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2007 National Survey of Substance Abuse Treatment Services (N-SSATS)

Chapter 4
Facility Characteristics and Services

Facility Operation and Primary Focus Type of Care Offered Client Substance Abuse Problem and Co-occurring Mental Health Disorders
Facility Size Facility Capacity and Utilization Rates Services Provided
Clinical/Therapeutic Approaches Programs or Groups for Specific Client Types Services in Sign Language for the Hearing Impaired and in Languages Other than English
Client Detoxification Substance Client Outreach Facility Licensing, Certification, or Accreditation
Facility Standard Operating Procedures Payment Options Facility Funding
Facilities with Opioid Treatment Programs (OTPs)

This chapter describes key characteristics of facilities and programs in 2007. Facilities are described in terms of operation, that is, the type of entity responsible for the operation of the facility: private non-profit; private for-profit; or government—local, county, or community; State; Federal; or tribal. They are also described in terms of the facility’s primary focus of activity: substance abuse treatment services; mental health services; a mix of mental health and substance abuse treatment services; general health care; and other.

Facility Operation and Primary Focus

Table 4.1. Private non-profit organizations operated 58 percent of all facilities on March 30, 2007. On that date, private for-profit organizations operated 29 percent of all facilities, local governments operated 6 percent, State governments operated 3 percent; the Federal government operated 2 percent, and tribal governments operated 1 percent of all facilities.

The provision of substance abuse treatment services was the focus of activity of 61 percent of all facilities on March 30, 2007. A mix of mental health and substance abuse treatment services was the focus of 29 percent of all facilities on that date; the provision of mental health services, 7 percent; and general health care, 1 percent.

These proportions were fairly constant for each operational type within a specific focus of activity, and vice versa. One notable exception was the relationship between facilities operated by the Federal government operation and those providing general health care. Twenty-nine percent of facilities focused on providing general health care were operated by the Federal government, and only 8 percent by private for-profit organizations. Conversely, 17 percent of facilities operated by the Federal government provided general health care. This association was largely because of facilities operated by the Department of Veterans Affairs (VA). Of the 328 facilities operated by the Federal government, 183 (56 percent) were operated by the VA and were generally hospital-based.1

Type of Care Offered

Tables 4.2a and 4.2b. Type of care offered is made up of three broad categories—outpatient treatment, residential (non-hospital) treatment, and hospital inpatient treatment. Each has several subcategories. A facility could offer more than one type of care.

Outpatient treatment was offered by 81 percent of all facilities on March 30, 2007. Regular outpatient care was offered by 74 percent of all facilities on that date, intensive outpatient treatment by 44 percent, outpatient day treatment/partial hospitalization by 15 percent, outpatient detoxification by 11 percent, and outpatient methadone/buprenorphine maintenance by 10 percent.

Outpatient treatment was offered in the majority of facilities in each of the operational categories (from 71 percent of State government-operated facilities to 98 percent of Federal government-operated facilities). It was also offered in the majority of each of the foci of activity (from 77 percent of facilities providing substance abuse treatment to 89 percent each of facilities providing a mix of mental heath and substance abuse treatment services and those providing mental health services.

Outpatient detoxification and outpatient methadone/buprenorphine maintenance were offered by relatively high proportions of Federal government-operated facilities (36 and 24 percent, respectively), driven by high proportions of VA-operated facilities (45 and 41 percent, respectively). Outpatient methadone/buprenorphine maintenance was also offered by a relatively high proportion of private for-profit facilities (17 percent).

Residential (non-hospital) treatment was offered by 27 percent of all facilities on March 30, 2007. Long-term treatment (more than 30 days) was offered by 22 percent of all facilities on that date, short-term care (30 days or fewer) by 13 percent, and detoxification by 7 percent.

Residential (non-hospital) treatment availability varied widely by facility operation (from 14 percent of private for-profit facilities to 35 percent of private non-profit facilities), and by facility focus of activity (from 9 percent of facilities providing mental health services to 34 percent of facilities providing substance abuse treatment services).

Hospital inpatient treatment was offered by 7 percent of all facilities on March 30, 2007. Detoxification was offered by 6 percent of all facilities on that date, and treatment by 5 percent.

Hospital inpatient treatment availability varied widely by facility operation. It was 27 percent in Federal government-operated facilities, but otherwise ranged from 3 to 13 percent. Availability also varied with facility focus of activity. It was 40 percent in facilities providing general health care, but otherwise ranged from 5 to 18 percent.

Client Substance Abuse Problem and Co-occurring Mental Health Disorders

Table 4.3. Almost all facilities (91 percent) had clients in treatment for both alcohol and drug abuse on March 30, 2007. Seventy-nine percent had clients in treatment for abuse of drugs alone, and 78 percent for abuse of alcohol alone. Most facilities (87 percent) also had clients in treatment with co-occurring substance abuse and mental health disorders. These proportions were relatively constant across facility operation categories and by the primary focus of the facility.

Facility Size

Table 4.4. The median number of clients in substance abuse treatment at a facility on March 30, 2007, was 42. The median number of clients ranged from 38 in facilities operated by tribal governments to 55 in facilities operated by local governments. The relatively high median number of clients in facilities operated by the Federal government (53 clients) is because of the median of 105 clients in treatment at VA facilities.

Facility size varied by type of care offered. In facilities offering outpatient care, the median number of clients was 48. However, this represented a range by type of outpatient care, from 1 client in outpatient detoxification on March 30, 2007, to 30 clients in regular outpatient care and 132 clients receiving outpatient methadone/buprenorphine maintenance. In facilities offering residential (non-hospital) care, the median number of clients in treatment on March 30, 2007, was 18. In hospital inpatient facilities, the median number of clients was 9.

The median number of clients also varied according to primary focus of the facility. It ranged from 20 clients in treatment in facilities focused on providing mental health services to 46 clients in treatment in facilities providing substance abuse treatment services.

Table 4.5. There was little difference in facility size by facility operation, but there were differences by the primary focus of the facility. Facilities with a primary focus on the provision of mental health services tended to be smaller than facilities providing substance abuse treatment services. Only 9 percent of facilities with a mental health focus had 120 or more clients in treatment on March 30, 2007, and 38 percent had fewer than 15 clients in treatment on that date. In contrast, 23 percent of facilities with a substance abuse treatment focus had 120 or more clients in treatment, while 17 percent had fewer than 15 clients in treatment.

Facility Capacity and Utilization Rates

Facilities were asked to report the number of residential (non-hospital) and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of residential (non-hospital) or hospital inpatient clients by the number of residential (non-hospital) or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates could be more than 100 percent.

Table 4.6. Some 3,260 facilities reported having 109,617 residential (non-hospital) beds designated for substance abuse treatment. On March 30, 2007, 92 percent of all residential (non-hospital) beds designated for substance abuse treatment were in use.2 In residential (non-hospital) facilities, utilization rates ranged from 85 percent in facilities operated by local governments to 96 percent in residential (non-hospital) facilities operated by State governments. By facility focus, utilization rates ranged from 88 percent in facilities providing general health care to 105 percent in facilities providing mental health treatment services.

Table 4.7. Some 921 facilities reported having 13,387 hospital inpatient beds designated for substance abuse treatment. On March 30, 2007, 84 percent of all hospital inpatient beds designated for substance abuse treatment were in use.3 In hospital inpatient facilities, utilization rates ranged from 71 percent in facilities operated by local governments to 104 percent in hospital inpatient facilities operated by Federal governments. By facility focus, utilization rates ranged from 65 percent in facilities focused on general health care to 106 percent in facilities focused on mental health services.

Figure 9 and Tables 4.6 and 4.7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds. Sixty percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent or more. Forty-three percent of facilities with hospital inpatient beds had utilization rates in that range, and 22 percent had utilization rates of 50 percent or less compared to only 7 percent of residential (non-hospital) facilities.

Services Provided

Facilities were asked about the types of services they provided. Services were grouped into six broad categories. (See Appendix B, the 2007 N‑SSATS Questionnaire, Questions 12-16 for specific services within each category.)

Figure 9
Residential (Non-Hospital) and Hospital Inpatient Utilization Rates:
March 30, 2007

Figure 9: Bar chart comparing Residential (Non-Hospital) and Hospital Inpatient Utilization Rates on March 30, 2007. Links to accessible data table below.

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration,
National Survey of Substance Abuse Treatment Services (N-SSATS), 2007.

Go to figure data tables 4.6 and 4.7

Tables 4.8 and 4.9. The majority of facilities provided one or more of the specific services in each category, although the availability of services varied by facility operation and primary focus.

Assessment and pre-treatment services. At least one of the six assessment and pre-treatment services was provided in 98 percent of all facilities. Facilities operated by Federal or tribal governments were most likely to offer any individual service. Private for-profit facilities were least likely to offer all but one of the services.

Screening for substance abuse was provided in 92 percent of all facilities and comprehensive substance abuse assessment was provided in 89 percent. There was little difference in provision of these services by facility operation or facility focus.

Screening for mental health disorders was provided in 60 percent of all facilities, and comprehensive mental health assessment in 42 percent. In facilities focused on providing mental health services or a mix of mental health and substance abuse treatment services, screening for mental health disorders was provided by 93 percent and 87 percent, respectively. Comprehensive mental health assessment was provided by 91 percent and 78 percent, respectively.

Outreach to persons in the community who may need treatment was provided by 49 percent of all facilities, ranging widely from 41 percent of private for-profit facilities to 86 percent of facilities operated by tribal governments. There was little variation by facility focus.

Interim services for clients when immediate admission was not possible were provided by 40 percent of all facilities, ranging from 33 percent of private for-profit facilities to 66 percent of facilities operated by tribal governments. There was little variation by facility focus.

Counseling. The use of counseling in substance treatment programs was reported by 99 percent of all facilities. Individual counseling was reported by 96 percent of all facilities, group counseling by 89 percent, and family counseling by 72 percent. Marital/couples counseling was used by less than half (45 percent) of all facilities. There was little variation in the provision of counseling services by facility operation or facility focus.

Pharmacotherapies. Pharmacotherapies were used in 47 percent of all facilities. Medications for psychiatric disorders were the most common pharmacotherapy (35 percent of all facilities), followed by Campral and Antabuse (17 percent each), nicotine replacement (16 percent), naltrexone (15 percent), buprenorphine (14 percent), and methadone (11 percent).

Availability differed widely by facility operation and facility focus. Pharmacotherapies were most likely to be used in Federal government-operated facilities (79 percent) and least likely to be used in tribal government-operated facilities (38 percent). Availability of pharmacotherapies by facility focus ranged from 37 percent of facilities providing substance abuse treatment services to 85 percent of facilities providing general health care.

Testing. Testing services were provided in 87 percent of all facilities. Urine screening for drugs or alcohol was the most common procedure (83 percent of all facilities), followed by breathalyzer or other blood alcohol testing (58 percent). Communicable disease testing was provided by a much smaller range of facilities—TB screening by 34 percent, HIV testing by 29 percent, Hepatitis C screening by 23 percent, Hepatitis B screening by 22 percent, and STD testing by 21 percent.

The availability of the communicable disease tests was generally more variable than that of the substance abuse tests, by both facility operation and facility focus. In facilities operated by the Federal government, each of the disease tests was provided in 65 percent or more of facilities, while communicable disease tests were available in only about 20 percent of privately operated facilities (both for-profit and non-profit).

Among facilities focused on general health care communicable disease tests were provided by 83 to 84 percent of facilities, but were available in only 21 to 34 percent of all other facilities.

Transitional services. Transitional services were provided by 96 percent of all facilities. Discharge planning was provided by 92 percent of all facilities, and aftercare/continuing care services by 81 percent. There was little variation in the provision of these services by facility operation of facility focus.

Ancillary services. One or more of the 17 specified ancillary services were provided by 99 percent of all facilities.

Ancillary services provided by more than half of all facilities included substance abuse education (94 percent); case management (76 percent); social skills development (66 percent); HIV or AIDS education, counseling, or support (56 percent); mental health services (54 percent); and assistance with obtaining social services (52 percent).

Ancillary services provided by 25 percent to 50 percent of facilities included health education other than HIV/AIDS (49 percent), self-help groups (47 percent), monitoring/peer support (45 percent), assistance in locating housing (43 percent), transportation assistance to treatment and domestic violence services (36 percent each), employment counseling (34 percent), and early intervention for HIV (25 percent).

Ancillary services that were rarely provided included child care for clients’ children (8 percent), and acupuncture and residential beds for clients’ children (4 percent each).

The provision of ancillary services varied widely by facility operation and facility focus. By facility operation, private for-profit facilities were the least likely to provide 15 of the 17 specified ancillary services. By facility focus, those providing mental health services were the least likely to provide 12 of the 17 specified ancillary services.

Clinical/Therapeutic Approaches

Table 4.10. A question about the frequency with which a facility used specific clinical/therapeutic approaches was added to the 2007 N-SSATS survey. Substance abuse counseling was reported to be used often by 96 percent of all facilities. Relapse prevention was used often by 91 percent of all facilities. Cognitive-behavioral therapy was used often by 68 percent of all facilities and used sometimes by 22 percent. A 12-step approach was used often by 66 percent of all facilities and used sometimes by 21 percent.

Approaches used less frequently were motivational interviewing (often, 56 percent; sometimes, 28 percent); anger management (often, 47 percent; sometimes, 39 percent); and brief intervention (often, 41 percent; sometimes, 41 percent). Approaches used least frequently were trauma-related counseling (often, 24 percent; sometimes, 41 percent; rarely or never, 32 percent).

Contingency management was used often by 20 percent all facilities, sometimes by 31 percent, and rarely or never by 32 percent. Nineteen percent responded that they were unfamiliar with this clinical/therapeutic approach.

Programs or Groups for Specific Client Types

Facilities may offer treatment programs or groups designed to address the specific needs of specific client types. These client types include adolescents, clients with co-occurring mental health and substance abuse disorders, persons with HIV or AIDS, gays or lesbians, and pregnant or postpartum women. Special programs or groups may also be offered for adult women, for adult men, and for seniors or older adults. Many facilities offer treatment for persons arrested while driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI), as well as for other criminal justice clients.

Tables 4.11a and 4.11b. Overall, 82 percent of facilities offered at least one special program or group to serve a specific client type. High proportions of facilities offering a broad range of special programs or groups were found in tribal government-operated and private non-profit facilities. Facilities operated by the Federal government were the least likely to offer special programs for most client types, and only 65 percent offered special programs for any client type.

Facilities providing a mix of substance abuse treatment and mental health services had high proportions of facilities offering a broad range of special programs or groups. Facilities providing general health care were the least likely to offer special programs for most client types, and only 65 percent offered special programs for any client type.

Clients with co-occurring mental health and substance abuse disorders. Programs or groups for clients with co-occurring mental health and substance abuse disorders were provided by 37 percent of all facilities. Availability was greatest in State government-operated facilities (49 percent) and in facilities providing a mix of mental health and substance abuse treatment services (52 percent).

Adult women. Special programs or groups for adult women were offered in 32 percent of all facilities. Availability was greatest in local government-operated facilities (39 percent) and in facilities providing substance abuse treatment services (35 percent).

Adolescents. Thirty-one percent of facilities offered programs or groups for adolescents. Availability was greatest in tribal government-operated facilities (47 percent) and in facilities providing a mix of mental health and substance abuse treatment services (42 percent).

DUI/DWI offenders. Special programs or groups for DUI/DWI offenders were offered by 31 percent of all facilities. Availability was greatest in private for-profit facilities (46 percent) and in facilities providing a mix of mental health and substance abuse treatment services (37 percent).

Criminal justice clients.4 Twenty-seven percent of all facilities provided programs or groups for criminal justice clients other than DUI/DWI offenders. Availability was greatest in local government-operated facilities (33 percent) and in facilities providing a mix of mental health and substance abuse treatment services (31 percent).

Adult men. Special programs or groups for adult men were offered in 25 percent of all facilities. Availability was greatest (28 percent each) in tribal government-operated facilities and in facilities providing substance abuse treatment services.

Pregnant or postpartum women. Programs or groups for pregnant or postpartum women were offered by 14 percent of all facilities. Availability was greatest in local government-operated facilities (20 percent) and in facilities providing substance abuse treatment services (16 percent).

Persons with HIV or AIDS. Ten percent of facilities offered programs or groups for persons with HIV or AIDS. There was little variation by facility operation or by facility focus. Availability was greatest in State government-operated facilities (14 percent) and in facilities providing general health care (11 percent).

Seniors or older adults. Seven percent of all facilities provided programs or groups for seniors or older adults. There was little variation by facility operation or by facility focus.

Gays or lesbians. Special programs or groups for gays or lesbians were offered in 6 percent of all facilities. There was little variation by facility operation or by facility focus.

Services in Sign Language for the Hearing Impaired and in Languages Other than English

Tables 4.12a and 4.12b. Substance abuse treatment services in sign language for the hearing impaired were offered in 30 percent of all facilities. Facilities operated by local and State governments were most likely to offer these services (48 percent and 43 percent, respectively), followed by private non-profits (34 percent). Facilities providing mental health services (39 percent), or a mix of mental health and substance abuse treatment services (35 percent) were the most likely to offer sign language.

Substance abuse treatment services in languages other than English were provided in 49 percent of all facilities. This proportion ranged from 28 percent in Federal government-operated facilities to 63 percent in local government-operated facilities. There was little variation according to the facilities’ primary focus, and the proportions offering treatment in languages other than English ranged from 40 to 52 percent among the languages specified.

Substance abuse treatment services in languages other than English could be provided by staff counselors, on-call interpreters, or both. Of the facilities offering these services, 42 percent reported that the services were provided by staff counselors only. Thirty-eight percent used on-call interpreters only, and 20 percent used both staff counselors and on-call interpreters.

Spanish was the most commonly reported language among facilities using staff counselors to provide services in languages other than English. It was reported by 91 percent of these facilities. Treatment services in American Indian/Alaska Native languages were offered in 4 percent of these facilities overall, but in 90 percent of those operated by tribal governments and in 73 percent of those operated by the Indian Health Service.

Client Detoxification Substance

In 2007, a question was added to the N-SSATS survey asking facilities that provided detoxification services about the specific substances for which these services were provided.

Table 4.13. Opiate detoxification was provided by 93 percent of all facilities that provided detoxification services, alcohol detoxification by 78 percent, cocaine detoxification by 64 percent, and detoxification from other substances by 39 percent. Medications were routinely used as part of the detoxification process in 84 percent of the facilities offering detoxification services.

Private for-profit detoxification facilities differed from private non-profit and government-operated facilities. Almost all (97 percent) reported opiate detoxification, but only 62 percent or less reported detoxification from other substances. Use of medications during detoxification was reported by 91 percent. Among detoxification facilities operated by other entities, tribal government-operated detoxification facilities were by far the least likely to offer detoxification from any of the substances listed, or to use medications during detoxification. Federal government operated detoxification facilities were most likely to report detoxification for most substances listed, as well as the use of medications during detoxification.

There was little variation by facility focus. However, 99 percent of facilities providing general health care offered alcohol detoxification, and 99 percent used medications during detoxification.

Client Outreach

Facilities were asked whether the facility operated a hot-line responding to substance abuse problems and whether it had a web site providing information about its substance abuse treatment programs.

Table 4.14. A hot-line responding to substance abuse problems was operated by 22 percent of all facilities. Hot-line operation varied widely by facility operation. Hot-lines were most common among local government-operated facilities (36 percent) and least common among Federal government-operated facilities (11 percent). There was less variation by facility focus.

Web sites providing information about a facility’s substance abuse treatment programs were maintained by 65 percent of all facilities. Web site availability varied widely by facility operation. Web sites were most common among private non-profit facilities (74 percent) and least common among tribal government-operated facilities (31 percent). There was less variation by facility focus.

Facility Licensing, Certification, or Accreditation

Facilities were asked to report the agencies or organizations that licensed, certified, or accredited them. These included the State substance abuse agency, mental health department, and public health department or board of health; hospital licensing authority; and other State/local agency or other organization. Also included were accreditation organizations: JCAHO, CARF, NCQA, and COA.5

Tables 4.15a and 4.15b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. The State substance abuse agency licensed, certified, or accredited 81 percent of facilities; the State public health department/board of health, 41 percent; the State mental health department, 34 percent; and the hospital licensing authority, 7 percent. JCAHO and CARF were cited as accrediting organizations by 21 percent and 20 percent of all facilities, respectively. Accreditation by COA or NCQA was relatively rare (5 percent and 3 percent, respectively). Eleven percent of all facilities reported licensing, certification, or accreditation by a State or local agency or other organization that was not specifically listed in the N-SSATS questionnaire.

Facility licensing, certification, or accreditation was associated with facility operation. Federal and tribal government-operated facilities were by far the least likely to be licensed, certified, or accredited by any of the State agencies. Private for-profit organizations and tribal government-operated facilities were most likely to report licensing by an agency or organization not listed on the questionnaire (15 percent and 14 percent, respectively). Conversely, they were least likely to report licensing by the hospital authority or accreditation by one of the organizations listed. Facilities operated by the Federal government were the most likely to report high rates of licensure or accreditation by JCAHO (80 percent), the hospital licensing authority (18 percent), and the NCQA (8 percent).

Facilities whose focus was the provision of mental health services reported high proportions of facilities licensed by the State mental health department, JCAHO, and the hospital licensing authority (70 percent, 36 percent, and 17 percent respectively). Facilities whose focus was general health care had high rates of licensure, certification, or accreditation by JCAHO and the hospital licensing authority (67 percent, 28 percent, respectively), but also by the NCQA (14 percent. Licensing rates for facilities focused on provision of a mix of substance abuse services and mental health treatment services generally fell between the rates for those providing substance abuse or mental health separately.

Tables 4.16a and 4.16b. Facility licensing, certification, or accreditation was also associated with the type of care offered. The State substance abuse agency licensed, certified, or accredited 82 percent each of facilities offering outpatient treatment and residential (non-hospital) treatment, but only 60 percent of facilities offering hospital inpatient treatment. Conversely, the State mental health department, licensed, certified, or accredited 46 percent of hospital inpatient facilities but only 36 percent of outpatient facilities and 26 percent of residential (non-hospital) facilities. Facilities offering hospital inpatient treatment and outpatient methadone maintenance were more likely than other types of care to be licensed, certified, or accredited by the State public health department/board of health.

Hospital inpatient facilities were most likely to be licensed by the hospital licensing authority (51 percent) and accredited by JCAHO (79 percent), NCQA (12 percent), and COA (6 percent). Several types of outpatient care (detoxification, day treatment/partial hospitalization, and methadone maintenance) also had relatively high rates of hospital authority licensure and agency accreditation, while rates for long-term residential facilities were relatively low.

Facility Standard Operating Procedures

Beginning in 2007, facilities were asked about specific practices they employed as standard operating procedures.

Tables 4.17a and 4.17b. Almost all the standard practices listed were used by 80 percent or more of all facilities. Continuing education for staff was the most widespread, required by 95 percent of all facilities, followed by supervisor case review (93 percent), client satisfaction surveys (89 percent), client drug testing (83 percent), and utilization reviews (81 percent). Case reviews by a quality assurance committee were conducted less frequently (67 percent), as was post-discharge outcome follow-up (64 percent).

There was little variation by facility operation or by facilities’ primary focus of activity, although certain types of facilities were considerably less likely to use some of the practices. These exceptions included supervisor case review, used by 75 percent of facilities providing general health care; client satisfaction surveys, conducted by 76 percent of tribal government-operated facilities; client drug testing, used by 51 percent of facilities providing mental health services; and utilization reviews, conducted by 68 percent of tribal government-operated facilities.

Payment Options

Tables 4.18a and 4.18b. More than half of all facilities accepted cash or self-payment (60 percent), Medicare (54 percent), or private health insurance (52 percent). Medicaid was accepted by 47 percent, State-financed health insurance by 41 percent, and Federal military insurance by 32 percent. Facilities operated by State and local governments and private non-profit facilities were generally the most likely to accept cash or self payment, Medicaid, Medicare, and State-financed health care, ranging from 46 to 64 percent. Facilities operated by the Federal government were the most likely to accept Federal military insurance (49 percent).

Facilities providing mental health services were the most likely to accept each of the payment types listed, while facilities providing substance abuse services were least likely to accept each of the payment types.

Access to Recovery (ATR) vouchers were accepted by 10 percent of all facilities. However, this program was offered in only 14 States;6 the acceptance rates ranged from 11 percent to 63 percent in those States [see Table 6.20a].

A sliding fee scale for substance abuse treatment charges was used by 62 percent of all facilities, but availability ranged from 12 percent of Federal government-operated facilities to 82 percent of local government-operated facilities.

More than half (52 percent) of all facilities offered treatment at no charge to eligible clients who could not pay, but availability ranged from 24 percent of private for-profit facilities to 81 percent of facilities operated by tribal governments.

Facility Funding

Facilities were asked about agreements or contracts with managed care organizations for the provision of substance abuse treatment services, and whether the facility received Federal, State, or local government funds for the provision of substance abuse treatment.

Table 4.19. Less than half of all facilities (46 percent) reported that they had agreements or contracts with managed care organizations for the provision of substance abuse treatment services. In general, private non-profit and private for-profit organizations were more likely to have such agreements or contracts (49 and 48 percent, respectively) than were government-operated facilities (41 percent or less). Facilities whose primary focus was the provision of mental health services or a mix of mental health and substance abuse treatment services were most likely to have agreements or contracts with managed care organizations (56 percent and 55 percent, respectively).

Sixty percent of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services. Not surprisingly, government-operated and private non-profit organizations were more likely to receive these funds than were private for-profit facilities (between 70 percent and 86 percent, compared to 22 percent for private for-profit organizations).

Facilities with Opioid Treatment Programs (OTPs)

Opioid Treatment Programs (OTPs) are certified by the Substance Abuse and Mental Health Services Administration to provide medication-assisted therapy in the treatment of opioid addiction. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of opioid addiction.

OTPs were available at 1,108 (8 percent) of all substance abuse treatment facilities on March 30, 2007 [Table 2.3]. Half (50 percent) of OTPs were operated by private for-profit organizations, compared to 29 percent of all substance abuse treatment facilities [Table 4.1].

Table 4.20. Over half (55 percent) of all OTPs provided both maintenance and detoxification. Thirty-seven percent provided maintenance only, and 8 percent provided detoxification only.

Facilities with OTPs were likely to be dedicated entirely or almost entirely to medication-assisted therapy. Overall, 89 percent of clients in treatment on March 30, 2007, in facilities with OTPs were receiving methadone or buprenorphine. This proportion was highest (97 percent) in private for-profit facilities and in facilities providing substance abuse treatment services (91 percent). Additionally, 68 percent of facilities certified as OTPs reported that all of the clients in treatment on March 30, 2007, were receiving either methadone or buprenorphine.

Of the 265,716 clients receiving one of the two medications approved for the treatment of opioid addiction, 99 percent received methadone and only 3,032 (1 percent) received buprenorphine.

Tables 4.21a and 4.21b. Most facilities with OTPs (93 percent) offered outpatient treatment. Residential (non-hospital) treatment were offered 9 percent, and hospital inpatient treatment were offered by 10 percent of all facilities with OTPs. Outpatient methadone/buprenorphine maintenance was offered in 90 percent of facilities with OTPs, regular outpatient treatment in 62 percent, detoxification in 51 percent, intensive outpatient treatment in 27 percent, and day treat/partial hospitalization in 9 percent.

Federal government-operated facilities with OTPs had the highest proportion of facilities offering more types of care. One-hundred percent of the Federal governement-operated facilities offered outpatient treatment, 46 percent offered hospital inpatient treatment, and 41 percent offered residential (non-hospital) treatment. Additionally, 100 percent offered outpatient methadone/buprenorphine maintenance. Private for-profit facilities with OTPs had the lowest proportions of facilities offering residential (non-hospital) and hospital inpatient treatment (4 percent each).

Facilities with OTPs providing substance abuse treatment services were most likely to offer outpatient treatment (94 percent), but least likely to offer residential (non-hospital) or hospital inpatient treatment (7 percent each). Facilities with OTPs providing mental health services were least likely to offer outpatient treatment (67 percent), but most likely to offer hospital inpatient treatment (67 percent).

Tables 4.22a and 4.22b. More than 99 percent of facilities with OTPs reported that they were licensed, certified, or accredited by one or more agencies or organizations. Most facilities with OTPs (86 percent) listed the State substance abuse agency, 58 percent listed the State public health department/board of health, and 21 percent listed the State mental health department. Accreditation was higher among facilities with OTPs than among facilities overall [Table 4.15b]. Accreditation by CARF was 63 percent, compared to 20 percent of all facilities. Accreditation by JCAHO was 33 percent, compared to 21 percent of all facilities. Twenty-four percent of facilities with OTPs reported licensing, certification, or accreditation by a State or local agency or organization that was not specifically listed in the N-SSATS questionnaire, as compared to 11 percent of all facilities combined [Table 4.15b].

Accreditation by JCAHO and CARF were generally inversely related. For example, accreditation by JCAHO was highest in facilities with OTPs that offered hospital inpatient treatment (91 percent), while accreditation by CARF in those facilities was only 20 percent. Conversely, accreditation by CARF was highest among outpatient treatment facilities (65 percent) while JCAHO accreditation was 30 percent.


1Of the 183 facilities operated by the VA, 162 (89 percent) reported that they were located in or operated by a hospital [data not shown].
2Residential (non-hospital) utilization rates are based on a subset of 3,042 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
3Hospital inpatient utilization rates are based on a subset of 560 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
4Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.
5JCAHO: Joint Commission on Accreditation of Healthcare Organizations; CARF: Commission on Accreditation of Rehabilitation Facilities; NCQA: National Committee for Quality Assurance; and COA: Council on Accreditation for Children and Family Services.
6California, Connecticut, Florida, Idaho, Illinois, Louisiana, Missouri, New Jersey, New Mexico, Tennessee, Texas, Washington, Wisconsin, and Wyoming.

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This page was last updated on January 30, 2009.