USADA’s Chief Science Officer, Dr. Matthew Fedoruk, discusses the importance of ethics when young athletes face pressure to dope and  identifies the warning signs of performance-enhancing drug use.

Learn more about Dr. Matt Fedoruk.

When it comes to how success is achieved, there’s also no question that young athletes are very much influenced by those around them. In addition to parents, athletes are often influenced by coaches, trainers, medical support personnel, professional sports idols, and their peers.

Young athletes exposed to the win-at-all-costs attitudes of others are susceptible to adopting the behaviors that go along with that climate, and in some cases, may even be directed to abuse substances. These substances can enhance performance and violate the rules of sport, but more importantly, they can lead to devastating physical and mental effects.

As parents, it’s important to evaluate the influencers in your athlete’s life and be aware of substance abuse warning signs. Here are three red flag phrases that might indicate your athlete is in a risky situation or facing pressure to dope.

1. “Everyone does it.”

The phrase “everyone does it” has been used to justify doping for decades at all levels of sport, from high schools to the Tour de France. This reasoning can result from exposure to PED abuse by peers, as well as the many examples of professional athletes who’ve found success through shortcuts.

Unfortunately, the life-threatening impact of this mentality is evidenced by the story of Taylor Hooten, one of the most well-known examples of a student athlete whose quest for success through steroid use led to the worst possible outcomes, including physical effects like back acne and rapid muscle growth, as well as mental effects like depression and aggression, and finally, suicide.

Taylor sourced the steroids from a local gym, and even in 2003, before widespread internet use made substances even more accessible, Taylor’s close friend Billy Ajello told the New York Times that steroid use was “extremely widespread” at the boys’ high school before Taylor’s death.

In addition to the “everyone does it” mentality among peers, Ajello believed that students construed mixed messages from coaches. ”Coaches don’t come out and say, ‘Take steroids,’ ” Ajello told the New York Times. ”Freshman, sophomore, junior year, they tell you you’re too small. A kid thinks high school sports are everything: ‘I have to take it to the next level to get bigger and stronger to play.’”

He also noted, “I think the coaches know and almost kind of turn their heads. I think if they knew for sure, certain coaches would pull a kid aside and say, ‘What are you doing?’ I think other coaches would turn their heads, and even if they knew wouldn’t say anything to a kid.”

As the TrueSport Report further confirms through national research and data, “High school and college coaches who turn the other way on bad or delinquent behavior (e.g., drinking, violence off and on the field) are sending a strong signal that such behavior is acceptable.”

2. “It’s for their health or benefit.”

In some cases, the pressure to dope may be more forceful and come directly from a person of influence in an athlete’s life. If an authority figure – whether it be a coach, medical professional, or parent – encourages an athlete to dope, it’s extremely unlikely that the athlete will be able to resist or even realize that they are doing anything wrong because their sense of security and understanding of right and wrong is frequently dependent upon the adults around them.

These trusted authority figures may also attempt to justify the behavior by insisting that a pill or treatment is necessary to protect the athlete’s health, is required for inclusion in a training group, or is the only way to achieve success. An authority figure may also insist that an athlete hide their use from friends, family, and other adults because they wouldn’t understand, which can alienate the athlete from positive influencers while further uniting the athlete with a negative influencer.

There are many examples of authority figures directly facilitating doping behaviors by young athletes, but one of the most egregious may be the case of Corey Gahan, whose own father, a trainer, and an alleged medical provider arranged for him to receive increasingly risky injections to improve his in-line skating performance . It started with b-12 vitamin injections when he was 12 and quickly escalated to testosterone and hGH injections.

“Both his father and his trainer, Corey says, assured him that the shots were for the best,” according to a Sports Illustrated article. “The prick of the needle was accompanied by a pinch of guilt; it felt, as Corey puts it, ‘like I was doing something wrong.’ But he believed in his dad, a charismatic and fiercely ambitious former high school wrestler. He also trusted his trainer, a bodybuilder who acted like a big brother. Besides, what did Corey know about the substances being injected into his body? ‘Testosterone cypionate, it’s just a word,’ he says. ‘It doesn’t have a meaning. At least not when you’re 13.’”

By 16, Corey was breaking records at top competitions and testing positive for testosterone and another steroid. While his reinstatement from a two-year ban hinged on acceptance of counseling and a medical evaluation, Corey’s father, trainer, and the false doctor were under investigation and went on to receive jail time for their crimes.

“This case shows the extent to which drugs have infiltrated youth sports,” said U.S. Anti-Doping Agency CEO Travis T. Tygart to Sports Illustrated at the time. “It was hard to punish this kid. Yes, he cheated and unfairly beat other competitors, but he was under his father’s influence. The kid was a victim.”

3. “Don’t worry, it’s safe.”

Sometimes, there is also risk from trusting an influential person even when that person respects the athlete’s health and wellbeing, as well as the rules of sport. This is especially true in today’s climate of rampant supplement use and radical health trends to support and enhance performance. But with supplements regulated pre-market and wellness clinics offering treatments banned in sport, there are many opportunities for exposure to prohibited and potentially dangerous substances, even when assurances are provided that a product or treatment is safe.

Unfortunately, a recent case involving a young and up-and-coming weightlifter illustrates this risk. Abby Raymond was just 14 years old when a family friend and fitness influencer offered her a protein powder and a pre-workout supplement from his newly formed company. The family friend assured Abby that his company’s products were plant-based, vegan, and made from all-natural ingredients. Excited about the sponsorship opportunity but recognizing the risk that supplements pose, Abby’s father pointed out that she was subject to anti-doping rules, so the products would have to be completely free of prohibited substances. This concern was met with further assurances by the family friend and company owner that the supplements were safe. After just weeks of using the supplements, Abby had an anti-doping test and soon learned that she had tested positive for ostarine, a prohibited anabolic agent that’s not approved for human use or consumption anywhere in the world. Later testing confirmed that the supplements were contaminated, to the family friend’s surprise, but Abby still received a period of ineligibility from sport and devastating damage to her reputation.

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Remember, young athletes are vulnerable to the influence of trusted authority figures and their peers, so it’s important to stay alert for signs of a win-at-all-costs environment, including the red flag phrases and situations above. To learn how to support clean and healthy decisions, visit our Clean Sport Lesson.

Not all users look like bodybuilders, and especially given how much we now know about effective sport nutrition and training, putting on lean muscle quickly isn’t necessarily a sign of steroid abuse. Instead of just one telltale sign, learning that a teen is taking something they shouldn’t will likely come through a combination of clues. What makes this especially difficult is that many of these symptoms often coincide with symptoms of simply being a teenager.

But, knowing what to look for can help you separate the odd physical occurrence or two from a larger issue at hand, allowing you to then address the situation and get help for the athlete.

Physical Symptoms

There are many different types of steroids, but the ones most think of when they hear the term (and the ones banned in sport) are anabolic-androgenic steroids (AAS). In addition to stimulating rapid muscle growth and allowing for quicker recovery times, AAS users can also exhibit:

• Especially greasy skin or hair
• Stretch marks
• Acne breakouts on shoulders and back (often red or purple in color)
• Thinning hair, receding hairline, or hair loss
• Jaundice or yellowing of the skin
• Swollen feet or lower legs
• Continuous body odor or bad breath
• Skin infections, abscesses, and cysts
• Bloating in the face or body
• Urinating and/or vomiting blood
• Night sweats
• Abdominal pain
• Dizziness, trembling, nausea, or vomiting
• Shaking or trembling

Personality and Behavior Changes

Changes in appearance might be the most obvious hints of steroid abuse, but personality changes can also reveal just as much. Steroids’ effects on the body’s natural production of testosterone and estrogen can result in a wide array of emotions and behaviors:

• Aggressiveness and irritability
• Hyperactivity or lethargy
• Drastic and rapid mood swings
• Paranoia
• Insatiable hunger or loss of appetite
• Erratic sleep patterns (not sleeping or sleeping too much)

Internal Symptoms

There are also many changes hidden from the eye that can occur as a result of steroid use. Anabolic steroids are particularly stressful on the heart—in one study of the cardiac effects of anabolic steroids on 62 male powerlifters suspected of anabolic steroid use, the 12-year mortality rate was 12.9%, compared to 3.1% in the control population. Cardiac stress isn’t of course something that can be detected just by looking at an athlete, however the following symptoms can be by a medical exam:

• Blood clots
• High cholesterol
• Cholestasis (decreased bile flow from the liver)

Gender-Specific Changes

Symptoms of steroid use are not universal. Many warning signs are gender-specific, and like some of the internal changes, a parent or coach may only become aware of them if the athlete complains (or if a physician says something, in the case of a minor):

In men:

• Breast tissue development (gynecomastia)
• Male pattern baldness
• Shrunken testicles
• Decreased sperm count

In females:

• Decreased breast size
• Deepened voice
• Irregular periods
• Enlarged clitoris

What to Do If Your Teen Athlete Is Abusing Steroids

Should you reach the conclusion that a teen athlete is likely using steroids, there are several routes of action that can be taken. For many situations, an intervention and honest discussion about the effects of steroids is the best first step.

From there, it’s important to schedule a doctor’s appointment to determine if any long-term damage to their health has been done. A physician will also be able to prescribe ways to mitigate the damage of these side effects as well as how to better navigate any withdrawal symptoms. Meeting with a psychologist or counselor experienced with substance abuse can correct underlying attitudes and beliefs that may have led to using steroids in the first place.

If learning about the negative physical effects of steroid abuse is not enough to create a permanent behavior change, seek help through a specialized substance abuse program.

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References: http://teendrugabuse.us/effects-and-warning-signs-of-teen-steroid-use/

https://www.addictioncenter.com/stimulants/steroids/symptoms-signs/

http://www.anabolicsteroids.net/steroid-cycles.php

https://www.steroidabuse.org/information/steroid-abuse-among-student-athletes/

https://taylorhooton.org/anabolic-steroids/

https://www.livescience.com/3349-steroids-work.html

https://www.everydayhealth.com/liver-cancer/steroid-use-and-liver-cancer.aspx

https://www.wikihow.com/Stop-Your-Teen-from-Abusing-Steroids

How Kids Learn to Accept Doping

Research has identified a wide range of factors that influence how young athletes form their views on doping.

Causes of Success

An adolescent’s beliefs about the causes of success in sport influence their intentions to dope. Athletes who believe success or failure in sport is due to external factors (equipment, resources, etc.) are more likely to consider doping as an option. Particularly, a 2014 study by Barkoukis indicates a belief that deception (cheating or doping) is an accepted component of achieving success (e.g. “nobody wins without it”), or was already a factor in achieving success (e.g. “everybody else already does it”) is a good predictor of an athlete’s intent to use PEDs.

In contrast, athletes who believe effort and mastery of skills are the causes of success in sport are more likely to have negative views on cheating and doping.

Internal/External Locus of Control

A person’s locus of control is the degree to which that person believes he or she has control over the events and factors that determine outcomes in life. Kids with a high internal locus of control have a strong belief they can make decisions that shape the results they achieve. These kids are more likely to view effort and mastery as the causes for success in sport, and they have a greater ability to resist pressure to cheat.

Kids with a high external locus of control believe they don’t have the ability to make decisions and affect outcomes. When they don’t believe they have control over what happens to them, they also tend not to believe athletes in sport succeed because of effort and mastery, and hence are more likely to view deception and cheating as a likely and acceptable path to success.

Moral Disengagement

We have all seen people – perhaps our own kids – do something totally contrary to moral standards and find a way to justify the behavior. Psychologists refer to this behavior as moral disengagement.

A 2008 study by Lucidi includes a helpful list of justifications people use, saying, “One’s detrimental conduct can be evaluated as acceptable because:

• It serves socially worthy or moral purposes (moral justification).
• It is minimized or distorted by means of language (euphemism and convoluted language).
• It is compared with more flagrant inhumanities (exonerative comparison).
• It is removed from personal responsibility (displacement and diffusion of responsibility).
• Its social effects are misconstrued by ignoring, minimizing, and distorting the conduct’s harmful consequences (misrepresenting the harm).
• The responsibility of it is assigned to others or the victims (ascription of the blame).
• It strips the victim of any human quality (dehumanization).”

In Lucidi’s study, 762 Italian adolescents took assessment questionnaires related to their views on doping and then took behavior questionnaires 3 months later. The results aligned with international research showing PED use by adolescents is rare, but consistent at about 2% of adolescents (14% of adolescents used supplements during the same period, which was also consistent with other studies). The assessment questionnaires included questions asking how participants would act in hypothetical moral dilemmas, and how and whether they would justify decisions that broke the rules. They found adolescents who expressed greater moral disengagement – like adolescents who agreed with the statement “In comparison to the damaging effects of alcohol and tobacco, the use of illicit substances is not so bad.” – were more likely to be in the 2% who ended up taking PEDs.

How Parental Behavior Encourages Doping

Parents have a lot of influence over the factors that influence kids’ views on doping, and consequently, how likely they are to take PEDs. What’s important to note is that it’s not just your direct views on PEDs that matter. You may be vehemently against performance enhancing drugs, but inadvertently encouraging their use through your other interactions with your kids. Here’s how.

Pressure to Be Perfect

A 2015 study by Madigan examined the effect of perfectionism on attitudes toward doping in junior athletes, and found that of four aspects of perfectionism in sport – perfectionistic strivings (own desire to strive for perfection), perfectionistic concerns (own desire to avoid mistakes), parental pressure to be perfect, and coach pressure to be perfect – only parental pressure had a direct positive effect on junior athletes’ attitudes toward doping.

In contrast, perfectionistic strivings and coach pressure to be perfect had negative effects on athletes’ attitudes toward doping. The latter may seem strange, but the study found that coach pressure increased athletes’ own desire to perform at their best (increased perfectionistic strivings), and that increased perfectionistic strivings led athletes to have a more negative attitude toward doping.

What does this mean for parents? Try to encourage young athletes to want to improve performance for their own benefit (mastery of skills). Praise effort and progress, rather than putting pressure on kids to be perfect in your eyes. To prevent kids from feeling excessive pressure to avoid mistakes, or that you’ll be disappointed in them for making mistakes, praise effort and reframe mistakes as opportunities for growth and learning.

Moral Disengagement

Your moral compass plays a large role in establishing your child’s moral compass. The more parents find ways to justify moral disengagement, the more our children learn to justify breaking the rules. Even if you are against performance enhancing drugs, your willingness to disregard moral standards in other areas (praising elite athletes caught for PED use, cheating on taxes, breaking traffic laws, committing insurance fraud, etc.) can inadvertently lead your children to have more positive attitudes toward taking PEDs.

In the Lucidi study, kids who expressed greater moral disengagement had more positive attitudes toward doping, felt their families would be more approving of them using doping products, and were more likely to be in the 2% of participants who took PEDs during the 3-months after the assessment questionnaire.

Helicopter Parenting

Kids who believe they can control the decisions that affect their lives are less likely to have positive attitudes about doping and are more likely to resist external pressures to cheat. This means your child may be less likely to take PEDs if they believe they have ownership over, or at least genuine influence in, the choices that affect their lives.

When you fail to include your kids in decision making around activities and goals, you diminish their belief they can make decisions for themselves, and that makes them more likely to let someone else convince them to take performance enhancing drugs (or make other negative choices).

It’s tempting to believe only sports-obsessed hockey dads, soccer moms, or football families could be encouraging young athletes to take PEDs. The reality is there are more subtle ways parents may inadvertently encourage doping by the pressures we place on kids, our own justifications for breaking rules outside of sport, and our tendencies to make decisions for our kids rather than including them in those decisions.

References:

Vassilis Barkoukis, Lambros Lazuras & Haralambos Tsorbatzoudis (2014) Beliefs about the causes of success in sports and susceptibility for doping use in adolescent athletes, Journal of Sports Sciences, 32:3, 212-219, DOI: 10.1080/02640414.2013.819521

Fabio Lucidi , Arnaldo Zelli , Luca Mallia , Caterina Grano , Paolo M. Russo & Cristiano Violani (2008) The social-cognitive mechanisms regulating adolescents’ use of doping substances, Journal of Sports Sciences, 26:5, 447-456, DOI: 10.1080/02640410701579370

Daniel J. Madigan, Joachim Stoeber & Louis Passfield (2015): Perfectionism and attitudes towards doping in junior athletes, Journal of Sports Sciences, DOI: 10.1080/02640414.2015.1068441