10. Anabolic Steroids Dependence

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10. Anabolic Steroids Dependence

 

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INTRODUCTION………………………………………………………………………………………………………………… 1

Overview ……………………………………………………………………………………………………………………… 1

Organization ………………………………………………………………………………………………………………… 3

Scope……………………………………………………………………………………………………………………………. 3

Moving Forward……………………………………………………………………………………………………………. 4

PART I: THE ESSENTIALS………………………………………………………………………………………………. 7

CHAPTER 1. THE ESSENTIALS ON ANABOLIC STEROID DEPENDENCE: GUIDELINES…………………. 9

Overview ……………………………………………………………………………………………………………………… 9

What Is Anabolic Steroid Abuse?…………………………………………………………………………………… 12

What Are Steroidal Supplements? …………………………………………………………………………………. 13

What Is the Scope of Steroid Abuse in the United States? …………………………………………………. 14

Why Do People Abuse Anabolic Steroids?………………………………………………………………………. 14

How Are Anabolic Steroids Used?…………………………………………………………………………………. 16

What Are the Health Consequences of Steroid Abuse? ……………………………………………………… 16

What Effects Do Anabolic Steroids Have on Behavior? …………………………………………………….. 19

Are Anabolic Steroids Addictive? ………………………………………………………………………………….. 20

What Can Be Done to Prevent Steroid Abuse? ………………………………………………………………… 21

What Treatments Are Effective for Steroid Abuse? ………………………………………………………….. 21

Where Can I Get Further Scientific Information about Steroid Abuse? ………………………………. 22

Anabolic-Androgenic Steroids INFOFAX………………………………………………………………………. 22

Health Hazards……………………………………………………………………………………………………………. 23

Extent of Use ………………………………………………………………………………………………………………. 24

More Guideline Sources ……………………………………………………………………………………………….. 25

Vocabulary Builder………………………………………………………………………………………………………. 27

CHAPTER 2. SEEKING GUIDANCE……………………………………………………………………………………… 31

Overview ……………………………………………………………………………………………………………………. 31

Associations and Anabolic Steroid Dependence ……………………………………………………………….. 31

Finding Drug Treatment and Alcohol Abuse Treatment Programs ……………………………………. 33

Finding Doctors…………………………………………………………………………………………………………… 35

Selecting Your Doctor ………………………………………………………………………………………………….. 36

Working with Your Doctor …………………………………………………………………………………………… 37

Broader Health-Related Resources …………………………………………………………………………………. 38

Vocabulary Builder………………………………………………………………………………………………………. 38

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ……………………… 39

CHAPTER 3. BOOKS ON ANABOLIC STEROID DEPENDENCE…………………………………………………. 41

Overview ……………………………………………………………………………………………………………………. 41

Book Summaries: Online Booksellers ……………………………………………………………………………… 41

The National Library of Medicine Book Index………………………………………………………………….. 41

Chapters on Anabolic Steroid Dependence………………………………………………………………………. 44

General Home References ……………………………………………………………………………………………… 45

Vocabulary Builder………………………………………………………………………………………………………. 45

CHAPTER 4. MULTIMEDIA ON ANABOLIC STEROID DEPENDENCE ……………………………………….. 47

Overview ……………………………………………………………………………………………………………………. 47

Bibliography: Multimedia on Anabolic Steroid Dependence………………………………………………. 47

Vocabulary Builder………………………………………………………………………………………………………. 49

CHAPTER 5. PHYSICIAN GUIDELINES AND DATABASES ………………………………………………………. 51

Overview ……………………………………………………………………………………………………………………. 51

NIH Guidelines …………………………………………………………………………………………………………… 51

NIH Databases ……………………………………………………………………………………………………………. 52

Contents

viii

Other Commercial Databases ………………………………………………………………………………………… 55

Specialized References ………………………………………………………………………………………………….. 56

Vocabulary Builder………………………………………………………………………………………………………. 57

PART III. APPENDICES…………………………………………………………………………………………………. 59

APPENDIX A. RESEARCHING YOUR MEDICATIONS …………………………………………………………….. 61

Overview ……………………………………………………………………………………………………………………. 61

Your Medications: The Basics ……………………………………………………………………………………….. 62

Learning More about Your Medications …………………………………………………………………………. 64

Commercial Databases………………………………………………………………………………………………….. 65

Contraindications and Interactions (Hidden Dangers)……………………………………………………… 66

A Final Warning …………………………………………………………………………………………………………. 67

General References……………………………………………………………………………………………………….. 67

APPENDIX B. RESEARCHING NUTRITION…………………………………………………………………………… 69

Overview ……………………………………………………………………………………………………………………. 69

Food and Nutrition: General Principles ………………………………………………………………………….. 70

Finding Studies on Anabolic Steroid Dependence ……………………………………………………………. 74

Federal Resources on Nutrition……………………………………………………………………………………… 76

Additional Web Resources…………………………………………………………………………………………….. 77

Vocabulary Builder………………………………………………………………………………………………………. 78

APPENDIX C. FINDING MEDICAL LIBRARIES ……………………………………………………………………… 81

Overview ……………………………………………………………………………………………………………………. 81

Preparation …………………………………………………………………………………………………………………. 81

Finding a Local Medical Library ……………………………………………………………………………………. 82

Medical Libraries Open to the Public ……………………………………………………………………………… 82

APPENDIX D. PRINCIPLES OF DRUG ADDICTION TREATMENT……………………………………………… 89

Overview ……………………………………………………………………………………………………………………. 89

Principles of Effective Treatment …………………………………………………………………………………… 89

What Is Drug Addiction?……………………………………………………………………………………………… 92

Frequently Asked Questions …………………………………………………………………………………………. 93

Drug Addiction Treatment in the United States ……………………………………………………………. 100

General Categories of Treatment Programs …………………………………………………………………… 101

Treating Criminal Justice-Involved Drug Abusers and Addicts ………………………………………. 104

Scientifically-Based Approaches to Drug Addiction Treatment ……………………………………….. 105

Selected NIDA Educational Resources on Drug Addiction Treatment ……………………………… 113

Vocaubluary Builder ………………………………………………………………………………………………….. 117

ONLINE GLOSSARIES ………………………………………………………………………………………………… 119

Online Dictionary Directories……………………………………………………………………………………… 120

ANABOLIC STEROID DEPENDENCE GLOSSARY……………………………………………………. 121

General Dictionaries and Glossaries …………………………………………………………………………….. 131

INDEX………………………………………………………………………………………………. 133

Anabolic Steroids Dependence


Anabolic-androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects.


The anabolic-androgenic steroids (AAS) are a family of lipophilic hormones derived from cholesterol that includes the natural male hormone, testosterone, together with numerous synthetic testosterone derivatives (1). By ingesting supraphysiological doses of these hormones, in combination with intensive weight lifting and appropriate nutrition, AAS users can greatly increase their muscle mass, often well beyond the limits attainable by natural means (2). For decades, elite athletes have used AAS to improve performance (3). Today, however, most AAS users are not competitive athletes, but simply individuals who want to look leaner and more muscular (1, 4–8). As we have explained in detail elsewhere (9), this much larger but less visible population of illicit AAS users began to emerge in the 1980s – a trend stimulated in part by the appearance of progressively more sophisticated underground guides on how to self-administer AAS (10–14). Western cultural developments also likely contributed to the increased prevalence of use of AAS, as media images increasingly focused on male muscularity (15–18). Over the last few decades, even children’s action toys, such as “GI Joe” in America and “Action Man” in the British Commonwealth, have begun to acquire the bodies of AAS users (19). Perhaps as a result of these trends, illicit AAS use has now grown into a widespread form of substance abuse throughout Western societies, including the United States (20–22), British Commonwealth countries (23–25), Scandinavian countries (26–28), and others (25, 29–31). Although epidemiologic studies in these various countries have produced a wide range of prevalence estimates, most have reported a lifetime prevalence of AAS use of at least 3% in young men, suggesting that some tens of millions of individuals worldwide have used these drugs. By contrast, AAS use in women is uncommon, since women are less likely to want to become very muscular, and are also vulnerable to the masculinizing effects of AAS, such as beard growth, deepening of the voice, and masculinized sexual characteristics (32–35).
AAS users generally self-administer their drugs for blocks of time, colloquially called “cycles.” Cycles typically last 8–16 weeks, separated by drug-free intervals lasting months or years (36, 37). Planned cycles of increasing and decreasing AAS doses (“pyramiding”) allow users to avoid plateauing (developing tolerance), minimize withdrawal symptoms at the end of a cycle, and conserve drug supplies (38). Perhaps the most important rationale for cycles, however, is the fact that exogenous AAS administration suppresses the hypothalamic-pituitary-testicular (HPT) axis, leading to decreased endogenous testosterone production in men (39, 40). If a man uses AAS in cycles, rather than continuously, then the HPT axis can rebound during the drug-free intervals between cycles, restoring normal endogenous testosterone production.


Many individuals use only a few cycles of AAS in their careers, with a cumulative lifetime exposure of less than 12 months (36, 37). Such individuals often report few, if any, adverse medical or psychological effects from AAS (41, 42). On the other hand, some individuals progress from discrete cycles of AAS into a pattern of nearly unbroken use, which may continue despite prominent adverse medical, psychological, and social effects (43). This syndrome of AAS dependence has been recognized for more than 20 years; it appears to be common and possibly increasing in prevalence, as explained below, but much in need of further study (1). Here we attempt to summarize current knowledge on AAS dependence. We begin with an illustrative case of AAS dependence, then review the accumulating human and animal literature on this topic, compare AAS dependence with classical drug dependence, and suggest avenues for future research. This review is based on publications known to us, a search of publications involving “anabolic steroids” in the PubMed database, and additional publications referenced in these articles.


An undetermined percentage of steroid users may develop a steroid use disorder. Substance use disorders are defined by continued use despite adverse consequences; for steroid users, these may include physical or psychological problems such as breast growth (in men), sexual dysfunction, high blood pressure, excessive fats in the blood, heart disease, mood swings, severe irritability, or aggressiveness. Anabolic steroid users also may give up other important activities for fear that they will miss workouts, violate their dietary restrictions, or be prevented from using steroids. Steroid users also typically spend large amounts of time and money obtaining the drugs, and they may try to reduce or stop anabolic steroid use without success—possibly due to depression, anxiety about losing muscle mass, or and other unpleasant effects of withdrawal.
Withdrawal from steroids occurs when an individual develops dependence. A review of the research suggests that about 32 percent of people who misuse anabolic steroids become dependent. Symptoms of dependence can include tolerance, which is needing to take more steroids to achieve the same effects. Another indicator of dependence is withdrawal once anabolic steroid use stops.110 Withdrawal symptoms can include fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings. The most dangerous of the withdrawal symptoms is depression, because it sometimes leads to suicide attempts.


Anabolic steroids are either prescribed or illegally obtained by individuals who want to appear stronger and develop muscle mass in a short period of time, often resulting in increased confidence and self-esteem. There are over 100 types of anabolic steroids, only a fraction of which have been approved for medical use.


Even though steroids don’t chemically produce euphoria or a “high” like a typical addictive substance, those who regularly abuse these drugs are at risk of developing a severe addiction. The desire to continue feeling good about oneself and achieve a desired appearance can quickly take over, fueling greater and greater use. Any time a medication is used without a prescription or beyond its medical scope, intended purpose, at higher doses, or increased frequencies than prescribed, it is considered abuse.


Anabolic steroids are addictive due two primary factors. The first is a behavior of many individuals with substance use disorders, the compulsive need to seek out and use anabolic steroids. The second is the appearance of withdrawal symptoms due to when the user cuts back or stops using steroids completely. The obsessive-compulsive behavior to keep using anabolic steroids often begins when the steroids improve physical appearance and strength in a short amount of time, which may eventually result in an addiction developing.


Individuals with a history of substance use disorders are at higher risk of abusing anabolic steroids. This is also true of individuals who have co-occurring disorders, especially body dysmorphia, as they may find themselves continuously using steroids to “keep improving,” even after they have reached their original goal.
People taking steroids may also develop a tolerance to the drugs and experience withdrawal symptoms such as low sex drive, loss of appetite, mood swings, fatigue, insomnia, and depression when they stop taking them. These are both signs of an addiction.


Other signs of an addiction include:


• Spending large amounts of time and money getting or using steroids
• Ignoring responsibilities at work or home
• Continuing to use steroids despite physical side effects like hair loss
• Having persistent issues with friends and family
• Experiencing severe depression as a result of withdrawal


People who take steroids for a prolonged period of time disrupt natural hormonal balances in their bodies. When someone addicted to steroids suddenly stops taking the drugs, they can become depressed and even suicidal due to these hormonal imbalances. Someone looking to quit taking steroids should look for help. In treatment for steroid addiction, doctors can prescribe medications to restore healthy hormonal balance and reduce depressive symptoms.


What Are Anabolic Steroids?


Anabolic steroids are synthetic drugs that mimic testosterone, the male sex hormone. The full name of these drugs is “anabolic-androgenic steroids.” The word “anabolic” refers to the drug’s muscle-building effects, and “androgenic” refers to its masculinizing effects.


There is another type of steroid, known as corticosteroids, which shouldn’t be confused with anabolic steroids. Corticosteroids, such as prednisone, are often used to treat allergic reactions. These steroids don’t have the same effects as anabolic steroids, as they don’t facilitate muscle growth and don’t mimic the male sex hormone.


Anabolic steroids are available with a prescription and have important medical applications. Doctors prescribe anabolic steroids to treat several medical conditions, including:


• Delayed puberty, especially in adolescent boys
• Hormone imbalances in men
• Hypogonadism
• Impotence
• Breast cancer
• Osteoporosis
• Muscle loss due to disease
• Certain types of anemia
• Weight loss in individuals with HIV
• Endometriosis
• Other hormonal conditions


Anabolic steroids activate components of DNA in muscle cells that increase production of the proteins that build muscle tissues and fibers. This results in increased muscle growth and body mass in short periods of time. These components also increase bone minerals and impact the function of the immune, reproductive, central nervous, and other body systems and organs.


Anabolic steroids come in the form of pills, injectable liquids and topical gels or creams. Street names for anabolic steroids include juice, stackers, hype and roids. Some of the most common steroid brands include:


• Anadrol-50
• Oxandrin
• Winstrol
• Anavar
• Dianabol
Some steroid abusers have even been known to use veterinary steroids like Equipoise because these drugs are usually cheaper, more accessible and produce similar results.


Steroid Effects and Abuse


Any use of anabolic steroids without a doctor’s prescription is abuse. It’s also illegal. Those abusing anabolic steroids often take much larger doses than would ever be prescribed, in some cases 10 to 100 times larger. Anabolic steroids change how the body builds muscle. During exercise, people create small tears in their muscles. When it heals, the muscle tissue becomes stronger than before. Anabolic steroids quicken the healing process. This helps people exercise harder, more often and with greater results.


Some individuals who abuse anabolic steroids for extended periods of time eventually reach a high tolerance, resulting in the use of two or more different steroids at the same time, called “stacking.” This places individuals at much greater risk of negative side-effects and/or health risks.


People abuse anabolic steroids to change their physical appearance and abilities. Some athletes and bodybuilders use steroids for a competitive edge. Bodybuilders may use the drugs to get bigger, feel stronger, and increase their confidence. Some football players use steroids before a game to feel more aggressive. For years, several major league baseball players have taken steroids for more power at the bat. All of this despite the fact that is illegal and against professional codes to use steroids in sports.


For many, the pressure to stay competitive is a major factor in the decision to use steroids. However, many people taking steroids just want to look better.


Contrary to common belief, most [anabolic steroid] users do not engage in competitive athletics, but simply want to become leaner and more muscular.
– H.G. Pope Jr., Treatment of Anabolic-Androgenic Steroid Related Disorders, 2015


There are three common ways people abuse anabolic steroids. They are:


• “Stacking”
Stacking is taking multiple types of steroids at once or mixing oral and injectable formulations. Many steroid abusers believe stacking increases results, but this method has not been scientifically proven.


• “Cycling”
Cycling is a process of taking steroids during predetermined periods of time, usually 6-12 weeks. Users who are cycling take multiple doses for several weeks, stop for several weeks, and then start taking the steroids again. Steroid abusers use off-cycles to allow the body to produce its own testosterone and to reduce damage to internal organs.


• “Pyramiding”
Pyramiding is a method of taking steroids during a cycle. In the beginning of the cycle, users start with a low dose and gradually increase to a maximum dose mid-cycle. In the second half of the cycle, the user slowly tapers down their steroid dose.


According to the leading scientific research, none of these methods have been verified, nor do they reduce the risks or side effects of anabolic steroid use.

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