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

In this episode, host Tara McCausland speaks with Dr. Stefanie Cranes about the challenges of defining and diagnosing sex addiction. Topics covered include the historical context for diagnosis problems, the stigma and societal misunderstandings surrounding it, and the prevalence and causes of sex addiction based on recent research. Dr. Carnes also shares the distinct impact of sex addiction on individuals and families, compares it to other addictions, and offers hopeful advice for those starting or already on their recovery journey.

REGISTER FOR THE 2024 S.A. LIFELINE CONFERENCE

Learn more about our conference sponsor,
Circles of Grace. https://circlesofgrace.health/

Resources and connect with Dr. Carnes:
sexhelp.com
iitap.com
stefanie@iitap.com


00:00 Introduction and Conference Announcement
01:35 Guest Expert Introduction: Dr. Stephanie Carnes
03:38 Challenges in Diagnosing Sexual Addiction
05:03 Historical Context for Diagnosis Problems
07:51 Impact of Lack of Diagnosis on Treatment
11:55  Disparities in Care
23:36 Neuroscience and Behavioral Addiction
26:46 Debate Over Terminology and Classification
35:17 Prevalence and Future Trends
40:23 Primary Causes and Research Insights
44:46 Resources and Final Thoughts

Chapters

• 0:00 Introduction and Conference Announcement
• 1:35 Guest Expert Introduction: Dr. Stephanie Carnes
• 3:38 Challenges in Diagnosing Sexual Addiction
• 5:03 Historical Context for Diagnosis Problems
• 7:51 Impact of Lack of Diagnosis on Treatment
• 11:55 Disparities in Care
• 23:36 Neuroscience and Behavioral Addiction
• 26:46 Debate Over Terminology and Classification
• 35:17 Prevalence and Future Trends
• 40:23 Primary Causes and Research Insights
• 44:46 Resources and Final Thoughts

Transcript

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

Introduction and Conference Announcement

Tara: [00:00:00] Hey, before we get started, just a quick announcement. 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 on the final day we'll be discussing healing couples and families.

And on [00:01:00] Saturday, we have our live Q and A's. The first will be with our headliners at noon - Dr. Jake Porter, Janice Cottle, and Dan Drake and Crystal Hollenbeck. Our round table Q and A, which is an add on, will be an opportunity to speak to these breakout presenters, these experts in the field and to 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 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. 

Guest Expert Introduction: Dr. Stefanie Carnes

Tara: Our guest expert today is Dr. Stefanie Carnes. She is 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 [00:02:00] 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. Karnes is a clinical sexologist, licensed marriage and family therapist and an AAMFT 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. Her latest book is called Courageous Love: A Couple's Guide to Conquering Betrayal.

And by the way, if you want to hear more from Stefanie Kearns, she has two 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 [00:03:00] podcast. I am your host Tara McCausland, and I'm really very excited to have here with me Dr. Stefanie Carnes. Hey, Stefanie. Thank you so much for coming on. 

Stefanie: Hi, Tara. Thank you so much for having me. 

Tara: It's a treat. Actually, Stefanie 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 Stefanie a bit and just apart from being a very smart woman, she is a very kind and just down to earth gal. So I am just 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 where it comes from, how we can maybe better diagnose, et cetera. 

Challenges in Diagnosing Sexual Addiction

Tara: 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 [00:04:00] the various ways we've tried to describe this issue. 

Stefanie: Yeah, it's a great question, Tara. And it actually, at one point, one thing that a lot of people don't realize is that at one point we did have a diagnosis.

In the DSM 3 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 that there was concern that it would be used to get sex offenders a reduced sentence in court case situations. And so there were concerns that it would be misused in forensic settings. 

And, you know, activists for trauma victims and children's right advocates and people along those lines were very concerned about that. That concern, actually, is still alive and well [00:05:00] today. There are people that are still concerned that it will be used in court cases. Also if you think about the history of the DSM and what was going on at the time, that can help us gain a lot of insight too.

Historical Context for Diagnosis Problems

Stefanie: The field of sexology or sexual health has been developing a lot and the 70s and 80s were times where there was a big movement towards things like what we call sex positivity, really wanting to not judge people for whatever their sexual choices are. Not discriminating against sexual or erotic minorities, rights for women's health and birth control and things like that.

There were a lot of different kinds of advancements in the field that were being made at that time. And [00:06:00] 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 people at the DSM didn't want to repeat that. And so there were a lot of people in the field of sexology or sex therapists that were told, basically in training and things like that, “This isn't real. This doesn't exist.” And so what ended up happening is, people went for help in the 12 step programs because we all know this does exist and it's a real legitimate problem people need help and care and recovery and all of that.

So people went in and that's one of the big reasons why the S groups really exploded. [00:07:00] So [people were concerned] at the time and 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, they all have different theoretical tenets behind them. And so different people pushing for different terminology, created some infighting in the field, territorialism around different approaches, things like that. That has really slowed things down. And so there have been some other, smaller things, but those have been [00:08:00] some of the main concerns. 

Impact of Lack of Diagnosis on Treatment

Stefanie: 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. There's only been one or two federally funded research studies in this area, so it has kept everything back. It kept progress back. So it's been a real detriment to the field and has also kept the stigma alive. 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.

Still, people aren't recognizing that it's a legitimate illness on a large scale. [00:09:00] There's not been as much de-stigmatization 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, the end result is lack of access to care for people who are suffering, right? And, good care, people who are trained. That's why people seek out people with certifications like CSAT, Certified Sex Addiction Therapist, and people that have additional training so the therapists actually have a protocol that they can use to help them.

So it's been a big problem and it has really held things back. I mean, just in the last 10 years, we have made big progress in that research has greatly moved forward in the last 10 years. Also recently the World Health Organization back in [00:10:00] 2020, they put a 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 real condition.

There's still a very active scientific art argument going on in the literature about “Should we classify this as a behavioral addiction? Should it be a sexual compulsivity? Where should we put it in the book?” And basically the World Health Organization stated that 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 [00:11:00] 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 where it's going to 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. 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. 

Tara: Wow. This is so interesting, Stefanie, 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, 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 [00:12:00] impacts the individual and the family at a very deep level when people can't get a diagnosis. 

Disparities in Care

Tara: 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: 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. Because it is a specialty area and there's only certain treatment centers that are able to offer treatment for that, 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 [00:13:00] aren't. 

Also women, the research shows that female sex and love addiction 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 U. S., 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 percent for men and 7 percent for women, which is incredible. Those numbers are huge. And those are people that are at clinical levels of distress. And so it's like one in 10 men and almost as many women. 

Think about that. These are people that oftentimes feel like they can't talk to anybody about it. Therapists aren't trained on how to help [00:14:00] them. We have this huge problem that people aren't discussing, right? And people aren't getting help for. And so if you look at that, just as an example, there are probably about 15 treatment centers in the U. S. that specialize in sex addiction for men. And they're full a lot, most of the time.

There are only two places that take women. And even then, they're smaller programs. Sometimes they treat other things, so it's just the disparity in care between the populations is really different 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 [00:15:00] leap. They feel like because of the stigma still being so rampant and so many misunderstandings around it, people feel like there's something really wrong with them -  that they're untreatable and 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. And so there's a lot of hope and there's a lot of success. And personally, I find sex addiction a lot easier to treat than, for example, chemical dependency.

You know, I find more relapses when I'm working with CD patients. So people are very motivated typically to work and get help in this population. And so it's a shame that more people aren't getting the care [00:16:00] that they need. 

Tara: 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, like unwanted sexual behavior or compulsive behavior or addiction, right? Just to meet everybody's needs, needs for wherever they're at. But for the sake of this conversation, we're going to call it sex addiction.

And I'm really curious, how does sexual addiction compare to other addictions based on your research and experience? 

Stefanie: Well, first of all, just to speak about the name. It is kind of funny because there's this big argument about what we are going to call it and people are 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.

But in terms of [00:17:00] differences with treating other populations, I think that there's a lot of parallels between 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 90 meetings in 90 days and developing good boundaries and a good plan for recovery, relapse prevention. There's a lot that translates, the 12 step program and doing group therapy and really needing more group at the beginning of recovery. And there's just 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 having people recognize that they’re still worthwhile, [00:18:00] valuable, precious people, even though they've been struggling with this illness. Because they come in hating themselves and are so ashamed. And so 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 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. It creates such a feeling of hurt and betrayal among all family members, you know, the children as well. How do you explain things to the children, how do you share information with the [00:19:00] 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 the borderline around legal and ethical issues that can come up like crossing the line into viewing sexual abuse images online, for example, where it leads into offending behaviors and things like that. That's also a challenging problem, an area that  the other addictions typically don't have to deal with as much, legal consequences. 

So it's oftentimes a more delicate nuanced area to treat because of some of those issues - the family work and some of those legal issues that could come up. 

Tara: That's interesting how, I mean, obviously for a partner, it feels very personal. And we know though, that like a chemical [00:20:00] dependency, oftentimes people struggling with sexual addiction, it was a part of their life well before the partner became their partner, And yet we have, I think, as a society, a hard time wrapping our brain around that.

Like we still have faith leaders blaming partners or telling them, if you do X, Y, Z, then maybe he'll shape up and won't act out. Why that disconnect? Why is it so hard, societally, to embrace the reality that sex or pornography can become addictive and mirror the experience of a chemical dependency?

Stefanie: Right. I think that people don't still don't understand addiction and trauma and how these things come about. Just like a child that has been traumatized and has attachment difficulties and because people aren't there for them and they're not getting the care that they need, they don't learn how to self regulate their pain or co-regulate their pain [00:21:00] with other people. And it's excruciating and they will just reach out to whatever they can to [self] 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 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? And it's very hard for them [00:22:00] to grasp sometimes that this is an illness. That's often the case early on, but once they start to learn about the history of the behaviors and the trauma and see the escalation over time, oftentimes they start to understand that.

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

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

Stefanie: Well, in that case [00:23:00] 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. They are the trauma victims here. 

Tara: 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.  For some people, it's still hard for them to accept that sexual addiction is a thing. 

Neuroscience and Behavioral Addiction

Tara: But what does neuroscience say about sex addiction as a behavioral addiction? What's the research currently? 

Stefanie: There has been a real convergence in the research [00:24:00] 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 we see with sex addiction.

So the mesolimbic dopamine pathway or the brain's reward center, similar patterns there to what we call Q reactivity, which, for some of your listeners who may know the incentive salience model of addiction or what’s sometimes called the disease model, is brain changes that occur as the addiction escalates over time and your brain responds [00:25:00] 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 gotta have that now.” And that is happening across all the behavioral addictions. People can sometimes relate to that 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 outside the door. Right? 

Well, they did the same thing, studies on porn addiction and 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 causing the same effects on frontal lobes. [00:26:00] 

When people say, you know, should we classify this as an addiction? Should we classify this as compulsivity or whatnot? On one hand, some people can 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?” There's a problem there, just in classification. So this is why there's, again, still that very active scientific discussion going on and articles still coming out all the time about this and people arguing with different positions on it. 

Tara: 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. 

Debate Over Terminology and Classification

Tara: And I know that there is the moral [00:27:00] 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: It's numerous things. Some people don't feel that 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, they don't use alcohol addiction or drug addiction. They use substance disorders, so chances are it will never be sex addiction in the DSM.

It would probably be like compulsive sexual behavior in the addictive disorder section, perhaps. Or it could be in the sexual disorder section, we just don't know where that's going to come. But also there is as I mentioned, some [00:28:00] territorialism around some of the names and different viewpoints around that.

So for example, just to go back historically with things, in the 1980s, when people were saying, “This is not a real disorder,” most people that were suffering went to 12 step groups. That's how, as I mentioned, they 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.

This was in the early days of the field when 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,” actually until not that long ago. And then they kind of decided, “Well, actually this [00:29:00] does exist, we're going to 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, 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 there's been a lot of unnecessary rock throwing in the field.

Because we haven't had a diagnosis. It opened the field up for all these different perspectives. And really these different terms that people are using have different theoretical backgrounds, right? An impulse control disorder is just what it sounds like - you can't control your impulses and it’s just in the area of sexuality. A compulsion is something you're doing to medicate anxiety, like [00:30:00] somebody washes their hands a bunch of times to help calm them down. An addiction is something that actually escalates over time, becomes out of control and you have brain changes with it. 

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's impulsive, it bleeds into a compulsion and then its end stage is an addiction.”

And we're all just arguing about semantics. It's frustrating and there's been a lot of unnecessary, like I said before, intellectual rock throwing around instead of coming together on what's best for people and cross fertilizing ideas and approaches. There's a lot of stealing of ideas and remarketing them as somebody else's ideas. [00:31:00] We’ve made a big hot mess, essentially. 

Tara: And what a sad tale, right? This is a sad tale. If it's become us versus them, this is my territory, this is yours, and it really it's about money. It's about power.

Stefanie: And the person that suffers is the client. 

Tara: Right. 

Stefanie: It's the person that's struggling. 

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

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

Tara: Yeah. 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 [00:32:00] trying to determine what to even call this. And 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: Yeah. calling it a problematic sexual behavior too, because not everybody is struggling with what feels like a full blown addiction, right? Some people that have had maybe a couple of affairs and they're not really ready to own that this is a full blown addiction, you know? And so, people are at different stages of this as well. Not everybody's going to relate to that idea. 

But, the benefit of using the addiction label is that there's a trajectory of recovery, and it also provides family members with explanations of the behavior that is, oftentimes, very real: the [00:33:00] trauma that leads to self medicating that leads to an addiction. And it helps then that it's not, “My loved one is a pervert or a monster,” it's, “My loved one has an addiction that can be healed. You can recover from it.”

And then there's some people that also feel like addiction is a stigmatizing label. So you have that argument. There's a lot of different perspectives on it. One thing that I'll do is ask the client what language they like to use, to work with them and meet them where they're at. 

Tara: Everybody comes with a different story and background, but do you find that 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 fairly similar?

Stefanie: Oh yeah, there [00:34:00] can be very different paths. And that's the thing about it, that's one of the beauties of working with this particular population is that I always say that healthy sexuality is as unique as your fingerprint. For each person, what is right for that person is going to be unique for them.

And that's why using a three circle map or sexual health plan that is individualized for people can be very helpful, very important to again, kind of carve out a path that is unique and individualized for that person. There's a lot of different areas of focus. Clients all come in with different presentations.

So you can have someone that looks like they're struggling more with a love addiction kind of component. And you know, the [00:35:00] healing of that can be very different, than when you're dealing with an affair partner or a situation like that versus somebody who is into just anonymous hookups or somebody who's into pornography. That's where having a seasoned clinician that has the breadth of experience and that this is their specialty area can be very helpful because then that person can really tailor the treatment to that client. 

Tara: Hmm. Thank you. 

Prevalence and Future Trends

Tara: So you had talked a little bit about what current estimated prevalence rates are. And you said 10 percent for men could be classified or diagnosed. Go ahead. 

Stefanie: That was one study in the US. They did 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 hundreds of thousands of [00:36:00] people, and they looked globally at how many people had compulsive sexual behavior disorder. They use the term compulsive sexual behavior disorder and porn addiction, essentially. And for compulsive sexual behavior disorder it was 5 percent of the global population, which again is astounding that we don't have a diagnosis for that and that we are in this field. 

And for pornography addiction, it was two and a half percent, which sounds low, perhaps. But again, we're talking about averaging across the globe and different countries and whatnot. But two and a half percent translates to 250 million people, and so it's a lot of people and of course different countries have different rates and things like that.

But this is undoubtedly a global phenomenon. And people are struggling. It is all over and [00:37:00] talk about disparity of care. When we get into international countries, access to care in some areas is just completely unavailable.

Tara: I'm curious. As a clinician, what do you see happening? We have our youth growing up with phones in their hands and a lot of them are not being taught about how to handle pornography that's coming up on their phones, et cetera. We live 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: Unfortunately our sex education is the cell phone for our children right now. That's kind of the status of things. They've tried to do studies where they looked at kids who hadn't been exposed and they can't find any.

So 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. [00:38:00] It is the big shift in our culture. And you know, anytime you have widespread availability of something that is addictive or greater availability to have higher rates of addiction.

Soin areas where you have meth labs, you have more meth addiction. In areas where there's casinos, you have more problems gambling. Well, now everybody has a phone at five years old. And so naturally we have seen an increase in rates. I've seen, just watching studies over the years, the rates have just been generally increasing. You can see that across different populations. So certainly we're having a greater increase in people that are struggling. 

If you parallel it to substance use disorder, there are some relevant parallels there. You have people who recreationally drink alcohol and don't[00:39:00] 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 sexual addictions. There are a lot of people that are struggling with it. I think there are consequences of having that as our main form of sex education. I told my kids, learning about sex from watching porn is like learning how to drive by watching the Fast and the Furious.

It's not very realistic. There are elements of that that don't translate to a real life partner situation. They need basic education and also education [00:40:00] around pornography and how obviously it's geared towards male tastes and  there can be a lot of violence towards women. There can be a lot of racism and they need to be able to discern that. 

And as a parent, teach them what your values are and give them education. There's 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: Yeah. Thank you. 

Primary Causes and Research Insights

Tara: So what are you seeing as some of the primary causes of sex addiction? Do you have a type of person that comes into your office frequently? 

Stefanie: Let me talk about a few different areas. There was a recent study that was a meta analysis that evaluated 21 different studies that associated sexual trauma with sex addiction. We also have more emotional [00:41:00] 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 contributing factor. 

Then when you have trauma, often in those environments people have insecure attachment as well because they are growing up in homes where 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 have an insecure attachment style.

When you are dealing, like we were talking about earlier, if you have a young person who has a lot of pain, in confusion because they've been experiencing trauma and they don't have anybody that they can go to and rely on - they don't know how to cope with their [00:42:00] feelings. And that's when they 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 this component. I don't know if you're aware, Tara, but my dad is a Fulbright scholar with the University of Alberta in Canada, and they're doing the first large scale genetic study on sex addicts. 

And so we've been collecting saliva samples of our patients and of patients from other facilities. Actually, some of that original research is going to be coming out this year. And what they have found, just a little sneak peek, and I don't have access to any links yet, but my understanding from the research team [00:43:00] is that they have found parallels. A lot of what Ken Bloom researched is, 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 there is a genetic predisposition.

As we know 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 come to the table with this genetic vulnerability, and you throw a little trauma, and you throw a little attachment problems on it and there you go, right? Add some toxic stress in there and so you have that. 

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 and how they have [00:44:00] 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 that there has been some preliminary evidence that there's something there.

And then there have been all the neuroscience studies that I mentioned and a huge amount of new neuroscience studies showing these brain changes that occur. And so I think there's a lot of factors to consider, but I would say those areas are the most common ideological factors that would contribute to the development of the addiction.

Tara: 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: Yeah. It's been years in the making, so it's been kind of a long awaited study. And yeah, we're really excited about some of the papers coming out.

Tara: Well, thank you again. 

Resources and Final Thoughts

Tara: Before I let you go, a couple of [00:45:00] things. If people want to connect with you, what's the best way to find you? 

Stefanie: So usually through ITAP, I'm the president of ITAP, the International Institute for Trauma and Addiction Professionals. My email is stefanie@itap. com. 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, 3000 CSAT therapists in 35 different countries, so they can typically find somebody that can work with them either virtually or locally. 

And so they can go to itap.com or sexhelp.com and get some help. Also they can find me at The Meadows. 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, [00:46:00] but we have obviously a lot of focus on sex and love addiction for women.

And we also do have a trauma track where we work with sexual trauma and rape trauma survivors. And then we also have a Gentle Path for men at the Meadows. 

Tara: 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:  I try to engender that hope. So I always tell my addicts things like, “You know, recovering addicts can make great partners,” and “You guys are learning the tools now to be a great partner. You're getting in your integrity, if you really work a program, you can [00:47:00] become the person that you want to be.”

And so sometimes, even though it's painful, it can actually be 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, are you talking about people that have been in recovery for a while? 

Tara: Or that have been working their recovery for a while and just need a little bit of a boost.

Stefanie: I would say that service can be a great option for you. If they can turn around and help some of the newcomers, it can also help them grow and grow more confident in their own recovery. So that can be a great way to give service and to also grow themselves. 

Tara: [00:48:00] Wonderful. Well, thank you again, Dr. Carnes. So appreciate you and the expertise and wisdom that was shared here today.

Stefanie: Thanks for having me. [00:49:00]