The substance being considered will be performance enhancing drugs, particularly anabolic steroids. According to a 2006 survey funded by the National Institute on Drug Abuse, 3 percent of 12th graders have abused anabolic steroids. Although this sounds like a minority of the population, 40 percent claimed that finding administrators of anabolic steroids was easy. Anabolic steroid use without proper medical supervision and a prescription can have harmful effects on the psyche and physiology of users (Nieschlag, E., & Vorona, E., 2015). The abuse of anabolic steroids may lead to aggressive behavior, mood swings, depression, halted growth, premature skeletal maturation, accelerated puberty changes, changes in menstrual cycle, infertility, baldness, deepened voice, and liver damage, to name only a few consequences (Kam, P. C. A., & Yarrow, 2005). These side effects make preventing anabolic steroid abuse a primary concern amongst athletes and teenagers that suffer from body image issues or the pressure to perform athletically (Goldberg, Bosworth, Bents, & Trevisan, 1990). Federally funded efforts to prevent anabolic steroid use comes in two forms. One form aims to prevent the abuse of anabolic steroids specifically, while the second form aims to prevent substance abuse in general. Since anabolic steroid abuse is different than most substance abuse cases, primarily because the use of anabolic steroids does not have short-term gratification in mind such as immediate euphoria, then the approach to prevention must also be tailored specifically for anabolic steroid abuse prevention.

The effects of anabolic steroids have been documented for decades, although new conclusions about the dangers of the drug are recently reinforced. The common side-effects that are well associated with performance enhancing drugs such as anabolic steroids are aggression, acne, hormonal changes, mood swings, depression, poor self-image, and low self-esteem . Other dangers that are less well-known are liver toxicity, cognitive deficiency, hypertrophic myocardiopathy, and neurotoxicity. The majority of these claims have a building body of evidence. For example, neuron apoptosis has been associated with anabolic steroid abuse (Kaufman, Janes, Hudons, Brennan, Kanayama, Kerrigan, Pope, 2015). This cell death of the brain cells and neurons would lead to a predictable cognitive decline. Although it’s unclear whether psychopathology is a determinant of increased risk for using anabolic steroids, or whether psychopathology is instead a symptom of anabolic steroid abuse, the two are linked (Kam & Yarrow, 2005). More studies are associating anabolic steroid use and cancer, myocardial infarction, suicide, cirrhosis, atherosclerosis, hyper-coagulopathy, and hepatic dysfunction (Hoffman & Ratamesss, 2006). Long-term anabolic steroid abuse has been documented as related to increases in risky, violent behavior as well as physiological adaptations that put the user at risk for pre-mature mortality (Amsterdam, Opperhuizen, & Hartgens, 2010). Liver toxicity, a long with irritability, depression, and erratic behavior are primary concerns for users. Anabolic steroid usage is prevalent amongst athletes, particularly those who require strength or size to compete. Used as a performance enhancing drug, anabolic steroids are accompanied with many negative side effects. Amongst high school students, 27.9% of students will report having at least one acquaintance that has or is using anabolic steroids (Pallesen, Jøsendal, Johnsen, Larsen, & Molde, 2006). Roughly 6.5% of high school males and 2.5% of high school females admit to using anabolic steroids. As explained, the consequences of prolonged anabolic steroid use include alterations of the cardiovascular system, psyche and behavior, sexual dysfunction, and liver toxicity (Amsterdam, Opperhuizen, & Hartgens, 2010). The most primary, dangerous alterations will be liver toxicity (Neri,, Bonsignore, Cantatore, Riezzo, Turillazzi, & Fineschi, 2011). However, all side effects and corresponding consequences should be treated as serious concerns. This health concern is particularly prevalent amongst high school bodybuilding athletes and preventative measures must be taken to educate athletes of the potential negative consequences. In conclusion, anabolic steroid use is far outweighed by negative consequences opposed to the perceived benefits. Administering this knowledge is only one side of the coin toward prevention.

Underlying personality traits have been associated with increased risk for performance enhancing drug abuse. These are important indicators of whether a user begins or stops using performance enhancing drugs. Populations at risk include those who have a need for high athletic performance, those present with body image concerns, and several characteristics such as low self-esteem & confidence (Blouin, & Goldfield, 1995). Bodybuilders have a more liberal attitude about anabolic steroid use than many other athletes. This leniency allows the community to promote anabolic steroids and makes them convenient to those who seek them out. For the high school athlete, knowing a member of the bodybuilding community is often enough to make them vulnerable to use. After all, 27.9% of high school students report having at least one acquaintance who has or is currently using anabolic steroids. Once the athlete has been exposed to anabolic steroids and begins usage, it is often difficult to remain clean due to the short-term positive perceived benefits and lack of knowledge of long-term consequences (Goldberg, Elliot, Clarke, MacKinnon, Moe, Zoref, Green, Wolf, Greffrath, Miller, and Lapin, 1996). Being predisposed to use and enabled to abuse the substance often becomes a reinforcing factor once the athlete starts to see results.

The majority of motivation for using anabolic steroids comes from the need to appear more attractive to oneself and others (Petersson, Bengtsson, Voltaire-Carlsson, & Thiblin, 2010). Other motivations include low self-esteem, preparation for sport, and to improve confidence. These underlying characteristics predispose certain individuals to see anabolic steroids in a more beneficial light. The marked leniency amongst distributing anabolic steroids to competitors enables populations of all ages to have access to them. Further, a positive perception towards in shape, low body fat, high muscle content individuals enables and reinforces the image attained through anabolic steroids. Reinforcement of substance abuse includes depression following a cycle and a return to an insecure body image perspective (Piacentino, Kotzalidis, Del Casale, Aromatario, Pomara, Girardi, & Sani, 2015). The negative consequences of anabolic steroids are often hidden from view for athletes. Prolonged use often is accompanied with perceived benefits only, while psychological and physiological alterations are slow but steady. This boiling frog syndrome allows bodybuilders of all ages to participate in performance enhancing drugs without considering the long-term consequences (Deepinder, & Braunstein, 2012).

Intervention programs should aim to provide realistic awareness of the effects of anabolic steroids, while addressing the underlying body-image issues that are motivating the individual. High school athletes, particularly bodybuilders, are prone to the abuse of steroids due to the demands of the sport and often present underlying body image issues (Melnik, Jansen, & Grabbe, 2007). Lack of understanding of the consequences of anabolic steroid use can lead to a more positive outlook on participating in usage (Elliot, Goldberg, Bents, Bosworth, & Trevisan, 1991). Health education should be a primary component of preventing athletes from partaking in the dangerous action of anabolic steroid injection. Abuse of steroids can lead to greater body image issues and depression, effectively reinforcing the cycle of use (Piacentino, Kotzalidis, Del Casale, Aromatario, Pomara, Girardi, & Sani, 2015). Diminishing use can prevent alterations in the physiology and psychology of users. This preventative measure reduces the exposure of the user to a dangerous, unpredictable substance, as well as protecting their social circle. Proper education allows athletes to make an informed decision, weighing the benefits and costs of using the substance. Since the side effects often reinforce the original intention to use anabolic steroids, it’s important to address the use of anabolic steroids before they become a health concern.

The Anabolic Steroids Control Act of 1990 placed anabolic steroids into Schedule III of the Controlled Substances Act (CSA). Under such law, anabolic steroid possession or sale without a valid prescription is illegal. The penalty is determined by both federal and state laws. In conjunction with this act, several organizations have worked together to prohibit anabolic steroid use. The National Collegiate Athletic Association (NCAA), The International Olympic Committee (IOC), MLB, NFL, NHL, and other professional organizations have all banned the use of anabolic steroids.

Finding quality information on anabolic-androgenic steroids can be difficult, although it’s established that education on the effects of this substance prove effective in diminishing its use (Goldberg, Bosworth, Bents, Trevisan, 1990). There are several programs that offer educational resources on the subject matter. The Adolescent Training and Learning to Avoid Steroids program (ATLAS) raises awareness in high school athletes to avoid anabolic-androgenic steroids. In fact, surprising statistics accompany students who have completed the ATLAS program. Half the incidence of new abuse of anabolic steroids and less intention of abusing steroids in the future was reported after one-year post-completion of the program. This includes less likelihood of engaging in hazardous substance abuse behaviors such as drinking and driving, athletic enhancing supplements, and less use of other drugs.

The Athletes Targeting Heathy Exercise and Nutrition Alternatives (ATHENA) program is similar in structure to the ATLAS program. Although organizations exist that aim to prevent anabolic-androgenic steroid abuse, the majority of the focus remains on professional sports and Olympic games. The National Institute on Drug Abuse (NIDA) promotes the ATLAS program as a substantially effective methodology and framework for avoiding anabolic steroid use.

Although less information is available on the signs of abuse and dependence, it’s clear that use, whether short-term or long-term, has detrimental consequences. As discussed, the negative long-term affects of anabolic steroid use have not been properly evaluated. However, certain indicators are common that make the use of anabolic steroids apparent. One of which is anabolic steroid-induced hypogonadism (Rahnema, Lipshultz, Crosnoe, Kovac, & Kim, 2014). The cause of hypogonadism is a reduction of testosterone production within the testicles. Supplementation of testosterone and other anabolic agents can decrease or cease the natural production of testosterone made by the testicles. Another physiological indicator of anabolic steroid use is Gynecomastia (Deepinder, & Braunstein, 2012). The male breast tissue enlarges, an affect from a disturbance in the endocrine system. The ratio of estrogens to androgens is the primary cause of gynecomastia. As the anabolic steroids are administered, the ratio of androgens versus estrogens is displaced. This results in an excess production of estrogen, which leads to the development of enlarged breast tissue in men.

A final indicator of anabolic steroid usage is acne (Melnik, Jansen, & Grabbe, 2007). The over-secretion of the oil glands that are stimulated by testosterone production results in acne. This acne has become a typical sign of performance enhancing drug abuse. Besides health-threatening cardiovascular, hepatotoxic and psychiatric long-term side effects of AAS, acne occurs in about 50 % of AAS abusers and is an important clinical indicator of AAS abuse, especially in young men 18-26 years of age (Melnik, Jansen, & Grabbe, 2007).

Anabolic steroids are dangerous, addictive performance enhancing drugs. Their original intention was as a substitute for the hormone testosterone. However, their abuse has become popularized by the sports world and fitness industry. Much of the drive behind anabolic steroid use can be derived from low self-esteem, competitiveness, and reward seeking behavior. It’s unsurprising that those who are susceptible to using anabolic steroids are often striving to win competitions, improve body image, and seek validation from others. Proper education on the positive and negative benefits of anabolic steroid use must be addressed during public health interventions. The most effective form of prevention remains in adjusting the environmental and attitude related determinants (Goldberg, Elliot, Clarke, MacKinnon, Moe, Zoref, Green, Wolf, Greffrath, Miller, and Lapin, 1996). The likelihood of use increases when peers are approving of the use of anabolic steroids and when the user has an attitude that makes them susceptible to the attractiveness of steroids (Yates, Perry, & Andersen, 1990). One of the greater determinants of the likelihood of use is also lack of knowledge of long-term consequences. This goes hand in hand with the quick gratification mindset that makes anabolic steroids particularly seductive to users. In conclusion, anabolic steroids are a neglected public health issue although it is a substance that is being abused regularly across several demographics. Since the factors that increase the percentage of users are related to environment and attitudes, it’s possible that performance enhancing drugs can affect both sexes and many different demographics. Therefore, it’s important to raise awareness amongst the public as well as scientific community that this issue must be addressed.

References:

National Institute on Drug Abuse. DrugFacts: Anabolic Steroids. (March 2016). Retrieved March 3, 2016 from https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids

Goldberg, L., Bosworth, E. E., Bents, R. T., & Trevisan, L. (1990). Effect of an anabolic steroid education program on knowledge and attitudes of high school football players. Journal of Adolescent Health Care : Official Publication of the Society for Adolescent Medicine. Retrieved from http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/442/CN-00068442/frame.html

Goldberg, L.; Elliot, D.; Clarke, G.N.; MacKinnon, D.P.; Moe, E.; Zoref, L.; Green, C.; Wolf, S.L.; Greffrath, E.; Miller, D.J.; and Lapin, A. (1996). Effects of a multidimensional anabolic steroid prevention intervention: The adolescents training and learning to avoid steroids (ATLAS) program. JAMA 276(19):1555-1562, 1996.

Rahnema, C. D., Lipshultz, L. I., Crosnoe, L. E., Kovac, J. R., & Kim, E. D. (2014). Anabolic steroid-induced hypogonadism: Diagnosis and treatment. Fertility and Sterility, 101(5), 1271–1279. http://doi.org/10.1016/j.fertnstert.2014.02.002

Nieschlag, E., & Vorona, E. (2015). Mechanisms in Endocrinology: Medical consequences of doping with anabolic androgenic steroids: Effects on reproductive functions. European Journal of Endocrinology. http://doi.org/10.1530/EJE-15-0080

Deepinder, F., & Braunstein, G. D. (2012). Drug-induced gynecomastia: an evidence-based review. Expert Opinion on Drug Safety, 11(5), 779–95. http://doi.org/10.1517/14740338.2012.712109

Melnik, B., Jansen, T., & Grabbe, S. (2007). Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 5(2), 110–7. http://doi.org/10.1111/j.1610-0387.2007.06176.x

Kaufman, M. J., Janes, A. C., Hudson, J. I., Brennan, B. P., Kanayama, G., Kerrigan, A. R., … Pope, H. G. (2015). Brain and cognition abnormalities in long-term anabolic-androgenic steroid users. Drug and Alcohol Dependence, 152(2015), 47–56. http://doi.org/10.1016/j.drugalcdep.2015.04.023

Kam, P. C. A., & Yarrow, M. (2005). Anabolic steroid abuse: Physiological and anaesthetic considerations. Anaesthesia. http://doi.org/10.1111/j.1365-2044.2005.04218.x

Yates, W. R., Perry, P. J., & Andersen, K. H. (1990). Illicit anabolic steroid use: a controlled personality study. Acta Psychiatrica Scandinavica, 81(6), 548–550. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med3&AN=2378247\nhttp://openurl.ac.uk/athens:lee/?sid=OVID:medline&id=pmid:2378247&id=doi:&issn=0001-690X&isbn=&volume=81&issue=6&spage=548&pages=548-50&date=1990&title=Acta+Psychiatrica+

Hoffman, J. R., & Ratamess, N. A. (2006). Medical issues associated with anabolic steroid use: are they exaggerated? Journal of Sports Science & Medicine, 5(2), 182–93. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3827559&tool=pmcentrez&rendertype=abstract

Pallesen, S., Jøsendal, O., Johnsen, B.-H., Larsen, S., & Molde, H. (2006). Anabolic steroid use in high school students. Substance use & misuse41(13), 1705-17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17118811

Amsterdam, J. van, Opperhuizen, A., & Hartgens, F. (2010). Adverse health effects of anabolic-androgenic steroids. Regulatory Toxicology and Pharmacology57(1), 117-123.

Neri, M., Bello, S., Bonsignore, A., Cantatore, S., Riezzo, I., Turillazzi, E., & Fineschi, V. (2011). Anabolic androgenic steroids abuse and liver toxicity. Mini reviews in medicinal chemistry11(5), 430-437.

Elliot, Goldberg, Bents, Bosworth, & Trevisan (1991). Anabolic steroid education and adolescents: do scare tactics work? Pediatrics87(3), 283-286. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2000267?dopt=Abstract

Blouin, A. G., & Goldfield, G. S. (1995). Body image and steroid use in male bodybuilders. The International Journal of Eating Disorders18(2), 159-65.

Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., & Sani, G. (2015). Anabolic-androgenic Steroid use and Psychopathology in Athletes. A Systematic Review. Current neuropharmacology13(1), 101-21. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4462035&tool=pmcentrez&rendertype=abstract

Petersson, A., Bengtsson, J., Voltaire-Carlsson, A., & Thiblin, I. (2010). Substance abusersʼ motives for using anabolic androgenic steroids. Drug and Alcohol Dependence111(1-2), 170-172.

http://www.gao.gov/assets/270/268579.pdf

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