heoc - performance enhancing drugs and risk decision making

Running head: PROSPECT THEORY AND DRUG USE IN SPORT

Performance enhancing drug use in professional sport is a risk

decision: A qualitative analysis of Prospect Theory

Helen L OConnor

Supervisor: Dr Jeremy Adams

London Metropolitan University

Prospect theory and PEDs 1

Abstract

Current anti-doping legislation in competitive sports is advocated for reasons of fair-play and

concern for the health of athletes. Conceptualising performance enhancing drug use as a risk decision,

the present study examined how models of decision-making might be applied to understanding doping

in sport. Prospect Theory (Kahneman & Tversky, 1979) suggests that the way in which individuals

respond to risk decisions is likely to be influenced by a number of cognitive biases, including whether

the messages they receive about that decision are framed as a gain or a loss, and how they evaluate

that loss relative to a reference point, or point of view. Recent research has also emphasised the

importance of considering motivational and cultural constructs to account for the way in which

individuals evaluate the value of risk decisions. Qualitative data was collected from semi-structured

interviews conducted with 7 professional athletes (M=31.00, SD=11.05) to provide insight into the

factors that might explain an athletes decision to use performance enhancing drugs despite the risks

associated with use. Three major themes emerged from the data: goals, normalisation and affect. The

findings are discussed and recommendations are made for future decision-making research on risk

behaviours within sport. Anti-doping authorities should ensure that the effects of message framing are

built into future drug-compliance programmes.


Introduction

Performance enhancing drug use is assumed to be a serious problem across many sports, a

concern which cumulated in the formation of the World Anti-Doping Agency (WADA) in November

1999. Despite international recognition of this problem, and although athletes across many, if not

most, sports have tested positive for a broad range of banned substances, accurate data on the

prevalence of doping is difficult to obtain for three reasons. First, despite advanced drug-testing

procedures, it is not financially feasible to screen all athletes. Second, it is difficult to obtain reliable

estimates of self-reported use from athletes because doping in sport is essentially an underground

activity. Lastly, testing is not always accurate or reliable, and testing procedures are often one step

behind users and manufacturers in detecting new drugs and other techniques (Strelan & Boeckmann,

2006). Nevertheless, several surveys have revealed statistics which suggest that the use of

performance enhancing drugs has increased substantially over the past 50 years, perhaps

unsurprisingly considering the evolution of modern medicine in this period (Waddington, 2000). For

instance, in 1989, an Australian Senate Committee Report heard evidence that approximately 70% of

Australian athletes who had competed internationally had taken drugs (Australian Senate Committee,

1989). A similar enquiry by the UK Sports Council (1995) reported that, of the 448 British Olympic

athletes interviewed, 48% considered that drug use was a problem in their sport, a figure that

increased to 86% in track and field events. Moreover, it is evident that the use of performance-

enhancing drugs has spread from athletics, weightlifting and cycling, the three sports in which drugs

appear to have been most frequently used in the 1960s, to almost all other sports (Mottram, 2005;

Waddington, 2005). There is also a growing body of evidence that performance-enhancing drugs are

being used at lower levels of competition, and by younger athletes (e.g., Buzzini, 2007; Donati, 2004)

and that use of anabolic steroids in particular is increasing in recreational fitness populations (Simon,

Striegel, Aust, Dietz, & Ulrich, 2006). Whilst the prevalence of drug use is likely to vary considerably

from one sport to another it is clear that doping is widespread, and, in some sports, many athletes are

likely to be using performance-enhancing drugs (Hoberman, Wilson, & Derse, 2001).

The two main arguments for banning performance-enhancing substances in competitive sport

are that, first, it is widely considered that the enhancements to physical performance that these

substances offer is contrary to one of the virtues of sport: fair play (World Anti-Doping Agency

[WADA], 2002). Athletic competitions, it is argued, are designed to demonstrate the best performer

on a level playing-field reflecting natural capacities. It is, therefore, unfair if a particular resource,

such as performance enhancing drugs, is available to some competitors but not others (Sabini &

Monterosso, 2005). A second argument is the very real concern that many substances can be

detrimental to athletes health. For example, anabolic steroids can affect cardiovascular and mental

health (Gruber & Pope, 2000; Haller & Benowitz, 2000; Parssinen & Seppala, 2002); erythropoietin

(EPO) can lead to depression and increase the risk of heart attacks (Singbartl, 1994; Sullivan,

Martinez, Gennis, & Gallagher, 1998); and users of human growth hormone (HGH) can experience


hypertension, cardiac disease and overgrowth of hands, feet, and face (McHugh, Park, Sonksen, &

Holt, 2005). These are just some of the known risks: future generations of performance-enhancing

substances, or combinations thereof, might cause other physical or psychological damage.

Prevention Measures

In response to the continuing problem of performance-enhancing drug use in professional

sport, anti-doping policy has been based almost exclusively on what might be described as a punitive,

or law-and-order, approach (Waddington, 2000). Considerable resources have been directed towards

developing and implementing drug-testing programs both during and out of competition, with severe

penalties for those who test positive: usually a two-year ban for the first, and a lifetime ban for the

second offence (WADA, 2003). The WADA list of banned substances includes those which are

known to improve performance, and others, known as masking agents, which can be used to prevent

the detection of certain drugs in the blood or urine. The WADA prohibited substance list for 2008

includes over 200 specific substances (WADA, 2008d)., and every year, the number of banned

substances is likely to increase (Honour, 2004). Although biotechnological advancements often leave

sporting bodies one step behind athletes in identifying new substances that become available. the

WADA also maintains a strict monitoring programme in order to determine patterns of misuse for

currently non-prohibited substances (WADA, 2008b). Testing outside of competition for most

Olympic sports is conducted by the WADA, and an athlete can be required to be tested at any time or

place, and without notice. In-competition testing is the responsibility of the various International

Sports Federations for each summer, winter and paralympic sport. In recent years, other sporting

organisations, such as the World Association of Kickboxing Organisations (2006) and the World

Triathlon Corporation (2005), have adopted anti-doping guidelines and penalties in accordance with

the WADA code and banned substance list.

Measuring the effectiveness of testing programmes and the associated penalties is not

straightforward. Blanket testing is not carried out across all athletes in all sports and, more often than

not, random samples of athletes are tested, or the top performers in a particular competition are

singled out for screening. Ivan Waddington (2000) has criticised current mechanisms for measuring

the effectiveness of WADA policies (i.e., trends in the number of positive test results), arguing that

they are a, in fact, a poor index of the extent of drug use by athletes. Estimating that the number of

positive tests reported by WADA average one and a half percent of all tests undertaken in the past

five years, Waddington cautions against taking this as an indication that current screening

programmes are effectively tackling the problem of drug use in sport. Specifically, he points to

empirical findings which suggest that the breadth of drug use in sport is increasing, and that this trend

is diffusing to the lower levels of competition, as well as to adolescent athletes, and that use is

increasing in recreational fitness sports (e.g., Buzzini, 2007; Donati, 2004; Simon et al., 2006).


As well as directing considerable resources towards testing programmes and the development

of more sophisticated detection procedures (the WADA budget for 2008 is $27m (WADA, 2008a)),

the WADA anti-doping programme also incorporates some educational tools. In many instances,

education programmes merely provide factual information about the health risks and other

consequences of using performance-enhancing drugs, and ensure that athletes are aware of the latest

banned substances and testing requirements. The WADA also recommends educational programmes

which emphasise the other argument against doping: that it is unsportsmanlike. Such educational

programmes are specifically designed to promote appropriate moral reasoning, by developing

attitudes and social values that will encourage athletes to choose not to use performance-enhancers,

because they view such behaviour as the right thing to do (Donovan, Egger, Kapernick, & Mendoza,

2002). In most cases these programmes are directed at children and adolescents, such as the WADA

Values Based preventative educational programme, aimed at secondary school-aged children

(WADA, 2008c). Unfortunately there has been no research to date which has examined the

effectiveness of these programmes (Strelan & Boeckmann, 2006), potentially because the audience

for such programmes has been young athletes who are yet to enter the higher levels of sport

competition. But such programmes are, by nature of their target audiences, unable to address the

increase in potentially harmful drug use amongst non-elite athletes and recreational fitness

populations.

The main efforts by policy makers and sporting organisations to deter the use of banned and

potentially dangerous drugs within professional sport have focused on testing and penalties. This is

supplemented by some educational programmes emphasising the health risks and the moral aspect of

cheating. How, or whether, these measures are effective is difficult to evaluate, but evidence would

suggest that the use of performance enhancing drugs is still widespread. There is currently little

evidence in the sports medicine and sports science literature, either theoretical or empirical, on what

factors influence performance enhancing supplement use by sportspeople. The theoretical work is

limited to examinations of the relationship between attitude and behaviour for prohibited substance

use (Mazanov, Petroczi, Bingham, & Holloway, 2008). To gain a deeper insight into the decisions of

athletes who use illicit substances and escape detection, or the rationale behind the decisions of those

athletes who refrain from using, it might be possible to draw upon findings from research based upon

two theoretical models of decision-making under risk: deterrence theory (Paternoster, 1987) and

prospect theory (Kahneman & Tversky, 1979).

Perceptual Deterrence Theory

Criminologists have long considered the relationship between the threat of formal legal

sanctions and crime. Perceptual deterrence theory (Paternoster, 1987) was originally formulated to

explain the role that legal sanctions play in regulating behaviour, particularly criminal acts. The

theory is based upon the rational choice model of human behaviour, Homo Economicus, which


proposes that an individuals behaviour is determined by a conscious cost-benefit analysis of the

likely consequences of that behaviour (Cornish & Clarke, 1986). Specifically, rational choice models

propose that individuals attempt to maximise their returns, making their decisions based on two

factors: the utility of the various outcomes and their respective probability. Utility, in this sense, refers

to whatever end a person would like to achieve, whether internal goods (e.g., happiness) or external

goods (e.g., money) (Broome, 1995), and individuals are assumed to be able to rationally compute the

probability of the various outcomes. Proponents of perceptual deterrence theory suggest that

deterrence is a psychological process, dependent upon an individuals subjective assessments of the

utility of the various benefits and costs associated with committing a particular criminal act.

According to the theory, if individuals perceive that punishment for a criminal act is both highly

certain and severe, and that this outweighs the benefits of the act, they are more likely to avoid that

act. Conversely, if benefits are perceived to outweigh the costs, the crime is more likely to be carried

out (Paternoster, 1987).

Deterrence theory research has traditionally concentrated on street crime populations,

particularly with respect to drugs (Lenton, 2005; Marlowe, Festinger, Foltz, Lee, & Patapis, 2005).

The theory has also been applied to understand decision-making across a range of other criminal

behaviours including tax evasion (Varma & Doob, 1998), domestic violence (Williams, 2005), and

driving offences (Pogarsky & Piquero, 2003; South, 1998). Since most deterrence research concerns

crime policy, the costs associated with offending have been mainly conceptualised in legal terms, or

formal sanctions, such as fines or prison sentences. The effects of informal and social sanctions are,

however, also recognised by the theory. These might include how an individuals peers react to his or

her criminal behaviour with disapproval, or disciplinary measures, such as job loss.

The equivalent of legal sanctions in the sporting context is drug-testing and the associated

penalties for positive test results, although decision-making theories have received little attention

regarding the problem of illicit substance use in sport. In fact, the only specific application of

deterrence theory in this context to date is the Drugs in Sport Deterrence Model (DSDM) proposed by

Strelan and Boekchmann (2003). This model contains three components: costs, benefits, and

situational factors. Costs, naturally, include legal sanctions (such as fines and suspensions), but also

include social sanctions (such as disapproval, ostracism, and material loss resulting from a withdrawal

of sponsorship or funding); self-imposed sanctions (such as guilt and reduced self-esteem); and health

costs which relate to the negative side-effects of performance-enhancing drugs. The benefits in the

DSDM include external goods, or material gains (such as prize money, sponsorship and

endorsements); social gains (such as fame, status and approval from important others); and

internalised benefits, such as satisfaction at doing ones best (Strelan & Boeckmann, 2003).

Recognising that a cost-benefit analysis might be influenced by other factors, Strelan and Boekmann

(2003) include five contextual variables in their model, which they suggest are likely to affect

athletes subjective assessment of the costs and benefits of performance-enhancing drug use. These


are: prevalence perceptions; perceptions of ones competitiveness; professional status; perception of

authority legitimacy; and type of drug. Whilst providing some rationale for their inclusion, the authors

do not expand much upon these factors, which do warrant a closer evaluation.

With respect to prevalence perceptions, there is evidence that athletes who perceive

prohibited substance use as a problem in their sport might be more likely to use legal supplements as

an additional method of performance enhancement (next to methods like training and nutrition) to

overcome an assumed gap in competitive advantage (Goldberg et al., 2000; Sobal & Marquart, 1994).

Whilst limited to very few studies, a common-sense interpretation of these findings would suggest

that perceived prevalence of banned substances in a particular sport would also increase the likelihood

of an athlete choosing to use banned substances themselves, as a strategy to narrow the competitive

advantage (Breivik, 1992).

Strelan and Boekmanns (2003) second factor, perception of competitiveness, can perhaps

best be described in terms of the development in the structure of sporting competition in the past 50

years. Waddington (2005) has suggested that these developments, which include the politicisation of

sport and substantial increases in the rewards associated with sporting success, have had the

consequence of increasing the competitiveness of sport. According to Waddington, one result of this

has been the downgrading, in relative terms, of the traditional, or amateur, values associated with

taking part, and greatly increasing the value attached to winning. The fact that professional sport is

played for higher stakes is an important consideration when examining the context of the increasing

use of drugs in sport, particularly from a deterrence perspective. The rewards of success at an elite

level are great, both financially and in terms of personal glory and there is, consequently, greater

pressure for athletes to train longer and harder to maintain a constant improvement of sport

performance. Athletes are now encouraged to seek every possible way to improve their performance,

including a scientific approach to nutrition and training methods, seeking every biomechanical and

psychological advantage (Petrczi & Aidman, 2008). It is perhaps inevitable that some athletes will

seek an advantage through drugs.

Similarly, and perhaps unsurprisingly considering the increase in the competitive nature of

sport, professional status is a further variable cited by Strelan and Boekmann (2003) as potentially

contributing to an athletes perception of the costs and benefits associated with performance-

enhancing drugs. Skill, or competitive, level has been shown to influence a number of outcomes and

abilities relating to athletes, such as pain perception (Paparizos, Tripp, Sullivan, & Rubenstein, 2005),

imagery ability (Gregg & Hall, 2006), goal-setting (McPherson & Kernodle, 2007), aggression

(Rascle, Coulomb-Cabagno, & Delsarte, 2005), and coping with anxiety and stress. Whilst such

findings are typically measured in terms of age, this is, more often than not, a reflection of higher

competitive level and professionalism and almost all top level competitors are full time and, even if

not paid, are to all purposes professional (Waddington, 2005). There is also some limited evidence

that athletes are more likely to use performance-enhancing drugs towards the end of their careers


(Hughes & Coakley, 2001) or for rehabilitation purposes (Strelan & Boeckmann, 2006). It could be

argued that these athletes believe that the use of a banned harmful substance is a viable response to a

career-threatening situation such as a performance decline or injury.

Perception of authority legitimacy is, potentially, one of the more complicated situational

factors proposed in the DSDM. Fuller and LaFountain (1987) have suggested that some athletes are

able to rationalise the use of performance enhancing drugs as a victimless crime (p. 974). There is

also a moral argument that the WADA rules which dictate that professional athletes must

communicate their whereabouts at all times to the testing authorities, and be available with no notice

for random tests, is an infringement of privacy (Waddington, 2005). Discrepancies between some

sports regarding acceptable and banned substances might create a situation whereby athletes doubt the

rationale behind banning a substance in one sport that is allowed in another. Moreover, the likelihood

that many athletes who use banned substances escape detection is likely to affect the perceived

effectiveness, and therefore legitimacy of testing programmes. How athletes perceive the legitimacy

or effectiveness of testing controls has not been examined in detail, and warrants further study.

The final situational variable in the DSDM, and the one which would appear to be the most

obvious, is the type of drug. This point is illustrated in Robert Goldmans (1992) survey of 198 world-

class athletes. When asked whether they would take an imaginary undetectable banned drug that

would guarantee them victory, but kill them within five years, more than half the athletes in the study

said that they would. Intuitively it would seem likely that if an athlete believes there is no test for a

particular substance, they are more likely to consider using it, because the threat of legal sanctions

becomes irrelevant in the decision-making process. Even when the threat of legal sanctions is

removed from the costs of the decision, Goldmans finding raises an important question about why an

athletes motivation to win might override any consideration of a life-threatening health-risk, even to

the extent that social and self-imposed sanctions, are not taken into consideration. On a practical level,

even for athletes for whom the health risks are likely to be a potential deterrent, the long-term side-

effects for more recently developed substances and procedures are not yet fully known. In such cases

there is potentially little information that can be provided regarding the health risks.

The DSDM (Strelan & Boeckmann, 2003) has received little empirical attention. One

potential explanation for this is that a large proportion of the research examining deterrence theory has

provided evidence that perceptions of the severity or certainty of legal sanctions often have very little

influence upon the decision to commit a criminal act (Krebs, Costelloe, & Jenks, 2003). In most cases,

only when both the likelihood of detection and the severity of sanctions reach extreme (and often

unfeasible to implement) levels, do they have any effect. One reason for the failure of deterrence

theory to predict individual decision-making and, therefore, behaviour, is the variations observed in

how people compute the utility of various outcomes, which often does not equate to the actual

probabilities of those outcomes (Kahneman & Tversky, 1979). Whilst deterrence theory specifically

addresses criminal behaviour, expected utility theory (Von Neumann & Morgenstern, 1947), on which


deterrence theory is based, has also revealed similar findings. Of particular interest are the findings

from the health literature, which demonstrate that individuals are likely to vary widely when

calculating the utility of logically equivalent health outcomes. For example, Pinto-Prades and

Abellan-Perpian (2005) found that the utility of a hypothetical medical procedure varied between

0.48 and 0.80, depending on how the probabilities were described. Specifically, individuals accepted a

lower risk of death when success and failure probabilities of a medical procedure were given out of a

higher denominator (i.e., X out of 1000 will die, as opposed to Y out of 100), despite the percentages

being identical. Such findings demonstrate that individuals are not rational decision makers, which

has significant implications for the design of practical interventions.

Examining the DSDM in a sample of 116 elite footballers, Strelan and Boekmann (2006)

provided participants with two hypothetical scenarios. In the first scenario, they were told that,

following a serious and career-threatening injury, they had the option to take human growth hormone

(HGH) which would dramatically improve their chances of recovery, but were not given any

information regarding whether this could be detected. The second scenario was identical, but athletes

were told that there was no current test for HGH. In both scenarios athletes were asked to indicate the

probability that they would use HGH, as well as the certainty and severity of each of the legal, social,

moral, and health threats, as described in the DSDM. Supporting previous findings from the

deterrence literature, drug testing had little influence on athletes imagined drug use decision.

Moreover, after the athletes were informed that they could not be caught for using HGH, their mean

rating of decision to use increased from 23.88 to 36.58, a difference which was significant. This

finding would suggest that knowledge of the absence of legal sanctions impacts on athletes

hypothetical decisions to use a particular substance, and supports Strelan and Boekmanns inclusion

of type of drug as a situational variable in the DSDM. Specifically, when athletes considered each of

the deterrents together, they were most likely to be deterred by their moral beliefs (i.e., the guilt they

anticipate they would experience as a consequence of engaging in an act that is contrary to an

internalised code), and their fear of the negative side effects. Strelan and Boekmanns findings reflect

what has been found in deterrence studies relating to other types of criminal behaviour: that moral

beliefs are the best predictor of an individuals decision to break a law, and that formal sanctions work

most effectively in conjunction with informal sanctions, such as the perceived threat of social

disapproval and moral commitment, to inhibit illegal behaviour (Bachman, Paternoster, & Ward,

1992; Grasmick & Bursik, 1990; Nagin & Pogarsky, 2003).

The emphasis on drug testing assumes that individuals respond primarily to the instrumental

characteristics of a banned drug-use decision, and ignores the potential of other factors for deterring

use (Strelan & Boeckmann, 2006). However, the increasing pattern of drug use in professional sport

would suggest that, when evaluating the risks involved in a decision to use a banned, harmful

substance, athletes are motivated or influenced by other factors, besides the traditional deterrents or

the information provided in educational programmes. Strelan and Boekmanns DSDM provides a


framework and starting point for understanding the factors that influence a decision to commit the act

of illegal, and potentially harmful, drug use in competitive sports. Nevertheless, the key assumption of

deterrence theory, that individuals are assumed to be rational, and are capable of weighing the

possible risks and rewards associated with every possible options, choosing that with the highest

expected utility, makes it much easier to practice deterrence from a theoretical standpoint. Rational

choice models have often failed to successfully predict the actions of individuals in real-world settings

and fail to provide an adequate description of how people make choices in many circumstances.

Humans rarely, if ever, have all the information necessary to make a decision. Even if they did, they

would lack the ability to combine and weigh the information accurately, as described by deterrence

theory (Starmer, 2000). What is clear is that some athletes are prepared to take the greatest risks with

respect to their health and, potentially, their careers (Goldman & Klatz, 1992; Strelan & Boeckmann,

2006). It might, therefore, make more sense to consider alternative models, which are able to account

for decisions which depart from the usual rationality model. One such theory is Prospect Theory

(Kahneman & Tversky, 1979).

Prospect Theory

Developed by two psychologists, prospect theory (Kahneman & Tversky, 1979) recognises

that certain cognitive pressures might have an effect on an individuals choices, taking into account

the misperceptions and biases that affect decision-making, and which allow for departures from

rational-choice models of behaviour. Unlike rational choice models (such as deterrence theory), which

are concerned with how risk decisions should be made (a prescriptive approach), prospect theory

concerns itself with how these decisions are actually made (a descriptive approach). Prospect theory

differs from expected utility models in three other important respects. First, it replaces the notion of

utility, usually defined in terms of net wealth, with value, defined in terms of gains and losses. These

gains and losses are evaluated around a subjective reference point, or point of view. Much of the

research in this field assumes that, for most individuals, the reference point for any decision is their

current situation, or the status quo. The preference for the status quo is a cognitive bias which causes a

preference for neutrality, and gains and losses are evaluated with respect to maintaining it (Kahneman

& Tversky, 2000). This bias aside, the reference point can also be variable and moveable and can

include other, non-status quo, points of view, although this is not always emphasised in the literature

(Heath, Larrick, & Wu, 1999). Second, unlike rational choice models, which assume that equivalent

formulations of a choice problem should give rise to the same preferences, prospect theory predicts

that an individuals decision will systematically differ, depending on how the potential outcomes of

that decision are framed, or labelled, as gains or losses, relative to the reference point. Specifically,

prospect theory proposes that, depending how an outcome is framed, individuals will have a

preference for risk-adverse choices for relative gains, and risk-seeking choices for relative losses

(Plous, 1993).


Framing refers to the wording or other means of presenting logically equivalent information

and a framing effect (Tversky & Kahneman, 1981) arises when alternative framing of logically

equivalent information produces different decisions. Evidence to date suggests that framing effects are

a common phenomenon affecting both hypothetical and real decisions (Edwards, Elwyn, Covey,

Matthews, & Pill, 2001). This effect was illustrated in Tversky and Kahnemans (1981) well-known

Asian disease problem. Given a hypothetical situation in which the US was preparing for the outbreak

of a disease expected to kill 600 people, one group of participants were asked to chose between two

programs to combat the disease: programme A, in which 200 people will be saved, or programme B,

in which there is a one in three probability that 600 people will be saved, and a two in three

probability that no people will be saved. Using the same hypothetical scenario, a second group of

participants were provided with different options: programme A, in which 400 people will die, and

programme B in which there is a one in three probability that nobody will die, and a two in three

probability that 600 people will die. Despite the choices being identical in terms of real value, 72% of

participants in the first group preferred programme A, whilst only 22% of the second group chose this

programme. Tversky and Kahneman claim that prospect theory can predict these choices, by nature of

the way in which the solutions were framed as a gain or a loss. The majority choice in the first group

was risk averse: the prospect of saving 200 lives with certainty was more promising than the

probability of a one in three chance of saving 600 lives. For the second group, the certain death of 400

people was less acceptable than the two in three chance that 600 people would die.

The Asian disease problem also illustrates a third difference between the two theories, in

terms of how they handle the probabilities attached to particular outcomes. Classical utility theories

assume that rational decision makers value a 50% chance of winning as exactly that. In contrast,

prospect theory treats preferences as a function of decision weights, and recognises that these weights

can be distorted, and do not always correspond to probabilities. Specifically, prospect theory

postulates that decision weights tend to overweight small probabilities and underweight moderate and

high probabilities (Plous, 1993).

Prospect theory is able to account for decisions (such as the Asian disease problem) which

depart from the rational-choice model, and provides a description for how individual decisions are

determined by the way in which the value of various outcomes are framed as a gain or a loss, rather

than the actual probability of any particular outcome. The theory represents a great improvement over

classical utility theory, and many violations of utility theory are explicitly predicted by it (Plous,

1993). Prospect theory has been applied to study and predict individual decision-making behaviour in

a variety of fields including economics (Benartzi & Thaler, 1995), consumer behaviour (List, 2004)

and political science (J. S. Levy, 1996). Supporting prospect theorys assumption that people have a

tendency to be risk-averse for gains and risk-seeking for losses, a number of these studies have

reported the tendency for negative information to have a greater influence on decisions and judgments

than positive information (Kahneman & Tversky, 1984; Skowronski & Carlston, 1989). As a


consequence of this, prospect theory has also been applied to behavioural decision-making in the

health domain (J. E. Smith & von Winterfeldt, 2004), a primary focus being the effects of message

framing. More specifically, research in this field seeks to understand how the efficacy of public health

campaigns can be improved by presenting information about the risks associated with various

behaviours, or the benefits of protective measures, to account for this bias (Schwartz, Goldberg, &

Hazen, 2008). For example, a recommendation to use dental floss on a regular basis can be stated in

terms of potential loss: If you do not floss regularly, you will increase your chances of tooth decay.

This same recommendation can also be stated in terms of a potential gain: If you floss regularly, you

will increase your chances of having healthy teeth and gums. There is a relatively large body of

literature which examines the effects of similar message framing across a range of risk reduction

measures including cancer screening (Turvey & Fishkin, 2003), vaccination (Abhyankar, O'Connor,

& Lawton, 2008), HIV-prevention, and smoking cessation (Toll et al., 2008). A large proportion of

these studies report findings that are consistent with the predictions of prospect theory. For example,

Abhyankar and his colleagues (2008) examined the efficacy of loss- or gain-framed messages on

parents intentions to obtain the MMR vaccine for their child. Participants received either a negative

message (emphasising the health risks and the anticipated anxiety of the parent) or a positive message

(emphasising the benefits of vaccination, and the peace of mind brought about by this choice). In

accordance with prospect theory, participants who had been exposed to the loss-framed message

reported stronger intentions to vaccinate, although, without a follow-up study, it remains unclear

whether the loss-framed message resulted in more actual vaccinations in this group.

In simple terms, therefore, an individuals evaluation of a particular risk decision can differ

depending on how the outcome is framed as a gain or a loss. The messages he or she receives from

policy makers and other providers of information can play an important part in creating this frame.

However, in prospect theory, an individuals reference point, or point of view, will also determine

how particular outcomes are subjectively perceived to be a gain or a loss relative to it. Because the

reference point is not necessarily the status quo, understanding the processes by which an individual

selects a particular reference point from which to evaluate the value of various outcomes is, therefore,

an important factor in explaining risk behaviour. Very little is known about how an individual locates

the reference point for a particular decision, although recent research has begun to address this gap in

the prospect theory literature (Schwartz, Goldberg et al., 2008; Schwartz, Hazen, Leifer, &

Heckerling, 2008; Van Osch, van den Hout, & Stiggelbout, 2006).

Van Osch and her colleagues (2006) sought to examine the psychological processes which

might determine the selection of a reference point by combining quantitative and qualitative data. The

researchers used a life-year gamble protocol, instructing participants to choose between alternatives

across different hypothetical life-expectancy scenarios (e.g., a gamble between a 50% chance of living

in good health for 50 years, and a 50% chance of dying within one week, or a 100% chance of living

in good health for 25 years). Qualitative data was provided by instructing participants to think-aloud


during their evaluation of the different gambles, in order to assess which outcome in the gamble

served as the reference point. The qualitative findings from this study reveal some potentially useful

information regarding how individuals frame a risk decision with respect to their life-expectancy. In

particular, participants goals (e.g., career, retirement, or child-related) appeared to be an important

feature which caused the reference point to shift for different life-duration gambles. The authors

suggested that goals influenced the shift in outcomes that served as a reference point, and that the

outcomes closest to a goal-realising period most likely served as the reference point. More

specifically, to live for the period in which goal realisation is possible (e.g., I wont

consider my life a success if I cannot start a family; I could not do that if I only live until I am 39)

appeared to underlie the motivational processes of the individual, with goals being more frequently

mentioned for proximal than for distal life years. Another observation from this study was that some

participants were not attracted to the entire life-expectancy in the longer-duration gambles because

they anticipated disease at an advanced age. In other words, for some participants the longer life

expectancy was framed as a loss, meaning that general quality of life, as well as specific goals, was a

factor that influenced the decision for certain gamble scenarios.

The importance of goals is accepted in many accounts of human motivation and behaviour

across a variety of disciplines (Deci, 1992; Locke & Latham, 1996). Despite the wide use of

motivational concepts (such as goals) in other areas of psychology, the dominant tradition in decision-

making theory has emphasised value (or utility) as a basis for choice, with an emphasis on cognitive

processes. Nevertheless, some research based on prospect theory has examined the function of goals

in decision-making outcomes. For example, Levin and his colleagues (1998) distinguish between

three different types of decision frames: risky choice frames, attribute frames and goal frames, which

they propose will result in different decisions. Similarly, Heath and his colleagues (1999)

demonstrated that the goal itself might serve as a reference point by altering the (loss or gain) value of

outcomes as described by prospect theory. The authors attempt to explain motivational phenomena

like effort, persistence, and performance, by focusing not on the value of external rewards but on the

psychological effects of what they term mere goals (p. 80). Specifically, mere goals exclude

situations that can be examined with straightforward economic calculations (as are typical in the

decision-making literature), and include only those which are fundamentally psychological.

According to Heath et al., the reasoning behind this focus is to study the cognitive relevance of goals

without the confounding influence of economic gains. The authors also criticise the majority of

decision research for failing to explore non status quo reference points. In contrast, the goal literature

has shown the importance of changing and moveable goals (i.e., as non status quo reference points),

which will potentially change how outcomes are valued in human decision-making. Even the founders

of prospect theory, Kahneman and Tverskey (1979), have argued that, for some situations, an

individuals aspiration level might determine if outcomes are framed as gains or losses, and there is


some evidence that individuals are likely to accept more risk to achieve their aspiration level

(Verhoef, De Haan, & Van Daal, 1994).

Reflecting on findings such as these, Krantz and Kunreuther (2007) have suggested that the

cognitive aspects of decision-making theories and the motivational aspects of goal-setting approaches

can be combined, such that particular goals can be viewed as ways of increasing the utility of

outcomes. Moreoerver, Krantz and Kunreuther propose that this relationship will be more apparent for

proximal goals as opposed to distal goals. This would be consistent with evidence that setting goals in

the relatively near future might enhance expectations of future success (Bandura, 1986; Locke &

Latham, 1996, 2002).

Application of Prospect Theory to Drug Use in Sport

Prospect theory is, in many situations, able to account for decisions that depart from classical

rational choice models of risky decision-making. The observation that goals or aspirations can serve

to influence the perceived utility of outcomes, by serving as the reference point, or point of view, for a

particular decision, suggests that the theory is likely to hold promise in an application to drug-use in

sport. Athletes who choose to use performance-enhancing drugs are prepared to take risks: with their

health, and with detection and the associated penalties (potentially a lifetime ban from their sport). If

some athletes are prepared to use banned and harmful performance-enhancing drugs to guarantee a

win or to prolong their career it would appear that, within a prospect theory framework, those athletes

have a reference point that is framed, at least in part, by sport career goals and aspirations. This is an

important consideration which has implications for the success of measures to prevent or reduce the

use of drugs in sport, particularly in how anti-doping messages to athletes are framed, and in whether

athletes require specifically designed messages at particular points in their careers.

There is no debate that goals are an important aspect of motivation and success within elite

sport (Ames & Roberts, 1992; Gould, Dieffenbach, & Moffett, 2002; Jackson & Roberts, 1992;

Munroe-Chandler, Hall, & Weinberg, 2004). To understand how the reference point, as framed by

particular goals, might influence an athlete in making a risky choice, such as using performance-

enhancing drugs, it is important to explore how some particular goals and their timeframes might

establish a reference point from which this decision is yes. Within the health literature, an example

of a goal related to life-expectancy might often be I want to live to see my children grow up, which

creates a particular timeframe within which different life expectancy gamble outcomes will be framed

as a gain or a loss. However, elite athletes often have a narrow and specific set of goals pertaining to

their sport, the achievement of which typically involves the sacrifice of education, employment and

family or social goals (Hughes & Coakley, 2001). Likewise, the age at which a sportspersons career

is likely to end is far younger than for most other occupations (Van Raalte & Andersen, 2007), and

there is, consequently, a relatively small window of opportunity for them to achieve their sport-related

goals. Whilst for younger athletes some goals (such as to compete in an Olympic Games) represent


more distal timeframes, for the older athlete, this becomes a proximal goal, with, perhaps, one

remaining attempt. Sensitivity to the goal-realising period, as observed in Osch et al.s study (2006) is

therefore of interest with respect to elite athletes reference points regarding their decision to dope,

particularly considering the evidence that men and women participating in sport are more likely to

abuse drugs towards the end of their career (Hughes & Coakley, 2001).

Whilst an athletes goals are likely to be an important factor when evaluating the risk of a

decision to use performance-enhancing drugs, another potentially relevant, although under-

researched, finding from the sociocultural literature is that different cultural groups are likely to vary

in the way that they frame and respond to risk (Bunton, Nettleton, & Burrows, 1995; Collard,

Kempson, & Whyley, 2001). Whilst this evidence is derived from small gender, race and socio-

economic groups, and predominantly focuses on financial risk, it also has implications for

understanding the importance of the wider frame of the sporting culture to which an athlete belongs.

Whether or not the general public condemn certain behaviours of athletes, such as concealed doping,

it has also been suggested that such behaviour might be viewed as a cultural norm within sport.

Membership of this cultural group might, at least in part, serve to influence an athletes reference

point for both the moral and the health risks of using performance enhancing drugs. For instance, in

an early study which examined the attitudes of 50 athletes regarding performance enhancing drugs,

Fuller and La Fountain (1987) reported that some athletes rationalised doping as part of a "code of

commitment to sport." (p. 974). From a cultural perspective, Hughes and his colleagues (2001) refer

to such behaviour as positive deviance and hypothesise that many forms of deviance in sport are not

caused by a disregard or rejection of social values or norms; instead they are the result of an

unquestioned commitment to a value system framed by what they refer to as the sport ethic. This is

similar to the construct of athletic identity, or the extent to which an individual relates to and focuses

their self-identity on the role of an athlete (Brewer, Van Raalte, & Linder, 1993; Brown & Hartley,

1998; Grove, Lavallee, & Gordon, 1997).

Hughes and Coakley (2001) identified four common beliefs which they suggest are the most

commonly accepted factors defining what it means to identify oneself as an athlete: making sacrifices

for the game; striving for distinction; accepting risks and playing through pain; and refusing to accept

limits (pp. 362-363). Commitment to these beliefs has been linked to positive behaviours and

outcomes, such as improved performance (Lufi, Porat, & Tenenbaum, 1986), focus on sport goals

(Horton & Mack, 2000) and fostering motivation and discipline (Miller & Kerr, 2002). However,

over-commitment to the sport ethic can result in other, more problematic behaviours, such as over-

training, disordered eating and illicit use of performance-enhancers, the legitimacy of which is often

reinforced by those within the culture of sport. Studies which have examined attitudes of individuals

within the wider sporting culture have provided evidence that, at least at the elite level, coaches and

members of the medical profession are often supportive of the use of banned substances (Laure, 1997;

Millar, 1994). This point has been emphasised theoretically by Cialdini (2007), who advocates


research which distinguishes between injunctive norms (i.e., what most others say should be done)

and descriptive norms (i.e., what most others actually do), proposing that the latter appear to have

more influence than the former.

Speaking of risk cultures, writers such as Scott Lash (2000) have emphasised the

importance of considering how group membership influences the way in which individuals structure

their response to different types of risk. Lash also acknowledges an absence of empirical research

which explores this dimension of risk. Similarly, in sport, risk research has been limited to the

identification of risk- or sensation-seeking personality traits, with an emphasis on why some

individuals engage in high-risk sports (Diehm & Armatas, 2004; Franques et al., 2003; Rowland,

Franken, & Harrison, 1986; Yiannakis, 1976). To date, there has been little research which

investigates other types of risks some athletes take, such as performance-enhancing drug-use.

Aims

Research on the use of performance enhancing drug use in sport has focused primarily on

athletes attitudes to drug use and there has been limited in-depth qualitative research on athletes

motivations to dope (or not), or their decision-making process (Donovan et al., 2002). Prospect theory

is a promising source of psychological principles that explain decision-making in terms of how the

value of a given outcome is altered by the presence of a reference point such as a goal. Addressing the

lack of research which examines how the presence of particular goals can affect human decision-

making, Krantz and Kunreuther (2007) have recommended the use of qualitative methods.

Specifically, they argue that these methods can reveal more about goals, aspirations and their

perceived relationship to a decision outcome, by uncovering an individuals conscious and

unconscious cognitions and emotions. A number of recent studies in the sport literature have also

advocated the use of qualitative approaches in the investigation of psychological qualities and

processes used by athletes and other sports professionals (S. L. Cresswell & Eklund, 2007; Dionigi,

2006; Jones, Hanton, & Connaughton, 2007). Qualitative methods are useful within sport psychology,

stemming, in part, from the fact that the population from which samples can be drawn is relatively

small, but also because of the need to develop models for the behaviour or personality of athletes that

often can not be explained by traditional models and theories. Moreover, qualitative methods have

previously been applied specifically to examine performance-enhancing substance use in athletes,

with a focus on prevalence (Curry & Wagman, 1999) and attitudes (Diacin, Parks, & Allison, 2003;

Fuller & LaFountain, 1987).

Qualitative research with elite athletes has typically used both focus group and individual

interview methods for data-collection. Whilst focus groups are a viable means of collecting data, they

are not without limitations, including issues associated with group dynamics, and the fact that some

participants might be reluctant to state their views in such a public form, particularly for an

underground activity, such as drug-use. The focus group also limits the number of questions that can


be asked and it has been suggested that the focus interview can provide false or extreme views (Patton

1990). Consequently, this study will use individual, semi-structured interviews. This methodology

provides the opportunity to probe athletes responses and establish more detailed information

regarding the unique experiences and understandings of each athlete. The qualitative approach will

also enable purposeful sampling of athletes identified to be of particular interest to the research topic

(i.e., athletes who have competed at a professional level in sports where doping tests are conducted).

Recognising that individual decision-making for risky behaviours can not, in many situations,

be adequately explained by rational-choice models, the present study represents an attempt to explore

doping in sport using Kahneman and Tverskys prospect theory (1979). Prospect theory has, to date,

not been applied to this particular type of risk decision, and the present study is specifically informed

by prior research which has examined the motivational mechanisms underlying the reference point, or

point of view, from which the value of risk decisions are evaluated (Van Osch et al., 2006). The

purpose of the present study is to collect qualitative data which might provide more insight into the

reference point for a decision to use, or not use, performance enhancing drugs. There are three

specific aims: first, to generate data from which a greater understanding of how an athletes goals and

aspirations might contribute to a decision to use performance enhancing drugs; second, the study will

explore how the timeframes for achieving these goals might also influence a decision; lastly, this

methodology will also provide an opportunity to explore the influence of the wider cultural

framework of sport.


Method

Ethical approval was granted for this study in accordance with the requirements of London

Metropolitan Universitys Ethical Committee (see Appendix 1), and adheres to British Psychology

Society (2004) guidelines for psychological research with adult populations.

Approach

Thematic analysis was selected for the present study because it does not require the detailed

theoretical and technological knowledge of alternative approaches such as grounded theory and

discourse analysis. It is, consequently, a more accessible form of analysis for those inexperienced in

qualitative research (Braun & Clarke, 2006). Furthermore, thematic analysis has been recommended

for under-researched topics, or when working with participants whose views on the topic are not

known (Braun & Clarke), both of which apply to the topic of present study. Thematic analysis is a

method for identifying, analysing and reporting patterns within a data set in rich detail (C. Smith,

1992), whilst allowing the researcher to interpret various aspects of the research topic. This method

also acknowledges the active role the researcher plays in identifying patterns and themes, and

selecting those which are of interest (Boyatzis, 1998). In this context, thematic analysis is used as an

essentialist, or realist, method, which allows the researcher to theorise the motivations, experience,

and meaning of participants in a straightforward way (Boyatzis).

Participants

A priori power analysis is not required for qualitative designs, but, whilst qualitative

investigations (particularly in the sport psychology domain) typically employ small samples, sample

size still is an important consideration in this method of research. Samples should not be too large

that it is difficult to extract thick, rich data, nor too small that it is difficult to achieve data saturation,

theoretical saturation, or informational redundancy (Sandelowski, 1995). Consequently some

methodologists have provided guidelines for selecting samples in qualitative studies, including those

that employ individual interviews (J. W. Cresswell, 2007; Guest, Bunce, & Johnson, 2006;

Onwuegbuzie & Collins, 2007). Following these recommendations, a total of eight adult athletes were

recruited to participate in the study. One participant decided to withdraw from the study after the

interview, and so the final sample included seven male participants ranging in age from 20 to 50 years

(M=31.00, SD=11.05).

Consistent with qualitative methodologies, purposive sampling was used to select study

participants, a method that is particularly useful when the population for study is highly individual,

such as elite athletes (P. Levy & Lemeshow, 1991). The research question required that the sample

consisted of participants for whom both the benefits and costs of taking performance enhancing drugs

were relevant. Thus, to ensure that the sample was relevant to the research questions, participants

were drawn from sports, and competitive levels, in which drug-tests (and the associated penalties for


positive results) take place. The criteria for inclusion in the study were: (a) participants should have

had at least 3 years experience in national or international competition; (b) participants were drawn

from competitive sports in which athletes have previously tested positive for performance enhancing

drugs in the past, and in which testing is carried out; and (c) participants should be adults (classified

as any age above 18 years). To maximise sample sizes, despite the sensitive and potentially

contentious nature of the subject-matter, it was emphasised to potential participants that strict

confidentiality and data-protection measures would be taken. To provide an incentive to participants,

the researcher offered to provide a free introductory workshop about mental skills training in sport at

the athletes club.

The final sample represented 5 individual sports (kickboxing, karate, powerlifting, triathlon

and cycling) and two team sports (basketball and football). Two athletes had retired from sport and 5e

were still competing. Four athletes had or were competing at international level, and 3 at national

level. The mean number of years competing across all athletes was 7.14 (SD=2.45).

Instruments

Following the recommendations of Foddy (1999) a semi-structured interview guide was

prepared in advance of conducting interviews. The interview guide comprised 4 sections (see

Appendix 2). First, some introductory comments and general questions including demographic

information, as a way of building rapport with respondents. Second, the main descriptive questions

which guided the content of the interview. These were designed to seek the respondents perspectives,

experiences and opinions, whilst also avoiding jargon and emotionally-laden words (e.g., The

number of positive doping tests across many sports suggests some athletes do dope. Why do you think

that is?). In order to gather information relating to particular issues identified in prior research, some

questions were designed to provide facts that the interviewee did not have to hand, but without

leading them towards a particular answer (e.g., There is some evidence that performance enhancing

drugs are more likely to be used by some age-groups of athletes than others. Why do you think this

is?). Floating prompts were a third part of the interview guide, used to encourage detailed

description, clarify meaning, or elaborate upon certain issues. Finally, concluding comments enabled

clarification of the issues discussed, and allowed the respondent to raise additional issues that they did

not feel had been adequately covered previously.

Procedure

Potential participants were initially contacted through personal contacts of the researcher.

Attempts to contact a total of 25 athletes were made, of which 8 agreed to participate, and with whom

an interview time was arranged. One participant subsequently withdrew from the study. At the start of

the interview, participants signed a consent form (see Appendix 3) and received standardised

introductory comments concerning the rationale for the study, confidentiality, participants rights, and


the reasons for audio-recording the interviews. After collecting demographic information, a general

instruction was provided to encourage participants to draw upon all aspects of their experiences as an

athlete (i.e., their own experiences as well as observed examples). Using the interview schedule

prepared in advance, 8 semi-structured interviews were conducted and recorded, of which 6 were

conducted by telephone, and 2 in person. Clarification and elaboration probes were used to ensure an

accurate and in-depth understanding of what the participants were describing, and to create a

consistent level of depth across the interviews. Finally participants were asked to comment upon the

interview experience and any issues which might have been overlooked. Interviews ranged in length

from 35 to 102 minutes (M=63.00, SD=22.17). After the interview was finished, participants were

also provided further information about the rationale for the study, which constituted the participant

debrief.

Analysis

The interviews were transcribed verbatim and the content analysed by the researcher and two

other postgraduate psychology students. Analysis involved a repeatedly moving back and forward

between the entire data set and the coded extracts of data that were being analysed. Whilst limited

space is provided in the present paper to discuss the process of analysis in detail, a more

comprehensive explanation of the 6-step process followed can be found in Braun and Clarke (2006).

Initially, each investigator read and re-read the transcripts, observing and looking for patterns

of meaning and issues of potential interest in the data, and noting them down. Next, initial raw data

codes were collected, which represented the smallest meaningful pieces of interview text, using

quotes to represent a meaningful point or thought. The third stage involved collating codes into

potential themes, and gathering all data relevant to each potential theme. A theme was identified when

it was considered to represent a level of patterned response or meaning within the data set, even if it

was not directly related to the research question. In the next step of the process, themes were

reviewed, to see whether they worked in relation to the coded extracts and the entire data set,

generating a thematic map of the analysis. The coding and themes were consensually validated among

the three investigators during group meetings and no inconsistencies or differences arose. Ongoing

analysis of the data set was carried out to refine the specifics of each theme, generating clear

definitions and names for each theme. Finally, salient quotes were selected, which related back from

the analysis to the research aims and literature (Braun & Clarke, 2006).


Results

From the semi-structured interviews, three main thematic discourses became evident,

reflecting a number of factors that participants considered to influence an individual athletes decision

to use, or not use, performance enhancing drugs. These were goals, normalisation and affect.

Goals

All participants cited sport-related goals and ambition to reach the highest level of

performance or accolade as being the most common factor likely to influence an athletes decision to

use illegal performance enhancers.

In my mind, the only reason someone would take something is to get that ultimate goal

and everything that goes with it.to achieve that highest point in their sport.

Its the only thing an athlete wants.to be the best at whatever sport they do. If they

arent the best then all that training and all that sacrifice you makethen its worth

nothing.

Athletes also related the decision to use performance enhancing drugs to a strategy to enable

an athlete to achieve more than they could with natural methods alone, in order to achieve the goals of

being at the top of their sport:

They probably think that, well either Ill just be second place for the rest of my life and

not get anywhere else, or I can just take the risk and be at the top. Thats because that

is their onlyambition. Once they get that gold, they know they can retire at the peak

of their career.

I dont think these people care about.having a heart attack or whateverthey want

to go out on a highespecially if they know they wont get that chance again. You

have the Olympics every four yearsyou might not get another chance.

Similarly, participants considered that an athlete might respond to a performance decline or

injury by taking performance enhancing drugs that would keep them in the game, doing what they

love.

They have probably worked hard their whole lifefor this opportunity. Maybe they

had an injury or a slump...that can happen to everyone.they panic and think they can


cheat their way out of doing it the hard way, the natural wayfor that final chance to

achieve something.

All participants agreed that older athletes were more likely to use performance enhancing

drugs, because of their shrinking window of opportunity to achieve anything in sport and as a way

of remaining within sport:

Some people are just too stubborn to let it go.nowadays youve got people breaking

in the scene when theyre like 16, playing at the highest level anda lot of the people

of the older generation feel they have to use an enhancer to keep themselves on that

high level with them, on a par with those fitter younger athletes.

Athletes have a small window of competition within their particular discipline. I can

see that people feel their advantage slipping away, that their time is running out.their

resilience is going, their stamina is dropping.so they would seek other things just to

stay in there just maybe one more year, just get another year out of it

You go from playing every single day and pushing yourself and competing every

single day to doing nothingits a massive adjustment, and youd be left with well

what do I do now? Ive done nothing else in my lifeA lot of athletes arent rocket

scientists but,..they run, they shoot, they jump, whatever they do, its not like theyre

in business, its not like they have anything else to go on to. So of course you want to

continue on that lifestyle, its probably all you know.

Reflecting upon their own attitude towards performance enhancing drugs, some athletes had

also considered how the health related side-effects might affect their quality, and length, of life after

they had retired from sport. This was conceptualised with respect to other aspects of achievement or

non-sport goals.

I know I wont be competing beyond a certain age. There are other things I want to do,

like spend time with my kidsmaybe do a coaching qualification.I dont want to

drop dead of a heart attack when I am supposed to be fit from all my years of

training. Its not worth the risk.

Normalisation

At the start of each interview, participants were asked about their perceptions of

performance enhancing drug use, both in their own sport, and in the wider context of


professional sports. All participants considered that doping was a widespread problem, citing

various well-known examples in the public domain of athletes who had tested positive. They

also all believed that current prevention methods were unlikely to expose all of the athletes

who were using performance enhancers because its a game of cat and mouse, like computer

hacking. They cant keep up with all the new drugs and technology.

Whilst no athlete admitted to using performance enhancing drugs themselves (they

were not asked to reveal this), many were able to provide examples of athletes they had

trained with or competed against that evidently did dope, but avoided detection. When asked

why they thought these athletes were using drugs, most stated that it was the dramatic

changes in physical appearance between seasons that would be impossible with just diet or

training.

The most frequently cited categories across all interviews related to the normalisation

of illicit doping within sport, including issues relating to the increased financial rewards in

many sports, and the entertainment value of sport for the general public. Athletes also

discussed their opinion of how doping was encouraged behind the scenes by people

working with athletes.

YeahI know trainers and physios who put it out there as an option.and depending

on the situation, depending on the circumstancesan athlete might respond. If

somebody has been injured forthree or six months and the trainer suggests to them

that if they take this enhancement they could decrease their recovery time by a couple

of months they are more likely to, you know, to take it.

Trainers, and I know of some examples, can try and influence someone, saying, well

if you just take this everyone does it. And if that trainer or coach has taken

somebody to the top level before, then everyone respects them, and other athletes they

train think they have to follow his ways to have the same success.

I mean doctors aresupposed to keep people healthybut a doctor on a team is going

to know who is taking what substance arent they? They know absolutely everything

about that athletes physical health, they have to. They might try to make sure doping

isnt taken to extremes, but they dont stop it happening. They know its going on.

It has an evolution of some sort hasnt it, because youre passing it on, somebodys

passing it on to somebody else and it has a way of, and this is how it filters into certain

sports, because somebodys recommended what someone else did to performed better.


The increased monetary gains that are offered within sport, and the additional benefit

that celebrity status gives athletes, were also cited by participants as factors which encourage

doping in sport.

I think its changed a lot for a lot of sports... I expect if you go back forty, thirty years

there were a lot more people that did things because they enjoyed it rather than for the

fame, and there certainly wasnt the kind of money that there is now...I mean, someone

can win the Olympics and theyre made for life.

There is too much money pumped into a lot of sports now and that temptation has got

in the way. Top athletes know that they can be another of these celebrity type people,

who get moneyprobably more than they did when they were competingdoing

stupid things unrelated to sport like appearing in TV shows and launching their own

clothes line or advertising pointless products.

With all the extra money and sponsorship and advertising you can getathletes in

some sports in particular only need to do sport for a few years, then they can retire.

They get to keep all that money whatever happens down the line, like testing positive.

They need to put restrictions on these sums of money becauseif they couldnt afford

to retire on their earnings they would probably think twice about what they were

doing.

Another factor that participants believed contributes to the normalisation of drug use

in sport is the effect of audience attitudes to doping, in particular their ambivalence towards

athletes who are caught, and their enjoyment of watching high-level performance however it

is achieved.

I dont think the public really care whether people are doping or not. They dont care if

athletes are cheating. Its a freak showthey like watching other people pushing

themselves to extreme limitsdoing things they could never do themselves.

I mean there are people that are going to want to see people run the 100 metres in

seven and a half seconds, there's people that are going to want to see him be able to

jump eight metres in the long jump. Therell always be an audience for it.

People get bored when records arent broken all the timethe time or the length or the

height and world records seem to be more important however they are achieved.


When asked about how sport audiences react to athletes who are discovered to be

using performance enhancing drugs, participants suggest that sport audiences are not

bothered about cheating, they kind of forget about it and although they know it happens,

they dont seem to care.

People will always remember the person who stepped on the podium, even if they are

caught doping later and lose their medalbut they will never remember the person the

medal got passed on to because its not important after the eventeveryone just

moves onto watching the next Olympic Games or whatever.

You never know who got the gold medal retrospectively but you would still remember

the time someone broke a recordpeople talk about it for years afterwards, even if

that athlete had dopedand people still tune in or turn up to watch sporting events

despite all the scandals.

Affect

Participants described a number of feelings or emotions relating to decisions to use

performance enhancing drugs. The most common of which was the feel-good-factor or sense of

pride that comes from knowing you had achieved everything naturally. Similarly many athletes

discussed how doping would only be cheating yourself, one describing this as leaving you feeling

empty and worthless.

I get a lot more satisfaction from knowing Im doing all this naturally, by myself. I

wouldnt be able to cope with knowing I had achieved it by taking anything and if I

had won a title, the money.it wouldnt mean anything to me. All those good feeling

would be ruined.

I wanted to perform naturally and pure and have my conscience clearyoull know

that if you win a gold medal or you achieve something in the back of your mind will

taint what youve done.you cant feel good about yourself.

This was perceived to be of greater consequence than being condemned as a cheat by

other people.

I think if you get caught and everythings wiped clean then thats the worst thing that

can happenI would be devastatedworthless.whether people still look up to you


or not.I mean, if you do it for like, ten years, you build up all your records and then

all of a sudden they get wiped clean.even if for the first nine years you took nothing

and you got those records fair and square and all of a sudden theyre gone.

When asked about the feelings of athletes who do use performance enhancing drugs, participants

described how feelings of loss or disappointment in poor performance could lead an athlete to use

drugs:

Its a real downer. I mean, you remember what you used to be like and what you

could attain and you just dont bounce back so well. You feel depressed and like you

didnt try hard enough.

To work so hard to get to an Olympic Games and then mess up is devastatingBut

its all youve done, you think winning is the only thing that will make you happy and

it probably iseverything that makes you happy or sad is about sport.


Discussion

The objective of the present study was to examine how theories of decision-making are able

to provide a framework for understanding athletes use of performance enhancing drugs. Although

rational choice models of decision making have been applied to the issue of drug-use in sport (Strelan

& Boeckmann, 2003; Strelan & Boeckmann, 2006), this is the first study to apply prospect theory

(Kahneman & Tversky, 1979). Prospect theory is able to account for decisions that depart from

rational-choice models of behaviour, and acknowledges that individual decision-making is influenced

by a number of cognitive biases. These biases include how decisions differ depending on whether

identical outcomes are framed as gains or losses. Similarly, an individuals reference point will also

determine how particular outcomes are subjectively perceived to be a gain or a loss relative to it.

Whilst little is known about how an individual locates the reference point for a particular decision,

prior research in the health domain has provided some evidence that goals themselves can serve as a

reference point (Van Osch et al., 2006).

The qualitative findings from the present study provide information that, at least in part,

supports prior findings from decision-making research, with respect to the potential importance of an

individuals goals in shaping their attitude towards risk decisions. However, the themes which

emerged also provide further information that emphasise the importance of placing decision-making

processes within a wider cultural framework.

Goals

Goals were the most frequently occurring theme described by the athletes in the present study.

Specifically, some participants considered post-sport goals, such as health and longevity to be an

important consideration when evaluating the health risks of doping, but believed that other athletes

would be prepared to sacrifice longer term health benefits in order to achieve a more primary goal

within their sport, such as beating a personal best, or breaking a record. The study by Van Osch et al.

(Van Osch et al., 2006) provided preliminary findings that goals can serve as a reference point, which

might increase the utility of particular decision outcomes. It has subsequently been recommended that

the cognitive aspects of decision-making theories and the motivational aspects of goal-setting

approaches can be combined (Krantz & Kunreuther, 2007) to provide a more accurate account of

individual decision-making.

In the course of their career, athletes constantly set goals and make choices regarding the way

these goals can be achieved, and Petroczi and Aidman (2008) have advanced a model of goals within

sport, consisting of a cycle of choice goal to commitment execution feedback on goal attainment

goal evaluation/adjustment. The authors propose that this cycle has numerous exit points, each of

which provided an opportunity for behaviour change, which might or might not be related to the use

of prohibited methods, such as performance enhancing drug use. This model accounts for a

relationship between facilitating and inhibiting factors, such as subjective norms and personality


variables which are further influenced by situational factors. The combination of the factors might

influence intentions to use performance enhancing drugs. This would be consistent with recent

research examining whether risk appraisal or preference is independent of aspirations (Sokolowska,

2006) and which provides evidence that risk choices involve a balance between an individuals

disposition toward risk and the opportunities of the situation. Petroczi and Aidman emphasise that

these influences are likely to vary from one stage of athlete development to the next, making some

athletes more vulnerable to engaging in doping practices than others at certain time periods. Whilst

the model suggests that deterrence strategies are likely to be more effective if they target the

influencing factors at the appropriate career stage, the authors do not identify which groups of athletes

are likely to be at most risk. To enable more effective interventions to prevent illicit drug use in sport

would require further research to identify the groups of athletes and their respective career stages who

are at most risk of engaging in doping practices.

Normalisation

In the present study, normalisation was described by athletes in terms of the sport

workplace, including how coaches, medical professionals, and even team mates, might encourage

athletes to use performance enhancing drugs as a viable method of improving performance. Some

athletes also described how the ambivalent attitude of sport audiences has also reduced the perception

of doping as a morally unacceptable behaviour. With respect to normalisation of risk, Helms (1984)

has described a "risky shift" phenomena (p. 23) which might explain this acceptance of doping within

sport. Helms describes risk as occurring within a cultural framework, in which groups of individuals,

in certain contexts, are willing to take risks as a group that they would not take as individuals. Helms

suggests that when a group verbalises its decision concerning a risky situation, the group's decision

tends to be riskier than the individuals would have recommended privately. Specifically, when an

individual realises that he or she is not riskier than the other members of their group, they will adjust

their risk-taking attitude upward. Group discussion allows members to rehearse their arguments

regarding the decision, and, moreover, familiarity with a hazard is likely to promote a higher level of

acceptable risk concerning the hazard or situation.

A similar explanation is offered by a sociological explanation of deviance. Petetti-Watel and

Moatti (2006) suggest that many people engaged in risk behaviours tend to deny the risky label, and

describe deliberate risk-taking as a form of positive deviance, which is related to a need to conform to

the dominant risk culture. Reflecting on social risk and the meaning of sport, Frey (1991) emphasised

that risk perceptions are based on cultural and social factors, noting that in some cultures, including

sport, risk is an integral part of the value structure, and valued positively, especially if success is the

outcome of the risky action taken. This description is similar to that proposed by Hughes and Coakley

(Hughes & Coakley, 2001) who suggest that athletes are likely to take a number of risks, including

performance enhancing drug use, as a result of a commitment to the value systems of what they term


the sport ethic. What this finding would support is the observations by Ivan Waddington (2005) that

the value system of sport has shifted, such that the amateur moral principles of fair-play have been

superseded by values which place a higher emphasis on winning and professionalism. This shift in

values has in turn, potentially increased the value that is placed on risk.

Affect

In the present study, athletes identified feelings of regret, particularly with respect to retiring

from sport without having achieved the maximum level of performance that had been aspired for.

This was given as one reason that might cause athletes to resort to performance enhancers to cope

with performance decrements brought about by age or injury, and to avoid such feelings of regret.

Conversely, some athletes discussed how, knowing that they had cheated by using performance

enhancing drugs, would diminish any sense of pride, whatever their achievements. Most models of

decision-making are consequentialist in nature: they assume that decision makers choose between

alternative courses of action based on a cognitive evaluation of the utility and likelihood of their

consequences. However, writers such as George Loewenstein (Loewenstein, Weber, Hsee, & Welch,

2001) argue that choice can be an emotional experience as much as an cognitive one. Lowenstein

proposes a risk-as-feeling hypothesis, suggesting that emotions such as dread, hope and anxiety can

influence a decision maker as much as the formal details of the decision. Furthermore, emotional

reactions to risky situations often diverge from cognitive assessments of those risks, and when such

divergence occurs, emotional reactions can often drive behaviour. However, this does not necessarily

suggest that consequentialist models, such as prospect theory, are wrong, but might point to the fact

that the utility of a given outcome can also be determined by the immediate or expected emotional

reactions to that choice. Understanding how emotional processes can improve our understanding of

risk behaviour is a promising avenue of enquiry.

Limitations

The present study is the first to apply previous findings from prospect theory research to the

issue of drug-use in sport, but it is acknowledged that this study has several limitations. First, given

the sensitive nature of the subject-matter, participants might have felt uncomfortable with some of the

questions raised in the semi-structured interviews, and consequen

heoc - performance enhancing drugs and risk decision making

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