Kanayama Gen, Cohane Geoffrey H, Weiss Roger D, Pope Harrison G
Alcohol and Drug Abuse Research Center, McLean Hospital, Belmont, Mass 02478, USA.
J Clin Psychiatry. 2003 Feb;64(2):156-60. doi: 10.4088/jcp.v64n0208.
Recent reports suggest that anabolic-androgenic steroids (AAS) may cause mood disorders or dependence syndromes and may help to introduce some individuals to opioid abuse. At present, however, little is known about prior AAS use among men entering inpatient substance abuse treatment.
We assessed lifetime AAS use in 223 male substance abusers admitted to a substance abuse treatment unit primarily for treatment of alcohol, cocaine, and opioid dependence. Subjects reporting definite or possible AAS use were then asked to participate in a detailed semistructured interview that covered demographics, drug use history, and symptoms experienced during AAS use and withdrawal, and whether AAS use had helped introduce the subject to other classes of drugs.
Twenty-nine men (13%) reported prior AAS use, but this history was documented on physicians' admission evaluations in only 4 cases. Among 88 men listing opioids as their drug of choice, 22 (25%) acknowledged AAS use, versus only 7 (5%) of the other 135 men (p <.001). Twenty-four (83%) of the 29 AAS users were interviewed in detail. Seven (29%) of the men interviewed, all with opioid dependence, reported that they first learned about opioids from friends at the gym and subsequently first obtained opioids from the same person who had sold them AAS. Eighteen (75%) of the men interviewed reported that AAS were the first drugs that they had ever self-administered by injection, 4 (17%) reported severe aggressiveness or violence during AAS use, 1 (4%) attempted suicide during AAS withdrawal, and 5 (21%) described a history of AAS dependence.
Prior AAS use appears to be common but underrecognized among men entering inpatient substance abuse treatment, especially those with opioid dependence. AAS use may serve as a "gateway" to opioid abuse in some cases and may also cause morbidity in its own right.
近期报告表明，合成代谢雄激素类固醇（AAS）可能导致情绪障碍或依赖综合征，并可能促使一些人开始滥用阿片类药物。然而，目前对于进入住院药物滥用治疗的男性中既往使用AAS的情况知之甚少。
我们评估了223名主要因酒精、可卡因和阿片类药物依赖而入住药物滥用治疗单元的男性药物滥用者的终生AAS使用情况。报告明确或可能使用过AAS的受试者随后被要求参加一次详细的半结构化访谈，内容涵盖人口统计学、药物使用史、使用AAS及戒断期间经历的症状，以及AAS的使用是否促使受试者开始使用其他类别的药物。
29名男性（13%）报告既往使用过AAS，但只有4例在医生的入院评估中有记录。在88名将阿片类药物列为首选药物的男性中，22名（25%）承认使用过AAS，而在其他135名男性中只有7名（5%）承认使用过（p<.001）。29名AAS使用者中有24名（83%）接受了详细访谈。接受访谈的男性中有7名（29%），均有阿片类药物依赖，报告称他们最初是在健身房从朋友那里了解到阿片类药物，随后也是从卖给他们AAS的同一个人那里首次获得阿片类药物。接受访谈的男性中有18名（75%）报告AAS是他们首次自行注射的药物，4名（17%）报告在使用AAS期间有严重的攻击性或暴力行为，1名（4%）在AAS戒断期间企图自杀，5名（21%）描述有AAS依赖史。
既往使用AAS似乎很常见，但在进入住院药物滥用治疗的男性中，尤其是那些有阿片类药物依赖的男性中，未得到充分认识。在某些情况下，AAS的使用可能成为阿片类药物滥用的“门户”，其本身也可能导致发病。
