Chapter 4

TEDS aggregates data collected through the data collection systems of the Single State 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.

State-to-State comparisons must be made with extreme caution. Table 4.1 presents key characteristics of State data collection systems for 2001. 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. Sources of apparent variation in State-to-State substance abuse patterns include:

• Completeness of reporting. Completeness of reporting at the cutoff date for preparation of this report varied from State to State. Future submissions of 2001 data are unlikely to affect the percentage distributions that are the basis of this report but may affect State-level counts and rates of admission. In addition, States review and improve their data collection and processing. Occasionally, States send revised data for earlier years to TEDS.
  
  Figure 26 shows, for individual States and jurisdictions, the number of admissions reported by month. States are grouped according to the maximum number of admissions reported in any month.
   
• Facilities included. Most States require facilities that receive State/public funding to report data to the State. "State/public funding" generally refers to funding distributed by the SSA, but may also include funding distributed through another public agency. Some States require that additional categories (e.g., private facilities, methadone clinics, etc.) also report. In some States, other categories of facilities report voluntarily. See Table 4.1 for additional details.
   
• Clients included. Most States report data on all clients in a facility that is required to report to the State. However, some States report only those clients whose treatment is paid for with State/public funds. See Table 4.1 for additional details.
   
• Admissions and transfers. Great variation is seen in the States' ability to identify and report client admissions and transfers. The goal for the TEDS system is to identify treatment episodes. Thus a change in service type or a change in provider, without an interruption in treatment, would ideally be categorized as a transfer. 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. About half of all States can identify transfers that occur when a client changes service type within the structure of a given provider. However, far fewer can identify a transfer that occurs when a client changes providers. Several States do not track transfers themselves, but report as transfers those clients who are discharged and readmitted within a specified time period (which may vary from State to State). See Table 4.1 for additional details. Annual counts of admissions, transfers, and codependents are shown in Tables 4.2a, 4.2b, and 4.2c.
   
• Data items. Not all States report all data items in the Minimum and Supplemental Data Sets. Most States report the Minimum Data Set for all or nearly all TEDS admissions. However, the items reported from the Supplemental Data Set vary across States.
  
  Tables 4.3 and 4.4 indicate, by State, the item response rates for the Minimum and Supplemental Data Sets.
   
• Treatment resources available. 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.
   
• Population subgroups. States may include or exclude reporting by certain sectors of the treatment population, and this relationship 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.
  
  As an illustration, the number of TEDS admissions reported in Texas declined significantly between 1995 and 1996. The most significant factor in this decline was that a substantial number of substance abuse clients treated through the criminal justice system were no longer reported to the State substance abuse agency. In addition, a reallocation of resources resulted in the closure of several detoxification units.

Table 4.5a presents, by State, the numbers of admissions aged 12 and over for 1992-2001. Table 4.5b presents, by State, admission rates per 100,000 population aged 12 and over for 1992-2001. Table 4.6 presents rates per 100,000 population adjusted for age, sex, and race/ethnicity. Age adjustment is used to take into account demographic variation across States. It compares the distributions under the assumption that each State's TEDS population and the U.S. population had the same age, sex, and racial/ethnic composition.

Table 4.7a presents, by State and primary substance, the numbers of admissions aged 12 and over for 2001. Tables 4.7b and 4.8 present the crude and adjusted rates, respectively, based on these admissions.

Interpretation of these tables and comparisons across States should be made cautiously and should take into account the many sources of variation detailed above.

Figure 26
Monthly admissions by State or jurisdiction TEDS: 1992-2001
All admissions and States reporting more than 10,000 admissions in any month

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

Figure 26a
Monthly admissions by State or jurisdiction TEDS: 1992-2001
10,000 or fewer admissions per month