Intervention and Addiction Case Management: An interview with Cindy Feinberg
Cindy Feinberg is a recovery coach and addiction case manager in New York City. She and her staff are committed to helping addicts and their families move toward recovery and a better life. She coordinates on an ongoing basis referrals to treatment specialists (treatment centers, therapists, interventionists, sober companions, MDs, and the like), at the same time managing all other aspects of care appropriate for a client and the client’s family. I have been so consistently impressed with both her intervention and recovery coaching ability that I wanted to share a bit about her world with you here.
RW: Cindy, how did you get into recovery coaching?
CF: I’ve been in recovery myself for 28 years. In 1990 I went to school to become an addiction counselor, which at that time was a CAC, a Certified Alcohol Counselor. I worked in the field for a short period of time, then left to pursue other interests, but I always knew that I would come back at some point. About four years ago I started sober coaching. I got certified as a life coach first, and then I was trained as an interventionist. With coaching, I wanted to fill the gap between treatment and therapy. What I was finding was that people would go to treatment, they would get told what to do when they left, and then they would have no way to implement that plan. Four weeks in treatment is great, but it’s not enough to change a person. They’ve got to continue implementing change when they get home, but very often they don’t know how to do that. My job as a sober coach was to give them the skills they needed by literally meeting them in their home, taking them to their therapist’s office, taking them to their first 12-step meeting, helping them to understand what a good 12-step sponsor sounds like and looks like, helping them get into school, helping them find a job, just plain helping them with all the life skills that they didn’t have because they’d spent most of their time drinking, drugging, or in a process addiction.
RW: How did you move from sober coaching into case management?
CF: Early on, most of my referrals were coming from addiction psychiatrists who weren’t able to leave their offices to make sure their patients were taking their medications, or to see what they really looked like at home. Pretty much anybody can look good once a week for an hour in a psychiatrist’s office, but what’s going on with them the rest of the week? So I started getting phone calls from these addiction psychiatrists and they’d say something like, “I have this young patient, very prominent family, I got a call from her mom and she’s threatening suicide. I need to call 911, but I hear you’re good in a crisis, so can you go to her apartment and see what’s going on? And maybe you can get a sober companion on her, and get her to start taking her meds, and maybe even get her into treatment.” So suddenly I was case managing as much as I was coaching. That’s how things started. Now I have 14 people working with me, so at any given time I can get a male or female sober companion on a case, have them move in with the addicted individual for whatever period of time is needed, and even transport them to a treatment center if necessary. Now we’re able to be there for the whole process with some clients, everything from intervention to treatment to coming home from treatment and getting into aftercare.
RW: You’re sort of a one-stop shop, with a lot of referrals along the way?
CF: For sure. I’ll give you one example. This was a sex addiction case. A woman called me for help, telling me that her brother was really struggling with sexual acting out. She said that what she really wanted was to help her sister-in-law, who was in the dark about his behavior and all the potential consequences. So we had the necessary conversation with her sister-in-law the next day. There were several family members and myself at that meeting, and we revealed to her certain secrets that everyone else had known about for 20 years.
To backtrack for a second, my first question when somebody calls me with something they’ve known about for a long time is, “Why now? Why is this coming to a head right now?” Usually it’s that the addicted individual is in some sort of trouble or danger. In this case, the sex addict’s co-occurring alcoholism had really progressed, and he was also engaging in some risky sexual behaviors.
So we got the sister-in-law on-board, and then we did an intervention with the identified loved one the very next day, this time with the whole family present. We had already picked out a sex addiction treatment center for him, The Ranch in Tennessee, because it also handles substance abuse and co-occurring disorders. I brought an interventionist with me to help with the process, and I also hired a sober companion to take the addicted individual to Tennessee on flights we’d already set up. After some resistance, he agreed to go. He was actually booked into the treatment facility that very night.
While the addicted individual was away in treatment, my team helped the wife find a local therapist familiar with spousal betrayal and sex addiction so she could get support for the emotional trauma she was experiencing. Meanwhile, the whole time the addicted individual was being treated at The Ranch I was in constant contact with the team there about his progress and the aftercare he might need when he got out. In this way, when he returned to New York we were prepared with a referral to an appropriate sex addiction therapist. Plus we’d picked out some 12-step meetings for him. This story is typical of what our process looks like, both with substance and behavioral addictions. It is also not unusual for me to coach one or more family members for a certain amount of time following primary treatment to ensure they don’t return to enabling and have all the resources they may need, although that wasn’t the case in this particular instance.
RW: I love hearing this. So many people watch TV shows like Intervention and they end up thinking that the whole thing is more like a single event, rather than the beginning of long healing process. And sadly, they also often come away thinking that the only person in need of treatment is the addict.
CF: That’s exactly right. In fact, even if the identified loved one doesn’t show up for an invention we meet anyway, and that’s when I start the process of getting help for the rest of the family. If the family doesn’t start to change, nothing is going to change with the addicted individual, either. Then we try again later with the identified loved one and another intervention.
RW: It sounds like you do most of your work with the involvement of an entire team. Is that actually the case?
CF: Yes. What my company is best at is assembling the team. I never do anything by myself, unless maybe it’s coaching someone for an hour or two a week, and even then that’s usually in conjunction with a team that the client already has in place. I’ll give you another example. I just got an email from an outpatient program where a young woman I’ve been working with has relapsed. The email includes me, her psychiatrist, her therapists, her dad’s therapist, and the owner of the treatment center, and we’re all talking about what the next steps should be. So it’s never just my decision. Nor should it be, because there’s a lot that’s going into this. She’s in college and she’s doing well, for one thing. She’s on a certain medication, for another, and if we suggest a sober living are they going to take her while she’s on it? There are just a lot of questions in play here. She was with me a few days ago, and I’ve encouraged her to tell her parents. I’m not going to rat her out to them, but I did coach her around the conversation that she needs to have with them, and I’ll go with her if she needs me to do that. That’s my role as her coach. I will support her in whatever she needs to do for her sobriety and her life, but she needs to take the responsible actions herself.
RW: Do you see much of a difference when working with behavioral addicts versus substance abusers? Also, do you see a lot of cross- and co-occurring addictions?
CF: The answer to the latter of those questions is yes, absolutely. That’s an easy one. There’s almost always another addiction going on in addition to the primary issue, no matter what the primary addiction happens to be. This is especially true with sex addicts. I don’t think I’ve ever had a sex addict who didn’t also have a substance abuse problem.
As for your first question, there is definitely a difference between substance and process addicts, with process addictions typically being more difficult. When I have clients who are substance abusers, there’s abstinence to shoot for, which makes it easier. They need to be abstinent, even if a lot of them would rather I work with them in terms of harm reduction. But with an eating disorder, or spending, or sex, that’s not the case. Sobriety with those disorders is not about total abstinence, it’s about harm reduction, and there just seems to be a lot more wiggle room for circumventing recovery, a lot more potential for relapse. Usually with process addictions there has to be more willingness on the part of the client to want to change and get better, and that just makes the process a little more challenging. The most difficult clients I’ve ever had to work with are eating disorders. They are the hardest to get to, and their families are just as dysfunctional as they are, or even more dysfunctional sometimes. I wish I could tell you why this is, but I can’t. I just don’t know. But I can definitely tell you they’re the most difficult.
RW: It seems to me that the fields of intervention work, sober coaching, and addiction case management are constantly changing. Do you find that to be true?
CF: Let’s just say that I’m always looking to learn. In the last few years I’ve been trained in motivational interviewing, CRAFT (Community Reinforcement and Family Therapy), and CBC (Cognitive Behavioral Coaching), and I am getting trained in Positive Psychology starting next month.
RW: What’s the most important message you’d like to convey about what you do?
CF: Recovery from addiction is, in some respects, as much about the family as the addicted individual. If the family isn’t on fully board in terms of setting boundaries and following through with them, there’s very little that I can do that sticks. The minute that I get a family that doesn’t buy into setting clear boundaries as a way to help their child or spouse or parent or whoever the addicted individual happens to be, I know that there’s not much I can do. Without the full support of everyone who is close to the identified loved one, there’s no leverage for me to work with. Sadly, half my client base is young men and women in their twenties, living on mom and dad’s credit cards in apartments that their parents pay for, and it’s just a great big failure to launch. These parents need to learn to set boundaries, and then to give their kids a lot of positive reinforcement whenever they do something well. I work with some really good professionals in New York who use the CRAFT methodology in these cases to help the parents, and when they get it, it really works. But when they don’t, things usually don’t get better.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is the author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships, along with numerous peer-reviewed articles and chapters.
Weiss LCSW, R. (2014). Intervention and Addiction Case Management: An interview with Cindy Feinberg. Psych Central. Retrieved on September 2, 2015, from http://blogs.psychcentral.com/sex/2014/01/intervention-and-addiction-case-management-an-interview-with-cindy-feinberg/