A 28-Year-Old Man with Depression, PTSD, and Anabolic-Androgenic Steroid and Amphetamine Use

Abstract

CME Educational Objectives 1. Develop an understanding of anabolic-androgenic steroid (AAS) abuse, including risk factors, signs and symptoms of abuse, and other psychiatric comorbidities. 2. Identify different tools of assessments to diagnose AAS abuse and different options for treatment. 3. Describe factors associated with relapse for AAS abuse. The patient is a 28-year-old man who was referred to a psychiatric clinic for the evaluation of polysubstance dependence, depression, and posttraumatic stress disorder (PTSD). He reported that for the last 2 years he had been abusing “Tina,” the street name for methamphetamine; anabolic steroids, opioid narcotics; and occasionally alcohol. He reported that he started taking different steroids at the encouragement of his friends at the local gym. He reported that using amphetamine and anabolic steroids together in a binge pattern would give him energy; improve his physical exercise endurance; build up muscles; and, ultimately, improve his physical appearance.

Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis

“…One study [ 16 ] originated from Australia, Canada, and USA while another described the sample as European [ 43 ]. Thirty studies used interviews [ 10 - 12 , 17 , 19 - 22 , 24 , 27 , 28 , 30 - 32 , 34 - 38 , 40 - 43 , 45 , 47 , 48 , 51 , 53 , 55 , 58 ], seven were case studies [ 9 , 23 , 29 , 39 , 49 , 50 , 57 ], one used interviews and focus groups [ 13 ], and twelve [ 14 - 16 , 19 , 25 , 26 , 33 , 44 , 46 , 52 , 54 , 56 ] used interviews supported by a questionnaire. For the studies that used both interviews and questionnaires, we relied on the qualitative or descriptive results generated from the interviews.…”

The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research

“…The immediate social networks of respondents such as intimate partners, relatives, as well as friends or teammates also emerged as important sources of AAS [6,11,21,23-25,28,32,38,39,42,46,49] during the initiation of AAS use.…”

“…Moreover, one study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. Twenty-nine studies [ 6 - 8 , 12 , 19 - 21 , 25 - 27 , 30 - 36 , 38 - 47 , 49 , 51 , 52 ] used interviews, six were case studies [ 14 , 22 , 28 , 29 , 45 , 53 ], one used interviews and focus groups [ 9 ], and eight [ 10 , 11 , 13 , 23 , 24 , 37 , 48 , 50 ] used interviews supported by a questionnaire. For the eight studies that used both interviews and questionnaires, we relied on the qualitative results generated from the interviews.…”

“…AAS users also showed psychological syndromes such as mood and depressive disorders as well as troubled psychosocial histories including divorce, having suffered rape, poor parental connectedness or involvement, and poor social support [ 14 , 25 , 27 , 28 , 44 , 45 , 48 - 50 ] prior to the initiation of AAS use. In one study [ 27 ], five females initiated AAS use after the experience of rape:…”

“…Use of other drugs also emerged as a feature of AAS users prior to the initiation of AAS use [ 7 , 14 , 27 , 28 , 32 , 38 ]. Nøkleby and Skårderud [ 38 ] highlighted drug use networks as well as addiction clinics as major gateways for the initiation of use.…”