Chapter 1

Discharge Data Description and Data Overview for All Types of Service: TEDS 2008

Data Definitions
Data Overview
Reason for Discharge by Type of Service
Median LOS by Type of Service and Reason for Discharge
Characteristics at Admission
Treatment Completion or Transfer to Further Treatment

This report presents data from the Treatment Episode Data Set (TEDS) for discharges from treatment in 2008. It is a companion to the reports Treatment Episode Data Set (TEDS): 1998-2008 National Admissions to Substance Abuse Treatment and Treatment Episode Data Set (TEDS): 1998-2008 State Admissions to Substance Abuse Treatment. These reports provide information on the demographic and substance abuse characteristics of substance abuse treatment admissions and discharges aged 12 and older in facilities that report to individual State administrative data systems. Data in this report include records for discharges during calendar year 2008 that were received and processed through May 6, 2010.1


1 For researchers interested in more detailed analysis, TEDS public use files are available for online data analysis or download at the Substance Abuse and Mental Health Data Archive, which can be accessed at http://www.icpsr.umich.edu/icpsrweb/SAMHDA/.
Summary 2009 data for individual States that have submitted the full year of data are available online through the TEDS Quick Statistics website at http://wwwdasis.samhsa.gov/webt/NewMapv1.htm.


TEDS does not include all admissions to substance abuse treatment. It includes admissions to facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. Additional information on the history and methodology of TEDS and this report as well as important issues related to State data collection systems are detailed in Appendix A.

TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to and discharged from treatment twice within a calendar year would be counted as two discharges.

Data in this report are presented for specific service types rather than for treatment episodes, which can involve treatment in multiple service types. 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 linked pairs of admission/transfer and discharge records enable analyses of treatment completion and length of stay (LOS) in treatment in specific service types.

This chapter describes the discharge data and provides an overview of the linked admission/discharge records for discharges aged 12 and older in 2008. Some tables in this report present data by State or jurisdiction. It is important to note that comparisons between and across States and jurisdictions should be made with caution. There are many factors (e.g., facilities included, clients included, ability to track multi-service episodes, services offered, and completeness and timeliness of reporting) that can affect comparability. See Appendix A for a full discussion.

Data Definitions

Type of Service

Data are presented for each of eight different types of service (listed below). The first six service types exclude records where medication-assisted (i.e., with methadone or buprenorphine) opioid therapy or detoxification was planned as part of treatment; the other two service types include only medication-assisted opioid therapy or detoxification records:

Medication-assisted opioid therapy discharges from short- and long-term residential treatment and hospital residential treatment represented less than 1 percent of all records. They are excluded from the chapters that detail the eight specific service types listed above.

Reason for Discharge

The reasons for discharge from substance abuse treatment tabulated in this report include:

Because both treatment completion and transfer to further treatment represent positive conclusions to a treatment episode or component of a treatment episode, their rates are combined in some of the analyses.

Length of Stay (LOS) in Treatment

The length of stay (LOS) in days was calculated for each record by subtracting the date of admission from the date of last contact. For all outpatient service types, one day was added so that both the day of admission and the day of last contact were counted as days on which services were delivered. For hospital and residential service types, this was not done, and records where the date of admission and the date of last contact were the same (LOS = 0 days) were excluded from the analysis. The measure of LOS used in this report is the median—the number of days at which half of all discharges had taken place.

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.

Data Overview

Forty-seven States and jurisdictions submitted 1,907,193 eligible records for discharges aged 12 and older occurring in 2008. (Alabama, Georgia, New Mexico, Pennsylvania, and West Virginia submitted no data or incomplete data for 2008 and are excluded from this report.)

Table 1.1a-b. Of the 1,907,193 eligible discharge records, 85 percent (n = 1,626,740) could be linked to a TEDS admission or transfer record from 2000 through 2008. These 1,626,740 records form the basis of this report. Most of the 2008 discharge records linked to an admission or transfer occurring in 2008 (66 percent of the total discharge records). Seventeen percent were linked to an admission or transfer occurring in 2007; 2 percent linked to records from 2000 to 2006.

Type of Service

Tables 1.2a-b. These tables present type of service at discharge by State for 2008 discharges aged 12 and older. There was considerable State-to-State variability in the combination of service types available and in the proportions discharged from each of these service types.

Figure 1.1 illustrates the overall distribution of service type among 2008 discharges aged 12 and over: 42 percent of all 2008 discharges aged 12 and older were from outpatient treatment, 20 percent were from detoxification, 12 percent were from intensive outpatient treatment, 12 percent were from short-term residential treatment, 8 percent were from long-term residential treatment, 5 percent were from medication-assisted opioid therapy or detoxification, and less than 1 percent were from hospital residential treatment.

Figure 1.1
Type of service at discharge: TEDS 2008

Pie chart comparing Type of service at discharge: TEDS 2008

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, Treatment Episode Data Set (TEDS). Data received through 5.06.10.

Reason for Discharge

Tables 1.3a-b. These tables present reason for discharge by State. Figure 1.2 illustrates the overall distribution of reason for discharge among 2008 discharges aged 12 and over.

Almost half (47 percent) of all discharges aged 12 and over completed treatment. Another 14 percent were referred to further substance abuse treatment. Twenty-five percent dropped out of treatment, 6 percent had their treatment terminated at the facility's request, 2 percent were incarcerated during treatment, and 5 percent failed to complete treatment for other reasons.

Figure 1.2
Reason for discharge: TEDS 2008

Pie chart comparing Reason for discharge: TEDS 2008

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, Treatment Episode Data Set (TEDS). Data received through 5.06.10.

Reason for Discharge by Type of Service

Table 1.4 and Figure 1.3 present reason for discharge by type of service. The treatment completion rate was highest among discharges aged 12 and older from detoxification (65 percent), followed by short-term residential treatment (55 percent), long-term residential treatment (46 percent), and hospital residential treatment (45 percent). Completion rates were lower in less structured settings: 42 percent for outpatient treatment and 36 percent for intensive outpatient treatment. The completion rate for medication-assisted opioid detoxification was 41 percent and for outpatient medication-assisted opioid therapy only 15 percent.

Transfer to further substance abuse treatment was most common among discharges aged 12 and older from hospital residential treatment (31 percent). The rate was lower for intensive outpatient treatment (22 percent), outpatient medication-assisted opioid therapy (18 percent), short-term residential treatment (18 percent), and medication-assisted opioid detoxification (17 percent).

Treatment dropout was highest among discharges aged 12 and older from outpatient medication-assisted opioid therapy (40 percent) and medication-assisted opioid detoxification (39 percent).

Figure 1.3
Reason for discharge, by type of service: TEDS 2008

Stacked bar chart comparing Reason for discharge, by type of service: TEDS 2008

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, Treatment Episode Data Set (TEDS). Data received through 5.06.10.

Median LOS by Type of Service and Reason for Discharge

Table 1.4. The median LOS was longest for discharges aged 12 and older from outpatient medication-assisted opioid therapy (155 days), followed by outpatient treatment (92 days), long-term residential treatment (59 days), and intensive outpatient treatment (56 days). The median LOS for all discharges from short-term residential treatment was 24 days; from medication-assisted opioid detoxification, 10 days; from hospital residential treatment, 6 days; and from detoxification, 4 days.

Figure 1.4. In all service types except medication-assisted opioid detoxification, the median LOS for discharges aged 12 and older who completed treatment was longer than or equal to those who transferred to further treatment or who did not complete treatment. Among discharges aged 12 and older completing treatment, the median LOS was longest for outpatient medication-assisted opioid therapy (197 days), followed by outpatient treatment (124 days), long-term residential treatment (90 days), and intensive outpatient treatment (74 days). The median LOS for treatment completers in short-term residential treatment was 27 days; for hospital residential treatment, 16 days; for medication-assisted opioid detoxification, 5 days; and for detoxification, 4 days.

Figure 1.4
Median length of stay, by reason for discharge and type of service: TEDS 2008

Bar chart comparing Median length of stay, by reason for discharge and type of service: TEDS 2008

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, Treatment Episode Data Set (TEDS). Data received through 5.06.10.

Characteristics at Admission

Tables 1.5 and 1.6 summarize the number and percent distribution of selected characteristics at admission for all discharges aged 12 and older and for discharges aged 12 and older by service type. Summary findings of the admission characteristics of all discharges aged 12 and older combined include:

Characteristics at Admission by Type of Service

Table 1.6. Although the characteristics at admission of discharges aged 12 and older varied by service type, some general observations can be made.

Treatment Completion or Transfer to Further Treatment

Table 1.7 presents the percentage of discharges aged 12 and older either completing treatment or transferring to further treatment by selected characteristics at admission, for all discharges and by service type. For all service types combined, the combined treatment completion/transfer rate was 62 percent.

Completion/transfer rates were generally similar within admission characteristics, but varied widely by service type. Treatment completion/transfer rates ranged from 31 percent among discharges aged 12 and older from outpatient medication-assisted opioid therapy to 87 percent among discharges aged 12 and older from hospital residential treatment, while the largest variation by admission characteristic was for primary substance, ranging from 51 percent for opiates to 68 percent for unknown or unspecified substance.

Some general observations can be made about the completion/transfer rate for all discharges aged 12 and older combined:

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