{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:44:43Z","timestamp":1772721883729,"version":"3.50.1"},"reference-count":69,"publisher":"Cambridge University Press (CUP)","issue":"15","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291718000508_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Anabolic-androgenic steroid (AAS) use is known to be associated with other psychiatric disorders, such as body image disorders, conduct disorder\/sociopathy, and other substance use disorders (SUD) \u2013 but the causal pathways among these conditions remain poorly delineated.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291718000508_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>We created a directed acyclic graph to diagram hypothesized relationships among AAS use and dependence, body image disorder (BID), conduct disorder\/sociopathy, and other SUD. Using proportional hazards models, we then assessed potentially causal relationships among these variables, using a dataset of 233 male weightlifters, of whom 102 had used AAS.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291718000508_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>BID and conduct disorder\/sociopathy both strongly contributed to the development of AAS use, but did not appear to contribute further to the progression from AAS use to AAS dependence. Other SUD beginning prior to first AAS use \u2013 whether broadly defined or restricted only to opioids \u2013 failed to show an effect on AAS use or progression to AAS dependence. Conversely, AAS use contributed significantly to the subsequent first-time development of opioid use disorders but did not significantly increase the risk for first-time development of non-opioid SUD, taken as a whole.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291718000508_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions<\/jats:title><jats:p>Our analysis suggests that AAS use and other SUD are mutually attributable to underlying conduct disorder\/sociopathy. SUD do not appear to represent a \u2018gateway\u2019 to subsequent AAS use. AAS use may represent a gateway to subsequent opioid use disorder, but probably not to other SUD.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291718000508","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T04:58:47Z","timestamp":1519880327000},"page":"2601-2608","source":"Crossref","is-referenced-by-count":34,"title":["Associations of anabolic-androgenic steroid use with other behavioral disorders: an analysis using directed acyclic graphs"],"prefix":"10.1017","volume":"48","author":[{"given":"Gen","family":"Kanayama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Harrison G.","family":"Pope","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James 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