The anabolic androgenic steroid treatment gap: a national study of substance use disorder treatment

Background Anabolic-androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use amongst people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD-treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results Lifetime AAS use was reported by 156 (28.3%) SUD-patients, thereof 35.6 % of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%)of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS. Conclusion Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use amongst SUD patients, and the level of competence among health professionals