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Drug Free Youth-Steroids Back to Course Index







Substance Abuse and Mental Health Services Administration/Center of Substance Abuse Prevention (SAMHSA/CSAP) identified information dissemination/education as one of their initiatives to reduce alcohol, tobacco, and other drug (ATOD) use and abuse among youths.  The goal of this initiative is to provide awareness and knowledge of the nature and extent of use, abuse, and addiction and their effects on individual, families, and communities.  This initiative is also intended to provide knowledge and awareness of available prevention programs and services.  Information dissemination is characterized by one-way communication from the source to the audience whereas the education focus involves two-way communication and is distinguished from the information dissemination strategy by the fact that interaction between the educator/facilitator and the participants is the basis of its activities.  Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, coping and problem solving skills, critical analysis and systematic judgment abilities.


To achieve the greatest impact, educational programs must be appropriate to each audience, geared to specific needs, and used in conjunction with other strategies.   Programs components for educational initiatives may consist of family management training, alcohol, tobacco and other drug (ATOD) curricula, health and wellness curricula, violence prevention training and skills training. 


This continuing education course is intended to provide general information and instruction to help keep our youth drug and steroid free.  The early sections are general and not necessarily substance specific.  However, the final section is specific to steroids and provides parents/caregiver, teachers and mental health professional information they can use to educate youth regarding the use of steroids.  Subsequent Parts of this CEU series Drug Free Youth will deal with other drugs.





Researchers have concluded that recent trends in youth alcohol and other drug use have stabilized; unfortunately, the rate of use remains at a high level and many youths are adversely affected by their choice to use.  For steroids, the 2007 Monitoring The Future survey of 8th, 10th and 12th graders showed the rate of use unchanged from 2006.  Many youths that use steroids develop emotional and physical problems and have more conflicts with their family and in school than those youth that do not use. 


When examining this situation it is obvious that the parents/home environment is the first line of defense against all drug use.  As President George W. Bush stated: it is essential that our parents understand that theyre the childs most important teacher, and that the message of the parents must be unequivocal: dont use drugs. Based upon my personal counseling experiences I totally agree.  Parents are the most important role models in their childrens lives.  What they say and do about drugs matters a lot when it comes to the choices their children make.  For example parents can:



  •         Be a positive example; avoid use of all drugs in the home and in the presence of their children.
  •          Never involve them in adults use or use with them.
  •         Talk early and often about drugs.  The parents must be aware of the latest trends and the best way to combat them. 
  •          Discuss the consequences of drug use; focus on teen health, academic performance, school dropout, violence, teen pregnancy, and other antisocial consequences.
  •          Create clear, consistent expectations and enforce them.


Parents should stay involved in a youths life; show that they care about the choices they make.  Parents should always remember that children learn by example; They adopt the values the parents demonstrate through their example.  It should be noted that good values are modeled, as well as bad values, and we owe our children every positive value that we can offer to help them avoid the pitfalls associated with drug use.




For many parents and other caregivers it may seem too early to discuss drugs with this age group, but the attitudes and habits that they form during this phase of their life will have an important bearing on the decisions they make when they are older. Most psychologists support the early education concept.  For example, psychologists believe that an individuals value/belief system reflects his/her perception of self and represents values, judgments and myths that he/she believes to be true.  The psychologists go on to say that a persons value/belief system is fairly well established by about age seven and is refined and honed by lifes experiences to make them into the persons they are at any given time in their life.   The value/belief system is the major control and decision-making guide and helps the youth to choose between right and wrong and things we do versus things we dont do.  Most youths have a value/belief system about:



  •         Good and bad conduct; playing fair; being helpful
  •          Drug use; smoking; steroid use
  •          Religion/Church activities
  •          Peer pressure/social acceptance
  •          Social involvement
  •          Family roles




If steroid use or behavioral problem (violence) is encountered, then the clinician, counselor or parent/caregiver should explore the youths value/belief system to better understand what they believe about various topics including topics related to drug use.  An area I like to investigate is the environment they were exposed to during their early life.  For example, I want to determine if their parents or caregivers had a win at all costs attitude about competitive sports.  I also want to know if the youth had friends who used drugs and what the norm was regarding use in their school/community.  Also, one may also want to explore other issues to determine what boundaries, if any, were established for the youth.  For example:



  •         Was limits or restrictions imposed?
  •          Was the youth allowed to experiment with drugs?  Did anyone use in the home?
  •          Was there a permissive attitude regarding social activities?
  •          Did the youth have a detailed schedule?
  •          Did the parents involve themselves with the youths friends?
  •          Did the parents monitor school and other activities?



 Obviously, this exploration is an attempt to assess the variables that help the youth to establish or revise his or her value/belief system.  Generally, a permissive attitude and environment will provide early opportunities to experiment with drugs.  This liberal, permissive environment enables a young person to form a flawed image of most activities (no boundaries or limits) and/or to establish a distorted mental picture of specific activity (such as enhancing their athletic performance by using steroids).   To give an example of how our value/belief system works in the life of a steroid user, lets suppose a youth forms a concept of a problem user as one who is muscle bound.  Now, lets suppose this individual is a user but does not meet his or her pre-programmed concept of how a problem user would be.  In this case, the individual would test his or her situation against his or her value/belief system and would conclude he or she does not have a problem.  The cycle may be repeated until there is a match between his/her behavior and his/her pre-programmed value/belief/ system.  It should also be noted that an individuals value/belief system might change in response to his or her own experiences (health issue) and influences from clinicians and other treatment providers.  The cycle may also be disrupted by other factors (generally a crisis) in the users life.



The aforementioned concepts are presented in support of and to promote early family discussions regarding drugs.  Again, most professionals agree that to wait until a drug problem is encountered or until about age 16 is much too late (the value/belief system is already in place and the kid down the street will have more influence at this age than the parents).  Consequently, I encourage parents, caregivers, teachers and others to get involved early and stay focused on the consequences of drug use and abuse.  Also, everyone needs to remember that youths key on inconsistency.  For example, a youth is often confused when the parents says one thing and then does differently.  Youth also pit parents against each other and then migrate toward the most liberal parent; consequently, the parents should present a unified front to the child and resolve any difference in private.



We have put a heavy load on the parents/caregivers and have not offered any preventative measures the youth can take to help themselves.  So here are some considerations that will help the youth to shape and mold themselves (or to be shaped and molded by others) into well-adjusted young citizens that have developed age appropriate coping and problem solving skills.  Hopefully, they will also be capable of making good decisions about most aspects of their lives (what they should and should not do, social activities, peers, school, sports, hobbies, etc.).  Remember, they generally want your opinion on whats good and whats bad.  So here are some ways to help the youth make good decisions, have a high self-esteem and to develop age appropriate coping and problem solving skills:



  •         The youth should eat healthy foods; discuss food types and favorites and inform them how certain foods help build healthy bodies.
  •          Build strong bodies through proper diet and exercise programs.
  •          Build strong bonds of trust with parents/caregivers though dedicated family activities.
  •          Complement them when possible on their choices.  Let them know that you enjoy spending special time with them and doing activities they like.  Also, let them know that you love them and want them.
  •          Encourage and enforce fair play; also encourage and enforce being honest.  Be consistent especially when establishing rules of conduct.   Remember the goal is to help shape a well-rounded youth that can cope with the challenges of life.
  •          Encourage the youth to be self-sufficient.  For example, let them make appropriate decisions as this helps build positive self-esteem.  Look for opportunities to compliment (or praise) the youth; remember to praise in public and instruct in private.



The adolescence years are both exciting and challenging and this is the time when peer pressure becomes very important, as most youths desperately want to fit in.  Also, there are encounters with older youths that may have already begun to use steroids and may think they are cool because they look muscular and mature.  This peer pressure may tempt  youth to experiment with steroids so that he or she can be more competitive; It should be every parents goal to make sure their youths life is structured in such a way that drugs have no place in it.  The following actions are recommended to help to keep youth drug free:



  •         Ensure that they are well versed in the reasons why they should avoid use of all drugs.  Parents should go beyond because I said so and get age appropriate educational material and videos for them to digest.  There is loads of material on the Internet from website like National Institute of Drug Abuse (NIDA) that is free and readily available.
  •         Make the home youth friendly.  Get acquainted with the parents of the youths friends and learn about their interests and habits.  
  •          If possible, provide adult supervision for youth.  Its never good for them to be left on there on for long periods of time.  It is essential that parents/caregivers arrange to have their youth looked after and engaged in the after-school hours. An acceptable alternative is that the youth can get involved with reputable youth groups, arts, music, sports, community service and academic clubs.
  •          If it is mandatory to leave the youth alone make sure the youth feels an adult presence.  Give them a schedule and set limits on their behavior.  Give them household chores to accomplish and enforce strict “phone-in-to-you” policy.
  •          Make it easy for youth to leave a place where substances are being used.  Discuss with them in advance how to contact you or another designated adult in order to get a ride home.  
  •          Set age appropriate curfews and enforce them.
  •           Encourage open dialogue with youth about their experiences.  Tell a child, I love you and trust you, but I dont trust the world around you, and I need to know whats going on in your life so I can be a good parent to you.



Public and private schools have a responsibility to educate and protect all students; There should be nothing confusing or contradictory in what children learns about drugs from the parents and in the school system. For example, school policies need to reflect the same attitude toward use and abuse of drugs as is express in the home:  Drug use is not acceptable.   Its critical that youth understand that drugs diminish their ability to concentrate and follow through on academic responsibilities, they cause absenteeism and loss of motivation, and students who use them can be disruptive and drain teachers time and energy. The best way to ensure that the anti-drug policies at a childs school are strong is for parents to be involved. 



Parents can:


  •         Learn about the current policy regarding use of steroids at your school.  If there is not an anti-drug policy in place, schedule a meeting with the school administration to help develop a policy.  The policy should specify what constitutes an offense, spell out the consequences for failing to follow the rules and describe procedures for handling violations.
  •          Know the drug education program at your school.  Staff should be trained about steroid use and abuse and how to recognize symptoms in those who choose to use and abuse.  Drug education should be taught in an age appropriate way throughout the school year rather than once during a special week.  All teachers should incorporate anti-drug information into their classes.  The school program should be based on current research.  If the drug activity is high in your school you may want to become more involved and inform the school administration that there is a need for improvement in this area.
  •          Study the schools drug education program.  You should examine any existing material to ensure that they contain clear messages that steroid use is wrong and harmful.  You should also verify that the information is accurate and up to date.
  •          Ask about the consequences for those who are caught abusing drugs.   Does the school offer a list of referrals for students who need substance abuse counseling?



Determine if a school drug program is effective.  Research indicates that some of the most effective programs emphasize the value of life skills training such as coping with anxiety, problem solving, being assertive and feeling comfortable socially.  When these lessons are combined with drug education, students confronted with drugs are better equipped to resist them.






Drug addiction has been labeled a disease of the brain; consequently, lets take a look at the brain and how it functions to enhance our study on how to keep our youth drug free.  This material was taken for the National Institute of Drug Abuse (NIDA) website.


 The brain is the command center of the body. It weighs about three pounds, and has different centers or systems that process different kinds of information. The brain stem is the most primitive structure at the base of your brain and controls heart rate, breathing, and sleeping; it does the things you never think about.


 Various parts or lobes of the brain process information from your sense organs: the occipital lobe receives information from your eyes, for example. And the cerebral cortex, on top of the whole brain, is the “thinking” part of you. That’s where you store and process language, math, and strategies: It’s the thinking center. Buried deep within the cerebral cortex is the limbic system, which is responsible for survival: It remembers and creates an appetite for the things that keep you alive, such as good food and the company of other human beings.


 The cerebellum is responsible for things you learn once and never have to think about, such as balance when walking or how to throw a ball.


 The brain’s job is to process information. Brain cells called neurons receive and send messages to and from other neurons. There are billions of neurons in the human brain, each with as many as a thousand threadlike branches that reach out to other neurons.


In a neuron, a message is an electrical impulse. The electrical message travels along the sending branch, or axon, of the neuron. When the message reaches the end of the axon, it causes the release of a chemical called a neurotransmitter. The chemical travels across a tiny gap, or synapse, to other neurons.



Specialized molecules called receptors on the receiving neuron pick up the chemical. The branches on the receiving end of a neuron are called dendrites. Receptors there have special shapes so they can only collect one kind of neurotransmitter.



In the dendrite, the neurotransmitter starts an electrical impulse. Its work done, the chemical is released back into the synapse. The neurotransmitter then is broken down or is reabsorbed into the sending neuron.



Neurons in your brain release many different neurotransmitters as you go about your day thinking, feeling, reacting, breathing, and digesting. When you learn new information or a new skill, your brain builds more axons and dendrites first, as a tree grows roots and branches. With more branches, neurons can communicate and send their messages more efficiently.



What Do Drugs Do to the Brain?


Some drugs work in the brain because they have a similar size and shape as natural neurotransmitters. In the brain in the right amount or dose, these drugs lock into receptors and start an unnatural chain reaction of electrical charges, causing neurons to release large amounts of their own neurotransmitter.  Some drugs lock onto the neuron and act like a pump, so the neuron releases more neurotransmitter. Other drugs block reabsorption or reuptake and cause unnatural floods of neurotransmitter.


All drugs of abuse primarily affect the brain’s limbic system. Scientists call this the “reward” system. Normally, the limbic system responds to pleasurable experiences by releasing the neurotransmitter dopamine, which creates feelings of pleasure.


What Happens if Someone Keeps Using Drugs?


Think about how you feel when something good happens-maybe your team wins a game, you’re praised for something you’ve done well, or you drink a cold lemonade on a hot day-that’s your limbic system at work. Because natural pleasures in our lives are necessary for survival, the limbic system creates an appetite that drives you to seek those things.


The first time someone uses a drug of abuse, he or she experiences unnaturally intense feelings of pleasure. The limbic system is flooded with dopamine. Of course, drugs have other effects, too; a first-time user may feel nauseous from toxic chemicals.


But the brain starts changing right away as a result of the unnatural flood of neurotransmitters. Because they sense more than enough dopamine, for example, neurons begin to reduce the number of dopamine receptors. Neurons may also make less dopamine. The result is less dopamine in the brain: This is called down regulation. Because some drugs are toxic, some neurons may also die.



How Many Times Does Someone Have To Take a Drug To Become an Addict?


 No one knows how many times a person can use a drug without changing his or her brain and becoming addicted.



A person’s genetic makeup probably plays a role. But after enough doses, an addicted limbic system craves the drug as it craves food, water, or friends. Without a dose of the drug, dopamine levels in the drug abuser’s brain are low. The abuser feels flat, lifeless, depressed. Without drugs, an abuser’s life seems joyless. Now the abuser needs drugs just to bring dopamine levels up to normal levels. Larger amounts of the drug are needed to create a dopamine flood or high, an effect known as tolerance.



By abusing drugs, the addicted teen has changed the way his or her brain works. Drug abuse and addiction lead to long-term changes in the brain. These changes cause addicted drug users to lose the ability to control their drug use. Drug addiction is a disease.



If Drug Addiction Is a Disease, Is There a Cure?


There is no cure for drug addiction, but it is a treatable disease; drug addicts can recover. Drug addiction therapy is a program of behavior change or modification that slowly retrains the brain. Like people with diabetes or heart disease, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen.





Anabolic-androgenic steroids (AAS) are manufactured substances related to male sex hormones (e.g., testosterone). Anabolic refers to muscle-building and androgenic refers to increased male sexual characteristics. Steroids refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, but also body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass.







How is AAS Abused?


Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles of weeks or months interrupted by shorter resting periods (this is referred to as cycling). In addition, users often combine several different types of steroids, a practice referred to as stacking.



How Do AAS Affect the Brain?


The immediate effects of AAS in the brain are mediated by their binding to androgen and estrogen receptors, which can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning that they do not trigger rapid increases in the neurotransmitter dopamine, which are responsible for the high that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals such as dopamine, serotonin, and opioid systems that are affected by drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.


AAS and Mental Health



Taken together, the preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects. For example, many users report feeling good about themselves while on anabolic steroids, but extreme mood swings can also occur, including manic-like symptoms that could lead to violence. Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.



Addictive Potential


Animal studies have shown that AAS are reinforcing; that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs. This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations. Also, steroid abusers typically spend large amounts of time and money obtaining the drugs, which is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS, such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to the need for continued abuse. One of the most dangerous withdrawal symptoms is depression, because, when persistent, it can sometimes lead to suicide attempts.


Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. 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 AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.


What Other Adverse Effects do AAS Have on Health?


Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among them include liver damage, jaundice (yellowish pigmentation of skin, tissues, and body fluids), fluid retention, high blood pressure, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:


  • For men: shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer 
  • For women: growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice  
  • For adolescents: stunted growth due to premature skeletal maturation and accelerated puberty changes; adolescents risk not reaching their expected height if they take AAS before the typical adolescent growth spurt



In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.


What Treatment Options Exist?


There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.


How Widespread is AAS Abuse?


Monitoring the Future is an annual survey used to assess drug use among the Nations 8th-, 10th-, and 12th-grade students. Steroid use among all three grades remained unchanged from 2006 to 2007, for both boys and girls, although significant reductions were noted since 2001 for lifetime and past-year use among all grades, and for past-month use among 8th and 10th graders. Among seniors in 2007, past-year steroid use was reported by 2.3 percent of boys versus 0.6 percent of girls.


Anabolic Steroid Use by Students

2007 Monitoring the Future Survey


                  8th Grade    10th Grade         12th Grade

Lifetime             1.5%         1.8%                      2.2%

Past Year           0.8%         1.1%                      1.4% 

Past Month        0.4%         0.5%                      1.0%



Lifetime refers to use at least once during a respondents lifetime.


Past year refers to use at least once during the year preceding an individuals response to the survey.


Past month refers to use at least once during the 30 days preceding an individuals response to the survey.