National Survey of Substance Abuse
Treatment Services (N-SSATS): 2011

Data on Substance Abuse Treatment Facilities

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

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Table of Contents


Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), by Synectics for Management Decisions, Inc. (Synectics), Arlington, Virginia. Data collection was performed by Mathematica Policy Research (Mathematica), Princeton, New Jersey. Work by Synectics and Mathematica was performed under Task Order HHSS283200700048I/HHSS28342001T, Reference No. 283-07-4803 (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. National Survey of Substance Abuse Treatment Services (N-SSATS): 2011. Data on Substance Abuse Treatment Facilities, BHSIS Series: S-64, HHS Publication No. (SMA) 12-4730, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

Electronic Access and Copies of Publication

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

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

Originating Office

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

November 2012

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Table of Contents


Table of Contents

Title Page

Acknowledgments

List of Tables

List of Figures

Highlights

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

Chapter 2. Trends in Facility Characteristics

Chapter 3. Trends in Client Characteristics

Chapter 4. Facility Characteristics and Services

Chapter 5. Client Characteristics

Chapter 6. State Data

Appendix A. N-SSATS Background

Appendix B. 2011 N-SSATS Questionnaire

Appendix C. Item Response and Imputation for N-SSATS 2011


List of Tables

Chapter 1

1.1 N-SSATS facilities, by status and mode of response: 2011

Chapter 2

2.1 Facility turnover: 2007-2011.
Number and percent distribution

2.2 Facility operation and primary focus of facility: 2007-2011.
Number and percent distribution

2.3 Facilities, by type of care offered, and facilities with Opioid Treatment Programs: 2007-2011.
Number and percent

Chapter 3

3.1 Clients in treatment, by facility operation and primary focus of facility: 2007-2011.
Number and percent distribution

3.2 Clients in treatment, by type of care received, and clients receiving methadone or buprenorphine: 2007-2011.
Number and percent distribution

3.3 Clients in treatment, by substance abuse problem and diagnosed co-occurring substance abuse and mental disorders: 2007-2011.
Number and percent distribution

3.4 Clients under age 18 in treatment by type of care received, and clients under age 18 in treatment in facilities offering special programs or groups for adolescents: 2007-2011.
Number and percent distribution

Chapter 4

4.1 Primary focus of facilities, by facility operation: 2011.
Number and percent distribution

4.2a Type of care offered, by facility operation and primary focus of facility: 2011.
Number

4.2b Type of care offered, by facility operation and primary focus of facility: 2011.
Percent

4.3 Client substance abuse problem and diagnosed co-occurring mental disorders, by facility operation and primary focus of facility: March 31, 2011.
Number and percent

4.4 Facility size, according to type of care offered, by facility operation and primary focus of facility: March 31, 2011.
Median number of clients

4.5 Facility size in terms of number of clients, by facility operation and primary focus of facility: March 31, 2011.
Number and percent distribution

4.6 Facility capacity and utilization of residential (non-hospital) care, by facility operation and primary focus of facility: March 31, 2011.
Number, utilization rate, and percent distribution

4.7 Facility capacity and utilization of hospital inpatient care, by facility operation and primary focus of facility: March 31, 2011.
Number, utilization rate, and percent distribution

4.8 Services provided, by facility operation: 2011.
Number and percent

4.9 Services provided, by primary focus of facility: 2011.
Number and percent

4.10 Clinical/therapeutic approaches, by frequency of use: 2011.
Number and percent distribution

4.11a Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2011.
Number

4.11b Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2011.
Percent

4.12a Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of facility: 2011.
Number

4.12b Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of facility: 2011.
Percent

4.13 Facilities detoxifying clients, by substance, facility operation, and primary focus of facility: 2011.
Number and percent

4.14 Facilities with client outreach, by facility operation and primary focus of facility: 2011.
Number and percent

4.15a Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2011.
Number

4.15b Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2011.
Percent

4.16a Facility licensing, certification, or accreditation, by type of care offered: 2011.
Number

4.16b Facility licensing, certification, or accreditation, by type of care offered: 2011.
Percent

4.17a Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2011.
Number

4.17b Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2011.
Percent

4.18a Types of client payments accepted by facility, by facility operation and primary focus of facility: 2011.
Number

4.18b Types of client payments accepted by facility, by facility operation and primary focus of facility: 2011.
Percent

4.19 Facility funding, by facility operation and primary focus of facility: 2011.
Number and percent

4.20 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medication-assisted opioid therapy at OTPs and other facilities, by facility operation and primary focus of facility: March 31, 2011.
Number and percent distribution

4.21a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2011.
Number

4.21b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2011.
Percent

4.22a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2011.
Number

4.22b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2011.
Percent

4.23 Facilities using counseling as part of their substance abuse treatment program, by primary focus of facility: 2011.
Number

4.24 Facility smoking policy, by facility operation and primary focus of facility: 2011
Number and percent distribution

Chapter 5

5.1 Clients in treatment, by primary focus of facility and facility operation: March 31, 2011.
Number and percent distribution

5.2a Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2011.
Number

5.2b Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2011.
Percent distribution (row percent)

5.2c Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2011.
Percent distribution (column percent)

5.3 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental disorders, by facility operation and primary focus of facility: March 31, 2011.
Number and percent

5.4 Clients under age 18 in treatment, by facility operation and primary focus of facility: March 31, 2011.
Number and percent distribution

5.5 Clients under age 18 in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2011.
Number and percent distribution

Chapter 6

6.1 N-SSATS facilities, by status, response rate, mode of response, and by State or jurisdiction: 2011

Trends 2007-2011

6.2a Facilities and clients in treatment, by State or jurisdiction: 2007-2011.
Number

6.2b Facilities and clients in treatment, by State or jurisdiction: 2007-2011.
Percent distribution

6.3a Clients under age 18 in treatment, and clients under age 18 in facilities offering special programs or groups for adolescents, by State or jurisdiction: 2007-2011.
Number

6.3b Clients under age 18 in treatment, and clients under age 18 in facilities offering special programs or groups for adolescents, by State or jurisdiction: 2007-2011.
Percent

Facilities 2011

6.4a Facility operation, by State or jurisdiction: 2011.
Number

6.4b Facility operation, by State or jurisdiction: 2011.
Percent distribution

6.5 Primary focus of facility, by State or jurisdiction: 2011.
Number and percent distribution

6.6a Type of care offered, by State or jurisdiction: 2011.
Number

6.6b Type of care offered, by State or jurisdiction: 2011.
Percent

6.7 Client substance abuse problem and diagnosed co-occurring mental disorders, by State or jurisdiction: March 31, 2011.
Number and percent

6.8 Facility size, according to type of care offered, by State or jurisdiction: March 31, 2011.
Median number of clients

6.9 Facility size in terms of number of clients, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.10 Facility capacity and utilization of residential (non-hospital) and hospital inpatient care, by State or jurisdiction: March 31, 2011.
Number and utilization rate

6.11 Type of counseling used, by State or jurisdiction: 2011.
Number and percent

6.12a Clinical/therapeutic approaches used always or often or sometimes, by State or jurisdiction: 2011.
Number

6.12b Clinical/therapeutic approaches used always or often or sometimes, by State or jurisdiction: 2011.
Percent

6.13a Facilities offering special programs or groups for specific client types, by State or jurisdiction: 2011.
Number

6.13b Facilities offering special programs or groups for specific client types, by State or jurisdiction: 2011.
Percent

6.14a Facilities offering services in sign language for the hearing impaired and in languages other than English, by State or jurisdiction: 2011.
Number

6.14b Facilities offering services in sign language for the hearing impaired and in languages other than English, by State or jurisdiction: 2011.
Percent

6.15 Facilities detoxifying clients, by substance and State or jurisdiction: 2011.
Number and percent

6.16 Facilities with client outreach, by State or jurisdiction: 2011.
Number and percent

6.17a Facility licensing, certification, or accreditation, by State or jurisdiction: 2011.
Number

6.17b Facility licensing, certification, or accreditation, by State or jurisdiction: 2011.
Percent

6.18a Facilities employing specific practices as part of their standard operating procedures, by State or jurisdiction: 2011.
Number

6.18b Facilities employing specific practices as part of their standard operating procedures, by State or jurisdiction: 2011.
Percent

6.19a Types of client payments accepted by facility, by State or jurisdiction: 2011.
Number

6.19b Types of client payments accepted by facility, by State or jurisdiction: 2011.
Percent

6.20 Facility funding, by State or jurisdiction: 2011.
Number and percent

6.21 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medication-assisted opioid therapy at OTPs and other facilities, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.22a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by State or jurisdiction: 2011.
Number

6.22b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by State or jurisdiction: 2011.
Percent

6.23a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by State or jurisdiction: 2011.
Number

6.23b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by State or jurisdiction: 2011.
Percent

6.24 Facility smoking policy, by State or jurisdiction: 2011.
Number and percent

Clients 2011

6.25a Clients in treatment, according to facility operation, by State or jurisdiction: March 31, 2011.
Number

6.25b Clients in treatment, according to facility operation, by State or jurisdiction: March 31, 2011.
Percent distribution

6.26 Clients in treatment, according to primary focus of facility, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.27a Clients in treatment, according to type of care received, by State or jurisdiction: March 31, 2011.
Number

6.27b Clients in treatment, according to type of care received, by State or jurisdiction: March 31, 2011.
Percent distribution

6.28 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental disorders, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.29 Clients in treatment, according to counseling type, by State or jurisdiction: March 31, 2011.
Number and percent

6.30a Clients under age 18 in treatment, according to facility operation, by State or jurisdiction: March 31, 2011.
Number

6.30b Clients under age 18 in treatment, according to facility operation, by State or jurisdiction: March 31, 2011.
Percent distribution

6.31 Clients under age 18 in treatment, according to primary focus of facility, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.32 Clients under age 18 in treatment, according to type of care received, by State or jurisdiction: March 31, 2011.
Number and percent distribution

6.33 Clients in treatment aged 18 and over, according to substance abuse problem, by State or jurisdiction: March 31, 2011.
Number and clients per 100,000 population aged 18 and over

Appendix A

A.1 Survey contents: 1996-2011

Appendix C

C.1 N-SSATS item percentage response rates: 2011


List of Figures

Chapter 1

Figure 1 Survey Response Mode: 2007-2011

Chapter 2

Figure 2 Facility Operation: 2007-2011

Figure 3 Primary Focus of Facility: 2007-2011

Figure 4 Type of Care Offered and Facilities with Opioid Treatment Programs: 2007-2011

Chapter 3

Figure 5 Clients in Treatment, by Facility Operation: 2007-2011

Figure 6 Clients in Treatment, by Type of Care Received: 2007-2011

Chapter 4

Figure 7 Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 31, 2011

Chapter 6

Figure 8 Clients in Treatment per 100,000 Population Aged 18 and Over: March 31, 2011


Highlights

This report presents results from the 2011 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. Selected findings are given below.


Trends in Facility and Client Characteristics 2007-2011


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

Facility Operation—March 31, 20112

Primary Focus of Activity—March 31, 20112


2 Percentages may not sum to 100 percent because of rounding.

Type of Care—March 31, 20113


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

Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders—March 31, 2011

Facility Size and Utilization Rates—March 31, 2011

Medication-Assisted Opioid Therapy—March 31, 2011

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Table of Contents


Chapter 1

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

Data Collection Procedures for the 2011 N-SSATS
Facility Selection for the 2011 N-SSATS Report
Survey Response Mode
Data Considerations and Limitations
Organization of the Report
Terminology

This report presents tabular information and highlights from the 2011 National Survey of Substance Abuse Treatment Services (N-SSATS), conducted between March and October 2011, with a reference date of March 31, 2011. It is the 34th in a series of national surveys begun in the 1970s. The surveys were designed to collect data on the location, characteristics, and use of alcohol and drug treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions.4 The Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs N-SSATS.

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

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

http://findtreatment.samhsa.gov


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

Data Collection Procedures for the 2011 N-SSATS

Field period and reference date

The survey reference date for the 2011 N-SSATS was March 31, 2011. The field period was from March 31, 2011 through October 24, 2011.

Survey universe

The 2011 N-SSATS facility universe totaled 17,376 facilities, including all 17,043 active treatment facilities on SAMHSA's I-SATS at a point 6 weeks before the survey reference date and 333 facilities that were added by State substance abuse agencies or otherwise discovered during the first 3 months of the survey.

Content

The 2011 N-SSATS questionnaire was a 13-page document with 41 numbered questions (see Appendix B). Topics included:

Data collection

Three data collection modes were employed: a secure web-based questionnaire, a paper questionnaire sent by mail, and a telephone interview. Five weeks before the survey reference date (March 31, 2011), letters were mailed to all facilities to announce the survey. The letters also served to update records with new address information received from the U.S. Postal Service. During the last week of March 2011, data collection packets (including the SAMHSA cover letter, State-specific letter of endorsement, State profile, information on completing the survey on the web, and a sheet of Frequently Asked Questions) were mailed to each facility. Initially, respondents could also request a paper questionnaire be sent to them. During the data collection phase, contract personnel were available to answer facilities' questions concerning the survey. Web-based support for facilities completing the questionnaire on the web was also available. Three to 4 weeks after the initial data collection packet mailing, thank you/reminder letters were sent to all facilities. Approximately 8 weeks after the initial packet mailing, non-responding facilities were mailed a second packet that included a hard copy questionnaire. About 3 to 4 weeks after the questionnaire mailing, non-respondents received a reminder telephone call. Those facilities that had not responded within 3 to 4 weeks of the reminder call were telephoned and asked to complete the survey by computer-assisted telephone interview (CATI).

Facility status and response rate

Table 1.1 presents a summary of response rate information. There were 17,376 facilities in the survey universe. Of these facilities, 12 percent were found to be ineligible for the survey because they had closed or did not provide substance abuse treatment or detoxification. Of the remaining 15,222 facilities, 14,302 facilities (94 percent) completed the survey and 13,720 (90 percent) were eligible for this report.

Quality assurance

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

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

Item non-response was minimized through careful editing and extensive follow-up. The item response rate for the 2011 N-SSATS averaged 98.6 percent across 195 separate items. Appendix C details item response rates and imputation procedures.

Facility Selection for the 2011 N-SSATS Report

Table 1.1. The N-SSATS questionnaire serves several purposes, as noted earlier. Three hundred thirty-four of the 14,302 questionnaire respondents provided information but were deemed out of the scope of this report. They were excluded from the analyses presented here. The excluded facilities and reasons for exclusion fell into three categories:

An additional 248 facilities whose client counts were included in or "rolled into" other facilities' counts and whose facility characteristics were not reported separately were excluded from facility counts in this report. However, their client counts are included.

After the exclusion of 334 out-of-scope facilities and 248 rolled-up facilities, 13,720 eligible respondent facilities were included in the 2011 N-SSATS report.

Number of respondents reporting facility and client data

There were 13,720 eligible respondents to the 2011 N-SSATS. The breakdown of facility data and client counts reported by these respondents is summarized below.

Survey Response Mode

Figure 1. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since introduction of the option in 2002. The percentage of facilities responding via the web increased from 44 percent in 2007 to 79 percent in 2011. Mail response declined from 36 percent in 2007 to 8 percent in 2011. Telephone response, which represents follow-up of facilities that had not responded by mail or web, also declined, from 21 percent in 2007 to 12 percent in 2011.

Figure 1
Survey Response Mode: 2007-2011

Stacked bar chart comparing Survey Response Mode: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.

Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data from the 2011 N-SSATS. Some general issues are listed below; other considerations are detailed in Appendix A. Considerations and limitations of specific data items are discussed where the data are presented.

Organization of the Report

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

Terminology

The majority of tables in the report are organized by facility operation and by primary focus of the facility. Therefore, it is important to define these terms.

To Chapter 1 Table

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Table of Contents


Chapter 2

Trends in Facility Characteristics

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

This chapter presents trends in facility characteristics for 2007 to 2011.

Number of Facilities

Table 2.1. The total number of substance abuse treatment facilities increased slightly between 2007 and 2011. There was considerable turnover from year to year in the individual facilities responding to the survey: every year, although between 87 and 90 percent of the facilities responding to a given survey had also responded to the previous year's survey, some 10 to 12 percent of the facilities had closed or were no longer providing substance abuse treatment but were replaced by fairly similar numbers of new facilities.

There was a net increase of 381 facilities between 2010 and 2011, to 13,720 facilities. Of the facilities responding to the 2011 survey, 87 percent had also responded to the 2010 survey and 13 percent were new to the 2011 survey. Ten percent of the facilities responding in 2010 had closed or were no longer providing substance abuse treatment in 2011.

Despite the year-to-year changes in the facilities reporting, several core structural characteristics of the substance abuse treatment system remained stable from 2007 to 2011.

Facility Operation

Table 2.2 and Figure 2. The operational structure of the substance abuse treatment system (i.e., the type of entity responsible for operating the facility) changed very little between 2007 and 2011.

Figure 2
Facility Operation: 2007-2011

Stacked bar comparing Facility Operation: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.


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

Primary Focus of Facility

Table 2.2 and Figure 3. The primary focus of activity of the facility (i.e., the services the facility primarily provides) changed very little between 2007 and 2011.

Figure 3
Primary Focus of Facility: 2007-2011

Stacked bar comparing Primary Focus of Facility: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.

Type of Care Offered

Table 2.3 and Figure 4. The proportions of facilities offering the major types of care—outpatient, residential (non-hospital), and hospital inpatient—changed very slightly between 2007 and 2011.

Facilities with Opioid Treatment Programs

Table 2.3 and Figure 4. Opioid Treatment Programs (OTPs), certified by SAMHSA, provide medication-assisted therapy with methadone and buprenorphine, the only two opioid medications approved for the treatment of opioid addiction. OTPs can be associated with any type of care. They were provided by 8 to 9 percent of all facilities between 2007 and 2011.

Figure 4
Type of Care Offered and Facilities with Opioid Treatment Programs: 2007-2011

Bar and line chart comparing Type of Care Offered and Facilities with Opioid Treatment Programs: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.

To Chapter 2 Tables

To table of contents

Table of Contents


Chapter 3

Trends in Client Characteristics

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

This chapter presents trends in client characteristics for 2007 to 2011.

Table 3.1. The number of clients in treatment on the survey reference date increased by 8 percent from 2007 to 2011, from 1,135,425 in 2007 to 1,224,127 in 2011.

Facility Operation

Table 3.1 and Figure 5. In almost all categories of facility operation, the proportions of clients in treatment changed very little between 2007 and 2011.

Figure 5
Clients in Treatment, by Facility Operation: 2007-2011

Stacked bar chart comparing Clients in Treatment, by Facility Operation: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.


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

Primary Focus of Facility

Table 3.1. In almost all categories of facility primary focus of activity, the proportions of clients in treatment changed very little from 2007 to 2011.

Type of Care Received

Table 3.2 and Figure 6. The proportions of clients in treatment for the major types of care—outpatient, residential (non-hospital), and hospital inpatient—were stable between 2007 and 2011.

Figure 6
Clients in Treatment, by Type of Care Received: 2007-2011

Mixed bar/line chart comparing Clients in Treatment, by Type of Care Received: 2007-2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2007-2011.

Clients Receiving Methadone or Buprenorphine

Table 3.2 and Figure 6. Clients receiving methadone or buprenorphine could be in any type of care—outpatient, residential (non-hospital), or hospital inpatient. Clients could receive methadone only in Opioid Treatment Programs (OTPs), certified by SAMHSA to provide medication-assisted therapy with methadone and buprenorphine. However, clients could receive buprenorphine in any type of facility.8


8 Individual physicians can receive special authorization from the U.S. Department of Health and Human Services that allows them to prescribe buprenorphine for the treatment of opiate addiction. These physicians may prescribe buprenorphine to patients in an office setting or to patients at substance abuse treatment facilities.

Substance Abuse Problem Treated

Table 3.3.The proportion of clients in treatment for the three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse only, and alcohol abuse only—changed very little between 2007 and 2011. Clients in treatment for both drug and alcohol abuse made up 42 to 46 percent of all clients from 2007 to 2011. Clients in treatment for drug abuse only ranged from 35 to 39 percent of all clients from 2007 through 2011. The proportion of clients treated for alcohol abuse only ranged from 18 to 19 percent between 2007 and 2011. Clients in treatment for diagnosed co-occurring substance abuse and mental disorders made up 37 to 41 percent of all clients from 2007 through 2011.

Clients under Age 18 in Treatment

Table 3.4. Clients under age 18 made up between 7 and 8 percent of all clients from 2007 through 2011.

To Chapter 3 Tables

To table of contents

Table of Contents


Chapter 4

Facility Characteristics and Services

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

This chapter outlines key characteristics of facilities and programs in 2011.

Facility Operation and Primary Focus

Table 4.1. Facilities were asked to designate the type of entity responsible for the operation of the facility. They were also asked to designate the facility’s primary focus of activity.

  • The proportions of all facilities by facility operation were:9
    • Private non-profit organizations
    • Private for-profit organizations
    • Local, county, or community governments
    • State governments
    • Federal government10
    • Tribal governments
  • The proportions of all facilities by primary focus were:
    • Substance abuse treatment services
    • Mix of substance abuse treatment and mental heath services
    • Mental health services
    • General health care
    • Other and unknown focus

 
57 percent
31 percent
5 percent
3 percent
3 percent
2 percent
 
59 percent
32 percent
6 percent
1 percent
1 percent


9 Percentages do not sum to 100 percent because of rounding.
10 Data for the Federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified Federal agencies) are detailed in the tables.

Type of Care Offered

Table 4.2b. Type of care offered was made up of three broad categories (outpatient, residential [non-hospital], and hospital inpatient), each with several subcategories. A facility could offer more than one type of care. The proportions of all facilities offering the different types of care were:11

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

81 percent
75 percent
44 percent
12 percent
9 percent
9 percent
26 percent
21 percent
13 percent
6 percent
5 percent
5 percent
4 percent

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and more than one third (34 percent) provided residential (non-hospital) care. In contrast, 91 percent of private for-profit facilities provided outpatient care and 13 percent provided residential non-hospital) care.


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

Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders

Table 4.3. Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring substance abuse and mental disorders.

Facility Size

Table 4.4. Facility size is defined by the number of clients in substance abuse treatment. The median number of clients in substance abuse treatment at a facility on March 31, 2011 was 42 clients.

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

50 clients
28 clients
12 clients
3 clients
1 clients
200 clients
20 clients
16 clients
9 clients
4 clients
10 clients
7 clients
5 clients

Table 4.5. Facilities were sorted into five size groups based on the total number of clients in treatment on March 31, 2011. The smallest facilities were defined as having fewer than 15 clients and the largest as having 120 clients or more.


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

Facility Capacity and Utilization Rates

Facilities were asked to report the number of residential (non-hospital) and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of residential (non-hospital) or hospital inpatient clients by the number of residential (non-hospital) or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates could be more than 100 percent.

Figure 7
Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 31, 2011

Bar chart comparing Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 31, 2011

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2011.


13 Residential (non-hospital) utilization rates are based on a subset of 3,058 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
14 Hospital inpatient utilization rates are based on a subset of 476 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.

Services Provided

Tables 4.8 and 4.9. Facilities were asked about the types of services they provided. Services were grouped into the five broad categories shown below.

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate whether they used any of 12 specific clinical/therapeutic approaches.

Programs or Groups for Specific Client Types

Table 4.11b. Facilities were asked about the provision of treatment programs or groups specially designed for specific client types. Overall, 80 percent of facilities offered at least one special program or group to serve a specific client type.

  • The proportions of facilities providing special programs or groups were:
    • Clients with co-occurring mental and substance abuse disorders
    • Adult women
    • Persons arrested for DUI or DWI
    • Adolescents
    • Adult men
    • Other criminal justice clients15
    • Pregnant or postpartum women
    • Persons with HIV or AIDS
    • Seniors or older adults
    • Lesbian, gay, bisexual, or transgender (LGBT) clients

 
36 percent
32 percent
29 percent
28 percent
25 percent
24 percent
13 percent
8 percent
6 percent
5 percent


15 Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.

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

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

Detoxification Services

Table 4.13. Facilities that provided detoxification services were asked to indicate whether or not they detoxified clients from specified substances, and whether or not medication was routinely used during detoxification.

  • The proportions of facilities providing detoxification from the following specific substances were:
    • Opiates
    • Alcohol
    • Benzodiazepines
    • Cocaine
    • Methamphetamines
    • Other substances
  • Medications were routinely used during detoxification in 77 percent of the facilities providing detoxification services.

 
84 percent
67 percent
59 percent
54 percent
53 percent
12 percent

Client Outreach

Tables 4.14 and 4.8. Facilities were asked whether or not they had a website providing information about their substance abuse treatment programs.

Facility Licensing, Certification, or Accreditation

Facilities were asked to report licensure, certification, or accreditation by specified agencies or organizations. These included the State substance abuse agency, State mental health department, State department of health, hospital licensing authority, the Joint Commission, CARF, NCQA, COA, and other State or local agency or organization.16

    • State substance abuse agency
    • State department of health
    • State mental health department
    • CARF
    • Joint Commission
    • Hospital licensing authority
    • Another State or local agency or other organization
    • COA
    • NCQA

83 percent
42 percent
37 percent
23 percent
19 percent
7 percent
6 percent
5 percent
3 percent

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

79 percent
68 percent
58 percent
10 percent


16 Joint Commission: formerly JCAHO (Joint Commission on Accreditation of Healthcare Organizations); CARF: formerly Commission on Accreditation of Rehabilitation Facilities; NCQA: National Committee for Quality Assurance; and COA: Council on Accreditation.

Facility Standard Operating Procedures

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

    • Required continuing education for staff
    • Regularly scheduled case review with a supervisor
    • Periodic client satisfaction surveys
    • Periodic client drug testing
    • Periodic utilization reviews
    • Case review by an appointed quality assurance committee
    • Outcome follow-up after discharge

98 percent
95 percent
92 percent
86 percent
86 percent
72 percent
69 percent

Payment Options

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

    • Cash or self-payment
    • Private health insurance
    • Medicaid
    • State-financed health insurance
    • Medicare
    • Federal military insurance

90 percent
64 percent
57 percent
39 percent
33 percent
33 percent


17 Access to Recovery vouchers were available only in AK, AZ, CA, CO, CT, DC, FL, HI, IA, ID, IL, IN, LA, MI, MO, MT, NJ, NM, OH, OK, RI, TN, TX, WA, WI, and WY. See table 6.19a for number of facilities accepting ATRs by State.
18 Through a contract, tribes can receive the money that the Indian Health Service (IHS) would have used to provide direct health services for tribal members. Tribes can use these funds to provide directly, or through another entity, a broad range of health services. This option was part of P.L. 93-638 and is commonly known as "638 contracting."

Facility Funding

Table 4.19. Facilities were asked if they received Federal, State, or local government funds or grants to support their substance abuse treatment programs.

Facilities with Opioid Treatment Programs

Opioid Treatment Programs (OTPs) are certified by SAMHSA to provide medication-assisted therapy in the treatment of opioid addiction. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of opioid addiction.

Counseling Services Offered by Facilities

Facility Smoking Policy

To Chapter 4 Tables

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Table of Contents


Chapter 5

Client Characteristics

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

This chapter describes key characteristics of the 1,224,127 clients in substance abuse treatment on March 31, 2011. Clients in treatment were defined as: 1) hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services on March 31, 2011 and 2) outpatient clients who were seen at the facility for a substance abuse treatment or detoxification service at least once during the month of March 2011, and who were still enrolled in treatment on March 31, 2011.

Facility Operation and Primary Focus

Table 5.1. Facilities were asked to designate the type of entity responsible for the operation of the facility. They were also asked to designate the facility's primary focus of activity.

  • The proportions of clients in treatment on March 31, 2011, by facility operation were:
    • Private non-profit organizations
    • Private for-profit organizations
    • Local, county, or community governments
    • Federal government19
    • State governments
    • Tribal governments
  • The proportions of clients in treatment on March 31, 2011, by facility primary focus of activity were:
    • Substance abuse treatment services
    • Mix of substance abuse treatment and mental health services
    • Mental health services
    • General health care
    • Other and unknown focus

 

53 percent
32 percent
6 percent
4 percent
3 percent
2 percent

65 percent
30 percent
3 percent
1 percent
1 percent


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

Type of Care

Tables 5.2a, 5.2b, and 5.2c. Facilities were asked how many clients in treatment on March 31, 2011 received specified subcategories of type of care within three broad categories.

  • On March 31, 2011, the proportions of clients receiving different types of care were:
    • Outpatient treatment
      • Regular outpatient care
      • Outpatient methadone maintenance
      • Intensive outpatient treatment
      • Outpatient treatment/day hospitalization
      • Outpatient detoxification
    • Residential (non-hospital) treatment
      • Long-term treatment (more than 30 days)
      • Short-term treatment (30 days or fewer)
      • Detoxification
    • Hospital inpatient treatment


90 percent
50 percent
24 percent
12 percent
2 percent
1 percent
9 percent
6 percent
2 percent
1 percent
1 percent

Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders

Table 5.3. Facilities were asked to estimate the proportions of clients in treatment on March 31, 2011, by substance abuse problem treated (alcohol abuse only, drug abuse only, or both alcohol and drug abuse).

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

Clients under Age 18

Table 5.4. Facilities were asked how many clients in treatment on March 31, 2011 were under age 18.

To Chapter 5 Tables

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Table of Contents


Chapter 6

State Data

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

This chapter presents facility data by State and jurisdiction for March 31, 2011. Facilities operated by Federal agencies are included in the States in which the facilities are located, although these facilities may have clients from other States.

Table 6.1 details the 2011 N-SSATS response rate.

Tables 6.2 to 6.3 present data on treatment facility and client trends for 2007 to 2011.

Tables 6.4 to 6.24 present facility data for 2011.

Tables 6.25 to 6.32 present client data for 2011.

Table 6.33 presents the number of clients in treatment per 100,000 population aged 18 and over, according to substance abuse problem treated, by State or jurisdiction.

Survey Response

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

Trends

Tables 6.2a-b. California and New York had the largest numbers of both facilities and clients in treatment in every year from 2007 through 2011. On March 31, 2011, California had 12 percent of all facilities and 11 percent of all clients. New York had 7 percent of all facilities and 10 percent of all clients.

Florida and Illinois ranked 3rd or 4th in the total number of facilities from 2007 through 2011. Florida was 3rd or 4th for number of clients, but the number of clients in Illinois has been decreasing in recent years.

A core group of States (Michigan, Colorado, Pennsylvania, and Washington) generally ranked 5th to 10th in both the numbers of facilities and of clients from 2007 to 2011. Texas and North Carolina are part of this group based on the number of facilities, and Maryland and Massachusetts are part of it based on the number of clients.

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

Table 6.33 and Figure 8. For the United States, there were 473 clients in treatment per 100,000 population aged 18 and over on March 31, 2011. The rate was highest for persons with both alcohol and drug abuse (203 per 100,000 population), followed by drug abuse only (183 per 100,000 population), and alcohol abuse only (87 per 100,000 population). Figure 8 maps the rates of clients in treatment by State by quartile of rates­—there are 12 or 13 States in each quartile.

Figure 8
Clients in Treatment per 100,000 Population Aged 18 and Over: March 31, 2011

Map of the United States comparing Clients in Treatment per 100,000 Population Aged 18 and Over: March 31, 2011

To Chapter 6 Tables

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Table of Contents


Appendix A

N-SSATS Background

 

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

Survey History

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

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

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

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

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

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

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

Treatment facilities approved by State substance abuse agencies

The largest group of facilities (11,357 in 2011) includes facilities that are licensed, certified, or otherwise approved by the State substance abuse agency to provide substance abuse treatment. State BHSIS representatives maintain this segment of I-SATS by reporting new facilities, closures, and address changes to SAMHSA. Some facilities are not licensed, certified, or otherwise approved by the State agency. Some private for-profit facilities fall into this category. The approved facility group also includes programs operated by Federal agencies—the Department of Veterans Affairs (VA), the Department of Defense, the Indian Health Service—and Opioid Treatment Programs certified by SAMHSA. I-SATS records for Federally-operated facilities are updated annually through lists provided by these agencies.

Treatment facilities not approved by State substance abuse agencies

This group of facilities (2,363 in 2011) represents the SAMHSA effort since the mid-1990s to make I-SATS as comprehensive as possible by including treatment facilities that State substance abuse agencies, for a variety of reasons, do not fund, license, or certify. Many of these facilities are private for-profit, small group practices, or hospital-based programs. Most of them are identified through periodic screening of alternative source databases. (See Special efforts to improve survey coverage below.) State substance abuse agencies are given the opportunity to review these facilities and to add them to the State agency-approved list, if appropriate.

Survey Coverage

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

Unit of response

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

Special efforts to improve survey coverage

The great majority of treatment facilities in I-SATS are administratively monitored by State substance abuse agencies. Therefore, the scope of facilities included in I-SATS is affected by differences in State systems of licensure, certification, accreditation, and the disbursement of public funds. For example, some State substance abuse agencies regulate private facilities and individual practitioners while others do not. In some States, hospital-based substance abuse treatment facilities are not licensed through the State substance abuse agency.

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

Expansion of survey coverage to include all sites within networks at which treatment was provided yielded a net increase of about 2,600 facilities between 1997 and 1998. These additions were not necessarily new facilities, but were facilities not previously included in the survey as separate sites. The number of facilities reporting continued to increase in 1999, but at a slower pace, a net increase of 1,800 facilities. The increase between 1998 and 1999 was in large part because of the improved survey response rate (95 percent in 1999 vs. 90 percent in 1998). Between 2007 and 2011, the number of facilities eligible for inclusion in this report remained constant, at between 13,648 and 13,720. The total number is deceptive, however. There was significant turnover as facilities closed and others opened. (See Table 2.1.)

Data collection

Until 1996, State substance abuse agencies distributed and collected the facility survey forms. Beginning in 1996, data collection was centralized; since that time, SAMHSA has mailed survey forms directly to and collected forms directly from the facilities and has conducted follow-up telephone interviews with the facility director or his/her designee. In 2000, SAMHSA introduced an on-line web version of the questionnaire in addition to the hard-copy questionnaire. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since its inception in 2002.

Non-response

Beginning in 1992, SAMHSA expanded efforts to obtain information from non-responding facilities. A representative sample of non-respondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all non-responding facilities. In 1997, a series of measures was introduced to enhance the survey response rate. These included advance notification and improved methods for updating address and contact information. Between 2004 and 2011, use of these methods and intensive telephone follow-up resulted in an annual follow-up rate (i.e., facilities in the sample either completed the survey or were determined to be closed or otherwise ineligible) of 92 to 96 percent. In 2011, the follow-up rate was 94.7 percent.

Exclusions

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

Facilities operated by the Bureau of Prisons (BOP) were excluded from the 1997 survey and subsequent surveys because SAMHSA conducted a separate survey of correctional facilities.20 During that survey, it was discovered that jails, prisons, and other organizations treating incarcerated persons only were poorly enumerated on I-SATS. Beginning in 1999, these facilities were identified during the survey and excluded from analyses and public-use data files.

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

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


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

Changes in Survey Content

Table A.1 shows the major content areas for the survey from 1996 to 2011. Since 1992, SAMHSA has made adjustments each year to the survey design, both to minimize non-response and to include areas of emerging interest. For example, questions on the number of clients in treatment receiving buprenorphine were added in 2004. Questions about clinical/therapeutic methods, standard practices, and Access to Recovery grants were added in 2007.

There have also been changes within content areas. For example, in response to concerns about over-reporting of programs or groups for specific client types, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that offered specially designed programs or groups for that client type. As a result, the number and proportion of facilities offering programs or groups for each of the specified client types decreased. Surveys from 2003 and later are believed to more accurately represent the number and proportions of facilities providing programs or groups for the specified client types.

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Appendix B

2011 N-SSATS Questionnaire

This Appendix contains the hard copy version of the 2011 N-SSATS questionnaire. Facilities also had the option of responding to the questionnaire on the Internet. For those facilities that had not completed the survey after extensive follow-up efforts (see Chapter 1), the questionnaire was administered by computer-assisted telephone interview (CATI).

Of the responding eligible treatment facilities included in this report, 79 percent completed the questionnaire on the Internet, 8 percent completed it by mail, and 12 percent completed it by CATI [Table 1.1 and Figure 1].

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

To Sample 2011 N-SSATS Questionnaire PDF

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Table of Contents


Appendix C

Item Response and Imputation for N-SSATS 2011

This Appendix contains Table C.1, a list of item response rates for questions from the N-SSATS 2011 questionnaire. Item non-response was minimized through careful editing and extensive follow-up.

The item response rate for the 2011 N-SSATS averaged 98.6 percent across 195 separate response categories.

Item non-response was 10 percent or more for only 4 of 195 separate response categories.

Imputation was conducted for 11 instances of client values. An imputed value for a service type was assigned if a facility reported that it provided the service but had not provided a client or admissions count for the service.

When available, client values and admissions values from up to five previous surveys were used to impute the missing counts. If historical data were not available, the average client value, stratified by State and facility operation, was used to impute the missing client counts. If a facility were unique in its State and facility operation category, values were imputed using average values for the State only. Missing client counts were imputed for each type of service (i.e., hospital inpatient detoxification, hospital inpatient treatment, residential [non-hospital] detoxification, etc.) and summed to the larger service type totals (total hospital inpatient clients, total residential [non-hospital] clients, and total outpatient clients), and finally to total clients.

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

At Synectics, Parth Thakore, Sarbajit Sinha, Doren H. Walker, and Leigh Henderson were responsible for the content, analysis, and writing of the report.

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