Treatment Episode Data Set (TEDS) 2000 - 2010

National Admissions to Substance Abuse Treatment Services

 

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

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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., Arlington, Virginia. Work was performed under Task Order HHSS28320070048I/HHSS28343001T, Reference No. 283-07-4803 (Cathie Alderks, Task Order Officer). At Synectics, Bea Blacklow, Doren Walker, Sarbajit Sinha, and Leigh Henderson were responsible for the content, analysis, and writing of the report.

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): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

Electronic Access to Publication

This publication may be downloaded from http://store.samhsa.gov/home.

Hard copies may be obtained from 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 7-1044
Rockville, Maryland 20857

June 2012

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Treatment Episode Data Set (TEDS): 2000 - 2010.
National Admissions to Substance Abuse Treatment Services

Table of Contents

Title Page

Acknowledgments

List of Tables

List of Figures

Highlights

Chapter 1. Trends in Substance Abuse Treatment Admissions Aged 12 and Older: 2000-2010

Chapter 2. Characteristics of Admissions by Primary Substance: 2010

Chapter 3. Topics of Special Interest

Chapter 4. Type of Service: 2010

Appendix A. About the Treatment Episode Data Set (TEDS)

Appendix B. TEDS Data Elements

Tables

Trends 2000 - 2010

1.1a Admissions aged 12 and older, by primary substance of abuse: 2000-2010.
Number

1.1b Admissions aged 12 and older, by primary substance of abuse: 2000-2010.
Percent distribution

1.2 Admissions aged 12 and older, by alcohol/drug co-abuse: 2000-2010.
Number and percent distribution

1.3a Admissions aged 12 and older, by gender and age at admission: 2000-2010.
Number and average age at admission

1.3b Admissions aged 12 and older, by gender and age at admission: TEDS 2000-2010 and U.S. population aged 12 and older 2010.
Percent distribution

1.4 Admissions aged 12 and older, by race/ethnicity: TEDS 2000-2010 and U.S. population aged 12 and older 2010
Number and percent distribution

1.5 Admissions aged 16 and older by employment status: TEDS 2000-2010 and U.S. population aged 16 and older 2010.
Percent distribution

Characteristics of Admissions 2010

2.1a Admissions aged 12 and older, by gender and age at admission according to primary substance of abuse: 2010.
Column percent distribution and average age at admission

2.1b Admissions aged 12 and older, by gender and age at admission according to primary substance of abuse: 2010.
Row percent distribution

2.2 Admissions aged 12 and older, by race/ethnicity according to primary substance of abuse: 2010.
Column and row percent distribution

2.3a Admissions aged 12 and older, by selected race/ethnicity/gender/age group according to primary substance of abuse: 2010.
Column percent distribution

2.3b Admissions aged 12 and older, by selected race/ethnicity/gender/age group according to primary substance of abuse: 2010.
Row percent distribution

2.4 Admissions aged 12 and older, by frequency of use and usual route of administration according to primary substance of abuse: 2010.
Percent distribution

2.5 Admissions aged 12 and older, by age of first use and number of prior treatment episodes according to primary substance of abuse: 2010.
Percent distribution

2.6 Admissions aged 12 and older, by treatment referral source and detailed criminal justice referral according to primary substance of abuse: 2010.
Percent distribution

2.7 Admissions aged 12 and older, by type of service at admission and medication-assisted opioid therapy according to primary substance of abuse: 2010.
Percent distribution

2.8 Admissions aged 16 and older, by employment status and detailed not-in-labor-force category according to primary substance of abuse: 2010.
Percent distribution

2.9 Admissions aged 18 and older, by education according to primary substance of abuse: 2010.
Percent distribution

2.10 Admissions aged 12 and older, by marital status, living arrangements, pregnancy status, and veteran status according to primary substance of abuse: 2010.
Percent distribution

2.11 Admissions aged 12 and older, by psychiatric problem in addition to substance abuse problem and DSM criteria diagnosis according to primary substance of abuse: 2010.
Percent distribution

2.12 Admissions aged 16 and older, by source of income support according to primary substance of abuse: 2010.
Percent distribution

2.13 Admissions aged 12 and older, by type of health insurance and expected/actual primary source of payment according to primary substance of abuse: 2010.
Percent distribution

2.14 Admissions aged 12 and older, by arrests in 30 days prior to admission and days waiting to enter treatment according to primary substance of abuse: 2010.
Percent distribution

2.15 Admissions aged 12 and older, by primary, secondary, and tertiary detailed drug: 2010.
Number and percent distribution

Topics of Special Interest

3.1a Admissions aged 12 to 17, by primary substance of abuse: 2000-2010.
Number

3.1b Admissions aged 12 to 17, by primary substance of abuse: 2000-2010.
Percent distribution

3.2 Admissions aged 12 to 17, by gender and race/ethnicity according to primary substance of abuse: 2010.
Percent distribution

3.3 Admissions aged 12 to 17, by age at admission and treatment referral source according to primary substance of abuse: 2010.
Percent distribution

3.4 Admissions aged 12 to 17, by marijuana involvement and treatment referral source: 2000-2010.
Percent distribution

3.5 Heroin admissions aged 12 and older, by age group and race/ethnicity: 2000-2010.
Percent distribution

3.6 Heroin admissions aged 12 and older, by usual route of administration, age group, and characteristics of first treatment episode: 2000-2010.
Percent distribution

3.7 Heroin admissions aged 12 and older with planned medication-assisted opioid therapy, by usual route of administration and age group: 2000-2010.
Percent distribution

3.8 Admissions aged 12 and older, by primary substance of abuse according to additional substance abuse: 2010.
Percent distribution

3.9 Substance abuse combinations, by selected primary substance of abuse: 2010.
Number and percent distribution

Type of Service 2010

4.1a Admissions aged 12 and older, by type of service according to primary substance of abuse and age at admission: 2010.
Column percent distribution

4.1b Admissions aged 12 and older, by type of service according to primary substance of abuse and age at admission: 2010.
Row percent distribution

4.2a Admissions aged 12 and older, by type of service according to gender and race/ethnicity: 2010.
Column percent distribution

4.2b Admissions aged 12 and older, by type of service according to gender and race/ethnicity: 2010.
Row percent distribution

4.3a Admissions aged 12 and older, by type of service according to treatment referral source, frequency of use, and number of prior treatment episodes: 2010.
Column percent distribution

4.3b Admissions aged 12 and older, by type of service according to treatment referral source, frequency of use, and number of prior treatment episodes: 2010.
Row percent distribution

Appendix A. About the Treatment Episode Data Set (TEDS)

Appendix Table 1. State data system reporting characteristics: 2010

Appendix Table 2. Item percentage response rate by State or jurisdiction: TEDS Minimum Data Set 2010

Appendix Table 3. Item percentage response rate by State or jurisdiction: TEDS Supplemental Data Set 2010

Figures

Figure 1 Primary substance of abuse at admission: 2000-2010

Figure 2 Age at admission: TEDS 2000-2010 and U.S. population 2010

Figure 3 Race/ethnicity of admissions: TEDS 2000-2010 and U.S. population 2010

Figure 4 Employment status at admission, aged 16 and older: 2000-2010

Figure 5 All admissions, by gender, age, and race/ethnicity: 2010

Figure 6 Alcohol-only admissions, by gender, age, and race/ethnicity: 2010

Figure 7 Alcohol admissions with secondary drug abuse, by gender, age, and race/ethnicity: 2010

Figure 8 Heroin admissions, by gender, age, and race/ethnicity: 2010

Figure 9 Non-heroin opiate admissions by gender, age, and race/ethnicity: 2010

Figure 10 Smoked cocaine (crack) admissions, by gender, age, and race/ethnicity: 2010

Figure 11 Non-smoked cocaine admissions, by gender, age, and race/ethnicity: 2010

Figure 12 Marijuana/hashish admissions, by gender, age, and race/ethnicity: 2010

Figure 13 Methamphetamine/amphetamine admissions, by gender, age, and race/ethnicity: 2010

Figure 14 Tranquilizer admissions, by gender, age, and race/ethnicity: 2010

Figure 15 Sedative admissions, by gender, age, and race/ethnicity: 2010

Figure 16 Hallucinogens admissions, by gender, age, and race/ethnicity: 2010

Figure 17 Phencyclidine (PCP) admissions, by gender, age, and race/ethnicity: 2010

Figure 18 Inhalant admissions, by gender, age, and race/ethnicity: 2010

Figure 19 Adolescent admissions aged 12 to 17, by primary substance: 2000-2010

Figure 20 Adolescent admissions aged 12 to 17, by marijuana involvement and criminal justice referral: 2000-2010

Figure 21 Heroin admissions aged 12 and older, by age group and race/ethnicity: 2000-2010

Figure 22 Heroin admissions 12 and older, by route of administration and age group: 2000-2010

Figure 23 Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by route of heroin administration: 2000-2010

Figure 24 Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by age group: 2000-2010

Figure 25 Primary and secondary/tertiary substance of abuse: 2010

Figure 26 White (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 27 Black (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 28 Mexican origin admissions, by gender, primary substance, and age: 2010

Figure 29 Puerto Rican origin admissions, by gender, primary substance, and age: 2010

Figure 30 American Indian/Alaska Native admissions, by gender, primary substance, and age: 2010

Figure 31 Asian/Pacific Islander admissions, by gender, primary substance, and age: 2010


Highlights

This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2010 and trend data for 2000 to 2010. 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.


For 2010, 1,820,737 substance abuse treatment admissions aged 12 and older were reported to TEDS by 48 States and Puerto Rico. (Georgia, Mississippi, and the District of Columbia had submitted no data or incomplete data for 2010 by October 10, 2011, and are excluded from this report.)

Major Substances of Abuse

Alcohol

Heroin

Opiates Other than Heroin1


1These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, mor­phine, opium, oxycodone, pentazocine, pro­poxyphene, tramadol, and any other drug with morphine-like effects.

Marijuana/Hashish

Cocaine/Crack

Methamphetamine/Amphetamines

Adolescent Admissions to Substance Abuse Treatment

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

Polydrug Abuse

Polydrug abuse was reported by 55 percent of all TEDS admissions aged 12 and older in 2010 [Table 3.8].

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].

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Chapter 1

Trends in Substance Abuse Treatment Admissions
Aged 12 and Older: 2000 - 2010

Trends in Primary Substance of Abuse: 2000-2010
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 2010 and trend data for 2000 to 2010. It is a companion to the report Treatment Episode Data Set (TEDS): 2000-2010 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 2000 through 2010 that were received and processed through October 10, 2011.1

TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, 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 the 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 2000 to 2010. 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. (For example, limited resources and targeted programs may result in a shift of State funds from treatment of alcohol abusers to treatment to abusers of other drugs.) TEDS data thus have important implications for resource allocation and program planning.


1 For researchers interested in more detailed analysis, TEDS public use files are available for online data analysis or download at the Substance Abuse and Mental Health Data Archive, which can be accessed at http://www.datafiles.samhsa.gov.
Summary data for individual States that have submitted the full year of data are available online through the TEDS Quick Statistics website at http://wwwdasis.samhsa.gov/webt/NewMapv1.htm.

Trends in Primary Substance of Abuse: 2000-2010

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 increased by 4 percent from 2000 to 2010, commensurate with a similar increase in the U.S. population aged 12 and older.


2 These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

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.

Figure 1. Primary substance of abuse at admission: 2000-2010

Figure 1, Line chart comparing Primary substance of abuse at admission: TEDS 2000-2010

Trends in Demographic Characteristics

Table 1.3b. Males represented 68 percent of TEDS admissions aged 12 and older in 2010, a proportion that declined steadily, if slightly, from 70 percent in 2000.

Table 1.3b and Figure 2. The age distribution of TEDS admissions aged 12 and older changed between 2000 and 2010.

Figure 2. Age at admission: TEDS 2000-2010 and U.S. population 2010

Figure 2. Stacked bar chart comparing Age at admission: TEDS 2000-2010 and U.S. population 2010

Table 1.4 and Figure 3. The racial/ethnic composition of TEDS admissions aged 12 and older changed very little between 2000 and 2010.

Figure 3. Race/ethnicity of admissions: TEDS 2000-2010 and U.S. population 2010

Figure 3. Stacked bar chart comparing Race/ethnicity of admissions: TEDS 2000-2010 and U.S. population 2010

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.

Figure 4. Employment status at admission, aged 16 and older: 2000-2010

Figre 4. Line chart comparing Employment status at admission, aged 16 and older: 2000-2010


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.

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Chapter 2

Characteristics of Admissions by Primary Substance: 2010

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 2010 TEDS data. The tables include items in the TEDS Minimum and Supplemental Data Sets for 2010. (See Appendix B for a complete data dictionary.) Data are tabulated as percentage distributions of treatment admissions according to primary substance of abuse.

The Minimum Data Set consists of 19 items that include:

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).


1 Hispanics of Mexican and Puerto Rican origin made up 62 percent of all admissions of Hispanic origin in 2010.

All Admissions Aged 12 and Older


2 Percentages do not sum to total due to rounding.

Figure 5. All admissions, by gender, age, and race/ethnicity: 2010

Figure 5.Line chart comparing All admissions, by gender, age, and race/ethnicity: 2010

Alcohol Only

Figure 6. Alcohol-only admissions, by gender, age, and race/ethnicity: 2010

Figure 6. Line chart comparing Alcohol-only admissions, by gender, age, and race/ethnicity: 2010

Alcohol with Secondary Drug Abuse


3 Percentages do not sum to total due to rounding.

Figure 7. Alcohol admissions with secondary drug abuse, by gender, age, and race/ethnicity: 2010

Figure 7. Line chart comparing Alcohol admissions with secondary drug abuse, by gender, age, and race/ethnicity: 2010

Heroin


4 Percentages do not sum to total due to rounding.

Figure 8. Heroin admissions, by gender, age, and race/ethnicity: 2010

Figure 8. Line chart comparing Heroin admissions, by gender, age, and race/ethnicity: 2010

Opiates Other than Heroin

Figure 9. Non-heroin opiate admissions, by gender, age, and race/ethnicity: 2010

Figure 9. Line chart comparing Non-heroin opiate admissions, by gender, age, and race/ethnicity: 2010

Smoked Cocaine (Crack)


5 Percentages do not sum to total due to rounding.

Figure 10. Smoked cocaine (crack) admissions, by gender, age, and race/ethnicity: 2010

Figure 10. Line chart comparing Smoked cocaine (crack) admissions, by gender, age, and race/ethnicity: 2010

Non-Smoked Cocaine


6 Percentages do not sum to total due to rounding.

Figure 11. Non-smoked cocaine admissions, by gender, age, and race/ethnicity: 2010

Figure 11. Line chart comaparing Non-smoked cocaine admissions, by gender, age, and race/ethnicity: 2010

Marijuana/Hashish

Figure 12. Marijuana/hashish admissions, by gender, age, and race/ethnicity: 2010

Figure 12. Line chart comparing Marijuana/hashish admissions, by gender, age, and race/ethnicity: 2010

Methamphetamine/Amphetamines

Figure 13. Methamphetamine/amphetamine admissions, by gender, age, and race/ethnicity: 2010

Figure 13. Line chart comparing Methamphetamine/amphetamine admissions, by gender, age, and race/ethnicity: 2010

Tranquilizers

Figure 14. Tranquilizer admissions, by gender, age, and race/ethnicity: 2010

Figure 14. Line chart comparing Tranquilizer admissions, by gender, age, and race/ethnicity: 2010

Sedatives

Figure 15. Sedative admissions, by gender, age, and race/ethnicity: 2010

Figure 15. Line chart comparing Sedative admissions, by gender, age, and race/ethnicity: 2010

Hallucinogens

Figure 16. Hallucinogen admissions, by gender, age, and race/ethnicity: 2010

Figure 16. Line chart comparing Hallucinogen admissions, by gender, age, and race/ethnicity: 2010

Phencyclidine (PCP)

Figure 17. Phencyclidine (PCP) admissions, by gender, age, and race/ethnicity: 2010

Figure 17. Line chart comparing Phencyclidine (PCP) admissions, by gender, age, and race/ethnicity: 2010

Inhalants

Figure 18. Inhalant admissions, by gender, age, and race/ethnicity: 2010

Figure 18. Line chart comparing Inhalant admissions, by gender, age, and race/ethnicity: 2010

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Chapter 3

Topics of Special Interest

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:

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 increased by 15 percent between 2000 and 2002, but declined by 16 percent between 2002 and 2010. In 2010, 87 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 system.

The number of TEDS admissions for primary heroin abuse increased by 5 percent between 2000 and 2009 and fell 10 percent between 2009 and 2010.

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 37 percent in 2000 to 28 percent in 2010.

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

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.

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The number of adolescent admissions aged 12 to 17 increased by 15 percent from 2000 to 2002, then declined by 16 percent from 2002 to 2010.


1 These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Figure 19. Adolescent admissions aged 12 to 17, by primary substance: 2000-2010

Figure 19. Line chart comparing Adolescent admissions, by primary substance: 2000-2010

Table 3.2. In 2010, overall 71 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. There were more female than male adolescent admissions for methamphetamine/amphetamines (54 percent vs. 46 percent).

Almost half (48 percent) of adolescent admissions were non-Hispanic White, 24 percent were of Hispanic origin, 19 percent were non-Hispanic Black, and 9 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, 20 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 59 percent and 47 percent, respectively, were 17.

In 2010, almost half (46 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 14 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 2000, 43 percent of all adolescent admissions were marijuana involved and referred to treatment by the criminal justice system, and 40 percent were marijuana involved but referred by other sources. Between 2000 and 2002, the proportion referred by the criminal justice system increased to 45 percent while the proportion referred by other sources decreased to 37 percent. The proportions nearly converged in 2007 and 2009.

Adolescent admissions not involving marijuana that were referred by the criminal justice system fell from 7 percent in 2000 to 5 percent in 2010. Admissions not involving marijuana that were referred from other sources were fairly stable, at between 8 and 11 percent of adolescent admissions.

Figure 20. Adolescent admissions aged 12 to 17, by marijuana involvement and criminal justice referral: 2000-2010

Figure 20. Line chart comparing Adolescent admissions, by marijuana involvement and criminal justice referral: 2000-2010

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 2000 through 2010. Primary heroin abuse accounted for 14 to 16 percent of TEDS admissions in every year from 2000 through 2010. Injection was the preferred route of administration for 60 to 70 percent of primary heroin admissions, inhalation for 25 to 34 percent, and smoking or other route for 4 to 5 percent. The majority of primary heroin admissions were 35 years of age or older (54 to 56 percent from 2000 through 2007 and 45 percent in 2010).

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.

Figure 21. Heroin admissions aged 12 and older, by age group and race/ethnicity: 2000-2010

Figure 21. Line chart comparing Heroin admissions aged 12 and older, by age group and race/ethnicity: 2000-2010

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.

Figure 22. Heroin admissions aged 12 and older, by route of administration and age group: 2000-2010

Figure 22. Line chart comparing  Heroin admissions aged 12 and older, by route of administration and age group: 2000-2010

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 2000 and 2010.

Figure 23. Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by route of heroin administration: 2000-2010

Figure 23. Line chart comparing Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by route of heroin administration: 2000-2010

Figure 24. Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by age group: 2000-2010

Figure 24. Line chart comparing Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by age group: 2000-2010

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 55 percent of TEDS admissions aged 12 or older in 2010. 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 most treatment admissions. Forty-one percent of all treatment admissions were for primary alcohol abuse, and 19 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 60 percent of all treatment admissions reported alcohol as a substance of 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.

Figure 25. Primary and secondary/tertiary substance of abuse: 2010

Figure 25. Stacked bar chart comparing Primary and secondary/tertiary substance of abuse: 2010

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.

Figure 26. White (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 26. Line chart comparing White (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 27. Black (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 27. Line chart comparing Black (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 28. Mexican origin admissions, by gender, primary substance, and age: 2010

Figure 28. Line chart comparing Mexican origin admissions, by gender, primary substance, and age: 2010

Figure 29. Puerto Rican origin admissions, by gender, primary substance, and age: 2010

Figure 29. Line chart comparing Puerto Rican origin admissions, by gender, primary substance, and age: 2010

Figure 30. American Indian/Alaska Native admissions, by gender, primary substance, and age: 2010

Figure 30. Line chart comparing American Indian/Alaska Native admissions, by gender, primary substance, and age: 2010

Figure 31. Asian/Pacific Islander admissions, by gender, primary substance, and age: 2010

Figure 31. Line chart comparing Asian/Pacific Islander admissions, by gender, primary substance, and age: 2010

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Chapter 4

Type of Service: 2010

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 separate service types. The complete list of types of services detailed in this report include:

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


1 Percentages do not sum to total due to rounding.

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

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Appendix A

About the Treatment Episode Data Set (TEDS)

Introduction
History
State Data Collection Systems
Report-Specific Considerations

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 Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse treatment. The other two components are:

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 19 items that include:

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.

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 2000 through 2010, 83 percent of all records submitted were client admissions, 15 percent were client transfers, and 2 percent were codependents of substance abusers.

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

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Appendix B

TEDS Data Elements

TEDS Minimum Data Set
TEDS Supplemental Data Set

TEDS Minimum Data Set

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.

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.

GUIDELINES: Reporting of data for Codependent/collaterals is optional. If the State opts to report co-dependent/collateral clients, the mandatory fields are State code, Provider identifier, Client identifier, Client transaction type, Co-dependent/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.

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."

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:

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.

TYPE OF SERVICES

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

AGE

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

SEX

Identifies client's gender.

RACE

Specifies the client's race.

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.

MEDICATION-ASSISTED OPIOID THERAPY

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

ETHNICITY

Identifies client's specific Hispanic origin.

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

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.

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.

EDUCATION

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

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.

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

PRINCIPAL SOURCE OF REFERRAL

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

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.

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.

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

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

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

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

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.


TEDS Supplemental Data Set

PREGNANT AT TIME OF ADMISSION

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

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.).

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.

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.

MARITAL STATUS

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

LIVING ARRANGEMENTS

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

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.

HEALTH INSURANCE

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

EXPECTED/ACTUAL PRIMARY SOURCE OF PAYMENT

Identifies the primary source of payment for this treatment episode.

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.

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.

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.

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 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.

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.

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.

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