Illicit Drug Use Among Gym-Goers: a Cross-sectional Study of Gym-Goers in Sweden.

BACKGROUND: The use of anabolic-androgenic steroids has increased among gym-goers, and it has been proposed that this may be part of a polysubstance use pattern that includes the use of illicit drugs. Still, epidemiological data on illicit drug use among gym-goers of both genders are meager. The aim of the present study was thus to examine the use of illicit drugs and its correlates in a large sample of men and women who engaged in weight training at gyms across Sweden. METHODS: In this cross-sectional study, a total of 1969 gym-goers who engaged in weight training in 54 gyms across Sweden were invited to fill in a questionnaire. The questionnaire included 25 items on background variables, weight training frequency, use of illicit drugs and doping substances, and non-medical use of benzodiazepines. RESULTS: Of the gym-goers, 19.6% reported having ever used illicit drugs, 6.5% reported use during the past 12 months, and 2.1% during the past 30 days. The most commonly used drug was cannabis, followed by cocaine, amphetamine, and ecstasy. Almost 40% of those who reported drug use had used more than one drug. Male participants and participants between 20 and 39 years of age made up the majority of users. Furthermore, 5.1% of the reported drug users had ever used a doping substance. There was an almost threefold higher odds (OR = 2.99, 95% CI = 1.16-7.66, p < 0.023) of doping use among people who had reported drug use as compared to non-users. CONCLUSIONS: Training at gyms is typically considered a health-promoting behavior. However, our results revealed a slightly higher prevalence of illicit drug use among gym attendees as compared to the general population. Our findings may have captured an underrecognized group of young adult males who engage in weightlifting and use illicit drugs recreationally and/or as training aids. Developing knowledge is imperative in orientating preventive efforts among at-risk gym-goers. TRIAL REGISTRATION: ISRCTN11655041.

Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA).

In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled "Rethinking alcohol interventions in health care". The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.

Effectiveness and implementation of a community-based prevention programme targeting anabolic androgenic steroid use in gyms: study protocol of a quasi-experimental control group study.

BACKGROUND: During the past decades, concerns about increased anabolic androgenic steroid (AAS) use among recreational sportspeople have been raised, yet there is a paucity of AAS prevention efforts targeting this group. Accordingly, doping prevention efforts aimed at gyms have been recommended. The overall objective of the present project is to examine a prevention programme named 100% Pure Hard Training (100% PHT), which targets AAS use among recreational sportspeople training in gyms. Specifically, the project aims to: 1) assess the prevalence of AAS, and its associations with alcohol, illicit drugs, and nutritional supplements use; 2) examine whether 100% PHT can decrease AAS use in gyms, and 3) provide insights into which factors facilitate and/or impede implementation of the programme. METHODS/DESIGN: The intervention group consists of 27 gyms, and 27 gyms serve as controls. Intervention gyms take part in 100% PHT, a community-based programme involving several components: (a) training of key stakeholders (i.e., gym staff, gym owners, local police, and municipal prevention coordinators) regarding AAS use; (b) developing an action plan for AAS prevention for each gym; (c) certification of gyms that follow 100% PHT; (d) cooperative relationship between stakeholders; (e) annual follow-up of gyms. The project consists of two studies: Study A will examine the prevalence of AAS use and the effectiveness of 100% PHT (aims 1 and 2), and data for Study A will be collected using questionnaires distributed to gym attendees at two assessment points: baseline (pre-intervention) and follow-up (post-intervention). Study B will evaluate the implementation of 100% PHT (aim 3), and semi-structured interviews with participating stakeholders will be carried out post-intervention. DISCUSSION: Knowledge gained from the present project can be used to develop community-based doping prevention efforts aimed at recreational sportspeople training in gyms. Furthermore, it can provide insights into which factors are important for successful implementation of AAS prevention programmes that target gyms. Results are also expected to yield information on the prevalence of AAS use as well as associations between the use of AAS and other licit and illicit substances, including nutritional supplements, among recreational sportspeople. TRIAL REGISTRATION: The study was registered retrospectively at isrctn.com (Identifier: ISRCTN11655041; Registration date: 3 November 2016;).

Yoga as an adjunct treatment for alcohol dependence: a pilot study.

OBJECTIVES: This pilot study explores the feasibility of yoga as part of a treatment program for alcohol dependence. DESIGN: Eighteen alcohol dependent patients were randomized to receive either treatment as usual or treatment as usual plus yoga. Assessments were taken at baseline and six month follow-up. SETTING: 'Riddargatan 1': an outpatient alcohol treatment clinic located in Stockholm, Sweden. INTERVENTIONS: Treatment as usual consisted of psychological and pharmacological interventions for alcohol dependence. The 10-week yoga intervention included a weekly group yoga session. Participants were encouraged to practice the yoga movements at home once per day. MAIN OUTCOME MEASURES: Alcohol consumption (timeline follow-back method, DSM-IV criteria for alcohol dependence, and the Short Alcohol Dependence Data questionnaire), affective symptoms (the Hospital Anxiety and Depression Scale), quality of life (Sheehan Disability Scale) and stress (the Perceived Stress Scale and saliva cortisol). RESULTS: Yoga was found to be a feasible and well accepted adjunct treatment for alcohol dependence. Alcohol consumption reduced more in the treatment as usual plus yoga group (from 6.32 to 3.36 drinks per day) compared to the treatment as usual only group (from 3.42 to 3.08 drinks per day). The difference was, however, not statistically significant (p = 0.17). CONCLUSIONS: Larger studies are needed to adequately assess the efficacy and long-term effectiveness of yoga as an adjunct treatment for alcohol dependence.

Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence.

BACKGROUND: Alcohol use disorders are highly prevalent worldwide. However, only a minority with alcohol dependence seek and undergo treatment. From a public health perspective, it is important to understand why people do not seek treatment. OBJECTIVES: This study aims to describe how people with alcohol dependence perceive and discuss treatment for alcohol use disorders and their reasons for seeking and not seeking treatment. METHODS: 32 alcohol dependent adults from the general population participated in focus groups and individual interviews in Stockholm during 2011-2012. Data were analyzed with thematic content analysis. RESULTS: Suffering from alcohol dependence, as well as realizing the need for, and entering treatment, were associated with shame and stigma, and were strong barriers to treatment. Other barriers included the desire to deal with alcohol problems on one's own and the view that seeking treatment required total abstinence. Negative health-effects were mainly a nonissue. The participants' knowledge about treatment options was limited to lifelong abstinence, medication with Disulfiram and residential treatment. These were seen as unappealing and contrasted sharply with preferred treatment. CONCLUSIONS/IMPORTANCE: Public health literacy regarding alcohol use, dependence, and treatment ought to be improved in order to lower barriers to treatment. Treatment services need to better match the needs and wishes of potential service users, as well as taking stigmatization into account. In order to develop suitable treatments, and to reach the majority who do not seek treatment, the clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence.