Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolicandrogenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test-retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research considered.

The objective of the study was to validate the factorial structure of the short form of the Sense of Coherence Scale (SOC-13) with a sample of substance abuse clients to facilitate health promotion research with this population in the future. Participants were 406 clients recruited from seven residential therapeutic community programs for the treatment of substance abuse. Four confirmatory factor models were tested: (1) a three-factor correlated model; (2) a two-factor correlated model; (3) a 13-item one-factor model; and (4) a 9-item one-factor model. The results indicated that the data did not fit the three-factor correlated model and the two-factor correlated model, whereas empirical data fits the 13-item one-factor and the 9-item one-factor models reasonably well, with the latter representing a significantly better fit than the former one. These results are consistent with previous studies and reflected a unidimensional factor in the sense of coherence, as opposed to the two or three-factor structure. The SOC-9 has considerable promise as a brief measure of SOC in substance abuse assessment and treatment settings.

Appearance and performance enhancing drugs (APEDs) include a wide range of substances borrowed from a wide range of medical disciplines and associated fields and have a long history in sport and competition. The defining features of APED use are discussed and include polypharmacy, body image disturbance, and disturbances in diet and exercise. Appearance and performance enhancing drugs are unique among substances of abuse in their biological action, as well as in the basic motivations for their use. Although there are a wide range of potentially serious physical and psychiatric side effects, APEDs continue to be used by millions of men and women and to a greater degree by those engaged in sport and fitness activities. It is still unclear how individuals become illicit APED users, but it is possible that legal APEDs act as a gateway substance for illicit APED use. There are few empirically supported prevention programs for APED use and a complete absence of empirically supported interventions for those using APEDs. The engagement of APED users in treatment is complicated by the ethical-legal obstacles and mistrust between the APED-using and health services communities. Future research will need to overcome these barriers to provide effective and useful interventions for those APED users in the sport or performance fields.

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