By Gloria Hochman
For The Inquirer
When golfer Tiger Woods made a public apology to his wife and family for the pain and humiliation his sexual escapades had caused them, he said he was caught up in an “intoxicating cocktail of entitlement, fame and money.”
“I thought I could get away with whatever I wanted to,” Woods said. “I was wrong. I don’t get to play by different rules.” Woods did not describe himself as a sex addict.
Nonetheless, Woods’ sexual excesses, his intensive treatment in one of the country’s premier addiction centers, and his subsequent apology have placed the controversial subject of sex addiction onto center stage.
An array of experts argue that sex addiction is real and treatable. Costly centers like the one Woods is attending have sprung up along with support groups and individual therapists who specialize in the area.
Yet mental health experts disagree sharply about what sex addiction is, how treatable it is and even whether it exists.
Rob Kurzban, an experimental psychologist at the University of Pennsylvania, is incredulous that Tiger Woods’ behavior would be called an addiction and is stunned that the media have bought into that concept.
“It is not that Tiger Woods or other high-profile people are addicted to sex,” Kurzban says. “They are addicted to cheating, to sexual variety. They could have all the sex they want with their wives and no one would find that upsetting.”
Sex addiction is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the encyclopedia of the American Psychiatric Association, and it will not be listed as an addiction in the DSM-V, which will be published in 2013, though it could make later editions.
“There just isn’t enough evidence in peer literature, as there is in alcohol, drug or even gambling, to classify it as an addiction,” says Charles O’Brien, professor of psychiatry at the University of Pennsylvania and chair of the DSM-V working committee for substance-related disorders.
Does this mean, as Kurzban suggests, that Woods and other luminaries like Eliot Spitzer and David Duchovny may not be sex addicts, as has been suggested, but may simply have a broken moral compass? Would more ordinary men be called cheaters or worse?
The answer depends on whom you ask.
Those who treat sexual addiction maintain that while it is perplexing, there is no question that it exists. “The myth is that you have to take chemicals to be addicted,” writes Patrick Carnes, considered a guru in the field of sex addiction and who heads the Gentle Path program where Woods was treated for 45 days before heading for another facility in Arizona. “We accept that people can be sick with alcoholism or destroy themselves with gambling or food - but not sex.”
Studies at the Mayo Clinic indicate that from 3 percent to 6 percent of the population - men and women from all walks of life - suffer from sex addiction. Its hallmark, writes Carnes in his best-selling book Don’t Call It Love: Recovery From Sexual Addiction, is a pattern of out-of-control, high-risk sexual behavior. That includes not just serial affairs outside of marriage, but excessive masturbation, having sex with anonymous partners including prostitutes, obsession with pornography, engaging in sadistic sex, exhibitionism, compulsive telephone sex or fixating on an unattainable sex partner.
Alessandra, 49, and Lee, 59, say they are sex addicts. Both are members of Sex and Love Addicts Anonymous (SLAA), a self-help organization modeled on Alcoholics Anonymous’ 12-Step program. They joined local chapters because they could no longer tolerate their out-of-control sex lives. They and other patients interviewed here asked that their names be withheld to avoid the embarrassment of public disclosure.
In the four years following her divorce, Alessandra, then 45, says she had sex with 30 different men, most of whom she met through the Internet. Usually by the end of the first dinner date and certainly no later than the second, Alessandra, an attractive woman from Cherry Hill, and her newest companion would end up at his place. “My goal was seduction, then sex,” says Alessandra, who calls herself a “soccer mom” and is given to dressing in short skirts and high-heeled sandals. “When it was over, I just wanted to leave. I didn’t want to chitchat over breakfast or get to know him better. We had sex, then I was done.”
Lee is a high-profile, well-traveled corporate executive who seemed to have it all - a seven-figure salary, an attractive wife, two handsome teenage sons, and a grand home in a Philadelphia suburb. But Lee had a secret life - a network of romantic liaisons around the world - in London, Paris, Geneva, and Hong Kong. He lived this double life for 26 years until his younger son came across an e-mail message from his Geneva girlfriend.
“What’s this, Dad?” he demanded, shocked, and the secret was out. The next day, Lee’s wife asked him to leave the house. A year later, they were divorced.
Alessandra and Lee say they are in various stages of “recovery,” and will always have to work to maintain “sobriety,” an absence of the shameful, destructive behaviors that defined their lives.
“Sex addicts just can’t say no,” says Eric Griffin-Shelley, a psychologist with a private practice in Lafayette Hill who focuses on those who can’t rein in their sexual urges. “Every addict I know would be happy if they could do that. They want to stop and they can’t.”
Therapists in the field believe that sex addiction has become far more prevalent in the last 20 years; they blame the growth of pornography and its easy access through the Internet.
Now they worry about the effect of sexting - sending sexually explicit messages, photos or videos electronically, mainly through mobile phones. “We call the Internet the crack cocaine of sex addiction,” says Griffin-Shelley. “You get hooked faster and the consequences are more devastating.”
Some people may be predisposed to compulsive sexual behavior, according to a report from the Mayo Clinic’s Foundation for Medical Education and Research. High levels of certain brain chemicals may play a role. And over time, this addiction might actually cause changes in the brain’s neural circuits so that hypersexuality may cause pleasure and stopping it may bring about unpleasant side effects.
“Most sex addicts are people in pain,” says Jordan Lief, a staff psychologist at Philadelphia’s Council for Relationships. “Their sexual addictions can often be traced to trauma suffered earlier in life. We talk about the ‘Big T’ like rape or incest or being molested as a child, and the ‘Little T’ like an emotionally distant mother or an alcoholic father, resulting in you’re not getting what you needed growing up.” The experts estimate that sexual abuse figures in about 70 percent of cases.
Marilyn, 45, who was introduced to pornography-enhanced sex by an older man when she was 15, is still trying to blot out the ugly sexual visions that chase each other through her mind. “I can’t have an orgasm unless I’m thinking about violent porn,” she says. “And it has to get bigger and better and more violent to work. I turned to addiction to stop the pain, but I despised what I was doing.”
Most people with Woods’ condition, whatever you call it, do not go to pricey rehabilitation centers. They seek individual and group therapy and often marriage counseling to identify the roots of their sexual extravagance, calm the demons that rage within, and take responsibility for the damage their behavior has caused.
Sometimes they receive medication such as antidepressants or mood stabilizers, which may reduce the sex drive. J. Michael Bostwick, a psychiatrist at the Mayo Clinic, has had success with naltrexone, often used to fight alcohol and heroin dependence, to suppress devastating addiction to Internet pornography.
Many sex addicts are advised by their therapists to join a group such as SLAA, Sex Addicts Anonymous (SAA) or Sexaholics Anonymous (SA). “Together, we find hope and keep each other sober,” says Alessandra.
Those who can afford it may end up in a facility such as the KeyStone Center in Chester with a tab of $495 a day, rarely covered by insurance. For instance, Craig, 48, who was told he was a sex addict while in treatment for alcohol abuse (at least half of sex addicts have other addictions: alcohol, gambling, cocaine, eating), says that without his six-week stint at KeyStone, he probably wouldn’t be alive today.
KeyStone offers a vigorous, no-nonsense program. When Craig entered, he says he signed a contract outlining what to expect and which behaviors - such as physical contact with other patients or employees and masturbation - were banned. His schedule was crammed from early morning until 8:30 p.m. with group meetings, individual psychotherapy, meditation, victims groups, trauma groups, psychodrama, biofeedback, and role playing, all designed to help him understand why he turned to compulsive masturbation and sex with prostitutes and learn how to develop alternative coping strategies. He had to listen to “cost letters,” written by relatives or friends of patients, relating what their addictions have “cost” others in their lives.
“I learned a lot about myself,” says Craig, who laments that his addiction cost him 20 years and more than $200,000 in sexual indulgences and treatments.
The treatment goal for sex addicts, unlike that for alcoholics, is not abstinence. It is healthy sex. Although no success rates are available, many sex addicts can learn to control their impulses, says Carnes, who has a Ph.D. in counselor education from the University of Minnesota. But it could take from three to five years. Ongoing therapy and consistent attendance at 12-Step groups are essential.
Still, “there are few that never act out again,” says psychologist Lief. “There are relapses and slips. Someone could never take another drink and live a healthy life. But we are all sexual creatures so this addiction is more complicated . . . and more difficult to treat.”
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