The role of pharmacotherapy in addiction treatment of anabolic steroids dependence is poorly defined. While depression, mania, and psychosis are induced by anabolic steroids use or withdrawal, their etiology may be difficult to establish with certainty. Pharmacotherapy for Psychiatric symptoms should include a consideration of the risks and benefits, including the potential side effects of the medications and the consequences of inaction, which may include problems with retention in treatment. Maintenance and controlled taper have not been reported as therapeutic modalities, and no routine pharmacotherapy is recommended.
Although it is estimated that there are more than 1 million of anabolic steroids users in the United States, the percentage of those who receive treatment for addiction is very small.
Assessment of psychiatric status is essential; severe symptoms are an indication for inpatient treatment. Anabolic steroids users may have a variety of relationship problems that merit therapy for the relationship with a qualified family or couple therapist. Because assault may occur in anabolic steroids users’ relationships, it is important to interview the spouse separately and confidentially, and also to offer the spouse referral both to therapy and to appropriate recovery groups (for survivors of abuse, if indicated, and for partners of drug addicts). Ongoing assessment of sexual function is indicated, as impotence and decreased libido may occur upon discontinuation of anabolic androgenic steroids, and diminished sexual function has reportedly led to relapse. Persistent decrease in an individual’s sexual function relative to baseline, (i.e., prior to anabolic steroids use) is an indication for consultation with an endocrinologist.
Depression is another common problem in anabolic steroids abstinence syndrome and can lead to relapse. The recovering anabolic steroids addict should be evaluated for depression and treated accordingly.
Psychosocial treatment must include an understanding and acknowledgment of the motivation for continued use. Treatment approaches will differ for individuals. Those whose use persists because of anabolic steroids induced hypomania or euphoria will be different than those who continue to use because they want to improve body image or enhance performance.
The nature and course of anabolic steroids withdrawal should be reviewed with the user. Conventional drug-abuse treatment is appropriate for those who abuse anabolic androgenic steroids for their mood-altering effects or who are dependent on additional substances. For people who are engrossed in the body-building culture or who are seeking increased athletic performance, realistic goals related to appearance and performance must be outlined, and a diet and exercise plan should be agreed upon to achieve these goals. Peer counseling by ex-bodybuilders and group support may be of particular value for these users. Nutritional counseling and consultation with a fitness expert may be helpful. Gyms are a common location for the acquisition of anabolic androgenic steroids and need to be avoided until recovery is firmly established. Although a wide variety of individuals can deliver psychosocial treatment to anabolic steroids users, those who are physically fit or former anabolic steroids users will have certain advantages regarding relating to the anabolic steroids abuser seeking treatment.