May 29, 2019
Anabolic-androgenic steroids are found to affect the functioning of the central nervous system in people and laboratory animals. These effects play partly on the same areas of the brain, which are known to be linked, for instance, to the development of substance addiction. [1,2]
The abuse of anabolic steroids can cause dependence and expose one to the use of other intoxicants and substance addiction.  A recent Swedish study showed that doping is more common among gym goers who have a history of previous substance use. Furthermore, a number of people seeking treatment due to steroid use are found to be engaging in polydrug use.  The risk of developing an addiction is unique to each person, however.
Several of the research results on the mixed use of intoxicants are based on user interviews and animal testing with the primary steroid being nandrolone decanoate. However, the research results may also be applicable to the abuse of other anabolic steroids. These studies demonstrate that anabolic steroids mould the effects of substances in the brain and vice versa.
Anabolic steroid users have been found to abuse an extremely great variety of substances or medicines.  This article focuses on a few of the most frequently used intoxicants: amphetamine, ecstasy, cocaine, cannabis and alcohol.
Steroid use lessens the pleasure induced by stimulants
Steroid use is often associated with amphetamine, 3.4-methyl enedioxy methamphetamine (MDMA, or ecstasy), cocaine and other stimulating drugs. Their popularity may be explained by the effects described by anabolic steroid users, such as enhanced workouts and activated fat burning.
However, anabolic steroids are found to alter the rewarding effects of drugs. Taking nandrolone lessens the pleasure induced by amphetamine and ecstasy. Similar effects have also been found when interviewing users.  Because of the decrease in pleasure, steroid users may use higher drug doses to achieve the same pleasure level as users who do not use steroids. In turn, this may significantly increase the adverse effects of stimulants and the risk of overdosing.
Animal tests have shown that using stimulants enhances the aggressive behaviour associated with the use of steroids.  These effects may continue for a long time after discontinuing steroid use. 
Both anabolic steroid and cocaine use alter cardiac function. The concurrent use of these may contribute to the development of adverse structural changes and burden the heart, for instance, as a consequence of the increased heart rate. [11-13]
Steroids change the central nervous system sensitivity to cannabis
Some anabolic steroid users may use cannabis, for instance, to improve their sleep or reduce stress. Compared with the number of studies on the concurrent use of steroids and stimulating drugs, there are fewer studies on the concurrent use of cannabis and anabolic steroids.
Animal tests have shown that using nandrolone lessens the rewarding effects of cannabis, but that it simultaneously increases the withdrawal symptoms following the discontinuation of use. It has also been found that spontaneous cannabis use increases considerably after a course of nandrolone.  Thus, anabolic steroids mould the effects of cannabis in the brain and reduce the pleasure one can obtain from them.
Concurrent alcohol and steroid use increases aggression
In laboratory animals, nandrolone increases the use of alcohol for a long time after discontinuing the use of steroids. Together with abundant alcohol use, anabolic steroids further increase alcohol-induced behaviour problems, such as the loss of control and the loss of self-control. This may be a consequence of the effects of anabolic steroids on the functioning of the brain serotonin tractus. 
For example, the concurrent use of nandrolone and alcohol lessens fear and timidity and significantly increases aggressive behaviour in comparison with mere alcohol use. 
Ph.D., Senior Researcher
National Institute for Health and Welfare
Licentiate of Medicine (Lic. Med), Specializing Physician
Finnish Institute for Health and Welfare
1. Zotti M, Tucci P, Colaianna M, et al. Chronic nandrolone administration induces dysfunction of the reward pathway in rats. Steroids. 2014;79:7-13. http://www.sciencedirect.com/science/article/pii/S0039128X13002195. doi: //doi.org/10.1016/j.steroids.2013.10.005.
2. Mhillaj E, Morgese MG, Tucci P, Bove M, Schiavone S, Trabace L. Effects of anabolic-androgens on brain reward function. Front Neurosci. 2015;9:295. doi: 10.3389/fnins.2015.00295 [doi].
3. Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope HG,Jr. Issues for DSM-V: Clarifying the diagnostic criteria for anabolic-androgenic steroid dependence. Am J Psychiatry. 2009;166(6):642-645. doi: 10.1176/appi.ajp.2009.08111699 [doi].
4. Molero Y, Bakshi AS, Gripenberg J. Illicit drug use among gym-goers: A cross-sectional study of gym-goers in sweden. Sports Med Open. 2017;3(1):8. doi: 10.1186/s40798-017-0098-8 [doi].
5. Skarberg K, Nyberg F, Engstrom I. Multisubstance use as a feature of addiction to anabolic-androgenic steroids. Eur Addict Res. 2009;15(2):99-106. doi: 10.1159/000199045 [doi].
6. Sagoe D, McVeigh J, Bjornebekk A, Essilfie MS, Andreassen CS, Pallesen S. Polypharmacy among anabolic-androgenic steroid users: A descriptive metasynthesis. Subst Abuse Treat Prev Policy. 2015;10:5. doi: 10.1186/s13011-015-0006-5 [doi].
7. Kurling S, Kankaanpaa A, Seppala T. Sub-chronic nandrolone treatment modifies neurochemical and behavioral effects of amphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in rats. Behav Brain Res. 2008;189(1):191-201. doi: 10.1016/j.bbr.2007.12.021 [doi].
8. Meilman PW, Crace RK, Presley CA, Lyerla R. Beyond performance enhancement: Polypharmacy among collegiate users of steroids. J Am Coll Health. 1995;44(3):98-104. doi: 10.1080/07448481.1995.9939101 [doi].
9. Steensland P, Hallberg M, Kindlundh A, Fahlke C, Nyberg F. Amphetamine-induced aggression is enhanced in rats pre-treated with the anabolic androgenic steroid nandrolone decanoate. Steroids. 2005;70(3):199-204. doi: S0039-128X(05)00016-4 [pii].
10. Kailanto S, Kankaanpaa A, Seppala T. Subchronic steroid administration induces long lasting changes in neurochemical and behavioral response to cocaine in rats. Steroids. 2011;76(12):1310-1316. doi: 10.1016/j.steroids.2011.06.011 [doi].
11. Tseng YT, Rockhold RW, Hoskins B, Ho IK. Cardiovascular toxicities of nandrolone and cocaine in spontaneously hypertensive rats. Fundam Appl Toxicol. 1994;22(1):113-121. doi: S0272059084710141 [pii].
12. Engi SA, Cruz FC, Leao RM, Spolidorio LC, Planeta CS, Crestani CC. Cardiovascular complications following chronic treatment with cocaine and testosterone in adolescent rats. PLoS One. 2014;9(8):e105172. doi: 10.1371/journal.pone.0105172 [doi].
13. Phillis BD, Irvine RJ, Kennedy JA. Combined cardiac effects of cocaine and the anabolic steroid, nandrolone, in the rat. European Journal of Pharmacology. 2000;398(2):263-272. http://www.sciencedirect.com/science/article/pii/S0014299900002946. doi: //doi.org/10.1016/S0014-2999(00)00294-6.
14. Celerier E, Ahdepil T, Wikander H, Berrendero F, Nyberg F, Maldonado R. Influence of the anabolic-androgenic steroid nandrolone on cannabinoid dependence. Neuropharmacology. 2006;50(7):788-806. doi: S0028-3908(05)00405-3 [pii].
15. Struik D, Fadda P, Zara T, et al. The anabolic steroid nandrolone alters cannabinoid self-administration and brain CB1 receptor density and function. Pharmacological Research. 2017;115:209-217. http://www.sciencedirect.com/science/article/pii/S1043661816306685. doi: //doi.org/10.1016/j.phrs.2016.11.031.
16. Conacher GN, Workman DG. Violent crime possibly associated with anabolic steroid use. Am J Psychiatry. 1989;146(5):679.
17. Lindqvist A, Johansson-Steensland P, Nyberg F, Fahlke C. Anabolic androgenic steroid affects competitive behaviour, behavioural response to ethanol and brain serotonin levels. Behavioural Brain Research. 2002;133(1):21-29. http://www.sciencedirect.com/science/article/pii/S0166432801004089. doi: //doi.org/10.1016/S0166-4328(01)00408-9.
18. Johansson P, Lindqvist A, Nyberg F, Fahlke C. Anabolic androgenic steroids affects alcohol intake, defensive behaviors and brain opioid peptides in the rat. Pharmacology Biochemistry and Behavior. 2000;67(2):271-279. http://www.sciencedirect.com/science/article/pii/S0091305700003658. doi: //doi.org/10.1016/S0091-3057(00)00365-8.