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Sex, text and Tiger’s fall from grace.

Tiger and Elin in happier days KAREN BLEIER / AFP/Getty Images

Much has been written recently about Tiger and his ‘transgressions’. The revelation of the escapades of this once untouchable hero provide a timely opportunity to discuss the science of sex addiction.

It’s not really acceptable in medical circles to diagnose someone you have never met, so let’s stick with the undisputed facts.

Tiger Woods is a distinguished athlete and a very wealthy man, who can afford to buy just about anything he wants. He is married with children. By his own admission, he has had affairs with multiple partners in the recent past. He has lied about these. And, only by the dogged perseverance of the press and the release of those sordid texts, has he come clean.

In my business, there is really no room for judgement. Good people do bad things. Tiger was not the first, nor will he be the last to cheat on his wife and children. It is easy to frame his behaviour in moral terms, but that is a bit tired and does not give us any new insights.

If we could have a better understanding of why people cheat, maybe we might have a better chance of doing something useful about it. Regardless of why, it is clear that Tiger’s transgressions caused a lot of negative consequences for a lot of people.

Let’s start with Tiger’s embattled wife Ellie. Despite what financial benefits she may gain from this fiasco, it can’t be pleasant having your husband’s dalliances smeared all over the front pages, ditto for the kids. Ellie’s mom has already been to the hospital with what is likely stress induced gastritis. Tiger’s friends and associates are likely suffering too and as for Tiger…yikes, put yourself in his shoes. It’s a lose/ lose for everybody.

Imagine what the rest of his life will be like, no matter how much he apologizes, no matter what he does to make up for this, at any time, some wise-guy can bring it up again. Ha-ha, just kidding. Except it’s not so funny. As I stood at the check-out counter today, I saw Tiger’s anguished face on the cover of one of those gossip magazines. “Tiger suicidal”, read the headline. Can you blame him? He is now, and forever will be the laughing-stock of 2009.  No matter what short-term benefits he got from being sexual with his bevy of busty blondes, the long term harm is immeasurable. Never mind the billions of dollars in potential income lost, that’s the least of his worries.

Some in the psychiatric field have thrown around the term, “sexual addiction” which by definition is compulsive sexual activity despite evidence of harm. Well you might say, there was not, until recently, any evidence of harm. I can’t say for sure, but that’s unlikely. More likely is that there was a progressive loss of intimacy between Tiger and Elin that lead to the loss of attachment that preceded his transgressions. Maybe his kids felt the distance when he slipped out to be with his mistress, rather than spend time with them. The early harm associated with his affairs may not have been as evident, or as catastrophic, but the warning signs probably were. Intuitive women can tell when their man has other things on his mind.

So, does Tiger’s fall from grace follow from his sexual addiction. That has a certain amount of validity, but to understand what that really means, let’s break addiction it into three parts.

Addiction starts with dysphoria. Dysphoria is the opposite of euphoria. Basically you feel uneasy in some way. Dysphoria can be secondary to all kinds of emotional triggers: sadness, loneliness, worry, distress, boredom, pain, fatigue, confusion, irritability, agitation, anger, racing thoughts; you name it.

It would of course be optimal if we could manage these emotions on our own. That is the goal of cognitive therapy. Learn to recognize your emotions; Learn to “be” with your emotions; or because most emotions are secondary to thoughts, learn to modulate your thoughts as a way of managing your emotions. That sounds easy enough, but it’s not. Many people are neither capable of recognizing, reading or managing their emotions. When emotions become unmanageable they experience dysphoria.

The next step in the addiction cycle is… using a substance or behaviour as a coping mechanism for dysphoria.

“Using” as a way of coping starts off innocuously enough. Some might say that addiction is a kind of resourcefulness on the part of the addict. “I feel usually bad… but when I do this, I feel good”. Research suggests that addiction is a pediatric disorder. The large majority of addiction starts in adolescence.  For the truly vulnerable, it starts in childhood. As we progress though our youth, we are exposed to various behaviours and substances, experimentation naturally follows. In time, by an unconscious process of trial and error, we stumble upon what makes us feel good. We find out what calms us; interests, energizes and/or rewards us. We experience our environment and find out what is important. The neurobiologists call it salience attribution. Our brain has a way of recognizing what’s important and what’s necessary for survival because these stimuli light up the brain’s dopamine circuits. It just so happens that all addictive substances and all addictive behaviours stimulate also dopamine neurotransmission. So, on some level, addiction is really a big fake-out.

Addictive substances and behaviours stimulate dopamine, and as such, trick the brain into thinking that they are necessary for survival. That’s quite the story, but it’s not the whole story.

The third step in the addiction cycle is the loss of control.

While dopamine and the associated “feel good” that it provides, triggers the “go” switch that drives us to preferentially choose these substances and behaviours over others, we also have brain circuits give us control over the dopamine circuit.

Glutamate stimulates/ GABA inhibits

The dopamine “go” circuit can either be potentiated (by Glutamate) or inhibited (by GABA).

Glutamate says, “Just do it”. GABA says, “Hmmm, maybe that’s not such a good idea.”

Glutamate pushes us down a corridor that quickly turns into a tunnel, leading to loss of control. GABA buys us time. Time to weigh the pros and cons of using. Time to think through the consequences of our actions. Time to envision the look on a loved-one’s face. Time to insert a more rational thought.

Finally, when poor choices lead to negative consequences, we return full circle to dysphoria…and so it goes around and around and where it stops, nobody knows. Where it stops is usually a cold hard place.

Tiger’s transgressions, then, can be seen as behaviour that he initially chose as a coping mechanism for some type of dysphoria, but over which he progressively lost control, despite evidence of negative consequences, eventually resulting in unimaginably more dysphoria.

That does not excuse the behaviour, nor does it absolve him of the responsibility for the harm that his actions caused. It just takes this out of the realm of morality and puts it under a less judgemental light.

I think I’ll stop there.

Stay tuned for more QuestForFire next week.

Dr. Anthony Ocana  MSc, MD, CCFP, ABAM             Family Physician/ Addiction Medicine Specialist       

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