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 (Cathie Alderks, Task Order Officer).

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, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2002-2012. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-71, HHS Publication No. (SMA) 14-4850. 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 2-1084
Rockville, Maryland 20857

July 2014

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This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2012 and trend data for 2002 to 2012. The report provides information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual state administrative data systems. 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.

For 2012, 1,749,767 substance abuse treatment admissions aged 12 and older were reported to TEDS by 47 states, the District of Columbia, and Puerto Rico. Mississippi, Pennsylvania, and West Virginia had submitted no data or incomplete data for 2012 by October 17, 2013, and are
excluded from this report.

Major Substances of Abuse

• Five substance groups accounted for 96 percent of the primary substances reported by the 1,749,767 TEDS admissions aged 12 and older in 2012: alcohol (39 percent), opiates (26 percent), marijuana (17 percent), cocaine (7 percent), and methamphetamine/amphetamines
  (7 percent) [Table 1.1b].
  

Alcohol

• Primary alcohol admissions fluctuated between 2002 and 2012 from a high of 43 percent in 2002 to a low of 39 percent in 2005, 2011, and 2012 [Table 1.1b].
  
• Admissions for abuse of alcohol alone represented 21 percent of TEDS admissions aged 12 and older in 2012, while admissions for primary alcohol abuse with secondary drug abuse
  represented 18 percent of all TEDS admissions and 45 percent of primary alcohol admissions [Table 1.1b].
  
• Almost three-quarters of admissions for abuse of alcohol alone (71 percent) and for abuse of alcohol with secondary drug abuse (72 percent) were male [Table 2.1a].
  
• The average age at admission among alcohol-only admissions was 41 years compared with 37 years among admissions for primary alcohol with secondary drug abuse [Table 2.1a].
  
• About two-thirds (66 percent) of alcohol-only admissions were non-Hispanic White, followed by non-Hispanic Black admissions and admissions of Hispanic origin (13 percent each). Among admissions for primary alcohol with secondary drug abuse, 58 percent were non-Hispanic White, 23 percent were non-Hispanic Black, and 12 percent were of Hispanic origin [Table 2.2].

Heroin

• In 2002, 15 percent of admissions aged 12 or older were for primary heroin. This percentage dropped slightly to 14 percent in 2006 and remained at 14 percent until 2011 were it increased slightly to 15 percent. In 2012, the primary heroin admissions aged 12 and older increased to 16 percent [Table 1.1b].
  
• Heroin represented 86 percent of all opiate admissions in 2002 but only 63 percent in 2012 [Table 1.1a].
  
• About two-thirds (66 percent) of primary heroin admissions were male [Table 2.1a].
  
• For primary heroin admissions, the average age at admission was 34 years [Table 2.1a].
  
• Nearly two-thirds (65 percent) of primary heroin admissions were non-Hispanic White, followed by Hispanics (16 percent) and non-Hispanic Blacks (15 percent) [Table 2.2].
  
• Seventy-one percent of primary heroin admissions reported injection as the usual route of administration, and 24 percent reported inhalation [Table 2.4].
  

Opiates Other than Heroin¹

• Admissions for primary opiates other than heroin increased from 2 percent of admissions aged 12 and older in 2002 to 10 percent in 2011 and 2012 [Table 1.1b].
  
• Opiates other than heroin represented 14 percent of all opiate admissions in 2002 but rose to 37 percent in 2012 [Table 1.1a].
  
• Just over half (53 percent) of primary non-heroin opiate admissions were male [Table 2.1a].
  
• For primary non-heroin opiate admissions, the average age at admission was 32 years [Table 2.1a].
  
• Most primary non-heroin opiate admissions (86 percent) were non-Hispanic White [Table 2.2].
  
• More than half (59 percent) of primary non-heroin opiate admissions reported oral as the usual route of administration, while 21 percent reported inhalation and 17 percent reported injection [Table 2.4].
  

Marijuana/Hashish

• Admissions for primary marijuana were 15 percent of admissions aged 12 or older in 2002 and 17 percent in 2012 [Table 1.1b].
  
• Nearly three-quarters (73 percent) of primary marijuana admissions were male [Table 2.1a].
  
• For primary marijuana admissions, the average age at admission was 25 years [Table 2.1a].
  
• Slightly less than half (44 percent) of primary marijuana admissions were non-Hispanic White, 31 percent were non-Hispanic Black, and 18 percent were of Hispanic origin [Table 2.2].
  

Cocaine/Crack

• Admissions for primary cocaine declined from 13 percent of admissions aged 12 or older in 2002 to 7 percent in 2012. Smoked cocaine (crack) represented 69 percent of all primary cocaine admissions in 2012, down from 73 percent in 2002 [Tables 1.1a-b].
  
• Fifty-eight percent of primary smoked cocaine admissions were male compared with 67 percent of primary non-smoked cocaine admissions [Table 2.1a].
  
• The average age at admission among smoked cocaine admissions was 42 years compared with 37 years among non-smoked cocaine admissions [Table 2.1a].
  
• Among primary smoked cocaine admissions, 56 percent were non-Hispanic Black, 33 percent were non-Hispanic White, and 8 percent were of Hispanic origin. Among primary non-smoked cocaine admissions, 45 percent were non-Hispanic White, followed by non-Hispanic Blacks (32 percent) and admissions of Hispanic origin (19 percent) [Table 2.2].
  
• Seventy-nine percent of primary non-smoked cocaine admissions reported inhalation as their route of administration, and 11 percent reported injection [Table 2.4].
  

Methamphetamine/Amphetamines

• Admissions for primary methamphetamine/amphetamines aged 12 and over varied over the years. In 2002, there were 7 percent of admissions aged 12 and older for methamphetamine/amphetamines. This percentage increased to 8 percent in 2004 and 9 percent in 2006. The
  percentage of admissions aged 12 and older decreased to 8 percent in 2006 and further decreased to 6 percent in 2008 through 2011. In 2012, the primary admissions aged 12 and older for
  methamphetamine/amphetamines increased to the 2002 level of 7 percent [Table 1.1b].
  
• For primary methamphetamine/amphetamine admissions, the average age at admission was 33 years [Table 2.1a].
  
• Fifty-two percent of primary methamphetamine/amphetamine admissions were male [Table 2.1a].
  
• About two thirds (69 percent) of primary methamphetamine/amphetamine admissions were non-Hispanic White, followed by 18 percent who were of Hispanic origin [Table 2.2].
  
• Sixty-two percent of primary methamphetamine/amphetamine admissions reported smoking as the usual route of administration, 25 percent reported injection, and 8 percent reported inhalation [Table 2.4].
  

Adolescent Admissions to Substance Abuse Treatment

• The number of admissions to substance abuse treatment aged 12 to 17 decreased by 24 percent between 2002 and 2012 (from 157,914 to 120,239) [Table 3.1a].
  
• Forty-four percent of adolescent treatment admissions were referred to treatment through the criminal justice/DUI source [Table 3.3].
  
• Approximately 9 out of 10 (89 percent) adolescent treatment admissions involved marijuana as a primary or secondary substance in 2012 [Table 3.4].
  

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

• The proportion of non-Hispanic Whites aged 20 to 34 among heroin admissions increased from more than 1 in 5 (24 percent) in 2002 to more than 2 in 5 (45 percent) in 2012 [Table 3.5].
  
• The proportion of injectors aged 20 to 34 among heroin admissions increased from 1 in 4 (26 percent) in 2002 to more than 2 in 5 (44 percent) in 2012. During that period, the proportion of injectors aged 35 to 44 fell from 19 percent to 12 percent [Table 3.6].
  
• The proportion of heroin admissions with treatment plans that included receiving medication-assisted opioid therapy fell from 35 percent in 2002 to 28 percent in 2012 [Table 3.7].

Polydrug Abuse

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances (alcohol: 39 vs. 18 percent; opiates: 26 vs. 10 percent; methamphetamine/amphetamines: 7 vs. 5 percent).
  
• Marijuana and cocaine were reported less often as primary substances than as secondary or tertiary substances (marijuana: 17 vs. 21 percent; cocaine: 7 vs. 14 percent).

Race/Ethnicity

Alcohol was the most frequently reported primary substance at treatment admission among all racial/ethnic groups except admissions of Puerto Rican origin. However, the proportions reporting primary use of the other four major substance groups varied considerably by racial/ethnic group [Table 2.2].

• Among non-Hispanic Whites, alcohol (40 percent) was followed by opiates (31 percent), marijuana (13 percent), methamphetamine/amphetamines (8 percent), and cocaine (4 percent).
  
• Among non-Hispanic Blacks, alcohol (36 percent) was followed by marijuana (28 percent), cocaine (17 percent), opiates (15 percent), and methamphetamine/amphetamines (1 percent).
  
• Among persons of Mexican origin, alcohol (38 percent) was followed by marijuana (26 percent), methamphetamine/amphetamines (18 percent), opiates (14 percent), and cocaine (3 percent).
  
• Among persons of Puerto Rican origin, opiates (42 percent) were followed by alcohol (29 percent), marijuana (16 percent), cocaine (8 percent), and methamphetamine/amphetamines (1 percent).
  
• Among American Indians/Alaska Natives, alcohol (62 percent) was followed by marijuana (13 percent), opiates (13 percent), methamphetamine/amphetamines (8 percent), and cocaine (2 percent).
  
• Among Asians/Pacific Islanders, alcohol (37 percent) was followed by marijuana (21 percent), methamphetamine/amphetamines (20 percent), opiates (14 percent), and cocaine (4 percent).
  

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Trends in Primary Substance of Abuse: 2002-2012
Trends in the Co-Abuse of Alcohol and Drugs
Trends in Demographic Characteristics
Trends in Employment Status

This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2012 and trend data for 2002 to 2012. It is a companion to the report Treatment Episode Data Set (TEDS): 2002-2012 State Admissions to Substance Abuse Treatment. These reports provide information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems. Data include records for admissions during calendar years 2002 through 2012 that were received and processed through October 17, 2012.¹ 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.

TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would be counted as two admissions.

TEDS does not include all admissions to substance abuse treatment. It includes admissions at facilities that are licensed or certified by a state substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including federal block grant funds) for the provision of alcohol and/or drug treatment services. Additional information on the history and methodology of TEDS and this report, as well as important issues related to state data collection systems, are detailed in Appendix A.

This chapter details trends in the annual numbers and rates of admissions aged 12 and older for 2002 to 2012. Trend data are invaluable in monitoring changing patterns in substance abuse treatment admissions. These patterns reflect underlying changes in substance abuse in the population as well as changing priorities in the treatment/reporting system.

Trends in Primary Substance of Abuse: 2002-2012

Admissions can report up to three substances of abuse. These represent the substances that led to the treatment episode and are not necessarily a complete enumeration of all substances used at the time of admission. Most of the information in this report is based on an admission’s primary
substance of abuse. (See Appendix A for more details.)

Tables 1.1a-b and Figure 1.The number of admissions aged 12 and older decreased by 7 percent from 2002 to 2012. The U.S. population aged 12 and older increased by 9 percent during this time period.

• Between 2002 and 2012, five substance groups accounted for 96 percent of the primary substances of abuse reported by TEDS treatment admissions aged 12 and older: alcohol, opiates (primarily heroin), marijuana, cocaine, and methamphetamine/amphetamines. However, the proportions of admissions by primary substance changed considerably over that period:
  • Alcohol admissions aged 12 and over fluctuated between 2002 and 2012 from a high of 43 percent in 2002 to a low of 39 percent in 2005, 2011, and 2012. In 2012, 45 percent of primary alcohol admissions aged 12 and older reported secondary drug abuse as well.
    
  • Opiate admissions increased from 18 percent of admissions aged 12 and older in 2002 to 26 percent in 2012.
    
    • Admissions for primary heroin were fairly steady over this time period: they were 15 percent of admissions aged 12 and older from 2002 to 2004, 13 percent in 2007, 14 percent from 2008 to 2010, 15 percent in 2011, and 16 percent in 2012. Heroin represented 86 percent of all opiate admissions in 2002 but only 63 percent in 2012.
      
    • Opiates other than heroin² increased from 2 percent of admissions aged 12 and older in 2002 to 10 percent in 2012. Opiates other than heroin represented 14 percent of all opiate admissions in 2002 but 37 percent in 2012.
      
  • Marijuana admissions increased from 15 percent of admissions aged 12 and older in 2002 to 19 percent in 2010, decreasing to 18 percent in 2011, and 17 percent in 2012.
    
  • Cocaine admissions declined from 13 percent of admissions aged 12 and older in 2002 to 7 percent in 2012. Smoked cocaine (crack) represented 69 percent of all primary cocaine admissions in 2012, down from 73 percent in 2002.
    
  • Stimulant admissions (98 to 99 percent of these admissions were for methamphetamine or amphetamine abuse) increased from 7 percent of admissions aged 12 and older in 2002 to 9 percent in 2005, but then decreased to 6 percent in 2008, and in 2012 increased to 7 percent.
    
  • Tranquilizers, sedatives and hypnotics, hallucinogens, PCP, inhalants, and over-the-counter medications each accounted for 1 percent or less of TEDS admissions between 2002 and 2012.

Trends in the Co-Abuse of Alcohol and Drugs

Table 1.2. The concurrent abuse of alcohol and drugs continues to be a significant problem. Because TEDS collects a maximum of three substances of abuse and not all substances abused, alcohol use among polydrug abusers may be underreported.

• The proportion of admissions aged 12 and older reporting abuse of both alcohol and drugs declined from 41 percent in 2002 to 35 percent in 2012.
  
• The proportion reporting abuse of drugs only increased from 32 percent in 2002 to 42 percent in 2012, while the proportion reporting abuse of alcohol only fell slightly, from 24 percent in 2002 to 21 percent in 2012.
  
  

Trends in Demographic Characteristics

Table 1.3b. Males represented 67 percent of TEDS admissions aged 12 and older in 2012, a proportion that declined steadily, if slightly, from 70 percent in 2002.

• The distribution of TEDS admissions aged 12 and older differed markedly by gender from that of the U.S. population, where 49 percent of the population was male.
  

Table 1.3b and Figure 2. The age distribution of TEDS admissions aged 12 and older changed between 2002 and 2012.

• The proportion of admissions aged 18 to 29 years increased from 28 percent in 2002 to 34 percent in 2012. The proportion of admissions aged 12 to 17 decreased slightly from 8 percent in 2002 to 7 percent in 2012.
  
• Admissions aged 30 to 44 years made up 45 percent of TEDS admissions in 2002 but only 34 percent in 2012.
  
• The proportion of admissions aged 45 and older increased from 18 percent in 2002 to 25 percent in 2012.
  
• The age distribution of TEDS treatment admissions aged 12 and older differed considerably from that of the U.S. population. In 2012, some 68 percent of TEDS admissions were aged 18 to 44 years compared with 44 percent of the U.S. population. Adolescents aged 12 to 17 years made up 7 percent of TEDS admissions but 9 percent of the U.S. population. Admissions aged 45 and older made up 25 percent of TEDS admissions but 47 percent of the U.S. population.
  
  

Table 1.4 and Figure 3. The racial/ethnic composition of TEDS admissions aged 12 and older changed very little between 2002 and 2012.

• Non-Hispanic Whites increased from 58 to 61 percent of admissions over the time period.
  
• The proportion of non-Hispanic Blacks declined, from 24 percent of admissions in 2002 to 20 percent in 2012.
  
• The proportion of admissions of Hispanic origin remained steady at 13 percent from 2002 to 2012 except in 2005 when it increased to 14 percent.
  
• Other racial/ethnic groups combined made up 4 to 6 percent of admissions throughout the time period.
  
• The racial/ethnic composition of TEDS admissions differed from that of the U.S. population. Non-Hispanic Whites were the majority in both groups, but they represented 61 percent of TEDS admissions in 2012 compared with 70 percent of the U.S. population. Non-Hispanic Blacks represented 20 percent of TEDS admissions in 2012 and 11 percent of the U.S. population. However, the proportion of TEDS admissions of Hispanic origin was the same as the proportion of Hispanics in the U.S. population (13 percent each). Other racial/ethnic groups made up 6 percent of TEDS admissions and 6 percent of the U.S. population.
  

Trends in Employment Status

Table 1.5 and Figure 4. TEDS admissions aged 16 and older were less likely to be employed than the U.S. population aged 16 and older. This is evident in the unadjusted distributions of admissions by employment status (employed, unemployed, and not in labor force) shown in Table 1.5. Because TEDS admissions differ demographically from the U.S. population, Table 1.5 also shows distributions that have been statistically adjusted to provide a more valid comparison to the U.S. population.³ The adjusted distributions indicate an even greater disparity in socioeconomic status than do the unadjusted.

• Between 2002 and 2012, unemployment grew from the least common employment status reported (28 percent) by treatment admissions aged 16 and older to the most common treatment admission status (39 percent).
  
• The most common employment status reported by TEDS admissions aged 16 and older between 2002 and 2007 was “not in labor force.” However, this proportion declined from a peak of 42 percent in 2002 to 38 percent in 2012.
  
• Among the U.S. population aged 16 and older in 2012, 36 percent were not in the labor force.

³ The distributions have been adjusted for age, gender, and race/ethnicity to the U.S. population. In essence, this technique compares the distributions under the assumption that the TEDS population and the U.S. population had the same age, gender, and racial/ethnic characteristics.

TO TABLES

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All Admissions Aged 12 and Older
Alcohol Only
Alcohol with Secondary Drug Abuse
Heroin
Opiates Other than Heroin
Smoked Cocaine (Crack)
Non-Smoked Cocaine
Marijuana/Hashish
Methamphetamine/Amphetamines
Tranquilizers
Sedatives
Hallucinogens
Phencyclidine (PCP)
Inhalants

This chapter highlights important findings in the 2012 TEDS data. The tables include items in the TEDS Minimum and Supplemental Data Sets for 2012. (See Appendix B for a complete data dictionary.) Data are tabulated as percentage distributions of treatment admissions according to primary substance of abuse. 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.

The Minimum Data Set consists of items that include:

• Demographic information
  
• Primary, secondary, and tertiary substances and their route of administration, frequency of use, and age at first use
  
• Source of referral to treatment
  
• Number of prior treatment episodes
  
• Service type, including medication-assisted opioid therapy
  

The Supplemental Data Set consists of 17 items that include psychiatric, social, and economic measures.

Not all states report all data items in the Minimum and Supplemental Data Sets. Most states report the Minimum Data Set for all or nearly all TEDS admissions. However, the items reported from the Supplemental Data Set vary greatly across states.

The figures in this chapter represent counts of admissions for each primary substance of abuse by gender, age, and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic of Mexican origin, Hispanic of Puerto Rican origin,¹ American Indian/Alaska Native, and Asian/Pacific Islander).

All Admissions Aged 12 and Older

• The average age at admission was 35 years; 7 percent of admissions were aged 12 to 17 years [Table 2.1a].
  
• Non-Hispanic Whites made up 61 percent of all treatment admissions aged 12 and older in 2012 (39 percent were males and 22 percent were females). Non-Hispanic Blacks made up 20 percent of all admissions (14 percent were males and 6 percent were females) [Table 2.3a].
  
• Forty percent of treatment admissions had not been in treatment before the current episode, while 13 percent had been in treatment five or more times previously [Table 2.5].
  
• Most admissions (61 percent) received ambulatory treatment, 22 percent received detoxification, and 17 percent received rehabilitation/residential treatment [Table 2.7].
  
• Self- or individual referrals and the criminal justice/DUI source were responsible for 36 percent and 34 percent, respectively, of referrals to treatment [Table 2.6].
  
• Less than one-quarter (22 percent) of admissions aged 16 and older were employed [Table 2.8].
  
• Twenty-nine percent of admissions aged 18 and older had not completed high school or attained a GED [Table 2.9].
  
  

Alcohol Only

• Admissions for abuse of alcohol alone, with no secondary drug abuse, represented 21 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• The average age at admission among admissions for alcohol only was 41 years. The average age at admission for alcohol with secondary drug was 37 years [Table 2.1a]. Admission for alcohol only or with secondary drug was the most likely reason for admissions aged 30 and older [Table 2.1b].
  
• Non-Hispanic Whites made up 66 percent of all alcohol-only admissions (approximately 46 percent were males and 21 percent were females) [Table 2.3a].
  
• Eighty-seven percent of alcohol-only admissions reported that they first became intoxicated before age 21, the legal drinking age. Almost one-third (30 percent) first became intoxicated by age 14 [Table 2.5].
  
• Among admissions referred to treatment by the criminal justice/DUI source, alcohol-only admissions were more likely than admissions for alcohol with secondary drug abuse to have been referred as a result of a DUI/DWI offense (28 vs. 16 percent) [Table 2.6].
• Some 34 percent of alcohol-only admissions aged 16 and older were employed compared with 22 percent of all admissions that age [Table 2.8].
  

Alcohol with Secondary Drug Abuse

• Admissions for primary abuse of alcohol with secondary abuse of drugs represented 18 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• The average age at admission for primary alcohol with secondary drug abuse was lower, at 37 years, than for abuse of alcohol alone (41 years) [Table 2.1a].
  
• Non-Hispanic Whites accounted for 58 percent of admissions for primary alcohol with secondary drug abuse (41 percent were males and 17 percent were females). Non-Hispanic Blacks made up 23 percent of admissions (18 percent were males and 6 percent were females) [Table 2.3a].
  
• Almost half (45 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 93 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5].
  
• Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (35 vs. 46 percent) [Table 2.5].
  
• Among admissions referred to treatment by the criminal justice/DUI source, admissions for alcohol with secondary drug abuse were more likely than alcohol-only admissions to have been referred to treatment as a condition of probation/parole (30 vs. 17 percent) [Table 2.6].
• Among admissions for alcohol with secondary drug abuse, marijuana and smoked cocaine were the most frequently reported secondary substances (25 percent and 8 percent, respectively) [Table 3.8].

Heroin

• Heroin was reported as the primary substance of abuse for 16 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• Sixty-five percent of primary heroin admissions were non-Hispanic White (41 percent were males and 24 percent were females). Non-Hispanic Blacks made up 15 percent (10 percent were males and 5 percent were females) [Table 2.3a]. Among admissions of Puerto Rican origin, 39 percent were for primary heroin abuse [Table 2.2]. See Chapter 3 for additional data on heroin admissions.
  
• Injection was reported as the usual route of administration by 71 percent of primary heroin admissions; inhalation was reported by 24 percent. Daily heroin use was reported by 67 percent of primary heroin admissions [Table 2.4].
  
• Most primary heroin admissions (80 percent) had been in treatment prior to the current episode, and 27 percent had been in treatment five or more times [Table 2.5].
  
• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by the criminal justice/DUI source (16 vs. 34 percent) and more likely to be self- or individually referred (57 vs. 36 percent) [Table 2.6].
  
• Medication-assisted opioid therapy was planned for 28 percent of heroin admissions [Table 2.7].
  
• Only 13 percent of primary heroin admissions aged 16 and older were employed (vs. 22 percent of all admissions that age); 41 percent were unemployed (vs. 39 percent of all admissions that age) [Table 2.8].
  

Opiates Other than Heroin

• Opiates other than heroin were reported as the primary substance of abuse for 10 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b]. These drugs include methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.
  
• Forty-seven percent of admissions for opiates other than heroin were aged 20 to 29 compared with 30 percent of all admissions [Table 2.1a]. The peak age at admission for both males and females was about 25 years [Figure 9].
  
• Non-Hispanic Whites made up approximately 86 percent of admissions for primary opiates other than heroin (46 percent were males and 40 percent were females) [Table 2.3a].
  
• Primary opiates other than heroin were most frequently used orally (59 percent), followed by inhalation (21 percent) and injection (17 percent) [Table 2.4].
  
• Seventy-nine percent of admissions for opiates other than heroin reported first use after age 16 compared with 50 percent for all substances combined [Table 2.5].
  
• Medication-assisted opioid therapy was planned for 18 percent of admissions for primary opiates other than heroin [Table 2.7].
  
• Sixty-five percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana (26 percent), alcohol (20 percent), and tranquilizers (16 percent) [Table 3.8].
  

Smoked Cocaine (Crack)

• Smoked cocaine (crack) was reported as the primary substance of abuse by 5 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• Seventy-seven percent of primary smoked cocaine admissions were aged 35 or older compared with 45 percent of all admissions. The average age at admission for primary smoked cocaine was 42 years [Table 2.1a]. Admissions among non-Hispanic Black males peaked at 48 years; admissions among non-Hispanic White males peaked at 43 years of age [Figure 10].
  
• Non-Hispanic Blacks accounted for 56 percent of primary smoked cocaine admissions (35 percent were males and 21 percent were females), and non-Hispanic Whites accounted for 33 percent
  (17 percent were males and 16 percent were females) [Table 2.3a].
  
• Primary smoked cocaine admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (30 vs. 17 percent) [Table 2.7].
  
• Only 10 percent of primary smoked cocaine admissions aged 16 and older were employed compared with 22 percent of all admissions that age [Table 2.8].
  
• Sixty-nine percent of primary smoked cocaine admissions reported abuse of other substances. The most commonly reported secondary substances of abuse were alcohol (46 percent) and marijuana (30 percent) [Table 3.8].

Non-Smoked Cocaine

• Non-smoked cocaine was reported as the primary substance of abuse by 2 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• The average age at admission for primary non-smoked cocaine admissions was 37 years [Table 2.1a]. However, the peak age among non-Hispanic White male admissions was 16 years younger than the peak age among non-Hispanic Black male admissions (32 vs. 46 years of age). Admissions among both non-Hispanic White females and non-Hispanic Black females peaked in their early-30s [Figure 11].
  
• Non-Hispanic Whites accounted for 45 percent of primary non-smoked cocaine admissions (28 percent were males and 17 percent were females), and non-Hispanic Black males accounted for 23 percent [Table 2.3a].
  
• Seventy-nine percent of admissions for primary non-smoked cocaine reported inhalation as the usual route of administration, followed by injection (11 percent) [Table 2.4].
  
• Non-smoked cocaine admissions were more likely than smoked cocaine admissions to be referred to treatment by a criminal justice/DUI source (37 vs. 26 percent) [Table 2.6].
  
• Seventy-one percent of admissions for primary non-smoked cocaine reported abuse of additional substances. Alcohol was most common, reported by 40 percent, followed by marijuana (32 percent) [Table 3.8].
  

Marijuana/Hashish

• Marijuana was reported as the primary substance of abuse by 17 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• The average age at admission for primary marijuana admissions was 25 years [Table 2.1a], although the peak age at admission for both genders in all race/ethnicities was 15 to 17 years [Figure 12]. Thirty-nine percent of marijuana admissions were under age 20 (vs. 10 percent of all admissions), and primary marijuana abuse accounted for 76 percent each of admissions aged 12 to 14 and admissions aged 15 to 17 years [Tables 2.1a-b].
  
• Non-Hispanic Whites accounted for 44 percent of primary marijuana admissions (31 percent were males and 13 percent were females), and non-Hispanic Black males accounted for 24 percent [Table 2.3a].
  
• Twenty-four percent of primary marijuana admissions had first used marijuana by age 12 and another 32 percent by age 14 [Table 2.5].
  
• Primary marijuana admissions were less likely than all admissions combined to be self- or individually referred to treatment (18 vs. 36 percent). Primary marijuana admissions were most likely to be referred by a criminal justice/DUI source (52 percent) [Table 2.6].
  
• More than 4 in 5 marijuana admissions (85 percent) received ambulatory treatment compared with about 3 in 5 of all admissions combined (61 percent) [Table 2.7].
  
• Fifty-six percent of primary marijuana admissions reported abuse of additional substances. Alcohol was reported by 40 percent [Table 3.8].
  

Methamphetamine/Amphetamines

• Methamphetamine/amphetamines were reported as the primary substance of abuse by 7 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b]. Methamphetamine admissions represented 93 percent of this group [Table 1.1a].
  
• Primary methamphetamine/amphetamine admissions were on average 33 years old at admission [Table 2.1a]. Admissions for both genders in all race/ethnicities peaked in the late 20s and early 30s; non-Hispanic White male admissions had a secondary peak in their mid-30s [Figure 13].
  
• Non-Hispanic Whites accounted for 69 percent of primary methamphetamine/amphetamine admissions (36 percent were males and 33 percent were females) [Table 2.3a]. Twelve percent of all primary methamphetamine/amphetamine admissions were of Mexican origin [Table 2.2].
  
• The usual routes of administration for primary methamphetamine/amphetamines were smoking (62 percent), injection (25 percent), and inhalation (8 percent) [Table 2.4].
  
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to be referred to treatment by the criminal justice/DUI source (47 vs. 34 percent) [Table 2.6].
  
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to receive long-term rehabilitation/residential treatment (15 vs. 7 percent) [Table 2.7].
  
• Sixty-seven percent of primary methamphetamine/amphetamine admissions reported secondary use of other substances, primarily marijuana (36 percent) and alcohol (29 percent) [Table 3.8].
  
  

Tranquilizers

• Tranquilizers were reported as the primary substance of abuse by 1 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• The average age at admission for primary tranquilizers was 34 years [Table 2.1a].
  
• Non-Hispanic Whites accounted for 82 percent of admissions for primary abuse of tranquilizers (males and females each accounted for 41 percent) [Table 2.3a].
  
• Twenty-three percent of primary tranquilizer admissions first used tranquilizers after age 30 [Table 2.5].
  
• Primary tranquilizer admissions were the least likely of all admissions to receive ambulatory treatment (39 vs. 49 percent or above). They were the most likely of all admissions to receive hospital inpatient detoxification (11 vs. 6 percent or below) [Table 2.7].
  
• Secondary abuse of another substance was reported by 74 percent of primary tranquilizer admissions. Secondary abuse of opiates other than heroin was reported by 29 percent, alcohol by 24 percent, and marijuana by 23 percent [Table 3.8].
  

Sedatives

• Admissions for primary sedative abuse were responsible for less than one-quarter of 1 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• Six percent of primary sedative admissions were aged 65 and older compared with 1 percent of total admissions [Table 2.1a].
  
• Non-Hispanic Whites accounted for 79 percent of primary sedative admissions (45 percent were females and 34 percent were males) [Table 2.3a].
  
• Twenty-seven percent of primary sedative admissions first used sedatives after age 30 [Table 2.5].
  
• Primary sedative admissions were more likely than all admissions combined to receive short-term rehabilitation/residential treatment (11 vs. 9 percent) [Table 2.7].
  
• More than one-third (35 percent) of primary sedative admissions aged 18 and older had more than 12 years of education (vs. 27 percent of all admissions) [Table 2.9].
  
• Fifty-eight percent of primary sedative admissions reported abuse of other substances as well, primarily alcohol (20 percent), marijuana (19 percent), and opiates other than heroin (18 percent) [Table 3.8].
  

Hallucinogens

• Hallucinogens were reported as the primary substance of abuse by one-tenth of 1 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b]. Hallucinogens include LSD, DMT, STP, mescaline, psilocybin, peyote, etc.
  
• Twenty-nine percent of hallucinogen admissions were under age 20 compared with 10 percent of all admissions combined. Only 31 percent were 30 years of age or older compared with 59 percent of all admissions [Table 2.1a].
  
• Nearly three-quarters (72 percent) of admissions for primary hallucinogen abuse were non-Hispanic Whites (52 percent were males and 20 percent were females), and non-Hispanic Black males accounted for 9 percent [Table 2.3a].
  
• Forty-three percent of primary hallucinogen admissions reported not using the drug in the past month [Table 2.4].
  
• Primary hallucinogen admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (25 vs. 17 percent) [Table 2.7].
  
• Seventy-seven percent of primary hallucinogen admissions reported abuse of drugs in addition to hallucinogens, mainly marijuana (47 percent), alcohol (31 percent), methamphetamine/amphetamines (11 percent), and opiates other than heroin (9 percent) [Table 3.8].
  

Phencyclidine (PCP)

• Phencyclidine (PCP) was reported as a primary substance of abuse by approximately one-third of 1 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
  
• More than one-half (54 percent) of PCP admissions were aged 25 to 34 compared with about one-quarter (29 percent) of all admissions combined [Table 2.1a].
  
• Non-Hispanic Blacks accounted for 64 percent of primary PCP admissions (37 percent were males and 27 percent were females) [Table 2.3a].
  
• Among admissions referred to treatment through the criminal justice/DUI source, primary PCP admissions were more likely than all admissions combined to be referred as a condition of probation/parole (51 vs. 34 percent) [Table 2.6].
  
• Primary PCP admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (30 vs. 17 percent), particularly short-term rehabilitation/residential treatment (18 vs. 9 percent) [Table 2.7].
  
• Only 12 percent of PCP admissions aged 18 and older had more than a high school education (vs. 27 percent of all admissions combined) [Table 2.9].
  
• Sixty-seven percent of primary PCP admissions reported abuse of other substances. Marijuana was reported as a secondary substance by 40 percent of primary PCP admissions, while alcohol was reported by 33 percent. [Table 3.8].
  

Inhalants

• Inhalants were reported as the primary substance of abuse by one-tenth of 1 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b]. Inhalants include chloroform, ether, gasoline, glue, nitrous oxide, paint thinner, etc.
  
• Nine percent of primary inhalant admissions were aged 12 to 14 years and another 14 percent were aged 15 to 17 years compared with about one percent and six percent of all admissions, respectively [Table 2.1a].
  
• Two-thirds (68 percent) of primary inhalant admissions were non-Hispanic White (43 percent were males and 25 percent were females). Four percent of all primary inhalant admissions were males of Mexican origin [Table 2.3a].
  
• Primary inhalant admissions were about as likely as all admissions combined to be referred to treatment through the criminal justice/DUI source (32 vs. 34 percent) and less likely to be a self- or individual referral (31 vs. 36 percent) [Table 2.6].
  
• Sixty-five percent of primary inhalant admissions reported abuse of other substances, principally alcohol (36 percent) and marijuana (31 percent) [Table 3.8].
  
• Reflecting their overall youth, inhalant admissions were more likely than all admissions combined to have a dependent living arrangement (35 vs. 21 percent) or Medicaid as the expected source of payment for treatment (25 vs. 15 percent) [Tables 2.10 and 2.13].

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Adolescent Admissions to Substance Abuse Treatment
Trends in Heroin Admissions and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest. 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.

• Adolescent substance abuse 2002-2012

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 remained steady (from 157,914 to 157,184) between 2002 and 2003, but declined by 24 percent (to 120,239) between 2003 and 2012 [Table 3.1a]. In 2012, 89 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and 41 percent of these marijuana-involved admissions were referred to treatment through the criminal justice/DUI source [Table 3.4].

• Heroin admissions and medication-assisted opioid therapy 2002-2012

The number of TEDS admissions for primary heroin abuse was relatively stable over this period, with 285,041 admissions in 2002 and 285,451 admissions in 2012 [Table 3.5].

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 35 percent in 2002 to 28 percent in 2012 [Table 3.7].¹

• Polydrug abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance [Table 3.8].

• Racial/ethnic subgroups

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin [Table 2.2].

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The number of adolescent admissions aged 12 to 17 remained steady between 2002 and 2003, then declined by 24 percent from 2003 to 2012.

• Two primary substances—marijuana and alcohol—accounted for between 83 and 89 percent of adolescent admissions from 2002 to 2012.
  
• Marijuana admissions increased from 63 percent of adolescent admissions in 2002 to 76 percent in 2012; however, the total number of adolescent marijuana admissions decreased by 9 percent (from 99,632 to 91,106) between 2002 and 2012.
  
• Alcohol admissions declined from 21 percent of adolescent admissions in 2002 to 13 percent in 2012.
  
• Methamphetamine/amphetamine admissions increased from 4 percent in 2002 to 6 percent in 2005, but then decreased to 3 percent in 2012.
  
• Opiate admissions represented 1 to 2 percent of adolescent admissions from 2002 to 2008 but rose to 3 percent in 2009 where it remained in 2012.
  
  • Opiates other than heroin² represented 32 percent of adolescent opiate admissions in 2002 but rose to 59 percent in 2012.
    
• Cocaine accounted for between 2 and 3 percent of adolescent admissions between 2002 and 2008. Beginning in 2009, cocaine accounted for 1 percent of adolescent admissions.
• All other substances combined accounted for about 2 percent of adolescent admissions between 2002 and 2012.

Table 3.2. In 2012, overall, 72 percent of adolescent admissions were male, a proportion heavily influenced by the 77 percent of marijuana admissions that were male. The proportion of female admissions was greater than 40 percent for most other substances. Adolescent admissions reporting a primary substance of methamphetamine/amphetamines were the only adolescent admissions that had a higher proportion of females to males (55 vs. 45 percent).

Forty-five percent of adolescent admissions were non-Hispanic White, 26 percent were of Hispanic origin, 20 percent were non-Hispanic Black, and 10 percent were of other racial/ethnic groups.

Table 3.3. The number of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 32 percent who were 17 years old. Among admissions for inhalants, 17 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 63 percent and 48 percent, respectively, were age 17.

In 2012, 44 percent of adolescent admissions were referred to treatment through the criminal justice/DUI source, 18 percent were self- or individual referrals, and 15 percent were referred through schools.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 2002, 45 percent of all adolescent admissions were marijuana involved and referred to treatment by the criminal justice/DUI source, and 37 percent were marijuana involved but referred by other sources. By 2012, the proportion referred by the criminal justice/DUI source had decreased to 41 percent, while the proportion referred by other sources had increased to 48 percent. The proportions nearly converged in 2007 and 2009.

Adolescent admissions not involving marijuana that were referred by the criminal justice/DUI source fell from 9 percent in 2002 to 4 percent in 2012. Admissions not involving marijuana that were referred from other sources were fairly stable, fluctuating between 7 and 11 percent of adolescent admissions.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2002 through 2012. Primary heroin abuse accounted for 13 to 16 percent of TEDS admissions in every year from 2002 through 2012 [Table 1.1b]. In 2012, injection was the preferred route of administration for 71 percent of primary heroin admissions, inhalation for 24 percent, and smoking for 4 percent [Table 2.4]. The majority of primary heroin admissions from 2002 to 2012 were 20 to 34 years of age (41 to 43 percent from 2002 through 2007 and 55 percent in 2012) [Table 3.5].

However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of some subpopulations among heroin-using admissions.

Table 3.5 and Figure 21. TEDS data show an increase in heroin admissions among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.

• In 2002, more than 1 in 5 heroin admissions (24 percent) were non-Hispanic White aged 20 to 34. By 2012, more than 2 in 5 primary heroin admissions (45 percent) belonged to this subgroup. The proportion of primary heroin admissions who were non-Hispanic White aged 35 to 44 fell from 13 percent to 10 percent in the same period, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
  
• In contrast, the proportion of primary heroin admissions that were non-Hispanic Black aged 20 to 34 fell from 5 percent to 2 percent between 2002 and 2012, while the proportion aged 35 to 44 fell from 10 percent to 4 percent. However, the proportion of non-Hispanic Black admissions aged 45 and older remained between 9 and 11 percent from 2002 through 2012. Non-Hispanic Black admissions aged 12 to 19 accounted for one-tenth of 1 percent or less of all primary heroin admissions.
  

Table 3.6 and Figure 22. Route of administration of heroin was closely linked to age. Injection increased among young adults; inhalation increased among those 45 and older.

• In 2002, 1 in 4 primary heroin admissions (26 percent) were injectors aged 20 to 34 and nearly 1 in 5 (19 percent) were injectors aged 35 to 44. By 2012, more than 2 in 5 primary heroin admissions (44 percent) were injectors aged 20 to 34, but the proportion that were injectors aged 35 to 44 had dropped to 12 percent.
• The proportion of primary heroin admissions who were inhalers aged 20 to 34 fell from 13 percent in 2002 to 8 percent in 2012, while the proportion who were inhalers aged 45 and older rose from 6 percent in 2002 to 9 percent in 2012.

Table 3.7 and Figures 23 and 24. Planned use of medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 2002 and 2012.

• Table 3.7 and Figure 23. In 2002, 35 percent of primary heroin admissions overall had treatment plans that included medication-assisted opioid therapy, although the proportion varied by route of administration—39 percent each of heroin injectors and heroin smokers, and 32 percent of heroin inhalers. By 2012, only 28 percent of primary heroin admissions had treatment plans that included medication-assisted opioid therapy, with 26 percent being heroin injectors, 29 percent being smokers, and 32 percent being inhalers (see footnote 1 above).
  

• Figure 24. Older heroin admissions were most likely to have medication-assisted opioid therapy planned. In 2002, opioid therapy was planned for 48 percent of admissions aged 45 and older, 37 percent of those aged 35 to 44, 28 percent of those aged 20 to 34, and 15 percent of those aged 12 to 19. The proportions fell for all age groups, and by 2012, opioid therapy was planned for 40 percent of primary heroin admissions aged 45 and older, 30 percent of those aged 35 to 44, 22 percent of those aged 20 to 34, and 13 percent of those aged 12 to 19.
  

Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

Table 3.8 and Figure 25. Polydrug abuse was reported by 56 percent of TEDS admissions aged 12 or older in 2012. Marijuana, alcohol, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of a majority of treatment admissions. Thirty-nine percent of all treatment admissions were for primary alcohol abuse, and 18 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 57 percent of all treatment admissions reported alcohol as a substance of abuse.

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances. Thirty-six percent of all admissions involved opiate abuse, with 26 percent reporting primary abuse and 10 percent reporting secondary or tertiary abuse. Twelve percent of all admissions reported methamphetamine/amphetamine abuse, with 7 percent reporting primary abuse and 5 percent reporting secondary or tertiary abuse.
  
• Marijuana and cocaine were reported more often as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 17 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, resulting in 38 percent of all treatment admissions reporting marijuana as a substance of abuse. Cocaine was a primary substance for 7 percent of admissions, but was a secondary or tertiary substance for an additional 14 percent. Thus 21 percent of all treatment admissions involved cocaine abuse.

Table 3.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 5 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31. TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups. Among admissions of Hispanic origin, substance abuse patterns differed according to country of origin. Patterns also differed between men and women within subgroups.

• Among non-Hispanic Whites [Figure 26], alcohol was the primary substance reported by 44 percent of male admissions and 34 percent of female admissions.
  
  • Opiates and marijuana were the most frequently reported illicit drugs among non-Hispanic White male admissions (29 percent and 14 percent, respectively), followed by methamphetamine/amphetamines (7 percent) and cocaine (4 percent).
    
  • Among non-Hispanic White female admissions, opiates were the primary illicit drug (36 percent), followed by methamphetamine/amphetamines (11 percent), marijuana (10 percent), and cocaine (5 percent).

• Among non-Hispanic Blacks [Figure 27], 38 percent of male admissions reported alcohol as the primary substance. Among non-Hispanic Black female admissions, alcohol (30 percent) was more frequently reported as a primary substance than was cocaine (22 percent).
  
  • Marijuana and cocaine were the most commonly reported illicit substances for non-Hispanic Black male admissions (30 percent and 15 percent, respectively), followed by opiates (13 percent).
  • For non-Hispanic Black female admissions, other primary substances were marijuana and cocaine (24 percent and 22 percent, respectively).
    
  • Methamphetamine/amphetamines were reported by about 1 percent and 2 percent, respectively, of non-Hispanic Black male and female admissions.
    

• Among persons of Mexican origin [Figure 28], alcohol was the primary substance reported by 42 percent of male admissions, but among female admissions, methamphetamine/amphetamines were reported as a primary substance as frequently as was alcohol (29 percent each).
  
  • Marijuana (27 percent) was the most commonly reported illicit substance for male admissions of Mexican origin, followed by methamphetamine/amphetamines (14 percent) and opiates (13 percent).
    
  • For female admissions of Mexican origin, other commonly reported primary substances were marijuana (22 percent) and opiates (15 percent).
    

• Among admissions of Puerto Rican origin [Figure 29], opiates were the main primary substances at treatment admission for both men and women (44 percent and 37 percent, respectively), followed by alcohol (29 percent and 26 percent, respectively).
  
  • For both male and female admissions of Puerto Rican origin, other primary substances were marijuana (16 percent and 19 percent, respectively) and cocaine (8 percent and 11 percent, respectively).
    
  • Admissions for primary methamphetamine/amphetamine abuse were 1 percent for women of Puerto Rican origin and less than 1 percent for men of Puerto Rican origin.
    

• American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 2.2] [Figure 30]. Among American Indian/Alaska Native admissions, 68 percent of men and 52 percent of women entered treatment because of primary alcohol abuse.
  
  • Marijuana was the most frequently reported illicit substance for American Indian or Alaska Native male admissions (14 percent), followed by opiates (10 percent), methamphetamine/amphetamines (5 percent), and cocaine (2 percent).
    
  • Opiates and marijuana were the most frequently reported illicit substances for American Indian or Alaska Native female admissions (19 percent and 12 percent, respectively), followed by methamphetamine/amphetamines (11 percent) and cocaine (3 percent).

• Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 2.2]. Among this group [Figure 31], alcohol was the primary substance reported by 39 percent of male admissions and 32 percent of female admissions.
  
  • Marijuana and methamphetamine/amphetamines were the most commonly reported illicit drugs for Asian or Pacific Islander male admissions (23 percent and 18 percent, respectively), followed by opiates (13 percent) and cocaine (4 percent).
    
  • For Asian or Pacific Islander female admissions, methamphetamine/amphetamines were the most commonly reported illicit substance (25 percent), followed by marijuana (18 percent), opiates (15 percent), and cocaine (4 percent).

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The Treatment Episode Data Set (TEDS) records the type of service to which clients are admitted for treatment. The major categories are broadly defined as ambulatory, rehabilitation/residential, and detoxification. For this report, admissions for which medication-assisted opioid therapy (i.e., therapy using methadone or buprenorphine) was planned have been categorized as a separate service type. 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. The complete list of types of services detailed in this report include:

• Ambulatory (excluding medication-assisted opioid therapy)
  • Outpatient—Ambulatory treatment services including individual, family, and/or group services; these may include pharmacological therapies.
  • Intensive outpatient—As a minimum, the client must receive treatment lasting two or more hours per day for three or more days per week.
• Detoxification (excluding medication-assisted opioid therapy)
  • Free-standing residential—24-hour per day services in a non-hospital setting providing for safe withdrawal and transition to ongoing treatment.
  • Hospital inpatient—24-hour per day medical acute care services in a hospital setting for detoxification of persons with severe medical complications associated with withdrawal.
  • Ambulatory—Outpatient treatment services providing for safe withdrawal in an ambulatory setting (pharmacological or non-pharmacological).
• Rehabilitation/residential (excluding medication-assisted opioid therapy)
  • Short-term (30 days or fewer)—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 (more than 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.
  • Hospital—24-hour per day medical care in a hospital facility in conjunction with treatment services for alcohol and other drug abuse and dependency.
• Medication-assisted opioid therapy
  • Outpatient—Includes outpatient and intensive outpatient therapy (see above).
  • Detoxification—Includes free-standing residential detoxification, hospital detoxification, and ambulatory detoxification (see above).
  • Residential—Includes short-term, long-term, and hospital inpatient therapy (see above).

Table 4.1b. The type of service received was associated with primary substance of abuse.

• Ambulatory treatment accounted for 55 percent of all admissions—44 percent in outpatient treatment and 12 percent in intensive outpatient treatment. Admissions for marijuana and methamphetamine/amphetamines were more likely to receive ambulatory services than were all admissions (85 percent of marijuana admissions and 63 percent of methamphetamine/amphetamine admissions vs. 55 percent of all admissions).
  
• Detoxification services accounted for 22 percent of all admissions—18 percent in free-standing residential, 3 percent in hospital inpatient, and 1 percent in ambulatory. Admissions for tranquilizers, alcohol, and opiates were more likely to receive a detoxification service than were all admissions (39 percent of tranquilizer admissions, 29 percent of alcohol admissions, and 28 percent of opiate admissions vs. 22 percent of all admissions).
  
• Rehabilitation/residential treatment accounted for 17 percent of all admissions—9 percent in short-term, 7 percent in long-term, and less than 1 percent in hospital inpatient. Admissions for cocaine, methamphetamine/amphetamines, and tranquilizers were more likely to receive rehabilitation/residential services than were all admissions (27 percent of cocaine admissions, 26 percent of methamphetamine/amphetamine admissions, and 21 percent of tranquilizer admissions vs. 17 percent of all admissions).
  
• Medication-assisted opioid therapy accounted for 6 percent of all admissions—5 percent in outpatient, 1 percent in detoxification, and less than 1 percent in residential. Medication-assisted opioid therapy was planned for about one-quarter (23 percent) of admissions for opiates.

Table 4.3a. The type of service received was associated with the treatment referral source.

• Admissions receiving an ambulatory service were more likely than all admissions to have been referred through the criminal justice/DUI source (49 percent of outpatient admissions and 44 percent of intensive outpatient admissions vs. 34 percent of all admissions).
  
• Admissions receiving a detoxification service were more likely to be self- or individual referrals (74 percent of hospital inpatient admissions, 56 percent of free-standing residential admissions, and 50 percent of ambulatory admissions vs. 36 percent of all admissions).
  
• Admissions receiving short-term or long-term rehabilitation/residential treatment were more likely to have been referred by a substance abuse care provider (25 percent of short-term admissions and 19 percent of long-term admissions vs. 9 percent of all admissions).
  
• Admissions receiving outpatient or detoxification medication-assisted opioid therapy were more likely to be self- or individual referrals (81 percent of detoxification admissions and 76 percent of outpatient admissions vs. 36 percent of all admissions).

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Introduction

This report presents data from the Treatment Episode Data Set (TEDS) on the demographic and substance abuse characteristics of admissions to substance abuse treatment. The Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages collection of TEDS data from the states.

The Treatment Episode Data Set (TEDS) is a compilation of client-level data routinely collected by the individual state administrative data systems to monitor their substance abuse treatment systems. Generally, facilities that are required to report to the state substance abuse agency (SSA) are those that receive public funds and/or are licensed or certified by the SSA to provide substance abuse treatment (or are administratively tracked for other reasons).

TEDS is one of the three components of SAMHSA’s Behavioral Health Services Information System (BHSIS), the primary source of national data on substance abuse treatment. The other two components are:

• The Inventory of Behavioral Health Services (I-BHS), formerly called the Inventory of Substance Abuse Treatment Services (I-SATS), a continuously-updated comprehensive listing of all known public and private substance abuse treatment facilities.
  
• The National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of the location, characteristics, services offered, and utilization of alcohol and drug abuse treatment facilities in I-BHS.

The TEDS system comprises two major components, the Admissions Data Set and the Discharge Data Set. The TEDS Admissions Data Set includes client-level data on substance abuse treatment admissions from 1992 through the present. The TEDS Discharge Data Set can be linked at record level to admissions, and includes information from clients discharged in 2000 and later. For both data sets, selected data items from the individual state data files are converted to a standardized format consistent across states. These standardized data constitute TEDS.

The TEDS Admissions Data System consists of a Minimum Data Set of items collected by all states, and a Supplemental Data Set where individual data items are reported at the states’ option.

The Minimum Data Set consists of items that include:

• Demographic information
• Primary, secondary, and tertiary substances and their route of administration, frequency of use, and age at first use
• Source of referral to treatment
• Number of prior treatment episodes
• Service type, including planned use of medication-assisted opioid therapy

The Supplemental Data Set consists of 17 items that include psychiatric, social, and economic measures.

History

National-level data collection on admissions to substance abuse treatment was first mandated in 1972 under the Drug Abuse Office and Treatment Act, P.L. 92-255. This act initiated federal funding for drug treatment and rehabilitation, and required reporting on clients entering drug (but not alcohol) abuse treatment. The Client-Oriented Data Acquisition Process (CODAP) was developed to collect admission and discharge data directly from federally-funded drug treatment programs. (Programs for treatment of alcohol abuse were not included.) Reporting was mandatory for all such programs, and data were collected using a standard form. CODAP included all clients in federally-funded programs regardless of individual funding source. Reports were issued from 1973 to 1981 based on data from 1,800 to 2,000 programs, including some 200,000 annual admissions.

In 1981, collection of national-level data on admissions to substance abuse treatment was discontinued because of the introduction of the Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant. The Block Grant transferred federal funding from individual programs to the states for distribution, and it included no data reporting requirement. Participation in CODAP became voluntary; although several states submitted data through 1984, the data were in no way nationally representative.

In 1988, the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690) established a revised Substance Abuse Prevention and Treatment (SAPT) Block Grant and mandated federal data collection on clients receiving treatment for either alcohol or drug abuse. The Treatment Episode Data Set (TEDS) data collection effort represents the federal response to this mandate. TEDS began in 1989 with the issue of 3-year development grants to states.

State Data Collection Systems

TEDS is an exceptionally large and powerful data set that covers a significant proportion of all admissions to substance abuse treatment. TEDS is a compilation of data collected through the individual data collection systems of the state substance abuse agencies (SSAs) for substance abuse treatment. States have cooperated with the federal government in the data collection process, and substantial progress has been made toward developing a standardized data set. However, because each state system is unique and each state has unique powers and mandates, significant differences exist among state data collection systems. These differences are compounded by evolving health care payment systems, and state-to-state comparisons must be made with extreme caution.

The number and client mix of TEDS admissions do not represent the total national demand for substance abuse treatment or the prevalence of substance abuse in the general population.

States differ widely in the amount of public funding available for substance abuse treatment and in the constraints placed on the use of funds. States may be directed to target special populations such as pregnant women or adolescents. Where funds are limited, states may be compelled to exercise triage in admitting persons to treatment, admitting only those with the most "severe" problems. In states with higher funding levels, a larger proportion of the population in need of treatment may be admitted, including the less severely impaired.

States may include or exclude reporting by certain sectors of the treatment population, and these sectors may change over time. For example, treatment programs based in the criminal justice system may or may not be administered through the state SSA. Detoxification facilities, which can generate large numbers of admissions, are not uniformly considered treatment facilities and are not uniformly reported by all states.

Appendix Table 1 presents key characteristics of state data collection systems for 2010. However, these characteristics can change as state substance abuse treatment systems change, and thus may be responsible for some year-to-year variation within states.

• Facilities included. The scope of facilities included in TEDS is affected by differences in state licensure, certification, and accreditation practices, and disbursement of public funds. Most SSAs require facilities that receive state/public funding (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services to report data to the SSA. Generally this funding is distributed by the SSA but may be distributed by another public agency.
• Some SSAs regulate private facilities, methadone clinics, and/or individual practitioners and require them to report TEDS data. Others do not because of the difficulty in obtaining data from these facilities, although these facilities may report voluntarily. Facilities operated by federal agencies (e.g., the Bureau of Prisons, the Department of Defense, and the Department of Veterans Affairs) generally do not report TEDS data to the SSA, although some facilities operated by the Indian Health Service are included. Hospital-based substance abuse treatment facilities are frequently not licensed through the SSA and do not report TEDS data. Correctional facilities (state prisons and local jails) are monitored by the SSA and report TEDS data in some states but not in others.
• The primary goal of TEDS is to monitor the characteristics of clients admitted to planned, continuing treatment regimens. Thus early intervention and crisis intervention programs that do not lead to enrollment in continued treatment are excluded from TEDS.
• Clients included. About 60 percent of states reported data on all admissions to all eligible facilities, although some reported only, or largely, admissions financed by public funds. TEDS is an admission-based system; therefore, TEDS admissions do not represent individuals. For example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
• Ability to track multi-service episodes. The goal for the TEDS system is to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different service type (e.g., from rehabilitation/residential treatment to outpatient) within a single continuous treatment episode. Thus TEDS records are ideally coded as admissions if they represent the initial treatment service in a treatment episode and as transfers if they represent a change in service type or a change in provider without an interruption in treatment.

This requires, however, that clients be assigned unique IDs that can be linked across providers; not all states are legally and/or technologically able to do this. Most states can identify as transfers a change in service type within the structure of a given provider. However, fewer can also identify a transfer involving a change of provider. Several states do not track transfers, but instead report as transfers those clients who are discharged and readmitted within a specified (state-specific) time period.

Because some admission records in fact may represent transfers, the number of admissions reported probably overestimates the number of treatment episodes. Some states reported a limited data set on codependents of substance abusers entering treatment. On average, from 2010 through 2010, 83 percent of all records submitted were client admissions, 15 percent were client transfers, and 2 percent were codependents of substance abusers.

• Services offered. A state's mix of service types (e.g., outpatient, detoxification, rehabilitation/residential, opioid therapy) can have a significant effect on its admission rate. There is higher client turnover and therefore more admissions in short-stay services such as detoxification than in long-stay services such as outpatient or long-term residential treatment. Admission rates for individual substances of abuse may be affected as well (e.g., detoxification is more closely associated with alcohol or heroin use than with use of other substances).
• Completeness and timeliness of reporting. SAMHSA, in reporting national-level TEDS data, must balance timeliness of reporting and completeness of the data set. There may be a time lag in the publication of SAMHSA's annual report because preparation cannot begin until states have completed their data submission for that year. States in turn rely on individual facilities to report in a timely manner so they can submit TEDS data to SAMHSA at regular intervals.

Admissions from facilities that report late to the states will appear in a later data submission to SAMHSA, so the number of annual admissions in a report may be higher in subsequent reports. The number of additional admissions is small because of the time lag in issuing the report. Thus the percentage distributions will change very little in subsequent reports, although Census division- and state-level data may change somewhat more for states with reporting delays (state report only).

States continually review and improve their data collection and processing. When systematic errors are identified, states may revise or replace historical TEDS data files. While this process represents an improvement in the data system, the historical statistics in this report will differ slightly from those in earlier reports.

Appendix Tables 2 and 3 indicate the proportions of records by state or jurisdiction for which valid data were received for 2010. States are expected to report all variables in the Minimum Data Set (Appendix Table 2). Variables in the Supplemental Data Set are collected at the states' option (Appendix Table 3).

Report-Specific Considerations

• The report focuses on treatment admissions for substance abusers, so admissions for treatment as a codependent of a substance abuser are excluded. Records for identifiable transfers within a single treatment episode are also excluded.
• Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable other than primary, secondary, or tertiary substance, those records are excluded from tabulations of that variable. For substance variables, missing or unknown responses were included in the category "Other." The total number of admissions on which a percentage distribution is based is reported in each table.
• Records with partially complete data have been retained. If a variable is coded with a value indicating the data were missing or miscoded, the record is excluded from tabulations of that variable. The total number of records on which a percentage distribution is based is reported in each table.
• Variables in the Supplemental Data Set are not collected by all states. States that did not collect a specific variable are excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.
• The primary, secondary, and tertiary substances of abuse reported to TEDS are those substances that led to the treatment episode and not necessarily a complete enumeration of all drugs used at the time of admission.
• Primary alcohol admissions are classified as "Alcohol only" or "Alcohol with secondary drug abuse." The latter indicates a primary alcohol admission with a specified secondary and/or tertiary drug. All other primary alcohol admissions are classified as "Alcohol only."
• Cocaine admissions are classified according to route of administration as smoked and other route. Smoked cocaine primarily represents crack or rock cocaine, but can also include cocaine hydrochloride (powder cocaine) when it is free-based. Non-smoked cocaine includes all cocaine admissions where cocaine is injected, inhaled, or taken orally; it also includes admissions where the route of administration is unknown or not collected. Thus the TEDS estimate of admissions for smoked cocaine is conservative.
• Methamphetamine/amphetamine admissions include admissions for both substances, but are primarily for methamphetamine. In 2010, methamphetamine constituted about 91 percent of combined methamphetamine/amphetamine admissions. Oregon and Texas, states with large numbers of methamphetamine admissions, reported them as Other amphetamines until 2005 and 2006, respectively.
• For this report, secondary and tertiary substances (see Appendix B) are grouped and referred to as secondary substances.
• Significant changes in the clients or facilities reported to TEDS by some states and jurisdictions can result in changes in the number of admissions large enough to influence trends.
  

TO TABLES

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TEDS Minimum Data Set
TEDS Supplemental Data Set

AGE OF FIRST USE (OF PRIMARY, SECONDARY, AND TERTIARY SUBSTANCE)

For drugs other than alcohol, these fields identify the age at which the client first used the respective substance. For alcohol, these fields record the age of first intoxication.

• 0—Indicates a newborn with a substance dependency problem
• 1-96—Indicates the age at first use

CLIENT OR CODEPENDENT/COLLATERAL

Specifies whether the admission record is for a substance abuse treatment client, or a person being treated for his/her codependency or collateral relationship with a substance abuser.

Client—Must meet all of the following criteria:

• Has an alcohol or drug related problem
• Has completed the screening and intake process
• Has been formally admitted for treatment or recovery service in an alcohol or drug treatment unit
• Has his or her own client record

A person is not a client if he or she has completed only a screening or intake process or has been placed on a waiting list.

Codependent/collateral—Must meet all of the following criteria:

• Has no alcohol or drug related problem
• Is seeking services because of problems arising from his or her relationship with an alcohol or drug user
• Has been formally admitted for service to a treatment unit
• Has his or her own client record or has a record within a primary client record

GUIDELINES: Reporting of data for Codependent/collaterals is optional. If the state opts to report codependent/collateral clients, the mandatory fields are State code, Provider identifier, Client identifier, Client transaction type, Codependent/collateral, and Date of admission. Reporting of the remaining fields in the TEDS Minimum and Supplemental Data Sets is optional. For all items not reported, the data field should be coded with the appropriate “Not collected” or “Not applicable” code.

If a substance abuse client with an existing record in TEDS becomes a codependent, a new client record should be submitted indicating that the client has been admitted as a codependent, and vice versa.

If a record does not include a value for this field, it is assumed to be a substance abuse client record.

DATE OF ADMISSION

The day when the client receives his or her first direct treatment or recovery service. For transfers, this is the date when client receives his or her first direct treatment after the transfer has occurred.

DEMOGRAPHICS

AGE

Identifies client’s age at admission. Derived from client’s date of birth and date of admission.

• 0—Indicates a newborn with a substance dependency problem
• 1-96—Indicates the age at admission

EDUCATION

Specifies the highest school grade (number of school years) completed by the client.

• 0—Less than one grade completed
• 1-25—Years of school (highest grade) completed. For General Equivalency Degree, use 12.

GUIDELINES: States that use specific categories for designating education level should map their codes to a logical number of years of school completed. For Associate’s Degree, use 14. For Bachelor’s Degree, use 16.

EMPLOYMENT STATUS

Identifies the client’s employment status at the time of admission or transfer.

• Full time—Working 35 hours or more each week, including active duty members of the uniformed services
• Part time—Working fewer than 35 hours each week
• Unemployed—Looking for work during the past 30 days, or on layoff from a job
• Not in labor force—Not looking for work during the past 30 days, or a student, homemaker, disabled, retired, or an inmate of an institution. Clients in this category are further defined in the TEDS Supplemental Data Set item Detailed not in labor force.

GUIDELINES: Seasonal workers are coded in this category based on their employment status at admission.

ETHNICITY

Identifies client’s specific Hispanic origin.

• Cuban—Of Cuban origin, regardless of race
• Hispanic (specific origin not specified)—Of Hispanic origin, but specific origin not known or not specified
• Mexican—Of Mexican origin, regardless of race
• Not of Hispanic origin
• Other specific Hispanic—Of known Central or South American or any other Spanish cultural origin (including Spain), other than Puerto Rican, Mexican, or Cuban, regardless of race
• Puerto Rican—Of Puerto Rican origin, regardless of race

GUIDELINES: If a state does not collect specific Hispanic detail, code Ethnicity for Hispanics as Hispanic (specific origin not specified).

RACE

Specifies the client’s race.

• Alaska Native (Aleut, Eskimo, Indian)—Origins in any of the original people of Alaska
• American Indian (other than Alaska Native)—Origins in any of the original people of North America and South America (including Central America) and who maintain cultural identification through tribal affiliation or community attachment
• Asian or Pacific Islander—Origins in any of the original people of the Far East, the Indian subcontinent, Southeast Asia, or the Pacific Islands
  • Asian—Origins in any of the original people of the Far East, the Indian subcontinent, or Southeast Asia, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Philippine Islands, Thailand, and Vietnam
  • Native Hawaiian or other Pacific Islander—Origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands
• Black or African American—Origins in any of the black racial groups of Africa
• White—Origins in any of the original people of Europe, North Africa, or the Middle East
• Other single race—Client is not classified in any category above or whose origin group, because of area custom, is regarded as a racial class distinct from the above categories
• Two or more races—For use when the state data system allows multiple race selection and more than one race is indicated

GUIDELINES: If a state does not distinguish between American Indian and Alaska Native, both should be coded as American Indian. If a state does not distinguish between Asian and Native Hawaiian or other Pacific Islander, both should be coded as Asian or Pacific Islander. For states that collect multiple races: a) when a single race is designated, the specific race code should be used; b) if the state collects a primary or preferred race along with additional races, the code for the primary/preferred race should be used; c) if the state uses a system such as an algorithm to select a single race when multiple races have been designated, the same system may be used to determine the race code for TEDS. When two or more races have been designated and neither (b) nor (c) above apply, the TEDS code for Two or more races should be used.

SEX

Identifies client’s gender.

• Male
• Female

FREQUENCY OF USE (OF PRIMARY, SECONDARY, AND TERTIARY SUBSTANCES)

These fields identify the frequency of use of the respective Substance problems.

• No use in the past month
• 1-3 times in the past month
• 1-2 times in the past week
• 3-6 times in the past week
• Daily

MEDICATION-ASSISTED OPIOID THERAPY

Identifies whether the use of methadone or buprenorphine is part of the client’s treatment plan.

• Yes
• No

NUMBER OF PRIOR TREATMENT EPISODES

Indicates the number of previous treatment episodes the client has received in any drug or alcohol program. Changes in service for the same episode (transfers) should not be counted as separate prior episodes.

• 0 previous episodes
• 1 previous episode
• 2 previous episodes
• 3 previous episodes
• 4 previous episodes
• 5 or more previous episodes

GUIDELINES: It is preferred that the number of prior treatments be a self-reporting field collected at the time of client intake. However, this data item may be derived from the state data system if the system has that capability and episodes can be counted for at least several years.

PRINCIPAL SOURCE OF REFERRAL

Describes the person or agency referring the client to the alcohol or drug abuse treatment program.

• Alcohol/drug abuse care provider—Any program, clinic, or other health care provider whose principal objective is treating clients with substance abuse problems, or a program whose activities are related to alcohol or other drug abuse prevention, education, or treatment
  
• Court/criminal justice referral/DUI/DWI—Any police official, judge, prosecutor, probation officer, or other person affiliated with a federal, state, or county judicial system. Includes referral by a court for DWI/DUI, clients referred in lieu of or for deferred prosecution, or during pretrial release, or before or after official adjudication. Includes clients on pre-parole, pre-release, work or home furlough, or TASC. Client need not be officially designated as “on parole.” Includes clients referred through civil commitment. Client referrals on this category are further defined in the TEDS Supplemental Data Set item Detailed criminal justice referral.
• Employer/EAP—A supervisor or an employee counselor
• Individual (includes self-referral)—Includes the client, a family member, friend, or any other individual who would not be included in any of the following categories; includes self-referral due to pending DWI/DUI
• Other community referral—Community or religious organization or any federal, state, or local agency that provides aid in the areas of poverty relief, unemployment, shelter, or social welfare. Self-help groups such as Alcoholics Anonymous (AA), Al-Anon, and Narcotics Anonymous (NA) are also included in this category. Defense attorneys are included in this category.
• Other health care provider—A physician, psychiatrist, or other licensed health care professional; or a general hospital, psychiatric hospital, mental health program, or nursing home
• School (educational)—A school principal, counselor, or teacher; or a student assistance program (SAP), the school system, or an educational agency

SUBSTANCE PROBLEM (PRIMARY, SECONDARY, OR TERTIARY)

These fields identify the client’s primary, secondary, and tertiary substance problems. Each Substance problem (primary, secondary, and tertiary) has associated fields for Route of administration, Frequency of use, Age at first use, and the TEDS Supplemental Data Set item Detailed drug code.

• Alcohol
• Amphetamines
• Barbiturates—Amobarbital, pentobarbital, phenobarbital, secobarbital, etc.
• Benzodiazepines—Includes alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, flunitrazepam, flurazepam, halazepam, lorazepam, oxazepam, prazepam, temazepam, triazolam, and other unspecified benzodiazepines
• Cocaine/crack
• Heroin
• Inhalants—Includes chloroform, ether, gasoline, glue, nitrous oxide, paint thinner, etc.
• Marijuana/hashish—Includes THC and any other cannabis sativa preparations
• Methamphetamine
• Non-prescription methadone
• Other amphetamines—Includes amphetamines, MDMA, phenmetrazine, and other unspecified amines and related drugs
• Other hallucinogens—Includes LSD, DMT, STP, hallucinogens, mescaline, peyote, psilocybin, etc.
• Other non-barbiturate sedatives or hypnotics—Includes chloral hydrate, ethchlorvynol, glutethimide, methaqualone, and other non-barbiturate sedatives or hypnotics
• Other non-benzodiazepine tranquilizers—Includes meprobamate and other non-benzodiazepine tranquilizers
• Other opiates and synthetics—Includes buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects
• Other stimulants—Includes methylphenidate and any other stimulants
• Over-the-counter medications—Includes aspirin, cough syrup, diphenhydramine and other antihistamines, sleep aids, and any other legally obtained nonprescription medication
• PCP—Phencyclidine
• Other—Includes diphenylhydantoin/phenytoin, GHB/GBL, ketamine, etc.
• None

GUIDELINES: Substance problems are further defined in the TEDS Supplemental Data Set item Detailed drug code. For guidance on which specific substances to include in the substance categories, please refer to the detailed drug categories listed for Detailed drug code.

• Substance problem and Route of administration:
  • For states that do collect Detailed drug code—Records may have duplicate Substance problems and identical Route of administration IF the corresponding Detailed drug codes are different or are ‘‘multiple’’ drug codes
  • For states that do not collect Detailed drug code—A record may not have duplicate Substance problems with identical Routes of administration

TRANSACTION TYPE

Identifies whether a record is for an initial admission or a transfer/change in service. Note: Some states may use other terminology such as “initial admission” and “transfer admission” in place of “admission” and “transfer.”

• A—Admission
• T—Transfer/change in service

GUIDELINES: For TEDS, a treatment episode is defined as that period of service between the beginning of treatment for a drug or alcohol problem and the termination of services for the prescribed treatment plan. The episode includes one admission (when services begin) and at least one discharge (when services end). Within a treatment episode, a client may transfer to a different service, facility, provider, program, or location. Each admission and transfer record should have an associated discharge record.

When it is feasible for the state to identify transfers, they should be reported as transfers in admissions data submissions. When admissions and transfers cannot be differentiated in a state data system, such changes in service or facility should be reported to TEDS as admissions.

Data set considerations for transfers:

• All fields from the transfer record should be updated to reflect values at the time of transfer except the following fields, which must have the same values as in the associated (preceding) admission record: Client ID, Codependent/collateral, Date of birth, Sex, Race, and Ethnicity. If a field cannot be updated, it should be transmitted to TEDS with its value from the associated (preceding) admission record.
• Date of admission is defined as the date services begin after the transfer to another service or facility.

TYPE OF SERVICES

Describes the type of service and treatment setting in which the client is placed at the time of admission or transfer.

• Ambulatory, detoxification—Outpatient treatment services providing for safe withdrawal in an ambulatory setting (pharmacological or non-pharmacological)
• Ambulatory, intensive outpatient—As a minimum, the client must receive treatment lasting two or more hours per day for three or more days per week
• Ambulatory, non-intensive outpatient—Ambulatory treatment services including individual, family, and/or group services, and may include pharmacological therapies
• Detoxification, 24-hour service, free-standing residential—24-hour per day services in a non-hospital setting providing for safe withdrawal and transition to ongoing treatment
• Detoxification, 24-hour service, hospital inpatient—24-hour per day medical acute care services in a hospital setting for detoxification of persons with severe medical complications associated with withdrawal
• 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
• Rehabilitation/residential, short-term (30 days or fewer)—Typically, 30 days or less of non-acute care in a setting with treatment services for alcohol and other drug abuse and dependency
• Rehabilitation/residential, long-term (more than 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

USUAL ROUTE OF ADMINISTRATION (OF PRIMARY, SECONDARY, AND TERTIARY SUBSTANCES)

These fields identify the usual route of administration of the respective Substance problems.

• Inhalation
  
• Injection (IV or intramuscular)
  
• Oral
  
• Smoking
  
• Other

DAYS WAITING TO ENTER TREATMENT

Indicates the number of days from the first contact or request for service until the client was admitted and the first clinical service was provided.

• 0-996—Number of days waiting

GUIDELINES: This item is intended to capture the number of days the client must wait to begin treatment because of program capacity, treatment availability, admissions requirements, or other program requirements. It should not include time delays caused by client unavailability or client failure to meet any requirement or obligation.

DETAILED CRIMINAL JUSTICE REFERRAL

This item gives more detailed information about those clients who are coded as “Court/criminal justice referral/DUI/DWI” in the TEDS Minimum Data Set item Principal source of referral.

• Diversionary program (e.g., TASC)
• DUI/DWI
• Other court (not state or federal)
• Other recognized legal entity (e.g., local law enforcement agency, corrections agency, youth services, review board/agency)
• Prison
• Probation/parole
• State/federal court
• Other
• Not applicable

DETAILED DRUG CODE (PRIMARY, SECONDARY, AND TERTIARY)

These fields identify, in greater detail, the drug problems recorded in the TEDS Minimum Data Set item Substance problem.

• Aerosols
• Alcohol
• Alprazolam (Xanax)
• Amphetamines
• Anesthetics
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin, Rivotril)
• Clorazepate (Tranxene)
• Codeine
• Crack

• Diazepam (Valium)
• Diphenhydramine
  
• Diphenylhydantoin/phenytoin (Dilantin)
• Ethchlorvynol (Placidyl)
• Flunitrazepam (Rohypnol)
• Flurazepam (Dalmane)
• GHB/GBL (gamma-hydroxybutyrate, gamma-butyrolactone)
• Glutethimide (Doriden)
• Heroin
  
  
• Hydrocodone (Vicodin)
• Hydromorphone (Dilaudid)
• Ketamine (Special K)
• Lorazepam (Ativan)
• LSD
• Marijuana/hashish
• Meperidine (Demerol)
• Meprobamate (Miltown)
• Methadone (non-prescription)
• Methamphetamine/speed
• Methaqualone
• Methylenedioxymethamphetamine (MDMA, Ecstasy)
• Methylphenidate (Ritalin)
• Nitrites

DETAILED NOT IN LABOR FORCE

This item gives more detailed information about those clients who are coded as “Not in labor force” in the TEDS Minimum Data Set item Employment Status.

• Disabled
• Homemaker
• Inmate of institution (prison or institution that keeps a person, otherwise able, from entering the labor force)
• Retired
• Student
• Other
• Not applicable

DSM CRITERIA DIAGNOSIS

The diagnosis of the substance abuse problem from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. DSM-IV is preferred, but use of the Third Edition or ICD codes is permissible.

EXPECTED/ACTUAL PRIMARY SOURCE OF PAYMENT

Identifies the primary source of payment for this treatment episode.

• Blue Cross/Blue Shield
• Medicaid
• Medicare
• Other government payments
• Other health insurance companies
• Self-pay
• Worker’s Compensation
• No charge (free, charity, special research, or teaching)
• Other

FREQUENCY OF ATTENDANCE AT SELF-HELP PROGRAMS

This field records the number of times the client has attended a self-help program in the 30 days preceding the date of admission to treatment services.

• No attendance in the past month
• 1-3 times in the past month
• 4-7 times in the past month
• 8-15 times in the past month
• 16-30 times in the past month
• Some attendance in the past month, but frequency unknown

HEALTH INSURANCE

Specifies the client’s health insurance (if any). The insurance may or may not cover alcohol or drug treatment.

• Blue Cross/Blue Shield
• Health maintenance organization (HMO)
• Medicaid
• Medicare
• Private insurance (other than Blue Cross/Blue Shield or an HMO)
• Other (e.g., TRICARE)
• None

LIVING ARRANGEMENTS

Specifies whether the client is homeless, living with parents, in a supervised setting, or living on his or her own.

• Dependent living. Clients living in a supervised setting such as a residential institution, halfway house, or group home, and children (under age 18) living with parents, relatives, or guardians, or in foster care
• Homeless. Clients with no fixed address; includes shelters
• Independent living. Clients living alone or with others without supervision

MARITAL STATUS

Describes the client’s marital status. The following categories are compatible with the U.S. Census.

• Divorced
• Never married. Includes clients whose only marriage was annulled
• Now married. Includes those living together as married
• Separated. Includes those separated legally or otherwise absent from spouse because of marital discord
• Widowed

NUMBER OF ARRESTS IN 30 DAYS PRIOR TO ADMISSION

This field records the number of arrests in the 30 days preceding the date of admission to treatment services.

• 0-96—Number of arrests

PREGNANT AT TIME OF ADMISSION

Specifies whether the client was pregnant at the time of admission.

• Yes
• No
• Not applicable. Use this code for male clients

PSYCHIATRIC PROBLEM IN ADDITION TO ALCOHOL OR DRUG PROBLEM

Identifies whether the client has a psychiatric problem in addition to his or her alcohol or drug use problem.

• Yes
• No

SOURCE OF INCOME SUPPORT

Identifies the client’s principal source of financial support. For children under 18, this field indicates the parents’ primary source of income/support.

• Disability
• Public assistance
• Retirement/pension
• Wages/salary
• Other
• None

VETERAN STATUS

Identifies whether the client has served in the uniformed services (Army, Navy, Air Force, Marines, Coast Guard, Public Health Service Commissioned Corps, Coast and Geodetic Survey, etc.).

• Yes
• No

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