Anabolic-androgenic steroid users in treatment Örebro Studies in Medicine 28 Kurt Skårberg Anabolic-androgenic steroid users in treatment Social background, drug use patterns, and criminality © Kurt Skårberg, 2009 Title: Anabolic-androgenic steroid users in treatment: social background, drug use patterns, and criminality. Publisher: Örebro University 2009 www.publications.oru.se Editor: Maria Alsbjer [email protected] Printer: Intellecta Infolog, V Frölunda 04/2009 issn 1652-4063 isbn 978-91-7668-662-1 ABSTRACT Skårberg, Kurt (2009). Anabolic-androgenic steroid users in treatment: social background, drug use patterns, and criminality. Örebro Studies in Medicine 28. 98pp. This dissertation is based on interviews with 36 users of anabolic androgenic steroids (AAS) seeking help at an addiction centre. A comparison group of 277 gym clients were asked to answer a questionnaire. The dissertation consists of four studies. Histories of a troubled childhood as well as current social disadvantage were both more frequent among the AAS users. Users also reported poor relationships with their parents and almost half of them had experienced physical or mental abuse. The AAS user’s experiences from school were mostly negative, and included concentration problems, boredom and learning difficulties. Their current circumstances included abuse of other drugs, battering of spouses and other crimes such as assault, illegal possession of weapons and theft. There was significant variation in the development of drug use in relation to social background, onset of drug use, relationship to AAS use and experience of AAS effects. All patients had initially experienced positive effects from AAS but, over time, the negative experiences had outweighed the positive effects. All patients were dedicated to excess training and took AAS in combination with gym training, indicating that the use of these drugs is closely related to this form of training. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients also used human growth hormones. Moreover, almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for using AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a mean of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The criminal activity level increased significantly for the majority of the participants after they began using drugs. This was particularly obvious in the two subgroups who started their involvement with drugs by using AAS. Crimes of violence and weapon offences showed the greatest increases in incidence after drug use was initiated. The study also showed a significant decrease in criminality after treatment, particularly among participants who started their drug use with AAS. The results suggest that there is an association between the use of AAS and criminality, in particular with respect to crimes of violence and weapon offences, and that this criminality is enhanced when AAS are combined with other drugs of abuse. This dissertation shows that AAS users often have a history of and a current problematic social situation, that AAS use is often combined with a polysubstance drug use, that AAS use is connected to criminal activities including crimes of violence and weapon crimes, and that AAS use can be a gateway to the use of other drugs of abuse. Keywords: Anabolic androgenic steroids, narcotics, drugs of abuse, alcohol, pharmaceuticals, dietary supplements, social background, criminality Kurt Skårberg, Örebro University, SE-70182 Örebro, Sweden. E-mail: [email protected] 5 6 LIST OF PUBLICATIONS This dissertation is based on the following original papers, which will be referred to in in the text by their Roman numerals: I. Skarberg, K. & Engstrom, I. (2007) Troubled social background of male anabolic-androgenic steroid abusers in treatment. Substance Abuse Treatment, Prevention, and Policy, 2, 20. II. Skårberg, K., Nyberg, F. & Engström, I. (2008) The development of multiple drug use among anabolic-androgenic steroid users: six subjective case reports. Substance Abuse Treatment, Prevention, and Policy, 3, 24. III. Skarberg, K., Nyberg, F. & Engstrom, I. (2009) Multisubstance Use as a Feature of Addiction to Anabolic-Androgenic Steroids. European Addiction Research, 15: 99–106. IV. Skarberg, K., Nyberg, F. & Engstrom, I. Is there an association between use of anabolic-androgenic steroids and criminality? Submitted. The studies presented in this dissertation have been reprinted with the kind permission of the publishers concerned (BioMed Central and S. Karger AG, Basel). 7 8 LIST OF ABBREVATIONS AAS Anabolic androgenic steroids AC Addiction clinic ANOVA Analysis of variance AUDIT The alcohol use disorders identification test BRÅ The Swedish national council for crime prevention CLA Conjugated linoleic acid DHT 5(cid:68) -dihydrotestosterone DSM IV Diagnostic and statistical manual of mental disorder, 4th edition FASS The Swedish drug catalogue FSH Follicle stimulating hormone GDR German Democratic Republic GHB Gamma-hydroxybutyric acid GRH Gonadotropin-releasing hormone HCG Human chorionic gonadotropin HDL High-density lipoprotein hGH Human growth hormone HMB Beta-hydroxy-beta-methylbutyrate HPG-axis Hypothalamic-pituitary-gonadal axis IGF-1 Insulin liked growth factor-1 LDL Low-density lipoprotein LH Luteinizing hormone LSD Lysergic acid diethylamide SASB Structural analysis of social behavior SCL-90 Symtom checklist-90 SHBG Sex hormone binding globulin SPSS Statistical package for the social sciences TCI Temperament and character inventory THC Tetrahydrocannabiol (cannabis) THG Tetrahydrogestrione 9 10