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Treatment Episode Data Set (TEDS) 

CODAP (1979-1981) to TEDS (1992-1995)

For purposes of tracking change through the decade of the eighties, the measure of primary drug problems at admission is comparable from CODAP to TEDS for all substances except alcohol. Figure 1 clearly shows the emergence of smoked cocaine as the most likely drug abuse problem at admission in 1992, followed by heroin and then marijuana/hashish. By 1995, these three drug abuse problems have converged to become about equally likely reasons for admission to drug abuse treatment.

Figure 1. Primary drug, not alcohol, at admission: CODAP (1979-1981) to TEDS panel of 37 States (1992-1995)

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TEDS-only Trends (1992-1995)

Substances

Once alcohol admissions are added back to the TEDS, combined alcohol and drug abuse show up as the most frequent problem at admission to substance abuse treatment (Figure 2). This trend coincides with the aging of the population and may possibly reflect the relative mortality of older persons who established their drinking pattern before the drug culture of the nineteen sixties. On the other hand, it may reflect improved screening for drug problems at admission to treatment.

If the co-abuse of alcohol with drug is ignored by examining only the primary substance abuse problem at admission (Figure 3), alcohol appears to dominate the substance abuse scene. This is misleading, however, because alcohol and drug abuse account for nearly half of TEDS admissions, as shown in Figure 2. The inadequacy of single substances to define most substance abuse problems highlights the importance of reporting multiple substance use in national statistics.

Clients

Clients entering the treatment systems reporting to TEDS are more male, black, and young-middle-aged than the U.S. Census Bureau statistics for the U.S. resident population. These gender, race/ethnicity, and age differences are charted from 1992-1995 in Figures 4, 5, and 6.

Figure 2. Alcohol-only, drug-only, and alcohol/drug co-abuse at admission: TEDS panel 1992-1995

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The low percentage of females among TEDS admissions (Figure 4) may indicate a low rate of substance abuse or a low treatment rate. Child care and transportation needs have repeatedly been identified as a barrier to treatment for women. The percentage difference between male and female admissions shows a small but progressive reduction from 1992 to 1995.

Figure 3. Primary drug and alcohol problems reported at admission: TEDS panel 1992-1995

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Figure 4. Sex distribution in TEDS panel compared to U. S. population, 1992-1995

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The racial and ethnic mix in TEDS (Figure 5) shows White non-Hispanics to be under represented, although they are the single largest group in treatment. Asians and Pacific Islanders are also under represented, but only slightly. Black non-Hispanics are over represented compared to the general population, and the remaining minorities are slightly over represented in treatment.

The age distribution of TEDS admissions (Figure 6) shows a clear pattern when compared to the U.S. population. Those older than fifteen and younger than forty-five are over represented, and all other ages are under represented. Because the legal drinking age is typically 21 in the U.S., experimentation with alcohol and other psychoactive substances tends to accelerate near that age. For those older than forty-five, a high mortality rate, voluntary abstinence (maturing out), or the inclusion of generations not affected by the drug culture of the nineteen sixties may reduce entry to treatment.

By adjusting the U.S. resident population to match the TEDS distribution for sex, race/ethnicity,and age, improved comparisons can be made between the TEDS and the general population. U.S. national statistics for employment and education are available from the Census Bureau for years 1992 through 1995, and these are used to compare the TEDS to national averages. The differences are charted in Figures 7 and 8, showing that the TEDS population is disadvantaged in employment and education.

Figure 5. Race/ethnicity in TEDS panel compared to U. S. population, 1992-1995

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The employment picture for TEDS admissions (Figure 7) compares poorly to the U.S. population. Persons coming into substance abuse treatment who are employed full-time are under represented in TEDS by 30% when compared to the general population. The unemployed and those out of the labor force, on the other hand, are over represented.

Figure 6. Age in TEDS panel compared to U. S. population, 1992-1995

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Figure 7. Employment in TEDS panel compared to U. S. population, 1992-1995

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Education (Figure 8) is another area of disadvantage for substance abuse admissions. Compared to the U.S. population, TEDS admissions overall have achieved a lower grade level than the U.S. population. About 21% of TEDS admissions go beyond a high school education compared to 48% in the general population in 1995.

Figure 8. Highest completed grade in TEDS compared to U. S. population, 1992-1995

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These observed disadvantages of the TEDS population could relate to substance abuse in any of three ways: 1) substance abuse contributes to causing a disadvantage, 2) a disadvantage contributes to causing substance abuse, or 3) other factors contribute to causing both substance abuse and a disadvantage. Because of these multiple possibilities, cause and effect cannot be concluded from relationships in the TEDS admissions.

AGGREGATE PROFILES OF CALENDAR YEAR 1995

The way an admission is defined can vary from State to State such that the absolute number of admissions is not a valid measure for comparing States. For this reason, TEDS data are aggregated within States and jurisdictions and reported as percentage distributions to allow meaningful comparison of the patterns of admission. Aggregate percentage distribution data for calendar year 1995 are presented in this section.

A benefit of the TEDS is its large number of admissions each year, well over a million admissions. This large number makes it meaningful to examine minority populations that might otherwise not be measured in sufficient numbers. Looking just at the patterns of primary substance abuse, distinct patterns characterize different racial/ethnic groups. These patterns are charted in Figure 9 separately for males and females. The more striking patterns are as follows: 1) a high percentage of smoked cocaine (crack) admissions for non Hispanic Blacks, 2) a high percentage of heroin admissions for Hispanics of both Puerto Rican and Mexican origin, 3) a high percentage of alcohol admissions for American Indians/Alaskan Natives, and 4) an unusual percentage of methamphetamine admissions for Other females, the category comprising Asian groups. On the whole, males and females of the same racial/ethnic group resemble each other more than they do other racial/ethnic groups.

Heroin and crack/cocaine emerge as the substances most consistently associated with dysfunctional lifestyle, showing high rates of homelessness, lack of health insurance, and high joblessness, as detailed in Tables 14 and 15.

Age at first use depicts inhalants, alcohol-with-secondary-drug, and marijuana as the substances most likely to be first used before age 13 (Table 9). Alcohol and marijuana have long had this distinction, but inhalants now seem to top the list.

Based on the patterns observed for 1995, the TEDS may prove a useful tool for tracking emerging trends in the patterns of substance abuse nationally, by States, and other jurisdictions.

Figure 9. Percent primary substance by age for sex and race/ethnicity groups: 1995

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Figure 9. Percent primary substance by age for sex and race/ethnicity groups: 1995 - (page 2 of 3)

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Figure 9. Percent primary substance by age for sex and race/ethnicity groups: 1995 - (page 3 of 3)

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Figure 10. Percent distribution by selected client characteristics, according to primary substances: 1995 - (page 1 of 2)

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Figure 10. Percent distribution by selected client characteristics, according to primary substances: 1995 - (page 2 of 2)

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Figure 11. Percent distribution by source of referral for clients 18 and older, according to primary substance: 1995

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Figure 12. Percent distribution by service setting, according to primary substance: 1995

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Figure 13. Percent distribution by marital status, according to primary substance: 1995

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Figure 14. Percent distribution by living arrangement, according to primary substance: 1995

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Figure 16. Percent distribution by health insurance, according to primary substance: 1995

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STATE LEVEL DATA, CALENDAR YEAR 1995

Establishing a national data set from administrative data collected by over fifty jurisdictions is a gradual process. In order to report to the TEDS, a State must crosswalk data elements in its local data system to the national standard; it must decide which optional data items to report; and it must establish a regular reporting cycle. Figure 17 shows the number of monthly admissions reported by each State and jurisdiction from 1992 through 1995. Where the chart shows the number of admissions trending down, this may indicate under reporting rather than a decline in substance abuse problems, particularly for States not part of the panel of 37 used for trends. Down trends observed only in the 1995 year, on the other hand, are more likely to result from delays in submitting or finalizing annual data.

Based on all submitted TEDS admissions, the distribution of primary abused substances varies among geographic divisions, as shown in Figure 18. Where the patterns are noteworthy - the high rate of heroin admissions in the Pacific Division for example - a single State may account for the regional effect, California in this example. A high rate of admission for a particular primary substance can indicate a diagnostic practice pattern, a high rate of abuse, or both.

Further detail by State and jurisdiction is contained in Tables 17 through 20.

Figure 17. TEDS monthly admissions by State: 1992-1995 - (page 1 of 4)

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Figure 17. TEDS monthly admissions by State: 1992-1995 - (page 2 of 4)

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Figure 17. TEDS monthly admissions by State: 1992-1995 - (page 3 of 4)

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Figure 17. TEDS monthly admissions by State: 1992-1995 - (page 4 of 4)

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Figure 18. Admission rates by geographic division: 1995 - (page 1 of 2)

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Figure 18. Admission rates by geographic division: 1995 - (page 2 of 2)

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TABLES

Table 1. Percent distribution of initial drug admissions by primary drug of abuse: CODAP 1979-81 and TEDS panel 1992-95

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Table 2. Number and percent distribution of initial admissions by primary substance of abuse: TEDS panel 1992-1995

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Table 3. Number and percent distribution of TEDS panel admissions and U.S. population by sex, race/ethnicity, and age at admission: 1992-1995

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Table 4. Percent distribution of TEDS panel admissions and of U.S. population 18 years and older by employment and education: 1992-1995

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Table 5. Percent distribution of admissions by sex, race/ethnicity, and age at admission, for each primary substance of abuse at admission: 1995 - (page 1 of 2)

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Table 5. Percent distribution of admissions by sex, race/ethnicity, and age at admission, for each primary substance of abuse at admission: 1995 - (page 2 of 2)

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Table 6. Percent distribution of admissions by primary substance of abuse at admission according to sex, race/ethnicity, and age at admission: 1995 - (page 1 of 2)

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Table 6. Percent distribution of admissions by primary substance of abuse at admission according to sex, race/ethnicity, and age at admission: 1995 - (page 2 of 2)

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Table 7. Percent distribution of admissions by selected race/ethnicity/sex/age at admission groups, according to primary substance of abuse at admission: 1995 - (page 1 of 4)

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Table 7. Percent distribution of admissions by selected race/ethnicity/sex/age at admission groups, according to primary substance of abuse at admission: 1995 - (page 2 of 4)

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Table 7. Percent distribution of admissions by selected race/ethnicity/sex/age at admission groups, according to primary substance of abuse at admission: 1995 - (page 3 of 4)

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Table 7. Percent distribution of admissions by selected race/ethnicity/sex/age at admission groups, according to primary substance of abuse at admission: 1995 - (page 4 of 4)

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Table 8. Percent distribution of admissions by primary substance of abuse, according to selected race/ethnicity/sex/age at admission groups: 1995 - (page 1 of 4)

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Table 8. Percent distribution of admissions by primary substance of abuse, according to selected race/ethnicity/sex/age at admission groups: 1995 - (page 2 of 4)

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Table 8. Percent distribution of admissions by primary substance of abuse, according to selected race/ethnicity/sex/age at admission groups: 1995 - (page 3 of 4)

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Table 8. Percent distribution of admissions by primary substance of abuse, according to selected race/ethnicity/sex/age at admission groups: 1995 - (page 4 of 4)

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Table 9. Percent distribution of admissions separately by selected substance use characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 1 of 2)

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Table 9. Percent distribution of admissions separately by selected substance use characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 2 of 2)

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Table 10. Percent distribution of admissions age 18 and over by employment, education, and source of referral to treatment, according to primary substance of abuse at admission: 1995

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Table 11. Percent distribution of admissions by service setting at admission, according to primary substance of abuse at admission: 1995

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Table 12. Percent distribution of admissions by additional substance at admission, according to primary substance of abuse at admission: 1995

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Table 13. Multiple substance use among all admissions and admissions reporting drug use: 1995

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Table 14. Percent distribution of admissions by selected client characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 1 of 2)

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Table 14. Percent distribution of admissions by selected client characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 2 of 2)

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Table 15. Percent distribution of admissions by economic characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 1 of 2)

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Table 15. Percent distribution of admissions by economic characteristics at admission, according to primary substance of abuse at admission: 1995 - (page 2 of 2)

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Table 16. Percent distribution of admissions by treatment characteristics at admission, according to primary substance of abuse at admission: 1995

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Table 17. Number of admissions and admissions per 100,000 population, all ages, by State: 1992-1995 - (page 1 of 2)

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Table 17. Number of admissions and admissions per 100,000 population, all ages, by State: 1992-1995 - (page 2 of 2)

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Table 18. Age-, sex-, and race/ethnicity-adjusted admissions per 100,000 population, all ages, by geographic division and State, according to primary substance of abuse at admission: 1995 - (page 1 of 3)

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Table 18. Age-, sex-, and race/ethnicity-adjusted admissions per 100,000 population, all ages, by geographic division and State, according to primary substance of abuse at admission: 1995 - (page 2 of 3)

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Table 18. Age-, sex-, and race/ethnicity-adjusted admissions per 100,000 population, all ages, by geographic division and State, according to primary substance of abuse at admission: 1995 - (page 3 of 3)

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Table 19. Item percentage response by State: TEDS Minimum Data Set 1995 - (page 1 of 2) [19- pg 2]

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Table 19. Item percentage response by State: TEDS Minimum Data Set 1995 - (page 2 of 2)

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Table 20. Item percentage response by State: TEDS Supplemental Data Set 1995 - (page 1 of 2) [20- pg 2]

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Table 20. Item percentage response by State: TEDS Supplemental Data Set 1995 - (page 2 of 2)

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APPENDIX A

Data Limitations

The TEDS is collected by States according to their own systems for monitoring substance abuse treatment and then cross walked to the TEDS data elements, according to a mutually-approved protocol. Given variation among the States in how they define and collect substance abuse treatment data, the following should be considered when using these data:

States continually review the quality of their data processing. As States identify systematic errors, they may revise or replace historical TEDS data files. While this system improves the data set over time, reported historical statisticsmay change slightly from year to year.

The number and client mix of TEDS records depends, to some extent, on external factors - including the availability of public funds. In States with higher funding levels, a larger percentage of the substance abusing population may be admitted to treatment, including the less severely impaired and the less economically disadvantaged.

Public funding constraints maydirect States to selectively target special populations, for example, pregnant women or adolescents.

States vary in the extent to which coercion plays a role in referral to treatment. This variation derives from criminal justice practices and differing concentrations of abuser sub-populations.

States vary in their reporting practices. For instance, drunk drivers who are referred to education or treatment are excluded from TEDS reporting in all but a few States.

Initial admissions do not necessarily represent unique clients. Readmission of the same client would be counted as a new admission, and most States identify clients uniquely at the program or provider level so that a client would have a new identifier if admitted to another provider. It is possible, therefore, for clients to have multiple initial admissions within a State and even within providers that have multiple treatment sites within the State. A few States uniquely identify clients at the State-level and several more States are attempting to achieve this level of client identification. The TEDS provides a good national snapshot of what is seen at admission to treatment, but is currently unable to follow individual clients through a sequence of treatment episodes.

The TEDS distinguishes between "transfer admissions" and "initial admissions." Transfer admissions are to distinct services within an episode of treatment. All identifiable transfer admissions have been excluded from the current report.

Records with partially complete information have been retained for this report. Where records include missing or invalid data, the records are excluded from tabulations involving the missing or invalid data. For this reason, the total number of admissions will vary slightly from table to table.

Alcohol admissions are defined as "alcohol only" or "alcohol with drug". Alcohol-only admissions are primary for alcohol with secondary and tertiary substances listed "none," "unknown," or "not collected." Alcohol-with-drug indicates an admission primary for alcohol with a secondary or tertiary drug.

Cocaine admissions are defined as "smoked cocaine" or "non-smoked cocaine" to reveal the important difference between routes of administration. While crack currently accounts for the majority of "smoked cocaine" admissions, the distinction is important for any form of cocaine that is smoked, the route of administration being key to the severity of a substance dependency. Crack is currently the most inexpensive form of illicit cocaine. "Non-smoked cocaine" includes all other primary cocaine admissions, including those where route of administration is unknown or not collected. For this reason, the TEDS estimate of smoked-cocaine admissions is a conservative one.

Capture of Known Universe

The TEDS attempts to capture all admissions to providers receiving any public funds. Because the TEDS eligibility of a provider is decided by each state or jurisdiction, there is no independent check on the actual sources of funding. For calendar 1993, we estimate the capture for TEDS-eligible providers to be 91% and the capture for all treatment providers to be 76% (including privately-funded providers). The method for determining these estimates is as follows:

Determining Open Treatment Providers for the Year:

SAMHSA maintains a list of substance abuse services providers (the National Facility Register) that includes prevention, administrative, and treatment entities. By removing the prevention and administrative entities, the known universe of treatment providers is determined and updated each year (see Table C.1).

The update is performed as part of a one-day census (NDATUS, now UFDS) conducted for a day in October. In 1993, the one-day census was for October 1, 1993. During the rest of the year, if a provider reports admissions to TEDS, the provider is characterized as open and TEDS-eligible, regardless of its status at the one-day census. If necessary, the provider's status is changed from what it had been at the one-day census: a) if new, the provider is added, b) if changed from closed or non-treatment, the provider's status is updated. In calendar 1993, there were 11,983 open treatment providers in the known universe, of which 8,457 (71%) were deemed TEDS-eligible (see Table C.2).

Determining Annual Admissions to Open Treatment Providers for the Year:

Annual admissions were determined directly from TEDS (6,811 providers that reported to TEDS) or estimated from each provider's one-day census (5,172 providers not reporting to TEDS). Because the one-day census was known for every treatment provider in the known universe in 1993, annual admissions could be calculated for non-reporting providers by multiplying their census by estimated annual turnover. The estimate of turnover was based on actual turnover in providers reporting to TEDS.

In 1993, all known open treatment providers (11,983) reported an October one-day census, and 6,811 also reported annual admissions to TEDS. For the 6,811 providers reporting both, turnover rate is the annual admissions divided by the one-day census. Using these 6,811 actual turnover rates, analysis of variance showed two variables to be significantly related to turnover: 1) census size (p<.0001), and 2) funding type (p<.0001) as public or other. Regression analysis yielded the following relationships between turnover and census size for publicly-funded and other-funded providers.

For providers receiving public funds:

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For all other providers:

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where :

T = Turnover rate

N = One-day census

Figure C.1 shows how actual turnover is related to census size for both publicly-funded and other-funded providers. Using these functional relationships, an estimated turnover rate was calculated for providers with a known one-day census and a known funding type that did not report to TEDS. In 1993, these variables were known for all 11,983 open treatment providers on the National Facility Register.

The estimated annual admissions and reported annual admissions, when summed, are the total admissions universe for 1993. Based on these calculations (see Table C.2), there were a total of 1,915,965 admissions to the known universe of treatment providers in 1993. Admissions reported by the TEDS-eligible providers totaled 1,448,927 or 91% of the TEDS-eligible admissions universe and 76% of the known admissions treatment universe.

Difficulties in Estimating TEDS Coverage:

Several problems regarding the above assessment of TEDS coverage should be recognized. First, the capture rates for TEDS reflect percentages of known treatment facilities, that is the facilities that have been identified and included in the National Facility Register maintained by SAMHSA. It is not possible to estimate the size of the "unknown" universe, but there clearly are some treatment facilities not included in the NFR. Studies are underway to attempt to estimate the size of this additional universe. Secondly, because TEDS eligibility is basically determined by States, and they submit TEDS data for their TEDS-eligible units, the meaning of the 91% capture rate for TEDS-eligible facilities is ambiguous. For example, if eligibility is based in part on which units data can be obtained from, then the capture rate can approach 100% simply because of the way eligibility is defined. It is possible that States may not be able to report on providers they deem eligible. Finally, the estimation method described above will over or under estimate the capture rate to the extent that reported TEDS admissions are under or over reported by TEDS facilities. This is because reported TEDS admissions are treated as "actual" admissions.

Another estimate (4) of 3.2 million 1993 admissions to specialty substance abuse treatment was calculated based on the 1993 NDATUS, but using a different methodology. This estimation did not use reported TEDS admissions, rather it used reports of 1993 annual admissions directly to NDATUS, which was done by less than half of the 1993 NDATUS providers. Turnover rates were calculated from the NDATUS and adjusted by findings from the California Drug and Alcohol Treatment Assessment (CALDATA) report to arrive at the figure of 3.2 million episodes of treatment in 1993. This second estimate compares closely to an estimate of 3.3 million 1993 admissions to specialty substance abuse treatment calculated by multiplying the 1993 census by an overall turnover rate derived from the overall length of stay from the 1990 Drug Services Research Survey.

Table C.1. Identification of active treatment providers in 1993

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Table C.2. TEDS capture of the known admissions universe in 1993

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Figure C.1 Annual turnover as function of provider one-day census in 1993

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Figure C.2 Annual admissions as function of provider one-day census in 1993

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APPENDIX B

Data Elements: The Data Treatment Episode Data Set (TEDS) - (1992-present)(2)

TEDS Minimum Data Set

Provider Identifier

All clinics and/or programs receiving any State Alcohol and/or Drug Agency (including Federal Block Grant) funds for the provision of alcohol or drug treatment services must report client data. At the State's option, data will be accepted on other programs which are identified on SAMHSA's master files as non-state programs, identified as non-treatment programs (e.g., sobering-up stations, crisis centers, etc.), and others such as private programs. For purposes of reporting to the Treatment Episode Data Set, early intervention is considered to be a subset of prevention services, not treatment services, and, accordingly, is not reportable.

This identifier must be unique within the State and must not be reassigned. The identifier is limited to 15 alphanumeric characters. The identifier can be unintelligent (containing no second-level coding). At the State's option, unique numbers to providers within a given State may be assigned by the State, or by SAMHSA.

Client Identifier

Data must be reported for all clients admitted to reporting clinics/programs, regardless of source of funding for individual clients.

At the State's option, client reporting may be done either by programs, clinics, or at the service level, provided each admission to a new service is reported. However, the level chosen must be the same as previous reporting to the National Drug and Alcoholism Treatment Survey (NDATUS) now replaced by the Uniform Facility Data Set (UFDS) survey. The reporting programs and clinics are referred to as the provider in the Minimum Data Set.

A Client is a person who meets all of the following criteria: 1) has an alcohol- or drug-related problem; 2) has completed the screening and intake process; 3) has been formally admitted for treatment/recovery service to an alcohol/drug treatment unit; 4) has his/her own client record; 5) is receiving treatment for an alcohol- or drug-related problem by a provider monitored or funded by a State Alcohol or State Drug authority. A person who has completed only the screening and/or intake process or has been placed on a waiting list is not a client.

Client identifiers should, at the very least, be unique within the provider programs and must not be reassigned. The identifier can be unintelligent. The client identifier should not exceed 15 alphanumeric characters. The responsibility for assigning numbers to the clients will reside within the individual state. Whatever identifier is employed, steps must be taken to ensure confidentiality of patient records.

Codependent/Collateral

A Codependent/Collateral is a person who: 1) is seeking services due to problems arising from his/her relationship with an alcohol or drug user; 2) has been formally admitted for service to a State-operated or State-funded treatment unit; 3) has his/her own client record or has a record within a primary client record.

The reporting of any or all of the Minimum Data Set for codependent/collateral/significant other is optional. When the data are extracted from the State system, the Codependent/Collateral flag will need to be set to discriminate between client and codependent/collateral records. If the state opts to report codependent/collateral information, the only mandatory data items will be Provider Identifier, Client Identifier, Data of Admission, and the Co dependent/Collateral flag. If a State elects not to report a portion of the codependent/collateral data, those items not reported will have a unique code to indicate that the item is not used/reported by the State.

A yes or no identifier. For States that do not collect Codependent/Collateral information, this item may be automated.

Transaction Type

Initial admission in episode or a change in service/transfer in episode. An episode is defined as a continuous period of care. It may involve multiple types of services but may not involve a break in service.

Date of Admission

For the purposes of data collection and subsequent reporting to SAMHSA, the initial admission and each change/transfer in service will be reported. This means that for a change in facility, program, or location, with no change in the type of service, an admission/transfer record is not needed.

An admission is counted on the day when the client actually receives his/her first direct treatment/recovery service within each service category.

Number of Prior Treatment Episodes in any Drug or Alcohol Treatment Program

0/1/2/3/4/5 or more. Do not count changes in service for same episode.

Principal Source of Referral

Individual (includes self-referral): This includes self, family or friend, or any other individual that referred the client to the program/clinic that is not included as part of a category below.

Alcohol/drug abuse care provider: Any program/clinic or other health care provider whose principal objective is the treatment of clients who have substance abuse problems, or a program whose activities are related to prevention, education, and/or treatment of alcoholism or drug abuse.

Other health care provider: This includes a physician, psychiatrist, or other licensed health care professional, general hospital, psychiatric hospital, mental health program, and nursing home.

School (educational): This includes a school principal, counselor, teacher, or student assistance program (SAP), the school system, or education agency.

Employer/Employee Assistance Program (EAP): This includes a supervisor or an employee counselor.

Other community referral: This includes a Federal, State, or local agency that provides aid in the areas of poverty relief, unemployment, shelter, or social welfare. Additionally, community and religious organizations are included in this category.

Court/Criminal justice referral/DUI/DWI: Referrals from a judge, prosecutor, probation officer, or other personnel affiliated with a Federal, State, and/or county judicial system, and referrals from the police. Referrals for DWI/DUI, and clients who have been referred in lieu of or for deferred prosecution and pretrial release, before or after official adjudication. Referrals for clients on pre-parole, pre-release, work and/or home furlough (the client need not be officially designated as "on parole"), and TASC clients who have been referred because of civilian commitment.

Date of Birth

Month, day, year.

Sex

Male, female.

Race

Alaskan Native (Aleut, Eskimo, Indian): A person having origins in any of the people of Alaska.

American Indian (other than Alaskan Native): A person having origins in any of the original people of North America and who maintains cultural identification through tribal affiliation or community recognition.

Asian or Pacific Islander: A person having origins in any of the original people of the Far East, Indian subcontinent, Southeast Asia, or the Pacific Islands.

Black: A person having origins in any of the black racial groups of Africa.

White: A Caucasian person having origins in any of the people of Europe (including Portugal), North Africa, or the Middle East.

Other: A default category for use in instances in which the client is not classified above, or whose origin group, because of area custom, is regarded as a racial class distinct from the above categories.

Ethnicity

Puerto Rican: A person of Puerto Rican origin, regardless of race.

Mexican: A person of Mexican origin, regardless of race.

Cuban: A person of Cuban origin, regardless of race.

Other Hispanic: A person from Central or South America and all other Spanish cultures and origins, regardless of race (includes Spain).

Education at Time of Admission

Highest school grade completed (GED=12).

Employment Status

Employed full time: 35 hours or more a week; includes Armed Forces.

Employed part time: Less than 35 hours a week.

Unemployed: Looking for work in the past 30 days; on layoff from job.

Not in Labor Force: Includes homemaker, student, disabled, retired, not looking for work in the past 30 days, and inmate of institution.

Substance Problem (Primary, Secondary, and Tertiary)

In determining primary, secondary, and tertiary substance problems, clinical judgment will ultimately determine the degree of impairment that a substance has for an individual client. In determining the degree of impairment, the following considerations should be made: patterns of drug involvement; degree of present or past physical, mental, social dysfunction caused by the substance; degree of present or past physical or psychological dependence on drugs, regardless of the frequency of use of a specific drug.

Substance Problems

None.

Alcohol.

Cocaine/crack.

Marijuana/hashish. This includes THC and any other cannabis sativa preparations.

Heroin.

Non-prescription methadone.

Other opiates and synthetics. This includes codeine, Dilaudid, morphine, Demerol, opium, and any other drug with morphine-like effects.

PCP. Phencyclidine.

Other hallucinogens. This includes LSD, DMT, STP, mescaline, psilocybin, peyote, etc.

Methamphetamine.

Other amphetamines. This includes Benzedrine, Dexedrine, Preludin, Ritalin, and any other amines and related drugs.

Other stimulants.

Benzodiazepine. This includes Diazepam, Flurazepam, Chlordiazepoxide, Clorazepate, Lorazepam, Alprazolam, Oxazepam, Temazepam, Prazepam, Triazolam, Clonazepam, and Halezepam.

Other tranquilizers.

Barbiturates. This includes Phenobarbital, Seconal, Nembutal, etc.

Other sedatives or hypnotics. This includes chloral hydrate, Placidyl, Doriden, etc.

Inhalants. This includes ether, glue, chloroform, nitrous oxide, gasoline, paint thinner, etc.

Over-the-counter. This includes aspirin, cough syrup, Sominex, and any other legally-obtained nonprescription medication.

Other.

Usual Route of Administration (optional when substance is Alcohol Only and for tertiary drug problems.)

Oral.

Smoking.

Inhalation.

Injection (intravenous or intramuscular).

Other.

Frequency of Use (optional when substance is Alcohol Only and for tertiary drug problems.)

No past-month use.

1-3 times in past month.

1-2 times per week.

3-6 times per week.

Daily.

Age of First Use or First Alcohol Intoxication (optional when substance is Alcohol Only and for tertiary drug problems.)

For drugs other than alcohol, record age of first use. The recorded age should reflect willful use.

For alcohol, record age of first intoxication. The recorded age should reflect willful use.

A value of zero (0) indicates a newborn with a substance dependency problem.

Services

Detoxification, 24-hour per day service:

- Hospital inpatient (24-hour per day medical acute care services for detoxification for persons with severe medical complications associated with withdrawal.)

- Free-standing residential (24 hour per day services in non-hospital setting providing for safe withdrawal and transition to ongoing treatment.)

Rehabilitation/residential:

- Hospital-other than detoxification (24-hour per day medical care in a hospital facility in conjunction with treatment services for alcohol and other drug abuse and dependency.)

- Short-term-30-days-or-less (Typically 30 days or less of non-acute care in a setting with treatment services for alcohol and other drug abuse and dependency.)

- Long-term-over-30-days (Typically more than 30 days of non-acute care in a setting with treatment services for alcohol and other drug abuse and dependency. This may include transitional living arrangements such as halfway houses.)

Ambulatory:

- Non-intensive outpatient (Ambulatory treatment services including individual, family, and/or group services; these may include pharmacologic therapies.)

- Intensive outpatient (As a minimum, the client must receive treatment lasting two or more hours per day on three or more days per week.)

- Detoxification (Outpatient treatment services providing for safe withdrawal in an ambulatory setting (pharmacologic or non-pharmacologic.)

Use of Methadone Planned as Part of Treatment.

A yes/no item.

TEDS Supplemental Data Set

Detailed Drug Codes (primary, secondary, and tertiary)

Alcohol Phenobarbital

Heroin/morphine Secobarbital/Amobarbital

d-Propoxyphene Secobarbital

Methadone Other sedatives

Oxycodone Amphetamine

Codeine Methamphetamine/speed

Heperidine HCL Other stimulants

Hydromorphone Solvents

Other narcotic analgesics Aerosols

Diazepam Anesthetics

Alprazolam Nitrites

Triazolam Other inhalants

Chlordiazepoxide PCP/PCP combinations

Clorazepate LSD

Lorazepam Other hallucinogens

Other benzodiazepine Crack

Meprobamate Other cocaine

Other tranquilizer Marijuana/hashish

Methaqualone Pentazocine

Flurazepam Methylphenidate

Ethchlorvinyl Diphenhydramine

Glutethimide Diphenylhydantoin sodium

Other non-barbiturate sedatives Other drugs

Substance Abuse Diagnosis Based on Diagnostic Statistical Manual- Revised (DSM III-R) Criteria

Psychiatric Problem in Addition to Alcohol or Drug Problem

Yes/no item.

Pregnant at Time of Admission

Yes/no item.

Veteran Status

A veteran is any person who has served on active duty in the armed forces of the United States, including the Coast Guard. Not counted as veterans are those whose only service was in the Reserves, National Guard, or Merchant Marines.

Yes/no item.

Living Arrangements

Homeless. No fixed address; includes shelters.

Dependent living. Includes dependent children and adults living in a supervised setting, e.g., halfway houses and group homes.

Independent living.

Primary Source of Income/Support

In the case of children under 18 years old, indicate parents' primary source of income/support.

Wages/salary

Public assistance

Retirement/pension

Disability

Other

None

Health Insurance (May or May Not Cover Alcohol or Drug Treatment)

None

Medicare

Medicaid

Private insurance

Blue Cross/Blue Shield

Health maintenance organization (HMO)

Other (e.g., Civilian Health and Medical Plan of Uniformed Services - CHAMPUS)

Unknown

Expected Primary Source of Payment for This Treatment Episode

Self-pay

Workman's Compensation

Medicare

Medicaid

Other government payments

Blue Cross/Blue Shield

Other health insurance companies

No charge (free, charity, special research, or teaching)

Other

Unknown

Detailed "Not in Labor Force" Categories

Homemaker

Student

Retired

Disabled

Inmate of Institution

Other

Detailed Criminal Justice Referral Categories

State/Federal court

Formal adjudication process (other than above)

Probation/parole

Recognized legal entity (other than above)

Driving under the influence (DUI) or driving while intoxicated (DWI)

Diversionary program, i.e Treatment Alternatives to Street Crime (TASC)

Prison

Other

Marital Status

Never married: persons whose only marriage has been annulled are classified as never married. (Definition compatible with the U.S. Census.)

Now married: Individuals living as married are counted as married.

Separated: Individuals reported as separated (either legally or otherwise absent from their spouse because of marital discord) are classified as separated. (Definition compatible with the U.S. Census.

Divorced

Widowed

Time Waiting to Enter Treatment

This is the number of days that elapsed from the first contact/request for service until the client was admitted and the first clinical service was provided.

Data Elements: The Client-Oriented Data Acquisition Process (CODAP) - (1979-1981)

Age at Admission

Derived by subtracting a client's year of birth from year of admission to treatment.

Age at First Use

The chronological age at which a person first used the drug now listed as his/her primary drug problem.

Clients

Persons admitted to a clinic for the prevention or treatment of a drug problem; they are assigned a treatment plan and receive the clinical and supportive services identified in the regimen. Criteria for completing treatment are established at this time. When a clinic's Federal contract or grant states that both prevention and treatment services are to be provided, the persons receiving prevention services are also considered clients. The guidelines of the Federal funding agencies state that a client is considered active if he/she receives treatment services at least once every thirty days. Only active clients are reported on CODAP. If the client has not received treatment or direct services for 30 days, he/she must be discharged from the CODAP reporting system. Partial services are occasionally offered to community groups, clients; families, and individuals; this activity is not reported by CODAP clinics because the people involved in receiving partial services are not treated for diagnosed drug problems.

Clinics

Units that provide drug abuse treatment services. Several types of treatment may be provided by a single clinic.

Drug Types

None

Heroin

Non-prescription Methadone

Other opiates and synthetics - opium, morphine, codeine, Demerol, Dilaudid, etc.

Alcohol - (Note: alcohol treatment programs were excluded from CODAP)

Barbiturates - phenobarbital, Seconal, Nembutal, etc.

Other sedatives or Hypnotics - methaqualone, chloralhydrate, Placidyl, Doriden, etc.

Amphetamines - Benzedrine, Dexedrine, methamphetamine, "speed," and related compounds such as Preludin, Ritalin, etc.

Cocaine

Marijuana/Hashish - includes THC, "hash oil," other cannabis preparations.

Hallucinogens - LSD, mescaline, psilocybin, MCA, DMT, mushrooms, peyote, etc.

Inhalants - glue, nitrous oxide, organic solvents, etc.

Over-the-Counter - those drugs legally obtained, non-prescription medication.

Tranquilizers - Librium, Valium, Miltown, etc.

PCP - phencyclidine

Other

Drug Unknown

Educational or skill development program, participation in:

Participation in an educational program is attendance at a school or college from which the client will receive a diploma or degree. High school equivalency programs are included. Participation in a skill development program provides the client with vocational training, e.g., secretary, barber, mechanic.

Employment status:

The following categories are used to indicate if the client is legally employed (includes self-employment) at the time of admission. To qualify as being employed, the client's earnings must be subject to income taxes. For example, stipends and welfare payments are not taxable; therefore, the client receiving these monies would not be considered employed. The categories are:

Unemployed, not seeking work - has not sought employment in last 30 days.

Unemployed, seeking work - has sought employment in last 30 days. This includes registering with employment agencies, etc.

Part-time - working less than 35 hours a week.

Full-time - working 35 hours or more a week. This category also includes clients with concurrent, full-time and part-time positions.

Environment:

The physical setting and circumstances in which clients receive treatment. There are five categories:

Prison - treatment takes place within a Federal, State, or local correctional institution.

Hospital - this environment applies to inpatients who are being treated primarily for a drug abuse problem; the patients may also receive care for medical or psychiatric problems.

Residential - this category includes halfway houses, therapeutic communities, and all settings other than prisons and hospitals that provide both living arrangements and treatment.

Day care - a setting in which clients reside outside the clinic but spend a substantial amount of time at the treatment center, usually amounting to five or more hours per day for at least five days per week. The client is assigned supervised work at the clinic and may be provided a variety of counseling, legal, vocational, and educational services.

Outpatient - a setting similar to day care; less time is spent at the clinic by the client, and supervised work is not regularly assigned. Treatment, counseling, and supportive services are provided to the client.

Frequency of use of primary drug:

The number of times a client uses the primary drug during the month prior to admission. There are seven categories:

No use during month prior to admission.

Less than once per week.

Once per week.

Several times per week.

Once daily.

Two or three times daily.

More than three times daily.

Health insurance type:

The following categories indicate the client's health insurance status at the time of admission to the clinic:

No health insurance.

Blue Cross/Blue Shield.

Other private insurance.

Medicaid/Medicare.

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services).

Other public funds for health care.

Last formal school year completed:

Number of years of education the client completed.

Marital Status:

The following categories indicate the client's marital status at time of admission:

Never married - this includes annulment.

Married - this includes common-law marriage and those clients who consider themselves married.

Widowed.

Divorced.

Separated - this refers to married persons not living together by choice, whether or not the separation is legal.

Modality:

The type of therapy or treatment a client receives. There are four categories:

Detoxification - the planned withdrawal of a client from a drug. Prescribed medication, or decreasing doses of the problem drug, must be used as the primary element of the detoxification process; if drugsare not used therapeutically (e.g., the client undergoes "cold turkey"), the modality classification would be "drug free" rather than detoxification. The detoxification period may not exceed 21 days when methadone is prescribed in detoxifying opiate addicts; after 21 days, the modality becomes "maintenance." Detoxification from non-opiate substances, such as barbiturates, may take longer.

Maintenance -treatment of an addicted client only by the continued administration of methadone, L-alpha-acetylmethadol (LAAM), or propoxyphene napsylate (Darvon-N) to achieve stabilization. Slow methadone withdrawal, detoxification from a maintenance regimen, and the abstinence phase of maintenance are included in this category.

Drug free - treatment regimen that does not include any chemical agent or medication. However, drugs may be used as an adjunct to treatment or to treat any medical problems the client may have. Temporaryuse of medication (e.g., tranquilizers) for treating psychiatric problems may occur in drug free modalities. Primary treatment method is traditional counseling.

Other - the primary treatment modality assigned the client is other than those specified above. It may be with or without medication and includes acupuncture, chemotherapy, and transcendental meditation.

Primary drug:

The drug type that is the major problem in that it has caused the most dysfunction. It is the drug problem for which the client was admitted to treatment. Only one primary problem may be reported. (See also "Drug types.")

Primary treatment experiences, number of:

The number of uninterrupted periods, from admission to discharge, in any drug treatment program.

Race/ethnicity:

Based on staff observation and client self-identification, the following categories have been selected to conform with the FICE Ad Hoc Subcommittee on Racial and Ethnic Definitions:

White (not of Hispanic origin) - a person having origins in any of the people of Europe, North Africa, or the Middle East.

Black (not of Hispanic origin) - a person having origins in any of the people of sub-Saharan Africa.

American Indian - a person having origins in any of the original people of North America.

Alaskan Native (Aleut, Eskimo Indian) - a person having origins in any of the original people of North America.

Asian or Pacific Islander - a person having origins in any of the original people of the Far East, Indian subcontinent, Southeast Asia, or the Pacific Islands.

Hispanic - Mexican

Hispanic - Puerto Rican

Hispanic - Cuban

Other Hispanic

Reason for discharge:

The circumstances under which a client leaves treatment. Several types of discharge are reported as follows:

Completed treatment, no drug use - the client has successfully completed the prescribed treatment regimen in the program and no further treatment services are prescribed within this program or any other program; however, follow-up contact may be recommended. The client is no longer using illegal drugs or abusing alcohol.

Completed treatment, some drug use - the decision of the clinic staff is that the client has successfully completed the prescribed treatment regimen in the program, and no further treatment services are prescribed within this program or any other program. The client meets all other criteria for completion of treatment except concerning the use of drugs during the month prior to discharge.

Transfer to a CODAP reporting clinic within this program - the client is discharged from the clinic and, with no interruption in treatment, is transferred to another clinic that does submit CODAP reports to the National Institute on Drug Abuse (NIDA) and is within the same program.

Transfer to a non-CODAP reporting clinic within this program - the client is discharged from the clinic and, with no interruption in treatment, is transferred to another clinic that does not submit CODAP reports to NIDA and is within the same program.

Referred outside this program - the client is discharged from the clinic; treatment is not completed. The client is referred to another drug treatment program or to a medical or psychiatric institution.

Program decision to discharge client for noncompliance with program rules - treatment is not completed; the client is discharged for violation of program rules.

Left before completion - the client is discharged because of his/her decision to leave the clinic before completion of treatment, or his/her refusal to continue a further phase of treatment in this or any other program.

Incarcerated - treatment is not completed; the client is discharged because of incarceration.

Died - the client died before completing treatment; however, this does not necessarily imply a drug-related death.

Regions:

Geographic regions used are based on divisions used by the U.S. Bureau of Census, 1970 Census of Population. They are comprised of the following States and territories:

New England - Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont.

Middle Atlantic - New Jersey, New York, Pennsylvania.

East North Central - Illinois, Indiana, Michigan, Ohio, Wisconsin.

West North Central - Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.

South Atlantic - Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia.

East South Central - Alabama, Kentucky, Mississippi, Tennessee.

West South Central - Arkansas, Louisiana, Oklahoma, Texas.

Mountain - Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming.

Pacific - Alaska, California, Hawaii, Oregon, Washington.

Outlying Areas - Guam, Puerto Rico, Virgin Islands.

Route of administration, most recent usual:

Indicates the most recent method employed by the client to use the drug type(s) identified. If more than one recent method of administration of a drug type has been used, the most usual or frequent route is indicated. There are five categories:

Oral - ingested by mouth.

Smoking - absorbed through lungs and respiratory system by mouth.

Inhalation - absorbed through lungs and respiratory system by nose.

Intramuscular - administered by injection into muscles.

Intravenous - administered by injection into veins.

Secondary drug:

The drug type, if any, that has resulted in a lesser degree of dysfunction than the primary drug problem. (See also "Primary drug" and "Drug types.")

Skill development program:

See "Educational or skill development program, participation in."

Source of referral:

The following categories indicate the agency, individual, or legal situation through which the client is committed to or referred to treatment:

Self referral.

Hospital- includes a medical or psychiatric hospital, or affiliated clinics.

Community mental health center.

Community services agencies/individuals - includes Federal, State or local agencies, another drug program, and a private physician, psychiatrist, or other mental health professional.

Family/friend.

Employer.

School.

Other voluntary.

TASC (Treatment Alternatives to Street Crime).

Federal/State/county probation.

Federal/State/county parole.

Other non-voluntary - includes police, NARA I, and NARA III.

Bureau of Prisons (BOP) - includes BOP NARA II, BOP study, BOP-IPDDR, BOP probationer, and other BOP (formerly DAP).

VAASMRO (Veterans Administration Armed Services Medical Referral Office).

SMSA's:

Standard Metropolitan Statistical Areas, as defined by the U.S. Department of Commerce, Office of Federal Statistical Policy Standards as of April 1978.

Tertiary drug:

The drug type, if any, that has resulted in a lesser degree of dysfunction than the secondary drug problem. (See also "Primary drug," "Secondary drug," and "Drug types.")

Times arrested within 24 months prior to this admisssion, number of:

Indicates the number of times the client has been arrested and booked during the 24 months prior to admission. This item does not imply conviction and relates to alleged offenses. Arrests for traffic infractions are not included. However, arrests for driving while under the influence of alcohol or drugs and driving while intoxicated because of alcohol or drugs are included.

Weeks in treatment:

The number of uninterrupted weeks a client spends in treatment at a clinic.

Years between first use and admission:

The number of years between the first use of a drug and admission to a drug treatment clinic.

1. Blanken, A. (1989) Evolution of a National Database for Drug Abuse Treatment Clients. Proceedings of the Community Epidemiology Work Group: Epidemiologic Trends in Drug Abuse, June.

2. From Alcohol and Drug Abuse Client Minimum Data Set, National Institute on Drug Abuse, April 1, 1990.

3. Statistical Series Quarterly Report Provisional Data January-March 1980: Data from the Client Oriented Data Acquisition Process (CODAP), Series D, No. 14, National Institute on Drug Abuse, DHHS Publication No. ADM) 80-968, printed 1980.

4. Denmead G., Fountain D., Harwood, H., and Zhang D. (1995) Substance Abuse Treatment Services: Treatment Facilities and Funded Capacity , September.

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