Like other athletes, the pressure to perform better has some military members turning to performance enhancing drugs.

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The military seeks a force made up of physically strong, tough soldiers who are also mentally sharp. To keep up with these demands, many military members have turned to over-the-counter supplements, which carry some risks. But like other athletes, the pressure to perform better, stronger and longer, has caused some military members to turn to performance enhancing drugs such as amphetamines, human growth hormones and steroids.

The latest Defense Department survey - conducted in 2008 - found that 2.5 percent of Army personnel had illegally used steroids within the past 12 months, a jump from three years earlier, when 1.5 percent said they had used these drugs illegally.

Possession of these substances without a doctor's prescription counts as a violation of the Uniform Code of Justice. However, the difference in the cost of testing for steroids (ranging from $240 to $365) and what a marijuana test costs (about $8) is significant, and officials do not routinely test for steroids unless abuse is suspected.

"We know that troops use a lot of dietary supplements on their own, but historically, so much of the military has fought on amphetamines to stay awake when in combat," says Maxwell Mehlman J.D., a professor of Bioethics at Case Western Reserve University. "But it is unclear what other PEDs they may be using and how much testing is really done. In fact, there are biathletes, string instrument players and surgeons that use beta blockers to lower their heart rate and steady their hands - something that could be seen as beneficial to snipers and other members of the military."

While the use of Adderall, Ritalin and other stimulants has long been associated with military use to help keep troops alert and ready for action during operations, some military members may be turning to these and other enhancers to not just perform better in combat, but also to increase chances of passing fitness tests. This means that there is a chance that users of military fitness centers may also be users of PEDs.

But while these perceived benefits of physical strength, increased energy and endurance may seem worth it for active personnel, the long-term risks may impact them for years in the future.

"Steroids work. They work really well," says Jeff Rutstein, author of The Steroid Deceit: A Body Worth Dying For? and founder of feelgoodexercise.com. "But there are drawbacks especially beyond the physical most people hear about. When you come off of steroids it can lead to a vicious cycle - a never-ending cycle of emotional struggles - from irrational behavior to depression."

And it may be that the long-term effects military members face are unique to them and more detrimental than those faced by civilian users of performance enhancing drugs.

"While I haven't seen decent data that roid rage exists, there is proof that there is a link between anabolic steroids and depression," says Mehlman. "Combine this with the demands of combat and it stands to reason that there would be increased impact on PTSD."

There are also other long-term side effects that may be associated with PED abuse.

"It can lead to other issues that may stem from that depression as users come off of it," says Rutstein. "PED users may turn to alcohol and other drugs, to help feel that energy they did while using them."

That said, Mehlman isn't sure that it is totally unethical for military personnel to utilize PEDs in combat situations.

"From an ethical standpoint it is tough to argue that troops shouldn't use anything that can help them, including properly administered PEDs," he says. "The problems, of course, come from issues of self-administering and post-use."

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