Steroid Addiction & Abuse

Steroids are similar to other drugs in that dependency can occur, but the reasons for this happening are a little different. People who abuse steroids do not do so because they experience a high. Often, steroid addiction develops when men are trying to cope with underlying psychological issues. These can range from low self-esteem to body dysmorphia.

Because steroid addiction works a little differently than alcoholism or other substance dependence, the approach to treatment is very individualised. One of the major side effects of withdrawing from steroids is depression, which can be so severe that it can lead to suicide.

Corticosteroids are commonly referred to as steroids. These synthetic drugs are made to resemble cortisol, a hormone produced in the body by the adrenal glands. They are often prescribed when the body’s defences are not able to control inflammation or other conditions, for example, in treating rheumatoid arthritis and lupus. (1)

Both steroids and Ritalin can be used by athletes to increase performance, but the drugs work in two very different ways.

Steroids act as physical enhancers, stimulating muscle growth and increasing stamina. This can give athletes more strength and endurance.

• Prednisolone
• Beclometasone
• Fluticasone
• Methylprednisolone
• Hydrocortisone

Under the Misuse of Drugs Act 1971, anabolic steroids are a class C drug in the UK, the same classification as benzodiazepines. A prescription is required for medical use, and there is no offence for possession for personal use. Manufacturing, supplying or intent to supply without a license are all illegal. Offenders may face a hefty fine, up to 14 years in prison or both.

Studies have shown that long-term use of anabolic steroids has significant effects on the brain. One major study ran from the fall of 2013 to the summer of 2014 and used three different brain imaging techniques to examine the impact on brain structure and activity, as well as oxygenation and chemical changes.

One of the major findings was significant enlargement of the amygdala in steroid users versus non-users. The amygdala is the part of the brain that regulates emotions, including anxiety, aggression and depression.

Testosterone comes in various forms. Axiron, Androgel, Fortesta and Testim are topical gels that are directly absorbed into the skin. (9) (10) (11) (12)
Androderm is a patch that releases a slow, steady dose through the skin’s surface. (13)

Testopel consists of small pellets that are injected under the skin, where the crystals release a slow and steady dose of testosterone into the body. The effects last anywhere from three to six months. (14)

Striant is meant for buccal administration, meaning it’s absorbed through the gum or cheek. It’s in tablet form and dissolves quickly when placed in the mouth. (15)

Stanozolol (Winstrol)

Stanozolol is a synthetic derivative of testosterone and is meant to be used for continuous treatment of hereditary angioedema, which is rapid swelling beneath the skin. These round pink tablets are taken orally and classified as a controlled substance. Side effects can be quite severe and include liver damage and an increased risk of atherosclerosis. (18)

Nandrolone (Deca-Durabolin)

Deca‑Durabolin is used to treat osteoporosis, particularly in post-menopausal women, and is only legal for those with a prescription. It’s administered through deep intramuscular injection and should be given every three weeks. Side effects can include nausea, fluid retention, changes in blood lipids and abnormal liver function. (19)

• Increased blood pressure
• Hormonal imbalances
• Paranoia
• Impaired judgment
• Delusions
• Extreme irritability

A lot of people assume that athletes or bodybuilders primarily abuse anabolic steroids, but that’s not the case. The truth is that most people who abuse steroids are male amateur weightlifters in their 20s and 30s. Women are less likely to use steroids because they do not typically have a desire for building extreme muscle mass or the possibly masculine side effects.

Men who are most likely to abuse steroids tend to have low self-esteem and poor understanding and attitudes about their health, and they participate more in sports that emphasise the importance of weight and strength.

One study done on 62 powerlifters from Finland showed a 12.1% mortality rate 12 years after the study began. As a reference, the mortality rate for the control population was only 3.1%. Investigators concluded that this was likely due to steroid use. Other researchers have suggested that the premature deaths could have some relation to underlying psychiatric disease or additional substance abuse. (24)

Some cardiac problems associated with steroid abuse can resolve if the steroid use stops, but others, including atherosclerosis and cardiomyopathy, are difficult or impossible to reverse.

Anabolic steroids can also increase the concentration of oxygen-carrying haemoglobin in the blood, though it’s inconclusive whether or not this affects endurance. (26) Theoretically, more oxygen should allow endurance athletes like cyclists and marathon runners to go farther and last longer.

Anecdotal evidence would disagree with these findings, which is probably why synthetic testosterone has been used to enhance performance since World War II. Russian bodybuilders were given testosterone during the 1954 Olympics, and use extended into the general population in the 1980s.

Why People Abuse Anabolic Steroids

People abuse steroids for various reasons. Self-esteem usually has a key part to play, since the main effect of steroids is to grow muscle mass and increase strength. This insecurity can come from a variety of different causes.

Muscle dysmorphia is a disorder where men see themselves as weak and small, no matter how strong and muscular they are. This form of body dysmorphia distorts the person’s perception of what they really look like. Someone with this condition may abuse steroids because of their need to build muscle. Exterior pressure can lead to steroid abuse, too. Men who are drawn to sports that emphasise strength, size and stamina may feel added pressure to perform.

Cycling

Cycling refers to the pattern that the person using steroids follows. They take multiple doses of steroids over a specific period, stopping and then starting again. Cycles can run any length but usually span anywhere from six to 12 weeks before starting over again.

Pyramiding

Pyramiding usually involves cycling steroids for six to 12 weeks, tapering down and back up again, rather than stopping abruptly as in cycling. The person starts with low doses, works up to high, then weans back down again. They may even stop completely for a few weeks before pyramiding again.

There are some social cues that can indicate a problem, too, including changes in relationships and social interactions, private phone conversations, the inability to concentrate on conversations, forgetting plans and scheduled activities and sudden urges to work out. Private phone conversations may increase, and they may behave more secretively.

Behavioural changes

Small studies and some case reports have shown that steroid abuse can lead to irritability and aggression, though people who are likely to abuse steroids may already have these personality traits.
Steroid users are also more likely to deal with anxiety, and high doses of steroids can be associated with major depression or mania. (35)

Erectile dysfunction

Long-term effects of anabolic steroids on erectile dysfunction (ED) are not well studied. Data indicates that ED more commonly occurs when men use high doses for a long time and then stop using. It’s likely that the steroid use has a negative impact on the body’s ability to produce a sufficient amount of testosterone naturally. (37)

Carfilzomib, an anti-cancer drug, can also have significant interactions with steroids. Both substances increase the risk of blood clots, so using the two together elevates the risk. Blood clots can lead to medical emergencies like heart attack, pulmonary embolism and stroke.

Leflunomide is used to treat rheumatoid arthritis and can be hard on the liver. When combined with steroids, the liver can be placed under even more stress, increasing the risk of significant damage. The same is true when steroids are used with lomitapide or mipomersen, each used to lower cholesterol.

When considering drug rehabilitation for steroid abuse, it’s very important to keep the underlying reasons for the substance abuse in mind. Steroid addiction doesn’t work the same way as other chemical addictions, so it must be approached a little differently.

There are three things that must be addressed to help someone though steroid addiction. First, there may be underlying issues such as muscle dysmorphia. Second, depression and low production of natural testosterone can occur when someone stops taking steroids. Finally, people addicted to steroids often get pleasure out of taking them and seeing the results. Resolving these three things should be part of any treatment plan. (39)

Withdrawal symptoms for anabolic steroids are different from those of other drugs, with the exception of cravings, which are common across the board. The most common withdrawal symptoms are restlessness, loss of appetite, sleep problems and low libido. While these symptoms may not seem as severe as those for other drugs, steroid withdrawal is unfortunately still very complicated.

The risk of severe depression when withdrawing from steroids is an important thing to consider as well. There are significant links between depression and alcoholism. In fact, nearly a third of people with major depression also have problems with alcohol. (41)

Whether inpatient or outpatient rehab is best depends on the severity of the addiction and the underlying causes of it, as well as any concurrent addictions that need to be addressed.

Inpatient rehab programmes usually last at least 28 days but can be longer if necessary. The benefit of inpatient is that clients are completely immersed in their recovery and can better focus on getting well and learning about their addiction.

A huge benefit of inpatient rehab is that the person is removed from the stressors of everyday life, including people, places and other triggers that make them want to use. There are also a lot of opportunities to work on the underlying issues that may have led to steroid addiction in the first place. Inpatient programmes provide a lot of emotional support that may be needed to cope with the depression that often comes with steroid withdrawal.

Because the underlying causes of most steroid addictions are psychological, counselling is usually very important to recovery. For a client who has body dysmorphia or a history of abuse or was raised in a home where body image was important, counselling is likely the best approach. It also helps the client grow their self-esteem and become more confident in who they are as a person, which goes a long way to staying clean.

First, it’s always important to be kind. Be compassionate and let the person know someone loves them and is not going to criticise, judge or insult them. Try to see it from their perspective as best you can, even if you don’t agree with their behaviour.

Be consistent. Don’t tell them you think they have a problem with steroids and then compliment them on their physique or go to the gym with them. It’s important that they know what you expect.

Always let them know they are loved, no matter what. Let them know that you will be there for them if they want to get help but that you are not willing to put up with certain things. Give them clear limits and follow through.