'Roid rage: districts' latest drug problem doesn't involve getting high, but getting stronger. Learn how steroids are infiltrating high schools and what districts are doing to stem the abuse.

Thanks to Major League Baseball, anabolic steroid use and abuse is once again in the news. In his State of the Union address this January, President Bush called for legislation against steroid abuse in professional sports (federal laws against steroid use have been in place since 1990). In April, a bill called the Drug Free Sports Act that would regulate steroid use in professional sports began wending its way through Congress. And in May, California passed a law that requires teen athletes and their parents to sign an anti-steroid pledge. The leap from tightening steroid controls on the pros to tightening steroid controls on the young shouldn't surprise anyone in the education community. Kids, especially athletes, are increasingly "on the juice," and lawmakers, parents and educators are worried.

"School systems are getting hammered with having to come up with rules," says Jon Almquist, Fairfax County Public School Athletic Training Program Specialist and National Athletic Trainers Association Task Force Chair. Education about steroids is, he says, the only way to reach the greatest number of kids and stem the abuse. Detection and testing alone aren't going to cut it. The task force lobbied to get $15 million in federal funding for education as well as testing onto an expansion of the existing antisteroid law passed in 2004. But even getting that amount of money set aside, he says, is "like chipping away at an iceberg."

The National Institute on Drug Abuse funds the University of Michigan's Monitoring the Future project, an annual survey since 1975 of 50,000 high school students around the country. From 1998 to 1999, the number of 10th graders who admitted to using steroids jumped from 2 percent to closer to 3 percent, and the perceived risk of steroid use slipped from 68 percent to 62 percent. In 2004, the number of high school seniors who report using steroids at least once is 3.4 percent. If you think of the hundreds of kids playing high school sports in any given district and then imagine that three or four out of every hundred, on average, have used steroids, there's cause for concern.

Steroid use and abuse has been around for a long time, even among high school students. Almquist remembers the last time there was a big flare-up of steroid abuse in high schools. It was in the mid-80s when, he says, there was the first increase of kids experimenting with steroid use. "Kids knew they couldn't get caught," says Almquist, "so they used them." At the time, the abuse was eradicated by a two-pronged attack: vigorous education about the possible side effects and long-term health concerns plus mandatory blood pressure checks before games and practices. Since the kids were made well aware that higher blood pressure--a sign that something, possibly digestible anabolic steroids, may in their bodies--meant restricted participation, a phone call home, and possible suspension, they stopped using.

Now, says Almquist, kids are using for a variety of different reasons, and once again they have little fear of getting caught. "The supplements issue has boiled over everything," he says. Protein powder, ephedra, and other non-FDA-regulated "supplements" that may or may not contain steroids are readily available at stores like GNC. Kids who aren't athletes are experimenting and becoming what Almquist calls "mirror athletes," individuals who become so obsessed with their own looks that they spend hours in the gym gazing at their physique in the mirror instead of working out or playing a sport. Unlike drugs and alcohol, steroids aren't about getting high, having fun and partying; in this case they're about making yourself physically and therefore sexually attractive. For the kid who is truly an athlete and is in a position to be recruited for college-level sports, the pressure to "beef up" can be intense. In some cases, coaches and even parents could be encouraging the idea that in order to compete, an athlete has to be bigger, stronger and leaner. And that makes supplements and steroids look mighty tempting.

Damned If You Do 

Steroids are ridiculously easy to obtain. Just like any other popular and quasi-illegal substance, you just have to know where to look. The Internet is stop No, 1; south of the border is second. Friends and even coaches will share recipes for bulking up and burning fat. And when the high-achieving sports superstars who are serving as role models for young athletes are "on the juice," who are parents and teachers to say that steroid use is wrong? Even the governor of California can go on television and admit that when he was a body builder he used steroids (they were legal then), and in the same breath tell kids not to take drugs.

To keep kids from trying steroids, says Carleton Kendric, family therapist and the author of Take Out Your Nose Ring, Honey, We're Going To Grandma's, you have to hit them where they live. "Appeal to their vanity," he says. When talking to kids about smoking, showing them a blackened and diseased lung might gross them out but they aren't going to believe that could happen to them some time in the future. "You have to make it personal and immediate. The "you're going to die" approach doesn't work. Almquist agrees. "You shouldn't say to 16 year olds, 'you could die in a car accident if you drive too fast.' You say, 'you could lose your license and not be able to drive at all for two years.' That's an immediate and, to them, a more horrible consequence." When discussing steroids, once you tell kids that steroids can give them tiny testicles and "acne up the ying-yang," you've got their attention.

Damned If You Don't

The real problem with steroids, Kendric readily admits, is that they are effective. "All drugs are taken for one reason: they work. Steroids work so damn fast and so damn well it's almost like you can see the muscles growing from week to week. That's seductive." Boys are looking at models on magazine covers and saying, "I want to look like that," with six-pack abs and a well-muscled chest. They're using steroids to achieve sexual attractiveness. So are girls. In low doses, steroids can act as a diet drug, causing the body to lose fat, gain muscle, getting a girl "ready for bathing suit season" and again, enhancing her sex appeal. The look that girls are going for, either the "unnaturally thin with fake boobs that defy gravity look or the improbably tight, lean, toned, athletic look," they can achieve with steroids without the kind of discipline and effort it would take otherwise. "You get more of what a weight-trained athlete gets, fast. This stuff works." And in greater doses and in combination, it works even better. "If you become a little chemist and start stacking [using multiple drugs at higher dosages], the sky's the limit."

You can also, of course, crash and burn. "You can get very negative side-effects within weeks," Kendric says. It's important to be honest with teens--not everyone experiences negative side effects from steroids. "It is legitimate and honest to say you may be one of the ones without side effects. But you have to make it clear that it's like Russian roulette." One user could be lucky, while another could be covered in zits. What's in the steroids they're taking is unpredictable as well. Products purchased over the Internet can come from anywhere, can contain all kinds of fillers and unknown materials, and may not even contain the substance the user believes he or she has purchased. "People lie," says Kendric. "You don't know what is in what you're taking. We don't know what these drugs can do to you over your lifetime. You have to ask kids, 'Do you want to be part of a long-term guinea pig study?'"

Run For The Border

Mexican drugs are a lure to kids in the border states, especially in Texas, where high school sports are something of an industry. "It's worse for us here in the valley," says Chris Ardis, a high school teacher and weekly columnist in McAllen, Texas, a town in the Rio Grande valley. "You can go across the border to a pharmacia in 15-20 minutes. It's that accessible." Ardis has had students tell her that the counter help in a Mexican pharmacy will offer to inject substances on the spot. While other drugs may merit just as much time and energy spent on education and prevention--the list of what teens can experiment with boggles the imagination--"the fact that even one kid committed suicide on steroids is enough to make it a concern."

Interestingly, economics plays a role in steroid use. Troy Mott, offensive coordinator for the Napa (Calif.) High School varsity football team, knows how easy it can look to get steroids over the Internet, but in reality, it's expensive. "Most kids don't have the means to buy cycles of steroids," he says. "We have way more problems with over-the-counter supplements." Kids shop at their local GNC for "supplements" that will supposedly help them grow bigger. "We steer them away from creatine and all that," says Mort, by talking to the kids about proper nutrition and the safest way to build muscle and lose fat. "Creatine is hard on the liver and kidney--that's not the way to be a good athlete."

Education is key to preventing kids from trying steroids in the first place. "An athletic trainer can tell you there's a health risk" with any steroid use, Almquist says, but engaging in risky behavior is often the hallmark of being a teenager. The medical community's recommendations, unfortunately, don't carry a lot of weight with kids, especially in this case. "Doctors tried to say, 'Steroids don't work,' when they clearly do," says Almquist. "Now they're saying, 'Steroids work but they're bad for you,' and kids won't listen." Coaches and athletic trainers have to learn from the "mistakes of the medical community" and emphasize that the health of the athlete comes first by laying out the facts:

* Used appropriately, steroids are a safe drug, just as opiates, when prescribed for pain by a doctor, are safe and effective.

* Anything used without control and in excess is bad for you

* Steroid use is cheating. It gives an unfair advantage to some while leaving others out.

Proper training of coaches is a big first step, one that the national task force is working on. Laws need to be passed that make distribution of anabolic steroids illegal, and parents, teachers and students have to be educated on the risks and warning signs of steroid abuse.

The California Interscholastic Federation, the governing body of high school sports in California, has instituted a series of rules that any high school that wishes to stay in the CIF fold will have to follow. Barbara France, principal at Napa Valley High School in Napa, Calif., is happy that CIF is taking the lead in formalizing a steroid policy. Now, student athletes at Napa High and their parents are required to sign a piece of paper that specifically bans them from using steroids. "Having language in there specific to steroids gives our policy teeth," says France. "It gives us a platform to speak from" when dealing with the parents. There is no drug testing in place at Napa High; France doesn't see the need, and couldn't afford it anyway. Health education that contains a unit on steroids and close communication with the student body, she says, should do the trick. Coaches who may not have sufficient training in recognizing steroid use will be brought up to speed: beginning in 2008, CIF will require a coaches' training program that includes education on recognizing steroid abuse.

Healthy Dose of Self-Esteem

Kendric would like to see drug abuse discussed at an earlier age, since for him part of combating abuse is creating a healthy sense of self-esteem. "Some people want to be the star so badly," he says, "that they risk harming their body." As a society, we have a "passion for excelling and winning," says Almquist. "We created it, now we have to deal with it." Parents expect the school to step in to educate, stop steroid abuse, and create testing that will eradicate steroid users. But, Almquist says, parents are the first to object when it is their child caught using. "Kids get it. Kids like the rules to be enforced, but they don't always admit it." Laws against steroid use--state and federal laws are on their way--are a "good concept" because they force the issue, but the use of extreme punishments like a two-year suspension (proposed in some current legislation) could ruin lives, not save them.

"You have to define 'caught using steroids,'" Almquist says. What he can see happening is a situation where schools turn a blind eye to abuse because they can't afford the process of verifying and following through on the accusation. "If you are obligated to test you're also obligated to prove, so you never make an accusation because the process [of proving abuse] is so huge, cumbersome and expensive." Assuming that randomized testing and laws against steroid distribution are in place, Almquist recommends a policy that punishes first-time offenders without wrecking their careers. "Making mistakes is part of growing up; we have to expect kids to make mistakes." First offenders would receive a 30-day suspension from sports and mandatory counseling. A second offense, however, would merit stiffer penalties. "Then you throw the book at them," says Almquist.

Education should focus on lifelong good health first rather than coming in after the fact to tell kids that what they may already be doing is bad for their health. "It is my hope," says Kendric, "that a fuller exploration of this complex issue develops."

For Ardis, teaching all members of the school community how to recognize steroid use is the key to stopping it. "They have the marijuana talk at our in-service every year," she says. "If there's one thing I know it's how to recognize marijuana use. I would hate to think that there is a child using steroids right under my nose and I wouldn't know."

Pros and Cons 

Education about steroids and even mandatory testing isn't going to eradicate the problem if at higher levels of competition steroid use is condoned. Almquist asks rhetorically, "Do the pros have an influence? Darn right they do." Professional sports have a responsibility to make the ramifications of steroid use significant. "Major League Baseball's policy is a joke. The NFL's program is more effective." All the I didn't do it" testimony on the news every night sends kids the wrong message as well. "Kids learn there's a way out of everything instead of learning to be responsible for their actions." They also know that certain drug screens catch only certain drugs; tests have to be made specific for steroids in order to be effective.

Maybe, slowly, things are changing. On May 12, Major League Baseball gave 15-game suspensions to 11 minor league players. All 11 tested positive for steroids. Giants manager Felipe Aloud was quoted in the San Francisco Chronicle as saying, "I believe they should test kids when they sign.... If you test positive, we won't sign you. No million-dollar bonus." Maybe if the big boys start to play by the rules, the kids who admire them and want to be like them will, too.

What Are Steroids?

Anabolic steroids are a man-made chemical similar to naturally occurring testosterone, the male sex hormone. The term anabolic means growing or building, in this case, growing or building muscle.

Steroids are prescribed in low doses for conditions that require a boost to the body's ability to produce muscle, like during recovery from a severe accident o debilitating illness.

Possible Side Effects Of Steroid Abuse

Ironically, this drug that is supposed to make you big and strong can actually create a smaller person. If an adolescent is taking steroids before he or she is finished growing, the steroid use can cause the bones to fuse instead of grow further and permanently stunt one's growth.

Boys can experience:

* Aggression, volatility

* Testicular shrinkage

* Breast development

Girls can experience:

* Irregular periods 

* "Male" pattern baldness

* Facial hair

* Voice changes (deepening)

Both boys and girls can experience:

* Rages

* Severe acne

* Higher blood pressure

* Suicidal feelings

* When strengthening muscles too fast, bones and tendons can't keep up, which can cause strains and even breaks

Long-term risks:

* Liver tumors

* Infertility

* Cancer

* Jaundice 

* High blood pressure

Resources

www.aap.org

www.cdc.gov

www.nata.org

www.nida.nih.gov

www.steroidabuse.org

Elizabeth Crane is a contributing editor.