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It is difficult to measure steroid misuse in the United States because many national surveys do not measure it. However, use among teens is generally minimal. The 2016 NIDA-funded Monitoring the Future study has shown that past-year misuse of steroids has declined among 8th and 10th graders in recent years, while holding steady for 12th graders. How do people misuse anabolic steroids? People who misuse anabolic steroids usually take them orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses may be 10 to 100 times higher than doses prescribed to treat medical conditions. Commons patterns for misusing steroids include: cycling’taking multiple doses for a period of time, stopping for a time, and then restarting stacking’combining two or more different steroids and mixing oral and/or injectable types pyramiding’slowly increasing the dose or frequency of steroid misuse, reaching a peak amount, and then gradually tapering off to zero plateauing’alternating, overlapping, or substituting with another steroid to avoid developing a tolerance. There is no scientific evidence that any of these practices reduce the harmful medical consequences of these drugs. How do anabolic steroids affect the brain? Anabolic steroids work differently from other drugs of abuse; they do not have the same short-term effects on the brain. The most important difference is that steroids do not directly activate the reward system to cause a ‘high’; they also do not trigger rapid increases in the brain chemical dopamine, which reinforces most other types of drug taking behavior. 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