Until ten years ago the practice of doping was limited to a restricted circle of professional athletes, only a few days before a competition. Doping has now become a phenomenon involving a vast section of sports. Rather than professional doping we could label it as domestic or “amateur” doping. Another recent phenomenon is cosmetic doping.

The desire to win at all costs heightens the pressure from the sponsors, the coach and the trainers, and even more so for the accompanying family members. All this pushes the athlete to improve his/her competitive performance. The expectations of the public, or of an entire nation are often greater with regard to team sports and may become factors which favour the use of doping substances. The psychological pressure is so high that the athlete is lead to believe that sports cannot exist without ergogenic substances. The simple thought that competitors may have used doping substances puts the athlete in a psychological state of inferiority which urges him/her to do the same. Lastly, the hectic schedules may cause the assumption of doping substances.

In the meanwhile, the winning model proposed, together with the quest for the best performance and triumphant results by all means, has an influence on children and young people, in all the aspects and levels of sports and in all sports associations, contaminating the fundamental values of sport itself. Other issues come into play in cosmetics doping instead. Dysmorphophobic young people who regard themselves as thin despite the time spent in gyms and the substances taken to increase the mass of their muscles evidence a separation between their real body and their mental state.

Anabolizing steroids (AS) are one of the most widely-spread doping substances (in both professional and amateur sports and in cosmetic doping) and are powerful enough to create dependency. In sportive activities they are given in very big dosages to increase muscle mass and strength (ergogenic effect). This substance influences moods, determining an increase of aggressiveness, urging athletes to train even harder.

Numberless health risks are linked to the use of these substances, which damage the muscle-skeletal system (resulting in a predisposition towards breaking of tendons) and cause disturbances in the cardiovascular system (increasing the risk for ictus and myocardial infarction) and in the genital organs (abnormal hair growth in women, lowering of the vocal timbre, menstrual irregularity) which may become permanent. Testicular atrophy and oligo/azospermia may result in men, together with problems in the nervous system (increased aggressiveness, violent changes of moods, depression, maniacal and hyper-maniacal conditions and signs of dependence).

The AS substances were not even mentioned in the Diagnostic and Statistical Manual for Mental disorders III (DSM), whereas in DSM IV they are described in the section regarding “Other substance-related disorders”. This goes to show the growing awareness that the AS may be associated to relevant mental and behavioral disturbances.

The first disturbance may be of the primary type (through the activation of the endogen opioids and of the dopaminergic system, with mechanisms which resemble the action of stimulants and cocaine), that secondary derivative arising from the improvement of muscle mass and body strength (greater self-esteem, sensation of being admired). The negative reinforcement is a result of the surge of abstinence symptoms characterized by craving, asthenia, dissatisfaction for the physical image (dismorphophobia), depression, insomnia, diminished libido, acathisia, anorexia, headaches. Predictive factors for the development of dependence are the masculine gender, the assumption of AS at an early age and the mixing of different types of AS , or the assumption via injection and the satisfaction with one’s physique.

Not many people ask for treatment against a problematic use of AS, despite the estimated growing consumption, especially in the Anglo-Saxon countries and in northern Europe. According to some researchers, we are at the latent stage between an epidemic consumption increase and the manifestation of problems caused by abuse. Other factors are the fact that many consumers do not regard AS substances as potentially dangerous and the lack of specific treatment programs.