National Survey of Substance Abuse
Treatment Services (N-SSATS): 2012

Data on Substance Abuse Treatment Facilities

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

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 HHSS283200800048I/HHSS28342001T, Reference No. 283-07-4803.

Public Domain Notice

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

Recommended Citation

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2012. Data on Substance Abuse Treatment Facilities. BHSIS Series S-66, HHS Publication No. (SMA) 14-4809. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Table of Contents

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

Appendix A. N-SSATS Background

Appendix C. Item Response and Imputation for N-SSATS 2012

List of Tables

Chapter 1

1.1 N-SSATS facilities, by status and mode of response: 2012

Chapter 2

2.1 Facility turnover: 2008-2012.
Number and percent distribution

2.2 Facility operation and primary focus of facility: 2008-2012.
Number and percent distribution

2.3 Facilities, by type of care offered, and facilities with Opioid Treatment Programs: 2008-2012.
Number and percent

Chapter 3

3.1 Clients in treatment, by facility operation and primary focus of facility: 2008-2012.
Number and percent distribution

3.2 Clients in treatment, by type of care received, and clients receiving methadone or buprenorphine: 2008-2012.
Number and percent distribution

3.3 Clients in treatment, by substance abuse problem and diagnosed co-occurring mental and substance abuse disorders: 2008-2012.
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: 2008-2012.
Number and percent distribution

Chapter 4

4.1 Primary focus of facilities, by facility operation: 2012.
Number and percent distribution

4.2a Type of care offered, by facility operation and primary focus of facility: 2012.
Number

4.2b Type of care offered, by facility operation and primary focus of facility: 2012.
Percent

4.3 Type of client substance abuse problem treated and treatment of clients with diagnosed co-occurring mental and substance abuse disorders, by
facility operation and primary focus of facility: March 30, 2012.
Number and percent

4.4 Facility size, according to type of care offered, by facility operation and primary focus of facility: March 30, 2012.
Median number of clients

4.5 Facility size in terms of number of clients, by facility operation and primary focus of facility: March 30, 2012.
Number and percent distribution

4.6 Facility outpatient operational capacity, by facility operation and primary focus of facility: March 2012
Number and percent distribution

4.7 Facility capacity and utilization of residential (non-hospital) care, by facility operation and primary focus of facility: March 30, 2012.
Number, utilization rate, and percent distribution

4.8 Facility capacity and utilization of hospital inpatient care, by facility operation and primary focus of facility: March 30, 2012.
Number, utilization rate, and percent distribution

4.9 Services provided, by facility operation: 2012.
Number and percent

4.10 Services provided, by primary focus of facility: 2012.
Number and percent

4.11 Clinical/therapeutic approaches, by frequency of use: 2012.
Number and percent distribution

4.12a Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2012.
Number

4.12b Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2012.
Percent

4.13a Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of
facility: 2012.
Number

4.13b Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of facility: 2012.
Percent

4.14 Facilities detoxifying clients, by substance, facility operation, and primary focus of facility: 2012.
Number and percent

4.15 Facilities with client outreach, by facility operation and primary focus of facility: 2012.
Number and Percent

4.16a Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2012.
Number

4.16b Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2012.
Percent

4.17a Facility licensing, certification, or accreditation, by type of care offered: 2012.
Number

4.17b Facility licensing, certification, or accreditation, by type of care offered: 2012.
Percent

4.18a Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2012.
Number

4.18b Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2012.
Percent

4.19a Types of client payments accepted by facility, by facility operation and primary focus of facility: 2012.
Number

4.19b Types of client payments accepted by facility, by facility operation and primary focus of facility: 2012.
Percent

4.20 Facility funding, by facility operation and primary focus of facility: 2012.
Number and percent

4.21 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medication-assisted opioid therapy at OTPs and other facilities, by facility operation and primary focus of facility: March 30, 2012.
Number and percent distribution

4.22a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2012.
Number

4.22b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2012.
Percent

4.23a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2012.
Number

4.23b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2012.
Percent

4.24 Facilities using counseling as part of their substance abuse treatment program, by primary focus of facility: 2012.
Number

4.25 Facility smoking policy, by facility operation and primary focus of facility: 2012
Number and percent distribution

Chapter 5

5.1 Clients in treatment, by primary focus of facility and facility operation: March 30, 2012.
Number and percent distribution

5.2a Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 30, 2012.
Number

5.2b Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 30, 2012.
Row percent distribution

5.2c Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 30, 2012.
Column percent distribution

5.3 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by facility operation and primary focus of facility: March 30, 2012.
Number and percent

5.4 Clients under age 18 in treatment, by facility operation and primary focus of facility: March 30, 2012.
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 30, 2012.
Number and percent distribution

Chapter 6

6.1 N-SSATS facilities, by status, response rate, mode of response, and state or jurisdiction: 2012

Trends 2008-2012

6.2a Facilities and clients in treatment, by state or jurisdiction: 2008-2012.
Number

6.2b Facilities and clients in treatment, by state or jurisdiction: 2008-2012.
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: 2008-2012.
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: 2008-2012.
Percent

Facilities 2012

6.4a Facility operation, by state or jurisdiction: 2012.
Number

6.4b Facility operation, by state or jurisdiction: 2012.
Percent distribution

6.5 Primary focus of facility, by state or jurisdiction: 2012.
Number and percent distribution

6.6a Type of care offered, by state or jurisdiction: 2012.
Number

6.6b Type of care offered, by state or jurisdiction: 2012.
Percent

6.7 Client substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by state or jurisdiction: March 30, 2012.
Number and percent

6.8 Facility size, according to type of care offered, by state or jurisdiction: March 30, 2012.
Median number of clients

6.9 Facility size in terms of number of clients, by state or jurisdiction: March 30, 2012.
Number and percent distribution

6.10 Facility capacity and utilization of residential (non-hospital) and hospital inpatient care, by state or jurisdiction: March 30, 2012.
Number and utilization rate

6.11 Type of counseling used, by state or jurisdiction: 2012.
Number and percent

6.12a Clinical/therapeutic approaches used always or often or sometimes, by state or jurisdiction: 2012.
Number

6.12b Clinical/therapeutic approaches used always or often or sometimes, by state or jurisdiction: 2012.
Percent

6.13a Facilities offering special programs or groups for specific client types, by state or jurisdiction: 2012.
Number

6.13b Facilities offering special programs or groups for specific client types, by state or jurisdiction: 2012.
Percent

6.14a Facilities offering services in sign language for the hearing impaired and in languages other than English, by state or jurisdiction: 2012.
Number

6.14b Facilities offering services in sign language for the hearing impaired and in languages other than English, by state or jurisdiction: 2012.
Percent

6.15 Facilities detoxifying clients, by substance and state or jurisdiction: 2012.
Number and percent

6.16 Facilities with client outreach, by state or jurisdiction: 2012.
Number and percent

6.17a Facility licensing, certification, or accreditation, by state or jurisdiction: 2012.
Number

6.17b Facility licensing, certification, or accreditation, by state or jurisdiction: 2012.
Percent

6.18a Facilities employing specific practices as part of their standard operating procedures, by state or jurisdiction: 2012.
Number

6.18b Facilities employing specific practices as part of their standard operating procedures, by state or jurisdiction: 2012.
Percent

6.19a Types of client payments accepted by facility, by state or jurisdiction: 2012.
Number

6.19b Types of client payments accepted by facility, by state or jurisdiction: 2012.
Percent

6.20 Facility funding, by state or jurisdiction: 2012.
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 30, 2012.
Number and percent distribution

6.22a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2012.
Number

6.22b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2012.
Percent

6.23a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2012.
Number

6.23b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by state or jurisdiction: 2012.
Percent

6.24 Facility smoking policy, by state or jurisdiction: 2012.
Number and percent distribution

Clients 2012

6.25a Clients in treatment, according to facility operation, by state or jurisdiction: March 30, 2012.
Number

6.25b Clients in treatment, according to facility operation, by state or jurisdiction: March 30, 2012.
Percent distribution

6.26 Clients in treatment, according to primary focus of facility, by state or jurisdiction: March 30, 2012.
Number and percent distribution

6.27a Clients in treatment, according to type of care received, by state or jurisdiction: March 30, 2012.
Number

6.27b Clients in treatment, according to type of care received, by state or jurisdiction: March 30, 2012.
Percent distribution

6.28 Clients in treatment, according to substance abuse problem and diagnosed co-occurring mental and substance abuse disorders, by state or jurisdiction: March 30, 2012.
Number and percent distribution

6.29 Clients in treatment, according to counseling type, by state or jurisdiction: March 30, 2012.
Number and percent

6.30a Clients under age 18 in treatment, according to facility operation, by state or jurisdiction: March 30, 2012.
Number

6.30b Clients under age 18 in treatment, according to facility operation, by state or jurisdiction: March 30, 2012.
Percent distribution

6.31 Clients under age 18 in treatment, according to primary focus of facility, by state or jurisdiction: March 30, 2012.
Number and percent distribution

6.32 Clients under age 18 in treatment, according to type of care received, by state or jurisdiction: March 30, 2012.
Number and percent distribution

6.33 Clients in treatment aged 18 and over, according to substance abuse problem, by state or jurisdiction: March 30, 2012.
Number and clients per 100,000 population aged 18 and over

Appendix A

A.1 Survey contents: 1996-2012

Appendix C

C.1 N-SSATS item percentage response rates: 2012

List of Figures

Chapter 1

Figure 1 Survey Response Mode: 2008-2012

Chapter 2

Figure 2 Facility Operation: 2008-2012

Figure 3 Primary Focus of Facility: 2008-2012

Figure 4 Type of Care Offered and Facilities with Opioid Treatment Programs: 2008-2012

Chapter 3

Figure 5 Clients in Treatment, by Facility Operation: 2008-2012

Figure 6 Clients in Treatment, by Type of Care Received: 2008-2012

Chapter 4

Figure 7 Residential (Non-Hospital) and Hospital Inpatient Utilization Rates: March 30, 2012

Chapter 6

Figure 8 Clients in Treatment per 100,000 Population Aged 18 and Over: March 30, 2012

Highlights

This report presents results from the 2012 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. It is important to note that values in charts, narrative lists, and percentage distributions are calculated using actual raw numbers and rounded for presentation in this report; calculations using rounded values may produce different results.

• The N-SSATS facility response rate in 2012 was 93 percent. Thirty-one states or jurisdictions had response rates that equaled or surpassed the overall rate [Tables 1.1 and 6.1].
  
• A total of 14,995 facilities completed the survey. The 14,311 facilities eligible for this report had a one-day census of 1,248,905 clients enrolled in substance abuse treatment on March 30, 2012 [Tables 1.1 and 3.1].
  
• In the United States, there were 479 clients in treatment per 100,000 population aged 18 and older on March 30, 2012. The rate was highest for persons with both alcohol and drug problems (206 per 100,000 population aged 18 and older), followed by drug problems only (186 per 100,000), and alcohol problems only (86 per 100,000) [Table 6.33].
  

Trends in Facility and Client Characteristics 2008-2012

• Both the total numbers of substance abuse treatment facilities and clients in treatment increased slightly between 2008 and 2012. The number of eligible facilities responding to the 2012 survey increased by 5 percent, from 13,688 facilities in 2008 to 14,311 facilities in 2012 [Table 2.1]. The number of clients in treatment on the survey reference date also increased by 5 percent, from 1,192,490 in 2008 to 1,248,905 in 2012 [Table 3.1].
  
• The operational structure of the substance abuse treatment system (i.e., the type of entity responsible for operating the facility: private non-profit, private for-profit, or government—local, state, federal,¹ or tribal) changed very little between 2008 and 2012 [Table 2.2 and Figure 2].
• Primary focus of facilities: Substance abuse treatment services was the primary focus in 61 percent of all facilities in 2008, decreasing to 56 percent in 2012. During this same time period, facilities with a primary focus of a mix of mental health and substance abuse treatment services increased from 30 percent to 33 percent [Table 2.2 and Figure 3].
  
• The major types of care—outpatient, residential (non-hospital), and hospital inpatient—changed little from 2008 to 2012 in terms of the proportion of facilities offering each type of care or the proportion of clients in treatment in each type of care [Tables 2.3 and 3.2 and Figures 4 and 6].
  
• Opioid Treatment Programs certified by SAMHSA for the provision of medication-assisted therapy with methadone and/or buprenorphine were provided by 8 to 9 percent of all facilities between 2008 and 2012 [Table 2.3 and Figure 4].
  
• The proportion of all clients receiving methadone ranged from 22 percent to 25 percent in the period 2008 to 2012 [Table 3.2].
• The proportion of all clients receiving buprenorphine ranged from 1 percent to 3 percent in the period 2008 to 2012 [Table 3.2].
• The proportion of clients in treatment for the three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse only, and alcohol abuse only—changed little between 2008 and 2012. Clients in treatment for both drug and alcohol abuse made up 42 to 46 percent of all clients. Clients in treatment for drug abuse only made up 35 to 39 percent, and clients in treatment for alcohol abuse only remained fairly steady around 18 percent [Table 3.3].
  
• Clients under age 18 made up 7 percent of all clients in treatment between 2008 and 2012. The proportion of clients under age 18 in treatment in each type of care (outpatient, residential [non-hospital], or hospital inpatient) differed little from the proportion of adults, and was stable between 2008 and 2012 [Table 3.4].
  

Facility Operation—March 30, 2012

• Private non-profit organizations operated 56 percent of all facilities and were treating 52 percent of all clients.
• Private for-profit organizations operated 31 percent of all facilities and were treating 34 percent of all clients.
• Local governments operated 5 percent of all facilities and were treating 6 percent of all clients.
• State governments operated 3 percent of all facilities and were treating 3 percent of all clients.
• The federal government operated 3 percent of all facilities and was treating 3 percent of all clients.
• Tribal governments operated 2 percent of all facilities and were treating 2 percent of all clients [Tables 4.1 and 5.1].

Primary Focus—March 30, 2012

• The provision of substance abuse treatment services was the primary focus of 56 percent of facilities, and 61 percent of all clients were in treatment at these facilities.
• A mix of mental health and substance abuse treatment services was the primary focus of 33 percent of facilities, and 30 percent of all clients were in treatment at these facilities.
• The provision of mental health services was the primary focus of 7 percent of facilities, and 5 percent of all clients were in treatment at these facilities.
• General health care was the primary focus of 2 percent of facilities and 1 percent of all clients were in treatment at these facilities.
• Activities other than those listed above were the primary focus of 3 percent of facilities, and 2 percent of all clients were in treatment at these facilities [Tables 4.1 and 5.1].
  

Type of Care—March 30, 2012²

• Outpatient treatment was offered by 81 percent of all facilities and was received by 90 percent of all clients in treatment.
• Residential (non-hospital) treatment was offered by 25 percent of all facilities and was received by 9 percent of all clients in treatment.
• Hospital inpatient treatment was offered by 5 percent of all facilities and was received by 1 percent of all clients in treatment [Tables 4.2b and 5.2b].

Client Substance Abuse Problem and Diagnosed Co-occurring Mental Disorders—March 30, 2012

• Clients in treatment for both alcohol and drug abuse made up 44 percent of all clients.
• Clients in treatment for drug abuse only made up 38 percent of all clients.
• Clients in treatment for abuse of alcohol only made up 18 percent of all clients.
• Forty-six percent of clients in treatment had diagnosed co-occurring substance abuse and mental disorders [Table 5.3].
  

Facility Size and Utilization Rates—March 30, 2012

• The median number of clients at substance abuse treatment facilities was 40 clients. Outpatient facilities had a median of 47 clients, while residential (non-hospital) facilities had a median of 19 clients and hospital inpatient facilities had a median of 10 clients [Table 4.4].
• Ninety-six percent of all residential (non-hospital) beds and 111 percent of all hospital inpatient beds (there were more hospital inpatient clients than hospital beds) designated for substance abuse treatment were in use [Tables 4.7 and 4.8].
  

Medication-Assisted Opioid Therapy—March 30, 2012

• Clients receiving methadone or buprenorphine in Opioid Treatment Programs (OTPs) accounted for 25 percent of all clients in treatment, although OTPs were available in only 1,167 (8 percent) of all substance abuse treatment facilities [Tables 2.3 and 4.21].
• Private for-profit organizations operated 57 percent of OTPs compared with 31 percent of all substance abuse treatment facilities [Tables 4.1 and 4.21].
• Of the 313,921 clients receiving medication-assisted opioid therapy in OTPs, 98 percent (306,512) received methadone [Table 4.21].
• Of the 39,223 clients receiving buprenorphine, 81 percent received it in facilities that were not OTPs [Table 4.21].
• More than half (60 percent) of clients receiving methadone were in private for-profit facilities whereas 47 percent of clients receiving buprenorphine were in private for-profit facilities. Clients receiving buprenorphine were more likely than those receiving methadone to be in private non-profit facilities (39 percent vs. 34 percent) [Table 4.21].
• Most (92 percent) of the clients receiving methadone were in facilities whose primary focus was the provision of substance abuse treatment services. Fifty-eight percent of buprenorphine clients were treated in facilities whose primary focus was the provision of substance abuse treatment services whereas 33 percent of buprenorphine clients were treated in facilities providing a mix of mental health and substance abuse treatment services [Table 4.21].

Table of Contents

Chapter 1

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

Data Collection Procedures for the 2012 N-SSATS
Facility Selection for the 2012 N-SSATS Report
Survey Response Mode
Data Considerations and Limitations
Organization of the Report
Terminology

The 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) was conducted between March and November 2012, with a reference date of March 30, 2012. It is the 35th in a series of national surveys begun in the 1970s. The surveys were designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other U.S. jurisdictions.³ The Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs N-SSATS. This report presents tabular information and highlights from the 2012 N-SSATS. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

N-SSATS is designed to collect information from all facilities⁴ in the United States, both public and private, that provide substance abuse treatment. (Additional information on N-SSATS, its history, and changes in the survey and survey universe over time is provided in Appendix A.)

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

• Assist SAMHSA and state and local governments in assessing the nature and extent of services provided in state-supported and other substance abuse treatment facilities and in forecasting substance abuse treatment resource requirements;
• Update SAMHSA's Inventory of Substance Abuse Treatment Services (I-SATS), which includes all known drug and alcohol abuse treatment facilities (see Appendix A);
• Analyze substance abuse treatment services trends and conduct comparative analyses for the nation, regions, and states;
• Generate the National Directory of Drug and Alcohol Abuse Treatment Programs, a compendium of facilities approved by state substance abuse agencies for the provision of substance abuse treatment;
• Update the information in SAMHSA's Substance Abuse Treatment Facility Locator, a searchable database of facilities approved by state substance abuse agencies for the provision of substance abuse treatment. The Treatment Facility Locator is available on the Internet at:
  

http://findtreatment.samhsa.gov

Data Collection Procedures for the 2012 N-SSATS

Field period and reference date

The survey reference date for the 2012 N-SSATS was March 30, 2012. The field period was from March 30, 2012, through November 19, 2012.

Survey universe

The 2012 N-SSATS facility universe totaled 19,316 facilities, including all 18,833 active treatment facilities on SAMHSA’s I-BHS at a point 6 weeks before the survey reference date and 483 facilities that were added by state substance abuse agencies or otherwise discovered during the first 3 months of the survey.

Content

The 2012 N-SSATS questionnaire was a 13-page document with 41 numbered questions (see Appendix B). Topics included:

• Facility identification information
• Operating entity
• Primary focus
• Type of care provided
  • Outpatient treatment services (regular outpatient treatment, intensive outpatient treatment, day treatment or partial hospitalization, detoxification, methadone maintenance)
  • Residential (non-hospital) treatment services (long-term—more than 30 days, short-term—30 days or fewer, detoxification)
  • Hospital treatment services (inpatient treatment, inpatient detoxification)
• Services offered (assessment and pre-treatment services, counseling, pharmacotherapies, testing, transitional services, ancillary services)
• Clinical/therapeutic approaches
• Special programs or groups provided for specific client types
• Provision of services in sign language and/or in languages other than English
• Detoxification from alcohol, benzodiazepines, opioids, cocaine, methamphetamines, or other drugs, and routine use of medication during detoxification
• Client outreach (outreach to persons in the community who may need treatment, provision of a facility website)
• Licensure, certification, or accreditation agencies or organizations
• Standard operating procedures
• Payment options accepted, including use of a sliding fee scale and/or treatment at no charge
• Receipt of government funding
• Smoking policy
• Operation of an Opioid Treatment Program (OTP) certified by SAMHSA and offering maintenance and/or detoxification with opioid drugs such as methadone
• Number of clients in treatment on March 30, 2012 (total, clients under age 18, clients receiving methadone, clients receiving buprenorphine)
• Percentage of clients in treatment on March 30, 2012, for abuse of both alcohol and drugs, alcohol abuse only, and drug abuse only
• Percentage of clients in treatment on March 30, 2012, with diagnosed co-occurring mental and substance abuse disorders
• Number of beds designated for residential (non-hospital) and hospital inpatient substance abuse treatment on March 30, 2012
  

Data collection

Three data collection modes were employed: a secure web-based questionnaire, a paper questionnaire sent by mail, and a telephone interview. Five weeks before the survey reference date of March 30, 2012, 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 2012, a data collection packet (including the SAMHSA cover letter, state-specific letter of endorsement, state profile, information on completing the survey on the web, and a sheet of Frequently Asked Questions) was mailed to each facility. Initially, respondents could also request a paper questionnaire be sent to them. During the data collection phase, contract personnel were available to answer facilities’ questions concerning the survey. Web-based support for facilities completing the questionnaire on the web was also available. Three weeks after the initial data collection packet mailing, thank you/reminder letters were sent to all facilities. Approximately 8 weeks after the initial packet mailing, non-
responding facilities were mailed a second packet that included a hard copy questionnaire. About 2 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 19,316 facilities in the survey universe. Of these facilities, 17 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 16,114 facilities, 14,995 facilities (93 percent) completed the survey and 14,311 (89 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 2012 N-SSATS averaged 98 percent across 201 separate items. Appendix C details item response rates and imputation procedures.

Facility Selection for the 2012 N-SSATS Report

Table 1.1. The N-SSATS questionnaire is deliberately sent to some facilities that are excluded from this report, as explained below. For this cycle, 394 of the 14,995 questionnaire respondents provided information but were deemed out of the scope of this report and excluded from the analyses presented here. The excluded facilities and reasons for exclusion fell into three categories:

• 191 facilities were halfway houses that did not provide substance abuse treatment. These facilities were included in the survey so that they could be listed in the Directory and the Treatment Facility Locator.
  
• 115 facilities were solo practitioners. I-BHS and N-SSATS are designed to include facilities rather than individuals. Solo practitioners are listed and surveyed only if a state substance abuse agency explicitly requests that they be included in the survey. The excluded solo practitioners had not been identified for inclusion by a state substance abuse agency.
  
• 88 facilities were jails, prisons, or other organizations that treated incarcerated clients exclusively.
  

An additional 290 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 394 out-of-scope facilities and 290 rolled-up facilities, 14,311 eligible respondent facilities remained to be included in the 2012 N-SSATS report.

Number of respondents reporting facility and client data

There were 14,311 eligible respondents to the 2012 N-SSATS. The breakdown of facility data and client counts reported by these respondents is summarized below.

• 12,839 facilities reported facility data and client counts for themselves only.
• 528 facilities reported facility characteristics for themselves and provided client counts for their own facility and for 1,596 other facilities.
• 944 facilities reported facility characteristics only. Their client counts were reported by another facility.
  

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 48 percent in 2008 to 81 percent in 2012. Mail response declined from 33 percent in 2008 to 7 percent in 2012. Telephone response, which represents follow-up of facilities that had not responded by mail or web, also declined, from 19 percent in 2008 to 12 percent in 2012.

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 2012 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.

• N-SSATS attempts to obtain responses from all known treatment facilities, but it is a voluntary survey. There was no adjustment for the 7 percent facility non-response.
• N-SSATS is a point-prevalence survey. It provides information on the substance abuse treatment system and its clients on the reference date. Client counts reported here do not represent annual totals. Rather, N-SSATS provides a “snapshot” of substance abuse treatment facilities and clients on an average day.
• Multiple responses were allowed for certain variables (e.g., services provided and specialized programs). Tabulations of these variables include the total number of facilities reporting each response.

Organization of the Report

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

• Chapter 2 presents trends in facility characteristics for 2008 to 2012.
• Chapter 3 presents trends in client characteristics for 2008 to 2012.
• Chapter 4 describes key characteristics of facilities and the programs and services they provided in 2012.
• Chapter 5 describes key characteristics of clients in substance abuse treatment on March 30, 2012.
• Chapter 6 presents state-level detail for most of the tables presented in Chapters 4 and 5.
• Appendix A provides additional information on N-SSATS, its history, and changes in the survey and survey universe over time.
• Appendix B contains the 2012 N-SSATS mail survey questionnaire.
• Appendix C contains information on item response and imputation.
  

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.

• Facility operation indicates the type of entity responsible for the operation of the facility:
  • Private for-profit
  • Private non-profit
  • Government­
    • Local, county, or community
    • State
    • Federal (Dept. of Veterans Affairs, Dept. of Defense, Indian Health Service, other)
    • Tribal
• Primary focus indicates the services the facility primarily provides:
  • Substance abuse treatment services
  • Mental health services
  • A mix of substance abuse treatment and mental health services
  • General health care
  • Other
• Clients in treatment were defined as:
  • Hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services at the facility on March 30, 2012
    and
  • Outpatient clients who were seen at the facility for a substance abuse treatment or detoxification service at least once during the month of March 2012, and who were still enrolled in treatment on March 30, 2012

To Chapter 1 Table

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 2008 to 2012.

Number of Facilities

Table 2.1.The total number of substance abuse treatment facilities increased slightly between 2008 and 2012. There was considerable turnover from year to year in the individual facilities responding to the survey: every year, although between 85 and 89 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 591 facilities between 2011 and 2012, to 14,311 facilities. Of the facilities responding to the 2012 survey, 85 percent had also responded to the 2011 survey and 15 percent were new to the 2012 survey. Ten percent of the facilities that responded in 2011 had closed or were no longer providing substance abuse treatment in 2012.

Despite the year-to-year changes in the facilities reporting, several core structural characteristics of the substance abuse treatment system remained stable from 2008 to 2012.

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 little between 2008 and 2012.

• Private non-profit organizations operated 58 percent of all facilities in 2008 compared to 56 percent in 2012.
• Private for-profit organizations operated 29 percent of facilities in 2008, increasing slightly but steadily to 31 percent of facilities in 2012.
• Local, county, or community governments operated 6 percent of facilities in 2008, decreasing slightly but steadily to 5 percent in 2012.
• State governments operated about 3 percent of facilities each year.
• The federal government operated 2 to 3 percent of facilities each year.⁵
• Tribal governments operated 1 to 2 percent of facilities each year.
  

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 little between 2008 and 2012.

• Facilities whose main focus was substance abuse treatment services declined from 61 percent to 56 percent of facilities during the period 2008 to 2012.
• Facilities that had a primary focus of a mix of mental health and substance abuse services increased from 30 percent to 33 percent of facilities during the period 2008 to 2012.
• Facilities with a primary focus of mental health services made up 6 to 7 percent of facilities each year.
• Facilities with a primary focus of general health care operated 1 percent of facilities in 2008, increasing slightly but steadily to 2 percent of facilities in 2012.
• Facilities whose main focus was other made up about 1 to 3 percent of facilities each year.
  
  

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 little between 2008 and 2012.

• Outpatient treatment was provided by 80 to 81 percent of facilities.
• Residential (non-hospital) treatment was provided by 25 to 27 percent of facilities.
• Hospital inpatient treatment was provided by 5 to 6 percent of facilities.
  

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 2008 and 2012.

• Outpatient treatment was provided by 90 to 95 percent of OTP facilities.
• Residential (non-hospital) treatment was provided by 7 to 10 percent of OTP facilities.
• Hospital inpatient treatment was provided by 7 to 12 percent of OTP facilities.
  

To Chapter 2 Tables

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 2008 to 2012.

Table 3.1. The number of clients in treatment on the survey reference date increased by 5 percent from 2008 to 2012, from 1,192,490 in 2008 to 1,248,905 in 2012.

Facility Operation

Table 3.1 and Figure 5. In almost all categories of facility operation, the proportions of clients in treatment changed little between 2008 and 2012.

• Private non-profit facilities treated 53 percent of clients in 2008, decreasing steadily to 52 percent in 2012. (The number of clients in private non-profit facilities increased by 3 percent, from 635,347 in 2008 to 653,392 in 2012.)
• Private for-profit facilities treated 31 percent of clients in 2008, increasing to 34 percent in 2012. (The number of clients in private for-profit facilities increased by 17 percent, from 363,695 in 2008 to 424,871 in 2012.)
• Local government-operated facilities treated 7 percent of clients in 2008, decreasing to 6 percent in 2012. (The number of clients in local government-operated facilities decreased by 17 percent, from 82,632 in 2008 to 68,903 in 2012.)
• State government-operated facilities treated 4 percent of clients in 2008, decreasing to 3 percent in 2012. (The number of clients in state government-operated facilities decreased by 13 percent, from 43,799 in 2008 to 38,226 in 2012.)
• Federal government-operated facilities treated 5 percent of clients in 2008, decreasing to 3 percent in 2012. (The number of clients in federal government-operated facilities decreased by 25 percent, from 55,290 in 2008 to 41,391 in 2012.)⁶
• Tribal government-operated facilities treated 1 percent of clients in 2008, increasing to 2 percent of clients in 2012. (The number of clients in tribal government-operated facilities increased by 89 percent, from 11,727 in 2008 to 22,122 in 2012.)
  

Primary Focus of Facility

Table 3.1. In almost all categories of facility primary focus of activity, the proportions of clients in treatment changed little from 2008 to 2012.

• Facilities with a primary focus of substance abuse treatment services showed a decline from 67 to 61 percent of clients from 2008 to 2012. (The number of clients in facilities with a primary focus of substance abuse treatment services decreased by 3 percent, from 794,172 in 2008 to 767,218 in 2012.)
• Facilities that had a primary focus of a mix of mental health and substance abuse services showed a steady increase from 27 to 30 percent of clients treated from 2008 to 2012. (The number of clients in facilities with a primary focus of mix of mental health and substance abuse treatment services increased by 17 percent, from 324,342 in 2008 to 378,326 in 2012.)
• Facilities with a primary focus of mental health services treated 4 percent of clients in 2008, increasing to 5 percent of clients in 2012. (The number of clients in facilities with a primary focus of mental health treatment services increased by 40 percent, from 42,740 in 2008 to 59,745 in 2012.)
• Facilities with a primary focus of general health care showed a decline in clients from 2 percent in 2008 to 1 percent in 2012. (The number of clients in facilities with a primary focus of general health care decreased by 29 percent, from 24,443 in 2008 to 17,415 in 2012.)
• Facilities whose main focus was other showed an increase in clients from 1 percent in 2008 to 2 percent in 2012. (The number of clients in facilities with main focus of other increased by 286 percent, from 6,793 in 2008 to 26,201 in 2012.)
  

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 2008 and 2012.

• Clients in outpatient treatment made up 90 percent of clients in each year.
• Clients in residential (non-hospital) treatment made up 9 percent of all clients in each year.
• Clients in hospital inpatient treatment made up 1 percent of all clients in each year.
  

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.⁷

• The proportion of all clients receiving methadone was 22 to 25 percent between 2008 and 2012.
• The proportion of clients receiving buprenorphine was 1 percent in 2008 but increased to 2 percent in 2009 and 2010, and to 3 percent in 2011 and 2012.
  

Substance Abuse Problem Treated

Table 3.3.The proportion of clients in treatment for the three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse only, and alcohol abuse only—changed little between 2008 and 2012. Clients in treatment for both drug and alcohol abuse made up 42 to 46 percent of all clients from 2008 to 2012. Clients in treatment for drug abuse only ranged from 35 to 39 percent of all clients from 2008 through 2012. The proportion of clients treated for alcohol abuse only ranged from 18 to 19 percent between 2008 and 2012. Clients in treatment for diagnosed co-occurring mental and substance abuse disorders made up 39 to 43 percent of all clients from 2008 through 2012.

Clients under Age 18 in Treatment

Table 3.4. The proportion of clients under age 18 remained steady at 7 percent of all clients from 2008 through 2012.

• The proportion of types of care received by clients under age 18 were stable between 2008 and 2012.
  • 87 to 90 percent of all clients under age 18 were in outpatient treatment.
  • 9 to 12 percent of all clients under age 18 were in residential (non-hospital) treatment.
  • 1 to 2 percent of all clients under age 18 were in hospital inpatient treatment.
• The proportion of clients under age 18 in treatment facilities with special programs or groups for adolescents ranged from 80 to 83 percent between 2008 and 2012.

To Chapter 3 Tables

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 2012.

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.

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

Type of Care 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:⁹

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and one third (33 percent) provided residential (non-hospital) care. In contrast, 92 percent of private for-profit facilities provided outpatient care and 12 percent provided residential (non-hospital) 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 mental and substance abuse disorders.

• Almost all facilities (94 percent) had clients in treatment for both alcohol and drug abuse on March 30, 2012. Eighty-five percent had clients in treatment for drug abuse only, and 82 percent had clients in treatment for alcohol abuse only.
• Most facilities (90 percent) also had clients in treatment with diagnosed co-occurring mental and substance abuse disorders on March 30, 2012.
  

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 30, 2012, was 40 clients.

• The median number of clients ranged from 30 in facilities operated by tribal governments to 60 in facilities operated by the federal government.
  
• The median number of clients ranged from 21 clients in facilities with a primary focus of mental health services to 45 in those with a primary focus of providing substance abuse treatment services.
  
• By type of care, the median¹⁰ number of clients in treatment on March 30, 2012, was:

Table 4.5.Facilities were sorted into five size groups based on the total number of clients in treatment on March 30, 2012. These five groups were treating fewer that 15 clients, 15-29 clients, 30-59 clients, 60-119 clients and 120 or more clients respectively.

• Facilities operated by the federal government were generally larger than facilities operated by other entities—32 percent had 120 clients or more in treatment on March 30, 2012, compared with 21 percent of all facilities.
  

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.

• Table 4.6. Some 2,401 facilities (23 percent) reported outpatient operational capacity under 80 percent, 3,628 facilities (34 percent) reported outpatient operational capacity between 80 and 94 percent, 3,818 facilities (36 percent) reported outpatient operational capacity between 95 and 105 percent and 727 facilities (7 percent) reported operational capacity above 105 percent.
• Table 4.7. Some 3,281 facilities reported having 107,888 residential (non-hospital) beds designated for substance abuse treatment on March 30, 2012. The utilization rate¹¹ was 96 percent, and ranged from 86 percent in facilities operated by local governments to 112 percent in facilities operated by tribal governments.
• Table 4.8. Some 731 facilities reported having 11,280 hospital inpatient beds designated for substance abuse treatment on March 30, 2012. The utilization rate¹² was 111 percent, and ranged from 79 percent in facilities operated by the state government to 2,000 percent in facilities operated by tribal governments. By facility focus, utilization rates ranged from 88 percent in facilities primarily focused on general health care to 165 percent in facilities focused on mental health services.
• Tables 4.7 and 4.8 and Figure 7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds. Forty-eight percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent and 10 percent had utilization rates above 100 percent. Twenty-nine percent of facilities with hospital inpatient beds had utilization rates of 91 to 100 percent while 16 percent had utilization rates above 100 percent.
  
  

Services Provided

Tables 4.9 and 4.10. Facilities were asked about the types of services they provided. Services were grouped into the five broad categories shown below.

• Assessment and pre-treatment services were offered by 98 percent of all facilities.
  • Screening for substance abuse was provided by 95 percent of all facilities.
  • Comprehensive substance abuse assessment or diagnosis was provided by 91 percent of all facilities.
  • Screening for mental disorders was provided by 68 percent of all facilities; rates were higher in facilities primarily focused on mental health services (94 percent), facilities with a mixed focus of mental health and substance abuse services (93 percent), and facilities primarily focused on general health care (92 percent). For facilities with primary focus of substance abuse treatment only, the rate was only 50 percent.
  • Screening for tobacco use was provided by 56 percent of all facilities.
  • Comprehensive mental health assessment or diagnosis was provided by 47 percent of all facilities; rates were higher in facilities primarily focused on mental health services (86 percent), facilities primarily focused on general health care (79 percent), and facilities with a mixed focus of mental health and substance abuse services (78 percent). For facilities with primary focus of substance abuse treatment only, the rate was only 23 percent.
  • Outreach to persons in the community who may need treatment was provided by 57 percent of all facilities, but by 82 percent of tribal government-operated facilities.
  • Interim services for clients when immediate admission was not possible were provided by 45 percent of all facilities, but by 73 percent of federal government facilities.
• Testing services were provided by 88 percent of all facilities.
  • Drug or alcohol urine screening was provided by 84 percent of all facilities.
  • Breathalyzer or other blood alcohol testing was provided by 61 percent of all facilities, but by 83 percent of federal government-operated facilities.
  • Testing of TB, HIV, hepatitis B and C, and STDs was provided by between 21 and 36 percent of all facilities, but by 86 to 89 percent of facilities with a primary focus of general health care.
• Transitional services were provided by 97 percent of all facilities.
  • Discharge planning was provided by 94 percent of all facilities.
  • Aftercare/continuing care was provided by 84 percent of all facilities.
• Pharmacotherapies were provided by 51 percent of all facilities; rates were higher in facilities primarily focused on general health care (88 percent) and in federal government-operated facilities (81 percent).
  • Medications for psychiatric disorders were the most frequently available pharmacotherapies—in 38 percent of all facilities and in 79 percent of facilities primarily focused on general health care.
• Ancillary services were provided by 99 percent of all facilities.
  • Substance abuse education was provided by 96 percent of all facilities.
  • Case management services were provided by 80 percent of all facilities.
  • Mental health services were provided by 62 percent of all facilities; rates were higher in facilities with a primary focus of mental health services (98 percent), facilities providing a mixed focus of mental health and substance abuse services (94 percent), and facilities with a primary focus of general health care (89 percent). For facilities with primary focus of substance abuse treatment only, the rate was only 38 percent.

Clinical/Therapeutic Approaches

Table 4.11. Facilities were asked to indicate whether they used any of 13 specific clinical/therapeutic approaches.

• Two approaches were each used always or often by nearly all facilities:
  • Substance abuse counseling was used always or often by 93 percent of facilities.
  • Relapse prevention was used always or often by 84 percent of facilities.
• A number of approaches were used at least sometimes (always, often, or sometimes) by more than half of facilities:
  • Cognitive-behavioral therapy was used at least sometimes by 91 percent of facilities.
  • Motivational interviewing was used at least sometimes by 87 percent of facilities.
  • Anger management was used at least sometimes by 81 percent of facilities.
  • Brief intervention was used at least sometimes by 80 percent of facilities.
  • 12-step facilitation was used at least sometimes by 75 percent of facilities.
  • Trauma-related counseling was used at least sometimes by 70 percent of facilities.
  • Contingency management/motivational incentives were used at least sometimes by 57 percent of facilities.
    
• Some approaches were used rarely or never, or were unfamiliar to the respondent, for more than half of all facilities:
  • Rational emotive behavioral therapy was used rarely or never by 50 percent of facilities, and it was unfamiliar to an additional 4 percent of facilities.
  • The matrix model was used rarely or never by 48 percent of facilities, and it was unfamiliar to an additional 14 percent of facilities.
    
  • Community reinforcement plus vouchers were used rarely or never by 78 percent of facilities, and it was unfamiliar to an additional 9 percent of facilities.
    
  • Computerized substance abuse treatment was used rarely or never by 83 percent of facilities, and it was unfamiliar to an additional 4 percent of facilities.
    

Programs or Groups for Specific Client Types

Table 4.12b. Facilities were asked about the provision of treatment programs or groups specially designed for specific client types. Overall, 82 percent of facilities offered at least one special program or group to serve a specific client type.

¹³ Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.
¹⁴ Persons who have experienced trauma, active duty military, and the military families categories appeared for the first time in the 2012 questionnaire.

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

Table 4.13b. 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.

• Substance abuse treatment services in sign language for the hearing impaired were offered in 28 percent of all facilities. Facilities operated by local and state governments were most likely to offer these services (52 and 43 percent, respectively). By foci of activity, facilities with a primary focus of mental health services or a mixed focus of mental health and substance abuse services (37 and 35 percent, respectively) were the most likely to offer services in sign language.
• Substance abuse treatment services in languages other than English were provided in 41 percent of all facilities, ranging from 20 percent of federal government-operated facilities to 56 percent of local government-operated facilities.
• Forty-one percent of facilities providing services in languages other than English used only staff counselors who spoke other languages; another 24 percent of facilities used both staff counselors and on-call interpreters.
• In facilities where staff counselors provided services in languages other than English, Spanish was the most frequently spoken language (at 94 percent of those facilities). Services in American Indian/Alaska Native languages were provided by 4 percent of all facilities where staff counselors provided services in languages other than English. Most tribal government-operated and Indian Health Services-operated facilities where staff counselors provided services in languages other than English offered services in American Indian/Alaska Native languages (96 and 87 percent, respectively).
  

Detoxification Services

Table 4.14. 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.

Client Outreach

Tables 4.15. Facilities were asked whether or not they had a website providing information about their substance abuse treatment programs.

• Websites providing information about a facility’s substance abuse treatment programs were maintained by 78 percent of all facilities. Website availability ranged from 45 percent among facilities operated by tribal governments and 51 percent among facilities operated by the federal government to 85 percent among private non-profit facilities.
  
• Outreach to persons in the community who may need treatment was provided by 57 percent of all facilities, but by 82 percent of tribal government-operated facilities.
  

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.¹⁵

Table 4.16b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. The proportions of facilities reporting the specified agencies or organizations were:

Table 4.17b. Facility licensing, certification, or accreditation was associated with the type of care offered.

• State substance abuse agencies licensed, certified, or accredited 82 percent each of facilities offering outpatient treatment and residential (non-hospital) treatment, but only 57 percent of facilities offering hospital inpatient treatment.
  
• State mental health departments licensed, certified, or accredited 44 percent of hospital inpatient facilities, but only 40 percent of outpatient facilities and 30 percent of residential (non-hospital) facilities.
  
• Facilities offering hospital inpatient treatment were more likely than facilities offering other types of care to report licensure, certification, or accreditation by the following:
  

Facility Standard Operating Procedures

Table 4.18b. Facilities were asked to indicate whether or not they followed specified practices as part of their standard operating procedures. All the standard practices listed were used by two thirds or more of all facilities.

• The proportions of facilities reporting use of the specified standard practices were:
  

Payment Options

Table 4.19b. 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.

• The proportions of all facilities reporting acceptance of specific payment options were:
  

• Facilities operated by federal and tribal governments were least likely to accept cash or self-payment (41 and 42 percent, respectively). Private for-profit and federal government-operated facilities were less likely to accept Medicare, Medicaid, or state-financed health insurance than were facilities operated by private non-profits and state, local, or tribal governments.
• Acceptance of Access to Recovery vouchers was reported in 35 states or jurisdictions. The proportion of facilities accepting Access to Recovery vouchers ranged from 2 percent in Utah to 74 percent in Idaho [Table 6.19b].¹⁶
• Use of a sliding fee scale was reported by 62 percent of all facilities, ranging from 18 percent of facilities operated by the federal government to 82 percent of facilities operated by local governments.
  
• Facilities operated by tribal governments were the most likely to accept IHS/638¹⁷ contract care funds (70 percent).
• Treatment at no charge for persons who cannot afford to pay was offered by 50 percent of all facilities, ranging from 21 percent of private for-profit facilities to 84 percent of facilites operated by tribal grovernments.

Facility Funding

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

• Overall, 58 percent of facilities reported receiving government funds to support substance abuse treatment programs. The proportions were highest in facilities operated by local or state governments (87 and 81 percent, respectively). Seventy-four percent of programs operated by private non-profit organizations reported receiving public funds whereas 20 percent of facilities operated by private for-profit organizations reported receiving public funds.  
  

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.

• Tables 2.3 and 4.21. Clients receiving methadone or buprenorphine in OTPs accounted for 25 percent of all clients in treatment on March 30, 2012, although OTPs were available in only 1,167 (8 percent) of all substance abuse treatment facilities.
  
• Tables 4.1 and 4.21. Private for-profit organizations operated 57 percent of OTPs, but only 31 percent of all substance abuse treatment facilities.
  
• Table 4.21. Of the 313,921 clients receiving medication-assisted opioid therapy in OTPs, 98 percent (306,512) received methadone and 2 percent (7,409 clients) received buprenorphine. (There were also 31,814 clients that received buprenorphine as part of their treatment in non-OTP facilities.)
  
  • More than half (60 percent) of clients receiving methadone were in private for-profit facilities with OTPs. Most (92 percent) of the clients receiving methadone were in facilities whose primary focus was the provision of substance abuse treatment services.
    
  • Clients receiving buprenorphine in OTPs were more likely than clients receiving methadone to be in federal government-operated facilities (13 vs. 1 percent).
    
  • Almost all clients receiving buprenorphine in OTPs were in facilities whose primary focus was either the provision of substance abuse treatment services (74 percent) or a mix of mental health and substance abuse treatment services (21 percent).
    
• Table 4.22b. Most facilities with OTPs offered outpatient treatment (95 percent). Ninety-two percent offered outpatient methadone maintenance, and 51 percent offered detoxification.
  
• Tables 4.17b and 4.23b. Facilities with OTPs were more likely than all facilities combined to be licensed, certified, or accredited by a state department of health (58 vs. 43 percent), the Joint Commission (27 vs. 19 percent), CARF (68 vs. 23 percent), or state substance abuse agencies (89 vs. 81 percent).
  

Counseling Services Offered by Facilities

• Table 4.24. Individual counseling was the most frequently reported form of counseling, by 98 percent of facilities, and marital/couples counseling was reported least frequently, by 59 percent of facilities.

Facility Smoking Policy

• Table 4.25. Forty-nine percent of facilities permitted smoking outdoors only whereas 35 percent of facilities that did not allow smoking on the property or within any building.

To Chapter 4 Tables

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 in Treatment

This chapter describes key characteristics of the 1,248,905 clients in substance abuse treatment on March 30, 2012. Clients in treatment were defined as: 1) hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services on March 30, 2012, 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 2012, and who were still enrolled in treatment on March 30, 2012.

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.

Type of Care

Tables 5.2a, 5.2b, and 5.2c. Facilities were asked how many clients in treatment on March 30, 2012 received specified subcategories of type of care within three broad categories.

• As shown previously [Table 5.1], the majority of clients (52 percent) were in facilities operated by private non-profit organizations. The majority of clients in each of the three types of care (outpatient, residential and hospital inpatient) were in private non-profit facilities. However, the majority of clients in outpatient methadone maintenance (59 percent) and in outpatient detoxification (52 percent) were in facilities operated by private for-profit organizations [Table 5.2c].
  
• About three-quarters (76 percent) of clients in residential (non-hospital) treatment were in facilities operated by private non-profit organizations.
  

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 30, 2012, by substance abuse problem treated (alcohol abuse only, drug abuse only, or both alcohol and drug abuse).

• On March 30, 2012, 44 percent of clients were in treatment for both alcohol and drug abuse, 38 percent were in treatment for drug abuse only, and 18 percent were in treatment for alcohol abuse only.
  
  • By facility operation, the highest proportion of clients in treatment for abuse of both alcohol and drugs was in tribal government-operated facilities (57 percent). For abuse of drugs only, the highest proportion of clients was in private for-profit facilities (51 percent); for abuse of alcohol only, the highest proportion was in federal-operated facilities (35 percent).
    
  • At facilities with a primary focus of substance abuse treatment services, 40 percent of clients were in treatment for abuse of both alcohol and drugs. Facilities with other foci of services reported similar proportions of clients in treatment for abuse of both alcohol and drugs (45 to 56 percent).

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

• On March 30, 2012, 46 percent of clients who were in treatment had a diagnosed co-occurring mental and substance abuse disorder.
  
  • The highest proportions of clients with co-occurring mental and substance abuse disorders were in federal government-operated facilities (61 percent) and in facilities with a primary focus of mental health services (74 percent).

Clients under Age 18 in Treatment

Table 5.4. Facilities were asked how many clients in treatment on March 30, 2012 were under age 18.

• There were 89,521 clients under age 18 in substance abuse treatment on March 30, 2012, some 7 percent of the total 1,248,905 clients in treatment on that date.
  
• Clients under age 18 in substance abuse treatment on March 30, 2012, were more likely to be in private non-profit facilities than the general client population (63 vs. 52 percent, respectively) but less likely to be in private for-profit facilities (21 vs. 34 percent, respectively) [Table 5.1].
  
• Equal proportions (45 percent each) of clients under age 18 were in facilities with a primary focus of substance abuse treatment and facilities whose primary focus was provision of a mix of mental health and substance abuse treatment services; the proportions among the general client population were 61 and 30 percent, respectively [Table 5.1].
  
• Table 5.5. The proportion of adolescents receiving each type of care was similar to the total treatment population [Table 5.2b]. Most (90 percent) were in outpatient treatment, 9 percent were in residential (non-hospital) treatment, and 2 percent were in hospital inpatient treatment.
  

To Chapter 5 Tables

Table of Contents

Chapter 6

State Data

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

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

Table 6.1 details the 2012 N-SSATS response rate.

Tables 6.2 to 6.3 present data on treatment facility and client trends for 2008 to 2012.

Tables 6.4 to 6.24 present facility data for 2012.

Tables 6.25 to 6.32 present client data for 2012.

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 93 percent. Thirty-one 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 2008 through 2012. On March 30, 2012, California had 11 percent of all facilities and 10 percent of all clients. New York had 7 percent of all facilities and 9 percent of all clients.

Five other states were in the top 10 for both total numbers of facilities and clients in every year from 2008 through 2012: Florida (always 3rd or 4th for both), Illinois (always 3rd or 4th for number of facilities), Pennsylvania (always 3rd or 4th for number of clients), Michigan, and Washington. Texas, Colorado, and North Carolina filled in the top 10 for number of facilities all five years. Massachusetts was in the top 10 for number of clients all five years, and Colorado and Maryland were there for four of those years, from 2009 to 2012.

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

Table 6.33 and Figure 8. For the United States, there were 479 clients in treatment per 100,000 population aged 18 and over on March 30, 2012. The rate was highest for persons with both alcohol and drug abuse (206 per 100,000 population), followed by drug abuse only (186 per 100,000 population) and alcohol abuse only (86 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.

To Chapter 6 Tables

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

Treatment facilities approved by state substance abuse agencies

The largest group of facilities (11,623 in 2012) includes facilities that are licensed, certified, or otherwise approved by the state substance abuse agency to provide substance abuse treatment. State BHSIS representatives maintain this segment of I‑BHS by reporting new facilities, closures, and address changes to SAMHSA. Some facilities are not licensed, certified, or otherwise approved by the state agency. Some private for-profit facilities fall into this category. The approved facility group also includes programs operated by federal agencies—the Department of Veterans Affairs (VA), the Department of Defense, the Indian Health Service—and Opioid Treatment Programs certified by SAMHSA. I-BHS records for federally-operated facilities are updated annually through lists provided by these agencies.

Treatment facilities not approved by state substance abuse agencies

This group of facilities (2,688 in 2012) represents the SAMHSA effort since the mid-1990s to make I-BHS as comprehensive as possible by including treatment facilities that state substance abuse agencies, for a variety of reasons, do not fund, license, or certify. Many of these facilities are private for-profit, small group practices, or hospital-based programs. Most of them are identified through periodic screening of alternative source databases. (See Special efforts to improve survey coverage below.) State substance abuse agencies are given the opportunity to review these facilities and to add them to the state agency-approved list, if appropriate.

Survey Coverage

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

Unit of response

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

Special efforts to improve survey coverage

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

To address these differences, SAMHSA conducted a large-scale effort during 1995 and 1996 to identify substance abuse treatment facilities that, for a variety of reasons, were not on the inventory. Some 15 source lists were examined, and facilities not on the inventory were contacted to ascertain whether they provided substance abuse treatment. As expected, this yielded a number of hospital-based and small private facilities that were not on the inventory. (These facilities were surveyed in 1995 and 1996, but they were not included in the published results of the survey until 1997.) Analysis of the results of this effort led to similar but more targeted updates
before subsequent surveys. Potential new facilities are identified using data from the American Business Index, 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 2008 and 2012, the number of facilities eligible for inclusion in this report increased steadily, from 13,688 to 14,311. 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 trial web version of the questionnaire for a few facilities in addition to the hard-copy questionnaire. The web version of the questionnaire was fully implemented in 2002. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since its full inception in 2002.

Non-response

Beginning in 1992, SAMHSA expanded efforts to obtain information from non-responding facilities. A representative sample of non-respondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all non-responding facilities. In 1997, a series of measures was introduced to enhance the survey response rate. These included advance notification and improved methods for updating address and contact information. Between 2004 and 2012, use of these methods and intensive telephone follow-up resulted in an annual follow-up rate (i.e., facilities in the sample either completed the survey or were determined to be closed or otherwise ineligible) of 92 to 96 percent. In 2012, the follow-up rate was 93.1 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 the inventory. Beginning in 1999, these facilities were identified during the survey and excluded from analyses and public-use data files.

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

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

Changes in Survey Content

Table A.1 shows the major content areas for the survey from 1996 to 2012. 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. Questions about facility smoking policy were added in 2011, and questions about outpatient facility operating capacity were added in 2012.

There have also been changes within content areas. For example, in response to concerns about over-reporting of programs or groups for specific client types, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that offered specially designed programs or groups for that client type. As a result, the number and proportion of facilities offering programs or groups for each of the specified client types decreased. Surveys from 2003 and later are believed to more accurately represent the number and proportions of facilities providing programs or groups for the specified client types. In addition, over time more categories have been added to the specific client types (e.g., persons who have experienced trauma, active duty military, and members of military families in 2012).

To Table A.1

This Appendix contains the hard copy version of the 2012 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, 81 percent completed the questionnaire on the Internet, 7 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 2012 N-SSATS Questionnaire PDF

This Appendix contains Table C.1, a list of item response rates for questions from the N-SSATS 2012 questionnaire. Item non-response was minimized through careful editing and extensive follow-up.

The item response rate for the 2012 N-SSATS averaged 98 percent across 201 separate response categories.

Item non-response was 10 percent or more for only 4 of 201 separate response categories.

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

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, Anand Borse, Doren H. Walker, and Leigh Henderson were responsible for the content, analysis, and writing of the report.

To Table C.1