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had been on the Internet as kids. Now they’re in their twenties and they’re telling us they had gotten into trouble for something that they’ve done, and now we started seeing the history of that. Now I would say today, anybody who treats sex addiction, sooner or later most of them … it’s very rare now that we see a sex addict who doesn’t also have some issue also with the Internet because the Internet is such an easy form for access. It’s really changed things. I thought to be truthful, and I think you’ve heard me say this, Carol; I thought that we had the answers in the 90s and that we had done all this research and found what the path was. Well, that path was accurate until that time. The path is now different and there are many different ways that people can get there.

      Carol: I so agree with you. Certainly, we’re now learning how to be neuroscientists and brain scientists, because we have to do brain work to help people recover. You and I both know how much we’re learning about that every single day.

      Dr. Carnes: In fact, one of the things that I think is important, obviously as the basis for recovery, and is that the Twelve Steps have a formula that worked, and now we’re starting to make sense of why. For example, one of the ways the brain changes has to do with the brain’s need to feel safe. In other words, if there is a commonality of story, all of those things that go into a Twelve Step program from a neuroscience point of view, make lots of sense now, but nobody had that idea in the 1930s and nobody thought about applying it to things other than alcohol. But the reality is that system worked. The truth is whether you’re in recovery or not in recovery, I think that brain consciousness now is something that everybody has to start learning about. It’s not just that professionals need to become aware of the way the brain changes, but all of us need to become good consumers of information about how to take care of our brain, how to feed it better, how to stimulate it, how to keep it going.

      Carol: And how to rest it.

      Dr. Carnes: The brain replaces itself every two years, like our blood supply is replaced every six months. The brain actually reconstitutes itself and it’s very, very plastic. Part of what we have to do is to be aware … one of the things we can do to help our brain consolidate, learn new things, be stimulated, and develop new ways of behaving and thinking, which brings our brain to a new level of functioning. That actually begins … it goes well into what many people would consider elderly. The truth is the brain actually reaches kind of an epitome in the mid-60s. I think there may be listeners who, as they get older, will forget things like they go into a room and forget why you went there, forget names and things that they are familiar with and what have you that they can’t recall. The fact is the brain gets very complex, so the brain is able to handle a lot of variables as you age and sometimes where you’ve been—stuff is forgotten. I think for a lot of people, they worry about maybe their brain is deteriorating, but in fact brains really keep maturing. There are good books out there that can help with that, but for sure what people need to understand is that addiction is a brain disease. In other words, it’s a problem where the brain doesn’t function like it’s supposed to.

      When we think of Alzheimer’s, people understand Alzheimer’s and nod their heads and think, “What happens if somebody has Alzheimer’s?” Well, they have trouble with their memory; they have trouble with feelings; they have trouble managing their feelings; they lose contact with reality—that’s a brain disease. It’s also true of what happens with addicts. They start to lose contact with reality; they start making bad decisions; they have a hard time managing their feelings; they have difficulty with being in touch with what is going on around them. The fact of the matter is that addiction is very much a brain problem as opposed to a moral one, which of course many people were judged by. When I started my career … that’s the other thing that I would say was one of the major changes. The change is that one of the reasons we didn’t publish Out of the Shadows for so long was because of just the fear. We were teaching other professionals and talking about it and what have you, but we were aware of what the public reaction would be to the idea of sex addiction. Today it’s a pretty commonly understood concept. Some countries have been notable in pioneering the public’s understanding of that. For example, in Canada in the province of Alberta, they did a public education thing much like you do, Carol—where you’re trying to help the public understand that there is a problem—and they brought in experts and told the story and what have you. It appeared on all their TV channels and health channels and in hospitals and subways, and then they surveyed the average citizen on what they thought about addiction. Then two years later, they did an assessment and what they found is they totally changed the culture’s perception about the nature of addictions. When they were asked, “Now that you understand this, what treatments do you think we need the most help with,” the number one thing they were requesting was more services for sex addiction.

      Carol: That is amazing. I had no idea. So would you say that their treatment centers and their workshops and their experts … that is actually more available to the public?

      Dr. Carnes: That in fact put the whole system … starting with medical schools and hospitals and delivery systems, and the health care system is very different from ours, so it really required very different thinking in order to understand what it was going to take to build a system that would really deal with addiction as a problem. They took a giant step by educating their public. It’s interesting; the people they brought in were from American institutions and it was headed by a Washington think tank that helped them design the whole process. So they used American technology to help them with their problem, which we haven’t even accessed in our own country.

      Carol: Did they ask you to be part of the think tank?

      Dr. Carnes: There were numbers of us that were involved in the education, but they were from all kinds of addiction institutions and academic institutions in the U.S. There is a lot of common agreement amongst professionals and people who work both in the addiction community and the brain community about this as a problem.

      Actually, Europe has been in some ways further ahead than we are in some of the neuroscience studies. For example, out of Cambridge, we’ve been getting studies of what pornography can do to the brain. One of them, for example, really opened their eyes to the fact that four hours of Internet pornography a week will actually decrease gray matter volume, affect the decision making for brains, and would also affect the bottom of the brain where you have feelings and learning and motivation. All those things were affected. One of the most interesting side effects is that it affected the ability to be sexual with another human being, so for example erectile dysfunction was one of the common side effects. That’s what four hours would do for you. The whole idea was to understand that it was something that seemed so innocent … like it wouldn’t have an impact. The stimulation the brain was receiving was so great that it actually altered how the brain was functioning. I think it was really eye-opening to a lot of people. Now there are studies … there is one from Germany from the great University of Berlin, so that appeared in the Journal of the American Medical Association. In other words, more and more evidence is coming in about the impact of it, and it’s being understood worldwide.

      Carol: That is absolutely amazing. When you think that the average male describes that he watches at least four hours of porn a week, you’re saying that decreases the gray matter, which then affects the ability to process feelings and learning and to be motivated, and then physiological, erectile dysfunction, anorexia. I mean, it just trickles down; it ripples out. So we have a whole lot more to do to educate the public about how notorious this situation is.

      What are you doing right now, because I know that I was reading in the Guinness interview and you said probably four or five years ago that your proudest book thus far was the recovery stuff. So what are you doing these days? I know you’re running a circuit where you’re really helping to connect people to the Twelve Steps. Tell us a little bit about how you’re doing and what you’re doing.

      Dr. Carnes: Well, the Twelve Step part is that in the late 80s we put a book out called A Gentle Path through the 12 Steps and it was a way of structuring how you worked, and I kind of started thinking differently in a more psychological and self-aware way about doing Step work. In fact, when I proposed the book to the publisher, they said it was a book that was never going to sell, but they thought that a tape set would, and they would include it as a

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