constantly influenced by situational factors could result in an outcome vector of 'doping attitudes', which combines with subjective norms to influence intentions to choose prohibited PE methods. These influences also vary from one stage of athlete development to the next, making some athletes more vulnerable to engaging in doping practices than others, and more vulnerable at certain time periods - and not others.

TESTING THE HYPOTHESIS

Model-testing requires a series of carefully planned and coordinated studies. Correlational studies can establish relationships where the directionality is not-known or not important. Experimental studies with the manipulation of doping expectancies and risk factors can be used to demonstrate causality and evaluate potential intervention strategies. The final model can be tested via a behavioural simulation, with outcomes compared to those expected from literature precedence or used as a simulated computer game for empirical data collection.

IMPLICATIONS

A hypothesized life-cycle model of PE identifies vulnerability factors across the stages of athlete development with the view of informing the design of anti-doping assessment and intervention. The model suggests that, instead of focusing on the actual engagement in prohibited PE practices, deterrence strategies are likely to be more effective if they target the influencing factors at the appropriate stage and identify groups of athletes and their respective career stages, which pose particular risks of engagement in doping practices. This enables a more effective intervention approach by targeting specific risk factors and expectancies.

Limited agreement exists between rationale and practice in athletes' supplement use for maintenance of health: a retrospective study

Background

The widespread use of nutritional supplements among athletes is poorly understood. The prevalence of supplement intake and users' knowledge have been researched independently leading to useful, but disconnected, information on supplement use.

Methods

The 'UK Sport 2005 Drug Free Survey' data (n = 874) were re-analysed using association [χ²] and 'strength of association' tests [φ], to discover observed incongruencies between self-reported supplement use and the underlying motives. Results are given for test pairs between 'motive for use' [doctor's advice, avoiding sickness, overcoming injuries and enhancement of diet] and each supplement used and these were categorized as strong (φ > .7), intermediate (7 < φ > .3) and weak (φ < .3).

Results

The use of selected supplements varied widely as follows: multivitamin (72.7%), vitamin C (70.4%), echinacea (30.8%), iron (29.8%), magnesium (11.0%) and ginseng (8.3%). Associations with motive were found in 8 of the 10 test pairs which were expected from literature precedents, however only weak associations exist. Of these, four were associated with avoidance of sickness [iron (χ² = 11.94, p < .001; φ = .15, p = .001), multivitamin (χ² = 6.43, p < .001; φ = .11, p = .011), vitamin C (χ² = 54.67, p < .001; φ = .32, p < .001) and echinacea (χ² = 40.34, p < .001; φ = .28, p < .001)]. The remaining 4 associations were: no time to prepare meals with ginseng (χ² = 7.64, p = .006; φ = .12, p = .006) and multivitamin (χ² = 9.103, p = .003; φ = .13, p = .003); overcoming injuries with magnesium (χ² = 6.99, p = .008; φ = .11, p = .008); doctors' advice and iron (χ² = 35.00, p < .001; φ = .25, p = .001).

Conclusion

These results suggest a lack of understanding regarding supplements and health maintenance, except for vitamin C and echinacea. Furthermore, supplement use is apparently independent of physicians/dieticians' advice, except for iron. This may suggest a widespread circumvention of expert advice in the growing area of supplement use and therefore should be addressed to underscore potential health risks.