Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Nordic Studies on Alcohol and Drugs

The Journal of Nordic Centre for Welfare and Social Issues

6 Issues per year


IMPACT FACTOR 2016: 0.746

CiteScore 2016: 0.54

SCImago Journal Rank (SJR) 2016: 0.348
Source Normalized Impact per Paper (SNIP) 2016: 0.383

Open Access
Online
ISSN
1458-6126
See all formats and pricing
More options …
Ahead of print

No issues found

Anabolic-androgenic Steroid Use in the Nordic Countries: A Meta-analysis and Meta-regression Analysis

Dominic Sagoe / Torbjørn Torsheim / Helge Molde / Cecilie Schou Andreassen
  • Department of Psychosocial Science, University of Bergen, Norway
  • The Competence Center, Bergen Clinics Foundation, Norway
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ståle Pallesen
Published Online: 2014-12-16 | DOI: https://doi.org/10.2478/nsad-2014-0037

Abstract

AIMS – To investigate the lifetime prevalence and moderators of non-medical AAS use in the five Nordic countries. METHODS – We conducted a meta-analysis and meta-regression using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference checks. Included were 32 studies that provided original data on 48 lifetime prevalence rates based on a total of 233,475 inhabitants of the Nordic countries. RESULTS – The overall lifetime prevalence obtained was 2.1% [95% confidence interval (CI): 1.3-3.4, I 2 = 99.5, P < 0.001]. The prevalence for males, 2.9% (95% CI: 1.7-4.8, I 2 = 99.2, P < 0.001), was significantly higher (Qbet = 40.5, P < 0.001) than the rate for females, 0.2% (95% CI: 0.1-0.4, I 2 = 90.5, P < 0.001). Sweden has the highest prevalence of AAS use: 4.4%, followed by Norway: 2.4%, Finland: 0.8%, Iceland: 0.7%, and Denmark: 0.5%. Country, sample type, and male sample percentage significantly predicted AAS use prevalence in a meta-regression analysis. No indication of publication bias was found. CONCLUSION – Though subject to some limitations, our findings suggest that non-medical AAS use should be regarded as a serious public health problem in the Nordic countries.

Keywords: anabolic steroids; Nordic countries; Scandinavia; prevalence; meta-analysis; meta-regression

References

  • Andrade, A. G., Duarte, P. C. A. V., Barroso, L. P., Nishimura, R., Alberghini, D. G., & Oliveira, L. G. (2012). Use of alcohol and other drugs among Brazilian college students: Effects of gender and age. Revista Brasileira de Psiquiatria, 34(3), 294–305.CrossrefGoogle Scholar

  • Bahrke, M. S., & Yesalis, C.E. (2004). Abuse of anabolic androgenic steroids and related substances in sport and exercise. Current Opinion in Pharmacology, 4(6), 614–620.CrossrefGoogle Scholar

  • Baker, J. S., Thomas, N. E., Davies, B., & Graham, M. R. (2008). Anabolic androgenic steroid (AAS) abuse: Not only an elite performance issue? Open Sports Medicine Journal, 2, 38–39.Google Scholar

  • Biostat Inc. (2014). Comprehensive Meta- Analysis Version 3.0. Englewood, NJ.: Biostat Inc.Google Scholar

  • Bojsen-Møller, J., & Christiansen, A. V. (2010). Use of performance-and image-enhancing substances among recreational athletes: A quantitative analysis of inquiries submitted to the Danish anti-doping authorities. Scandinavian Journal of Medicine and Science in Sports, 20(6), 861–867.CrossrefGoogle Scholar

  • Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2009). Introduction to Meta- Analysis. Chichester, West Sussex: Wiley- Blackwell.Google Scholar

  • Boyadjiev, N., Georgieva, K., Massaldjieva, R., & Gueorguiev, S. (2000). Reversible hypogonadism and azoospermia as a result of anabolic-androgenic steroid use in a bodybuilder with personality disorder. A case report. Journal of Sports Medicine and Physical Fitness, 40(3), 271–274.Google Scholar

  • Calabria, B., Degenhardt, L., Nelson, P., Bucello, C., Lynskey, M., Hall, W., Roberts, A., & McLaren, J. (2009). Methodology used in a systematic review of evidence on the prevalence of cannabis use and dependence. Global Burden of Disease Mental Disorders and Illicit Drug Use Expert group. Illicit drugs discussion paper No. 14. Sydney: National Drug and Alcohol Research Centre, University of New South Wales.Google Scholar

  • Degenhardt, L., & Hall, W. (2012). The extent of illicit drug use, dependence, and their contribution to global burden of disease. Lancet, 379(9810), 55–70.CrossrefPubMedGoogle Scholar

  • Dodge, T., & Hoagland, M. F. (2011). The use of anabolic androgenic steroids and polypharmacy: a review of the literature. Drug and Alcohol Dependence, 114(2-3), 100–109.Google Scholar

  • Dodge, T. L., & Jaccard, J. J. (2006). The effect of high school sports participation on the use of performance-enhancing substances in young adulthood. Journal of Adolescent Health, 39(3), 367–373.CrossrefGoogle Scholar

  • Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463.PubMedCrossrefGoogle Scholar

  • Gårevik, N., & Rane, A. (2010). Dual use of anabolic-androgenic steroids and narcotics in Sweden. Drug and Alcohol Dependence, 109(1), 144–146.CrossrefGoogle Scholar

  • Gmel, G., & Daeppen, J. B. (2007). Recall bias for seven-day recall measurement of alcohol consumption among emergency department patients: Implications for case-crossover designs. Journal of Studies on Alcohol and Drugs, 68, 303–310.Google Scholar

  • Grace, F., Baker, J., & Davies, B. (2001). Anabolic androgenic steroid use in recreational gym users: a regional sample of the Mid-Glamorgan area. Journal of Substance Use, 6(3), 189–195.Google Scholar

  • Hakansson, A., Mickelsson, K., Wallin, C., & Berglund, M. (2012). Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. European Addiction Research, 18(2), 83–90.PubMedCrossrefGoogle Scholar

  • Haug, J., & Ingvaldsen, R. (1974). Noen synspunkter pa bruken av hormonpreparater blant aktive idrettsutøvere [Some views on the use of hormone drugs among active athletes]. Oslo: Institute of Psychology, University of Oslo.Google Scholar

  • Hibell, B., Anderson, B., Ahlström, S., Balakieva, O., Bjarnason, T., Kokkevi, A., & Morgan, M. (2000). The 1999 ESPAD report. Alcohol and other drug use among students in 30 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).Google Scholar

  • Hibell, B., Anderson, B., Bjarnason, T., Ahlström, S., Balakieva, O., Kokkevi, A., & Morgan, M. (2004). The ESPAD Report 2003. Alcohol and other drug use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).Google Scholar

  • Hibell, B., Andersson, B., Bjarnason, T., Kokkevi, A., Morgan, M., & Narusk, A. (1997). Alcohol and other drug use among students in 26 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe.Google Scholar

  • Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2012). The 2011 ESPAD report: substance use among students in 36 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).Google Scholar

  • Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2007). The 2007 ESPAD report. Substance use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN), The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).Google Scholar

  • Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., & Kraus, L. (2009). The 2007 ESPAD report. Substance use among students in 35 European countries. The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden.Google Scholar

  • Hoffman, J. R., & Ratamess, N.A. (2006). Medical issues associated with anabolic steroid use: are they exaggerated. Journal of Sports Science and Medicine, 5(2), 182–193.Google Scholar

  • Johnson, M. D., Jay, M. S., Shoup, B., & Rickert, V.I. (1989). Anabolic steroid use by male adolescents. Pediatrics, 83(6), 921–924.PubMedGoogle Scholar

  • Kanayama, G., Boynes, M., Hudson, J. I., Field, A. E., & Pope Jr., H. G., (2007). Anabolic steroid abuse among teenage girls: An illusory problem? Drug and Alcohol Dependence, 88, 156–162.CrossrefGoogle Scholar

  • Kanayama, G., Hudson, J. I., & Pope Jr., H. G. (2008). Long-term psychiatric and medical consequences of anabolic–androgenic steroid abuse: A looming public health concern? Drug and Alcohol Dependence, 98(1), 1–12.CrossrefGoogle Scholar

  • Kanayama, G., Hudson, J. I., & Pope Jr., H. G. (2010). Illicit anabolic–androgenic steroid use. Hormones and Behavior, 58(1), 111–121.CrossrefPubMedGoogle Scholar

  • Kanayama, G., Hudson, J. I., & Pope Jr., H. G. (2012). Culture, psychosomatics and substance abuse: The example of body image drugs. Psychotherapy and Psychosomatics, 81(2), 73–78.CrossrefPubMedGoogle Scholar

  • Kindlundh, A. M., Isacson, D. G., Berglund, L., & Nyberg, F. (1998). Doping among high school students in Uppsala, Sweden: A presentation of the attitudes, distribution, side effects, and extent of use. Scandinavian Journal of Public Health, 26(1), 71–74.CrossrefGoogle Scholar

  • Klötz, F., Petersson, A., Hoffman, O., & Thiblin, I. (2010). The significance of anabolic androgenic steroids in a Swedish prison population. Comprehensive Psychiatry, 51(3), 312–318.CrossrefGoogle Scholar

  • Korte, T., Pykäläinen, J., & Seppälä, T. (1998). Drug abuse of Finnish male prisoners in 1995. Forensic Science International, 97(2-3), 171–183.PubMedCrossrefGoogle Scholar

  • Leifman, H., Rehnman, C., Sjöblom, E., & Holgersson, S. (2011). Anabolic androgenic steroids—use and correlates among gym users—an assessment study using questionnaires and observations at gyms in the Stockholm region. International Journal of Environmental Research and Public Health 8(7), 2656–2674.CrossrefGoogle Scholar

  • Lindqvist, A. S., Moberg, T., Eriksson, B. O., Ehrnborg, C., Rosén, T., & Fahlke, C. (2013). A retrospective 30-year follow-up study of former Swedish-elite male athletes in power sports with a past anabolic androgenic steroids use: A focus on mental health. British Journal of Sports Medicine, 47, 965–969.CrossrefPubMedGoogle Scholar

  • Lindström, M., Nilsson, A., Katzman, P., Janzon, L., & Dymling, J. F. (1990). Use of anabolic-androgenic steroids among body builders—frequency and attitudes. Journal of Internal Medicine, 227(6), 407–411.CrossrefPubMedGoogle Scholar

  • Ljungqvist, A. (1975). The use of anabolic steroids in top Swedish athletes. British Journal of Sports Medicine, 9(2), 82.CrossrefPubMedGoogle Scholar

  • Lood, Y., Eklund, A., Garle, M., & Ahlner, J. (2012). Anabolic androgenic steroids in police cases in Sweden 1999–2009. Forensic Science International, 219(1-3), 199–204.PubMedCrossrefGoogle Scholar

  • Lorang, M., Callahan, B., Cummins, K. M., Achar, S., & Brown, S. A. (2011). Anabolic androgenic steroid use in teens: Prevalence, demographics, and perception of effects. Journal of Child and Adolescent Substance Abuse, 20(4), 358–369.Google Scholar

  • Lundholm, L., Haggård, U., Möller, J., Hallqvist, J., & Thiblin, I. (2013). The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: A case-crossover study. Drug and Alcohol Dependence, 129(1-2), 110–115.CrossrefGoogle Scholar

  • Lundholm, L., Käll, K., Wallin, S., & Thiblin, I. (2010). Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug and Alcohol Dependence, 111(3), 222–226.CrossrefGoogle Scholar

  • Mattila, V., Parkkari, J., Laakso, L., Pihlajamäki, H., & Rimpelä, A. (2009). Use of dietary supplements and anabolic-androgenic steroids among Finnish adolescents in 1991–2005. European Journal of Public Health, 20(3), 306–311.PubMedGoogle Scholar

  • Mattila, V., Rimpelä, A., Jormanainen, V., Sahi, T., & Pihlajamäki, H. (2010). Anabolic-androgenic steroid use among young Finnish males. Scandinavian Journal of Medicine and Science in Sport, 20(2), 330–335.Google Scholar

  • Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Medicine, 6(6), e1000097.CrossrefGoogle Scholar

  • Nilsson, S. (1995). Androgenic anabolic steroid use among male adolescents in Falkenberg. European Journal of Clinical Pharmacology, 48, 9–11.PubMedGoogle Scholar

  • Nilsson, S., Baigi, A., Marklund, B., & Fridlund, B. (2001a). Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden. Scandinavian Journal of Primary Health Care, 19(3), 181–182.Google Scholar

  • Nilsson, S., Baigi, A., Marklund, B., & Fridlund, B. (2001b). The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden. European Journal of Public Health, 11(2), 195–197.CrossrefGoogle Scholar

  • Nilsson, S., Spak, F., Marklund, B., Baigi, A., & Allebeck, P. (2005). Attitudes and behaviors with regards to androgenic anabolic steroids among male adolescents in a county of Sweden. Substance Use and Misuse, 40(1), 1–12.Google Scholar

  • Nøkleby, H. (2013). Use of doping agents and symptoms of eating disorders among male and female patients in drug addiction treatment. Nordic Studies on Alcohol and Drugs, 30(4), 331–346.Google Scholar

  • Pagonis, T. A., Angelopoulos, N. V., Koukoulis, G. N., & Hadjichristodoulou, C. S. (2006). Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. European Psychiatry, 21, 551–562.CrossrefGoogle Scholar

  • Pallesen, S., Jøsendal, O., Johnsen, B.-H., Larsen, S., & Molde, H. (2006). Anabolic steroid use in high school students. Substance Use and Misuse, 41(13), 1705–1717.PubMedGoogle Scholar

  • Parkinson, A. B., & Evans, N. A. (2006). Anabolic androgenic steroids: a survey of 500 users. Medicine and Science in Sports and Exercise, 38(4), 644–651.CrossrefGoogle Scholar

  • Pope Jr., H. G., & Kanayama, G. (2012). Anabolic–androgenic steroids. In J. Verster, K. Brady, M. Galanter, & P. Conrod (Eds.), Drug abuse and addiction in medical illness: Causes, consequences and treatment (pp. 251–264). New York: Springer.Google Scholar

  • Pope Jr., H. G., Kanayama, G., & Hudson, J. I. (2012). Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study. Biological Psychiatry, 71(3), 254– 261.PubMedCrossrefGoogle Scholar

  • Pope Jr., H. G., Kanayama, G., Athey, A., Ryan, E., Hudson, J. I., & Baggish, A. (2013). The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates. American Journal of Addictions, doi: 10.1111/j.1521- 0391.2013.12118.x [Epub ahead of print]CrossrefGoogle Scholar

  • Sagoe, D., Molde, H., Andreassen, C. S., Torsheim, T., & Pallesen, S. (2014a). The global epidemiology of anabolic-androgenic steroid use: A meta-analysis and meta-regression analysis. Annals of Epidemiology, 24(5), 383–398.CrossrefPubMedGoogle Scholar

  • Sagoe, D., Andreassen, C. S., Molde, H., Torsheim, T., & Pallesen, S. (2014b). Prevalence and correlates of anabolic-androgenic steroid use in a nationally representative sample of 17 year-old Norwegian adolescents. Substance Use and Misuse, doi: 10.3109/10826084.2014.958859 [Epub ahead of print].CrossrefGoogle Scholar

  • Singhammer, J. (2013). Attitudes toward anabolic-androgenic steroids among non-competing athletes in various types of sports–a cross-sectional study. Sport Science Review, 22(1), 109–128.Google Scholar

  • Solberg, S. (1974). Unpublished data. In: Solberg, S., 1982. Anabolic steroids and Norwegian weightlifters. British Journal of Sports Medicine, 16(3), 169–171.Google Scholar

  • Striegel, H., Simon, P., Frisch, S., Roecker, K., Dietz, K., Dickhuth, H.-H., et al. (2006). Anabolic ergogenic substance users in fitness-sports: A distinct group supported by the health care system. Drug and Alcohol Dependence, 81(1), 11–19.CrossrefGoogle Scholar

  • Stroup, D. F., Berlin, J. A., Morton, S. C., Olkin, I., Williamson, G. D., Rennie, D., et al. (2000). Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283, 2008–2012.Google Scholar

  • Swedish National Institute of Public Health, & Lund University. (2009). Sub study in the Swedish National Institute of Public Health’s prevalence project with the aim of surveying narcotics use in Sweden. Unpublished study. Stockholm: Swedish National Institute of Public Health.Google Scholar

  • Swedish National Institute of Public Health. (1991). Lagen om förbud mot vissa dopningsmedel. [Act prohibiting certain doping substances.] Stockholm: Government of Sweden.Google Scholar

  • Tanner, S. M., Miller, D. W., & Alongi, C. (1995). Anabolic steroid use by adolescents: Prevalence, motives, and knowledge of risks. Clinical Journal of Sport Medicine, 5(2), 108–115.CrossrefGoogle Scholar

  • Thorlindsson, T., & Halldorsson, V. (2010). Sport, and use of anabolic androgenic steroids among Icelandic high school students: a critical test of three perspectives. Substance Abuse Treatment, Prevention, and Policy, 5(1), 1–11.Google Scholar

  • Urhausen, A., Albers, T., & Kindermann, W. (2004). Are the cardiac effects of anabolic steroid abuse in strength athletes reversible? Heart, 90(5), 496–501.PubMedCrossrefGoogle Scholar

  • Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: the kappa statistic. Family Medicine, 37(5), 360–363.PubMedGoogle Scholar

  • Wichstrøm, L. (2006). Predictors of future anabolic androgenic steroid use. Medicine and Science in Sports and Exercise, 38(9), 1578–1583.CrossrefGoogle Scholar

  • Wichstrøm, L., & Pedersen, W. (2001). Use of anabolic-androgenic steroids in adolescence: Winning, looking good or being bad? Journal of Studies on Alcohol, 62(1), 5–13.Google Scholar

  • Yesalis, C. E., & Bahrke, M.S. (2008). Anabolic-androgenic steroids. Sports Medicine, 19(5), 326–340.Google Scholar

About the article

Received: 2014-03-19

Accepted: 2014-05-21

Published Online: 2014-12-16


Citation Information: Nordic Studies on Alcohol and Drugs, ISSN (Online) 1458-6126, DOI: https://doi.org/10.2478/nsad-2014-0037.

Export Citation

© 2014 Dominic Sagoe et. al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

Comments (0)

Please log in or register to comment.
Log in