11

Oregon Department of Oregon Department of EducationEducation

Anabolic Steroids and Anabolic Steroids and Performance-Enhancing Performance-Enhancing

Substances TrainingSubstances Training

General Information, General Information, Resources,Resources,

andandPrevention StrategiesPrevention Strategies

22

Senate Bill 517 and Senate Bill Senate Bill 517 and Senate Bill 10661066

In 2007 Session, the Legislature In 2007 Session, the Legislature passed Senate Bill (SB) 517 in an passed Senate Bill (SB) 517 in an attempt to respond to the very serious attempt to respond to the very serious issue of use and abuse of anabolic issue of use and abuse of anabolic steroids and performance-enhancing steroids and performance-enhancing substances among school-age children.substances among school-age children.

During the 2008 Session, SB 1066 During the 2008 Session, SB 1066 updated SB 517 with technical updated SB 517 with technical changes. changes.

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The Key ComponentsThe Key Components

School districts shall:School districts shall:– Include information on anabolic steroids Include information on anabolic steroids

and performance-enhancing substances and performance-enhancing substances in health and PE curricula for K-12 in health and PE curricula for K-12 students.students.

– Require all school district employees who Require all school district employees who are coaches and athletic directors to are coaches and athletic directors to receive training once every four years.receive training once every four years.

– Utilize evidence-based programs.Utilize evidence-based programs.

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Definition of Definition of “School district employee”“School district employee”

An administrator, teacher or other An administrator, teacher or other person employed by a school district;person employed by a school district;

A person who volunteers for a school A person who volunteers for a school district; anddistrict; and

A person who is performing services A person who is performing services on behalf of a school district on behalf of a school district pursuant to a contract.pursuant to a contract.

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Definition of Definition of Anabolic SteroidAnabolic Steroid

““Anabolic steroid” includes any drug or Anabolic steroid” includes any drug or hormonal substance chemically or hormonal substance chemically or pharmacologically related to testosterone, pharmacologically related to testosterone, all prohormones, including all prohormones, including dehydroepiandrosterone and all dehydroepiandrosterone and all substances listed in the Anabolic Steroid substances listed in the Anabolic Steroid Control Act of 2004. “Anabolic steroid” Control Act of 2004. “Anabolic steroid” does does notnot include estrogens, progestins, include estrogens, progestins, corticosteroids, orcorticosteroids, or mineralocorticoids.mineralocorticoids.

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Definition of Performance-Definition of Performance-Enhancing SubstanceEnhancing Substance

““Performance-enhancing substance” Performance-enhancing substance” means a manufactured product for oral means a manufactured product for oral ingestion, intranasal application or ingestion, intranasal application or inhalation containing compounds that:inhalation containing compounds that:– Contain a stimulant, amino acid, hormone Contain a stimulant, amino acid, hormone

precursor herb or other botanical or any other precursor herb or other botanical or any other substance other than an essential vitamin or substance other than an essential vitamin or mineralmineral

– Are intended to increase athletic performance, Are intended to increase athletic performance, promote muscle growth, induce weight loss or promote muscle growth, induce weight loss or increase an individual’s endurance or capacity increase an individual’s endurance or capacity for exercise.for exercise.

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Performance-Enhancing Performance-Enhancing SupplementsSupplements

The Dietary Supplement and Health Education The Dietary Supplement and Health Education Act of 1994 – Limits the Food and Drug Act of 1994 – Limits the Food and Drug Administration from regulating productsAdministration from regulating products

18.6% of U.S. supplements contain anabolic 18.6% of U.S. supplements contain anabolic steroids – International Olympic Committee steroids – International Olympic Committee (IOC) study of 240 supplements(IOC) study of 240 supplements

Many products contaminated: lead, pesticides, Many products contaminated: lead, pesticides, arsenic, mercuryarsenic, mercury

Strengths of the products available can vary Strengths of the products available can vary Effectiveness studies have not been Effectiveness studies have not been

performed among high school age athletesperformed among high school age athletes

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Variations of Steroids and Variations of Steroids and Performance-Enhancing Performance-Enhancing

SubstancesSubstances

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Steroid Use Among Oregon Steroid Use Among Oregon YouthYouth

According to the CDC, during the 2007-2008 school According to the CDC, during the 2007-2008 school year, about one of every 25 high school students year, about one of every 25 high school students reported using anabolic steroids in their lifetime without reported using anabolic steroids in their lifetime without a doctor’s prescription.a doctor’s prescription. 2

In 2008, 1.3% of 8th graders and 1.2% of 11th graders In 2008, 1.3% of 8th graders and 1.2% of 11th graders reported using steroids in the past 12 months reported using steroids in the past 12 months 1

Use of steroids by Oregon 8th and 11th graders is Use of steroids by Oregon 8th and 11th graders is consistent with national use dataconsistent with national use data 2

However, significant disparities do exist within those However, significant disparities do exist within those youth who report steroid useyouth who report steroid use

Males are 1.7 times more likely to report steroid use Males are 1.7 times more likely to report steroid use than femalesthan females

Hispanic youth are twice as likely and black youth three Hispanic youth are twice as likely and black youth three times as likely to report use than White/non-Hispanic times as likely to report use than White/non-Hispanic youthyouth

1 All data comes from the 2008 Oregon Healthy Teens surveyAll data comes from the 2008 Oregon Healthy Teens survey2 National data comes from the CDC’s Youth Risk Behavior Survey. In 2007, about 4% of National data comes from the CDC’s Youth Risk Behavior Survey. In 2007, about 4% of

high school students reported lifetime use of steroids.high school students reported lifetime use of steroids.

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Steroid Use Among Oregon Steroid Use Among Oregon YouthYouth

Youth who report steroid use also bear a Youth who report steroid use also bear a disproportionate burden of other health disproportionate burden of other health risks. Compared to non-users, 8th graders risks. Compared to non-users, 8th graders who reported steroid use are:who reported steroid use are:

– Almost twice as likely to have an unmet mental Almost twice as likely to have an unmet mental health needhealth need

– 2-3 times as likely to have used alcohol in the 2-3 times as likely to have used alcohol in the past monthpast month

– 4-5 times as likely to have smoked cigarettes in 4-5 times as likely to have smoked cigarettes in the past monththe past month

– 3 times as likely to have ever participated in the 3 times as likely to have ever participated in the “choking game” (briefly strangle oneself or “choking game” (briefly strangle oneself or another with hands or a device to feel euphoria)another with hands or a device to feel euphoria)

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Steroid Use Among Oregon Steroid Use Among Oregon YouthYouth

Steroid Use & Risk Behaviors - Oregon 8th grade

20%

36%26% 30%

76%

33%

6%

19% 15% 15%27%

7%

0%

20%

40%

60%

80%

Participatedin "choking

game"

Had unmetphysical

health need

Had unmetmental health

need

Contemplatedsuicide inpast year

Drank alcoholin past month

Smokedcigarette inpast month

2008 Oregon Healthy Teen (OHT)

Used steroids Non-user

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Steroid Use Among Oregon Steroid Use Among Oregon YouthYouth

Steroid use by youth is related to lower Steroid use by youth is related to lower academic achievement. academic achievement.

– 76% of students who reported that they do not 76% of students who reported that they do not use steroids also reported that they mostly get use steroids also reported that they mostly get A’s or B’s. This compares to 64% of steroid A’s or B’s. This compares to 64% of steroid users who reported receiving As or Bs.users who reported receiving As or Bs.

– Steroid users were about one-fifth less likely to Steroid users were about one-fifth less likely to report As or Bs over the past year.report As or Bs over the past year.

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Steroid Use Among Oregon Steroid Use Among Oregon YouthYouth

Steroid Use & Grades: Oregon 8th graders reporting Mostly As or Bs

64%

76%

50%

55%

60%

65%

70%

75%

80%

Steroid user Non-user

2008 OHT (Oregon Healthy Teen)

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Why do students take anabolic Why do students take anabolic steroids or performance-steroids or performance-enhancing substances?enhancing substances?

To:To: Boost athletic performanceBoost athletic performance Build muscleBuild muscle Increase body massIncrease body mass Lose body fatLose body fat

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What influences a student to What influences a student to take anabolic steroids or take anabolic steroids or performance-enhancing performance-enhancing

substances?substances?

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Desire to Emulate Role Desire to Emulate Role ModelsModels

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Peer Pressure to SucceedPeer Pressure to Succeed

1818

Media InfluencesMedia Influences

Images that portray steroids in a positive lightImages that portray steroids in a positive light

1919

Cover Stories About Cover Stories About SteroidsSteroids

2020

Desired Body ImageDesired Body ImageBased on GenderBased on Gender

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Dangers of Anabolic Steroids Dangers of Anabolic Steroids and Performance-Enhancing and Performance-Enhancing

SubstancesSubstances

Steroids are dangerous for two reasons:Steroids are dangerous for two reasons:– They are ILLEGAL.They are ILLEGAL.– They can damage a person’s mental and They can damage a person’s mental and

physical health.physical health. If used by adolescents, can have permanent If used by adolescents, can have permanent

negative consequences negative consequences

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Some Health Risks for Both Some Health Risks for Both Males and Females:Males and Females:

– Acne, really bad acne, Acne, really bad acne, especially on face and especially on face and backback

– Stunted growth in Stunted growth in teens (by causing teens (by causing bones to mature too bones to mature too fast and stop growing fast and stop growing at an early age)at an early age)

– High blood pressure, High blood pressure, unhealthy cholesterol unhealthy cholesterol changes, and heart changes, and heart diseasedisease

– Blood clots and strokeBlood clots and stroke– Liver damage, Liver damage,

jaundice, or liver jaundice, or liver cancercancer

– Headaches, aching Headaches, aching joints, and muscle joints, and muscle crampscramps

– Increased risk of Increased risk of ligament and tendon ligament and tendon injuries, which can injuries, which can end an athlete’s end an athlete’s career for goodcareer for good

– Needle sharing results Needle sharing results in higher risk for in higher risk for serious infections like serious infections like Hepatitis B and C or Hepatitis B and C or HIV, which causes HIV, which causes AIDS AIDS

– BaldnessBaldness

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Gender Differences and Risks Gender Differences and Risks of Drug Useof Drug Use

Young FemalesYoung Females

Self-esteemSelf-esteem Depression/moodDepression/mood Body image*Body image* Media*Media*

Young MalesYoung Males

Risky behaviorRisky behavior ImpulsivityImpulsivity Body image*Body image* Media* Media*

*Specific, based on gender

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Health Risks for Males:Health Risks for Males:

Shrinking of the testiclesShrinking of the testicles Low sperm countLow sperm count Impotence (inability to get an Impotence (inability to get an

erection)erection) Increased breast growth in males, Increased breast growth in males,

especially teensespecially teens Enlarged prostateEnlarged prostate

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Health Risks for Females:Health Risks for Females:

Breast shrinkageBreast shrinkage Male-type facial and body hair Male-type facial and body hair

growthgrowth Deepening of the voiceDeepening of the voice Problems with menstrual periodsProblems with menstrual periods Enlarged clitoris Enlarged clitoris

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Psychological Health Risks:Psychological Health Risks:

““Roid rage”- severe, aggressive behavior Roid rage”- severe, aggressive behavior that may result in violence, such as that may result in violence, such as fighting or destroying propertyfighting or destroying property

Severe mood swingsSevere mood swings Paranoia- extreme feelings of mistrust and Paranoia- extreme feelings of mistrust and

fearfear Anxiety and panic attacksAnxiety and panic attacks Depression and thoughts of suicideDepression and thoughts of suicide

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Definition of “Cycling”Definition of “Cycling”

Anabolic steroids are taken orally or Anabolic steroids are taken orally or injected, typically in cycles of weeks injected, typically in cycles of weeks or months, rather than continuously.or months, rather than continuously.

Cycling involves taking multiple Cycling involves taking multiple doses of steroids over a specific doses of steroids over a specific period of time, stopping for a period, period of time, stopping for a period, and starting again.and starting again.

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Definition of “Stacking”Definition of “Stacking”

Users often combine several different Users often combine several different types of steroids to maximize their types of steroids to maximize their effectiveness while trying to effectiveness while trying to minimize negative effects.minimize negative effects.

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Slang for anabolic steroids or Slang for anabolic steroids or performance-enhancing performance-enhancing

substancessubstances You may have heard steroids You may have heard steroids

called:called:– RoidsRoids– Juice Juice – HypeHype– PumpersPumpers– Gym CandyGym Candy– ArnoldsArnolds– GearGear– Weight TrainersWeight Trainers– StackersStackers– 420 (pronounced “four-twenty”)420 (pronounced “four-twenty”)

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What should you look for if you are What should you look for if you are concerned that a student/child may be concerned that a student/child may be

taking anabolic steroids or taking anabolic steroids or performance-enhancing substances?performance-enhancing substances?

Unfortunately, many of the symptoms of steroid Unfortunately, many of the symptoms of steroid abuse look very similar to typical appearances abuse look very similar to typical appearances and attitudes that occur during adolescence. and attitudes that occur during adolescence. Here are some signs to look for:Here are some signs to look for:– Increased aggressionIncreased aggression– Rapid weight gain (10 lb/month or 40lb/year)Rapid weight gain (10 lb/month or 40lb/year)– Pustular acne Pustular acne – An obsession with and bragging about increased An obsession with and bragging about increased

performance (i.e. increased bench press)performance (i.e. increased bench press)– Virilization in females (lowering of voice; facial hair, male Virilization in females (lowering of voice; facial hair, male

pattern of hair growth on body)pattern of hair growth on body)

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Steroids are safe Taking any kind of steroid will result in death Injectable steroids are safer than oral steroids Steroids won’t really stunt your growth All steroids are pretty much the same Steroid abuse isn’t really a big problem in the U.S. All steroids are pills Only a certain kind of person uses steroids Steroids aren’t addictive Steroids aren’t as illegal as other drugs Steroids build muscle without working out Women don’t use steroids Roid rage isn’t real

A list (not inclusive) gathered from the following sites: – Association Against Steroid Abuse - Steroid Myths

http://www.steroidabuse.com/steroid-myths.html – Bodybuilding – The Myths and Dangers of Anabolic Steroid Usage

http://bodybuilding.about.com/od/supplementationbasics/a/steroiddangers.htm – Roid Report http://www.roidreport.com/steroids/steroid-myths/

Common MythsCommon Myths

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What coaches can do…What coaches can do…Does your student plan to compete for athletic scholarships? If so, he or she is under considerable pressure to succeed. And besides the pressure from parents and peers, teens place a lot of pressure on themselves. Not surprisingly, the pressure may contribute to the lure of performance-enhancing drugs and supplements.

Reassure the student of your support — even when they do not perform well in competitive sports. If you're worried that they may be using performance-enhancing drugs or supplements, here's what you can do:

Be clear about your expectations. Talk to student athletes that unless the long-term effects of performance-enhancing drugs on young athletes are known to be safe, you expect him or her to avoid them. Discuss alternatives to performance enhancers, include sports nutrition and strength training techniques.Set rules. For example, if a student uses performance-enhancing drugs, he or she will be removed from the team. Teach students that short-term gains can lead to long-term problems.

Excerpt from: Performance-enhancing drugs and your teen athlete, By Mayo Clinic staff

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What coaches can do…What coaches can do…continuedcontinued

Discuss ethics and proper training. Athletes should compete fairly. Remind them that using a performance-enhancing drug is similar to cheating, but even more importantly, could lead to serious health problems or even death. Another key message is that a balanced diet and rigorous training are the true keys to athletic performance. Encourage the student athlete to feel good about his or her sports performance. Monitor for signs of drug use. Signs the student may be taking anabolic steroids include increased acne and male-pattern baldness. If a female takes anabolic steroids, she may develop male characteristics, such as a deep voice or dark facial hair. Teens who take anabolic steroids may seem unusually moody and have angry outbursts known as ‘roid rage’.Discuss the school district’s policy concerning anabolic steroids and other performance enhancing drugs with all student athletes.

Excerpt from: Performance-enhancing drugs and your teen athlete, By Mayo Clinic staff

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Talking to Students About Talking to Students About SteroidsSteroids

You’ve probably taken the time to talk to a teen about not using illegal drugs like marijuana or cocaine, and it’s just as important for you to talk with him or her about not using Steroids and Performance Enhancing Substances (SPES).Talking about using SPESs and other drugs isn’t easy, but it is important. Letting a teen know how you feel about SPES use and the potential, dangerous side effects can help him or her make the smart decision to compete drug-free.

Educate yourself about Steroids and Performance Enhancing Substances (SPES). Be prepared to answer hard questions about SPESs and their side effects. Focus on short-term effects, like severe acne and increased body hair, rather than long-term health risks like heart disease or cancer. Teens tend to live in the here-and-now. They’re really not concerned with what could happen years from now.

Speak out against the use of SPESs on a regular basis. Use recent news coverage of SPESs-related scandals to start a conversation. Discuss ethics of cheating and using SPESs as well as the importance of proper training. As a coach, let your athletes know how you feel about using SPESs and cheating.

Talk about the pressures to use SPESs. Help teens establish realistic and healthy expectations. Excerpt from the Healthy Competition web site http://www.healthycompetitiontn.org/coaches/talking_tips.shtm

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Talking to Students About Steroids - Talking to Students About Steroids - ContinuedContinued

Stress positive alternatives to SPESs.Stress positive alternatives to SPESs. Encourage hard work, Encourage hard work, good nutrition, proper training regimens, hydration and rest as the good nutrition, proper training regimens, hydration and rest as the right tools to improve athletic performance. Above all, remind right tools to improve athletic performance. Above all, remind teens that sports are supposed to be fun.teens that sports are supposed to be fun.

Communicate that shortcuts don’t work.Communicate that shortcuts don’t work. Gimmicks and quick- Gimmicks and quick-fix approaches are not the ways to enhance athletic performance fix approaches are not the ways to enhance athletic performance or appearance. The human body responds well to nutrition and or appearance. The human body responds well to nutrition and different types of training to improve strength, muscle tone and different types of training to improve strength, muscle tone and ability – safe and healthy options are out there. ability – safe and healthy options are out there.

If a teen you know is using SPESs, intervene and help him If a teen you know is using SPESs, intervene and help him or her get support.or her get support. The most important part of intervention is The most important part of intervention is reminding the teen that you care and that help is available. It’s a reminding the teen that you care and that help is available. It’s a good idea to have a medical or mental health care professional good idea to have a medical or mental health care professional involved with a teen who wants to quit using SPESs. Many teens involved with a teen who wants to quit using SPESs. Many teens that stop using steroids experience severe depression and suicidal that stop using steroids experience severe depression and suicidal thoughts. A medical or mental health care professional can help thoughts. A medical or mental health care professional can help teens work through these feelings safely and win back their sense teens work through these feelings safely and win back their sense of well-being. of well-being.

Excerpt from the Healthy Competition web site http://www.healthycompetitiontn.org/coaches/talking_tips.shtm

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Resources for Talking to Resources for Talking to StudentsStudents

National Institute for Drug Abuse (NIDA) http://teens.drugabuse.gov/parents/index.php

Substance Abuse and Mental Health Services Administration (SAMHSA) http://family.samhsa.gov/be/athblocked.aspx

Office of Juvenile Justice and Delinquency Prevention (OJJDP) – Coaches Playbook Against Drugs http://www.ojjdp.ncjrs.org/pubs/coachesplaybook/

Healthy Competition – Blue Cross/Blue Shield of TN http://www.healthycompetitiontn.org/coaches/classroom.shtm

Additional resources can be found on the Oregon Department of Education web page at http://www.ode.state.or.us/search/page/?id=2569

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Anabolic Steroids and Anabolic Steroids and Performance-Enhancing Performance-Enhancing Substances PreventionSubstances Prevention

Least Effective MethodLeast Effective Method::– Simply teaching students about steroids’ Simply teaching students about steroids’

harmful effects does not convince harmful effects does not convince adolescents that they personally will be adolescents that they personally will be adversely affected. adversely affected.

More Effective Method:More Effective Method:– Presenting both the risks and benefits of Presenting both the risks and benefits of

steroid use is more effective in convincing steroid use is more effective in convincing adolescents about steroids’ negative adolescents about steroids’ negative effects, because they find a balanced effects, because they find a balanced approach more credible and less biased. approach more credible and less biased.

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Anabolic Steroids and Anabolic Steroids and Performance-Enhancing Performance-Enhancing Substances PreventionSubstances Prevention

MOST EFFECTIVE Method:MOST EFFECTIVE Method:– Science-based, research-based Science-based, research-based

curriculum with predictable outcomes, curriculum with predictable outcomes, combined with credible, unbiased facts.combined with credible, unbiased facts.

3939

Prevention Programs Prevention Programs That Typically FailThat Typically Fail

““Just Say No” campaignsJust Say No” campaigns Scare tacticsScare tactics Knowledge-only Knowledge-only

programs and pamphletsprograms and pamphlets ““One size” fits all not One size” fits all not

specifically focused on an specifically focused on an age or genderage or gender

Primarily adult lecturersPrimarily adult lecturers

4040

Evidence-Based ProgramsEvidence-Based Programs

Team programs for boys and girls proven Team programs for boys and girls proven to workto work

4141

Evidence-Based ProgramsEvidence-Based ProgramsATLAS ATLAS (Athletes Training & Learning to Avoid (Athletes Training & Learning to Avoid Steroids)Steroids)

• Male athlete program, taught by peer (squad) Male athlete program, taught by peer (squad) leadersleaders• Reduces anabolic steroids, alcohol, illicit drugsReduces anabolic steroids, alcohol, illicit drugs• Lowers drinking and drivingLowers drinking and driving• Reduces supplement use Reduces supplement use • Improves exercise and nutrition behaviorsImproves exercise and nutrition behaviors

ATHENAATHENA (Athletes Targeting Healthy Exercise & (Athletes Targeting Healthy Exercise & Nutrition Alternatives)Nutrition Alternatives)

• Female athlete program, taught by peer (squad) Female athlete program, taught by peer (squad) leadersleaders• Reduces steroids, alcohol and other drug useReduces steroids, alcohol and other drug use• Lowers supplement and diet pill useLowers supplement and diet pill use• Improves nutrition and exercise behaviors Improves nutrition and exercise behaviors (Endorsed by the National Football League, Sports Illustrated, U.S. Department of Education, (Endorsed by the National Football League, Sports Illustrated, U.S. Department of Education, and The U.S. Department of Health & Human Services)and The U.S. Department of Health & Human Services)

4242

Additional ResourcesAdditional Resources Parent informational letter – The Mayo Clinic

http://www.mayoclinic.com/health/performance-enhancing-drugs/SM00045

Teen Health – Are Steroids Worth the Risk http://kidshealth.org/teen/food_fitness/sports/steroids.html

US Drug Enforcement Administration http://www.usdoj.gov/dea/concern/steroids.html

National Institute on Drug Abuse (NIDA) http://www.nida.nih.gov/Infofacts/steroids.html

Additional resources may be found on the Oregon Additional resources may be found on the Oregon Department of Education web site at Department of Education web site at http://www.ode.state.or.us/search/page/?id=2569

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AcknowledgementsAcknowledgementsThe “Myths” page contains a list (not inclusive) gathered from the following sites: – Association Against Steroid Abuse - Steroid Myths

http://www.steroidabuse.com/steroid-myths.html – Bodybuilding – The Myths and Dangers of Anabolic Steroid Usage

http://bodybuilding.about.com/od/supplementationbasics/a/steroiddangers.htm – Roid Report http://www.roidreport.com/steroids/steroid-myths/

Special thanks to Dr. Linn Goldberg for the use of his slides and to all the representatives from the many Health, Physical Education, and sports organizations that volunteered their time to help develop this training.

Information from the following articles has been included in this presentation:– NIDA InfoFacts – Steroids (Anabolic-Androgenic) March 2007

http://www.nida.nih.gov/Infofacts/steroids.html – Addiction Intervention web site – Steroid Prevention

http://www.addictionintervention.com/addiction/steroidprevention.asp – Kids Health web site – Steroids

http://kidshealth.org/kid/exercise/safety/steroids.html – American Academy of Pediatrics web site – Teen Q&A Steroids

http://www.aap.org/publiced/BR_Teen_Steroids.htm – Healthy Kids Learn Better/ODHS – Steroid use among Oregon Youth

http://www.oregon.gov/DHS/ph/ah/cshp/cshp.shtml

Please note the inclusion of external web links in this document does not imply endorsement of either the reliability of the information presented or its suitability for a particular age group or grade level.Updated 8/25/2009

4444

Online AssessmentOnline Assessment

After completing this training please After completing this training please access the Anabolic Steroids and access the Anabolic Steroids and Performance-Enhancing Substances Performance-Enhancing Substances Assessment here Assessment here ((http://www.surveymonkey.com/s.aspx?sm=r1HRuNFwRnTcXsLVyaF5Yg_3d_3d).).

After your assessment has been After your assessment has been completed a completion certificate will be completed a completion certificate will be sent to you.sent to you.