Highlights

This report presents results from the 2007 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. Selected findings are given below.

• The N-SSATS facility response rate in 2007 was 94.5 percent. Thirty-four States or jurisdictions had response rates that equalled or surpassed the overall rate [Tables 1.1 and 6.1].
• A total of 14,359 facilities completed the survey. The 13,648 facilities eligible for this report had a one-day census of 1,135,425 clients enrolled in substance abuse treatment on March 30, 2007 [Tables 1.1 and 3.1].
  
• There were 85,518 clients under age 18 in treatment on March 30, 2007, making up 8 percent of the total population in treatment on that date [Table 6.4a and 6.4b].
  

Trends in Facility and Client Characteristics

• The facility retention rate (facilities responding to N-SSATS that had also responded to the previous year’s survey) was between 86 and 90 percent in every year from 2003 to 2007. About 10 to 15 percent of the facilities had closed or were no longer providing substance abuse treatment, but were replaced by similar numbers of new facilities [Table 2.1].
• The total number of substance abuse treatment facilities remained relatively constant between 2003 and 2007, while the number of clients in treatment increased slightly. There were 13,623 facilities reporting in 2003 and 13,648 facilities in 2007. The number of clients in treatment on the survey reference date increased by 4 percent, from 1,092,546 in 2003 to 1,135,425 in 2007 [Tables 2.2 and 3.1].
  
• The operational structure of the substance abuse treatment system changed very little from 2003 to 2007. Private non-profit organizations operated 61 percent of all facilities in 2003 and decreased slightly but steadily to 58 percent in 2007. However, the proportion of clients in private non-profit facilities remained at 55 to 56 percent of all clients during that period. Private for-profit organizations operated 25 percent of all facilities in 2003, increasing slightly but steadily to 29 percent in 2007. The proportion of clients in private for-profit facilities also increased, from 26 percent in 2003 to 30 percent in 2007. Government-operated facilities maintained stable proportions of both facilities and clients between 2003 and 2007 [Tables 2.2 and 3.1 and Figures 1 and 5].
  
• The primary focus of activity of facilities changed slightly from 2003 to 2007. Facilities whose primary focus was the provision of substance abuse treatment services made up 61 to 62 percent of all facilities between 2003 and 2007, and treated 68 to 69 percent of all clients. Facilities providing a mix of mental health and substance abuse treatment services increased slightly as a percentage of all facilities, from 26 percent in 2003 to 29 percent in 2007; the proportion of clients treated in these facilities also increased slightly, from 23 percent in 2003 to 26 percent in 2007. Facilities whose primary focus was the provision of mental health services made up 7 to 8 percent of all facilities and treated 4 to 5 percent of all clients. Facilities whose primary focus was general health care made up only 1 to 2 percent of all facilities and treated only 1 or 2 percent of all clients [Tables 2.2 and 3.1 and Figure 2].
  
• The major types of care—outpatient, residential (non-hospital), and hospital inpatient—were stable between 2003 and 2007 in terms of the proportions of both facilities and clients in treatment. Outpatient treatment was provided by 80 to 81 percent of all facilities from 2003 to 2007, and 89 to 90 percent of all clients received outpatient care. Residential (non-hospital) treatment was provided by 27 to 28 percent of all facilities, and 9 to 10 percent of all clients received this type of care. Hospital inpatient treatment was provided by 7 to 9 percent of all facilities, and 1 percent of all clients received this type of care [Tables 2.3 and 3.2 and Figures 3 and 6].
• Opioid Treatment Programs certified by SAMHSA for the provision of therapy with methadone and buprenorphine were provided by 8 to 9 percent of all facilities between 2003 and 2007. The proportion of clients receiving methadone ranged from 21 percent to 23 percent in that period [Tables 2.3 and 3.2 and Figures 3 and 6].
• Agreements or contracts with managed care organizations were reported by 51 percent of all facilities in 2003; this proportion fell to 47 percent in 2007. Similarly, the proportion of clients in facilities with managed care agreements or contracts fell from 52 percent of all clients in 2003 to 48 percent in 2007 [Tables 2.4 and 3.4 and Figures 4 and 7].
• The client substance abuse problem treated fluctuated slightly between 2003 and 2007. Clients in treatment for both drug and alcohol abuse made up 45 to 47 percent of all clients from 2003 to 2007. Clients in treatment for drug abuse only increased slightly but steadily, from 33 percent in 2003 to 36 percent in 2007. The proportion of clients treated for alcohol abuse ranged from 18 to 20 percent between 2003 and 2007 [Table 3.3].
• Clients under age 18 made up 8 percent of all clients in treatment in every year from 2003 through 2007. The type of care received by clients under age 18 differed little from that received by adults, and was stable between 2003 and 2007. Outpatient care was received by 87 to 88 percent, residential (non-hospital) care by 11 to 12 percent, and hospital inpatient care by 1 percent. The proportion of clients under age 18 in treatment facilities with special programs or groups for adolescents ranged from 82 to 85 percent between 2003 and 2007 [Tables 3.5, 6.3b, and Figure 8].

Facility Operation

• Private non-profit organizations operated 58 percent of all facilities on March 30, 2007, and were treating 55 percent of all clients. Private for-profit organizations operated 29 percent of all facilities on March 30, 2007, and were treating 30 percent of all clients. Local governments operated 6 percent of all facilities on March 30, 2007, and were treating 8 percent of all clients, State governments operated 3 percent of all facilities on March 30, 2007, and were treating 4 percent of all clients. The Federal government operated 2 percent of all facilities on March 30, 2007, and was treating 3 percent of all clients. Tribal governments operated 1 percent of all facilities on March 30, 2007, and were treating 1 percent of all clients [Tables 4.1 and 5.1].

Primary Focus

• The provision of substance abuse treatment services was the primary focus of activity of 61 percent of facilities on March 30, 2007, with 68 percent of all clients in treatment. A mix of mental health and substance abuse treatment services was the primary focus of 29 percent of facilities on March 30, 2007, with 26 percent of all clients in treatment. The provision of mental health services was the primary focus of 7 percent of facilities on March 30, 2007, with 4 percent of all clients in treatment. General health care was the primary focus of 1 percent of facilities on March 30, 2007, with 1 percent of all clients in treatment [Tables 4.1 and 5.1].
  

Type of Care

• Outpatient treatment was offered by 81 percent of all facilities on March 30, 2007, and reported 1,016,913 clients (90 percent of all clients) in treatment on that date. On March 30, 2007:
  - Regular outpatient care was offered by 74 percent of facilities and had 52 percent of clients.
  - Intensive outpatient care was offered by 44 percent of facilities and had 12 percent of clients.
  - Outpatient day treatment/partial hospitalization was offered by 15 percent of facilities and had 2 percent of clients.
  - Outpatient detoxification was offered by 11 percent of facilities and had 1 percent of clients.
  - Outpatient methadone/buprenorphine maintenance was offered by 10 percent of facilities and had 22 percent of clients [Tables 4.2b, 5.2a, and 5.2b].
• Residential (non-hospital) treatment was offered by 27 percent of all facilities on March 30, 2007, and reported 103,709 clients (9 percent of all clients) in treatment on that date. On March 30, 2007:
  - Residential (non-hospital) long-term treatment was offered by 22 percent of facilities and had 6 percent of clients.
  - Residential (non-hospital) short-term treatment was offered by 13 percent of facilities and had 2 percent of clients.
  - Residential (non-hospital) detoxification was offered by 7 percent of facilities and had less than 1 percent of clients [Tables 4.2b, 5.2a, and 5.2b]
• Hospital inpatient treatment was offered by 7 percent of all facilities on March 30, 2007, and reported 14,803 clients (1 percent of all clients) in treatment on that date. On March 30, 2007:
  - Hospital inpatient detoxification was offered by 6 percent of facilities and had less than 1 percent of clients.
  - Hospital inpatient treatment was offered by 5 percent of facilities and had less than 1 percent of clients [Tables 4.2b, 5.2a, and 5.2b].

Client Substance Abuse Problem and Co-occurring Mental Health Disorders

• On March 30, 2007, 45 percent of all clients were in treatment for both alcohol and drug abuse, 36 percent were in treatment for drug abuse only, and 19 percent were in treatment for abuse of alcohol alone [Tables 4.3 and 5.3].
• Eighty-seven percent of facilities had clients in treatment for co-occurring mental health and substance abuse disorders. Forty percent of all clients were in treatment for these disorders [Tables 4.3 and 5.3].
• In the United States, there were 459 clients in treatment per 100,000 population aged 18 and older on March 30, 2007. The rate was highest for persons with both alcohol and drug problems (203 per 100,000 population aged 18 and older), followed by drug abuse only (170 per 100,000), and alcohol abuse only (86 per 100,000) [Table 6.33].

Facility Size

• The median number of clients in substance abuse treatment at a facility on March 30, 2007, was 42 [Table 4.4].
• Facility size varied by type of care offered. In facilities offering outpatient care, the median number of clients in treatment on March 30, 2007, was 48. By type of outpatient care, however, the median ranged from 1 client in outpatient detoxification to 30 clients in regular outpatient care and to 132 clients receiving outpatient methadone/buprenorphine maintenance. In facilities offering residential (non-hospital) care, the median number of clients was 18, and in hospital inpatient facilities, it was 9 [Table 4.4].
• Facilities whose focus was the provision of mental health services tended to be smaller than facilities whose focus was the provision of substance abuse treatment [Table 4.5].
  

Facility Capacity and Utilization Rates

• On March 30, 2007, 92 percent of all residential (non-hospital) beds and 84 percent of all hospital inpatient beds designated for substance abuse treatment were in use [Tables 4.6 and 4.7].
• 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, while 43 percent of facilities with hospital inpatient beds had utilization rates in that range [Tables 4.6 and 4.7].

Services Provided

• Screening for substance abuse, comprehensive substance abuse assessment or diagnosis, individual counseling, group counseling, drug or alcohol urine screening, discharge planning, aftercare/continuing care, substance abuse education, and case management were each provided by 75 percent or more of all facilities [Tables 4.8 and 4.9].
• Screening for mental health disorders; family counseling; breathalyzer or other blood alcohol testing; social skills development; HIV or AIDS education, counseling, or support; mental health services; and assistance with obtaining social services were each provided by between 50 and 74 percent of all facilities [Tables 4.8 and 4.9].
  

Clinical/Therapeutic Approaches

• Substance abuse counseling and relapse prevention were used often by almost all facilities (96 percent and 91 percent, respectively). Cognitive-behavioral therapy, a 12-step approach, anger management, motivational interviewing, and brief intervention were each used sometimes or often by 80 to 90 percent of all facilities. Trauma-related counseling was used sometimes or often by 65 percent, and contingency management by 50 percent [Table 4.10].
  

Programs or Groups for Specific Client Types

• Overall, 82 percent of facilities offered programs or groups designed to address the specific needs of specific client types. Special programs or groups for clients with co-occurring mental health and substance abuse disorders were provided by 37 percent of facilities, for adult women by 32 percent, for adolescents and DUI/DWI offenders by 31 percent each, for criminal justice clients by 27 percent, and for adult men by 25 percent. Less frequently offered were programs or groups for pregnant or postpartum women (14 percent), persons with HIV or AIDS (10 percent), seniors or older adults (7 percent), and gays or lesbians (6 percent) [Table 4.11b].
  

Services in Sign Language and in Languages Other than English

• Substance abuse treatment services in sign language for the hearing impaired were offered in 30 percent of all facilities [Table 4.12b].
• Of the facilities offering substance abuse treatment services in a language other than English, 42 percent reported that the services were provided by staff counselors only, 38 percent by on-call interpreters, and 20 percent by both staff counselors and on-call interpreters [Table 4.12b].
• Spanish was the most commonly reported language among facilities using staff counselors to provide treatment services in languages other than English. It was reported by 91 percent of these facilities. American Indian/Alaska Native languages were offered in 4 percent of these facilities overall and in 90 percent of those operated by tribal governments and in 73 percent of those operated by the Indian Health Service [Table 4.12b].
  

Client Detoxification Substances

• 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 [Table 4.13].

Client Outreach

• A hot-line responding to substance abuse problems was operated by 22 percent of all facilities [Table 4.14].
  
• Web sites providing information about a facility’s substance abuse treatment programs were maintained by 65 percent of all facilities [Table 4.14].

Facility Licensing, Certification, or Accreditation

• Ninety-five 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; and the State mental health department, 34 percent. JCAHO and CARF were cited as accrediting organizations by 21 percent and 20 percent of all facilities [Table 4.15b].
  
• Facility licensing, certification, or accreditation was 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 [Table 4.16b].

Standard Operating Procedures

• Almost all the practices listed were used as standard operating procedures by 80 percent or more of all facilities. Continuing education for staff was required by 95 percent of all facilities, supervisor case review by 93 percent, client satisfaction surveys by 89 percent, client drug testing by 83 percent, and utilization reviews by 81 percent [Table 4.17b].
  

Payment Options

• A sliding fee scale for substance abuse treatment charges was used by 62 percent of all facilities. More than half of all facilities accepted cash or self-payment (60 percent), Medicare (54 percent), or private health insurance (52 percent), and 52 percent offered treatment at no charge to eligible clients who could not pay [Table 4.18b].
• Access to Recovery (ATR) vouchers were accepted by between 11 percent and 63 percent of all facilities in the 14 States in which they were available [Table 6.20b].

Facility Funding

• Sixty percent of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services. 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) [Table 4.19].

Facilities with Opioid Treatment Programs (OTPs)

• Opioid Treatment Programs (OTPs) were available at 8 percent of all substance abuse treatment facilities on March 30, 2007, and clients receiving methadone or buprenorphine accounted for 23 percent of all clients in treatment [Tables 2.3 and 3.2].
• Fifty percent of OTPs were operated by private for-profit organizations, compared to 29 percent of all substance abuse treatment facilities [Tables 4.1 and 4.20].
• Facilities with OTPs were likely to be dedicated almost entirely to medication-assisted therapy (treatment including methadone or buprenorphine). Overall, 89 percent of clients in facilities with OTPs on March 30, 2007, were receiving methadone or buprenorphine [Table 4.20].
• Most facilities with OTPs offered outpatient treatment (93 percent). Outpatient methadone/buprenorphine maintenance was offered in 90 percent, regular outpatient treatment in 62 percent, detoxification in 51 percent, intensive outpatient treatment in 27 percent, and day treat/partial hospitalization in 9 percent. Residential (non-hospital) treatment was offered by 9 percent, and hospital inpatient treatment were offered by 10 percent of facilities with OTPs [Table 4.21a].
• 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 [Table 4.20].

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