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Introduction
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Included in this document are selections of topic-specific articles reprinted from NIDAs research newsletter,
NIDA NOTES. Six times per year, NIDA NOTES reports on important highlights from NIDA-sponsored research,
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to remind regular NIDA NOTES readers and inform other readers of important research discoveries during the periods
they cover.
We hope the information contained here answers your needs and interests. To subscribe to NIDA NOTES and for
further information on NIDAs drug abuse and addiction research, please visit our Web site at www.drugabuse.gov.
ii
Table of Contents
Study Links Anabolic Steroids to Brain Changes in Study Provides Additional Evidence That High
Adolescent Female Mice (V21-4; October 2007)........... 1 Steroid Doses Elicit Psychiatric Symptoms in Some
Men (V15-4; September 2000)...................................... 9
Steroid Abuse Is a High-Risk Route to the Finish Line
(V21-1; October 2006).................................................. 3 NIDA Initiative Targets Increasing Teen Use of
Anabolic Steroids (V15-3; August 2000)...................... 11
ATLAS and ATHENA Prevention Programs
Receive First Sports Illustrated Champion Award About Anabolic Steroid Abuse
(V20-6; July 2006)......................................................... 4 (V15-3; August 2000).................................................. 13
NIDA Web Site Addresses Consequences of Steroid Prevention Program Scores With High School
Steroid Abuse (V20-2; August 2005)............................. 5 Athletes (V12-4; July/August 1997)............................. 14
ATHENA Program Reduces Substance Abuse Adolescent Girls Abuse Steroids, Too
by Girls on High School Sports Teams (V12-4; July/August 1997) (Sidebar)........................... 15
(V20-1; August 2005).................................................... 6
Questions and Answers About Anabolic Steroids
Steroid Abusers May Go On to Abuse Opioids, (V12-4; July/August 1997).......................................... 17
Too (V15-6; January 2001)........................................... 8
iii
Research Findings
Volume 21, Number 4 (October 2007)
Anabolic androgenic steroid (AAS) abuse, once largely Dr. Henderson says. Going into the experiment, we
limited to elite athletes, has spread to a wider population assumed wed see an anabolic steroid effect on the GABA
that includes adolescents along with adults, and girls as system in the MPOA and expected there would be differ-
well as boys. While the psychological and behavioral ences between males and females. This area of the brain,
consequences of AAS use presumably reflect its impact particularly the cluster of neurons within it called the
on a number of brain areas, a NIDA-funded study at medial preoptic nucleus (MPN), is structurally different
Dartmouth Medical School has identified one neurobio- in the sexes.
logical effect that has potentially important implications
for the emotional stability and well-being of adolescent Drug Targets Receptors
girls in particular. The researchers injected mice with a solution of 17-
Principal investigator Dr. Leslie Henderson and colleagues MeT in sesame oil, in doses (7.5 mg/kg/d) that would
studied the effect of the AAS, 17-methyltestosterone correspond to those taken by humans who are abusing
(17-MeT), on the activity of the neurotransmitter the drug heavily. They injected a control group of mice
gamma-aminobutyric acid (GABA) in adolescent mice. with the sesame oil vehicle alone. The researchers exam-
Loosely speaking, GABA acts as a calming agent through- ined brain tissue from half the mice in each group after 3
out the nervous system: It dampens activity of the neurons weeks of treatment and from the other half after 6 weeks.
to which they are connected. Specifically, the researchers They focused on the subunits that make up GABA type
focused on the steroids impact on GABA functioning in A receptors (GABAA) in cells of the MPN and on the way
the medial preoptic area (MPOA) of the basal forebrain, a that AAS exposure affected the function of these receptors.
region that participates in the regulation of sexual behav- Each receptor contains five of these subunits, proteins that
ior, anxiety, and aggression. They found that in female, determine the receptors sensitivity to drugs and hormones.
but not male, animals the AAS interfered with GABA
transmission in the
area. Theoretically,
this effect would
reduce GABAs
inhibitory influence
and thus potentially
contribute to the
excessive emotions
and behaviors seen in
AAS abuse. Various
studies have linked
increased anxiety
and aggression, and
both increased and
decreased libido to
AAS use.
The GABA system
isnt the only target
for the effects of
AAS, but it is likely
an important one,
1
To test how the reduction in 2 subunit production sion of sexual behaviors, but this is something we are
might affect GABAA receptor function, the research- just beginning to explore, Dr. Henderson says. Whats
ers measured the amplitude and frequency of inhibitory more, there are 60 to 100 AAS, and their neurobiological
postsynaptic currents (IPSCs)a measure of the recep- effects are unlikely to be uniform. In time, we may be able
tors efficacy in inhibiting the activity of neuronsin the to start parsing out whether certain commonly abused ste-
MPN. Here, too, they found sex-based differences that roids are likely to amplify aggression and libido in women
were magnified by AAS. In untreated mice, the IPSCs or in men while others affect both genders equally.
were smaller in amplitude in females than in males. Dr. Henderson notes that alterations in GABAA receptor
Female mice that received 3 to 4 weeks of AAS displayed function could have other important effects as well. The
smaller and less frequent currents than controls, suggest- GABAA receptor is a major target of many drugs, includ-
ing that exposure to the drug had reduced GABAA recep- ing alcohol and benzodiazepines. Changing the subunit
tor function, thereby widening the gender gap. There was composition could alter the brains sensitivity to these
no comparable change in males. chemicals.
The researchers concentrated on the 2 subunit family, Although this is a basic research study, its potential trans-
which earlier studies had shown that 17-MeT alters. lation to humans, even if speculative, is striking, says Dr.
Before treatment, levels of messenger RNA (mRNA) for Pushpa Thadani, formerly of NIDAs Division of Basic
the 2 subunit were lower in female than in male mice in Neuroscience and Behavioral Research. It demonstrates
cells of the MPN. After 6 weeks, 2 subunit mRNAan that AAS exposure in the adolescent period produces
indicator of the quantity of the subunit being produced gender-specific changes at the molecular level that may be
had declined by 37 percent in female mice treated with correlated with known behavioral outcomes.
the AAS compared with controls, but was essentially
unchanged in males. When the researchers measured the Although applying findings from this and similar studies
actual protein that makes up the 2 subunit in female in actual interventions remains a distant goal, these stud-
mice, they found a small but significant reduction (8 per- ies advance our understanding of the actions of AAS on
cent) in the number of neurons containing 2 protein. the brain and behavior, which can empower us to better
educate the lay public on the harmful effects associated
Chronic exposure to AAS augmented gender differences with abuse, Dr. Thadani says. The research is still in its
in both the structure and function of certain GABA infancy, she observes. Other studies, now under way, are
receptors, Dr. Henderson says. Overall, the effect was seeking to clarify the links between aggression in female
to decrease GABA transmission in the MPN of female, mice and AAS-associated neurobiological changes. When
but not male, adolescent mice. This would presumably these findings are available, well probably be in a bet-
increase the level of activity or change the pattern of activ- ter position to translate this information into the human
ity in postsynaptic neurons of the female mice. arena.
A Closer Look Source
How do these neurobiological changes contribute to the Penatti, C.A.A., et al. Sex-specific effects of chronic
behavioral manifestations of AAS abuse? It could be that anabolic androgenic steroid treatment on GABAA
an AAS that promotes aggression in males would promote receptor expression and function in adolescent mice.
it more in females, or have different effects on the expres- Neuroscience 135(2):533-543, 2005.
2
Research Findings
Volume 21, Number 1 (October 2006)
Starting last fall, capitalizing on the mice were particularly sensitive to the effects
interest raised by the Winter Olympics of the steroid on GABA, which is critical to
in Turin, Italy, NIDA intensified its the display of female sexual behaviors and
campaign to warn young people that ste- is involved in the regulation of hormone
roid abuse is a dangerous way to become release and ovarian maturation.
faster, stronger, and bigger. The need to educate young people about the
Boys and girls who abuse these drugs serious health risks associated with steroids
before reaching their full natural height remains urgent. Among American teens,
may prematurely halt bone growth, such abuse declined over the past decade,
resulting in permanently shorter stat- but that encouraging trend shows signs of
ure. Boys and men who abuse steroids weakening, especially among younger boys
risk shrinkage of the testicles, reduced and girls. In 2005, according to the annual
sperm count, infertility, baldness, devel- NIDA-funded Monitoring the Future
opment of breasts, and an increased (MTF) Survey, the number of high school
risk for prostate cancer. Girls and women are subject to seniors reporting steroid abuse dropped significantly, to
menstrual abnormalities, voice deepening, breast shrink- 1.5 percent, from peak levels of about 2.5 percent just a
age, male-pattern baldness, and an increase in sex drive, year before. The rates were unchanged, however, among
acne, body hair, and clitoris size. Some of these adverse 10th graders (1.3 percent) and 8th graders (1.1 percent).
effectsincluding breast enlargement in men, menstrual NIDA has responded by updating our Research Report on
abnormalities in women, and reduced height in both Steroids to provide the public with the newest informa-
sexesmay be permanent. For both sexes, steroid abuse tion about steroids and their abuse. The Research Report is
increases the risk of liver and heart disease, stroke, aggres- available on NIDAs Web site at www.drugabuse.gov/
sion, and depression. Users of injectable steroids may ResearchReports/Steroids. A Spanish version is available at
acquire hepatitis, HIV, and other infections if they use www.drugabuse.gov/ResearchReports/Esteroides/Esteroides.html.
contaminated needles. Game Plan, a public service announcement that has
In recent animal studies, NIDA-supported researchers aired more than 8,000 times in 75 television markets
tested the effects of chronic exposure to anabolic (muscle- across the United States, reminds young athletes that
building) and androgenic (masculinizing) steroids on brain quick fixes can be dangerously deceptive and that cheat-
circuits that underlie aggression and reproductive behav- ing is damaging in the long run. NIDA will continue
iors. They found that in mice, a regimen corresponding to to conduct and publicize research on steroids, and to
chronic human abuse of these drugs reduced levels of the drive home the point that, ultimately, steroid abuse is a
receptor for the neurochemical GABA. Adolescent female losing strategy.
3
Research Findings
Volume 20, Number 6 (July 2006)
4
Research Findings
Volume 20, Number 2 (August 2005)
Dr. Volkows statement is one example of what visitors Anabolic steroids are taken orally or injected, typically in
can find on NIDAs Web site, http://www.steroidabuse. cycles of weeks or months. Cycling involves taking multi-
gov, which is devoted to educating the public about the ple doses of steroids over a specific period of time, stopping
dangers of anabolic steroids. The site provides resources, for a period, and starting again. In addition, users often
publications, and links to public service announcements combine (or stack) several types of steroids to maximize
about the consequences of steroid abuse. In the full text the substances effects whileor so abusers believe
of Dr. Volkows March 17, 2005, testimony before minimizing their negative effects.
the Government Reform Committee, she discusses the Some percentage of steroid abusers become addicted to the
Institutes many efforts to find treatments to mitigate drugs, as evidenced by their continuing to take steroids in
the adverse effects of anabolic steroid abuse and to better spite of seriously adverse medical and behavioral problems,
understand how these substances affect the body and brain. Dr. Volkow said. One of the most dangerous consequenc-
Anabolic-androgenic steroids are synthetic substances es is the severe depression that can occur during withdrawal,
related to male sex hormones. Anabolic refers to muscle- which, if not recognized and treated properly, can result in
building, and androgenic refers to these substances effect suicide weeks after drug discontinuation. Indeed, untreated,
of promoting masculine characteristics such as hair growth depressive symptoms have been known to persist for a year
or a deepened voice. Steroid drugs are available legally only or more after the abuser stops taking the drugs.
by prescription to treat conditions that occur when the Other consequences of anabolic steroid abuse can include
body produces abnormally low amounts of testosterone, liver and heart disease, stroke, and increased aggression.
such as delayed puberty and some types of impotence. They People who inject anabolic steroids run the added risk of
are also prescribed to treat body-wasting in patients with contracting and/or transmitting HIV/AIDS or hepatitis
AIDS and other diseases that result in loss of lean muscle through sharing contaminated needles. In addition, there
mass. Abuse of anabolic steroids can lead to serious health are some sex-specific side effects:
problems, some irreversible. For menshrinking of the testicles, reduced sperm
Anabolic steroids differ from other drugs of abuse in that count, infertility, baldness, enlarged breasts, increased
many of their reinforcing effects (i.e., those effects that risk for prostate cancer.
keep a person using a drug) are not experienced immediately For womengrowth of facial hair, male-pattern bald-
or rapidly. The main reasons people abuse steroids are to ness, changes in or cessation of the menstrual cycle,
improve their performance in sports by increasing muscle enlargement of the clitoris, deepened voice.
size and to enhance their appearance by reducing body fat.
Although these effects can take months to develop, once they For adolescentspermanent short stature due to
do, they may comprise a strong incentive to continue abuse. premature cessation of skeletal growth.
The most recent NIDA-University of Michigan Monitoring NIDAs Web site also features links to the Institutes
the Future survey found that in 2003 and 2004, about 2.5 Game Plan public service announcements, which encour-
percent of 12th-graders reported abusing steroids during age young men and women to work with what nature has
the past year. This is a peak level among this group, and provided and not to cheat by using steroids and thereby
translates into an estimated 79,000 high school seniors expose themselves to the negative side effects associated
involved with these substances. Meanwhile, the percent- with these drugs. NIDA released its most recent Game
age of 12th-graders concerned that steroids might do them Plan in June 2005.
harm had fallen to 56 percent from a high of 71 percent
5
Research Findings
Volume 20, Number 1 (August 2005)
High school girl athletes who participated in a recently Elliott and Linn Goldberg,
evaluated NIDA-supported nutritional and behavioral selected team leaders to
guidance program were less likely than nonparticipating receive a 90-minute orien-
peers to engage in substance abuse and other high-risk tation and then conduct
behaviors. Girls on teams that used ATHENA (Athletes discussion and activity
Targeting Healthy Exercise and Nutrition Alternatives) sessions during scheduled
were less likely than girls on teams that received only team practices. Each team
printed information to use diet pills or so-called perfor- leader works with a squad
mance-enhancing substances such as steroids, amphet- of approximately six teammates, following a manual that
amines, and muscle-building supplements. The ATHENA is much like a playbook, with scripts for eight 45-min-
team members also were less likely to be sexually active ute sessions dealing with the harmful consequences of
and more likely to wear seat belts, and they experienced substance abuse and other unhealthy behaviors and the
fewer injuries during the sports season. beneficial effects of good diet and exercise. Along with
In the ATHENA program, developed at the Oregon providing information, the workbook engages the girls in
Health & Science University in Portland by Drs. Diane activities such as critiquing magazine advertising and other
media influences on
self-image; classifying
ATHENAs Impact on Behavior and Nutrition various foods according
to carbohydrate, fat,
Control Group Experimental Group and protein content;
Before After Before After and determining the
Intervention Intervention Intervention Intervention best balance of dietary
Nutrition, Exercise Abilities, and Beliefs* fuels for athletic train-
Tracking protein intake 2.11 2.03 2.16 2.54 ing and competition.
Eating more protein in the last 2 months 3.95 3.92 4.19 5.10 Each ATHENA athlete
Knowing how to lift weights to improve strength 5.48 5.61 5.15 5.92 uses a pocket-sized
Self-rating of skill in strength training 5.48 5.61 5.15 5.92 nutrition and training
Believing that nutrition affects sport performance 5.75 5.64 6.06 6.01 guide to monitor diet
Additional Health-Influencing Behaviors and exercise. Coaches
Rode in a car with an alcohol-consuming driver** 0.44 0.42 0.41 0.26 and other staff mem-
Knowing how to turn down unhealthy weight-loss
bers receive an orienta-
5.80 5.77 5.91 6.14 tion to assist the team
behaviors*
leaders as timekeepers
No. of sport injuries so could not train in the last
0.32 0.36 0.32 0.26 and facilitators for
3 months
the sessions.
Intentions Toward Future Disordered Eating
Behaviors and Drug Use* To evaluate ATHENA,
Diet pill use 1.74 1.79 1.87 1.62 the researchers recruit-
Vomiting to lose weight 1.66 1.76 1.62 1.57 ed 40 girls sports
Tobacco use 1.56 1.79 1.55 1.58 teams in 18 public high
Creatine (muscle-building supplement) use 1.87 1.77 1.72 1.51 schools in northwest
Oregon and southwest
Data are significant differences expressed as the mean. Washington. Teams
*Scored using a seven-item agreement scale ranging from 1 (strongly disagree) to 7 (strongly agree).
**Scored 0 to 4 for times occurred with 0 indicating none; 1, once; 2, two or three times; 3, four or five times; or 4, six or more times. from half the schools
followed the ATHENA
High-school girls who participated in the ATHENA curriculum were less likely to engage in drug abuse or
other unhealthy behaviors than were girls given printed information about drugs and nutrition. program. The other
6
teams received printed information about eating disorders, substances such as steroids, diuretics, laxatives, and even
substance abuse, and sports nutrition, but did not take tobacco, Dr. Elliott says. However, the athletic environ-
part in discussion or group activities. Before the first prac- ment can exert positive peer pressure also. The researchers
tice of their sports season and again within 2 weeks after modeled ATHENAs use of sports teams as a forum to
the season ended, each girl filled out a questionnaire about promote healthy lifestyles on a similar program they devel-
her eating patterns; nutritional awareness; use of diet pills, oped for male high school athletes (see Like ATHENA,
amphetamines, anabolic steroids, and muscle-building ATLAS Targets High School Athletes). We found
supplements; and other health-related behaviors. that the team-based approach used in ATLAS [Athletes
Preseason survey results were essentially the same for girls Training and Learning to Avoid Steroids] produced
on ATHENA teams and those in the control group, but greater positive change than did a more conventional
in postseason surveys the ATHENA participants reported classroom-style approach, Dr. Elliott says.
significant decreases in risky behaviors. According to Dr. Two features of the ATHENA program are striking,
Elliott, the control athletes were three times more likely to says Dr. Larry Seitz of NIDAs Division of Epidemiology,
begin using diet pills and almost twice as likely to begin Services and Prevention Research. One is the peer-based
using other body-shaping substances, including amphet- rather than classroom-based approach, and the other is the
amines, anabolic steroids, and muscle-building supple- effect on a wide spectrum of linked behaviors, from vom-
ments, during the season. The use of diet pills went up iting to induce weight loss to believing nutritional claims
among control girls, while it fell to approximately half its in advertising. Improvements like these can help young
preseason level among ATHENA girls. ATHENA athletes female athletes make healthier choices throughout life, not
also were more likely to use seatbelts and less likely to ride just during the sport season.
in a car with a driver who had been drinking, to believe The Oregon Health & Science University Sports
claims in advertising, or to agree with the statement that Medicine Web site, www.ohsu.edu/hpsm/index.html,
men find thin women most attractive. provides more information about ATHENA and ATLAS.
Adolescent girls experience social and cultural pressure
about body image, and they look to each other for role Source
models more than they follow the guidance offered in Elliott, D.L., et al. Preventing substance use and
classrooms, research has shown. The competitive environ- disordered eating: Initial outcomes of the ATHENA
ment of athletic programs may compound the pressure, program. Archives of Pediatric and Adolescent Medicine
leading to disordered eating and the use of body-shaping 158(11):1043-1049, 2004.
7
Research Findings
Volume 15, Number 6 (January 2001)
8
Research Findings
Volume 15, Number 4 (September 2000)
NIDA-supported research has produced additional evi- critics said. Perhaps abusers were exaggerating the extent
dence that high doses of anabolic-androgenic steroids can of their aggression because they considered aggression to
produce aggressive symptoms in some men. Dr. Harrison be manly.
Pope and his colleagues at McLean Hospital in Belmont, The only way to conclusively demonstrate that high
Massachusetts, compared aggressive reactions in men who steroid doses can provoke aggression and other manic
received alternate doses of steroids and placebo. symptoms is to administer high doses to volunteers in
Anabolic-androgenic steroids have been widely, but illegal- double-blind studies in which both the volunteers and
ly, available since the 1960s. Anabolic refers to steroids the scientists are unaware of who is receiving steroids and
ability to promote tissue growth, while androgenic refers who is receiving an inactive substance, or placebo. Three
to their ability to promote the development of male sexual previous double-blind studies have been conducted: one
characteristics. People typically abuse steroids because they at the University of Oklahoma College of Medicine in
boost muscle size, particularly in the chest and shoulders. Tulsa in 1999; one at the Charles R. Drew University of
Starting in the late 1980s, evidence began to accumu- Medicine and Science in Los Angeles in 1996; and one
late that steroids may provoke manic symptoms, such as at the National Institute of Mental Health in Rockville,
aggression, euphoria, grandiose beliefs, reckless behavior, Maryland, in 1993. Collectively they confirm that high
and a decreased need for sleep. Reports of violence com- steroid doses can provoke severe aggressive and manic
mitted by people who had taken large doses of steroids reactions in a minority of men.
began to appear in both the scientific literature and The study conducted by Dr. Pope and his colleagues
the lay press, and in surveys, steroid abusers themselves was the most recent and extensive, recruiting 50 men
reported that the drugs prompted them to acts of aggres- between the ages of 20 and 50. For the first 6 weeks of
sion. However, some scientists questioned the significance the study, the investigators gave half of the volunteers
of these reports. Perhaps the more aggressive or manic weekly injections of the steroid testosterone cypionate
steroid abusers were the ones volunteering for the studies, in gradually increasing doses. For the next 6 weeks, the
Responses to treatment with testosterone cypionate varied greatly among three study participants. On the Young Mania Rating Scale, a stan-
dard scale for rating mania, scores of less than 10 indicated that the participant had minimal psychiatric effects; participants with scores of
10 to 19 were rated moderately manic; and those with scores of 20 or higher were rated markedly manic.
9
men were given nothing, then for the subsequent 6-week substantial aggression. These aggressive responders would
period, they were given injections of a placebo, followed pound on the board and yell and swear at what they
by another 6 weeks of no injections. The other half of the thought was their opponent in the neighboring booth,
men were treated the same, except they received 6 weeks who was, of course, a computer, says Dr. Pope. It was
of placebo injections before receiving 6 weeks of steroid quite dramatic.
injections. Each time the men came in for their weekly Why a few men develop manic reactions to steroids while
injection, the researchers administered psychological tests most do not remains a mystery, Dr. Pope says. Those who
to them. In addition, the men kept daily diaries of their reacted with manic symptoms were not more likely to
psychological symptoms. have taken steroids before, to have been a weightlifter,
Of the 50 men who received all their steroid injections, or to have a family history of psychiatric disorder. They
42 had only minimal psychiatric reactions to the drugs. also did not differ in various physiological measures,
However, two men developed prominent manic symp- such as the blood level of testosterone following the ste-
toms, and another six developed moderate symptoms. roid injections.
People who responded to the steroid had different com- I think that the evidence from this and previous studies
binations of manic symptoms, says Dr. Pope. One man indicates that, for unknown reasons, somewhere between
had an aggressive outburst at work. Once, when he got 2 and 10 percent of men develop manic behavior and
cut off in traffic, he followed the person in his car for sev- other neuropsychiatric complications from high doses of
eral miles. The other man with a marked reaction became steroids, says Dr. Jag Khalsa of NIDAs Center on AIDS
euphoric and had a decreased need for sleep. Among the and Other Medical Consequences of Drug Abuse. These
moderate responders, one man playing in a college sports studies were done with 500 and 600 mg per week of ste-
competition found himself wanting to beat up his oppo- roids, while in actual practice, steroid abusers often take as
nent. He said that he had never had such aggressive feel- much as 1,000 or 1,500 mg per week. With these higher
ings before in the course of a competition. doses, the percentage developing manic symptoms is likely
One of the psychological tests given to the volunteers was to be higher.
the Point Subtraction Aggression Paradigm, which has
been widely used to measure aggression in alcoholics, drug Sources
abusers, adolescents, and other populations. In this test, Pope, H.G., Jr.; Kouri, E.M.; and Hudson, J.I.
the volunteers played a computer game in a booth. Each Effects of supraphysiologic doses of testosterone on
was told that he was playing against a man in another mood and aggression in normal men: A random-
booth, when actually his opponent was a computer. The ized controlled trial. Archives of General Psychiatry
man could accumulate points by pressing one button on 57(2):133-140, 2000.
a board and could deprive his opponent of points by Pope, H.G., Jr.; Phillips, K.A.; and Olivardia, R.
pressing another button. At the end of the game, accu- The Adonis Complex: The Secret Crisis of Male Body
mulated points could be exchanged for money. During Obsession. New York: The Free Press. 2000.
the game, the computer provoked the man by randomly
depriving him of points. The mans aggression score con- For More Information
sisted of the number of points that he subtracted from his
For additional information on anabolic steroids and
opponent in retaliation.
NIDAs efforts to curtail their use, see NIDA Initiative
The results showed that the steroid injections significantly Targets Increasing Teen Use of Anabolic Steroids. NIDA
increased aggression scores, although, again, most of the has also created a special Web site, www.steroidabuse.org,
men were only minimally affected, while a few showed that also provides information.
10
Research Findings
Volume 15, Number 3 (August 2000)
To reverse the rising use of anabolic steroids by high to increase muscle mass and improve performance. Some
school-age children, NIDA and seven national partners teens use them because of concern about body image.
have launched an initiative designed to alert the public In adolescents, anabolic steroid abuse can halt bone
about the risks associated with anabolic steroid use. growth and has been associated with damage to the heart,
kidneys, and liver. In males, steroid abuse can lead to
impotence, shrunken testicles, and breast enlargement.
In females, the drugs effects include menstrual irregulari-
ties, growth of body hair and loss of scalp hair, a deepened
voice, and reduction in breast size. Some of these biologi-
cal effects are irreversible. Use of anabolic steroids also
has been linked to increased and unpredictable levels of
aggression in human and animal studies.
NIDAs initiative includes a new Web sitewww.steroid
abuse.orgthat provides science-based information about
the risks and prevention of steroid abuse. NIDA has
also released an updated Research Report on anabolic
steroids as part of the nationwide multimedia initiative.
NIDA and its partners will distribute 250,000 copies of
a special Community Drug Alert Bulletin on anabolic
steroid abuse and will place 500,000 art cardscolor-
As part of NIDAs anabolic steroids initiative, the Institute ful postcards with messages about the harmful effects of
has distributed more than 500,000 art cardscolorful steroid abusein gyms, bookstores, restaurants, and clubs
postcards with messages about the harmful effects of steroid in Washington, D.C., Los Angeles, Miami, Baltimore,
abusein gyms, restaurants, bookstores, and clubs. Seattle, and Indianapolis.
The most recent data from our Monitoring the Future The Institutes partners in the initiative include the
survey tell us that the trends in use of these drugs and in National Collegiate Athletic Association, the American
teenagers attitudes about them are going in the wrong Academy of Pediatrics, the American College of Sports
direction, said NIDA Director Medicine, the National Association
Dr. Alan I. Leshner at a of School Nurses, the National
Washington, D.C., press Federation of High Schools,
conference to announce the International Students in Action,
initiative. More than a half and Dr. Drew Pinsky, a physician
million 8th- and 10th-grade who hosts discussions about relation-
students are now using these ships and sexual behavior on MTVs
dangerous drugs, and increasing Loveline and the Web site
numbers of high school seniors www.drDrew.com.
say they dont believe the drugs The press conference announcing the
are risky. initiative was followed by a scientific
Anabolic steroids are synthetic session at which NIDA-supported
compounds that mimic the scientists presented summaries of
action of the male sex hormone Dr. Linn Goldberg (left) of Oregon Health research on anabolic steroids. Dr.
testosterone. The drugs have Sciences University, explains the Adolescent Charles Yesalis of Pennsylvania State
some medical uses, but they Training and Learning to Avoid Steroids University discussed the history and
also are abused by some athletes (ATLAS) program to reporters at a science social context of steroid use and
and sports enthusiasts who want session following the NIDA press conference. abuse. Dr. Linn Goldberg and
11
More than a half million 8th-
and 10th-grade students are now
using these dangerous drugs, and
increasing numbers of high school
seniors say they dont believe
the drugs are risky.
12
Research Findings
Volume 15, Number 3 (August 2000)
13
Research Findings
Volume 12, Number 4 (July/August 1997)
A NIDA-funded drug abuse prevention program is show- The Adolescents Training and Learning to Avoid
ing high school football players that they do not need Steroids (ATLAS) program uses a team-oriented educa-
to take anabolic steroids to build powerful muscles and tional approach that motivates and empowers student
improve athletic performance. By educating student athletes to make the right choices about steroid use, says
athletes about the harmful effects of anabolic steroids Dr. Linn Goldberg of Oregon Health Sciences University
and providing nutrition and weight-training alternatives in Portland, who led the research team that developed and
to steroid use, the program has increased football tested the program. The program consists of classroom,
players healthy behaviors and reduced their intentions weight-training, and parent information components.
to use steroids. Together, they give student athletes the knowledge and
Until now, anabolic steroids, drugs derived from the male skills to resist steroid use and achieve their athletic goals in
hormone testosterone, have rarely been the focus of drug more effective, healthier ways, he says.
abuse prevention studies, says Dr. Ro Nemeth-Coslett In ATLASs classroom component, football coaches and
of NIDAs Division of Epidemiology and Prevention student leaders conduct seven highly interactive sessions
Research. This may be because steroids are not widely that explore the effects of steroids, the elements of sports
abused. Only about 2 percent of 8th, 10th, and 12th nutrition, and strength-training alternatives to steroid use.
grade students have ever used These classes also hone the athletes decisionmaking and
steroids, according to the NIDA- drug-refusal skills. In a typical session, the football team
supported Monitoring the Future is split into squads of six or seven students, with student
study for 1996. However, steroid squad leaders conducting the sessions and teaching most
abuse occurs more often among of the intervention, according to Dr. Goldberg. Its
young people who are involved in kids talking to kids; thats an important
physical training because ana- ingredient in our program, he says.
bolic steroids can increase muscle Coaches, who have a substantial
mass, strength, and stamina, Dr. influence on these student athletes,
Nemeth-Coslett points out. also play an important role on
Although adolescent boys, the steroid prevention team, Dr.
particularly those involved in Goldberg says. Coaches introduce
athletics such as football or body topics and wrap up each session,
building, make up the majority of he explains.
high school steroid users, national The ATLAS program is voluntary, and
surveys show that adolescent girls students get no credit for it, so it bet-
also are vulnerable to the lure of ter be entertaining, he says. As a result,
steroid use. However, that lure ATLAS classroom sessions are designed
contains a hookanabolic steroid to combine fun and games and learn-
use can have severe physical and ing. Coaches move from squad to squad
emotional consequences for both and introduce a topic, such as the effects
males and females. Physical effects of anabolic steroids. Then squad leaders
can include stunted growth, high take over and initiate an action game that
blood pressure, and liver tumors. incorporates the topic. For example, players
Psychological effects can include may toss a football to each other as they
wide mood swings that range answer questions about problems that stem
from episodes of uncontrolled from steroid use. Although they are play-
anger and aggressiveness to clini- ing a game, each one is paying attention and
cal depression when steroid use is listening because someone is flipping the ball
Students in the ATLAS program learn that
stopped. to them, says Dr. Goldberg. No one is
stunted growth and many other harmful
effects can result from steroid use.
14
saying to them, Watch out, steroids cause liver disease, The programs positive effects flow from changing the
acne, and so forth, he notes. But while they are laughing student athletes attitudes and perceptions about steroids
and having a good time, they are actually watching and and then changing their nutrition and exercise behaviors,
learning at every step of the way. Dr. Goldberg says. These changes in behavior are rein-
Football players are athletes; they like to compete, forced by conducting periodic tests of the athletes body
Dr. Goldberg notes. Therefore, several games pit squads composition, strength, and power. If they are training
against each other to try and earn the most points for cor- properly, they are a heck of a lot stronger. So, its real
rect answers about weight training, nutrition, and steroids. positive reinforcement to them, he says.
In addition to games, students do mock public service Student athletes who participate in the ATLAS program
announcements, they do rap, they do songs, and they do achieve, Dr. Goldberg says. The year before they entered
newspaper articles in the classroom sessions, he says. the program, the football teams that were randomly
In ATLASs weight-training component, research staff assigned to receive the intervention had much worse
members conduct seven hands-on sessions that teach the won-lost records in football than the teams in the control
students proper weight training techniques. These sessions group had, he says. At the end of the first year, the two
are designed to help student athletes build the muscular groups records were about the same, but teams in the
strength and agility needed to achieve their athletic goals ATLAS program did slightly better. At the end of the
without using steroids.
In the parent information component, parents participate
in an information and discussion session about the pro-
Adolescent Girls Abuse Steroids, Too
gram with the ATLAS staff. The staff gives the parents a
family sports nutrition guide and encourages them to sup- What do anabolic steroids have in common with
port and reinforce the antisteroid and nutritional goals of amphetamines, tobacco, diet pills, laxatives, and
the program at home. Students in the program say their anorectics? They all are drugs used by adolescent girls
parents are more opposed to steroid use after the interven- seeking to stay thin, says Dr. Linn Goldberg of Oregon
tion and often provide healthier meals at home, according Health Sciences University. The use of these drugs,
to Dr. Goldberg. which often goes hand in hand with eating disorders, is
particularly prominent among adolescent girls engaged
Late last year, Dr. Goldberg reported results of an ongo- in athletic activities ranging from track and field,
ing study of ATLASs effectiveness in preventing steroid soccer, basketball, and volleyball to school dance
use among more than 1,500 football players from 31 high and drill teams, Dr. Goldberg says.
schools in the Portland area. Some 702 football players at
randomly selected schools received the 7-week program Dr. Goldberg and his colleague Dr. Dianne Elliot
during football season. Another 804 football players at have been conducting preliminary research, funded
matched schools served as a control group and received by NIDA, to identify risk factors that influence adoles-
only a standard informational brochure on the dangers of cent girls use of harmful drugs. Among other things,
steroid use. the researchers have found that many adolescent girls
use drugs to maintain thinness, Dr. Goldberg says.
Assessments conducted immediately after the interven- National surveys indicate that girls account for about
tion and 1 year later show that, compared with control one-third of the high school students who abuse ste-
students, student athletes who participated in the ATLAS roids, Dr. Goldberg says. The primary reason that
program knew more about exercise, nutrition, and the these girls use steroids is to lose fat and gain lean
harmful effects of anabolic steroids. ATLAS participants muscle, he says.
also had an increased sense of personal vulnerability to
negative effects of steroids, more unfavorable attitudes Dr. Elliot and Dr. Goldberg have already developed
toward their own and others use of steroids, and reduced an effective steroid prevention program for male high
intent to use steroids. ATLAS students also showed greater school athletes described beginning on the previous
page. Now, they are developing a similar drug abuse
improvement in their nutritional habits than did con-
prevention program for adolescent girls. In their future
trol students. For example, they were more likely to eat
research, the researchers hope to test the effectiveness
high-protein low-fat meals at school, home, and fast-food of the intervention in reducing drug use and eating
restaurants. In addition, ATLAS students were more likely disorders among female athletes in Oregons public
than students who did not participate in the program to middle and high schools.
use established weight-lifting and strength-conditioning
techniques.
15
Source
The prevention program gives Goldberg, L.; Elliot, D.; Clarke, G.N.; MacKinnon,
student athletes the knowledge D.P.; Moe, E.; Zoref, L.; Green, C.; Wolf, S.L.;
Greffrath, E.; Miller, D.J.; and Lapin, A. Effects
and skills to resist steroid use and of a multidimensional anabolic steroid prevention
achieve their athletic goals in more intervention: The adolescents training and learn-
ing to avoid steroids (ATLAS) program. JAMA
effective, healthier ways. 276(19):1555-1562, 1996.
16
Research Findings
Volume 12, Number 4 (July/August 1997)
17
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