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Associations of anabolic-androgenic steroid use with other behavioral disorders: an analysis using directed acyclic graphs

Published online by Cambridge University Press:  01 March 2018

Gen Kanayama ,
Harrison G. Pope Jr  and
James I. Hudson
Gen Kanayama
Affiliation:
From the Biological Psychiatry Laboratory, McLean Hospital/Harvard Medical School, 115 Mill St, Belmont, Massachusetts 02478, USA
Harrison G. Pope Jr*
Affiliation:
From the Biological Psychiatry Laboratory, McLean Hospital/Harvard Medical School, 115 Mill St, Belmont, Massachusetts 02478, USA
James I. Hudson
Affiliation:
From the Biological Psychiatry Laboratory, McLean Hospital/Harvard Medical School, 115 Mill St, Belmont, Massachusetts 02478, USA
*
Author for correspondence: Harrison G. Pope, E-mail: [email protected]
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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.

Keywords

Anabolic-androgenic steroidsbody image disordermensociopathysubstance-use disorder
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2601 - 2608
Copyright
Copyright © Cambridge University Press 2018 

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