Highlights

• The N-SSATS facility response rate in 2004 was 96 percent. Thirty-one States or jurisdictions had response rates that equaled or surpassed the overall rate, and six States or jurisdictions achieved response rates of 100 percent [Tables 1.1 and 6.1].



• A total of 14,167 facilities completed the survey [Table 1.1]. The 13,454 facilities included in this report reported a one-day census of 1,072,251 clients enrolled in substance abuse treatment on March 31, 2004 [Tables 2.2 and 3.1].



• There were 91,112 clients under age 18 in treatment on March 31, 2004, making up 8 percent of the total population in treatment on that date [Table 3.5].

• The number of reporting facilities remained relatively stable between 1998 and 2004. There were 13,455 reporting facilities in 1998 and 13,454 facilities in 2004. The number of clients in treatment on the survey reference date increased by 3 percent over the same period, from 1,038,378 in 1998 to 1,072,251 in 2004 [Tables 2.2 and 3.1 and Figures 1 and 5].



• Facilities operated by private non-profit organizations made up 60 percent of all facilities on March 31, 2004, compared to 56 percent in 1998. The proportion of private for-profit facilities decreased from 28 percent of all facilities in 1998 to 26 percent on March 31, 2004. There was little or no change in the proportions of government-operated facilities between 1998 and 2004 [Table 2.2 and Figure 1].



• The proportion of clients in facilities operated by private non-profit organizations changed little between 1998 and 2004, increasing from 54 percent of all clients in 1998 to 55 percent of all clients on March 31, 2004. The proportion of clients in private for-profit facilities increased from 24 percent in 1998 to 28 percent on March 31, 2004. The proportions of clients in government-operated facilities generally fell between 1998 and 2004 [Table 3.1 and Figure 5].



• Eighty-nine percent of all clients in treatment on March 31, 2004, were in outpatient treatment, 9 percent were in non-hospital residential treatment, and 1 percent were in hospital inpatient treatment. In 1998, 88 percent of all clients were in outpatient treatment, 10 percent were in non-hospital residential treatment, and 1 percent were in hospital inpatient treatment [Table 3.2 and Figure 6].¹



• The number and proportion of clients receiving methadone increased from 145,610 (14 percent of all clients) in 1998 to 240,961 clients (22 percent of all clients) in 2004 [Table 3.2 and Figure 6].



• Almost half (49 percent) of all facilities had managed care agreements or contracts in 2004, compared to 44 percent in 1998. On March 31, 2004, 50 percent of all clients were in facilities with managed care agreements or contracts, compared to 46 percent of all clients in 1998 [Tables 2.4 and 3.4 and Figures 3 and 7].



• The proportion of clients in treatment for both drug and alcohol abuse decreased from 49 percent in 1998 to 46 percent in 2004. The proportion of clients treated for drug abuse only increased from 27 percent in 1998 to 34 percent in 2004. The proportion of clients treated for alcohol abuse only declined from 24 percent in 1998 to 20 percent in 2004 [Table 3.3].

• On March 31, 2004, there were 91,112 clients under age 18 in treatment. Clients under age 18 made up 10 percent of all clients in 1998, but the proportion fell to 8 percent in 2000 and remained stable through 2004 [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, 2004, 75,878 clients under age 18 (83 percent of all clients under age 18) were in treatment facilities with special programs or groups for adolescents [Table 3.5].

• On March 31, 2004, there were 588,170 clients (55 percent of all clients in treatment) in facilities operated by private non-profit organizations, which made up 60 percent of all facilities. Private for-profit organizations reported 296,533 clients (28 percent of all clients), and made up 26 percent of all facilities. Facilities operated by local governments accounted for 97,261 clients (9 percent of all clients), and made up 7 percent of all facilities. State government-operated facilities reported 43,455 (4 percent of all clients), and made up 3 percent of all facilities. Facilities operated by the Federal government accounted for 36,378 clients (3 percent of all clients), and made up 2 percent of all facilities. Facilities operated by tribal governments accounted for 10,454 clients (1 percent of all clients), and made up 1 percent of all facilities [Tables 4.1 and 5.1].

• On March 31, 2004, 62 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. Eight 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].

• On March 31, 2004, there were 954,551 clients (89 percent of all clients) in outpatient treatment, which was offered by 81 percent of all facilities. On the same date, there were 101,713 clients (9 percent of all clients) in non-hospital residential treatment, which was offered by 27 percent of all facilities. On March 31, 2004, there were 15,987 clients (1 percent of all clients) in hospital inpatient treatment, which was offered by 8 percent of all facilities [Tables 4.2b, 5.2a, and 5.2b].²

• On March 31, 2004, nearly half (46 percent) of all clients were in treatment for both alcohol and drug abuse. Approximately one-third (34 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 459 clients in treatment per 100,000 population aged 18 and older on March 31, 2004. The rate was highest for persons with both alcohol and drug problems (209 per 100,000), followed by drug abuse only (159 per 100,000), and alcohol abuse only (91 per 100,000) [Table 6.27].

• Opioid Treatment Programs (OTPs) were available at 8 percent of all substance abuse treatment facilities on March 31, 2004, and clients receiving methadone accounted for 22 percent of all clients in treatment [Tables 2.3 and 3.2].



• Forty-three percent of OTPs were operated by private for-profit organizations, compared to 26 percent of all substance abuse treatment facilities [Tables 4.1 and 4.18].



• Outpatient methadone maintenance was most likely to be offered by private for-profit facilities (13 percent) and facilities operated by the Federal government (10 percent) [Table 4.2b].



• Facilities with OTPs were likely to be dedicated almost entirely to medication-assisted therapy; that is, treatment with methadone or buprenorphine. Overall, 88 percent of clients in facilities with OTPs were receiving methadone or buprenorphine on March 31, 2004 [Table 4.18].

• The median number of clients in substance abuse treatment at a facility on March 31, 2004, was 40. Government-operated facilities were generally larger than private for-profit or private non-profit facilities [Table 4.4].

• On March 31, 2004, 92 percent of all non-hospital residential beds and 91 percent of all hospital inpatient beds designated for substance abuse treatment were in use [Tables 4.6 and 4.7].

• Facilities with non-hospital residential beds had higher utilization rates than facilities with hospital inpatient beds. Fifty 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 14 percent of hospital inpatient facilities and 9 percent of non-hospital residential facilities had utilization rates over 100 percent [Tables 4.6 and 4.7].

Programs or Groups for Specific Client Types

• Most facilities (82 percent) offered specially designed programs or groups directed at specific client types. Special programs or groups for clients with co-occurring mental health and substance abuse disorders were offered by 35 percent of facilities. Special programs or groups for DUI/DWI offenders were offered by 31 percent, for adolescents by 31 percent, for adult women by 30 percent, and for criminal justice clients by 27 percent of facilities. Less frequently offered were 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) [Table 4.9b].

Services in Sign Language and Languages Other than English

• Substance abuse treatment services in sign language for the hearing impaired were offered in 29 percent of all facilities [Table 4.12b].



• Substance abuse treatment services in a language other than English could be provided by staff counselors, on-call interpreters, or both, and were provided in 47 percent of all facilities. Of the facilities offering these services, 43 percent reported that the services were provided by staff counselors only. Thirty-nine percent used only on-call interpreters, and 18 percent used both staff counselors and on-call interpreters. Among facilities using staff counselors to provide substance abuse treatment services in languages other than English, Spanish was the most commonly reported language, provided in 26 percent of all facilities [Table 4.12b].



• Treatment services in American Indian/Alaska Native languages were offered in 1 percent of facilities overall. However, 35 percent of facilities operated by the Indian Health Service and 27 percent of facilities operated by tribal governments offered these services [Table 4.12b].

Payment Options

• A sliding fee scale for substance abuse treatment charges was used by 64 percent of all facilities. More than half (54 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 4.13b].

Facility Licensing, Certification, or Accreditation

• Ninety-five 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, 33 percent listed the State mental health department, and 31 percent listed the State public health department/board of health [Table 4.14b].

Facility Funding

• Approximately two-thirds (64 percent) of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services [Table 4.16].

Client Outreach

• Almost one-quarter (23 percent) of all facilities reported that they operated a hotline responding to substance abuse problems [Table 4.17].



• Most facilities (91 percent) reported that they had access to the Internet. Over half of all facilities (57 percent) had web sites providing information about their substance abuse treatment programs [Table 4.17].

¹ Client percentages sum to less than 100 percent because of rounding.
² Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.