May, 2012

NICHE MARKETING

The popularity of particular drugs can vary over time, and from place to place. Yet American society’s overall addiction problem persists--so there’s 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 haven’t seen a lot of meth issues yet, but I know it’s a big problem...More so in Missouri (just over the border) than in Kansas."

One thing that helps Dressman draw referrals is his location: He’s in a building with a group of psychiatrists. He’s also devoted a lot of time to building working relationships with area medical and psychiatric hospitals--which refer patients to him after inpatient care.

"I’m 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 who’s on this person’s 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 hands."

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 clinicians avoid.)

He starts each case with an assessment, billed at $140. "I don’t develop a real rigid treatment plan. I sort of go with them on this journey. I want them to be able to talk about what’s 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 don’t have any time frame on it.

"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...I’m 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, that’s about $450. That includes an evaluation and extensive paperwork.

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.

Unlike Dressman, he’s 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. It’s a drug you’ll 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 it’s 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. You’re looking at his driver’s license and see that he’s 24--and then you look up at him and he looks 42. You can’t just say, ‘OK, I hope he can go to weekly counseling sessions and detox himself.’ Methamphetamines don’t work that way. The side effects are much like the severe side effects of opiate withdrawal."

A big chunk of Crotty’s substance abuse referrals have been court-ordered, with many other clients coming from direct insurance company referrals. Over the years, he’s also made presentations to community groups to get the word out about his services.

Crotty’s treatment begins with a drug test--which costs about $50. "Anyone who comes into my office, I want to know what’s in their system. If they come and tell me what drugs they’re on up front, that’s fine. But we’re still going to do the test. I always tell them, ‘I trust but I verify.’ That’s part of the treatment plan."

His standard fees are in the neighborhood of $130 for an initial evaluation; $90 for individual therapy. Another product he’s featured over the years: intervention housecalls. The charge for that has ranged from $350 to $3,000, depending on travel and other expenses.

Contacts: 1) Martin Dressman, Leawood, KS, www.martinjdressmanmsw.com; 2) Brandon Crotty, Orlando, FL.