Problematic alcohol use linked to legal performance-enhancing substances

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A study published in the journal Pediatrics found that young adults aged 18 to 26 who used legal performance-enhancing substances were significantly more likely to report several problematic alcohol use and drinking-related risk behaviours seven years later, reports the University of Toronto. This relationship was especially strong among men.

The study, which analysed a sample of more than 12,000 United States participants from the National Longitudinal Study of Adolescent Health (Add Health), highlights the need for more research and government oversight and regulation of legal performance-enhancing substances.

“The results from our study are concerning given the common use of legal performance-enhancing substances among young people, particularly boys and men,” said Kyle T Ganson, the study lead author and Assistant Professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto.

Performance-enhancing substances can be legal, such as creatine monohydrate or protein powders, or illegal, such as anabolic-androgenic steroids.

Research has consistently shown adverse health and social outcomes due to the illegal use of unprescribed steroid use, but few studies have been conducted to identify outcomes associated with legal performance-enhancing substance use.

Some findings

The researchers found that men who used legal performance-enhancing substances were more likely to experience five alcohol use problems and risk behaviours.

This included binge drinking, getting hurt or engaging in risky behaviours while under the influence of alcohol, experiencing legal problems while under the influence of alcohol, continued alcohol use despite emotional or physical health problems, and reduced activities and socialisation that interfered with alcohol use.

“Risky alcohol use is a serious problem for adult men, who have higher rates of death associated with alcohol use compared to women,” said Ganson. “Problematic alcohol use ultimately impedes economic and employment success, and increases health care and law enforcement costs.”

According to the University of Toronto material, Ganson hypothesises that the social pressure that boys and men feel to achieve a lean and muscular body type may explain the different results between genders.

"For most boys and men, this body ideal is unattainable, leading to performance-enhancing substance use," he said. "This body image contrasts with the thin ideal for girls and women."

There are other reasons to be concerned about legal performance-enhancing substances.

“Legal performance-enhancing substances are unregulated by the Food and Drug Administration,” said senior author Jason M Nagata, MD, assistant professor at the University of California, San Francisco's Department of Pediatrics.

“These substances are also commonly mislabeled and may contain harmful ingredients, such as anabolic steroids, which can lead to heart, liver, and kidney problems and worsen mental health."

An earlier study, led by Nagata and published in JAMA Pediatrics, also showed a relationship between legal performance-enhancing substances and later use of illegal anabolic-androgenic steroids.

Some recommendations

The study's authors say health professionals and policy-makers need to adjust their practices and goals to account for the gateway-like relationship they have observed between alcohol use and legal performance-enhancing substances, reports the University of Toronto.

"Health professionals should screen for these behaviours and counsel young people about potential health risks," said Ganson. “We also need state and federal policy-makers to begin to take these substances seriously and recognise the adverse effects they have on youth."

Several states, including Massachusetts, California and New York are making efforts to regulate the sale of these substances to young people.

"These legislative efforts are a great start and we need to get them passed into law," said Ganson. "I hope that we see more efforts from federal regulators."

 

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults

The journal Pediatrics. September 2020, 146 (3).

Authors

Kyle T Ganson, Deborah Mitchison, Stuart B Murray and Jason M Nagata

Abstract

Background

Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors.

Methods

We analysed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994–2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use–associated risk behaviors (Wave IV), adjusting for potential confounders.

Results

Among the sample of 12,133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13–1.70).

Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviours, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07–1.71), injurious and risky behaviours (aOR 1.78; 95% CI 1.43–2.21), legal problems (aOR 1.52; 95% CI 1.08–2.13), cutting down on activities and socialisation (aOR 1.91; 95% CI 1.36–2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04–1.99).

Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20–7.44).

Conclusion

Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviours, particularly among young men.

 

Problematic alcohol use linked to legal performance-enhancing substances

 

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults

 


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