Search

In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK, USA, Canada, Australia, Slovenia, Norway, Spain, Turkey, Switzerland, Japan, and five global studies and were published between 1996 and 2021. Age ranged overall from 14 to 78 years old, however our review only discussed findings pertaining to those older than 40. Three main themes with subthemes were generated as follows: 1) Characteristics of AAS Use; Self-reported Adverse Effects from AAS Use; and Harms Diagnosed by Medical Professional. The review highlights the significant risks to hypothalamic-pituitary testicular function, cardiovascular health, and other organ systems as a result of the ageing man who is motivated to sustain masculine characteristics such as muscularity, youthfulness, sexual function, and perceived desirability and attractiveness. Future research is required to further understand the motivations of older men who use AAS. Furthermore, there is a need for age-specific research and recommendations to inform future policy and practice pertaining so that age-appropriate healthcare and policy decisions can be made in the future.

The Internet offers increased availability and accessibility of medicinal pharmaceuticals including those containing opioids, sedatives and gamma-aminobutyric acid (GABA) drugs through both legal and illegal routes. Sourcing concerns have been further heightened due to the current severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic which reduced face-to-face access for non-COVID-19 related health conditions and to drug treatment services. This study is the second of a two stage study comprising interviews with three key stakeholders who were policy makers, health care professionals or police, and three individuals who sourced medicinal products online (ISOs). An in-depth case study approach was adopted. Thematic analysis of in-depth case narratives revealed the following key themes; Motivations, initiation, and making the move online; Process of sourcing online; Supply issues and COVID-19; Perception of control; Quality of medications; and Public health recommendations. Motivations for purchasing online are complex and methods to divert and control the supply of medicinal pharmaceuticals are equally complex and difficult to navigate. Novel routes to access now include Telegram, a cross-platform messaging service with enhance encryption and privacy. Whilst stakeholders and ISOs had similar views on the prevalence and ease of access to medication, there were also some substantial differences primarily in terms of perceptions of risk. This study highlights the need for enhanced pharmacovigilance of non-regulated online vendors and the imperatives of continued health messaging around the potential self-directed use of these controlled drugs and the dangers of using websites purporting to be regulated pharmacies.

Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in the UK these are lacking. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the key parameters needed for indirect estimation from attendances at needle and syringe programmes (NSP) for AAS use. An expert panel (n = 63) was surveyed three times (n = 40, 39, and 37) to refine the parameters needed to generate a likely range from data on NSP attendances. A broad agreement was reached on: regional variations in use; the proportion of men using AAS who only use them orally; the proportion of men who inject AAS using NSP; and the proportion of the AAS population who are women. We conclude that previous general population survey-based estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics.

Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in the UK these are lacking. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the key parameters needed for indirect estimation from attendances at needle and syringe programmes (NSP) for AAS use. An expert panel (n = 63) was surveyed three times (n = 40, 39, and 37) to refine the parameters needed to generate a likely range from data on NSP attendances. A broad agreement was reached on: regional variations in use; the proportion of men using AAS who only use them orally; the proportion of men who inject AAS using NSP; and the proportion of the AAS population who are women. We conclude that previous general population survey-based estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics.

Introduction Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. Objective To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). Methods Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. Results Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. Conclusion Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.

Background: Effective harm reduction work is needed to prevent and respond to the harms associated with image and performance enhancing drug (IPED) use and the diverse needs of IPED communities. Methods based around understanding and mapping complex systems have previously been applied to advance thinking on a range of complex health issues. We applied a systems perspective to explore factors that contribute to IPED-related harms in the UK and to identify harm reduction priorities. Methods: An illustrative systems map was developed based on methods for mapping complex systems with expert stakeholders. Participants in two online workshops debated the important factors contributing to harm amongst people who use IPEDs and helped to refine and clarify the map. Discussions using the map reflected on where in the system intervention is needed and the policy implications. Results: Stakeholders (n=18) identified 51 distinct factors as being important determinants of IPEDs-related harms, and the connections between them. These were grouped under nine domains that formed this system: identity, cognitive processes, beliefs about risk and harm, health and wellbeing, social environment, beliefs about healthcare, healthcare providers, interventions, and IPED markets. Four harm reduction priorities identified through reflexive discussion included providing a wider range of interventions, improving engagement between the IPED communities and healthcare professionals, new approaches to disseminating information in the community, and early intervention. Conclusion: Systems mapping methods are a useful approach to engage stakeholders to discuss drug use issues. A comprehensive policy response is required to this complex issue that recognises diversity in IPEDs communities, their decision-making, and their intervention and service needs, as current approaches are failing to adequately address important areas of harm. Engaging with a wide range of stakeholders is critical to generate n

Background: Effective harm reduction work is needed to prevent and respond to the harms associated with image and performance enhancing drug (IPED) use and the diverse needs of IPED communities. Methods based around understanding and mapping complex systems have previously been applied to advance thinking on a range of complex health issues. We applied a systems perspective to explore factors that contribute to IPED-related harms in the UK and to identify harm reduction priorities. Methods: An illustrative systems map was developed based on methods for mapping complex systems with expert stakeholders. Participants in two online workshops debated the important factors contributing to harm amongst people who use IPEDs and helped to refine and clarify the map. Discussions using the map reflected on where in the system intervention is needed and the policy implications. Results: Stakeholders (n=18) identified 51 distinct factors as being important determinants of IPEDs-related harms, and the connections between them. These were grouped under nine domains that formed this system: identity, cognitive processes, beliefs about risk and harm, health and wellbeing, social environment, beliefs about healthcare, healthcare providers, interventions, and IPED markets. Four harm reduction priorities identified through reflexive discussion included providing a wider range of interventions, improving engagement between the IPED communities and healthcare professionals, new approaches to disseminating information in the community, and early intervention. Conclusion: Systems mapping methods are a useful approach to engage stakeholders to discuss drug use issues. A comprehensive policy response is required to this complex issue that recognises diversity in IPEDs communities, their decision-making, and their intervention and service needs, as current approaches are failing to adequately address important areas of harm. Engaging with a wide range of stakeholders is critical to generate n

Introduction Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. Objective To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). Methods Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. Results Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. Conclusion Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications worldwide and have analgesic, antipyretic and anti-inflammatory properties. Although NSAIDs are recognised as generally safe and effective, non-medical and extra-medical use of these products can arise. Unlike use of illegal and many prescription drugs, which are subject to extensive research attention, inappropriate use of NSAIDs has been less well investigated. This scoping review collates and describes what is known regarding non-medical and extra-medical use of NSAIDs. Seventy two studies were included in this scoping review. Three themes emerged from the review: Theme 1: Indicative profile of people who engage in non-medical or extra medical use of NSAIDS; Theme 2: Antecedents for non-medical or extra-medical use; and Theme 3: Adverse health effects of non-medical and extra-medical use of NSAIDs. The review concluded that there is a need for enhanced patient education, including among sports people, pharmacovigilance in terms of clinician recognition of aberrance and prescriber and pharmacist awareness of the potential for extra medical, non-medical use and the related health harms.

Sourcing and self-medication of medicinal pharmaceuticals including those containing opioids obtained from nonregulated online suppliers is a serious public health issue. The main concerns include a lack of quality control, drug side effects, drug interactions, diversion and possible pathway to drug dependence. The internet offers increased availability and accessibility of these medicines through both legal routes obtaining pharmaceuticals on prescription and illegal routes via websites on both the surface and Dark Web. The impact of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic reduced face-to face access for non-COVID-19 related health conditions and to drug treatment services. This study provides an overview of the extent of online sourcing of UK controlled medicines (opioids, sedatives and GABA drugs) from unregulated suppliers and estimates of customer interest, in particular focusing on the COVID-19 lockdown period in the UK, where access to some healthcare services was limited. Whilst it was not possible to identify an increase for online searches for controlled medicines over the past five years, or during the COVID-19 period, searches remained plentiful, in particular for oxycodone, morphine and diazepam. This study highlights the need for enhanced pharmacovigilance of non-regulated online suppliers and the imperatives of continued health messaging around the potential abuse of these controlled drugs and the dangers of using sites purporting to be regulated pharmacies.

Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to significant associated harms and fatalities this practice has been largely linked to distinct cultural groups in recent times. This scoping review gathers what is currently known on the self injection of body fillers for aesthetic purposes, using Arksey and O’Malley’s (2005) five stage iterative process scoping review methodology. Thematic manual coding then organised the data into themes through identified patterns: indicative profiling of individuals who self inject body fillers; motivation for use across types of oil injection; sourcing routes and documented harms. It was found that the majority of people who inject body fillers are male and do so to grossly increase muscle size. Injection of oils and other materials in the male genitalia was also described, in addition to female self-injection in the breast, hand and leg areas for augmentation. A range of health consequences were reviewed. Recommendations are made for further research into this unique phenomenon, which although is relatively rare warrant future research attention considering the documented increase in DIY facial fillers and contemporary body image culture.

The use of image- and performance-enhancing drugs particularly anabolic-androgenic steroids (AAS) is not a new phenomenon. AAS use is not limited to athletes, with mainstream populations using these drugs for aesthetic purposes. Prevalence has been predominantly in Western countries, with some recent studies indicating a rise in popularity in the Eastern Mediterranean region. A scoping review of extant empirical literature from the Eastern Mediterranean region described and mapped what is known about the extent of AAS in the region. Four themes emerged from the review: (1) profile of AAS users; (2) AAS within gymnasium practice; (3) AAS regimes of use; and (4) knowledge and understanding of the AAS concept and related adverse effects. The review highlights a relatively new phenomenon of AAS use in the Eastern Mediterranean. The review underscores the need to carry out further research, particularly qualitative and quantitative studies with both genders, and cognisant of the complexities of culture and religiosity.

Background: The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods: A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. Results: In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. Conclusion: There is a need for the development of effectiveness

Sourcing and self-medication of medicinal pharmaceuticals including those containing opioids obtained from nonregulated online suppliers is a serious public health issue. The main concerns include a lack of quality control, drug side effects, drug interactions, diversion and possible pathway to drug dependence. The internet offers increased availability and accessibility of these medicines through both legal routes obtaining pharmaceuticals on prescription and illegal routes via websites on both the surface and Dark Web. The impact of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic reduced face-to face access for non-COVID-19 related health conditions and to drug treatment services. This study provides an overview of the extent of online sourcing of UK controlled medicines (opioids, sedatives and GABA drugs) from unregulated suppliers and estimates of customer interest, in particular focusing on the COVID-19 lockdown period in the UK, where access to some healthcare services was limited. Whilst it was not possible to identify an increase for online searches for controlled medicines over the past five years, or during the COVID-19 period, searches remained plentiful, in particular for oxycodone, morphine and diazepam. This study highlights the need for enhanced pharmacovigilance of non-regulated online suppliers and the imperatives of continued health messaging around the potential abuse of these controlled drugs and the dangers of using sites purporting to be regulated pharmacies.

Background: The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods: A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. Results: In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. Conclusion: There is a need for the development of effectiveness

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications worldwide and have analgesic, antipyretic and anti-inflammatory properties. Although NSAIDs are recognised as generally safe and effective, non-medical and extra-medical use of these products can arise. Unlike use of illegal and many prescription drugs, which are subject to extensive research attention, inappropriate use of NSAIDs has been less well investigated. This scoping review collates and describes what is known regarding non-medical and extra-medical use of NSAIDs. Seventy two studies were included in this scoping review. Three themes emerged from the review: Theme 1: Indicative profile of people who engage in non-medical or extra medical use of NSAIDS; Theme 2: Antecedents for non-medical or extra-medical use; and Theme 3: Adverse health effects of non-medical and extra-medical use of NSAIDs. The review concluded that there is a need for enhanced patient education, including among sports people, pharmacovigilance in terms of clinician recognition of aberrance and prescriber and pharmacist awareness of the potential for extra medical, non-medical use and the related health harms.

Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to significant associated harms and fatalities this practice has been largely linked to distinct cultural groups in recent times. This scoping review gathers what is currently known on the self injection of body fillers for aesthetic purposes, using Arksey and O’Malley’s (2005) five stage iterative process scoping review methodology. Thematic manual coding then organised the data into themes through identified patterns: indicative profiling of individuals who self inject body fillers; motivation for use across types of oil injection; sourcing routes and documented harms. It was found that the majority of people who inject body fillers are male and do so to grossly increase muscle size. Injection of oils and other materials in the male genitalia was also described, in addition to female self-injection in the breast, hand and leg areas for augmentation. A range of health consequences were reviewed. Recommendations are made for further research into this unique phenomenon, which although is relatively rare warrant future research attention considering the documented increase in DIY facial fillers and contemporary body image culture.

The use of image- and performance-enhancing drugs particularly anabolic-androgenic steroids (AAS) is not a new phenomenon. AAS use is not limited to athletes, with mainstream populations using these drugs for aesthetic purposes. Prevalence has been predominantly in Western countries, with some recent studies indicating a rise in popularity in the Eastern Mediterranean region. A scoping review of extant empirical literature from the Eastern Mediterranean region described and mapped what is known about the extent of AAS in the region. Four themes emerged from the review: (1) profile of AAS users; (2) AAS within gymnasium practice; (3) AAS regimes of use; and (4) knowledge and understanding of the AAS concept and related adverse effects. The review highlights a relatively new phenomenon of AAS use in the Eastern Mediterranean. The review underscores the need to carry out further research, particularly qualitative and quantitative studies with both genders, and cognisant of the complexities of culture and religiosity.

Background Anabolic-androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use amongst people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD-treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results Lifetime AAS use was reported by 156 (28.3%) SUD-patients, thereof 35.6 % of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%)of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS. Conclusion Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use amongst SUD patients, and the level of competence among health professionals.

Pre-exposure prophylaxis (PrEP) is an evidence-based new biomedical HIV prevention intervention, which involves the pre-emptive use of daily (or event-based) antiretroviral drugs, to reduce risk of HIV acquisition if exposed. PrEP has recently been positioned as an integral prevention tool to reduce HIV acquisition risk among men who have sex with men (MSM) at country-level and within global prevention strategies. Given this global scale up of PrEP, we conducted a scoping review of extant international literature documenting service related perspectives, models and lessons learnt in PrEP programming for MSM. A systematic search of literature was conducted, and restricted to English language records in the timeframe 2008 to February 2019. Eligibility criteria centered on whether studies broadly described PrEP programming and service delivery for MSM as well as health communication. Following exclusion of ineligible records and removal of duplicates, 84 records were charted and thematically analysed according to scoping review methods. Four themes emerged from the thematic analysis of data; ‘PrEP service aspects, settings and staff’; ‘PrEP prescriber experiences, therapeutic alliance and care planning’; ‘PrEP adherence within formal service structures’; and ‘Multi-disciplinary and innovative PrEP care pathways’. The review highlights the complexities in providing optimal PrEP services for MSM by mapping and illustrating the importance of understanding the informal and formal routes to PrEP use among this HIV risk population; the barriers to uptake; the requirement for the presence of a positive therapeutic alliance between patient and prescriber in supporting patient initiation and adherence to PrEP regimes; and the need for availability in different culturally and ethnically sensitive models of PrEP service delivery according to low to high risk groups within the MSM communities.

Background Anabolic-androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use amongst people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD-treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results Lifetime AAS use was reported by 156 (28.3%) SUD-patients, thereof 35.6 % of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%)of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS. Conclusion Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use amongst SUD patients, and the level of competence among health professionals.

Contemporary recovery-models of treatment for substance misuse prioritise community-based support systems that focus on developing individuals’ strengths and quality of life. The research project aimed to explore the perceived mechanisms and processes that underpinned support in three abstinence-based recovery communities (RCs) across England. Focus groups and telephone interviews were conducted with 44 individuals. This was to identify self-prioritised outcomes for members and other key factors contributing to the delivery of an effective recovery community. Data were thematically analysed. Along with a number of other key outcomes, the achievement and maintenance of abstinence by participants was considered to be a key indicator of an effective RC. RC processes were also viewed as underpinning the development of recovery capital. The study provides an insight into the processes of RCs and highlights that development and support of recovery capital is an important aspect of service provision and delivery for those in abstinence-based recovery.

Contemporary recovery-models of treatment for substance misuse prioritise community-based support systems that focus on developing individuals’ strengths and quality of life. The research project aimed to explore the perceived mechanisms and processes that underpinned support in three abstinence-based recovery communities (RCs) across England. Focus groups and telephone interviews were conducted with 44 individuals. This was to identify self-prioritised outcomes for members and other key factors contributing to the delivery of an effective recovery community. Data were thematically analysed. Along with a number of other key outcomes, the achievement and maintenance of abstinence by participants was considered to be a key indicator of an effective RC. RC processes were also viewed as underpinning the development of recovery capital. The study provides an insight into the processes of RCs and highlights that development and support of recovery capital is an important aspect of service provision and delivery for those in abstinence-based recovery.

peer-reviewed, COVID-19 is a new highly contagious viral infection that can be transmitted by asymptomatic patients. Without a vaccine or a specific cure for this disease, our current management strategy is to attempt to contain its spread. The many risks and challenges of managing COVID-19 in prisons have been reported and include: overcrowded prison environments, the poor general heath profile of prisoners, the quality of prison healthcare services, existing high levels of communicable diseases, and the inability to comply with most social distancing and hand hygiene rules.1 However, little attention has been focused on the opportunities that prison healthcare can provide in the management of COVID-19 and other public health concerns

This chapter examines gender and mental health service provision with particularreference to alcohol related disorders and sensitivity of care. The theoretical andempirical literature in relation to gender, mental health care provision and alcohol relatedissues is explored.The Irish Government has adopted Gender Mainstreaming as a strategy to promoteequal opportunities between women and men in its National Development Plan.However, while current mental health policy addresses the principle of partnership andsocial inclusiveness as a way forward for mental health service provision, it still does notexplicitly deal with the notion of gender and gender sensitivity. Irish mental health policyand service provision is criticised for being gender-neutral. Research exploring thegendered needs of service users is lacking and this further compounds any attempt in theprovision of care that is gender sensitive. Drinking alcohol is considered a genderedactivity and impacts upon gender sensitivity and mental health care provision. Genderdifferences exist and the literature suggests that there is less social acceptability forwomen with alcohol related problems as traditional codes of femininity are seen to bebroken, and such behaviour patterns are largely viewed as deviant. This mirrors dominantsocietal expectations for women and alcohol use. Drinking alcohol and related problemsare viewed as belonging within a masculine domain and such practices are still moresocially acceptable for men. © 2012 Nova Science Publishers, Inc. All rights reserved.