Prospective Associations between Adverse Childhood Experiences and Performance-Enhancing Substances Use Among Young Adults

Background and Purpose: Performance-enhancing substances, both legal (e.g. creatine) and illegal (e.g. anabolic-androgenic steroids) are widely used among young people, particularly boys and men. Overall, little is known about that risk factors that lead to performance-enhancing substances use while research has consistently shown that adverse childhood experiences (ACES) lead to substance use problems later in life. This study aimed to identify the prospective association between ACES and legal and illegal performance-enhancing substances use in young adulthood.

Methods: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I-III (1994-2002). Logistic regressions were used to analyze the association between ACES (physical abuse, sexual abuse, and neglect) retrospectively assessed at Wave III and lifetime steroid use, past year legal performance-enhancing substances use, and weight gain goals at Wave III. Logistic regressions were also used to analyze the association between total number of ACES (0-4) and lifetime steroid use, past year legal performance-enhancing substances use, and weight gain goals at Wave III. Analyses were adjusted for demographic and confounding variables.

Results: Among the sample of 14,322, both men and women who experienced ACES had greater odds of using both legal and illegal performance-enhancing substances, as well as endorsing weight gain goals. For example, among men, physical abuse (AOR 1.70, 95% CI 1.04-2.77), sexual abuse (AOR 9.12, 95% CI 5.48-15.18), basic needs not being met (AOR 3.58, 95% CI 2.37-5.41), and being left alone (AOR 2.46, 95% CI 1.55-3.91) were associated with higher odds of using anabolic-androgenic steroids while adjusting for demographic and confounding variables. Among women, sexual abuse (AOR 5.76, 95% CI 2.34-14.16) and basic needs not being met (AOR 2.96, 95% CI 1.45-6.05) were associated with higher odds of using anabolic-androgenic steroids while adjusting for demographic and confounding variables. Among men, sexual abuse (AOR 1.58, 95% CI 1.01-2.48) and being left alone (AOR 1.23, 95% CI 1.03-1.48) were associated with higher odds of using legal performance-enhancing substances while adjusting for demographic and confounding variables. Among women, sexual abuse (AOR 3.79, 95% CI 1.66-8.66) and being left alone (AOR 2.11, 95% CI 1.13-3.92) were associated with higher odds of using legal performance-enhancing substances while adjusting for demographic and confounding variables. Among both men and women, greater number of cumulative ACES were associated with higher odds of using both legal and illegal performance-enhancing substances, as well as endorsing weight gain goals.

Conclusions and Implications: Adverse childhood experiences have been known to increase the likelihood of mental health diagnoses and substance abuse problems. This study is among the first to show that ACES are prospectively associated with higher likelihood of using both legal and illegal performance-enhancing substances, as well as endorsing weight gain goals, among both men and women. Individuals may use performance-enhancing substances and strive to gain weight in order to live in a larger, stronger, more muscular body to protect against additional interpersonal traumas. The results from this study provide further emphasis for reducing childhood trauma which will ensure the healthy development of all youth.