Differences in Mental Health, Risk Behaviors, and Social Determinants Among Anabolic-Androgenic Steroid Consumers With and Without Co-occurring Methamphetamine Use in Australia.

Objective: People who use anabolic-androgenic steroids (AAS) frequently engage in polypharmacy, with evidence highlighting recurrent co-use with amphetamine-like stimulants. While the independent risks of each substance are established, little is known about their combined impact in treatment-engaged populations. This study compared people who co-use AAS with methamphetamine (AAS-M) and without (AAS-non-meth [AAS-NM]) across mental health, risk behaviors, and social determinants. Methods: Intake data were drawn from Lives Lived Well (LLW), a large Australian non-government alcohol and other drug (AOD) service provider. Clients attending any LLW service Australia-wide between 1 November 2022 and 28 February 2025 reporting past three-month AAS use on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST) formed the analytic sample (N = 517). The sample was stratified into AAS-M (n = 429) and AAS-NM (n = 88) groups. Group differences in social, structural, and quality of life indicators were tested using χ2 and independent samples t-tests. Results: Compared to the AAS-NM group, clients in the AAS-M group were significantly more likely to report trauma, psychosis, and driving under the influence, with higher impulsivity scores on negative urgency, positive urgency, and sensation seeking (χ2 and t-tests, all p < .05; ϕ = .10-.12, d = -0.29 to -0.37). They also showed greater engagement in unsafe injecting and recent overdose (χ2, both p < .05). Social vulnerabilities were more pronounced, including elevated risks of homelessness, eviction, and recent violence (χ2, all p ≤ .01; ϕ = .11-.19). Finally, loneliness indicators were significantly higher among AAS-M clients (t-tests, both p < .01; d = -0.31 to -0.32). Conclusions: Co-use of AAS and methamphetamine among AOD service-engaged individuals is linked to heightened mental health concerns, risk behaviors, and social disadvantage. The findings indicate that AAS users who also use methamphetamine experience greater vulnerability than those who do not, underscoring the need for targeted responses within Australian treatment services.