Gateways and gatekeepers: Two factors that influence the use of performance and image enhancing drugs (PIEDs) among UK military veterans

Recent reports have identified that PIEDs use is rising within the Armed Forces leading to concerns over health and concomitant operational risks. The aim of this study was to identify the roles of gateways and gatekeepers on PIEDs use among a cohort of UK military veterans. Semi-structured interviews were conducted with 14 ex-Service personnel. Interviews were transcribed verbatim and thematically analysed using NVivo12 software. Common themes were identified around the ways in which the veterans were introduced to PIEDs and how they accessed them. Gateways consisted of two categories of Circumstances and Behaviour, including excessive gym use, the need to cope with fitness demands of military service, overseas deployment, and previous experiences with nutritional and body-building supplements. Gatekeepers included friends, colleagues, and mentors and their roles were captured in two categories of Procurement of PIEDs and Information Dissemination. Recommendations include the need for further research on the roles of gatekeepers and gateways as important pathways to PIEDS use. Additionally, there is a need to build on themes suggested by earlier researchers to identify social, cultural, and economic factors that underpin motives for PIEDs use in the uniformed services. These two recommendations would inform the design and evaluation of PIEDs-related interventions.