Development and Psychopathology


What can allostasis tell us about anabolic–androgenic steroid addiction?

Tom Hildebrandta1 c1, Rachel Yehudaa1a2 and Lauren Alfanoa1

a1 Mount Sinai School of Medicine

a2 James J. Peters Veterans Affairs Medical Center


Anabolic–androgenic steroids (AASs) are synthetic hormones used by individuals who want to look better or perform better in athletics and at the gym. Their use raises an interesting paradox in which drug use is associated with a number of health benefits, but also the possibility of negative health consequences. Existing models of AAS addiction follow the traditional framework of drug abuse and dependence, which suggest that harmful use occurs as a result of the drug's ability to hijack the motivation–reward system. However, AASs, unlike typical drugs of abuse, are not used for acute intoxication effects or euphoria. Rather, AASs are used to affect the body through changes to the musculoskeletal system and the hypothalamic–pituitary–gonadal axis as opposed to stimulating the reward system. We offer an allostatic model of AAS addiction to resolve this inconsistency between traditional drug addiction and AAS addiction. This allostatic framework provides a way to (a) incorporate exercise into AAS misuse, (b) identify where AAS use transitions from recreational use into a drug problem, and (c) describe individual differences in vulnerability or resilience to AASs. Implications for this model of AAS addiction are discussed.

(Online publication July 15 2011)


c1 Address correspondence and reprint requests to: Tom Hildebrandt, Eating and Weight Disorders Program, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029; E-mail:


Support for this work was provided by NIDA Grant DA-024043 (to T.H.).