Steroids & Alcohol: Can You Drink on Steroids?

What Are Steroids?

AAS, the most studied class of appearance- and performance-enhancing drugs (APEDs), are synthetically produced and mimic the male sex hormone testosterone, promoting muscle building and increased male sex characteristics.²

Health care providers may prescribe anabolic steroids to treat hormonal issues such as delayed puberty, but they are also subject to unhealthy use, typically taken in doses greater than normally present in the body in an effort to increase muscle growth, reduce body fat, boost self-confidence and enhance athletic or physical performance.^2,3 AAS differ from other steroids, like corticosteroids and female reproductive hormones, neither of which is typically subject to unhealthy use. Corticosteroids are commonly used to fight inflammation related to a host of medical conditions, including asthma, contact dermatitis, inflammatory bowel disease, rheumatoid arthritis, and more.⁴

Are Steroids Addictive?

Anabolic steroids are Schedule III substances, which means they have a moderate to low potential for physical or psychological dependence.⁵  Research suggests that 32% of the individuals who misuse anabolic steroids become dependent on using them.² In addition, an undetermined number of anabolic steroid users may become addicted to them—that is, they will continue to seek out and use steroids despite negative consequences detrimental to their physical, mental, social, or financial well-being. But the factors causing the addiction may be far more complex and different in nature than those associated with other substances of abuse.⁶

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Is it OK to Mix Anabolic Steroids and Alcohol?

Studies indicate that there is a strong correlation among individuals who use anabolic steroids and those who also use alcohol or illicit drugs.⁸ There’s even research suggesting that anabolic steroids might be the gateway to other substances with addiction liability⁹ Some studies suggest steroid-induced alterations in the brain and brain functioning makes users increasingly sensitive to alcohol use, promoting its rewarding effects and thereby increasing alcohol intake.¹⁰

In addition, research indicates that some adolescents who abuse steroids also partake in other high-risk behaviors, such as drinking and driving or using illicit drugs.³

It’s estimated that 14% to 57% of AAS users meet the criteria for anabolic steroid use disorder.¹¹ Although there is little research on studies of dependent AAS users, one study suggests that they are at increased risk of opioid use disorder (vs. nondependent users) but not more (or less) at risk of developing other types of substance use disorders.¹²

People who abuse alcohol are at heightened risk of liver damage. The same is true for those who abuse AAS. Although research is limited, there have been reports of liver damage in anabolic steroid users with risk factors for liver disease (including alcohol consumption)¹³ as well as a reported case of liver disease attributed to alcohol and anabolic steroid use.¹⁴

Treatment for Steroid Abuse and Alcoholism

Effective treatment for any substance use disorder addresses addictions to other substances and co-occurring mental disorders as well. Treatment generally includes behavioral therapies, medications, support groups, counseling, and ongoing aftercare services.¹⁶  Withdrawal symptoms from alcohol can be severe, and heavy users may benefit from detox in a medically supervised environment.

The good news is that treatment can work. Research suggests that about 1 in 3 people who seek treatment for alcohol use disorder show no further symptoms after a year.¹⁶

Unfortunately, research also suggests that individuals who abuse steroids often do not seek treatment. In fact, one study revealed that 56% of the participants never told their health care provider that they were taking or had taken AAS.³  Treatment for steroid abuse generally focuses on the cause behind the steroid use and may include:³

• Psychological therapies for muscle dysmorphia, the preoccupation with one’s body that it is not sufficiently lean or muscular.
• Endocrine therapies that add, block, or remove hormones depending on the individual. For example, some might need hormone therapy to help resolve sex drive issues.
• Antidepressants to help alleviate the symptoms of depression.
• For those also addicted to opioids, medication and psychosocial therapies used to treat opioid use disorder may also be effective at mitigating signs of anabolic steroid dependence.

Sources

1. Sagoe, Dominic, McVeigh, Jim, Bjørnebekk, Astrid, Essilfie, Marie-Stella, Andreassen, Cecile Schou, and Pallesen, Ståle. (2015). Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Substance Abuse Treatment, Prevention, and Policy, 10, 12.
2. National Institute on Drug Abuse. (August 2018). Anabolic Steroids DrugFacts.
3. National Institute on Drug Abuse. (February 2018). Steroids and Other Appearance and Performance Enhancing Drugs (APEDs) Research Report.
4. Hodgens, Alexander and Sharman, Tariq. (June 29, 2021). Corticosteroids. StatPearls Publishing.
5. United States Drug Enforcement Administration. Drug Scheduling.
6. National Institute on Drug Abuse. (January 2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
7. Zoorob, Roger J., M.D., M.P.H. and Cender, Dawn, Pharm.D. (1998). A Different Look at Corticosteroids. American Family Physician, 58(2), 443-450.
8. Dodge, Tonya and Hoagland, Margaux F. (2012). The Use of Anabolic Androgenic Steroids and Polypharmacy: A Review of the Literature. Drug Alcohol Dependence, 114 (2-3), 100-109.
9. Mhillaj, Emanuela, Morgese, Maria G., Tucci, Paolo, Bove, Maria, Schiavone, Stefania, and Trabace, Luigia. (2015). Effects of anabolic-androgens on brain reward function. Frontiers in Neuroscience, 9, 295.
10. Pope, Harrison G. Jr., Wood, Ruth I., Rogol, Alan, Nyberg, Fred, Bowers, Larry, and Bhasin, Shalender. (2014). Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocrine Reviews, 35(3), 341-375.
11. Kaufman, Marc J., Ph.D., Kanayama, Gen, M.D., Ph.D, Hudson, James I., M.D., Sc.D., and Pope, Harrison G. Jr., M.D. (2019) Supraphysiologic-dose anabolic-androgenic steroid use: a risk factor for dementia? Neuroscience and Behavioral Reviews, 100, 180-207.
12. Kanayama, Gen, Hudson, James I., and Pope, Harrison G. Jr. (2009) Features of Men with Anabolic-Androgenic Steroid Dependence: A Comparison With Nondependent AAS Users and With AAS Nonusers. Drug and Alcohol Dependence, 102(1-3), 130-137.
13. Schwingel, Paulo Adriano, Cotrim Helma Pinchemel, dos Santos, Crimério Jr., dos Santos, Adriano Oliveira, de Andrade, Antônio Ricardo Cardia Ferraz, Carruego, Marcos Vinicius Boas, and Zoppi, Cláudio Cesar. (2015). Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men. Substance Use and Misuse, 50(11), 1,490-1,498.
14. Díaz-García, J.D., Córdova-Gallardo, J., Torres-Viloria, A., Estrada-Hernández, R., and Torre-Delgadillo, A. (January-March 2020). Drug-induced liver injury secondary to anabolic steroid use. Revista De Gastroenterología De México. 85(1), 92-94.
15. Department of Justice/Drug Enforcement Administration. (April 2020) Drug Fact Sheet: Steroids.
16. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for alcohol problems: Finding and getting help.