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Steroids Coming Back To Haunt

Anabolic-androgenic steroids (AAS) are a group of hormones that include natural testosterone and numerous synthetic testosterone-like substances. When taken in very large doses and combined with strenuous exercise and proper nutrition, AAS can cause users to gain muscle and lose fat. In the United States alone the number of those who have used AAS has surpassed 2 million. The great majority of AAS users are men because women rarely aspire to becoming extremely muscular. Evidence is showing that AAS can cause dependence wherein individuals will use these drugs for years despite harmful effects. Demand for treatment of AAS abuse is expected to increase because illicit AAS use only became widespread in the 1980s. Thus, those who used AAS as youths in the 1980s are just now reaching middle age and entering the age of risk for cardiac complications and hormonal fluctuations affecting their behavior sufficient to motivate them to seek treatment.

Growing evidence suggests that classical drugs of abuse cause addiction via a common neural reward pathway, leading some to lose cognitive control. AAS, on the other hand, produce few immediate intoxicating effects and thus probably induce dependence via more complex pathways. This review of current research addresses the question, “Will AAS patients seek treatment?” and suggests at least three mechanisms by which AAS dependence might develop and that treatment should address: a body image mechanism,  an androgenic mechanism, and an hedonic mechanism.

Most people take AAS for their anabolic effects – to gain muscle and lose fat. AAS use may be involved with disorders of body image in which individuals see themselves as small and weak even though they are large and muscular: a kind of “reverse anorexia nervosa”. These body image concerns may stimulate escalating use in some individuals, leading to dependence.

AAS may cause male users to experience decreased production of testosterone, other important hormones, and reduced sperm. This can cause a number of adverse physiological impacts including loss of muscle and increased fat. Studies also show that AAS withdrawal may induce major depression. Treatment for these androgenic related effects should therefore treat both the sexual dysfunction and any AAS induced depression.

Though not considered intoxicating, AAS may produce increased self-confidence and aggressiveness.  These hedonic effects may vary with the type of AAS used and be impacted by alcohol and stimulants. Both animal and human studies show the same kind of reinforcement of the brain’s reward center as occurs with the classical addictive drugs. Evidence suggests that pharmacological and psychosocial treatments effective for substance dependence in general and opioid dependence in particular might be beneficial in cases of AAS dependence.

This review concludes that, unlike conventional addictive drugs, AAS may induce dependence via three separate paths – the anabolic, the androgenic, and the hedonic. Evolving understanding of these mechanisms indicates that clinicians should be prepared to treat these three conditions: underlying body image disorders, AAS induced sexual dysfunctions, and possible major depression, and co-existing dependence on alcohol and the classical addictive drugs.

(Kanayama, G, Brower, K, Wood, R, Hudson, J, Pope,H: Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications. Drug and Alcohol Dependence 109: 6-13, 2009)

Related posts:

1. Steroid Abuse – Not Just a Locker Room Problem
2. What the Heck Does “Hedonic Homeostatic Dysregulation” Mean?
3. Alcohol, Tobacco, and Marijuana Interactions
4. Naltrexone as Treatment for Amphetamine Dependence

One Response to “Steroids Coming Back to Haunt”

1. Rodney Stillion MD says:

   July 15, 2010 at 7:23 pm

   This was very helpful. Keep them coming. Say hi to Dr. O’Connor for me.