Anabolic Steroid Abuse among Women - Coursework Example

Anabolic Steroid Abuse among Women In order to discuss anabolic steroid abuse among women; the non-medical application of anabolic steroids and their undesirable medical effects will be discussed. This will be followed by an identification of the prevalence of female anabolic steroid abuse in the United States and Massachusetts specifically. Treatment programs available within the Massachusetts area will be identified, followed by consideration and evaluation of treatment options for females experiencing anabolic steroid addiction. This will include examination of pharmacological and psychological interventions and will stress the need to target issues of body dysmorphia, self-confidence and the wider social context of the addiction. The twin discoveries of the anabolic activity of testosterone; and the isolation and synthesis of the biologically active component resulted in research activity motivated to produce a steroid with strong anabolic activity and minimal androgenic activity (Kochakian & Yesalis, 2000). The result was the anabolic steroid, and research programs were quick to study its application in tissue growth in athletics. Misuse of anabolic steroids can result in a range of concerning medical effects (Lenehan, 2003). Derived from testosterone, anabolic steroids have a masculinizing effect upon both sexes as tissue growth effects and secondary male character developments are mediated by the same receptors (Elliot & Goldberg, 2000). Alongside skeletal tissue growth, women using anabolic steroids may also experience increase in clitoris size, development of polycystic ovaries, growth of body hair and loss of scalp hair, increase in libido, vocal chord thickening and a decrease in body fat. Furthermore, there are also risks of neuro-psychiatric effects from anabolic steroid use. Gruber and Pope (2000) performed extensive psychiatric and medical evaluations upon 75 dedicated female athletes in Boston, Massachusetts. Female athlete anabolic steroid users demonstrated hypomania during use and depression during withdrawal. Interestingly, both anabolic users and non-users presented with rigid dietary habits, and showed a significant dissatisfaction and preoccupation with their physical frame and their body in general. Therefore treatment programs targeted at female anabolic steroid users need to address both the biological and psychological expressions of misuse, as well as the underlying, motivating factors that contribute to risk of steroid use. Prevalence of anabolic steroid users is growing in the United States, and the most rapid growth of use is occurring within adolescent female populations (Yesalis, 1997). While the number of users remains slightly higher among males than females, it is estimated that hundreds of thousands of females use anabolic steroids at least once a year (Yesalis, Kennedy, Kopstein & Bahrke, 1993). It is currently assumed that approximately 5.9% of female competitors use anabolic steroids to enhance their performance (Elliott & Goldberg, 2000). Research studies examining prevalence of anabolic steroid use among females in the Massachusetts area tend to reveal the same results. Faigenbaum, Zaichkowsky, Gardner and Micheli (1997) found that 2.6% of males and 2.6% of females from four Massachusetts middle schools reported anabolic steroid use. Reporting research specifically aimed at documenting the ill psychiatric effects of anabolic steroid abuse in women, Gruber and Pope (2000) found that one third of a female athletic sample recruited from Boston, Massachusetts reported anabolic steroid use. If this is assumed to be representative of the Massachusetts athletic population, then it would be expected that a third of these individuals will be using anabolic steroids. The tendency for adults to continually use steroids despite negative and unwanted effects indicates an addictive property to the drug. Unfortunately, research regarding the treatment of anabolic steroid addiction is minimal. Treatment for anabolic steroid addiction tends to be non-specialist and non-specific, borrowing from other programs of substance misuse. While this is sufficient to treat the shared components between anabolic addiction and other substance addictions, it is not necessarily sufficient for the unique features of the addiction (Brower, 2002). Within the Massachusetts area, anabolic steroid addiction treatment tends to fall within the remit of generalized addiction services. The Adcare Hospital1 tackles anabolic steroid addiction in women via provision of a broad spectrum of addiction healthcare. The approach advocates structured counseling and the involvement of family members in their treatment program. Specifically beneficial to women users, the treatment centre demonstrates interest in the changing inter-personal relations that female addicts experience during the recovery process. The approach also emphasizes a distinction between the rehabilitation and the recovery process. Rehabilitation focuses upon the biological treatment of co-morbidity and instability. The recovery process is psycho-social based, examining the process of the individual re-engaging with their environment without reverting back to anabolic steroid abuse. The North Suffolk Mental Health Association2 advocate both outpatients and residential approaches, according to which is most suitable for the patient. Outpatient services primarily focus upon providing individual, group and family counseling. Additionally, there is provision of psycho-educational training and relapse services. Importantly, this treatment program acknowledges the behavioral effects evident in dependent women (e.g. Christiansen, 2001) and emphasizes the requirement to counsel inter-personal relationships so that a supportive and understanding social network may be achieved. One local source of addiction treatment in Massachusetts that recognizes the uniqueness of anabolic steroid dependence in the Beth Israel Deacons Medical Centre3; research referred to by the centre attributes the development of the disorder to perceived aesthetic inequalities. For example, females using anabolic steroids are motivated by the desire to improve their bodies in a non-traditional fashion for their gender. Essentially, the issues that should be addressed in treatments are the perception of physical inadequacy in a manner that is traditionally experienced by males (Perry, Lund, Deninger, Kutscher, & Schneider, 2005), alongside the psychological effects of withdrawal. As previously mentioned, research into the treatment available for women addicted to anabolic steroids is minimal. This is in part due to the unresolved issue of whether physical dependence and addiction with anabolic steroids is possible. Options for treatment are becoming more developed as recognition of the addiction among women increases within the scientific community. One result of this is that users themselves do not recognize their addiction and are unlikely to present themselves for rehabilitation treatment. Therefore, psychiatrists and doctors are required to be sensitive to this possibility when assessing individuals who present with the common psychiatric complications associated with anabolic steroid use (Rashid, Omerod & Day, 2007). Treatment, while not specialized for anabolic steroid addiction, should follow two main strands for female users coping with addiction. Firstly, the role of pharmacotherapy, while still experimental, does have a role to play in the treatment of female anabolic steroid addiction. Interventions can be targeted at the symptoms of withdrawal; however the benefits should be sure to exceed side effects (Rashid et al. 2007). Secondly, the unique emphasis on appearance and the possibility of perceptual abnormalities should be approached with psychological based interventions. Anabolic steroid addiction has been identified as a perpetuating factor in the development of muscle dysmorphia (Rohman, 2009). Therefore, cognitive-behavioral programs typically used for the treatment of other body dysmorphias should be considered as a viable treatment option (Corove & Gleaves, 2001; Leone, Sedory, & Gray, 2005). Withdrawal from anabolic steroids causes disturbances in the hypothalamic-pituitary glands which results in behavioral and psychological symptoms (Tarter & Ammerman, 1998). The most frequently reported effects include aggressiveness, irritability, hostility, depression. Also possible are the presence of rage, impulsiveness and impaired judgment. This indicates that the withdrawal from anabolic steroids results in disruption of self-regulatory systems that typically function within the frontal lobes of the brain. There are certain pharmaceutical treatments that can alleviate these symptoms until hypothalamic-pituitary functioning is resumed to normality. These include the prescription of benzodiazepines to target anxiety and depression. It is arguably counter productive to prescribe anti-depressants to alleviate these symptoms, as action upon the serotonin uptake system depresses hypothalamic regulatory function and will deter the readjustment of this system to typical functioning. An alternative approach to the minimization of withdrawal symptoms in females is to adopt a harm reduction strategy before anabolic steroid abstinence is achieved (Brower, 2000). The motivation for the individual suffering with addiction is to reduce the negative effects they are experiencing from anabolic steroid abuse by reducing their intake. This in turn reduces the physical dependency upon the anabolic steroids. When the individual is able to find the motivation for abstinence, their experience of withdrawal symptoms will already have been significantly reduced due to their previous harm reduction behavior. However, a focus upon withdrawal symptoms is not encompassing enough to enable women to relinquish dependence upon anabolic steroids. Psychological interventions that take into account the underlying psychological factors and wider social issues relating to the addiction are also essential. Substance abuse counseling is useful at it incorporates issues of self-esteem, race and ethnicity alongside specific considerations of gender, family relationships and unhealthy interpersonal issues (Rasmussen, 2000). This allows the woman to understand the components of her identity as a female in her societal context that may have led to pressures which are perceived as solvable via the use of anabolic steroids. In addition to this, women overcoming anabolic steroid addiction should be offered the opportunity to take part in group counseling sessions and to receive life-skills training sessions. This will enable individuals to build support networks that can be used during periods where the threat of relapse is prevalent. Life-skills training will enable the individual to re-orientate themselves within their social context to enhance their experience as a non-using identity. One particular psychological intervention which has proved successful in the reduction of anabolic steroid abuse among women is that of self-efficacy training. Hyde, Hankins, Deale and Marteau (2008) found that seven of ten studies in which a self-efficacy intervention was employed resulted in a significant reduction in dependent behaviors. MacKinnon, Goldberg, Clarke, Elliot, et al. (2001) compared the anabolic steroid use behavior of athletics who had and had not received a self-efficacy training intervention. They found that usage was significantly lower in the intervention group; a mediation analysis confirmed that the intervention was a primary motivator. It may be that increasing self-efficacy increases the individual’s belief in her own ability to achieve the physical goal she desires using non-assisted methods. Women using anabolic steroids are at risk of unwanted physical and psychiatric side effects. This addiction problem among women is unique due to the emphasis upon the physical aesthetic. Use of anabolic steroids is growing most rapidly in female populations. Approximately one third of female athletes in Massachusetts will have used anabolic steroids at least once. Treatment centers in Massachusetts tend to provide non-specialist treatment for women suffering anabolic steroid addiction, although there is some recognition of the uniqueness of the disorder. Treatment options include pharmacological and psychological approaches. Psychological interventions should focus upon body dysmorphia, underlying psychological factors, the wider social context and self-efficacy. References Brower, K. (2002). Anabolic Steroid Abuse and Dependence. Current Psychiatry Reports, 4(5), 377-387. Christiansen, K. (2001). Hormones and Sport: Behavioural Effects of Androgen in Men and Women. Journal of Endocrinology, 170, 39-48. Corove, M.D., & Gleaves, B.H. (2001). 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Anabolic Steroids in Sports and Exercise. Leeds, UK: Human Kinetics Europe Ltd. Pp. 17-29. Lenehan, P. (2003). Anabolic Steroids. Boca-Raton, FL: CRC Press Leone, J.E., Sedory, E.J., & Gray, K.E. (2005). Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders. Journal of Athletic Training, 40(4), 352-359. MacKinnon, D.P., Goldberg, L., Clarke, G., Elliot, D.L., Cheong, J., Lapin, A., Moe, D.L., & Krull, J.L. (2001). Mediating Mechanisms in a Program to Reduce Intentions to Use Anabolic Steroids and Improve Exercise Self-Efficacy and Dietary Behavior. Prevention Science, 2(1), 15-28. Perry, P.J., Lund, B.C., Deninger, M.J., Kutscher, E.C., & Schneider, J. (2005). Anabolic steroid use in weightlifters and bodybuilders: An Internet Survey of Drug Utilization. Clinical Journal of Sports Medicine, 15, 326-330. Rashid, H., Omerod, S., & Day, E. (2007). Anabolic androgenic steroids: What the psychiatrist needs to know. Advances in Psychiatric Treatment, 13, 203-211. Rasmussen, S. (2000). Addiction Treatment: Theory and Practice. London: Sage Publications Inc. Rohman, L. (2009). The Relationship Between Anabolic Steroids and Muscle Dysmorphia: A Review. Eating Disorders, 17(3), 187-199. Tarter, R.E., & Ammerman, R.T. (1998). Handbook of Substance Abuse: Neurobehavioral Pharmacology. New York: Springer. Yesalis, C.E. (1997). Trends in anabolic-androgenic steroid use among adolescents. Archives of Paediatric and Adolescent Medicine, 151, 1197-1206. Yesalis, C.E., Kennedy, N.J., Kopstein, A.N., & Bahrke, M.S. (1993). Anabolic-androgenic steroid use in the United States. Journal of the American Medical Association, 270(10), 1217-1221. Read More