Hours, Contact Information, Etc.

I am generally available most weekdays from 9 to 5.  If you need another time or day, just contact me and we will figure something out.

I try to never answer the phone when I am doing something important such as driving, talking with a client, or eating dinner.  If you get my voicemail, leave a message and I will do my best to get back to you as soon as i can.

Texting or email in o.k. for setting or changing appointments; but, i will not be discussing clinical issues via text or email.

All that said, it is easiest to reach me by calling:  (501) 478-0182

My email address is: christopherhgerhart@gmail.com

 

The 4 L’s

There is a brief diagnostic tool that I use with many clients that are questioning if they have a problem with their use of substances.  The short answer for me has almost always been if it causes a problem when you do it, or when you don’t, then it’s a problem.  This model goes a bit deeper and can also help to shape a treatment plan and even establish some concrete goals to address early on, and later, in the therapeutic process.

Anyway, it is “The Four L’s” Liver, Lover, Livelihood and Legal.  These are four main areas that are usually affected by an individual’s use of a substance, combination of substances, behavior(s), etc.   When there are impacts in these areas related to a specific behavior, then that behavior is often the problem*.  That is not to say that there are not difficulties in these areas due to other factors such as the human condition, the economy, weather, acts of God…..

Liver, or any physical complication, is sometimes one of the easiest to diagnose.  When a man in his early 30’s who drinks heavily and frequently is diagnosed with cirrhosis, this is an obvious one.  There are more, and less, subtle symptoms to consider.  An assault, on either side of it, is frequently painful and damaging.  From personal excessive drinking experience, in the last several circumstances where I was part of an a## whipping, I provided at least 80% of the a## that got whipped.   This may also show up in more extreme cases as malnutrition, obesity and other health issues.  An intoxicated person is far more likely to be involved in a car crash, an assault, a domestic battery or any other form of violence than someone who is sober.  Think about the crazy, stupid things that people will eat just before going to sleep it off and it is no wonder that there are significant health problems.

This brings us to lover, or any interpersonal relationship, that has been negatively impacted by substance use.  Like the medical area, this may be overt such as divorce, loss of child custody, or lack of positive, pro-social connections.  Or, it may be more covert and even aggravating.  The client may not drink unless his wife nags him about his drinking, so he provokes her to nag him so that he can drink.  When a client tells me “Everybody drinks (smokes, gets high, etc.)” that tells me that his worldview is limited to those people that do what he does, effectively normalizing his level, frequency and intensity of drug or alcohol use.  If the only place where a person has fun with other people is at a bar, then not drinking is going to be a really hard sell.

Livelihood, or employment, the means of making a living are so important in our culture that in many cases it is one of the last bastions to fall to addiction.  There is so much ego and identity tied up in one’s profession that it is often held on to as a means of denial.  Just try asking someone in line at the grocery store, church, or gym “What do you do?”  Chances are that they will respond with their profession.  Most of us spend more than 25% of our week actually doing our jobs and countless hours commuting, preparing and recuperating.  Having a career is also a way of providing funding for substance abuse, while a mechanism for denial of the problems caused, or aggravated by, the use of a substance.  Losing a job is fairly easy to quantify; however, being passed over for a promotion, not being able to work in certain professions and poor performance are sometimes overlooked.  I had a client that could not pass a simple urine drug screen that would have given him a promotion along with a 75% increase in his salary, because he was unable, or unwilling, to stop smoking cannabis.  Drug problem?  You better believe it.

Legal problems are one of the areas where substance abuse problems become abundantly apparent.  Judges, as do police, probation and parole officers, have a way of bringing to someone’s attention the error of their ways.    A single, lifetime, DWI arrest could be a mistake; several probably are not.  Drug possession is almost always illegal, as is distributing medications without a prescription.  These are criminal charges; but, also consider the civil matters that are at stake with a substance use disorder.  Would the client be going through a divorce, child custody issue, dispute with a neighbor if they were not intoxicated?  This is not to imply that these circumstances are not always the result of drinking or drug use; however, if drinking or drug use is the cause, or impairs the amicable resolution of these issues, then the using is at least part, if not the only part, of the problem.

Finally, these issues intertwine and overlap, overshadowing one another.  For instance, if a person gets a DWI arrest, there is an obvious legal issue.  There will be a significant financial issue for fines, fees and lawyering.  Even a first DWI can run into the thousands of dollars.  Their job may be in peril, especially if they missed days from work due to jail or court.   Their status as an employee that represents their company may be compromised.  Some professions, such as truck drivers, physicians and pilots, have specific penalties for substance-related infractions.   The impact a night in jail has for someone’s status as a parent is incalculable.  As mature, responsible adults, we are rightfully expected to be someone who can be trusted, respected and accountable.   Not showing up for supper, a child’s ball game or other social commitment because of an arrest is inexcusable and injurious to a relationship.  Finally, jail is a bad place to be physically.  The client may find himself sleeping on the floor, either there or at home, neither of which is all that attractive or pleasant.

 

*Note:  I seldom like to use the work “problem.”  I prefer to use the terms situation, challenge or circumstance because I can turn one of them into a problem just by sprinkling a little dope or liquor on top of it.  Similarly, by staying sober, they can become accomplishments, trials and points of growth.

Fees, finances and why I do not accept insurance

Just before I started working for myself, actually for you, the customer, I became significantly disillusioned by the sheer volume of paperwork that was required by both insurance companies and government funding agencies just to sit down with a client and say:  “I am glad you are here.  So, what would you like to talk about today?”

If you have not noticed, government agencies and insurance companies have some very peculiar and particular ideas about what and how much information needs to be collected, collated, copied and filed before services can begin.  I really believe that if someone is interested and willing enough to walk through my door, then they already have a pretty good idea about what they would like to talk about.

Over the course of our professional interaction, we may get around to some pretty personal details over the course of our conversations and counseling sessions, or we may not,  it depends more on you than on a government or an insurance form.

One thing that I learned in my previous career as a chef was that the customer is always right and the reason for that is that they are the ones paying the bill.  If I made them a lousy meal or they had a terrible experience at my establishment, then they did not come back, and they told their friends about it. I am bringing the same approach to my counseling practice because I believe that it works.

Some time ago, I was working for a state-funded treatment agency, serving predominantly a criminal justice population sentenced there for substance abuse treatment as part of their probation or parole.  There was a pilot program where the participants paid a nominal fee for each group and individual counseling session that they attended.  Initially, I though that it would not work as they did not have much money and had many other financial obligations.  I was wrong, dead wrong.  The clients that paid something for their treatment had far more favorable outcomes than those that did not.  They missed fewer sessions, were late less often, had fewer positive drug tests and lower rates of relapse and re-offense.   By paying for their treatment, they placed value on it, making it important to them made it work better for them.  Why they stopped the pilot, I do not know; looking back on it, without keeping up relapse rates, treatment businesses might have been afraid of working themselves out of business.

Another reason that I do not accept insurance is that it takes an awful lot of work to file  a claim, ensure payment and negotiate with declined requests for payment.  As a sole provider, I do not want my clinical judgement clouded by a fight that I had with an insurance company over a client’s bill.

The other thing about employer sponsored insurance that I detest is the lack of privacy and confidentiality inherent in the billing system.  In many cases, human resources, owners, managers, their secretaries and supervisors know who is using what type of insurance.  If the insurance company, or any other payer wants to see clinical records, very often they are allowed to, otherwise they do not pay.

Short of you threatening to harm me, yourself or another human being, I am generally not required to report to anyone, anything you may say to me.

Anyway, if you have read this far, you must be interested in what I though would be fair, honest pricing, for fair, honest work.  So, here goes:

  1.  DOT/SAP Assessments $425.  This includes an initial assessment, co-ordination of a referral to treatment or education program, re-assessment and providing a follow-up testing program for employers.
  2. Non-DOT Assessments $150.  This includes an initial assessment and a written summary.  I think that it would be well worth while to find out from an independent source just what appears to be wrong and what may be an appropriate and diligent course of action.  I will be writing a whole post about this later.
  3. Individual Counseling  $50/hr.  Whatever you want to talk about regarding a substance use issue.  I have also talked with couples, partners and family members about strategies, plans and expected outcomes.
  4. Court testimony  $250/day, plus expenses.  I have qualified as an expert witness in a number of courts.  A lot of child custody proceedings have an element of “he said/she said” regarding substance use.  Having an expert opinion can be invaluable.
  5. No shows $25.  My time is worth money to me and my family.  I will gladly reschedule almost any appointment, without a fee, if you call ahead of time.
  6. Substance Education Group $30/hr.  I do not presently have a group schedule; however, if you are interested in this, we can develop one to fit you, at these rates, just know that other persons, with similar conditions may be present.

Anyhow, I am seeking to make a living out helping others to make changes in their lives in regard to their use of substances.  I really believe that treatment that has no cost has no value and treatment that has no value is of no use and may even prolong problems.

 

First Customers

I had my first paying customers last week.  Because of HIPPA, licensing boards and my own personal ethics, I am not going to say anything about them; however, I am extremely happy that I now have an actual business, rather than just an expensive hobby.

A friend just gave me a wonderful desk.  I had to replace a leg; but, it worked out very well.  I am working on a bookshelf/stand for my printer/copier/scanner.  Then I will have somewhere else to put my coffee pot, etc.   I will take and post pictures shortly.

Anyway, I hope everyone is having a safe, happy and healthy new year.

Chris

Day One

 

This is my new office.  I was there today with my wife and daughter, hanging up pictures and moving around furniture.   Gerhart LADAC SAP DOT

I got these really great Thomasville wing-back chairs and a coffee table on Craigslist.  The artwork comes from the lady next door.   She was planning on throwing away the wonderful painting that she had done of a waterfall.  gerhart SAP DOT Little Rock Substance abuse counselor office north little rock