An interview with
Patrick Carnes, PhD, CAS
Conducted by Patrick B. McGinnis, PhD
Patrick Carnes is the Clinical
Director for Sexual Disorders Services at The Meadows. Dr. Carnes is a
world-renowned speaker on addiction and recovery issues, mostly notable in the
area of sex addiction. Much of the current work being done around sex addiction
is based on the research and studies of Dr. Carnes. He is also co-editor of
"Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention",
the official publication of the National Council of Sexual Addiction and
Compulsivity. He is the author of several best-selling books, including Out
of the Shadows, A Gentle Path Through the Twelve Steps and In the
Shadows of the Net.
I interviewed Dr. Carnes for Recover and asked:
Q: How many books on addiction and recovery have you written now?
A: Ten; we’re right on the cusp
because Clinical Management is coming off the press this week.
Q: Your book, A Gentle Path Through the Twelve Steps has helped many
addicts in recovery from a multitude of addictions. I noticed that it has been
revised. Why and what was changed?
A: There is quite a story behind it. I knew that there needed to be a more
structured way of doing the twelve steps and there is kind of a spirit of going
about it. When I wrote that book I couldn’t get it published. The publisher said
it would never sell; but I pressed him on it, and the only way that he agreed to
sell it at all was as part of a tape set. And then about six months after the
release he called me and said, “You know people are buying the book without the
tapes.” And then, of course, the rest is history and it just grew. We did the
revision simply because people would write or discuss it with me, and I could
see where the book needed to be more. And the truth is, now in many ways, the
task-centered approach to therapy and recovery which Facing the Shadow,
and The Recovery Zone, and all these things I’m working on now, are the
next generation Gentle Path.
Q: You use the task-centered approach for treating sexual addiction. What do
you see as the most difficult and most common types?
A: In terms of types of sex addicts, 10 types were identified. (See
Sidebar) We started off in 1985 researching 1000 families; we had 144
different behaviors we asked about. We did a factor analysis and they literally
clustered into 10 specific types. Those types have really been helpful to many
addicts in understanding that while they were doing what seemingly are different
kinds of behavior that there is an underlying commonality that made those
behaviors occur in the same person.
Q: When I read about the ten types being correlated with the stages of
courtship (See Sidebar) in The Shadows of the Net, I immediately
began incorporating that material into my treatment groups. (That was before I
discovered the Facing the Shadow workbook-which I now use) I am really
looking forward to The Recovery Zone being published.
A: Actually The Recovery Zone is one of the most exciting things I
have done in years.
Q: What does it feel like to touch and help so many people through your
A: I appreciate that people are grateful, but I am also kind of awed by it.
There is a part of me that responds that all of this stuff has helped me too. I
don’t feel thrilled about it; I see it as a journey that we have all been on.
There are times, for example, people will read something to me from Out of the
Shadows and I will wonder where did that come from. Sometimes I don’t think I
even wrote that book, because I just go into a state where it seems that these
things come. Sometimes I don’t think it’s me.
Q: Right. That happens to me a lot in doing therapy; I say things and wonder
to myself, where did that come from? And then I realize that I need to listen to
what I’m saying for my own growth.
A: Great. That works for me too.
Q: Do you believe it is possible to be in a good solid recovery from sexual
addiction or a constellation of addictions using just the twelve steps?
A: No. I think it works both ways, that you cannot do this without the twelve
steps. The twelve steps are the basis of it all. However, the level of
self-examination that is assisted through therapy is also indispensable; and
it’s never been an either/or for me; they both go together. The therapist should
be supporting the twelve step process and twelve step processes should be
supporting the therapy.
Q: What do you see as the number one addiction-related problem that is not
A: Multiple addictions. When the field realizes that it’s not simply that
there are addictions and they coexist, but, literally, there is this interaction
that occurs between them. That there are patterns in which addictions and
deprivations literally reinforce each other.
I guess that the other thing would be deprivations. In the sense that a lot of
people who have addictions don’t realize that they also have deprivations that
literally are part of the whole pattern. It is a combination of living in the
extremes, either over or under, and that the reason that we have failed, and why
we have so much recidivism has a lot to do with people not seeing the pattern in
addiction and deprivation and how they reinforce one another. The term we use
for that is Addiction Interaction Disorder.
Q: Those multiple addictions and deprivations don’t usually get addressed in
most rehab facilities.
A: I find that there are a number of key factors in relapse. The number one is
that not all the addictions are treated. The second is no one has shown people
how addictions relate to one another. The third is not addressing the core
issues, like trauma and family-of-origin issues. All of those are critical, but
also there has not been a structured way for people to go through this process;
which is where The Gentle Path stuff comes in.
For instance, we found in a hospital study that only 23% of our patients where
doing steps one through nine of the twelve steps in the first eighteen months
after treatment. Of those who did do steps one through nine there was very
little relapse. In other words recovery has a lot to do with how much you do. So
what we are talking about here, is that we focus on treatment as the fix for
addiction, when in fact, recovery is an ongoing process which has a series of
tasks which take time to do. The Gentle Path was a book that taught me about how
important it was to create a structure which people would be able to follow.
Q: What do you think about people using Rational Recovery, or other recovery
programs, instead of using the twelve steps?
A: I would never presume that I knew all of the ways that people could do
recovery; but I know empirically that the people who did the best appeared to be
in the twelve step program. As a scientist following people for years, it
appears that there has to be some spiritual transformation.
Q: Research has shown that in relationships where one partner is in recovery
that it is important that both people be involved in their own recovery work,
and couples recovery and/or counseling. You have recommended Recovering Couples
Anonymous (RCA) and Imago Relationship Therapy. Would you comment on this issue?
A: When we followed 1000 addicts the people who did the very best were in a
twelve step program for couples. The common denominator for those with the
highest quality of recovery was that they were in Alanon Twofers, SAnon family
group, or RCA. In part it is that research which inspired Open Hearts as a book
for couples. Also it lead to the "We Came To Believe" program, which is a
retreat program for recovering couples.
Q: I believe that the twelve step program is one of many spiritual paths toward
recovery and ultimately self-actualization. I believe that I have been hearing
you say that?
A: My belief is that we are learning that addiction, and what makes for
excellence in optimum performance taps into the same physiological, emotional
and intellectual processes. Too often, what people do in recovery is surviving
or white-knuckling, as opposed to looking at excellence and how they can be the
most they can be. When we do that we fail people by not asking more of them then
Q: So this gets in the way of self-actualization occurring?
A: One of the things that Maslow said, and others have written about, is what
sustains excellence is your coming from a basis of where it can matter so much.
Recovery has to matter. It has got to matter enough that you’re willing to go
through any lengths to make it happen.
Q: You would say that self-actualization is an attainable goal?
A: Not only obtainable, I’m saying that is what The Recovery Zone book is going
to be about. It’s not just about obtainable; it’s got to be what we really
strive for, otherwise, it’s just surviving.
Q: Some people seem to get stuck going to meetings almost compulsively even
years into recovery almost at the same rate that they did at the beginning of
their recovery. Can this be a problem?
A: I think that it’s important that people make meetings central to their
recovery. But the twelve steps and the meetings are a recipe; it’s like making a
cake. If you do certain things, you have a predictable result. That’s why we
talk about specific tasks in Facing the Shadow and The Recovery Zone. It’s a
recipe; follow the recipe and you’re going to have the result. That’s not to say
you can’t tinker with the recipe. Some great recipes have evolved from moving
things around a little more sugar, a little less flour. When we make the
recipe sacerdotal is when we get into trouble. By sacerdotal, I mean making it
sacred and making it so that it is immutable, we can’t change it. That’s when we
get into rigidity. When that rigidity comes in, then you’re losing the spirit
which recovery was trying to obtain.
Q: One of the things that I have written about in previous articles in “Recover”
concerned people being in too big a hurry to have their character defects
removed. I believe that we need to be asking for integration of those pieces of
ourselves and find the gifts those have for us and integrate that into our lives
rather than just asking that something be removed. In doing that, we are losing
a valuable part of ourselves when we could be gaining something greater. Can you
comment on that?
A: Yes. I believe that the core of the program is not the first step. The core
of the program is the sixth and seventh steps. There we are doing that work on
the shadow side of ourselves; it is exactly what this is all about. We need to
continue to work on this. It is the core part; it is the examined life. Which is
what therapy is stringent self-examination. In many ways we get people so
focused on the first step and getting sober; yet many of us have gotten sober
over and over again. It’s staying sober which is the critical part. Getting
sober is, by comparison, easy. The core issue is really involved in looking at
the deeper inner-issues. So the sixth and seventh steps are core requirements.
They are the parts that people gloss over; they go to their fourth and fifth
step to the eighth and ninth steps. They want to make amends and they want to do
the confessional experience, and they are skipping over that deeper work of
understanding what is it that keeps bringing them to this place of addictive
behaviors. This is a long-term project.
In the book, The Recovery Zone, it really is where we do an anatomy of
all the parts of our defects ... the shame, the multiple addictions. How does
all this thrive together? It is one of the ways to make that process easier.
Q: Out of that, and working the twelve steps as an ongoing process, is what
self-actualization or living in excellence would come from?
Q: What do you see as hope for the future of addiction treatment and recovery?
A: I think there are a number of things that are hopeful. I believe that the
response around the country to the canceling of the addiction parity act is
going to mobilize people. The average Congressional District has 644,000 people,
approximately 127,000 of those people are either addicts or loved ones. So
literally, a fourth of the voters are involved in this problem. If we can ever
get to the point where we stop hiding and start voting. The reason we lost the
addiction parity dollars is because we have not spoken up. If you looked at some
agencies and groups, like the National Rifle Association, who really has,
compared to their influence, a modest level of membership. And you look at the
number of recovering people in the system who are affected by addictions, or
people who are affected by these people, it’s tremendous. If they were to
mobilize, we’d change the healthcare system. Not just a little bit, we would
change the healthcare system dramatically because the number one source of
medical cost is addiction. The number one source of problems in school is
addiction. The number one source of abuse of children is addiction. The number
one social problem; most crimes are committed under the influence. The number
one problem in terms of violence comes out of addiction. Why would we not make
this a priority? When we, as recovering people, start articulating, then we’ll
see massive social change.
Q: What I’m hearing you say is almost like doing the twelfth step on a massive
A: It will change this country. It already has ... the twelve step programs have
literally created a different way that people take care of their health.
Self-help – we are now taking more and more responsibility for our healthcare.
We know, in other illnesses (like cancer, diabetes, leukemia) that patients
actually often know more than their physicians. Technically, they know more.
That started when Bill W. and Dr. Bob got together; people taking responsibility
for their health.
10 Types of Sex Addicts