The Scoop on Defining and Diagnosing the Problem and the Latest in Sexual Addiction Research w/ Stefanie Carnes

Narrator: This is Pathway to Recovery, an SA Lifeline Foundation podcast featuring hosts Tara McCausland, who is the SA Lifeline Executive Director, and Justin B., a sex addict living in long-term recovery. We have conversations with experts and individuals who understand the pathway to healing from sexual addiction and betrayal trauma because we believe that recovering individuals leads to the healing of families. Hey, before we get started, just a quick announcement.

Tara McCausland: Tickets are still available for our SA Lifeline virtual conference coming up on September 26th through the 28th. The first day we'll be talking about unwanted sexual behavior. We'll be talking then the next day about betrayal trauma healing. And the final day we'll be discussing healing couples and families. And on Saturday we have our live Q&As, the first with our headliners at noon, Dr. Jake Porter, Janice Caudle, and Dan Drake, and Crystal Hollenbeck, and our roundtable Q&A, which is an add-on.

Um, but it will be an opportunity to speak to these breakout presenters, these experts in the field, ask your hard questions in a small group setting. I'm so excited about this conference. I hope you'll join us. Scholarships are still available. You can register at salifeline.org. And if you have questions, please reach out. You can also look at the full agenda if you go to salifeline.org and see who the presenters are and what their presentation titles are.

And just a shout out to our sponsor for the conference, Circles of Grace. We'll put a link for, uh, their website in the show notes. Thanks to Circles of Grace and for the great work that they are doing in the field of sexual addiction and betrayal trauma. Our guest expert today is Dr. Stephanie Carnes. She's the president of the International Institute for Trauma and Addiction Professionals and a senior fellow At The Meadows, where she works with clients struggling with sexuality and intimacy issues such as compulsive and addictive sexual behaviors, infidelity, sexual trauma, and sexual assault.

She is the clinical architect for Willow House, a treatment program for women struggling with sex, love, and intimacy disorders. Dr. Carnes is a clinical sexologist, licensed marriage and family therapist, and an AA/MFT approved supervisor. She's also the author of numerous publications, including her books, Mending a Shattered Heart: A Guide for Partners of Sex Addicts, Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts, and Facing Addiction: Starting Recovery from Alcohol and Drugs. Her latest book is called Courageous Love: A Couple's Guide to Conquering Betrayal.

And by the way, if you wanna hear more from Stephanie Carnes, she, she has 2 presentations in our digital recovery library, one on healing the couple. and one on disclosure to children. So if you want to check that out, you can go to salifeline.org and hear more from her on our digital recovery library. Welcome to the Pathway to Recovery podcast. I am your host, Tara McCausland, and I'm really very excited to have here with me, Dr.

Stephanie Carnes. Hey, Stephanie, thank you so much for coming on. Hi, Tara.

Stefanie Carnes: Thank you so much for having me.

Tara McCausland: It's, it's a treat actually. Stephanie and I met back in, I think it was '21. Right? When you came and presented at our SA Lifeline conference. And we had a nice little conversation on our way to the venue. I got to know Stephanie a bit and she's just, apart from being a very smart woman, is a very kind and, uh, just down-to-earth gal. So I just am grateful to have this time with you. So I think that this will be a conversation that many of our listeners will be interested in because I know that there are things happening in the field of sexual addiction and our understanding of, of where it comes from, how we can maybe better diagnose, et cetera.

So maybe we'll start off with this question. Why has it been so difficult to get a diagnosis? And maybe give us a little bit of history or background on like the various ways we've tried to describe this issue.

Stefanie Carnes: Yeah, it's a, it's a great question, Tara. And it actually, at one point, one, one thing that a lot of people don't realize is that at one point we did have a diagnosis. In the DSM-III-R, we had a category called non-paraphilic sexual addiction, and it was pulled out of the DSM. And there were numerous reasons for that, but the most prominent reason at the time was it was, it was, there was concern that it would be used to get sex offenders sort of a reduced sentence in court case situations.

And so there was concerns that it would be misused in forensic settings. And, you know, activists for, you know, trauma victims and, you know, children's rights advocates and people along those lines were very concerned about that. And that concern actually is still alive and well today. There are people that are still concerned that it will be used in court cases. Also, if you think about, you know, the history of the DSM and what was going on at the time, Um, that can help us gain a lot of insight too.

Um, the field of sexology or sexual health has been developing a lot, and the, the '70s, '80s were, uh, times where there was a big movement towards things like what we call sex positivity, you know, really wanting to not judge people for whatever their sexual choices are, you know, not discriminating against. Mm-hmm. Sexual or erotic minorities, you know, rights for, for women's health and birth control and things like that. There was a lot of different kinds of advancements in, and in the field that were being made at that time.

And so there was a real concern about not over-pathologizing anybody's sexual behavior. And at one point in the DSM, we did have a diagnosis for homosexuality, and that was very controversial. And, you know, people at the DSM don't mean, didn't wanna repeat that. And so there was a, a lot of people in the field of sexology or sex therapists when, you know, basically in trainings and, and things like that, they were told, you know, this isn't real.

This isn't, this doesn't exist. And so what ended up happening is, you know, the 12-step programs, you know, people went for help in the 12-step programs because we all know this does exist and it's a real legitimate problem. And, you know, people need help and care and recovery and all of that. So people went in and that's how one of the big reasons why the S groups really exploded. Yeah. So there was that concern at the time.

And people were, you know, just a lot of the research, because we didn't have a diagnosis, people have used a lot of different terms to describe it. You know, is it an impulse control disorder? Is it hypersexual behavior disorder? Is it sexual compulsivity? Is it sex addiction? And so a lot of different types of terminology has been used. And the way that those different variations have been conceptualized is, you know, they all have different theoretical tenets behind them.

And so different people kind of pushing for different terminology, which created some infighting in the field, territorialism around different approaches, things like that, that has really slowed things down. And so it's, and you know, there have been some other, you know, smaller things, but those have been some of the main concerns. So not having a diagnosis is actually very, very problematic because therapists aren't trained on how to work with this. It's not taught in mental health training programs as a diagnosis and how to treat it.

Insurance doesn't cover it. Mm-hmm. You know, there's no big, there's only been 1 or 2 federally funded research studies in this area. So it has kept everything back. It's kept progress back. So it's been a real detriment to the field. Also has kept the stigma alive. You know, we're kind of where alcoholism was 30 or 40 years ago when people looked at it as a lack of willpower or a moral failing, or, you know, and, and that's still, people aren't recognizing that it's a legitimate illness on a large scale.

And so, you know, there's, there's not been as much destigmatization that could be happening in our popular culture where people realize that this is a legitimate problem that they can get help for and they can get treatment for, and this exists. So. You know, the end result is lack of access to care for people who are suffering, right? And, oh, and good care, people who are trained. That's why people seek out people with certifications like CSAT, Certified Sex Addiction Therapists, and, and people that have additional training.

So the therapists actually have a protocol that they can use to help them. Yeah. So it's a, it's been a big problem and it has really held things back. I mean, we are just in the last 10 years, we have made big progress in that research has greatly moved forward in the last 10 years. And also recently the World Health Organization, back in 2020, they put compulsive sexual behavior disorder into the ICD-11, the International Classification of Diseases book, which is the book that physicians use for diagnosing worldwide.

And so that has gone a long way in legitimizing this as a, as a real condition. And there's still a lot of, there's still a very active scientific argument going on in the literature about should we classify this As a behavioral addiction? Should it be a sexual compulsivity? Should it be— where should we put it in the book? And basically the World Health Organization stated that, you know, for now we're going to take a conservative approach and we're going to put it as an impulse.

We're going to call it compulsive sexual behavior and put it as an impulse control disorder. And then see how things pan out as more research comes out. Which is what they did with gambling. They initially classified gambling as an impulse control disorder and then moved it over to addictive disorders. So I think really the ruling is still out in terms of, you know, where it's gonna ultimately be in the DSM, but there is a lot more pressure now for the DSM to put a diagnosis in now that the World Health Organization has taken that stance.

So. And there are people that are actively pursuing proposals for the DSM and trying to get it in there. So with any luck, that will happen. Wow.

Tara McCausland: This is so interesting, Stephanie, because as an organization, we bump up against this problem frequently. Obviously we don't offer therapy in-house. We offer 12-step, we offer education, but yes, I mean, what you're describing is very muddy waters. And really what it boils down to is a lack of access to good care. It really impacts the individual and the family at a very deep level when people can't get a diagnosis. I'm actually really curious on an individual or anecdotal level, would you be able to share a story of how these muddied waters have impacted people's ability to find good recovery because they lack a diagnosis?

Stefanie Carnes: Yeah. Absolutely. Well, one of the things that research shows is that unfortunately our minority populations and women are the ones that have the least access to care. You know, cuz if you look at who gets treat— because it is a specialty area and there's only certain treatment centers that are able to offer treatment for that, you know, it requires money, right? And so only people typically with money, which tend to be more Caucasian, affluent, and mostly males are getting access to care.

And so a lot of our minority populations aren't. Also women, the research shows that female sex and love addiction is, is likely to be overlooked by clinicians at a much higher rate. And if you look at prevalence rates between men and women in the US, if we look at the most recent data that looks at a nationally representative sample across different minority populations, orientations, gender, socioeconomic status, all of that. The data averages out to be 10% for men and 7% for women, which is incredible.

Those numbers are huge. And those are people that are at clinical levels of distress. And so that's like 1 in 10 men and 1 in, you know, or, you know, almost as many women. Right. And, and think about that, that these are people that oftentimes feel like they can't talk to anybody about it. Therapists aren't trained on how to help them. We have this huge problem that people aren't discussing. Right. And, and people aren't getting help for. And so if you look at that, like just as an example, there are probably about 15 treatment centers in the US that specialize in sex addiction for men, and they're full a lot, you know, most of the time.

There are only 2 places that take women. And even then, you know, they're smaller programs. Sometimes they treat other things, you know, so it's like just the, the disparity in care between the populations is, is really different. Yeah. And unfortunate. So we have a long way to go in terms of getting that access. And going back to your question, there are many, many people that when this emerges in their lives, they feel like they have to take it to their grave.

They cannot tell anybody. And just even going to a therapist is a big leap. They feel like because of the stigma still being so rampant and so much, so many misunderstandings around it. You know, people feel like, you know, there's something really wrong with them, that they're untreatable. And it's, it's a real shame because we know that this is treatable. We know that there's a path to recovery, that people can get so much stronger through recovery than they ever were before the whole crisis happened.

Mm-hmm. And so there's a lot of hope and there's a lot of success. And personally, I find sex addiction a lot of, a lot easier to treat than, for example, chemical dependency. You know, I find more relapses when I'm working with CD patients. So it's, you know, it, it, people are very motivated typically to, to work and get, and get help in this, in this population. And so it's a, it's a shame that more people aren't getting the care that they need.

Tara McCausland: Yeah. Hmm. Thank you so much for sharing that. Sometimes we have a hard time knowing even what to call this. Even within our organization, we'll go back and forth with like unwanted sexual behavior or compulsive behavior or addiction, right? Just to meet everybody's needs wherever they're at. But for, for the sake of this conversation, we're going to call it sex addiction. And I'm really curious, how does sexual addiction compared to other addictions based on your research and experience?

Stefanie Carnes: Well, first of all, just to, to, to speak about the name, it really is, it is kind of funny because there's this big argument about what are we going to call it and people so adamant about different areas. But in reality, the vast majority of our population do use the term sex addiction, but really ultimately it's really not that important whether you want to call it CSBD or whatever. As long as we know what the symptoms are.

And but in terms of differences with treating other populations, you know, I think that there's a lot of parallels between addiction or sex addiction and other addictions and a lot of things that translate over and apply to sex addiction that are similar to chemical dependency. Things like, you know, 90 meetings in 90 days and developing good boundaries and a good plan for recovery, relapse prevention. You know, there's a lot that translates, you know, the 12-step program and, you know, doing group therapy and really needing more group at the beginning of recovery.

And there's just so much, so many similarities. I think what's different with sex addiction is first of all, the shame. And having to cope with toxic shame around it. And, you know, having people recognize that, you know, they're still worthwhile, valuable, precious people, even though they've been struggling with this illness because they, you know, they come in hating themselves and so ashamed. And so that's a, that's a real difference. Also the calamities that they leave behind and that come in the wake of this.

I mean, there's everything from significant health challenges like STIs or throat cancers and, you know, things like that to losing their jobs and financial consequences. So, you know, that there's a little bit of a flavor of that, but mainly the biggest area is family consequences because the partners are devastated, absolutely devastated. And it just creates such an attachment rupture in the coupleship. Mm-hmm. It creates, you know, such a feeling of, of hurt and betrayal among all family members, even, you know, the children as well.

You know, how to explain things to the children, how to share information with the partners that have been devastated. So there's a lot of nuances there that are very different from chemical dependency. The other thing that I would say is also just You know, the borderline around legal and ethical issues that can come up, like crossing the line into viewing sexual abuse images online, for example, or, you know, where it leads into offending behaviors and things like that.

That's also a challenging area that is not— the other addictions typically don't have to deal with as much legal consequences. Um, so it's, it's oftentimes a more delicate, nuanced area to treat because of some of those issues, the family work and some of those, um, legal issues that can come up.

Tara McCausland: That's interesting how, I mean, obviously for a partner it feels very personal and we know though that like a chemical dependency, oftentimes people struggling with sexual addiction, it was a part of their life well before the partner became And yet we have, I think as a society, we have a hard time wrapping our brain around that. Like we still have faith leaders blaming partners or we're telling them if you do XYZ, then maybe he'll shape up.

Right. And he, he won't act out. And why, why that disconnect? Why is it so hard for us societally to embrace the reality that sex can become addictive or pornography and mirror that with the experience of like a chemical dependency?

Stefanie Carnes: Right. I think that people don't, still don't understand addiction. And trauma and how these things come about. Just like, you know, any, you know, child that has been traumatized and has, you know, attachment difficulties and because people aren't there for them and they're, they're not getting the care that they need. They don't learn how to self-regulate their pain or co-regulate their pain with other people. And it's excruciating and they will just reach out to Whatever they can to medicate.

And so it can be gaming, it can be food, it can be addictions. There's a big pool of pain there. But when it's sexual, we have a lot of judgment around sexual behavior and they don't see the same process occurring and they don't have that as part of the paradigm. So they just see the sexual behavior and they think, oh, this is, you know, this is horrible. This is a lack of willpower or something like that when they don't see all the behavior that led up to it.

And you're absolutely right that for a partner, it's very hard not to take that personally because it's not like you chose a bottle over me. You chose another person over me. So what's wrong with me? You know, and it's very hard for them to grasp sometimes that this is an illness until, you know, and that's, you know, often the case early on, but once they start to learn about the history of the behaviors and the trauma and the, and see the escalation over time, oftentimes they start to understand that.

But at the beginning, that can be very hard to grasp. Yeah. for a partner or somebody who doesn't know the whole history for this person. And so I think, you know, I think that those are some of the reasons.

Tara McCausland: I just know that we have a lot of partners that still feel blamed, especially again in, in their faith community or even clinicians, um, not being well trained in this area, um, may not be giving good counsel to partners. Um, because their understanding of addiction is limited.

Stefanie Carnes: Well, they're in, in that case, they're blaming a trauma survivor. That would be like blaming a rape victim for dressing a certain way or something like that. There's nothing that the partner did that caused this. And people really need to be educated around that. And when you blame a trauma survivor, it really compounds their pain. And so it's very important that people understand that and understand they are the trauma victim here.

Tara McCausland: Right, right. Thank you. So let's talk a little bit more about this idea of behavioral addiction because we do accept that there are behavioral addictions, that those are a real thing. It's, you know, it's for some people, it's still hard for them to accept that sexual addiction is a thing. But what does neuroscience say about sex addiction as a behavioral addiction? What's in the research currently?

Stefanie Carnes: There has been a real convergence in the research literature in the last 10 years. And basically what we see is shared patterns of neuroplasticity between sex addiction and other established addictive disorders. So similar brain patterns for substance use, similar brain patterns for gambling, similar brain patterns for gaming, actually similar brain patterns for food as, as we see with sex addiction. So the mesolimbic dopamine pathway or the brain's reward center, similar patterns there. Similar patterns of what we call cue reactivity, which is a part of the, for some of your listeners may know the incentive salience model of addiction, or sometimes called like the disease model, that you have brain changes that occur as the addiction escalates over time in which your brain responds to cues and triggers in your environment.

And causes craving. So for example, if I am a cocaine addict and I see a line of cocaine, there's a very specific part in my brain that says, you know, I, I gotta have that now, right? And that is happening across the behavioral addictions. People can sometimes relate when I talk about it with food. Like if you go into a conference and somebody has pizza outside or brownies, usually it's like, Salty, fatty, highly palatable foods. And you sit down in the conference, but all you can think about is the brownies that are outside the door, right?

Well, they did the same thing, studies on porn addiction, put people in fMRI machines and showed them pornography in the machine and found the same region of the brain is activated. So we're seeing the same part of The same regions of the brain are triggered, same effects on frontal lobes. When people say, you know, should we classify this as an addiction? Should we classify this as, you know, compulsivity or whatnot? You know, on one hand, some people could say, well, it doesn't really matter.

But on the other hand, it's like, well, then how do you explain that gambling is an addiction? Gaming is an addiction. Chemical dependency is an addiction. And porn and sex are not, even though we're having the same brain patterns. You know, there's a, there's a problem there, uh, in, in, in just in classification, right? So this is why there's again, still that very active scientific discussion going on and people, articles still coming out all the time about this.

You know, people arguing different positions on it.

Tara McCausland: We do spend a lot of time And mental bandwidth, just arguing over what we ought to even call this. And this is a hard question. Maybe you don't even have a good answer. And I know that there, there is the moral aspect of this that makes this challenging, but what are the roots of that debate? What is the root of our inability to come to an agreement in this conversation?

Stefanie Carnes: It's numerous things. Some people don't feel using the term addiction is appropriate. Even in the DSM, they don't use the term. They have the category of addictive disorders and everything is in that category, but they don't use the term like for, they don't use alcohol addiction or drug addiction. They use substance use disorders. So chances are it will never be sex addiction in the DSM. It would probably be like maybe compulsive sexual behavior in the addictive disorder section, perhaps, you know, that could be, or, you know, it could be in the sexual disorder section.

We just don't know where that's gonna come. But also there is, as I mentioned, some territorialness around some of the names and different viewpoints around that. So Like, for example, just again, again, to go back historically with things, you know, back in when in the 1980s, when people were saying this is not a real disorder, you know, most people that were suffering went to 12-step groups. That's how they all, as I mentioned, all blew up. And so from that, they went to addiction therapists and people specializing in addiction who were more open to looking at it as an addiction and applied what they knew to chemical dependency to try and help people, right?

This is like in the early days of the field where we're, you know, people were just trying to figure out how to help. And so a lot of people working in the field of sexual health continued with this idea of this doesn't exist, this doesn't exist for actually until not that long ago. And then they kind of decided, well, actually this this does exist, we're gonna call it out-of-control sexual behavior and it's not an addiction and repudiate it as a result.

And so you have some people kind of sticking organizations and also individuals sticking their lines in the sand. This is my model, this is my approach, and this is my book on it. Or organizations saying, we use this model, we don't use this model. And it's become, there's been a lot of unnecessary rock throwing in the, in the field because we haven't had a diagnosis. You know, it's, oh, it opened the field up for all these different perspectives.

And, you know, really these different terms that people are using have different theoretical backgrounds, right? Mm-hmm. Uh, you know, an impulse control disorder is, you know, just what it sounds like. You can't control your impulses and it gets it just in the area of sexuality. A compulsion is something you're doing to medicate anxiety. Like somebody washes their hands a bunch of times to help calm them down, right? Mm-hmm. An addiction is something that actually escalates over time, becomes out of control, and you have brain changes with, right?

So they have different theoretical causes. And then there are some people that believe, like there was a genetic paper that was very interesting that said Well, really it's all of the above. Maybe it starts as something that, that's impulsive. It leads into a compulsion and then its end stage is an addiction. And we're all just arguing about, you know, semantics. Yeah, it's a, it's frustrating. And, you know, there's been a lot of unnecessary, like I said, intellectual rock throwing around it instead of coming together on what's, what's best for people and You know, cross-fertilizing ideas and approaches.

There's more, you know, there's a lot of stealing of ideas and remarketing them as somebody else's ideas. So, and they made a big hot mess essentially. Yeah. And what a sad tale, right? That this is—

Tara McCausland: if it's become us versus them, this is my territory, this is yours. And it really, it's about money.

Stefanie Carnes: It's about money and power. suffers is the client, right? Is the person that is the, the person that's struggling.

Tara McCausland: Do you think that the porn industry itself is part of what's driving the narrative behind this?

Stefanie Carnes: There are some actors, we'll put it that way. There are some actors that had a link, directly worked for the porn industry or had a connection with them. That have been stirring the pot, certainly. Yeah.

Tara McCausland: Well, thanks. We kind of went off the beaten path, but as you can tell, this is something I feel passionately about because again, it is something that we have people coming to us and they're wasting a lot of time and energy trying to determine what to even call this. And we, we often will tell people, if you're not sure what to call it, treat it like an addiction and you'll have different resources at your disposal.

Stefanie Carnes: Yeah. Calling it a problematic sexual behavior too, because not everybody is struggling with what feels like a full-blown addiction. Right. Right. Some people, you know, maybe you have somebody that has had maybe a couple of affairs and, or, and they're not really ready to own that this is a full-blown addiction, you know? And so, you know, people are at different stages of this. Yeah. As well. And so it's. You know, so not everybody's gonna relate to that idea.

Mm-hmm. Um, but you know, the, the benefit of using the addiction label is that there's a trajectory of recovery and it also provides family members with an explanation of the behavior that is, you know, oftentimes, you know, very real, the trauma that leads to self-medicating that leads to an addiction and it helps, then it's not my loved one is a pervert or a monster, or, you know, it's my loved one has an addiction that can be healed.

Right. Um, you can get recovery for. And then there's some people also that feel like addiction is a stigmatizing label. So you have that also, that argument. So there's a lot of different perspectives. Mm-hmm. One thing that I'll do is ask the client how, you know, what language they like to use, work with them and meet them where they're at.

Tara McCausland: Everybody comes with a different story and background, but do you find that you generally, you have a path and it's not recognizing that people are at different stages? Do you have a different path for people where you see maybe more of a compulsive issue versus an addiction, or does it look Oh yeah, there's very, there can be very different paths.

Stefanie Carnes: And that's the thing about, that's one of the beauties of working with, in this particular population is that I always say that healthy sexuality is as unique as your fingerprint. You know, for each person, what is right for that person is going to be unique for them. And that's why, you know, using a 3-circle map or a sexual health plan that is individualized for people. That can be very helpful, very important to kind of, again, kind of carve out a path that looks, that is unique and individualized for that person.

And, you know, there's a lot of different areas of focus, you know, that not, you know, clients all come in kind of different presentations. So you can have someone that looks more Yeah. Like they're struggling more with a love addiction kind of component. And, you know, the healing of that can be very different, you know, when you're dealing with an affair partner, you know, a situation like that versus somebody who is into, you know, just anonymous hookups or somebody who's into pornography or, you know, there's, that's where having a seasoned clinician that has the breadth of experience and that this is their specialty area.

Yeah. can be very helpful because then that person can really tailor the treatment to that client.

Tara McCausland: Hmm. Thank you. So you had talked a little bit about what current estimated prevalence rates are, and you said 10% for men could be classified or diagnosed. Go ahead.

Stefanie Carnes: That was one study in the US. They, they did do a, a global study that came out just a few months ago that was very interesting. It was called the International Sex Survey, and they looked at 83 countries and had researchers collecting data in 83 countries. And it was, you know, hundreds of thousands of people. And they looked globally and they looked at how many people had compulsive sexual behavior disorder. They used the term compulsive sexual behavior disorder and porn addiction, essentially.

And if for compulsive sexual behavior disorder, it was 5% of the global population. Wow. Which again is, is astounding that we don't have a diagnosis for that. And then, you know, we are in this field. And for pornography addiction, it was 2.5%, which that sounds low perhaps. But again, we're talking about averaging across the globe in different countries and whatnot. But 2.5% translates to 250 million people. And so it's a lot. people. And of course, different countries have different rates and things like that, but this is a global phenomenon, undoubtedly.

And people are struggling, you know, all over it and talk about disparity of care. When we get into international countries, you know, access to care is just in some areas completely unavailable.

Tara McCausland: I'm curious, as a clinician, do you, what do you see happening We have our youth growing up with phones in their hands, right? And a lot of them not being taught about how to handle pornography that's coming up on their phones, et cetera. We live in a, in a pornified world. As a clinician, what are you seeing currently in the folks that are coming to you and how do you see this progressing in the next decade or two?

Stefanie Carnes: Unfortunately, our sex education is the cell phone for our children right now. That's kind of the status of things. I mean, most You know, they, they've tried to do studies where, you know, they looked at kids who hadn't been exposed and they can't find any, right? So it's like, and it's happening at younger and younger ages. They're sharing it in the back of study hall and this is what they're learning. And so it's, you know, it is the big shift in our culture.

And, you know, anytime you have Widespread availability of something that is addictive or, you know, greater availability, you do have higher rates of addiction. So, you know, in areas where you have meth labs, you have more meth addiction. In areas where there's casinos, you have more problem gambling. Well, now everybody has a phone at, you know, 5 years old. And so naturally we have seen an increase in, in rates. I've seen just watching studies over the years, the rates have just been generally increasing.

Yeah. You can see that in different, across different populations. So certainly we're having a greater increase in people that are struggling. If you parallel it to sub— to substance use disorder, you can, you know, some relevant parallels there. You have people who recreationally drink alcohol and don't, you know, have life consequences, major life consequences from it. And then you have people that are kind of at risk in the spectrum, and then you have people that are struggling and have clinical levels of distress.

Well, the same is true with, you do have people that just recreationally use and then you never develop that problem. But you know, the, the numbers of people that are down on this end of the spectrum are going up and we are having more and more people, um, struggling with it. And so, and then also just, you know, there are, I think, consequences of having that as our main form of sex education. Yeah. I, I told my kids learning about sex from watching porn is like learning how to drive by watching The Fast and the Furious.

Yeah. It's like not very realistic. You know, there are elements of that that don't translate to a real life partner situation. They need basic, you know, education and also education around pornography and how, you know, obviously it's geared towards male tastes and there's a lot, there can be a lot of violence towards women. There can be a lot of racism and they need to be able to discern, you know, and as a parent, what your values are and teach them and to, to give them education.

You know, there can be, there's, you know, things like dating violence and rape myth acceptance and things like that, that need to be considered when we're talking about that as our main form of education.

Tara McCausland: Yeah. Thank you. So what are you seeing as some of like the, the primary causes of sex addiction? Do you have kind of a, a type of person that comes into your office frequently?

Stefanie Carnes: Let me talk about a few different areas. There was a recent study that, that was a meta-analysis that evaluated 20, 21 different studies. That associated sexual trauma with sex addiction. We have also more emotional abuse and neglect is also very common. And it's not that people don't have physical abuse, but there's just higher rates of sexual trauma and emotional trauma. And so that certainly is one factor, contributing factor. Then when you have trauma, often in those environments, People have insecure attachment as well because they are growing up in, in homes where, you know, they, they do not get what they need from an attachment perspective.

And there are many studies that show that people with sex addiction are more likely to, to have an insecure attachment style. When you are dealing, like we were talking about earlier, you have a young person who has a lot of pain. From, in confusion because they've been experiencing trauma and they don't have anybody that they can go to and rely on about that. They can't, they don't know how to cope with their feelings. And that's when they, you know, reach out for forms of self-medicating.

So you have that piece. Then there's also the physiological piece and the research in that area. So there's genetic research, there's been hormonal research. And there's neuroscience research that shows that there's, you know, this component. So I, I don't know if, if you're aware, Tara, but my, my dad is a Fulbright scholar from with the University of Alberta in Canada, and they're doing the first large-scale genetic study on sex addicts. Oh. And so we've been collecting saliva samples of our patients and of patients from other facilities.

Actually, some of that original research is gonna be coming out this year. And what they have found, just a little sneak peek, and I haven't, you know, I don't have access to any links yet, but it, my understanding from the research team is that it par— what they have found parallels a lot of what Ken Bloom researched. And he's a professor from the University of Florida. And he basically looked at behavioral addictions and substance use disorder and the genetics of that.

And that Basically that there is a genetic predisposition as we know that there is in alcoholism, right? And there's a lot of research in that. So there's a potential genetic component. And I think if you, you come to the table with this genetic vulnerability, you throw a little trauma, you throw a little attachment problems on it, and you know, there you go, right? Mm-hmm. Toxic stress in there and, and what have you. So you have that.

You also, and how the genetics interplays with the neuroscience and the hormonal aspect, we still don't know. So there was a study that came out last summer around males with compulsive sexual behavior have higher levels of oxytocin. And so that was an interesting study and there haven't been a lot of studies in that area yet, but it's something. Yeah. You know, that, that there has been some preliminary evidence that there's something there. And then there have been, you know, all the neuroscience studies that I mentioned, a huge amount of new neuroscience studies showing these brain changes that occur.

And so, you know, I think there's a lot of factors to consider, but I would say, you know, those areas are the most common etiological factors that would contribute to the development of the addiction. Yeah.

Tara McCausland: Hmm. I love all the research that you've been sharing and I'm excited to see the final results of this work that your dad's doing.

Stefanie Carnes: Yeah. So are we. It's been, it's been years in the making, so it's, it's been kind of a long-awaited study. Yeah. We're really excited about some of the papers coming out.

Tara McCausland: Well, thank you again. Before I let you go, a couple things. If people want to connect with you, what's the best way to find you? Yeah.

Stefanie Carnes: So usually through ITAP. Um, I'm president of ITAP, the International Institute for Trauma and Addiction Professionals. My email is stephanie@itap.com, I-I-T-A-P.com. It's Stephanie with an F. Reach out to me, email me. If they're looking for a therapist, they can go to sexhelp.com. They can find a CSAT on there. They can type in their zip code. There's over 3,000 CSAT therapists in 35 different countries. So they can, you know, typically find somebody that can either work with them either virtually or locally.

And so that's, they can go to itap.com, I-I-T-A-P.com, or sexhelp.com and get some help. Also, they can find me at The Meadows, which is, you know, I helped them develop a program called Willow House for Women, which is a program for women really struggling with any kind of sexual issue, but we have obviously a lot of focus on sex and love addiction for women. And we also do have like a trauma track with where we work with sexual trauma and rape trauma survivors.

And so, and then also Gentle Path for men at The Meadows.

Tara McCausland: Awesome. Well, I'll put all of that in the show notes and I'm sure that there will be people interested in reaching out. So. Before I let you go, we always ask our experts our final question, which is, what would you tell someone that's just starting this path of recovery? And what would you tell someone that's been walking this path for a while?

Stefanie Carnes: I try to engender that hope. So I always tell my addicts things like, you know, recovering addicts can make great partners. And, you know, you guys are learning the tools now to be a great partner. You know, you're getting in your integrity, you're getting into, you know, if you really work a program, you can become the person that you want to be. And so sometimes this can, even though it's painful, it can be actually a blessing that people can turn this around and couples going through this can become much stronger than they ever were before any of this happened.

So there is a path to recovery. There is hope. So I would say that to the new people because they often feel very demoralized about everything. Let's see, to people that have been in it, are you talking about people that have been in recovery for a while or that have been working their recovery for a while and just need a little bit of a boost? I would say that, you know, service can be a great option for your— if they can turn around and help some of the newcomers, it can help them.

also grow and grow more, more confident in their own recovery. So that can be a great way to give service and to also grow themselves.

Tara McCausland: Wonderful. Well, thank you again, Dr. Carnes. So appreciate you and the expertise and wisdom that was shared here today.

Stefanie Carnes: Thanks for having me.

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