Article Index

Written by Dan Gwartney, MD
05 May 2009

Steroid Addiction: Fact or Fallacy?

 

Maximizing the benefits of the hormone testosterone. Testosterone is responsible for many positive effects in the body; some being anabolic— meaning it increases tissue size, while other effects are androgenic— affecting sexual development, creating a masculine appearance and behavior. In terms of providing maximum therapeutic benefit, scientists have strived to separate the two properties, anabolic and androgenic. An ideal anabolic steroid for use in people wasting away from AIDS, cancer or starvation would build muscle, increase bone mass and red blood cell production, but not have any androgenic effect. A lady undergoing chemotherapy for breast cancer needs to increase muscle mass, bone density and avoid anemia— not worry about facial hair or clitoral growth. A child trying to recover from starvation needs to rebuild lean mass, not go through precocious puberty. On the other hand, testosterone is also being investigated as a libido enhancer for post-menopausal women, an androgenic feature of testosterone.

Bodybuilders and the Steroid Control Act
For many bodybuilders, a similar search takes place, but not to such extremes. Bodybuilders and athletes have learned that a divergence from the innate androgenic properties often leads to less than ideal mass/strength gains and may interfere with energy, libido and erection. Commonly, the choice of steroid(s) used depends on the goals of the athlete. If maximum size and strength are the goals, then highly androgenic, aromatizable steroids are chosen (i.e., testosterone esters). If hard, dry muscle is the goal, non-aromatizing steroids are used, stacked with anabolic steroids, which have been designed to minimize their androgenic properties. Athletes base their decision solely on the results.


In 1990 and again in 2004, Steroid Control Acts placed a number of anabolic steroids under Drug Enforcement Agency jurisdiction as controlled substances. Categorizing anabolic steroids was intended to stem what was perceived, as a drug trafficking problem by defining anabolic steroids as drugs of abuse. In the minds of many, including the American Medical Association, Drug Enforcement Agency and others testifying during the 1989-90 sessions, this act was inappropriate and misguided. Regardless, the acts passed and anabolic steroids are now considered to be as much a public scourge as methamphetamines, cocaine, opiates and other psychoactive drugs. In many ways, the Steroid Control Act is self-defining, in that anabolic steroids have become controlled substances because the government considers performance enhancement use as abuse (use of a drug for a purpose not medically warranted). Columbia University Press has a more insightful response on the website answers.com.1 “Definitions of drug abuse and addiction are subjective and infused with the political and moral values of the society or culture.” It also states that abuse and addiction relate to chemicals, not drugs, which are used habitually to alter the state of the body or mind.


Clearly, if the government won’t recognize that anabolic steroids have therapeutic benefits (despite building evidence from published studies), then it’s impossible to openly debate a medically warranted or socially acceptable use of anabolics.2-6
It’s clear many discrepancies exist in today’s culture: alcohol used to alter the mind recreationally, as is caffeine and nicotine (from tobacco); botulin toxin (botox) alters the body cosmetically, as does silicon/saline implants and hair dyes. Many prescription drugs are used outside approved indications.

Steroids and Legitimate Use
It’s possible anabolic steroids don’t belong on the list of controlled substances. The U.S. Code (Title 21, chapter 13, subchapter 1, part A, section 811(f)) discusses the abuse potential of a drug, focusing on its psychoactive effects. Abuse potential relates to the stimulant, depressant or hallucinogenic effect of drugs on the brain. Confusing criteria as Rachel Adelson, a writer for Monitor on Psychology, a publication of the American Psychological Association, states in her article “The power of potent steroids,” “…neuroscientists are racing to find out whether and how these drugs affect the nervous system.”7  Proponents of the current prohibition need to prove that use of steroids for cosmetic or performance enhancement isn’t medically acceptable practice. Rather than prove this, the government and professional regulatory agencies have simply banned such use. The recent suspension of South Carolina physician James Shortt’s medical license for treating several members of the Carolina Panthers is one example.8 Compare this attitude to the multiple cosmetic procedures that proliferate in medicine and the long-standing use of female hormones as contraceptives. Consider also that anabolic steroids have been prescribed for decades in aging, elderly, frail and emaciated individuals with a reasonable safety history.4 Anabolic steroids have also been used by millions in a completely unregulated fashion for decades, with few reported adverse effects.9


Secondly, it must be shown that anabolic steroids hold a potential for abuse. In order to do this, you must show a pattern of behavior detrimental to the user or rewarding effects of the drug on the brain that would overwhelm self-control. It’s very easy to see how psychoactive drugs like heroin, cocaine and methamphetamines quickly control the lives of drug abusers— lost jobs, broken homes, deteriorating health and death are the realities of addiction with these drugs.10 With relatively few exceptions, this isn’t the case with rational anabolic steroid users.

It’s true a small number of users have experienced violent mood swings or abnormal behavior. According to Harvard researcher Dr. Harrison Pope, this reaction is rare; unfortunately, there’s no screening test to uncover those who may be susceptible.11 Contrasting the behavior and drug use of a steroid user to a cocaine/heroin/methamphetamine addicts and you’ll see there’s clear differences. Addicts will part with relationships, steal from friends, family and work; lose jobs and neglect their health and appearance for their addiction. The dose and frequency of use often escalates as addicts habituate to the psychoactive effects of the drugs.12 The vast majority of adult anabolic steroid users are motivated in order to improve appearance, strength, performance or self-confidence. These are productive goals, which when balanced and not stigmatized by society, lead to positive health changes. Many adult steroid users are emotionally supported by their spouses and are viewed as inspirations by family, neighbors and friends. Steroid use need not be expensive— effective cycles can cost less than $200 per month.