Highlights
This report presents results from the 2003 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. Selected findings are given below.
The N-SSATS facility response rate in 2003 was 96 percent.
Thirty-seven States or jurisdictions had response rates that equalled or
surpassed the overall rate, and seven States or jurisdictions achieved
response rates of 100 percent [Tables 1.1 and 6.1].
A total of 13,623 facilities responded to
the survey and reported a one-day census of 1,092,546 clients enrolled in
substance abuse treatment on March 31, 2003 [Tables 2.1 and 3.1].
There were 92,251 clients under age 18 in treatment on March 31, 2003, making up 8 percent of the total population in treatment on that date [Table 3.5].
Trends in Facility and Client Characteristics
The number of reporting facilities increased by 25 percent between 1997 and 2003, from 10,860 in 1997 to 13,623 in 2003. The number of clients in treatment on the survey reference date increased by 18 percent over the same period, from 929,086 in 1997 to 1,092,546 in 2003 [Tables 2.1 and 3.1 and Figures 1 and 5]. These increases are most likely due to improved survey methodology rather than to actual increases in the numbers of facilities and clients. The principal improvements were an increase in the response rate from 86 percent in 1997 to 96 percent in 2003, and an extensive effort to improve the coverage of the facility universe.
Facilities operated by private non-profit organizations made up 61 percent of all facilities on March 31, 2003, compared to 60 percent in 1997. Private for-profit facilities increased from 24 percent of all facilities in 1997 to 28 percent in 1998, then fell to between 25 and 26 percent from 1999 to 2003. Fluctuations in the proportion of private-for-profit facilities are probably because of SAMHSA’s efforts to expand survey coverage to these facilities, followed by the decision to exclude solo practitioners that were not State agency-approved. There was little or no change in the proportions of government-operated facilities between 1997 and 2003 [Table 2.1 and Figure 1].
On March 31, 2003, 56 percent of all clients in treatment were in facilities operated by private non-profit organizations, compared with 55 percent of all clients in 1997. The proportion of clients in private for-profit facilities increased from 18 percent in 1997 to 26 percent on March 31, 2003. The proportions of clients in government-operated facilities fell or was unchanged between 1997 and 2003 [Table 3.1 and Figure 5].
Eighty-nine percent of all clients in treatment on March 31, 2003, were in outpatient treatment, 10 percent were in non-hospital residential treatment, and 1 percent were in hospital inpatient treatment. In 1997, 87 percent of all clients were in outpatient treatment, 11 percent were in non-hospital residential treatment, and 2 percent were in hospital inpatient treatment [Table 3.2 and Figure 6].
The number and proportion of clients receiving methadone/LAAM increased from 138,009 (15 percent of all clients) in 1997 to 229,567 clients (21 percent of all clients) in 2003 [Table 3.2 and Figure 6].
Over half (51 percent) of all facilities had managed care agreements or contracts in 2003, compared to 46 percent in 1997. Trends in the proportion of clients in facilities with agreements or contracts with managed care organizations were grossly similar to those for the proportion of facilities with such agreements or contracts. On March 31, 2003, 52 percent of all clients were in facilities with managed care agreements or contracts, compared to 47 percent of all clients in 1997 [Tables 2.3 and 3.4 and Figures 3 and 7].
The proportion of clients in treatment for both drug and alcohol abuse increased from 41 percent in 1997 to 47 percent in 2003. The proportion of clients treated for drug abuse only remained between 27 and 33 percent from 1997 to 2003. The proportion of clients treated for alcohol abuse only declined from 26 percent in 1997 to 20 percent in 2003 [Table 3.3].
Clients under Age 18
On March 31, 2003, there were 92,251 clients
under age 18 in treatment. These represented 8 percent of all clients. The
proportion of clients under age 18 was relatively stable between 1997 and 2003
[Table 3.5 and Figure 8].
The majority of clients under age 18 were in treatment facilities with special programs or groups for adolescents. On March 31, 2003, 78,330 clients under age 18 (85 percent of all clients under age 18) were in treatment facilities with special programs or groups for adolescents [Table 3.5].
Facility Operation
On March 31, 2003, there were 615,410 clients (56
percent of all clients in treatment) in facilities operated by private
non-profit organizations, which made up 61 percent of all facilities. Private
for-profit organizations reported 282,161 clients (26 percent of all clients),
and made up 25 percent of all facilities. Facilities operated by local
governments accounted for 101,826 clients (9 percent of all clients), and made
up 7 percent of all facilities. State government-operated facilities reported
45,649 (4 percent of all clients), and made up 4 percent of all facilities.
Facilities operated by the Federal government accounted for 37,155 clients (3
percent of all clients), and made up 3 percent of all facilities [Tables 4.1
and 5.1]. Primary Focus On March 31, 2003, 61 percent of facilities (with 68 percent of all
clients in treatment) reported that providing substance abuse treatment
services was their primary focus of activity. A mix of mental health and
substance abuse treatment services was the primary focus of 26 percent of
facilities, treating 23 percent of clients. Nine percent of facilities, with 5
percent of all clients, reported the provision of mental health services as
their primary focus. General health care was the primary focus of 2 percent of
facilities, treating 2 percent of clients [Tables 4.1 and 5.1]. Type of Care There were 968,719 clients (89 percent of all clients) in outpatient
treatment on March 31, 2003, which was offered by 80 percent of all
facilities. There were 108,592 clients (10 percent of all clients) in
non-hospital residential treatment on March 31, 2003, which was offered by 28
percent of all facilities. There were 15,235 clients (1 percent of all
clients) in hospital inpatient treatment on March 31, 2003, which was offered
by 7 percent of all facilities [Tables 4.2b and 5.2b]. Client Substance Abuse Problem On March 31, 2003, nearly half (47 percent) of all clients
were in treatment for both alcohol and drug abuse. One-third (33 percent) of
clients were in treatment for drug abuse only, and 20 percent were in
treatment for abuse of alcohol alone [Table 5.3]. Nationwide, there were 454 clients in treatment per 100,000 population age 18
and older on March 31, 2003. The rate was highest for persons with both alcohol
and drug problems (209 per 100,000), followed by drug abuse only (152 per
100,000), and alcohol abuse only (93 per 100,000) [Table 6.27]. Facilities with Opioid Treatment Programs (OTPs) Opioid Treatment Programs (OTPs) were available at
8 percent of all substance abuse treatment facilities on March 31, 2003 and
accounted for 21 percent of all clients in treatment [Tables 2.2 and 3.2]. Private for-profit facilities operated 42 percent
of all OTPs, although they operated only 25 percent of all substance abuse
treatment facilities [Tables 4.1 and 4.4]. Outpatient
detoxification was most likely to be offered by facilities operated by the
Federal government (40 percent), largely because half (50 percent) of
facilities operated by the Department of Veterans Affairs (VA) provided
outpatient detoxification. Outpatient detoxification was also relatively
widely available in private for-profit facilities (17 percent) [Table 4.2b]. Outpatient
methadone or LAAM maintenance was most likely to be offered by private
for-profit facilities (13 percent) and facilities operated by the Federal
government (12 percent) [Table 4.2b]. Facilities with OTPs were likely to be dedicated entirely or almost
entirely to treatment with methadone or LAAM. Overall, 85 percent of clients in
facilities with OTPs were receiving methadone or LAAM on March 31, 2003 [Table
4.4].
Facility Size
The median number of clients in substance abuse treatment at a facility on March 31, 2003, was 40. Government-operated facilities were generally larger than private for-profit or private non-profit facilities [Table 4.5].
Facility Capacity and Utilization Rates
On March 31, 2003, 94 percent of all
non-hospital residential beds and 80 percent of all hospital inpatient beds
designated for substance abuse treatment were in use [Tables 4.7 and 4.8].
Facilities with non-hospital residential beds had generally higher utilization rates than facilities with hospital inpatient beds. Fifty-six percent of facilities with non-hospital residential beds had utilization rates of 91 to 100 percent, while only 29 percent of facilities with hospital inpatient beds had utilization rates in that range. About 12 percent of hospital inpatient facilities and 8 percent of non-hospital residential facilities had utilization rates over 100 percent [Tables 4.7 and 4.8].
Programs or Groups for Specific Client Types
Most facilities (84 percent) offered specially designed programs or groups directed at specific client types. Special programs or groups for women and for clients with co-occurring mental health and substance abuse disorders were each reported by 35 percent of facilities. One-third of facilities offered special programs for DUI/DWI offenders (33 percent) and for adolescent clients (32 percent). Twenty-seven percent of facilities offered special programs or groups for men and for criminal justice clients. Less frequently offered were programs or groups for pregnant or postpartum women (14 percent), persons with HIV or AIDS (11 percent), seniors or older adults (7 percent), and gays or lesbians (6 percent) [Table 4.10b].
Services in Sign Language and in Languages Other than English
Substance abuse treatment services
in sign language for the hearing impaired were offered in 28 percent of all
facilities [Table 4.13].
Substance abuse treatment services
in a language other than English were provided in 44 percent of all
facilities. Spanish was the most commonly reported language, with treatment
services in Spanish offered by 40 percent of all facilities [Table 4.13].
Treatment services in American Indian/Alaska Native languages were offered in 2 percent of facilities overall. However, 50 percent of facilities operated by the Indian Health Service and 36 percent of facilities operated by tribal governments offered these services [Table 4.13].
Payment Options
A sliding fee scale for substance abuse treatment charges was used by 64 percent of all facilities. More than half (55 percent) of all facilities offered treatment at no charge to eligible clients who could not pay, and 4 percent provided treatment at no charge to all clients [Table 4.14b].
Facility Licensing, Certification, or Accreditation
Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. Most facilities (81 percent) named the State substance abuse agency, 34 percent listed the State mental health department, and 32 percent listed the State public health department/board of health [Table 4.15b].
Facility Funding
Two-thirds (66 percent) of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services [Table 4.16].
Client Outreach
One-quarter (25 percent) of all facilities reported that they operated a hotline responding to substance abuse problems [Table 4.17].
Most facilities (89 percent) reported that they had access to the Internet. Half of all facilities (50 percent) had web sites providing information about their substance abuse treatment programs [Table 4.17].