Performance Enhancing Drugs

What are Performance Enhancing Drugs (PEDs)?

Performance enhancing drugs (PEDs) are drugs taken to improve physical performance. Elite athletes often use these drugs despite restrictions in sports and laws against the use of some of these drugs.

One of the most commonly used PEDs is anabolic steroids, but there are several available that improve performance. 

Many of the steroids and hormones used to enhance performance have other approved medical uses. But because they enlarge muscles, speed up healing, and have other physical effects, they are often used to boost athletic performance and appearance. 

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How Do They Work?

How PEDs work depends on the type of substance ingested. PEDs improve the body’s natural abilities. They speed up areas of the brain/body and boost heart rate, blood pressure, metabolism, and body temperature. These drugs also make athletes faster and stronger and speed up healing.

Are They Legal?

Some PEDs are legal and others are illegal.

The use of anabolic steroids, one of the most commonly used PEDs, has been illegal in the United States since the early 1990s. It’s a Schedule II drug, which is the same category into which codeine, opium, and morphine fall.

Federal penalties for someone convicted of the use of anabolic steroids for performance enhancement include up to a year or more in prison and a $1,000 to $5,000 fine. 

In addition to legal issues, athletes must follow the guidelines issued by their governing sports bodies. For example, professional sports leagues including Major League Baseball (MLB) and the National Football League (NFL) have banned performancing enhancing drugs and randomly test for these substances. 

Even if a player uses a legal substance, they can be suspended, fined, or face other penalties if their test shows they’ve used PEDs. The same is true in amateur sports and for Olympic athletes.

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Common Types of Performance Enhancing Drugs

The most common types of PEDs include:

• Anabolic steroids
• Androstenedione
• Human growth hormone
• Erythropoietin
• Diuretics
• Creatine
• Stimulants

Side Effects of Performance Enhancing Drugs

Like all drugs, the use of PEDs triggers side effects of varying degrees. Side effects are both short- and long-term. They also vary between males and females.

Short-term effects of PEDs include:

• Increased aggressiveness
• Increased sexual appetite (leading to abnormal and/or criminal behavior)
• Increased lean body mass
• Decreased fat mass
• Enhanced strength

Long-term effects of PEDs include:

• Tolerance (higher doses are needed to achieve the same effect)
• Acne and oily skin
• Headache
• Fluid retention
• Yellowing of the skin and whites of the eyes from steroid-induced jaundice

Male-specific effects include:

• Decreased sperm count
• Hair loss
• Shrunken testicles
• Infertility
• Breast development/enlargement
• Prostate cancer 

Female-specific effects include:

• Growth of facial hair
• Enlargement of the clitoris
• Changes in the menstrual cycle
• Deepening of the voice
• Male-pattern baldness

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Dangers & Risks of Taking PEDs

Here are some of the most common risks associated with PEDs:

• Infection at the injection site
• Increased aggression
• Anger
• Extreme mood swings
• Delusions
• Mania
• Extreme irritability
• Paranoid jealousy
• Violent outbursts
• Impaired judgment
• Feelings of invincibility
• Negative impact on neural activity

Are Performance Enhancing Drugs Addictive?

Some PED users develop steroid use disorder. The more you use some substances over time, the more you’ll need to achieve the same effect. Consistent, long-term use of steroids and other PEDs leads to tolerance, causing someone to use higher doses of the drug.

Additionally, people who continue to use PEDs despite the negative consequences (including sexual dysfunction, high blood pressure, heart disease, and more) fit the profile of an addicted person or person with substance use disorder (SUD). 

Many PED users give up important activities in their lives to focus on the use of the drugs. They spend a significant amount of time and money on obtaining the drugs.

Many people try to stop using PEDs without success. Some PED users experience withdrawal symptoms when attempting to stop using the drugs. In fact, studies show that more than 30 percent of anabolic steroid users develop dependency and experience withdrawal. 

Symptoms of steroid withdrawal include:

• Fatigue
• Loss of appetite
• Insomnia
• Restlessness
• Reduced sex drive
• Cravings
• Depression
• Suicidal ideation

In addition to dependence on the substance, many steroid users become addicted to physical fitness. Working out is usually a significant aspect of steroid use disorder and those using PEDs spend as much time exercising as they do securing and using drugs.

What is Steroid Use Disorder?

Steroid use disorder occurs when someone continues to use steroids despite its negative effects. Steroid users grow accustomed to the positive effects of steroid use, including improved performance and endurance. Because of this, they continue to use them over time, even though they experience negative short- and long-term effects.

There is no specific diagnosis of steroid use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But research shows that the existing criteria for substance use disorder, after slight adjustment, fits. However, steroids do not cause an immediate “high,” which is the case with many addictive drugs.

Symptoms of Steroid Use Disorder

Symptoms of steroid use disorder include:

• Need for larger doses to achieve the same effect
• Withdrawal symptoms (e.g., depression, fatigue, insomnia, and more)
• Using steroids to avoid withdrawal symptoms
• Shortening “off periods” or ceasing to use them at all
• Anxiety and depression
• Excessive focus on acquiring and using steroids
• Neglecting other hobbies and interests to use steroids 
• Using steroids despite negative physical and psychological effects (e.g., sexual dysfunction, mood swings, aggression, and more)

Treatment Options for Steroid Use Disorder

There are several treatment options for steroid use disorder. It is treated in much the same way as other drug addictions. 

Individuals with steroid use disorder benefit most from medically supervised detox, ongoing behavioral therapy, and relapse prevention. Additionally, patients should be supervised for depression and suicide during the initial detoxification phase. 

One of the most important things people with steroid use disorder can do is learn healthy coping mechanisms for the mood swings they experience during withdrawal. These erratic emotions tend to trigger an intense desire to return to the drug. 

It’s important to work with addiction professionals who have experience dealing specifically with PEDs and steroids. 

Treatment is available on an inpatient and outpatient basis. Inpatient rehab is especially effective for treating steroid use disorder because it removes the user from their regular environment that includes temptations to use drugs. 

Patients struggling with depression, anxiety, and anger issues are especially well-suited for the safe, temptation-free environment of inpatient treatment. 

Inpatient rehab programs offer rigorously structured environments that include individual counseling, support groups, meals, family visits, activities, and help with long-term care. Inpatient programs typically range from 30 to 90 days. 

Detox is the first step in recovering from steroid use disorder. Medically-assisted detox makes the process easier and prevents complications. Medications used in this type of detox may include:

• Synthetic hormones
• Antidepressants
• Clonidine
• Nonsteroidal anti-inflammatory drugs

Once stabilized, patients begin intensive therapy that usually includes cognitive behavioral therapy (CBT). In therapy, patients work on adjusting to a life without steroids, learning life skills that help them prevent relapse, and identifying their triggers. 

Therapy for the steroid-addicted focuses on shifting from a competitive mindset to one that focuses on a healthy lifestyle. 

Additionally, therapy helps with treating co-occurring mental health conditions. Some steroid users have body dysmorphic disorder or muscle dysmorphia.

Outpatient treatment is also available for treating steroid use disorder. Steroid users with mild to moderate addiction benefit from outpatient treatment. These programs are flexible and provide care to those who do not want to or cannot be removed from their regular lives during recovery.

Outpatient care is also available to those who have completed an inpatient program as they transition back to regular life.

The ultimate goal of long-term treatment for steroid use disorder is preventing a return to the use of the substance. Ongoing therapy, the use of medications when advised, and avoiding triggers all decrease the risk of relapse.

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