Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes / Harrison G. Pope Jr, David L. Katz. - (Archives of general psychiatry 51 (1994) 5 (May); p. 375-382)

• PMID: 8179461
• DOI: 10.1001/archpsyc.1994.03950050035004

Abstract

Background: We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them.

Methods: We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed.

Results: Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol-high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes--mania, hypomania, or major depression--in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P < .001) and significantly more frequently than nonusers (P < .01). Users rarely abused other drugs simultaneously with steroids.

Conclusion: Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.

Psychological and behavioural effects of endogenous testosterone and anabolic-androgenic steroids. An update M.S. Bahrke, C.E. Yesalis 3rd, J.E. Wright. - (Sports Medicine 22 (1996) 6 (December) ; p. 367-390)

• PMID: 8969015
• DOI: 10.2165/00007256-199622060-00005

Abstract

Endogenous testosterone levels have been linked to aggressive behaviour in both animals and humans. Studies administering moderate doses of exogenous testosterone for contraceptive and clinical purposes reveal essentially no adverse effects on male sexual and aggressive behaviour. However, investigations and case reports of athletes, usually involving higher doses, demonstrate an association between anabolic-androgenic steroid use and affective and psychotic syndromes and psychological dependence. Efforts to study the psychological and behavioural effects of anabolic-androgenic steroids are complicated by a variety of methodological limitations. Only 3 prospective, blinded studies demonstrating aggression or adverse overt behaviour resulting from anabolic-androgenic steroid use have been reported. With estimates of over 1 million past or current users in the US, an extremely small percentage of individuals using anabolic-androgenic steroids appear to experience mental disturbances severe enough to result in clinical treatment and medical case reports. Even among those so affected, the roles of previous psychiatric history, genetic susceptibility to addictions or mental disorders, environmental and peer influences, and individual expectations remain unclear.

Psychological and Physical Impact of Anabolic-Androgenic Steroid Dependence / Eric J. Ip, Debbie H. Lu, M.P.H. Mitchell, J. Barnett, Michael, J. Tenerowicz, Justin, C. Vo, Paul, J. Perry. - Pharmacotherapy 32 (2011) 10 (October); p. 910-919).

• PMID: 23033230.
• DOI: 10.1002/j.1875-9114.2012.01123

Abstract

STUDY OBJECTIVE:
To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence.

DESIGN:
Subanalysis of data from the Anabolic 500, a cross-sectional survey.

PARTICIPANTS:
One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009.

MEASUREMENTS AND MAIN RESULTS:
Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users.

CONCLUSION:
Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

Psychological characteristics of adolescent steroid users / K.F. Burnett, M.E. Kleiman. - (Adolescence 29 (1994) 113; p. 81-89)

• PMID: 8036984

Abstract

The Millon Adolescent Personality Inventory and the Profile of Mood States were used to assess a broad range of psychological characteristics in 24 adolescent athletes who reported steroid use. In addition, a steroid knowledge questionnaire was administered and an evaluation of physical symptoms of steroid use was conducted. Corresponding data were obtained from 24 adolescent athletes who did not use steroids, and 24 nonathletic adolescents. Although some personality variables differentiated between athletes and nonathletes, no personality variables significantly differentiated between athletes who used steroids and athletes who did not use steroids. Steroid users, however, had significantly higher levels of muscular density and hardness, bloating, gynecomastia, and acne than did athletes who did not use steroids; steroid users who were currently on a steroid use cycle had significantly more depression, anger, vigor, and total mood disturbance than those who were not on a cycle. Prospective longitudinal studies are needed to develop our understanding of psychological issues related to adolescent steroid use.

The Millon Adolescent Personality Inventory and the Profile of Mood States were used to assess a broad range of psychological characteristics in 24 adolescent athletes who reported steroid use. In addition, a steroid knowledge questionnaire was administered and an evaluation of physical symptoms of steroid use was conducted.

Corresponding data were obtained from 24 adolescent athletes who did not use steroids, and 24 nonathletic adolescents.
Although some personality variables differentiated between athletes and nonathletes, no personality variables significantly differentiated between athletes who used steroids and athletes who did not use steroids. Steroid users, however, had significantly higher levels of muscular density and hardness, bloating, gynecomastia, and acne than did athletes who did not use steroids; steroid users who were currently on a steroid use cycle had significantly more depression, anger, vigor, and total mood disturbance than those who were not on a cycle.

Psychological determinants of doping behaviour through the testimony of sanctioned athletes / Mattia Piffaretti

Objectives:
A) The main objective of the study is to gain knowledge about the psychological and psycho-social determinants of their doping behaviour, by interviewing sanctioned athletes.

B) Moreover, the investigation aims to assess how athletes experience the banning period, while identifying their specific needs. With such intelligence, the study aims to launch a new project encompassing:
1) PRIMARY PREVENTION: to enrich the prevention campaigns for young athletes with the testimonials of experienced athletes
2) SECUNDARY PREVENTION: to improve detection of psychological attitudes and risky behaviours in young athletes
3) TERTIARY PREVENTION: to contribute to the set-up of a prevention programme to decrease sanctioned athletes‟ relapse risk and to improve their chances for a sport and/or professional relocation

Summary: Current research indicates motivational orientations (Kleinert and Jüngling, 2007; Donahue et al., 2006), perception of sport‟s culture and attitude towards substance abuse (Ohl et Buissonneau, 2009) and obsessive passion (Vallerand et al., 2003) as possible psychological determinants of deviant behaviour in sports, and more particularly of athletes‟ substance abuse. In this study, 11 athletes who were condemned for their substance abuse by their national or international Federation, and were willing to speak out about their deviant behaviour, were interviewed through a theory-based interview guide. In particular, questions focused on the motivational orientations of the athletes, the perception they have about their environment, and the perception of the challenges like career transitions, injury or competitive pressure. Interview data were analysed sound qualitative research methods.

Main results: First of all, the study allowed to clarify the role of the athletes‟ awareness, sport transition, motivations, stress level and perception of anti-doping and ethical norms in their sporting environment, on the risk to violate the anti-dopoing code. Secundarily, it shed a light on the psychological and emotional reactions of the athletes who are banned from their sport for a long period, while throwing a light on their specific needs, to minimise risks of relapse or psychological distress.

Psychological drivers in doping: the life-cycle model of performance enhancement / Andrea Petróczi, Eugene Aidman. - (Substance Abuse Treatment, Prevention, and Policy 3 (2008); 7)

• PMID: 18331645
• PMCID: PMC2315642
• DOI: 10.1186/1747-597X-3-7

Abstract

Background: Performance enhancement (PE) is a natural and essential ingredient of competitive sport. Except for nutritional supplement contamination, accidental use of doping is highly unlikely. It requires deliberation, planning and commitment; and is influenced by a host of protective and risk factors.

Hypothesis: In the course of their career, athletes constantly set goals and make choices regarding the way these goals can be achieved. The cycle of choice - goal commitment - execution - feedback on goal attainment - goal evaluation/adjustment has numerous exit points, each providing an opportunity for behaviour change, which may or may not be related to the use of prohibited methods. The interplay between facilitating and inhibiting systemic and personality factors, constantly influenced by situational factors could result in an outcome vector of 'doping attitudes', which combines with subjective norms to influence intentions to choose prohibited PE methods. These influences also vary from one stage of athlete development to the next, making some athletes more vulnerable to engaging in doping practices than others, and more vulnerable at certain time periods - and not others.

Testing the hypothesis: Model-testing requires a series of carefully planned and coordinated studies. Correlational studies can establish relationships where the directionality is not-known or not important. Experimental studies with the manipulation of doping expectancies and risk factors can be used to demonstrate causality and evaluate potential intervention strategies. The final model can be tested via a behavioural simulation, with outcomes compared to those expected from literature precedence or used as a simulated computer game for empirical data collection.

Implications: A hypothesized life-cycle model of PE identifies vulnerability factors across the stages of athlete development with the view of informing the design of anti-doping assessment and intervention. The model suggests that, instead of focusing on the actual engagement in prohibited PE practices, deterrence strategies are likely to be more effective if they target the influencing factors at the appropriate stage and identify groups of athletes and their respective career stages, which pose particular risks of engagement in doping practices. This enables a more effective intervention approach by targeting specific risk factors and expectancies.

Psychosocial factors and performance enhancing substances in gym users : A systematic review / Ana Sofia R. Tavares, Sidónio Serpa, Luís Horta, António Rosado. - (Revista de Psichología del Deporte = Journal of Sport Psychology 28 (2019) 1; p. 131-142)

Abstract

The use of performance-enhancing substances (PES) occurs among gym/fitness center users. This systematic review aimed to analyze studies describing prevalence, attitudes, beliefs, and knowledge, as conceptualized in the Theory of Planned Behavior (TPB), influenced by the use of PES by this population. Twenty-six articles were identified from a systematic approach following the PRISMA statement via electronic databases (SPORTDiscusTM, PubMed, Scopus, Web of Science, B-On and Psychology and Behavioral Science Collection) and hand-searching bibliographies of reference lists. Only peer-reviewed primary research published in English, Portuguese and Spanish (1997-2016), focusing on gym/fitness center users and providing information on psychosocial factors (e.g., attitudes, beliefs, intention, social influence/ peer pressure) towards using PES, were included. It was concluded that the most prevalent substance used were anabolic-androgenic steroids (AAS). Attitudes of male bodybuilders using AAS as the prevalent drug are mainly related to aesthetic issues. Important influences come from groups (e.g., friends, training colleagues) and instructors. Although some AAS users indicated a general lack of knowledge of the potentially harmful effects of these drugs, others were aware of the side effects. The TPB illustrated a relationship between psychosocial factors influencing gym users to use PES.

Psychosocial factors facilitating use of cognitive enhancing drugs in education : a qualitative investigation of moral disengagement and associated processes / Andrew Robert Heyes, Ian David Boardley

• Drugs: Education, Prevention and Policy 26 (2019) 4, p. 329-338
• DOI:10.1080/09687637.2019.1586831
• Special Issue: Pharmaceutical Cognitive Enhancement

Abstract

Illicit use of prescription drugs (e.g. modafinil) to enhance academic performance – termed cognitive enhancement (CE) – is a legal, health, and ethical issue. Guided by Bandura’s social cognitive theory of moral thought and action, this study investigated whether student users of CE evidenced specific psychosocial mechanisms (i.e. mechanisms of moral disengagement) when explaining their reasons for CE. Following ethical approval from the lead author’s institution, in-depth-semi-structured interviews were conducted with nine students with experience of CE. Data were content analysed deductively, using definitions for the eight mechanisms of moral disengagement; six of the eight mechanisms were identified through data analysis: diffusion of responsibility (DR), advantageous comparison (AC), distortion of consequences (DCs), displacement of responsibility, moral justification, and euphemistic labelling. In addition, inductive data analysis identified three further themes; self-medication, family and friends, and institutional position. Overall, the study findings suggest students may morally disengage to justify and rationalise use of CE to minimise negative emotional responses (e.g. guilt) that may be expected to result given the potential legal-, health-, and ethics-based deterrents to CE.

Public health impact and implications of the use of anabolic androgenic steroids (AAS) and associated drugs amongst the male general population / James McVeigh. - Liverpool : Liverpool John Moores University (LJMU), 2009

• Doctoral thesis, Liverpool John Moores University
• DOI: 10.24377/LJMU.T.00010247

Abstract:

Anabolic androgenic steroids (AAS) and associated drug use is now recognised as a significant concern and an emerging public health issue. Once restricted to the elite sporting arena, recent decades have seen AAS diffuse through bodybuilding and gym culture to an increasingly image conscious general population. This portfolio of research contributes to our understanding of this phenomenon in relation to our understanding of the extent and characteristics of AAS use, emerging harms and the policy response to the issue, as summarised below.

While specific prevalence is unknown, data from needle and syringe programmes (NSPs) indicate growing numbers of people who inject AAS and associated drugs. Often portrayed in the media as a homogenous group of young male, working class men, a growing body of research indicates a much more diverse population in relation to demographic characteristics and motivations for use. Further research indicates that this is by no means confined to the United Kingdom (UK) but is a global public health issue although barely recognised in some countries such as the Republic of Ireland.

Changes in the specific drugs of use and the regimes employed have been identified, with a growing pharmacopeia of easily accessible and affordable peptide hormones being used as a direct result of the rise of the Internet, coupled with developments in manufacturing and transportation. Opinion, anecdote and targeted marketing on the Internet fill the void of a lack of empirical evidence in the field of AAS, image and performance enhancing drugs (IPEDs) influencing a trend towards higher dosages, multiple drugs and prolonged use. Drug use is not confined to IPEDs, with psychoactive drug use identified in populations in UK and Internationally.

Our understanding of the chronic health harms associated with AAS has increased over the last 25 years, in particular cardiovascular damage, psychological harms and the potential for dependence. However, this research has made a significant contribution to the recognition and understanding of the harms associated with the administration of these drugs through injection and the impact of adulterated products as a result of the illicit market. The extent of localised infection and soft tissue injury is a cause for concern, an issue previously neglected. Of further concern is the prevalence of blood borne virus (BBV) infection within the population of AAS users. In the first studies of their kind, HIV amongst AAS injectors has been shown to be at a similar level as that in psychoactive drug injectors in the UK. Hepatitis B and hepatitis C levels were identified as being higher than in the general population, and of key concern is the low levels of awareness of hepatitis C positive status amongst AAS injectors.

The UK has operated a comprehensive NSP system since the 1980s, which has seen increasing numbers of AAS injectors however, there remains barriers to engagement with this population of people who inject drugs. Data from interviews and surveys submitted here identify a level of mistrust and lack of confidence among AAS users when it comes to engaging with health professionals.

Pure Kracht : een effectief trainingsprogramma voor maximale power / red. Arien Bosch. - Koninklijke Nederlandse Krachtsport en Fitnessfederatie (KNKF); Nederlands Centrum voor Dopingvraagstukken (NeCeDo). - Utrecht : Forte Uitgevers, 2006
ISBN10 9058776417
ISBN13 9789058776419

Pure kracht is een uniek krachtsportprogramma bestaande uit de componenten training, voeding en mentaal. Een programma dat bewezen heeft dat je met de juiste inzet en een uitgebalanceerd trainingsprogramma opmerkelijke resultaten kunt behalen. Welke resultaten je kunt behalen, hoe je dit moet doen en wat je hiervoor moet laten, staat in dit boek centraal.

Pure kracht is ontwikkeld door een team van internationale experts die ook betrokken zijn bij de begeleiding van onze Olympische sporters. Het programma heeft al onomstotelijk bewezen dat je in een korte periode een krachttoename kunt verwezenlijken van meer dan 50% en een paar kilo aan spiermassa kunt winnen.

Bevat tevens de ervaringen, belevenissen en resultaten van een team van zeven sporters die het Pure kracht-programma volgden.

Dit boek is aanbevolen door de Koninklijke Nederlandse Krachtsport en Fitnessfederatie (KNKF).