History
State Data Collection Systems
Report-Specific Considerations

Introduction

This report presents results from the Treatment Episode Data Set (TEDS) for discharges from substance abuse treatment. The Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages collection of TEDS data from the States.

The TEDS is a compilation of client-level data routinely collected by the individual State administrative data systems to monitor their substance abuse treatment systems. Generally, facilities that are required to report to the State substance abuse agency (SSA) are those that receive public funds and/or are licensed or certified by the SSA to provide substance abuse treatment (or are administratively tracked for other reasons).

TEDS is one of the three components of SAMHSA's Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse treatment. The other two components are:

• The Inventory of Substance Abuse Treatment Services (I-SATS), a continuously-updated comprehensive listing of all known public and private substance abuse treatment facilities.
• The National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of the location, characteristics, services offered, and utilization of alcohol and drug abuse treatment facilities in I-SATS.

The TEDS system comprises two major components, the Admissions Data Set and the Discharge Data Set. The TEDS Admissions Data Set includes client-level data on substance abuse treatment admissions from 1992 through the present. The TEDS Discharge Data Set can be linked at record level to admissions, and includes information from clients discharged in 2000 and later. 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 of items collected by all States, and a Supplemental Data Set where individual data items are reported at the States' option. 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 (not presented in this report) consists of 16 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.

History

National-level data collection on admissions to substance abuse treatment was first mandated in 1972 under the Drug Abuse Office and Treatment Act, P.L. 92-255. This act initiated Federal funding for drug treatment and rehabilitation, and required reporting on clients entering drug (but not alcohol) abuse treatment. The Client-Oriented Data Acquisition Process (CODAP) was developed to collect admission and discharge data directly from Federally-funded drug treatment programs. (Programs for treatment of alcohol abuse were not included.) Reporting was mandatory for all such programs, and data were collected using a standard form. CODAP included all clients in Federally-funded programs regardless of individual funding source. Reports were issued from 1973 to 1981 based on data from 1,800 to 2,000 programs, including some 200,000
annual admissions.

In 1981, collection of national-level data on admissions to substance abuse treatment was discontinued because of the introduction of the Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant. The Block Grant trans­ferred Federal funding from individual programs to the States for distribution, and it included no data reporting requirement. Participation in CODAP became voluntary; although several States submitted data through 1984, the data were in no way nationally representative.

In 1988, the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690) established a revised Substance Abuse Prevention and Treatment (SAPT) Block Grant and mandated Federal data collection on clients receiving treatment for either alcohol or drug abuse. The Treatment Episode Data Set (TEDS) data collection effort represents the Federal response to this mandate. TEDS began in 1989 with the issue of 3-year development grants to States.

State Data Collection Systems

TEDS is an exceptionally large and powerful data set that covers a significant proportion of all admissions to substance abuse treatment. TEDS is a compilation of data collected through the individual data collection systems of the State substance abuse agencies (SSAs) for substance abuse treatment. States have cooperated with the Federal Government in the data collection process, and substantial progress has been made toward developing a standardized data set. However, because each State system is unique and each State has u­nique powers and mandates, significant differences exist among State data collection systems. These differences are compounded by evolving health care payment systems, and State-to-State comparisons must be made with extreme caution.

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.

States differ widely in the amount of public funding available for substance abuse treatment and in the constraints placed on the use of funds. States may be directed to target special populations such as pregnant women or adolescents. Where funds are limited, States may be compelled to exercise triage in admitting persons to treatment, admitting only those with the most "severe" problems. In States with higher funding levels, a larger proportion of the population in need of treatment may be admitted, including the less severely impaired.

States may include or exclude reporting by certain sectors of the treatment population, and these sectors may change over time. For example, treat­ment programs based in the criminal justice system may or may not be administered through the State SSA. Detoxification facilities, which can generate large numbers of admissions, are not uniformly considered treatment facilities and are not uniformly reported by all States.

Appendix Table 1 presents key characteristics of State data collection systems for 2008. However, these characteristics can change as State substance abuse treatment systems change, and thus may be responsible for some year-to-year variation within States.

• Facilities included. The scope of facilities included in TEDS is affected by differences in State licensure, certification, and accreditation practices, and disbursement of public funds. Most SSAs require facilities that receive State/public funding (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services to report data to the SSA. Generally this funding is distributed by the SSA but may be distributed by another public agency.
  
  Some SSAs regulate private facilities, methadone clinics, and/or individual practitioners and require them to report TEDS data. Others do not because of the difficulty in obtaining data from these facilities, although these facilities may report voluntarily. Facilities operated by Federal agencies (e.g., the Bureau of Prisons, the Department of Defense, and the Department of Veterans Affairs) generally do not report TEDS data to the SSA, although some facilities operated by the Indian Health Service are included. Hospital-based substance abuse treatment facilities are frequently not licensed through the SSA and do not report TEDS data. Correctional facilities (State prisons and local jails) are monitored by the SSA and report TEDS data in some States but not in others.
  
  The primary goal of TEDS is to monitor the characteristics of clients admitted to planned, continuing treatment regimens. Thus early intervention and crisis intervention programs that do not lead to enrollment in continued treatment are excluded from TEDS.
  
  
• Clients included. About 60 percent of States reported data on all admissions to all eligible facilities, although some reported only, or largely, admissions financed by public funds. TEDS is an admission-based system; therefore, TEDS admissions do not represent individuals. For example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
  
  
• Ability to track multi-service episodes. The goal for the TEDS system is to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different service type (e.g., from residential treatment to outpatient) within a single continuous treatment episode. Thus TEDS records are ideally coded as admissions if they represent the initial treatment service in a treatment episode and as transfers if they represent a change in service type or a change in provider without an interruption in treatment.
  
  This requires, however, that clients be assigned unique IDs that can be linked across providers; not all States are legally and/or technologically able to do this. Most States can identify as transfers a change in service type within the structure of a given provider. However, fewer can also identify a transfer involving a change of provider. Several States do not track transfers, but instead report as transfers those clients who are discharged and readmitted within a specified (State-specific) time period.
  
  Because some admission records in fact may represent transfers, the number of admissions reported probably overestimates the number of treatment episodes. Some States reported a limited data set on codependents of substance abusers entering treatment. On average, from 1998 through 2008, 85 percent of all records submitted were client admissions, 15 percent were client transfers, and 2 percent were codependents of substance abusers.
  
  
• Services offered. A State's mix of service types (e.g., outpatient, detoxification, residential, opioid therapy) can have a significant effect on its admission rate. There is higher client turnover and therefore more admissions in short-stay services such as detoxification than in long-stay services such as outpatient or long-term residential treatment. Admission rates for individual substances of abuse may be affected as well (e.g., detoxification is more closely associated with alcohol or heroin use than with use of other substances.)¹
  
  
• Completeness and timeliness of reporting. SAMHSA, in reporting national-level TEDS data, must balance timeliness of reporting and completeness of the data set. There may be a time lag in the publication of SAMHSA's annual report because preparation cannot begin until States have completed their data submission for that year. States in turn rely on individual facilities to report in a timely manner so they can submit TEDS data to SAMHSA at regular intervals.
  
  Admissions from facilities that report late to the States will appear in a later data submission to SAMHSA, so the number of annual admissions in a report may be higher in subsequent reports. The number of additional admissions is small because of the time lag in issuing the report. Thus the percentage distributions will change very little in subsequent reports, although Census division and State-level data may change somewhat more for States with reporting delays.
  
  In addition, States continually review and improve their data collection and 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.
  
  Appendix Table 2 indicates the proportions of records by State or jurisdiction for which valid data were received for 2008. States are expected to report all variables in the Minimum Data Set.

Report-Specific Considerations

• The report focuses on treatment for substance abusers according to service type. Thus admissions for treatment as a codependent of a substance abuser are excluded. Records for identifiable transfers within a single treatment episode are included.
• Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable other than primary, secondary, or tertiary substance, those records are excluded from tabulations of that variable. For substance variables, missing or unknown responses were included in the category "Other." The total number of admissions on which a percentage distribution is based is reported in each table.
• States that did not collect a specific variable are excluded from tabulations of that variable. The total number of records on which a percentage distribution is based is reported in each table.
• 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.
• Stimulant admissions include methamphetamine, amphetamines, and other stimulants. However, over 90 percent are for methamphetamine.¹
• The data presented in this report focus on treatment for substance abusers within service type. They do not represent complete treatment episodes, as a single episode may involve stays in more than one service type. States are asked to submit a record for each initial admission to a treatment service, for each transfer from one service to another, and for a discharge corresponding to each admission or transfer.
• The number of States included in each of the service type chapters varies because not all States reported discharges for every service type. The first table for each chapter details the States reporting discharges of that service type.
• Linkage of discharge records from 2008 to admission records from 2000 to 2008 means that the maximum LOS in treatment included in this report is 9 years. However, outpatient medication-assisted opioid therapy can have a much longer duration. Indeed, some admissions may receive this form of treatment for an indefinite period. Because this report includes data only on discharges, it will underestimate LOS in treatment for those receiving outpatient medication-assisted opioid therapy. Similarly, the number and proportion of treatment completers will reflect only those who have been discharged because treatment is complete and not those who successfully remain in long-term outpatient medication-assisted opioid therapy. In addition, the characteristics at admission of those admitted to and discharged from outpatient medication-assisted opioid therapy within 9 years may differ from those of admissions who remain in outpatient medication-assisted opioid therapy for longer than 9 years.

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