Abuse of performance-enhancing drugs

Anabolic-androgen steroids (AASs) are the primary drug class in a larger pattern of drug use designed to improve one’s appearance or alter their ability to perform in athletic or other competitive environments. The use of these substances has evolved tremendously in the last century. The evolution of this form of drug use has been aided by the advancements in the understanding of the basic neuroscience of androgen effects in the central nervous system (CNS). This chapter summarizes the current knowledge on the psychiatric effects of AASs and the theoretical and preclinical models that support the possibility for AAS intoxication and dependence. Emerging evidence suggests that these two aspects of AAS use are mediated by distinct neuroendocrine events involving drug metabolism into other active androgens or estrogens and the ability of AASs to stimulate natural opiates and inhibit stress response. This latter effect is also linked to the neuroendocrine effects of intense exercise, which are mimicked by AAS use. Future directions for preclinical, translational, and clinical research are discussed.