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your recovery. What are you doing that’s working in your life? What is making a difference? Is it the reading you’re doing? I recommend the workbook Facing the Shadow from Gentle Path Press to every person I work with. Why is that? Because it’s the workbook that deals with the ABCs of sexual addiction, and the more you look at the problems that it has caused in your life—the consequences—the more you understand that maybe it’s not just Internet porn. Maybe there is some fantasy; there is some seduction; there is that risk taking that is imperative to the illness itself. You can interrupt that at different points. Dr. Carnes talks about a “fire drill.” Have a fire drill ready so that when you begin to feel urges and cravings, you know how to interrupt that pattern immediately. This might entail writing a letter reminding yourself how much healthier you are, because you no longer utilize pornography, prostitution, exhibitionism, that kind of thing. When you’ve got those things on hand, as well as your fellowship list so that you can call anybody for support at any time, you’re much more likely to make successful choices. Some people have found that certain medications make a big difference in their urges and cravings, so they combine pharmacology with utilizing those healthy outside behaviors like exercise and relationship building and church. Addicts may go to additional Twelve Step meetings when they feel more at risk to slip or relapse.

      Other times you may be a partner and say, “You know what? I need to go to a partner trauma workshop so that I can work with a group of people who really know how I feel and can give me the support I need to make the necessary changes in my life. Maybe I need a separation. Maybe I need a full disclosure. Maybe I am tired of information leaking out over and over and over again, which leaves me feeling re-traumatized.”

      One of the things I do with addicts is that I ask them to have empathy for what’s going on in the lives of their partner. It’s not all about them; it’s also about how is this affecting your wife or your husband? How is this affecting the kids? How is it affecting your work? And although you need to have somebody who really is there for you and who understands and won’t stigmatize or shame or guilt you, they also need to help you rebuild the lives of the people whose lives you have shattered.

      I am so pleased to announce that we have Dr. Carnes on the phone.

      Carol: I’m very glad to have you on the show, because I’ve got some important things to check out with you, and of course I wanted to talk to you first and foremost about AFAR. Can you tell our listening audience why AFAR is such an important organization and what it’s doing for the field of sexual addiction?

      Dr. Carnes: There is no other organization that really takes into account all the addictions. There are things around some of the chemical addictions, but there isn’t anything that also takes into account what we call a “process addiction,” like compulsive eating or compulsive sex or some of the things that don’t involve chemicals. AFAR is committed to fostering research across all the various types of addiction.

      Carol: So in some ways this differentiates process addictions from chemical addictions and will help people to understand through research that this is just as devastating and compulsive as a chemical addiction.

      Dr. Carnes: Well, in fact from a neurobiological and medical point of view, this is something that has been in the works for a long time. People have understood that the reward centers of the brain can be accessed in many ways besides chemicals. With both food and sex, for example, they actually are in some ways harder wired in the brain, because they are connected with survival. The reality is that both in food and sex, we can now see this in brain scans documenting that the same parts of the brain are affected as cocaine or other chemicals would affect them. In some ways, like for example in the case of sex, the brain will categorize something as sexual for both men and women 20 percent faster than anything else that it is presented with. So the reality is that physicians are saying and writing about that, and they’re saying of course sex can be addictive. Of course, now it is delivered in ways that we never knew before, because the Internet has really opened technology to flooding the brain and the reward centers of the brain in ways that the human race has never faced before. So we have a greater challenge than we know.

      About six or seven years ago, there was an article in Pediatrics talking about the fact that two-thirds of our junior high students are doing sexual things while they do their homework, and 34 percent will go on to have a lifelong problem. That period in an adolescent’s life between the ages of twelve and sixteen is very powerful in terms of forming addictions. Like if you smoke at the age of thirteen or fourteen or if you drink alcohol at the age of thirteen or fourteen, it can be a real problem. One of the things that we are starting to understand is those kids—and roughly that’s about six million U.S. teenagers at this point in time—40 percent of those kids who are having the problem started when they were actually ten. The fact of the matter is that there are parents out there who literally do not know what their kids are doing or that a kid would even be having a problem.

      One of the things that AFAR is trying to do is mobilize the recovery community as well as the research community and public health people to become aware that we have a major problem. Addiction is our number one public health problem. In chemicals alone, there is over $500 billion a year in medical expenses connected with the chemical addictions. When you fold in the eating disorders and compulsive overeating—for example, with a third of our adults having obesity, which leads to diabetes and cardiovascular problems, etc.—then you fold in sex addiction and you start getting to sexually transmitted diseases and AIDS. In fact, a recent statistic shows that the leading cause of throat cancer—which used to be either alcohol or nicotine—the leading cause of throat cancer now is HPV, the virus that is transmitted by oral sex in adolescents, and it’s reduced the age of onset from the early fifties to the mid-thirties. It’s stunning to see that we have major consequences, major things that are happening in our culture, and people are oblivious to it. It’s AFAR’s mission to help people understand that we as a nation have a huge addiction problem. We are one of the most expensive medical systems in the world, and we are not one of the healthiest nations in the world.

      Carol: That makes total sense. So, in some ways, it’s going to have to hit a physical realm for people to grasp how this addiction is affecting our kids, our families, and certainly adults. Tell me, what is the greatest change you’ve seen in the past forty years in your work with sexual addiction? Actually, has it been forty or is it fifty years now? Wasn’t it in the mid-80s that you first started this work?

      Dr. Carnes: I actually started … the book that kind of started it all for me in my career was Out of the Shadows. I actually wrote the majority of that in 1972.

      Carol: Did you really?

      Dr. Carnes: We did not publish it until 1983, because at that time we were still learning. To talk about any non-chemical addiction was a real problem, so what we did in 1985 is we started off really researching. We followed 1,000 families for seven years, and what we found is we were able to document that there was a process, probably an age-old process, in that sex addiction comes from certain kinds of families; it usually involved things with childhood abuse, sexual abuse, physical abuse, emotional abuse. We knew that it was very stress and trauma related. We also knew that early sexual experiences could have a tremendous effect on it and that it traveled with other addictions. So we had kind of a pathway. If you’d ask me the biggest change that has happened in my career, I thought by 1991 that we had a map of how all this happened and we did. At that time, we had a really good picture and really good numbers about how sex addiction occurred.

      Carol: Before the Internet, right?

      Dr. Carnes: It was before the Internet. We started getting people … I was getting patients who didn’t fit that pattern. What did happen is they got on the Internet, and as we have since learned from a number of different sources, there are now people who struggle with the problem who never would have had it if not for the Internet. Reality is that, first of all, I had people tell me that and one of my clues was it happened so fast. I remember having a minister tell me that he discovered the Internet in his church when he was working alone one day on a holiday, and he quickly went through his family savings and he embezzled from the church, and he said it happened so fast. That’s what cocaine addicts would tell me about how fast it happened. Then we started getting people who not only would

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