2020-02, van de Ven, Katinka, Ritter, Alison, Berends, Lynda, Chalmers, Jenny, Lancaster, Kari

Introduction and Aims. Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms. Design and Methods. Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes. Results. Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources. Discussion and Conclusions. In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach.

2020, van de Ven, Katinka, Mulrooney, Kyle J D, McVeigh, Jim

Despite increasing interest in the use of human enhancement drugs (HEDs), our understanding of this phenomenon and the regulatory framework used to address it has lagged behind. Encompassing public health, epidemiology, neuroethics, sport science, criminology, and sociology, this book brings together a broad spectrum of scholarly insights and research expertise from leading authorities to examine key international issues in the field of HEDs. As "traditional" and other "new" drug markets have occupied much of the academic attention, there has been a lack of scholarly focus on human enhancement drugs. This book provides readers with a much-needed understanding of the illicit drug market of HEDs. The authors, from a variety of cultural contexts, disciplines and perspectives, include both academics and practitioners. Topics explored in this collection amongst others include: the anti-doping industry and performance and image enhancing drugs, steroids and gender, the use of cognitive enhancing drugs in academia, the use of sunless synthetic tanning products, the (online) trade of HEDs, regulations of the enhancement drugs market. This collection will serve as a reference for students, academics, practitioners, law enforcement and others working in this area to reflect on the current state of research and consider future priorities. This detailed exploration will provide a valuable knowledge base for those interested in human enhancement drugs, while also promoting critical discussion.

2023-06, Walsh, Adrian, van de Ven, Katinka

There is a long history and growing evidence base that the use of drugs, such as anabolic-androgenic steroids, to enhance human performance is common amongst armed forces, including in Australia. We should not be surprised that this might have occurred for it has long been predicted by observers. It is a commonplace of many recent discussion of the future of warfare and future military technology to proclaim the imminent arrival of Super Soldiers, whose capacities are modified via drugs, digital technology and genetic engineering, in ways that increase their performance exponentially. This is what some observers have referred to as the “Gladiator Model” wherein the aim is to create soldiers able to perform feats of which ordinary citizens are not capable. One key aspect of this “gladiator project” is the use of illicit drugs to enhance performance. Could we use drugs, such as steroids or amphetamines, to enhance performance? Should we use such drugs? In this paper we explore the ethics of creating Super Soldiers, and raise issues of consent, coercion and the extent to which such use is permitted or condemned by just war theory. We conclude that much will depend on the extent to which such use is harmful to the soldiers themselves and this is still an open question.

2022-01, van de Ven, K, Ritter, A, Vuong, T, Livingston, M, Berends, L, Chalmers, J, Dobbins, T

Objective: Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia.

Methods: The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length).

Results: Government providers were more likely to provide medically oriented treatment types such as with-drawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable.

Conclusion: Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.

2021-01, van de Ven, Katinka, Ritter, Alison, Stirling, Robert, Network of Alcohol and other Drugs Agencies (NADA): Australia

The Drug Policy Modelling Program (DPMP) at the University of New South Wales has released a report on 'The impact of the COVID-19 pandemic on the non-government alcohol and other drug sector: future implications'. NADA commissioned DPMP to undertake the study to explore the impact of the COVID-19 pandemic on it's members and provide advice on the immediate, medium and long-term actions that need to follow.

COVID-19 has demanded significant changes to funding arrangements, leadership and strategic planning, the types of care provided, and workforce requirements and support. It provides the opportunity to review all aspects of non government AOD treatment services, including the ways in which services are commissioned and funded by governments, and how services are supported, led, and delivered.

The actions resulting from the study are directed at treatment providers, NADA, and non government AOD funders. Whilst many of these actions have commenced, some are longstanding issues impacting on the sector, such as the underfunding of AOD treatment, and recruitment and retention of staff. NADA is committed to working with sector to implement the actions.

2023, Zeeuw, Tjeerd Idger de, Brunt, Tibor Markus, Amsterdam, Jan van, van de Ven, Katinka, Brink, Wim van den

Introduction: The use of anabolic androgenic steroids (AAS) and other image- and performance-enhancing drugs is a growing public health concern. AAS use is associated with various physical and mental harms, including cardiovascular risks, cognitive deficiencies, and dependence. The aim of this study was to determine whether patterns of AAS use and other variables are associated with the presence of an AAS use disorder (AASUD). Methods: An online survey was completed by 103 male AAS consumers visiting gyms. The association of different patterns of AAS consumption (cycling vs. continuous forms of AAS use), psychoactive substance use, mental health disorders, and sociodemographic variables with moderate-severe AASUD (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ≥4 criteria) was investigated. The associations between duration of AAS use and the AAS dose with moderate-severe AASUD were investigated using logistic regression analysis with moderate-severe AASUD as the dependent variable. Results: Mod-erate-severe AASUD was present in 25 (24.3%) of the participants. AAS consumers meeting criteria for moderate-severe AASUD, compared to those that did not, in the last 12 months reported a longer duration of AAS use (in weeks), a higher average AAS dose (mg/week), and a greater number of AAS side effects. Duration of AAS use and the AAS dose were the only independent predictors, with an increase of 3.4% in the probability of moderate-severe AASUD with every week increase of the duration of AAS use in the last year (p < 0.05) and an increase in moderate-severe AASUD of 0.1% with every 10 mg increase in the average AAS dose per week (p < 0.05), respectively. Conclusion: Our findings show that moderate-severe AASUD is relatively frequent among male AAS consumers and is positively associated with the duration and average dose of AAS use in the last 12 months.

2019, Mulrooney, Kyle J D, van de Ven, Katinka, McVeigh, Jim, Collins, Rick

Recently the journal Performance Enhancement & Health put out a call to produce a special issue on the dark side of human enhancement, including the use of legal and illegal substances, leading us to ponder whether the “dark side” of anabolic-androgenic steroids (from here on, “steroids”) has been overstated. In this commentary, we will briefly engage with this question by unpacking what we describe here as the “narrative of harm”, which tends to dominate discourses on steroid use in wider society. We then consider an alternative perspective on steroid use which focuses on the users’ experience and understanding, with particular attention to the role of pleasure. Finally, we conclude by exploring some of the negative policy consequences arising from the dominance of the “narrative of harm” and advance a regulatory approach grounded in rational and research informed discussions around both the pleasures and pains of steroid use. A more developed version of this argument can be found in the forthcoming collection Human Enhancement Drugs, published by Routledge in 2019 (Mulrooney, van de Ven, McVeigh, & Collins, 2019).

2019-05, Barrett, L, Hughes, C, Ritter, A, van de Ven, K, Barratt, M, Kowalski, M

Recommendation 1. Measures of harmful consumption should replace the focus on population prevalence of use (1.1.1; 1.1.2)

Population prevalence measures of drug use have been the focus of most governments for many years (and this is reflected in questions 1.1.1 and 1.1.2 where the Commission is seeking better ways to measure prevalence). However, population prevalence of use is a meaningless measure of the success or otherwise of policies and actions against drug use. The problem with population prevalence of use is that it does not identify either patterns of consumption that may be of concern, nor the harms associated with use. For example, if population prevalence of the use of amphetamines is 5%, those people may have used once in the last year or every day. Clearly there are major differences between infrequent annual use and daily use - and significant differences in the policy implication (as can be seen for example in early DPMP work on the social cost per gram Moore, 2007). This is why measures of the quantity, frequency and/or intensity of use are vital to inform policy (Bewley-Taylor, 2017; Kilmer, Reuter, & Giommoni, 2015).

2022-11-17, van de Ven, Katinka, Kayser, Bengt, Claussen, Malte Christian, Iff, Samuel

The sports world can be represented as a continuum of rule-based play involving at least some physical activity and skills, ranging from improvised soccer on the school playground all the way to elite sports at Olympic level. Whereas recreational sports are often promoted for public health reasons, elite sports, affecting only a small fraction of the population, drives for maximization of performance at a potential health cost [1, 2]. Hence, recreational and elite athletes inhabit distinct socio-cultural, medical, and regulatory environments. Since the inception of the World Anti-Doping Agency (WADA) in 1999, an international regulatory framework restricts the use of various methods and substances in elite-level sports because they may enhance performance, represent a potential health risk and/or are against the ‘spirit of sport’ [3]. Since athletes can also have health issues necessitating treatment, exceptions can be made through so-called strictly regulated Therapeutic Use Exemptions (TUEs) [4]. Despite some regulatory restrictions, however, use of medication by recreational athletes, or outside of sports by gym and fitness goers is not uncommon and rather tolerated by society [5, 6]. In the present special issue of Sports Psychiatry, a series of articles discusses some of the socio-cultural, medical, and regulatory issues related to the similarities and differences of substance use between recreational and elite sports. Collectively these articles advocate for a more “health-based” approach, especially in recreational sport. In addition, instead of the current prohibitive zero-tolerance punitive environment created by the anti-doping movement for elite sport – which increasingly encroaches into recreational sport and the gym and fitness realm –, arguments are presented in favour of fostering individual physical and mental health and of promoting unstigmatized access to necessary treatment, including for those who tested positive for doping use.

2016, van de Ven, Katinka

Over the past decade there has been an increase in the use of steroids and other human enhancement drugs (HEDs) (e.g., illegal weight-loss drugs, 'smart drugs') across the globe. Specifically, the Internet appears to be playing an important role in facilitating this rising global demand for HEDs: by acting both as a source of information and as a tool for obtaining these substances. Indeed, Internet based sources, such as online 'pharmacies', bodybuilding forums and steroid-selling websites, seem to increasingly be replacing the 'local (gym) vendors' by offering a wide range of HEDs at affordable prices and without a prescription.