Psychosocial correlates of gap time to anabolic–androgenic steroid use

Objective: Theoretically, legal supplement use precedes and increases the risk for illicit appearance and performance enhancing drug (APED) use—also referred to as the gateway hypothesis. Little is known about associations between the speed of progression, or gap time, from legal to illicit APED use, and psychological risk factors, such as sociocultural influence, eating disorders, body image disturbance, and impulsivity. Method: The sample taken from two studies included 172 active steroid users (n = 143) and intense-exercising healthy controls (n = 29) between the ages of 18 and 60 (M = 34.16, SD = 10.43), the majority of whom were male (91.9%). Participants, retrospectively, reported APED use and completed measures assessing psychological and behavioral factors, including eating concern, muscle dysmorphia, and impulsivity. Participants had a gap time from initial APED use to anabolic–androgenic steroid (AAS) use that ranged from 0 to 38 years. Results: Continuous survival analysis indicated that interactions between self- versus other sociocultural influence on APED onset and both higher eating concern and impulsivity are associated with a shorter gap time from initial legal to illicit APED use. Discussion: The results indicate the potential value in developing different strategies for individuals with other sociocultural versus self-influence on illicit APED use, and among more impulsive and eating-concerned APED users. Future research is needed to assess different trajectories of APED use, such that eating-concerned and impulsive individuals who perceive less other sociocultural influence may be at greatest risk for a speedier progression to AAS use.