Jan 29, 2015Safe from Steroids?
More than ever before, there is pressure to find out how serious steroid use is at the college and high school levels. Is more testing the answer?
By Laura Ulrich
Laura Ulrich is a contributing writer for Training & Conditioning. She can be reached at: [email protected].
Mention the phrase “Mitchell Report” and you’ll likely end up deep in conversation. The controversial report, released in December by former Senator George Mitchell and alleging steroid use by many Major League Baseball players, has the subject of performance-enhancing drugs on everybody’s mind.
Implicating 89 athletes from all 30 ball clubs, the report chronicles baseball’s “steroids era” and claims that more than a decade of inadequate testing and willful ignorance have created a culture of widespread use. Coupled with news of high-profile track and field and cycling athletes being caught doping, the report is raising questions about whether professional and elite sports will ever be clean again.
For some, it’s also raising another question: Is steroid use a problem in high school and college athletics? With just four percent of college athletes tested by the NCAA every year, only three states currently conducting high school testing, and individual schools’ testing programs varying widely, many are wondering whether the same quiet epidemic exists in educational athletics.
There’s no consensus on how widespread high school and college steroid use is, or on what should be done to address it. One thing is clear, however–schools cannot afford to ignore the subject. “It would be naive to say it’s not an issue at our level,” says Kevin Murphy, Athletic Director at Washington Township High School in Sewell, N.J. “High school kids pay attention to what’s happening in college athletics and college athletes look to the culture of professional sports.”
“The most important thing we can do is communicate openly about performance-enhancing drug use,” says Herman Frazier, former Athletic Director at the University of Hawai’i, who served on the Board of Directors of the United States Olympic Committee for over 20 years and helped to establish the United States Anti-Doping Agency. “We have to acknowledge that our athletes are highly motivated to get bigger, stronger, and faster to excel at their sports, and that it’s not inconceivable for that motivation to take a wrong turn.”
RUNNING THE NUMBERS
If someone collected data for the equivalent of a Mitchell Report in high school and college athletics, what would they find? No one knows for sure, but efforts are being made on a few fronts to determine the prevalence of performance-enhancing drug use.
At the college level, the largest source of information about steroid use is the NCAA Study of Substance Use Habits of College Student-Athletes. Conducted every four years, this report surveys athletes from every NCAA institution in all three divisions. The most recent edition, published in 2005, included responses from 19,676 college student-athletes about their use habits and attitudes on a variety of substances, including steroids.
According to the anonymous, self-report study, steroid use among Division I college athletes in 2005 was the lowest since the study began in 1985, with 1.2 percent of respondents reporting they had used steroids in the past 12 months–down from 1.6 in 2001 and a high of 4.8 in 1989. In Division II, reported use fell from 2.5 percent in 2001 to 1.2 in 2005, and in Division III, 1.0 percent of athletes reported using steroids, compared to 1.4 in 2001.
At the high school level, a University of Michigan study called “Monitoring the Future” polls 50,000 students each year on steroid use. In its 2007 report, 1.1 percent of eighth grade males, 1.7 percent of 10th grade males, and 2.3 percent of 12th grade males reported having tried steroids. Use among high school girls ranged from 0.4 percent to 0.6 percent across the grade levels.
In November, the LA84 Foundation, an organization established to manage California’s share of the profits from the 1984 Olympic Games, announced the results of a study of California high school students’ self-reported steroid use. Of 252 students representing 11 sports and 12 schools, less than one percent said they had used steroids.
While those numbers may sound encouraging, there is a growing concern that the reports and statistics don’t tell the real story. The decline in user rates in self-reported studies may come because athletes are more aware of the consequences of getting caught using steroids. And some experts believe high school and college programs rarely see positive steroid tests not because few athletes are using, but because testing programs aren’t looking hard enough.
“Does the fact that we’re seeing few positives mean high school and college athletes aren’t using steroids? I don’t think so,” says Andrew Gregory, MD, FAAP, FACSM, Team Physician at Vanderbilt University, Belmont University, and Hillwood High School in Nashville, Tenn., who is a member of the American Academy of Pediatrics Executive Committee of the Council of Sports Medicine and Fitness and a frequent lecturer on the topic of performance-enhancing drugs. “I believe we’re seeing low numbers simply because we aren’t doing very many tests.”
Charles Yesalis, ScD, MPH, Professor Emeritus at Pennsylvania State University, who has authored books on performance-enhancing drugs and testified before Congress six times on the topic, told The Salt Lake Tribune that the college testing system is “disastrously flawed.” Yesalis said college administrators who deny that steroids are a major problem are turning a blind eye.
COLLEGE TESTING QUESTIONED
The NCAA conducts a small amount of year-round drug testing in Divisions I and II, and also screens athletes who are involved in its national championships at all levels. Division III, currently conducting a two-year pilot program, may soon see a permanent year-round testing program in place as well.
One frequent criticism of the NCAA program is that it tests just four percent of participants each year, so individual athletes understand the odds of being selected are slim. “If no one you know or know of has been tested, you’re not going to be very scared of being tested yourself,” Gregory says. “I think college athletes might be saying, ‘I’ll take my chances.'”
More criticism has been leveled at individual institutions, mostly because of the wide variation across programs. In November, The Salt Lake Tribune conducted a broad investigation into college athletes’ steroid use. It found that institutional budgets for drug testing range from $3,000 to $160,000, and that schools’ penalties for a positive steroid test run the gamut from counseling to expulsion. For example, according to the article, an athlete who tests positive at the University of Houston is suspended for one calendar year and loses a year of eligibility, whereas an athlete who tests positive for the same anabolic agent at the University of Idaho faces counseling and periodic re-testing.
“The inconsistencies are a problem,” says Rod Walters, DA, ATC, a sports medicine consultant and former Head Athletic Trainer and Assistant Athletic Director for Sports Medicine at the University of South Carolina. “Even within a conference, programs vary widely. That sends a confusing message and sets up an unfair situation.”
In addition, most institutions that have extensive testing programs in place focus on education, not punishment. At Hawai’i, a student-athlete’s first positive test for steroids isn’t even reported to the athletic director. “A first positive is between the athlete and the team physician, and it’s done that way on purpose,” Frazier says. “This is about education.”
At Vanderbilt, a first positive for any drug, including steroids, has no institutional penalty. “The athlete may have a penalty from his or her coach, and there will be mandatory counseling and regular screening,” Gregory says. “But there is no loss of playing time from the athletic department.”
Frank Uryasz, MBA, CAE, President of the National Center for Drug Free Sport, which handles the NCAA drug-testing program, does not believe the NCAA needs to expand its program, but he would like to see schools, conferences, and the NCAA work more in concert. “The NCAA program is excellent, but it’s true that the likelihood of any one athlete being tested by the NCAA is fairly small,” he says. “I think the key is to have all three entities–the NCAA, the conference, and the individual school–conduct strong testing programs.”
HIGH SCHOOL TESTING INCREASES
At the high school level, the past few years have seen a growing emphasis on statewide testing programs. Prior to 2006, there were no statewide programs testing high school athletes for steroids. Today, at least 10 states have testing programs or are thinking about developing them.
New Jersey was the first state to implement testing. Now completing its second year, the program randomly screens athletes who are competing for state championships. In 2006-07, the program tested 500 athletes and detected one steroid user. Lawmakers are looking to expand the program to 1,000 athletes per year over the next few years and extend it to the regular season. The state’s Senate Education Committee advanced a bill in March that would introduce random testing in middle school age student-athletes as well as require the New Jersey State Interscholastic Athletic Association to develop a prevention program for coaches and athletic directors to use.
Florida is in the first year of a program that screens athletes in six sports–football, baseball, boys’ and girls’ weightlifting, girls’ flag football, and softball. Six hundred athletes will be tested this year, and out of the 425 conducted so far, one test came back positive. The Illinois High School Association Board of Directors voted in January to begin testing in the 2008-09 school year. New Mexico, West Virginia, Connecticut, Indiana, Missouri, and Delaware have considered starting programs, and discussions within the California legislature about testing were reopened this winter after the Mitchell Report was released.
In Texas, a program mandated by the state legislature and developed by the University Interscholastic League (UIL) began this spring. It will test 20,000 to 25,000 athletes per year for the next two years, making it the largest steroid testing program in the world.
Testing will take place multiple times throughout the school year and both male and female athletes in all sports will be randomly selected. “Because we’re testing so many athletes, over the next few years we’ll accumulate a lot more data than has been available in the other states with testing programs,” says Mark Cousins, Athletic Coordinator at the UIL.
The program’s random selection process will be weighted toward Texas’s larger high schools, with more student-athletes tested at schools in the state’s higher classifications. Results will be confidential, released only to the athlete, his or her parents, and school administrators. Students will be notified immediately before they are tested, and those who do not appear for testing without receiving an excused absence will be treated as if they had tested positive.
Under the program, a student-athlete who tests positive once will be suspended from competing for 30 competition days and required to produce a negative test result before resuming play. A second positive will result in suspension for one calendar year, and an athlete who tests positive a third time will be banned for the remainder of his or her high school career. Student-athletes with one or two positives will still be allowed to participate in practices.
Murphy believes both state-led and individual-school programs are important. Washington Township added steroid testing to its overall drug screening program last year, testing only in-season athletes at first. This year, out-of-season athletes were tested as well.
“Having programs at both the state and school levels means there is a greater chance of getting tested, so there’s more of a deterrent effect,” Murphy says. “It also ensures that athletes are getting the message from multiple sources to not use steroids.”
Murphy says it was clear his athletes had received that message after Washington Township’s baseball team won the state championship last year. “A few minutes after hoisting the trophy, six of our players were sitting in a room waiting to be tested by the state program,” he says. “I was proud of them because they handled it so well–they knew they had nothing to worry about. I believe they understand the importance of testing and keeping a level playing field because we have a testing program back at home.” MAKING IT WORK
When administrators decide to set up a steroid testing program at their institution, they often begin by talking about how many athletes will be tested and the details of collecting and processing samples. According to Walters, that approach leaves out a critical step.
“Before you start designing a program, you have to make sure everybody at the institution is on the same page,” he says. “You need to know where the rest of the administration stands. Are they supportive? What do they want a testing program to accomplish? Does the school want the program to act as a deterrent or to catch every offender?
“Answering those questions involves sitting down with all the key players and having an open discussion about the school’s philosophy on testing,” Walters continues. “These are hard questions to ask, but they’re necessary.”
Murphy agrees. When Washington Township considered steroid testing two years ago, his first step was to assemble a task force with representation from administrators, parents, and coaches. “You need to start by getting in tune with what your community wants,” Murphy says. “If your institution and your community don’t see the need for testing, you’re not going to get anywhere. In that case, I’d advise putting the idea on hold and first working to educate people on the need.”
Once there is a consensus and a shared philosophy, the next step is to bring in your school’s legal counsel. “They need to be actively involved in drafting the plan,” Walters says. “They can also help you determine what local, state, and federal laws you need to consider when setting up your program.”
The third step is to examine other schools’ policies and think through the logistics. Several key elements need to be in place for a program to work:
Year-round testing: Confining testing to in-season athletes, the school year, or the postseason is less effective than testing throughout the year. “It has to be year-round, and by that I mean 12 months,” Uryasz says. “Otherwise, you’re opening a window when athletes can use steroids and escape detection.”
Adequate numbers: As the percentage of athletes tested goes down, so does the deterrent effect. For that reason, Washington Township tests 50 percent of its student-athletes. “Kids run the numbers,” Murphy says. “We have 1,500 student-athletes, so they know 750 of them are going to be selected for our overall drug-testing program, and they don’t know which of those 750 will be selected for steroid testing.”
There is no magic percentage that creates a deterrent effect, however. “The reality is that testing costs money, so administrators are always going to try to figure out the smallest number that will prevent use,” Uryasz says. “There’s no perfect answer, but the more individuals you can test, the better.”
Short notice: The less time between when an athlete is notified that he or she will be tested and when the test actually occurs, the more accurate the results will be. “One of the best things we did at South Carolina was to make our tests very spontaneous,” Walters says. “The smaller the window of notification, the less chance an athlete will manipulate the result.”
A clear plan for positives: “There must be a complete, written document that states what is going to happen if an athlete tests positive,” Walters says. “Is there an appeal process? Will you re-test? If you do, and the re-test is positive, is that considered a second positive or just confirmation of the first? These are all policy elements that need to be spelled out.”
A plan should also specify how self-referrals will be handled. “If an athlete comes in and says, ‘If you test me, I will be positive,’ what will you do?” Walters says. “Some programs treat that more leniently than a positive test and others don’t. I believe leniency for athletes who self-refer is a good idea, but your plan must address it.”
Informed athletes: Broad awareness of the testing policy will help ensure it deters use. Walters advises having the person in charge of testing meet with each team every season to go over the details of the program.
Strict adherence: Everyone involved must follow the testing plan to the letter, Walters says. “Whenever you deviate from your procedure, even in a small way, you will have problems,” he explains. “The plan has to be carried out in its entirety every time.”
Re-evaluate frequently: At Hawai’i, Frazier met annually with all sport administrators, the compliance coordinator, the team physician, and the strength and conditioning and athletic training staffs to discuss how the testing program was working. “We’d review our numbers, look at trends, and talk about whether the program was doing what we wanted it to do,” he says.
Walters took a similar approach at South Carolina. “We created a policy annually and lived with it for a year,” he says. “During the year, I made notes about any concerns or any changes we might want to consider. Then we’d take all that into consideration and revamp the program the next year. It was an involved process, but it worked.”
As both high schools and colleges continue to hear calls for more steroid testing, Walters advises athletic trainers and strength coaches to listen carefully. He feels that if high school and college sports take the issue of steroids seriously, through both testing and education, lasting changes can be made.
And for him, that’s the most important part. “I believe when you have an athlete for four years and educate him or her about steroids, real learning takes place,” he says. “They leave your program not believing in taking shortcuts and they understand that hard work and honest effort can get them where they want to go. Those are good lessons for the rest of their lives.”
A version of this article previously appeared in Athletic Management, a sister publication to T&C.
SIDEBAR: TRICKLE DOWN EFFECT?
Will the Mitchell Report’s allegations that 89 Major League Baseball players used steroids to achieve their success encourage high school and college players to follow the same path? Or will the very public humiliation of the accused players deter younger athletes from trying performance-enhancing drugs? Opinions vary greatly. “In my mind, there’s no question that knowing elite athletes are using steroids pushes younger athletes to use them,” says Herman Frazier, former Athletic Director at the University of Hawai’i, who served on the Board of Directors of the United States Olympic Committee for over 20 years and helped to establish the United States Anti-Doping Agency. “Take Marion Jones for example. My women’s track and field team looked up to her and aspired to be like her. When she admitted to using performance-enhancing drugs, it couldn’t help but have an effect.”
Frank Uryasz, President of the National Center for Drug Free Sport, disagrees. “I don’t believe steroid use in professional sports has as much impact on high school and college athletes’ use as people think,” he says. “The decision to take a steroid is a very private, immediate decision. It’s not a decision about how you can compete better down the road. It’s a decision about how to gain an advantage today, next week, or next month. It’s not as calculated as seeing someone else take the drug and deciding to jump on the bandwagon.”
Kevin Murphy, Athletic Director at Washington Township High School in Sewell, N.J., believes the effect will depend on how Major League Baseball and other professional sports organizations respond. “If they take a hard-line stance, barring former athletes who are found guilty from halls of fame, taking away records, and toughening up testing, it will act as a deterrent,” he says. “If they don’t, it will encourage kids to use steroids.”
Besides the role modeling effect of athletes at higher levels, there are several other factors that can sway an athlete’s decision. “Surveys show that an athlete who feels they are not genetically gifted is more likely to take steroids,” says Andrew Gregory, MD, FAAP, FACSM, Team Physician at Vanderbilt University, Belmont University, and Hillwood High School, in Nashville, Tenn. “An athlete who feels like they have to make big changes to their body composition in a short amount of time is also at greater risk.”
“The athlete who has fallen behind because of an injury or because they are growing or maturing slower than their peers is more likely to use steroids,” Uryasz adds. “They may feel like they need to turn to something other than exercise and diet to keep up.”
Because the choice to use steroids is a very personal one, building relationships with athletes and working to understand their goals can be a big help. At Washington Township, Athletic Trainer Tonya Dargusch, MS, ATC, pays close attention to individual athletes’ body goals so she can spot red flags.
“If we have an athlete who says, ‘I’m 185 pounds this summer and I want to be 215 by the fall,’ Tonya takes notice,” Murphy says. “She spends extra time talking to that athlete about how to set realistic goals and how to improve through diet and exercise. She builds relationships with athletes and they know she cares about them. I believe that relationship helps counteract unhealthy messages they may be getting elsewhere.