Anabolic/androgenic steroids (AAS) are considered drugs of abuse. While there is no universally accepted definition, abuse typically refers to the continued use of a substance despite adverse consequences. Given the detrimental health effects of using AAS drugs beyond therapeutic doses, this classification is difficult to dispute. Abused drugs are also often dependency drugs, implying that they impair an individual's ability to control substance use. The question of whether anabolic steroids meet the definition of dependency drugs has long been debated. Furthermore, among those who support the concept of anabolic steroid dependency, there is disagreement about the nature of this dependency (psychological or physical).

Physical dependency is usually considered the most severe form of drug dependence, although both types can be extremely distressing depending on the situation. Physical dependency is defined as the need to manage a substance for the body to function normally. Physical dependency is often characterized by drug tolerance and withdrawal symptoms if the drug is abruptly discontinued. The most well-known examples of physical dependency drugs are opioids, such as morphine, hydrocodone, oxycodone, and heroin. Quitting opioid use is very challenging due to severe withdrawal symptoms, including physical pain, sweating, tremors, changes in heart rate and blood pressure, and intense cravings for the dr

ug. Physical symptoms of withdrawal can last from days to weeks, while psychological symptoms may persist for months or longer.

Anabolic/androgenic steroid abuse can be associated with many of the DSM-IV criteria needed to diagnose psychological and physical drug dependency. For example, individuals may plan to use these drugs at high doses or for extended periods (Criterion #1). Many abusers also wish to reduce their use but fear losing muscle size, strength, or performance, which can deter them from making this decision (Criterion #2). Individuals often continue to abuse steroids despite adverse health consequences (Criterion #5). Steroid abuse is also associated with increasing effect levels and dosages (Criterion #6). Finally, steroid discontinuation is associated with withdrawal symptoms (Criterion #7), including decreased libido, fatigue, depression, insomnia, suicidal thoughts, restlessness, lack of interest, dissatisfaction with body image, headaches, anorexia, and cravings for more steroids.

According to the American Psychiatric Association and its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), three or more of the following criteria must be met to diagnose substance dependency:

1. The substance is taken in larger amounts or over a longer period than intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

3. A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of the substance.

4. Important social, occupational, or recreational activities are given up or reduced because of substance use.

5. Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substance.

6. Tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect or a markedly diminished effect with continued use of the same amount of the substance.

7. Withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance or the substance is taken to relieve or avoid withdrawal symptoms.

8. 
   

Criteria #1 to #5 describe psychological dependency, while Criteria #6 or #7 suggest that the dependency also involves a physical component.

The physical benefits of anabolic/androgenic steroids complicate the issue of drug dependency. Unlike narcotics, the primary motivation for steroid use is the positive impact on muscle and performance. Considering this, steroid addiction may often be a misdiagnosis of muscle dysmorphia—a psychological disorder characterized by a belief of insufficient muscularity despite extreme muscle development. Steroid abuse (often extreme) is prevalent among individuals with muscle dysmorphia and compulsive resistance training. However, steroid abuse is viewed as a symptom of this disorder rather than its cause. Similarly, the effects of AAS on body composition, strength, and performance improvements likely drive much of their abuse. This can be likened to so-called "chocolate addiction," where some individuals develop psychological issues around chocolate consumption, including uncontrollable binge eating and negative social and health consequences, but chocolate itself is not considered an addictive substance.

There is some evidence that the reinforcing properties of steroid use extend beyond physical fitness. Experimental animals such as mice and hamsters repeatedly self-administer testosterone and other AAS, suggesting an effect not solely driven by perceived changes. Testosterone has also been shown to interact with the mesolimbic dopamine system, commonly implicated in other drugs of abuse. Additional studies indicate that AAS influence dopamine transporter density and increase the sensitivity of the brain's reward system. It is known that steroids affect psychology, with abusers often reporting increased feelings of well-being, energy, and confidence while on the drugs. Some speculate this may be due to inherent psychotropic effects. More research is needed to determine whether anabolic/androgenic steroids are, in fact, mild psychoactive drugs.

Anabolic/androgenic steroids are not overtly intoxicating drugs and are very different from other substances of abuse or dependency. This makes diagnosing them as drugs of dependency challenging. By definition, drug dependency involves the abuse of psychoactive substances, and whether AAS drugs can accurately be classified as psychoactive is unknown. Currently, most experts do not consider anabolic/androgenic steroids to be genuinely physically addictive drugs. It is difficult to associate post-cycle hormonal imbalances with traditional withdrawal symptoms, and tolerance is typically limited to muscle growth, not necessarily a decrease in biological effect. However, individuals are still warned that steroid abuse is commonly associated with signs of psychological dependency. Further research is necessary to assess the biological and psychological nature of steroid hormones.