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The media attention that steroids have received in recent months is good news and bad news for Minnesota parents. The good news is that the general public is much more aware of the dangers steroids pose to our youth. The bad news is that the revelation of steroid use in professional sports creates an implied legitimacy in the eyes of many young athletes.

Think about it: your teenager looks at these professional athletes and sees a celebrity, who seems to be in great physical shape, is performing superbly at his or her sport, and is making millions of dollars. Ironically, media stories about steroids may paint an appealing picture of the drug for aspiring young athletes'our sons and daughters.

Risks of abuse
Steroids are hormones that the body uses to cause physiological activity, such as growth or metabolism. Performance-enhancing steroids, sometimes referred to as anabolic or androgenic steroids, are synthetic versions of the male hormone testosterone. Synthetic derivatives of natural steroids have many valid medical applications, such as treating asthma, skin disorders, impotence, osteoporosis, breast cancer, and inflammation. When taken under a doctor's supervision and in prescribed doses, steroids are not typically harmful. However, individuals using steroids for their performance- enhancing qualities are taking doses 10 to 100 times higher than would ever be prescribed.

It is through sustained use at these high doses that long-term health consequences can occur. Some of the long-term health risks are heart disease, high blood pressure, liver or kidney tumors and even cancer, adverse psychiatric effects, and infection (HIV or hepatitis) from sharing needles.

Putting it in perspective
Steroid use by high school students has been on the rise since the early 1990s. The Youth Risk Behavior Surveillance, conducted by the Centers for Disease Control and Prevention (CDC) in 2003, found that 6.1 percent of high school students (grades 9'12) nationwide had used steroids without a prescription one or more times in their lifetime. With 17.1 million students enrolled in high school, that is over 1 million kids in the U.S. experimenting with steroids.

When we think of steroids and high school students, we probably think of football players and wrestlers. What the CDC study shows is that the highest groups for steroid use are Hispanic males, at 7.8 percent, and ninth-grade females, at 7.3 percent. Bodybuilding athletes may be the obvious users, but more adolescents are turning to steroids as a means of dealing with their own body image issues. Comparing steroid use with other teenage risk behaviors, the CDC survey found that:

* Motor vehicle crashes remain the No. 1 cause of death among adolescents.

* 74.9 percent of high school students had had at least one alcoholic drink during their lifetime, and 28.3 percent showed episodic heavy drinking.

* 58.4 percent of high school students had ever tried cigarette smoking, and 3.1 percent smoked more than ten cigarettes a day.

* 34.3 percent of high school students had had sexual intercourse during the three months preceding the survey, and 4.2 percent had ever been pregnant or gotten someone pregnant.

* 8.5 percent of high school students had attempted suicide at least once in the 12 months preceding the survey, and 6.1 percent of high school students had carried a gun on at least one of the 30 days preceding the survey.

Legal aspects
Much like the current visibility provided by the media attention to steroids in baseball, the attention on steroids was highlighted by the stripping of Ben Johnson's Olympic gold medal during the 1988 Olympic Games. This was one contributing factor to heightened interest by Congress and the subsequent passage of the Anti- Drug Abuse Act of 1988, which categorized the sale or possession of anabolic steroids as a felony. The publisher's sale of this reprint does not constitute or imply any endorsement or sponsorship of any project, service, company or organization.

Following the BALCO (Bay Area Laboratory Co-operative) investigation, which involved a controversial sports nutrition center in Burlingame, Calif., that allegedly provided anabolic steroids and other banned performance-enhancing drugs to athletes, Congress once again turned its attention to steroids. The Anabolic Steroid Control Act of 2004 increased the list of banned substances and included steroid 'precursors.' Precursors are not steroids outside of the body; however, they can be metabolized into steroids once they are introduced into the body.

Warning signs
So, how do you tell if your teenager is using steroids? While there are a number of signs to watch for, parents sometimes overlook the most obvious one: rapid muscle growth. It is not uncommon for a user to gain 20 to 30 pounds of lean muscle mass in one month's time while abusing steroids. Other visible signs of steroid abuse are acne, which can become severe and show up in unlikely areas such as the back or chest; jaundice; and hair loss. In addition, females may experience deepening of the voice, growth of facial and body hair, and reduction in breast size, while breast growth (gynecomastia) occurs in males.

Changes in behavior also can be an indicator of steroid use. Your child may exhibit a new-found fixation with working out and with body image. Side affects include increased aggressiveness and sexual desire from higher testosterone levels, as well as euphoria, confusion, sleeping disorders, pathological anxiety, paranoia, and hallucinations. Users who become dependent on the drug may experience symptoms of withdrawal after cessation that include aggressive and violent behavior, mental depression with suicidal behavior, mood changes, and, in some cases, acute psychosis.

Talk to your child
If you are not sure that your child is using steroids and you just want to talk to him or her about the drug, remember to keep it simple. Discussing the long-term health risks, such as cancer and heart disease, will mean little to teenagers, who can't imagine becoming older than 30. Teenagers live in the here and now, so the aspects of steroid use that will get their attention are the superficial effects. Even with a great physique, it's tough to look attractive when you are a female growing facial hair or have severe acne.

When talking to your child about steroids, be prepared to discuss other matters that might cause a child to be tempted to take the drug. Be ready to discuss the pressures your child may be dealing with in competitive sports or in self-esteem and body image issues. It is important to stress, in words and in your own behavior, positive alternatives that encourage a healthy lifestyle.

Intervention
Intervention can help to prevent abuse and to end abuse once it has become a problem. There are two basic types of intervention: active intervention, which deals with individuals who have a substance abuse problem; and proactive intervention, which prevents abuse.

The only science-based education programs that have been proven to prevent steroid use are ATLAS (Athletes Training & Learning to Avoid Steroids) and ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives). ATLAS is targeted at preventing steroid use by male high school athletes; ATHENA deters body-shaping drug use and disordered eating among adolescent females. Both programs use good nutritional behaviors and proper exercise technique as alternatives to these risky behaviors. ATLAS has been recognized by SAMHSA (Substance Abuse and Mental Health Services Administration) as a 'model program' and by the U.S. Department of Education's Safe and Drug-Free Schools as an 'exemplary program.' In addition, both ATLAS and ATHENA are the only preferred programs mentioned in the Anabolic Steroid Control Act of 2004. According to Oregon Health and Science University's Linn Goldberg, M.D., principal investigator of ATLAS, 'Young developing bodies are likely more sensitive to the adverse health effects of steroids, some of which can be irreversible, such as the stunting of height in males and voice and body-facial hair changes in females.'

As parents, encourage your child's school to investigate these programs. If your child is already using steroids, an active intervention is designed to motivate an individual to accept help. If unable to act upon an active intervention, professionals are available to assist you.

The most important aspect of intervention is the recurring theme, 'We see you are struggling, we love you, we are concerned for you, and help is available today.' When parents discover that their children are using steroids, they have two options: do nothing or get involved. Denying or ignoring the problem of steroids will not make it go away. When it comes to children and steroids, the only real option is to get involved and stay involved.