This article was downloaded by: [Temple University Libraries] On: 07 January 2015, At: 23:05 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Psychoactive Drugs Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujpd20
Anabolic Steroids Robert D. Daigle
a
a
Monte Villa Hospital , 17925 Hale Avenue, Morgan Hill , California , 95037 Published online: 20 Jan 2012.
To cite this article: Robert D. Daigle (1990) Anabolic Steroids, Journal of Psychoactive Drugs, 22:1, 77-80, DOI: 10.1080/02791072.1990.10472199 To link to this article: http://dx.doi.org/10.1080/02791072.1990.10472199
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Short Communication ingly popular among athletes since that time (Haupt & Rovere 1984). At first,anabolicsteroidswere used almost exclusively by weightliftersand shot-putters as well as hammer,discus, and javelin throwers. However, their use later spread to football players, swimmers, and other track-and-field participants. Today, the use of anabolic steroids by athletes has reached almost epidemic proportions . In 1972, one-third of the Swedish track team was reported to have used injectable steroids.Fifty percent of professionalfootballlinemen and linebackers have taken steroids, and more than 80%of weightliftersand bodybuildershave used these substances (Wilson & Griffin 1980). During the 1983 PanAmerican Games held in Caracas, Venezuela, 19 competitors were disqualified when their drug use was detected. Dozens more of the athletes voluntarily withdrew from the games, apparently in fear of the stringent drugtesting techniques (Haupt & Rovere 1984). Well-known athletes who have been penalized because of steroid abuse include BenJohnsonand Brian Bosworthas well as a number of other athletes involved in the past two Olympiads. It is now unlikely that one can compete in some of these events on a world-class level without the use of steroids. Six to ten percent of male high-school students are users of anabolic steroids, and this estimate is felt to be an underestimation by most sports medicine physicians and addiction specialists (Duda 1988). Now the use has spread to high-schooland junior high-school students who just want to look good by taking anabolic steroids to build self-esteem. Of those high-school seniors who have used anabolic steroids, over two-thirds initiated use before age 16, and one-third before age 15. More than 35% of them did not participate in school sports, and 27% said that they used anabolic steroids to "improve their appearance" (Strauss 1989; Buckley, Yesalis & Friedl 1988).
ANABOLIC STEROIDS
Downloaded by [Temple University Libraries] at 23:05 07 January 2015
Robert D. Daigle, M.D.· Athletes,likeothers,userecreational and/orillicitpsychoactive drugs. However, many athletes also use drugs to enhance their training or performance, including an array of bizarre and exotic substances. Although the majority of these substances are not psychoactive, they may be abused by athletes. Some of these substances, such as anabolicsteroidsand humangrowthhormone,are referred to as ergogenic aids, due to their alleged strength-, endurance- or performance-enhancing properties. Derivatives of testosterone, anabolic steroids accelerate training by increasing muscle mass. These steroids were derived from testosterone in the hope of finding a drug that would not produce the detrimental and toxic androgenic effectsof testosterone but wouldallowthe muscle hypertrophy and strengthto prevail (i.e., anabolic effects). As yet, it has not been possible to completely dissociate these two effects (Trager 1988). More specifically, these drugs should be called androgenic-anabolic steroids, as they produce both androgenic (masculinizing) and anabolic (tissue-building) effects (Wadler& Hainline 1989). Anabolic steroidsmayalso havepsychoactive effects, such as increasing confidence and aggressiveness with an elevation of mood. HISTORY AND EPIDEMIOLOGY The search for a formulato increase muscle massand strength is an old one, and has long been thought to relate to the male hormone testosterone. In the late 1800s, scientists self-injected extracts of animal testosterone; in 1935,synthesisof testosteronewas achieved. At that time, testosteronewas used in an attempt to helpchronicallydebilitated patients suffering from malnutrition and muscle wasting (Schuckit 1988). Anabolic steroids were reportedly first used during World War II when they were given to German troops to enhance theiraggressiveness. The first use in athleticswas reported by the Russians in 1954. A team physician from the United States recognized their use at that time, and in the late 1950s conducted tests of the drugs in American athletes. The use of anabolicsteroidshavebecomeincreas-
PHARMACOLOGY The original medical applications of anabolic steroids were for breast cancer, aplastic anemia , treatment of angioneurotic edema, growth failure in young males, stimulating sexual development in hypogonadal males, and possibly for the treatment of osteoporosis. However, these uses are limited. Oral forms include Anovar and Dianabol. Injectable formsincludeDurabolinand Deca-Durabolin. Most athletes self-administerthese drugs in four- to twelve-week cycles,
-Chemical Dependency Medical Director, Monte Villa Hospital. 17925 Hale Avenue. Morgan Hill. California 95037 .
Journal ofPsychoactive Drugs
77
Vol. 22(1). Jan-Mar 1990
SHORT COMMUNICATION
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DAIGLE
The oral preparations appear to be more hepatotoxic (Haupt & Rovere 1984). However, injectable forms carry the increased risk of systemic infections (Unsigned 1987) and-if needles are shared-human immunodeficiency virus. High-school users are willing to put up with these side effects by saying that they are not that bad, and many athletes believe that the side effects are not serious or permanent (Haupt & Rovere 1984).
frequently administrating multiple drugs simultaneously in a practice known as slacking (adding more anabolic steroids as the cycle progresses) and pyramiding (starting with fewer anabolic steroids in smaller doses at the beginning of the cycle, progressing to a maximum number and dose of steroids at mid-cycle, and then tapering off at the end of the 12-weekcycle).They oftenconsume 10 to 1,000 times the normally prescribed doses (Wadler & Hainline 1989). The use of anabolic steroids will result in significant increases in strength as well as body size and weight if the athlete has been intensively trained in weight lifting immediately before the start of the steroidregimen. Anabolic steroids have their most pronounced effects in those athletes who have trainedto the point that theyare in a chronic catabolicstate and have also maintained a high-protein diet (2.0-2.2 g/kg/day). In this regard, anabolic steroids do work, and this is where there is a credibility gap between athletes and the medical profession. However, there is no improvement in the aerobic athletic performance or in the cardiorespiratory function of athleteson thesedrugs (Haupt & Rovere 1984).
Psychological There arc also emotional and psychological changes that may occur from the use of anabolic steroids. In fact, research points to a powerful psychological action of steroids (Pope & Katz 1988). Users report surges in selfesteem, energy and sex drive, increased appetite and aggression, and lowered tolerance to pain. In addition, users are less able to control their emotions, particularly anger, and exhibit a generally lowered tolerance of frustration or poor performance. Initially,the user has enhanced feelings of well-being and euphoria. After a four- to 12-week cycle is finished, users complain of irritability, dysphoria, a lack of energy, and a decreased sex drive. Severe depressions, feelings of guilt, and anorexia as well as impaired sleeping patterns commonly develop (Schuckit 1988). There are reports (Lubell 1989; Pope & Katz 1988) of anabolic steroid abusers who developed steroid psychosis, with hallucinations, ideas of reference, severe paranoid delusions, and violent mood swings. In the study by Pope and Katz, as manyas 32% of the bodybuilders reportedmanicIike symptomswhileusinganabolicsteroids. Of those with maniclike symptoms,38% experiencedfull-scalepsychoticepisodes, as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-lll). Morethan 12% reported majordepressionwhen they stopped use and 10% reported enhanced feelings of aggressiveness along with irritabilityand antisocial behavior, known as "roid rages" (Trager 1988). Pope and Katz studied dozens of violent crimes committed by steroid abusers. In each of the cases that they examinedin detail,the individual involved had been a normal person with a normal psychiatric history, no criminal history, and no history of violence. Under the influence of steroids, however,the person became uncharacteristically aggressive, and in some instances was not aware of how he had changed.In thecourseof events,that individual then committed a violent crime in a manner totally uncharacteristic of his prior behavior. Examples of such poor impulse control in bodybuilders on anabolic steroids are plentiful. A typical story is thatof HoraceWilliams who was accusedof participating in thebrutal murderof a hitchhikerwhile he and his friends were out joyriding in West Palm Beach, Florida (Lubell 1989; Pope & Katz 1988). Williams, in his early twen-
PROBLEM AREAS
Medical These muscle-building steroids do have severe side effects: more than 30%of the athletesquestioned in a study reported subjective side effects while taking them (Haupt & Rovere 1984). All anabolic steroids have some element of male hormone (testosterone) activity, resulting in a decrease ofthe body's production of pituitary hormonesand subsequent decrease of the body's own production of testosterone. At the same time, the androgenlike effects stimulate the development of male sex characteristics, and through metabolism to estrogenlike by-products can also produce some feminizing side effects. Anabolic steroids can also cause liver damage (Schuckit 1988; Haupt & Rovere 1984). Medical problems occurring from these side effects in males include testicular atrophy,prostate enlargement, difficultyin urinationsecondaryto changesin the prostate, sterility or decreased sperm production, impotence, gynecomastia (breast enlargement), and an accentuation of the malepatternof baldness. In females, side effectsinclude deepened voice, male hair distribution(includingbaldness and beard growth), menstrual irregularities, shrinkage of the uterus and breast tissue, and clitoral enlargement. In both sexes there may occurprematureclosureof the growth plates of the bones (resulting in permanent short stature), severe acne (secondary to a proliferation of oil glands in the skin), abnormal liver function tests, liver cysts and tumors (including liver cancer), and early coronary disease, stroke, and high blood pressure (Schuckit 1988). JOIITNJI
ofPsychoactive Drugs
78
Vol. 22(1), Jan-Mar 1990
SHORT COMMUNICATION
DAIGLE
withdrawal effects at the end of their cycles, many bodybuilders will use chorionic gonadotropin (a hormone that acts like luteinizing hormone by stimulating the testes to produce testosterone) to restimulatetheir own endogenous testosterone production. Several treatment strategies that bodybuilders have advocated for the prevention and selftreatment of gynecomastia include the use of tarnoxifen (a medicationused in breast cancer patients), mesterolone, and chorionic gonadotropin (Friedl & Yesalis 1989). This is an indication of the polypharmacy that many of the anabolic steroids abusers engage in. The issue of anabolic steroid use is multifaceted. On the one hand,manyphysicians doubt theirefficacyin building strength and bulk, while bodybuilders see the results. Subsequently, the credibility gap between physicians and athletes has widened. There is little doubt that, in conjunction with rigorous weight training and a high-protein diet, anabolic steroids do help to increase strength . Most of the studies on the medical side effects of anabolic steroids were derived from medically ill patients, not from athletes. However, the doses employed in bodybuilding may be over 1,000times the normalrecommended dose. Subsequently, these medical side effects can be predicted to increase. The psychological ramifications, however,are already recognized and appear to be more serious. The initial enhanced feelings, improved self-esteem, and aggressiveness that occur with anabolic steroid use lessen the ability for sound reasoning or decision making . Psychoticlike symptoms and depression all too often follow. In an attempt to alleviate the withdrawal symptoms, the athletewilloftenbegin a new cycle of anabolicsteroids. The vicious circle of drug use and abuse then continues. The psychiatric problemsare well-documented, but are not sufficiently emphasized in the literature. The lure of fame and big moneyin becoming a worldclass athlete is quite compelling.The "just say no" attitude will not suffice when such high stakes are involved. The amount of prestige society places on the young athlete can be overwhelming. The debate over anabolic steroids is just beginning. Simply stated, anabolic steroids-with their adverse medical and psychological consequences-will present new and difficult challenges to professionals in the addiction field in the future.
ties-previously described as a kind, considerate, regular churchgoer-had dramatic personality changes in the months preceding the murder. As described by his family and friends,Williamsbecameobsessedwith bodybuilding, had been obtaining anabolic steroids on the black market, and had been taking them for over a year.
Downloaded by [Temple University Libraries] at 23:05 07 January 2015
CONCLUSION
In its broadest defmition, addiction has three components: compulsion,loss of control, and continued use despite adverseconsequences. This type of dependenceoften results in severe physical and psychological problems. The reviewedliteratureindicated that anabolicsteroids are only psychologically addictive; however, these drugs have much more severe effects on the brain's neurochemistry. They appear to be both physiologically and psychologically addicting. As in the past with cocaine, the clinician can be lulled into a false sense of security. Unfortunately, the general public continues to view these substances as relatively benign, and few users have been adequately informed of the potentially severe consequences. The growing demand for anabolic steroids by an increasingly younger population and a concomitant rise in the black market demand for these drugs shouldbe of concern. The recent closure of a factory in Tijuana, Mexico, whereanabolicsteroidswere being illegally manufactured, and the association of Panama's Manuel Noriega to that lab, is an indication of the magnitude of the problem. The U.S. Department of Justice, Federal Bureau of Investigation, Customs Service, and the Food and Drug Administration have coordinated activities to hand down a recent I100count indictmentcharging34 individualswith a complex conspiracy to counterfeit, smuggle, and distribute these drugs nationwide. Worth millions of dollars, the black market drugs are unsafe and have been found to be both nonsterile and pyrogenic (Unsigned 1987). It is noteworthy that the anabolic steroids are not presently regulated under the federal government's Controlled Substances Act,and therefore production quotas are not imposed. Congressis attemptingto enact legislation to place anabolic steroids in Schedule II. However, if anabolic steroids were categorized as controlled substances, the flow of black market products might just increase, as it did withcocaine. The AmericanMedicalAssociation opposes such legislation and contends that this will not adequately address the problem, inasmuch as over 80% of the anabolic steroids are not obtained through medical channels (Cowart 1989). In California, the use of these drugs are proscribed and there are penalties imposed for trafficking. Many anabolic steroid abusers will use other medications illegally to combat their side effects. To minimize JOIU7J(J[
ofPsychoactive Drugs
BEYOND ANABOLIC STEROIDS
A new ergogenic aid is human growth hormone (hGH), which is secreted from the pituitary gland. It is responsible for stimulating the production of growth factors known as somatomedins. In the past, the only source of hGH was from the pituitaryextractsof cadavers. However, there are now commercially synthetic forms available that are distributed on the black market. It is growing rapidly 79
Vol. 22(1). Jan-Mar 1990
DAIGLE
SHORT COMM UNICATION
in popularity in southern California. Currently, hGH is in a mythological stage. There is presently no method to test for its presence in vivo. The claims among athletes is that it is even more effective than anabolic steroids. However, this is unproven. Many athletes believe that it will provide the benefits of anabolic steroids much more safely. This is patently false because hGH causes acromegaly, organomegaly, diabetes, heart and thy-
roid diseases, menstrual disorders, decreased sexual desire, and a shortened life span (Cowart 1988; Dye 1987). Most athletes who claim to have had significant gains with hGH were using it along with anabolic steroids. It is extremely expensive and can be easily adulterated on the black market. It does not appear to enhance performance, but it presently occupies a position of mythological status among athletes.
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REFERENCES Buckley, W.E.; Yesalis, C.E. & Friedl, K.E. 1988. Estimated prevalence of anabolic steroid use among male high school senio rs. Journal of the American Medical Association Vol. 260(23): 3441-3445. Cowart, V.S. 1989. Support lags for research on steroid effects. Journal ofthe American Medical Association Vol. 262(18): 2500-2502. Cowart, V.S. 1988. Human growth hormone: The latest ergogenic aid? Physician and Sportsmedlcine Vol. 16(3): 175-185 . Duda, H. 1988. Gauging steroid use in high school kids. Phys ician and Sportsmedicine Vol. 16(8): 16-17. Dye, C. 1987. Human growth hormone : Beyond steroids? New service Vol. 3(3) : 1-8. Friedl , E.F. & Yesalis, C.E. 1989. Self-treatment of gynec omastia in bodybuilders who use anabolic steroids . Ph ys ician and Sportsmedlcine Vol. 17(3) : 67-79 . Haupt, H.A. & Rovere, G.D . 1984. Anabolic steroids: A review of the literature. American Joumal ofSportsmedicine Vol. 12(6): 464-484. Lubell, A. 1989 . Does steroid abuse cause---or excuse-violence?
Journal ofPsychoactive Drugs
Phys ician and Sportsmedicine Vol. 17(2): 176-185 . Pope, H.G. & Katz , D.L. 1988. Affective and psychotic symptoms associated with anabolic steroids. American Journal ofPsychiatry Vol. 145(4) : 487-490. Schuckit, M.A. 1988. Weight lifter's folly: The abuse of anabolic steroids. Drug Abuse &: Alcoholism Newsletter Vol. 17(8): 1-4. Strauss, R.H. 1989. High school kids: Looking better,living worse? Physician and Sportsmedicine Vol. 17(2): 35. Trager, J. 1988. Beware "roid rage" in athletes. Medical Tribune Vol. 29(16) : 1-13. Unsigned . 1987. Anabolic steroid abuse . FDA Drug Bulletin October: 27 -28. Wadler, G.!. & Hainline, B. 1989. Drugs and the Athlete. Philadelphia: EA . Davis . Wilson, J. & Griffin, J. 1980. The use and misuse of androgens. Metabolism Vol. 29(12): 1278-1295.
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Journal of Psychoactive Drugs Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujpd20
Anabolic Steroids Robert D. Daigle
a
a
Monte Villa Hospital , 17925 Hale Avenue, Morgan Hill , California , 95037 Published online: 20 Jan 2012.
To cite this article: Robert D. Daigle (1990) Anabolic Steroids, Journal of Psychoactive Drugs, 22:1, 77-80, DOI: 10.1080/02791072.1990.10472199 To link to this article: http://dx.doi.org/10.1080/02791072.1990.10472199
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Short Communication ingly popular among athletes since that time (Haupt & Rovere 1984). At first,anabolicsteroidswere used almost exclusively by weightliftersand shot-putters as well as hammer,discus, and javelin throwers. However, their use later spread to football players, swimmers, and other track-and-field participants. Today, the use of anabolic steroids by athletes has reached almost epidemic proportions . In 1972, one-third of the Swedish track team was reported to have used injectable steroids.Fifty percent of professionalfootballlinemen and linebackers have taken steroids, and more than 80%of weightliftersand bodybuildershave used these substances (Wilson & Griffin 1980). During the 1983 PanAmerican Games held in Caracas, Venezuela, 19 competitors were disqualified when their drug use was detected. Dozens more of the athletes voluntarily withdrew from the games, apparently in fear of the stringent drugtesting techniques (Haupt & Rovere 1984). Well-known athletes who have been penalized because of steroid abuse include BenJohnsonand Brian Bosworthas well as a number of other athletes involved in the past two Olympiads. It is now unlikely that one can compete in some of these events on a world-class level without the use of steroids. Six to ten percent of male high-school students are users of anabolic steroids, and this estimate is felt to be an underestimation by most sports medicine physicians and addiction specialists (Duda 1988). Now the use has spread to high-schooland junior high-school students who just want to look good by taking anabolic steroids to build self-esteem. Of those high-school seniors who have used anabolic steroids, over two-thirds initiated use before age 16, and one-third before age 15. More than 35% of them did not participate in school sports, and 27% said that they used anabolic steroids to "improve their appearance" (Strauss 1989; Buckley, Yesalis & Friedl 1988).
ANABOLIC STEROIDS
Downloaded by [Temple University Libraries] at 23:05 07 January 2015
Robert D. Daigle, M.D.· Athletes,likeothers,userecreational and/orillicitpsychoactive drugs. However, many athletes also use drugs to enhance their training or performance, including an array of bizarre and exotic substances. Although the majority of these substances are not psychoactive, they may be abused by athletes. Some of these substances, such as anabolicsteroidsand humangrowthhormone,are referred to as ergogenic aids, due to their alleged strength-, endurance- or performance-enhancing properties. Derivatives of testosterone, anabolic steroids accelerate training by increasing muscle mass. These steroids were derived from testosterone in the hope of finding a drug that would not produce the detrimental and toxic androgenic effectsof testosterone but wouldallowthe muscle hypertrophy and strengthto prevail (i.e., anabolic effects). As yet, it has not been possible to completely dissociate these two effects (Trager 1988). More specifically, these drugs should be called androgenic-anabolic steroids, as they produce both androgenic (masculinizing) and anabolic (tissue-building) effects (Wadler& Hainline 1989). Anabolic steroidsmayalso havepsychoactive effects, such as increasing confidence and aggressiveness with an elevation of mood. HISTORY AND EPIDEMIOLOGY The search for a formulato increase muscle massand strength is an old one, and has long been thought to relate to the male hormone testosterone. In the late 1800s, scientists self-injected extracts of animal testosterone; in 1935,synthesisof testosteronewas achieved. At that time, testosteronewas used in an attempt to helpchronicallydebilitated patients suffering from malnutrition and muscle wasting (Schuckit 1988). Anabolic steroids were reportedly first used during World War II when they were given to German troops to enhance theiraggressiveness. The first use in athleticswas reported by the Russians in 1954. A team physician from the United States recognized their use at that time, and in the late 1950s conducted tests of the drugs in American athletes. The use of anabolicsteroidshavebecomeincreas-
PHARMACOLOGY The original medical applications of anabolic steroids were for breast cancer, aplastic anemia , treatment of angioneurotic edema, growth failure in young males, stimulating sexual development in hypogonadal males, and possibly for the treatment of osteoporosis. However, these uses are limited. Oral forms include Anovar and Dianabol. Injectable formsincludeDurabolinand Deca-Durabolin. Most athletes self-administerthese drugs in four- to twelve-week cycles,
-Chemical Dependency Medical Director, Monte Villa Hospital. 17925 Hale Avenue. Morgan Hill. California 95037 .
Journal ofPsychoactive Drugs
77
Vol. 22(1). Jan-Mar 1990
SHORT COMMUNICATION
Downloaded by [Temple University Libraries] at 23:05 07 January 2015
DAIGLE
The oral preparations appear to be more hepatotoxic (Haupt & Rovere 1984). However, injectable forms carry the increased risk of systemic infections (Unsigned 1987) and-if needles are shared-human immunodeficiency virus. High-school users are willing to put up with these side effects by saying that they are not that bad, and many athletes believe that the side effects are not serious or permanent (Haupt & Rovere 1984).
frequently administrating multiple drugs simultaneously in a practice known as slacking (adding more anabolic steroids as the cycle progresses) and pyramiding (starting with fewer anabolic steroids in smaller doses at the beginning of the cycle, progressing to a maximum number and dose of steroids at mid-cycle, and then tapering off at the end of the 12-weekcycle).They oftenconsume 10 to 1,000 times the normally prescribed doses (Wadler & Hainline 1989). The use of anabolic steroids will result in significant increases in strength as well as body size and weight if the athlete has been intensively trained in weight lifting immediately before the start of the steroidregimen. Anabolic steroids have their most pronounced effects in those athletes who have trainedto the point that theyare in a chronic catabolicstate and have also maintained a high-protein diet (2.0-2.2 g/kg/day). In this regard, anabolic steroids do work, and this is where there is a credibility gap between athletes and the medical profession. However, there is no improvement in the aerobic athletic performance or in the cardiorespiratory function of athleteson thesedrugs (Haupt & Rovere 1984).
Psychological There arc also emotional and psychological changes that may occur from the use of anabolic steroids. In fact, research points to a powerful psychological action of steroids (Pope & Katz 1988). Users report surges in selfesteem, energy and sex drive, increased appetite and aggression, and lowered tolerance to pain. In addition, users are less able to control their emotions, particularly anger, and exhibit a generally lowered tolerance of frustration or poor performance. Initially,the user has enhanced feelings of well-being and euphoria. After a four- to 12-week cycle is finished, users complain of irritability, dysphoria, a lack of energy, and a decreased sex drive. Severe depressions, feelings of guilt, and anorexia as well as impaired sleeping patterns commonly develop (Schuckit 1988). There are reports (Lubell 1989; Pope & Katz 1988) of anabolic steroid abusers who developed steroid psychosis, with hallucinations, ideas of reference, severe paranoid delusions, and violent mood swings. In the study by Pope and Katz, as manyas 32% of the bodybuilders reportedmanicIike symptomswhileusinganabolicsteroids. Of those with maniclike symptoms,38% experiencedfull-scalepsychoticepisodes, as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-lll). Morethan 12% reported majordepressionwhen they stopped use and 10% reported enhanced feelings of aggressiveness along with irritabilityand antisocial behavior, known as "roid rages" (Trager 1988). Pope and Katz studied dozens of violent crimes committed by steroid abusers. In each of the cases that they examinedin detail,the individual involved had been a normal person with a normal psychiatric history, no criminal history, and no history of violence. Under the influence of steroids, however,the person became uncharacteristically aggressive, and in some instances was not aware of how he had changed.In thecourseof events,that individual then committed a violent crime in a manner totally uncharacteristic of his prior behavior. Examples of such poor impulse control in bodybuilders on anabolic steroids are plentiful. A typical story is thatof HoraceWilliams who was accusedof participating in thebrutal murderof a hitchhikerwhile he and his friends were out joyriding in West Palm Beach, Florida (Lubell 1989; Pope & Katz 1988). Williams, in his early twen-
PROBLEM AREAS
Medical These muscle-building steroids do have severe side effects: more than 30%of the athletesquestioned in a study reported subjective side effects while taking them (Haupt & Rovere 1984). All anabolic steroids have some element of male hormone (testosterone) activity, resulting in a decrease ofthe body's production of pituitary hormonesand subsequent decrease of the body's own production of testosterone. At the same time, the androgenlike effects stimulate the development of male sex characteristics, and through metabolism to estrogenlike by-products can also produce some feminizing side effects. Anabolic steroids can also cause liver damage (Schuckit 1988; Haupt & Rovere 1984). Medical problems occurring from these side effects in males include testicular atrophy,prostate enlargement, difficultyin urinationsecondaryto changesin the prostate, sterility or decreased sperm production, impotence, gynecomastia (breast enlargement), and an accentuation of the malepatternof baldness. In females, side effectsinclude deepened voice, male hair distribution(includingbaldness and beard growth), menstrual irregularities, shrinkage of the uterus and breast tissue, and clitoral enlargement. In both sexes there may occurprematureclosureof the growth plates of the bones (resulting in permanent short stature), severe acne (secondary to a proliferation of oil glands in the skin), abnormal liver function tests, liver cysts and tumors (including liver cancer), and early coronary disease, stroke, and high blood pressure (Schuckit 1988). JOIITNJI
ofPsychoactive Drugs
78
Vol. 22(1), Jan-Mar 1990
SHORT COMMUNICATION
DAIGLE
withdrawal effects at the end of their cycles, many bodybuilders will use chorionic gonadotropin (a hormone that acts like luteinizing hormone by stimulating the testes to produce testosterone) to restimulatetheir own endogenous testosterone production. Several treatment strategies that bodybuilders have advocated for the prevention and selftreatment of gynecomastia include the use of tarnoxifen (a medicationused in breast cancer patients), mesterolone, and chorionic gonadotropin (Friedl & Yesalis 1989). This is an indication of the polypharmacy that many of the anabolic steroids abusers engage in. The issue of anabolic steroid use is multifaceted. On the one hand,manyphysicians doubt theirefficacyin building strength and bulk, while bodybuilders see the results. Subsequently, the credibility gap between physicians and athletes has widened. There is little doubt that, in conjunction with rigorous weight training and a high-protein diet, anabolic steroids do help to increase strength . Most of the studies on the medical side effects of anabolic steroids were derived from medically ill patients, not from athletes. However, the doses employed in bodybuilding may be over 1,000times the normalrecommended dose. Subsequently, these medical side effects can be predicted to increase. The psychological ramifications, however,are already recognized and appear to be more serious. The initial enhanced feelings, improved self-esteem, and aggressiveness that occur with anabolic steroid use lessen the ability for sound reasoning or decision making . Psychoticlike symptoms and depression all too often follow. In an attempt to alleviate the withdrawal symptoms, the athletewilloftenbegin a new cycle of anabolicsteroids. The vicious circle of drug use and abuse then continues. The psychiatric problemsare well-documented, but are not sufficiently emphasized in the literature. The lure of fame and big moneyin becoming a worldclass athlete is quite compelling.The "just say no" attitude will not suffice when such high stakes are involved. The amount of prestige society places on the young athlete can be overwhelming. The debate over anabolic steroids is just beginning. Simply stated, anabolic steroids-with their adverse medical and psychological consequences-will present new and difficult challenges to professionals in the addiction field in the future.
ties-previously described as a kind, considerate, regular churchgoer-had dramatic personality changes in the months preceding the murder. As described by his family and friends,Williamsbecameobsessedwith bodybuilding, had been obtaining anabolic steroids on the black market, and had been taking them for over a year.
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CONCLUSION
In its broadest defmition, addiction has three components: compulsion,loss of control, and continued use despite adverseconsequences. This type of dependenceoften results in severe physical and psychological problems. The reviewedliteratureindicated that anabolicsteroids are only psychologically addictive; however, these drugs have much more severe effects on the brain's neurochemistry. They appear to be both physiologically and psychologically addicting. As in the past with cocaine, the clinician can be lulled into a false sense of security. Unfortunately, the general public continues to view these substances as relatively benign, and few users have been adequately informed of the potentially severe consequences. The growing demand for anabolic steroids by an increasingly younger population and a concomitant rise in the black market demand for these drugs shouldbe of concern. The recent closure of a factory in Tijuana, Mexico, whereanabolicsteroidswere being illegally manufactured, and the association of Panama's Manuel Noriega to that lab, is an indication of the magnitude of the problem. The U.S. Department of Justice, Federal Bureau of Investigation, Customs Service, and the Food and Drug Administration have coordinated activities to hand down a recent I100count indictmentcharging34 individualswith a complex conspiracy to counterfeit, smuggle, and distribute these drugs nationwide. Worth millions of dollars, the black market drugs are unsafe and have been found to be both nonsterile and pyrogenic (Unsigned 1987). It is noteworthy that the anabolic steroids are not presently regulated under the federal government's Controlled Substances Act,and therefore production quotas are not imposed. Congressis attemptingto enact legislation to place anabolic steroids in Schedule II. However, if anabolic steroids were categorized as controlled substances, the flow of black market products might just increase, as it did withcocaine. The AmericanMedicalAssociation opposes such legislation and contends that this will not adequately address the problem, inasmuch as over 80% of the anabolic steroids are not obtained through medical channels (Cowart 1989). In California, the use of these drugs are proscribed and there are penalties imposed for trafficking. Many anabolic steroid abusers will use other medications illegally to combat their side effects. To minimize JOIU7J(J[
ofPsychoactive Drugs
BEYOND ANABOLIC STEROIDS
A new ergogenic aid is human growth hormone (hGH), which is secreted from the pituitary gland. It is responsible for stimulating the production of growth factors known as somatomedins. In the past, the only source of hGH was from the pituitaryextractsof cadavers. However, there are now commercially synthetic forms available that are distributed on the black market. It is growing rapidly 79
Vol. 22(1). Jan-Mar 1990
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SHORT COMM UNICATION
in popularity in southern California. Currently, hGH is in a mythological stage. There is presently no method to test for its presence in vivo. The claims among athletes is that it is even more effective than anabolic steroids. However, this is unproven. Many athletes believe that it will provide the benefits of anabolic steroids much more safely. This is patently false because hGH causes acromegaly, organomegaly, diabetes, heart and thy-
roid diseases, menstrual disorders, decreased sexual desire, and a shortened life span (Cowart 1988; Dye 1987). Most athletes who claim to have had significant gains with hGH were using it along with anabolic steroids. It is extremely expensive and can be easily adulterated on the black market. It does not appear to enhance performance, but it presently occupies a position of mythological status among athletes.
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REFERENCES Buckley, W.E.; Yesalis, C.E. & Friedl, K.E. 1988. Estimated prevalence of anabolic steroid use among male high school senio rs. Journal of the American Medical Association Vol. 260(23): 3441-3445. Cowart, V.S. 1989. Support lags for research on steroid effects. Journal ofthe American Medical Association Vol. 262(18): 2500-2502. Cowart, V.S. 1988. Human growth hormone: The latest ergogenic aid? Physician and Sportsmedlcine Vol. 16(3): 175-185 . Duda, H. 1988. Gauging steroid use in high school kids. Phys ician and Sportsmedicine Vol. 16(8): 16-17. Dye, C. 1987. Human growth hormone : Beyond steroids? New service Vol. 3(3) : 1-8. Friedl , E.F. & Yesalis, C.E. 1989. Self-treatment of gynec omastia in bodybuilders who use anabolic steroids . Ph ys ician and Sportsmedlcine Vol. 17(3) : 67-79 . Haupt, H.A. & Rovere, G.D . 1984. Anabolic steroids: A review of the literature. American Joumal ofSportsmedicine Vol. 12(6): 464-484. Lubell, A. 1989 . Does steroid abuse cause---or excuse-violence?
Journal ofPsychoactive Drugs
Phys ician and Sportsmedicine Vol. 17(2): 176-185 . Pope, H.G. & Katz , D.L. 1988. Affective and psychotic symptoms associated with anabolic steroids. American Journal ofPsychiatry Vol. 145(4) : 487-490. Schuckit, M.A. 1988. Weight lifter's folly: The abuse of anabolic steroids. Drug Abuse &: Alcoholism Newsletter Vol. 17(8): 1-4. Strauss, R.H. 1989. High school kids: Looking better,living worse? Physician and Sportsmedicine Vol. 17(2): 35. Trager, J. 1988. Beware "roid rage" in athletes. Medical Tribune Vol. 29(16) : 1-13. Unsigned . 1987. Anabolic steroid abuse . FDA Drug Bulletin October: 27 -28. Wadler, G.!. & Hainline, B. 1989. Drugs and the Athlete. Philadelphia: EA . Davis . Wilson, J. & Griffin, J. 1980. The use and misuse of androgens. Metabolism Vol. 29(12): 1278-1295.
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