Performance Enhancing Drugs

What are Performance Enhancing Drugs (PEDs)?

Performance-enhancing drugs (PEDs) are drugs taken to improve physical performance. Elite athletes often use them for greater athletic performance despite restrictions in sports and laws against their use.

One of the most commonly used PEDs is anabolic steroids. Many other steroids and hormones that enhance performance have other approved medical uses. But because they enlarge muscle mass, speed up healing, and have other physical effects, they’re often used to boost athletic performance and appearance. 

How Do They Work?

How performance-enhancing drugs work depends on the type of substance ingested. In general, PEDs:

• Improve the body’s natural abilities
• Speeding up areas of the brain/body 
• Boost heart rate 
• Increase blood pressure
• Fasten metabolism
• Regulate body temperature
• Make athletes faster and stronger 
• Speed up healing

Are They Legal?

Some performance-enhancing drugs are legal, and others are illegal. Anabolic steroids, one of the most commonly used PEDs, have been illegal in the United States since the early 1990s. It’s a Schedule III drug, in the same category as codeine, opium, and morphine.

Consequences and Sports Governance 

Federal penalties for someone convicted of the use of anabolic steroids for performance enhancement include:

• Up to a year or more in prison 
• A $1,000 to $5,000 fine
• Endurance athletes must follow the guidelines issued by their governing sports bodies

Professional sports leagues, including Major League Baseball (MLB) and the National Football League (NFL), have banned performance-enhancing drugs and conduct random drug tests for these substances. 

Even if players use a legal substance, they can be suspended, fined, or face other penalties if their drug tests show they’ve used PEDs. The same is true in amateur sports and for Olympic athletes. Sports regulatory authorities now have strict anti-doping regulations and severe consequences for testing positive for banned substances.

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Side Effects of Performance-Enhancing Drugs

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

The short-term effects of PEDs include:

• Increased aggressiveness
• Dysfunctional or impaired sexual appetite
• Increased lean body mass
• Decreased fat mass
• Enhanced strength

The 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

The male-specific effects include:

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

The 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

The following 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
• PEDs that increase red blood cells (blood doping) can lead to potential cardiovascular complications
• Hormone imbalance
• Cardiovascular problems

Common Types of Performance-Enhancing Drugs

The most common types of PEDs include:

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

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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 also leads to tolerance, causing someone to use higher doses of the drug. Additionally, people who continue to use PEDs despite the negative consequences fit the profile of a person with substance use disorder (SUD).

These repercussions include:

• Sexual dysfunction
• High blood pressure
• Heart disease 

Addicted PED users also give up important activities to focus on using these drugs. Moreover, they spend significant time and money on obtaining PEDs.

Withdrawal Symptoms

Many people try to stop using PEDs without success. Some PED users even experience withdrawal symptoms when attempting to stop drug use. Studies show that over 30% 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 a steroid use disorder.

What is Steroid Use Disorder?

Steroid use disorder occurs when a person continues to use substances like anabolic steroids despite their 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’s 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 can diagnose steroid use disorder. 

However, steroids don’t cause an immediate “high,” which is the case with many addictive drugs. Their effects are different, and the addictive potential of steroids is related to long-term use and dependency rather than an immediate euphoric sensation.

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)

Importance of Treatment for Steroid Use Disorder

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

People with steroid use disorder benefit most from:

• Medically supervised detox
• Ongoing behavioral therapy
• Relapse prevention

They should be supervised for depression and suicide during the initial detoxification phase. It’s important to work with addiction professionals who have experience dealing specifically with performance-enhancing substances and steroids. 

Different Treatment Options for Steroid Use Disorder

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 trigger an intense desire to return to the drug. 

Treatment for misuse of PEDs, such as anabolic steroids and human growth hormone, is available on both an inpatient and outpatient basis.  

Inpatient Rehab Programs 

Inpatient rehab programs offer rigorously structured environments that include:

• Individual counseling
• Support groups
• Meals
• Family visits
• Activities
• Help with long-term care

They typically range from 30 to 90 days. Inpatient rehab is especially effective for treating steroid use disorder because it removes the user from their regular environment, which includes temptations to use drugs.

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

Medically-Assisted Detox (MAT)

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

• Synthetic hormones
• Antidepressants
• Clonidine
• Nonsteroidal anti-inflammatory drugs
• Benzodiazepines
• Clonidine
• Hormone replacement therapy (HRT)
• Medications for cardiovascular health

Cognitive Behavioral Therapy (CBT)

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

Therapy for steroid addiction may involve addressing cognitive and behavioral aspects of the addiction. Therapy should encompass a comprehensive approach to address addiction, underlying psychological factors, and overall well-being.

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

Outpatient Treatment

Steroid users with mild to moderate addiction benefit from outpatient treatment. These flexible programs provide care to those who don’t want to or can’t 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.

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

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