Chapter 4

Facility Characteristics and Services

Facility Operation and Primary Focus
Type of Care Offered
Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders
Facility Size
Facility Capacity and Utilization Rates
Services Provided
Clinical/Therapeutic Approaches
Programs or Groups for Specific Client Types
Services in Sign Language for the Hearing Impaired and in Languages Other than English
Detoxification Services
Client Outreach
Facility Licensing, Certification, or Accreditation
Facility Standard Operating Procedures
Payment Options
Facility Funding
Facilities with Opioid Treatment Programs
Counseling Services Offered by Facilities
Facility Smoking Policy

This chapter outlines key characteristics of facilities and programs in 2011.

Facility Operation and Primary Focus

Table 4.1. Facilities were asked to designate the type of entity responsible for the operation of the facility. They were also asked to designate the facility’s primary focus of activity.

⁹ Percentages do not sum to 100 percent because of rounding.
¹⁰ 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.

Type of Care Offered

Table 4.2b. Type of care offered was made up of three broad categories (outpatient, residential [non-hospital], and hospital inpatient), each with several subcategories. A facility could offer more than one type of care. The proportions of all facilities offering the different types of care were:¹¹

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and more than one third (34 percent) provided residential (non-hospital) care. In contrast, 91 percent of private for-profit facilities provided outpatient care and 13 percent provided residential non-hospital) care.

Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders

Table 4.3. Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring substance abuse and mental disorders.

• Almost all facilities (92 percent) had clients in treatment for both alcohol and drug abuse on March 31, 2011. Eighty-two percent had clients in treatment for drug abuse only, and 80 percent had clients in treatment for alcohol abuse only.
• Most facilities (88 percent) also had clients in treatment with diagnosed co-occurring substance abuse and mental disorders on March 31, 2011.
  

Facility Size

Table 4.4. Facility size is defined by the number of clients in substance abuse treatment. The median number of clients in substance abuse treatment at a facility on March 31, 2011 was 42 clients.

• The median number of clients ranged from 33 in facilities operated by tribal governments to 68 in facilities operated by the Federal government.
• The median number of clients ranged from 20 clients in facilities with a primary focus of mental health services to 46 in those with a primary focus of providing substance abuse treatment services.
  
• By type of care, the median¹² number of clients in treatment on March 31, 2011, was:

Table 4.5. Facilities were sorted into five size groups based on the total number of clients in treatment on March 31, 2011. The smallest facilities were defined as having fewer than 15 clients and the largest as having 120 clients or more.

• Facilities operated by the Federal government were generally larger than facilities operated by other entities—37 percent had 120 clients or more in treatment on March 31, 2011, compared to 22 percent of all facilities.
  

Facility Capacity and Utilization Rates

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

• Table 4.6. Some 3,237 facilities reported having 109,451 residential (non-hospital) beds designated for substance abuse treatment on March 31, 2011. The utilization rate¹³ was 97 percent, and ranged from 93 percent in facilities operated by private for-profit entities and local governments to 143 percent in facilities operated by tribal governments.
• Table 4.7. Some 676 facilities reported having 11,896 hospital inpatient beds designated for substance abuse treatment on March 31, 2011. The utilization rate¹⁴ was 96 percent, and ranged from 72 percent in facilities operated by the Federal government to 750 percent in facilities operated by tribal governments. By facility focus, utilization rates ranged from 85 percent in facilities primarily focused on substance abuse treatment services to 133 percent in facilities focused on mental health services.
• Tables 4.6 and 4.7 and Figure 7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds. Forty-seven percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent, while 29 percent of facilities with hospital inpatient beds had utilization rates in that range.
  

Services Provided

Tables 4.8 and 4.9. Facilities were asked about the types of services they provided. Services were grouped into the five broad categories shown below.

• Assessment and pre-treatment services were offered by 99 percent of all facilities.
  • Screening for substance abuse was provided by 94 percent of all facilities.
  • Comprehensive substance abuse assessment or diagnosis was provided by 91 percent of all facilities.
  • Screening for mental health disorders was provided by 66 percent of all facilities; rates were higher in facilities primarily focused on mental health services (95 percent), facilities with a mixed focus of substance abuse treatment and mental health services (92 percent), and facilities primarily focused on general health care (89 percent).
  • Screening for tobacco use was provided by 50 percent of all facilities.
  • Comprehensive mental health assessment or diagnosis was provided by 44 percent of all facilities; rates were higher in facilities primarily focused on mental health services (88 percent), facilities with a mixed focus of substance abuse treatment and mental health services (77 percent), and facilities primarily focused on general health care (76 percent).
  • Outreach to persons in the community who may need treatment was provided by 55 percent of all facilities but by 81 percent of tribal government-operated facilities.
  • Interim services for clients when immediate admission was not possible were provided by 44 percent of all facilities but by 73 percent of Federal government facilities.
    
• Testing services were provided by 88 percent of all facilities.
  • Drug or alcohol urine screening was provided by 84 percent of all facilities.
  • Breathalyzer or other blood alcohol testing was provided by 61 percent of all facilities but by 85 percent of Federal government-operated facilities.
  • Testing for each of TB, HIV, hepatitis B and C, and STDs was provided by between 20 and 36 percent of all facilities but by 81 to 85 percent of facilities with a primary focus of general health care.
    
• Transitional services were provided by 97 percent of all facilities.
  • Discharge planning was provided by 94 percent of all facilities.
  • Aftercare/continuing care was provided by 83 percent of all facilities.
• Pharmacotherapies were provided by 49 percent of all facilities; rates were higher in facilities primarily focused on general health care (83 percent) and by Federal government-operated facilities (82 percent).
  • Medications for psychiatric disorders were the most frequently available pharmacotherapies—in 36 percent of all facilities and in 75 percent of facilities primarily focused on general health care.
• Ancillary services were provided by 99 percent of all facilities.
  • Substance abuse education was provided by 96 percent of all facilities.
  • Case management services were provided by 79 percent of all facilities.
  • Mental health services were provided by 60 percent of all facilities; rates were higher in facilities with a primary focus of mental health services (97 percent), facilities providing a mixed focus of substance abuse treatment and mental health services (94 percent), and facilities with a primary focus of general health care (87 percent).
    

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate whether they used any of 12 specific clinical/therapeutic approaches.

• Two approaches were each used always or often by nearly all facilities:
  • Substance abuse counseling was used always or often by 94 percent of facilities.
  • Relapse prevention was used always or often by 84 percent of facilities.
• A number of approaches were used at least sometimes (always, often, or sometimes) by more than half of facilities:
  • Cognitive-behavioral therapy was used at least sometimes by 91 percent of facilities.
  • Motivational interviewing was used at least sometimes by 87 percent of facilities.
  • Anger management was used at least sometimes by 81 percent of facilities.
  • Brief intervention was used at least sometimes by 80 percent of facilities.
  • 12-step facilitation was used at least sometimes by 77 percent of facilities.
  • Trauma-related counseling was used at least sometimes by 68 percent of facilities.
  • Contingency management/motivational incentives were used at least sometimes by 58 percent of facilities.
    
• Some approaches were used rarely or never, or were unfamiliar to the respondent, for more than half of all facilities:
  • Rational emotive behavioral therapy was used rarely or never by 48 percent of facilities, and it was unfamiliar to an additional 5 percent of facilities.
  • The matrix model was used rarely or never by 47 percent of facilities, and it was unfamiliar to an additional 15 percent of facilities.
  • Community reinforcement plus vouchers was used rarely or never by 77 percent of facilities, and it was unfamiliar to an additional 10 percent of facilities.
    

Programs or Groups for Specific Client Types

Table 4.11b. Facilities were asked about the provision of treatment programs or groups specially designed for specific client types. Overall, 80 percent of facilities offered at least one special program or group to serve a specific client type.

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

Table 4.12b. Facilities were asked about the provision of substance abuse treatment services in sign language for the hearing impaired. They were also asked if treatment was provided in languages other than English, if this treatment was provided by a staff counselor or by an on-call interpreter, and in what languages staff counselors provided treatment.

• Substance abuse treatment services in sign language for the hearing impaired were offered in 28 percent of all facilities. Facilities operated by local and State governments were most likely to offer these services (49 and 41 percent, respectively). By foci of activity, facilities with a primary focus of mental health services or a mixed focus of substance abuse treatment and mental health services (38 and 35 percent, respectively) were the most likely to offer services in sign language.
• Substance abuse treatment services in languages other than English were provided in 41 percent of all facilities, ranging from 19 percent of Federal government-operated facilities to 54 percent of local government-operated facilities.
• Forty-two percent of facilities providing services in languages other than English used only staff counselors who spoke other languages; another 24 percent of facilities used both staff counselors and on-call interpreters.
• In facilities where staff counselors provided services in languages other than English, Spanish was the most frequently spoken language (at 94 percent of those facilities). Services in American Indian/Alaska Native languages were provided by 3 percent of all facilities where staff counselors provided services in languages other than English, but by 93 percent of those facilities that were also operated by tribal governments and by 85 percent of those that were also operated by the Indian Health Service. Other languages were spoken at 26 percent of the facilities.
  

Detoxification Services

Table 4.13. Facilities that provided detoxification services were asked to indicate whether or not they detoxified clients from specified substances, and whether or not medication was routinely used during detoxification.

Client Outreach

Tables 4.14 and 4.8. Facilities were asked whether or not they had a website providing information about their substance abuse treatment programs.

• Websites providing information about a facility's substance abuse treatment programs were maintained by 79 percent of all facilities. Website availability ranged from 49 percent among facilities operated by tribal governments and 51 percent among facilities operated by the Federal government to 86 percent among private non-profit facilities.
• Outreach to persons in the community who may need treatment was provided by 55 percent of all facilities but by 81 percent of tribal government-operated facilities.
  

Facility Licensing, Certification, or Accreditation

Facilities were asked to report licensure, certification, or accreditation by specified agencies or organizations. These included the State substance abuse agency, State mental health department, State department of health, hospital licensing authority, the Joint Commission, CARF, NCQA, COA, and other State or local agency or organization.¹⁶

• Table 4.15b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. The proportions of facilities reporting the specified agencies or organizations were:
  

• Table 4.16b. Facility licensing, certification, or accreditation was associated with the type of care offered.
• State substance abuse agencies licensed, certified, or accredited 83 percent each of facilities offering outpatient treatment and residential (non-hospital) treatment but only 58 percent of facilities offering hospital inpatient treatment.
  • State mental health departments licensed, certified, or accredited 44 percent of hospital inpatient facilities but only 39 percent of outpatient facilities and 29 percent of residential (non-hospital) facilities.
  • Facilities offering hospital inpatient treatment were more likely than facilities offering other types of care to report licensure, certification, or accreditation by the following:
    

Facility Standard Operating Procedures

Table 4.17b. Facilities were asked to indicate whether or not they followed specified practices as part of their standard operating procedures. All the standard practices listed were used by two thirds or more of all facilities.

• The proportions of facilities reporting use of the specified standard practices were:
  

Payment Options

Table 4.18b. Facilities were asked to indicate whether they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.

• The proportions of all facilities reporting acceptance of specific payment options were:
  

• Facilities operated by Federal and tribal governments were least likely to accept cash or self-payment (43 and 46 percent, respectively). Private for-profit and Federal government-operated facilities were less likely to accept Medicare, Medicaid, or State-financed health insurance than were facilities operated by private non-profits and State, local, or tribal governments.
• Acceptance of Access to Recovery vouchers was reported in 26 States or jurisdictions. The proportion of facilities accepting Access to Recovery vouchers ranged from 8 percent in New Jersey to 75 percent in Rhode Island [Table 6.19b].¹⁷
• Use of a sliding fee scale was reported by 62 percent of all facilities, ranging from 16 percent of facilities operated by the Federal government to 82 percent of facilities operated by local governments.
• Facilities operated by tribal governments were the most likely to accept IHS/638¹⁸ contract care funds (63 percent).
• Treatment at no charge for persons who cannot afford to pay was offered by 50 percent of all facilities, ranging from 21 percent of private for-profit facilities to 82 percent of facilities operated by tribal governments.
  

Facility Funding

Table 4.19. Facilities were asked if they received Federal, State, or local government funds or grants to support their substance abuse treatment programs.

• Overall, 59 percent of facilities reported receiving government funds to support substance abuse treatment programs. The proportions were highest in facilities operated by local or tribal governments (88 and 87 percent, respectively). Seventy-four percent of programs operated by private non-profit organizations reported receiving public funds compared to 23 percent of facilities operated by private for-profit organizations.  

Facilities with Opioid Treatment Programs

Opioid Treatment Programs (OTPs) are certified by SAMHSA 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.

• Tables 2.3 and 4.20. Clients receiving methadone or buprenorphine in OTPs accounted for 26 percent of all clients in treatment on March 31, 2011, although OTPs were available in only 1,189 (9 percent) of all substance abuse treatment facilities.
• Tables 4.1 and 4.20. Private for-profit organizations operated 54 percent of OTPs but only 31 percent of all substance abuse treatment facilities.
• Table 4.20. Of the 313,460 clients receiving medication-assisted opioid therapy in OTPs, 98 percent (306,440) received methadone and 2 percent (7,020 clients) received buprenorphine. The remaining 25,656 clients that received buprenorphine were treated in non-OTP facilities.
  • More than half (56 percent) of clients receiving methadone were in private for-profit facilities with OTPs. Most (93 percent) of the clients receiving methadone were in facilities whose primary focus was the provision of substance abuse treatment services.
  • Clients receiving buprenorphine in OTPs were more likely than clients receiving methadone to be in Federal government-operated facilities (13 vs. 1 percent).
  • Almost all clients receiving buprenorphine in OTPs were in facilities whose primary focus was either the provision of substance abuse treatment services (70 percent) or a mix of mental health and substance abuse treatment services (25 percent).
• Table 4.21b. Most facilities with OTPs offered outpatient treatment (93 percent). Eighty-nine percent offered outpatient methadone maintenance, and 49 percent offered detoxification.
• Tables 4.16b and 4.22b. Facilities with OTPs were more likely than all facilities combined to be licensed, certified, or accredited by a State department of health (59 vs. 42 percent), the Joint Commission (29 vs. 19 percent), CARF (67 vs. 23 percent), or State substance abuse agencies (90 vs. 83 percent).
  

Counseling Services Offered by Facilities

• Table 4.23. Individual counseling was the most frequently reported form of counseling, by 98 percent of facilities, and marital/couples counseling was reported least frequently, by 60 percent of facilities.

Facility Smoking Policy

• Table 4.24. Fifty-five percent of facilities permitted smoking outdoors compared to 34 percent of facilities that did not allow smoking on the property or within any building.
  

To Chapter 4 Tables

Table of Contents