Adolescent Steroid Abuse

 

 

Introduction

Since their inception into medicine in the early 1950’s to treat hypogonadism (the decrease of testosterone production in males), steroid use has been steadily growing. The use of steroids has been increasing throughout the athletic world in order to enhance athletic performance and increase strength through muscular development[1].  Since the introduction of steroids into athletics, the use of steroids has become more common and widely accepted in the fitness world.  In the past, steroids were most commonly used among college athletes, most notably in football and wrestling; and also among professional weight lifters, bodybuilders, and power lifters.  Generally, steroids have always been more common in the strength-based athlete due to the little benefit steroids give to the endurance athlete.  In recent times, we have seen a dramatic increase in the use of steroids among non-professional and non-college athletes[2].  Specifically, steroid use in adolescents has been increasing in grades 7 through 12 for the past 10 years in athlete and non-athletes alike (See table 1).

 

 

What are Steroids?

Anabolic-androgenic steroids are chemical compounds that resemble the male sex hormone, testosterone.  Steroids are named anabolic-androgenic steroids because these terms describe the two known effects of steroids.

 

Steroids are believed to support the development of skeletal muscle growth:  known as an anabolic effect. Steroids are also known to initiate the development of secondary sex characteristics: known as an androgenic effect[3].  The anabolic effect of increasing muscle size is also known as muscular hypertrophy. 

 

Androgenic effects allow the body to develop sexual traits that allow us to distinguish between the two sexes.  Some common male secondary sex characteristics are hair growth, development of courser skin, development of a lower voice and fatty deposits in the abdominal area.  Some common female secondary sex characteristics are enlargement of breasts, development of smoother skin, hip development, and fatty deposits in the hip and thigh area. 

 

Anabolic-androgenic steroids are most commonly referred to as ‘steroids’ without the modifiers ‘anabolic’ or ‘androgenic’.  This is because all steroids elicit certain levels of anabolic and androgenic effects and it would therefore be redundant to refer to steroids as anabolic-androgenic steroids.  For the purpose of this chapter, the term, ‘steroids’ will be used to describe all types of anabolic-androgenic steroids[4]. It should be noted that there are many different types of steroids and the discussion of these steroid variants is beyond the scope of this chapter. For more information on steroids types and effects please see Appendix A.

 

Medicinal uses

Steroids were developed for and are still used for medicinal purposes.  Although steroid treatments are not as popular as they once were, they are still used in treating hypogonadism (low testosterone production), delayed puberty, some types of impotence, and for body wasting as is often found in HIV and cancer.

 

Common routes of administration

Whether for medicinal or athletic purposes, there are three common routes of administering steroids. These three routes of administration are: intra-muscular (directly into the muscle tissue via a syringe), oral (via pill), and intra-dermal (through the skin using a cream that penetrates the skin and delivers the drug directly into the blood stream).

 

Additional Steroid Resources

For more information on anabolic-androgenic steroids please refer to Appendix A.

 

 

Prevalence, Incidence and Scope

Steroid abuse among adolescents in the United States has been on a sharp rise over the past decade.  Using data collected from,  Monitoring the Future National Results on Adolescent Drug Use, an annual survey that collects data on the behaviors and attitudes of young Americans, a sharp increase in the lifetime use of steroids among adolescents is seen.  As depicted in Table I, lifetime prevalence of steroid abuse in 10th graders increased by 1.7% (1.8%-3.5%) over a ten-year period. Similarly, lifetime prevalence of steroid abuse in 12th graders increased by 2.9% (1.1%-4.0%) over a ten-year period.

 

Table I: All data collected from Monitoring the Future National Results on Adolescent Drug Use: Overview of key findings, 2002. (NIH Publication No. 03-5374)

 

During the same time period where the survey demonstrated an increase in the lifetime prevalence of steroid use, a decline in the perception of risk from steroid use was also demonstrated. Data on the perceived risk was collected for 8th and 10th graders for a portion of the ten-year period. All grade levels demonstrated a peak in perceived risk of steroid use around 1993.  Long-term data for 12th graders showed a 6 percentage-point drop between 1998 and 1999 and an additional 4-percentage point drop in 2000. This drop is unusual and suggests that some event in 1998 might have changed beliefs about the dangers of steroid use. By 2002, the perceived risk of harm from steroid use was at a low of 57.1%[5].

 

Table II: All data from Monitoring the Future National Results on Adolescent Drug Use: Overview of key findings, 2002. (NIH Publication No. 03-5374)

 

In addition to the challenges involving the adolescents’ perception of risk from steroid use, is the problem of the black market steroid industry.  This industry is large and it is estimated to collect more than 400 million dollars in annual retail sales[6].

 

Steroid abuse is higher among males; however, steroid abuse in females is a fast-growing problem[7].

 

Table II demonstrates interesting relationships between the prevalence of amphetamines (a powerful stimulant), heroin (euphoric stimulant), steroids (sports enhancement drug), PCP (a hallucinogen), and ICE (a powerful stimulant).  Unpredictably, steroids are on average more prevalent among 12th graders than heroin, nitrates, and in recent times PCP.  This would suggest that a better program should be initiated to deal with the growing usage of steroids in adolescents.

 

Additional resources on steroid research

For more information on current steroid research please refer to Appendix B.

 

 

What is Steroid Abuse?

For the purpose of this chapter steroid abuse will be used to describe any use of a controlled steroid substance that has not been prescribed by a physician for a medical condition.  Steroid abuse will include all types of steroids at all doses.  Gym doses used by athletes can vary between 10 and 100 times the suggested medical dose[8].  Like many illicit drugs, steroid abuse may lead to addiction problems.

 

 

Health Consequences?

Steroids have many benefits and are used by doctors to treat various medical conditions; however, they have many potential side effects when used at gym-doses.

 

 

 

 

 

 

 

 

 

 

 

 

 


How frequently are these health effects seen? 

Because of the paucity of data on steroid addiction and abuse, the actual frequency of these various health effects is not known.  All of these side effects from steroid use are well documented from controlled animal and human studies; however, the occurrence of health effects from uncontrolled, non-medical doses of steroids taken by athletes requires further research.

 

Additional resources on steroid health effect

For more information on steroid health effects please refer to Appendix C.

 

 

Why do adolescents abuse steroids?

There are many reasons why adolescents abuse steroids.  The most common reason given for the use of steroids is to improve athletic performance. Other reasons involve desires for aesthetic improvements by increasing muscle mass and/or decreasing body fat. Some experts believe that the latter frequently has to do with a condition called muscle dysmorphia[9].  Muscle dysmorphia, sometimes referred to as ‘bigorexia,’ is the antithesis to anorexia nervosa.  Muscle dysmorphia is an individual's constant obsession with the belief that they are not sufficiently muscular[10].  Individuals with muscle dysmorphia show striking parallels with known eating disorders: "the pursuit of 'bigness' shows remarkable parallels to the pursuit of thinness" seen in anorexics”[11].

 

Individuals who abuse steroids may have been victims of physical and or sexual abuse.  A study utilizing male weight lifters, reported by the National Institutes of Health (NIH), demonstrated that 25% of men who abused steroids were victims of sexual and or physical abuse[12].  In a similar study reported by the NIH of female weight lifters, 50% of the women who reported using steroids had been raped[13].  While the results of these studies are intriguing, most researchers concur that the majority of steroid users are psychologically normal upon steroid initiation.

 

Finally, many adolescents abuse steroids within a pattern of numerous high-risk behaviors.  Steroid users usually show patterns of high-risk behaviors such as drinking and driving, carrying a weapon, not wearing a helmet on a motorcycle, and abusing other illicit drugs[14].  Little data exist to quantitatively describe how strongly these are correlated; however, it is very likely that the correlations are as strong as we would expect for any other illicit drug.

 

Additional resources on the psychology of steroid addiction

For more information on the psychology of steroid addiction please refer to Appendix D.

 

 

Clinical Treatment of Abuse

One of the larger problems with steroid abuse, as with many drugs, is its cessation.  It is often difficult and even dangerous to stop steroid use suddenly and many people will require professional medical support for this purpose.  One of the largest risks of steroid cessation is depression.  Depression, which is often observed when many drugs are stopped, is likely to be a key component in steroid addiction. “Researchers report that [steroid] users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.  Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused anabolic steroids before trying any other illicit drug. Of these 9.3 percent, 86 percent first used opioids to counteract insomnia and irritability resulting from the anabolic steroids[15].”

 

Research and anecdotal evidence suggest that in most cases, supportive therapy is sufficient to aid in steroid cessation[16].  Hospitalization may be required in some cases of severe withdrawals.  Hormone therapy is useful in restoring natural hormone levels and anti-depressants may be necessary to reduce the risk of suicide attempts during steroid cessation.  Behavioral therapy may be necessary to help steroid addicts avoid risky behaviors.

 

Program Recommendations

ATLAS

The Athletes Training and Learning to Avoid Steroids (ATLAS) program is the only known program that has demonstrated a reduction in the use of steroids and sports supplements in adolescents.  The ATLAS program is designed for young male high school athletes aged 13 to 19.  It uses a peer-centered approach to create positive peer pressure and role modeling to reduce the use of steroids, performance enhancement supplementation, alcohol, and other drugs.

 

The program is delivered to school sports teams and lead by peers and coaches to promote healthy eating and exercise, as an alternative to performance enhancement drugs.  ATLAS is a 10-session program that is very scripted and contains interactive activities to make a fun, easy-to-deliver program.

 

With funding from the NIH’s National Institute on Drug Abuse (NIDA) ATLAS was initiated in 1993.  The ATLAS program was tested in randomized controlled trials at 31 schools with more than 3,200 participants and was shown to decrease the use of sports supplements by half[17]. 

 

ATLAS is delivered to entire sports teams in the classroom.  Students are divided into smaller groups with one peer squad-leader per group.  This team-centered approach hopes to create positive peer pressure and promote healthy behaviors through this positive role modeling.

 

The ATLAS program addresses potential immediate consequences of steroid use and the use of other sports supplements as opposed to focusing on the long-term effects.  Athletes are educated on proper nutrition and exercise programs and techniques to avoid harmful substances that may harm their physical well-being.

 

More than ATLAS

The ATLAS program is a good start to the much-needed solution to the sports supplement abuse problems in the United States. The biggest problem with ATLAS is that it focuses only on male high-school population and gives no support to individuals outside of this group. In addition, it gives little support and information to individuals who already use steroids and need to safely stop.  Therefore, similar programs should be initiated for the populations not being reached by ATLAS.

 

 

Programs that have failed

  1. Drug testing only programs
  2. Education only programs
  3. Physical training/nutrition and education programs that do not focus on risk perception change

 

In the early 1990’s, researchers began an attempt to create programs that would dissuade young athletes from initiating the use of steroids.  These programs were largely drug testing programs and educational interventions that attempted to use alternatives to steroids and scare tactics that focused on the negative effects resulting from the use of steroids.  These programs were effective at increasing awareness in the general public but failed to change the perception of risk in the general student and athlete populations[18].  This was demonstrated from researchers using a typical drug prevention model on the distinct steroid using population.  Unlike traditional illicit drug users, the steroid using population has significantly different risk factors.  Some of the traditional risk factors such as socio economic status (SES), academic status, and ethnicity have no known effect on the prevalence or incidence of steroid use[19]. 

 

Additional resources on the steroid programs

For more information on steroid programs please refer to Appendix E.

 

 

Conclusion

The rate of steroid abuse in the past ten years has been increasing at a steady rate and this rate has been reported as a significant increase in steroid use by the Monitoring the Future National Results on Adolescent Drug Use conducted by the NIH.  The increase in the use of steroids, which is growing the fastest in the female population, is placing adolescents in this country at risk for many potential adverse reactions to these drugs.

 

Adolescents in the United States are using steroids for many reasons; however, the most common reasons for steroid use are to improve athletic performance, increase muscle size, and to lose fat.  These problems are normally ego-centric as the adolescent is trying to improve their own athletic performance or their own aesthetic appeal. 

 

These adolescents do not respond to traditional drug prevention programs because the reasons for using steroids is very different from other illicit drug use such as alcohol, tobacco, marijuana, or cocaine.  In order to deal with steroid abuse in adolescents, their perceptions of steroid use must be influenced and changed. 

 

This is important to understand because it explains why traditional education programs and drug testing fail at reducing steroid use.  Traditional education programs and drug testing fail because they do not alter the adolescents’ perception of the use of steroids.

 

The motivations that drive adolescents to use steroids are very powerful and must be dealt with using a new approach.  The most successful new approach to dealing with steroid abuse has been through the development of ATLAS.  ATLAS is unique because it uses a multifaceted curriculum delivered at the team level by fellow students.  ATLAS builds-up positive peer pressure against the use of steroids, provides skills to avoid and say no to steroids, and provides alternatives to steroid use through proper training and nutrition.

 

ATLAS has set a new precedence in steroid abuse prevention and new programs are being developed to fill-in additional gaps that still remain. This includes the use of steroids in women, those already using steroids, and the use of steroids in non-school athletes: those who participate in sports outside of the school environment where ATLAS is delivered.

 

 

 


Appendix A

 

References: What are Steroids?

 

Anabolic Steroids: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References by Icon Health Publications

Publisher: ICON Health Publications; (November 2003)

ISBN: 059783699X

 

Steroids 101 by Jeff Summers

Publisher: Anabolics.com, Inc.; (March 15, 2003)

ISBN: 0972103902

 

Anabolic Primer by Phill Embleton

Publisher: Musclemag International; (August 1, 1998)

ISBN: 1552100103

 

Anabolics 2000 : Anabolic Steroid Reference Manual
by William Llewellyn

Publisher: Anabolics.com, Inc.; (April 2, 2000)

ISBN: 0967930405

 

Anabolics 2004 by William Llewellyn

Publisher: Molecular Nutrition; (November 2003)

ISBN: 0967930421

 

http://www.anabolics.com

 


Appendix B

 

References: Steroid Research

 

Monitoring the Future National Results on Adolescent Drug Use: Overview of key findings 2002, U.S. Department of Health and Human Services Public Health Service

National Institutes of Health, by Lloyd D. Johnston, Ph.D., Patrick M. O'Malley, Ph.D. and Jerald G. Bachman, Ph.D.  (NIH Publication No. 03-5374).

 

National Institute on Drug Abuse (NIDA) Info-Facts: Steroids (Anabolic-Androgenic) U.S. Department of Health and Human Services Public Health Service

National Institutes of Health. March 2004

 

NIDA Research Report Series: Anabolic Steroid Abuse.  U.S. Department of Health and Human Services Public Health Service, National Institutes of Health. April 2000. (NIH Publication 00-3721)

 

http://www.drugabuse.gov

 

http://www.steroidabuse.org

 

http://www.Nida.nih.gov

 

 

 


Appendix C

 

References: The Consequences of Steroid Use

 

The Steroids Game by Charles E. Yesalis, Virginia S. Cowart

Publisher: Human Kinetics Pub; (April 1998)

ISBN: 0880114940

 

Adverse effects of anabolic androgenic steroids on the cardiovascular, metabolic and reproductive systems of anabolic substance abusers

by Tuomo Karila

Drug Research Unit, Department of Mental Health and Alcohol Research

National Public Health Institute, Helsinki

ACADEMIC DISSERTATION 2003

ISBN 951-740-388-2 (printed version)

 

Metabolism of Anabolic-Androgenic Steroids by Victor A. Rogozkin

Publisher: CRC Press; (June 14, 1991)

ISBN: 0849364159

 

 

Bodybuilding, Drugs and Risk (Health, Risk and Society)
by Lee F. Monaghan

Publisher: Routledge; (February 2001)

ISBN: 041522683X

 

Anabolic Androgenic Steroids and the Brain: Studies of Neurochemical and Behavioural Changes Using an Animal Model
by Pia Steensland

Publisher: Uppsala Universitet; (December 2001)

ISBN: 9155451926

 

Steroids, Sports, and Body Image: The Risks of Performance-Enhancing Drugs (Issues in Focus) by Judy Monroe

Publisher: Enslow Publishers, Inc.; (July 2004)

ISBN: 0766021602

 

Steroid Drug Dangers by Judy Monroe

Publisher: Enslow Publishers, Inc.; (July 1999)

ISBN: 0766011542

 

 


Appendix D

 

References: Steroid Addiction

 

Sport and Exercise Pharmacology By Stan Reents
Publisher: Human Kinetics Pub; 2000
ISBN: 0873229371

 

Sport Psychology Interventions By Shane Murphy
Publisher: Human Kinetics Pub; 1995
ISBN: 0873226593

 

The Mental Athlete By Kay Porter
Publisher: Human Kinetics Pub; 2003
ISBN: 0736046542

 

Alcohol and Sport By Robert Stainback
Publisher: Human Kinetics Pub; 1997
ISBN: 0873225317

 

Death in the Locker Room: Steroids & Sports
by Bob Goldman, Patricia Bush, Ronald Klatz

Publisher: Hardwood Press; (June 1984)

ASIN: 0896511553

 

Anabolic Steroid Abuse by Geraline C. Lin, Lynda Erinoff

Publisher: DIANE Publishing Co; Reprint edition (July 1996)

ISBN: 0788129694

 

http://www.Driesen.com/muscle_dysmorphia.htm

 

http://www.Drug-rehabs.com/steroid-abuse.htm

 

 

 

 


Appendix E

 

Reference: Steroid Programs

 

Goldberg, L., et al. The ATLAS program: Preventing drug use and promoting health behaviors. Archives of Pediatrics and Adolescent Medicine 154: 332-338, 2000.

 

http://www.modelprograms.samhsa.gov

 

 


Appendix F

 

Reference: General Steroid Information

 

 

Performance-Enhancing Substances in Sport and Exercise By Michael Bahrke
Publisher: Human Kinetics Pub; 2002
ISBN: 0736036792

 

Anabolic Steroids and the Athlete by William N. Taylor

Publisher: McFarland & Company; 2nd edition (January 16, 2002)

ISBN: 0786411287

 

Anabolic Steroids: And Other Performance-Enhancing Drugs by Pat Lenehan

Publisher: Taylor & Francis; (October 2003)

ISBN: 0415280303

 

Anabolic Steroids in Sport and Exercise by Charles Yesalis

Publisher: Human Kinetics Pub; 2nd edition (September 2000)

ISBN: 0880117869


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Anabolics.com, Inc

 

AAP.org/family/sterods.htm (last accessed March-2004)

 

Bronson, F.H., and Matherne, C.M. Exposure to anabolic-androgenic steroids shortens life span of male mice. Medicine and Science in Sports and Exercise 29(5): 615-619, 1997.

 

Driesen.com/muscle_dysmorphia.htm (last accessed March-2004)

 

Drug-rehabs.com/steroid-abuse.htm (last accessed March-2004)

 

Goldberg, L., et al. Anabolic steroid education and adolescents: Do scare tactics work? Pediatrics

87(3): 283-286, 1991.

 

Goldberg, L., et al. Effect of an anabolic steroid education program on knowledge and attitudes of school football players. J Adolesc Health Care. 1990 May; 11(3):210-4.

 

Goldberg, L., et al. The ATLAS program: Preventing drug use and promoting health behaviors.

Archives of Pediatrics and Adolescent Medicine 154: 332-338, 2000.

 

Gruber, A.J., and Pope, H.G., Jr. Compulsive weight lifting and anabolic drug abuse among women rape victims. Comprehensive Psychiatry 40(4): 273-277, 1999.

 

Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2003). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2002. (NIH Publication No. 03-5374). Bethesda, MD: National Institute on Drug Abuse.

 

Leder, B.Z., et al. Oral androstenedione administration and serum testosterone concentrations in young men. Journal of the American Medical Association 283(6): 779-782, 2000.

 

Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

 

Lovstakken. K et al., Risk factors for anabolic steroid use in college students and the role of expectancy. Addictive Behavior. 1999 May-Jun; 24(3):425-30.

 

Nida.nih.gov (last accessed March-2004)

 

Medstudents.com.br/sport/sport2.htm (last accessed April-2004)

 

Mesomorphosis.com/articles/collins/anabolic-steroids-and-the-law.htm  (last accessed March-2004)

 

Pope, H.G., Jr., Kouri, E.M., and Hudson, M.D. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men. Archives of General Psychiatry 57(2): 133-140, 2000.

 

Rich, J.D., Dickinson, B.P., Flanigan, T.P., and Valone, S.E. Abscess related to anabolic-androgenic steroid injection. Medicine and Science in Sports and Exercise 31(2): 207-209, 1999.

 

SAMHSA Model Programs (modelprograms.samhsa.gov) (last accessed March-2004)

 

Yesalis, C.E. Androstenedione. Sport Dietary Supplements Update, 2000, E-SportMed.com.

the experiments.



[1] Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

[2] http://www.aap.org/family/sterods.htm (las accessed March-2004)

[3] Ibid.     

[4] http://www.medstudents.com.br/sport/sport2.htm

[5] Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2003). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2002. (NIH Publication No. 03-5374). Bethesda, MD: National Institute on Drug Abuse.

[7] Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

[8] Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

[9] Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

[11] Ibid.

[12] Leshner, Alan I., Research Report Series: Anabolic Steroid Abuse (April 2000), National Institute on Drug Abuse (National Institutes of Health Publication 00-3721)

[13] Ibid.

[14] Ibid.

[16] www.nida.nih.gov (las accessed March-2004)

[17] Goldberg, L., et al. The ATLAS program: Preventing drug use and promoting health behaviors.

Archives of Pediatrics and Adolescent Medicine 154: 332-338, 2000.

[18] Goldberg, L., et al. Effect of an anabolic steroid education program on knowledge and attitudes of school football players. J Adolesc Health Care. 1990 May; 11(3):210-4.

[19] Lovstakken. K et al., Risk factors for anabolic steroid use in college students and the role of expectancy. Addictive Behavior. 1999 May-Jun; 24(3):425-30.