National Survey of Substance Abuse
Treatment Services (N-SSATS): 2013

Data on Substance Abuse Treatment Facilities

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

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Table of Contents


Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), by Synectics for Management Decisions, Inc. (Synectics), Arlington, Virginia. Data collection was performed by Mathematica Policy Research (Mathematica), Princeton, New Jersey. Work by Synectics and Mathematica was performed under Task Order HHSS283200700048I/HHSS28342001T, Reference No. 283-07-4803.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services.

Recommended Citation

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2013. Data on Substance Abuse Treatment Facilities. BHSIS Series S-73, HHS Publication No. (SMA) 14-4890. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at store.samhsa.gov

Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727)
(English and Español).

Originating Office

Center for Behavioral Health Statistics and Quality
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road, Room 2-1044
Rockville, Maryland 20857

September 2014

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Table of Contents


Table of Contents

Title Page

Acknowledgments

List of Tables

List of Figures

Highlights

Chapter 1. Description of the National Survey of Substance Abuse Treatment Services (N-SSATS)

Chapter 2. Trends in Facility Characteristics

Chapter 3. Trends in Client Characteristics

Chapter 4. Facility Characteristics and Services

Chapter 5. Client Characteristics

Chapter 6. State Data

Appendix A. N-SSATS Background

Appendix B. 2013 N-SSATS Questionnaire

Appendix C. Item Response and Imputation for N-SSATS 2013


List of Tables

Chapter 1

1.1 N-SSATS facilities, by status and mode of response: 2013

Chapter 2

2.1 Facility turnover: 2003-2013
Number and percent distribution

2.2 Facility operation: 2003-2013
Number and percent distribution

2.3 Facilities, by type of care offered, and facilities with Opioid Treatment Programs: 2003-2013
Number and percent

Chapter 3

3.1 Clients in treatment, by facility operation: 2003-2013
Number and percent distribution

3.2 Clients in treatment, by type of care received, and clients receiving methadone, buprenorphine, or Vivitrol®: 2003-2013
Number and percent distribution

3.3 Clients in treatment, by substance abuse problem and diagnosed co-occurring mental and substance abuse disorders: 2003-2013
Number and percent distribution

3.4 Clients under age 18 in treatment, by type of care received, and clients under age 18 in treatment in facilities offering specifically tailored programs or groups for adolescents: 2003-2013
Number and percent distribution

Chapter 4

4.1 Type of care offered, by facility operation: 2013
Number and percent

4.2 Type of client substance abuse problem treated and treatment of clients with diagnosed co-occurring mental and substance abuse disorders, by facility operation: March 29, 2013
Number and percent

4.3 Facility size, according to type of care offered, by facility operation: March 29, 2013
Median number of clients

4.4 Facility size in terms of number of clients, by facility operation: March 29, 2013
Number and percent distribution

4.5 Facility outpatient operational capacity, by facility operation: March 29, 2013
Number and percent distribution

4.6 Facility capacity and utilization of residential (non-hospital) care, by facility operation: March 29, 2013
Number, utilization rate, and percent distribution

4.7 Facility capacity and utilization of hospital inpatient care, by facility operation: March 29, 2013
Number, utilization rate, and percent distribution

4.8 Services provided, by facility operation: 2013
Number and percent

4.9 Facilities using counseling as part of their substance abuse treatment program, by facility operation: 2013
Number

4.10 Clinical/therapeutic approaches, by frequency of use: 2013
Number and percent distribution

4.11 Facilities offering specifically tailored programs or groups, by facility operation and client type: 2013
Number and percent

4.12 Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation: 2013
Number and percent

4.13 Facilities detoxifying clients, by substance and facility operation: 2013
Number and percent

4.14 Facilities with client outreach, by facility operation: 2013
Number and percent

4.15 Facility licensing, certification, or accreditation, by facility operation: 2013
Number and percent

4.16 Facility licensing, certification, or accreditation, by type of care offered: 2013
Number and percent

4.17 Facilities employing specific practices as part of their standard operating procedures, by facility operation: 2013
Number and percent

4.18 Types of client payments accepted by facility, by facility operation: 2013
Number and percent

4.19 Methods used to accomplish work at facility, by facility operation: 2013
Number and percent distribution

4.20 Facility funding, by facility operation: 2013
Number and percent

4.21 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medication-assisted opioid therapy at OTPs and other facilities, by facility operation: March 29, 2013
Number and percent distribution

4.22 Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation: 2013
Number and percent

4.23 Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2013
Number and percent

4.24 Facility smoking policy, by facility operation: 2013
Number and percent distribution

Chapter 5

5.1a Clients in treatment, according to type of care received, by facility operation: March 29, 2013
Number

5.1b Clients in treatment, according to type of care received, by facility operation: March 29, 2013
Row percent distribution

5.1c Clients in treatment, according to type of care received, by facility operation: March 29, 2013
Column percent distribution

5.2 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by facility operation: March 29, 2013
Number and percent

5.3 Clients under age 18 in treatment, according to type of care received, by facility operation: March 29, 2013
Number and percent distribution

Chapter 6

6.1 N-SSATS facilities, by status, response rate, mode of response, and state or jurisdiction: 2013

6.2a Facilities and clients in treatment, by state or jurisdiction: 2003-2013
Number

6.2b Facilities and clients in treatment, by state or jurisdiction: 2003-2013
Percent distribution

6.3a Clients under age 18 in treatment, and clients under age 18 in facilities offering specifically tailored programs or groups for adolescents, by state or jurisdiction: 2003-2013
Number

6.3b Clients under age 18 in treatment, and clients under age 18 in facilities offering specifically tailored programs or groups for adolescents, by state or jurisdiction: 2003-2013
Percent

6.4a Facility operation, by state or jurisdiction: 2013
Number

6.4b Facility operation, by state or jurisdiction: 2013
Percent distribution

6.5a Type of care offered, by state or jurisdiction: 2013
Number

6.5b Type of care offered, by state or jurisdiction: 2013
Percent

6.6 Client substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by state or jurisdiction: March 29, 2013
Number and percent

6.7 Facility size, according to type of care offered, by state or jurisdiction: March 29, 2013
Median number of clients

6.8 Facility size in terms of number of clients, by state or jurisdiction: March 29, 2013
Number and percent distribution

6.9 Facility capacity and utilization of residential (non-hospital) and hospital inpatient care, by state or jurisdiction: March 29, 2013
Number and utilization rate

6.10 Type of counseling used, by state or jurisdiction: 2013
Number and percent

6.11a Clinical/therapeutic approaches used always or often or sometimes, by state or jurisdiction: 2013
Number

6.11b Clinical/therapeutic approaches used always or often or sometimes, by state or jurisdiction: 2013
Percent

6.12a Facilities offering specifically tailored programs or groups for specific client types, by state or jurisdiction: 2013
Number and percent

6.12b Facilities offering specifically tailored programs or groups for specific client types, by state or jurisdiction: 2013
Number and percent

6.12c Facilities offering specifically tailored programs or groups for specific client types, by state or jurisdiction: 2013
Number and percent

6.13a Facilities offering services in sign language for the hearing impaired and in languages other than English, by state or jurisdiction: 2013
Number

6.13b Facilities offering services in sign language for the hearing impaired and in languages other than English, by state or jurisdiction: 2013
Percent

6.14 Facilities detoxifying clients, by substance and state or jurisdiction: 2013
Number and percent

6.15 Facilities with client outreach, by state or jurisdiction: 2013
Number and percent

6.16a Facility licensing, certification, or accreditation, by state or jurisdiction: 2013
Number

6.16b Facility licensing, certification, or accreditation, by state or jurisdiction: 2013
Percent

6.17a Facilities employing specific practices as part of their standard operating procedures, by state or jurisdiction: 2013
Number

6.17b Facilities employing specific practices as part of their standard operating procedures, by state or jurisdiction: 2013
Percent

6.18a Types of client payments accepted by facility, by state or jurisdiction: 2013
Number

6.18b Types of client payments accepted by facility, by state or jurisdiction: 2013
Percent

6.19 Facility funding, by state or jurisdiction: 2013
Number and percent

6.20 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medication-assisted opioid therapy at OTPs and other facilities, by state or jurisdiction: March 29, 2013
Number and percent distribution

6.21a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2013
Number

6.21b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2013
Percent

6.22a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2013
Number

6.22b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2013
Percent

6.23 Facility smoking policy, by state or jurisdiction: 2013
Number and percent distribution

6.24a Clients in treatment, according to facility operation, by state or jurisdiction: March 29, 2013
Number

6.24b Clients in treatment, according to facility operation, by state or jurisdiction: March 29, 2013
Percent distribution

6.25a Clients in treatment, according to type of care received, by state or jurisdiction: March 29, 2013
Number

6.25b Clients in treatment, according to type of care received, by state or jurisdiction: March 29, 2013
Percent distribution

6.26 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by state or jurisdiction: March 29, 2013
Number and percent distribution

6.27 Clients in treatment, according to counseling type, by state or jurisdiction: March 29, 2013
Number and percent

6.28a Clients under age 18 in treatment, according to facility operation, by state or jurisdiction: March 29, 2013
Number

6.28b Clients under age 18 in treatment, according to facility operation, by state or jurisdiction: March 29, 2013
Percent distribution

6.29 Clients under age 18 in treatment, according to type of care received, by state or jurisdiction: March 29, 2013
Number and percent distribution

6.30 Clients in treatment aged 18 and over, according to substance abuse problem, by state or jurisdiction: March 29, 2013
Number and clients per 100,000 population aged 18 and over

6.31 Clients in treatment, according to opioid treatment, by state or jurisdiction: March 29, 2013
Number and clients per 100,000 population

Appendix A

A.1 Survey contents: 1996-2013

Appendix C

C.1 N-SSATS item percentage response rates: 2013


List of Figures

Chapter 1

Figure 1 Survey Response Mode: 2003-2013

Chapter 2

Figure 2 Facility Operation: 2003-2013

Figure 3 Type of Care Offered and Facilities with Opioid Treatment Programs: 2003-2013

Chapter 3

Figure 4 Clients in Treatment, by Facility Operation: 2003-2013

Figure 5 Clients in Treatment, by Type of Care Received: 2003-2013

Chapter 4

Figure 6 Residential (Non-hospital) and Hospital Inpatient Utilization Rates: March 29, 2013

Chapter 6

Figure 7 Clients in Treatment per 100,000 Population Aged 18 and Over: March 29, 2013


Highlights

This report presents results from the 2013 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 alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other U.S. jurisdictions.1 It is important to note that values in charts, narrative lists, and percentage distributions are calculated using actual raw numbers and rounded for presentation in this report; calculations using rounded values may produce different results.


1 U.S. jurisdictions include the Federation of Micronesia, Guam, Palau, and Virgin Islands.

Trends in Facility and Client Characteristics 2003-2013


2 Data for the federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified federal agencies) are detailed in the tables.

Facility Operation—March 29, 2013

Primary Focus of Activity—March 29, 2013

Type of Care—March 29, 20133


3 Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.

Client Substance Abuse Problem and Diagnosed Co-occurring Mental and Substance Abuse Disorders—March 29, 2013

Facility Size and Utilization Rates—March 29, 2013

Medication-Assisted Opioid Therapy—March 29, 2013

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Table of Contents


Chapter 1

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

Data Collection Procedures for the 2013 N-SSATS
Facility Selection for the 2013 N-SSATS Report
Survey Response Mode
Data Considerations and Limitations
Organization of the Report
Terminology

The 2013 National Survey of Substance Abuse Treatment Services (N-SSATS) was conducted between March and November 2013, with a reference date of March 29, 2013. It is the 36th in a series of national surveys begun in the 1970s. The surveys were designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other U.S. jurisdictions.4 The Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs N-SSATS. This report presents tabular information and highlights from the 2013 N-SSATS. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

N-SSATS is designed to collect information from all facilities5 in the United States, both public and private, that provide substance abuse treatment. (Additional information on N-SSATS, its history, and changes in the survey and survey universe over time is provided in Appendix A.)

N-SSATS provides the mechanism for quantifying the dynamic character and composition of the U.S. substance abuse treatment delivery system. N-SSATS collects multipurpose data that can be used to:

http://findtreatment.samhsa.gov


4 The jurisdictions include the territory of Guam, the Federated States of Micronesia, the Republic of Palau, the Commonwealth of Puerto Rico, and the Virgin Islands of the United States.
5 In this report, entities responding to N-SSATS are referred to as “facilities.” As discussed later in the report, a “facility” may be a program-level, clinic-level, or multi-site respondent.

Data Collection Procedures for the 2013 N-SSATS

Field period and reference date

The survey reference date for the 2013 N-SSATS was March 29, 2013. The field period was from March 29, 2013, through November 18, 2013.

Survey universe

The 2013 N-SSATS facility universe totaled 18,048 facilities, including all 17,777 active treatment facilities on SAMHSA’s I-BHS at a point 6 weeks before the survey reference date and 271 facilities that were added by state substance abuse agencies or otherwise discovered during the first 3 months of the survey.

Content

The 2013 N-SSATS questionnaire was a 16-page document with 41 numbered questions (see Appendix B). Topics included:

Data collection

Three data collection modes were employed: a secure web-based questionnaire, a paper questionnaire sent by mail, and a telephone interview. Five weeks before the survey reference date of March 29, 2013, letters were mailed to all facilities to announce the survey. The letters also served to update records with new address information received from the U.S. Postal Service. During the last week of March 2013, a data collection packet (including the SAMHSA cover letter, state-specific letter of endorsement, state profile, information on completing the survey on the web, and a sheet of Frequently Asked Questions) was mailed to each facility. Initially, respondents could also request a paper questionnaire be sent to them. During the data collection phase, contract personnel were available to answer facilities’ questions concerning the survey. Web-based support for facilities completing the questionnaire on the web was also available. Three weeks after the initial data collection packet mailing, thank you/reminder letters were sent to all facilities. Approximately 8 weeks after the initial packet mailing, non-responding facilities that had completed a hard-copy questionnaire in either of the past two years (2012 or 2011) were mailed a second packet that included a hard-copy questionnaire along with the rest of first packet mailing materials. Eleven weeks after the second packet mailing, all the facilities that had not responded to previous mailings were mailed a hard-copy questionnaire along with the first and second packet mailing materials. About 2 weeks after the questionnaire mailing, nonrespondents received a reminder telephone call. Those facilities that had not responded within 3 to 4 weeks of the reminder call were telephoned and asked to complete the survey by computer-assisted telephone interview (CATI).

Facility status and response rate

Table 1.1 presents a summary of response rate information. There were 18,048 facilities in the survey universe. Of these facilities, 14 percent were found to be ineligible for the survey because they had closed or did not provide substance abuse treatment or detoxification. Of the remaining 15,496 facilities, 14,630 facilities (94 percent) completed the survey and 14,148 (91 percent of the respondents) were eligible for this report.

Quality assurance

The web questionnaire was programmed to be self-editing; that is, respondents were prompted to complete missing responses and to confirm or correct inconsistent responses.

All mail questionnaires were reviewed manually for consistency and for missing data. Calls were made to facilities to resolve unclear responses and to obtain missing data. After data entry, automated quality assurance reviews were conducted. The reviews incorporated the rules used in manual editing, plus consistency checks and checks for data outliers not readily identified by manual review.

Item non-response was minimized through careful editing and extensive follow-up. The item response rate for the 2013 N-SSATS averaged 97 percent across 242 separate items. Appendix C details item response rates and imputation procedures.

Facility Selection for the 2013 N-SSATS Report

Table 1.1. The N-SSATS questionnaire is deliberately sent to some facilities that are excluded from this report, as explained below. For this cycle, 313 of the 14,630 questionnaire respondents provided information but were deemed out of the scope of this report and excluded from the analyses presented here. The excluded facilities and reasons for exclusion fell into three categories:

An additional 169 facilities whose client counts were included in or “rolled into” other facilities’ counts and whose facility characteristics were not reported separately were excluded from facility counts in this report. However, their client counts are included.

After the exclusion of 313 out-of-scope facilities and 169 rolled-up facilities, 14,148 eligible respondent facilities remained to be included in the 2013 N-SSATS report.

Number of respondents reporting facility and client data

There were 14,148 eligible respondents to the 2013 N-SSATS. The breakdown of facility data and client counts reported by these respondents is summarized below.


6 The 910 facilities include 741 facilities reporting facility characteristics only and 169 rolled-up facilities.

Survey Response Mode

Figure 1. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since introduction of the option in 2002. The percentage of facilities responding via the web increased from 27 percent in 2003 to 87 percent in 2013. Mail response declined from 49 percent in 2003 to 2 percent in 2013. Telephone response, which represents follow-up of facilities that had not responded by mail or web, also declined, from 23 percent in 2003 to 10 percent in 2013.

Figure 1
Survey Response Mode: 2003-2013

Stacked bar chart comparing Survey Response Mode: 2003-2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration,
National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.

Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data from the 2013 N-SSATS. Some general issues are listed below; other considerations are detailed in Appendix A. Considerations and limitations of specific data items are discussed where the data are presented.

Organization of the Report

The balance of this report is organized into the following chapters.

Terminology

The majority of tables in the report are organized by facility operation and by the type(s) of care offered by the facility. Therefore, it is important to define these terms.

To Chapter 1 Table

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Table of Contents


Chapter 2

Trends in Facility Characteristics

Number of Facilities
Facility Operation
Type of Care Offered
Facilities with Opioid Treatment Programs

This chapter presents trends in facility characteristics for 2003 to 2013.

Number of Facilities

Table 2.1. The total number of substance abuse treatment facilities increased slightly between 2003 and 2013. There was considerable turnover from year to year in the individual facilities responding to the survey: every year, although between 86 and 90 percent of the facilities responding to a given survey had also responded to the previous year’s survey, some 10 to 15 percent of the facilities had closed, no longer provided substance abuse treatment, or didn’t respond to the previous year’s survey but were replaced by fairly similar numbers of new facilities.

There was a net decrease of 163 facilities between 2012 and 2013, to 14,148 facilities. Of the facilities responding to the 2013 survey, 90 percent had also responded to the 2012 survey and 10 percent were new to the 2013 survey. Eleven percent of the facilities that responded in 2012 had closed, no longer provided substance abuse treatment, or did not respond to the survey in 2013.

Despite the year-to-year changes in the facilities reporting, several core structural characteristics of the substance abuse treatment system remained stable from 2003 to 2013.

Facility Operation

Table 2.2 and Figure 2. The operational structure of the substance abuse treatment system (i.e., the type of entity responsible for operating the facility) changed slightly between 2003 and 2013.

Figure 2
Facility Operation: 2003-2013

Stacked bar comparing Facility Operation: 2003-2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.


7 Data for the federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified federal agencies) are detailed in the tables.

Type of Care Offered

Table 2.3 and Figure 3. The proportions of facilities offering the major types of care—outpatient, residential (non-hospital), and hospital inpatient—changed little between 2003 and 2013.

Facilities with Opioid Treatment Programs

Table 2.3 and Figure 3. Opioid Treatment Programs (OTPs), certified by SAMHSA, provide medication-assisted therapy with methadone, buprenorphine, and Vivitrol®, the only three opioid medications approved for the treatment of opioid addiction. Facilities with OTPs can be associated with any type of care. They were provided by 8 to 9 percent of all facilities between 2003 and 2013.

Figure 3
Type of Care Offered and Facilities with Opioid Treatment Programs: 2003-2013

Bar and line chart comparing Type of Care Offered and Facilities with Opioid Treatment Programs: 2003-2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.

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Table of Contents


Chapter 3

Trends in Client Characteristics

Facility Operation
Type of Care Received
Clients Receiving Methadone, Buprenorphine, or Vivitrol®
Substance Abuse Problem Treated
Clients under Age 18 in Treatment

This chapter presents trends in client characteristics for 2003 to 2013.

Table 3.1. The number of clients in treatment on the survey reference date increased by 14 percent from 2003 to 2013, from 1,092,546 in 2003 to 1,249,629 in 2013.

Facility Operation

Table 3.1 and Figure 4. In almost all categories of facility operation, the proportions of clients in treatment changed little between 2003 and 2013.

Figure 4
Clients in Treatment, by Facility Operation: 2003-2013

Stacked bar chart comparing Clients in Treatment, by Facility Operation: 2003-2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.


8 Data for the federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified federal agencies) are detailed in the tables.

Type of Care Received

Table 3.2 and Figure 5. The proportions of clients in treatment for the major types of care—outpatient, residential (non-hospital), and hospital inpatient—were stable between 2003 and 2013.

Clients Receiving Methadone, Buprenorphine, or Vivitrol®

Table 3.2 and Figure 5. Clients receiving methadone, buprenorphine, or Vivitrol® could be in any type of care—outpatient, residential (non-hospital), or hospital inpatient. Clients could receive methadone only in SAMHSA-certified Opioid Treatment Programs (OTPs). However, clients could receive buprenorphine or Vivitrol® in any type of facility.9

Figure 5
Clients in Treatment, by Type of Care Received: 2003-2013

Bar and line chart comparing Clients in Treatment, by Type of Care Received: 2008-2012

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.


9 Individual physicians can receive special authorization from the U.S. Department of Health and Human Services that allows them to prescribe buprenorphine for the treatment of opioid addiction. These physicians may prescribe buprenorphine to patients in an office setting or to patients at substance abuse treatment facilities. This report includes only those clients who were prescribed buprenorphine through a substance abuse treatment facility or an OTP; it does not include any clients who were prescribed buprenorphine by an independent physician not associated with a substance abuse treatment facility.
10 N-SSATS started collecting information on the number of buprenorphine clients in 2004. About 2,000 clients (0.2% of the total number of clients) were reported in 2004. The number has continued to increase since then.

Substance Abuse Problem Treated

Table 3.3. The proportion of clients in treatment for the three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse only, and alcohol abuse only—changed little between 2003 and 2013. Clients in treatment for both drug and alcohol abuse made up 43 to 47 percent of all clients from 2003 to 2013. Clients in treatment for drug abuse only ranged from 33 to 39 percent of all clients from 2003 through 2013. The proportion of clients treated for alcohol abuse only ranged from 17 to 20 percent between 2003 and 2013. Clients in treatment for diagnosed co-occurring mental and substance abuse disorders made up 37 to 45 percent of all clients from 2007 through 2013. (The co-occurring mental and substance abuse disorders question was introduced in the survey in 2007.)

Clients under Age 18 in Treatment

Tables 3.1 and 3.4. The proportion of clients under age 18 decreased from 8 percent (92,251 clients) of all clients in 2003 to 6 percent (78,156 clients) of all clients in 2013.

To Chapter 3 Tables

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Table of Contents


Chapter 4

Facility Characteristics and Services

Facility Operation
Type of Care Offered
Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders
Facility Size
Facility Capacity and Utilization Rates
Services Provided
Counseling Services Offered by Facilities
Clinical/Therapeutic Approaches
Specifically Tailored Programs or Groups
Services in Sign Language for the Hearing Impaired and in Languages Other than English
Detoxification Services
Client Outreach
Facility Licensing, Certification, or Accreditation
Facility Standard Operating Procedures
Payment Options
Work Activity Methods
Facility Funding
Facilities with Opioid Treatment Programs
Facility Smoking Policy

This chapter outlines key characteristics of facilities and programs in 2013.

Facility Operation

Table 4.1. Facilities were asked to designate the type of entity responsible for the operation of the facility.

  • The proportions of all facilities by facility operation were:
    • Private non-profit organizations
    • Private for-profit organizations
    • Local, county, or community governments
    • State governments
    • Federal government11
    • Tribal governments

 
55 percent
32 percent
5 percent
2 percent
3 percent
2 percent


11 Data for the federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified federal agencies) are detailed in the tables.

Type of Care Offered

Table 4.1. Type of care offered was made up of three broad categories (outpatient, residential [non-hospital], and hospital inpatient), each with several subcategories. A facility could offer more than one type of care. The proportions of all facilities offering the different types of care were:12

  • Outpatient treatment
    • Regular outpatient care
    • Intensive outpatient treatment
    • Outpatient day treatment/partial hospitalization
    • Outpatient detoxification
    • Outpatient methadone/buprenorphine maintenance or Vivitrol® treatment
  • Residential (non-hospital) treatment
    • Long-term treatment (more than 30 days)
    • Short-term care (30 days or fewer)
    • Detoxification
  • Hospital inpatient treatment
    • Detoxification
    • Treatment

82 percent
76 percent
45 percent
12 percent
10 percent
13 percent
24 percent
20 percent
12 percent
6 percent
5 percent
5 percent
4 percent

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and one third (33 percent) provided residential (non-hospital) care. In contrast, 92 percent of private for-profit facilities provided outpatient care and 11 percent provided residential (non-hospital) care.


12 Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.

Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders

Table 4.2. Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring mental and substance abuse disorders.

Facility Size

Table 4.3. Facility size is defined by the number of clients in substance abuse treatment. The median number of clients in substance abuse treatment at a facility on March 29, 2013, was 40 clients.

  • The median number of clients ranged from 28 in facilities operated by tribal governments to 65 in facilities operated by the federal government.
  • By type of care, the median13 number of clients in treatment on March 29, 2013, was:
    • Outpatient treatment
      • Regular outpatient care
      • Intensive outpatient treatment
      • Outpatient day treatment/partial hospitalization
      • Outpatient detoxification
      • Outpatient methadone/buprenorphine maintenance or Vivitrol® treatment
    • Residential (non-hospital) treatment
      • Long-term treatment (more than 30 days)
      • Short-term treatment (30 days or fewer)
      • Detoxification
    • Hospital inpatient treatment
      • Treatment
      • Detoxification

46 clients
25 clients
10 clients
3 clients
1 clients
106 clients
18 clients
15 clients
8 clients
3 clients
10 clients
6 clients
5 clients

Table 4.4. Facilities were sorted into five size groups based on the total number of clients in treatment on March 29, 2013. These five groups were treating fewer that 15 clients, 15-29 clients, 30-59 clients, 60-119 clients, and 120 or more clients, respectively.


13 The median number of clients for the main categories of type of care (outpatient, residential [non-hospital], and hospital inpatient) can be greater than the median for any of the subcategories because a facility can provide more than one subcategory of the main types of care.

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.

Figure 6
Residential (Non-hospital) and Hospital Inpatient Utilization Rates: March 29, 2013

Bar chart comparing Residential (Non-hospital) and Hospital Inpatient Utilization Rates: March 29, 2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2003-2013.



14 Residential (non-hospital) utilization rates are based on a subset of 3,082 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
15 Hospital inpatient utilization rates are based on a subset of 483 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.

Services Provided

Table 4.8. Facilities were asked about the types of services they provided. Services were grouped into the five broad categories shown below.

Counseling Services Offered by Facilities

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate whether they used any of 13 specific clinical/therapeutic approaches.

Specifically Tailored Programs or Groups

Table 4.11. Facilities were asked about the provision of treatment programs or groups specifically tailored for specific client types. Overall, 86 percent of facilities offered at least one such program or group to serve a specific client type.

  • The proportions of facilities providing special programs or groups were:
    • Adult women
    • Clients with co-occurring mental and substance abuse disorders
    • Adult men
    • Criminal justice clients (other than DUI/DWI)16
    • Adolescents
    • Persons who have experienced trauma17
    • DUI or DWI clients
    • Young adults
    • Persons who have experienced intimate partner violence, domestic violence
    • Persons who have experienced sexual abuse
    • Pregnant or postpartum women
    • Persons with HIV or AIDS
    • Veterans
    • Lesbian, gay, bisexual, transgender (LGBT) clients
    • Seniors or older adults
    • Members of military families
    • Active duty military

 
44 percent
43 percent
39 percent
33 percent
30 percent
29 percent
29 percent
23 percent
20 percent
20 percent
17 percent
14 percent
13 percent
12 percent
12 percent
7 percent
6 percent


16 Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.
17 Persons who have experienced sexual abuse, persons who have experienced domestic violence, and young adults categories appeared for the first time in the 2013 questionnaire.

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

Table 4.12. Facilities were asked about the provision of substance abuse treatment services in sign language for the hearing impaired. They were also asked if treatment was provided in languages other than English, if this treatment was provided by a staff counselor or by an on-call interpreter, and in what languages staff counselors provided treatment.

Detoxification Services

Table 4.13. Facilities that provided detoxification services were asked to indicate whether or not they detoxified clients from specified substances, and whether or not medication was routinely used during detoxification. The number of facilities providing any type of substance detoxification services was 2,581 (18 percent) out of a total of 14,148 facilities.

  • Of those providing detoxification services, the proportions of facilities providing detoxification from the following specific substances were:
    • Opiates
    • Alcohol
    • Benzodiazepines
    • Methamphetamines
    • Cocaine
    • Other substances
  • Medications were routinely used during detoxification in 79 percent of the facilities providing detoxification services.

 

85 percent
65 percent
58 percent
51 percent
50 percent
10 percent

Client Outreach

Table 4.14. Facilities were asked whether or not they had a website providing information about their substance abuse treatment programs.

Facility Licensing, Certification, or Accreditation

Facilities were asked to report licensure, certification, or accreditation by specified agencies or organizations. These included the state substance abuse agency, state mental health department, state department of health, hospital licensing authority, the Joint Commission, CARF, NCQA, COA, and other state or local agency or organization.18

Table 4.15. Overall, 94 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations.

  • The proportions of facilities reporting the specified agencies or organizations were:
    • State substance abuse agency
    • State department of health
    • State mental health department
    • CARF
    • Joint Commission
    • Hospital licensing authority
    • COA
    • Another state or local agency or other organization
    • NCQA


81 percent
43 percent
39 percent
24 percent
18 percent
7 percent
5 percent
4 percent
3 percent

Table 4.16. Facility licensing, certification, or accreditation was associated with the type of care offered.

    • Joint Commission
    • State department of health
    • Hospital licensing authority
    • NCQA

76 percent
68 percent
55 percent
10 percent


18 CARF: Commission on Accreditation of Rehabilitation Facilities; NCQA: National Committee for Quality Assurance; and COA: Council on Accreditation.

Facility Standard Operating Procedures

Table 4.17. Facilities were asked to indicate whether or not they followed specified practices as part of their standard operating procedures. All the standard practices listed were used by two thirds or more of all facilities.

  • The proportions of facilities reporting use of the specified standard practices were:
    • Required continuing education for staff
    • Regularly scheduled case review with a supervisor
    • Periodic client satisfaction surveys
    • Periodic utilization reviews
    • Periodic drug testing of clients
    • Case review by an appointed quality assurance committee
    • Outcome follow-up after discharge

98 percent
95 percent
92 percent
86 percent
86 percent
73 percent
70 percent

Payment Options

Table 4.18. Facilities were asked to indicate whether or not they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about the use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.

  • The proportions of all facilities reporting acceptance of specific payment options were:
    • Cash or self-payment
    • Private health insurance
    • Medicaid
    • State-financed health insurance
    • Medicare
    • Federal military insurance

90 percent
65 percent
59 percent
41 percent
33 percent
33 percent


19 Through a contract, tribes can receive the money that the Indian Health Service (IHS) would have used to provide direct health services for tribal members. Tribes can use these funds to provide directly, or through another entity, a broad range of health services. This option was part of P.L. 93-638 and is commonly known as “638 contracting.”
20 Access to Recovery vouchers were available only in AK, AR, AZ, CA, CO, CT, DC, FL, HI, IA, ID, IL, IN, LA, MA, MD, MI, MO, MT, NH, NJ, NM, NY, OH, OK, OR, PA, RI, SD, TN, TX, UT, WA, WI, and WY. See table 6.18b for number of facilities accepting ATRs by state.

Work Activity Methods

Table 4.19. Facilities were asked to indicate what methods they used to accomplish their work.

Facility Funding

Table 4.20. Facilities were asked if they received federal, state, or local government funds or grants to support their substance abuse treatment programs.

Facilities with Opioid Treatment Programs

Table 3.2. Opioid Treatment Programs (OTPs) are certified by SAMHSA 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.

Facility Smoking Policy


21 This report includes only those clients who were prescribed buprenorphine or Vivitrol® through a substance abuse treatment facility or an OTP; it does not include any clients who were prescribed buprenorphine or Vivitrol® by an independent physician not associated with a substance abuse treatment facility.

To Chapter 4 Tables

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Table of Contents


Chapter 5

Client Characteristics

Facility Operation
Type of Care
Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders
Clients under Age 18 in Treatment

This chapter describes key characteristics of the 1,249,629 clients in substance abuse treatment on March 29, 2013. Clients in treatment were defined as: 1) hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services on March 29, 2013, and 2) outpatient clients who were seen at the facility for a substance abuse treatment or detoxification service at least once during the month of March 2013, and who were still enrolled in treatment on March 29, 2013.

Facility Operation

Table 5.1a and 5.1c. Facilities were asked to designate the type of entity responsible for the operation of the facility.

  • The proportions of clients in treatment on March 29, 2013, by facility operation were:
    • Private non-profit organizations
    • Private for-profit organizations
    • Local, county, or community governments
    • Federal government22
    • State governments
    • Tribal governments

 

51 percent
34 percent
6 percent
4 percent
3 percent
1 percent


22 Data for the federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified federal agencies) are detailed in the tables.

Type of Care

Tables 5.1a, 5.1b, and 5.1c. Facilities were asked how many clients in treatment on March 29, 2013, received specified subcategories of type of care within three broad categories.

  • On March 29, 2013, the proportions of clients receiving different types of care were:
    • Outpatient treatment
      • Regular outpatient care
      • Outpatient methadone/buprenorphine maintenance or Vivitrol® treatment
      • Intensive outpatient treatment
      • Outpatient day treatment/partial hospitalization
      • Outpatient detoxification
    • Residential (non-hospital) treatment
      • Long-term treatment (more than 30 days)
      • Short-term treatment (30 days or fewer)
      • Detoxification
    • Hospital inpatient treatment



90 percent
48 percent
27 percent
12 percent
2 percent
1 percent
9 percent
6 percent
2 percent
1 percent
1 percent

Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders

Table 5.2. Facilities were asked to estimate the proportions of clients in treatment on March 29, 2013, by substance abuse problem treated (alcohol abuse only, drug abuse only, or both alcohol and drug abuse).

Facilities were asked to estimate the proportion of clients in treatment with diagnosed co-occurring mental and substance abuse disorders.

Clients under Age 18 in Treatment

Table 5.3. Facilities were asked how many clients in treatment on March 29, 2013, were under age 18.

To Chapter 5 Tables

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Table of Contents


Chapter 6

State Data

Survey Response
Trends
Clients in Treatment per 100,000 Population Aged 18 and Older
Clients in Opioid Treatment per 100,000 Population

This chapter breaks down data presented in earlier chapters by state and jurisdiction. The Chapter 6 tables correspond to most of the tables presented in Chapters 4 and 5. Note that facilities operated by federal agencies are included in the states in which the facilities are located, although these facilities may have clients from other states.

Table 6.1 details the 2013 N-SSATS response rate.

Tables 6.2 to 6.3 present data on treatment facility and client trends for 2003 to 2013.

Tables 6.4 to 6.23 present facility data for 2013.

Tables 6.24a to 6.29 present client data for 2013.

Table 6.30 presents the number of clients in treatment per 100,000 population aged 18 and over, according to substance abuse problem treated, by state or jurisdiction.

Table 6.31 presents the number of clients in treatment per 100,000 population, according to opioid treatment, by state or jurisdiction.

Survey Response

Table 6.1. The overall response rate for the survey was 94 percent. Thirty-four states or jurisdictions had response rates that equaled or surpassed the overall rate.

Trends

Tables 6.2a-b. California and New York had the largest numbers of both facilities and clients in treatment in every year from 2003 through 2013. On March 29, 2013, California had 11 percent of all facilities and 9 percent of all clients. New York had 6 percent of all facilities and 9 percent of all clients.

Four other states were in the top 10 for both total numbers of facilities and clients in the 6 years shown in Tables 6.2a-b: Florida, Illinois, Michigan, and Pennsylvania. Texas and Colorado were in the top 10 for total number of facilities each year and Massachusetts, Maryland, and Washington were in the top 10 for number of clients in 5 out of the 6 years shown in the tables.

Clients in Treatment per 100,000 Population Aged 18 and Older

Table 6.30. For the 50 states, the District of Columbia, and Puerto Rico, there were 481 clients in treatment per 100,000 population aged 18 and over on March 29, 2013. The rate was highest for persons with both alcohol and drug abuse (203 per 100,000 population), followed by drug abuse only (194 per 100,000 population) and alcohol abuse only (84 per 100,000 population).

Clients in Opioid Treatment per 100,000 Population

Table 6.31. For the 50 states, the District of Columbia, and Puerto Rico, there were 121 clients in opioid treatment per 100,000 population on March 29, 2013. The rate was highest for persons receiving methadone (105 per 100,000 population), followed by buprenorphine (15 per 100,000 population) and Vivitrol® (1 per 100,000 population).

Figure 7
Clients in Treatment per 100,000 Population Aged 18 and Over: March 29, 2013

U.S. map comparing Clients in Treatment per 100,000 Population Aged 18 and Over: March 29, 2013

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2013.

 

To Chapter 6 Tables

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Table of Contents


Appendix A

N-SSATS Background

 

Survey History
N-SSATS in the Context of the Behavioral Health Services Information System (BHSIS)
Survey Coverage
Changes in Survey Content

Survey History

N-SSATS has evolved from national survey efforts begun in the 1970s by the National Institute on Drug Abuse (NIDA) to measure the scope and use of drug abuse treatment services in the United States. The sixth of these surveys, conducted in 1976, introduced the data elements and format that have formed the core of subsequent surveys. These include organizational focus, service orientation, services available, clients in treatment by type of care, and hospital inpatient/residential capacity. The 1976 survey, called the National Drug Abuse Treatment Utilization Survey, was repeated in 1977 and 1978.

In 1979, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) became a cosponsor of the survey, alcoholism treatment facilities were added, and the study was renamed the National Drug and Alcoholism Treatment Utilization Survey. This survey was repeated in 1980 and 1982. In 1984, a one-page version called the National Alcoholism and Drug Abuse Program Inventory was used. In 1987, the full version of the survey was reinstated and renamed the National Drug and Alcoholism Treatment Unit Survey (NDATUS). NDATUS was conducted annually from 1989 to 1993.

In 1992, with the creation of SAMHSA, responsibility for conducting the survey shifted to SAMHSA’s Office of Applied Studies (now the Center for Behavioral Health Statistics and Quality). The survey was redesigned, and it was conducted annually as the Uniform Facility Data Set (UFDS) survey from 1995 to 1998. During these years, the survey was conducted by mail with telephone follow-up of non-respondents. The 1999 survey year was a transition year during which the survey was redesigned and an abbreviated telephone survey of treatment facilities was conducted. In 2000, a redesigned full mail survey was reinstated with telephone follow-up; it was renamed the National Survey of Substance Abuse Treatment Services (N‑SSATS). The reference date for the annual survey had always been the end of September or beginning of October. After the 2000 survey, the reference date was changed to the end of March, and no survey was conducted during 2001.

In 2000, the use of an Internet-based questionnaire was tested; beginning in 2002, all facilities were offered the opportunity to respond via the Internet.

N-SSATS in the Context of the Behavioral Health Services Information System (BHSIS)

N-SSATS is one of the three components of SAMHSA’s Behavioral Health Services Information System (BHSIS—formerly the Drug and Alcohol Services Information System, or DASIS) that contain information on substance abuse treatment.22 The core of BHSIS includes the Inventory of Behavioral Health Services (I-BHS), until recently called the Inventory of Substance Abuse Treatment Services (I-SATS). I-BHS includes a continuously updated, comprehensive listing of all known substance abuse treatment facilities. The other substance abuse component of BHSIS is the Treatment Episode Data Set (TEDS), a client-level database of admissions to and discharges from substance abuse treatment. Together, the components provide national- and state-level information on the numbers and characteristics of individuals admitted to alcohol and drug treatment programs and describe the facilities that deliver care to those individuals.

I-BHS is the list frame for N-SSATS. Facilities in I-BHS fall into two general categories and are distinguished by the relationship of the facility to its state substance abuse agency. These categories are described below.

Treatment facilities approved by state substance abuse agencies

The largest group of facilities (11,496 in 2013) includes facilities that are licensed, certified, or otherwise approved by the state substance abuse agency to provide substance abuse treatment. State BHSIS representatives maintain this segment of I-BHS by reporting new facilities, closures, and address changes to SAMHSA. Some facilities are not licensed, certified, or otherwise approved by the state agency. Some private for-profit facilities fall into this category. The approved facility group also includes programs operated by federal agencies—the Department of Veterans Affairs (VA), the Department of Defense, the Indian Health Service—and Opioid Treatment Programs certified by SAMHSA. I-BHS records for federally-operated facilities are updated annually through lists provided by these agencies.

Treatment facilities not approved by state substance abuse agencies

This group of facilities (2,652 in 2013) represents the SAMHSA effort since the mid-1990s to make I-BHS as comprehensive as possible by including treatment facilities that state substance abuse agencies, for a variety of reasons, do not fund, license, or certify. Many of these facilities are private for-profit, small group practices, or hospital-based programs. Most of them are identified through periodic screening of alternative source databases. (See Special efforts to improve survey coverage below.) State substance abuse agencies are given the opportunity to review these facilities and to add them to the state agency-approved list, if appropriate.


22 The fourth BHSIS component is the National Mental Health Services Survey (N-MHSS).

Survey Coverage

The use of I-BHS as the list frame for N-SSATS imposes certain constraints related to the unit of response and the scope of facilities included. In addition, the expansion of I-BHS in recent years to provide a more complete enumeration of substance abuse treatment facilities means that year-to-year comparisons of the numbers of facilities reporting to N-SSATS must be interpreted with caution.

Unit of response

N-SSATS is designed to collect data from each physical location where treatment services are provided. Accordingly, SAMHSA requests that state substance abuse agencies use the point of delivery of service (i.e., physical location) as the defining factor for a facility. Because of the different state administrative systems, however, there are some inconsistencies in implementation. For example, in some states, multiple treatment programs (e.g., detoxification, residential, and outpatient) at the same address and under the same management have separate state licenses. These are treated as separate by the state substance abuse agency, and are given separate I-BHS ID numbers. In other states, multiple sites are included as a single entity under a parent or administrative unit. In many of these cases, individual sites can report services data in N-SSATS, but client data are available only at a higher administrative level. Beginning in 1995, efforts have been made to identify facility networks and to eliminate duplicate reporting by networks. For most facilities, reporting level remains consistent from year to year. However, beginning in 1998, an emphasis was placed on collecting minimum information from all physical locations, and this has resulted in an increase in the number of ­facilities.

Special efforts to improve survey coverage

The great majority of treatment facilities in I-BHS are administratively monitored by state substance abuse agencies. Therefore, the scope of facilities included in I-BHS is affected by differences in state systems of licensure, certification, accreditation, and the 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.

To address these differences, SAMHSA conducted a large-scale effort during 1995 and 1996 to identify substance abuse treatment facilities that, for a variety of reasons, were not on the inventory. Some 15 source lists were examined, and facilities not on the inventory were contacted to ascertain whether they provided substance abuse treatment. As expected, this yielded a number of hospital-based and small private facilities that were not on the inventory. (These facilities were surveyed in 1995 and 1996, but they were not included in the published results of the survey until 1997.) Analysis of the results of this effort led to similar but more targeted updates before subsequent surveys. Potential new facilities are identified using data from the American Business Index and the annual American Hospital Association survey, and SAMHSA’s National Mental Health Services Survey (which was then called the Inventory of Mental Health Organizations), the source lists that yielded the most new facilities in 1995 and 1996. Survey participants, who are asked to report all of the treatment facilities in their administrative networks, also identify additional facilities during the survey itself. All newly identified facilities are initially included as not approved by the state substance abuse agency. State substance abuse agencies are given the opportunity to review these facilities and to add them to the state agency-approved list, if appropriate.

Expansion of survey coverage to include all sites within networks at which treatment was provided yielded a net increase of about 2,600 facilities between 1997 and 1998. These additions were not necessarily new facilities, but were facilities not previously included in the survey as separate sites. The number of facilities reporting continued to increase in 1999, but at a slower pace, a net increase of 1,800 facilities. The increase between 1998 and 1999 was in large part because of the improved survey response rate (95 percent in 1999 vs. 90 percent in 1998). Between 2003 and 2013, the number of facilities eligible for inclusion in this report increased steadily, from 13,623 to 14,148. The total number is deceptive, however. There was significant turnover as facilities closed and others opened. (See Table 2.1.)

Data collection

Until 1996, state substance abuse agencies distributed and collected the facility survey forms. Beginning in 1996, data collection was centralized; and SAMHSA began mailing survey forms directly to and collected forms directly from the facilities and conducting follow-up telephone interviews with the facility director or his/her designee. In 2000, SAMHSA introduced an on-line trial web version of the questionnaire for a few facilities in addition to the hard-copy questionnaire. The web version of the questionnaire was fully implemented in 2002. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since its full inception in 2002. Beginning with the 2011 N-SSATS, a questionnaire is only mailed to respondents by request.

Non-response

Beginning in 1992, SAMHSA expanded efforts to obtain information from non-responding facilities. A representative sample of non-respondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all non-responding facilities. In 1997, a series of measures was introduced to enhance the survey response rate. These included advance notification and improved methods for updating address and contact information. Between 2004 and 2012, use of these methods and intensive telephone follow-up resulted in an annual follow-up rate (i.e., facilities in the sample either completed the survey or were determined to be closed or otherwise ineligible) of 92 to 96 percent. In 2013, the final response rate was 95.2 percent.

Exclusions

In 1997, facilities offering only DUI/DWI programs were excluded; these facilities were reinstated in 1998.

Facilities operated by the Bureau of Prisons (BOP) were excluded from the 1997 survey and subsequent surveys because SAMHSA conducted a separate survey of correctional facilities.23 During that survey, it was discovered that jails, prisons, and other organizations treating incarcerated persons only were poorly enumerated on the inventory. Beginning in 1999, these facilities were identified during the survey and excluded from analyses and public-use data files.

I-BHS and N-SSATS are designed to include specialty substance abuse treatment facilities rather than individuals. Solo practitioners are listed on I-BHS and surveyed in N-SSATS only if the state substance abuse agency explicitly requests that they be included.

Beginning in 2000, halfway houses that did not provide substance abuse treatment were included on I-BHS and in N-SSATS so that they could be listed in the National Directory of Drug and Alcohol Abuse Treatment Programs and on the Treatment Facility Locator (http://findtreatment.samhsa.gov). These facilities are excluded from analyses and public-use data files.


23 SAMHSA, Office of Applied Studies. Substance Abuse Treatment in Adult and Juvenile Correctional Facilities: Findings from the Uniform Facility Data Set 1997 Survey of Correctional Facilities. Drug and Alcohol Services Information System Series: S-9. DHHS Publication No. (SMA) 00-3380. Rockville, MD, 2000.

Changes in Survey Content

Table A.1 shows the major content areas for the survey from 1996 to 2013. Since 1992, SAMHSA has made adjustments each year to the survey design, both to minimize non-response and to include areas of emerging interest. For example, questions on the number of clients in treatment receiving specific medication-assisted opioid therapies have changed over the years: LAAM was replaced by buprenorphine in 2004 and Vivitrol® was added in 2013. Questions about clinical/therapeutic methods, standard practices, and Access to Recovery grants were added in 2007. Questions about facility smoking policy were added in 2011; questions about outpatient facility operating capacity and Vivitrol® as a pharmacotherapy were added in 2012; and questions about work activity and means to accomplish them as well as the Vivitrol® client count question were added in 2013.

There have also been changes within content areas. For example, in response to concerns about over-reporting of programs or groups for specific client types, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that offered specially designed programs or groups for that client type. As a result, the number and proportion of facilities offering programs or groups for each of the specified client types decreased. Surveys from 2003 and later are believed to more accurately represent the number and proportions of facilities providing programs or groups for the specified client types. In addition, over time more categories have been added to the specific client types (e.g., persons who have experienced trauma, active duty military, and members of military families in 2012 and special programs for young adults, persons who have experienced sexual abuse, and persons who have experienced intimate partner violence, domestic violence were added in 2013). Because of the increase of programs for specific client types, and the corresponding question of those types of clients being accepted into treatment, the question was again revised in 2013 to clarify and reduce respondent burden. Moreover, the programs are now described as “specifically tailored” for specific client types.

To Table A.1

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Table of Contents


Appendix B

2013 N-SSATS Questionnaire

This Appendix contains the hard copy version of the 2013 N-SSATS questionnaire. Facilities also had the option of responding to the questionnaire on the Internet. For those facil­ities that had not completed the survey after extensive follow-up efforts (see Chapter 1), the questionnaire was administered by computer-assisted telephone interview (CATI).

Of the responding eligible treatment facilities included in this report, 87 percent completed the questionnaire on the Internet, 2 percent completed it by mail, and about 10 percent completed it by CATI [Table 1.1 and Figure 1].

Text versions of the Internet and CATI surveys are not included here because they are computer programs that contain complex skip patterns, are difficult to read, and are extremely long in text format.

To Sample 2013 N-SSATS Questionnaire PDF

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Table of Contents


Appendix C

Item Response and Imputation for 2013 N-SSATS

This Appendix contains Table C.1, a list of item response rates for questions from the N-SSATS 2013 questionnaire. Item non-response was minimized through careful editing and extensive follow-up.

The item response rate for the 2013 N-SSATS averaged 97 percent across 242 separate response categories.

Item non-response was 10 percent or more for only 18 of 242 separate response categories.

When available, client values and admissions values from up to five previous surveys were used to impute the missing counts. If historical data were not available, the average client value, stratified by state and facility operation, was used to impute the missing client counts. If a facility were unique in its state and facility operation category, values were imputed using average values for the state only. Missing client counts were imputed for each type of service (i.e., hospital inpatient detoxification, hospital inpatient treatment, residential [non-hospital] detoxification, etc.) and summed to the larger service type totals (total hospital inpatient clients, total residential [non-hospital] clients, and total outpatient clients), and finally to total clients. There is no imputation for 2013 N-SSATS data.

Several facilities report client counts for themselves (parent) as well as for other facilities (children) within their family of substance abuse treatment facilities. Instead of reporting only the aggregate client count, we attempted to disaggregate and redistribute or unroll the parent facilities’ total client count wherever possible to reflect the number of clients served by each facility within the family of facilities. Our procedure was to first calculate the mean client count per type of care received (hospital inpatient, outpatient, and residential) for the facilities in N-SSATS that reported only for themselves. We then used these means to determine how to distribute the clients reported by a parent facility to its children facilities based on the type of facilities and the types of clients indicated by the family of facilities. Therefore, numbers reported may be an actual number reported by the facility itself or they may be an unrolled estimate based on the unrolling procedures. All totals sum to the actual reported numbers.

At Synectics, Parth Thakore, Hongwei Zhang, and Doren H. Walker were responsible for the content, analysis, and writing of the report.

To Table C.1

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Table of Contents