An Apology With Echoes of 12 Steps

MAKING AMENDS Tiger Woods’s televised apology did not mention sex addiction, but his words seemed to embrace that of a common treatment.

By DONALD G. McNEIL Jr.
Published: February 22, 2010

In the long, self-lacerating statement that he read to a nationwide audience last week, Tiger Woods never used the words sex addiction. Yet by publicly apologizing for his infidelity, saying he was returning to his religious faith and admitting that he has “work to do,” he appeared to be carrying out several steps of a common 12-step treatment for just that.

Experts in the field note that Woods hit several key points in the program used by the Gentle Path clinic in Hattiesburg, Miss., at whose front door he has been photographed.

In Steps 8 and 9 of the program, for instance, patients are admonished to list everyone they have harmed and make amends. In his statement, Woods dwelled on his mistakes and apologized to his family, his wife’s family, his business partners and sponsors, and parents who “used to point to me as a role model for their kids.”

In his seeming embrace of the 12-step approach — first formulated by Alcoholics Anonymous but since adopted by Narcotics Anonymous, Sex Addicts Anonymous and groups for gambling, food and shopping addictions — Woods waded into a longstanding debate over sexual disorders and how to treat them.

The very idea that someone can be addicted to sex is controversial and inevitably leads to chuckles and jokes. Those claiming addiction may be accused of seeking a medical excuse for simple promiscuity.

But while sex addiction is not recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, psychiatrists have long recognized that there are “clear cases in which people ruin their lives because of sex,” said Dr. Michael First, a Columbia University psychiatry professor who edited the manual. “Hypersexual disorder” is now under consideration for the next edition.

“The question,” Dr. First said, “is how you draw the boundary between a healthy sexual appetite and addiction.”

Diagnosis depends on how much pursuing sex interferes with other goals, on whether the patient has tried to stop and failed, and on what mood the activity brings on.

For example, said Dr. Richard B. Krueger, a Columbia University psychiatrist specializing in the treatment of sex offenders, “a couple in love, floating five feet off the ground, having frequent sex” is different from a patient unable to stop watching pornography at work.

Treatment “is in its infancy,” Dr. Krueger said. “Chemical castration” with testosterone blockers, as has been used on some pedophiles, is inappropriate in such cases. Antidepressants suppress sex drive, erections or orgasm in some patients, but not all. Individual psychotherapy helps some addicts; 12-step programs help others.