Anabolic-androgenic Steroid Dependence Research Articles

Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters

BackgroundAnabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.MethodsA sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use.ResultsIn a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified.ConclusionsAAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

NONISCHEMIC CARDIOMYOPATHY AND CARDIAC ARREST ATTRIBUTABLE TO ANABOLIC-ANDROGENIC STEROIDS

NONISCHEMIC CARDIOMYOPATHY AND CARDIAC ARREST ATTRIBUTABLE TO ANABOLIC-ANDROGENIC STEROIDS

Anabolic androgenic steroid dependence is associated with executive dysfunction

BackgroundAnabolic androgenic steroid (AAS) dependence is associated with a high prevalence of intra- and interpersonal problems, hence it is central to identify cognitive factors related to the development and maintenance of dependence. MethodsThe study explores executive functions (EFs) in a sample of 174 male weightlifters, divided into three groups; 1) AAS dependents; n = 58, 2) AAS non-dependents; n = 38 and 3) AAS non-users; n = 78, using a targeted battery of neuropsychological (NP) tests, and self-report questionnaires assessing EFs in everyday life, ADHD symptoms and psychological distress. ResultsMultivariate analysis of variance showed significant between-group differences on several EFs, including working memory [F (2, 169) = 13.79, p < .001, ηp² = 0.14], mental flexibility [F (2, 169) = 4.82, p = .009, ηp² = 0.05], problem-solving [F (2, 169) = 4.77 p = .010, ηp² = 0.05] and inhibition [F (2, 163) = 4.15, p = .017, ηp² = 0.05]. Additionally, significant between-group differences were seen for self-reported problems with EFs [F (2, 124) = 4.38 p = .015, ηp² = 0.07], ADHD symptoms [F (2, 124) = 7.02 p = .001, ηp² = 0.10], and psychological distress [F (2, 124) = 4.11 p = .019, ηp² = 0.06]. Post hoc tests showed that AAS dependents exhibited poorer EFs and reported more psychological distress compared to non-users. ConclusionAAS dependence is associated with executive dysfunction, which might be related to continued abuse despite adverse side-effects and social consequences. Increased awareness of executive dysfunction could have important implications for treatment and rehabilitation.

Structural brain characteristics of anabolic-androgenic steroid dependence in men.

AimTo identify differences in brain morphology between dependent and non‐dependent male anabolic–androgenic steroid (AAS) users.DesignThis study used cross‐sectional data from a longitudinal study on male weightlifters.ParticipantsOslo University Hospital, Norway.SettingEighty‐one AAS users were divided into two groups; AAS‐dependent (n = 43) and AAS‐non‐dependent (n = 38).MeasurementsNeuroanatomical volumes and cerebral cortical thickness were estimated based on magnetic resonance imaging (MRI) using FreeSurfer. Background and health information were obtained using a semi‐structured interview. AAS‐dependence was evaluated in a standardized clinical interview using a version of the Structured Clinical Interview for DSM‐IV, adapted to apply to AAS‐dependence.FindingsCompared with non‐dependent users, dependent users had significantly thinner cortex in three clusters of the right hemisphere and in five clusters of the left hemisphere, including frontal, temporal, parietal and occipital regions. Profound differences were seen in frontal regions (left pars orbitalis, cluster‐wise P < 0.001, right superior frontal, cluster‐wise P < 0.001), as has been observed in other dependencies. Group differences were also seen when excluding participants with previous or current non‐AAS drug abuse (left pre‐central, cluster‐wise P < 0.001, left pars orbitalis, cluster‐wise P = 0.010).ConclusionMale dependent anabolic–androgenic steroid users appear to have thinner cortex in widespread regions, specifically in pre‐frontal areas involved in inhibitory control and emotional regulation, compared with non‐dependent anabolic–androgenic steroid users.

Anabolic androgenic steroid dependence is associated with impaired emotion recognition.

Illicit use of anabolic androgenic steroids (AAS) has grown into a serious public health concern throughout the Western World. AAS use is associated with adverse medical, psychological, and social consequences. Around 30% of AAS users develop a dependence syndrome with sustained use despite adverse side effects. AAS dependence is associated with a high frequency of intra- and interpersonal problems, and it is central to identify factors related to the development and maintenance of dependence. The present study investigated the ability to recognize emotion from biological motion. The emotional biological motion task was administered to male AAS dependent users (AAS dependents; n = 45), AAS non-dependent users (AAS non-dependents; n = 38) and a comparison-group of non-using weightlifters (non-users; n = 69). Multivariate analysis of variance showed a general impairment in emotion recognition in AAS dependents, compared to the non-using weightlifters, whereas no significant impairment was observed in AAS non-dependents. Furthermore, AAS dependents showed impaired recognition of fearful stimuli compared to both AAS non-dependents and non-using weightlifters. The between-group effect remained significant after controlling for Intelligence Quotient (IQ), past 6months of non-AAS drug use, antisocial personality problems, anxiety, and depression. AAS dependents show impaired emotion recognition from body movement, fear in particular, which could potentially contribute to higher frequency of interpersonal problems and antisocial behaviors in this population.

Pornography use in sexual minority males: Associations with body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life.

We examined two hypotheses regarding the potential association of pornography use with body image-related and eating disorder-related psychopathology among sexual minority males (i.e. non-heterosexual males). Our primary hypothesis was that pornography use would be associated with males' body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life impairment; our secondary hypothesis was that the type of pornography, namely, professional versus amateur pornography, which contains idealised and non-idealised (i.e. regular) bodies, respectively, would moderate these associations. A sample of 2733 sexual minority males living in Australia and New Zealand completed an online survey that contained measures of pornography use, body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life. Almost all (98.2%) participants reported pornography use with a median use of 5.33 hours per month. Multivariate analyses revealed that increased pornography use was associated with greater dissatisfaction with muscularity, body fat and height; greater eating disorder symptoms; more frequent thoughts about using anabolic steroids; and lower quality of life. Effect sizes for these associations were uniformly small. Neither relationship status nor genital dissatisfaction was associated with pornography use. The association between pornography use and thoughts about using anabolic steroids was stronger for viewers of professional pornography than viewers of amateur pornography. The findings suggest that the use of pornography is weakly associated with body dissatisfaction and related variables and that the type of pornography (amateur vs professional) viewed may be a moderating factor in some cases. Within the limits of a cross-sectional study design, these findings may have implications for clinicians who treat individuals with eating disorders, body dysmorphic disorder, anabolic-androgenic steroid dependence and related concerns.

Exercise reinforcement, stress, and β-endorphins: An initial examination of exercise in anabolic–androgenic steroid dependence

BackgroundAnabolic–androgenic steroids (AASs) are abused primarily in the context of intense exercise and for the purposes of increasing muscle mass as opposed to drug-induced euphoria. AASs also modulate the HPA axis and may increase the reinforcing value of exercise through changes to stress hormone and endorphin release. To test this hypothesis, 26 adult males drawn from a larger study on AAS use completed a progressive ratio task designed to examine the reinforcing value of exercise relative to financial reinforcer. MethodSixteen experienced and current users (8 on-cycle, 8 off-cycle) and 10 controls matched on quantity×frequency of exercise, age, and education abstained from exercise for 24h prior to testing and provided 24-h cortisol, plasma cortisol, ACTH, β-endorphin samples, and measures of mood, compulsive exercise, and body image. ResultsBetween group differences indicated that on-cycle AAS users had the highest β-endorphin levels, lowest cortisol levels, higher ACTH levels than controls. Conversely, off-cycle AAS users had the highest cortisol and ACTH levels, but the lowest β-endorphin levels. Exercise value was positively correlated with β-endorphin and symptoms of AAS dependence. ConclusionThe HPA response to AASs may explain why AASs are reinforcing in humans and exercise may play a key role in the development of AAS dependence.

Chronic nandrolone administration induces dysfunction of the reward pathway in rats

Data in animal models and surveys in humans have revealed psychiatric complications of long-term anabolic androgenic steroid abuse. However, the neurobiochemical mechanisms behind the observed behavioral changes are poorly understood.The aim of the present study was to investigate the effects of nandrolone decanoate on emotional behavior and neurochemical brain alterations in gonadally intact male rats.The behavioral reactivity to the elevated plus maze and the social interaction test was used to assess anxiety-related symptoms, and the sucrose preference test was used to evaluate anhedonia. Dopaminergic, serotonergic and noradrenergic transmissions were also evaluated in selected brain areas.The chronic administration of nandrolone, at 5mgkg−1 injected daily for 4weeks, induced the loss of sweet taste preference, a sign of anhedonia and dysfunction of the reward pathway. The behavioral outcomes were accompanied by reductions in the dopamine, serotonin and noradrenaline contents in the nucleus accumbens. Alterations in the time spent in the open arms and in the social interaction test were not found, suggesting that nandrolone did not induce an anxiogenic profile. No differences were revealed between the experimental groups in the amygdala in terms of the neurotransmitters measured.Our data suggest that nandrolone-treated rats have a depressive, but not anxiogenic-like, profile, accompanied by brain region-dependent changes in dopaminergic, serotonergic and noradrenergic neurotransmission. As anabolic androgenic steroid dependence is plausibly the major form of worldwide substance dependence that remains largely unexplored, it should be highlighted that our data could contribute to a better understanding of the altered rewards induced by nandrolone treatment and to the development of appropriate treatments.

Psychological and Physical Impact of Anabolic‐Androgenic Steroid Dependence

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. Subanalysis of data from the Anabolic 500, a cross-sectional survey. One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009. Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users. Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

A diagnostic interview module for anabolic-androgenic steroid dependence: Preliminary evidence of reliability and validity.

The syndrome of anabolic-androgenic steroid (AAS) dependence, though well recognized, remains poorly studied. In this preliminary psychometric study, American and British investigators separately administered a structured diagnostic interview module, based on recently proposed criteria for AAS dependence, to 42 male AAS users in Middlesbrough, England. Another investigator, blinded to the diagnostic interview findings, assessed self-reported symptoms of "muscle-dysmorphia"; effects of AAS on various aspects of functioning; and maximum proportion of annual income spent on AAS. We also assessed demographic measures, history of other substance use, and performance on a hypothetical AAS-purchasing task. The interview module yielded very good interrater reliability (kappa = 0.76 and overall intraclass correlation = 0.79) and strong internal consistency (Cronbach's alpha = 0.77-0.87). Men diagnosed as AAS-dependent, when compared to nondependent men, reported significantly earlier onset of AAS use, longer duration and higher maximum doses of AAS used, more frequent use of other performance-enhancing drugs, and a somewhat larger maximum percentage of income spent on AAS. Dependent users also "bought" more AAS in the hypothetical purchase task, but rated significantly more negatively the effects of AAS on their mental health-findings all suggesting that the diagnosis of AAS dependence shows construct validity. As a group, AAS users showed high preoccupation with muscular appearance, but dependence per se was not significantly associated with this measure-suggesting that the diagnosis of AAS dependence shows some evidence of discriminant validity. Collectively, these findings suggest that AAS dependence may be diagnosed reliably, with preliminary evidence for construct and discriminant validity.

Supplemental Material for A Diagnostic Interview Module for Anabolic-Androgenic Steroid Dependence: Preliminary Evidence of Reliability and Validity

Supplemental Material for A Diagnostic Interview Module for Anabolic-Androgenic Steroid Dependence: Preliminary Evidence of Reliability and Validity

Dr. Pope Replies

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. Pope RepliesHARRISON G. POPE Jr., M.D.,HARRISON G. POPE Jr., M.D.Search for more papers by this author,Published Online:1 Oct 2009https://doi.org/10.1176/appi.ajp.2009.09060846rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We agree with virtually all of the points raised by Drs. Scally and Tan, except for a minor semantic issue regarding their suggestion that anabolic steroid-induced hypogonadism represents a possible “confounding variable” in the diagnosis of anabolic-androgenic steroid dependence. To explain, we need to carefully define our terms. Anabolic steroid-induced hypogonadism is certainly a common physiologic response to chronic anabolic-androgenic steroid exposure, and it may contribute to anabolic-androgenic steroid withdrawal symptoms. Withdrawal symptoms, in turn, are a cluster of physical and psychological symptoms that may occur after discontinuing a drug that induces physiological dependence. Withdrawal symptoms are only one of the seven DSM-IV criteria for substance dependence and are neither necessary nor sufficient for a DSM-IV diagnosis of substance dependence. With these definitions in mind, then, we would say that anabolic steroid-induced hypogonadism represents simply one underlying mechanism for the etiology of anabolic-androgenic steroid withdrawal symptoms and should not be considered a confounder for making a DSM-IV diagnosis of anabolic-androgenic steroid dependence. As an example, opioid withdrawal is caused in part by abnormal signaling at central opioid receptors (1) . However, this abnormal receptor activity is not a “confounding variable” in diagnosing opioid dependence. Rather, it is one of the underlying mechanisms of opioid withdrawal, and opioid withdrawal, in turn, is a frequent (but not necessary) criterion for diagnosing opioid dependence. Similarly, if an anabolic-androgenic steroid user suppresses his own testosterone production as a result of prolonged exogenous anabolic-androgenic steroid administration and then develops consequent hypogonadal symptoms upon withdrawing (2) , these withdrawal symptoms would legitimately count as one criterion (although not a necessary criterion) for the diagnosis of anabolic-androgenic steroid dependence. On the basis of these considerations, we would agree with Drs. Scally and Tan that anabolic steroid-induced hypogonadism needs to be differentiated from anabolic-androgenic steroid dependence, since not all patients who suffer from anabolic steroid-induced hypogonadism will qualify for a diagnosis of anabolic-androgenic steroid dependence. However, we would suggest that anabolic steroid-induced hypogonadism does not disqualify an individual from a diagnosis of anabolic-androgenic steroid dependence either. Instead, anabolic steroid-induced hypogonadism represents one of the primary mechanisms of anabolic-androgenic steroid withdrawal and physiological dependence.Belmont, Mass.The author’s disclosures accompany the original editorial.This letter (doi: 10.1176/appi.ajp.2009.09060846r) was accepted for publication in July 2009.

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

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.

Psychiatric Effects and Psychoactive Substance Use in Anabolic-Androgenic Steroid Users

The purpose of this study was to assess the psychiatric effects of anabolic-androgenic steroid (AAS) use and assess the frequency of other psychoactive substance use in a population of AAS users compared with non-AAS-using weight-lifter controls. One hundred sixty-four subjects were administered a demographic survey, including psychiatric history, substance use history, AAS use history, and medical history. Psychiatric diagnoses were made and psychological testing was performed. User categories were determined by history and urine testing. The user categories did not differ significantly on psychological testing. Past AAS users had a higher incidence of psychiatric diagnosis than the nonuser and current user groups. Hypomania was correlated with AAS use, and major depression with AAS discontinuation. Present psychoactive substance abuse or dependence was relatively low across all user categories. AAS dependence was seen in 12.9% of current users and 15.2% of past users of AAS. In conclusion, AAS use may lead to psychiatric disorders in certain individuals. Concurrent use of psychoactive drugs other than AAS does not appear to be common in intensively training weight lifters and bodybuilders.

Symptoms and correlates of anabolic‐androgenic steroid dependence

Forty-nine male weight lifters, all users of anabolic-androgenic steroids (AASs), completed an anonymous, self-administered questionnaire to investigate addictive patterns of use. At least one DSM-III-R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n = 28) could be distinguished from non-dependent users (n = 21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.