Treating drug problems:
from alcohol to crystal meth
The popularity of particular drugs can vary over time, and from
place to place. Yet American societyís overall addiction problem
persists--so thereís always a demand for clinicians who can help
clients deal with it.
In our March, 2012, issue, we profiled a Connecticut clinician who
draws most of his practice income from substance abuse
clients--operating an intensive outpatient program (IOP) right in his
office. But Martin Dressman, in the Kansas City suburb of Leawood, KS,
has a more generalized practice.
Dressman estimates that perhaps 40% of his clients see him for
substance abuse problems. "The people I see these days use
alcohol, marijuana, or cocaine," he says, adding, "I havenít
seen a lot of meth issues yet, but I know itís a big problem...More
so in Missouri (just over the border) than in Kansas."
One thing that helps Dressman draw referrals is his location: Heís
in a building with a group of psychiatrists. Heís also
devoted a lot of time to building working relationships with area
medical and psychiatric hospitals--which refer patients to him after
"Iím getting a lot more attention from the hospitals and
insurers these days...The insurance companies contract with these
hospitals, so when they release patients, they want to know whoís on
this personís insurance plan."
Note: Most of the clinicians we know who are adept at
attracting physician referrals emphasize the importance of cultivating
nurses and office managers. Dressman, on the other hand, concentrates
on the physicians themselves--as well as hospital administrators.
"I visited folks, sent materials over, squeezed a lot of
His "standard fee" is $110 per session; less for managed
care--which covers 70% or more of his practice. (Interestingly,
Dressman makes a point to advertise his fees online, which most
He starts each case with an assessment, billed at $140. "I donít
develop a real rigid treatment plan. I sort of go with them on this
journey. I want them to be able to talk about whatís going on
and not impose a certain template...I have a very cognitive
behavioral, solution-focused approach. That includes homework, work in
sessions with different exercises, thinking about the costs of their
activities, and craving management. I donít have any time frame on
"Early on I see people much more frequently. Then, as things
progress and I see them begin to get connected to the recovery
community, I begin to stretch those sessions out...Iím a believer in
maintaining a clinical connection for about a year, and after that,
contact as needed."
Dressman occasionally does DOT work as well. In this program,
transportation workers who fail a drug test are referred for
assessment. That nets him $150 an hour. On a per case basis, he
explains, thatís about $450. That includes an evaluation and
Another addiction specialist is Brandon Crotty, an Orlando, FL,
clinician. When we spoke to him in connection with another PsyFin
article, he explained that 95% of his clients had a chemical
dependency--and the rest were addicted to gambling or to the Internet.
Dressman, heís done a lot of work with meth users--they
make up almost a third of his clients. According to Crotty, meth has
flowed out of the corners of the culture--the youth and club
scenes--and into the cultural mainstream.
"When meth was under the radar, you found it in raves, clubs,
and so forth. But now we have a lot of adults--stockbrokers who
are working 16-hour days, homemakers who go to work and then come home
and clean the house, and the soccer moms. Itís a drug youíll find
in a real estate office, or among cafeteria workers. It knows no
economic or demographic barrier these days." (On the other hand,
Dressman tells us itís particularly common among lower income
populations. See the box, right.)
Treating meth users can be intense, and many of them have to be
referred to detox before they come back to Crotty for outpatient
counseling. "A man comes into the office. Youíre looking at his
driverís license and see that heís 24--and then you look up at him
and he looks 42. You canít just say, ĎOK, I hope he can go to
weekly counseling sessions and detox himself.í Methamphetamines donít
work that way. The side effects are much like the severe side
effects of opiate withdrawal."
A big chunk of Crottyís substance abuse referrals have been
court-ordered, with many other clients coming from direct insurance
company referrals. Over the years, heís also made presentations to
community groups to get the word out about his services.
Crottyís treatment begins with a drug test--which costs about
$50. "Anyone who comes into my office, I want to know whatís in
their system. If they come and tell me what drugs theyíre on up
front, thatís fine. But weíre still going to do the test. I always
tell them, ĎI trust but I verify.í Thatís part of the treatment
His standard fees are in the neighborhood of $130 for an initial
evaluation; $90 for individual therapy. Another product heís
featured over the years: intervention housecalls. The charge for that
has ranged from $350 to $3,000, depending on travel and other
Contacts: 1) Martin Dressman, Leawood, KS,
www.martinjdressmanmsw.com; 2) Brandon Crotty, Orlando, FL.