ReviewThe use of anabolic androgenic steroids and polypharmacy: A review of the literature
Introduction
Performance enhancing substances (PES) are substances used by individuals to help improve their athletic performance or physical appearance. One of the most commonly studied PES is anabolic-androgenic steroids ([AAS], Yesalis, 2000). Although there are a number of legitimate medical uses for AAS, research suggests that some individuals use AAS for illegitimate reasons. Those who misuse AAS often do so to improve their physical appearance or athletic performance (Bahrke et al., 2000, Dodge and Jaccard, 2006). Prevalence estimates of AAS use tend to hover around 2% in studies with adolescent and college aged samples (Dodge and Jaccard, 2006, Hoffman et al., 2007), but are generally higher among those involved in power sports or weight lifting with estimates ranging from about 20% to more than 50% (Beel et al., 1998, Kanayama et al., 2009).
Misuse of AAS is believed to lead to a number of health problems like liver malfunction, problems with reproductive organs, and cardiac problems (Bolding et al., 2002, Büttner and Thieme, 2010, Nieminen et al., 1996, Salas-Ramirez et al., 2010, Santora et al., 2006, Sullivan et al., 1999). In addition to health risks, misuse of, and dependence on, AAS is associated with psychological disturbances like higher levels of aggression, depression, conduct disorder, and body dysmorphic disorder (Bolding et al., 2002, Choi and Pope, 1994, Kanayama et al., 2009).
A great deal of research has focused on identifying factors that place individuals at risk for AAS misuse (for a complete review see Bahrke et al., 2000). These risk factors include being male, participating in a strength-related sport, lifting weights at a commercial gym, and knowing an AAS user (Dodge and Jaccard, 2006, McCabe et al., 2007, Pedersen and Wichstrøm, 2001, Wichstrøm, 2006, Wichstrøm and Pedersen, 2001).
Over the past decade and a half there has been increasing interest in understanding the relationship between the use of AAS and other drugs. Some of this literature has reported that use of AAS is positively associated with the use of other substances including legal PES, alcohol, tobacco, and illicit drugs (DuRant et al., 1995, Kindlundh et al., 1999). However, other studies have failed to document such relationships (Dodge and Jaccard, 2006, Pedersen and Wichstrøm, 2001) raising questions about the nature of the relationship between AAS use and the use of other substances. Furthermore, recent studies have suggested that similar physiological mechanisms may be responsible for AAS abuse and the abuse of specific types of substances. For example, Kanayama et al., 2003a, Kanayama et al., 2009 have found that AAS abuse and opioid abuse tend to co-occur, but AAS abuse and the abuse of other drugs (e.g., alcohol) do not.
The purpose of the present paper is twofold. One purpose is to characterize the relationship between AAS use and the use of other drugs. A second purpose is to identify whether this relationship differs by type of drug.
Section snippets
Selection of studies
Relevant studies were identified by searching the following databases: Medline, PubMed, PsychInfo and SportDiscus (from April 2010 to August 2010). The search was restricted to peer-reviewed empirical studies, with human subjects, published in the English language between the years 1995 and 2010.2
Bivariate relationships
A total of 13 studies reported bivariate relationships between alcohol use and AAS use. Eleven of the studies reported positive relationships between the two substances. The studies indicate that lifetime use of AAS use is positively associated with recent alcohol use (DuRant et al., 1995, Kindlundh et al., 1999, Kokkevi et al., 2008), lifetime alcohol use (Luetkemeier et al., 1995, Nilsson et al., 2005, Pallesen et al., 2006), lifetime drunkenness (Papadopoulos et al., 2006), amount of alcohol
Role of funding source
This project was supported by Award Number R21DA023147 from the National Institute On Drug Abuse (NIDA). The NIDA played no role in manuscript writing, preparation or interpretation of the results. The content is solely the responsibility of the author and does not necessarily represent the official views of the NIDA or the National Institutes of Health.
Contributors
Tonya Dodge developed the idea for the manuscript, integrated the literature and wrote the first draft of the manuscript. Margaux Hoagland was responsible for conducting the literature search, providing perspectives on the manuscript and creating the content in the tables. Both authors contributed to, and approve of, the manuscript.
Conflict of interest
There are no conflicts of interest to disclose.
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