Anabolic ergogenic substance users in fitness-sports: A distinct group supported by the health care system

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Abstract

Background

Anabolic ergogenic substance use, in particular the use of anabolic androgenic steroids, is a serious problem in general. Nevertheless, it is subject to debate whether ergogenic substance users exhibit similar features as multiple substance users or whether they constitute a discrete group.

Methods

One thousand eight hundred and two standardized, anonymous questionnaires were distributed among visitors of 113 fitness centers. Questions were asked concerning biometric parameters, social indicators, physical fitness, use of natural stimulants, general illicit drugs and ergogenic substances. With logistic regression analysis, multivariate odds ratios were estimated to investigate the association of anabolic ergogenic substance or general illicit drug use with other parameters.

Results

13.5% of all participants confessed to having used anabolic ergogenic substances at some point in time. Anabolic ergogenic substance use was positively related with cocaine use, training years, training frequency, negatively related to the level of education, alcohol intake and less frequently used by Germans than by non-Germans. General illicit drug use, however, was positively related with alcohol intake, smoking and a university degree and negatively with having children. In addition, anabolic ergogenic substance use was significantly related with the use of general illicit drugs based on the strong relation with the use of cocaine, which is an ergogenic substance itself. The health care system supplies 48.1% of the anaolic ergogenic substance users with their substances and 32.1% are even monitored by a physician.

Conclusions

The results of this study strengthen the notion that anabolic ergogenic substance users constitute a specific body-oriented substance user group. Uncommon for general illicit drug use, the health care system is a major sponsor of anabolic ergogenic substance users. These findings suggest the need for alternative approaches for successful prevention and intervention programs.

Introduction

During the last 20 years the prevalence of anabolic ergogenic substance use has increased in Western societies. Anabolic ergogenic substances, like anabolic androgenic steroids (AAS) and clenbuterol, are illegal even if prescribed by a physician for non-therapeutic purposes and are prohibited in sports by the World Anti-Doping Agency in the list of prohibited substances and methods (WADA, 2004).

Studies in the US and Great Britain have indicated that especially AAS are being used more and more by younger people and no longer predominantly taken by elite athletes (Buckley et al., 1988, Korkia and Stimson, 1997). In the US, more than one million people with an average starting age of 18 years and with more than 250,000 high-school students among them are estimated to have used AAS (Durant et al., 1993, Yesalis et al., 1993, Goldberg et al., 1996). Indeed, recent studies have suggested that anabolic ergogenic substances and especially AAS are frequently used by regular fitness center visitors (Korkia, 1996, Kanayama et al., 2001).

The development and initiation of successful prevention programs should start with the identification of a reliable profile of anabolic ergogenic substance users. In the case of AAS, the user profile is controversial. On the one hand, studies using high-school students within the US and Europe have suggested that AAS use is generally associated with the use of other substances such as alcohol, nicotine or general illicit drugs (Durant et al., 1993, Bahrke et al., 2000, Nilsson et al., 2001). It has even been suggested that anabolic ergogenic substances provide a gateway for the use of general illicit drugs (Arvary and Pope, 2000). This phenomenon might be based on physiological effects or may simply be due to the black market contact as source of supply for both substance classes. On the other hand, it has been argued that AAS users want to improve their body rather than harm their health by drug consumption (Komoroski and Rickert, 1992, Kanayama et al., 2001). The latter view suggests, in contrast to the former one, a specific rather than a general substance user profile. For the development of prevention and intervention programs, it would certainly be beneficial to know which of these two views should be favored.

Unfortunately, it is difficult to assess these views on the basis of the existing literature on drug use. First, most studies surveyed high-school students (Buckley et al., 1988, Durant et al., 1993, Wichstrom and Pedersen, 2001). Thus, the conclusions of these studies are limited to this subgroup, which is particularly restricted with regard to age. Second, the conclusions of other studies are even more difficult to generalize because they were conducted on highly specialized groups such as bodybuilders (Lindstrom et al., 1990), elite athletes (Scarpino et al., 1990), football players (Goldberg et al., 1996) or drug clinic patients (Arvary and Pope, 2000). Finally, studies employing more heterogeneous groups only included AAS users (Yesalis et al., 1993, Korkia and Stimson, 1997) or over the counter drug users (Kanayama et al., 2001) and did not report parameters like body data, social indicators and parameters related to physical fitness, which are important for clarifying the ergogenic substance user profile (Bahrke et al., 2000).

The present study was designed to assess a broad range of anabolic ergogenic substance user-related variables, and used a more heterogeneous group of fitness center visitors as a study sample group. To evaluate the hypothesis of general versus specific substance use, the present study employed two logistic regression models. One model predicted general illicit drug consumption and the other anabolic ergogenic substance use based on various predictor variables, such as body-mass index, education, training frequency and alcohol consumption.

In addition, a detailed analysis of the characteristics associated with anabolic ergogenic substance use was conducted. Special attention was given to the source of supply of anabolic ergogenic substances, since it had been suggested that black market contact is responsible for an association of general illicit drug and anabolic ergogenic substance use (Kanayama et al., 2001, Wichstrom and Pedersen, 2001). It is hoped that the implications of these results together with the results from the logistic regression analysis will further prevention and intervention programs.

Section snippets

Study sample groups

The training directors of 113 fitness centers in Germany were recruited. These facilities reflect the whole spectrum of fitness centers and include a total of 90,100 members with an average of 797 members per center (range 250–2500). According to the official numbers of the German Association of Fitness Centers, the average facility had 800 members in 2001. The training directors were instructed to distribute an anonymous questionnaire to 2% of their total members, which had to be

Descriptive statistics

Table 1 summarizes the basic characteristics of all fitness center visitors. Most participants were male (62.8%). The average age of all participants was 33.7 years (S.D. = 10.6), their average BMI was 24.3 kg/m2 (S.D. = 4.3), and they were training for a median of 7 years (range 0.2–35 years). A high percentage (13.5%) of participants conceded that they had at some point used or were still using ergogenic substances; 98.5% of them used anabolic ergogenic substances according to the List of

Discussion

The purpose of this study was to elucidate whether anabolic ergogenic substance users show a propensity for general drug use, or whether they specifically use anabolic ergogenic substances and differ from the group of people using general illicit drugs with regard to basic characteristics. The results of the descriptive as well as the correlation analysis indicate that anabolic ergogenic substance users are a physical-achievement-oriented group adapted to society's stereotypes of body image,

Acknowledgement

This research was supported by internal funds only.

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