Treating Steroid Abuse: A Psychiatric Perspective

Abstract

Anabolic-androgen steroids (AAS) are indicated medically for specific conditions, particularly androgen deficiency. However, because of their apparent capacity to improve physical and psychological performance, young athletes have been using AAS to increase competitiveness and self-image. AAS act on skeletal muscle to increase nitrogen retention and protein synthesis, thus increasing muscle size and strength. Aggressivity, euphoria and diminished fatigue are produced by effects on central nervous system androgen receptors. Psychiatric effects include depression, hyperaggressivity, mania and psychosis. Physical problems include cardiovascular abnormalities, hypertension, and tumor formation. Women report anovulation and virilization.Currently, over one million Americans have used AAS to enhance athletic performance or increase muscle mass. Nearly three-fourths of this group are high school students. Four to ten percent of all high school boys and 0.5% to 2.5% of all high school girls have misused steroids. In addition, 20% of college athletes, 80% of male bodybuilders and 40% of female body builders use AAS as performance enhancers. Most steroids are purchased through illegal sources: these include veterinary AAS and those of illicit manufacture. In addition, physicians provide a small source of these steroids despite state sanctions against this practice.Most exogenous steroid abuse can be directly detected by chromatography-mass spectrometry but the technique is tedious and expensive. If detection is not needed for legal purposes, a ratio of urinary testosterone to epitestosterone that is greater than 6:1 1 is usually sufficient to diagnose misuse of AAS. Withdrawal from AAS usually involves three steps: detoxification, rehabilitation and after-care. Inpatient detoxification is indicated only if there are severe physical problems or psychosis. Treatment is then directed towards the sequelae of anabolic steroid abuse as the steroids are withdrawn. Rehabilitation can be conducted on an in-patient or outpatient basis. The modalities are psychotherapeutic and include individual, group and milieu therapy, as well as rigorous physical therapy. Because of the long-term nature of the recovery process, weekly attendance at self-help addiction groups such as Narcotics Anonymous is strongly encouraged.On the basis of high prevalence and severe side-effects, pediatricians and other physicians treating adolescents should be alert for anabolic steroid abuse in their practice. The expense and difficulty involved in direct laboratory testing, necessitate careful history taking and examination. If steroid abuse is detected, treatment is mandatory.Thus, careful attention to the patient's history and proper psychotherapeutic treatment modalities are all necessary components in attending to this serious drug problem.

Integrated Treatment Principles and Strategies for Patients with Eating Disorders, Substance Use Disorder, and Addictions

“…Inpatient treatment may be necessary if the patient is experiencing severe physical problems or becomes psychotic. Recovery from steroid abuse is often long term, and, in addition to individual therapy or milieu treatment, patients are encouraged to attend self-help groups like Narcotics Anonymous (Giannini, Miller, & Kocjan, 1991).…”

Eating Disorders, Addictions and Substance Use Disorders

“…Recovery from steroid abuse is often long term, and, in addition to individual therapy or milieu treatment, patients are encouraged to attend self-help groups like Narcotics Anonymous (Giannini, Miller, & Kocjan, 1991). Inpatient treatment may be necessary if the patient is experiencing severe physical problems or becomes psychotic.…”

Treatments for people who use anabolic androgenic steroids: a scoping review

“…Criteria such as tolerance, withdrawal, use of the substance in larger amounts, unsuccessful attempts to reduce or stop using the substance, and time spent on activity related to the substance use have all been identified as features of AAS dependence [44, 46]. A number of hypotheses to explain AAS dependence have been put forward [47, 48] and recommendations for treating what has been described as steroid ‘abuse’ or dependence have long been proposed [49–51].…”