AAS Dependency



The two most widely-accepted standards for defining, classifying and diagnosing drug abuse and dependence are the DSM-IV and the International Classification of Diseases, Volume 10 (ICD-10). The DSM IV and the ICD 10 differ in the way they regard Anabolic-Androgenic Steroids' (AAS) potential for producing dependence.  DSM IV regards AAS as potentially dependence producing and ICD 10 regards them as non-dependence producing. In DSM-IV, AAS are found in the "other substance-related disorder" section and can be coded as either "other substance dependence" or "other substance abuse" depending on which diagnostic criteria they meet. Alternatively, ICD-10 codes steroids and hormones in the "abuse of non-dependence-producing substances" section. ICD-10 goes on to state, "although it is usually clear that the patient has a strong motivation to take the substance, there is no development of dependence or withdrawal symptoms as in the case of the psychoactive substances." This difference in approach towards AAS prompts debate as to whether or not AAS are dependence-producing substances.

In 1990, the National Institute of Drug Abuse (NIDA) published an extensive monograph on anabolic steroid abuse.  The conclusion from this monograph is anabolic steroids do not satisfy the criteria for abuse potential. In 1994, the DSM-IV Sourcebook evidence review of the published literature states, "Despite increasing clinical descriptive data on anabolic steroid withdrawal, dependence, and abuse, there are insufficient substantial basic or clinical research data to support the inclusion of these syndromes in DSM-IV."  Later, in 2005, a DHHS report found, “Although anabolic steroid dependency may be a problem, its prevalence, and symptomatology are difficult to reliably establish based on the existing literature. It is interesting to note that with a million or more steroid users in the United States, only an extremely small percentage of users appear to experience mental disturbances that result in clinical treatment.”  

Politicized by both the public and medical community, AAS are a class of medicines that have been poorly studied. Contrary to prior long-standing belief, it is now accepted that anabolic steroids positively affect muscle mass and muscle strength.  Moreover, there is a clear dose-response effect of androgen administration and increasing muscle mass and strength.  Further, cessation of anabolic steroid administration leads to a loss of muscle mass and muscle strength.  This influences the concept of tolerance.

Anabolic steroid-induced hypogonadism (AIH) is an important consideration in the complete understanding of anabolic steroids (AAS).  The signs and symptoms of AIH are identical to many of those described for AAS withdrawal. As such, AIH is a confounding variable in the diagnosis for “AAS dependency.” The development of treatments to restore hypothalamic pituitary testicular axis function will clearly prove insightful and productive in the understanding of AIH and AAS dependency. Individuals who do not suffer from AIH might represent a subclass of anabolic steroid users that fulfill the criteria for dependency.  







Make A Donation