Psychology of addiction

Lecture 18

Anabolic Androgenic Steroids

The government's expert advisers on illicit drugs yesterday warned of the growing use of anabolic steroids by boys as young as 12 as they confirmed they are reviewing the legal status of ecstasy as well as cannabis.

The Advisory Council on the Misuse of Drugs is to write to the home secretary, Jacqui Smith, voicing grave concerns about the growing abuse of anabolic steroids which are now being used by "tens of thousands" of bodybuilders and teenagers.

It had been estimated that there were tens of thousands of people using steroids to improve the results of training regimes to make themselves look more muscular, said Professor David Nutt, chairman of the council's technical committee. Steroid users, rather than heroin injectors, were now the main clients of needle exchanges, the committee heard.

Those who used anabolic steroids were often oblivious of the risks, which included acne, breast enlargement, sterility, liver tumours and hepatitis, the council chairman, Professor Sir Michael Rawlins, said. He added: "It can also make the testicles wither - which is probably not what the users want."

(From Guardian 2007)

The latest figures show that 200,000 people in Britain have tried anabolic steroids, with 42,000 saying they have used them in the last year and 20,000 in the previous month. Home Office controls on anabolic steroids are aimed at suppliers and traffickers and it is not an offence to possess them to enhance performance.

Lord Victor Adebowale, chief executive of the drugs charity Turning Point, said elite athletes knew what they were doing using steroids, but their increasing use by boys as young as 12 and 13 was extremely worrying. "They do it because they want to be in boy bands and get girls," he said.

The advisory council, which was meeting in public for the first time in its 36-year history, is also to press the government to ban 26 anabolic steroids currently proscribed by the World Anti-Doping Agency, which controls the use of illicit substances in sport. Council members said action was needed in the run-up to the 2012 Olympics.

Some members claimed the council would be better off looking at the anabolic steroid problem than spending two days in February debating whether cannabis should be regraded from class C to class B

(From Guardian 2007)

Effects

increase muscle size, muscle mass, strength

- anabolic

have masculinizing properties - androgenic

also used therapeutically - for anaemia, thrombosis, and to build muscle for the bed-ridden

addictive?

Demonstration of effects

Bhasin et al.

Healthy men 18-35, prior weightlifting experience, but hadn't taken steroids

given monthly treatments testosterone, with another drug to suppress endogenous testosterone

Demonstration of effects

lower (20-50 mg) doses --> testosterone levels below baseline

125-mg dose --> testosterone at baseline

300 and 600mg dose --> testosterone 2-4 times baseline

(all anabolic steroids either contain testosterone, or are testosterone derivatives)

Muscle strength & volume following chronic testosterone administration to men

Muscle strength & volume following chronic testosterone administration to men

taken orally or intramuscularly

endurance athletes and sprinters: low doses

bodybuilders and strength athletes: up to 100 x therapeutic dose

often use more than one at a time - called stacking

supposedly enhances effectiveness

often cycled - take for 6-12 weeks then abstain:

supposedly:

minimises tolerancereduces occurrence of side effectsmaximises performanceavoids detection

another technique combined with cycling is pyramiding -- increase dose gradually till midpoint of cycle then decrease again

supposedly reduces withdrawal

1. THE DOWNHILL RUN STACK

Very high strength and very high size gains.

The following cycle is designed with male, weighing 110KG, experienced steroid user, in mind. To adjust for the proper dosage for your weight, figure a factor of 10% / 10KG of body weight. Example: If you weigh 120KG, increase the dosage 10% (or to the closest possible dosage).

Week Anadrol Sustanon Deca Dianabol Primobolan mg/day mg/week mg/week mg/day mg/week

1 50 750 100 - -2 50 500 100 - -3 50 500 300 - -4 50 250 400 - -5 50 - 400 50 1006 - - 300 50 2007 - - 200 50 3008 - - 100 30 300

Juice needed: 40 tabs of Anadrol8 vials of Sustanon 250 mg/vial10 amps of deca 200 mg/amp300 tabs of Dianabol9 vials of Primobolan 100 mg/vial

oral steroids potentially metabolised too fast in liver to act

specially designed to avoid this problem

they are based on testosterone

Chemical structures of some commonly abused anabolic steroids

initially mainly used by Soviet Union and Eastern bloc countries in 1950's by both men and women

gained popularity in US for this purpose

by mid 80's use widespread among even amateurs and even in schools

law passed so that could only be obtained on prescription

now banned by many sports organisations

The law

Anabolic steroids are Class C drugs to be sold only by pharmacists with a doctor's prescription. It's legal to possess or import steroids as long as they're for personal use. But possession or importing with intent to supply (which includes giving them to friends) is illegal and could lead to 14 years in prison and an unlimited fine.

Cost

Prices can vary from region to region. Approximately £20 for 100 tablets. The prices given here are an average of street prices reported from 20 different parts of England.

http://www.talktofrank.com/drugs.aspx?id=170

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http://euro-steroids.co.uk/

Performance enhancement of a former East German female shot-putter

How?

theory is they act at androgen receptors, present in cytoplasm of skeletal muscle (and many other places)

androgens bind, and activate receptor, which moves to cell nucleus and regulates DNA transcription

increases protein synthesis and muscle growth

Steroid design issues

testosterone can be converted in some tissues to dihydrotestosterone (DHT) by 5-reductase

this has androgenic effects - so is to be avoided as want the anabolic effects

(doesn't happen in skeletal muscle)

Steroid design issues

testosterone can be converted to estradiol by aromatase (aromatisation)

normal process, mediating testosterone effects on CNS

this has feminising effects - so is also to be avoided

A problem for the theory

some argue that normally androgen receptors already saturated -- so how can steroids work on them?

alternative mechanisms:

possible steroid treatment induces receptor expression in muscle

possible that androgens are antagonists for glucocorticoid hormones - which are catabolic - decrease protein synthesis.

Side effects: physical

- If you're female, you can get acne, extra facial hair, a deep voice, shrinking breasts, an enlarged clitoris, an increased risk of menstrual problems and changes in sex drive.

- You could experience dramatic mood swings.

- You may find that you start getting paranoid and confused, along with having trouble sleeping.

- Steroids can also give you high blood pressure and increase your risk of liver failure, stroke or heart attack.

http://www.talktofrank.com/

Side effects: physical - Users claim the drug makes them feel more aggressive. Normally calm people can become irritable and aggressive, or even violent, and they can experience mood swings.

- If you're young, abuse of anabolic steroids can stop you growing properly.

- Injecting any drug can cause vein damage, ulcers and gangrene particularly with dirty needles. Shared needles and other injecting works can help the spread of HIV and hepatitis virus infections.

- If you're male, regular use can lead to erection problems, growing of breasts, becoming sterile and developing acne. It can also make your testicles shrink.

http://www.talktofrank.com/

Side effects: physical

some common (e.g. acne) others rare (peliosis hepatitis)

many reversible (cardiovascular effects)

which occur depend on age, sex of user, steroid type, dose, pattern and duration of use

can stunt younger users as prematurely closes epiphyses

Side effects: behavioural

increased irritability and aggression?

Sydney has recently witnessed two particularly brutal murders by users of anabolic steroids. One man with recent paranoid tendencies took a claw hammer and battered his wife to death, and then shot himself. In the second murder a man met a woman he knew at a nightclub and they went to the stairwell of a nearby hotel. In the man's words "something snapped" and he murdered the woman. Experienced police described it as the most brutal attack they had encountered. In both these murders the level of aggression and violence fits the descriptive term steroid rage ("roid rage").

http://www.mja.com.au/public/issues/aug19/corrigan/corrigan.html

Side effects: behavioural

increased irritability and aggression?

controlled studies produce mixed results:very dependent on individual

Pope et al (2000):

84% almost no change12% mild mania4% strong mania

differential susceptibility?

Side effects: behavioural

addictive? reported in users (DSM criteria)

take more than intended

can't cut down even though want to

spend much time obtaining and using

continue use despite problems use causes

replace other activities with substance use

Side effects: behavioural

addictive? to some extent -- users show:

withdrawal symptoms -- fatigue, depression, insomnia, restlessness, anorexia, decreased libido, dissatisfaction with body image, desire for more steroids(!)

but no big studies so don't know how common this is...

symptoms could be rare... or just unreported

Side effects: behavioural

addictive? laboratory studies:

systemic testosterone produces a place preference in mice

so does testosterone in nucleus accumbens

this is blocked by D1/D2 antagonist -flupenthixol

accumbens supposedly helps mediate reward

Side effects: behavioural

addictive? yes but....

doesn't produce euphoria, or elicit cravings during withdrawal

so perhaps initially reinforcing because of effect on body image - only get dependence in people for whom this is important - not because it is psychoactive

maybe with repeated use "true" dependence develops?

Psychopharmacology: Drugs, the brain and behaviour Meyer & Quenzer

Chapter 15

Lectures may be found here:

http://www.psychology.nottingham.ac.uk/staff/lch/C81ADD/