Features of men with anabolic-androgenic steroid dependence: A comparison with nondependent AAS users and with AAS nonusers

Abstract

Background Anabolic-androgenic steroid (AAS) dependence has been a recognized syndrome for some 20 years, but remains poorly understood. Methods We evaluated three groups of experienced male weightlifters: (1) men reporting no history of AAS use ( N = 72); (2) nondependent AAS users reporting no history of AAS dependence ( N = 42); and (3) men meeting adapted DSM-IV criteria for current or past AAS dependence ( N = 20). We assessed demographic indices, lifetime history of psychiatric disorders by the Structured Clinical Interview for DSM-IV, variables related to AAS use, and results from drug tests of urine and hair. Results Nondependent AAS users showed no significant differences from AAS nonusers on any variable assessed. Dependent AAS users, however, differed substantially from both other groups on many measures. Notably, they reported a more frequent history of conduct disorder than nondependent AAS users (odds ratio [95% CI]: 8.0 [1.7, 38.0]) or AAS nonusers (13.1 [2.8, 60.4]) and a much higher lifetime prevalence of opioid abuse and dependence than either comparison group (odds ratios 6.3 [1.2, 34.5] and 18.6 [3.0, 116.8], respectively). Conclusions Men with AAS dependence, unlike nondependent AAS users or AAS nonusers, showed a distinctive pattern of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence. AAS dependence showed a particularly strong association with opioid dependence – an observation that recalls recent animal data suggesting similarities in AAS and opioid brain reward mechanisms. Individuals with AAS dependence and individuals with “classical” substance dependence may possibly harbor similar underlying biological and neuropsychological vulnerabilities.