Chapter 2

Trends in Facility Characteristics

This chapter presents trends in facility characteristics for 1998 to 2004. It should be kept in mind, however, that the facility universe, methods, and survey instrument have changed during this period. These changes are detailed in Appendix C.

Number of Facilities

Table 2.1. The number of reporting facilities remained relatively stable between 1998 and 2004—13,455 facilities reported in 1998 and 13,454 facilities reported in 2004. Although the total number of facilities remained relatively constant, there was considerable turnover from year to year in the reporting facilities. Between 1998 and 2004, the majority of the facilities responding to a given survey had also responded to the previous survey—between 71 percent and 90 percent. However, between 10 percent and 29 percent of responding facilities were new in the survey year, and from 12 percent to 20 percent of the facilities responding to a given survey had closed or were no longer providing substance abuse treatment by the following survey year.

Between 2003 and 2004, the number of facilities declined by 169 (1 percent), from 13,623 in 2003 to 13,454 in 2004. Of these facilities, 11,954 (89 percent of the 2004 facilities) were in both the 2003 and 2004 surveys; 1,500 new facilities were added between the 2003 and 2004 surveys; and 1,669 of the 2003 facilities (12 percent) had closed or were no longer providing substance abuse treatment in 2004.

Facility Operation

Table 2.2 and Figure 1. Facilities are described in terms of operation, that is, the type of entity responsible for the operation of the facility: private non-profit; private for-profit; or government—local, county, or community; State; Federal; or tribal. Despite year-to-year fluctuations in the number of facilities reporting, the operational structure of the treatment system (as reflected in the N-SSATS facility operation data) changed very little from 1998 to 2004.

Facilities operated by private non-profit organizations made up the bulk of the system (60 percent of all facilities) on March 31, 2004, compared to 56 percent in 1998. Private for-profit facilities decreased from 28 percent of all facilities in 1998 to 26 percent in 2004. Facilities operated by local governments accounted for 8 percent of all facilities in 1998 and 7 percent in 2004. The proportions of facilities operated by State, Federal, and tribal governments changed little between 1998 and 2004, and were 3 percent, 2 percent, and 1 percent, respectively, on March 31, 2004.

Figure 1
Facility Operation: 1998-2004

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set (UFDS), 1998-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2004. No survey was conducted in 2001.

Type of Care Offered

Table 2.3 and Figure 2. The proportion of facilities offering the major types of care—outpatient, non-hospital residential, and hospital inpatient—changed very little between 1998 and 2004. On March 31, 2004, 81 percent of all facilities offered outpatient treatment, 27 percent offered non-hospital residential treatment, and 8 percent offered hospital inpatient treatment. (Percents sum to more than 100 percent because a facility could offer more than one type of care.) In 1998, 81 percent of all facilities offered outpatient treatment, 26 percent offered non-hospital residential treatment, and 8 percent offered hospital inpatient treatment.

Facilities with Opioid Treatment Programs

Table 2.3 and Figure 2. In 2004, a total of 1,070 facilities (8 percent of all facilities) reported that they operated an Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration. OTPs provide medication-assisted therapy with methadone and buprenorphine, the only two opioid medications approved for the treatment of opioid addiction.

Figure 2
Type of Care Offered: 1998-2004

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set
(UFDS), 1998-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2004. No survey was
conducted in 2001.

Managed Care

Table 2.4 and Figure 3. In general, the term "managed care" refers to the prepaid health care sector where care is provided under a fixed budget within which costs are "managed." Forty-nine percent of facilities had agreements or contracts with managed care organizations in 2004, compared to 44 percent in 1998. The percentage of facilities with managed care agreements or contracts increased between 1998 and 1999 for all facility operation categories. Between 1999 and 2004, however, the proportion of facilities with managed care agreements or contracts generally declined slightly. Private non-profit and private for-profit facilities had the highest proportion of facilities with managed care agreements or contracts on March 31, 2004, at 52 percent and 51 percent, respectively. Among local and State government-operated facilities, 39 percent and 35 percent, respectively, had managed care agreements or contracts. Facilities operated by Federal or tribal governments were least likely to have agreements or contracts with managed care organizations, at 15 percent and 23 percent, respectively.
 

Figure 3
 Facilities with Managed Care Contracts, by Facility Operation: 1998-2004

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set
(UFDS), 1998-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2004. No survey was
conducted in 2001.

Programs or Groups for Specific Client Types

Table 2.5 and Figure 4. Facilities may offer treatment programs or groups designed to address the specific needs of certain client types. These client types include adolescents, clients with co-occurring mental and substance abuse disorders, criminal justice clients (other than DUI/DWI), persons with HIV or AIDS, gays or lesbians, seniors or older adults, adult women, pregnant or postpartum women, adult men, and DUI/DWI offenders. Data on programs or groups for adolescents, clients with co-occurring mental and substance abuse disorders, persons with HIV or AIDS, adult women, and pregnant or postpartum women have been collected since 1998. Questions on the provision of programs or groups for criminal justice clients and DUI/DWI offenders were added in 1999. Questions on the provision of programs or groups for gays or lesbians, seniors or older adults, and adult men were added in 2000.

In response to concerns about over-reporting of special programs or groups, the question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that had specially designed programs or groups for that client type. As a consequence, the number and proportion of facilities offering programs or groups for each of the specified client types decreased after 2002. The numbers from the 2003 and 2004 surveys are believed to be a more accurate representation of the number of facilities providing special programs for the specific client types.

Special programs or groups for clients with co-occurring mental health and substance abuse disorders were reported by 35 percent of facilities. Slightly less than one-third of facilities offered special programs or groups for DUI/DWI offenders (31 percent), for adolescents (31 percent), and for adult women (30 percent). Twenty-seven percent of facilities offered special programs or groups for criminal justice clients. Facilities less frequently offered programs or groups for adult men (23 percent), pregnant or postpartum women (14 percent), persons with HIV or AIDS (11 percent), seniors or older adults (7 percent), and gays or lesbians (5 percent).
 

Figure 4
Facilities with Programs or Groups for Specific Client Types: 1998-2004

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data Set
(UFDS), 1998-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000, 2002-2004. No survey was
conducted in 2001.

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