Chapter 4
Facility Characteristics and Services

Facility Operation and Primary Focus Type of Care Offered Client Substance Abuse Problem Treated
Facility Size Facility Capacity and Utilization Rates  
Programs or Groups for Specific Client Types
  Clients with co-occurring disorders   Adult women   Adolescents
DUI/DWI offenders Criminal justice clients Adult men
Pregnant or postpartum women Persons with HIV or AIDS Seniors or older adults
Gays or lesbians    
Services Offered Services in Sign Language for the Hearing Impaired and in Languages Other than English Payment Options
Facility Licensing, Certification, or Accreditation Facility Funding Client Outreach
Facilities with Opioid Treatment Programs (OTPs)    

This chapter describes key characteristics of facilities and programs in 2006. 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. They are also described in terms of the facility’s primary focus: substance abuse treatment services, mental health services, a mix of mental health and substance abuse treatment services, general health care, and other.

Facility Operation and Primary Focus

Table 4.1. Facilities operated by private non-profit organizations made up the majority of facilities (59 percent of all facilities) on March 31, 2006, ranging from 53 percent of facilities focused on the provision of general health care to 61 percent of facilities focused on the provision of mental health services. Facilities operated by private for-profit organizations made up 28 percent of all facilities on March 31, 2006, ranging from 3 percent of facilities focused on the provision of general health care to 29 percent of facilities focused on the provision of substance abuse treatment services. Facilities operated by local governments made up 7 percent, and those operated by State governments, 3 percent. Facilities operated by the Federal government made up 2 percent of all facilities on March 31, 2006, ranging from 1 to 2 percent of facilities providing substance abuse treatment and/or mental health services, but 32 percent of facilities providing general health care. Of the 331 facilities operated by the Federal government, 186 (56 percent) were operated by the Department of Veterans Affairs (VA) and were generally hospital-based.1 This greatly influenced the association between facilities operated by the Federal government and a focus on the provision of general health care.

Most facilities (62 percent) reported their primary focus of activity on March 31, 2006, as the provision of substance abuse treatment services. This proportion ranged from 48 percent of facilities operated by the Federal government to 65 percent of facilities operated by private for-profit organizations. More than one-quarter (27 percent) of all facilities reported their primary focus of activity as the provision of a mix of mental health and substance abuse treatment services. This proportion ranged from 25 percent of facilities operated by the Federal government to 39 percent of facilities operated by tribal governments. Eight percent of all facilities reported the provision of mental health services as their primary focus, ranging from 2 percent of facilities operated by tribal governments to 11 percent each of facilities operated by State and local governments. Overall, 2 percent of all facilities were focused primarily on the provision of general health care. This proportion ranged from less than 1 percent to 6 percent for all categories of facility operation except the Federal government, where the proportion was 22 percent, largely because of the inclusion of VA facilities.

Type of Care Offered

Tables 4.2a and 4.2b. Outpatient treatment was the most widely available type of care, offered by 81 percent of all facilities on March 31, 2006. The proportion of facilities offering outpatient care ranged from 74 percent of State government-operated facilities and facilities operated by private non-profit organizations to 98 percent of Federal government-operated facilities, and from 76 percent of facilities with a primary substance abuse treatment focus to 90 percent each of facilities with a mixed mental heath and substance abuse treatment focus and facilities with a focus on the provision of mental health services.

Among the subcategories of outpatient treatment, regular outpatient care was offered by 74 percent of all facilities and intensive outpatient care by 45 percent of all facilities. Outpatient day treatment/partial hospitalization was offered by 15 percent of all facilities. Outpatient detoxification was offered at 12 percent of all facilities, ranging from 8 to 19 percent according to facility operation, with the exception of facilities operated by the Federal government, where it was offered by 41 percent (and by 48 percent of VA-operated facilities). Outpatient methadone maintenance was offered at 10 percent of all facilities, ranging from 4 to 8 percent according to facility operation, with the exception of facilities operated by the Federal government, where it was offered by 19 percent (and by 33 percent of VA-operated facilities) and facilities operated by private for-profit organizations (17 percent).

Non-hospital residential treatment was offered by 28 percent of all facilities. This proportion ranged from 14 percent of private for-profit facilities to 36 percent of facilities operated by private non-profit organizations, and from 9 percent of facilities focused on the provision of mental health services to 35 percent of facilities focused on the provision of substance abuse treatment services.

Among the subcategories of non-hospital residential treatment, long-term treatment (more than 30 days) was offered by 23 percent of all facilities. Twelve percent offered non-hospital residential short-term care (30 days or less), and 7 percent offered non-hospital residential detoxification.

Hospital inpatient treatment was offered by 7 percent of all facilities. This proportion ranged from 2 to 12 percent according to facility operation, with the exception of facilities operated by the Federal government, where it was offered by 27 percent of facilities. The availability of hospital inpatient treatment in facilities without a general health care focus ranged from 4 to 16 percent, and was 45 percent in facilities with a general health care focus.

Among the subcategories of hospital inpatient treatment, in facilities without a general health care focus, availability of treatment ranged from 3 to 11 percent; availability of detoxification ranged from 3 percent to 14 percent. In facilities with a general health care focus, the availability of treatment was 17 percent, and of detoxification, 42 percent.

Client Substance Abuse Problem Treated

Table 4.3. Almost all facilities (94 percent) had clients in treatment for both alcohol and drug abuse on March 31, 2006. More than 80 percent each had clients in treatment for abuse of drugs alone (82 percent) and for abuse of alcohol alone (81 percent). These proportions were relatively constant across facility operation categories and by the primary focus of the facility. Clients with alcohol abuse alone were treated in 94 percent of Federal government-operated facilities.

Facility Size

Table 4.4. The median number of clients in substance abuse treatment at a facility on March 31, 2006, was 40. The median number of clients ranged from 32 in facilities operated by tribal governments to 55 and 56 in facilities operated by the Federal and local government, respectively. The relatively high median number of clients in facilities operated by the Federal government is due in large part to the median of 110 clients in treatment at VA facilities.

Facility size varied by type of care offered. In facilities offering outpatient care, the median number of clients was 47. However, this represented a range by type of outpatient care, from no clients in outpatient detoxification on March 31, 2006, to 27 clients in regular outpatient care and 140 clients receiving outpatient methadone maintenance. In facilities offering non-hospital residential care, the median number of clients in treatment on March 31, 2006, was 19. In hospital inpatient facilities, the median number of clients was 9.

The median number of clients also varied according to primary focus of the facility. It ranged from 20 clients in treatment in facilities focused on the provision of mental health services to 45 clients in treatment in facilities with a primary focus on the provision of substance abuse treatment services.

Table 4.5. There was little difference in facility size by facility operation, but there were differences by the primary focus of the facility. Facilities with a primary focus on the provision of mental health services tended to be smaller than facilities focused on the provision of substance abuse treatment. Only 9 percent of facilities with a mental health focus had 120 or more clients in treatment on March 31, 2006, and 40 percent had fewer than 15 clients in treatment on that date. In contrast, 23 percent of facilities with a substance abuse treatment focus had 120 or more clients in treatment, while 17 percent had fewer than 15 clients in treatment.

Facility Capacity and Utilization Rates

Facilities were asked to report the number of non-hospital residential and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of non-hospital residential or hospital inpatient clients by the number of non-hospital residential or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates may be more than 100 percent.

Table 4.6. Some 3,436 facilities reported having 113,851 non-hospital residential beds designated for substance abuse treatment. On March 31, 2006, 91 percent of all non-hospital residential beds designated for substance abuse treatment were in use.2 In non-hospital residential facilities, utilization rates ranged from 89 percent in facilities operated by private for-profit organizations to 101 percent in non-hospital residential facilities operated by the Federal government. By facility focus, utilization rates ranged from 90 percent in facilities providing substance abuse treatment services to 114 percent in facilities providing mental health treatment services.

Table 4.7. Some 867 facilities reported having 12,246 hospital inpatient beds designated for substance abuse treatment. On March 31, 2006, 90 percent of all hospital inpatient beds designated for substance abuse treatment were in use.3 In hospital inpatient facilities, utilization rates ranged from 81 percent in facilities operated by private non-profit organizations to 101 percent in hospital inpatient facilities operated by private for-profit facilities. By facility focus, utilization rates ranged from 68 percent in facilities providing a mix of mental health and substance abuse treatment services to 113 percent in facilities focused on mental health services.

Figure 9 and Tables 4.6 and 4.7 show the distribution of the facility-level utilization rates separately for non-hospital residential and hospital inpatient beds. Facilities with non-hospital residential beds had generally higher utilization rates than facilities with hospital inpatient beds. Fifty-two percent of facilities with non-hospital residential beds had utilization rates of 91 to 100 percent or more. Only 29 percent of facilities with hospital inpatient beds had utilization rates in that range, and 21 percent had utilization rates of 50 percent or less, compared to only 6 percent of non-hospital residential facilities.

Figure 9
Non-Hospital Residential and Hospital Inpatient Utilization Rates:
March 31, 2006

Bar chart comparing Non-Hospital Residential and Hospital Inpatient Utilization Rates on March 31, 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration,
National Survey of Substance Abuse Treatment Services (N-SSATS), 2006.

Programs or Groups for Specific Client Types

Facilities may offer treatment programs or groups designed to address the specific needs of specific client types. These client types include adolescents, clients with co-occurring mental health and substance abuse disorders, persons with HIV or AIDS, gays or lesbians, and pregnant or postpartum women. Special programs or groups may also be offered for adult women, for adult men, and for seniors or older adults. Many facilities offer treatment for persons arrested while driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI), as well as for other criminal justice clients.

In response to concerns about over-reporting of special programs or groups, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that offered specially designed programs or groups for each client type.

Tables 4.8a and 4.8b. These tables indicate the proportions of facilities that offered specially designed substance abuse treatment programs or groups exclusively for specific client types. Overall, 83 percent of facilities offered special programs or groups directed at a specific client type. This proportion was fairly consistent across operating organizations, with the exception of the Federal government, where 69 percent of facilities offered programs or groups designed for specific client types. Facilities focused on general health care and facilities focused on the provision of mental health services also had relatively low availability of such programs (69 percent each).

Clients with co-occurring disorders
Overall, 37 percent of all facilities provided programs or groups for clients with co-occurring mental health and substance abuse disorders. These services were most likely to be provided in State government-operated facilities (52 percent). By facility focus, the facilities most likely to offer programs or groups for clients with co-occurring disorders were facilities whose focus was the provision of a mix of mental health and substance abuse treatment services (54 percent) or of mental health services (44 percent).

Adult women
Special programs or groups for adult women were offered in 32 percent of all facilities.

Adolescents
Thirty-two percent of facilities offered programs or groups for adolescents. The highest proportions of adolescent programs were found in facilities operated by tribal governments (52 percent). Programs or groups for adolescents were available in 42 percent of facilities whose focus was the provision of a mix of mental health and substance abuse treatment services.

DUI/DWI offenders
Special programs or groups for DUI/DWI offenders were offered by 31 percent of all facilities. Almost half (46 percent) of private for-profit facilities had such programs, as did 38 percent of tribal government-operated facilities. By facility focus, programs or groups for DUI/DWI offenders were most likely to be offered by facilities providing a mix of mental health and substance abuse treatment services (39 percent).

Criminal justice clients
Twenty-eight percent of all facilities provided programs or groups for criminal justice clients other than DUI/DWI offenders. (Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.)

Adult men
Special programs or groups for adult men were available in 25 percent of all facilities.

Pregnant or postpartum women
Programs or groups for pregnant or postpartum women were offered by 14 percent of all facilities. These programs were most likely to be available in facilities operated by local, State, or tribal governments (19 percent, 18 percent, and 18 percent, respectively).

Persons with HIV or AIDS
Ten percent of facilities offered programs or groups for persons with HIV or AIDS. Facilities operated by State governments and private non-profit organizations were most likely to offer such programs (11 percent each).

Seniors or older adults
Seven percent of all facilities provided programs or groups for seniors or older adults. Facilities most likely to have this type of program were those operated by tribal governments (12 percent) or by Federal governments (10 percent). Nine percent each of facilities focused on the provision of a mix of mental health and substance abuse treatment services and facilities with a focus on general health care offered programs or groups for seniors or older adults.

Gays or lesbians
Special programs or groups for gays or lesbians were available in 6 percent of all facilities. They were most likely to be offered in facilities operated by private for-profit organizations (8 percent). Six percent each of facilities whose primary focus was the provision of a mix of mental health and substance abuse treatment services, facilities with a focus on general health care, and facilities with a focus on the provision of substance abuse treatment had programs for gays and lesbians.

Services Offered

Facilities were asked about the types of services they offered. Services were grouped into six broad categories. (See Appendix B, the 2006 N‑SSATS Questionnaire, Question 10, for specific services within each category.)

The majority of facilities offered one or more of the specific services in each category, although the availability of services varied somewhat by facility operation and primary focus. Differences were most apparent in pharmacotherapies, testing, transitional services, and other services.

Tables 4.9a and 4.9b. At least one of the seven assessment services was available in 97 percent of all facilities. Comprehensive substance abuse assessment and diagnosis was available in 88 percent of all facilities, and differed little by facility operation. However, comprehensive mental health assessment and diagnosis was available at 42 percent of all facilities and ranged from 36 percent of facilities operated by private for-profit organizations to 64 percent of facilities operated by the Federal government.

The 2006 N-SSATS survey also asked about additional assessment services, such as outreach to persons in the community who may need treatment, brief intervention services for substance users who are not yet dependent, and interim services for clients when immediate admission is not possible. Forty-seven percent of all facilities offered outreach to persons in the community, ranging from 39 percent of facilities operated by private for-profit organizations to 81 percent of facilities operated by tribal governments. Nearly half of all facilities (49 percent) offered brief intervention for substance users who are not yet dependent, usually 1 to 5 sessions, and this proportion was similar among most facilities regardless of facility operation; the exceptions were facilities operated by the Federal government (74 percent) and tribal governments (85 percent). Interim services for clients when immediate admission is not possible were offered by 40 percent of all facilities and ranged from 38 percent of facilities operated by private for-profit organizations to 75 percent of facilities operated by tribal governments.

Substance abuse therapy and counseling services were offered by 99 percent of all facilities, and they differed little in availability by facility operation. Individual therapy was offered by 95 percent of all facilities, followed by group therapy (90 percent), relapse prevention groups (81 percent), aftercare counseling (78 percent), and family counseling (76 percent).

Pharmacotherapies, available in 46 percent of all facilities, were most readily available in Federal government-operated facilities (79 percent) and least available in tribal government-operated facilities (32 percent). Medications for psychiatric disorders were the most common pharmacotherapy (34 percent), followed by Antabuse and buprenorphine (16 percent each), Campral, Nicotine replacement, and naltrexone, (13 percent each), and methadone (10 percent). Antabuse was available in 58 percent of Federal government-operated facilities, and naltrexone in 51 percent. Buprenorphine was available in 7 percent of tribal government-operated facilities and 29 percent of facilities operated by the Federal government.

Testing services were available in 86 percent of all facilities. Urine screening for drugs or alcohol was the most common procedure, available in 82 percent of facilities, followed by breathalyzer or blood alcohol testing (57 percent). Disease testing was available in a much smaller range of facilities—TB screening in 34 percent, HIV testing in 30 percent, Hepatitis C screening in 23 percent, Hepatitis B screening in 22 percent, and STD testing in 21 percent. State and Federal government-operated facilities were most likely to offer at least one testing service (93 percent and 92 percent, respectively), while facilities operated by tribal governments were least likely to offer a testing service (68 percent).

Transitional services were offered in 90 percent of all facilities. Discharge planning was the most common service, offered by 86 percent of all facilities, followed by assistance with obtaining social services (54 percent), assistance in locating housing for clients (45 percent), and employment counseling or training for clients (37 percent). Facilities operated by private for-profit organizations were less likely than facilities operated by other entities to offer any of the transitional services (82 percent compared to between 89 percent and 95 percent), and least likely to offer any specific transitional service.

Specified other services were offered by 98 percent of all facilities. Substance abuse education was the most common service (91 percent) followed by case management services (72 percent), social skills development (60 percent), outcome follow-up after discharge (54 percent), HIV or AIDS education, or counseling, or support (53 percent) mental health services (52 percent), health education other than HIV/AIDS (47 percent), self-help groups (45 percent), mentoring/peer support (42 percent), transportation assistance to treatment (35 percent), domestic violence--family or partner violence services (33 percent), early intervention for HIV (21 percent), child care for clients’ children (8 percent), and acupuncture and residential beds for clients’ children (5 percent each). At least 97 percent of facilities in each operation category offered at least one of the services in this group. While transportation assistance to treatment was offered by 35 percent of all facilities, the availability of this service ranged from 19 percent of private for-profit facilities to 74 percent of tribal government-operated facilities.

Tables 4.10a and 4.10b. The overall availability of assessment services (97 percent) differed little by facility focus. However, comprehensive mental health assessment and diagnosis was more readily available in facilities focused on mental health services, a provision of a mix of mental health and substance abuse treatment services, and general health care (89 percent, 78 percent, and 71 percent, respectively) than in facilities primarily providing substance abuse treatment services (20 percent). Brief intervention for substance users who are not yet dependent, usually 1 to 5 sessions, was offered by 49 percent of all facilities, but ranged from 40 percent of facilities with a focus on substance abuse treatment services to 69 percent of facilities focused on the provision of a mix of mental health and substance abuse treatment services.

The overall availability of substance abuse therapy and counseling services (99 percent) differed little by primary focus. Each type of substance abuse therapy and counseling services were offered by at least 76 percent of facilities. Relapse prevention groups were offered by 81 percent of all facilities, ranging from 53 percent of facilities focused on the provision of mental health services to 86 percent of facilities focused on the provision of substance abuse treatment services.

Pharmacotherapies, available in 46 percent of all facilities, were more readily available in facilities focused on provision of general health care (81 percent) than in facilities focused on provision of mental health services (69 percent), a mix of mental health and substance abuse treatment services (58 percent) or substance abuse treatment services (37 percent).

Testing services were available in 86 percent of all facilities, ranging from 61 percent of facilities focused on the provision of mental health services to 96 percent of facilities focused on general health care. While testing/screening for hepatitis B and C, HIV, STDs, and TB were available in only 21 to 34 percent of all facilities, they were available in 81 to 86 percent of facilities focused on general health care and in 36 percent or less of facilities in every other primary focus category.

Transitional services, available in 90 percent of all facilities, ranged from 84 percent in facilities focused on the provision of mental health services to 93 percent of facilities with a general health care focus. Employment counseling or training for clients was the least common service, offered in 38 percent or fewer facilities in any of the major categories.

Services in Sign Language for the Hearing Impaired and in Languages Other than English

Tables 4.11a and 4.11b. Substance abuse treatment services in sign language for the hearing impaired were offered in 29 percent of all facilities. Facilities operated by local and State governments were most likely to offer these services (46 percent and 40 percent, respectively), followed by private non-profits (33 percent). Facilities focused on a mix of mental health and substance abuse treatment services (37 percent) and facilities focused on the provision of mental health services (36 percent) were more likely to offer sign language than facilities focused on substance abuse treatment services or general health care.

Substance abuse treatment services in languages other than English were provided in 45 percent of all facilities. This proportion ranged from 21 percent in Federal government-operated facilities to 57 percent in facilities operated by local governments. There was little variation according to the facilities’ primary focus, and the proportions offering treatment in languages other than English ranged from 39 to 51 percent among the languages specified.

Substance abuse treatment services in languages other than English could be provided by staff counselors, on-call interpreters, or both. Of the facilities offering these services, 45 percent reported that the services were provided by staff counselors only. Thirty-six percent used only on-call interpreters, and 19 percent used both staff counselors and on-call interpreters. Private for-profit organizations were most likely to use staff counselors only (58 percent), and State, local, and Federal government-operated facilities were most likely to use on-call interpreters only (51 percent, 48 percent, and 46 percent, respectively). Facilities with a focus on the provision of substance abuse treatment services were the most likely to use staff counselors only (52 percent), while those whose focus was the provision of mental health services were most likely to use on-call interpreters only (58 percent).

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 27 percent of all facilities. Treatment services in American Indian/Alaska Native languages were offered in 1 percent of facilities overall. However, 31 percent of facilities operated by the Indian Health Service and 24 percent of facilities operated by tribal governments offered these services.

Payment Options

Tables 4.12a and 4.12b. Cash or self-payment and private health insurance were the most frequently accepted forms of payment (90 percent and 64 percent of facilities, respectively). Medicaid was accepted by 52 percent of all facilities, Medicare by 33 percent, State-financed health insurance by 32 percent, and Federal military insurance by 32 percent.

Access to Recovery (ATR) vouchers were accepted by 10 percent of all facilities. However, this program was offered in only 14 States;4 the acceptance rates ranged from 11 percent to 81 percent in those States [see Table 6.14].

A sliding fee scale for substance abuse treatment charges was used by 63 percent of all facilities. Facilities operated by local and State governments and by private non-profits were most likely to use a sliding fee scale (82 percent, 73 percent, and 70 percent, respectively).

More than half (53 percent) of all facilities offered treatment at no charge to eligible clients who could not pay. Facilities operated by State and local governments were most likely to provide this service (74 percent and 69 percent, respectively).

Private non-profit facilities and facilities operated by local and State governments were the most likely to accept Medicaid, Medicare, and State-financed health car, whereas private for-profit facilities were the most likely to accept cash or self payment and private health insurance. Facilities operated by the Federal government were the most likely to accept Federal military insurance.

Facilities focused on the provision of substance abuse treatment services were less likely than facilities with a different primary focus (mental health services, a mix of mental health and substance abuse treatment services, or general health care) to accept each of the specified types of payment. At the same time, facilities with a primary focus of substance abuse treatment were more likely to provide treatment at no cost to the client.

Facility Licensing, Certification, or Accreditation

Facilities were asked whether they were licensed, certified, or accredited by various organizations. These included the State substance abuse agency, State mental health department, State public health department or board of health, hospital licensing authority, or State/local agency or other organization. Also included were accreditation organizations: the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the National Committee for Quality Assurance (NCQA), and the Council on Accreditation for Children and Family Services (COA).

Tables 4.13a and 4.13b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. This proportion was between 92 percent and 98 percent for most of the major facility operation and primary focus categories. The exception was facilities operated by tribal governments, where only 81 percent of facilities were licensed, certified, or accredited by any of the agencies or organizations. As the licensing, certifying, or accrediting agency or organization, 81 percent of facilities named the State substance abuse agency, 40 percent listed the State public health department/board of health, 34 percent listed the State mental health department, and 8 percent listed the hospital licensing authority. Accreditation by JCAHO was reported by 22 percent of facilities, and was highest for facilities operated by the Federal government (84 percent) and in facilities focused on the provision of general health care (71 percent). Accreditation by CARF, COA, or NCQA was relatively rare (18 percent, 4 percent, and 2 percent, respectively). Twelve percent of all facilities reported licensing, certification, or accreditation by a State or local agency or other organization that was not specifically listed in the N-SSATS questionnaire.

Tables 4.14a and 4.14b. The State substance abuse agency licensed, certified, or accredited 82 percent of facilities offering outpatient treatment and 81 percent of facilities offering non-hospital residential treatment, but only 54 percent of facilities offering hospital inpatient treatment. The State public health department/board of health licensed, certified, or accredited 38 percent of outpatient facilities, 45 percent of non-hospital residential facilities, and 67 percent of hospital inpatient facilities. The State mental health department licensed, certified, or accredited 36 percent of outpatient facilities, 25 percent of non-hospital residential facilities, and 45 percent of hospital inpatient facilities. The hospital licensing authority licensed 8 percent of facilities offering outpatient treatment, 6 percent of facilities offering non-hospital residential treatment, and 58 percent of facilities offering hospital inpatient treatment. Accreditation by JCAHO and the NCQA was highest in facilities offering hospital inpatient treatment (84 percent and 10 percent, respectively). Accreditation by CARF was highest among facilities offering outpatient methadone maintenance (49 percent). Accreditation by COA was highest among facilities offering regular outpatient treatment (5 percent).

Facility Funding

Facilities were asked several questions about sources of funding, including whether the facility had agreements or contracts with managed care organizations for the provision of substance abuse treatment services, and whether the facility received Federal, State, or local government funds for the provision of substance abuse treatment.

Table 4.15. Less than half of all facilities (47 percent) reported that they had agreements or contracts with managed care organizations for the provision of substance abuse treatment services. In general, government-operated facilities were less likely to have such agreements or contracts than were privately operated facilities (between 13 percent and 39 percent, compared to 49 percent for private for-profit and private non-profit organizations). By primary focus, facilities providing a mix of mental health and substance abuse treatment services were most likely to have agreements or contracts with managed care organizations (59 percent), while facilities providing general health care were the least likely to have managed care agreements or contracts (40 percent).

Fifty-nine percent of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services. Not surprisingly, government-operated and private non-profit organizations were more likely to receive these funds than were private for-profit facilities (between 62 percent and 86 percent, compared to 22 percent for private for-profit organizations).

Client Outreach

Facilities were asked several questions about client outreach, including whether the facility operated a hotline responding to substance abuse problems, whether it had Internet access, and whether it had a web site providing information about its substance abuse treatment programs.

Table 4.16. Twenty-one percent of all facilities reported that they operated a hotline responding to substance abuse problems. This proportion ranged from 8 percent of facilities operated by the Federal government to 34 percent of local government-operated facilities. Higher proportions of hotline operation were reported by facilities providing mental health services (32 percent) or a mix of mental health and substance abuse treatment services (30 percent) than by facilities focused on general health care or the provision of substance abuse treatment services (21 percent and 16 percent, respectively).

Almost two-thirds of all facilities (64 percent) had web sites providing information about their substance abuse treatment programs. These were most common among facilities operated by private non-profit organizations (72 percent) and least common among tribal government-operated facilities (29 percent).

Facilities with Opioid Treatment Programs (OTPs)

Opioid Treatment Programs (OTPs) are certified by the Substance Abuse and Mental Health Services Administration to provide medication-assisted therapy in the treatment of opioid addiction. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of opioid addiction.

Table 4.17. OTPs were available at 1,203 (9 percent) of all substance abuse treatment facilities on March 31, 2006 [Table 2.3]. Forty-five percent of OTPs were operated by private for-profit organizations, compared to 28 percent of all substance abuse treatment facilities [Table 4.1]. Over half (54 percent) of all OTPs provided both maintenance and detoxification. Thirty-eight percent provided maintenance only, and 8 percent provided detoxification only.

Facilities with OTPs were likely to be dedicated entirely or almost entirely to medication-assisted therapy. Sixty-two percent of facilities certified as OTPs reported that all of the clients in treatment on March 31, 2006, were receiving either methadone or buprenorphine. Overall, 86 percent of clients in treatment on March 31, 2006, in facilities with OTPs were receiving methadone or buprenorphine. This proportion was highest (95 percent) in private for-profit facilities and in facilities focused on the provision of substance abuse treatment services (90 percent).

Of the 259,961 clients receiving one of the two medications approved for the treatment of opioid addiction, more than 99 percent received methadone and only 2,042 (less than 1 percent) received buprenorphine.

Tables 4.18a and 4.18b. Facilities with OTPs were most likely to offer outpatient treatment (92 percent), followed by non-hospital residential treatment (12 percent) and hospital inpatient treatment (11 percent). Outpatient methadone maintenance was offered in 85 percent of facilities with OTPs, ranging from 62 percent of facilities operated by State governments to 100 percent of tribal government-operated facilities. Outpatient detoxification was offered in 57 percent of all facilities with OTPs, ranging from 32 percent of local government-operated facilities to 73 percent of Federal government-operated facilities. Federal government-operated facilities with OTPs offered the widest range of types of care. In addition to those named above, 98 percent offered regular outpatient care, 88 percent offered intensive outpatient care, 40 percent offered outpatient day treatment/partial hospitalization, 48 percent offered hospital inpatient detoxification, and 30 percent offered short-term residential treatment.

Tables 4.19a and 4.19b. Over 99 percent of facilities with OTPs reported that they were licensed, certified, or accredited by one or more agencies or organizations. Most facilities with OTPs (85 percent) named the State substance abuse agency, 60 percent listed the State public health department/board of health, and 22 percent listed the State mental health department. Accreditation by JCAHO was higher among facilities with OTPs than among facilities overall (36 percent, compared to 22 percent [Table 4.14b]), as was accreditation by CARF (56 percent, compared with 18 percent). Accreditation by COA and NCQA was relatively low (4 percent and 2 percent, respectively). Twenty percent of facilities with OTPs reported licensing, certification, or accreditation by a State or local agency or organization that was not specifically listed in the N-SSATS questionnaire, as compared to 12 percent of all facilities combined. Accreditation by JCAHO was highest in facilities with OTPs that offered hospital detoxification or hospital treatment (90 percent and 88 percent, respectively), and lowest in facilities with OTPs that offered outpatient methadone maintenance or outpatient detoxification (31 percent and 29 percent, respectively). Conversely, accreditation by CARF was highest where JCAHO accreditation was low (63 percent for outpatient methadone maintenance and 64 percent for outpatient detoxification) and lowest where JCAHO accreditation was high (14 percent for hospital detoxification and 13 percent for hospital treatment).


1Of the 186 facilities operated by the VA, 162 (87 percent) reported that they were located in or operated by a hospital [data not shown].
2 Non-hospital residential utilization rates are based on a subset of 3,213 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
3 Hospital inpatient utilization rates are based on a subset of 507 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
4 CA, CT, FL, ID, IL, LA, MO, NJ, NM, TN, TX, WA, WI, and WY.

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