Psychological Characteristics of Adolescent Steroid Users

Article excerpt

While anabolic-androgenic steroids have been used since the early 1950s to enhance athletic performance, the incidence of use appears to have increased considerably in recent years (Buckley et al., 1988; Duda, 1988; Johnson, Jay, Shoup, & Rickert, 1989; Nightingale, 1986; Office of The Inspector General (OIG), 1990; Tierney & McLain, 1990; Windsor & Dumitru, 1989; Yesalis et al., 1989). Particularly disturbing is the increased frequency of their use among adolescents.

Although there are no definitive national statistics, the estimated incidence of use by adolescents in the United States ranges from 6.6% of male 12th grade students (Buckley et al., 1988; Johnson et al., 1989; OIG, 1990) to 11.1% of male 11th grade students (Johnson, 1990). It has been estimated that at least 700,000 high school students use anabolic steroids (Tierney & McLain, 1990) and that at least two thirds begin use by 16 years of age (Johnson, 1990; OIG, 1990; OIG, 1990; Yesalis et al., 1989). Among both adults and adolescent steroid users, the majority increase the dosages, variety, and length of time drugs are taken while on a steroid use cycle (Neff, 1990; OIG, 1990). Many users also engage in a practice known as "stacking"; that is, using several steroids at once (Bohigian et al., 1988; Donohoe, Blackwell, & Johnson, 1986; Pope & Katz, 1988a).

There have been reports of addictive behavior and habituation among both adult and adolescent steroid users (Brower, Blow, Beresford, & Fuelling, 1989; Scott et al., 1990; OIG, 1990; Taylor, 1985; Yesalis et al., 1988), as well as reports of affective and psychotic symptoms, often characterized by impulsive, aggressive and violent behavior (Lubell, 1989; Pope & Katz, 1988a; Pope & Katz, 1990b).

Adolescent steroid users appear to be at special risk for many of the adverse psychological and physical consequences of steroid use (Nideffer, 1989; OIG, 1990). Recent literature clearly shows that adolescent users believe that steroids produce the physical effects they desire, and approximately 86% of those cited in the 1990 study of the OIG have no plans to stop using steroids. Nearly all the adolescent users interviewed in the OIG report (93%) stated that starting steroid use was a good decision (1990). Recent studies also indicate that many adolescent users are either unaware or unconvinced of negative physical and psychological effects of steroids (Dunsky, 1990).

The growing evidence of habituation among adolescent steroid users, and the powerfully reinforcing properties of the drugs, have created a pressing need for more information about the psychosocial characteristics of the adolescents who use these drugs. Such information would serve an important role in the development of effective intervention and prevention programs. Thus, the goals of the present study were to systematically assess a wide variety of psychosocial characteristics in both steroid-using and nonsteroid-using adolescents and to determine if any of these characteristics might prove useful in differentiating between these groups.

METHOD

Subjects

Participants in this study consisted of 72 male adolescents ranging in age from 16-19. Of these, 24 were self-identified as serious weight trainers or bodybuilders who reported using steroids and were currently either on asteroid use cycle or between cycles. Another 24 consisted of adolescents who identified themselves as serious weight trainers who reported no use of anabolic steroids. Serious weight training was defined as participating three or more times per week. The third group of 24 adolescents consisted of nonathletic, nonweight trainers who did not participate in competitive, organized sports. Only male subjects were chosen to control for the possible confounding effects of gender.

Both the athletic steroid user and nonuser samples were secured through the junior author's personal contacts with operators of various gyms in the South Florida area, through contacts with athletes at those gyms, and through contacts with athletes at bodybuilding events. The nonathlete, nonweight training sample was obtained through health education classes at a senior high school located in the same geographic area.

All subjects from the steroid user, and weight training nonuser groups were paid 10 dollars for their participation in the study. The nonathlete nonusers were paid 5 dollars for their participation. All subjects were offered feedback regarding the results and findings of the research.

Instrumentation and Materials

The Millon Adolescent Personality Inventory (MAPI) is a measure devised by Theodore Millon, based on his comprehensive theory of personality (Millon, Green, & Meagher, 1982). It is designed to measure personality styles salient to the teenage years and is geared to the sixth-grade reading level. The inventory consists of 150 items, which are completed by most subjects in approximately 20 minutes.

The MAPI yields scores on eight personality variables: introversive, inhibited, sociable, confident, forceful, respectful, and sensitive. Eight additional scales measure clinical issues: self-concept, personal esteem, body comfort, sexual acceptance, peer security, social tolerance, family rapport, and academic confidence. The final four scales of the MAPI measure behavioral correlates such as school-related attendance, school achievement, social conformity, and impulse control.

The Profile of Mood States (POMS) (McNair, Lorr, & Droppleman, 1981) is designed to measure transient, fluctuating mood states. It consists of 65 adjective rating scales. Subjects were asked to describe how they have been feeling during the past week. Subjects take approximately four minutes to complete the instrument. The POMS has been used extensively in studying mood variability in competitive athletes, including adult athletes who use steroids (Humbert, 1990).

The POMS measures six identifiable mood states: Tension-Anxiety (T); Depression-Dejection (D); Anger-Hostility (A); Vigor-Activity (V); Fatigue-Inertia (F); and Confusion-Bewilderment (C).

The POMS was used to assess the level of transient mood disturbance among adolescents who were using anabolic steroids. It was expected that the user group that was currently between steroid use cycles would display less elevation in POMS scores than would the user group currently on a use cycle.

Procedure

All interviews and ratings were conducted on an individual basis. The strong assurances of anonymity that were provided were critical to obtaining valid data, since the adolescent steroid user is engaging in an illegal activity which is currently listed under the Federal Controlled Substances Act (BonDurant, 1991).

Participants from each group were administered a brief personal background questionnaire, the MAPI, the POMS, and a structured interview, including asteroid knowledge test and questions about physical health symptoms reportedly associated with steroid use (e.g., sleep problems, gynecomastia, shrunken testicles). While participants in the steroid user group and the athletic nonuser group completed these materials, the junior author rated each participant on physical characteristics commonly associated with steroid use (e.g., acne, muscular density, muscular hardness). These ratings, as well as the steroid knowledge assessment, were made in an attempt to corroborate participants' self-reported use or nonuse of steroids.

The assessments were identical for all groups, except that no ratings of physical characteristics were made for nonathletes nor were any questions asked about personal steroid use. The nonathletes were questioned, however, concerning general knowledge about steroids.

Research Design

Data were collected on three groups: athletic steroid users, athletic nonsteroid users, and nonathletic nonusers. The three groups were treated as an independent variable. Dependent variables consisted of each of the scale level scores on the MAPI and the POMS, as well as individual item scores on the steroid knowledge test, item level scores on the physical characteristics and symptoms of steroid use test. A series of univariate one-way analyses of variance were used to examine between-group differences on each of the dependent variables. Due to the exploratory nature of the study, and the small sample size (n = 24 per group), the .10 probability level was adopted.

RESULTS

Overview

The results are presented in the following order: demographic information, personality characteristics, steroid use patterns, steroid users: on-and-off cycle, secondary hypotheses, steroid knowledge, and physical characteristics.

Demographic information. The mean age for the user group was 18.6, for the athletic nonuser group 17.9, and for the nonathletic nonweight training group, 15.8. The nonweight training group was significantly younger than the other groups (F = 39.27, p |is less than~ .0001). The younger age of the nonathletic group was due to the composition of the health classes from which this group was selected, and was a limitation of the study.

The subjects were 63% Hispanic, 1% black, 26% Caucasian, and 10% other ethnic groups. Except for the percentage of blacks (7%), these totals are representative of the demographics of the metropolitan area within which the study was conducted (Dade County Public Schools, 1990, p. 540). The user group contained the highest percentage of Hispanics, 75% with the nonathletic group the lowest at 54%.

Personality characteristics. Based on the anecdotal reports and the scant research literature, it was predicted that adolescent steroid users would score significantly higher on the following measures: (1) confidence, (2) forcefulness, (3) body image, (4) self-esteem, (5) short-term mood disturbance. To examine these hypotheses, a series of one-way analyses of variance were conducted.

On these a priori hypotheses, a between-group difference was found only on forcefulness (F(2, 68) = 3.083, p |is less than~ .05), which was significantly higher for steroid users than nonathletes (Fisher Least Significant Difference = 12.905, p |is less than~ .05). The mean score on forcefulness for the

athletic nonusers was between that of the steroid users and the nonathletes. Although a strong trend was evident, differences in scores between the athletic users and nonusers were not statistically significant.

One-way analysis of variance was used to explore between-group differences on all of the remaining personality and mood variables. Significant between-group differences were found on the following MAPI personality style measures: sexual acceptance (F(2, 68) = 3.083, p |is less than~ .08), impulsivity (F(2,68) = 3.248, p |is less than~ .05), and cooperativeness (F(2,68) = 2.678, p |is less than~ .007).

For both impulsivity and cooperativeness, comparison of individual group means showed significant differences between steroid users and nonathletes, with steroid users having higher levels of impulsivity (Fisher LSD = 13.687, p |is less than~ .05) and lower levels of cooperativeness (Fisher LSD = 13.552, p |is less than~ .05) than nonathletes. As with forcefulness, the means for impulsivity and cooperativeness for the athletic nonusers were between those of the steroid users and the nonathletes. Although strong trends were evident on beth of these variables, the differences between the athletic users and nonusers were not statistically significant.

Comparison of individual group means showed that compared to the nonathletes, the athletic nonusers possessed significantly higher levels of personal satisfaction with their sexuality and with their heterosexual relationships than did nonathletes (Fisher LSD = 10.689, p |is less than~ .05).

Steroid use patterns. Of the 24 users in the sample, 21% (n = 5) reported that they were currently on a cycle, 79% (n = 19) reported that they were not on a cycle, and 75% of the user group reported that they were either currently stacking or had stacked steroids during previous cycles. Of the five users currently on a cycle, all reported stacking on the current cycle. The mean amount of time for steroid use among the sample was 16.5 months, with a range from 2 to 48 months. The mean amount of time between cycles among steroid users was 4.2 months, with a range from zero to 18 months. Sixty-four percent of the users' steroid dosages were at what has been defined as moderate levels, and 18 percent were at both the low and high levels (Duchaine, 1989; Phillips, 1991). Of the five steroid users who were on a cycle at the time of the study, one was at a low dosage level, three were on a moderate level, and one was at a high level.

A total of 16 different steroids were used by the sample. In addition, one diuretic was used in conjunction with one subject's pre-contest preparation. The most commonly used injectable steroid was testosterone cypionate, with 16 subjects either current or past users. The most commonly used oral steroid was Anadrol, with six subjects either current or past users.

Steroid users: On-off cycle. A series of two-tailed t tests were conducted to examine differences between users currently on a steroid use cycle and those not currently on a cycle. Users currently on a cycle reported significantly higher levels of depression, anger, and vigor as compared to those not on a cycle (p |is less than~ .05 for all). In addition, total mood disturbance was significantly higher in users currently on a cycle (p |is less than~ .10).

Steroid knowledge. There were significant between-group differences, determined by using one-way analysis of variance, in levels of knowledge about anabolic steroids (F(2, 68) = 69.887, p |is less than~ .0001), with the steroid users demonstrating significantly higher levels of knowledge about anabolic steroids than did either of the other groups.

Physical characteristics. A series of group mean comparisons were performed to examine differences between steroid users and athletic nonusers. The steroid users had higher levels of bloating, gynecomastia, muscular density and hardness, shrunken testicles, and acne about the face, neck, shoulders, and back (p |is less than~ .05 for all).

DISCUSSION

The assessment of personality characteristics revealed that adolescent steroid users had significantly higher levels of forcefulness and impulsiveness and lower levels of cooperativeness than did nonathletes. On each of these measures, the athletes who did not use steroids (i.e., nonusers) scored between the steroid users and the nonathletes. Although strong trends were evident on each of these measures, the differences between the athletes who used steroids and the athletes who did not use steroids were not statistically significant. Thus, based on the present data, adolescent athletes who adopt steroid use appear to be relatively similar to other athletic adolescents in terms of personality. Given the strong trends that were evident, this conclusion merits further investigation with a larger sample.

Assessment of mood states revealed that steroid users who were currently on asteroid use cycle had significantly higher levels of depression, anger, vigor, and total mood disturbance than did steroid users who were not currently on asteroid use cycle. These data are consistent with Humbert's (1990) findings, obtained with an adult sample, of greater mood disturbance in steroid users while on a steroid use cycle. These findings have important clinical implications, since many adolescents can be expected to have significant difficulty in coping with such mood states.

The measures used to assess knowledge about anabolic steroids clearly differentiated between the three groups, with the user group displaying significantly higher levels of knowledge than did either the athletic nonusers or the nonathletes. Evaluation of the physical symptoms of steroid use also clearly distinguished between steroid users and nonusers. In addition to having higher levels of muscular density and hardness than the nonusers, the steroid users also had significantly higher levels of bloating, gynecomastia, and acne about the face, neck, shoulders, and back. These findings are consistent with previous literature indicating that it is possible for an experienced observer to accurately identify athletes who are steroid users, particularly those who are currently on a steroid use cycle.

An important limitation of the current study is that no cause-and-effect conclusions are possible regarding psychological characteristics. Given the cross-sectional nature of the present research, one can only hypothesize as to whether a particular psychological characteristic (e.g., personality style or mood state) predisposes an adolescent athlete to adopt steroid use, whether this characteristic develops only as a result of steroid use, or whether it is merely correlated with another unidentified variable. Cause-and-effect hypotheses regarding psychological characteristics can be more adequately addressed in prospective, longitudinal research.

In the case of adolescent steroid use, this would involve intensively tracking adolescents prior to, during, and after their decision to begin (or refrain from) steroid use. For the research to be generalizable, large numbers of male and female subjects from diverse ethnic and cultural subgroups would need to be studied. In addition to the obvious high costs of such research, long-term tracking of adolescents who are engaging in an illegal behavior will involve surmounting numerous ethical and legal constraints. Although fraught with significant difficulties, prospective longitudinal investigations are clearly needed in order to increase our understanding of this complex phenomenon.

In summary, the data did not identify any unique personality characteristics that differentiate athletic adolescents who use steroids from athletic adolescents who do not use steroids. Although steroid use does produce physical effects that are desired by many athletes (e.g., increased muscular hardness and density), the data clearly show many negative physical side effects. Further, while no cause-and-effect conclusions can be drawn, the mood disturbance data indicate that there are some potentially serious negative psychological effects during steroid use cycles.

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Mark Kleiman, Ph.D., Counseling Psychology Program, School of Education, University of Miami, Coral Gables, Florida 33124.

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