United States Government Accountability Office

GAO Report to the Committee on Oversight 

and Government Reform, House of 

Representatives 

ANABOLIC STEROID 

ABUSE 

Federal Efforts to 

Prevent and Reduce 

Anabolic Steroid 

Abuse among 

Teenagers 

October 2007 

 

GAO-08-15 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

October 2007

ANABOLIC STEROID ABUSE 

Federal Efforts to Prevent and Reduce Anabolic 

Steroid Abuse among Teenagers

Highlights of GAO-08-15, a report to the 

Committee on Oversight and Government 

Reform, House of Representatives

The abuse of anabolic steroids by

teenagers—that is, their use

without a prescription—is a health

concern. Anabolic steroids are 

synthetic forms of the hormone

testosterone that can be taken 

orally, injected, or rubbed on the

skin. Although a 2006 survey 

funded by the National Institute on

Drug Abuse (NIDA) found that less 

than 3 percent of 12th graders had 

abused anabolic steroids, it also 

found that about 40 percent of 12th

graders described anabolic steroids 

as “fairly easy” or “very easy” to 

get. The abuse of anabolic steroids 

can cause serious health effects

and behavioral changes in 

teenagers. 

GAO was asked to examine 

federally funded efforts to address 

the abuse of anabolic steroids 

among teenagers and to review

available research on this issue.

This report describes (1) federally 

funded efforts that address teenage 

abuse of anabolic steroids, 

(2) available research on teenage 

abuse of anabolic steroids, and 

(3) gaps or areas in need of 

improvement that federal officials 

and other experts identify in

research that addresses teenage

anabolic steroid abuse. To do this 

work, GAO reviewed federal

agency materials and published

studies identified through a

literature review and interviewed 

federal officials and other experts. 

There are two categories of federally funded efforts that address teenage 

abuse of anabolic steroids. Efforts are either designed to focus on preventing 

the abuse of anabolic steroids among teenagers or are broader and designed 

to prevent substance abuse in general—which can include abuse of anabolic

steroids among teenagers. Two programs that received federal funding during 

their development and testing, Athletes Training and Learning to Avoid 

Steroids (ATLAS) and Athletes Targeting Healthy Exercise & Nutrition 

Alternatives (ATHENA), are designed to focus on preventing or reducing teen 

abuse of anabolic steroids through use of gender-specific student-led 

curricula. In addition, there are various research efforts and education and 

outreach activities that focus on this issue. Two federal grant programs—the

Office of National Drug Control Policy’s Drug-Free Communities Support 

program and the Department of Education’s School-Based Student Drug 

Testing program—are designed to support state and local efforts to prevent 

substance abuse in general and may include anabolic steroid abuse among 

teenagers as part of the programs’ substance abuse prevention efforts. In 

2007, about one-quarter of more than 700 Drug-Free Communities Support 

program grantees reported that they were addressing steroid abuse as one of 

their program’s objectives. 

Almost half of the 16 studies GAO reviewed identified certain risk factors and 

behaviors linked to the abuse of anabolic steroids among teenagers. Several of 

these studies found connections between anabolic steroid abuse and risk 

factors such as use of other drugs, risky sexual behaviors, and aggressive

behaviors. Most of the other studies were assessments of the ATLAS and 

ATHENA prevention programs and in general suggested that the programs

may reduce abuse of anabolic steroids and other drugs among high school 

athletes immediately following participation in the programs. 

Experts identified gaps in the research addressing teenage abuse of anabolic

steroids. Experts identified a lack of conclusive evidence of the sustained 

effectiveness over time of available prevention programs, for example at 

1 year following participants’ completion of the programs. Experts also 

identified gaps in the research on the long-term health effects of initiating 

anabolic steroid abuse as a teenager—including research on effects that may 

be particularly harmful in teens—and in research on psychological effects of 

anabolic steroid abuse. 

To view the full product, including the scope 

and methodology, click on GAO-08-15. 

For more information, contact Laurie E. 

Ekstrand at (202) 512-7114 or 

ekstrandl@gao.gov. 
Contents 

Letter 1

Results in Brief 3

Background 4

Some Federally Funded Efforts Are Designed to Focus on 

Preventing Teenage Steroid Abuse, While Other Efforts 

Designed to Address Substance Abuse in General May Include

Teenagers 9

Research Shows Teenage Anabolic Steroid Abuse Is Linked to

Certain Risk Factors and That Prevention Programs May Have

Some Short-term Effectiveness 14 

Experts Find There Are Gaps in Research on the Sustained 

Effectiveness of Prevention Programs and on the Long-term 

Health Effects for Teenagers 16 

Agency Comments 17 

Appendix I Selected Federally Funded Efforts That Address 

or Can Address Anabolic Steroid Abuse among 

Teenagers 18 

Appendix II Articles Included in GAO’s Review 21 

Appendix III GAO Contact and Staff Acknowledgments 23 

Table 

Table 1: Selected Federally Funded Efforts That Address or Can 

Address Anabolic Steroid Abuse among Teenagers 18 

Figures 

Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12th

Graders, 1991-2006 7 

Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and 

Female Adolescents, 2002-2006 8 

Page i GAO-08-15 Teenage Abuse of Anabolic Steroids 
Abbreviations 

ATHENA Athletes Targeting Healthy Exercise & Nutrition 

 Alternatives 

ATLAS Athletes Training and Learning to Avoid Steroids 

CDC Centers for Disease Control and Prevention 

HHS Department of Health and Human Services 

MTF Monitoring the Future 

NIDA National Institute on Drug Abuse 

NIH National Institutes of Health 

ONDCP Office of National Drug Control Policy 

SAMHSA Substance Abuse and Mental Health Services 

 Administration 

USADA United States Anti-Doping Agency

YRBS Youth Risk Behavior Survey 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 

Page ii GAO-08-15 Teenage Abuse of Anabolic Steroids 
United States Government Accountability Office

Washington, DC 20548 

October 31, 2007 

The Honorable Henry A. Waxman 

Chairman 

The Honorable Tom Davis 

Ranking Member 

Committee on Oversight and Government Reform 

House of Representatives 

The abuse of anabolic steroids1

 by teenagers—that is, their use without a 

prescription—is a health concern. Anabolic steroids are synthetic forms of 

the hormone testosterone that can be taken orally, injected, or rubbed on 

the skin. Although a 2006 survey funded by the National Institute on Drug 

Abuse (NIDA) showed that less than 3 percent of 12th graders had abused 

anabolic steroids, the survey also showed that about 40 percent of 12th

graders described anabolic steroids as “fairly easy” or “very easy” to get. 

The abuse of anabolic steroids can cause serious health effects and 

behavioral changes in teenagers. Under U.S. law, anabolic steroids are 

controlled substances whose manufacture, possession, and use are 

regulated by the federal government;2

 they also cannot be sold legally

without a prescription. 

You asked us to examine federally funded efforts to address the abuse of 

anabolic steroids among teenagers and to review available research on 

this issue. In this report, we 

1. describe major, federally funded efforts that address teenage abuse of 

anabolic steroids, 

2. describe the available research on teenage abuse of anabolic steroids, 

and 

 1

We use the term anabolic steroids to refer to anabolic steroids and their precursors, as

defined in the Controlled Substances Act. See 21 U.S.C. § 802 (23), (41). 

2

The Crime Control Act of 1990 amended the Controlled Substances Act to include anabolic 

steroids. 21 U.S.C. § 812(c), Schedule III (e). 

Page 1 GAO-08-15 Teenage Abuse of Anabolic Steroids
3. describe gaps or areas in need of improvement that federal officials 

and other experts identify in research that addresses anabolic steroid 

abuse among teenagers.

We focused our review on the abuse of anabolic steroids by teenagers in 

grades 8 through 12. To describe federally funded efforts to address 

anabolic steroid abuse among teenagers, we reviewed databases of federal 

grant programs.3

 We also obtained and reviewed pertinent reports and 

information from the Web sites of agencies within the Department of 

Health and Human Services (HHS)—the Centers for Disease Control and 

Prevention (CDC), the National Institutes of Health (NIH), and the 

Substance Abuse and Mental Health Services Administration (SAMHSA)—

as well as the Web sites of the Department of Education (Education) and

the Office of National Drug Control Policy (ONDCP). We used these 

resources to identify federally funded programs,4

 research, and education 

and outreach activities that address—through efforts to either prevent or

reduce—anabolic steroid abuse among teenagers. After identifying these 

efforts, we interviewed and collected information from federal officials to

confirm that these efforts are intended to prevent or reduce anabolic 

steroid abuse among teenagers. Where available, we requested funding 

information on the federal efforts that we identified.5

To describe the available research on teenage abuse of anabolic steroids, 

we conducted a systematic review of the published literature on this topic. 

We identified 16 articles that related to teenage abuse of anabolic steroids 

and were published from January 1995 through June 2007. To select the 

articles, we conducted a keyword search using the Dialog Database 

System,6

 a system that searches numerous database files, and reviewed the 

 3

We searched both the Catalog of Federal Domestic Assistance, a database of federal grant

programs maintained by the General Services Administration, and the Computer Retrieval 

of Information on Scientific Projects, a database of research grants funded by the National

Institutes of Health. 

4

We define federally funded programs as including programs that were developed,

implemented, or tested using federal funding. 

5

The efforts that we discuss in this report may not represent all federally funded activities 

that address anabolic steroid abuse among teenagers but reflect those efforts mentioned by 

federal officials with whom we consulted. We were unable to determine the extent of total 

federal funding for programs that address teenage anabolic steroid abuse because, in some 

instances, funding information covers more than prevention of teenage anabolic steroid 

abuse. 

6

We searched using the keywords anabolic steroids, abuse, addiction, teen, youth,

adolescent, prevent, and treat. 

Page 2 GAO-08-15 Teenage Abuse of Anabolic Steroids
resulting article titles and abstracts to identify whether the articles 

focused on teenage abuse of anabolic steroids. We did not select articles

that were international works, based on reviews of other articles or 

research, position papers, policy statements, or federal agency program 

documents. The references we make to articles refer strictly to those that 

we reviewed. 

To describe the gaps or areas in need of improvement in research that 

addresses teenage abuse of anabolic steroids as identified by experts, we 

interviewed experts in anabolic steroid abuse and reviewed relevant

literature. We interviewed federal officials from CDC, NIDA, SAMHSA, and 

Education, as well as other experts from universities and professional 

associations. We reviewed research articles identifying gaps or areas in 

need of improvement as part of our systematic review of the literature. We

conducted the work for our review from January 2007 through September 

2007 in accordance with generally accepted government auditing 

standards. 

There are two categories of federally funded efforts that address teenage 

abuse of anabolic steroids. Efforts are either designed to focus on 

preventing the abuse of anabolic steroids among teenagers or are broader 

and designed to prevent substance abuse in general—which can include 

abuse of anabolic steroids among teenagers. Two programs that received 

federal funding during their development and testing, Athletes Training 

and Learning to Avoid Steroids (ATLAS)7

 and Athletes Targeting Healthy 

Exercise & Nutrition Alternatives (ATHENA), are designed to focus on 

preventing or reducing teen abuse of anabolic steroids. In addition, there 

are various research efforts and education and outreach activities that 

focus on this issue. For example, in addition to steroid-related research, 

since 2000 NIDA has provided nearly $500,000 in funding for a variety of 

education and outreach activities including a multimedia educational 

initiative intended to prevent anabolic steroid abuse among teenagers. 

Two federal grant programs—ONDCP’s Drug-Free Communities Support 

program and Education’s School-Based Student Drug Testing program—

Results in Brief 

 7

ATLAS—the acronym for the prevention program named Athletes Training and Learning 

to Avoid Steroids—originally stood for Adolescents Training and Learning to Avoid

Steroids, which was the title of the NIDA research grants that supported the program’s

development. For this reason, some published research describing the program, as listed in 

appendix II, for example, refers to ATLAS as Adolescents Training and Learning to Avoid

Steroids. 

Page 3 GAO-08-15 Teenage Abuse of Anabolic Steroids
are designed to support state and local efforts to prevent substance abuse 

in general and may include anabolic steroid abuse among teenagers as part 

of the programs’ substance abuse prevention efforts. In 2007, about onequarter of more than 700 Drug-Free Communities Support program 

grantees reported that they were addressing steroid abuse as one of their 

program’s objectives. 

Almost half of the 16 studies we reviewed identified certain risk factors 

and behaviors linked to the abuse of anabolic steroids among teenagers. 

Several of these studies found connections between anabolic steroid 

abuse and risk factors such as use of other drugs, risky sexual behaviors, 

and aggressive behaviors. Most of the other studies we reviewed were 

assessments of the ATLAS and ATHENA prevention programs. In general, 

these studies suggested that the programs may reduce abuse of anabolic

steroids and other drugs among high school athletes immediately 

following participation in the programs. 

Experts identified gaps in the research that addresses anabolic steroid 

abuse among teenagers. Experts identified a lack of conclusive evidence

of sustained effectiveness over time of available prevention programs, for 

example at 1 year following participants’ completion of the programs. 

Experts also identified gaps in the research on the long-term heath effects 

of initiating anabolic steroid abuse as a teenager—including research on 

effects that may be particularly harmful in teenagers—and in the research

on psychological effects.

HHS and Education provided technical comments only, which we 

incorporated into the report as appropriate. 

The abuse of anabolic steroids differs from the abuse of other illicit 

substances. When users initially begin to abuse anabolic steroids, they 

typically are not driven by a desire to achieve an immediate euphoria like 

that which accompanies most abused drugs such as cocaine, heroin, and 

marijuana. The abuse of anabolic steroids is typically driven by the desire 

of users to improve their athletic performance and appearance—

characteristics that are important to many teenagers. Anabolic steroids 

can increase strength and boost confidence, leading users to overlook the 

potential serious and long-term damage to their health that these 

substances can cause. In addition, the methods and patterns of use for 

anabolic steroids differ from those of other drugs. Anabolic steroids are 

most often taken orally or injected, typically in cycles of weeks or months

(referred to as “cycling”), rather than continuously. Cycling involves taking

Background 

Page 4 GAO-08-15 Teenage Abuse of Anabolic Steroids
multiple doses of anabolic steroids over a specific period of time, stopping 

for a period, and starting again. In addition, users often combine several 

different types of anabolic steroids to maximize their effectiveness 

(referred to as “stacking”). 

While anabolic steroids can enhance certain types of performance or 

appearance, when used inappropriately they can cause a host of severe, 

long-term, and in some cases, irreversible health consequences. The abuse 

of anabolic steroids can lead to heart attacks, strokes, liver tumors, and 

kidney failure. In addition, because anabolic steroids are often injected, 

users who share needles or use nonsterile injection techniques are at risk

for contracting dangerous infections, such as HIV/AIDS and hepatitis B 

and C. There are also numerous side effects that are gender-specific, 

including reduced sperm count, infertility, baldness, and development of 

breasts among men; and growth of facial hair, male-pattern baldness, 

changes in or cessation of the menstrual cycle, and deepened voice among 

women. There is also concern that teenagers who abuse anabolic steroids 

may face the additional risk of halted growth resulting from premature 

skeletal maturation and accelerated puberty changes. 

The abuse of anabolic steroids may also lead to aggressive behavior and 

other psychological side effects. Many users report feeling good about 

themselves while on anabolic steroids, but for some users extreme mood 

swings also can occur, including manic-like symptoms leading to violence. 

Some users also may experience depression when the drugs are stopped,

which may contribute to dependence on anabolic steroids. Users may also 

suffer from paranoia, jealousy, extreme irritability, delusions, and 

impaired judgment stemming from feelings of invincibility. 

Two national surveys showed increasing prevalence in teenage abuse of 

steroids throughout the 1990s until about 2002 and a decline since then

(see fig. 1). One of these two national surveys, the Monitoring the Future

(MTF) survey, is an annual survey conducted by the University of 

Michigan and supported by NIDA funding.8

 The MTF survey measures drug 

use and attitudes among students in grades 8, 10, and 12, and asks several 

questions about the use of and attitudes towards anabolic steroids, such as 

perceived risk, disapproval, and availability of anabolic steroids. The 

 8

The MTF survey is administered to nationally representative samples of public and private 

secondary school students throughout the United States. In 2006, sample sizes were about 

17,000, 16,600, and 14,800 in 8th, 10th, and 12th grades, respectively. In all, about 48,500

students in 410 secondary schools participated in the 2006 survey. 

Page 5 GAO-08-15 Teenage Abuse of Anabolic Steroids
survey’s questions are designed to assess respondents’ use of steroids in 

the last 30 days, the past year, and over the course of the respondent’s 

lifetime. Questions about steroid use were added to the study beginning in

1989. The most recent results from this survey showed that in 2006, 

2.7 percent of 12th graders said they had used anabolic steroids without a 

prescription at least once. The second national survey, the Youth Risk 

Behavior Survey (YRBS), is a biennial survey conducted since 1991 by 

CDC.9 The YRBS is part of a surveillance system consisting of national, 

state, and local surveys of students in grades 9 through 12. These surveys

collect information about a wide variety of risk behaviors, including sexual 

activity and alcohol and drug use. The most recent available national 

YRBS survey—conducted in 2005—asked one question related to lifetime 

steroid use without a prescription, which showed that 3.3 percent of 12th

graders had used steroids at least once. 

 9

The sampling frame for the 2005 national YRBS survey consisted of all public and private 

schools with students in at least one of grades 9 through 12 in the 50 states and the District

of Columbia. For the 2005 national YRBS survey, 13,953 questionnaires were completed in 

159 schools by a nationally representative sample of students in grades 9 through12. 

Page 6 GAO-08-15 Teenage Abuse of Anabolic Steroids
Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12th Graders, 1991-2006

0

1

2

3

4

5

6

Monitoring the Future (MTF)

Youth Risk Behavior Survey (YRBS)

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Percentage

Source: GAO analysis of MTF and YRBS data.

The MTF and YRBS surveys indicate a low abuse rate for anabolic steroids 

among teenagers10 when compared with the abuse rates for other drugs.11

However, the reported easy availability of steroids12 and the potential for 

serious health effects make anabolic steroid abuse a health concern for 

teenagers, particularly among males. In general, the reported rates of 

 10Several researchers conducted an analysis indicating that the prevalence rates of teenage

anabolic steroid abuse reported by MTF and YRBS are overestimated and that actual 

prevalence of teenage anabolic steroid abuse is even lower than these surveys report. See 

Gen Kanayama et al., “Anabolic Steroid Abuse Among Teenage Girls: An Illusory Problem?” 

Drug and Alcohol Dependence, 88 (2007): 156-162. 

11For example, according to the 2006 MTF survey, 42.3 percent of 12th graders reported 

abusing marijuana at least once, and 8.5 percent reported abusing cocaine at least once. 

12In our previous work looking at the availability of anabolic steroids, we found that

anabolic steroids were easily obtained without a prescription through the Internet. See

GAO, Anabolic Steroids Are Easily Purchased Without a Prescription and Present 

Significant Challenges to Law Enforcement Officials, GAO-06-243R (Washington, D.C.: 

Nov. 3, 2005). 

Page 7 GAO-08-15 Teenage Abuse of Anabolic Steroids
anabolic steroid abuse are higher for males than for females (see fig. 2). 

Data from the 2006 MTF survey showed that 1.7 percent of teenage males 

reported abusing anabolic steroids in the past year, as compared with 

0.6 percent of females. Data from the 2005 YRBS survey showed that 

4.8 percent of high school males reported abusing steroids in their lifetime, 

as compared with 3.2 percent of females. 

Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female 

Adolescents, 2002-2006 

Year

Percentage

Source: GAO analysis of MTF data.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Males

Females

2002 2003 2004 2005 2006

Note: These are combined data for 8th, 10th, and 12th grade students.

Page 8 GAO-08-15 Teenage Abuse of Anabolic Steroids
There are two categories of federally funded efforts that address teenage 

abuse of anabolic steroids. Efforts are either designed to focus on 

preventing the abuse of anabolic steroids among teenagers or are broader 

and designed to prevent substance abuse in general—which can include 

abuse of anabolic steroids among teenagers. Two programs that received 

federal research funding for their development and testing, ATLAS and 

ATHENA, are designed to focus on preventing or reducing teen abuse of 

anabolic steroids. In addition, there are various research efforts and 

education and outreach activities that focus on this issue. Two federal 

grant programs—ONDCP’s Drug-Free Communities Support program and 

Education’s School-Based Student Drug Testing program—are designed to 

support state and local efforts to prevent substance abuse in general and 

may include anabolic steroid abuse among teenagers as part of the 

programs’ substance abuse prevention efforts. See appendix I for a list of 

the federally funded efforts discussed below. 

Some Federally 

Funded Efforts Are 

Designed to Focus on 

Preventing Teenage 

Steroid Abuse, While 

Other Efforts 

Designed to Address 

Substance Abuse in 

General May Include 

Teenagers 

Some Federally Funded 

Programs, Research, and 

Activities Are Designed to 

Focus on Preventing 

Teenage Anabolic Steroid 

Abuse 

There are various federally funded efforts—programs, research, and 

educational activities—that address teenage abuse of anabolic steroids. 

Some of these efforts are designed to focus on preventing or reducing 

anabolic steroid abuse among teenagers. As part of our review we 

identified two programs, the ATLAS and ATHENA programs, which 

received federal research funding during their development and testing 

and are designed to focus on preventing the abuse of anabolic steroids 

among male and female high school athletes, respectively. 

ATLAS is a student-led curriculum designed to prevent male high school 

athletes from abusing anabolic steroids and other performance-enhancing 

substances. The program’s intervention strategy relies on peer pressure 

and providing information on healthy alternatives for increasing muscle 

strength and size. The ATLAS curriculum is typically delivered during a

sport team’s season in a series of 45-minute sessions scheduled at the 

coaches’ discretion and integrated into the usual team practice activities. 

The athletes meet as a team in groups of six or eight students with one 

student functioning as the assigned group leader. Coaches, group leaders, 

and student athletes all work from manuals and workbooks, which 

provide brief, interactive activities that focus on drugs used in sports, 

sport supplements, strength training, sport nutrition, and decision making. 

The ATHENA program is designed to prevent the abuse of body-shaping 

substances such as diet pills and anabolic steroids, although abuse of the 

latter is less common in females than in males. Like ATLAS, the ATHENA 

curriculum is integrated into a sport team’s usual practice activities and 

Page 9 GAO-08-15 Teenage Abuse of Anabolic Steroids
uses workbooks and student group leaders. The ATHENA curriculum 

takes into account that female athletes are less likely than males to abuse 

anabolic steroids but are more likely to have problems with eating 

disorders and to use drugs such as diet pills and tobacco. As a result, 

ATHENA’s curriculum gives more attention than ATLAS’s to addressing 

these behaviors. 

The ATLAS and ATHENA curricula were developed and tested with 

funding provided by NIDA.13 From fiscal years 1993 through 2001, NIDA 

provided more than $3.4 million to fund the research that developed and 

tested the effectiveness of the ATLAS curriculum. Similarly, from fiscal 

years 1999 through 2003 NIDA provided $4.7 million in research funding to

develop and test the effectiveness of the ATHENA curriculum. While 

ATLAS and ATHENA were developed and tested with federal funding, the 

programs are implemented at the local level. Schools in at least 25 states 

have chosen to implement the programs with local and private funds, and 

the National Football League and Sports Illustrated magazine together 

have supported the programs in more than 70 schools nationwide.14

In addition to the ATLAS and ATHENA programs, there are various 

federally funded research efforts that focus on preventing or reducing 

anabolic steroid abuse among teenagers. NIDA has funded several 

research projects examining the factors that influence teenagers to abuse 

anabolic steroids and the effectiveness of interventions used to prevent 

teenage steroid abuse. From fiscal years 2000 through 2006, NIDA awarded 

nearly $10.1 million in grants to support an average of four research 

projects each year related to anabolic steroid abuse with a specific focus 

on adolescents.15 In fiscal year 2006, for example, NIDA awarded a total of 

nearly $638,000 to three research projects that examined risk factors for 

anabolic steroid abuse among teenagers or the effects of steroid abuse in 

 13The programs originated in investigator-initiated research into the risk factors associated 

with male and female high school athletes’ abuse of anabolic steroids. 

14According to NIDA officials, the principal investigators who developed the ATLAS and 

ATHENA programs signed a contract with the National Football League to place the 

programs in schools in the vicinity of eight National Football League teams in 2007. The 

contract was expected to support the training of about 800 coaches and 20,000 athletes. 

15For fiscal years 2000 through 2006, NIDA officials reported that they awarded a total of 31 

annual grants, many of which were continuation grants for previously-approved projects,

for steroid-related research focused on the adolescent age group in humans or animals. 

Because of the continuity of the projects from year to year, we are reporting the average

numbers of projects that were funded and active each year. 

Page 10 GAO-08-15 Teenage Abuse of Anabolic Steroids
this population. Like NIDA, the United States Anti-Doping Agency 

(USADA)—an independent, nonprofit corporation funded primarily by 

ONDCP—supports research related to the abuse of anabolic steroids and 

other performance-enhancing drugs by athletes, including teenage 

athletes.16 In fiscal year 2006, USADA spent $1.8 million for research, and 

an ONDCP official estimated that about one-third of that research funding 

was directed to anabolic steroids and another performance-enhancing 

drug, human growth hormone. 

In addition to research, there are various education and outreach activities

that focus on preventing anabolic steroid abuse among teenagers. Many of

these efforts have been supported by NIDA. Since 2000, NIDA has 

provided nearly $500,000 in funding for a variety of education and 

outreach efforts in support of this goal.17 For example, in April 2000, in 

response to an upward trend in steroid abuse among students, NIDA 

launched a multimedia educational initiative intended to prevent anabolic

steroid abuse among teenagers. Along with several national partners, 

including the National Collegiate Athletic Association, the American 

College of Sports Medicine, and the American Academy of Pediatrics, the 

initiative produced a Web site, a research report on steroid abuse, and 

postcard-sized messages about steroids for placement in gyms, movie 

theaters, shopping malls, bookstores, and restaurants in selected areas. By 

2007, NIDA funding for this particular initiative totaled about $124,000. 

In addition to NIDA, other federal agencies and organizations have 

supported educational and outreach activities that focus on preventing 

anabolic steroid abuse among teenagers, as the following examples 

illustrate. 

• ONDCP has funded six informational briefings since 2001 to encourage 

journalists, entertainment writers, and producers to accurately cover 

 16ONDCP officials told us that from fiscal years 2001 through 2007, USADA funding from

ONDCP totaled nearly $46 million. In 2007, for example, ONDCP funding was $8.4 million 

or about 70 percent of USADA’s $12 million budget, with the United States Olympic 

Committee providing the remaining 30 percent. 

17In addition to this funding for education and outreach activities specifically focused on

anabolic steroid abuse among teenagers, NIDA has contracted with Scholastic Magazines 

since 2002 to provide information about drug abuse and addiction to students and teachers

during the school year. This program, under which Scholastic Magazines receives $500,000 

per year for fiscal years 2002 through 2009 for a total of $4 million, supports broader 

substance abuse prevention activities that have at times included anabolic steroid 

prevention articles, posters, and other materials. 

Page 11 GAO-08-15 Teenage Abuse of Anabolic Steroids
anabolic steroids and drug abuse among teenage athletes. ONDCP also has 

Web sites for teens and parents with information about anabolic steroids 

and links to NIDA resources. 

• Since 2003, USADA has produced written publications and annual reports

on anabolic steroid abuse and has distributed those publications through 

high schools and state high school associations. In addition, some USADA 

public service announcements to be aired during televised sports events 

and movie trailers have targeted anabolic steroid abuse. 

• In fiscal years 2007 and 2008, SAMHSA expects to spend a total of $99,000

under a contract to develop and disseminate educational materials 

addressing the abuse of anabolic steroids by adolescent athletes. These 

materials, which are intended for use by high school athletic and health

science departments, include brochures, a video, and 10 high school 

outreach seminars. 

As part of our review, we identified two federal grant programs that are 

designed to support state and local efforts to prevent various forms of 

substance abuse and that may include teenagers. Grantees of these 

programs may address teenage anabolic steroid abuse as part of the 

programs’ general substance abuse prevention efforts. The Drug-Free 

Communities Support program, funded by ONDCP and administered by 

SAMHSA under an interagency agreement, provides grants to community 

coalitions to address drug abuse problems identified in their 

communities.18 Many community coalitions choose to implement schoolbased drug prevention programs with their grant funding and are allowed

to tailor these programs to address the drug prevention needs of their 

communities. In 2007, about one-quarter of more than 700 grantees 

reported that they were addressing steroid abuse as one of their program’s 

objectives.19 Each community coalition is eligible for grants of up to 

$125,000 per year, renewable for up to 4 more years, and requiring dollarfor-dollar community matching funds.

20 In 2007, the Drug-Free 

Two Federal Grant 

Programs Designed to 

Address Substance Abuse 

May Address Teenage 

Anabolic Steroid Abuse 

 18Project officers in SAMHSA’s Center for Substance Abuse Prevention work with the DrugFree Communities Support program grantees to provide technical assistance and help them

comply with grant requirements. 

19An ONDCP official told us that 189 of 702 communities (27 percent) provided information

that they were addressing steroids in their grant activities along with other drugs.

20Follow-on grants are also authorized. 21 U.S.C. § 1532(b)(3). 

Page 12 GAO-08-15 Teenage Abuse of Anabolic Steroids
Communities Support program is providing about $80 million in grants to 

709 community coalitions for drug prevention activities based on the 

needs of the communities. 

Another federal grant program that supports substance abuse prevention

efforts for teenagers and that may also include efforts to address anabolic

steroid abuse in this population is the School-Based Student Drug Testing 

program in Education’s Office of Safe and Drug-Free Schools.21 Since 2003, 

this program has provided grants to school districts and public and private 

entities to establish school-based drug-testing efforts. For fiscal years 2003 

through 2007, the Office of Safe and Drug-Free Schools awarded 

$32.2 million in grants to 87 individual School-Based Student Drug Testing 

grantees.22 According to information provided in the grantees’ grant 

applications, 34 of the grantees (representing 180 middle, junior, and high 

schools and at least 70,000 students) proposed using their grant-supported 

drug testing to test for anabolic steroids in addition to other substances 

such as amphetamines, marijuana, and cocaine.23 Education officials told 

us that although grantees generally identify the drugs for which they are 

testing in their annual performance reports, there has been no

independent verification by Education staff that confirms that the 34 

grantees actually have implemented anabolic steroid testing or whether 

additional grantees have included steroid testing in their efforts. 

 21Education funds no programs specifically targeting steroid prevention for teens. Except 

for alcohol prevention efforts, the department addresses illegal drug abuse in schools with 

a comprehensive strategy, not drug by drug. 

22Total funding for the School-Based Student Drug Testing program for fiscal years 2003 

through 2007 was about $36 million, of which $32.2 million (89 percent) was awarded to

grantees. The remainder of the funding supported evaluation and peer review activities. 

23During a discussion of Education’s program, an ONDCP official said that because testing 

for anabolic steroids is more expensive than for other drugs—adding $50 to $100 to the 

cost of a common panel of five drug tests—some schools add steroids to the tests for only 

a few of the students, as a deterrent. The official said that in some cases, federal funding

helps schools afford to add steroids to their usual test panel. The official estimated that

about 1,000 schools and school districts across the country were doing some sort of 

student drug testing and sometimes were including steroids. According to the official, New

Jersey requires steroid testing for some athletic teams and Florida and Texas were 

considering similar legislation. 

Page 13 GAO-08-15 Teenage Abuse of Anabolic Steroids
Of the 16 studies we reviewed, nearly half focused on linking certain risk 

factors and behaviors to teenagers’ abuse of anabolic steroids, including 

the use of other drugs, risky sexual behaviors, and aggressive behaviors.24

Most of the other studies we reviewed were assessments of the ATLAS and 

ATHENA prevention programs and in general suggested that the programs 

may reduce abuse of anabolic steroids and other drugs among high school 

athletes immediately following participation in the programs. Appendix II

is a list of the articles we reviewed. 

Almost half of the studies we reviewed identified certain risk factors and 

behaviors linked to the abuse of anabolic steroids among teenagers.25 Risk

factors, such as antisocial behavior, family violence, and low academic 

achievement, are linked to youths’ likelihood of engaging in risky 

behaviors, including drug abuse. Several studies found that the use of 

alcohol and other drugs—such as tobacco, marijuana, and cocaine—is 

associated with the abuse of anabolic steroids among teenagers, including 

teenage athletes and non-athletes. One 2005 study found that the use of 

other drugs was more likely to predict anabolic steroid abuse than 

participation in athletic activities. Several studies we reviewed found no 

difference between athletes and non-athletes in their abuse of anabolic

steroids, and one 2007 study of teenage girls found that female athletes 

were less likely than female non-athletes to abuse anabolic steroids. A few 

studies we reviewed found a positive correlation between anabolic steroid 

abuse and risky sexual behaviors such as early initiation of sexual activity 

and an increased number of sexual partners. Some studies found that 

aggressive behaviors such as fighting were related to anabolic steroid 

abuse by both males and females. Moreover, one 1997 study found that 

adolescents (both male and female) who reported abusing anabolic 

steroids in the past year were more likely to be perpetrators of sexual 

violence. However, the cause-and-effect relationships between anabolic

steroid abuse and other risky behaviors, such as violence, have not been 

determined.26

Research Shows 

Teenage Anabolic 

Steroid Abuse Is 

Linked to Certain Risk 

Factors and That 

Prevention Programs 

May Have Some 

Short-term 

Effectiveness 

 24We reviewed 16 studies published from January 1995 through June 2007. 

25These studies sought to identify a correlation between risk factors and behaviors and

anabolic steroid abuse by teenagers. The studies did not identify causation. 

26Because aggressive behavior is one of the potential psychological effects of anabolic 

steroid abuse, anabolic steroids could predispose an individual to aggressive acts, including 

sexual violence. 

Page 14 GAO-08-15 Teenage Abuse of Anabolic Steroids
About half of the studies we reviewed were assessments of the ATLAS and 

ATHENA prevention programs, and in general these studies suggested that

these programs may reduce abuse of anabolic steroids and other drugs 

among high school athletes immediately following participation in the 

programs. Researchers assessing the ATLAS program reported that both 

the intention to abuse anabolic steroids and the reported abuse of steroids 

were lower among athletes who participated in the ATLAS program than 

among athletes who did not participate in the program. The most recent 

study found that although the intention to abuse anabolic steroids 

remained lower at follow-up 1 year later for athletes who participated in 

the ATLAS program, the effectiveness of the program in reducing reported

use diminished with time. Similarly, researchers assessing the ATHENA 

program found that girls who participated in the program reported less 

ongoing and new abuse of anabolic steroids as well as a reduction in the 

abuse of other performance-enhancing and body-shaping substances. The 

authors note that these results are short term, and the long-term 

effectiveness of the ATHENA program is not known. 

The authors of the one study in our review that looked at student drugtesting programs found that the abuse of anabolic steroids and other illicit

drugs and performance-enhancing substances was decreased among 

athletes at schools that implemented mandatory, random drug-testing 

programs. However, this group of athletes also showed an increase in risk 

factors that are generally associated with greater abuse of illicit drugs, 

including anabolic steroids. For example, athletes at schools with drugtesting programs were more likely to believe that peers and authority 

figures were more tolerant of drug abuse, had less belief in the negative 

consequences of drug abuse, and had less belief in the efficacy of drug 

testing. Based on these seemingly inconsistent findings, the study’s 

authors called for caution in interpreting the findings. 

Page 15 GAO-08-15 Teenage Abuse of Anabolic Steroids
Experts identified gaps in the research that addresses anabolic steroid 

abuse among teenagers. Experts identified gaps in the current research on 

the outcomes of prevention programs that focus on anabolic steroids. 

Experts also identified gaps in the research on the long-term health effects 

of initiating the abuse of anabolic steroids as teenagers. 

According to experts, available research does not establish the extent to

which the ATLAS and ATHENA programs are effective over time in 

preventing anabolic steroid abuse among teenage athletes. Experts 

acknowledge that both programs appear promising in their ability to 

prevent the abuse of anabolic steroids among teenage athletes

immediately following participants’ completion of the programs. 

Assessment of the effectiveness of the ATLAS program 1 year later, 

however, found that the lower incidence of anabolic steroid use was not 

sustained, although participants continued to report reduced intentions to 

use anabolic steroids. The long-term effectiveness of the ATHENA 

program has not been reported. The effectiveness of these programs has 

been assessed only in some schools in Oregon, and therefore experts 

report that the effectiveness of the programs may not be generalizable. In

another example, experts identified the need for additional research to 

assess the effectiveness of drug-testing programs, such as those funded 

under Education’s School-Based Student Drug Testing program, in 

reducing anabolic steroid abuse among teenagers.

27

According to experts, there are several gaps in research on the health

effects of teenage abuse of anabolic steroids. Experts report that while 

there is some research that has examined the health effects of anabolic

steroid abuse among adults—for example, the harmful effects on the 

cardiovascular, hormonal, and immune systems—there is a lack of 

research on these effects among teenagers. There is also a lack of research

on the long-term health effects of initiating anabolic steroid abuse during 

the teenage years. Some health effects of steroid abuse among adults, such

as adverse effects on the hormonal system, have been shown to be 

reversible when the adults have stopped abusing anabolic steroids. 

Experts point out, however, that it is not known whether this reversibility 

holds true for teenagers as well. While some experts suggest that anabolic

steroid abuse may do more lasting harm to teenagers, due to the complex

physical changes unique to adolescence, according to other experts there 

Experts Find There 

Are Gaps in Research 

on the Sustained 

Effectiveness of 

Prevention Programs 

and on the Long-term 

Health Effects for 

Teenagers 

 27Education officials told us that the agency is currently conducting an evaluation of the

effectiveness of the student drug-testing programs implemented by its grantees. 

Page 16 GAO-08-15 Teenage Abuse of Anabolic Steroids
is no conclusive evidence of potentially permanent health effects. Experts 

also report that the extent of the psychological effects of anabolic steroid 

abuse and, in particular, of withdrawal from steroid abuse, is unclear due 

to limited research. Some experts we consulted noted a need to better 

inform primary care physicians and pediatricians about anabolic steroid 

abuse among teenagers, so these providers would be better able to 

recognize steroid abuse in their patients and initiate early intervention and 

treatment. 

We provided a draft of this report to HHS and Education for comment and 

received technical comments only, which we incorporated into the report 

as appropriate. 

As arranged with your offices, unless you publicly announce the contents 

of this report earlier, we plan no further distribution of it until 30 days 

after its issue date. At that time, we will send copies of this report to the 

Secretary of Health and Human Services and to the Secretary of 

Education. We will also provide copies to others upon request. In addition, 

the report is available at no charge on the GAO Web site at 

http://www.gao.gov. 

If you or your staff members have any questions regarding this report, 

please contact me at (202) 512-7114 or ekstrandl@gao.gov. Contact points 

for our Offices of Congressional Relations and Public Affairs may be found 

on the last page of this report. GAO staff members who made major 

contributions to this report are listed in appendix III. 

Laurie Ekstrand 

Director, Health Care 

Agency Comments 

Page 17 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix I: Selected Federally Funded

Efforts That Address or Can Address Anabolic 

Steroid Abuse among Teenagers 

Table 1 lists selected federally funded efforts—including programs, 

research, and educational and outreach activities—that are designed to 

focus on preventing or reducing the abuse of anabolic steroids by 

teenagers (focused efforts), as well as other broader efforts that may 

address teenage abuse of anabolic steroids as part of the programs’ 

general substance abuse prevention efforts. The list includes programs 

funded by two departments and the Office of National Drug Control Policy 

(ONDCP), in the Executive Office of the President. 

Table 1: Selected Federally Funded Efforts That Address or Can Address Anabolic Steroid Abuse among Teenagers 

Program 

Funding for

fiscal year 2006 

Program implementers

or eligible applicants Targeted beneficiaries Program description

Department of Health and Human Services 

National Institute on Drug Abuse (NIDA) 

Athletes Training and 

Learning to Avoid 

Steroids (ATLAS) 

---aSchool districts, schools, 

behavioral health 

agencies, others 

Male high school athletes Focused effort: program to 

prevent male high school 

athletes from abusing 

anabolic steroids and other 

performance-enhancing 

drugs, and to promote 

healthy strength training 

and nutrition 

Athletes Targeting 

Healthy Exercise & 

Nutrition Alternatives 

(ATHENA) 

---bSchool districts, schools, 

behavioral health 

agencies, others 

Female high school 

athletes 

Focused effort: program to 

prevent female high school 

athletes from abusing bodyshaping substances such 

as diet pills, tobacco, and 

anabolic steroids, and to 

promote healthy training 

and nutrition 

Research projects $638,000 Researchers Adolescent age group Focused effort: funding for 

three steroid-related 

research projects focused 

on the adolescent age 

group in humans and 

animals 

Educational and 

outreach activities 

$521,000 NIDA and its partners, 

including National 

Collegiate Athletic 

Association, American 

Academy of Pediatrics, 

American College of 

Sports Medicine, others 

Teenage students, 

teachers, general public 

Focused and broad efforts: 

to distribute a research

report on anabolic steroid 

abuse to schools; develop 

steroid abuse posters for 

schools; and support 

Scholastic Magazines 

substance abuse 

information to schools 

including anabolic steroids 

Appendix I: Selected Federally Funded 

Efforts That Address or Can Address 

Anabolic Steroid Abuse among Teenagers 

Page 18 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix I: Selected Federally Funded

Efforts That Address or Can Address Anabolic 

Steroid Abuse among Teenagers 

Program 

Funding for

fiscal year 2006 

Program implementers

or eligible applicants Targeted beneficiaries Program description

Substance Abuse and Mental Health Services Administration (SAMHSA) 

Center for Substance 

Abuse Treatment: What 

Steroids Can Do to You – 

The Drug-The DangerThe Deception

---cSAMHSA contractor High school teachers, 

coaches, students 

Focused effort: program of 

print materials, video, and 

high school assemblies to 

disseminate accurate 

information describing the 

health effects of anabolic 

steroids 

Department of Education

School-Based Student 

Drug Testing grants 

program 

$8.6 million School districts, public 

and private entities 

Students primarily in 

grades 6 through 12 

Broad effort: as of 2006, 72 

grants to support programs 

that address drug 

prevention in schools, 

including anabolic steroid 

prevention efforts 

Executive Office of the President 

Office of National Drug Control Policy (ONDCP) 

Drug-Free Communities 

Support program

about $80 million Community coalitions Various beneficiaries, 

including school-age 

youth, depending on 

community needs 

assessments 

Broad effort: as of 2006, 

more than 700 grants to 

communities to support 

coalitions and grassroots 

organizations engaged in

efforts to prevent use of 

alcohol, tobacco, and illicit 

drugs including anabolic 

steroids 

ONDCP public 

information and 

entertainment industry 

outreach 

$5,000 for 1 event in 

January 2006 

Medical experts, 

coaches, teen athletes 

Journalists, entertainment 

writers, producers 

Focused and broad efforts: 

6 briefings from 2001-2007, 

including roundtable for a 

journalists’ conference on

teen athletes, briefings for 

magazine staffs, and media 

roundtables on teen 

athletes and performanceenhancing drugs 

United States AntiDoping Agency (USADA) 

research projectsd

$1.8 million Researchers Young athletes including 

teenagers 

Focused and broad efforts: 

grants for research on 

current and emerging drug

issues; estimated one-third 

of research funding 

addresses anabolic 

steroids and human growth 

hormone

Page 19 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix I: Selected Federally Funded

Efforts That Address or Can Address Anabolic 

Steroid Abuse among Teenagers 

Program 

Funding for

fiscal year 2006 

Program implementers

or eligible applicants Targeted beneficiaries Program description

USADA education and 

outreach activitiesd

$1.5 million Public and private 

organizations 

Teenagers, young adult 

athletes, parents, coaches 

Focused and broad efforts: 

publications about anabolic 

steroid issues for high 

schools, public service 

announcements, and Web 

sites 

Sources: Agency documents and program officials. 

a

In 2006, NIDA did not provide any funding for the ATLAS program. From 1993 through 2001, 

however, NIDA funded $3.4 million in research related to developing and testing the ATLAS 

curriculum. 

b

Similarly, NIDA did not fund research related to the ATHENA program in 2006, but from 1999 

through 2003 the agency provided $4.7 million to develop and test the program. 

c

SAMHSA officials reported that the agency expects to spend up to $99,000 on this project. A contract

for that amount was awarded on July 6, 2006. As of August 2007, SAMHSA reported that it had made

$40,000 in payments under the contract and expects to pay the remaining $59,000 in fiscal year

2008. 

d

USADA is not organizationally part of the Executive Office of the President. However, because it is 

an independent, nonprofit corporation funded primarily by ONDCP, for purposes of this report we 

have grouped USADA’s activities with ONDCP’s. 

Page 20 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix II: Articles Included in GAO’s Appendix II: Articles Included in GAO’ Review s 

Review 

Borowsky, I.W., M. Hogan, and M. Ireland. “Adolescent sexual aggression: 

risk and protective factors.” Pediatrics, vol. 100, no. 6 (1997): e71-e78. 

Dukarm, C.P., R.S. Byrd, P. Auinger, and M. Weitzman. “Illicit substance 

use, gender, and the risk of violent behavior among adolescents.” Archives 

of Pediatric & Adolescent Medicine, vol. 150, no. 8 (1996): 797-801. 

DuRant, R.H., L.G. Escobedo, and G.W. Heath, “Anabolic-steroid use, 

strength training, and multiple drug use among adolescents in the United

States.” Pediatrics, vol. 96, no. 1 (1995): 23-28. 

Elliot, D., J. Cheong, E.L. Moe, and L. Goldberg. “Cross-sectional study of 

female students reporting anabolic steroid use.” Archives of Pediatric & 

Adolescent Medicine, vol. 161, no. 6 (2007): 572-577. 

Elliot, D., and L. Goldberg. “Intervention and prevention of steroid use in 

adolescents.” American Journal of Sports Medicine, vol. 24, no. 6 (1996):

S46-S47. 

Elliot, D.L., L. Goldberg, E.L. Moe, C.A. DeFrancesco, M.B. Durham, and H. 

Hix-Small. “Preventing substance use and disordered eating: Initial 

outcomes of the ATHENA (Athletes Targeting Healthy Exercise and 

Nutrition Alternatives) program.” Archives of Pediatric & Adolescent 

Medicine, vol. 158, no. 11 (2004): 1043-1049. 

Elliot, D.L., E.L. Moe, L. Goldberg, C.A. DeFrancesco, M.B. Durham, and H. 

Hix-Small. “Definition and outcome of a curriculum to prevent disordered 

eating and body-shaping drug use.” The Journal of School Health, vol. 76, 

no. 2 (2006): 67-73. 

Fritz, M.S., D.P. MacKinnon, J. Williams, L. Goldberg, E.L. Moe, and D.L.

Elliot. “Analysis of baseline by treatment interactions in a drug prevention

and health promotion program for high school male athletes.” Addictive 

Behaviors, vol. 30, no. 5 (2005): 1001-1005. 

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, E. Moe, L. Zoref, E. 

Greffrath, D.J. Miller, and A. Lapin. “Effects of a multidimensional anabolic 

steroid prevention intervention: the Adolescents Training and Learning to

Avoid Steroids (ATLAS) program.” JAMA, vol. 276, no. 19 (1996): 1555-

1562. 

Page 21 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix II: Articles Included in GAO’s 

Review

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, L. Zoref, E. Moe, C. 

Green, and S.L. Wolf. “The Adolescent Training and Learning to Avoid 

Steroids (ATLAS) prevention program: background and results of a model 

intervention.” Archives of Pediatric & Adolescent Medicine, vol. 150 

(1996): 713-721. 

Goldberg, L., D.L. Elliot, D.P. MacKinnon, E. Moe, K.S. Kuehl, L. Nohre, 

and C.M. Lockwood. “Drug testing athletes to prevent substance abuse:

Background and pilot study results of the SATURN (Student Athlete 

Testing Using Random Notification) study.” Journal of Adolescent Health, 

vol. 32, no. 1 (2003): 16-25. 

Goldberg, L., D.P. MacKinnon, D.L. Elliot, E.L. Moe, G. Clarke, and J. 

Cheong. “The Adolescents Training and Learning to Avoid Steroids 

Program: Preventing drug use and promoting health behaviors.” Archives 

of Pediatric & Adolescent Medicine, vol. 154, no. 4 (2000): 332-338. 

MacKinnon, D.P., L. Goldberg, G. Clarke, D.L. Elliot, J. Cheong, A. Lapin,

E.L. Moe, and J.L. Krull. “Mediating mechanisms in a program to reduce 

intentions to use anabolic steroids and improve exercise self-efficacy and 

dietary behavior.” Prevention Science, vol. 2, no. 1 (2001): 15-28. 

Miller, K.E., J.H. Hoffman, G.M. Barnes, D. Sabo, M.J. Melnick, and M.P. 

Farrell. “Adolescent anabolic steroid use, gender, physical activity, and 

other problem behaviors.” Substance Use & Misuse, vol. 40, no. 11 (2005):

1637-1657. 

Naylor, A.H., D. Gardner, and L. Zaichkowsky. “Drug use patterns among 

high school athletes and nonathletes.” Adolescence, vol. 36, no. 144 (2001): 

627-639. 

Rich, J.D., C.K. Foisie, C.W. Towe, B.P. Dickinson, M. McKenzie, and C.M. 

Salas. “Needle exchange program participation by anabolic steroid 

injectors.” Drug and Alcohol Dependence, vol. 56, no. 2 (1999): 157-160. 

Page 22 GAO-08-15 Teenage Abuse of Anabolic Steroids
Appendix III: GAO

A

 Contact and Staff 

cknowledgments 

Page 23 GAO-08-15

Appendix III: GAO Contact and Staff 

Acknowledgments 

GAO Contact Laurie Ekstrand, at (202) 512-7114 or ekstrandl@gao.gov. 

In addition to the contact named above, key contributors to this report 

were Christine Brudevold, Assistant Director; Ellen M. Smith; Julie 

Thomas; Rasanjali Wickrema; and Krister Friday. 

 Teenage Abuse of Anabolic Steroids

Staff 

Acknowledgments 

(290594) 
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