Chapter 2
Discharge Data Description and Data Overview for All Types of Service: 2005

Data Definitions
Comparison of Discharge and Admission Data
State Data
Data Overview
Client Characteristics
Client Characteristics Associated with Completion of Treatment or Transfer to Further Treatment

Chapter 2 describes the discharge data and provides an overview of the 1,454,768 linked admission/discharge records for clients discharged in 2005 in 34 reporting States [Table 2.2a]. Discharge data linked to admissions data represent treatment episodes that enable analyses of treatment completion and length of stay (LOS) in treatment.

Data Definitions

Reason for Discharge

The different reasons for discharge are listed below. Because both treatment completion and transfer to further treatment represent positive conclusions to 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 earlier of either the date of last contact (if available) or the date of discharge. Both the day of admission and the day of discharge were counted as full days for all outpatient service types. For hospital and residential service types, a stay of less than one day was counted as a full day. Two measures of LOS are included: the median—the number of days at which half of all clients had been discharged—and the average (or mean). The average LOS was calculated by summing the number of days in treatment for all Year 2005 discharges and dividing the total by the number of discharges in 2005.

For each type of service, the average LOS was longer, often much longer, than the median LOS, indicating that the distribution of LOS was skewed. In other words, while half of all clients had been discharged by the median LOS, some of the remainder had exceptionally long stays, ranging up to the maximum possible in this analysis, 4 years (about 1,460 days) [Appendix C]. Many of these exceptionally long periods may be the result of administrative procedures in which records for clients who had dropped out of the system were periodically “purged.” In this case, if the date of last contact with these clients was unknown, the records were assigned a discharge date that represented the date of the administrative procedure.

Type of Service

Data are presented for each of eight discrete types of service. Treatment completion rates, median LOS, and average LOS were not aggregated across service types. There was significant State-to-State variation in types of services available [Tables 2.3a and 2.3b]. Treatment completion rates, median LOS in treatment, and average LOS in treatment varied considerably among the service types [Tables 2.5 and 2.6].

Six service types exclude records where opioid replacement therapy was planned as part of treatment:

a) Free-standing residential detoxification—24-hour per day services in a non-hospital setting providing for safe withdrawal and transition to ongoing treatment (89 percent of all discharges from detoxification);
b) Ambulatory detoxification—Outpatient treatment services providing for safe withdrawal in an ambulatory setting (7 percent of all discharges from detoxification); and
c) Hospital detoxification—24-hour per day acute medical care services in a hospital setting for persons with severe medical complications associated with withdrawal (4 percent of all discharges from detoxification).

Opioid replacement therapy (medication-assisted therapy with methadone or buprenorphine) can be used in any service type [Table 2.6]. In 2005, 65 percent of discharges from opioid replacement therapy were from an outpatient setting and 31 percent of discharges from opioid replacement therapy were from detoxification. Data are presented in separate chapters for:

No data are presented on the 4 percent of opioid replacement therapy discharges in other service types because there are so few records.

Comparison of Discharge and Admission Data

Tables 2.1a and 2.1b present the distribution of key variables for all Year 2005 admissions, for Year 2005 admissions in the 34 States submitting usable discharge data, and for linked and non-linked Year 2005 discharge records in the 34 States reporting discharge data. These tables indicate that admission characteristics for the discharges submitted by the 34 States were similar to the admission characteristics in all States.

State Data

Data Linkage

Tables 2.2a and 2.2b.A total of 1,519,415 records for clients discharged in Year 2005 were submitted by 34 States. Ninety-six percent of these discharge records (n = 1,454,768) could be linked to a TEDS admission record from 2002, 2003, 2004, or 2005. No matching admission record was found in those years for 64,647 of the Year 2005 discharges.

Type of Service

Tables 2.3a and 2.3b and Figure 2.1 present type of service at discharge by State for the 34 States that submitted discharge data in 2005. There was considerable State-to-State variability in the combination of service types available and in the proportions of clients in each of these service types.

Overall, 45 percent of discharges were from outpatient treatment, 22 percent were from detoxification, 9 percent each were from intensive outpatient treatment and from short-term residential treatment, 8 percent were from long-term residential treatment, 6 percent were from opioid replacement therapy, and 1 percent were from hospital residential treatment.

Figure 2.1
Type of service at discharge: TEDS 2005

Pie chart comparing type of Service at discharge in TEDS 2005

 

* Opioid replacement therapy discharges may be any service type.
SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.03.06.

Reason for Discharge

Tables 2.4a and 2.4b present reason for discharge by State. Overall, 41 percent of the Year 2005 discharges completed treatment, 13 percent were transferred to further treatment, and 24 percent dropped out of treatment. Eight percent had treatment terminated by the facility, 2 percent had treatment terminated because of incarceration, less than 1 percent died, and 7 percent failed to complete treatment for other reasons. The reason for discharge was unknown for 6 percent of discharges.*


* Percentages do not sum to 100 percent because of rounding.

Data Overview

Primary Substance

Tables 2.1a and 2.1b. More than a third (38 percent) of all Year 2005 linked discharges reported primary alcohol abuse at admission. Nineteen percent reported opiate abuse, 15 percent reported marijuana abuse, 14 percent reported cocaine abuse, 10 percent reported stimulant abuse, and 4 percent reported abuse of other substances at admission.

Reason for Discharge by Type of Service

Table 2.5 and Figure 2.2 present reason for discharge by type of service. Of the 1,370,716 Year 2005 discharges who reported a reason for discharge, 44 percent completed treatment and 14 percent transferred to another treatment program. One quarter (25 percent) dropped out of treatment, while the treatment of an additional 8 percent was terminated by the facility. Nine percent left treatment for other reasons.

The treatment completion rate was greater than 50 percent among discharges from hospital residential treatment (67 percent), detoxification (65 percent), and short-term residential treatment (56 percent). Completion rates were lower in longer-term and less structured settings: 39 percent for long-term residential treatment and 36 percent for both intensive outpatient treatment and outpatient treatment.

The completion rate was lowest among discharges from opioid replacement therapy (19 percent). Of those who were discharged from opioid replacement therapy, 41 percent dropped out of treatment. Opioid replacement therapy could be in any type of service; for more detail on opioid replacement therapy discharges, see Table 2.6 and Chapters 9 and 10.

Discharges from intensive outpatient treatment were the most likely to have been transferred to further substance abuse treatment (19 percent). In each of the other service types, 12 percent to 18 percent were transferred to further treatment.

Figure 2.2
Reason for discharge, by type of service: TEDS 2005

Stacked bar chart comparing Reason for discharge, by type of service in TEDS 2005

* Opioid replacement therapy discharges may be any service type.
SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.03.06.

Median LOS by Reason for Discharge and Type of Service

Table 2.5 and Figure 2.3.The median LOS among all non-opioid replacement therapy discharges was longest for discharges from outpatient treatment (76 days), followed by long-term residential treatment (53 days) and intensive outpatient treatment (46 days). The median LOS for all discharges from short-term residential treatment was 21 days; from hospital residential treatment, 16 days; and from detoxification, 3 days.

The median LOS among non-opioid replacement therapy completers was longest for outpatient treatment (117 days), followed by long-term residential treatment (90 days) and intensive outpatient treatment (59 days). The median LOS for treatment completers in short-term residential treatment was 25 days; for hospital residential treatment, 19 days; and for detoxification, 4 days.

In most service types, the median LOS was longer for discharges who completed treatment than for those who transferred to further treatment. Detoxification and opioid replacement therapy discharges were exceptions. In turn, the median LOS among those who did not complete treatment was generally shorter than among either treatment completers or transfers.

Figure 2.3
Median length of stay, by reason for discharge and type of service: TEDS 2005

Bar chart comparing Median length of stay, by reason for discharge and type of service in TEDS 2005

* Opioid replacement therapy discharges may be any service type.
SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.03.06.

Average LOS by Reason for Discharge and Type of Service

Table 2.5 and Figure 2.4. The average LOS among all non-opioid replacement therapy discharges was longest for discharges from outpatient treatment (117 days), followed by long-term residential treatment (88 days) and intensive outpatient treatment (79 days). The average LOS for all discharges from hospital residential treatment was 48 days; from short-term residential treatment, 26 days; and from detoxification, 9 days.

The average LOS among non-opioid replacement therapy completers was longest for outpatient treatment (152 days), followed by long-term residential treatment (128 days), and intensive outpatient treatment (91 days). The average LOS for treatment completers in hospital residential treatment was 55 days; for short-term residential treatment, 27 days; and for detoxification, 7 days.

The average LOS for treatment completers was generally longer than for clients who transferred to further treatment, similar to the pattern seen for median LOS.

Figure 2.4
Average length of stay, by reason for discharge and type of service: TEDS 2005

Bar chart comparing Average length of stay, by reason for discharge and type of service in TEDS 2005

* Opioid replacement therapy discharges may be any service type.
SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.03.06.

Discharges from Opioid Replacement Therapy

Table 2.6. There were 75,682 discharges where records showed that opioid replacement therapy was planned at the time of admission and where data could be linked to admission records from 2002 to 2005, and where data indicated reason for discharge. These records were limited to opioid replacement therapy that began and ended within a maximum period of 4 years and, because opioid replacement therapy can extend for a much longer period, may not be representative of all opioid replacement therapy discharges. Sixty-five percent of opioid replacement therapy discharges were from outpatient treatment (including both outpatient and intensive outpatient treatment), 31 percent from detoxification, 2 percent each from long-term residential treatment and short-term residential treatment, and less than 1 percent from hospital residential treatment.

The treatment completion rate for discharges from opioid replacement therapy was 19 percent overall, but varied by type of service. It was 11 percent among discharges from outpatient opioid replacement therapy and 35 percent among discharges from opioid replacement detoxification. The completion rate was higher among the few discharges from more structured settings, at 51 percent for short-term residential treatment, 50 percent for hospital residential treatment, and 27 percent for long-term residential treatment.

The median LOS for all clients discharged from opioid replacement therapy was longest (128 days) among outpatient opioid replacement therapy discharges. The median LOS was 9 days among opioid replacement detoxification discharges, and it was between 8 days and 69 days for opioid replacement therapy discharges from the other service types.

The median LOS for opioid replacement therapy discharges completing treatment was longest (180 days) among outpatient opioid replacement therapy completers. The median LOS was 7 days among opioid replacement detoxification completers, and it was between 5 days and 108 days for opioid replacement therapy completers from the other service types.

The average LOS for all clients discharged from opioid replacement therapy was longest (245 days) among outpatient opioid replacement therapy discharges. The average LOS was 32 days among opioid replacement detoxification discharges, and it was between 22 days and 129 days for opioid replacement therapy discharges from the other service types.

The average LOS for opioid replacement therapy discharges completing treatment was longest (289 days) among outpatient opioid replacement therapy completers. The average LOS was 21 days among opioid replacement detoxification completers, and it was between 22 days and 191 days for opioid replacement therapy completers from the other service types.

Client Characteristics

Table 2.7 summarizes the distributions of the client characteristics included in this report for all discharges and by service type. Each chapter about a specific service type highlights significant differences from all discharges combined for that service type.

Among all discharges combined, the majority (68 percent) were male. Fifty-six percent were non-Hispanic White. The largest age groups were 31 to 40 years (29 percent), 21 to 30 years (26 percent), and 41 to 50 years (25 percent). Fourteen percent were under age 21, and nine percent were over age 50.

Alcohol was the most common primary substance, reported by 39 percent. Daily use at admission of the primary substance was reported by 43 percent. The most common age group for beginning to use the primary substance was 15 to 17 years.

Almost half (45 percent) of discharges had never been in treatment before. About one-third were referred to treatment by the criminal justice system (35 percent), while an equal proportion (34 percent) were self- or individually referred.

Almost half of all discharges (44 percent) were not in the labor force. Forty-four percent also reported completing 12 years of education or a GED.

Client Characteristics Associated with Treatment Completion or Transfer to Further Treatment

Two of the Reason for discharge categories, treatment completion and transfer to further substance abuse treatment, represent positive conclusions to a treatment episode. A statistical analysis of the client characteristics associated with treatment completion or transfer to further treatment was conducted and is presented below.

To examine the client characteristics associated with treatment completion or transfer to further treatment, univariate logistic regression was conducted for all service types combined and for each service type separately. Then, a multivariate conditional logistic regression model was used to identify, for all service types combined and for each service type separately, client characteristics that remained associated with treatment completion or transfer to further treatment when controlled for the other client characteristics.*


* To examine the client characteristics associated with substance abuse treatment completion or transfer to further treatment, the variables representing these characteristics were dichotomized. (See Tables 2.7a and 2.7b.) Univariate logistic regression was conducted for all service types combined and for each service type separately to test whether the client characteristic was related to completion of treatment or transfer to further treatment for that service type. Logistic regression yields an odds ratio, that is, the odds of one group completing treatment or transferring to further treatment over the odds of the other group completing treatment or transferring. For example, the odds ratio among all discharges combined for males completing treatment or transferring to further treatment versus females completing treatment or transferring is 1.148 (Table 2.7a). This can be expressed as a percentage; that is, male discharges were 14.8 percent more likely than female discharges to complete treatment or transfer to further treatment.

Many of the client characteristics are related to each other, and the univariate odds ratio can reflect that interrelatedness. For example, if both age and gender are related to treatment completion or transfer, and age is related to gender, then calculation of the univariate odds ratios for age and gender will effectively count some treatment completers twice (i.e., once in the age calculation and once in the gender calculation). To produce an odds ratio for age that is independent of (or adjusted for) the odds ratio for gender, and vice versa, a multivariate conditional logistic regression model is used. In this analysis, for each service type and for all service types combined, client characteristics that were associated with treatment completion or transfer to further treatment at the significance level of p < 0.05 were used in SAS software stepwise regression procedures (alpha = 0.001 to enter or remove).

Note: Age at first use was reported for 83 percent of all discharges, and for less than 85 percent of discharges from outpatient treatment (78 percent), long-term residential treatment (69 percent), outpatient opioid replacement therapy (80 percent), and opioid replacement detoxification (46 percent). Number of prior treatment episodes was reported for 83 percent of all discharges, and for less than 85 percent of discharges from short-term residential treatment (82 percent) and detoxification (66 percent). Both variables were excluded from the multiple logistic regression analyses.

Univariate Analyses of Discharges from All Service Types Combined

Table 2.8a presents the odds ratio, 95 percent confidence interval, and p value from the univariate analyses of each client characteristic for all service types combined and for each service type separately.

In univariate analyses of discharges from all service types combined, all client characteristics were associated with treatment completion or transfer to further treatment:

Univariate Analyses of Discharges from Individual Service Types

Among the individual service types, univariate analyses demonstrated that, for discharges from outpatient treatment, intensive outpatient treatment, short-term residential treatment, long-term residential treatment, and detoxification, each client characteristic was significantly associated with treatment completion or transfer to further treatment.

For discharges from hospital residential treatment, outpatient opioid replacement therapy, and opioid replacement detoxification, the majority of the client characteristics were significantly associated with treatment completion or transfer to further treatment.

Multivariate Analysis of Discharges from All Service Types Combined

Table 2.8b presents the odds ratio, 95 percent confidence interval, and p value from the multivariate analyses of each client characteristic for all services types combined and for each service type separately.

Among all discharges combined, all of the client characteristics remained significantly associated with treatment completion or transfer to further treatment. However, the association was weakened for most client characteristics when adjusted for the presence of the other client characteristics in the model:

The association of two client characteristics, prior treatment and referral source, were strengthened after adjustment for the other client characteristics in the model.

Multivariate Analyses of Discharges from Individual Service Types

Table 2.8b and Figure 2.5. For the multiple conditional logistic regression models, a different set of predictors of treatment completion or transfer to further treatment was evident for each of the different service types. Some client characteristics that displayed significant univariate associations with treatment completion or transfer to further treatment were no longer significant when the other client characteristics in the model were taken into account.

Overall model fit was good for most of the multivariate analyses (p < 0.0001). It was weaker for hospital residential treatment (p = 0.0022) and opioid replacement detoxification (p = 0.0023), where the numbers of discharges were smallest (n = 7,301 and n = 15,895, respectively).

Figure 2.5
Odds ratios for client characteristics associated with treatment completion or transfer to further treatment, by type of service: TEDS 2005
Multiple conditional logistic regression1

Bar and scatter chart comparing Average length of stay, by reason for discharge
and type of service in TEDS 2005

1 Bars show client characteristics with significant effects at the p < 0.05 level or less. See Table 2.7b.
SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.03.06.

All discharges combined. For all discharges combined, the strongest predictor of treatment completion or transfer to further treatment was the use of alcohol rather than other drugs. Clients discharged from all types of service combined were 82 percent more likely to complete treatment or to transfer to further treatment if their primary substance was alcohol, after taking into account all other characteristics associated with that outcome.

The use of alcohol as a predictor was followed by all seven of the other variables, although their influence was much weaker. These included daily use (21 percent), being over 40 at admission (19 percent), having 12 or more years of education (14 percent), being White (13 percent), referral to treatment by the criminal justice system (9 percent), being employed (7 percent), and being male (5 percent).

Outpatient treatment. The strongest predictors of outpatient treatment completion or transfer to further treatment were referral to treatment by the criminal justice system (58 percent) and the use of alcohol as the primary substance (48 percent).

These were followed by weaker predictors that included being employed (27 percent), being non-Hispanic White (26 percent), less than daily use (14 percent), being female (10 percent), being over age 40 (9 percent), and having 12 or more years of education (5 percent).

Intensive outpatient treatment. The strongest predictors of intensive outpatient treatment completion or transfer to further treatment were the use of alcohol as the primary substance (36 percent), referral to treatment by the criminal justice system (34 percent), being employed (29 percent), and being non-Hispanic White (28 percent). Weaker predictors were less than daily use (15 percent), having 12 or more years of education (14 percent), being over age 40 (10 percent), and being male (9 percent).

Short-term residential treatment. The strongest predictors of short-term residential treatment completion or transfer to further treatment were the use of alcohol as the primary substance (50 percent), being employed (45 percent), and being over 40 (45 percent). Referral to treatment by the criminal justice system was slightly weaker (37 percent). The weakest predictors were having 12 or more years of education (25 percent), less than daily use (23 percent), being non-Hispanic White (11 percent). Gender was not a factor in short-term residential treatment completion or transfer to further treatment.

Long-term residential treatment. The strongest predictor of long-term residential treatment completion or transfer to further treatment was being employed (85 percent). Weaker predictors included use of alcohol as the primary substance (33 percent), being over 40 (31 percent), referral to treatment by the criminal justice system (28 percent), and being non-Hispanic White (27 percent). The weakest predictors were being female (15 percent), having 12 or more years of education (15 percent), and less than daily use (11 percent).

Hospital residential treatment. The strongest predictors of hospital residential treatment completion or transfer to further treatment were being employed (63 percent) and use of alcohol as the primary substance (62 percent). Weaker predictors included referral to treatment by the criminal justice system (34 percent), being non-Hispanic White (22 percent), and being male (15 percent). Age, frequency of substance use, and education were not factors in hospital residential treatment completion or transfer to further treatment.

Detoxification. The strongest predictors of detoxification completion or transfer to further treatment were less than daily use (89 percent) and use of alcohol as the primary substance (56 percent). Weaker predictors included being employed (29 percent), being over age 40 (27 percent), referral to treatment by the criminal justice system (22 percent), being from a racial/ethnic group other than non-Hispanic White (18 percent), and being female (11 percent). Having at least 12 years of education was the weakest predictor (5 percent).

Outpatient opioid replacement therapy.* The strongest predictors of outpatient opioid replacement therapy completion or transfer to further treatment were less than daily use of opiates at admission (34 percent) and being female (32 percent). Having at least 12 years of education was the weakest predictor (11 percent). Age, race/ethnicity, referral to treatment by the criminal justice system, and employment status were not factors in outpatient opioid replacement therapy completion or transfer to further treatment.

Opioid replacement detoxification.* The strongest predictor of opioid replacement detoxification completion or transfer to further treatment was referral to treatment by the criminal justice system (120 percent). Weaker predictors were having 12 or more years of education (21 percent), being female (13 percent), and being non-Hispanic White (13 percent). Age, frequency of use, and employment status were not factors in opioid replacement detoxification completion or transfer to further treatment.


* Alcohol vs. other substances was not included in the logistic regression analysis of outpatient opioid replacement therapy or opioid replacement detoxification services, as 94 percent and 67 percent, respectively, of discharges from these service types reported their primary substance as opiates.

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