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. Work by Synectics was performed under Task Order HHSS283200700048I/HHSS28342001T, Reference No. 283-07-4803 (Cathie Alderks, Task Order Officer).

Public Domain Notice

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

Recommended Citation

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2003-2013. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-75, HHS Publication No. (SMA) 15-4934. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

Electronic Access and Copies of Publication

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

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

Originating Office

Center for Behavioral Health Statistics and Quality
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1 Choke Cherry Road, Room 2-1084
Rockville, Maryland 20857

December 2015

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This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2013 and trend data from 2003 to 2013. It provides information on the demographic and substance abuse characteristics of admissions aged 12 and older to treatment for abuse of alcohol and/or drugs in facilities that report to individual state administrative data systems.

TEDS is an admission-based system and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would be counted as two admissions. TEDS, while comprising a significant proportion of all admissions to substance abuse treatment, does not include all such admissions. TEDS is a compilation of data collected through the individual data collection systems of the state substance abuse agencies (SSAs) for substance abuse treatment. Therefore the number and client mix of TEDS admissions do not represent the total national demand for substance abuse treatment or the prevalence of substance abuse in the general population.

States have cooperated with the federal government in the data collection process, and substantial progress has been made toward developing a standardized data set over the years. However, because each state system is unique and each state has unique powers and mandates, significant differences exist among state data collection systems. These differences are compounded by evolving health care payment systems. State-to-state comparisons must be made with extreme caution.

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..

For 2013, 1,683,451 substance abuse treatment admissions aged 12 and older were reported to TEDS by 49 states, the District of Columbia, and Puerto Rico. Pennsylvania had submitted no data for 2013 by January 23, 2015, and is excluded from this report.

Major Substances of Abuse

• Five substance groups accounted for 97 percent of the primary substances reported by the 1,683,451 TEDS admissions aged 12 and older in 2013: alcohol (38 percent), opiates (28 percent), marijuana (17 percent), methamphetamine/amphetamines (8 percent), and cocaine (6 percent) [Table 1.1b].
  

Alcohol

• The proportion of primary alcohol admissions fluctuated between 2003 and 2013 from a high of 42 percent in 2003 and 2009 to a low of 38 percent in 2013 [Table 1.1b].
  
• Admissions for abuse of alcohol alone represented 21 percent of TEDS admissions aged 12 and older in 2013, while admissions for primary alcohol abuse with secondary drug abuse represented 16 percent of all TEDS admissions and 44 percent of primary alcohol admissions [Table 1.1b].
  
• Almost three-quarters of admissions for abuse of alcohol alone (71 percent) and for abuse of alcohol with secondary drug abuse (72 percent) were male [Table 2.1a].
  
• The average age at admission among alcohol-only admissions was 42 years compared with 38 years among admissions for primary alcohol with secondary drug abuse [Table 2.1a].
  
• About two-thirds (66 percent) of alcohol-only admissions were non-Hispanic White, followed by non-Hispanic Black admissions and admissions of Hispanic origin (13 percent each). Among admissions for primary alcohol with secondary drug abuse, 58 percent were non-Hispanic White, 23 percent were non-Hispanic Black, and 12 percent were of Hispanic origin [Table 2.2].

Heroin

• In 2003, 15 percent of admissions aged 12 or older were for primary heroin. This proportion was fairly steady from 2003 to 2011, fluctuating between 15 and 13 percent; however, the proportion of primary heroin admissions aged 12 and older increased to 16 percent in 2012 and 19 percent in 2013 [Table 1.1b].
  
• Primary herion represented 84 percent of all opiate admissions in 2003 but only 67 percent in 2013 [Table 1.1a].
  
• About two-thirds (66 percent) of primary heroin admissions were male [Table 2.1a].
  
• For primary heroin admissions, the average age at admission was 34 years [Table 2.1a].
  
• More than two-thirds (67 percent) of primary heroin admissions were non-Hispanic White, followed by admissions of Hispanic origin (16 percent) and non-Hispanic Blacks (13 percent) [Table 2.2].
  
• Seventy-one percent of primary heroin admissions reported injection as the usual route of administration and 23 percent reported inhalation [Table 2.4].
  

Opiates Other than Heroin¹

• The proportion of admissions for primary opiates other than heroin increased from 3 percent of admissions aged 12 and older in 2003 to 9 percent in 2013 [Table 1.1b].
  
• Opiates other than heroin represented 16 percent of all primary opiate admissions in 2003 but rose to 33 percent in 2013 [Table 1.1a].
  
• Just over half (53 percent) of primary non-heroin opiate admissions were male [Table 2.1a].
  
• For primary non-heroin opiate admissions, the average age at admission was 32 years [Table 2.1a].
  
• Most primary non-heroin opiate admissions (85 percent) were non-Hispanic White [Table 2.2].
• More than half (59 percent) of primary non-heroin opiate admissions reported oral as the usual route of administration, while 19 percent reported inhalation and 18 percent reported injection [Table 2.4].
  

Marijuana/Hashish

• The proportion of admissions for primary marijuana was fairly steady across the years: 16 percent of admissions aged 12 or older in 2003 and 17 percent in 2013 [Table 1.1b].
  
• Nearly three-quarters (73 percent) of primary marijuana admissions were male [Table 2.1a].
  
• For primary marijuana admissions, the average age at admission was 25 years [Table 2.1a].
  
• Forty-three percent of primary marijuana admissions were non-Hispanic White, 32 percent were non-Hispanic Black, and 18 percent were of Hispanic origin [Table 2.2].
  
  

Cocaine/Crack

• The proportion of admissions for primary cocaine declined from 14 percent of admissions aged 12 or older in 2003 to 6 percent in 2013 [Table 1.1b].
  
• Smoked cocaine (crack) represented 68 percent of all primary cocaine admissions in 2013; it was 73 percent in 2003 [Tables 1.1a].
  
• Fifty-nine percent of primary smoked cocaine admissions were male compared with 68 percent of primary non-smoked cocaine admissions [Table 2.1a].
  
• The average age at admission among primary smoked cocaine admissions was 43 years compared with 38 years among primary non-smoked cocaine admissions [Table 2.1a].
  
• Among primary smoked cocaine admissions, 57 percent were non-Hispanic Black, 31 percent were non-Hispanic White, and 9 percent were of Hispanic origin. Among primary non-smoked cocaine admissions, 43 percent were non-Hispanic White, 33 percent were non-Hispanic Black, and 19 percent were of Hispanic origin [Table 2.2].
  
• Eighty-one percent of primary non-smoked cocaine admissions reported inhalation as their route of administration, and 11 percent reported injection [Table 2.4].
  

Methamphetamine/Amphetamines

• The proportion of admissions for primary methamphetamine/amphetamines aged 12 and older ranged from 6 to 9 percent of admissions aged 12 and older between 2003 and 2013 [Table 1.1b].
  
• Fifty-three percent of primary methamphetamine/amphetamine admissions were male [Table 2.1a].
  
• For primary methamphetamine/amphetamine admissions, the average age at admission was 33 years [Table 2.1a].
• About two thirds (68 percent) of primary methamphetamine/amphetamine admissions were non-Hispanic White, 18 percent were of Hispanic origin, and 4 percent were non-Hispanic Blacks [Table 2.2].
  
• Sixty-one percent of primary methamphetamine/amphetamine admissions reported smoking as the usual route of administration, 26 percent reported injection, and 8 percent reported inhalation [Table 2.4].
  

Adolescent Admissions to Substance Abuse Treatment

• The proportion of admissions to substance abuse treatment aged 12 to 17 decreased by 35 percent between 2003 and 2013 (from 157,181 to 101,665) [Table 3.1a].
  
• Forty-four percent of adolescent treatment admissions were referred to treatment through a criminal justice source² [Table 3.3].
  
• Approximately 9 out of 10 (89 percent) adolescent treatment admissions involved marijuana as a primary or secondary substance in 2013 [Table 3.4].

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

• The proportion of non-Hispanic Whites aged 20 to 34 among heroin admissions increased from one quarter (25 percent) in 2003 to nearly one half (48 percent) in 2013 [Table 3.5].
  
• The proportion of injectors aged 20 to 34 among heroin admissions increased from about 1 in 4 (26 percent) in 2003 to almost one half (46 percent) in 2013. During that period, the proportion of injectors aged 35 to 44 fell from 18 percent to 12 percent [Table 3.6].
  
• The proportion of heroin admissions with treatment plans that included receiving medication-assisted opioid therapy fell from 32 percent in 2003 to 27 percent in 2013 [Table 3.7].

Polydrug Abuse

• When alcohol was reported as a secondary or tertiary drug, four substance groups accounted for 97 percent of the primary substances reported: marijuana (38 percent), opiates (30 percent), cocaine (15 percent), and methamphetamine/amphetamines (14 percent).
• When methamphetamine/amphetamines were reported as a secondary or tertiary drug, four substance groups accounted for 96 percent of the primary substances reported: opiates (34 percent), alcohol (31 percent), marijuana (27 percent), and cocaine (5 percent).
  
• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances (alcohol: 38 vs. 17 percent; opiates: 28 vs. 10 percent; methamphetamine/amphetamines: 8 vs. 5 percent).
  
• Marijuana and cocaine were reported less often as primary substances than as secondary or tertiary substances (marijuana: 17 vs. 21 percent; cocaine: 6 vs. 13 percent).

Race/Ethnicity

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

• Among non-Hispanic Whites, alcohol (38 percent) was followed by opiates (34 percent), marijuana (12 percent), methamphetamine/amphetamines (9 percent), and cocaine (3 percent).
  
• Among non-Hispanic Blacks, alcohol (36 percent) was followed by marijuana (29 percent), cocaine (16 percent), opiates (15 percent), and methamphetamine/amphetamines (2 percent).
  
• Among persons of Mexican origin, alcohol (37 percent) was followed by marijuana (24 percent), methamphetamine/amphetamines (21 percent), opiates (15 percent), and cocaine (2 percent).
  
• Among persons of Puerto Rican origin, opiates (44 percent) were followed by alcohol (27 percent), marijuana (16 percent), cocaine (7 percent), and methamphetamine/amphetamines (1 percent).
  
• Among American Indians/Alaska Natives, alcohol (60 percent) was followed by opiates (14 percent), marijuana (13 percent), methamphetamine/amphetamines (9 percent), and cocaine (2 percent).
  
• Among Asians/Pacific Islanders, alcohol (36 percent) was followed by methamphetamine/amphetamines and marijuana (21 percent each), opiates (15 percent), and cocaine (4 percent).
  

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Trends in Primary Substance of Abuse: 2003-2013
Trends in the Co-Abuse of Alcohol and Drugs
Trends in Demographic Characteristics
Trends in Employment Status

This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2013 and trend data from 2003 to 2013. It is a companion to the report Treatment Episode Data Set (TEDS): 2003-2013 State Admissions to Substance Abuse Treatment. These reports provide information on the demographic and substance abuse characteristics of admissions aged 12 and older to treatment for abuse of alcohol and/or drugs in facilities that report to individual state administrative data systems. Data include records for admissions during calendar years 2003 through 2013 that were received and processed through January 23, 2015.³ It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

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

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

This chapter details trends in the annual numbers and rates of admissions aged 12 and older from 2003 to 2013. Trend data are invaluable in monitoring changing patterns in substance abuse treatment admissions. These patterns reflect underlying changes in substance abuse in the population as well as changing priorities in the treatment/reporting system.

Trends in Primary Substance of Abuse: 2003-2013

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

Tables 1.1a-b and Figure 1.The proportion of admissions aged 12 and older decreased by 10 percent from 2003 to 2013. The U.S. population aged 12 and older increased by 9 percent during this time period.

• Between 2003 and 2013, five substance groups accounted for between 96 and 97 percent of the primary substances of abuse reported by TEDS treatment admissions aged 12 and older: alcohol, opiates, marijuana, cocaine, and methamphetamine/amphetamines. However, the proportions of admissions by primary substance changed considerably over that period:
  
  • The proportion of alcohol admissions aged 12 and over fluctuated between 2003 and 2013 from a high of 42 percent in 2003 and 2009 to a low of 38 percent in 2013. In 2013, 44 percent of primary alcohol admissions aged 12 and older reported secondary drug abuse as well.
    
  • The proportion of opiate admissions increased from 18 percent of admissions aged 12 and older in 2003 to 28 percent in 2013.
    
    • The proportion of admissions for primary heroin was fairly steady from 2003 to 2011, moving from 15 percent in 2003 to 13 percent in 2007 and back to 15 percent in 2011; however, the proportion of admissions increased to 16 percent in 2012 and 19 percent in 2013. Heroin represented 84 percent of all opiate admissions in 2003 but only 67 percent in 2013.
    • The proportion of admissions for opiates other than heroin⁴ increased from 3 percent of admissions aged 12 and older in 2003 to 10 percent in 2011 and 2012 and then dropped to 9 percent in 2013. Opiates other than heroin represented 16 percent of all opiate admissions in 2003 but 33 percent in 2013.
      
  • The proportion of marijuana admissions increased from 16 percent of admissions aged 12 and older in 2003 to 19 percent in 2010, then decreased to 18 percent in 2011 and 2012 and 17 percent in 2013.
    
  • The proportion of cocaine admissions declined from 14 percent of admissions aged 12 and older in 2003 to 6 percent in 2013. Smoked cocaine (crack) represented 68 percent of all primary cocaine admissions in 2013; it was 73 percent in 2003.
    
  • The proportion of stimulant admissions (98 to 99 percent of these admissions were for methamphetamine or amphetamine abuse) increased from 7 percent of admissions aged 12 and older in 2003 to 9 percent in 2005, but then decreased to 6 percent in 2008, and in 2013 increased to 8 percent.
    
  • Tranquilizers, sedatives/hypnotics, hallucinogens, PCP, inhalants, and over-the-counter medications together accounted for approximately 2 percent of TEDS admissions between 2003 and 2013.

⁴ These drugs include methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Trends in the Co-Abuse of Alcohol and Drugs

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

• The proportion of admissions aged 12 and older reporting abuse of both alcohol and drugs declined from 40 percent in 2003 to 33 percent in 2013.
  
• The proportion reporting abuse of drugs only increased from 34 percent in 2003 to 45 percent in 2013, while the proportion reporting abuse of alcohol only fell slightly, from 23 percent in 2003 to 21 percent in 2013.

Trends in Demographic Characteristics

Table 1.3b. Males represented 66 percent of TEDS admissions aged 12 and older in 2013; the proportion of males was 69 percent in 2003. The distribution of TEDS admissions aged 12 and older differed markedly by gender from that of the U.S. population, where 49 percent of the population was male.

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

Table 1.3b and Figure 2. The age distribution of TEDS admissions aged 12 and older changed between 2003 and 2013.

• The proportion of admissions aged 12 to 17 decreased slightly from 8 percent in 2003 to 6 percent in 2013.
  
• The proportion of admissions aged 18 to 29 years increased from 29 percent in 2003 to 34 percent in 2013.
  
• The proportion of admissions aged 30 to 44 years decreased from 43 percent of TEDS admissions in 2003 to 34 percent in 2013.
  
• The proportion of admissions aged 45 and older increased from 19 percent in 2003 to 26 percent in 2013.
  
• The age distribution of TEDS admissions differed considerably from that of the U.S. population. Adolescents aged 12 to 17 years made up 6 percent of TEDS admissions but 9 percent of the U.S. population. In 2013, some 68 percent of TEDS admissions were aged 18 to 44 years compared with 43 percent of the U.S. population. Admissions aged 45 and older made up 26 percent of TEDS admissions but 48 percent of the U.S. population.

Table 1.4 and Figure 3. The racial/ethnic composition of TEDS admissions aged 12 and older changed very little between 2003 and 2013.

• The proportion of non-Hispanic Whites increased from 59 to 61 percent of admissions over the time period.
  
• The proportion of non-Hispanic Blacks declined, from 24 percent of admissions in 2003 to 19 percent in 2013.
  
• The proportion of admissions of Hispanic origin remained steady at 13 to 14 percent from 2003 to 2013.
  
• Other racial/ethnic groups combined made up 5 to 6 percent of admissions throughout the time period.
  
• The racial/ethnic composition of TEDS admissions differed somewhat from that of the U.S. population. Non-Hispanic Whites were the majority in both groups, but they represented 61 percent of TEDS admissions in 2013 compared with 69 percent of the U.S. population. Non-Hispanic Blacks represented 19 percent of TEDS admissions in 2013 and 12 percent of the U.S. population. TEDS admissions of Hispanic origin represented 14 percent and 13 percent of U.S. population. Other racial/ethnic groups made up 6 percent of TEDS admissions and 6 percent of the U.S. population.
  

Trends in Employment Status

Table 1.5 and Figure 4. TEDS admissions aged 16 and older were less likely to be employed than the U.S. population aged 16 and older. This is evident in the unadjusted distributions of admissions by employment status (employed, unemployed, and not in labor force) shown in Table 1.5. Because TEDS admissions differ demographically from the U.S. population, Table 1.5 also shows distributions that have been statistically adjusted to provide a more valid comparison to the U.S. population.⁵ The adjusted distributions indicate an even greater disparity in socioeconomic status than do the unadjusted.

• Between 2003 and 2013, unemployment increased from 30 percent to 39 percent among TEDS admissions aged 16 and older.
  
• The most common employment status reported by TEDS admissions aged 16 and older between 2003 and 2007 was “not in labor force.” However, this proportion declined from a peak of 41 percent in 2003 to 38 percent in 2013.
  
• Among the U.S. population aged 16 and older in 2013, 59 percent were employed, 5 percent were unemployed, and 37 percent were not in the labor force.

⁵ The distributions were adjusted for age, gender, and race/ethnicity to the U.S. population. In essence, this technique compares the distributions under the assumption that the TEDS population and the U.S. population had the same age, gender, and racial/ethnic characteristics.

TO TABLES

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

This chapter highlights important findings in the 2013 TEDS data. The tables include items in the TEDS Minimum and Supplemental Data Sets for 2013 (see Appendix B for a complete data dictionary). Data are tabulated as percentage distributions of treatment admissions according to primary substance of abuse. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

The Minimum Data Set consists of items that include:

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

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

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

The figures in this chapter represent counts of admissions for each primary substance of abuse by gender, age, and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic of Mexican origin, Hispanic of Puerto Rican origin,⁶ American Indian/Alaska Native, and Asian/Pacific Islander).

All Admissions Aged 12 and Older

• The average age at admission was 35 years; 6 percent of admissions were aged 12 to 17 years [Table 2.1a].
  
• Non-Hispanic Whites made up 61 percent of all admissions aged 12 and older in 2013 (39 percent were males and 22 percent were females). Non-Hispanic Blacks made up 19 percent of all admissions (13 percent were males and 5 percent were females) [Table 2.3a].
  
• Forty percent of admissions had not been in treatment before the current episode, while 14 percent had been in treatment five or more times previously [Table 2.5].
  
• Self- or individual referrals and criminal justice referrals were responsible for 37 percent and 34 percent, respectively, of referrals to treatment [Table 2.6].
  
• Most admissions (61 percent) received ambulatory treatment, 22 percent received detoxification, and 17 percent received rehabilitation/residential treatment [Table 2.7].
  
• Less than one quarter (23 percent) of admissions aged 16 and older were employed [Table 2.8].
  
• Twenty-eight percent of admissions aged 18 and older had not completed high school or attained a GED [Table 2.9].

Alcohol Only

• Admissions for abuse of alcohol alone, with no secondary drug abuse, represented 21 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• The average age at admission among admissions for alcohol only was 42 years [Table 2.1a]. Abuse of alcohol was the problem most likely to be reported by admissions aged 40 and older, and it was often followed by abuse of alcohol with a secondary drug [Table 2.1b].
  
• Non-Hispanic Whites made up 66 percent of all alcohol-only admissions (45 percent were males and 20 percent were females) [Table 2.3a].⁷
  
• Eighty-six percent of alcohol-only admissions reported that they first became intoxicated before age 21, the legal drinking age. Almost one third (30 percent) first became intoxicated by age 14 [Table 2.5].
  
• Among admissions referred to treatment by a criminal justice source, alcohol-only admissions were more likely than admissions for alcohol with secondary drug abuse to have been referred as a result of a DUI/DWI offense (28 vs. 16 percent) [Table 2.6].
  
• Some 35 percent of alcohol-only admissions aged 16 and older were employed compared with 23 percent of all admissions that age [Table 2.8].
  

Alcohol with Secondary Drug Abuse

• Admissions for primary abuse of alcohol with secondary abuse of drugs represented 16 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• The average age at admission for primary alcohol with secondary drug abuse was lower, at 38 years, than for abuse of alcohol alone (42 years) [Table 2.1a].
  
• Non-Hispanic Whites accounted for 58 percent of admissions for primary alcohol with secondary drug abuse (40 percent were males and 17 percent were females). Non-Hispanic Blacks made up 23 percent of admissions (18 percent were males and 6 percent were females) [Table 2.3a].
  
• Almost half (45 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 93 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5].
  
• Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (35 vs. 47 percent) [Table 2.5].
  
• Among admissions referred to treatment by a criminal justice source, admissions for alcohol with secondary drug abuse were more likely than alcohol-only admissions to have been referred to treatment as a condition of probation/parole (29 vs. 17 percent) [Table 2.6].
  
• Among admissions for alcohol with secondary drug abuse, marijuana (25 percent), smoked cocaine (7 percent), and non-smoked cocaine (6 percent) were the most frequently reported secondary substances [Table 3.8].

Heroin

• Heroin was reported as the primary substance of abuse for 19 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• Sixty-seven percent of primary heroin admissions were non-Hispanic White (42 percent were males and 25 percent were females). Non-Hispanic Blacks made up 13 percent (9 percent were males and 4 percent were females) [Table 2.3a]. Among admissions of Puerto Rican origin, 41 percent were for primary heroin abuse [Table 2.2]. See Chapter 3 for additional data on heroin admissions.
  
• Injection was reported as the usual route of administration by 71 percent of primary heroin admissions; inhalation was reported by 23 percent. Daily heroin use was reported by 67 percent of primary heroin admissions [Table 2.4].
  
• Most primary heroin admissions (78 percent) had been in treatment prior to the current episode, and 27 percent had been in treatment five or more times previously [Table 2.5].
  
• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by a criminal justice source (16 vs. 34 percent) and more likely to be self- or individually referred (58 vs. 37 percent) [Table 2.6].
  
• Medication-assisted opioid therapy was planned for 27 percent of heroin admissions [Table 2.7].
• Only 14 percent of primary heroin admissions aged 16 and older were employed (vs. 23 percent of all admissions that age); 45 percent were not in labor force (vs. 38 percent of all admissions that age) [Table 2.8].

Opiates Other than Heroin

• Opiates other than heroin were reported as the primary substance of abuse for 9 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b]. These drugs include methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.
  
• Forty-four percent of admissions for opiates other than heroin were aged 20 to 29 compared with 31 percent of all admissions [Table 2.1a]. The peak age at admission for both males and females was about 25 years [Figure 9].
  
• Non-Hispanic Whites made up approximately 85 percent of admissions for primary opiates other than heroin (45 percent were males and 40 percent were females) [Table 2.3a].
  
• Primary opiates other than heroin were most frequently administered orally (59 percent), followed by inhalation (19 percent) and injection (18 percent) [Table 2.4].
  
• Eighty percent of admissions for opiates other than heroin reported first use after age 16 compared with 52 percent for all admissions combined [Table 2.5].
  
• Medication-assisted opioid therapy was planned for 18 percent of admissions for primary opiates other than heroin [Table 2.7].
• Sixty-three percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana (25 percent), alcohol (19 percent), and tranquilizers (14 percent) [Table 3.8].
  

Smoked Cocaine (Crack)

• Smoked cocaine (crack) was reported as the primary substance of abuse by 4 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• Seventy-eight percent of primary smoked cocaine admissions were aged 35 or older compared with 46 percent of all admissions combined. The average age at admission for primary smoked cocaine was 43 years [Table 2.1a]. Admissions among non-Hispanic Black males peaked at 48 years; admissions among non-Hispanic White males peaked at 42 years of age [Figure 10].
  
• Non-Hispanic Blacks accounted for 57 percent of primary smoked cocaine admissions (35 percent were males and 21 percent were females), and non-Hispanic Whites accounted for 31 percent (16 percent were males and 15 percent were females) [Table 2.3a].
  
• Primary smoked cocaine admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (30 vs. 17 percent) [Table 2.7].
  
• Only 10 percent of primary smoked cocaine admissions aged 16 and older were employed compared with 23 percent of all admissions that age [Table 2.8].
• Sixty-eight percent of primary smoked cocaine admissions reported abuse of other substances. The most commonly reported secondary substances of abuse were alcohol (43 percent) and marijuana (30 percent) [Table 3.8].

Non-Smoked Cocaine

• Non-smoked cocaine was reported as the primary substance of abuse by 2 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• The average age at admission for primary non-smoked cocaine admissions was 38 years [Table 2.1a]. The peak age among non-Hispanic White male admissions was 17 years younger than the peak age among non-Hispanic Black male admissions (31 vs. 48 years of age). Admissions among both non-Hispanic White females and non-Hispanic Black females peaked in their early 30s [Figure 11].
  
• Non-Hispanic Whites accounted for 43 percent of primary non-smoked cocaine admissions (28 percent were males and 16 percent were females), and non-Hispanic Black males accounted for 24 percent [Table 2.3a].
  
• Eighty one percent of admissions for primary non-smoked cocaine reported inhalation as the usual route of administration, followed by injection (11 percent) [Table 2.4].
  
• Non-smoked cocaine admissions were more likely than smoked cocaine admissions to be referred to treatment by a criminal justice source (37 vs. 26 percent) [Table 2.6].
• Sixty-nine percent of admissions for primary non-smoked cocaine reported abuse of additional substances. Alcohol was most common, reported by 37 percent, followed by marijuana (30 percent) [Table 3.8].
  

Marijuana/Hashish

• Marijuana was reported as the primary substance of abuse by 17 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• The average age at admission for primary marijuana admissions was 25 years [Table 2.1a], although the peak age at admission for both genders in all race/ethnicities was about 16 to 17 years [Figure 12].Thirty-six percent of marijuana admissions were under age 20 (vs. 9 percent of all admissions combined), and primary marijuana abuse accounted for 77 percent of admissions aged 12 to 14 and 76 percent of admissions aged 15 to 17 years [Table 2.1b].
  
• Non-Hispanic Whites accounted for 43 percent of primary marijuana admissions (30 percent were males and 13 percent were females), and non-Hispanic Black males accounted for 24 percent [Table 2.3a].
  
• Twenty-four percent of primary marijuana admissions had first used marijuana by age 12 and another 31 percent had first used it by age 14 [Table 2.5].
  
• Primary marijuana admissions were less likely than all admissions combined to be self- or individually referred to treatment (18 vs. 37 percent). Primary marijuana admissions were most likely to be referred by a criminal justice source (52 percent) [Table 2.6].
• More than 4 in 5 marijuana admissions (86 percent) received ambulatory treatment compared with about 3 in 5 of all admissions combined (61 percent) [Table 2.7].
  
• Fifty-four percent of primary marijuana admissions reported abuse of additional substances. Alcohol was reported by 38 percent [Table 3.8].
  

Methamphetamine/Amphetamines

• Methamphetamine/amphetamines were reported as the primary substance of abuse by 8 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b]. The proportion of methamphetamine admissions represented 93 percent of this group [Table 1.1a].
  
• Primary methamphetamine/amphetamine admissions were on average 33 years old at admission [Table 2.1a]. Admissions for both genders in all race/ethnicities peaked in the late 20s and early 30s [Figure 13].
  
• Non-Hispanic Whites accounted for 68 percent of primary methamphetamine/amphetamine admissions (36 percent were males and 33 percent were females) [Table 2.3a]. Twelve percent of all primary methamphetamine/amphetamine admissions were of Mexican origin [Table 2.2].
  
• The usual routes of administration for primary methamphetamine/amphetamines were smoking (61 percent), injection (26 percent), and inhalation (8 percent) [Table 2.4].
  
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to be referred to treatment by a criminal justice source (47 vs. 34 percent) [Table 2.6].
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to receive long-term rehabilitation/residential treatment (15 vs. 7 percent) [Table 2.7].
  
• Sixty-six percent of primary methamphetamine/amphetamine admissions reported secondary use of other substances, primarily marijuana (37 percent) and alcohol (28 percent) [Table 3.8].
  

Tranquilizers

• Tranquilizers were reported as the primary substance of abuse by 1 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• The average age at admission for primary tranquilizer admissions was 35 years [Table 2.1a].
  
• Non-Hispanic Whites accounted for 81 percent of admissions for primary abuse of tranquilizers (females accounted for 42 percent and males accounted for 39 percent) [Table 2.3a].
  
• Twenty-four percent of primary tranquilizer admissions first used tranquilizers after age 30 [Table 2.5].
  
• Primary tranquilizer admissions were the least likely of all admissions to receive ambulatory treatment (38 vs. 49 percent or above). They were the most likely of all admissions to receive hospital inpatient detoxification (10 vs. 5 percent or below) [Table 2.7].
• Secondary abuse of another substance was reported by 74 percent of primary tranquilizer admissions. Secondary abuse of opiates other than heroin was reported by 29 percent, alcohol by 24 percent, and marijuana by 21 percent [Table 3.8].
  

Sedatives

• Admissions for primary sedative abuse were responsible for less than one quarter of 1 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• Fourteen percent of primary sedative admissions were aged 65 and older compared with 1 percent of all admissions combined [Table 2.1a].
  
• Non-Hispanic Whites accounted for 82 percent of primary sedative admissions (48 percent were females and 34 percent were males) [Table 2.3a].
  
• Thirty-two percent of primary sedative admissions first used sedatives after age 30 [Table 2.5].
  
• More than one third (38 percent) of primary sedative admissions aged 18 and older had more than 12 years of education (vs. 27 percent of all admissions combined) [Table 2.9].
  
• Fifty percent of primary sedative admissions reported abuse of other substances as well, primarily marijuana (18 percent), alcohol (17 percent), and opiates other than heroin (13 percent) [Table 3.8].
  

Hallucinogens

• Hallucinogens were reported as the primary substance of abuse by one tenth of 1 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b]. Hallucinogens include LSD, DMT, STP, mescaline, psilocybin, peyote, etc.
  
• Twenty-nine percent of hallucinogen admissions were under age 20 compared with 9 percent of all admissions combined. Only 30 percent were 30 years of age or older compared with 60 percent of all admissions [Table 2.1a].
  
• Nearly three-quarters (69 percent) of admissions for primary hallucinogen abuse were non-Hispanic Whites (51 percent were males and 18 percent were females), and 15 percent were non-Hispanic Blacks (10 percent were males and 4 percent were females) [Table 2.3a].
  
• Forty-one percent of primary hallucinogen admissions reported not using the drug in the past month [Table 2.4].
  
• Primary hallucinogen admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (26 vs. 17 percent) [Table 2.7].
  
• Seventy-six percent of primary hallucinogen admissions reported abuse of drugs in addition to hallucinogens, primarily marijuana (47 percent), alcohol (31 percent), methamphetamine/amphetamines (12 percent), and opiates other than heroin (7 percent) [Table 3.8].
  

Phencyclidine (PCP)

• Phencyclidine (PCP) was reported as a primary substance of abuse by approximately one third of 1 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b].
  
• More than one half (54 percent) of PCP admissions were aged 25 to 34 compared with nearly one third (31 percent) of all admissions combined [Table 2.1a].
  
• Non-Hispanic Blacks accounted for 64 percent of primary PCP admissions (38 percent were males and 26 percent were females) [Table 2.3a].
  
• Among admissions referred to treatment through a criminal justice source, primary PCP admissions were more likely than all admissions combined to be referred as a condition of probation/parole (46 vs. 34 percent) [Table 2.6].
  
• Primary PCP admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (28 vs. 17 percent), particularly short-term rehabilitation/residential treatment (17 vs. 9 percent) [Table 2.7].
  
• Only 12 percent of PCP admissions aged 18 and older had more than a high school education (vs. 27 percent of all admissions combined) [Table 2.9].
  
• Sixty-seven percent of primary PCP admissions reported abuse of other substances. Marijuana was reported as a secondary substance by 38 percent of primary PCP admissions, while alcohol was reported by 33 percent [Table 3.8].
  

Inhalants

• Inhalants were reported as the primary substance of abuse by one tenth of 1 percent of TEDS admissions aged 12 and older in 2013 [Table 1.1b]. Inhalants include chloroform, ether, gasoline, glue, nitrous oxide, paint thinner, etc.
  
• Seven percent of primary inhalant admissions were aged 12 to 14 years and another 12 percent were aged 15 to 17 years compared with about 1 and 5 percent, respectively, of all admissions combined [Table 2.1a].
  
• Over two-thirds (71 percent) of primary inhalant admissions were non-Hispanic White (44 percent were males and 27 percent were females). Five percent of all primary inhalant admissions were non-Hispanic Black males [Table 2.3a].
  
• Primary inhalant admissions were less likely than all admissions combined to be referred to treatment through a criminal justice source (28 vs. 34 percent) or a self- or individual referral (31 vs. 37 percent) [Table 2.6].
  
• Sixty-two percent of primary inhalant admissions reported abuse of other substances, principally alcohol (32 percent) and marijuana (31 percent) [Table 3.8].
  
• Reflecting their overall youth, inhalant admissions were more likely than all admissions combined to have a dependent living arrangement (33 vs. 20 percent) or Medicaid as the expected source of payment for treatment (23 vs. 15 percent) [Tables 2.10 and 2.13].

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

This chapter highlights topics that are of current or special interest. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

• Adolescent substance abuse 2003-2013

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 declined by 35 percent (from 157,181 to 101,665) between 2003 and 2013 [Table 3.1a].

In 2013, 89 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and 41 percent of these marijuana-involved admissions were referred to treatment through a criminal justice source [Table 3.4].

• Heroin admissions and medication-assisted opioid therapy 2003-2013

The proportion of TEDS admissions for primary heroin abuse increased by 15 percent (from 274,459 to 316,797) between 2003 and 2013 [Table 3.5].

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 32 percent in 2003 to 27 percent in 2013 [Table 3.7].⁸

• Polydrug abuse

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

• Racial/ethnic subgroups

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

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The proportion of adolescent admissions aged 12 to 17 declined by 35 percent from 2003 to 2013.

• Two primary substances—marijuana and alcohol—accounted for between 83 and 89 percent of adolescent admissions each year from 2003 to 2013.
  
• Marijuana admissions increased from 64 percent of adolescent admissions in 2003 to 76 percent in 2013; however, the total number of adolescent marijuana admissions decreased by 24 percent (from 101,378 to 77,062) between 2003 and 2013.
  
• Alcohol admissions declined from 19 percent of adolescent admissions in 2003 to 13 percent in 2013.
  
• Methamphetamine/amphetamine admissions increased from 4 percent in 2003 to 6 percent in 2005, but then decreased to 3 percent in 2013.
  
• Opiate admissions represented 2 percent of adolescent admissions from 2003 to 2008 and 3 percent from 2009 to 2013.
  
• Opiates other than heroin⁹ represented 39 percent of adolescent opiate admissions in 2003 but 48 percent in 2013.
  
• Cocaine accounted for between 2 and 3 percent of adolescent admissions between 2003 and 2008. Beginning in 2009, cocaine accounted for 1 percent of adolescent admissions.
• All other substances combined accounted for 2 percent of adolescent admissions between 2003 and 2013.

Table 3.2. In 2013, overall, 71 percent of adolescent admissions were male, a proportion heavily influenced by the 76 percent of marijuana admissions that were male. The proportion of female admissions was greater than 30 percent for most other substances. Among adolescent admissions, the two primary substances that had a higher proportion of females to males were methamphetamine/amphetamines and phencyclidine (52 and 48 percent, respectively).

Forty-three percent of adolescent admissions were non-Hispanic White, 26 percent were of Hispanic origin, 19 percent were non-Hispanic Black, and 11 percent were of other racial/ethnic groups.

Table 3.3.The proportion of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 32 percent who were 17 years old. Among admissions for PCP and for alcohol, 14 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 64 percent and 48 percent, respectively, were age 17.

In 2013, 44 percent of adolescent admissions were referred to treatment through a criminal justice source, 19 percent were self- or individual referrals, and 14 percent were referred through schools.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 2003, 44 percent of all adolescent admissions were marijuana involved and referred to treatment by a criminal justice source, and 38 percent were marijuana involved but referred by other sources. By 2013, the proportion of all adolescent admissions that were marijuana involved and referred by the criminal justice source had decreased to 41 percent, while the proportion that were marijuana involved and referred by other sources had increased to 48 percent.

The proportion of adolescent admissions not involving marijuana that were referred by a criminal justice source fell from 8 percent in 2003 to 4 percent in 2013. Admissions not involving marijuana that were referred from other sources were fairly stable, fluctuating between 8 and 11 percent of adolescent admissions.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2003 through 2011, accounting for 13 to 15 percent of TEDS admissions in those years, but rose to 16 percent in 2012 and 19 percent in 2013 [Table 1.1b]. In 2013, injection was the preferred route of administration for 71 percent of primary heroin admissions, inhalation for 23 percent, and smoking for 4 percent [Table 2.4]. The majority of primary heroin admissions from 2003 to 2013 were 20 to 34 years of age (41 to 43 percent from 2003 through 2007 and 58 percent in 2013) [Table 3.5].

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

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

• In 2003, 1 in 4 heroin admissions (25 percent) were non-Hispanic White aged 20 to 34. By 2013, almost half of primary heroin admissions (48 percent) belonged to this subgroup. The proportion of primary heroin admissions who were non-Hispanic White aged 35 to 44 decreased from 12 percent to 10 percent in the same period, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
  
• In contrast, the proportion of primary heroin admissions that were non-Hispanic Black aged 20 to 34 fell from 5 percent to 2 percent between 2003 and 2013, while the proportion aged 35 to 44 fell from 11 percent to 3 percent. However, the proportion of non-Hispanic Black admissions aged 45 and older remained between 8 and 11 percent from 2003 through 2013. Non-Hispanic Black admissions aged 12 to 19 accounted for one tenth of 1 percent or less of all primary heroin admissions in the same time period.
  

Table 3.6 and Figure 22.

• In 2003, 1 in 4 primary heroin admissions (26 percent) were injectors aged 20 to 34 and nearly 1 in 5 (18 percent) were injectors aged 35 to 44. By 2013, almost one half of primary heroin admissions (46 percent) were injectors aged 20 to 34, but the proportion that were injectors aged 35 to 44 had dropped to 12 percent.
  
• The proportion of primary heroin admissions who were inhalers aged 20 to 34 fell from 12 percent in 2003 to 9 percent in 2013, while the proportion who were inhalers aged 45 and older fluctuated between 8 percent to 10 percent from 2003 through 2013.

Table 3.7 and Figures 23 and 24. Planned use of medication-assisted opioid therapy (MAT, opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 2003 and 2013.

• Table 3.7 and Figure 23. In 2003, 32 percent of primary heroin admissions overall had treatment plans that included MAT, although the proportion varied by route of administration—37 percent of heroin smokers, 35 percent of heroin injectors, and 30 percent of heroin inhalers. By 2013, only 27 percent of primary heroin admissions had treatment plans that included MAT, with 31 percent being heroin inhalers, 28 percent being smokers, and 26 percent being injectors (see footnote 1).
  

• Figure 24. Older heroin admissions were most likely to have MAT planned. In 2003, MAT was planned for 44 percent of heroin admissions aged 45 and older, 34 percent of those aged 35 to 44, 26 percent of those aged 20 to 34, and 14 percent of those aged 12 to 19. The proportions fell for all age groups, and by 2013, MAT was planned for 40 percent of primary heroin admissions aged 45 and older, 30 percent of those aged 35 to 44, 22 percent of those aged 20 to 34, and 13 percent of those aged 12 to 19.
  

Polydrug Abuse

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

Table 3.8 and Figure 25. Polydrug abuse was reported by 55 percent of TEDS admissions aged 12 or older in 2013. Marijuana, alcohol, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of a majority of treatment admissions. Thirty-eight percent of all treatment admissions were for primary alcohol abuse, and 17 percent of admissions for primary illicit drug abuse reported that they also had an alcohol problem. Overall, 54 percent of all treatment admissions reported alcohol as a substance of abuse.

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances. Thirty-eight percent of all admissions involved opiate abuse, with 28 percent reporting primary abuse and 10 percent reporting secondary or tertiary abuse. Fourteen percent of all admissions reported methamphetamine/amphetamine abuse, with 8 percent reporting primary abuse and 5 percent reporting secondary or tertiary abuse.
  
• Marijuana and cocaine were reported more often as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 17 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, resulting in 37 percent of all treatment admissions reporting marijuana as a substance of abuse. Cocaine was a primary substance for 6 percent of admissions, but was a secondary or tertiary substance for an additional 13 percent. Thus 19 percent of all treatment admissions involved cocaine abuse.

Table 3.9.This table details the most common substance combinations for selected primary substances. For example, of primary alcohol admissions, 56 percent reported abuse of alcohol alone, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 5 percent reported
primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31.TEDS data indicate that substance abuse patterns differed widely in 2013 among racial/ethnic subgroups. Among admissions of Hispanic origin, substance abuse patterns differed according to country of origin. Patterns also differed between men and women within subgroups.

• Among non-Hispanic Whites [Figure 26], alcohol was the primary substance reported by 42 percent of male admissions and 32 percent of female admissions.
  
  • Opiates and marijuana were the most frequently reported primary illicit drugs among non-Hispanic White male admissions (31 percent and 13 percent, respectively), followed by methamphetamine/amphetamines (8 percent) and cocaine (3 percent).
    
  • Among non-Hispanic White female admissions, opiates were the most frequently reported primary substance (38 percent), followed by, among the illicit drugs, methamphetamine/amphetamines (12 percent), marijuana (10 percent), and cocaine (4 percent).

• Among non-Hispanic Blacks [Figure 27], alcohol was reported as the primary substance by 37 percent of male admissions and 31 percent of female admissions.
  
  • Marijuana, cocaine, and opiates were the most commonly reported illicit substances for non-Hispanic Black male admissions (30 percent, 14 percent, and 14 percent, respectively).
    
  • For non-Hispanic Black female admissions, the most commonly reported primary illicit substances were marijuana and cocaine (25 and 20 percent, respectively).
    
  • Methamphetamine/amphetamines were reported by 2 percent each of non-Hispanic Black male and female admissions.
    

• Among admissions of Mexican origin [Figure 28], alcohol was the most frequently reported primary substance by male admissions (41 percent), but among female admissions, methamphetamine/amphetamines were the most frequently reported primary substance (32 percent).
  
  • Marijuana (25 percent) was the most commonly reported illicit substance for male admissions of Mexican origin, followed by methamphetamine/amphetamines (16 percent) and opiates (15 percent).
    
  • For female admissions of Mexican origin, the next most commonly reported primary substances were alcohol (28 percent), marijuana (20 percent) and opiates (16 percent).
    

• Among admissions of Puerto Rican origin [Figure 29], opiates were the most common primary substance at treatment admission for both men and women (46 and 38 percent, respectively), followed by alcohol (28 and 26 percent, respectively).
  
  • For both male and female admissions of Puerto Rican origin, other primary substances were marijuana (15 percent and 20 percent, respectively) and cocaine (7 percent and 10 percent, respectively).
    
  • Admissions for primary methamphetamine/amphetamine abuse were 2 percent for women of Puerto Rican origin and 1 percent for men of Puerto Rican origin.
    

• Among admissions of American Indian/Alaska Native origin, 67 percent of men and 50 percent of women entered treatment because of primary alcohol abuse [Figure 30]. Note: Only 3 percent of all TEDS admissions were American Indians/Alaska Natives [Table 2.2].
  
  • Marijuana was the most frequently reported illicit substance for American Indian/Alaska Native male admissions (13 percent), followed by opiates (10 percent), methamphetamine/amphetamines (6 percent), and cocaine (2 percent).
    
  • Opiates and marijuana were the most frequently reported illicit substances for American Indian/Alaska Native female admissions (19 percent and 12 percent, respectively), followed by methamphetamine/amphetamines (13 percent) and cocaine (3 percent).

• Among admissions of Asian/Pacific Islander origin, alcohol was the primary substance reported by 38 percent of male admissions and 31 percent of female admissions [Figure 31]. Note: Only 1 percent of all TEDS admission were Asian/Pacific Islanders.
  
  • Marijuana and methamphetamine/amphetamines were the most commonly reported illicit drugs for Asian/Pacific Islander male admissions (21 percent and 20 percent, respectively), followed by opiates (14 percent) and cocaine (4 percent).
    
  • For Asian/Pacific Islander female admissions, methamphetamine/amphetamines were the most commonly reported illicit substance (25 percent), followed by marijuana (20 percent), opiates (17 percent), and cocaine (3 percent).

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The Treatment Episode Data Set (TEDS) records the type of service to which clients are
admitted for treatment. The major categories are broadly defined as ambulatory, rehabilitation/residential, and detoxification. For this report, admissions for which medication-assisted opioid therapy (i.e., therapy using methadone or buprenorphine) was planned have been categorized as a separate service type. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding. The complete list of types of services detailed in this report include:

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

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

• Ambulatory treatment services accounted for 55 percent of all admissions (43 percent in outpatient treatment, and 11 percent in intensive outpatient treatment). Admissions for marijuana and methamphetamine/amphetamines were more likely to receive ambulatory services (86 percent and 61 percent, respectively) than all admissions receiving ambulatory treatment (55 percent).
  
• Detoxification services accounted for 22 percent of all admissions (18 percent in free-standing residential treatment, 3 percent in hospital inpatient treatment, and 1 percent in ambulatory treatment). Free-standing residential admissions for tranquilizers (29 percent), opiates and alcohol (24 percent each) were reported most often. Free-standing residential admissions for marijuana were least often reported (2 percent).
  
• Rehabilitation/residential treatment accounted for 17 percent of all admissions (9 percent in short-term treatment, 7 percent in long-term treatment, and less than 1 percent in hospital inpatient treatment). Admissions for cocaine (27 percent), methamphetamine/amphetamines (27 percent), and tranquilizers (20 percent) were more likely to receive rehabilitation/residential services than all admissions receiving rehabilitation/residential treatment (17 percent).
  
• Medication-assisted opioid therapy accounted for 7 percent of all admissions (5 percent in outpatient treatment, 1 percent in detoxification, and less than 1 percent in residential treatment). Medication-assisted opioid therapy was planned for about one quarter (23 percent) of admissions for opiates.

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

• Ambulatory admissions (49 percent in outpatient treatment, and 43 percent in intensive outpatient treatment) were more likely to have been referred to treatment by the criminal justice system than all criminal justice referrals (34 percent).
  
• Detoxification admissions (78 percent in hospital inpatient treatment, 56 percent in free-standing residential treatment, and 49 percent in ambulatory treatment) were more likely to be self- or individual referrals than all self- or individual referrals (37 percent).
  
• Short-term or long-term rehabilitation/residential admissions (23 percent in short-term treatment and 19 percent in long-term treatment) were more likely to have been referred by a substance abuse care provider than all referrals from substance abuse care providers (9 percent).
  
• Admissions receiving detoxification or outpatient medication-assisted opioid therapy were more likely to be self- or individual referrals (78 percent of detoxification admissions and 77 percent of outpatient admissions) compared to 37 percent of all self- or individual referrals.
  

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Introduction
History
State Data Collection Systems
Report-Specific Considerations

Introduction

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

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

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

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

The Minimum Data Set consists of items that include:

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

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

History

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

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

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

State Data Collection Systems

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

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

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

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

Appendix A Table 1 presents key characteristics of state data collection systems for 2013. However, these characteristics can change ­as state substance abuse treatment systems change, and thus may be responsible for some year-to-year variation within states.

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

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

Because some admission records in fact may represent transfers, the number of admissions reported probably overestimates the number of treatment episodes. Some states reported a limited data set on codependents of substance abusers entering treatment. On average, from 2003 through 2013, 87 percent of all records submitted were client admissions, 12 percent were client transfers, and 1 percent were codependents of substance abusers.

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

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

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

Appendix A Tables 2 and 3 indicate the proportions of records by state or jurisdiction for which valid data were received for 2013. States are expected to report all variables in the Minimum Data Set (Appendix A Table 2). Variables in the Supplemental Data Set are collected at each state’s option (Appendix A Table 3).

Report-Specific Considerations

• The report focuses on treatment admissions for substance abusers, so admissions for treatment as a codependent of a substance abuser are excluded. Records for identifiable transfers within a single treatment episode are also excluded.
  
• Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable other than primary, secondary, or tertiary substance, those records are excluded from tabulations of that variable. For substance variables, missing or unknown responses were included in the category “Other.” The total number of admissions on which a percentage distribution is based is reported in each table.
  
• The primary, secondary, and tertiary substances of abuse reported to TEDS are those substances that led to the treatment episode and not necessarily a complete enumeration of all drugs used at the time of admission.
• Primary alcohol admissions are classified as “Alcohol only” or “Alcohol with secondary drug abuse.” The latter indicates a primary alcohol admission with a specified secondary and/or tertiary drug. All other primary alcohol admissions are classified as “Alcohol only.”
  
• Cocaine admissions are classified according to route of administration as smoked and other route. Smoked cocaine primarily represents crack or rock cocaine, but can also include cocaine hydrochloride (powder cocaine) when it is free-based. Non-smoked cocaine includes all cocaine admissions where cocaine is injected, inhaled, or taken orally; it also includes admissions where the route of administration is unknown or not collected. Thus the TEDS estimate of admissions for smoked cocaine is conservative.
  
• Methamphetamine/amphetamine admissions include admissions for both substances, but are primarily for methamphetamine. In 2013, methamphetamine constituted about 93 percent of combined methamphetamine/amphetamine admissions. Oregon and Texas, states with large numbers of methamphetamine admissions, reported them as Other amphetamines until 2005 and 2006, respectively.
  
• For this report, secondary and tertiary substances (see Appendix B) are grouped and referred to as secondary substances.
  
• Significant changes in the clients or facilities reported to TEDS by some states and jurisdictions can result in changes in the number of admissions large enough to influence trends.
  

TO TABLES

To Table of Contents

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TEDS Minimum Data Set
TEDS Supplemental Data Set

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

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

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

CLIENT OR CODEPENDENT/COLLATERAL

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

Client—Must meet all of the following criteria:

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

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

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

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

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

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

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

DATE OF ADMISSION

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

DEMOGRAPHICS

AGE

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

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

EDUCATION

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

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

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

EMPLOYMENT STATUS

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

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

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

ETHNICITY

Identifies client’s specific Hispanic origin.

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

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

RACE

Specifies the client’s race.

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

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

SEX

Identifies client’s gender.

• Male
• Female

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

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

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

MEDICATION-ASSISTED OPIOID THERAPY

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

• Yes
• No

NUMBER OF PRIOR TREATMENT EPISODES

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

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

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

PRINCIPAL SOURCE OF REFERRAL

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

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

SUBSTANCE PROBLEM (PRIMARY, SECONDARY, OR TERTIARY)

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

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

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

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

TRANSACTION TYPE

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

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

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

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

Data set considerations for transfers:

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

TYPE OF SERVICES

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

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

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

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

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

DAYS WAITING TO ENTER TREATMENT

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

• 0-996—Number of days waiting

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

DETAILED CRIMINAL JUSTICE REFERRAL

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

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

DETAILED DRUG CODE (PRIMARY, SECONDARY, AND TERTIARY)

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

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

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

DETAILED NOT IN LABOR FORCE

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

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

DSM CRITERIA DIAGNOSIS

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

EXPECTED/ACTUAL PRIMARY SOURCE OF PAYMENT

Identifies the primary source of payment for this treatment episode.

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

FREQUENCY OF ATTENDANCE AT SELF-HELP PROGRAMS

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

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

HEALTH INSURANCE

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

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

LIVING ARRANGEMENTS

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

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

MARITAL STATUS

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

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

NUMBER OF ARRESTS IN 30 DAYS PRIOR TO ADMISSION

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

• 0-96—Number of arrests

PREGNANT AT TIME OF ADMISSION

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

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

PSYCHIATRIC PROBLEM IN ADDITION TO ALCOHOL OR DRUG PROBLEM

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

• Yes
• No

SOURCE OF INCOME SUPPORT

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

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

VETERAN STATUS

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

• Yes
• No

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