AAS – CNS Effects

[Michael Scally MD]

IMO, the signs and symptoms attributed to AAS dependency are due to Anabolic-Androgenic Steroid Induced hypogonadism (ASIH). In order for studies on AAS dependency to be minimally credible, they must include for the monitoring of hypogonadism. Further, treatments aimed at preventing or mitigating ASIH will prove beneficial to stop AAS use. There are added benefits, including the retention of muscle mass and strength important for many chronic diseases and ageing.


The association of AAS with adverse psychological and behavioral effects is extensive. Historically, researchers went so far as to categorically state that AAS are without any evidence upon muscle going so far as to argue that there is saturation of the androgen receptor with eugonadal levels of testosterone. This attitude spurned the concept that the large doses commonly used by nonprescription AAS users indicate that the drug use is for actions other than their normal physiological effects, implying an addictive nature to AAS, with the signs and symptoms after AAS cessation indications of AAS withdrawal. Upon nonprescription AAS cessation, psychological disturbances include aggressiveness, depression, anxiousness, potency problems (libido), sleep disorders, violent behavior, rage, and suicidal ideation.

The two most widely-accepted standards for defining, classifying and diagnosing drug abuse and dependence are the Diagnostic Statistical Manual IV (DSM-IV) and the International Classification of Diseases, Volume 10 (ICD-10). The Diagnostic Statistical Manual IV (DSM IV) and the International Classification of Diseases, Volume 10 (ICD 10) differ in the way they regard Anabolic-Androgenic Steroids' (AAS) potential for producing dependence. DSM IV regards AAS as potentially dependence producing (this is true for ALL drugs) and ICD 10 regards them as non-dependence producing.

This difference in approach towards AAS prompts debate as to whether or not AAS are dependence-producing substances. The main work in this area has been conducted by Brower et al. who investigated the existence of a "steroid dependency syndrome" and classified subjects as dependent on AAS using an adaptation of the DSM-III-R criteria for dependence on psychoactive substances, which differ only slightly from those of DSM-IV.

In 2002, Brower summarizes the literature on AAS abuse and dependence and reports of at least 165 cases of addiction or dependence in the medical literature. Brower also concludes no cases of dependence have been associated with legitimate prescriptions of AAS used at therapeutic doses for medical purposes. According to Brower, individuals who use high doses of AAS over prolonged periods may develop withdrawal symptoms that include fatigue, depressed mood, restlessness, anhedonia, impaired concentration, increased aggression, anorexia, insomnia, decreased libido, self-image dissatisfaction, androgen desire, headaches, suicidal ideation, decrease in size/weight/strength, and feeling depressed/down/unhappy due to size loss when they stop taking AAS and these withdrawal effects may contribute to a syndrome of dependence. The patient with hypogonadism may experience almost all of these above symptoms. Rather than diagnosing substance abuse or dependence the criteria in use by these investigators is the patient examination for hypogonadism.

In 1990, the National Institute of Drug Abuse (NIDA) published an extensive monograph on anabolic steroid abuse (45). This monograph represents a “state-of-the-art” information resource concerning anabolic steroid abuse. "It must be concluded at this time that the use of steroids by humans does not meet the criteria necessary to establish that steroids have significant abuse liability as defined in pharmacological terms." The conclusion from this monograph is anabolic steroids do not satisfy the criteria for abuse potential. Echoing this opinion is a report from President’s Council on Physical Fitness. In 1994, evidence review of the published literature states, "Despite increasing clinical descriptive data on anabolic steroid withdrawal, dependence, and abuse, there are insufficient substantial basic or clinical research data to support the inclusion of these syndromes in DSM-IV." In the intervening eighteen years since the original findings, there is nothing in the published scientific literature to change these conclusions. There are few, if any, well-controlled investigations or studies on the dependence potential of AAS. IMO, AAS dependency/addiction is a myth/fiction.

 

[haas480]

Based on literature, i would agree with your opinion of no factual proof to conclude physiological dependency/addiction is a direct result of AAS.

However, under extreme circumstances, one's psychological state can directly alter one's physiological state. I would attribute the dependence/addiction (on AAS) of an individual to what they expect from taking AAS. Concluding, the majority of "dependency" on AAS is at the psychological level (which would induce a physiological response, such as stress, etc).

 

[Michael Scally MD]

Anabolic–androgenic steroids (AASs) are used primarily in pursuit of a perfect appearance and the perceived social and health benefits that come from having a perfect body. This undertaking also involves a range of healthy activities including attention to diet and regular exercise, two behaviors almost universally endorsed by the medical community, health organizations, and public health officials as essential to one’s mental and physical health. The addition of AASs to these behaviors creates an interesting paradox where the pursuit of health and well-being may actually lead to too much of a good thing.

Although AASs enhance certain markers of mental and physical health (e.g., increased muscularity, decreased body fat, increased sex drive, improved mood and cognition, etc.), the long-term effects of this lifestyle may rob individuals of their health and well-being. Drawing the line between life enhancement and long-term health risk becomes an interesting exercise, currently influenced by the sociopolitical environment of cheating athletes and without substantial clinical or empirical data to aid in this challenge. Thus, the pressing questions become: how does AAS use turn life enhancement into poor health, where does life enhancement transition into a harmful pattern of drug use, and who is vulnerable to the negative outcomes of this AAS lifestyle?

Much of the attention given to these questions has focused on AAS addiction where traditional categories of abuse and dependence are used to define harmful use and the biological risk is drug-centric, attributing risk to the ability of AASs to hijack the reward system. There are limitations to answering these questions about harmful use with AAS abuse and dependence.

First, this framework pathologizes the substance and consequently makes any use of the substance dangerous. This drug-centric approach contradicts the well-established safety and low abuse potential of AASs when used to treat certain medical conditions (i.e., testosterone deficiency, wasting syndrome in AIDS patients, etc.).

Second, the classic addiction framework relies heavily on the substance’s ability to alter one’s brain, such that an individual would need the drug to feel pleasure. This focus is inconsistent with the primary uses of AASs; they are used almost exclusively for their effects on the body and not for their ability to produce pleasure in the brain.

Third, vulnerabilities are attributed to individual differences in the brain’s motivation–reward system. Those who have an altered motivation–reward system are believed to be more sensitive to the drug’s pleasure producing effects and consequently more likely to develop addiction upon use.

In the absence of data, it is unclear what makes certain individuals vulnerable to the negative effects of AASs and others resistant to these outcomes. Thus, the use of AAS addiction to answer these questions about how, where, and who is limited by a narrow focus on the pleasure producing properties of AASs and an individual’s innate sensitivity to this pleasure.

There are also a number of basic features of AASs and their use that suggest a broader focus is necessary to answer these questions and resolve the AAS paradox. First, illicit AASs use occurs exclusively in the context of dietary control and intense exercise, and the desired effects of AASs require some baseline investment in these healthy behaviors. Thus, these associated features must be included in the basic understanding of how AASs use can result in some health-related benefits as well as the potential for health risk. Second, AASs are synthetic hormones and consequently have broad effects on a range of peripheral tissues (e.g., muscle, bone, kidneys, liver, etc.) as well as the central nervous system (CNS). The motivation–reward system, which lies within the CNS, simply does not adequately capture the major psychological effects of AASs. Third, there is a significant degree of heterogeneity in the population of AAS users and the potential for AASs to lead to negative mental or physical health outcomes includes more than specific vulnerabilities in the motivation–reward system. Vulnerability to the negative effects of AASs are likely to encompass psychological features such as body image disturbance as well as the primary biological effects of AASs, which include the regulation of the hypothalamic–pituitary–gonadal (HPG) and hypothalamic– pituitary–andrenal (HPA) axes.


Hildebrandt T, Yehuda R, Alfano L. What can allostasis tell us about anabolic-androgenic steroid addiction? Dev Psychopathol 2011;23(3):907-19. What can allostasis tell us about anabolic-androge... [Dev Psychopathol. 2011] - PubMed result

Anabolic-androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation-reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic-pituitary-gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

 

[Bill Roberts]

I am puzzled (not a sarcastic comment, but a literal one) at what is behind these.

Why, when anabolic steroids don't fit the established criteria for addictive drugs, would researchers wish to find alternative definitions or mechanisms of addiction?

The academic interest is somewhat escaping me, as is medical utility.

But on the other hand I'm not ready to jump on a conspiracy explanation of a desire to push the square peg of anabolic steroids into the round hole of addictive controlled substances. While I wouldn't doubt that there are parties that would like to do it, I wouldn't assume that these researches have that as their motivation. But how exactly their career tracks could have taken them in this direction, I really have no idea and find it kind of odd.

 

[haas480]

My initial post was directing attention toward the possibility of the reward pathway acting in these cases. It can be accessed via psychological activity alone. The AAS could be the possible suspect as an indirect player. The user's psychological activity changes as the physical changes of the AAS are displayed. The AAS is not a direct contributor. However, the user's new psychological activity could be accessing the reward pathway (via self psychological stimulation).

In short, here's a possible scenario: a person uses AAS. The AAS does not access the reward pathway. However, their new psychological activity does (they get high from seeing the results/expectations from the AAS). In turn, if AAS use stops, their psychological activity is possibly altered, losing touch with the reward pathway. i.e. there is now a void, and the person "experiences withdrawl".

I'm pointing towards it being strictly psychological. The AAS is not having any <b>direct</b> effect.

 

[Bill Roberts]

Well, EVERYTHING people do is associated with expected reward of some sort, whether internal or external.

I agree that there is a lack of direct effect, or at least of any substantial direct effect.

 

[haas480]

i concur. i believe we're on the same side of thought.

 

[Michael Scally MD]

Oberlander JG, Porter DM, Penatti CAA, Henderson LP. Anabolic Androgenic Steroid Abuse: Multiple Mechanisms of Regulation of GABAergic Synapses in Neuroendocrine Control Regions of the Rodent Forebrain. Journal of Neuroendocrinology 2011;24(1):202-14. Anabolic Androgenic Steroid Abuse: Multiple Mechanisms of Regulation of GABAergic Synapses in Neuroendocrine Control Regions of the Rodent Forebrain - Oberlander - 2011 - Journal of Neuroendocrinology - Wiley Online Library / Anabolic Androgenic Steroid Abuse: Multiple Mechanisms of Regulation of GABAergic Synapses in Neuroendocrine Control Regions of the Rodent Forebrain - Oberlander - 2011 - Journal of Neuroendocrinology - Wiley Online Library

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone originally developed for clinical purposes but are now predominantly taken at suprapharmacological levels as drugs of abuse. To date, almost 100 different AAS compounds that vary in metabolic fate and physiological effects have been designed and synthesised. Although they are administered for their ability to enhance muscle mass and performance, untoward side effects of AAS use include changes in reproductive and sexual behaviours. Specifically, AAS, depending on the type of compound administered, can delay or advance pubertal onset, lead to irregular oestrous cyclicity, diminish male and female sexual behaviours, and accelerate reproductive senescence. Numerous brains regions and neurotransmitter signalling systems are involved in the generation of these behaviours, and are potential targets for both chronic and acute actions of the AAS. However, critical to all of these behaviours is neurotransmission mediated by GABAA receptors within a nexus of interconnected forebrain regions that includes the medial preoptic area, the anteroventral periventricular nucleus and the arcuate nucleus of the hypothalamus. We review how exposure to AAS alters GABAergic transmission and neural activity within these forebrain regions, taking advantage of in vitro systems and both wild-type and genetically altered mouse strains, aiming to better understand how these synthetic steroids affect the neural systems that underlie the regulation of reproduction and the expression of sexual behaviours.

 

[Sworder]

Reminds me of a psychology study I was reading recently. Addiction is a misconception which has a blurred definition in today's society. These days we can get ADDICTED to shopping, sex, gambling, computers, adrenaline rushes you name it! It is one of those words which the media loves to use to taint a subject with. This being said from a very bias point of view.

If I would flip my subjective mind I would say, do steroids make you physically dependent on them? Well, if you use AAS your body stops producing hormones and depend on the exogenous androgens. Do they cause withdrawals like heroine? Nope, but the intensity of withdrawals aren't what makes a compound addictive. I believe we would all agree that caffeine is addictive. Steroids produce a high much like other drugs. Everybody doesn't feel it though because the onset is subtle(especially with longer esters) and aren't as tuned with their mind as others.

In all honesty what am I really saying? Not much, I like looking at things from different point of views and then gathering them and making a logical decision. I don't think steroids are addictive like the media loves to point them out to be or as scientists try to prove. Heroine is addictive, crack is too, I don't need a scientist to write a report about it since the answer is clear to everybody already.

Pastoral Psychology
Volume 50, Number 4, 291-315, DOI: 10.1023/A:1014074130084
Religious Addiction: Obsession with Spirituality
Cheryl Zerbe Taylor
http://www.springerlink.com/content/9ner79ge7kntx3hp/ (Pastoral Psychology, Volume 50, Number 4 - SpringerLink)
Religious addiction is a disease only recently recognized; however, it has been with humanity throughout the ages. This obsession with spirituality not only has harmful effects for the individual but also a devastating effect on his/her family. As with any addiction, recovery is possible. This article covers the history of religious addiction, its symptoms and characteristics, and also its downward spiral. The effects on the addict, the codependent spouse, and children are discussed. Recovery, including intervention and treatment, is also covered.

 

[dyna5]

Steroids and addiction

ive been at this for over 20 years, nothing very heavy but cycles nonetheless. why did i start using steroids? they work ! i always enjoyed lifting weights but just stopped growing no matter what i did. my body simply reached its full potential.
however, i was also insecure and somewhat shy. additionally i was depressed as well, off and on but enough to always make me feel as if i was different from everyone else.
steroids : i was always intrigued with steroids but had the usual trepadation of taking them; after all, they made you go bald and caused cancer and sterility. really ?. well, after some research, i came to the conclusion that steroids, when taken resposibly are actually pretty darn safe.
my first cycle was winstrol tabs ( 2 mgs 3x per day) . i put on 12 pounds in 8 weeks and was finally benching over 300 which was alot considering i weighed 168..i loved the pumps i got innthe gym, i loved seeing my shirts get tighter, and i loved seeing my body transform itself into the body i should of had with all the work i put into the gym. 6 mgs of winstrol tabs a day is barely a cycle but i justresponded so well. thats when i started my 3 months on, 3 months off career and graduated to anadrol-50 as well as parabolan and permistril. keep in mind, the the late 1980's and early 90's, i had a friend in the service over in europe and he would send us things straight from a pharmacy..none of this powder from china bull shit to where the powder says tren but its only test....
anyway, more than anything, i loved the person i had become..i became much more confident and out going ..plenty of friends and girl friends..a good thing of course...
problem was, my insecurity and shyness was still there but was masked by the steroids. what hapapens when i go off and revert back to " normal" ? where will all of that confidence come from
now? if im at a club with a hot girl no one will screw with a big guy. a small guy, forget it.. everyone will hit on her. this is what kept me going. i was always afraid to stay off and confront my true issues and this is what i am dealing with now.. this is the addiction part of it. NOT EVERYONE is taking steroids for the same reasons as i was but there are plenty that do. remember, for whatever reason, you are going to have to eventually come off. eventually the music does stop and you will need to get your confidence from within. when you are on a cycle, you have an edge in life, you are bigger, stronger, and walk with a swagger . but when its all gone, how will you deal with it? i guess you could just worry about that when the time comes.

 

[Michael Scally MD]

Making Sense Of Addiction Terminology
Making sense of addiction terminology

David Nutt and Anne Lingford-Hughes of Imperial College London's Neuropsychopharmacology Unit together with Jonathan Chick from Queen Margaret University, Edinburgh suggest that a better understanding of current treatments' modes of action and targets would aid understanding in the addiction field. This should be coupled with clarity as to exactly which patient groups or symptom stages each treatment works upon, they recommend.

Nutt's team discuss the differing uses of terms such as addiction and dependence, and outline the three main treatment avenues for addiction or dependence on drugs or alcohol: withdrawal treatment, substitution therapy and abstinence. Withdrawal treatment is typically well understood, but elements of the other two categories remain open to interpretation.

Physicians prescribe substitutes to prevent drug withdrawal, a preferred treatment avenue for many patients. Interaction with treatment providers can lead to patients gaining assistance with other problems, while still dependent on a drug, albeit a less harmful one. Debate still rages about methadone and buprenorphine use for heroin addiction, despite proof that these substitutes can reduce related crime, HIV spread and overdose deaths. Offering benzodiazepines or sodium oxybate (GHB) as a substitute in alcoholism treatment is even more controversial, and is not supported by some guidelines (e.g. NICE, 2011), despite evidence of efficacy. Anti-smoking aids such as patches and gum, though not labelled as such, are 'substitution' therapies because in practice many patients use these long-term.

The authors discuss definitions of abstinence - the most widely recognised goal for addiction treatment. Abstinence strictly means cutting out the addictive substance without substitution. However, some use the term to describe abstinence from street drugs while using substitute medication. Anti-depressants or anti-psychotics may be allowed if there is a mental health issue, where medications which target 'addiction' would be unacceptable.

Harm reduction - any intervention that reduces the harms of drug/alcohol use - includes social measures such as needle exchanges. In the UK this term may mean substitution treatment, particularly for heroin addiction.

The article details opioid substitution therapies, and antagonist medications such as naltrexone and nalmefene that promote abstinence. The authors also look at the pharmacological arsenal against alcohol addiction. Substitution is not such a well-worn route in this case as it is for opioids or tobacco: treatments such as sodium oxybate and baclofen may cut withdrawal and reduce drinking, and physicians can prescribe acamprosate to promote abstinence. Vitamins are also useful in harm reduction. Drink-regulating agents like naltrexone are a recent innovation, which aims to reduce the number of drinks taken at any one session. The exact terminology for this class of drugs has yet to be agreed.

Substitution has been the mainstay of treatment for tobacco addiction for years. The antidepressant bupropion (Zyban) also assists with abstinence from cigarettes. Vaccines against nicotine are also in clinical trials. As yet there are no proven pharmacological treatments for other drug addictions such as cocaine/crack dependence. Cannabis dependence is another recognized problem without proven pharmacological treatment, the authors say.

"We have seen the development and use of different terminologies for different drug addictions, which confuses prescribers, users and regulators alike," says Nutt. "Alcohol/drug dependence and addiction are huge medical as well as social problems for the treatment of which new medications could be helpful. A better understanding of the modes of actions and targets for current treatments is required."


Nutt DJ, Lingford-Hughes A, Chick J. Through a glass darkly: can we improve clarity about mechanism and aims of medications in drug and alcohol treatments? Journal of Psychopharmacology 2012;26(2):199-204. http://jop.sagepub.com/content/26/2/199.full

The treatment of addiction and dependence on, and misuse of, alcohol and other drugs is one of the largest unmet needs in medicine today, so the development of new treatments is a pressing need. However, we have seen the development and use of different terminologies for different drug addictions, which confuses prescribers, users and regulators alike. Here we try to clarify terminology of treatment models based on the pharmacology of treatment agents. This editorial covers all drugs that are used for their pleasurable effects and which therefore can lead to harmful/hazardous use, dependence and addiction. These include nicotine, alcohol and abused prescription drugs such as benzodiazepines, as well as opioids and stimulants.

 

[Gear_Addict]

Anabolic–androgenic steroids (AASs) are used primarily in pursuit of a perfect appearance and the perceived social and health benefits that come from having a perfect body. This undertaking also involves a range of healthy activities including attention to diet and regular exercise, two behaviors almost universally endorsed by the medical community, health organizations, and public health officials as essential to one’s mental and physical health. The addition of AASs to these behaviors creates an interesting paradox where the pursuit of health and well-being may actually lead to too much of a good thing.

Although AASs enhance certain markers of mental and physical health (e.g., increased muscularity, decreased body fat, increased sex drive, improved mood and cognition, etc.), the long-term effects of this lifestyle may rob individuals of their health and well-being. Drawing the line between life enhancement and long-term health risk becomes an interesting exercise, currently influenced by the sociopolitical environment of cheating athletes and without substantial clinical or empirical data to aid in this challenge. Thus, the pressing questions become: how does AAS use turn life enhancement into poor health, where does life enhancement transition into a harmful pattern of drug use, and who is vulnerable to the negative outcomes of this AAS lifestyle?

Much of the attention given to these questions has focused on AAS addiction where traditional categories of abuse and dependence are used to define harmful use and the biological risk is drug-centric, attributing risk to the ability of AASs to hijack the reward system. There are limitations to answering these questions about harmful use with AAS abuse and dependence.

First, this framework pathologizes the substance and consequently makes any use of the substance dangerous. This drug-centric approach contradicts the well-established safety and low abuse potential of AASs when used to treat certain medical conditions (i.e., testosterone deficiency, wasting syndrome in AIDS patients, etc.).

Second, the classic addiction framework relies heavily on the substance’s ability to alter one’s brain, such that an individual would need the drug to feel pleasure. This focus is inconsistent with the primary uses of AASs; they are used almost exclusively for their effects on the body and not for their ability to produce pleasure in the brain.

Third, vulnerabilities are attributed to individual differences in the brain’s motivation–reward system. Those who have an altered motivation–reward system are believed to be more sensitive to the drug’s pleasure producing effects and consequently more likely to develop addiction upon use.

In the absence of data, it is unclear what makes certain individuals vulnerable to the negative effects of AASs and others resistant to these outcomes. Thus, the use of AAS addiction to answer these questions about how, where, and who is limited by a narrow focus on the pleasure producing properties of AASs and an individual’s innate sensitivity to this pleasure.

There are also a number of basic features of AASs and their use that suggest a broader focus is necessary to answer these questions and resolve the AAS paradox. First, illicit AASs use occurs exclusively in the context of dietary control and intense exercise, and the desired effects of AASs require some baseline investment in these healthy behaviors. Thus, these associated features must be included in the basic understanding of how AASs use can result in some health-related benefits as well as the potential for health risk. Second, AASs are synthetic hormones and consequently have broad effects on a range of peripheral tissues (e.g., muscle, bone, kidneys, liver, etc.) as well as the central nervous system (CNS). The motivation–reward system, which lies within the CNS, simply does not adequately capture the major psychological effects of AASs. Third, there is a significant degree of heterogeneity in the population of AAS users and the potential for AASs to lead to negative mental or physical health outcomes includes more than specific vulnerabilities in the motivation–reward system. Vulnerability to the negative effects of AASs are likely to encompass psychological features such as body image disturbance as well as the primary biological effects of AASs, which include the regulation of the hypothalamic–pituitary–gonadal (HPG) and hypothalamic– pituitary–andrenal (HPA) axes.


Hildebrandt T, Yehuda R, Alfano L. What can allostasis tell us about anabolic-androgenic steroid addiction? Dev Psychopathol 2011;23(3):907-19. What can allostasis tell us about anabolic-androge... [Dev Psychopathol. 2011] - PubMed result

Anabolic-androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation-reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic-pituitary-gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

Good read ^

 

[Michael Scally MD]

Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. The Lancet 2012;376(9752):1558-65. Drug harms in the UK: a multicriteria decision analysis : The Lancet

Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm. Centre for Crime and Justice Studies (UK).

 

[Michael Scally MD]

Kanayama G, Pope HG, Jr. Illicit use of androgens and other hormones: recent advances. Curr Opin Endocrinol Diabetes Obes. Illicit use of androgens and other hormones: recent advance... : Current Opinion in Endocrinology, Diabetes and Obesity

PURPOSE OF REVIEW: To summarize recent advances in studies of illicit use of androgens and other hormones.

RECENT FINDINGS: Androgens and other appearance-enhancing and performance-enhancing substances are widely abused worldwide. Three notable clusters of findings have emerged in this field in recent years. First, studies almost unanimously find that androgen users engage in polypharmacy, often ingesting other hormones (e.g., human growth hormone, thyroid hormones, and insulin), ergo/thermogenic drugs (e.g., caffeine, ephedrine, and clenbuterol), and classical drugs of abuse (e.g., cannabis, opiates, and cocaine). Second, reports of long-term psychiatric and medical adverse effects of androgens continue to accumulate. In cardiovascular research particularly, controlled studies have begun to supersede anecdotal evidence, strengthening the case that androgens (possibly acting synergistically with other abused drugs) may cause significant morbidity and even mortality. Third, it is increasingly recognized that androgen use may lead to a dependence syndrome with both psychological and physiological origins. Androgen dependence likely affects some millions of individuals worldwide, and arguably represents the least studied major class of illicit drug dependence.

SUMMARY: Given mounting evidence of the adverse effects of androgens and associated polypharmacy, this topic will likely represent an expanding area of research and an issue of growing public health concern.

 

[Michael Scally MD]

Hildebrandt T, Harty S, Langenbucher JW. Fitness Supplements as a Gateway Substance for Anabolic-Androgenic Steroid Use. Psychol Addict Behav. Fitness Supplements as a Gateway Substa... [Psychol Addict Behav. 2012] - PubMed - NCBI

Approximately 3.0% of young Americans have used anabolic-androgenic steroids (AAS). A traditional model of adolescent substance use, the gateway hypothesis, suggests that drug use follows a chronological, causal sequence, whereby initial use of a specific drug leads to an increased likelihood of future drug use. Therefore, the use of illicit appearance and performance enhancing drugs (APED), such as AASs, also follows an analogous progression, whereby legal APEDs, (e.g., nutritional supplements) precedes illicit APED use. We examined the relationship between nutritional supplement use, beliefs about APEDs, and APED use in 201 male (n = 100) and female (n = 101) undergraduates. Participants completed measures of muscle dysmorphia (MDDI), body checking (BCQ, MBCQ), eating disorder symptoms (EDE-Q), perfectionism (FMPS), positive beliefs about the efficacy-safety of AAS use and APED use patterns. A series of covariance structure models (CSM) showed body image disturbance, compulsive exercise, illicit drug use, and perfectionism, independent of gender, were significant predictors of positive beliefs about AAS. Those who used both fat burning and muscle building supplements reported the strongest beliefs in AAS efficacy-safety, which was associated with higher likelihood of current illicit APED use. There was evidence of significant indirect relationships between supplement use and illicit APED use through contact with other AAS users and beliefs about AAS. The potential role for nutritional supplement use in the initiation of illegal APED use is discussed. Future prevention efforts may benefit from targeting legal APED users in youth.

 

[Bill Roberts]

Do you happen to have the full text, Dr Scally?

Survey studies have a bad tendency to be unreliable, particularly when self-reporting behavior.

There was a survey study done some years back which "discovered" that a quite substantial percentage of pre-teen girls used anabolic steroids.

I'd be curious to see what care was taken in this study to be certain that, for example, prescribed corticosteroids were not being counted as anabolic steroids, and what figures they obtained for self-reported alleged use of drugs that are known to have essentially zero abuse problem.

On an anonymous survey, sometimes kids will self-claim drug use that they don't do, perhaps because it makes them feel cool, or any other motivation, or error. So a good study should have a means of validating that the level of false or erroneous claims is well below the finding.

 

[Michael Scally MD]

Chichinadze K, Chichinadze N, Gachechiladze L, Lazarashvili A. The role of androgens in regulating emotional state and aggressive behavior. Rev Neurosci 2012;23(2):123-33. The role of androgens in regulating emotional state and aggressive behavior : Reviews in the Neurosciences

This manuscript attempts to develop a new theory to explain both the pre- and post-encounter increase in testosterone levels and the varying dynamics of androgen levels in dominant and subordinate males. The new theory includes the following hypotheses: (i) The pre-encounter increase in testosterone levels is a result of the excitement that is caused by the anticipation of victory. Individuals who do not experience this kind of emotion before the encounter usually do not demonstrate an increased secretion of androgens. (ii) The post-encounter increase in testosterone levels is related to the pleasure that results as a result of victory and the sharp decrease in emotional tension. Additionally, an increased secretion of testosterone acts as a positive reward for the type of behavior that has led to the victory. (iii) A high basal level of testosterone in dominant males is only present in those instances when dominating not only results in a profit that is related to the possession of resources, but is also associated with low emotional tension.

 

[Michael Scally MD]

Nyberg F, Hallberg M. Interactions between opioids and anabolic androgenic steroids: implications for the development of addictive behavior. Int Rev Neurobiol 2012;102:189-206. ScienceDirect.com - International Review of Neurobiology - Interactions Between Opioids and Anabolic Androgenic Steroids: Implications for the Development of Addictive Behavior

Over the past decades, research on doping agents, such as anabolic androgenic steroids (AAS), has revealed that these compounds are often used in combination with other drugs of abuse. It seems that misuse of AAS probably involves more than a desire to enhance appearance or sports performance and studies have revealed that steroids are commonly connected with alcohol, opioids, tobacco, and psychotropic drugs. We have observed that AAS may interact with the endogenous opioids, excitatory amino acids, and dopaminergic pathways involved in the brain reward system. Furthermore, our studies provide evidence that AAS may induce an imbalance in these signal systems leading to an increased sensitivity toward opioid narcotics and central stimulants. In fact, studies performed in various clinics have shown that individuals taking AAS are likely to get addicted to opioids like heroin. This chapter reviews current knowledge on interactions between AAS and endogenous as well as exogenous opioids based not only on research in our laboratory but also on research carried out by several other clinical and preclinical investigators.

 

[Sworder]

Nyberg F, Hallberg M. Interactions between opioids and anabolic androgenic steroids: implications for the development of addictive behavior. Int Rev Neurobiol 2012;102:189-206. ScienceDirect.com - International Review of Neurobiology - Interactions Between Opioids and Anabolic Androgenic Steroids: Implications for the Development of Addictive Behavior

Over the past decades, research on doping agents, such as anabolic androgenic steroids (AAS), has revealed that these compounds are often used in combination with other drugs of abuse. It seems that misuse of AAS probably involves more than a desire to enhance appearance or sports performance and studies have revealed that steroids are commonly connected with alcohol, opioids, tobacco, and psychotropic drugs. We have observed that AAS may interact with the endogenous opioids, excitatory amino acids, and dopaminergic pathways involved in the brain reward system. Furthermore, our studies provide evidence that AAS may induce an imbalance in these signal systems leading to an increased sensitivity toward opioid narcotics and central stimulants. In fact, studies performed in various clinics have shown that individuals taking AAS are likely to get addicted to opioids like heroin. This chapter reviews current knowledge on interactions between AAS and endogenous as well as exogenous opioids based not only on research in our laboratory but also on research carried out by several other clinical and preclinical investigators.

Sadly this is a story told all to often. Steroids one week, heroin the next.. Beware brothers!

like·ly/?l?kl?/
Adjective:
Such as well might happen or be true; probable

 

[leoclaw79]

who wouldn't be addicted to seeing their muscle grow at an alarming rate??? [)]

but on another note, this reminds me of psychedelics being a Schedule I substance (the definition of a schedule I substance is that theyre addictive, have no medical use, and are dangerous even under supervision), which shouldn't be the case because its IMPOSSIBLE to be addicted to them since they don't even work if you try to repeatedly abuse them (due to rapid increase in tolerance)

screw the media and its hype about AAS -_-