Use and Misuse of Steroids

Glucocorticoid-reinforced responding in the rhesus monkey

“…Subjective reports of relief from the illness for which glucocorticoids were prescribed may precede any objective change in the patient's medical condition (Rees 1953;Kimball 1971). In some cases, patients begin to self-medicate with glucocorticoids (Goldberg and Wise 1986), escalating the dose over time to the point where the criteria for a diagnosis of physical or psychological dependence may be met (Kimball 1971;Morgan et al 1973;Berlinger 1974). Case studies of these patients provide evidence for dependence on glucocorticoids, signs of glucocorticoid withdrawal (Dixon and Christy 1980), denial of glucocorticoid use, drug-seeking behavior and relapse after a period of abstinence (Kimball 1971;Morgan et al 1973), all of which suggest that prolonged use of glucocorticoids at doses that are sufficient to produce subjective effects has significant abuse potential in susceptible individuals (Dixon and Christy 1980).…”

“…Methylprednisolone is somewhat less potent and selective than dexamethasone, and has a shorter half-life. Hydrocortisone is short-acting and non-selective (Berlinger 1974). The effects of these glucocorticoids on mood, ad-renocorticotropin (ACTH) suppression and sodium retention (an indication of their mineralocorticoid activity) are summarized in a review by von Zerssen (1976), who described dexamethasone as having a "very marked" effect on mood and ACTH suppression relative to the "marked" or "slight" effects of methylprednisolone and cortisol (hydrocortisone).…”