Reports that Tiger Woods has been photographed at an addiction clinic in Mississippi prompt the question on the minds of many: Is there such a thing as sexual addiction - or are men like Woods merely taking advantage of the many opportunities that come their way?
To many Americans, sex addiction is often a punch line. "People say, 'If I have an addiction, I want to have that one,'" Manley said. But Manley and other sex therapists say most clients don't get treatment until their sexual behavior has ruined their lives - wrecking their marriages, causing them to spend thousands of dollars on pornography or prostitutes, or even getting arrested for soliciting prostitutes.
But for someone like Tiger Woods, is this an addiction - or merely a way of life for rich, powerful men?
"I am cautious and a little leery of the term sex addiction," said Dr. Alan Grieco, an Orlando, Fla., psychologist who noted that the American psychiatric community considered homosexuality a mental disorder 60 years ago. "In my opinion, monogamy does not come naturally to most men. We can do it, but it's a struggle. ... If an attractive woman throws herself at a guy and he thinks he can get away with it, he will - married or not - have sex."
Grieco says that athletes are surrounded by - and tempted by - women, just the way doctors are surrounded by and tempted by prescription drugs. "These opportunities challenge our human frailties," he said. "We're all weak; some of us have stronger boundaries. But for younger males, who have high levels of success and opportunity, it's a gauntlet out there."
Making matters worse: Research shows that testosterone is linked to success and failure. Men who are told they're great have higher testosterone levels than men who've been chewed out by the boss.
That's not to say that a man can't say no. "Testosterone doesn't make anybody do anything," Grieco said. "But it primes the pump. It's a heady mixture of hormones and success."
While some sex addicts are women, men are nearly three times more likely to fall into that category. Experts say that 75 percent to 80 percent of the patients who seek treatment for sex addiction are men.
For both men and women, the line between a healthy sexual appetite and an addiction is based, in part, on how much time you spend on sex and fantasies. The current definition of sexual addiction comes from Patrick Carnes, the therapist whose staff is reportedly treating Woods. Carnes, who directs the sexual-addiction program at Pine Grove Behavioral Health and Addiction Services in Hattiesburg, Miss., is recognized as a pioneer in treating sexual addiction. He defines the addiction based in part on the time someone spends on sex, said Grieco.
"If you're spending over 14 hours a week - or two hours a day - doing something sexual or quasi-sexual, like cruising the Internet for porn or cruising the streets looking for a particular type of prostitute, you're in the addictive range," Grieco said.
Treatment of sexual addiction relies heavily on 12-step programs, much like Alcoholics Anonymous.
"It takes enormous courage to walk into a meeting of complete strangers and say, 'Hello, my name is John Doe, and I'm a sex addict,'" said Manley. "It's not as hard for drug and alcohol addiction, because there have been so many people who have been through it. Sex addiction is about the most shameful of all the addictions."
The key to taming the addiction, said Lake Mary certified sex therapist Toni Furbringer, is bonding with someone who has been through it, too. "So you could be sitting in the middle of the New York Shoe Show and you have a foot fetish, but that's your job and you've haven't figured out how to change jobs, so you get on the phone with your sponsor and you say, 'I'm here; this is what I'm experiencing,'" Furbringer said. "You can call your sponsor before you act out."
In addition to 12-step programs, some therapists treat patients with talk therapy, cognitive-behavioral therapy and even antidepressants, which blunt the sex drive.
Regardless of the type of treatment, sex addicts - like other addicts - frequently relapse. The problem, says Furbringer, is that they can never escape those salacious mental images they've created - whether it's pornography or experiences with another person.
"You cannot get those images out of your mind," she said. "And that's one of the things the sex addicts I work with say: 'It's there all the time. Even if I control my behavior, I have to constantly watch my thoughts.'"