Introduction
Limitations of TEDS
Interpretation of the Data

Introduction

This report presents results from the Treatment Episode Data Set (TEDS) for 2007, and trend data for 1997 to 2007. The report provides information on the demographic and substance abuse characteristics of the annual admissions to treatment for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems. The Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages collection of TEDS data from the States. (Additional information on TEDS, its history, and its relationship to SAMHSA’s other data collection activities can be found in Appendix A.)

The TEDS system comprises two major components, the Admissions Data Set and the Discharge Data Set. The TEDS Admissions Data Set is an established program that has been operational since 1992. It includes data on treatment admissions that are routinely collected by States to monitor their individual substance abuse treatment systems. The TEDS Discharge Data Set is more recently established, with the first data reported for Year 2000. For both data sets, selected data items from the individual State data files are converted to a standardized format consistent across States. These standardized data constitute TEDS.

The TEDS Admissions Data System consists of a Minimum Data Set collected by all States, and a Supplemental Data Set collected by some States. The Minimum Data Set consists of 19 items that include:

• Demographic information
• Primary, secondary, and tertiary substances and their route of administration, frequency of use, and age at first use
• Source of referral to treatment
• Number of prior treatment episodes
• Service type, including planned use of medication-assisted opioid therapy

The Supplemental Data Set consists of 15 items that include psychiatric, social, and economic measures.

The TEDS Discharge Data System was designed to enable TEDS to collect information on entire treatment episodes. Discharge data, when linked to admissions data, represent treatment episodes that enable analyses of questions that cannot be answered with admissions data alone. Examples are the proportion of discharges that completed treatment and the average length of stay of treatment completers. Results from the TEDS Discharge Data System are published in a separate report.

Definitions and classifications used in the Admissions Minimum and Supplemental Data Sets are detailed in Appendix B.

Limitations of TEDS

TEDS, while comprising a significant proportion of all admissions to substance abuse treatment, does not include all such admissions. TEDS is a compilation of facility data from State administrative systems. The scope of facilities included in TEDS is affected by differences in State licensure, certification, and accreditation practices, and disbursement of public funds. For example, some State substance abuse agencies regulate private facilities and individual practitioners, while others do not. In some States, hospital-based substance abuse treatment facilities are not licensed through the State substance abuse agency. Some State substance abuse agencies track correctional facilities (State prisons and local jails), while others do not.

In general, facilities reporting TEDS data receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. (See Chapter 4.) Most States are able to report all admissions to all eligible facilities, although some report only admissions financed by public funds. States may report data from facilities that do not receive public funds, but generally do not because of the difficulty in obtaining data from these facilities. TEDS generally does not include data on facilities operated by Federal agencies, including the Bureau of Prisons, the Department of Defense, and the Department of Veterans
Affairs. However, some facilities operated by the Indian Health Service are included.

The primary goal of TEDS is to monitor the characteristics of treatment episodes for substance abusers. Implicit in the concept of treatment is a planned, continuing treatment regimen. Thus TEDS does not include early intervention programs that are considered to be prevention programs. Crisis intervention facilities such as sobering-up stations and hospital emergency departments generally are not included in TEDS.

TEDS is an exceptionally large and powerful data set. Like all data sets, however, care must be taken that interpretation does not extend beyond the limitations of the data. Limitations fall into two broad categories: those related to the scope of the data collection system, and those related to the difficulties of aggregating data from highly diverse State data collection systems.

Limitations to be kept in mind while analyzing TEDS admissions data include:

• TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
• TEDS attempts to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different service type (for example, from residential treatment to outpatient) within a single continuous treatment episode. However, States differ greatly in their ability to identify transfers; some can distinguish transfers within providers but not across providers. (See Chapter 4 and Table 4.1.) Some admission records in fact may represent transfers, and therefore the number of admissions reported probably overestimates the number of treatment episodes.
• The number and client mix of TEDS admissions do not represent the total national demand for substance abuse treatment or the prevalence of substance abuse in the general population.
• The primary, secondary, and tertiary substances of abuse reported to TEDS are those substances that led to the treatment episode, and not necessarily a complete enumeration of all drugs used at the time of admission.
• States continually review the quality of their data processing. When systematic errors are identified, States may revise or replace historical TEDS data files. While this process represents an improvement in the data system, the historical statistics in this report will differ slightly from those in earlier reports.

Interpretation of the Data

Considerations specific to this report include:

• The report includes admissions records for calendar years 1997 through 2007 that were received and processed by SAMHSA through October 6, 2008.
• SAMHSA, in reporting national-level TEDS data, must balance timeliness of reporting and completeness of the data set. This can result in a time lag in the publication of annual data because preparation of the report is delayed until nearly all States have completed their data submission for that year. Summary statistics for individual States that have completed their 2007 submissions are available on-line at: http://oas.samhsa.gov
• States rely on individual facilities to report in a timely manner so they can in turn report data to SAMHSA at regular intervals. Admissions from facilities that report late to the States may appear in a later data submission to SAMHSA. Thus the number of admissions reported for 2007 may increase as submissions of 2007 data continue. However, additional submissions are unlikely to have a significant effect on the percentage distributions that are the basis of this report.
• The report focuses on treatment admissions for substance abusers. Thus admissions for treatment as a codependent of a substance abuser are excluded. Records for identifiable transfers within a single treatment episode are also excluded.
• Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable, those records are excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.
• Variables in the Supplemental Data Set (Tables 3.8-3.13) are not collected by all States. States that did not collect a specific variable are excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.
• Primary alcohol admissions are characterized as alcohol only or alcohol with secondary drug. Alcohol with secondary drug indicates a primary alcohol admission with a specified secondary drug. All other alcohol admissions are classified as alcohol only.
• Cocaine admissions are classified according to route of administration as smoked and other route. Smoked cocaine primarily represents crack or rock cocaine, but can also include cocaine hydrochloride (powder cocaine) when it is free-based. Non-smoked cocaine includes all cocaine admissions where cocaine is injected, inhaled, or taken orally; it also includes admissions where the route of administration is unknown or not collected. Thus the TEDS estimate of admissions for smoked cocaine is conservative.
• Methamphetamine/amphetamine admissions include admissions for both substances, but are primarily for methamphetamine. Methamphetamine constitutes about 96 percent of combined methamphetamine/amphetamine admissions. Oregon and Texas, States with large numbers of methamphetamine admissions, reported them as Other amphetamines until 2005 and 2006, respectively.
• For this report, secondary and tertiary substances (see Appendix B) are grouped and referred to as secondary substances.
• Tables 2.3a to 2.8b, 4.5, 4.6a, and 4.6b, and Figures 3 to 8 show trends in State admission rates. Data were not submitted for one or more years in some States or jurisdictions because of changes to their data collection systems. These States were: Alabama (2007), Alaska (2004-2007), Arizona (1997), the District of Columbia (2004-2006), Georgia (2006-2007), Indiana (1997), Mississippi (2007), and West Virginia (1997-1998, 2000, and 2007).
  
  In addition, significant changes in the clients or facilities reported to TEDS by some States and jurisdictions can result in changes in the number of admissions large enough to influence trends. For these States, rates are not indicated on Figures 3 to 8 for the years affected, although the actual data reported are included in Tables 2.3a-2.8b. In this report, only Louisiana (1997) is affected.

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