Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them.
Ostensibly, it is this perception of steroid users that has led the Queensland government to enact tougher penalties for steroids. The Safe Night out legislation increases the maximum penalty for possession or supply of steroids to 25 years in jail.
But tougher steroid laws are unlikely to have an impact on violence in the community because a) most steroid users are not violent, and b) other substances, including alcohol, are stronger risk factors for violent behaviour.
Who uses steroids?
The public perception of steroid users doesn’t match the reality.
The first red flag comes from demographic data. It turns out that in the United States, the typical steroid user is male, around 30 years old, has a bachelor’s degree, is employed full-time in a white-collar occupation, earns an above-average income, and does not play any form of competitive sport. Local data is lacking, but smaller studies of Australian steroid users corroborate this profile.
In a large US study of nearly 2,000 steroid users, the most-commonly reported occupations were in sales and marketing, information technology, banking and finance, health care, management and executives, and skilled labour. The least-commonly held occupations? Athletes, coaches, personal trainers and the military.
So these men don’t sound like a particularly violent bunch, but aren’t steroids still linked with increased aggression and violent behaviour?
How steroids affect behaviour
Some studies suggest that steroid users are more aggressive and irritable than non-users. Further, some population-based studies have found links between self-reported anabolic steroid use and self-reported involvement in aggressive and violent behaviour.
Arguably, however, the best data comes from studies where anabolic steroid use is objectively tested and violent behaviour is confirmed through legal records rather than self-report.
To this end, a Swedish retrospective cohort study that compared registered criminal activity among individuals who had tested positive for anabolic steroids to those who had tested negative for steroids found that those who tested positive were no more likely to have committed violent crimes.
In fact, after controlling for substance abuse, the researchers found a lower risk for crimes against property among those individuals who tested positive for anabolic steroids.
A general limitation of studies on steroid use and violent behaviour is that few have controlled for other forms of substance use, including alcohol.
A recent Swedish study examined the link between anabolic steroid use and violent crime in a sample of 3,594 remanded prisoners and found that 28% reported using steroids at least once in their lifetime. Prisoners who reported any lifetime use of steroids were 1.7 times more likely to be suspected of a violent crime. However, there was no temporal relation between the use of anabolic steroids and the suspected violent crime.
In contrast, there was a four-fold increase in the risk of violent crime if alcohol had been consumed 24 hours earlier. The average amount of alcohol consumed in the 24 hours prior to a violent offence was 107 grams, equivalent to 10.7 Australian standard drinks.
A second Swedish population study of 10,365 men found that 4.9% had been convicted for a violent crime and 0.7% reported anabolic steroid use. Further examination showed that violent offenders were five times more likely to report anabolic steroid use than non-offenders.
But after controlling for other forms of lifetime substance abuse, including alcohol, this association lost statistical significance. In other words, once the researchers looked at alcohol and other drugs, it appeared that anabolic steroids were not at all associated with violent crime.
Steroid use is probably not a proximal risk factor for violent behaviour. Rather, co-occurrence of abuse of other substances, including alcohol, are probably more to blame. Another possibility is that using anabolic steroids makes people more susceptible to the violence-inducing effects of other substances such as alcohol or amphetamines, an idea which has some support in animal research.
Cost of penalising steroid users
The potential benefit of tougher laws on steroid use to curb violence and antisocial behaviour must be weighed against the potential costs. The proportion of steroid users who disclose their use to health professionals, which is already low, will likely fall.
Community health-promotion services, such as needle exchanges, may see a drop in visits from steroid users concerned about the potential for discovery and prosecution.
Steroid use is undoubtedly growing in Australia. In New South Wales in 2007, the proportion of needle exchange service-users who reported that their last injection was steroids was just 2%. But by 2012 this had increased sixfold to 12%. Queensland fared no better: rising from 2% in 2007 to 11% in 2012. By 2012, almost two-thirds of all new service-users, or “new initiates,” reported that their last injection was anabolic steroids.
These men are not competitive athletes or criminals. Overwhelmingly, they are men who are unhappy with their appearance and want to look better.
For some, large parts of their self-worth or self-esteem are tied to their bodies and their appearance. If building muscle becomes a preoccupation, a mental condition called muscle dysmorphia, formerly named “reverse anorexia”, may develop. Little wonder that up to 50% of men with muscle dysmorphia also use steroids.
Derisively labelling steroid users as vain or narcissistic “gym bros” and disparaging their culture as “bruss” betrays a deep lack of compassion. There is a reason why extreme dieting and self-induced vomiting grew faster among Australian males than Australian females between 1998 and 2008 and a reason why teenage boys consistently rank body image among their top three major life concerns.
Our culture celebrates physically attractive and “masculine” men: tall, muscular, stiff upper-lipped. Research shows that media portrayals of men have become more and more muscular during the past few decades and the rise in steroid use in contemporary Australia is a symptom of men succumbing to body image pressures.
Solving this problem demands a compassionate understanding of the psychology behind why men start to use steroids. Too often we turn to outright denigration. We do not publicly berate girls for their attempts to look more attractive, so why do we berate men?
Tougher steroid laws are unlikely to have an impact on violence in the community. Rather, the steroid-using community will be driven further underground, making it more difficult to deliver health services to this misunderstood and under-served group of people, allowing the problem of steroids in Australia to grow even larger.