Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Work was performed under Task Order HHSS283200700048I/HHSS28342001T, Reference No. 283-07-4803 (Cathie Alderks, Task Order Officer).

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad,
discapacidad o sexo.

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): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.

Electronic Access and Copies of Publication

This publication may be downloaded at datafiles.samhsa.gov.

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

Originating Office

Center for Behavioral Health Statistics and Quality
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Room 15SEH03
Rockville, Maryland 20857

February 2017

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This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2015 and trend data from 2005 to 2015. 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 2015, there were 1,537,025 substance abuse treatment admissions aged 12 and older reported to TEDS by 45 states, the District of Columbia, and Puerto Rico.

Major Substances of Abuse

• Five substance groups accounted for 96 percent of the primary substances reported by the 1,537,025 TEDS admissions aged 12 and older in 2015: alcohol (34 percent), opiates (34 percent), marijuana/hashish (14 percent), stimulants (9 percent), and cocaine (5 percent) [Table 1.1b].
  

Alcohol

• The proportion of admissions with alcohol as the primary substance of abuse increased from 39 percent in 2005 to a high of 42 percent in 2009 then decreased to a low of 34 percent in 2015 [Table 1.1b].
• Admissions for abuse of alcohol alone represented 19 percent of TEDS admissions aged 12 and older in 2015, while admissions for primary alcohol abuse with another drug as secondary represented 15 percent of all TEDS admissions. Therefore, of those admissions with primary alcohol abuse, 56 percent were for alcohol abuse and 44 percent were for alcohol with a secondary drug [Table 1.1b].
• Almost three-quarters of admissions for abuse of alcohol with secondary drug abuse or for abuse of alcohol alone (73 and 71 percent respectively) were male [Table 2.1b].
• The average age at admission among alcohol-only admissions was 42 years compared with 39 years among admissions for primary alcohol with secondary drug abuse [Table 2.1b].
• Almost two-thirds (64 percent) of alcohol-only admissions were non-Hispanic White, 14 percent were of Hispanic origin, and 13 percent were non-Hispanic Black. Among admissions for primary alcohol with secondary drug abuse, 57 percent were non-Hispanic White, 22 percent were non-Hispanic Black, and 14 percent were of Hispanic origin [Table 2.2b].
  
  

Heroin

• In 2005, 14 percent of admissions aged 12 or older were for primary heroin. This proportion was fairly steady from 2005 to 2010, fluctuating between 14 and 13 percent; however, the proportion of primary heroin admissions aged 12 and older increased steadily from 2011 to 2015, when it reached 26 percent [Table 1.1b].
• Primary heroin represented 78 percent of all opiate admissions in 2005 and 76 percent in 2015.
• Almost two-thirds (64 percent) of primary heroin admissions were male [Table 2.1b].
• For primary heroin admissions, the average age at admission was 35 years [Table 2.1b].
• Around two-thirds (67 percent) of primary heroin admissions were non-Hispanic White, while 14 percent each were non-Hispanic Blacks and of Hispanic origin [Table 2.2b].
• Sixty-eight percent of primary heroin admissions reported injection as the usual route of administration and 25 percent reported inhalation [Table 2.4b].
  

Opiates Other than Heroin¹

• The proportion of admissions aged 12 or older for primary opiates other than heroin slowly increased from 4 percent in 2005 to a peak of 10 percent in 2011 and 2012, and then slowly decreased to 8 percent in 2015 [Table 1.1b].
• Opiates other than heroin represented 22 percent of all primary opiate admissions in 2005 but rose to 24 percent in 2015.
• Just over one-half (52 percent) of primary non-heroin opiate admissions were male [Table 2.1b].
• For primary non-heroin opiate admissions, the average age at admission was 34 years [Table 2.1b].
• Most primary non-heroin opiate admissions (82 percent) were non-Hispanic White [Table 2.2b].
• Sixty-one percent of primary non-heroin opiate admissions reported oral as the usual route of administration, 18 percent reported inhalation, and 16 percent reported injection [Table 2.4b].

Marijuana/Hashish

• The proportion of marijuana/hashish admissions increased from 16 percent of admissions aged 12 and older in 2005 to 19 percent in 2010, then decreased to 14 percent in 2015 [Table 1.1b].
• Nearly three-quarters (72 percent) of primary marijuana/hashish admissions were male [Table 2.1b].
• For primary marijuana/hashish admissions, the average age at admission was 26 years [Table 2.1b].
• Forty-two percent of primary marijuana/hashish admissions were non-Hispanic White, 31 percent were non-Hispanic Black, and 19 percent were of Hispanic origin [Table 2.2b].
  

Cocaine/Crack

• The proportion of admissions for primary cocaine declined from 14 percent of admissions aged 12 or older in 2005 to 5 percent in 2015 [Table 1.1b].
• Smoked cocaine (crack) represented 72 percent of all primary cocaine admissions in 2005; it was 63 percent in 2015.
• Sixty-nine percent of primary non-smoked cocaine admissions and 59 percent of primary smoked cocaine admissions were male [Table 2.1b].
• The average age at admission among primary smoked cocaine admissions was 44 years; among primary non-smoked cocaine admissions, the average age was 38 years [Table 2.1b].
• Among primary smoked cocaine admissions, 54 percent were non-Hispanic Black, 32 percent were non-Hispanic White, and 9 percent were of Hispanic origin. Among primary non-smoked cocaine admissions, 43 percent were non-Hispanic White, 32 percent were non-Hispanic Black, and 20 percent were of Hispanic origin [Table 2.2b].
• Eighty-one percent of primary non-smoked cocaine admissions reported inhalation as their route of administration, and 11 percent reported injection [Table 2.4b].

Methamphetamine/Amphetamines

• The proportion of admissions for primary methamphetamine/amphetamines aged 12 and older fluctuated between 2005 and 2015 from 9 percent in 2005 to 6 percent around the middle of the time interval and back to 9 percent in 2015 [Table 1.1b].
• Fifty-four percent of primary methamphetamine/amphetamine admissions were male [Table 2.1b].
• For primary methamphetamine/amphetamine admissions, the average age at admission was 34 years [Table 2.1b].
• About two-thirds (66 percent) of primary methamphetamine/amphetamine admissions were non-Hispanic White, 19 percent were of Hispanic origin, and 5 percent were non-Hispanic Blacks [Table 2.2b].
• Sixty-one percent of primary methamphetamine/amphetamine admissions reported smoking as the usual route of administration, 27 percent reported injection, and 8 percent reported inhalation [Table 2.4b].
  
  

Adolescent Admissions to Substance Abuse Treatment

• The proportion of admissions to substance abuse treatment aged 12 to 17 decreased by 56 percent between 2005 and 2015 (from 148,805 to 65,370) [Table 3.1a].
• Forty-three percent of adolescent treatment admissions were referred to treatment by the court/criminal justice system² [Table 3.3b].
• Approximately 89 percent of adolescent treatment admissions involved marijuana/hashish as a primary, secondary, or tertiary substance in 2015 [Table 3.4b].

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

• The proportion of non-Hispanic Whites aged 20 to 34 among heroin admissions increased from 28 percent in 2005 to 49 percent in 2014 and then decreased to 46 percent in 2015 [Table 3.5b].
• The proportion of injectors aged 20 to 34 among heroin admissions increased from 29 percent in 2005 to 46 percent in 2014 and decreased to 43 percent in 2015. [Table 3.6b].
• The proportion of heroin admissions with treatment plans that included receiving medication-assisted opioid therapy was fairly steady from 2005 to 2014, fluctuating between 30 and 28 percent; but then suddenly increased to 37 percent in 2015 [Table 3.7b].
  

Polydrug Abuse

Polydrug abuse was reported by 54 percent of all TEDS admissions aged 12 and older in 2015 [Table 3.8].

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances (alcohol: 34 vs. 15 percent; opiates: 34 vs. 10 percent; methamphetamine/amphetamines: 9 vs. 6 percent).
• Marijuana/hashish and cocaine were reported less often as primary substances than as secondary or tertiary substances (marijuana/hashish: 14 vs. 20 percent; cocaine: 5 vs. 13 percent).
  

Race/Ethnicity

Alcohol was the most frequently reported primary substance at treatment admission among all racial/ethnic groups except admissions of non-Hispanic Whites and admissions of Puerto Rican origin. However, the proportions reporting primary use of the other four major substance groups (Opiates, Cocaine, Marijuana/hashish, and Methamphetamine/amphetamines) varied considerably by racial/ethnic group [Table 2.2b].

• Among non-Hispanic White admissions, opiates (40 percent) were the most common primary substance of abuse. Next were alcohol (34 percent), marijuana/hashish and methamphetamine/amphetamines (10 percent each), and cocaine (3 percent).
• Among non-Hispanic Black admissions, alcohol (32 percent) was the most common primary substance of abuse. Next were marijuana/hashish and opiates (24 percent each), cocaine (13 percent), and methamphetamine/amphetamines (2 percent).
• Among admissions of Mexican origin, the most common primary substances of abuse were alcohol (34 percent), methamphetamine/amphetamines (24 percent), marijuana/hashish (20 percent), opiates (19 percent), and cocaine (2 percent).
• Among admissions of Puerto Rican origin, the most common primary substances of abuse were opiates (49 percent), alcohol (25 percent), marijuana/hashish (15 percent), cocaine (6 percent), and methamphetamine/amphetamines (1 percent).
• Among American Indians/Alaska Native admissions, alcohol (56 percent) was the most common primary substance of abuse. Next were opiates (17 percent), marijuana/hashish (12 percent), methamphetamine/amphetamines (11 percent), and cocaine (2 percent).
• Among Asians/Pacific Islander admissions, alcohol (32 percent) was the most common primary substance of abuse. Next were methamphetamine/amphetamines (23 percent), opiates (19 percent), marijuana/hashish (18 percent), and cocaine (3 percent).

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Trends in Primary Substance of Abuse: 2005-2015
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 2015 and trend data from 2005 to 2015. It is a companion to the report Treatment Episode Data Set (TEDS): 2005-2015 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 2005 through 2015 that were received and processed through November 1, 2016.³ 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 available in Appendix A.

This chapter details trends in the annual numbers and rates of admissions aged 12 and older from 2005 to 2015. 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 and reporting system. Census population estimate data on age, gender, and race/ethnicity are currently not available for Puerto Rico.

Trends in Primary Substance of Abuse: 2005-2015

Admissions can report up to three substances of abuse and are referred to as primary, secondary, and tertiary in the order that they are reported. 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 or first mentioned substance of abuse unless otherwise specified. (See Appendix A for more details.)

Table 1.1b and Figure 1. The number of all admissions aged 12 and older decreased by 19 percent from 2005 to 2015. The U.S. population aged 12 and older increased by 9 percent during this time period (U.S. Bureau of the Census, Population estimates 2005-2015).

• Between 2005 and 2015, 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/hashish, 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 older fluctuated between 2005 and 2015 from a high of 42 percent in 2009 to a low of 34 percent in 2015. In 2015, 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 2005 to 34 percent in 2015.
    • The proportion of admissions for primary heroin was fairly steady from 2005 to 2011, moving from 14 percent in 2005 to 13 percent in 2007 and to 15 percent in 2011; however, the proportion of admissions increased steadily from 2011 to 2015, when it reached 26 percent. Heroin represented 78 percent of all opiate admissions in 2005 but only 76 percent in 2015.
    • The proportion of admissions for opiates other than heroin⁴ increased from 4 percent of admissions aged 12 and older in 2005 to 10 percent in 2011 and 2012 and then dropped to 8 percent in 2015. Opiates other than heroin represented 22 percent of all opiate admissions in 2005 but 24 percent in 2015.
• The proportion of marijuana/hashish admissions increased from 16 percent of admissions aged 12 and older in 2005 to 19 percent in 2010, then decreased to 14 percent in 2015.
• The proportion of cocaine admissions declined from 14 percent of admissions aged 12 and older in 2005 to 5 percent in 2015. Smoked cocaine (crack) represented 72 percent of all primary cocaine admissions in 2005; it was 63 percent in 2015.
• The proportion of stimulant admissions aged 12 and older (98 to 99 percent of these admissions were for methamphetamine or amphetamine abuse) ranged from 6 to 9 percent of admissions aged 12 and older between 2005 and 2015.
• Tranquilizers, sedatives/hypnotics, hallucinogens, PCP, inhalants, over-the-counter medications, and other drugs not previously listed together accounted for approximately 2 percent of TEDS admissions between 2005 and 2015.
  

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 39 percent in 2005 to 34 percent in 2015.
• The proportion reporting abuse of drugs only increased from 37 percent in 2005 to 50 percent in 2015, while the proportion reporting abuse of alcohol only fell slightly, from 22 percent in 2005 to 19 percent in 2015.

Trends in Demographic Characteristics

Table 1.3b.Males represented 68 percent of TEDS admissions aged 12 and older in 2005; the proportion of males was 66 percent in 2015. 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 aged 12 and older was male in 2015.

Table 1.3b and Figure 2. The age distribution of TEDS admissions aged 12 and older changed between 2005 and 2015.

• The proportion of admissions aged 12 to 17 decreased slightly from 8 percent in 2005 to 4 percent in 2015.
• The proportion of admissions aged 30 to 44 years decreased from 40 percent of TEDS admissions in 2005 to 36 percent in 2015.
• The proportion of admissions aged 45 and older increased from 21 percent in 2005 to 27 percent in 2015.
• The age distribution of TEDS admissions differed considerably from that of the U.S. population in 2015. Adolescents aged 12 to 17 years made up 4 percent of TEDS admissions but 9 percent of the U.S. population in 2015. A total of 69 percent of TEDS admissions were aged 18 to 44 years compared with 42 percent of the U.S. population. Admissions aged 45 and older made up 27 percent of TEDS admissions but 48 percent of the U.S. population in 2015.
  

Table 1.4 and Figure 3. The racial/ethnic composition of TEDS admissions aged 12 and older changed very little between 2005 and 2015.

• The proportion of non-Hispanic Whites increased from 59 to 61 percent of admissions from 2005 to 2015.
• The proportion of non-­Hispanic Blacks declined from 22 percent of admissions in 2005 to 18 percent in 2015.
• The proportion of admissions of Hispanic origin remained steady at 14 percent in both 2005 and 2015.
  
• Other racial/ethnic groups combined made up 5 to 7 percent of admissions from 2005 to 2015.
• The racial/ethnic composition of TEDS admissions differed somewhat from that of the U.S. population in 2015. Non-Hispanic Whites were the majority in both groups, but they represented 61 percent of TEDS admissions in 2015 and 64 percent of the U.S. population. Non-Hispanic Blacks represented 18 percent of TEDS admissions in 2015 and 12 percent of the U.S. population. Hispanics represented 14 percent of TEDS admissions and 16 percent of the U.S. population. Other racial/ethnic groups made up 7 percent of TEDS admissions and 8 percent of the U.S. population.
  

Trends in Employment Status

Tables 1.5a-b 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 Tables 1.5a-b. Because TEDS admissions differ demographically from the U.S. population, Tables 1.5a-b also show 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. The analysis below, however, uses the unadjusted distributions.

• Between 2005 and 2015, unemployment increased from 32 percent to 37 percent among TEDS admissions aged 16 and older.
• The most common employment status reported by TEDS admissions aged 16 and older between 2005 and 2007 was “not in labor force.” However, this proportion declined from a peak of 39 percent in 2005 to 36 percent in 2008, but it increased to 39 percent again in 2015.
• Among the U.S. population aged 16 and older in 2015, 60 percent were employed, 37 percent were not in the labor force, and 3 percent were unemployed.
  

⁵ The distributions were adjusted for age, gender, and race/ethnicity to the U.S. population using data from the U.S. Bureau of the Census, Population estimates by state, age, gender, race, and ethnicity, 2005-2015. 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. Population estimates by age, gender, race, and ethnicity are not currently available for Puerto Rico.

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 2015 TEDS data. The tables include items in the TEDS Minimum and Supplemental Data Sets for 2015 (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
• Type of treatment service, 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 36 years; 4 percent of admissions were aged 12 to 17 years [Table 2.1a-b].
• Non-Hispanic Whites made up 61 percent of all admissions aged 12 and older in 2015 (38 percent were males and 23 percent were females). Non-Hispanic Blacks made up 18 percent of all admissions (13 percent were males and 5 percent were females) [Table 2.3b].
• Thirty-six percent of admissions had not been in treatment before the current episode, while 16 percent had been in treatment five or more times previously [Table 2.5b].
• Self or individual referrals and court/criminal justice system referrals were responsible for 41 percent and 30 percent, respectively, of referrals to treatment [Table 2.6b].
• Most admissions (61 percent) received ambulatory treatment; 22 percent received detoxification, and 17 percent received rehabilitation/residential treatment [Table 2.7b].
• One quarter (25 percent) of admissions aged 16 and older were employed [Table 2.8b].
• Twenty-seven percent of admissions aged 18 and older had not completed high school or attained a GED [Table 2.9b].
  

Alcohol Only

• Admissions for abuse of alcohol alone, with no secondary drug abuse, represented 19 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• The average age at admission among admissions for alcohol only was 42 years [Table 2.1b]. Admissions 40 and older reported abuse of alcohol only more frequently than any other substance abuse problem [Table 2.1c].
• Non-Hispanic Whites made up 64 percent of all alcohol-only admissions (44 percent were males and 20 percent were females) [Table 2.3b].
• Eighty-six percent of alcohol-only admissions reported that they first became intoxicated before age 21, the legal drinking age. About one-third (30 percent) first became intoxicated by age 14 [Table 2.5b].
• Among admissions referred to treatment by the court/criminal justice system, 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 (30 vs. 17 percent) [Table 2.6b].
• Alcohol-only admissions aged 16 and older were more likely than all admissions combined of that age to be employed (35 vs. 25 percent) [Table 2.8b].
  

Alcohol with Secondary Drug Abuse

• Admissions for primary abuse of alcohol with secondary abuse of drugs represented 15 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• The average age at admission for primary alcohol with secondary drug abuse was lower, at 39 years, than for abuse of alcohol alone (42 years) [Table 2.1b].
• Non-Hispanic Whites accounted for 57 percent of admissions for primary alcohol with secondary drug abuse (40 percent were males and 17 percent were females). Non-Hispanic Blacks made up 22 percent of those admissions (17 percent were males and 5 percent were females) [Table 2.3b].
• Almost one-half (44 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 92 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5b].
• Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (31 vs. 43 percent) [Table 2.5b].
• Among admissions referred to treatment by the court/criminal justice system, 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 (25 vs. 16 percent) [Table 2.6b].
• Among admissions for alcohol with secondary drug abuse, marijuana/hashish (23 percent), and smoked cocaine and non-smoked cocaine (6 percent each) were the most frequently reported secondary substances [Table 3.8].
  

Heroin

• Heroin was reported as the primary substance of abuse for 26 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• Sixty-seven percent of primary heroin admissions were non-Hispanic White (41 percent were males and 26 percent were females). Non-Hispanic Blacks made up 14 percent (9 percent were males and 5 percent were females). Admissions of Puerto Rican origin made up 7 percent of primary heroin admissions (6 percent were males and 1 percent were females) [Table 2.3b]. See Chapter 3 for additional data on heroin admissions.
• Injection was reported as the usual route of administration by 68 percent of primary heroin admissions; inhalation was reported by 25 percent. Daily heroin use was reported by 63 percent of primary heroin admissions [Table 2.4b].
• Twenty-two percent of primary heroin admissions had no prior treatment episode, and 25 percent had been in treatment five or more times previously [Table 2.5b].
• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by the court/criminal justice system (14 vs. 30 percent) and more likely to be self or individually referred (61 vs. 41 percent) [Table 2.6b].
• Medication-assisted opioid therapy was planned for 37 percent of heroin admissions [Table 2.7b].
• Only 17 percent of primary heroin admissions aged 16 and older were employed (vs. 25 percent of all admissions that age); 45 percent were not in labor force (vs. 39 percent of all admissions that age) [Table 2.8b].
• Sixty-one percent of primary heroin admissions reported abuse of additional substances. Marijuana/hashish was reported by 18 percent, alcohol by 14 percent, and non-smoked cocaine by 13 percent [Table 3.8].
  

Opiates Other than Heroin

• Opiates other than heroin were reported as the primary substance of abuse for 8 percent of TEDS admissions aged 12 and older in 2015 [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.
• Admissions for primary opiates other than heroin were more likely than all admissions combined to be aged 20 to 39 (74 vs. 58 percent) [Table 2.1b].
• Non-Hispanic Whites made up approximately 82 percent of admissions for primary opiates other than heroin (43 percent were males and 39 percent were females) [Table 2.3b].
• The usual route of administration most frequently reported by admissions of primary opiates other than heroin was oral (61 percent); next were inhalation (18 percent) and injection (16 percent) [Table 2.4b].
• Admissions for primary opiates other than heroin were more likely than all admissions combined to report first use after age 18 (66 vs. 39 percent) [Table 2.5b].
• Medication-assisted opioid therapy was planned for 31 percent of admissions for primary opiates other than heroin [Table 2.7b].
• Fifty-eight percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana/hashish (22 percent), alcohol (16 percent), and tranquilizers (12 percent) [Table 3.8].

Smoked Cocaine (Crack)

• Smoked cocaine (crack) was reported as the primary substance of abuse by 3 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• Primary smoked cocaine admissions were more likely than all admissions combined to be aged 40 to 64 years (67 vs. 35 percent). The average age at admission for primary smoked cocaine was 44 years [Table 2.1b].
• Non-Hispanic Blacks accounted for 54 percent of primary smoked cocaine admissions (34 percent were males and 20 percent were females), and non-Hispanic Whites accounted for 32 percent (17 percent were males and 15 percent were females) [Table 2.3b].
• Primary smoked cocaine admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (31 vs. 17 percent) [Table 2.7b].
• Only 13 percent of primary smoked cocaine admissions aged 16 and older were employed; 25 percent of all admissions that age were employed [Table 2.8b].
• Sixty-six percent of primary smoked cocaine admissions reported abuse of other substances. The most commonly reported secondary substances of abuse were alcohol (40 percent) and marijuana/hashish (28 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 2015 [Table 1.1b].
• The average age at admission for primary non-smoked cocaine admissions was 38 years [Table 2.1b].
• Twenty-seven percent of primary non-smoked cocaine admissions were non-Hispanic White males compared to 38 percent of all admissions [Table 2.3b].
• Non-Hispanic Whites accounted for 43 percent of primary non-smoked cocaine admissions (27 percent were males and 15 percent were females), and non-Hispanic Blacks accounted for 32 percent (23 percent were males and 9 percent were females) [Table 2.3b].
• The usual route of administration most frequently reported by admissions for primary non-smoked cocaine was inhalation (81 percent); 11 percent reported injection as their usual route of administration [Table 2.4b].
• Non-smoked cocaine admissions were more likely than smoked cocaine admissions to be referred to treatment by the court/criminal justice system (37 vs. 24 percent) [Table 2.6b].
• Seventy percent of admissions for primary non-smoked cocaine reported abuse of additional substances. Alcohol and marijuana/hashish were most common, reported by 35 percent and 30 percent, respectively [Table 3.8].
  

Marijuana/Hashish

• Marijuana/hashish was reported as the primary substance of abuse by 14 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• The average age at admission for primary marijuana/hashish admissions was 26 years [Table 2.1b]. Thirty-one percent of marijuana/hashish admissions were under age 20 (vs. 7 percent of all admissions combined), and primary marijuana/hashish abuse accounted for 78 percent of admissions aged 12 to 14 and 75 percent of admissions aged 15 to 17 years [Table 2.1c].
• Non-Hispanic Whites accounted for 42 percent of primary marijuana/hashish admissions (29 percent were males and 13 percent were females), and non-Hispanic Blacks accounted for 31 percent (23 percent were males and 7 percent were females) [Table 2.3b].
• Twenty-four percent of primary marijuana/hashish admissions had first used marijuana/hashish by age 12 and another 30 percent had first used it at age 13 or 14 [Table 2.5b].
• Primary marijuana/hashish admissions were most likely to be referred by the court/criminal justice system (51 percent). Primary marijuana/hashish admissions were less likely than all admissions combined to be self or individually referred to treatment (19 vs. 41 percent) [Table 2.6b].
• More than 4 in 5 marijuana/hashish admissions (85 percent) received ambulatory treatment; among all admissions combined, 3 in 5 (61 percent) received ambulatory treatment [Table 2.7b].
• Fifty-four percent of primary marijuana/hashish admissions reported abuse of additional substances. Alcohol was reported by 35 percent [Table 3.8].
  

Methamphetamine/Amphetamines

• Methamphetamine/amphetamines (stimulants) were reported as the primary substance of abuse by 9 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b]. The proportion of methamphetamine admissions represented 94 percent of this group [Table 1.1a].
• Primary methamphetamine/amphetamine admissions were on average 34 years old at admission [Table 2.1b].
• Non-Hispanic Whites accounted for 66 percent of primary methamphetamine/amphetamine admissions (35 percent were males and 30 percent were females). Twelve percent of primary methamphetamine/amphetamine admissions were of Mexican origin (7 percent were males and 5 percent were females) [Table 2.3b].
• The usual route of administration most frequently reported by admissions for primary methamphetamine/amphetamines was smoking (61 percent); 27 percent of primary methamphetamine/amphetamine admissions reported injection as the usual route of administration, and 8 percent reported inhalation [Table 2.4b].
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to be referred to treatment by the court/criminal justice system (44 vs. 30 percent) [Table 2.6b].
• Primary methamphetamine/amphetamine admissions were more likely than all admissions combined to receive long-term rehabilitation/residential treatment (16 vs. 7 percent) [Table 2.7b].
• Sixty-six percent of primary methamphetamine/amphetamine admissions reported secondary use of other substances, primarily marijuana/hashish (36 percent) and alcohol (26 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 2015 [Table 1.1b].
• The average age at admission for primary tranquilizer admissions was 34 years [Table 2.1b].
• Non-Hispanic Whites accounted for 78 percent of admissions for primary abuse of tranquilizers (males accounted for 40 percent and females accounted for 38 percent) [Table 2.3b].
• Twenty percent of primary tranquilizer admissions first used tranquilizers after age 30 [Table 2.5b].
• Primary tranquilizer admissions were the least likely of all admissions with any other primary substance to receive ambulatory treatment (39 vs. 53 percent or above). They were the most likely of all admissions with any other primary substance to receive hospital inpatient detoxification (10 vs. 3 percent or below) [Table 2.7b].
• Secondary abuse of another substance was reported by 74 percent of primary tranquilizer admissions. Secondary abuse of opiates other than heroin and marijuana/hashish were reported by 24 percent each [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 2015 [Table 1.1b].
• Twenty-five percent of primary sedative admissions were aged 65 and older; 1 percent of all admissions combined were in that age group [Table 2.1b].
• Non-Hispanic Whites accounted for 80 percent of primary sedative admissions (47 percent were females and 33 percent were males) [Table 2.3b].
• Forty-one percent of primary sedative admissions first used sedatives after age 30 [Table 2.5b].
• More than two-fifths (41 percent) of primary sedative admissions aged 18 and older had more than 12 years of education (vs. 26 percent of all admissions combined) [Table 2.9b].
• Fifty percent of primary sedative admissions reported abuse of other substances as well, primarily marijuana/hashish (17 percent), alcohol (16 percent), and opiates other than heroin (12 percent) [Table 3.8].
  

Hallucinogens

• Hallucinogens were reported as the primary substance of abuse by 0.1 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b]. Hallucinogens include LSD, DMT, STP, mescaline, psilocybin, peyote, etc.
• Twenty-two percent of hallucinogen admissions were under age 20 compared with 7 percent of all admissions combined. Thirty-eight percent were 30 years of age or older compared with 63 percent of all admissions [Table 2.1b].
• About two-thirds (61 percent) of admissions for primary hallucinogen abuse were non-Hispanic Whites (46 percent were males and 15 percent were females), and 21 percent were non-Hispanic Blacks (15 percent were males and 6 percent were females) [Table 2.3b].
• Forty-four percent of primary hallucinogen admissions reported not using the drug in the past month [Table 2.4b].
• Primary hallucinogen admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (25 vs. 17 percent) [Table 2.7b].
• Seventy-four percent of primary hallucinogen admissions reported abuse of drugs in addition to hallucinogens, primarily marijuana/hashish (42 percent), alcohol (27 percent), methamphetamine/amphetamines (12 percent) [Table 3.8].
  

Phencyclidine (PCP)

• Phencyclidine (PCP) was reported as a primary substance of abuse by approximately 0.3 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
• Seventy percent of PCP admissions were aged 25 to 39 years [Table 2.1b].
• Non-Hispanic Blacks accounted for 60 percent of primary PCP admissions (37 percent were males and 23 percent were females) [Table 2.3b].
• Among admissions referred to treatment by the court/criminal justice system, primary PCP admissions were more likely than all admissions combined to be referred as a condition of probation/parole (47 vs. 31 percent) [Table 2.6b].
• Primary PCP admissions were more likely than all admissions combined to receive rehabilitation/residential treatment (26 vs. 17 percent), particularly short-term rehabilitation/residential treatment (15 vs. 10 percent) [Table 2.7b].
• PCP admissions aged 18 and older were less likely than all admissions combined to have more than a high school education (12 vs. 26 percent) [Table 2.9b].
• Sixty-four percent of primary PCP admissions reported abuse of other substances. Marijuana/hashish was reported as a secondary substance by 36 percent of primary PCP admissions, while alcohol was reported by 30 percent [Table 3.8].
  

Inhalants

• Inhalants were reported as the primary substance of abuse by less than 0.05 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b]. Inhalants include chloroform, ether, gasoline, glue, nitrous oxide, paint thinner, etc.
• Three percent of primary inhalant admissions were aged 12 to 14 years and another 7 percent were aged 15 to 17 years; 1 percent of all admissions combined were aged 12 to 14 years and 4 percent were aged 15 to 17 years [Table 2.1b].
• About 75 percent of primary inhalant admissions were non-Hispanic White (45 percent were males and 30 percent were females). Two percent of all primary inhalant admissions were non-Hispanic Black males [Table 2.3b].
• Primary inhalant admissions were less likely than all admissions combined to be a self or individual referral (34 vs. 41 percent of all admissions) [Table 2.6b].
• Reflecting their overall youth, inhalant admissions were more likely than all admissions combined to have a dependent living arrangement (29 vs. 18 percent) [Tables 2.10b].
• Sixty-five percent of primary inhalant admissions reported abuse of other substances, principally alcohol (35 percent) and marijuana/hashish (28 percent) [Table 3.8].

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

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 2005-2015

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 declined by 56 percent (from 148,805 to 65,370 admissions) between 2005 and 2015 [Table 3.1a].

In 2015, 89 percent of adolescent treatment admissions involved marijuana, that is, 89 percent of adolescent treatment admissions reported marijuana as a primary, secondary, or tertiary substance. Thirty-nine percent of the adolescent admissions that involved marijuana were referred to treatment by the court/criminal justice system [Table 3.4b].

• Heroin admissions and medication-assisted opioid therapy 2005-2015

The proportion of TEDS admissions for primary heroin abuse increased by 54 percent (from 260,902 to 401,743 admissions) between 2005 and 2015 [Table 3.5b].

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) increased from 30 percent in 2005 to 37 percent in 2015 [Table 3.7b].⁷

• Racial/ethnic subgroups

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol (alcohol only and alcohol with other drugs combined) was the predominant substance for all racial/ethnic groups except non-Hispanic Whites, where opiates were the predominant substances, and persons of Puerto Rican origin, where the predominant substance was heroin [Table 2.2b].

• 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].

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 56 percent from 2005 to 2015.

• Two primary substances—marijuana and alcohol—accounted for between 83 and 87 percent of adolescent admissions each year from 2005 to 2015.
• Marijuana admissions increased from 65 percent of adolescent admissions in 2005 to 76 percent in 2015; however, the total number of adolescent marijuana admissions decreased by 48 percent (from 96,129 to 49,730 admissions) between 2005 and 2015.
• Alcohol admissions declined from 18 percent of adolescent admissions in 2005 to 11 percent in 2015.
• Stimulants (methamphetamine/amphetamine) admissions decreased from 6 percent in 2005 to 4 percent in 2015.
• Opiate admissions represented 2 percent of adolescent admissions from 2005 to 2008 and 3 to 4 percent from 2009 to 2015.
  • Opiates other than heroin⁸ represented 48 percent of adolescent opiate admissions in 2005 and increased to 68 percent in 2010 but fell to 39 percent in 2015.
  • Heroin represented 52 percent of adolescent opiate admissions in 2005 and decreased to 32 percent in 2010 but increased to 61 percent in 2015.
• Cocaine adolescent admissions decreased from about 3 percent in 2005 and 2006 to less than 1 percent of adolescent admissions in 2015.
• All other substances combined accounted for 2 to 3 percent of adolescent admissions between 2005 and 2015.
  

Table 3.2b.In 2015, overall, 69 percent of adolescent admissions were male, a proportion heavily influenced by the 74 percent of marijuana/hashish admissions that were male. The proportion of female admissions was greater than 30 percent for most substances other than marijuana/hashish. Among adolescent admissions, the two primary substances that had a higher proportion of females to males were heroin (59 percent female) and methamphetamine/amphetamines (56 percent female).

Forty-three percent of adolescent admissions were non-Hispanic White, 27 percent were of Hispanic origin, 17 percent were non-Hispanic Black, and 13 percent were of other racial/ethnic groups.

Table 3.3b. The proportion of adolescent admissions increased with age, from 1 percent of these admissions who were 12 years old at admission to 33 percent who were 17 years old. Among admissions for inhalants and alcohol only, 15 and 12 percent, respectively, were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 67 percent and 49 percent, respectively, were age 17.

In 2015, 43 percent of adolescent admissions were referred to treatment by the court/criminal justice system, 20 percent were self or individual referrals, and 13 percent were referred through schools.

Table 3.4b and Figure 20.An admission was considered marijuana-involved if marijuana/hashish was reported as a primary, secondary, or tertiary substance. In 2005, 45 percent of all adolescent admissions were marijuana involved and referred to treatment by the court/criminal justice system, and 39 percent were marijuana involved but referred by other sources. By 2015, the proportion of all adolescent admissions that were marijuana involved and referred by the court/criminal justice system had decreased to 39 percent, while the proportion that were marijuana involved and referred by other sources had increased to 49 percent.

The proportion of adolescent admissions not involving marijuana that were referred by the court/criminal justice system fell from 7 percent in 2005 to 4 percent in 2015. Admissions not involving marijuana that were referred from other sources fluctuated between 7 and 10 percent of adolescent admissions between 2005 and 2015.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

The proportion of primary heroin admissions aged 12 and older was relatively consistent from 2005 through 2011, accounting for 14 to 15 percent of TEDS admissions in those years, but the proportion rose to 17 percent in 2012, 22 percent in 2014, and 26 percent in 2015 [Table 1.1b]. In 2015, injection was reported as the usual route of administration by 68 percent of primary heroin admissions; 25 percent of primary heroin admissions reported inhalation as the usual route of administration, and 5 percent reported smoking [Table 2.4b]. From 2005 to 2015, the largest proportion of primary heroin admissions were 20 to 34 years of age (42 to 59 percent from 2005 through 2015) [Table 3.5b].

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

Table 3.5b and Figure 21. TEDS data show a general increase in heroin admissions among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions generally declined from 2005 to 2015.

• From 2005 to 2015, the proportion of primary heroin admissions that were non-Hispanic White aged 20 to 34 increased from 28 to 46 percent. The proportion of primary heroin admissions that were non-Hispanic White aged 35 to 44 ranged from 9 to 12 percent, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained relatively 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 generally decreased. The principal decrease was in non-Hispanic Black admissions aged 35 to 44, which fell from 10 percent in 2005 to 3 percent in 2015. However, non-Hispanic Black admissions aged 20 to 34 decreased from 4 percent to 2 percent between 2005 and 2015, while the proportion aged 45 years and older fluctuated between 7 and 11 percent from 2005 to 2015. Non-Hispanic Black admissions aged 12 to 19 accounted for 0.1 percent or less of all primary heroin admissions from 2005 to 2015.
  

Table 3.6b and Figure 22.

• In 2005, over 1 in 4 primary heroin admissions (29 percent) were injectors aged 20 to 34, 17 percent were injectors aged 35 to 44, and 15 percent were injectors aged 45 and older. By 2015, almost 1 in 2 primary heroin admissions (43 percent) were injectors aged 20 to 34, but the proportion that were injectors aged 35 to 44 had decreased to 13 percent, and the proportion that were injectors aged 45 and older had declined to 11 percent.
• The proportion of primary heroin admissions that were inhalers aged 20 to 34 decreased from 11 percent in 2005 to 9 percent in 2015, and the proportion who were inhalers aged 35 to 44 fell from 13 percent in 2005 to 5 percent in 2015, while the proportion that were inhalers aged 45 and older fluctuated between 8 percent and 10 percent from 2005 through 2015.
  
  

Table 3.7b and Figures 23 and 24. Planned use of medication-assisted opioid therapy (MAT, i.e., opioid therapy using methadone or buprenorphine) declined among primary heroin admissions between 2005 and 2014 from 30 percent to 28 percent but increased sharply to 37 percent in 2015.

• Table 3.7b and Figure 23. In 2005, 30 percent of primary heroin admissions overall had treatment plans that included MAT, although the proportion varied by route of administration: 36 percent of heroin smokers, 31 percent of heroin injectors, and 28 percent of heroin inhalers. By 2015, 37 percent of primary heroin admissions had treatment plans that included MAT, with 42 percent being heroin inhalers, 36 percent being heroin smokers, and 35 percent being heroin injectors (see footnote 7 above).
  

• Table 3.7b and Figure 24. Older primary heroin admissions were most likely to have MAT planned. In 2005, MAT was planned for 42 percent of primary heroin admissions aged 45 and older, 31 percent of those aged 35 to 44, 24 percent of those aged 20 to 34, and 11 percent of those aged 12 to 19. The proportions changed for all age groups in 2015: MAT was planned for 54 percent of primary heroin admissions aged 45 and older, 40 percent of those aged 35 to 44, 30 percent of those aged 20 to 34, and 18 percent of those aged 12 to 19.
  

Racial/Ethnic Subgroups

Table 2.3c and Figures 25-30. TEDS data indicate that patterns of primary substance use differed widely in 2015 among not only racial/ethnic subgroups, but country of origin among Hispanic admissions, and gender within subgroups.

Figure 25.

• Among non-Hispanic White male admissions, alcohol was the most frequently reported primary substance (37 percent; 22 percent reported alcohol only and 15 percent reported alcohol with secondary drug). Next were heroin (28 percent), marijuana/hashish (10 percent), non-heroin opiates (9 percent), methamphetamine/amphetamines (8 percent), and smoked cocaine (1 percent).
• Among non-Hispanic White female admissions, heroin was the most frequently reported primary substance (30 percent). Next were alcohol (28 percent; 17 percent reported alcohol only and 11 percent reported alcohol with secondary drug), non-heroin opiates (14 percent), methamphetamine/amphetamines (12 percent), marijuana/hashish (8 percent), and smoked cocaine (2 percent).
  

Figure 26.

• Among non-Hispanic Black male admissions, alcohol was the most frequently reported primary substance (35 percent; 15 percent reported alcohol only and 20 percent reported alcohol with secondary drug). Next were marijuana/hashish (26 percent), heroin (19 percent), smoked cocaine (8 percent), and non-smoked cocaine (3 percent).
• Among non-Hispanic Black female admissions, alcohol was the most frequently reported primary substance (27 percent; 12 percent reported alcohol only and 15 percent reported alcohol with secondary drug). Next were heroin (25 percent), marijuana/hashish (20 percent), smoked cocaine (12 percent), and non-heroin opiates (5 percent).
• Primary methamphetamine/amphetamine abuse was reported by 3 percent of non-Hispanic Black female admissions and 2 percent of non-Hispanic Black male admissions.
  

Figure 27.

• Among male admissions of Mexican origin, alcohol was the most frequently reported primary substance (39 percent; 24 reported alcohol only and 15 percent reported alcohol with secondary drug). Next were marijuana/hashish (21 percent), methamphetamine/amphetamines (19 percent), and heroin (16 percent).
• Among female admissions of Mexican origin, methamphetamine/amphetamines were the most commonly reported primary substance (35 percent). Next were alcohol (24 percent; 13 percent reported alcohol only and 11 percent reported alcohol with secondary drug), marijuana/hashish (17 percent), and heroin (15 percent).

Figure 28.

• Among male admissions of Puerto Rican origin, heroin (48 percent) was the most frequently reported primary substance. Next were alcohol (26 percent; 11 percent reported alcohol only and 15 percent reported alcohol with secondary drug), marijuana (14 percent), and non-smoked cocaine and non-heroin opiates (3 percent each).
• Among female admissions of Puerto Rican origin, heroin (38 percent) was the most frequently reported primary substance. Next were alcohol (24 percent; 11 percent reported alcohol only and 12 percent reported alcohol with secondary drug), marijuana/hashish (18 percent), smoked cocaine and non-heroin opiates (5 percent each), and non-smoked cocaine (3 percent).
  

Figure 29. Note: Only 2 percent of all TEDS admissions were American Indians/Alaska Natives [Table 2.2b].

• Among American Indian/Alaska Native male admissions, alcohol was the most frequently reported primary substance (64 percent; 39 percent reported alcohol only and 24 percent reported alcohol with secondary drug). Next were marijuana/hashish (13 percent), methamphetamine/amphetamines and heroin (8 percent each), and non-heroin opiates (5 percent).
• Among American Indian/Alaska Native female admissions, alcohol was the most frequently reported primary substance (45 percent; 25 percent reported alcohol only and 19 percent reported alcohol with secondary drug). Next were methamphetamine/amphetamines (17 percent), heroin (13 percent), marijuana/hashish (11 percent), and non-heroin opiates (10 percent).
  

Figure 30. Note: Only 1 percent of all TEDS admissions were Asian/Pacific Islanders [Table 2.2b].

• Among Asian/Pacific Islander male admissions, alcohol was the most commonly reported primary substance (34 percent; 22 percent reported alcohol only and 12 percent reported alcohol with secondary drug). Next were methamphetamine/amphetamines (22 percent), marijuana/hashish (19 percent), and heroin (13 percent).
• Among Asian/Pacific Islander female admissions, alcohol (27 percent; 16 percent reported alcohol only and 11 percent reported alcohol with secondary drug) was the most commonly reported primary substance. Next were methamphetamine/amphetamines (25 percent), marijuana/hashish (17 percent), heroin (15 percent), and non-heroin opiates (7 percent).

Polydrug Abuse

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

Tables 1.1 and 3.8 and Figure 31. Polydrug abuse was reported by 54 percent of TEDS admissions aged 12 or older in 2015. Marijuana/hashish, alcohol, and non-smoked 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-four percent of all treatment admissions were for primary alcohol abuse, and 15 percent of admissions for primary illicit drug abuse reported that they also had an alcohol problem. Overall, 49 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. Forty-four percent of all admissions involved opiate abuse, with 34 percent reporting primary abuse and 10 percent reporting secondary or tertiary abuse. Fifteen percent of all admissions reported methamphetamine/amphetamine abuse, with 9 percent reporting primary abuse and 6 percent reporting secondary or tertiary abuse.
• Marijuana/hashish and cocaine were reported more often as secondary or tertiary substances than as primary substances. Marijuana/hashish was reported as a primary substance by 14 percent of all admissions, but was a secondary or tertiary substance for another 20 percent, resulting in 34 percent of all treatment admissions reporting marijuana/hashish as a substance of abuse. Cocaine was a primary substance for 5 percent of admissions, but was a secondary or tertiary substance for an additional 13 percent. Thus 18 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, 14 percent reported abuse of alcohol and marijuana/hashish but no other drugs, and 4 percent reported primary abuse of alcohol with abuse of cocaine and marijuana/hashish as secondary and tertiary substances.

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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 treatment 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 treatment services detailed in this report includes:

• 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 4.1c. The type of treatment service received was associated with primary substance of abuse.

• Ambulatory treatment services accounted for 49 percent of all admissions (38 percent in outpatient treatment and 12 percent in intensive outpatient treatment). Admissions for marijuana/hashish and methamphetamine/amphetamines were more likely to receive ambulatory services (85 percent and 59 percent, respectively) than all admissions combined.
• 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). Admissions for tranquilizers and opiates were about equally likely to receive detoxification or ambulatory treatment (for tranquilizers, 37 and 35 percent, respectively; for opiates, 25 and 27 percent, respectively). Admissions for marijuana rarely received detoxification (3 percent).
• Rehabilitation/residential treatment accounted for 16 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 methamphetamine/amphetamines, cocaine, and tranquilizers (29, 27, and 20 percent, respectively) were more likely to receive rehabilitation/residential treatment services than all admissions combined (16 percent).
• Medication-assisted opioid therapy accounted for about 13 percent of all admissions (11 percent in outpatient treatment, 1 percent each in detoxification and in residential treatment). Medication-assisted opioid therapy was planned for 35 percent of admissions for opiates.

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

• Nearly one-half of ambulatory admissions were referred by the court/criminal justice system (48 percent in outpatient treatment, and 41 percent in intensive outpatient treatment), and one quarter were self or individual referrals (25 percent and 28 percent in outpatient and intensive outpatient treatment, respectively).
• Over fifty percent or more of detoxification admissions (81 percent in hospital inpatient treatment, 60 percent in free-standing residential treatment, and 58 percent in ambulatory treatment) were self or individual referrals.
• Short-term rehabilitation/residential admissions were most commonly self or individual referrals (35 percent) or substance abuse care provider referrals (26 percent). Long-term rehabilitation/residential treatment admissions were most commonly referred by the court/criminal justice system (36 percent) or were self or individual referrals (28 percent). About half (48 percent) of hospital admissions were self or individual referrals.
• About three-quarters of admissions receiving detoxification or outpatient medication-assisted opioid therapy were self or individual referrals (79 and 76 percent, respectively).
  
  

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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 Linked Discharge Data Set. The TEDS Admissions Data Set includes client-level data on substance abuse treatment admissions from 1992 through the present. The TEDS Linked Discharge Data Set is 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
• Type of treatment service, 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 2015. 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 2005 through 2015, 89 percent of all records submitted were client admissions, 10 percent were client transfers, and less than 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 2015. 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 2015, methamphetamine constituted about 94 percent of combined methamphetamine/amphetamine admissions.Texas, which has a large number of methamphetamine admissions, reported them as Other amphetamines until 2006.
• For this report, secondary and tertiary substances (see Appendix B) are grouped and referred to as secondary substances.
• Significant changes in the clients or facilities reported to TEDS by some states and jurisdictions can result in changes in the number of admissions large enough to influence trends.

TO TABLES

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TEDS Minimum Data Set
TEDS Supplemental Data Set

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

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

• 0—Indicates a newborn with a substance dependency problem
• 1-95—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
• 1-95—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
• 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
• Hallucinogens—Includes LSD, DMT, STP, hallucinogens, mescaline, peyote, psilocybin, etc.
• 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 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 TREAMENT 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.

• 00-96—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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This report was prepared by Synectics for Management Decisions, Inc., and by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (HHS). Work was performed under Contract No. HHSS283200700048I/HHSS28342001T.

Production of the report at SAMHSA was managed by Cathie Alderks. SAMHSA contributors and reviewers, listed alphabetically, include: Cathie Alderks, Herman Alvarado, Elizabeth Hoeffel, Heydy Juarez, and Sharon Liu.

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