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van de Ven K, Malouff J, McVeigh J. The Association Between the Nonmedical use of Anabolic-Androgenic Steroids and Interpersonal Violence: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1484-1495. [PMID: 37467456 DOI: 10.1177/15248380231186150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The nonmedical use of anabolic-androgenic steroids (AAS) by athletes and the general population is a public health concern. One particular concern relates to the link between AAS use and violence. Although there is a growing body of research on the association between AAS and violence, results as to what the relationship is seem to be mixed. The aim of this meta-analysis is to improve our understanding of what the current evidence base indicates regarding the relationship between the use of AAS and interpersonal violence. In total, 14 studies with a total of 16 samples met the inclusion criteria, comprising a total sample size of 137,055 participants. The findings show that there is a significant association between AAS use and interpersonal violence (r = .21 [95% confidence intervals (CI): 0.15, 0.27], p < .00001), although small. It is however unclear what the direction of this relationship is as almost all studies failed to demonstrate whether AAS use occurred prior or subsequent to the violent behavior. Risk of bias for most studies was moderate or high. Three potential moderators, AAS use via self-report or testing, interpersonal violence via self-report or criminal records of violent behavior, and proportion of males, were nonsignificant. Although a meta-analytic relationship between AAS use and interpersonal violence was found, it is unclear to what extent AAS causes violent acts. We need to carefully consider the role of mediating factors, and that the relationship between the two could be part of a broader context as opposed to AAS being the cause of violence.
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Affiliation(s)
- Katinka van de Ven
- University of New England, Armidale, NSW, Australia
- University of NSW, Sydney, NSW, Australia
- Human Enhancement Drugs Network, NSW, Australia
| | - John Malouff
- University of New England, Armidale, NSW, Australia
| | - Jim McVeigh
- Manchester Metropolitan University, Manchester, UK
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Thirumalai A, Anawalt BD. Androgenic Steroids Use and Abuse. Urol Clin North Am 2022; 49:645-663. [DOI: 10.1016/j.ucl.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kildal E, Hassel B, Bjørnebekk A. ADHD symptoms and use of anabolic androgenic steroids among male weightlifters. Sci Rep 2022; 12:9479. [PMID: 35676515 PMCID: PMC9178025 DOI: 10.1038/s41598-022-12977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Use of anabolic androgenic steroids (AAS) is associated with adverse health effects. The factors that predispose to AAS use among athletes are poorly understood, but attention deficit/hyperactivity disorder (ADHD), which is known to occur among athletes more often than in the general population, is associated with risk behaviors, including substance abuse. We aimed to see if AAS use in male weightlifters was associated with ADHD symptoms, and test the link between ADHD symptoms and cognitive performance. Hundred and forty male weightlifters, 72 AAS users and 68 weightlifting controls (WLC), completed the Achenbach system of empirically based assessment (ASEBA) for ADHD symptoms and underwent cognitive examination. Self-reported ADHD symptom scores were significantly higher among AAS users compared to WLC, and scores in the range indicating clinically important ADHD was significantly more common in the AAS-using group. Age of onset of AAS use correlated inversely with ADHD scale score (r = - 0.35; p = 0.003). ADHD score correlated inversely with cognitive scores for working memory (r = - 0.25, p < 0.001), processing speed (r = - 0.24, p < 0.001), verbal learning and memory (r = - 0.19, p = 0.03), and problem solving (r = - 0.20, p = 0.02). AAS use among weightlifters is associated with ADHD symptoms and corresponding lower cognitive performance. Recognising a relationship between ADHD symptoms and AAS use may guide drug prevention strategies in sports.
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Affiliation(s)
- Emilie Kildal
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørnar Hassel
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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Giorgetti A, Busardò FP, Giorgetti R. Toxicological Characterization of GHB as a Performance-Enhancing Drug. Front Psychiatry 2022; 13:846983. [PMID: 35509886 PMCID: PMC9058118 DOI: 10.3389/fpsyt.2022.846983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Performance-enhancing drugs (PEDs) are represented by several compounds used to ameliorate the image, the appearance, or an athletic or non-athletic performance. Gamma-hydroxybutyrate (GHB) is an endogenous molecule first used as anesthetic and then marketed as a nutritional supplement with a wide diffusion in the bodybuilding community. The aim of the present work is to provide a toxicological characterization of the use of GHB as a PED, including the scientific basis for its use, the patterns of use/abuse, and the health risks arising from its consumption in this peculiar recreative setting. A literature search was performed on multiple databases including experimental studies on humans and animals as well as epidemiological reports and forensic case reports/series. Experimental studies demonstrated that the use of GHB as a PED is motivated by the release of growth hormone and the induction of sleep. However, the panel of desired performance-related effects was much wider in real cases and epidemiological studies. Even though the use of GHB among bodybuilders has decreased, its use to enhance some kind of performance, particularly sexual ones or social-communicative ones, as well as means to increase mood and perceived energy, is still common.
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Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
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Havnes IA, Bukten A, Rognli EB, Muller AE. Use of anabolic-androgenic steroids and other substances prior to and during imprisonment - Results from the Norwegian Offender Mental Health and Addiction (NorMA) study. Drug Alcohol Depend 2020; 217:108255. [PMID: 32949884 DOI: 10.1016/j.drugalcdep.2020.108255] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anabolic-androgenic steroid (AAS) use is associated with health problems and substance use. Substance use is common among inmates. This study aims to estimate lifetime and prison use of AAS and other substances, compare characteristics of groups of inmates, and describe factors associated with AAS use in a national prison population. METHODS Data from the Norwegian Offender Mental Health and Addiction (NorMA) Study, a cross-sectional survey of people in prisons, included sociodemographic variables and lifetime and prison use of AAS and other substances. Altogether 1,499 inmates, including 96 (6.4%) women, were divided into three mutually exclusive groups according to lifetime AAS use, non-AAS substance use and no substance use. RESULTS Lifetime AAS use was reported by 427 (28.5%) inmates; 6 women and 421 men. Non-AAS substance use was reported by 593 (39.6%) and 479 (31.9%) had never used AAS or non-AAS substances. Compared to the non-AAS substance group, the AAS group reported younger debut ages for nearly all non-AAS substances, higher mean number of non-AAS substances used in their lifetime (8.9, 6.6, p < 0.001), during the six months prior to incarceration (5.2, 3.1, p < 0.001), and during (2.3, 1.3, p < 0.001) imprisonment. Although 120 (8.0%) inmates used AAS during the six months prior to incarceration, only ten continued during imprisonment. CONCLUSIONS Lifetime AAS use is common among inmates and may be an indicator of more severe substance use problems. Screening for previous and present AAS use at incarceration and increased staff awareness are needed to tailor treatment approaches appropriately.
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Affiliation(s)
- Ingrid Amalia Havnes
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Pb 4959, Nydalen, 0424, Oslo, Norway.
| | - Anne Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway; Section for Clinical Addiction Research (RusForsk), Oslo University Hospital, Pb 4956, Nydalen, 0424, Oslo, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research (RusForsk), Oslo University Hospital, Pb 4956, Nydalen, 0424, Oslo, Norway
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Delgado PF, Maya-Rosero E, Franco M, Montoya-Oviedo N, Guatibonza R, Mockus I. Testosterona y homicidio: aspectos neuroendocrinos de la agresión. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.73237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Las tasas de homicidio, suicidio y agresión son mayores en el sexo masculino; la testosterona podría desempeñar un papel importante en el desarrollo de estos comportamientos. Objetivo. Realizar una revisión de los aspectos endocrinos y neurobiológicos de la testosterona y su relación con comportamientos agresivos, homicidas y suicidas.Materiales y métodos. Se realizó una revisión narrativa con diferentes estrategias de búsqueda en PubMed, SpringerLink, ScienceDirect y SciELO. Se incluyeron artículos de investigación, revisiones y reportes de caso publicados en español y en inglés entre 2002 y 2018.Resultados. De los 66 estudios incluidos en la revisión, más del 50% asociaron el comportamiento agresivo u homicida con niveles elevados de testosterona, hormona que podría modular la actividad de las vías cerebrales serotoninérgicas y dopaminérgicas involucradas en el comportamiento agresivo por medio de receptores androgénicos y estrogénicos. Se encontraron relaciones entre uso de esteroides anabólicos y homicidio, y entre testosterona circulante en mujeres y rasgos de personalidad antisocial. Asimismo, se observaron cambios de concentraciones séricas de testosterona en sujetos con tendencias suicidas.
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Christoffersen T, Andersen JT, Dalhoff KP, Horwitz H. Anabolic-androgenic steroids and the risk of imprisonment. Drug Alcohol Depend 2019; 203:92-97. [PMID: 31421475 DOI: 10.1016/j.drugalcdep.2019.04.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of Anabolic-Androgenic Steroids (AAS) has been associated with increased aggressiveness and violent behavior. We therefore investigated the proposed correlation between the use of AAS and criminality while controlling for important socio-economics covariates and for psychiatric comorbidity. METHODS The primary endpoints were prison sentences, and time to first prison sentence. A retrospective matched cohort study design consisting of 545 males, who tested positive for AAS in Danish gyms during the period January 3, 2006 to January 31, 2017. They were matched with 5450 randomly chosen male controls. Data were cross-referenced with national register information on education, employment status, substance abuse and psychiatric comorbidity. In addition, 638 males sanctioned because they rejected to participate in the doping control and 6380 controls were used as a replication cohort. RESULTS Already at baseline, 20.6% of the AAS users had a previous prison sentence whereas the rate was 3.7% in the control cohort (p < 0.0001). During the follow-up period the cumulative prevalence increased to 29.5% and 4.9%, respectively (unadjusted HR 9.15, 95% CI 6.33-13.20). The associations remained highly significant after controlling for socio-economic factors, drug abuse and psychiatric comorbidity. The results could be replicated in a similar cohort. CONCLUSION Our study shows that AAS users have a 9-fold increased risk of being convicted of a crime compared to matched controls, randomly chosen from the general population. This association could not be explained by common socioeconomic factors or by psychiatric comorbidity.
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Affiliation(s)
- Thea Christoffersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Prison primary care and non-communicable diseases: a data-linkage survey of prevalence and associated risk factors. BJGP Open 2019; 3:bjgpopen19X101643. [PMID: 31366674 PMCID: PMC6662881 DOI: 10.3399/bjgpopen19x101643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/03/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations. AIM To explore both the prevalence of NCDs and their risk factors. DESIGN & SETTING A cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England. METHOD Self-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records. RESULTS It was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence.The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001). CONCLUSION Compared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high.Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence.
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Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:20. [PMID: 31096999 PMCID: PMC6524231 DOI: 10.1186/s13011-019-0206-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Abstract
Background Anabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. In Norway, the substance use disorder treatment system provides health care to this patient group, but few AAS users have sought such treatment. Therefore, a service was created to inform AAS users and next of kin of potential negative consequences and their treatment options. This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users. Methods Over four years, 232 AAS users and 60 next of kin contacted the information service and received an hour-long information session with healthcare personnel. Information about AAS use, physical and mental health problems, substance use, motivation for cessation, and whether the information seeker desired treatment were registered. Qualitative interviews were conducted among seven individuals and analyzed thematically to explore information service experiences. Results Of the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. Those who desired treatment were significantly older, had used AAS longer, reported more physical and mental health side effects, and a higher proportion reported having children than those who did not desire treatment. Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n = 108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). Findings from qualitative interviews suggest that barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process. Conclusions Healthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects. The desire for health care reveals extensive health problems and the user group is so non-homogeneous that examination and treatment must be adapted individually with focus on physical, mental and social factors as well as possible dependence of AAS and/or psychoactive substances.
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Affiliation(s)
- Ingrid Amalia Havnes
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424, Oslo, Norway.
| | - Marie Lindvik Jørstad
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424, Oslo, Norway
| | - Christine Wisløff
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424, Oslo, Norway
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Inmates with Harmful Substance Use Increase Both Exercise and Nicotine Use Under Incarceration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122663. [PMID: 30486386 PMCID: PMC6313574 DOI: 10.3390/ijerph15122663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
Abstract
Exercise is increasingly understood as an important resource for people who engage in harmful substance use, including those in prison. Little is known about how inmates adopt various health behaviors during incarceration, without interventions. This cross-sectional study analyzed self-reports from 1464 inmates in Norwegian prisons in 2013–2014, compared them according to harmful substance use pre-incarceration, and explored changes in exercise and nicotine use during incarceration. Results were presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inmates with harmful substance use reported higher rates of smoking, smokeless tobacco, and physical inactivity pre-incarceration than inmates without harmful use. However, inmates with harmful use also exhibited more behavioral changes: they adopted exercise, ceased smoking, and adopted smokeless tobacco at higher rates during incarceration than the non-harmful group, to the extent that inmates with harmful use exercised during incarceration more. Exercise is being taken up by a significant proportion of inmates, and may in particular be a replacement behavior for substance use. However, unhealthy behaviors also begin or are maintained. If prisons were used as an arena to facilitate healthy behaviors, the public health benefits to a marginalized group such as substance-using inmates could be substantial.
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Kanayama G, Pope HG, Hudson JI. Associations of anabolic-androgenic steroid use with other behavioral disorders: an analysis using directed acyclic graphs. Psychol Med 2018; 48:2601-2608. [PMID: 29490719 DOI: 10.1017/s0033291718000508] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Anabolic-androgenic steroid (AAS) use is known to be associated with other psychiatric disorders, such as body image disorders, conduct disorder/sociopathy, and other substance use disorders (SUD) - but the causal pathways among these conditions remain poorly delineated. METHODS We created a directed acyclic graph to diagram hypothesized relationships among AAS use and dependence, body image disorder (BID), conduct disorder/sociopathy, and other SUD. Using proportional hazards models, we then assessed potentially causal relationships among these variables, using a dataset of 233 male weightlifters, of whom 102 had used AAS. RESULTS BID and conduct disorder/sociopathy both strongly contributed to the development of AAS use, but did not appear to contribute further to the progression from AAS use to AAS dependence. Other SUD beginning prior to first AAS use - whether broadly defined or restricted only to opioids - failed to show an effect on AAS use or progression to AAS dependence. Conversely, AAS use contributed significantly to the subsequent first-time development of opioid use disorders but did not significantly increase the risk for first-time development of non-opioid SUD, taken as a whole. CONCLUSIONS Our analysis suggests that AAS use and other SUD are mutually attributable to underlying conduct disorder/sociopathy. SUD do not appear to represent a 'gateway' to subsequent AAS use. AAS use may represent a gateway to subsequent opioid use disorder, but probably not to other SUD.
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Affiliation(s)
- Gen Kanayama
- From the Biological Psychiatry Laboratory,McLean Hospital/Harvard Medical School,115 Mill St,Belmont,Massachusetts 02478,USA
| | - Harrison G Pope
- From the Biological Psychiatry Laboratory,McLean Hospital/Harvard Medical School,115 Mill St,Belmont,Massachusetts 02478,USA
| | - James I Hudson
- From the Biological Psychiatry Laboratory,McLean Hospital/Harvard Medical School,115 Mill St,Belmont,Massachusetts 02478,USA
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Sagoe D, Torsheim T, Molde H, Andreassen CS, Pallesen S. Anabolic-Androgenic Steroid use in the Nordic Countries: A Meta-Analysis and Meta-Regression Analysis. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims To investigate the lifetime prevalence and moderators of non-medical AAS use in the five Nordic countries. Methods We conducted a meta-analysis and meta-regression using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference checks. Included were 32 studies that provided original data on 48 lifetime prevalence rates based on a total of 233,475 inhabitants of the Nordic countries. Results – The overall lifetime prevalence obtained was 2.1% [95% confidence interval (CI): 1.3-3.4, I2 = 99.5, P < 0.001]. The prevalence for males, 2.9% (95% CI: 1.7-4.8, I2 = 99.2, P < 0.001), was significantly higher (Qbet = 40.5, P < 0.001) than the rate for females, 0.2% (95% CI: 0.1-0.4, I2 = 90.5, P < 0.001). Sweden has the highest prevalence of AAS use: 4.4%, followed by Norway: 2.4%, Finland: 0.8%, Iceland: 0.7%, and Denmark: 0.5%. Country, sample type, and male sample percentage significantly predicted AAS use prevalence in a meta-regression analysis. No indication of publication bias was found. Conclusion – Though subject to some limitations, our findings suggest that non-medical AAS use should be regarded as a serious public health problem in the Nordic countries.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science University of Bergen, Norway
| | | | - Helge Molde
- Department of Clinical Psychology University of Bergen, Norway
| | - Cecilie Schou Andreassen
- Department of Psychosocial Science University of Bergen, Norway; The Competence Center, Bergen Clinics Foundation, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science University of Bergen, Norway
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Uxoricide and dismemberment in a case of illicit anabolic steroid use: A case report and literature review. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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McVeigh J, Begley E. Anabolic steroids in the UK: an increasing issue for public health. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1245713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jim McVeigh
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Emma Begley
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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Abstract
PURPOSE The existing evidence base and policy context of sports-based prisoner health promotion is evaluated, and an original analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales is presented, with a focus on the variability of provision across different prison establishments. DESIGN/METHODOLOGY/APPROACH Inspectorate reports published by Her Majesty's Inspectorate of Prisons (n=184) were analysed to assess the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. Examples of innovative sport-based health promoting programmes are drawn upon in order to illustrate principles of best practice. FINDINGS Despite health promotion being engrained in existing policy, the degree to which physical, mental health and substance misuse needs are addressed through sport in prison remains highly variable and locally contingent across the secure estate, although examples of innovative practice are evident. RESEARCH LIMITATIONS/IMPLICATIONS For sport to promote prisoner health most effectively, tailored sports provision should be embedded within multi-modal interventions which draw on internal and external partnerships and promote opportunities for ongoing sporting participation. Further research is required to delineate principles of best practice applicable to discrete prisoner populations. ORIGINALITY/VALUE Sport can play a key role in addressing a multitude of prisoner health needs whilst contributing to achieving "healthy prison" objectives in practice. Sport and physical activity clearly offers a valuable way of motivating prisoners to engage in health promoting initiatives.
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Affiliation(s)
- Rosie Meek
- School of Social Sciences and Law, Teesside University, Middlesbrough, UK.
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Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaëlsson K, Gedeborg R. Anabolic steroids and cardiovascular risk: A national population-based cohort study. Drug Alcohol Depend 2015; 152:87-92. [PMID: 26005042 DOI: 10.1016/j.drugalcdep.2015.04.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/10/2015] [Accepted: 04/18/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Non-therapeutic use of anabolic androgenic steroids (AAS) has been associated with various adverse effects; one of the most serious being direct cardiovascular effects with unknown long-term consequences. Therefore, large studies of the association between AAS and cardiovascular outcomes are warranted. We investigated cardiovascular morbidity and mortality in individuals who tested positive for AAS. METHODS AND RESULTS Between 2002 and 2009, a total of 2013 men were enrolled in a cohort on the date of their first AAS test. Mortality and morbidity after cohort entry was retrieved from national registries. Of the 2013 individuals, 409 (20%) tested positive for AAS. These men had twice the cardiovascular morbidity and mortality rate as those with negative tests (adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2-3.3). Compared to the Swedish population, all tested men had an increased risk of premature death from all causes (standardized mortality ratio for AAS-positive: 19.3, 95% CI 12.4-30.0; for AAS-negative: 8.3, 95% CI 6.1-11.0). CONCLUSION Non-therapeutic exposure to AAS appears to be an independent risk factor for cardiovascular morbidity and premature death.
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Affiliation(s)
- Ingemar Thiblin
- Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Hans Garmo
- King's College London, Medical School, London, UK
| | - Mats Garle
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Holmberg
- Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden; King's College London, Medical School, London, UK
| | - Liisa Byberg
- Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Rolf Gedeborg
- Dept. of Surgical Sciences, Uppsala University, Uppsala, Sweden; Medical Products Agency, Uppsala, Sweden
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Sagoe D, McVeigh J, Bjørnebekk A, Essilfie MS, Andreassen CS, Pallesen S. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:12. [PMID: 25888931 PMCID: PMC4377045 DOI: 10.1186/s13011-015-0006-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
Background As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published. Method We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users’ polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n = 22), followed by Sweden (n = 7), England only (n = 5), and the United Kingdom (n = 4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Conclusions Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway.
| | - Jim McVeigh
- Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, Liverpool, L3 2ET, UK.
| | - Astrid Bjørnebekk
- Department of Physical Medicine and Rehabilitation, Unit of Neuropsychology, Oslo University Hospital, Kirkeveien 166, Ullevål, Norway.
| | | | - Cecilie Schou Andreassen
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway. .,The Competence Centre, Bergen Clinics Foundation, Vestre Torggate 11, 5015, Bergen, Norway.
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway.
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Affiliation(s)
- Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Vic, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 3220, Australia.
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Gårevik N, Rane A, Björkhem-Bergman L, Ekström L. Effects of different doses of testosterone on gonadotropins, 25-hydroxyvitamin D3, and blood lipids in healthy men. Subst Abuse Rehabil 2014; 5:121-7. [PMID: 25525405 PMCID: PMC4266340 DOI: 10.2147/sar.s71285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS To study the effect and time profile of different doses of testosterone enanthate on the blood lipid profile and gonadotropins. EXPERIMENTAL DESIGN Twenty-five healthy male volunteers aged 27-43 years were given 500 mg, 250 mg, and 125 mg of testosterone enanthate as single intramuscular doses of Testoviron(®) Depot. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), blood lipid profile (total cholesterol, plasma [p-] low-density lipoprotein, p-high-density lipoprotein [HDL], p-apolipoprotein A1 [ApoA1], p-apolipoprotein B, p-triglycerides, p-lipoprotein(a), serum [s-] testosterone, and 25-hydroxyvitamin D3) were analyzed prior to, and 4 and 14 days after dosing. Testosterone and epitestosterone in urine (testosterone/epitestosterone ratio) were analyzed prior to each dose after a washout period of 6-8 weeks. RESULTS AND DISCUSSION All doses investigated suppressed the LH and FSH concentrations in serum. LH remained suppressed 6 weeks after the 500 mg dose. These results indicate that testosterone has a more profound endocrine effect on the hypothalamic-pituitary-gonadal axis than was previously thought. There was no alteration in 25-hydroxyvitamin D3 levels after testosterone administration compared to baseline levels. The 250 and 500 mg doses induced decreased concentrations of ApoA1 and HDL, whereas the lowest dose (125 mg) did not have any effect on the lipid profile. CONCLUSION The single doses of testosterone produced a dose-dependent increase in serum testosterone concentrations together with suppression of s-LH and s-FSH. Alterations in ApoA1 and HDL were observed after the two highest single doses. It is possible that long-time abuse of anabolic androgenic steroids will lead to alteration in vitamin D status. Knowledge and understanding of the side effects of anabolic androgenic steroids are important to the treatment and care of abusers of testosterone.
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Affiliation(s)
- Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Hedlund J, Ahlner J, Kristiansson M, Sturup J. A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009. Forensic Sci Int 2014; 244:25-9. [DOI: 10.1016/j.forsciint.2014.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
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Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:27. [PMID: 24984881 PMCID: PMC4091955 DOI: 10.1186/1747-597x-9-27] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/26/2014] [Indexed: 12/31/2022]
Abstract
Background To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use. Methods We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation. Conclusions Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway.
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Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35:341-75. [PMID: 24423981 PMCID: PMC4026349 DOI: 10.1210/er.2013-1058] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs. There is a widespread misperception that PED use is safe or that adverse effects are manageable. In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated. This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem. PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors. PED use has been linked to an increased risk of death and a wide variety of cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders. Because randomized trials cannot ethically duplicate the large doses of PEDs and the many factors associated with PED use, we need observational studies to collect valid outcome data on the health risks associated with PEDs. In addition, we need studies regarding the prevalence of PED use, the mechanisms by which PEDs exert their adverse health effects, and the interactive effects of PEDs with sports injuries and other high-risk behaviors. We also need randomized trials to assess therapeutic interventions for treating the adverse effects of PEDs, such as the anabolic-androgen steroid withdrawal syndrome. Finally, we need to raise public awareness of the serious health consequences of PEDs.
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Affiliation(s)
- Harrison G Pope
- McLean Hospital (H.G.P.), Harvard Medical School, Belmont, Massachusetts 02478; University of Southern California (R.I.W.), Los Angeles, California 90089; University of Virginia (A.R.), Charlottesville, Virginia 22904; Department of Pharmaceutical Biosciences, (F.N.), Upsala University, SE-751 24, Upsala, Sweden; United States Anti-Doping Agency (L.B.), Colorado Springs, Colorado 80919; and Brigham and Women's Hospital (S.B.), Harvard Medical School, Boston, Massachusetts 02115
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Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol 2014; 24:383-98. [PMID: 24582699 DOI: 10.1016/j.annepidem.2014.01.009] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/29/2013] [Accepted: 01/23/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE To estimate the global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use and investigate moderators of the prevalence rate. METHODS A meta-analysis and meta-regression analysis was performed using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I(2) index and the Q-statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction. RESULTS The global lifetime prevalence rate obtained was 3.3% (95% confidence interval [CI], 2.8-3.8; I(2) = 99.7, P < .001). The prevalence rate for males, 6.4% (95% CI, 5.3-7.7, I(2) = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3-1.9, I(2) = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias. CONCLUSION Nonmedical AAS use is a serious widespread public health problem.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.
| | - Helge Molde
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Cecilie S Andreassen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway; The Competence Center, Bergen Clinics Foundation, Bergen, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Abstract
PURPOSE OF REVIEW To summarize recent advances in studies of illicit use of androgens and other hormones. RECENT FINDINGS Androgens and other appearance-enhancing and performance-enhancing substances are widely abused worldwide. Three notable clusters of findings have emerged in this field in recent years. First, studies almost unanimously find that androgen users engage in polypharmacy, often ingesting other hormones (e.g., human growth hormone, thyroid hormones, and insulin), ergo/thermogenic drugs (e.g., caffeine, ephedrine, and clenbuterol), and classical drugs of abuse (e.g., cannabis, opiates, and cocaine). Second, reports of long-term psychiatric and medical adverse effects of androgens continue to accumulate. In cardiovascular research particularly, controlled studies have begun to supersede anecdotal evidence, strengthening the case that androgens (possibly acting synergistically with other abused drugs) may cause significant morbidity and even mortality. Third, it is increasingly recognized that androgen use may lead to a dependence syndrome with both psychological and physiological origins. Androgen dependence likely affects some millions of individuals worldwide, and arguably represents the least studied major class of illicit drug dependence. SUMMARY Given mounting evidence of the adverse effects of androgens and associated polypharmacy, this topic will likely represent an expanding area of research and an issue of growing public health concern.
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Affiliation(s)
- Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA
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Hakansson A, Mickelsson K, Wallin C, Berglund M. Anabolic androgenic steroids in the general population: user characteristics and associations with substance use. Eur Addict Res 2012; 18:83-90. [PMID: 22286840 DOI: 10.1159/000333037] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/08/2011] [Indexed: 11/19/2022]
Abstract
AIMS To analyse correlates of anabolic androgenic steroids (AAS) use in the general male population. DESIGN A national household survey. PARTICIPANTS Individuals aged 15-64 years in Sweden. MEASUREMENTS AAS use and potential correlates of AAS use, including demographic data, financial situation, physical training, and substance use. In hierarchical logistic regression analyses, lifetime users of AAS (n = 240) were compared to all nonusers (n = 13,920) and to nonusers who reported that they had been offered AAS (n = 487). RESULTS AAS use was most strongly associated with a lifetime history of illicit drug use and the misuse of prescription drugs. When controlling for substance use, AAS was associated with physical training and lower education. Illicit drug use and misuse of prescription drugs separated AAS users from nonusers who had been offered AAS. No associations were seen with AUDIT scores for risk alcohol drinking. CONCLUSIONS In this general population survey in men, lifetime use of AAS appears to share common characteristics with illicit substance use. Both substance use variables and physical training remained associated with AAS use when controlling for one another.
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Affiliation(s)
- Anders Hakansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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Use of anabolic androgenic steroids in substance abusers arrested for crime. Drug Alcohol Depend 2010; 111:222-6. [PMID: 20627426 DOI: 10.1016/j.drugalcdep.2010.04.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/25/2010] [Accepted: 04/28/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. METHODS Data were collected from structured interviews with substance abusers (n=3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use. RESULTS Those stating AAS experience (n=924, 20 women and 904 men) were more often apprehended for violent crimes (OR=1.65). This association remained significant after controlling for age and sex (OR=1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR=2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users. CONCLUSIONS Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.
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