Can Sex-Addiction Rehab Save Tiger?

A new report says the golf star may enter an Arizona rehab clinic for “sexual compulsion.” Abby Ellin on the science behind a controversial disorder—and why there’s little chance he’ll be cured.

12.18.09 9:35 PM ET

After weeks of predictions, it finally happened: Tiger Woods has reportedly decided to check into rehab for sex addiction. But to treat a real disorder, or just his fractured image? Sex addiction is the diagnosis du jour for male public figures caught cheating or gawking at porn: David Duchovny, Eliot Spitzer, and Christie Brinkley’s ex-husband Peter Cook, and ESPN’s Steve Phillips have all done their time on the couch.

Sex addiction isn’t in the DSM-IV, the bible of psychological medicine, but neither are many disorders that therapists routinely treat. And the team of doctors currently revising the guide are considering adding sex addiction to the new version.

“What would make him an addict is if his behavior gets in the way of his day-to-day functioning,” says one psychologist. “Tiger Woods is obviously a highly functioning person in his job.”

According to Nancy Irwin, a Los Angeles psychotherapist who treats sexual dysfunctions, sex addicts don’t always have multiple mistresses on the side, like Tiger did. Some of them are porn addicts, or chronic masturbators. Or they have sex with inappropriate people—bosses, strangers—or put themselves in dangerous situations. The Internet has made sex addiction easier than ever, with entire Web sites dedicated to facilitating anonymous sex. Some sex addicts can’t curtail their sexual behavior, needing more and more sex to attain a high. Or they’re unable to be faithful to their mate, chronically cheating or hiring prostitutes. “When any or several of these negatively impact one's normal functionality at work, in relationships, life, sleep, health,” says Irwin, “one may be a sex addict.”

What’s fascinating about so-called sex addicts is that they don’t necessarily enjoy sex at all, at least not in the way most people do. For some, it’s all about the rush they get from the conquest. Others are filling a void within themselves, like people who use drugs or booze to escape emotional pain. The difference is that with drugs you can at least physically distance yourself from your vice; sex addiction follows you everywhere.

It doesn’t help that sex addiction is thought of as psychobabble by much of the public—and more than a few therapists, too. “The general public has little compassion for people who are addicted to sex. They don’t understand,” says Michele Weiner-Davis, a marriage counselor and author of The Sex-Starved Marriage. “For those who are vulnerable to addiction, engaging in the chase, having sex and an orgasm creates biochemical changes in the body and brain that are pleasurable. Then, when reality sets in, just like any other addict, there is often deep remorse and regret followed by shame and promises to stop the behavior. Time passes, and the duplicitous life continues, leading to shame and guilt, which then become assuaged by the next sexual encounter.”

Worse, like many substance abusers, sex addicts have to increase their “dosage” just to get the same effect. Often, keeping this charge means making the sex riskier and riskier over time. “Sex addicts often adore their spouses, cherish their families, but feel compelled to participate in the cycle,” says Weiner-Davis.

The medical community is split on the existence of sex addiction. “My opinion is that many people who claim to engage in sex because of ‘addiction’ are actually engaging in it because they have the opportunity to, and they don't have the will, skills, or moral or legal imperative to prevent themselves from doing something that provides an instantaneous flood of physical and emotional pleasure,” says Scott Haltzman, a clinical assistant professor in the Brown University Department of Psychiatry and Human Behavior. “If you're at work, and someone leaves doughnuts out, and you have one every day even though you know you shouldn't for health reasons, you don't have a doughnut addiction, you're just responding to an impulse and rationalizing your actions.”

In other words, men cheat because they can—which brings us back to Tiger. When you’re a young guy in your sexual prime, when you have money and fame and beautiful women chasing you everywhere, is it even possible to be a sex addict?

“What would make him an addict is if his behavior gets in the way of his day-to-day functioning, work, family, school, relationships,” says Jordan Lief, a staff psychologist at the Council for Relationships in Philadelphia. “Tiger Woods is obviously a highly functioning person in his job. I never assume anyone is anything until I sit down and talk to them face to face.”

Whether he is or not, Tiger shares one thing in common with sex addicts: His behavior has severely disrupted his life. A first-hand witness to such chaos, “Elle” has been married to a sex addict for years. She started a blog to connect with other women who have been betrayed by a partner.

“[Sex addiction] is often misunderstood as relating to someone who loves sex or is particularly wild, but in fact is really an intimacy disorder,” she says. “Sex is not a way to connect, but rather a distraction from feelings that the addict simply lacks the coping skills to manage—anxiety, insecurity, loneliness, etc. They often feel disconnected from those around them and use sex as a way to self-medicate.”

Therapists who treat sex addicts say there’s no cure, but the condition can be managed through in-patient therapy, 12-step programs, and medication. Some rehab centers make their sex-addict patients sign a celibacy contract, which means they can’t engage in any sexual behavior—be it with themselves or others.

“They learn about what it is that drove them to these lengths,” says Lief. “The goal is to cope with their pain in healthy ways as opposed to unhealthy ways.”

Ironically, Tiger’s chances of managing his disorder, if he has one, are higher than the average person’s, simply because of the massive public scandal his behavior has created, says Lief.

“I think sex rehab can work if it focuses on how to manage impulses and teach people how to be empathetic about others they are hurting,” he says. “Many rehab programs have better results if the stakes are high, that is to say, if the person in treatment has much to lose by not changing behavior.”

Which means, with his million-dollar sponsors heading for the hills, Tiger’s famous motivation may be at an all-time high.

Abby Ellin regularly writes the Vows column for the New York Times, and previously wrote the Preludes column for that newspaper about young people and money. She is the author of Teenage Waistland, but her greatest claim to fame is naming “Karamel Sutra” ice cream for Ben and Jerry's.