Confidence in Managing Use and Minimising Harm as Mediators of Quality of Life among Anabolic-Androgenic Steroid Consumers in Alcohol and Other Drug Treatment Settings

Background: Anabolic-androgenic steroid (AAS) consumers frequently experience elevated physical and psychological risks, yet the psychological mechanisms linking risk exposure to health outcomes remain poorly understood. This study examined whether general confidence in managing substance use and minimising harm mediates the relationship between clinical risk and quality of life among AAS consumers engaged with community-based alcohol and other drug (AOD) services. Methods: Intake data from 517 adults (93.4% male) reporting lifetime AAS use were analysed, drawn from a broader cohort of 18,786 clients at Lives Lived Well services between 2020 and 2024. Mediation analyses tested whether two confidence variables, 1. substance use management and 2. harm minimisation, explained associations between clinical risk (defined by World Health Organisation – Alcohol, Smoking and Substance Involvement Screening Test steroid risk score), and three quality of life domains: physical, psychological, and overall wellbeing. Results: Higher clinical steroid risk scores were significantly associated with poorer quality of life across domains; however, these effects were fully mediated by lower general confidence in managing substance use and minimising harm among clients who reported AAS use. Confidence in consumption practices buffered against physical undesired effects, while confidence in harm reduction was strongly linked to psychological wellbeing. Conclusions: Among AAS consumers in AOD treatment, broader substance-use confidence appears meaningfully related to quality of life. While the confidence measures are general rather than AAS-specific, these findings provide a preliminary insight into confidence-related processes in a clinically underexamined group. Interventions that promote these strategies may offer a critical mechanism for ensuring this cohorts physical and psychological wellbeing.