Other Substance Use Disorders: Anabolic Steroids
This group of substance-induced conditions most notably includes anabolic steroids and nitrite inhalants. Both have psychoactive effects and can have consequences for the individual and broad public health, which suggest that future research may lead to their inclusion in DSM-V as separate disorders.
In 1988, a survey of male high school seniors showed that anabolic steroids had a lifetime use rate of 6.6% (Buckley et al., 1988). Thus, by the late 1980s, widespread abuse of anabolic steroids was occurring among males as well as females. Multiple types of steroid derivatives were being used in order to make the lipid soluble steroids more water soluble and easier to administer than the intramuscular injections that were typically required. Because of this abuse, anabolic steroids were added to Schedule III of the Controlled Substances Act in 1990.
The clinical effects of anabolic steroids are related to a typ-ical “cycle” 4 to 18 weeks on steroids and 1 month to 1 year off. While taking the steroids, the primary effects sought by abusers are increasing muscle mass and strength and not euphoria. In the context of an adequate diet and significant physical activity, these individuals appear quite healthy and they are unlikely to appear for treatment of their anabolic steroid abuse. However, some of the adverse cardiovascular, hepatic and musculoskeletal effects of steroids as well as virilization in women may bring these users to medical attention. Severe cases of acne can also bring some ado-lescents to medical attention. Abuse of other psychoactive drugs may occur in up to a third of these steroid users, but generally is relatively low compared with other substance abusers.
Heavy use can increase aggression, change libido and sexual functions, and induce mood changes with occasional psy-chotic features (Brower et al., 1991; Su et al., 1993). In studies comparing doses of 40 to 240 mg/day of methyltestosterone in a double-blind inpatient trial, irritability, mood swings, violent feelings and hostility were greater during the high dose period than at baseline. The tendency of Androgenic steroids to provoke aggression and irritability has raised concerns about violence towards family members by abusers. Prospective trials have re-ported mood disturbances in over 50% of body builders using anabolic steroids, as well as cognitive impairment including dis-tractibility, forgetfulness and confusion.
Dependence symptoms have included a withdrawal syn-drome with common symptoms being fatigue, depressed mood and desire to take more steroids. Other common dependence symptoms are using the substance more than intended, continu-ing to use steroids despite problems worsened by its use and the excessive spending of time relating to obtaining steroids. Because few clinical laboratories are equipped to conduct steroid tests and these tests are quite expensive, these signs of dependence and some common laboratory abnormalities are usually used to ac-cess the diagnosis.
Anabolic steroid abuse leads to hypertrophied muscles, acne, oily skin, needle punctures over large muscles, hirsutism in females and gynecomastia in males. Heavy users can also de-velop edema and jaundice. Common laboratory abnormalities in-clude elevated hemoglobin and hematocrit, elevated low density lipoprotein cholesterol, elevated liver function tests and reduced luteinizing hormone levels.
Mental health professionals may have these patients come to their attention due to the excessive aggression, loss of sexual ability, or mood disturbances. Treatment approaches are gener-ally symptomatically oriented towards controlling the depressed mood and the psychotic features, but longer-term interventions such as peer counseling by former body builders and group sup-port may be of value for these users.