Alienation and Lack of Trust

Abstract

Anabolic-androgenic steroid (AAS) use became illegal when the Norwegian Drug Act was amended in 2013, and AAS and other image- and performance-enhancing drugs were included in the politics and treatment of substance use. Few individuals with AAS-related health problems seek substance use disorder (SUD) treatment. This article aims to explore understandings of AAS dependence, barriers to treatment-seeking, and experiences of entering SUD treatment among a sample of men with AAS-related health problems struggling to cease AAS use. Seeking treatment for AAS-related health problems within SUD treatment services was described as alienating. First, because the participants experienced their struggle to quit using AAS to be different from being dependent upon psychoactive substances. They linked their struggles to symptoms of hormonal disturbance, need for a certain body size, and/or the sense of wellbeing provided by AAS and which enable them to function socially. Second, they experienced alienation because of their healthy identities, bodies and lifestyles, as opposed to how they viewed individuals with severe SUDs and emaciated bodies. A major barrier to treatment-seeking was participants’ lack of trust that SUD treatment providers had the knowledge and the means to provide treatment of their AAS-related health problems and struggle to quit AAS use. Experienced barriers towards seeking SUD treatment should be taken into account when planning, organizing and implementing health services for individuals with AAS-related health problems.

Health service engagement, side effects and concerns among men with anabolic-androgenic steroid use: a cross-sectional Norwegian study

“…The high satisfaction levels with private health care might reflect easier access to clinical examinations, testosterone substitution or PCT, including less reporting practises in private clinics. At the same time, mental health was the main motivating factor for seeking SUD treatment, as this therapeutic approach focuses mainly on psychosocial interventions and symptom-relieving treatment, targeting conditions such as depression, anxiety and sleep disorder [28].…”

“…Frequently reported reasons for not seeking treatment or not disclosing use are beliefs that physicians lack knowledge about AAS [23], or are not able to help [24]. Other reasons include concerns about stigma [25] or that the problem is not significant enough to seek help [21,[26][27][28]. Many prefer to seek information from peers [29,30] and online sources [31][32][33] on how to avoid and handle side effects [34].…”

A sentinel population: The public health benefits of monitoring enhanced body builders

“…A recent study in Norway reported that 28% of patients being treated for substance use disorders had used AAS (Havnes, Jorstad et al 2020), levels that are considerably higher than previous research in the United States (Kanayama, Cohane et al 2003). Yet AAS use is often poorly recognised and inadequately addressed within treatment settings (Havnes and Skogheim 2019) with AAS users at times using these drugs as self-directed treatment for the adverse effects of opiate dependence (Havnes, Jorstad et al 2020). This polypharmacy clearly requires ongoing investigation.…”