A qualitative study of the motivations for anabolic-androgenic steroid use: The role of muscle dysmorphia and self-esteem in long-term users

Abstract

Background: The use of Anabolic-androgenic steroids (AAS) among the non-competitive weightlifting community has increased considerably in the UK in recent years, presenting a public health issue. The motives behind use have received considerable attention, with motivations linked to body dissatisfaction, low self-esteem, and more recently, muscle dysmorphia (MD). However, the causal roles of MD and self-esteem in AAS use remain unclear. Therefore, this paper examines the origins and changes to motivations in long-term users.Methods: A qualitative study recruited eight male weightlifters from a needle exchange programme in South Wales, UK. Participants were interviewed about their initial introduction to AAS and their motivations for initial and continued use. Results: The interview data confirmed the importance of the training community in providing advice and guidance on AAS. Those interviewed cited some motivations for use which included self-esteem, body dissatisfaction, MD, social acceptance, and age-related concerns. Implicit in these motivations was a psychological addiction to the positive effects following AAS use, which for some men, had led to psychological dependency and body image pathology. Conclusions: The changes in motivations described by the AAS users provide key insights into the complex nature of AAS use. For some men, low self-esteem, body dissatisfaction and MD precede AAS use, and for others, they are consequences of use. These findings have significant implications for future research and public health initiatives.

Anabolic-Androgenic Steroid Use in the Eastern Mediterranean Region: a Scoping Review of Extant Empirical Literature

“…The use of AAS for performance and image enhancement is a growing concern in these countries; however, knowledge, understanding, and awareness of health harms related to AAS appear to be varied and somewhat limited. Most studies in this review reported AAS users as single and in fulltime employment, highlighting high rates of employment, similar to studies in the UK (Baker et al 2008;Begley et al 2017;Greenway and Price 2018), Australia (Jacka et al 2017), and the USA (Pope et al 2014a(Pope et al , 2014b. Educational status of AAS current and former users in the Middle East was highest in the 'higher education' range which corroborates research in Australia (Cohen et al 2007) and the USA (Westerman et al 2016).…”

Australia's Adonis: Understanding what motivates young men's lifestyle choices for enhancing their appearance

“…In the context of a muscularity‐centred culture, some men overtly stated that AAS were used specifically to prepare for night clubbing and/or festival appearances. Certainly, the presence of reinforcers such as increased self‐esteem, body confidence, and social acceptance, have been shown in previous work to be important in maintenance of AAS use (Greenway & Price, ). Unlike recreational drugs, steroids do not necessarily produce an immediate high or intoxicating effect.…”

“…Unlike recreational drugs, steroids do not necessarily produce an immediate high or intoxicating effect. The literature available suggests that the reward experienced by the user comes much later in the form of these secondary reinforcers (Greenway & Price, ). In the present investigation, even though the participants did not describe themselves as AAS dependent, they exhibited many other features suggestive of dependence, such as the use of the drugs in larger amounts than originally intended, commitments of considerable time and money to obtain supplies of the drugs, and continued use of various drugs despite adverse physical or psychological effects.…”

“…Research suggests that significant signs of body anxiety in men may result in PIED use (Kanayama, Hudson, & Pope, 2010;Kanayama, Pope, Cohane, & Hudson, 2003). Interestingly, some authors have found this relationship to work in reverse, in which AAS use had led to body obsession and resulted in excessive training and body anxiety (Greenway & Price, 2018). The same authors went on to suggest that as body image issues were not mentioned before initiation to AAS, muscle dysmorphia symptoms were, in fact, a result post use (Greenway & Price, 2018).…”

“…Research has highlighted the use of PIEDs such as anabolic-androgenic steroids (AAS) in reducing body dissatisfaction and muscle dysmorphia symptoms (Grogan, 2006)a condition where individuals become preoccupied with the belief that they are small or weak (Pope Jr., Gruber, Choi, Olivardia, & Phillips, 1997). Recent qualitative work provides insight into the complexities of AAS use, showing initial motivations to use revolve around social acceptance, whereas the maintenance of use is primarily through secondary reinforcers such as self-esteem, confidence, and social acceptance (Greenway & Price, 2018). The authors also argue that AAS use becomes a part of an individual's identity, to the point that they do not know who they are apart from it (Greenway & Price, 2018).…”