This report presents results from the 2008 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 alcohol 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 2008 was 94.1 percent. Thirty-two States or jurisdictions had response rates that equaled or surpassed the overall rate [Tables 1.1 and 6.1].
- A total of 14,423 facilities completed the survey. The 13,688 facilities eligible for this report had a one-day census of 1,192,490 clients enrolled in substance abuse treatment on March 31, 2008 [Tables 1.1 and 3.1]
- In the United States, there were 474 clients in treatment per 100,000 population aged 18 and older on March 31, 2008. The rate was highest for persons with both alcohol and drug problems (214 per 100,000 population aged 18 and older), followed by drug problems only (171 per 100,000), and alcohol problems only (89 per 100,000) [Table 6.33].
Trends in Facility and Client Characteristics 2004-2008
- The total number of substance abuse treatment facilities remained relatively constant between 2004 and 2008, while the number of clients in treatment increased slightly. The number of facilities increased by 2 percent, from 13,454 facilities in 2004 to 13,688 facilities in 2008. The number of clients in treatment on the survey reference date increased by 11 percent, from 1,072,251 in 2004 to 1,192,490 in 2008 [Tables 2.2 and 3.1].
- The operational structure of the substance abuse treatment system (i.e., the type of entity
responsible for operating the facility: private non-profit, private for-profit, or government—
local, State, Federal,1 or tribal) changed very little between 2004 and 2008 [Tables 2.2 and 3.1 and Figures 2 and 6].
- The primary focus of activity of facilities (substance abuse treatment services, mental health services, a mix of mental health and substance abuse treatment services; general health care, or other activity) changed very little between 2004 and 2008 [Tables 2.2 and 3.1 and Figure 3].
- The major types of care—outpatient, residential (non-hospital), and hospital inpatient—changed very little from 2004 to 2008 in terms of the proportion of facilities offering each type of care or the proportion of clients in treatment in each type of care [Tables 2.3 and 3.2 and Figures 4 and 7].
- Opioid Treatment Programs certified by SAMHSA for the provision of medication-assisted therapy with methadone and buprenorphine were provided by 8 to 9 percent of all facilities
between 2004 and 2008. The proportion of clients receiving methadone or buprenorphine ranged from 22 percent to 24 percent in that period [Tables 2.3 and 3.2 and Figures 4 and 7].
- Agreements or contracts with managed care organizations were reported by 46 to 49 percent of all facilities from 2004 to 2008 [Table 2.4 and Figure 5].
- The proportion of clients in treatment for three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse only, and alcohol abuse only—changed very little between 2004 and 2008. Clients in treatment for both drug and alcohol abuse made up 45 to 46 percent of all clients. Clients in treatment for drug abuse only made up 34 to 36 percent, and clients in treatment for alcohol abuse only made up 18 to 20 percent [Table 3.3].
- Clients under age 18 made up between 7 and 8 percent of all clients in treatment between 2004 and 2008. The type of care (outpatient, residential (non-hospital), or hospital inpatient) received by clients under age 18 differed little from that received by adults, and was stable between 2004 and 2008 [Table 3.4].
1 Data for the Federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified Federal agencies) are detailed in the tables.
Facility Operation—March 31, 20082
- Private non-profit organizations operated 58 percent of all facilities and were treating 53 percent of all clients.
- Private for-profit organizations operated 29 percent of all facilities and were treating 30 percent of all clients.
- Local governments operated 6 percent of all facilities and were treating 7 percent of all clients.
- State governments operated 3 percent of all facilities and were treating 4 percent of all clients.
- The Federal government operated 2 percent of all facilities and was treating 5 percent of all clients.
- Tribal governments operated 1 percent of all facilities and were treating 1 percent of all clients [Tables 4.1 and 5.1].
Primary Focus of Activity—March 31, 20082
- The provision of substance abuse treatment services was the primary focus of activity of 61 percent of facilities with 67 percent of all clients in treatment.
- A mix of mental health and substance abuse treatment services was the primary focus of 30 percent of facilities with 27 percent of all clients in treatment.
- The provision of mental health services was the primary focus of 7 percent of facilities with 4 percent of all clients in treatment.
- General health care was the primary focus of 1 percent of facilities with 2 percent of all clients in treatment.
- Other activities were the primary focus of 1 percent of facilities with 1 percent of all clients in treatment [Tables 4.1 and 5.1].
2 Percentages may not sum to 100 percent because of rounding.
Type of Care—March 31, 20083
- Outpatient treatment was offered by 80 percent of all facilities, and accounted for 90 percent of all clients in treatment.
- Residential (non-hospital) treatment was offered by 27 percent of all facilities, and accounted for 9 percent of all clients in treatment.
- Hospital inpatient treatment was offered by 6 percent of all facilities and accounted for 1 percent of all clients in treatment [Tables 4.2 and 5.2].
3 Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.
Client Substance Abuse Problem and Co-occurring Mental Health Disorders—March 31, 2008
- Clients in treatment for both alcohol and drug abuse made up 46 percent of all clients.
- Clients in treatment for drug abuse only made up 35 percent of all clients.
- Clients in treatment for abuse of alcohol only made up 19 percent of all clients [Table 5.3].
- Thirty-nine percent of all clients in treatment had diagnosed co-occurring substance abuse and mental health disorders [Table 5.3].
Facility Size and Utilization Rates—March 31, 2008
- The median number of clients in substance abuse treatment at a facility was 41 [Table 4.4].
- Ninety-two percent of all residential (non-hospital) beds and 85 percent of all hospital inpatient beds designated for substance abuse treatment were in use [Tables 4.6 and 4.7].
Medication-Assisted Opioid Therapy—March 31, 2008
- Clients receiving methadone or buprenorphine in Opioid Treatment Programs (OTPs) accounted for 24 percent of all clients in treatment, although OTPs were available in only 1,132 (8 percent) of all substance abuse treatment facilities [Tables 2.3 and 3.2].
- Forty-nine percent of OTPs were operated by private for-profit organizations compared to 29 percent of all substance abuse treatment facilities [Tables 4.1 and 4.20].
- Of the 272,351 clients receiving medication-assisted opioid therapy in OTPs, 98 percent (268,071) received methadone. Of the 15,732 clients receiving buprenorphine, 73 percent received it in facilities that were not OTPs [Table 4.20].
- More than half (52 percent) of clients receiving methadone were in private for-profit facilities compared to 38 percent of clients receiving buprenorphine. Clients receiving buprenorphine were more likely than those receiving methadone to be in private non-profit facilities (46 percent) [Table 4.20].
- Most (92 percent) of the clients receiving methadone were in facilities whose primary focus was the provision of substance abuse treatment services, while these facilities accounted for only 59 percent of buprenorphine clients. Nearly one-third (32 percent) of buprenorphine
clients were treated in facilities providing a mix of substance abuse treatment and mental health services [Table 4.20].