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 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.
TEDS in the Context of DASIS
TEDS is one of the three components of SAMHSA’s Drug and Alcohol Services Information System (DASIS). DASIS is the primary source of national data on substance abuse treatment.
The core component of DASIS is the Inventory of Substance Abuse Treatment Services (I-SATS), a continuously-updated comprehensive listing of all known public and private substance abuse treatment facilities.
TEDS includes facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons), and that are required by the States to provide TEDS client-level data.
The third component of DASIS is 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.
Components of TEDS
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:
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. 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:
Interpretation of the Data
Considerations specific to this report include: