2 February 2021

What is the association between anabolic androgenic steroid dependence and executive dysfunction?

We recently spoke with Dr Lisa Evju Hauger to discuss the impact CANTAB had on her research into exploring executive function in relation to long-term anabolic androgenic steroids (AAS) use and dependence.

The Anabolic Androgenic Research Group are a multidisciplinary group of researchers and clinicians investigating the long-term effects of anabolic androgenic steroids (AAS) on the cardiovascular system, brain structure, cognitive functioning and mental health.

Can you provide some background to your study?

The use of AAS has become widespread and is considered a public health problem due to accumulating evidence for their adverse effect on physical and mental health. The risk of side-effects seems to increase with the duration of the use and with AAS dependence. Over 30% of AAS users develop a dependence syndrome characterized by a maladaptive pattern of AAS use causing clinically significant impairment or distress. AAS dependence shares some features with other drugs of abuse, but the underlying mechanisms are largely unknown and research on long-term AAS use and dependence is only in its infancy. There appears to be an association between substance abuse and reduced executive functioning. Executive functions (EFs) are often described as “the captain of the ship”, as they are cognitive control mechanisms mediating our ability to successfully regulate thoughts, emotions and behaviours in a goal directed manner. Thus, EFs are essential for mental and physical health and adaptive social functioning. The aim of the present paper was to explore executive function in relation to long-term AAS use and dependence.

What methods did you use in your research?

We included 174 adult male weightlifters who either had never used AAS or equivalent doping substances, or who reported previous or current AAS use corresponding to at least 1 year of cumulative AAS use (summarizing on-cycle periods). AAS users were further subdivided based on whether they fulfilled the AAS dependence criteria. This subdivision yielded three groups: 1) AAS dependents; n = 58, 2) AAS non-dependents; n = 38 and 3) non-users; n = 78.

EFs was assed using both performance based neuropsychological tests and an electronic self-report questionnaire called Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A). The neuropsychological subtests were classified into the four components; problem-solving, mental flexibility, working memory and inhibition. The Stop Signal Task was used to assess response inhibition/impulse control. Additionally, electronic self-report questionnaires mapping clinical data, psychological distress and ADHD symptoms were administered.

Can you summarise your findings and their implications?

The results showed that AAS dependence is associated with executive dysfunction in both test setting and every-day life. Furthermore, the AAS dependents experienced more psychological distress, as they reported higher levels of both anxiety and depression. Dysfunctional executive control could serve as a partly explanation for the intra- and interpersonal problems associated with AAS dependence. Also, problems with EFs such as inhibitory control and problem-solving may increase the likelihood of drug-seeking behaviour despite repeatedly adverse outcomes on psychical, emotional and social wellbeing.

It is critical to consider executive dysfunction in relation to treatment and rehabilitation, since EF is associated with treatment retention and drug relapse. Furthermore it is essential important to consider the complexity of symptoms accompanying AAS dependence, where an interdisciplinary focus is needed in order to provide optimal treatment.

Why did you choose CANTAB for your research project?

CANTAB provides tasks covering a variety of cognitive domains, and the tasks are very easily administered. A major benefit of app-based neuropsychological testing is that they remove potential measurement errors that can occur when different people administer and score the tests. This also makes it easier to compare across different research samples that enable greater collaboration with international research groups. The present paper we report on findings from the Stop Signal Task, a unique version of a classic approach to measuring response inhibition/impulse control. Our research group are currently working on papers based on other CANTAB tasks, such as emotion recognition.

What are the next steps for you and your research?

A major focus of our research group is to explore the relations between different factors associated with long-term AAS use and dependence, such as brain structure, cardiovascular conditions, cognition and mental health. Furthermore, most of the existing knowledge on the AAS user population is based on cross-sectional data, and longitudinal follow-up studies are needed to further explore causal relations.

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Lisa Evju Hauger PhD

Clinical Psychologist

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