Book excerpt: In the pursuit of more muscle, enhanced strength, sustained endurance and idealised physiques, an increasing number of elite athletes, recreational sport enthusiasts and body-conscious gym-users are turning to performance and image enhancing drugs and substances (PIEDS). In many instances, such use occurs with little regard for the health, social and economic consequences. This book presents a nuanced, evidence-based examination of PIEDS. It provides a classification of PIEDS types, physical impacts, rates of use, user profiles, legal and sporting status, and remedial program interventions, covering both elite and recreational use. It offers the perfect guide to assist students, government policy makers and sport managers in understanding the complex issues surrounding PIEDS consumption.