Banner image for CBHSQ Data Review, Center for Behavioral Health Statistics and Quality
April 2014

Comparing and Evaluating Substance Use Treatment Utilization Estimates from the National Survey on Drug Use and Health and Other Data Sources

Authors
Kathryn Batts, Michael Pemberton, Jonaki Bose, Belinda Weimer, Leigh Henderson, Michael Penne, Joseph Gfroerer, Deborah Trunzo, Alex Strashny

Abstract
This report presents an evaluation of the coverage, overlap, biases, strengths, and weaknesses of three sources of data on the receipt of specialty substance use treatment: the National Survey on Drug Use and Health (NSDUH), the National Survey of Substance Abuse Treatment Services (N-SSATS), and the Treatment Episode Data Set (TEDS). NSDUH is an annual survey of a representative sample of persons aged 12 or older at their places of residence. N-SSATS is an annual census of all known drug and alcohol abuse treatment facilities in the United States. TEDS is a compilation of data detailing the demographic and substance use characteristics of admissions to and discharges from substance use treatment. Methodological differences among these data sources that may contribute to differences in estimates are described. Specialty substance use treatment measures compared include numbers and characteristics of persons treated in a given year, single-day treatment counts, numbers of admissions in a given year, and estimates of the numbers of persons who needed substance use treatment but did not receive it.

NSDUH estimates of persons treated in a given year were significantly higher than the estimate from TEDS. Single-day treatment counts from NSDUH were similar to those from N-SSATS, and both were significantly higher than those from TEDS. N-SSATS counts of annual admissions were significantly higher than counts derived from TEDS data. The consistently lower counts in TEDS appear to be due to coverage differences in the three data systems. TEDS is mainly limited to those persons whose treatment was publicly funded, whereas N-SSATS includes a census of all facilities regardless of funding, and NSDUH includes persons who are treated in both privately and publicly funded facilities.

Precise agreement among the data sources is not expected, and this lack of agreement does not reduce the importance of NSDUH, N-SSATS, and TEDS in contributing to our understanding of specialty substance use treatment in the United States. The analyses presented in this report provide a strong basis for improving the interpretation of results from these three studies. This will facilitate developing clear guidance for future analyses to better answer some basic questions about substance use treatment, such as how many persons receive treatment in a year, how large is the gap between treatment received and treatment needed, and how have the numbers of persons receiving and needing treatment changed over time.

1. Introduction


This report presents an evaluation of the coverage, overlap, biases, strengths, and weaknesses of three sources of data on the receipt of substance use treatment. These data sources are managed by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ). Substance use treatment includes treatment for alcohol, illicit drugs, or both alcohol and illicit drugs. The three data sources include the following:

The overall objective of the analyses presented in this report is to improve the understanding of the information on substance use treatment from these three data sources and to inform future reporting of results and uses of the data. NSDUH, TEDS, and N-SSATS differ in their intended goals and in their methods of data collection. A clear understanding of the differences between these three data systems, as well as their strengths and limitations, is necessary in order to maximize the usefulness of the systems and ensure the accurate interpretation of findings related to the number of persons who receive substance use treatment. The specific goals of this study are to

Most comparisons of the three data sets in this report are based on consideration of treatment in specialty substance use treatment facilities. Multiple measures of treatment receipt are examined, including treatment within the past year, treatment for the first time within a given year, single-day counts of the number of persons in treatment, and admissions to treatment in a 12-month period.

1.1. Background

Substance use disorder (alcohol or drug dependence or abuse) is a serious public health threat in the United States and is associated with psychosocial and legal problems, such as mental and physical health conditions, lower educational attainment, underemployment or unemployment, involvement with the criminal justice system, victimization by and perpetration of violence, and homelessness (Chermack, Fuller, & Blow, 2000; Hser, Hoffman, Grella, & Anglin, 2001; Kubiak, Arfken, Swartz, & Koch, 2006; Mansell et al., 2006; Mertens, Lu, Parthasarathy, Moore, & Weisner, 2003; Stein, Dixon, & Nyamathi, 2008; CBHSQ, 2012). Substance use treatment has been shown to be effective in reducing substance use and can produce positive psychosocial and physical outcomes for persons who receive it (O'Brien & McLellan, 1996). In general, persons with substance dependence who receive treatment have been found to experience less disability related to substance use in their lifetime than untreated persons (Hasin, Stinson, Ogburn, & Grant, 2007). Given the public health implications of substance use treatment, obtaining accurate counts of the number of persons who need and receive substance use treatment is critical.

1.2. Overview of Data Sources

1.2.1 NSDUH

NSDUH, formerly called the National Household Survey on Drug Abuse (NHSDA), is the Federal Government's primary source of information on the nature and extent of substance use and abuse in the United States. Conducted since 1971, the survey collects data by administering questionnaires to a representative sample of persons aged 12 or older at their places of residence. The survey is sponsored by SAMHSA and is planned and managed by CBHSQ. Data collection is currently conducted under contract with RTI International, Research Triangle Park, North Carolina.1 Approximately 67,500 persons are surveyed each year through face-to-face interviews. Data from the survey are used extensively by policymakers and researchers to measure the prevalence and correlates of licit and illicit substance use; to identify and monitor trends in substance use, treatment need, and treatment; and to analyze differences in substance use patterns by population subgroups. NSDUH also collects data on mental disorders and mental health treatment. This section briefly describes the survey methodology; Appendix A provides a more complete description. Reports on results from NSDUH data are available on the SAMHSA Web site (http://www.samhsa.gov/data/NSDUH.aspx).

NSDUH collects information from residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases. The survey excludes homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals.

From 1971 through 1998, the survey used paper-and-pencil data collection. Since 1999, the NSDUH interview has been carried out in English or Spanish using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential mode for responding to questions in order to increase the level of honest responses to questions about illicit drug use and other sensitive behaviors. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).

This review uses NSDUH data collected in the 6-year period from 2005 through 2010. Multiple years of data were used in order to provide a sufficient sample size to produce estimates for demographic subgroups. During those years, NSDUH employed a State-based design with an independent, multistage area probability sample within each State and the District of Columbia. The 8 States with the largest populations (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas, which together account for about half of the total U.S. population aged 12 or older) were designated as "large sample States" and had an annual sample size of about 3,600 respondents each. For the remaining 42 States and the District of Columbia, the annual sample size was about 900 respondents per State. The design oversampled adolescents aged 12 to 17 and young adults aged 18 to 25.

A 5-minute screening procedure using a handheld computer involves listing all household members along with their basic demographic data. Depending on the composition of the household, zero to two persons in each household are selected for an interview. The household screening response rates for the survey years 2005 to 2010 ranged from 88.8 percent in 2010 to 91.3 percent in 2005. Interview response rates for persons aged 12 to 17 ranged from 84.8 percent in 2007 to 87.1 percent in 2005; interview response rates for persons aged 18 to 25 ranged from 79.8 percent in 2007 to 83.1 percent in 2005; and interview response rates of persons aged 26 or older ranged from 71.4 percent in 2005 to 73.5 percent in 2007. Appendix B of the 2012 NSDUH report on national findings discusses how NSDUH response rates are calculated (see CBHSQ, 2013).

Because of the change in interviewing mode in 1999, the estimates from the pre-1999 surveys are not comparable with estimates from the current CAI-based surveys. Although the design of the 2002 through 2010 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are also important methodological differences that affect the comparability of the 2002 to 2010 estimates with estimates from prior surveys. The most important change was the incentive payment that started in 2002 and continued in subsequent surveys. Each NSDUH respondent completing the interview is given $30. Also, the name of the survey was changed in 2002, from National Household Survey on Drug Abuse (NHSDA) to National Survey on Drug Use and Health (NSDUH). Improved data collection quality control procedures were introduced in the survey starting in 2001, and updated population data from the 2000 decennial census were incorporated into the sample weights beginning with the 2002 estimates. Analyses of the effects of these factors on NSDUH estimates have shown that 2002 and later data should not be compared with 2001 and earlier data from the survey series to assess changes over time. Appendix C of the 2004 NSDUH report on national findings discusses these changes to the survey in more detail (see OAS, 2005).

NSDUH questions about receipt of substance use treatment are asked of all respondents who report having used alcohol or an illicit substance at least once during their lives. In addition to alcohol, the illicit drugs include the following:

Data analyzed in this report include those from interviews completed with persons aged 12 or older in the 2005, 2006, 2007, 2008, 2009, and 2010 NSDUHs. Approximately 406,900 completed interviews were obtained from persons aged 12 or older in the 2005 to 2010 NSDUHs.

1.2.2 TEDS

TEDS is a compilation of data detailing the demographic and substance use characteristics of admissions to and discharges from substance use treatment. TEDS is part of the Behavioral Health Services Information System (BHSIS), formerly known as the Drug and Alcohol Services Information System (DASIS), a cooperative program among SAMHSA and State substance abuse agencies to collect data on substance use treatment services. BHSIS is coordinated and managed by CBHSQ. TEDS data collection and analysis are currently conducted under contract with Synectics for Management Decisions, Inc. This data collection effort was developed in response to the 1988 Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690), which established a revised Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and mandated Federal data collection on clients receiving treatment for either alcohol or drug abuse. This section briefly describes the data collection methodology; Appendix A provides a more complete description. Reports on results from TEDS data are available on the SAMHSA Web site (http://www.samhsa.gov/data/DASIS.aspx?qr=t#TEDS).

The TEDS system comprises two major components—the Admissions Data Set and the Discharge Data Set—which are linked at the record level for approximately 85 percent of admissions included in these analyses. Information on substance use treatment admissions and discharges that State administrative systems routinely collect is submitted to TEDS in a standard format on a monthly or quarterly schedule. Data are reported on approximately 2 million annual admissions to treatment by approximately 10,000 facilities, programs, or administrative units in the 50 States, the District of Columbia, and Puerto Rico.

The scope of facilities included in TEDS is affected by differences in State licensure, certification, and accreditation practices, as well as disbursement of public funds. Most State substance abuse agencies require facilities that receive any State/public funding (including Federal block grant funds) for the provision of alcohol and/or drug treatment services to report TEDS data to the State. States differ widely in the amount of public funding available for substance use treatment and in the constraints placed on the use of funds. Some State substance abuse agencies license or monitor facilities operating in their State that do not receive any public funding and also require them to report TEDS data. In States where not all facilities are required to report TEDS data, some facilities do so voluntarily. Facilities operated by Federal agencies (e.g., the Bureau of Prisons [BOP], the Department of Defense [DOD], and the Department of Veterans Affairs [VA]) generally do not report TEDS data to the State, although some facilities operated by the Indian Health Service (IHS) are included. Hospital-based substance use treatment facilities are frequently not licensed through the State substance abuse agency (Single State Authority [SSA]) and typically do not report TEDS data. To the extent that hospital-based facilities do report to TEDS, the records include those from specialty substance use treatment units within hospitals. Correctional facilities (State prisons and local jails) report TEDS data in some States but not in others. A table summarizing the State data system reporting characteristics for 2007, 2008, and 2009 is provided in Appendix A (see Table A.1).

The primary goal of TEDS is to monitor the characteristics of clients admitted to planned, continuing treatment regimens. Thus, TEDS excludes early intervention and crisis intervention programs that do not lead to enrollment in continued treatment.

This review focuses on TEDS data collected for the years 2007, 2008, and 2009. TEDS data used in this report are from the Admissions Minimum Data Set, a core set of data elements collected at admission by all States, and the Discharge Data Set, for which 44 States, the District of Columbia, and Puerto Rico reported clients discharged in 2007; 48 States, the District of Columbia, and Puerto Rico reported clients discharged in 2008; and 48 States, the District of Columbia, and Puerto Rico reported clients discharged in 2009. Ultimately, analyses were conducted on data from 47 States. Data from Alabama, Alaska, the District of Columbia, and Georgia were not included in these analyses because they submitted no or incomplete data for 1 or more of the 3 years analyzed. In order to establish as much comparability between TEDS and NSDUH as possible, data from Puerto Rico are not included in the estimates from TEDS shown in this report.

The TEDS Minimum Data Set includes the following information for each admission: date of admission; type of service; age; gender; race; ethnicity; number of prior treatment episodes; education; employment status; principal source of referral; primary, secondary, and tertiary substance problems and their usual route of administration, frequency of use, and age of first use; and planned use of medication-assisted opioid therapy. Information on use of primary, secondary, and tertiary problem substances is collected for the following substances:

TEDS observations represent admissions to or discharges from substance use treatment, not individuals. For example, one individual admitted to treatment twice within a calendar year would be counted as two separate admissions. For the purposes of comparability with the other data sets, we have used data from multiple years of the TEDS Admission Data Set, Discharge Data Set, and the unique person identifiers to produce estimates of the unduplicated number of persons who received treatment. Admission and discharge records linked by a unique identifier represent clients who had been both admitted and discharged. Admission records with no linked discharge should indicate that a client had been admitted but not yet discharged. However, because the discharge system was not fully operational in all States during the years examined, it was assumed that a number of these admissions had, in fact, been discharged. For each admission with no linked discharge, a probability of having been discharged was computed in order to provide estimates of the unduplicated number of persons who received treatment. More information on this is provided in Section 1.3 of this report.

1.2.3 N-SSATS

N-SSATS is an annual census of all known drug and alcohol abuse treatment facilities in the United States. N-SSATS, along with TEDS, is part of BHSIS, a cooperative program between SAMHSA and State substance use treatment agencies to collect data on substance abuse services. BHSIS is coordinated and managed by CBHSQ. N-SSATS data collection and analysis are currently conducted under contract with Synectics for Management Decisions, Inc., and Mathematica Policy Research, Inc.

N-SSATS is a paper/Web/telephone census designed to collect information from all facilities in the United States, both public and private, that provide substance use treatment. N-SSATS is designed to collect data on the location, characteristics, and utilization of services at public and private alcohol and drug use treatment facilities throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. N-SSATS provides a mechanism for tracking the changing character and composition of the U.S. substance use treatment delivery system. The N-SSATS questionnaire covers the characteristics of the treatment facility, including client payment sources, services provided, hospital and residential capacity, as well as the number of treatment admissions in the past 12 months and a single-day client census. The objective of the census is to collect multipurpose data that can be used to

This section briefly describes the survey methodology; Appendix A provides a more complete description. Reports on N-SSATS data are available on the SAMHSA Web site (http://www.samhsa.gov/data/DASIS.aspx).

This review focuses on N-SSATS data collected in the 3-year period from 2007 through 2009. N-SSATS collects data on approximately 14,000 facilities, with some 1.2 million clients in treatment on the survey reference date (the last working day of March) and 3.6 million admissions to treatment in the previous 12 months. Information is collected at the site of delivery of services rather than according to administrative structure. A Web-based version of the paper questionnaire was introduced in 2002. Participation using the Web-based survey has increased over the years; in 2007, about 40 percent of survey responses were submitted via the Web and in 2009 about 58 percent of surveys were completed on the Web.

Although N-SSATS is a voluntary census, response rates are consistently about 95 percent. The incentive for participation is the opportunity to be included in SAMHSA's online Substance Abuse Treatment Facility Locator and annual National Directory of Drug and Alcohol Treatment Services. This searchable directory of drug and alcohol treatment programs shows the location of facilities around the country that treat alcohol use and drug use problems.

1.2.4 Key Differences between Data Sources

NSDUH, TEDS, and N-SSATS have important differences in data collection methodology and inclusion or exclusion criteria that can affect the interpretation of data from these sources. Table 1.1 summarizes some key differences between these three data sources.

Table 1.1 Key Methodological Differences Related to Substance Use Treatment Data from NSDUH, TEDS, and N-SSATS
Category CBHSQ Data Sources
NSDUH TEDS N-SSATS
Methodology National household self-report survey of noninstitutionalized civilians who live in households Compilation of data on the demographic and substance use characteristics of admissions and discharges, primarily from publicly funded substance use treatment facilities Annual census of all known substance use treatment facilities
Unit of Analysis Individuals aged 12 or older Admission records and linked admission/discharge records Facilities
Time Frame Continuous and annual; includes persons in treatment during the past year, currently in treatment, and in treatment on October 1 of the year before the interview; age at first treatment Continuous and annual; data are submitted monthly or quarterly; back- or resubmissions are permitted Annual; includes single-day count of number of persons in treatment on the last working/business day in March of each year as well as count of admissions to treatment in the previous 12 months
Facility Type
Inclusions and
Exclusions
Includes self-reports of treatment received at:
  • public and private facilities
  • solo practices
  • IHS, DOD, and VA facilities if patient is living in a household at time of interview but not if institutionalized
  • For most States, only includes admissions to facilities receiving public funds
  • Does not include admissions to solo practices or facilities operated by DOD, VA, or BOP
  • Includes some facilities operated by IHS
  • Includes all known facilities
  • Does not include solo practices or facilities treating incarcerated clients only
  • Includes IHS, DOD, and VA facilities
  • In hospital settings, includes single-day treatment count of number of persons treated in specialty substance use treatment units, but not in other units/departments of the hospital
Substances
Included
  • Includes treatment for use of alcohol and illicit drugs, including nonmedical use of prescription-type drugs
  • Excludes over-the-counter drugs
  • Includes treatment for use of both illicit and prescription-type drugs as well as alcohol and over-the-counter substances
  • TEDS allows reporting of up to three "problem drugs" at the time of admission
  • Does not specify substances for which clients received treatment
  • Includes data on percentage of clients in treatment for alcohol problems, drug problems, or problems with both alcohol and drugs
  • Includes data on Opioid Treatment Programs, which specialize in the treatment of dependence on opioid drugs
NOTE: NSDUH = National Survey on Drug Use and Health; TEDS = Treatment Episode Data Set; N-SSATS = National Survey of Substance Abuse Treatment Services; CBHSQ = Center for Behavioral Health Statistics and Quality; IHS = Indian Health Service; DOD = Department of Defense; VA = Department of Veterans Affairs; BOP = Bureau of Prisons.

Data Collection Methodology/Unit of Analysis. NSDUH provides self-reported data at the person level among noninstitutionalized civilians who live in households. TEDS provides information at the admission level about the characteristics of persons served by (mainly) publicly funded programs; for the increasing number of States that submit unique individual identifiers, TEDS data can also be analyzed at the person or episode level. As mentioned previously, analyses in this report mainly focus on the person-level TEDS data. N-SSATS provides information at the facility level about characteristics of treatment facilities, their operations, a single-day client census, and an estimate of admissions in the previous 12 months.

Inclusion and Exclusion Criteria. All three data sources have differing inclusion and exclusion criteria. NSDUH collects data on treatment received at both public and private facilities, as well as treatment received from solo practitioners, whereas it excludes active duty military members and persons who do not live in households (homeless persons not in shelters and persons in institutions such as jails or prisons, hospitals, or residential treatment facilities) during the majority of the quarter of the year in which they were interviewed. The facilities that report TEDS data are primarily those that receive State alcohol and/or drug agency funds for the provision of drug or alcohol services. These facilities often do not include facilities that do not receive funding through the SSA, IHS facilities, or hospital-based programs. TEDS does not include VA and military treatment facilities or Federal prisons. N-SSATS is a voluntary census with a very high response rate that includes IHS, DOD, and VA facilities but excludes most solo practitioners and facilities in jails, prisons, or other correctional facilities that exclusively treat incarcerated clients. These variations should be considered when interpreting differences in substance use treatment data between these data sources or when specific subgroups are being considered for analysis.

Seasonal Variation. Because of differences in reference dates used to compute the NSDUH estimates and TEDS/N-SSATS counts, it is possible that differences between TEDS/N-SSATS and NSDUH in the single-day counts may reflect seasonal variation in treatment utilization. Chapter 2 of this report includes analyses of the seasonality of admissions based on TEDS data and a discussion of this topic.

1.3. Measures of Receipt of and Need for Substance Use Treatment

This section provides descriptions of measures of substance use treatment receipt and need for treatment from NSDUH, TEDS, and N-SSATS that are included in this report. Three main measures of receiving substance use treatment were examined—total number of persons receiving substance use treatment in a given year, average number of persons receiving treatment on a single day in a given year, and total number of substance use treatment admissions in a given year. All three data sets allow for classification of persons who received alcohol treatment only, drug treatment only, or both alcohol and drug treatment. Among those who received alcohol and drug treatment, NSDUH and TEDS allow for the identification of which substances (alcohol or drugs) were the primary and secondary reasons for treatment.

In addition to the total number of persons who received treatment in a given year, another important measure when tracking changes in substance use treatment is the number of persons who received treatment for the first time in a given year. Both the NSDUH and TEDS provide information that allows for the estimation of the number of persons who received substance use treatment for the first time in a given year.

1.3.1 Receipt of Substance Use Treatment in the Past Year

NSDUH and TEDS data were used to derive estimates of the number of persons in specialty treatment in the past year.

NSDUH. The NSDUH measure of receipt of substance use treatment in the past year is derived from a series of questions about treatment received for alcohol use or illicit drug use (including the nonmedical use of prescription type drugs). NSDUH asks about treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Persons could report having received treatment at more than one location. For comparison purposes, this report focuses only on "specialty treatment," or treatment for substance use at a specialty treatment facility. Specialty treatment is defined as treatment received at any of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. The definition of specialty treatment does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient.

TEDS. TEDS data provide an overall count of the annual number of admissions for substance use treatment at facilities including outpatient, residential, and hospital inpatient facilities. The total number of persons admitted to treatment in a calendar year and the total number of persons who received treatment in a calendar year (including those who were admitted to treatment in a prior year but remained in treatment during the target year) were determined using the unique person identifier and linked admission and discharge data or, if there was no unique identifier, they were estimated using the probabilities of discharge prior to the start of the reference year. A unique identifier was defined as having a unique combination of State of residence, client ID, age, gender, and race/ethnicity. Multiple treatment episodes in a given year linked by a single unique identifier were counted as one person. For those admissions with no linked admission and discharge data, no attempt was made to account for multiple admissions by a single individual, which means that the annual count of persons who received treatment may be an overcount. Records for codependents (persons who do not have a substance use disorder but who receive treatment because a loved one has a substance use disorder) were excluded.

For the count of the number of persons receiving treatment in the past year, records were used for persons admitted on or before December 31 of that year and discharged on or after January 1 of that year. Each estimate is made up of two parts: (1) a direct count from linked admission/discharge records and (2) an estimate, based on the probability of being in treatment on January 1 of the given year if admitted in a different year, for those admissions not linked to discharges. For States with linked admissions and discharge data, this algorithm should identify any client who has been admitted and not yet discharged. However, because the discharge system was not fully operative in all States for the years we examined, it can be assumed that a number of these admissions without linked discharges had, in fact, been discharged. Therefore, a probability of having been discharged by each reference date (January 1) was computed for each unlinked admission record, based on the assumption that the unlinked admission records would have the same probability of being discharged on a given day following treatment as the linked admission records. The probability of being in treatment on the reference date was calculated as 1 minus the cumulative frequency. That is, if 0.34 (34 percent) of clients had been discharged by day 10, then a record with date of admission 10 days before the reference date had a 1.00 − 0.34 = 0.66 (66 percent) chance of being in treatment on the reference date. Probabilities of being in treatment were summed for each reference date. Thus, if 100 clients were admitted 10 days before the reference date, each would have a probability of 0.66, yielding a total of 66 clients likely to be in treatment on the reference date.

N-SSATS. N-SSATS data provide an overall count of the annual number of admissions for substance use treatment at all substance use treatment facilities that respond to the census and cannot be used to determine the number of persons who received treatment services in the prior 12 months.

1.3.2 Single-Day Counts of the Number of Persons in Drug or Alcohol Treatment

All three sources of data were used to derive single-data counts or estimates of the number of persons in drug or alcohol treatment.

NSDUH. For this report, two different estimates of the number of persons in specialty substance use treatment (i.e., substance use treatment received from a hospitals [inpatient only], drug or alcohol rehabilitation facility [inpatient or outpatient], or mental health center) on a single day were derived from NSDUH. One estimate was based on whether a respondent reported current treatment at the time of the survey.2 Respondents who indicated that they had received specialty alcohol or drug treatment in the past year were asked if, at the time of the survey, they were currently receiving treatment for alcohol or drug use. The second measure of single-day treatment counts was derived from a question in which respondents who had received drug or alcohol treatment in their lifetime were asked if they had been enrolled in a treatment program at a hospital, drug rehabilitation facility, or mental health center on October 1 of the year prior to the survey. From this question, an estimate was derived of the number of persons in treatment on that specific day.

TEDS. For this report, estimates were computed for the number of clients in treatment on the last working day in March each year from 2007 to 2009 (March 30, 2007; March 31, 2008; and March 31, 2009) using linked admission and discharge records from TEDS data processed through October 10, 2011. Records for codependents (persons who do not have a substance use disorder but who receive treatment because a loved one has a substance use disorder) were excluded. The last working day of March was selected for these counts in order to be as consistent as possible with the counts provided by the N-SSATS data. Counts included total clients and the numbers of clients by treatment for alcohol only, drugs only, alcohol and drugs, primary alcohol/secondary drug, and primary drug/secondary alcohol. Admission records with date of admission on or after January 1, 2000, were included. Even though annual averages for 2007 to 2009 are presented in the report, as a data quality check, estimates for reference dates of the last working day in March were calculated for each year from 2000 to 2008 to check that this method yielded plausible data even when discharge records were sparse.

Estimates comprised the sum of two parts:

  1. Linked records representing clients who had been both admitted and discharged. The number of clients who were admitted on or before the reference date and discharged on or after the reference date was calculated.
  2. Admissions records with no linked discharge. This situation should indicate that a client has been admitted and not yet discharged. However, because the discharge system was not fully operative in all States for the years we examined, it can be assumed that a number of these admissions without linked discharges had, in fact, been discharged. Therefore, a probability of having been discharged by each reference date was computed for each unlinked admission record, based on the assumption that the unlinked admission records would have the same probability of being discharged on a given day following treatment as the linked admission records. The probability of being in treatment on the reference date was calculated as 1 minus the cumulative frequency. That is, if 0.34 (34 percent) of clients had been discharged by day 10, then a record with date of admission 10 days before the reference date had a 1.00 − 0.34 = 0.66 (66 percent) chance of being in treatment on the reference date. Probabilities of being in treatment were summed for each reference date. Thus, if 100 clients were admitted 10 days before the reference date, each would have a probability of 0.66, yielding a total of 66 clients likely to be in treatment on the reference date.

N-SSATS. The N-SSATS census provides a single-day count of the number of persons in hospital inpatient, residential (nonhospital), and outpatient substance use treatment on the last working day of March of each year. For outpatient clients, the count is the number of active clients; an active outpatient client is defined as someone who was seen at the facility for substance use treatment or detoxification at least once during the month of March and was still enrolled in treatment on the last working day of March.

1.3.3 Need for and Receipt of Substance Use Treatment

NSDUH. Using NSDUH data, an individual is defined as needing treatment for an alcohol or drug use problem if he or she met the diagnostic criteria for dependence on or abuse of alcohol or illicit drugs in the past 12 months specified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994), or if he or she received specialty treatment for alcohol use or illicit drug use in the past 12 months. The questions related to dependence ask about having health and emotional problems associated with substance use, making unsuccessful attempts to cut down on use, developing tolerance, experiencing withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law because of substance use. Dependence is considered to be a more severe substance use disorder than abuse because it involves the psychological and physiological effects of tolerance and withdrawal.

For the purpose of this study, individuals needing treatment for an illicit drug use problem are defined as receiving treatment for their drug use problem only if they reported receiving specialty treatment for drug use in the past year. Thus, individuals who needed treatment for illicit drug use but only received specialty treatment for alcohol use in the past year or who received treatment for illicit drug use only at a facility not classified as a specialty facility are not counted as receiving treatment for drug use. Similarly, individuals who needed treatment for an alcohol use problem are only counted as receiving alcohol use treatment if the treatment was received for alcohol use at a specialty treatment facility. Individuals who reported receiving specialty substance use treatment but are missing information on whether the treatment was specifically for alcohol use or drug use are not counted in estimates of specialty drug use treatment or in estimates of specialty alcohol use treatment; however, they are counted in estimates for "drug or alcohol use" treatment.

1.3.4 Admissions in a Given Year

Substance use disorders are chronic and remitting conditions that often require multiple treatment episodes before they are effectively managed. Annual admissions are another important measure of substance use treatment receipt. N-SSATS and TEDS data provide counts of the number of admissions to specialty treatment in a given year.

1.4. Demographic Variables

This section describes key measures of demographic and geographic characteristics that are presented in this report to compare the distributions of numbers of persons in treatment.

Comparisons between NSDUH and TEDS of the number of persons who received substance use treatment in the past year are presented by racial/ethnic group. Data are presented for racial/ethnic groups based on current guidelines for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997). Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the basic groups listed in the survey question (white, black or African American, American Indian or Alaska Native, Native Hawaiian, other Pacific Islander, Asian, other). Respondents choosing both the Native Hawaiian and the other Pacific Islander categories but none of the other categories are classified in the combined "Native Hawaiian or other Pacific Islander" category instead of the "two or more races" category. Except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in this report include only non-Hispanics; the category "Hispanic or Latino" includes Hispanics of any race. Data reported to TEDS3 allow for reporting of the same race/ethnicity categories included in NSDUH. Race and ethnicity data about clients are not collected as part of N-SSATS.

Comparisons of single-day treatment counts are presented for States and for four U.S. geographic regions. These regions and divisions, defined by the U.S. Census Bureau, consist of the following groups of States:

It should be noted that NSDUH States/geographic regions reflect where the respondents lived at the time they completed the survey, which is not necessarily the State or region in which they received substance use treatment during the past year. N-SSATS data give the facility location, which is not necessarily where the person receiving treatment lived. The geographic data in TEDS correspond to the location of the facility to which the person was admitted, but may also reflect the location of, for example, the administrative unit of a multicounty health service region.

NSDUH estimates of the number of persons who needed and received treatment are presented for those classified as having "low income." Individuals are classified as low income if their family income is less than 100 percent of the Federal poverty threshold. Poverty level is based on income level, size of family, number of children in family, and additional family relationships such as foster children.

1.5. Organization of This Report

This report contains separate chapters that provide estimates of persons receiving substance use treatment and persons needing but not receiving substance use treatment. Chapter 2 presents national, regional, and State estimates from the NSDUH, TEDS, and N-SSATS data about the numbers of persons receiving past year and single-day substance use treatment as well as total admissions to treatment, including a discussion of the variations in seasonality of substance use treatment admissions and comparisons between NSDUH and TEDS in the number of persons who received treatment for the first time. Chapter 3 focuses on national and State estimates of the number of adults who needed but did not receive substance use treatment, with a focus on a new technique of estimating this statistic by combining NSDUH and TEDS data. A final chapter discusses the information provided by these three data sources and how this information can be used to provide a better understanding of substance use treatment in this country and the current unmet need for treatment services.

Tables, text, and figures in this report present estimates of numbers of past year substance use treatment admissions, numbers of persons receiving treatment in the past year (including those admitted during the past year and those admitted prior to the past year), treatment outcomes, and numbers of persons needing but not receiving substance use treatment. In all tables and figures, estimates are presented based on data combined from 2 or more years to increase precision of the estimates; those estimates are annual averages based on multiple years of data.

Statistical tests have been conducted for all statements appearing in the text of the report that compare estimates between data sources (e.g., NSDUH vs. TEDS) or between subgroups within a given survey (e.g., by age group within NSDUH). Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level. Differences are described using terms such as "higher," "lower," "more likely," and "less likely." Statements that use terms such as "similar," "no difference," or "same" to describe the relationship between estimates denote that a difference is not statistically significant. In addition, a set of estimates for a given data source or for population subgroups may be presented without a statement of comparison; in these instances, a statistically significant difference between these estimates is not implied, and testing may not have been conducted.

All estimates presented in the report have met the criteria for statistical reliability. Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. Subgroups with suppressed estimates are not included in statistical tests of comparisons. Appendix B of the 2012 NSDUH report on national findings discusses these suppression criteria in more detail (see CBHSQ, 2013).

All statistical tables produced for this report are provided in Appendix C.

2. Comparisons between Data Sources in Receipt of Substance Use Treatment

This chapter presents comparisons of estimates of the number of persons who received substance use treatment from NSDUH, TEDS, and N-SSATS and counts of the number of substance use treatment admissions reported in TEDS and N-SSATS. The first section of this chapter presents estimates of the number of persons who received substance use treatment in a given year based on annual averages from 2005 to 2010 NSDUH data and combined 2007 to 2009 TEDS data. The second section presents estimates of the number of persons who received substance use treatment for the first time in the past year based on NSDUH and TEDS data. The third section presents estimates of single-day counts of the number of persons in treatment for alcohol use, drug use, or both alcohol and drug use, based on annual averages for combined 2008 to 2010 NSDUH, combined 2007 to 2009 TEDS, and combined 2007 to 2009 N-SSATS data. The fourth section presents counts of annual treatment admissions for 2007 through 2009, based on annual averages for counts from TEDS and N-SSATS. Combining data from multiple years increases the sample size to support detailed estimates and is particularly useful for examining demographic and geographic correlates of receipt of alcohol use and drug use treatment.

2.1. Number of Persons Who Received Treatment in the Past 12 Months

This section presents comparisons between NSDUH and TEDS estimates of the numbers and characteristics of persons who received substance use treatment in the past year.

2.1.1 NSDUH Estimates

Description of NSDUH Estimates

In NSDUH, estimates of the number of persons who received substance use treatment in the past year are based on self-reports of treatment received. So that NSDUH estimates would be more comparable to TEDS data, we have used NSDUH estimates of the number of persons who received treatment in the past year in a specialty treatment facility, which includes treatment received at any of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. Specialty treatment does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. Persons could report receiving treatment at more than one location; persons who reported receiving treatment from at least one specialty treatment location were counted as having received treatment at a specialty treatment facility. Likewise, persons could report receiving treatment for more than one type of substance (e.g., alcohol, marijuana, and cocaine).

NSDUH data can also be used to estimate the number of persons who received treatment in the past year at any location. This includes specialty treatment facilities, as defined previously, or nonspecialty treatment facilities, such as an emergency room, a private doctor's office, a prison or jail, or a self-help group such as Alcoholics Anonymous or Narcotics Anonymous. For comparison, we have included a table in Appendix C that provides estimates and percentages of persons who received substance use treatment at any location based on NSDUH data (see Table C.2.1AL).

Limitations of the NSDUH Estimates

NSDUH is a household survey that relies on the sampled respondents to provide accurate and honest reports of their substance use and substance use treatment experiences. The NSDUH sample is drawn to represent the noninstitutionalized population of the United States aged 12 or older. It excludes persons who are in jail or prison, persons who are in a hospital or residential treatment during the majority of the quarter when the survey is conducted, and homeless persons who do not reside in shelters.

2.1.2 TEDS Counts

Description of TEDS Counts

The TEDS counts of the number of persons who received past year substance use treatment are derived from linked admission and discharge records from specialty substance use treatment facilities. More specific information about how these counts are derived is provided in Section 1.3 of this report. Persons could receive treatment at more than one type of treatment facility during a given year. Likewise, TEDS records include up to three types of substances (e.g., alcohol, marijuana, and cocaine) that a person could have received treatment for.

Limitations of the TEDS Counts

TEDS does not include all admissions to substance use treatment. It typically includes admissions to facilities that are licensed or certified by an SSA to provide substance abuse treatment, as well as admissions that are administratively tracked for other reasons. TEDS typically does not include clients treated in a jail/prison not run with State agency-administered funds, emergency room, private doctor's office, or self-help group. As Section 1.2 notes, many States require only publicly funded facilities to report data to TEDS, and some States only require facilities to report TEDS data for patients for whom treatment is publicly funded. Also noted in Section 1.2, hospital inpatient substance use treatment facilities are frequently not licensed through the SSA and may not be required to report TEDS data. A detailed list of institutions/clients included or excluded in each State is provided in Table A.1 in Appendix A.

2.1.3 National Estimates

This section compares the numbers and demographic/treatment characteristics of persons who received substance use treatment services in a specialty treatment facility in the past year. Alabama, Alaska, the District of Columbia, and Georgia were excluded from TEDS estimates because no or incomplete TEDS data were submitted for 1 or more of the 3 years examined (2007 to 2009) in these areas. In addition to NSDUH estimates based on all 50 States plus the District of Columbia, NSDUH estimates were also restricted to the subset of 47 States that were used to generate TEDS estimates; these are referred to as the "TEDS States." These estimates are presented in Appendix C (Table C.2.1). The NSDUH estimate for all States is approximately 4.5 percent higher than the NSDUH estimate for the TEDS States. In terms of the total count/estimate of the number of persons who received substance use treatment from specialty treatment facilities in the past year, the NSDUH estimate for the TEDS States was greater than the TEDS count (2,357,118 vs. 1,928,578).

Treatment Characteristics

A comparison of the treatment characteristics of persons who received substance use treatment from a specialty facility in the past year also shows several differences between the two data sources. NSDUH estimates were higher than TEDS counts across the three principal modality categories (hospital inpatient, residential rehabilitation—inpatient, and outpatient). Although the NSDUH estimate and the TEDS count reflected a similar proportion of persons who received treatment in an outpatient setting (81.3 and 78.2 percent, respectively), the NSDUH estimate included a notably greater percentage of persons who received treatment in an inpatient hospital setting than the TEDS count (31.3 vs. 3.2 percent). The NSDUH estimate also reflected a greater percentage of persons who received treatment in a residential rehabilitation facility than the TEDS count (40.6 vs. 28.2 percent).

Figure 2.1 shows the percentages of persons treated for specific substances or substance groups. The percentage of persons in the NSDUH estimate who were treated for marijuana use problems was lower than the percentage in the TEDS count who reported marijuana as a problem drug at the time of treatment admission (30.9 vs. 39.7 percent for NSDUH TEDS States only and TEDS, respectively). The NSDUH estimates for TEDS States only included greater percentages of persons treated for prescription drugs, inhalants, hallucinogens, and alcohol than did the TEDS counts (26.3 vs. 12.5 percent for prescription drugs, 6.0 vs. 0.2 percent for inhalants, 10.9 vs. 0.6 percent for hallucinogens, and 69.3 vs. 59.5 percent for alcohol). One possible explanation for the difference between the percentage of persons treated for prescription drugs reflected in the NSDUH estimate and the TEDS count is that TEDS queries treatment for methamphetamine use as a separate category, whereas NSDUH includes treatment for methamphetamine use as treatment for prescription drugs. The NSDUH estimate included a lower proportion of injection drug users than the TEDS count did (7.3 vs. 12.4 percent; data not shown). Note that restricting the NSDUH findings to the TEDS States does not have an appreciable effect on the percentage of persons receiving treatment for any of the substances.

Figure 2.1 Distribution of Treatment for Specific Substances among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Bar chart comparing distribution of treatment for specific substances among persons who received treatment from specialty treatment programs in the past year: NSDUH 2005 to 2010 and TEDS 2007 to 2009.

Figure 2.1 Table. Distribution of Treatment for Specific Substances among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Source Alcohol Hallucinogens Inhalants Methamphet-
amine*
Prescription
Drugs
Heroin Cocaine
(Including
Crack)
Marijuana
NSDUH - All States (N = 2,464,150) 68.8% 11.0% 6.1%   26.7% 13.8% 25.8% 31.0%
NSDUH - TEDS States Only1 (N = 2,357,118) 69.3% 10.9% 6.0%   26.3% 14.0% 25.6% 30.9%
TEDS (N = 1,928,578) 59.5%   0.6% 0.2% 11.1% 12.5% 15.2% 25.3% 39.7%
* Treatment specifically for methamphetamine use is not measured in NSDUH.
1 TEDS States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005 to 2010; and Treatment Episode Data Set (TEDS), 2007 to 2009.
Demographic Characteristics

There was some variation between the treatment counts from the two data sources on several demographic characteristics. Figure 2.2 shows the distribution across age groups of persons receiving specialty treatment. The NSDUH estimate included a lower percentage of youths and a greater percentage of older persons. Specifically, in the NSDUH estimate, 6.4 percent were aged 12 to 17 (150,083 persons), and in the TEDS count, 8.8 percent were aged 12 to 17 (170,289 persons). In the NSDUH estimate, 29.0 percent were aged 45 or older (683,673 persons), and in the TEDS count, 22.5 percent were aged 45 or older (433,924 persons). The restriction of the NSDUH sample to include only the TEDS States did not affect the percentage distribution across age groups; the percentages of the four age groups were nearly identical for the full NSDUH sample and for the NSDUH TEDS States only sample.

Figure 2.2 Distribution of Age Groups among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Stacked bar chart comparing distribution of age groups among persons who received treatment from specialty treatment programs in the past year: NSDUH 2005 to 2010 and TEDS 2007 to 2009.

Figure 2.2 Table. Distribution of Age Groups among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Source Aged
45 or Older
Aged
35 to 44
Aged
25 to 34
Aged
18 to 24
Aged
12 to 17
NSDUH - All States (N = 2,464,150) 28.9% 22.6% 23.4% 18.8% 6.4%
NSDUH - TEDS States Only1 (N = 2,357,118) 29.0% 22.6% 23.4% 18.6% 6.4%
TEDS (N = 1,928,578) 22.5% 23.2% 26.2% 19.3% 8.8%
1 TEDS States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005 to 2010; and Treatment Episode Data Set (TEDS), 2007 to 2009.

Differences were also seen between NSDUH and TEDS distributions across racial ethnic groups and educational attainment. As shown in Figure 2.3, the NSDUH estimate included a greater proportion of non-Hispanic whites and lower percentages of non-Hispanic blacks and Hispanics than the TEDS count. The NSDUH estimates were greater than the TEDS counts for both genders, although the proportions of males and females were similar between the two data sources. A comparison of the education status reflected in the two data sources shows the NSDUH estimate included a higher percentage of persons with more than a high school education and a lower percentage of persons with 8 or fewer years of education than the TEDS count. In the NSDUH estimate, 34.3 percent of persons had more than 12 years of education, and 5.7 percent had 0 to 8 years of education; in the TEDS count, 22.1 percent had more than 12 years of education, and 9.5 percent had 0 to 8 years of education.

Figure 2.3 Distribution of Racial/Ethnic Groups among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Bar chart comparing distribution of racial/ethnic groups among persons who received treatment from specialty treatment programs in the past year: NSDUH 2005 to 2010 and TEDS 2007 to 2009.

Figure 2.3 Table. Distribution of Racial/Ethnic Groups among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2007 to 2009
Source Hispanic
or Latino
Non-Hispanic
Other*
Non-Hispanic
Two or More
Races
Non-Hispanic
Asian/
Pacific Islander
Non-Hispanic
American Indian/
Alaska Native
Non-Hispanic
Black
Non-Hispanic
White
NSDUH - All States (N = 2,464,150) 12.6%   1.7% 1.0% 1.2% 17.2% 66.4%
NSDUH - TEDS States Only1 (N = 2,357,118) 13.1%   1.7% 1.0% 1.2% 16.4% 66.6%
TEDS (N = 1,928,578) 14.7% 1.3% 0.6% 1.1% 2.1% 19.6% 60.4%
* No NSDUH estimates are available.
1 TEDS States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005 to 2010; and Treatment Episode Data Set (TEDS), 2007 to 2009.

Figure 2.4 shows the results of a comparison of the NSDUH 2005 to 2010 specialty treatment data for employment status,4 with the TEDS data reported for those variables (CBHSQ, 2011a). When compared with estimates from TEDS, estimates from NSDUH show a higher percentage of persons employed full time (37.3 vs. 16.3 percent for NSDUH and TEDS, respectively) and part time (12.9 vs. 7.6 percent for NSDUH and TEDS, respectively). TEDS estimates include a higher percentage than NSDUH of persons who were unemployed (39.0 vs. 12.8 percent for TEDS and NSDUH, respectively). One possible explanation for these findings is that many States require only publicly funded facilities to report data to TEDS, and some States only require facilities to report TEDS data for patients for whom treatment is publicly funded.

Figure 2.4 Distribution of Employment Status among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2009
Bar chart comparing distribution of employment status among persons who received treatment from specialty treatment programs in the past year: NSDUH 2005 to 2010 and TEDS 2009.

Figure 2.4 Table. Distribution of Employment Status among Persons Who Received Treatment from Specialty Treatment Programs in the Past Year: NSDUH 2005 to 2010 and TEDS 2009
Source Employed
Full Time
Employed
Part Time
Unemployed Other2
NSDUH 2005 to 2010 Average (TEDS States Only1) 37.3% 12.9% 12.8% 37.1%
TEDS 2009 16.3%   7.6% 39.0% 37.1%
1 TEDS States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
2 The Other employment category includes students, persons keeping house or caring for children full time, retired or disabled persons, or other persons not in the labor force, and, in the NSDUH estimates, persons aged 12 to 17.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005 to 2010; and Treatment Episode Data Set (TEDS), 2009.

The findings for health insurance status were consistent with the pattern for employment, with a higher percentage of TEDS counts being uninsured (59.8 percent) compared with the NSDUH estimate (30.9 percent; data not shown).5

2.1.4 State Estimates

State-level NSDUH and TEDS estimates for the eight most populous States in the Nation (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) are presented in Tables C.2.1.1-C.2.1.8. Estimates from the other States and the District of Columbia are not presented because of the lack of precision of NSDUH estimates from these States due to the relatively small sample sizes; there were approximately 3,600 interviews per year in the eight most populous States and approximately 900 interviews per year in the remaining States and the District of Columbia.

In six of the eight States examined, the TEDS count of the number of persons who received substance use treatment in the past year was smaller than the NSDUH estimate. Notable differences between the overall TEDS count and the NSDUH estimate were found in five States. For example, in Florida, the NSDUH estimate (138,035) was greater than the TEDS count (67,305). There were similar disparities between the NSDUH estimates and TEDS counts in Illinois (95,950 vs. 69,483), Michigan (102,203 vs. 57,956), Pennsylvania (108,068 vs. 46,990), and Texas (84,936 vs. 41,930). In two States, the TEDS count was larger than the NSDUH estimate, but the disparities were not statistically significant. In New York, the TEDS count was 245,898 persons, and the NSDUH estimate was 207,852. In Ohio, the TEDS count was 105,443 persons, and the NSDUH estimate was 96,729.

Treatment Characteristics

A comparison of the treatment characteristics showed several differences between the counts from the two data sources at the State level. Similar to the comparisons made at the national level, the State-level NSDUH estimates for all eight States reflected greater percentages of persons who received treatment in an inpatient hospital setting or residential rehabilitation setting than the TEDS counts. The State-level NSDUH estimates for five of the eight States reflected greater percentages of persons who received treatment in an outpatient setting than the TEDS counts, though only the differences in Pennsylvania were statistically significant; the exceptions were California (72.6 vs. 79.9 percent), Florida (70.2 vs. 81.7 percent), and Ohio (83.6 vs. 94.7 percent).

In some States, we found the two data sources produced similar percentages of persons treated for most substances, whereas in others, there was a large gap between many of the NSDUH estimates and the TEDS counts. The more notable differences include the following:

In two of the eight States (California and Texas), the NSDUH estimate included a lower proportion of injection drug users than the TEDS counts, reflecting the pattern seen in the national comparisons. In Ohio, Michigan, and Illinois, the NSDUH estimate indicated a lower proportion of injection drug users than the TEDS count for the State, but the difference between the two data sources was not statistically significant. In Florida and Pennsylvania, the two data sources had similar proportions of injection drug users (5.2 percent in both surveys for Florida, and 11.8 percent in TEDS and 12.0 percent in NSDUH for Pennsylvania). In New York, no NSDUH estimate of injection drug use was reported due to low precision.

Demographic Characteristics

Across the eight States, we observed some patterns of demographic characteristics of persons in treatment that were consistent with national comparisons, as well as some patterns that differed from national comparisons. For example, in five of the eight States (California, Florida, Illinois, Ohio, and Pennsylvania), the NSDUH estimates showed lower percentages of youths than the TEDS counts, as we found in the national estimates/counts. In the remaining three States (Michigan, New York, and Texas), the percentages of youths identified in the two sources were more similar to one another.

In the national comparisons, we found that the NSDUH estimate included a greater proportion of non-Hispanic whites and lower percentages of non-Hispanic blacks (not statistically significant) than the TEDS count. In Illinois, we found the same pattern. In Pennsylvania, the NSDUH estimate included a greater proportion of whites and similar proportion of blacks than the TEDS count. However, in the six remaining States, we found that the NSDUH estimates and TEDS counts of non-Hispanic whites were similar to each other. When comparing the two sources for each State, we found that in six States (California, Illinois, Michigan, New York, Ohio, and Pennsylvania), the NSDUH estimate included a lower percentage of non-Hispanic blacks than the TEDS count, although this difference was only statistically significant in Illinois and Ohio. In Florida and Texas, no NSDUH estimate of non-Hispanic blacks was reported due to low precision. In looking at State-level estimates of Hispanics, we found that in Pennsylvania, the NSDUH estimate had a lower percentage of Hispanics than the TEDS count, although this difference was not statistically significant. We found the converse to be true in Ohio, and the difference was statistically significant. In New York and Texas, no NSDUH estimates of Hispanics were reported due to low precision; in California, Florida, Illinois, and Michigan, the NSDUH estimates and TEDS counts were similar.

In the national comparisons, the NSDUH estimate included a higher percentage of persons with more than a high school education and a lower percentage than the TEDS count of persons with 8 or fewer years of education. The discrepancy between the two sources with regard to the percentage that had 8 or fewer years of education was present in all States. The most drastic, and only statistically significant difference between sources, was found in Pennsylvania, where the NSDUH estimate was that 6.7 percent of persons treated in specialty treatment had 8 or fewer years of education and the TEDS count reflected that 57.1 percent had that level of education. One possible explanation for this difference is that there were technical problems with the education variable in Pennsylvania during 1 or more of the years examined. It may also be possible that persons with little formal education are the recipients of publicly funded substance use treatment in that State or that persons with little formal education in Pennsylvania do not participate in the NSDUH. The pattern of NSDUH estimates having higher percentages of persons with more than a high school education was also found in seven of the eight States. In Texas, no NSDUH estimate of more than 12 years of education was reported due to low precision.

2.1.5 Conclusions and Limitations

At the national level, there were some differences between the treatment characteristics of the TEDS counts and those of the NSDUH estimates. As would be expected, the national TEDS estimate for persons receiving treatment in a hospital inpatient setting was much lower than the NSDUH estimate (61,382 vs. 738,366).

Treatment Characteristics

Because privately funded treatment facilities often are not included in TEDS but NSDUH collects data from persons who received treatment from both publicly and privately funded facilities, the TEDS count of persons who received substance use treatment in the past year was lower than the estimate from NSDUH for the 47 TEDS States (approximately 1.9 million vs. 2.4 million). A comparison of treatment modality also produces several expected differences between the two data sources. Although the TEDS count and the NSDUH estimate reflected a similar proportion of persons who received treatment in an outpatient setting (78.2 and 81.3 percent, respectively), the TEDS count included a notably lower proportion of persons who received treatment in an inpatient hospital setting than the NSDUH estimate (3.2 vs. 31.3 percent). This may be because hospital-based substance use treatment facilities are frequently not licensed through the State and therefore are often not required to report TEDS data. The TEDS count of persons receiving treatment in a residential rehabilitation setting also reflected a lower percentage than did the NSDUH estimates (28.2 vs. 40.6 percent).

To provide a comparison of the two data sources that is more equivalent with regard to inclusion/exclusion of hospital-based inpatient facilities, two additional tables are included in Appendix C (see Table C.2.1NH) that show demographic and other characteristics of persons who received substance use treatment from specialty treatment facilities excluding persons receiving treatment solely from hospital-based facilities. Despite the exclusion, the NSDUH estimate for the TEDS States (2,227,200) was greater than the TEDS count presented in Table C.2.1 (1,928,728).

Methodological differences between NSDUH and TEDS in the collection of data on specific substances of abuse may partially explain the differences found between data sources in the percentages of persons treated for specific substances. In the NSDUH, respondents who report past year treatment are asked whether they received that treatment for each of the substances (including alcohol) that they had used in their lifetime. If a respondent reports that he or she was treated for more than one substance, he or she is asked to identify the one substance that was the main reason for their treatment. The nature of substance use treatment might encourage the inclusion of most or all substances that have been abused. Treatment in many cases is generic and in instances of broad spectrum drug use is not linked to a specific substance. In TEDS, the client's primary, secondary, and tertiary problem substances are reported, which we infer to be the substances for which they are receiving treatment. The specific problem substances are provided by the client, but if more than one substance is reported, there are no specific guidelines concerning how to determine which substance is primary or which substances to include if a client has been misusing more than three substances. There may also be administrative reasons that influence which drugs are classified as primary and which are classified as secondary or tertiary.

The NSDUH percentages are significantly higher than the TEDS percentages for prescription drugs, inhalants, hallucinogens, and alcohol. One possible explanation is that these substances are less likely to be identified as problem substances at the time of treatment admission when other drugs (e.g., heroin and cocaine) have been identified as primary or secondary problem drugs. Being specifically asked whether or not a respondent was treated for use of each substance used in his or her lifetime may lead to a more inclusive list of substances than making a report of the primary, secondary, and tertiary problem substances at admission to treatment. In nearly 15 percent of cases, NSDUH respondents reported four or more substances for which treatment was received over the past year (which could have included multiple admissions).

Additionally, differences exist between the ways that NSDUH and TEDS define inhalants. In NSDUH, respondents are given a general description of inhalants (substances persons sniff or inhale for kicks or to get high) and then are provided with a list of the more common inhalants when they are asked about use of these types of drugs. The NSDUH list contains: amyl nitrite ("poppers," locker room odorizers, "rush"); correction fluid, degreaser, or cleaning fluid; gasoline or lighter fluid; glue, shoe polish, or toluene; halothane, ether, or other anesthetics; lacquer thinner or other paint solvents; lighter gases, such as butane or propane; nitrous oxide or "whippits"; spray paints; or other aerosol sprays. In TEDS, problem substance information is collected during the admission process. The TEDS guidelines for which drugs should be categorized as inhalants include the following: chloroform, ether, gasoline, nitrous oxide, and paint thinner. It is possible that the greater percentage of persons treated for inhalant use in NSDUH when compared with TEDS could be due, at least in part, to the more inclusive list of inhalants provided in NSDUH. However, it could also not be a reason because the definition in the manual provides examples rather than an exhaustive list, but States would still cross-walk the type of substances in the NSDUH list to the inhalants category in the TEDS. The person being admitted to treatment would not see or be limited to the examples in the TEDS manual.

The proportion of injection drug users in TEDS was higher than the proportion of injection drug users in the NSDUH. The TEDS estimates included only those admissions for which injection was the usual route of administration of their primary, secondary, or tertiary problem drug, whereas the NSDUH estimates included anyone who had injected one of the three queried substances (heroin, methamphetamine or Desoxyn®, and Methedrine®) one or more times in the past year. Although asking about injection as the usual route of administration in TEDS versus asking about any injection use in NSDUH would suggest that NSDUH estimates would be higher than TEDS counts; however, the opposite pattern was found. One possible explanation is that NSDUH respondents were queried about injection administration of only three drugs, whereas injection of any drug was included in TEDS counts. For example, cocaine was frequently named as an injection drug in TEDS, but it was not included in the NSDUH list of queried drugs for injection administration. Another possible explanation is that NSDUH estimates included a higher percentage of persons in treatment for alcohol use than did the TEDS counts, and injection is not a common route of administration of alcohol. The NSDUH injection questions were also included in a different module than the questions about the substances used and may be subject to reporting bias (respondents not wanting to reveal behaviors that are stigmatized or socially undesirable). Injection drug use might also be underreported in NSDUH due to conditioning (decreasing tendency of respondents to answer "yes" to questions that came later in an interview as a way of avoiding being asked additional follow-up questions) and social desirability concerns of respondents. Finally, in TEDS, accurate reporting of the typical route of drug administration at admission was relevant to the client's treatment plan and services received (i.e., injection drug use may increase the risk of contracting certain illnesses such as hepatitis C and HIV), whereas this was not the case when NSDUH respondents were retroactively reporting on their injection of drugs. It is likely that there are multiple such variations in methodology between NSDUH and TEDS, as well as variations in methodology in the collection of substance use data between States, facilities, and admissions in TEDS, which could impact these comparisons. It is not possible to determine the magnitude or the direction of the influence of each of these types of potentially biasing factors on these comparisons.

Demographic Characteristics

Differences between TEDS and NSDUH estimates of specific racial or ethnic groups might be related to the broader definition of treatment in NSDUH but might also be associated with differences in the way that data concerning race and ethnicity were collected for the two data sources. In NSDUH, the interviewer asked two questions about racial and ethnic identity, whereas in TEDS, the questions, definitions, and process used to identify a person's race/ethnicity varied somewhat between individual treatment facilities.

State-Level Estimates

Differences between TEDS and NSDUH State estimates of the number of persons who received past year treatment were likely to have been largely a consequence of the broader inclusiveness of treatment used in NSDUH. For example, in TEDS, hospital inpatient cases include only those treated in the chemical dependence unit of the hospital, whereas NSDUH does not make that distinction. State-level differences might also reflect requirements within the State for reporting TEDS data. (For a more detailed explanation of differences in State reporting requirements, see Table A.1 in Appendix A.) One limiting factor might include the types of facilities that were required to report TEDS data within an individual State. For example, in Texas, only facilities that received State/public funding were required to report, and those facilities were only required to report data on clients whose individual treatment was funded by State/public funds. For Texas, the NSDUH estimate of persons who received treatment in the past year was twice as great as the estimate from TEDS (84,936 vs. 41,930). In New York, all facilities that received State/public funding as well as those that were licensed/certified by the SSA were required to report TEDS data on all clients in their facilities. For New York, the NSDUH estimate of persons treated in the past year was less than the estimate from TEDS (207,852 vs. 245,898), although this difference was not statistically significant. Notably, the NSDUH estimates at the State level are less precise than the national NSDUH estimates due to the smaller sample size.

2.2. Numbers of Persons Who Received Treatment for the First Time in a Given Year

2.2.1 NSDUH Estimates

Description of NSDUH Estimates

NSDUH respondents who indicated that they had ever received treatment or counseling for their use of alcohol or any drug were asked to report the age at which they first received treatment or counseling for alcohol or other drug use. By subtracting the current age of the respondent from the age of first treatment, it is possible to identify respondents who received treatment for the first time in a given calendar year, and therefore estimate the number of persons who received treatment for the first time in any calendar year. Note that data from different survey years could be used to provide different estimates of the number of persons who received treatment for the first time in any one calendar year. For example, the number of persons who received treatment for the first time in 2006 could be estimated by determining the number of persons whose current age in 2007 was 1 year older than their age at first treatment or by determining the number of persons whose current age in 2008 was 2 years older than their age at first treatment. In this report, NSDUH estimates of the number of persons who received treatment for the first time in different years are based on combined 2008 and 2009 NSDUH data and represent the number of persons who had received treatment in their lifetime who first received treatment in each year from 1995 to 2007. The questions about first substance use treatment included treatment received at any location. This included treatment received at

Limitations of the NSDUH Estimates

The limitations of these estimates are similar to the limitations discussed previously for the number of persons who received treatment in the past year. The NSDUH is a household survey that relies on sample members to provide accurate and honest reports of their substance use and substance use treatment experiences; this may be especially problematic if asking persons who have been in treatment multiple times over many years to recall their age when they first received treatment. As a household survey, NSDUH also excludes persons who are in jail or prison, persons who are in a hospital or residential treatment, and homeless persons who do not reside in shelters for the majority of the quarter that their dwelling unit has been sampled. Finally, it should be noted that the NSDUH sample has been weighted to produce accurate estimates of substance use among the noninstitutionalized population of the United States aged 12 or older.

2.2.2 TEDS Counts

Description of TEDS Counts

Each TEDS admission record included the number of previous treatment episodes the client had received in any drug or alcohol treatment facility. Each admission for which there were no reported prior admissions for substance use treatment was considered a first-time admission. In this report, TEDS counts include the number of admissions in each year from 1995 to 2007 that reported no previous substance use treatment admissions. The TEDS counts of the number of persons who first received substance use treatment in a given year are derived from records for admissions.

Limitations of the TEDS Counts

As is true for the other counts discussed in this chapter, the generalizability of the TEDS counts is limited by the inclusion/exclusion criteria for the TEDS database and also by the State-level differences in reporting requirements that affect which data are reported to TEDS from the individual States. TEDS counts do not represent a census of all admissions to substance use treatment in a given year because TEDS includes primarily facilities that receive State-administered public funds. Privately funded facilities are generally not required to report to TEDS and are unlikely to do so; those that are operated by the Federal Government (e.g., those in VA hospitals or Federal prisons) are also unlikely to report to TEDS. TEDS explicitly excludes clients treated in an emergency room, a private doctor's office, a self-help group, or a jail/prison that is not run with funds administered by an SSA. Second, there are instances in which data submission is suspended temporarily for 1 or more years in some States or jurisdictions because of changes to their data collection systems (e.g., in 2006, Alaska, the District of Columbia, Georgia, and Vermont did not submit data to TEDS). Third, not every State that participates in TEDS submits all of the data about each client for all of the variables in the data set. For example, in 2006, there were incomplete or missing data from five States/districts for the previous treatment variable. In that year, there were 699,008 clients admitted to treatment who had not had a prior treatment episode and there were 339,995 cases with missing data for the prior treatment episode variable. The information collected on the TEDS is also mostly self-reported by the persons admitted for treatment; however, the recall of certain data (e.g., prior treatment or substances used) may be different depending on the saliency of the topic and the differences in the context within which the data are being collected.

2.2.3 Annual Estimates from 1995 to 2007

Figure 2.5 compares the annual estimates for the number of persons receiving substance use treatment for the first time in the years 1995 through 2007. Because the estimates from NSDUH included treatment or counseling received at any type of facility, whereas the TEDS counts included treatment received only at specialty treatment facilities, the number of persons who received treatment for the first time in any given year would be expected to be higher in NSDUH estimates than in TEDS counts. This was true for the estimates from 2006 and 2007 but was not true for estimates from previous years. In each year from 1997 to 2005, either there was no difference between the NSDUH and TEDS estimates or the TEDS estimates were higher than the NSDUH estimates. The NSDUH estimates for each year that were based on having to recall treatment from more than 3 or 4 years ago generally became smaller as the time between the interview and the year of first treatment increased (smaller numbers for earlier years), whereas the TEDS estimates were more consistent over time.

Figure 2.5 Estimated Numbers of Persons Receiving Substance Use Treatment for the First Time in 1995 to 2007: NSDUH 2008 and 2009, TEDS 1995 to 2007
Bar chart comparing estimated numbers of persons receiving substance use treatment for the first time in 1995 to 2007: NSDUH 2008 and 2009, TEDS 1995 to 2007.

Figure 2.5 Table. Estimated Numbers of Persons Receiving Substance Use Treatment for the First Time in 1995 to 2007: NSDUH 2008 and 2009, TEDS 1995 to 2007
Source 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995
NSDUH Estimate of Persons
Receiving Any Substance Use
Treatment for the First Time1,2
1,007,288 777,460 653,783 643,152 628,500 528,794 362,219 375,558 589,525 406,085 340,280 323,746 288,694
TEDS Count of Admissions with
No Prior Treatment
   755,796 699,008 708,211 656,595 688,879 725,548 668,876 652,982 585,645 570,576 571,790 613,262 663,9799
1 Based on combined 2008 and 2009 NSDUH data (Year of first treatment = [Survey year + Age of first treatment] − Interview Age).
2 Age of first treatment is defined as the minimum age of receipt of treatment for alcohol or drugs.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2008 to 2009; and Treatment Episode Data Set (TEDS), 1995 to 2007.

2.2.4 Conclusions and Limitations

There are multiple reasons to expect the NSDUH estimates to be higher than the TEDS estimates for the recent years (i.e., where the recall period is 1 or 2 years). First, the NSDUH estimates include any type of substance use treatment or counseling in each State, whereas the TEDS estimates are limited to treatment in a specialty substance use treatment facility and often include only facilities that receive State-administered public funds. This suggests that, as expected, due to its design, the TEDS counts of admissions with no prior treatment are much lower than the estimate of total number of persons who received any treatment for the first time in any given year.

There are also multiple possible explanations for the lower numbers in the NSDUH estimates in nearly all but the most recent years. Because NSDUH is a self-report survey, it relies on respondents' memory for when certain events, such as going to substance use treatment, occurred. Consequently, these estimates are susceptible to memory biases such as "forward telescoping," in which respondents tend to report that an important event from their past occurred more recently than it actually did (Johnson & Schultz, 2005) or simply forgetting treatment that occurred further back in the past. Another possible explanation is that in the early years shown in Figure 2.5 (e.g., 1995), a subset of NSDUH respondents in 2008 and 2009 who had received treatment in their lifetime were not at an age at which substance use treatment would have been a likely issue. For example, a respondent who was 18 years old in 2008 when he participated in the NSDUH was born in 1990. That respondent would have been 5 years old in 1995 and thus would have been very unlikely to have received substance use treatment for the first time in that year. A third possible explanation is that because of the increased risk of morbidity and mortality among persons with substance use problems, some of the persons who were in substance use treatment in 1995 might not have been eligible to have participated in the 2008 or 2009 survey due to incarceration, hospitalization, or death. These results indicate that estimates for a given year using NSDUH should use data from no more than 1 or 2 survey years after the year of interest (e.g., estimates for 2005 should use data from 2006 or 2007, not data from 2008 or later) because of declining data quality.

2.3. Single-Day Treatment Counts

Single-day treatment counts are estimates of the number of persons who were receiving substance use treatment on a given day of the year. The single-day treatment measures included in this section are

In the sections that follow, national and regional single-day treatment counts from these three data sources are presented, followed by counts from the eight most populous States. Tables containing single-day treatment counts for the Nation, the four census regions, and the eight most populous States are provided in Appendix C, Tables C.2.2-C.2.6. For comparison purposes, tables containing single-day treatment counts for the 50 States plus the District of Columbia are also included in Appendix C (see Tables C.2.7-C.2.11). The State estimates other than for the eight most populous States are not discussed in the text for this section.

Individual single-day treatment counts were generated for alcohol or drugs, alcohol only, drugs only, both alcohol and drugs, as well as with alcohol as the primary substance, and with a drug as the primary substance. N-SSATS data do not include sufficient detail to determine whether treatment received for both alcohol and drugs was primarily for alcohol or primarily for drugs; therefore, the alcohol primary and drug primary counts were not generated using N-SSATS data.

2.3.1 NSDUH Estimates

Description of NSDUH Estimates

Two different single-day treatment estimates can be generated using NSDUH data. One estimate uses data from a question about whether or not the respondent was receiving substance use treatment at the time of the interview,6 as well as the outcome of their last treatment episode. Respondents who indicated that they were currently receiving treatment were asked whether or not they were receiving this treatment for each of the substances they had used during their lifetime. This estimate will be referred to as the "average-day single-day treatment estimate."

In NSDUH, respondents who were receiving treatment at the time of the interview were asked whether they were receiving treatment for each of the substances they had used during their lifetime.7 If the respondent indicated this treatment was for more than one substance, they were asked to identify the main substance for which this treatment was received. These responses were used to determine which substances were the focus of the treatment they received during their current treatment episode.

The second estimate is based on responses to a question that asks respondents whether or not they were in substance use treatment on October 1 of the year prior to the survey. This estimate will be referred to as the "October 1 single-day treatment estimate." Due to a significant percentage (36.2 percent) of cases with unknown information about the substance(s) for which treatment was received, we present only estimates of treatment for either alcohol or drug use.

Both the average-day single-day treatment estimates and the October 1 single-day treatment estimates include only reports of specialty substance use treatment, which includes treatment received at a hospital, a drug rehabilitation facility, or a mental health center.

The overall average-day single-day treatment count was 1,196,460 persons. Among those persons, 36.7 percent were treated for alcohol use only, 26.3 percent were treated for drug use only, 33.2 percent were treated for both alcohol and drug use, and for 3.8 percent, this information was unknown. The October 1 single-day treatment count was 1,434,851 persons, who were treated for either alcohol or drug use.

Limitations of the NSDUH Estimates

As with the previous two sets of estimates discussed, the NSDUH sample is drawn to be representative of the noninstitutionalized population of the United States. In addition, NSDUH relies on respondents to remember accurately and report honestly their substance use and substance use treatment experiences.

The NSDUH questions do not specifically ask whether a person was in specialty treatment on the day of the interview. Respondents are asked what service types (modalities) they received in the past year and what the main type of treatment they are currently receiving is (for those who are still in treatment). Those who received specialty treatment in the past year and were in treatment on the day of the interview have been included in the average-day single-day treatment counts. Constructing the average-day single-day treatment counts in this way likely includes persons who were in specialty treatment in the past year but were not receiving specialty treatment at the time of the interview (e.g., had been receiving outpatient treatment at a mental health facility 6 months ago and is only participating in a self-help group at the time of the interview). Likewise, constructing the average-day single-day counts in this manner likely excludes persons who were receiving in-patient or residential treatment on the day of the interview (persons staying in a hospital or residential treatment center would not be available for an interview).

2.3.2 TEDS Counts

Description of TEDS Counts

The TEDS single-day treatment counts were computed for the number of persons in treatment on the last working day in March from 2007 to 2009 (March 30, 2007; March 31, 2008; and March 31, 2009). TEDS person-level treatment counts were obtained for 47 States, either through linking the admissions and discharge data processed through October 10, 2011, or through an alternate estimation method. A more detailed description of the methods used to link admission and discharge records is provided in Section 1.2. The TEDS single-day treatment counts are derived from counts of the number of admissions to a specialty substance abuse facility.

TEDS admission data include the primary, secondary, and tertiary problem substances. These data are used to determine which substances were the focus of the treatment received. The average single-day treatment count for 2007 to 2009 was 532,109 persons. Among those persons, 19.3 percent were treated for alcohol use only, 40.9 percent were treated for drug use only, 37.4 percent were treated for both alcohol and drug use, and 2.4 percent had no reported substance use at the time of admission.

Limitations of the TEDS Counts

As mentioned previously, the generalizability of the TEDS counts is somewhat limited by the inclusion/exclusion criteria for the TEDS database and also by State-level differences in reporting requirements that affect which data are reported to TEDS from the individual States. TEDS explicitly excludes clients treated in an emergency room, a private doctor's office, a self-help group, or a jail/prison not run with State agency-administered funds. As Section 1.2 notes, many States require only publicly funded facilities to report data to TEDS, and some States only require facilities to report TEDS data for patients for whom treatment is publicly funded.

2.3.3 N-SSATS Counts

Description of N-SSATS Counts

N-SSATS includes a single-day census of the number of persons in hospital inpatient substance use treatment units, residential (nonhospital) treatment, or outpatient substance use treatment on the last working day of March of each year (March 30, 2007; March 31, 2008; and March 31, 2009). For outpatient facilities, the count includes only active clients (those who were seen at the facility for substance use treatment or detoxification at least once during the month of March and who were still enrolled in treatment on the last working day of March).

N-SSATS data include the percentages of clients treated for only alcohol use, only drug use, or both alcohol and drug use, but it does not include information on whether alcohol or drugs were primary for those in treatment for both alcohol and drug use. The average single-day treatment count for 2007 to 2009 among all facilities was 1,153,617 persons. Among those persons, 18.8 percent were treated for alcohol use only, 36.0 percent were treated for drug use only, and 45.2 percent were treated for both alcohol and drug use.

2.3.4 National and Regional Estimates

Single-Day Treatment Counts for Alcohol or Drug Treatment

The single-day treatment counts in Figure 2.6 include persons who received treatment for either alcohol or drug use (also see Table C.2.2). As would be expected, the TEDS count (532,109) was significantly lower than either of the NSDUH or the N-SSATS counts. The NSDUH October 1 count (1,434,851) was the highest count, followed by the NSDUH average-day count (1,196,460). The N-SSATS all-facilities count (1,153,617) was somewhat lower than the NSDUH counts, followed by the N-SSATS count that excluded persons receiving treatment in hospitals (1,139,670). Regional counts for alcohol or drug treatment are consistent with the national counts for alcohol or drug treatment in that the NSDUH October 1 counts for alcohol or drug treatment were highest in all regions except the Northeast, followed by the NSDUH average-day counts, and the N-SSATS all-facilities counts. The TEDS counts were lowest in all regions.

Figure 2.6 National-Level Single-Day Treatment Counts for Alcohol or Drug Treatment: NSDUH 2008 to 2010 and 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for alcohol or drug treatment: NSDUH 2008 to 2010 and 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined*.

Figure 2.6 Table. National-Level Single-Day Treatment Counts for Alcohol or Drug Treatment: NSDUH 2008 to 2010 and 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Alcohol or Drug
NSDUH (October 1) 2008-2010 1,434,851
NSDUH (Average Day) 2007-2009 1,196,460
TEDS (March 30 or March 31) 2007-2009    532,109
N-SSATS - All Facilities (March 30 or March 31) 2007-2009 1,153,617
N-SSATS - Hospitals Excluded (March 30 or March 31) 2007-2009 1,139,670
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2010; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Alcohol-Only Treatment

Figure 2.7 and Table C.2.3 show single-day treatment counts (NSDUH average day, TEDS, and N-SSATS) of persons who were receiving treatment for alcohol use problems but not for other drugs. There was considerable variation across the four estimates. The NSDUH average-day count (438,665) was the highest, followed by the N-SSATS count that included all facilities (216,832). The TEDS count was less than one third of the NSDUH average-day count and less than half of the N-SSATS all-facilities count. Because the facilities that report to TEDS are a subset of the facilities that report to N-SSATS, it is not surprising that the TEDS counts were less than the N-SSATS counts; as with all tables included in Appendix C, excluding hospitals from N-SSATS had a minimal impact on the single-day treatment counts. TEDS also represents mainly admissions to publicly funded substance use treatment facilities, perhaps explaining why this count was lower for TEDS than for NSDUH, which reflected treatment received at both public and private facilities.

Figure 2.7 National-Level Single-Day Treatment Counts for Alcohol-Only Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for alcohol-only treatment: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined*. Accessible table located below this figure.

Figure 2.7 Table. National-Level Single-Day Treatment Counts for Alcohol-Only Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Alcohol Only
NSDUH (Average Day) 2007-2009 438,665
TEDS (March 30 or March 31) 2007-2009 102,587
N-SSATS - All Facilities (March 30 or March 31) 2007-2009 216,832
N-SSATS - Hospitals Excluded (March 30 or March 31) 2007-2009 213,888
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2010; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.

Table C.2.3 also shows regional single-day counts for alcohol-only treatment. The regional counts followed the same pattern as the national counts. The NSDUH average-day counts were significantly higher than the N-SSATS all-facilities counts except the Northeast, and the TEDS counts were appreciably lower than the N-SSATS counts.

Single-Day Treatment Counts for Drug-Only Treatment

The pattern of estimates across data sources for single-day treatment counts for persons receiving treatment for drug use but not alcohol use problems was different than the pattern for alcohol or drug treatment and alcohol-only treatment (Figure 2.8; Table C.2.4). For example, the N-SSATS counts including all facilities (414,845) and excluding hospitals (411,654) were higher than the NSDUH average-day count (314,806). As was true of the alcohol-only and alcohol or drug counts, the TEDS count (217,502) was appreciably lower than the other counts. One possible explanation of this shift between the counts for alcohol-only treatment and drug-only treatment in NSDUH and N-SSATS is that the increased stigma of receiving treatment for a drug use problem relative to that for receiving treatment for an alcohol use problem suppressed the self-reports of drug treatment receipt in NSDUH more than self-reports of alcohol treatment receipt. There was considerable variation at the regional level in the pattern of single-day counts for drug-only treatment. In the West, for example, the N-SSATS counts were the highest (96,774 and 96,368), followed by the TEDS count (68,868), with the NSDUH average-day count (62,355) as the lowest. In contrast, in the South, the N-SSATS counts were the highest (128,179 and 127,076), but the TEDS count (31,364) was less than one third of the NSDUH average-day count (Table C.2.4).

Figure 2.8 National-Level Single-Day Treatment Counts for Drug-Only Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for drug-only treatment: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined*. Accessible table located below this figure.

Figure 2.8 Table. National-Level Single-Day Treatment Counts for Drug-Only Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Drug Only
NSDUH (Average Day) 2007-2009 314,806
TEDS (March 30 or March 31) 2007-2009 217,502
N-SSATS - All Facilities (March 30 or March 31) 2007-2009 414,845
N-SSATS - Hospitals Excluded (March 30 or March 31) 2007-2009 411,654
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Alcohol and Drug Treatment

Figure 2.9 presents single-day treatment counts for persons receiving treatment for both alcohol and drug use problems (also see Table C.2.5). These counts show a pattern similar to those seen in the drug-only counts in that the N-SSATS counts (521,940 and 514,128) were significantly higher than both the NSDUH average-day count (397,732) and the TEDS count (198,971), and the NSDUH average-day count was significantly higher than the TEDS count. Several of the regional counts for alcohol and drug treatment show a different pattern than do the national counts. For example, in the Midwest, the TEDS count (61,125) was not significantly lower than the NSDUH average-day count (63,211), although both were appreciably lower than the N-SSATS counts (109,918 and 108,793). In the South, the NSDUH average-day count (120,097) was not significantly lower than the N-SSATS counts (134,368 and 131,470), and both were more than 4 times higher than the TEDS count (26,589). These regional differences are difficult to interpret, which may be due to regional variations in collecting N-SSATS and/or TEDS data.

Figure 2.9 National-Level Single-Day Treatment Counts for Alcohol and Drug Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for alcohol and drug treatment: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined*. Accessible table located below this figure.

Figure 2.9 Table. National-Level Single-Day Treatment Counts for Alcohol and Drug Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Alcohol and Drug
NSDUH (Average Day) 2007-2009 397,732
TEDS (March 30 or March 31) 2007-2009 198,971
N-SSATS - All Facilities (March 30 or March 31) 2007-2009 521,940
N-SSATS - Hospitals Excluded (March 30 or March 31) 2007-2009 514,128
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment

Figure 2.10 presents single-day treatment counts (NSDUH average day and TEDS) for persons receiving treatment for both alcohol and drug use problems and for whom alcohol was the primary substance of abuse (information on the primary substance of abuse for persons in treatment for both alcohol and drug problems is not available from N-SSATS) (also see Table C.2.6). These counts show a pattern similar to those seen in all of the previously reported counts in that the NSDUH average-day count (165,571) was significantly higher than the TEDS count (86,898). In two of the regional counts, however, the TEDS counts were not significantly lower than the NSDUH counts. In the Northeast, the NSDUH count was 29,702, and the TEDS count was 25,999. In the Midwest, the NSDUH count was 22,992, and the TEDS was 28,262, although the difference was not statistically significant.

Figure 2.10 National-Level Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for primary alcohol with secondary drug treatment: NSDUH 2007 to 2009 combined and TEDS 2007 to 2009 combined*. Accessible table located below this figure.

Figure 2.10 Table. National-Level Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Alcohol Primary, Drug Secondary
NSDUH (Average Day) 2007-2009 165,571
TEDS (March 30 or March 31) 2007-2009   86,898
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; and Treatment Episode Data Set (TEDS), 2007 to 2009.
Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment

Figure 2.11 presents single-day treatment counts from NSDUH (average day) and TEDS for persons receiving treatment for both alcohol and drug use problems and for whom a substance other than alcohol was their primary substance of abuse (information on the primary substance of abuse for persons in treatment for both alcohol and drug problems is not available from N-SSATS) (also see Table C.2.7). Similar to what was found with other counts, the TEDS count (111,973) was significantly lower than the NSDUH average-day count (228,813). Regional counts for primary drug with secondary alcohol treatment are consistent with the national counts in that the TEDS counts were lower than the NSDUH average-day counts. These differences were statistically significant in all regions but the Midwest.

Figure 2.11 National-Level Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined*
Bar chart comparing national-level single-day treatment counts for primary drug with secondary alcohol treatment: NSDUH 2007 to 2009 combined and TEDS 2007 to 2009 combined*. Accessible table located below this figure.

Figure 2.11 Table. National-Level Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined*
Source Single-Day Treatment Count -
Drug Primary, Alcohol Secondary
NSDUH (Average Day) 2007-2009 228,813
TEDS (March 30 or March 31) 2007-2009 111,973
* TEDS national-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined. Counts for NSDUH do not exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; and Treatment Episode Data Set (TEDS), 2007 to 2009.

2.3.5 State Estimates

The single-day treatment counts presented previously at the national and regional levels were also estimated for each of the 50 States and the District of Columbia. This section of the report focuses on the single-day treatment counts from the eight States with the largest populations (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). These States were selected for inclusion because the NSDUH sample size for these eight States was roughly 4 times the sample size for the other States, resulting in more precise estimates for these States. The estimates for the eight largest States are given at the bottom of Tables C.2.2-C.2.7, and single-day treatment counts for all 50 States plus the District of Columbia are presented in Tables C.2.8-C.2.12.

Single-Day Treatment Counts for Alcohol or Drug Treatment

The single-day treatment counts in Figure 2.12 include persons who received treatment for either alcohol or drug use (also see Table C.2.2). The estimates for these counts from seven of the eight States show a similar pattern to those of the national and several of the regional counts, in that the NSDUH October 1 count is the highest among the five data source estimates. The exception is New York, for which the N-SSATS count (117,075) is higher than both the NSDUH October 1 count (110,008) and the NSDUH average-day count (100,975), although neither difference is statistically significant. In six of the eight States, the TEDS estimates are the lowest, though not always statistically significantly so.

Figure 2.12 Single-Day Treatment Counts for Alcohol or Drug Treatment for the Eight Largest States: NSDUH 2008 to 2010 and 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for alcohol or drug treatment for the eight largest states: NSDUH 2008 to 2010 and 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined.

Figure 2.12 Table. Single-Day Treatment Counts for Alcohol or Drug Treatment for the Eight Largest States: NSDUH 2008 to 2010 and 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Source California Florida Illinois Michigan New York Ohio Pennsylvania Texas
NSDUH
(October 1)
2008-2010
201,700
(133,352-304,722)
75,198
(45,902-123,044)
71,469
(44,539-114,507)
57,947
(41,724-80,416)
110,008
(66,014-182,993)
50,830
(33,095-77,990)
53,555
(35,397-80,956)
66,942
(43,044-104,038)
NSDUH
(Average Day)
2007-2009
152,925
(100,457-232,583)
85,986
(53,239-138,693)
44,802
(28,032-71,538)
46,804
(31,818-68,788)
100,975
(68,315-149,107)
36,628
(24,087-55,658)
69,628
(47,989-100,928)
14,793
(7,643-28,634)
TEDS
(March 30 or March 31)
2007-2009
  68,868 15,646 13,794 12,552   80,054 25,825 20,791   7,972
N-SSATS -
All Facilities
(March 30 or March 31)
2007-2009
139,043 51,470 44,902 42,676 117,075 36,847 47,438 40,171
N-SSATS -
Hospitals Excluded
(March 30 or March 31)
2007-2009
138,179 50,566 44,536 42,539 115,100 36,418 46,977 39,351
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2010; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Alcohol-Only Treatment

Figure 2.13 shows single-day treatment counts for persons receiving treatment for alcohol use problems but not for other drugs, among the eight largest States (also see Table C.2.3). As with the counts for the Nation as a whole, all States had a higher NSDUH average-day count than any other count, although the differences between NSDUH and N-SSATS all-facilities counts in Illinois and New York were not statistically significant. Note that there is less variability between the counts in New York than between those in the other States, with a range from 20,683 (the NSDUH average-day count for New York) to 13,131 (the TEDS count for New York). In other States, such as California, there is a much larger gap between estimates. These differences in variability between estimates are likely caused by variability in individual State reporting requirements for TEDS data. In New York, all facilities that receive State/public funding and all facilities that are licensed/certified by the SSA are required to report data on all clients in the facility, whereas in Florida, facilities that receive State/public funding are required to report data on all clients, and in Illinois, facilities that receive funding through the SSA are required to report data on State-funded/publicly funded clients only.8

Figure 2.13 Single-Day Treatment Counts for Alcohol-Only Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for alcohol-only treatment for the eight largest states: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.13 Table. Single-Day Treatment Counts for Alcohol-Only Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Source California Florida Illinois Michigan New York Ohio Pennsylvania Texas*
NSDUH
(Average Day)
2007-2009
66,572
(31,492-140,547)
44,493
(21,906-90,230)
11,406
(5,730-22,691)
19,371
(12,153-30,860)
20,683
(8,702-49,108)
19,160
(9,980-36,751)
19,886
(9,614-41,091)
 
TEDS
(March 30 or March 31)
2007-2009
  6,318   2,186   2,599   3,042 13,131   5,086   5,521      901
N-SSATS -
All Facilities
(March 30 or March 31)
2007-2009
26,723   8,257 10,225 10,290 14,976   7,220   7,016   5,552
N-SSATS -
Hospitals Excluded
(March 30 or March 31)
2007-2009
26,542   8,007 10,137 10,265 14,614   7,133   6,935   5,405
* No NSDUH average-day estimate is reported due to low precision.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Drug-Only Treatment

Single-day treatment counts for persons receiving treatment for drug use but not alcohol use problems are shown in Figure 2.14 (and Table C.2.4). As was true for the national estimates, the single-day drug-only treatment counts from the eight States reflect a different pattern from the alcohol-only treatment counts. The N-SSATS count including all facilities is the highest count among the five estimates except those for Illinois, where the NSDUH average-day count is larger than the N-SSATS all-facilities count (20,963 vs. 16,527), and Pennsylvania, where the NSDUH average-day count is larger than the N-SSATS all-facilities count (29,081 vs. 19,470). Note that the differences between the N-SSATS count and NSDUH estimates in Florida, New York, Pennsylvania, and Texas are not statistically significant. There is considerable variation between the estimates for each of the eight States.

Figure 2.14 Single-Day Treatment Counts for Drug-Only Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for drug-only treatment for the eight largest states: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.14 Table. Single-Day Treatment Counts for Drug-Only Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Source California Florida Illinois Michigan New York Ohio Pennsylvania Texas
NSDUH
(Average Day)
2007-2009
12,431
(5,587-27,650)
20,276
(9,042-45,427)
20,963
(10,179-43,125)
13,789
(6,657-28,537)
41,299
(20,561-82,846)
2,825
(1,032-7,736)
29,081
(16,239-52,028)
  7,298
(2,503-21,263)
TEDS
(March 30 or March 31)
2007-2009
43,397   7,968   5,733   4,691 32,482 7,139   9,451   4,285
N-SSATS -
All Facilities
(March 30 or March 31)
2007-2009
50,213 20,407 16,527 14,111 47,811 8,731 19,470 15,212
N-SSATS -
Hospitals Excluded
(March 30 or March 31)
2007-2009
50,025 20,176 16,381 14,082 47,363 8,651 19,350 15,079
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Alcohol and Drug Treatment

Figure 2.15 shows single-day treatment counts (NSDUH average day, TEDS, and N-SSATS) for persons receiving treatment for both alcohol and drug use problems (also see Table C.2.5). There is a great amount of variation between estimates within individual States. The TEDS estimate is the lowest of the counts in all States, although not significantly so in Illinois, New York, Ohio, and Texas.

Figure 2.15 Single-Day Treatment Counts for Alcohol and Drug Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for alcohol and drug treatment for the eight largest states: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.15 Table. Single-Day Treatment Counts for Alcohol and Drug Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Source California Florida Illinois Michigan New York Ohio Pennsylvania Texas
NSDUH
(Average Day)
2007-2009
62,306
(36,309-106,851)
20,697
(7,506-56,981)
10,257
(3,264-32,181)
12,358
(6,473-23,578)
37,728
(22,958-61,964)
14,343
(7,164-28,694)
19,697
(10,850-35,733)
4,414
(2,000-9,741)
TEDS
(March 30 or March 31)
2007-2009
18,946   4,759   5,450   4,797 34,431 11,086   5,819   2,786
N-SSATS -
All Facilities
(March 30 or March 31)
2007-2009
62,106 22,805 18,149 18,275 54,287 20,896 20,953 19,407
N-SSATS -
Hospitals Excluded
(March 30 or March 31)
2007-2009
61,612 22,382 18,018 18,192 53,123 20,634 20,691 18,867
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.
Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment

Figure 2.16 shows single-day treatment counts (NSDUH average day and TEDS) for persons receiving treatment for both alcohol and drug use problems and for whom alcohol was the primary substance of abuse (also see Table C.2.6). With the exceptions of Florida and New York, the NSDUH average-day estimates are higher than the TEDS counts. This difference was statistically significant only in California and Michigan. No NSDUH average-day estimate is reported for Illinois due to low precision.

Figure 2.16 Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for primary alcohol with secondary drug treatment for the eight largest states: NSDUH 2007 to 2009 combined and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.16 Table. Single-Day Treatment Counts for Primary Alcohol with Secondary Drug Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined
Source California Florida Illinois* Michigan New York Ohio Pennsylvania Texas
NSDUH
(Average Day)
2007-2009
32,873
(14,906-72,444)
   942
(202-4,405)
  5,865
(2,385-14,418)
13,487
(6,648-27,349)
9,785
(3,892-24,579)
6,558
(2,581-16,654)
1,724
(412-7,206)
TEDS
(March 30 or March 31)
2007-2009
  6,137 1,676 2,165 2,211 14,990 5,360 2,879    857
* No NSDUH average-day estimate is reported due to low precision.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; and Treatment Episode Data Set (TEDS), 2007 to 2009.
Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment

Figure 2.17 shows single-day treatment counts for persons receiving treatment for both alcohol and drug use problems and for whom a substance other than alcohol was the primary substance of abuse (also see Table C.2.7). With the exception of Ohio, the NSDUH average-day estimates are higher than the TEDS counts. This difference was statistically significant in California, Florida, and Pennsylvania.

Figure 2.17 Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined
Bar chart comparing single-day treatment counts for primary drug with secondary alcohol treatment for the eight largest states: NSDUH 2007 to 2009 combined and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.17 Table. Single-Day Treatment Counts for Primary Drug with Secondary Alcohol Treatment for the Eight Largest States: NSDUH 2007 to 2009 Combined and TEDS 2007 to 2009 Combined
Source California Florida Illinois Michigan New York Ohio Pennsylvania Texas
NSDUH
(Average Day)
2007-2009
29,433
(14,255-60,741)
19,754
(6,874-56,680)
9,889
(3,023-32,302)
6,493
(2,581-16,325)
21,043
(10,759-41,130)
4,558
(1,831-11,340)
13,139
(6,105-28,252)
2,691
(1,070-6766)
TEDS
(March 30 or March 31)
2007-2009
12,809   3,083 3,285 2,586 19,441 5,726   2,940 1,929
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; and Treatment Episode Data Set (TEDS), 2007 to 2009.
Seasonality of Admissions

One issue that could impact comparisons between the single-day treatment counts based on the NSDUH October 1 measure and the TEDS and N-SSATS measures based on the last working day in March is seasonality of treatment admissions. If there are differences in the overall number of admissions around the times of these single-day treatment counts—for example, more admissions in the fall than in the spring—this could help explain the variation found in the counts between these data sources. In order to investigate whether there is seasonal variation in treatment admissions, we analyzed the TEDS admissions data from 2006 and 2007. These data show variation in admissions across the year, and the admissions patterns in both years were similar (see Figure 2.18). Average daily admissions for 2006 and 2007 combined ranged from a low of 4,262 in December to a high of 5,606 in January.

Figure 2.18 Average TEDS Admissions per Day,* by Month: 2006 and 2007
Bar chart comparing average TEDS admissions per day,* by month: 2006 and 2007. Accessible table located below this figure.

Figure 2.18 Table. Average TEDS Admissions per Day,* by Month: 2006 and 2007
Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2006 5,699 5,636 5,829 5,209 5,316 5,098 5,051 5,427 4,938 5,200 4,886 4,303
2007 5,512 5,236 5,316 5,168 5,073 4,844 5,223 5,189 4,836 5,456 4,886 4,221
* Adjusted for number of days per month.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, Treatment Episode Data Set (TEDS), 2006 and 2007.

Because substance dependence is a chronic disorder that often requires long-term treatment, we also looked at TEDS linked admission and discharge data from 2006 and 2007 to investigate whether there is seasonal variation in the number of clients receiving treatment. Among these clients, there were between 325,000 and 425,000 clients in treatment every day during 2006 and 2007. As Figure 2.19 shows, the patterns in both years were similar, with distinct dips in the number of persons receiving treatment at the end of June and the end of December. Note that one possible reason for the dip at the end of June is that the fiscal year ends at this time for some States, and resources for substance use treatment may be reduced during this period relative to other times of the year. Also note that the number of persons in treatment was somewhat higher at the end of March (an average of 410,906 persons in treatment on the last working day of March) than at the beginning of October (an average of 390,277 persons in treatment on October 1). These data indicate that although there are seasonal differences in the number of persons receiving substance use treatment, the differences found between the end of March and the beginning of October do not seem to be marked enough to explain the differences found between NSDUH single-day treatment estimates and the single-day treatment counts from TEDS and N-SSATS.

Figure 2.19 Daily Numbers of Persons in Substance Use Treatment: TEDS 2006 and 2007
Bar chart comparing daily numbers of persons in substance use treatment: TEDS 2006 and 2007. Accessible table located below this figure.

Figure 2.19 Table. Daily Numbers of Persons in Substance Use Treatment: TEDS 2006 and 2007
Date 2006 2007
1-Jan 382,055 383,596
2-Jan 382,161 388,429
3-Jan 387,403 389,757
4-Jan 388,432 390,861
5-Jan 389,488 390,244
6-Jan 389,125 386,602
7-Jan 385,234 385,854
8-Jan 384,543 392,489
9-Jan 391,366 394,104
10-Jan 392,842 395,439
11-Jan 393,784 396,077
12-Jan 394,665 395,190
13-Jan 393,805 391,449
14-Jan 389,807 390,636
15-Jan 389,169 392,431
16-Jan 390,874 396,713
17-Jan 395,397 397,517
18-Jan 396,140 398,473
19-Jan 396,973 397,305
20-Jan 396,172 393,707
21-Jan 392,300 392,781
22-Jan 391,543 398,919
23-Jan 397,888 400,680
24-Jan 399,296 401,765
25-Jan 400,199 402,641
26-Jan 400,881 401,334
27-Jan 399,542 397,675
28-Jan 395,529 396,768
29-Jan 394,645 402,811
30-Jan 400,558 403,801
31-Jan 401,029 404,047
1-Feb 401,467 403,757
2-Feb 401,576 401,878
3-Feb 400,606 397,953
4-Feb 396,711 397,099
5-Feb 395,972 403,056
6-Feb 402,250 403,748
7-Feb 403,513 404,920
8-Feb 404,497 405,506
9-Feb 405,224 404,081
10-Feb 404,121 400,320
11-Feb 400,178 399,387
12-Feb 399,226 405,138
13-Feb 404,808 405,417
14-Feb 405,823 404,992
15-Feb 406,767 406,700
16-Feb 406,922 405,549
17-Feb 405,709 401,826
18-Feb 401,867 401,041
19-Feb 401,131 403,561
20-Feb 403,719 406,942
21-Feb 407,072 407,615
22-Feb 407,500 408,288
23-Feb 407,815 406,749
24-Feb 406,355 402,938
25-Feb 402,363 402,051
26-Feb 401,555 407,856
27-Feb 407,136 408,895
28-Feb 407,428 408,965
1-Mar 406,955 408,448
2-Mar 406,321 406,222
3-Mar 405,311 402,724
4-Mar 401,407 402,022
5-Mar 400,555 408,099
6-Mar 406,984 409,084
7-Mar 407,843 409,935
8-Mar 408,467 410,750
9-Mar 408,995 409,370
10-Mar 407,937 405,610
11-Mar 403,858 404,713
12-Mar 403,033 410,638
13-Mar 408,957 411,612
14-Mar 410,096 412,146
15-Mar 410,640 412,526
16-Mar 410,545 410,744
17-Mar 409,255 407,287
18-Mar 405,369 406,492
19-Mar 404,590 412,247
20-Mar 410,663 413,134
21-Mar 411,169 413,669
22-Mar 411,794 413,932
23-Mar 411,999 412,526
24-Mar 410,525 408,710
25-Mar 406,657 407,825
26-Mar 405,838 413,712
27-Mar 411,308 414,392
28-Mar 412,063 414,433
29-Mar 412,124 414,318
30-Mar 412,075 412,062
31-Mar 409,749 407,400
1-Apr 405,207 406,345
2-Apr 403,806 411,627
3-Apr 409,562 412,093
4-Apr 410,073 412,650
5-Apr 410,465 412,842
6-Apr 410,935 410,555
7-Apr 409,406 407,440
8-Apr 405,385 406,514
9-Apr 404,563 411,937
10-Apr 410,392 413,106
11-Apr 410,562 413,548
12-Apr 410,645 413,730
13-Apr 410,534 412,211
14-Apr 408,205 408,521
15-Apr 404,768 407,649
16-Apr 403,619 413,035
17-Apr 409,011 413,893
18-Apr 409,836 414,188
19-Apr 409,965 414,433
20-Apr 409,959 412,740
21-Apr 408,142 408,763
22-Apr 404,149 407,792
23-Apr 403,241 413,352
24-Apr 408,641 413,489
25-Apr 408,867 413,491
26-Apr 408,423 413,433
27-Apr 408,004 411,689
28-Apr 405,744 407,599
29-Apr 400,913 406,591
30-Apr 399,991 411,931
1-May 405,313 411,094
2-May 405,011 410,168
3-May 404,747 410,335
4-May 404,588 408,571
5-May 402,854 404,788
6-May 399,163 403,882
7-May 398,221 409,599
8-May 403,765 410,022
9-May 404,169 410,210
10-May 404,415 410,303
11-May 404,305 408,431
12-May 402,441 404,780
13-May 398,297 403,901
14-May 397,440 409,142
15-May 402,868 409,313
16-May 402,776 408,976
17-May 402,460 408,897
18-May 401,943 407,000
19-May 399,805 403,208
20-May 395,786 402,344
21-May 394,835 407,447
22-May 400,002 407,556
23-May 400,016 407,595
24-May 399,497 407,191
25-May 398,902 405,191
26-May 396,359 401,195
27-May 392,229 400,418
28-May 391,366 399,992
29-May 390,809 404,768
30-May 395,257 404,551
31-May 394,037 403,248
1-Jun 392,845 400,395
2-Jun 389,885 395,489
3-Jun 385,835 394,631
4-Jun 385,145 400,138
5-Jun 390,350 400,338
6-Jun 390,491 400,344
7-Jun 390,150 400,217
8-Jun 389,745 398,043
9-Jun 387,533 394,398
10-Jun 383,411 393,422
11-Jun 382,510 398,596
12-Jun 387,682 399,012
13-Jun 387,646 398,914
14-Jun 387,304 398,352
15-Jun 386,763 396,280
16-Jun 384,351 392,192
17-Jun 380,158 391,196
18-Jun 379,343 396,492
19-Jun 384,253 396,588
20-Jun 383,949 396,567
21-Jun 383,296 396,101
22-Jun 382,605 394,104
23-Jun 380,370 390,310
24-Jun 376,445 389,415
25-Jun 375,608 394,314
26-Jun 380,156 394,094
27-Jun 379,717 393,393
28-Jun 378,417 392,324
29-Jun 376,808 388,885
30-Jun 373,017 383,779
1-Jul 370,041 383,270
2-Jul 368,661 388,966
3-Jul 375,200 389,594
4-Jul 371,630 384,708
5-Jul 377,938 389,327
6-Jul 380,340 388,207
7-Jul 379,720 384,852
8-Jul 376,098 383,963
9-Jul 375,456 389,813
10-Jul 382,163 390,880
11-Jul 384,073 392,043
12-Jul 385,193 392,626
13-Jul 385,393 391,102
14-Jul 384,269 387,404
15-Jul 380,610 386,566
16-Jul 379,784 392,073
17-Jul 385,387 392,771
18-Jul 386,587 393,399
19-Jul 387,439 393,770
20-Jul 387,910 392,354
21-Jul 386,499 388,423
22-Jul 382,697 387,549
23-Jul 382,108 393,111
24-Jul 387,490 393,921
25-Jul 388,443 394,632
26-Jul 388,909 394,872
27-Jul 389,070 393,129
28-Jul 387,309 389,386
29-Jul 383,425 388,493
30-Jul 382,533 393,933
31-Jul 387,442 393,885
1-Aug 387,976 393,213
2-Aug 387,621 392,655
3-Aug 388,072 391,159
4-Aug 386,722 387,370
5-Aug 383,191 386,540
6-Aug 382,481 391,969
7-Aug 388,014 392,729
8-Aug 388,893 393,152
9-Aug 389,240 393,309
10-Aug 389,391 391,836
11-Aug 387,738 388,064
12-Aug 384,125 387,118
13-Aug 383,247 392,606
14-Aug 388,583 392,909
15-Aug 389,116 393,409
16-Aug 389,613 393,344
17-Aug 389,809 391,598
18-Aug 388,227 388,003
19-Aug 384,400 387,239
20-Aug 383,730 392,930
21-Aug 388,917 393,382
22-Aug 389,552 393,783
23-Aug 389,981 394,037
24-Aug 390,464 392,289
25-Aug 388,594 388,457
26-Aug 385,030 387,545
27-Aug 384,221 392,903
28-Aug 389,270 393,286
29-Aug 389,743 393,281
30-Aug 389,913 393,157
31-Aug 389,163 390,859
1-Sep 386,879 384,914
2-Sep 382,561 383,599
3-Sep 381,880 383,241
4-Sep 381,618 388,633
5-Sep 386,597 389,193
6-Sep 387,210 390,055
7-Sep 387,558 388,966
8-Sep 386,324 385,279
9-Sep 382,674 384,496
10-Sep 381,959 390,329
11-Sep 387,453 391,162
12-Sep 388,393 391,735
13-Sep 388,905 392,183
14-Sep 389,282 391,007
15-Sep 388,133 387,297
16-Sep 384,445 386,309
17-Sep 383,643 392,233
18-Sep 389,091 392,908
19-Sep 389,771 393,660
20-Sep 390,393 393,930
21-Sep 390,767 392,549
22-Sep 389,287 388,910
23-Sep 385,616 388,131
24-Sep 384,854 393,627
25-Sep 390,184 394,352
26-Sep 390,616 394,682
27-Sep 390,507 394,838
28-Sep 390,418 393,041
29-Sep 388,351 388,831
30-Sep 384,156 387,914
1-Oct 382,857 392,773
2-Oct 387,781 392,849
3-Oct 388,960 393,278
4-Oct 389,658 393,774
5-Oct 390,434 392,222
6-Oct 389,475 388,476
7-Oct 385,684 387,809
8-Oct 384,920 391,770
9-Oct 388,796 393,622
10-Oct 391,345 394,420
11-Oct 391,848 394,717
12-Oct 392,466 393,749
13-Oct 391,250 389,781
14-Oct 387,913 388,859
15-Oct 387,249 394,560
16-Oct 392,831 395,453
17-Oct 393,806 395,921
18-Oct 394,547 395,929
19-Oct 395,002 394,234
20-Oct 393,906 390,628
21-Oct 390,331 389,783
22-Oct 389,476 395,104
23-Oct 394,975 395,913
24-Oct 395,915 396,266
25-Oct 396,378 396,548
26-Oct 396,619 394,743
27-Oct 394,982 391,260
28-Oct 391,340 390,269
29-Oct 390,652 395,601
30-Oct 395,903 395,800
31-Oct 395,534 395,321
1-Nov 395,634 394,714
2-Nov 395,414 392,426
3-Nov 394,295 388,849
4-Nov 391,075 388,196
5-Nov 390,183 393,892
6-Nov 396,082 394,318
7-Nov 396,733 395,158
8-Nov 397,664 395,497
9-Nov 398,238 394,170
10-Nov 395,642 390,557
11-Nov 393,048 389,662
12-Nov 392,348 392,807
13-Nov 397,601 395,115
14-Nov 398,117 395,309
15-Nov 398,575 395,514
16-Nov 398,633 393,746
17-Nov 397,221 390,081
18-Nov 393,555 389,288
19-Nov 392,655 394,718
20-Nov 398,171 395,208
21-Nov 398,639 394,107
22-Nov 397,802 389,302
23-Nov 393,117 389,862
24-Nov 393,713 388,573
25-Nov 392,335 387,997
26-Nov 391,746 393,149
27-Nov 397,011 393,563
28-Nov 397,496 393,764
29-Nov 397,951 393,831
30-Nov 398,061 391,785
1-Dec 395,672 386,916
2-Dec 391,145 385,492
3-Dec 390,319 390,927
4-Dec 395,910 391,577
5-Dec 396,538 392,092
6-Dec 397,122 392,331
7-Dec 397,261 390,874
8-Dec 395,794 386,906
9-Dec 392,166 386,007
10-Dec 391,396 391,507
11-Dec 396,645 391,653
12-Dec 397,118 392,201
13-Dec 397,177 391,710
14-Dec 397,169 390,346
15-Dec 395,210 386,519
16-Dec 391,208 385,554
17-Dec 390,352 390,752
18-Dec 395,510 390,771
19-Dec 395,300 390,490
20-Dec 394,709 390,056
21-Dec 393,753 387,618
22-Dec 391,325 383,485
23-Dec 387,908 382,641
24-Dec 387,065 383,336
25-Dec 386,254 381,173
26-Dec 389,264 384,656
27-Dec 390,557 385,348
28-Dec 390,606 383,876
29-Dec 388,581 380,357
30-Dec 384,904 379,746
31-Dec 383,954 381,769
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, Treatment Episode Data Set (TEDS), 2006 and 2007.

2.3.6 Conclusions and Limitations

Table 2.1 shows the single-day treatment counts for all alcohol or drug treatment, as well as those for alcohol only, drugs only, and alcohol and drugs, including, when available, treatment for alcohol and drugs in which alcohol was the primary substance and treatment for alcohol and drugs in which a drug was the primary substance. Figure 2.20 illustrates the proportion of the overall single-day treatment counts from each source that received treatment for alcohol only, drugs only, and alcohol and drugs. The N-SSATS and NSDUH single-day treatment counts for alcohol or drug treatment are nearly twice the TEDS count. It is unclear if this is solely because the facilities that report to TEDS and the clients that are reported about in TEDS are associated with the receipt of public funds, whereas NSDUH estimates and N-SSATS counts reflect treatment received at both publicly and privately funded facilities. Excluding clients receiving care at hospitals from N-SSATS had a minimal impact on the N-SSATS single-day treatment counts. The NSDUH single-day estimates range from more than 100 percent higher than the N-SSATS estimate (based on the average-day count for alcohol-only treatment) to 25 percent lower (based on the average-day count for drugs only).

Table 2.1 Single-Day Treatment Counts1 for Alcohol or Drug Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Substance for Which Treatment Was Received: NSDUH 2008 to 2010 Combined (October 1 and Average-Day Counts), N-SSATS 2007 to 2009 Combined (All Facilities), and TEDS 2007 to 2009 Combined
Substance NSDUH
October 1
2008 to 2010
NSDUH
Average Day
2007 to 20092,3
TEDS
March 30 or March 31
2007 to 2009
N-SSATS -
All Facilities
March 30 or March 31
2007 to 2009
# 95% CI # 95% CI # #
Any Treatment 1,434,851 (1,278,112-1,610,688) 1,196,460 (1,066,843-1,341,740) 532,109 1,153,617
Alcohol Only NA NA    438,665 (354,848-542,237) 102,587    216,832
Drugs Only NA NA    314,806 (261,637-378,764) 217,502    414,845
Alcohol and Drugs NA NA    397,732 (333,100-474,879) 198,871    521,940
Alcohol Primary NA NA    165,571 (125,368-218,657)   86,898 NA
Drug Primary NA NA    228,813 (180,823-289,525) 111,973 NA
Unknown Substance NA NA      45,257 (29,579-69,242)   13,148 NA
NA = not available.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. NSDUH "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43. "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and those for whom the substance for which they were treated is unknown are included.
2 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
3 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.

Figure 2.20 Percentages of Single-Day Treatment Counts Attributable to Alcohol Only, Drug Only, and Alcohol and Drug Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Set of pie charts comparing percentages of single-day treatment counts attributable to alcohol only, drug only, and alcohol and drug treatment: NSDUH 2007 to 2009 combined, N-SSATS 2007 to 2009 combined, and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 2.20 Table. Percentages of Single-Day Treatment Counts Attributable to Alcohol Only, Drug Only, and Alcohol and Drug Treatment: NSDUH 2007 to 2009 Combined, N-SSATS 2007 to 2009 Combined, and TEDS 2007 to 2009 Combined
Source Alcohol Only Drugs Only Alcohol
and Drugs
NSDUH Average-Day Single-Day Count (N = 1,196,460) 36.7% 26.3% 33.2%
TEDS Single-Day Treatment Count (N = 532,109) 19.2% 40.9% 37.4%
N-SSATS Single-Day Treatment Count (N = 1,153,617) 18.8% 36.0% 45.2%
NOTE: Cases with unknown treatment focus (alcohol only vs. drugs only vs. alcohol and drug) were excluded from this figure. In the NSDUH average-day single-day treatment count, 3.8 percent had an unknown treatment focus. In the TEDS single-day treatment count, 2.5 percent had an unknown treatment focus. In the N-SSATS single-day treatment count, 0.0 percent had an unknown treatment focus.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2007 to 2009; Treatment Episode Data Set (TEDS), 2007 to 2009; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009.

The NSDUH single-day treatment count for alcohol-only treatment is more than 4 times the TEDS count, but the TEDS single-day treatment count for drug-only treatment is about two thirds the NSDUH count. One possible explanation for this shift in the difference between NSDUH and TEDS counts for alcohol-only and drug-only treatment is that the increased stigma of receiving treatment for a drug use problem relative to receiving treatment for an alcohol use problem suppressed the self-reports of drug treatment receipt in NSDUH more so than self-reports of alcohol treatment receipt. Among other possible explanations, TEDS may not include a representative proportion of facilities that treat alcohol in the absence of other drug problems, problems related to alcohol use are minimized in the context of other drug use at the time of treatment admission, or a disproportionate number of persons who seek alcohol treatment receive the treatment at private facilities that are less likely to be included in TEDS.

There are two issues that limit the utility of national TEDS single-day treatment counts. First, a great deal of variability exists between States in data reporting requirements and, consequently, in the data reported to TEDS. In some States (such as New York), nearly all substance use treatment facilities are required to report TEDS data, whereas in other States, the reporting requirements are not as broadly applied. In many States, the only treatment facilities that report TEDS data are those that receive public funding. The N-SSATS data for these estimates are based on counts of persons in treatment on a single day of the year, the last working day of March. About 80 percent of the N-SSATS single-day count is comprised of clients receiving outpatient treatment. For outpatient clients, all clients who received any outpatient service in the month of March who had not been discharged as of the last working day of March are included in the single-day count. Seasonal variation of admissions may affect the representativeness of these estimates.

Each of the national single-day treatment estimates (NSDUH, TEDS, and N-SSATS) provides unique information about the number of persons receiving treatment on a given day of the year. N-SSATS is designed to provide a single-day treatment count. The N-SSATS count across all facilities is likely the most inclusive and stable estimate. The counts from TEDS (with some exceptions, such as New York State) provide information that more likely reflects the number of persons receiving treatment in publicly funded substance use treatment facilities that provide rehabilitation treatment services. The NSDUH estimates provide an estimation of the number of persons from the noninstitutionalized household population who were in substance use treatment (or specialty substance use treatment) on a single day of the year (October 1 of the year prior to the survey) or an average day of the year. The single-day count from TEDS was calculated using the last working day of March to match the date used in N-SSATS. The relative lack of seasonal differences in TEDS admissions indicates that comparisons of single-day counts from N-SSATS or TEDS with single-day counts from NSDUH (which uses an October 1 date) are reasonable. At the national level, the October 1 single-day treatment estimate from NSDUH is higher than the average-day estimates, although this pattern does not hold for all regions and States. These differences may reflect seasonal differences particular to a given region of the country, or they may be due to differences in the way the two estimates are derived (i.e., one is based on a question asking about having been in treatment on a particular day in the past and the other is based on the respondent currently being in treatment).

2.4. Past Year Admissions Counts

This section presents comparisons between TEDS and N-SSATS counts of the total number of substance use treatment admissions for a given calendar year.

2.4.1 TEDS Counts

Description of TEDS Counts

The TEDS counts of the number of persons who were admitted to substance use treatment are derived from admission records. As previously noted, TEDS data are less likely to include admissions for privately funded treatment than admissions for publicly funded treatment. The limitations of these counts are detailed subsequently.

Limitations of the TEDS Counts

TEDS does not include all admissions to substance abuse treatment. In some States, it includes admissions to facilities that are licensed or certified by an SSA to provide substance abuse treatment (or that are administratively tracked for other reasons). With few exceptions, TEDS does not include clients treated in a jail/prison not run with State agency-administered funds, emergency rooms, private doctor's offices, or self-help groups. As Section 1.2 notes, many States require only publicly funded facilities to report data to TEDS, and some States only require facilities to report TEDS data for patients for whom treatment is publicly funded. Also noted in Section 1.2, hospital inpatient substance use treatment facilities are frequently not licensed through the SSA and may not be required to report TEDS data.

2.4.2 N-SSATS Counts

Description of N-SSATS Counts

The N-SSATS counts of the number of treatment admissions to substance use treatment are derived from a question in the N-SSATS survey that asks facilities to report how many admissions for substance abuse treatment the facility had in the 12-month period beginning April 1 of the prior year and ending the last working day of March in the current year. Most facilities report this information. The item response rate for this question was 97.7 percent in 2007, 98.1 percent in 2008, and 100.0 percent in 2009.

2.4.3 National Estimates

This section compares the counts of substance use treatment admissions for N-SSATS and TEDS. Alabama, Alaska, the District of Columbia, and Georgia were excluded from the TEDS counts estimates because no or incomplete TEDS data were submitted for one or more of the 3 years examined (2007-2009) in these areas. For the purpose of these comparisons, N-SSATS estimates were restricted to the subset of 47 States that were used to generate the TEDS counts. These counts, for 2007, 2008, 2009, and an average of the 3 years are presented in Appendix C (Table C.2.13). As Figure 2.21 shows, the total TEDS admissions count is less than 60 percent of the N-SSATS admissions count (1,953,448 vs. 3,483,632, respectively). This difference is seen in all geographic regions except the Northeast. The discrepancy between the TEDS count of national admissions and that of N-SSATS is even greater when the TEDS national count is compared with the N-SSATS count for all 50 States and the District of Columbia (1,953,448 vs. 3,606,668).

Figure 2.21 Counts of Annual Admissions for the Total Nation and for Geographic Regions: TEDS 2007 to 2009 Annual Averages and N-SSATS 2007 to 2009 Annual Averages*
Bar chart comparing counts of annual admissions for the total nation and for geographic regions: TEDS 2007 to 2009 annual averages and N-SSATS 2007 to 2009 annual averages*. Accessible table located below this figure.

Figure 2.21 Table. Counts of Annual Admissions for the Total Nation and for Geographic Regions: TEDS 2007 to 2009 Annual Averages and N-SSATS 2007 to 2009 Annual Averages*
Source West South Northeast Midwest TOTAL
TEDS 453,837 404,771 620,415 474,426 1,953,448
N-SSATS 904,367 884,717 852,008 842,538 3,483,632
* TEDS national- and regional-level counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete TEDS data for one or more of the 3 years examined. Counts for N-SSATS also exclude data from States not reporting to TEDS.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys of Substance Abuse Treatment Services (N-SSATS), 2007 to 2009; and Treatment Episode Data Set (TEDS), 2007 to 2009.

2.4.4 Conclusions and Limitations

The N-SSATS admission counts for alcohol or drug treatment are almost twice the TEDS counts. This is likely because the facilities that report to TEDS are a subset of the facilities that report to N-SSATS. There are less pronounced differences between the two counts in the Northeast. This is likely because the Northeast includes New York and Massachusetts, which require all substance use treatment facilities licensed or certified by their SSAs to report TEDS data on all of their clients.


3. Needing but Not Receiving Substance Use Treatment


This chapter discusses methods for estimating past year need for substance use treatment, methods for estimating the number of persons who have received substance use treatment in the past year at a specialty treatment facility, and the relation between those two measures. Specialty treatment, as defined in NSDUH, is treatment received at any one of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. It does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. Specialty treatment facilities included in TEDS do include some hospital outpatient treatment.

The first section in this chapter presents the current method of assessing need for but not receiving specialty substance use treatment in the past year based on NSDUH data. The second section presents an alternative method of estimating the number of persons who needed but did not receive treatment in the past year based on data from NSDUH and TEDS. Note that it is not possible to assess the number of persons who received treatment in the past year using N-SSATS data because N-SSATS provides counts of past year treatment admissions but not counts of persons who received treatment. The third section provides estimates using both methods and a discussion of the comparability and limitations of the measures of substance use treatment.

3.1. Current Methods of Assessing Needing but Not Receiving Treatment

Currently in NSDUH, persons are classified as needing treatment for an alcohol or drug use problem if they met the diagnostic criteria of the DSM-IV (American Psychiatric Association, 1994) for dependence on or abuse of alcohol or an illicit drug in the past 12 months, or if he or she received specialty treatment for alcohol use or illicit drug use in the past 12 months. A person is classified as having received treatment for an illicit drug or alcohol use problem if he or she has reported receiving specialty treatment for his or her drug or alcohol use problem in the past year. Thus, an individual who needed treatment for illicit drug use but only received specialty treatment for alcohol use in the past year or who received treatment for illicit drug use only at a facility not classified as a specialty facility was not counted as having received treatment for drug use. Similarly, an individual who needed treatment for an alcohol use problem was only counted as having received alcohol use treatment if the treatment was received for alcohol use at a specialty treatment facility.

SAMHSA publishes annual national estimates of the numbers and percentages of persons who needed substance use treatment in the past year, as well as the numbers and percentages of persons who received specialty treatment among those who needed treatment (CBHSQ, 2011b). SAMHSA has published only one report providing State-level estimates of the percentage of persons who received specialty treatment among those who needed treatment (Han, Clinton-Sherrod, Gfroerer, Pemberton, & Calvin, 2011). Due to the relatively small sample size at the State level of the persons who needed treatment, multiple years of data had to be used for this report. SAMHSA also publishes State estimates of the percentage of the full population who needed treatment but did not receive specialty treatment using 2-year rolling averages based on small area estimation models (OAS, 2010). This measure has the advantage of higher precision for State estimates because the entire population is used in the denominator rather than just those who needed substance use treatment. A disadvantage of this measure is that it is not possible to determine whether changes over time in this measure are due to changes in the number of persons who need treatment or the proportion of persons who need treatment and actually receive it.

This section focuses on persons who needed treatment but did not receive specialty treatment; this estimate was produced by dividing the number of persons who needed treatment by the number who received specialty treatment, and subtracting that figure from 100 percent.

3.2. An Alternative Method of Assessing Needing but Not Receiving Treatment

One possible criticism of the current measure of needing but not receiving treatment using NSDUH data is that it relies on estimates of the number of persons who have received specialty treatment in any year based on relatively small sample sizes. Available data sources, such as TEDS, that provide actual counts of the number of persons who have received substance use treatment present an alternative to using NSDUH data for estimates of both those who need treatment and those who receive treatment. It may be that using actual counts from TEDS of the number of persons who received treatment may result in a more accurate measure than estimating that number using NSDUH data. This may be of interest especially when producing measures at the State level, given the relatively low number of sampled persons who receive specialty treatment in each State.

In order to evaluate this alternate method, the percentages of persons needing but not receiving specialty substance use treatment were computed in two ways. The first method used the NSDUH estimate of treatment need, based on annual averages from the 2008 to 2010 surveys as the denominator and the NSDUH estimate of the number of persons receiving specialty treatment as the numerator. The second method used the NSDUH estimate of treatment need as the denominator and the TEDS count, based on annual averages from the 2007 to 2009 data, of the number of persons receiving treatment as the numerator.

3.3. National and State Estimates of Needing but Not Receiving Treatment

3.3.1 National and State Estimates

Table C.3.1 in Appendix C presents the estimates from NSDUH of the number of persons who needed treatment and the number of persons who received specialty treatment and counts from TEDS of the number of persons who received treatment. Table C.3.1 also includes two estimates of the percentage of persons who needed and received treatment, one using the NSDUH estimate of the number of persons who received specialty treatment as the numerator, and the second using the TEDS count of the number of persons who received treatment as the numerator. Because these counts reflect the number of persons who received treatment (as opposed to the number of treatment admissions), these estimates and percentages are available only for the 47 States for which we have TEDS data (Alabama, Alaska, the District of Columbia, and Georgia are excluded) for all 3 years examined.

Figure 3.1 compares the percentages of persons who did not receive treatment among those who needed treatment in NSDUH (NSDUH estimate of the number of persons who received specialty treatment in the numerator) and TEDS (TEDS counts of the number of persons who received treatment in the numerator). Section 2.1.2 of this report provides details of how counts of persons who received treatment were computed using the TEDS data. The figure presents combined estimates or the set of 47 States for which sufficient data were available in TEDS (the "Total" bars) and presents separate estimates for the 8 most populous States. The total estimates of the number of persons who needed but did not receive treatment from NSDUH and TEDS are quite similar (89.3 and 91.7 percent, respectively). With the exceptions of Ohio and New York, the percentages of persons who needed but did not receive treatment are higher in State estimates using the TEDS numerator than in those based on the NSDUH numerator, although the differences in California and Illinois are not statistically significant. In California, the estimates generated using the NSDUH data and those generated using the TEDS data are quite similar. The two States with the largest gaps between estimates are Michigan (92.9 vs. 85.4 percent unmet treatment need for NSDUH and TEDS estimates, respectively) and Pennsylvania (87.6 vs. 94.5 percent unmet treatment need for the NSDUH and TEDS estimates, respectively).

Figure 3.1 Percentages of Persons Who Did Not Receive Specialty Substance Use Treatment among Those Who Needed Treatment in the Past Year in the Total Nation* and Selected States: NSDUH 2008 to 2010 Combined and TEDS 2007 to 2009 Combined
Bar chart comparing percentages of persons who did not receive specialty substance use treatment among those who needed treatment in the past year in the total nation* and selected states: NSDUH 2008 to 2010 combined and TEDS 2007 to 2009 combined. Accessible table located below this figure.

Figure 3.1 Table. Percentages of Persons Who Did Not Receive Specialty Substance Use Treatment among Those Who Needed Treatment in the Past Year in the Total Nation* and Selected States: NSDUH 2008 to 2010 Combined and TEDS 2007 to 2009 Combined
Source TOTAL California Florida Illinois Michigan New York Ohio Pennsylvania Texas
Percentage Who Did Not Receive
Specialty Substance Use Treatment
among Those Who Needed Treatment
in the Past Year (NSDUH Numerator)
89.3% 91.8% 88.9% 90.2% 85.4% 87.5% 89.6% 87.6% 94.9%
Percentage Who Did Not Receive
Specialty Substance Use Treatment
among Those Who Needed Treatment
in the Past Year (TEDS Numerator)
91.7% 92.3% 95.1% 92.8% 92.9% 84.6% 88.2% 94.5% 97.5%
* The TEDS count for the total Nation of those receiving specialty substance use treatment does not include data from Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined.
NOTE: For NSDUH, respondents were classified as needing substance use treatment if they met at least one of three criteria during the past year: (1) were dependent on alcohol or an illicit drug; (2) abused alcohol or an illicit drug; or (3) received treatment for alcohol or illicit drug use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient], or mental health center). Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, based on data from original questions, not including methamphetamine use items added in 2005 and 2006.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2008 to 2010; and Treatment Episode Data Set (TEDS), 2007 to 2009.

3.3.2 NSDUH Estimates for Persons with Low Income

The TEDS data in many States are representative of only the persons in that State who received substance use treatment in publicly funded treatment programs (e.g., Florida, Hawaii, Nevada) or only those clients in publicly funded programs whose individual treatment was publicly funded (e.g., Indiana, Louisiana, Nebraska). In an effort to make the NSDUH estimates of persons needing treatment more comparable with the TEDS counts of persons receiving treatment, an additional set of analyses were run using NSDUH data that were subset down to persons with a household income that is less than the Federal poverty threshold, and thus would be more likely to have received publicly funded treatment.

As a means of avoiding suppression of estimates due to lower sample sizes in this restricted group, we limited this analysis to the eight most populous States in the NSDUH data set (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). Nonetheless, estimates for Florida and New York were suppressed due to low precision. We also conducted these analyses on the remaining States (the States other than the eight most populous States); however, due to lower sample sizes of respondents who received treatment, estimates were suppressed for all but one of these States.

Figure 3.2 compares the estimates of the percentage of persons who did not receive treatment among those who needed treatment generated using the NSDUH estimates among persons with low income and TEDS counts of persons who received treatment in six of the eight most populous States for which we had sufficient sample size. As noted previously, in these analyses, we used NSDUH data from 2008 through 2010 and TEDS data from 2007 through 2009. Unlike the results of the analyses presented earlier, which were not restricted to persons with low incomes, the TEDS-based estimates are lower than those generated with NSDUH-based treatment estimates; however, for the Michigan estimates, this difference is not statistically significant. In some States, such as California, Illinois, and Ohio, there is a large difference between the percentage calculated using the TEDS numerator and the one in which the NSDUH numerator was used. For other States, such as Pennsylvania and Texas, the difference is less pronounced.

Figure 3.2 Percentages of Persons Aged 12 or Older Who Did Not Receive Specialty Substance Use Treatment among Those with Low Income Who Needed Treatment in the Past Year in the Total Nation and Selected States: NSDUH 2008 to 2010 Combined and TEDS* 2007 to 2009 Combined
Bar chart comparing percentages of persons aged 12 or older who did not receive specialty substance use treatment among those with low income who needed treatment in the past year in the total nation and selected states: NSDUH 2008 to 2010 combined and TEDS* 2007 to 2009 combined. Accessible table located below this figure.

Figure 3.2 Table. Percentages of Persons Aged 12 or Older Who Did Not Receive Specialty Substance Use Treatment among Those with Low Income Who Needed Treatment in the Past Year in the Total Nation and Selected States: NSDUH 2008 to 2010 Combined and TEDS* 2007 to 2009 Combined
Source TOTAL California Illinois Michigan Ohio Pennsylvania Texas
Percentage Who Did Not Receive
Specialty Substance Use Treatment
among Those Who Needed Treatment
in the Past Year (NSDUH Numerator)
82.2% 83.7% 87.9% 74.9% 80.0% 79.4% 91.5%
Percentage Who Did Not Receive
Specialty Substance Use Treatment
among Those Who Needed Treatment
in the Past Year (TEDS Numerator)
52.5% 48.8% 57.7% 66.0% 41.4% 70.3% 85.4%
* TEDS counts of those receiving specialty substance use treatment do not include data from Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years examined.
NOTE 1: For NSDUH, respondents were classified as needing substance use treatment if they met at least one of three criteria during the past year: (1) were dependent on alcohol or an illicit drug; (2) abused alcohol or an illicit drug; or (3) received treatment for alcohol or illicit drug use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient], or mental health center). Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, based on data from original questions, not including methamphetamine use items added in 2005 and 2006.
NOTE 2: Low-income NSDUH respondents are those who fall within a poverty level of <100% of the Federal poverty threshold. Poverty level is based on income level, size of family, and number of children in family. The POVERTY2 variable was used for 2006 to 2008.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2008 to 2010; and Treatment Episode Data Set (TEDS), 2007 to 2009.

3.4. Conclusions and Limitations

These findings indicate that the percentage of persons who needed but did not receive treatment was slightly higher overall and in most States for which we could conduct analyses when using the TEDS counts of the number of persons who received treatment as the numerator rather than NSDUH estimates of the number of persons who received specialty treatment. Importantly, there was little difference between the two estimates at the State level, suggesting that using the TEDS counts in the numerator does not provide an advantage in generating State estimates over using the NSDUH estimates. Given the considerable differences between NSDUH and TEDS described throughout this report, as well as the relatively similar findings when using the NSDUH and TEDS estimates as the numerator of this statistic, these analyses do not suggest that using TEDS counts in the numerator of this statistic provides an advantage over using NSDUH estimates.

Of the 46 State-level comparisons made, the TEDS and NSDUH estimates are within 2 percent of one another in 13 States. The NSDUH estimate of needing but not receiving treatment is smaller than the TEDS estimate in 23 States, and the TEDS estimate is smaller than the NSDUH estimate in the remaining 10 (Colorado, Iowa, Louisiana, Maine, Maryland, New Jersey, New York, South Dakota, Vermont, and Wyoming). Notably, all but 2 of these States (Vermont and Wyoming) require all facilities that are licensed or certified by the SSA to report data to TEDS on all clients, which generally indicates complete TEDS reporting from all facilities in the State. Among the other States that require more complete TEDS reporting, two had NSDUH estimates that were similar to the TEDS estimates (Arkansas and Connecticut), two had a NSDUH estimate of needing but not receiving treatment that was lower than the TEDS estimate (Montana and Rhode Island), and one had a TEDS estimate that was lower than the NSDUH estimate (New Jersey).

Regardless of which estimate of treatment receipt is used, the percentage of persons who did not receive treatment among those who needed it indicates that a large majority of persons who needed substance use treatment did not receive it. It may be that the broad criteria for classifying treatment need (i.e., having either substance abuse or dependence or having received specialty treatment in the past year) has an impact on this estimate. Specifically, it may be that some persons who are classified with substance abuse but not substance dependence may not meet the admissions criteria of chronic severity of substance use required by some types of specialty treatment facilities. The two measures of treatment receipt presented in this chapter focus on self-report of treatment at specialty facilities (i.e., a drug or alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient], or mental health center) or admission to one of the substance use treatment facilities that report to TEDS. Admission criteria for these types of programs often include some level of chronic severity of substance use disorder symptoms, most typically focusing on symptoms of dependence rather than abuse. In fact, for Opioid Treatment Programs, opioid dependence (not abuse) is one of the primary admission criteria. According to the 2007 NSDUH, 9.5 percent of the population was classified as needing substance use treatment, with 4.1 percent of the population meeting the criteria for abuse but not for dependence. Further research is needed to determine whether the sizable portion of those classified with treatment need who did not meet the criteria for substance dependence meet the admission criteria of different types of specialty treatment facilities and, if not, how this impacts the percentage of persons who needed but did not receive treatment.


4. Conclusions


This chapter discusses some conclusions that may be drawn from the examination of estimates of receipt of substance use treatment derived from the NSDUH, TEDS, and N-SSATS data. As described throughout the report, there is considerable variation between these three data sources in important factors such as coverage, methods and timing of data collection, definitions, and information captured. As a result, each data source has its own strengths and limitations that must be considered when deciding which data source to use in order to address specific policy or research questions. This report is an attempt to document some of these key strengths and weaknesses and to examine how the methodological differences impact the estimates of substance use treatment from these three data sources. Next steps for further analyses and guidelines to be used in answering basic questions about substance use treatment are also discussed.

4.1. Summary of Findings

4.1.1 Single-Day Treatment Counts

Single-day treatment counts, which provide a count or estimate of the number of persons enrolled in substance use treatment programs on a single day, can be computed using data from each of the three data sources. In general, NSDUH and N-SSATS estimates of total persons in treatment are similar, while estimates based on TEDS are lower by more than 50 percent (Table C.2.2). This was the case at the national level, and for most of the eight largest States, with some exceptions. A comparison of the NSDUH October 1 estimate and the NSDUH average-day estimate (i.e., the two methods that can be used to compute single-day treatment estimates from the NSDUH) shows that the average-day estimate is lower by 17 percent. Despite the similarity between the NSDUH and N-SSATS numbers, a concern with the NSDUH estimates is the inconsistencies in reporting across some treatment items. In particular, among the respondents whose interview occurred less than 12 months after the prior October 1 (i.e., quarters 1-3 of the following year), 25 percent of those respondents reporting that they had been in treatment on October 1 reported on separate questions that they had not received any treatment in the past 12 months.

While the overall single-day treatment counts between the N-SSATS and NSDUH are similar, there still is some variability among the single-day treatment counts for alcohol-only treatment (Table C.2.3) and drug-only treatment (Table C.2.4). For both drug-only and alcohol-only counts, the TEDS estimates are about 50 percent of the N-SSATS estimates, similar to the overall comparisons of persons in treatment. However, the NSDUH average-day alcohol-only estimate is higher than the corresponding N-SSATS estimate, while the NSDUH estimate for drug-only treatment is lower than the N-SSATS estimate. In terms of proportions, 37 percent of the estimated persons in treatment based on NSDUH were in treatment for alcohol only. Corresponding percentages for N-SSATS and TEDS were both 19 percent.

Figure 4.1 shows that the N-SSATS and TEDS single-day treatment counts were fairly stable across years, but the NSDUH estimates exhibited some variability from year to year. Overall, it appears that using a single-day treatment count to represent substance use treatment received on a typical day in a given year is acceptable because there is no significant seasonal variation in treatment receipt over the course of a year (Figure 2.18).

Figure 4.1 Trends in Single-Day Treatment Counts, Numbers of Persons Treated, and Numbers of Admissions: NSDUH, N-SSATS, and TEDS 2002 to 2011
Line chart comparing trends in single-day treatment counts, numbers of persons treated, and numbers of admissions: NSDUH, N-SSATS, and TEDS 2002 to 2011. Accessible table located below this figure.

Figure 4.1 Table. Trends in Single-Day Treatment Counts, Numbers of Persons Treated, and Numbers of Admissions: NSDUH, N-SSATS, and TEDS 2002 to 2011
Source 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
NSDUH Persons Treated in the Past Year 2,345,582 1,874,481 2,326,572 2,307,924 2,533,021 2,429,687 2,293,489 2,626,716 2,594,063 2,325,139
NSDUH (Average Day) Single-Day Treatment Count 1,212,013    841,248    989,287    874,340 1,077,034 1,209,611 1,130,270 1,249,499 1,204,036 1,202,035
NSDUH (October 1) Single-Day Treatment Count 1,230,828 1,227,155 1,344,655 1,449,863 1,362,826 1,525,541 1,666,738 1,444,995 1,192,819 1,266,871
N-SSATS - Single-Day Treatment Count 1,136,287 1,092,546 1,072,251 1,081,049 1,130,881 1,135,425 1,192,490 1,182,077 1,175,462 1,224,127
TEDS - Past Year Admissions 1,887,912 1,865,149 1,808,035 1,896,023 1,914,338 1,918,943 2,016,672 2,000,684 1,871,981 1,844,719
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011; Treatment Episode Data Set (TEDS), 2002 to 2011; and National Surveys of Substance Abuse Treatment Services (N-SSATS), 2002 to 2011.

4.1.2 Number of Persons Who Received Treatment in the Past Year

For this measure, comparisons were made between NSDUH and TEDS (Table C.2.1). The NSDUH national estimate is about 28 percent higher than the TEDS estimate. Limiting the NSDUH data to just the 47 States that reported to TEDS, the NSDUH estimate is still about 22 percent higher than the TEDS count.

The comparisons by treatment modality (i.e., hospital inpatient, residential rehabilitation, or outpatient) provide some insight on the sources of the underestimation in TEDS, and possibly NSDUH as well. The NSDUH estimates of the number of persons receiving inpatient treatment were substantially higher than the TEDS counts. In particular, NSDUH estimated more than 10 times the number of persons treated as an inpatient in a hospital (738,366 vs. 61,382 in the 47 TEDS States). Again comparing with N-SSATS single-day counts, the TEDS number is an undercount. N-SSATS indicates that during 2007 to 2009 there were about 14,000 persons receiving substance use treatment in a hospital inpatient setting on the single day surveyed. Given the typical length of stays for this type of treatment is short, the N-SSATS count would project to several hundred thousand persons treated in a year. The NSDUH estimate for persons receiving outpatient treatment in the past year is higher than the TEDS estimate (1,916,780 and 1,507,988, respectively, in the 47 TEDS States), but both appear to be low when considering the annual N-SSATS single-day counts of clients in outpatient treatment (approximately 1 million) and the median length of stay across all outpatient clients. Likewise, a comparison of N-SSATS and TEDS counts of the number of past year treatment admissions (Table C.2.13) shows that TEDS admissions counts are more than 40 percent lower than those from N-SSATS. It is likely that the lower TEDS counts are due to (1) TEDS counts including mainly substance use treatment received at publicly funded facilities, whereas NSDUH and N-SSATS estimates include all facilities; and (2) the limited inclusion of hospital inpatient treatment patients in the TEDS sample.

The NSDUH estimates also were higher than the TEDS counts for receiving treatment for several substances: prescription drugs (620,335 vs. 240,288), inhalants (141,049 vs. 3,574), and hallucinogens (257,338 vs. 12,139). This is likely due to the methodological differences in the way these data are collected in the data sources. For example, in TEDS, the primary, secondary, and tertiary problem substances are recorded from the admission record, whereas in NSDUH, respondents are asked whether or not the treatment received in the past year was received for each substance they have used in their lifetimes.

Regarding client characteristics, the NSDUH estimates included a slightly lower percentage of youths aged 12 to 17 (6.4 vs. 8.8 percent) and a higher percentage of older adults (aged 45 or older; 29.0 vs. 22.5 percent) than the TEDS counts. The NSDUH estimates also included a higher percentage of persons with more than a high school education than the TEDS count (34.3 vs. 22.1 percent) and a lower percentage of persons with 8 or fewer years of education than the TEDS count (5.7 vs. 9.5 percent). Differences between TEDS and NSDUH estimates of specific racial or ethnic groups might be related to the broader inclusion of privately funded treatment in NSDUH but might also be associated with differences in the way that data concerning race and ethnicity were collected for the two data sources. Specifically, NSDUH respondents are asked to self-report the racial and ethnic groups with which they identify, whereas in TEDS, the processes for gathering this information vary between individual treatment facilities. NSDUH estimates show a higher proportion of clients who were white (66.6 vs. 60.4 percent) and lower proportions who were black (16.4 vs. 19.6 percent) or Hispanic (13.1 vs. 14.7 percent).

Comparisons of the client characteristics of NSDUH estimates of persons who received substance use treatment in the past year with TEDS data reported for those variables (CBHSQ, 2011a) reveal higher proportions of persons employed full time and part time in the NSDUH sample than in the TEDS counts (37.3 vs. 16.3 percent of persons employed full time for NSDUH and TEDS, respectively, and 12.9 vs. 7.6 percent of persons employed part time for NSDUH and TEDS, respectively). The findings for health insurance status were consistent with the pattern for employment, with a higher percentage of TEDS counts being uninsured (59.8 percent) compared with the NSDUH estimate (30.9 percent).

4.1.3 Receiving Treatment for the First Time

Though TEDS data are not typically presented in this manner, both NSDUH and TEDS can be used to compare estimates of the number of clients receiving substance use treatment for the first time in a given year. The NSDUH numbers are higher than the TEDS number for the year prior to interview, but the NSDUH numbers clearly decrease monotonically for estimates in previous years, indicating recall bias. A similar phenomenon has been shown for drug use initiation. Therefore, the NSDUH should not be used to look at first-time treatment retrospectively beyond 2 years.

4.1.4 Needing but Not Receiving Treatment

Percentages of persons who needed but did not receive treatment were computed in two ways: one using the NSDUH estimate of persons receiving treatment in the numerator (over the NSDUH estimate of persons needing treatment in the denominator), and the other using the TEDS count of persons receiving treatment (again using the NSDUH estimate of persons needing treatment in the denominator). Of the 46 State-level comparisons made, the TEDS and NSDUH estimates were similar in 12 States. In the remaining States, the NSDUH estimate of needing but not receiving treatment is smaller than the TEDS estimate in 25 States, and the TEDS estimate is smaller than the NSDUH estimate in 9 States. Using the TEDS numerator has the advantage that it does not have the sampling error that NSDUH estimates have, but given the coverage and response issues associated with TEDS, it is not clear that using TEDS data results in a substantial improvement of the estimates.

4.2. Implications for Using Substance Use Treatment Data from These Sources

4.2.1 Coverage

Across most measures, TEDS shows undercoverage relative to N-SSATS and NSDUH. Overall, N-SSATS appears to be a good source of data with regard to coverage for client counts nationally and at the State level for specialty treatment. If overall client counts are of interest, N-SSATS seems to be the best source of data. Although NSDUH national estimates are similar to the N-SSATS counts, internal inconsistencies in NSDUH reporting of treatment suggest caution and further exploration.

TEDS includes persons who are homeless and those who are institutionalized in treatment facilities long term, whereas homeless or institutionalized persons have little chance of inclusion in the NSDUH. NSDUH includes persons who are treated in privately funded facilities and persons whose treatment is privately funded as well as those whose treatment was publicly funded, whereas TEDS is mainly limited to those whose treatment was publicly funded. NSDUH also includes a great deal of information about individuals who received treatment that can be tied to other covariates collected in the survey, allowing for more specific analyses regarding coverage for different demographic groups. N-SSATS includes a census of all facilities regardless of funding, although in some cases the counts reported are estimates rather than actual counts.

4.2.2 Comparisons across States

All three data systems produce counts or estimates by State. State-level analyses not only are useful to local and State officials but also can provide policy assessments based on differing laws, policies, and conditions in States. These analyses require consistent data collection methods, definitions, and coverage across States to ensure the data are comparable. While comparability is achieved in NSDUH and N-SSATS, small sample sizes by State is an important limitation of NSDUH for State-level comparisons. Reporting anomalies in TEDS require extra caution in drawing conclusions about differences in treatment by State:

4.2.3 Implications Concerning Trends

Some of the basic questions about substance use treatment concern trends over time in service need or utilization. In TEDS, there are two principal sources of variations in estimates of variation over time: reporting anomalies and true changes in admission and discharge patterns. N-SSATS and NSDUH have relatively fewer methodological shifts or anomalies that may cause variations in the data over time. In the absence of those, differences in N-SSATS or NSDUH counts or estimates, when statistically significant and meaningful, may be expected to reflect actual changes. One limitation of NSDUH is that because it is a sample survey, trends in rare events and among subpopulations may be difficult to assess due to potentially large sampling error.

4.2.4 Unique Contributions of Each Data Source

Each of the three data sources makes a unique contribution toward our understanding of substance use treatment. TEDS is the only data source that provides information about both treatment admissions and discharges. NSDUH is the only source that provides the ability to link treatment or client characteristics with an extensive set of other relevant covariates; it is also the only source that has a measure of all substance use treatment received in the past year, not just specialty treatment. NSDUH is also the only source that provides data concerning treatment need and percentages of those in need who received treatment. N-SSATS provides the best overall single-day treatment counts nationally, for individual States, and across time.

4.3. Next Steps

The analyses presented in this report are the first step in refining analyses to identify the best ways to utilize CBHSQ data systems to answer some basic questions about substance use treatment, such as how many persons receive treatment in a year, how large is the gap between treatment received and treatment needed, and how have the numbers of persons receiving and needing treatment changed over time. The discussion and conclusions in this report are also a step toward understanding how to answer questions about the data sources, such as why do these studies give conflicting results, and which estimate should be used to answer questions about substance use treatment.

Some specific questions raised by this analysis need to be explored further to achieve maximum benefit from studies utilizing these three data sets. Avenues of investigation should include the following:

Finally, it is important to recognize that the nature of these data sets and how they may be used in the future will not remain constant. The movement toward more integrated care, mental health parity, and health care reform will undoubtedly lead to changing data needs and data systems. The results presented here will be valuable to policymakers and designers of data systems as the substance use treatment system evolves within the broader health care context.


Appendix A: Description of the Data Sets


This appendix provides more details on the three sources of data for the estimates of receipt of substance use treatment that were presented in this report: NSDUH, TEDS, and N-SSATS. Specifically, this appendix briefly describes the following characteristics of each data source: (1) purpose of the data sets; (2) design; (3) data collection procedures; (4) data processing procedures, including procedures for handling missing or inconsistent data; and (5) content of the data sets.

The following publications for these studies were the principal sources of information presented in this appendix:

These publications provide more detailed information about these studies. Other publications for these surveys are cited as part of descriptions of specific methods (e.g., sample design). Additional information about these surveys' methods can be obtained from their respective Web sites:

A.1 Purpose of the Data Sets

While NSDUH is focused on alcohol and drug use in the general U.S. civilian, noninstitutionalized population, TEDS compiles information on client admissions to substance use treatment, and N-SSATS collects information from public and private facilities that provide substance use treatment. This section describes in more detail the objectives and scope of these three data sets.

NSDUH

NSDUH is the primary source of statistical information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse in the general U.S. civilian, noninstitutionalized population aged 12 or older. In particular, NSDUH provides information about trends in the use of alcohol, tobacco, and illegal drugs in the population and trends within specific population subgroups. NSDUH yields estimates of substance use for all 50 States, the District of Columbia, and substate regions within each State. NSDUH also collects data on sociodemographic variables such as age, gender, pregnancy status, race/ethnicity, education, employment, and geographic area.

NSDUH also presents findings on mental health issues in the civilian, noninstitutionalized population. Specifically, NSDUH allows estimates to be made of the prevalence of mental illness and mental health service utilization, including the prevalence of mental disorders that co-occurred with substance use or with substance use disorders, and treatment for co-occurring mental disorders and substance use or substance use disorders.

TEDS

TEDS is a compilation of data on the demographic and substance abuse characteristics of admissions to and discharges from substance abuse treatment. TEDS is coordinated and managed by CBHSQ and is part of BHSIS, formerly known as DASIS, a cooperative program among SAMHSA and State substance abuse agencies to collect data on substance abuse services. The TEDS data collection effort was developed in response to the 1988 Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690), which established a revised SAPTBG and mandated Federal data collection on clients receiving treatment for either alcohol or drug abuse.

The primary goal of TEDS is to monitor the characteristics of clients admitted to planned, continuing treatment regimens. Thus, TEDS excludes early intervention and crisis intervention programs that do not lead to enrollment in continued treatment. A majority of States report data on all admissions to all eligible facilities, although some report only admissions financed by public funds.

N-SSATS

N-SSATS was designed to collect data on the location, characteristics, and utilization of alcohol and drug treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions.9 CBHSQ plans and directs N-SSATS. N-SSATS, along with TEDS, is a component of DASIS, a cooperative program among SAMHSA and State substance abuse agencies to collect data on substance abuse services. The 2009 survey was the 32nd in this series of national surveys begun in the 1970s.

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

TEDS and N-SSATS in the Context of BHSIS

TEDS and N-SSATS are two of the three components of SAMHSA's BHSIS. Together, the components provide national- and State-level information on the numbers and characteristics of individuals admitted to alcohol and drug treatment programs and describe the facilities that deliver care to those individuals. BHSIS is the primary source of national data on substance use treatment. The core component of BHSIS is the I-SATS, a continuously updated comprehensive listing of all known public and private substance abuse treatment facilities. I-SATS is the list frame for N-SSATS. Facilities in I-SATS fall into two general categories and are distinguished by the relationship of the facility to its State substance abuse agency. These categories are described subsequently.

The largest group of facilities (about 80 percent of all active I-SATS facilities) includes those that are licensed, certified, or otherwise approved by the SSA to provide substance abuse treatment. State DASIS representatives maintain this segment of I-SATS by reporting new facilities, closures, and address changes to SAMHSA. Some facilities are not licensed, certified, or otherwise approved by the State agency. Some private for-profit facilities fall into this category. This group also includes programs operated by Federal agencies, the VA, the DOD, and the IHS. I‑SATS records for federally operated facilities are updated annually through lists provided by these agencies.

This group of facilities (about 20 percent of all active I-SATS facilities) represents the SAMHSA effort since the mid-1990s to make I-SATS as comprehensive as possible by including treatment facilities that State substance abuse agencies, for a variety of reasons, do not fund, license, or certify. Many of these facilities are private for-profit, small group practices, or hospital-based programs. Most of them are identified through periodic screening of alternative source databases. State substance abuse agencies are given the opportunity to review these facilities and to add them to the State agency-approved list, if appropriate.

TEDS includes facilities that are licensed or certified by the SSA to provide substance abuse treatment (or are administratively tracked for other reasons) and that are required by the States to provide TEDS client-level data. N-SSATS is an annual survey of the location, characteristics, services offered, and utilization of alcohol and drug abuse treatment facilities in I-SATS.

A.2 Design

Fundamental design differences characterize the NSDUH, TEDS, and N-SSATS data sets due to their differences in purpose and scope. The following descriptions provide more detail on the design characteristics of each data set.

NSDUH

The 2005 through 2010 NSDUHs are part of a coordinated 5-year sample design (extended through 2010) providing estimates for all 50 States plus the District of Columbia for the years 2005 through 2010. The respondent universe is the civilian, noninstitutionalized population aged 12 years old or older residing within the United States. The survey includes persons living in noninstitutionalized group quarters (e.g., shelters, rooming/boarding houses, college dormitories, migratory workers' camps, halfway houses) and civilians living on military bases.

Although this population includes almost 98 percent of the total U.S. population aged 12 or older, it excludes some important and unique subpopulations that may have very different substance use and treatment patterns. For example, the survey excludes active military personnel who have been shown to have significantly lower rates of illicit drug use. Also, persons living in institutional group quarters, such as prisons and residential substance use treatment centers, are not included in NSDUH, and they have been shown in other surveys to have higher rates of illicit drug use. Also excluded are other types of institutional group quarters such as nursing homes, mental institutions, and long-term hospitals. Also excluded from the survey are persons with no fixed household address, such as homeless persons not living in a shelter for the majority of the quarter in which the shelter is sampled; homeless persons are another population shown to have higher than average rates of illicit drug use.

For the 50-State design, 8 States were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) with target sample sizes of 3,600. For the remaining 42 States and the District of Columbia, the target sample size was 900. This approach ensures there is sufficient sample in every State to support small area estimation (SAE)10 while at the same time maintaining efficiency for national estimates.

More information on the sample design can be found in the 2008 NSDUH sample design report by Morton, Chromy, Hirsch, and Martin (2009) on the SAMHSA Web site (available as a PDF at http://www.samhsa.gov/data/Methodological_Reports.aspx).

TEDS

TEDS is designed to monitor the demographic and substance abuse characteristics of clients admitted to substance use treatment. TEDS admissions do not represent individuals but rather admission-level data. For example, one individual admitted to treatment twice within a calendar year would be counted as two admissions. However, data from some States include person-level identifiers that allow linkage of treatment episode records for an individual. This report uses these data to provide person-level rather than treatment episode-level estimates.

The national TEDS data are analyzed and published annually on a calendar year basis, although States submit TEDS data to SAMHSA on an ongoing basis as it is received from the provider facilities. The cutoff for receipt of data for each TEDS report is approximately August 31 of the year following the data year. Data received after that time does not appear in the initial annual report. For example, the annual report for calendar year 2009 admissions is prepared after the cutoff of August 31, 2010. For inclusion in the initial annual report, States must submit complete 2009 data before August 31, 2010.

TEDS data is not submitted by all States and jurisdictions each year. In 2007, Alabama, Alaska, Georgia, Mississippi, and West Virginia did not submit TEDS data; in 2008, Alabama and Georgia did not submit TEDS data; and in 2009, Georgia and the District of Columbia did not submit TEDS data.

Although TEDS does not exclude facilities, the facilities that report TEDS data are primarily those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of drug and/or alcohol treatment services. The scope of facilities included is affected by differences in State licensure, certification, and accreditation practices, and disbursement of public funds. Although there is variation by State, the majority include only facilities receiving public funding. Therefore TEDS generally does not include data on private facilities, VA-operated facilities, DOD-operated military treatment facilities, hospital-based programs, and Federal prisons; some facilities operated by the IHS are included. A list of State reporting requirements, which is provided in the annual TEDS admissions reports, is presented in Table A.1.

Table A.1 State Data Systems Reporting Characteristics: TEDS 2007 to 2009
State or
Jurisdiction
Facilities Reporting TEDS Data to the State SSA Eligible Clients
Facilities Required To Report to the
State SSA1
Facilities Reporting
Voluntarily to the State
SSA
Alabama Facilities that receive State/public funding None All clients in facility
Alaska Facilities that receive State/public funding None All clients in facility
Arizona Facilities that receive State/public funding None State/public-funded clients only
Arkansas Facilities that are licensed by State SSA State Community Correction facilities
Some private facilities
All clients in a licensed facility
California Facilities that receive State funding
All licensed narcotic treatment facilities
None All clients in facility except DUI
Colorado State-licensed facilities
Methadone facilities
Community-based juvenile and adult justice treatment programs, except institutionally-based
None All clients receiving substance abuse treatment services in facility
Connecticut Facilities that receive State/public funding (including corrections)
Facilities serving adults that are licensed by State Dept. of Public Health
Some facilities treating youths < 18
General hospitals funded by State SSA
None All clients in facility
Delaware Facilities that receive State/public funding, excluding:
  • Child/youth services
  • Most Medicaid-funded services
  • Most criminal justice system services
None State/public-funded clients only
District of Columbia Facilities that receive State/public funding None State/public-funded clients only
Florida Facilities that receive State/public funding None All clients in facility
Georgia 2007: Facilities that receive State/public funding
2008-2009: Facilities that receive SAPTBG, State, and Medicaid funding through State SSA (this includes Medicaid for foster children, aged, blind, and disabled individuals)
None 2007: State/public-funded clients only
2008-2009: SSA-funded clients with SA or co-occurring SA and MH disorders
Hawaii Facilities that receive State/public funding None All clients in facility
Idaho Facilities that receive State/public funding None State/public-funded clients only
Illinois Facilities that receive funding through State SSA (this includes Medicaid-paid subacute addiction treatment services) None State/public-funded clients only
Indiana Facilities that receive State/public funding None State/public-funded clients only
Iowa Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
Medicare-certified facilities
State prison
Department of Human Services youth facility
All clients in facility
Kansas Facilities that receive State/public funding
Medicaid-certified facilities
Department of Corrections fourth-time DUI facilities
None All clients in facility
Kentucky Facilities that receive State/public funding None All clients in facility
Louisiana Facilities that receive State/public funding
State programs
None State/public-funded clients only
Maine Facilities that receive State/public funding
Facilities licensed by the State must report all their substance abuse clients
Facilities seeking Medicaid reimbursement for substance abuse services
Clients who are being treated because of "Operating Under the Influence"
Some private substance abuse providers report their clients although not required by statute to do so All clients in facility
Maryland Facilities that are licensed/certified by the Health Department Office of Health Care Quality None All clients in facility
Massachusetts Facilities that are licensed/certified by State SSA None All clients in facility
Michigan Facilities that receive State/public funding
Medicaid providers of substance abuse treatment
None Clients whose services are supported by State/public funds through the Department of Community Health, including Medicaid
Minnesota Providers serving publicly funded clients None All clients in facility
Mississippi Facilities that receive State/public funding
Facilities certified by Mental Health Department
None All clients in facility
Missouri Facilities that receive State/public funding None State/public-funded clients only
Montana Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
None All clients in facility except DUI clients
Nebraska Facilities that receive SSA-administered State/public funding None State/public-funded clients only
Nevada Facilities that receive State/public funding None All clients in facility
New Hampshire Facilities that receive State/public funding None State/public-funded clients only
New Jersey Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
Facilities in State intoxicated driver program
Some private facilities and solo practitioners All clients in facility
New Mexico Facilities that receive SSA substance abuse funding None SSA-funded clients with SA or co-occurring SA and MH disorders
New York Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
None All clients in facility
North Carolina Facilities that receive State/public funding None All clients in facility
North Dakota Eight State divisional service centers and other facilities receiving SAPTBG funds
One State hospital
Some private facilities All clients in State Hospital and Regional Human Service Centers
Small privates report only SAPTBG-funded clients
Ohio Facilities that receive State/public funding None State/public-funded clients only
Oklahoma Facilities that receive State/public funding None State/public-funded clients only
Oregon Facilities that receive State/public funding or are required because they provide DUI or methadone treatment None All clients in facility
Pennsylvania Facilities that receive SAPTBG/State funds through the Department of Health; this includes some but not all Medicaid funds spent on substance abuse diagnoses Some, but not all, county prisons, hospitals, and private providers and solo practitioners State/public-funded clients only are required
Data on all clients are requested and received from some facilities
Rhode Island Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
VA Hospital reports voluntarily All clients in facility
South Carolina Facilities that receive State/public funding None All clients in facility
South Dakota Facilities that receive State/public funding
Facilities that are licensed/certified by State SSA
Medicare-certified facilities
Solo practitioners licensed/certified by State SSA
None All clients in facility
Tennessee Facilities that receive State/public funding None State/public-funded clients only
Texas Facilities that receive State/public funding None State/public-funded clients only
Utah Facilities that receive State/public funding None All clients in facility
Vermont Facilities that receive State/public funding None All clients in facility
Virginia Facilities that receive State/public funding None All clients in facility
Washington Facilities that receive State/public funding
Medicare-certified facilities
State-certified privately funded methadone treatment programs State/public-funded clients only are required
Data on all clients are requested and received from some facilities
West Virginia Facilities that receive State/public funding None All clients in facility
Wisconsin Facilities that receive State/public funding None State/public-funded clients only
Wyoming Facilities that receive State/public funding None All clients in a facility
DUI = driving under the influence; MH = mental health; SA = substance abuse; SAPTBG = Substance Abuse Prevention and Treatment Block Grant; SSA = Single State Authority; VA = U.S. Department of Veterans Affairs.
1 "State/public funding" generally refers to funding by the State substance abuse agency but may also include funding by another public agency.
Source: State Substance Abuse Agencies, July 2010.

N-SSATS

Whereas NSDUH collects individual-level data and TEDS collects admission-level data, N-SSATS collects data from all alcohol and drug abuse treatment facilities. N-SSATS includes both public and private treatment facilities and is designed to collect data throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. Treatment facilities that are licensed, certified, or otherwise approved by the SSA to provide substance abuse treatment make up the largest group of facilities. The survey also includes programs operated by Federal agencies: the VA, the DOD, and the IHS. Together, these facilities represent about 80 percent of the total. The remaining facilities included in N-SSATS are those that are not licensed or certified through the State substance abuse agencies or Federal agencies. These facilities are usually hospital-based or private for-profit facilities.

Some N-SSATS respondents provide information but are deemed to be out of the scope of the N-SSATS Annual Report and public use files. On average, 5 percent of responding facilities were excluded from the N-SSATS Annual Report and public use files each survey year from 2007 through 2009. The excluded facilities and reasons for exclusion fall into four categories:

An average of 13,616 facilities were included each survey year from 2007 through 2009 in the Annual Report and public use files.

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

A.3 Data Collection Methodology

There are fundamental differences in the data collection methodologies used across the three data sets because of their differing designs and objectives. NSDUH data collection involves in-person interviews with sample individuals; TEDS is a compilation of client-level admission data collected and submitted by the States as they are received from providers; and N-SSATS data collection involves questionnaires completed by surveyed facilities on hard copy, over the Internet, or by telephone. This section provides more detail on the data collection processes and procedures used for each data set.

NSDUH

The data collection method used in NSDUH involves in-person interviews with sample persons, incorporating procedures that would be likely to increase respondents' cooperation and willingness to report honestly about their illicit drug use behavior. Confidentiality is stressed in all written and oral communications with potential respondents. Respondents' names are not collected with the data, and CAI methods are used to provide a private and confidential setting to complete the interview.

Introductory letters are sent to sampled addresses, followed by an interviewer visit. A 5-minute screening procedure using a handheld computer involves listing all household members along with their basic sociodemographic data. The computer uses the demographic data in a preprogrammed selection algorithm to select zero to two persons, depending on the composition of the household. The selection process is designed to provide the necessary sample sizes for the specified population age groupings.

In areas where a third or more of the households contain Spanish-speaking residents, the initial introductory letters written in English are mailed with a Spanish version on the back. All interviewers carry copies of this letter in Spanish. If the interviewer is not certified bilingual, he or she uses preprinted Spanish cards to attempt to find someone in the household who speaks English and who can serve as the screening respondent or who can translate for the screening respondent. If no one is available, the interviewer schedules a time when a Spanish-speaking interviewer can come to the address.

In households where a language other than Spanish is encountered, another language card is used to attempt to find someone who speaks English to complete the screening. The NSDUH interview is available in English and Spanish, and both versions have the same content. If the sample person prefers to complete the interview in Spanish, a certified bilingual interviewer is sent to the address to conduct the interview. Because the interview is not translated into any other language, if a sample person does not speak English or Spanish, the interview is not conducted.

Interviewers attempt to conduct the NSDUH interview immediately after the screening with each sample person in the household. The interviewer requests the selected respondent to identify a private area in the home to conduct the interview away from other household members. The interview averages about an hour and includes a combination of CAPI in which the interviewer reads the questions and ACASI.

The NSDUH interview consists of core and noncore (i.e., supplemental) sections. A core set of questions critical for basic trend measurement of prevalence estimates remains in the survey every year and comprises the first part of the interview. Noncore questions, or modules, that can be revised, dropped, or added from year to year make up the remainder of the interview.

The core consists of initial demographic items (which are interviewer administered) and self-administered questions pertaining to the use of tobacco, alcohol, marijuana, cocaine, crack cocaine, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, and sedatives. Topics in the remaining noncore self-administered sections include (but are not limited to) injection drug use, perceived risks of substance use, substance dependence or abuse, arrests, treatment for substance use problems, pregnancy and health care issues, and mental health issues.

Noncore demographic questions (which are interviewer administered and follow the ACASI questions) address such topics as immigration, current school enrollment, employment and workplace issues, health insurance coverage, and income. It should be noted that some of the noncore portions of the interview have remained in the survey, relatively unchanged, from year to year (e.g., current health insurance coverage, employment). More detailed information on content of the survey instruments is provided in Section A.5 of this appendix.

The interview begins in CAPI mode with the field interviewer reading the questions from the computer screen and entering the respondent's replies into the computer. The interview then transitions to the ACASI mode for the sensitive questions. In this mode, the respondent can read the questions silently on the computer screen and/or listen to the questions read through headphones and enter his or her responses directly into the computer. At the conclusion of the ACASI section, the interview returns to the CAPI mode with the interviewer completing the questionnaire. Each respondent who completes a full interview is given a $30.00 cash payment as a token of appreciation for his or her time.

TEDS

The process of collecting and submitting TEDS data involves a number of tasks on the part of the States.

Data Collection through State Data Systems

First, the data is collected through the State data systems. There may be some variation from State to State in terms of the types of data systems and related infrastructures in place. States are provided with TEDS State Instruction Manuals containing detailed instructions on collection of admission and discharge data. The manuals include definitions of data items, reporting guidelines, acceptable code values, descriptions of data crosschecks, and formatting information for all TEDS data elements. Coding instructions include guidelines that take into account potential variations from State to State in types of data systems used. The TEDS-A and TEDS-D Codebooks for 2007 through 2009 can be found at http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/33261#method.

State Crosswalks

Next, the States must translate or crosswalk the State data to the appropriate TEDS data fields, codes, and file format. Each State is responsible for translating data from the State's own data collection system to the data elements used by TEDS. A computer program must be written to extract data from the State system and construct the appropriate data files for TEDS submission.

A State Crosswalk Plan is a document containing the general instructions (or map) for translating data from the State's own data collection system to the data elements used by TEDS. Each State, working with Synectics, develops this plan and maintains the plan as changes to State data systems require. The State Crosswalk Plan guides development of the State's computer program that converts the State data items to the TEDS data items. It is the State's responsibility to develop the computer program to extract State data for submission to TEDS according to the specifications in the State TEDS Crosswalk. It is also the State's responsibility to update that program as needed when a change is made to the State data system to ensure that the State data items are accurately cross-walked/translated to the TEDS data item codes.

Submission of Data Files

Finally, the States submit the data files to SAMHSA; methods of submission include using the State TEDS Submission System (STSS), using diskettes or CDs, or using electronic transmission. States are expected to report TEDS data on a regular and timely basis as the data are received from providers and become available from the State data system. It is preferred that States report monthly but States not able to report on a monthly basis may report on a quarterly basis.

States are encouraged to submit all data to TEDS within 2 months of the client admission date to enable timely analysis and publication of the national TEDS data. Admissions from facilities that report late to the States may appear in a later data submission to SAMHSA. Thus, the number of admissions reported for 2007 through 2009 may increase as submissions of 2007, 2008, and 2009 data continue to be submitted.

The TEDS data are analyzed and published annually on a calendar year basis. The cutoff for receipt of data for each report is approximately August 31 of the year following the data year. Data received after that time does not appear in the annual report. For example, the annual report for calendar year 2009 admissions is prepared after the cutoff of August 31, 2010. For inclusion in the report, States must submit complete 2009 data before August 31, 2010.

Additional information about data processing upon receipt of the TEDS data is provided in Section A.4 of this appendix.

Data Collection Notes

Several limitations to the TEDS data exist:

N-SSATS

Data collection packets containing a hardcopy N-SSATS questionnaire are mailed to surveyed facilities on the survey reference date. Surveyed facilities are also offered the options of completing the surveys over the Internet or by telephone. Until 1996, State substance abuse agencies distributed and collected the survey forms. Beginning in 1996, data collection was centralized; since that time, SAMHSA has mailed facility survey forms directly to and collected forms directly from the facilities, and has conducted follow-up telephone interviews with facility directors or their designee.

Exclusions

In 1997, facilities offering only DUI/DWI programs were excluded; these facilities were reinstated in 1998. Facilities operated by the BOP were excluded from the 1997 Uniform Facility Data Set survey and subsequent surveys because SAMHSA conducted a separate survey of correctional facilities. (OAS, 2000). During that survey, it was discovered that jails, prisons, and other organizations treating incarcerated persons only were poorly enumerated on I-SATS. Beginning in 1999, these facilities were identified during the survey and excluded from analyses and public-use data files. I-SATS and N-SSATS are designed to include specialty substance abuse treatment facilities rather than individuals. Solo practitioners are listed on I-SATS and surveyed in N‑SSATS only if the SSA explicitly requests that they be included. Beginning in 2000, halfway houses that did not provide substance abuse treatment were included on I-SATS and in N-SSATS so that they could be listed in the National Directory of Drug and Alcohol Abuse Treatment Programs and on the Treatment Facility Locator. These facilities are excluded from analyses and public-use data files.

Field Period and Reference Dates

The 2007 through 2009 N-SSATS surveys were conducted between March and October of each year, with a reference date of March 30 or March 31 of each year. The field period typically lasts about 6 months beginning on the reference date (i.e., from the last working day in March to the beginning of October). For example, the field period for the 2007 N-SSATS ran from March 30, 2007, through October 17, 2007, with a reference date of March 30, 2007.

Procedures

Six weeks before the N-SSATS survey is implemented, letters are mailed to all facilities to alert them to expect the survey; an additional purpose of the letters is to update records with new address information received from the Post Office. Subsequently, data collection packets are mailed to each facility out on the survey reference date, containing the questionnaire, SAMHSA cover letter, State-specific letter of endorsement, information on completing the survey on the Internet, and a sheet of Frequently Asked Questions. During the data collection phase, contract personnel are made available to answer facilities' questions concerning the survey, as well as support in responding to questions for those facilities completing the questionnaire over the Internet. About 4 to 5 weeks after the initial questionnaire mailing, thank-you/reminder letters are sent to all facilities. Approximately 8 weeks after the initial questionnaire mailing, nonresponding facilities are sent a second questionnaire mailing. About 4 to 5 weeks after the second questionnaire mailing, nonrespondents receive a reminder telephone call. Those facilities that have not responded within 2 to 3 weeks of the reminder call are telephoned and asked to complete the survey by telephone.

Two primary data collection modes were employed: a paper questionnaire sent by mail and a secure Web-based questionnaire. Respondents could select either method to complete the survey. Six weeks before the survey reference date, letters were mailed to all facilities to alert them to expect the survey. The letters also served to update records with new address information received from the Post Office. On the reference date, data collection packets (including the questionnaire, SAMHSA cover letter, State-specific letter of endorsement, information on completing the survey on the Web, and a sheet of Frequently Asked Questions) were mailed to each facility. During the data collection phase, contract personnel were available to answer facilities' questions concerning the survey. Web-based support for facilities completing the questionnaire on the Web was also available. About 4 to 5 weeks after the initial questionnaire mailing, thank-you/reminder letters were sent to all facilities. Approximately 8 weeks after the initial questionnaire mailing, nonresponding facilities were mailed a second questionnaire packet. About 4 to 5 weeks after the second questionnaire mailing, nonrespondents received a reminder telephone call. Those facilities that had not responded within 2 to 3 weeks of the reminder call were telephoned and asked to complete the survey by CATI.

Facility Status and Response Rate

Questionnaires were mailed to those facilities believed to be actively providing substance abuse treatment services, an average of 17,107 facilities each survey year from 2007 through 2009. Of those facilities, approximately 11 percent each survey year were found to be ineligible for the survey because they had either closed or did not provide substance abuse or detoxification services on the reference date. Of the eligible facilities, an average of 94 percent completed the survey each survey year from 2007 through 2009.

Beginning in 1992, SAMHSA expanded efforts to obtain information from nonresponding facilities. A representative sample of nonrespondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all nonresponding facilities. In 1997, a series of measures was introduced to enhance the survey response rate. These included advance notification and improved methods for updating address and contact information, as well as intensive telephone follow-up.

Survey Response Mode

The proportion of facilities using the Web survey to respond to N-SSATS has increased steadily since introduction of the option in 2002. The percentage of facilities responding via the Web increased from 44 percent in 2007 to 58 percent in 2009. Mail response declined from 36 percent in 2007 to 29 percent in 2009. Telephone response, which represents follow-up of facilities that have not responded by mail or Web, also changed, decreasing from 21 percent in 2007 to 14 percent in 2009.

Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data.

A.4 Data Processing

NSDUH

At the conclusion of the computer-assisted interview, interviewers securely transmit the completed encrypted data to RTI in Research Triangle Park, North Carolina, via home telephone lines. No personal identifying information is captured in the CAI record for the respondent. Computers at RTI direct the information to a raw data file (i.e., in which no editing of the data had been done) that consists of one record for each completed interview. Cases are retained only if respondents provided data on lifetime use of cigarettes and at least nine other substances in the core section of the questionnaire. Written responses to questions (e.g., names of other drugs that were used) are assigned numeric codes as part of the data processing procedures. Even though editing and consistency checks are done by the CAI program during the interview, additional, more complex edits and consistency checks are also completed during or after data collection processing. Additionally, statistical imputation is used to replace missing or ambiguous values after editing for some key variables. Analysis weights are created so that estimates will be representative of the target population.

Data Coding and Logical Editing

With the exception of industry and occupation data, coding of written answers that respondents or interviewers typed was performed at RTI for the 2005 through 2010 NSDUH. These written answers include mentions of drugs that respondents had used or other responses that did not fit a previous response option (subsequently referred to as "OTHER, Specify" data). Coding of the "OTHER, Specify" variables was accomplished through computer-assisted survey procedures and the use of a secure Web site that allowed for coding and review of the data. The computer-assisted procedures entailed a database check for a given "OTHER, Specify" variable that contained typed entries and the associated numeric codes. If an exact match was found between the typed response and an entry in the system, the computer-assisted procedures assigned the appropriate numeric code. Typed responses that did not match an existing entry were coded through the Web-based coding system. Data on the industries in which respondents worked and on respondents' occupations were assigned numeric industry and occupation codes by staff at the U.S. Census Bureau.

Therefore, the first important step in processing the raw NSDUH data was logical editing of the data. Logical editing involved using data from within a respondent's record to (1) reduce the amount of item nonresponse (i.e., missing data) in interview records, including identification of items that were legitimately skipped; (2) make related data elements consistent with each other; and (3) identify ambiguities or inconsistencies to be resolved through statistical imputation procedures (see Appendix B).

In 2005 through 2010 NSDUHs, statistical imputation was used to replace missing or ambiguous values after completion of data coding and logical editing. Analysis weights were created so that estimates would be representative of the target population.

Statistical Imputation

For some key variables that still had missing or ambiguous values after editing, statistical imputation was used to replace these values with appropriate response codes. For example, a response is ambiguous if the editing procedures assigned a respondent's most recent use of a drug to "use at some point in the lifetime," with no definite period within the lifetime. In this case, the imputation procedures assign a definite value for when the respondent last used the drug (e.g., in the past 30 days, more than 30 days ago but within the past 12 months, more than 12 months ago). Similarly, if a response is completely missing, the imputation procedures replace missing values with nonmissing ones.

In most cases, missing or ambiguous values are imputed in NSDUH using a methodology called predictive mean neighborhood (PMN), which was developed specifically for the 1999 survey and has been used in all subsequent survey years. The PMN method offers a rigorous and flexible method that was implemented to improve the quality of estimates and allow more variables to be imputed. Some of the key reasons for implementing this method include the following: (1) the ability to use covariates to determine donors is far greater than that offered in the hot deck, (2) the relative importance of covariates can be determined by standard estimating equation techniques, (3) the correlations across response variables can be accounted for by making the imputation multivariate, and (4) sampling weights can be easily incorporated in the models.

The PMN method has some similarity with the predictive mean matching method of Rubin (1986) except that, for the donor records, Rubin used the observed variable value (not the predictive mean) to compute the distance function. Also, the well-known method of nearest neighbor imputation is similar to PMN, except that the distance function is in terms of the original predictor variables and often requires somewhat arbitrary scaling of discrete variables. PMN is a combination of a model-assisted imputation methodology and a random nearest neighbor hot-deck procedure. The hot-deck procedure is set up in such a way that imputed values are made consistent with preexisting nonmissing values for other variables. Whenever feasible, the imputation of variables using PMN is multivariate, in which imputation is accomplished on several response variables at once. Variables requiring imputation using PMN are the core demographic variables, core drug use variables (recency of use, frequency of use, and age at first use), income, health insurance, and noncore demographic variables for work status, immigrant status, and the household roster. A weighted regression imputation is used to impute some of the missing values in the nicotine dependence variables.

In the modeling stage of PMN, the model chosen depends on the nature of the response variable Y. In the 2005 through 2010 NSDUHs, the models included binomial logistic regression, multinomial logistic regression, Poisson regression, and ordinary linear regression, where the models incorporated the sampling design weights.

In general, hot-deck imputation replaces an item nonresponse (missing or ambiguous value) with a recorded response that is donated from a "similar" respondent who has nonmissing data. For random nearest neighbor hot-deck imputation, the missing or ambiguous value is replaced by a responding value from a donor randomly selected from a set of potential donors. Potential donors are those defined to be "close" to the unit with the missing or ambiguous value according to a predefined function called a distance metric. In the hot-deck stage of PMN, the set of candidate donors (the "neighborhood") consists of respondents with complete data who have a predicted mean close to that of the item nonrespondent. The predicted means are computed both for respondents with and without missing data, which differs from Rubin's method, where predicted means are not computed for the donor respondent (Rubin, 1986). In particular, the neighborhood consists of either the set of the closest 30 respondents or the set of respondents with a predicted mean (or means) within 5 percent of the predicted mean(s) of the item nonrespondent, whichever set is smaller. If no respondents are available who have a predicted mean (or means) within 5 percent of the item nonrespondent, the respondent with the predicted mean(s) closest to that of the item nonrespondent is selected as the donor.

In the univariate case (where only one variable is imputed using PMN), the neighborhood of potential donors is determined by calculating the relative distance between the predicted mean for an item nonrespondent and the predicted mean for each potential donor, and then choosing those means defined by the distance metric. The pool of donors is restricted further to satisfy logical constraints whenever necessary (e.g., age at first crack use must not be less than age at first cocaine use).

Whenever possible, missing or ambiguous values for more than one response variable are considered at a time. In this (multivariate) case, the distance metric is a Mahalanobis distance (Manly, 1986) rather than a relative Euclidean distance. Whether the imputation is univariate or multivariate, only missing or ambiguous values are replaced, and donors are restricted to be logically consistent with the response variables that are not missing. Furthermore, donors are restricted to satisfy "likeness constraints" whenever possible. That is, donors are required to have the same values for variables highly correlated with the response. If no donors are available who meet these conditions, these likeness constraints can be loosened. For example, donors for the age-at-first-use variable are required to be the same age as the recipients, if at all possible. Further details on the PMN methodology are provided in RTI International (2013) and in Singh, Grau, and Folsom (2001, 2002).

Although statistical imputation could not proceed separately within each State due to insufficient pools of donors, information about each respondent's State of residence was incorporated in the modeling and hot-deck steps. For most drugs, respondents were separated into three "State usage" categories as follows: respondents from States with high usage of a given drug were placed into one category, respondents from States with medium usage were placed into another, and the remainder were placed into a third category. This categorical "State rank" variable was used as one set of covariates in the imputation models. In addition, eligible donors for each item nonrespondent were restricted to be of the same State usage category (i.e., the same "State rank") as the nonrespondent.

Development of Analysis Weights

The general approach to developing and calibrating analysis weights involved developing design-based weights, d sub k, as the product of the inverse of the selection probabilities at each selection stage. Unlike previous NSDUHs with three stages of selection (i.e., selection of segments, selection of household, and selection of persons), the 2005, 2006, and 2007 NSDUHs used a four-stage sample selection scheme in which an extra selection stage of census tracts was added before the selection of a segment. Thus, the design-based weights, d sub k, for the 2006 and 2007 NSDUH incorporated an extra layer of sampling selection to reflect the sample design change. Adjustment factors, a sub k as a function of lambda, then were applied to the design-based weights to adjust for nonresponse, to poststratify to known population control totals, and to control for extreme weights when necessary. In view of the importance of State-level estimates with the 50-State design, it was necessary to control for a much larger number of known population totals. Several other modifications to the general weight adjustment strategy that had been used in past surveys also were implemented for the first time beginning with the 1999 CAI sample.

Weight adjustments were based on a generalization of Deville and Särndal's (1992) logit model. This generalized exponential model (GEM) (Folsom & Singh, 2000) incorporates unit-specific bounds, where the lower and upper bounds are l sub k and u sub k, respectively, and k is an element of s, for the adjustment factor a sub k as a function of lambda as follows:

Equation A-1,     D


where c sub k are prespecified centering constants, such that c sub k is bounded below by l sub k and bounded above by u sub k and Capital A sub k is defined as the ratio of two quantities. The quantity in the numerator is calculated as the difference between u sub k and l sub k. The quantity in the denominator is calculated as the product of the difference between u sub k and c sub k and the difference between c sub k and l sub k.. The variables l sub k, c sub k, and u sub k are user-specified bounds, and lambda is the column vector of p model parameters corresponding to the p covariates x. The lambda-parameters are estimated by solving

Equation A-2,     D

where capital T tilde sub x denotes control totals that could be either nonrandom, as is generally the case with poststratification, or random, as is generally the case for nonresponse adjustment.

The final weights The w sub k equals the product of d sub k and a sub k as a function of lambda. minimize the distance function delta of the parameters w and d defined as

Equation A-3.     D


This general approach was used at several stages of the weight adjustment process, including (1) adjustment of household weights for nonresponse at the screener level, (2) poststratification of household weights to meet population controls for various demographic groups by State, (3) adjustment of household weights for extremes, (4) poststratification of selected person weights, (5) adjustment of responding person weights for nonresponse at the questionnaire level, (6) poststratification of responding person weights, and (7) adjustment of responding person weights for extremes.

Every effort was made to include as many relevant State-specific covariates (typically defined by demographic domains within States) as possible in the multivariate models used to calibrate the weights (nonresponse adjustment and poststratification steps). Because further subdivision of State samples by demographic covariates often produced small cell sample sizes, it was not possible to retain all State-specific covariates (even after meaningful collapsing of covariate categories) and still estimate the necessary model parameters with reasonable precision. Therefore, a hierarchical structure was used in grouping States with covariates defined at the national level, at the census division level within the Nation, at the State group within the census division, and, whenever possible, at the State level. In every case, the controls for the total population within a State and the five age groups (12 to 17, 18 to 25, 26 to 34, 35 to 49, 50 or older) within a State were maintained except that, in the last step of poststratification of person weights, six age groups (12 to 17, 18 to 25, 26 to 34, 35 to 49, 50 to 64, 65 or older) were used. Census control totals by age, race, gender, and Hispanicity were required for the civilian, noninstitutionalized population of each State. Beginning with the 2002 NSDUH, the Population Estimates Branch of the U.S. Census Bureau has produced the necessary population estimates in response to a special request based on the 2000 census.

Consistent with the surveys from 1999 onward, control of extreme weights through separate bounds for adjustment factors was incorporated into the GEM calibration processes for both nonresponse and poststratification. This is unlike the traditional method of winsorization in which extreme weights are truncated at prespecified levels and the trimmed portions of weights are distributed to the nontruncated cases. In GEM, it is possible to set bounds around the prespecified levels for extreme weights, and then the calibration process provides an objective way of deciding the extent of adjustment (or truncation) within the specified bounds. A step was added to poststratify the household-level weights to obtain census-consistent estimates based on the household rosters from all screened households; these household roster-based estimates then provided the control totals needed to calibrate the respondent pair weights for subsequent planned analyses. An additional step poststratified the selected person sample to conform to the adjusted roster estimates. This additional step takes advantage of the inherent two-phase nature of the NSDUH design. The final step poststratified the respondent person sample to external census data (defined within the State whenever possible, as discussed above). For more detailed information, see the 2010 NSDUH Methodological Resource Book (RTI International, 2008).

For certain populations of interest, multiple years of NSDUH data were combined to obtain annual averages. The person-level weights for estimates based on the annual averages were obtained by dividing the analysis weights for the multiple specific years by a factor of the number of years.

TEDS

In 2007, 2008, and 2009, TEDS records with partially complete data were retained. Where records included missing or invalid data for a specific variable, those records were excluded from tabulations of that variable. This section describes the processing of the TEDS data once the States have submitted the TEDS data files to SAMHSA. For a description of the data collection procedures conducted by the States, see Section A.3 of this appendix.

Upon receipt of the TEDS data files, Synectics verifies that the records meet the required standards, makes the appropriate updates to the TEDS database, and produces feedback reports summarizing the results of the data processing. The processing completed by Synectics includes the following:

Processing Data Submitted through STSS

When data are submitted through the STSS, most processing and editing steps are done automatically, with immediate feedback of processing reports available to the State. Data files uploaded by the State to the STSS are tested with all TEDS edit procedures, and processing reports are automatically generated. States may correct errors and retest the file until the data are deemed ready for final processing and addition to the TEDS database. At that time, the State submits the file through the STSS to Synectics, who does the final processing.

The information that follows describes procedures that are performed automatically through the STSS or are performed by Synectics for non-STSS data submissions.

Processing Data Submitted by Diskette, CD, or Electronic Transmission

The most important data fields in processing a State TEDS submission are the System Transaction Type codes (Add, Delete, and Change) and the key fields (State Code, Provider Identifier, Client Identifier, Co-Dependent/Collateral, Client Transaction Type, Date of Admission, and Type of Service). The System Transaction Type code determines whether to add, delete, or correct a record in the database. The key fields combine to form a unique identifier for each record in the TEDS database. Records with an invalid key field are not included in the final data set or used in analyses.

The records in a submission are processed in the following order according to the transaction code: Deletes, followed by Changes, followed by Adds. (This same order is followed during the STSS validation procedures). Within this processing order, records are matched against the database and the indicated action is performed. An "Add" record with key fields identical to another "add" record in the submission or to a record in the TEDS database is considered to be a duplicate and is rejected unless there is a corresponding "delete" record. Rejected records are not added to the database.

In addition to checking for duplicates and invalid key fields, the edit program examines all other fields on the admission record to make sure each field has a valid code. If errors are detected, the records and the errors or inconsistencies are listed in the processing reports. Records with errors in nonkey fields are added to the database, even those that contain one or more fields with invalid codes.

After Synectics receives a non-STSS State submission, the contractor runs the edit program in a "test mode." In this mode, the edit is performed and duplicate records and records with errors are identified, but the records are not added to the TEDS database. A processing feedback report is produced and the results are reviewed. If the data file is "reasonably clean," the submission is run again with the program in "production mode," adding acceptable records to the database. A processing report is produced and sent to the State so that detected errors may be corrected. If the test run shows a significant number of records with errors in the Minimum or Supplemental Data Set and/or a significant number of records that were rejected, Synectics will notify the State by telephone or e-mail that the file will not be run for production. Synectics will work with the State to make the necessary corrections so the data may be resubmitted.

Processing Reports

The STSS generates processing reports automatically for files submitted through STSS. Synectics will provide States with feedback regarding each non-STSS data submission. For each submission, each State will receive the following:

When applicable, the State will also receive one or more of the following reports:

The Submission Processing Results Summary—Admissions and the Fatal and Warning Errors in TEDS Submission reports, along with other report options, are immediately available to the STSS user. These reports will be sent as e-mail attachments for data files not submitted through the STSS.

States are responsible for reviewing these reports, resolving the errors, and resubmitting corrected records.

Frequent Errors in TEDS Records

In order to help prevent potential errors and to make the submission process smoother, States are alerted to the following commonly occurring errors:

Error Resolution and Correction of Client Records

The States review the submission processing reports so that they are aware of both systematic and individual errors detected during data processing. The Submission Processing Results Summary Report provides counts of the total number of errors found in the fields of the Minimum and Supplementary Data Sets. Examination of this report gives an overall evaluation of the quality of the submission in terms of records rejected because of errors in a key field and the number of accepted records with an error in a nonkey field. If State edits are working properly, the number of errors in any submission should be low (less than 5 percent). If a data field has a very large number of errors, it probably indicates a systematic error that, once resolved, will correct many of the records. Nonsystematic errors found in a submission require the examination of individual records to identify the error and discover the cause. Examination of the Fatal and Warning Errors in TEDS Submission—Grouped by Reason will assist States in determining the cause of the errors. This report shows each individual record by Client ID and other key fields, and contains a brief explanation of the erroneous field. Examination of this report should explain the reason for most errors. In those cases that are still in question, Synectics can assist the State in error resolution. Additional information on error correction is available in the Treatment Episode Data Set (TEDS) State Instruction Manual Admission Data with National Outcomes Measures (NOMS), which is available at http://wwwdasis.samhsa.gov/dasis2/teds.htm.

TEDS Master Files and Acceptable Admission Date

The TEDS Masterfile contains all of the accepted admission records submitted by the States (the files do not include records rejected during processing). The Masterfile consists of two components: an active file and an archived file. The TEDS Active Masterfile contains admissions data with date of admission in January 1, 2000, and later. Admission records older than that have been archived. Any data submitted with an admission date during the archive period will be rejected during the TEDS processing.

Resubmitting Data

States not using the STSS are notified of the status of their submission by a telephone call or e-mail from Synectics or by receipt of State feedback reports. Sometimes State submissions cannot be processed because the entire submission is unreadable. States will be notified by telephone of such major problems, and Synectics will work with the State to resolve them. States should resubmit corrected files in a timely manner. For situations in which a resubmission is necessary, States may send the data as a separate "special" resubmission, or they may include the resubmission with their next regular submission.

N-SSATS

Data Editing and Quality Assurance

The N-SSATS paper-and-pencil questionnaires allow respondents to leave some questions blank while still having the opportunity to respond to subsequent questions. In 2007 through 2009, all N-SSATS mail questionnaires were reviewed manually for consistency and for missing data. Calls were made to facilities to clarify questionable responses and to obtain missing data. If facilities could not be reached during the edit callbacks, responses that were clearly in error were replaced by imputation. After data entry, automated quality assurance reviews were conducted. The reviews incorporated the rules used in manual editing, plus consistency checks and checks for data outliers not readily identified by manual review. Item nonresponse was minimized through careful editing and extensive follow-up. The Web questionnaire was programmed to be self-editing; that is, respondents were prompted to complete missing responses and to confirm or correct inconsistent responses.

Item Nonresponse

Careful editing and extensive follow-up have minimized item nonresponse. Item nonresponse was generally low, averaging 3 percent across all items. It was 10 percent or more for only 13 items. Missing data for client count variables (i.e., the number of clients in hospital inpatient, residential [nonhospital], and outpatient treatment, and their subcategories) were imputed, as were total annual admissions. Facilities with missing values for nonimputed variables were excluded from the tabulations using those variables. As a result, the numbers of treatment facilities on which tables are based may vary somewhat from table to table. The total number of facilities is generally included on each table.

Appendix B provides information on the methodology used for imputation of missing N-SSATS data and outliers.


Appendix B: Statistical Methods and Measurement


This appendix describes and compares the statistical methods and measurement for the three sources of data for the estimates of receipt of substance abuse treatment that were presented in this report: NSDUH, TEDS, and N-SSATS.

Because of the multiple differences in scope of information gathered and methodology between the three data sets (described in Appendix A), there is variation in the complexity of their data processing procedures and statistical methods.

TEDS

Methodology for TEDS Estimates of Single-Day Treatment Counts

The following methods were used to produce single-day treatment counts and average counts of the number of persons who received treatment during calendar years 2007, 2008, and 2009.

Data Files

TEDS admissions and linked discharge records for data submitted through October 10, 2011, were used for these counts. Both counts used records reflecting admissions and those reflecting transfers from other substance use treatment services; records of codependents (persons who do not have a substance use disorder but who receive treatment because a loved one has a substance use disorder) were excluded.

Data Definitions and Recoding

Substances of Abuse. The substance treatment categories were assigned using the TEDS, based on data reported as primary, secondary, and tertiary problem substances. If alcohol was reported as the primary problem substance and no secondary or tertiary problem substance was recorded, the case was categorized as alcohol-only treatment. If alcohol was reported as the primary problem substance and a drug was reported as the secondary and/or tertiary problem substance, the case was categorized as primary alcohol with secondary drug treatment. Likewise, if a drug was reported as the primary problem substance and alcohol was not reported as the secondary or tertiary problem substance, the case was categorized as drug-only treatment. If a drug was reported as the primary problem substance and alcohol was reported as either the secondary or tertiary problem substance, the case was categorized as primary drug with secondary alcohol treatment.

The numbers of admissions on March 30, 2007; March 31, 2008; and March 31, 2009, were calculated as described previously, and then averaged over the 3 years. The primary substances of abuse included the following:

Modality (Type of Service). For the report variable "Modality," the eight TEDS service type categories were combined:

Estimation Methodology

Estimates of the numbers of clients in treatment on a single day comprised two parts. The time period of this report covers a period of significant improvement in discharge data reporting.

  1. Linked records represent clients who had been both admitted and discharged. The number of clients who were admitted on or before the reference date and discharged on or after the reference date was calculated.
  2. Admissions records with no linked discharge should indicate that a client has been admitted and not yet discharged. However, because the discharge system was not fully operative in all States for the dates required, it can be assumed that a number of the admissions had in fact been discharged. Therefore, a probability of having been discharged by each reference date was computed for each record.

    1. Admission and linked records were compared to identify unlinked readmission records. A frequency distribution of length of stay (LOS) in treatment was computed by service type using all linked records. (LOS is highly correlated with service type.) Service types were

      • Opioid Treatment Programs (OTP) detox
      • Non-OTP detox
      • Hospital residential
      • Short-term residential
      • Long-term residential
      • OTP intensive outpatient
      • OTP outpatient
      • OTP ambulatory detox
      • Non-OTP intensive outpatient
      • Non-OTP outpatient
      • Non-OTP ambulatory detox
      LOS was computed as date of last contact minus date of admission plus 1.
    2. The probability of being in treatment on the reference date was calculated as 1 minus the cumulative frequency (i.e., if 0.34 (34 percent). If clients had been discharged by day 10, then a record with date of admission 10 days before the reference date had a 1.00 - 0.34 = 0.66 (66 percent) chance of being in treatment on the reference date.
    3. The probability of being in treatment for each reference date was attached to each admission record. Probabilities of being in treatment were summed for each reference date. Thus, if 100 clients were admitted 10 days before the reference date, each would have a probability of 0.66, yielding a total of 66 clients likely to be in treatment on the reference date.
    4. Data from 2000 to 2009 were used to check the plausibility that estimated counts based on these procedures were accurate.

N-SSATS

Methodology of Imputation of Missing Data and Outliers

Client count variables (i.e., the number of clients in hospital inpatient, nonhospital residential, and outpatient treatment, and their subcategories) and total annual admissions were candidates for imputation. In 2007 and 2008, a total of 92 facilities in each year were missing 1-day client census counts for one or more types of service. In 2009, a total of 15 facilities were missing 1-day client census counts for one or more types of service. A facility was given an imputed value for a type of service if it reported that it provided the service but had not provided client counts for that service type. For example, if a facility reported that it provided hospital inpatient services and outpatient services, but not nonhospital residential services, client values were imputed for the hospital inpatient and outpatient variables only.

Outliers were identified as cases where the number of clients reported exceeded the 75th percentile of the distribution of client counts for all cases of one of the main service types. The 2007, 2008, and 2009 values were each compared with the respective average of previous years' data. If the difference exceeded 1.8 times the previous year's value in either direction, the value was imputed.

When available, client values from up to 5 previous years were used to impute the missing client counts on the 2007, 2008, and 2009 N-SSATS. In all other cases, the average client value, stratified by State and facility operation, was used to impute the missing client counts. If a facility were unique in its State and facility operation category, values were imputed using average values for the State only. Missing client counts were imputed for each type of service (i.e., hospital inpatient detoxification, hospital inpatient treatment, nonhospital residential detoxification, etc.) and summed to the larger service type totals (total hospital inpatient clients, total nonhospital residential clients, and total outpatient clients), and finally to total clients.


Appendix C: Estimate and Confidence Interval Tables for Chapters 2 and 3


Table C.2.1 Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in the United States: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
(All States)
NSDUH
2005 to 2010 Average
(TEDS States Only1)
TEDS2
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 2,464,150 (2,336,545-2,598,650) 100.0 (NA) 2,357,118 (2,230,925-2,490,372) 100.0 (NA) 1,928,578 100.0
Modality
Hospital Inpatient 774,093 (717,561-832,956) 31.4 (29.1-33.8) 738,366 (683,035-796,048) 31.3 (29.0-33.8) 61,382 3.2
Residential
   Rehabilitation—Inpatient
1,004,459    (943,901-1,066,177) 40.8 (38.3-43.3) 956,002    (896,748-1,016,446) 40.6 (38.0-43.1) 543,456 28.2
Outpatient 1,999,029 (1,946,842-2,047,078) 81.1 (79.0-83.1) 1,916,780 (1,865,867-1,963,529) 81.3 (79.2-83.3) 1,507,988 78.2
Outpatient Rehabilitation 1,673,268 (1,612,645-1,731,535) 67.9 (65.4-70.3) 1,608,483 (1,548,797-1,665,730) 68.2 (65.7-70.7) NA NA
Mental Health Center or
   Facility—Outpatient
1,032,262    (970,415-1,095,160) 41.9 (39.4-44.4) 978,815    (918,237-1,040,499) 41.5 (39.0-44.1) NA NA
Substance
Marijuana 764,690 (712,629-818,777) 31.0 (28.9-33.2) 727,542 (676,554-780,588) 30.9 (28.7-33.1) 766,433 39.7
Cocaine (including crack) 636,416 (582,894-693,043) 25.8 (23.7-28.1) 603,954 (551,842-659,192) 25.6 (23.4-28.0) 488,826 25.3
Heroin 341,168 (295,184-393,017) 13.8 (12.0-15.9) 329,798 (284,515-380,964) 14.0 (12.1-16.2) 293,395 15.2
Prescription Drugs 657,661 (608,386-709,401) 26.7 (24.7-28.8) 620,335 (572,908-670,213) 26.3 (24.3-28.4) 240,288 12.5
Methamphetamine NA   NA   NA   NA   213,176 11.1
Inhalants 149,737 (125,109-178,843) 6.1 (5.1-7.3) 141,049 (117,242-169,325) 6.0 (5.0-7.2) 3,574 0.2
Hallucinogens 271,434 (239,619-306,889) 11.0 (9.7-12.5) 257,338 (226,090-292,312) 10.9   (9.6-12.4) 12,139 0.6
Alcohol 1,695,291 (1,638,653-1,749,738) 68.8 (66.5-71.0) 1,632,830 (1,577,951-1,685,488) 69.3 (66.9-71.5) 1,146,597 59.5
Route of Administration
Injection 178,090 (148,707-212,739) 7.3 (6.1-8.7) 169,501 (141,004-203,224) 7.3 (6.0-8.7) 238,459 12.4
Age
12 to 17 158,143 (143,811-173,796) 6.4 (5.8-7.1) 150,083 (136,210-165,265) 6.4 (5.8-7.0) 170,289 8.8
18 to 24 462,044 (431,746-493,952) 18.8 (17.5-20.0) 439,308 (409,767-470,464) 18.6 (17.4-20.0) 372,992 19.3
25 to 34 576,308 (526,266-629,563) 23.4 (21.4-25.5) 552,228 (503,174-604,505) 23.4 (21.3-25.6) 504,865 26.2
35 to 44 556,134 (504,025-611,948) 22.6 (20.5-24.8) 531,826 (480,747-586,636) 22.6 (20.4-24.9) 446,508 23.2
45 or Older 711,521 (645,450-781,449) 28.9 (26.2-31.7) 683,673 (618,226-753,049) 29.0 (26.2-31.9) 433,924 22.5
Race/Ethnicity
Not Hispanic or Latino 2,153,846 (2,104,459-2,197,311) 87.4 (85.4-89.2) 2,047,365 (1,998,418-2,090,523) 86.9 (84.8-88.7) 1,601,402 85.3
White 1,636,071 (1,571,302-1,698,431) 66.4 (63.8-68.9) 1,569,932 (1,506,777-1,630,658) 66.6 (63.9-69.2) 1,135,068 60.4
Black/African American 422,623 (371,984-478,580) 17.2 (15.1-19.4) 386,811 (337,899-441,257) 16.4 (14.3-18.7) 368,823 19.6
American Indian/Alaska Native 29,939 (21,804-41,059) 1.2 (0.9-1.7) 27,490 (19,595-38,515) 1.2 (0.8-1.6) 39,924 2.1
Asian/Pacific Islander 24,320 (14,499-40,683) 1.0 (0.6-1.7) 22,721 (13,173-39,072) 1.0 (0.6-1.7) 21,267 1.1
Two or More Races 40,892 (29,041-57,463) 1.7 (1.2-2.3) 40,410 (28,580-57,017) 1.7 (1.2-2.4) 11,031 0.6
Other NA   NA   NA   NA   25,285 1.3
Hispanic or Latino 310,304 (266,839-359,691) 12.6 (10.8-14.6) 309,753 (266,594-358,700) 13.1 (11.3-15.2) 276,702 14.7
Gender
Male 1,640,333 (1,581,404-1,697,236) 66.6 (64.2-68.9) 1,573,132 (1,515,045-1,629,138) 66.7 (64.3-69.1) 1,292,491 67.0
Female 823,817 (766,914-882,746) 33.4 (31.1-35.8) 783,985 (727,980-842,073) 33.3 (30.9-35.7) 635,540 33.0
Years of Education
0 to 8 Years 138,804 (115,522-166,444) 5.6 (4.7-6.8) 133,869 (111,027-161,073) 5.7 (4.7-6.8) 180,424 9.5
9 to 11 Years 670,605 (616,389-727,711) 27.2 (25.0-29.5) 633,850 (581,585-688,989) 26.9 (24.7-29.2) 541,507 28.6
12 (High School/GED) 816,660 (759,160-876,277) 33.1 (30.8-35.6) 779,985 (723,609-838,499) 33.1 (30.7-35.6) 752,030 39.8
More than 12 838,081 (775,417-903,102) 34.0 (31.5-36.6) 809,414 (747,831-873,316) 34.3 (31.7-37.1) 417,619 22.1
* Low precisions; no estimate reported.
NA = not available.
1 TEDs States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
2 See Appendix B for information concerning how TEDS admissions data were adjusted to be person-level data.
Table C.2.1AL Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment at Any Location in the Past Year in the United States: NSDUH 2005 to 2010
  NSDUH
2005 to 2010 Average
(All States)
NSDUH
2005 to 2010 Average
TEDS States Only1)
Number (95% CI) Percentage
(95% CI)
Number (95% CI) Percentage
(95% CI)
Total 4,062,843 (3,901,488-4,230,757) 100.0 (NA) 3,889,756 (3,732,045-4,054,015) 100.0 (NA)
Modality
Hospital Inpatient 774,093 (713,157-838,933) 19.1 (17.6-20.6) 738,366 (678,187-802,552) 19.0 (17.4-20.6)
Residential
   Rehabilitation—Inpatient
1,004,459    (936,827-1,075,294) 24.7 (23.1-26.5) 956,002    (889,915-1,025,319) 24.6 (22.9-26.4)
Outpatient 1,999,029 (1,918,180-2,079,981) 49.2 (47.2-51.2) 1,916,780 (1,836,981-1,996,674) 49.3 (47.2-51.3)
Outpatient Rehabilitation 1,673,268 (1,592,592-1,755,126) 41.2 (39.2-43.2) 1,608,483 (1,528,654-1,689,498) 41.4 (39.3-43.4)
Mental Health Center or
   Facility—Outpatient
1,032,262    (964,029-1,103,604) 25.4 (23.7-27.2) 978,815    (911,778-1,049,044) 25.2 (23.4-27.0)
Substance
Marijuana 1,075,829 (1,015,367-1,138,546) 26.5 (25.0-28.0) 1,022,197    (962,487-1,084,240) 26.3 (24.7-27.9)
Cocaine (including crack) 782,136 (720,415-847,802) 19.3 (17.7-20.9) 741,993 (682,208-805,702) 19.1 (17.5-20.7)
Heroin 398,011 (346,348-456,433) 9.8   (8.5-11.2) 386,491 (335,392-444,402) 9.9   (8.6-11.4)
Prescription Drugs 829,629 (769,277-893,430) 20.4 (18.9-22.0) 789,473 (731,471-850,836) 20.3 (18.8-21.9)
Methamphetamine NA   NA   NA   NA  
Inhalants 210,565 (177,794-248,991) 5.2 (4.4-6.1) 201,459 (170,337-237,905) 5.2 (4.4-6.1)
Hallucinogens 362,935 (322,743-407,586) 8.9   (7.9-10.0) 347,833 (307,979-392,280) 8.9   (7.9-10.1)
Alcohol 2,607,725 (2,532,596-2,681,178) 64.2 (62.3-66.0) 2,507,755 (2,434,410-2,579,393) 64.5 (62.6-66.3)
Route of Administration
Injection 207,589 (175,011-245,845) 5.1 (4.3-6.1) 197,800 (166,685-234,355) 5.1 (4.3-6.1)
Age
12 to 17 324,763 (302,954-347,996) 8.0 (7.5-8.6) 308,631 (287,431-331,250) 7.9 (7.4-8.5)
18 to 24 826,199 (785,231-868,738) 20.3 (19.3-21.4) 794,147 (754,596-835,218) 20.4 (19.4-21.5)
25 to 34 895,344 (830,321-963,941) 22.0 (20.4-23.7) 864,838 (800,847-932,399) 22.2 (20.6-24.0)
35 to 44 879,887 (813,458-950,153) 21.7 (20.0-23.4) 819,699 (755,903-887,354) 21.1 (19.4-22.8)
45 or Older 1,136,651 (1,051,851-1,225,506) 28.0 (25.9-30.2) 1,102,441 (1,018,414-1,190,528) 28.3 (26.2-30.6)
Race/Ethnicity
Not Hispanic or Latino 3,484,002 (3,415,408-3,546,427) 85.8 (84.1-87.3) 3,318,307 (3,250,736-3,379,854) 85.3 (83.6-86.9)
White 2,718,528 (2,635,127-2,799,392) 66.9 (64.9-68.9) 2,616,805 (2,534,842-2,696,145) 67.3 (65.2-69.3)
Black/African American 610,258 (550,305-675,486) 15.0 (13.5-16.6) 553,887 (496,105-617,176) 14.2 (12.8-15.9)
American Indian/Alaska Native 52,882 (40,139-69,600) 1.3 (1.0-1.7) 47,892 (35,617-64,325) 1.2 (0.9-1.7)
Asian/Pacific Islander 42,835 (30,212-60,652) 1.1 (0.7-1.5) 41,128 (28,702-58,851) 1.1 (0.7-1.5)
Two or More Races 59,500 (45,779-77,254) 1.5 (1.1-1.9) 58,595 (44,892-76,398) 1.5 (1.2-2.0)
Other NA   NA   NA   NA  
Hispanic or Latino 578,842 (516,416-647,436) 14.2 (12.7-15.9) 571,449 (509,902-639,020) 14.7 (13.1-16.4)
Gender
Male 2,757,238 (2,685,608-2,826,858) 67.9 (66.1-69.6) 2,642,971 (2,572,570-2,711,334) 67.9 (66.1-69.7)
Female 1,305,605 (1,235,985-1,377,236) 32.1 (30.4-33.9) 1,246,784 (1,178,422-1,317,186) 32.1 (30.3-33.9)
Years of Education
0 to 8 Years 267,965 (233,343-307,312) 6.6 (5.7-7.6) 257,366 (223,210-296,326) 6.6 (5.7-7.6)
9 to 11 Years 1,056,425    (990,351-1,125,293) 26.0 (24.4-27.7) 997,768    (933,601-1,064,757) 25.7 (24.0-27.4)
12 (High School/GED) 1,293,156 (1,222,102-1,366,354) 31.8 (30.1-33.6) 1,239,086 (1,169,770-1,310,531) 31.9 (30.1-33.7)
More than 12 1,445,297 (1,365,615-1,526,996) 35.6 (33.6-37.6) 1,395,536 (1,317,781-1,475,247) 35.9 (33.9-37.9)
* Low precisions; no estimate reported.
NA = not available.
1 TEDs States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
Table C.2.1NH Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs Excluding Persons Receiving Treatment Solely from Hospital-Based Programs in the Past Year in the United States: NSDUH 2005 to 2010
  NSDUH
2005 to 2010 Average
(All States)
NSDUH
2005 to 2010 Average
TEDS States Only1)
Number (95% CI) Percentage
(95% CI)
Number (95% CI) Percentage
(95% CI)
Total 2,329,327 (2,205,220-2,460,348) 100.0 (NA) 2,227,200 (2,105,179-2,356,223) 100.0 (NA)
Modality
Residential
   Rehabilitation—Inpatient
1,004,459    (946,176-1,063,571) 43.1 (40.6-45.7) 956,002    (899,203-1,013,650) 42.9 (40.4-45.5)
Outpatient 1,999,029 (1,956,193-2,037,680) 85.8 (84.0-87.5) 1,916,780 (1,874,835-1,954,458) 86.1 (84.2-87.8)
Outpatient Rehabilitation 1,673,268 (1,617,351-1,726,430) 71.8 (69.4-74.1) 1,608,483 (1,553,897-1,660,258) 72.2 (69.8-74.5)
Mental Health Center or
   Facility—Outpatient
1,032,262    (972,246-1,092,998) 44.3 (41.7-46.9) 978,815    (919,747-1,038,662) 43.9 (41.3-46.6)
Substance
Marijuana 737,198 (687,065-789,232) 31.6 (29.5-33.9) 701,534 (652,502-752,489) 31.5 (29.3-33.8)
Cocaine (including crack) 609,513 (558,547-663,387) 26.2 (24.0-28.5) 577,424 (528,052-629,702) 25.9 (23.7-28.3)
Heroin 322,623 (278,560-372,391) 13.9 (12.0-16.0) 311,890 (268,572-360,907) 14.0 (12.1-16.2)
Prescription Drugs 633,240 (585,481-683,368) 27.2 (25.1-29.3) 599,023 (553,118-647,264) 26.9 (24.8-29.1)
Methamphetamine NA   NA   NA   NA  
Inhalants 145,398 (121,631-173,445) 6.2 (5.2-7.4) 136,741 (113,838-163,895) 6.1 (5.1-7.4)
Hallucinogens 261,816 (231,301-295,789) 11.2   (9.9-12.7) 247,720 (217,893-281,059) 11.1   (9.8-12.6)
Alcohol 1,599,275 (1,545,414-1,651,059) 68.7 (66.3-70.9) 1,538,275 (1,485,921-1,588,521) 69.1 (66.7-71.3)
Route of Administration
Injection 164,666 (137,773-196,333) 7.1 (6.0-8.5) 156,678 (130,734-187,307) 7.1 (5.9-8.5)
Age
12 to 17 145,276 (131,797-160,033) 6.2 (5.7-6.9) 138,634 (125,589-152,935) 6.2 (5.6-6.9)
18 to 24 437,325 (407,517-468,781) 18.8 (17.5-20.1) 417,180 (388,151-447,852) 18.7 (17.4-20.1)
25 to 34 559,354 (510,754-611,025) 24.0 (21.9-26.2) 536,170 (488,600-586,808) 24.1 (21.9-26.3)
35 to 44 538,483 (487,094-593,548) 23.1 (20.9-25.5) 514,175 (463,925-568,115) 23.1 (20.8-25.5)
45 or Older 648,888 (585,948-715,814) 27.9 (25.2-30.7) 621,041 (559,099-687,018) 27.9 (25.1-30.8)
Race/Ethnicity
Not Hispanic or Latino 2,045,502 (1,998,589-2,086,570) 87.8 (85.8-89.6) 1,943,927 (1,897,251-1,984,844) 87.3 (85.2-89.1)
White 1,555,494 (1,493,771-1,614,838) 66.8 (64.1-69.3) 1,492,639 (1,432,418-1,550,453) 67.0 (64.3-69.6)
Black/African American 401,174 (351,973-455,669) 17.2 (15.1-19.6) 365,836 (318,369-418,828) 16.4 (14.3-18.8)
American Indian/Alaska Native 26,697 (19,411-36,673) 1.1 (0.8-1.6) 24,248 (17,219-34,101) 1.1 (0.8-1.5)
Asian/Pacific Islander 22,410 (12,942-38,687) 1.0 (0.6-1.7) 21,932 (12,521-38,294) 1.0 (0.6-1.7)
Two or More Races 39,727 (28,005-56,236) 1.7 (1.2-2.4) 39,272 (27,572-55,810) 1.8 (1.2-2.5)
Other NA   NA   NA   NA  
Hispanic or Latino 283,825 (242,757-330,738) 12.2 (10.4-14.2) 283,273 (242,356-329,950) 12.7 (10.9-14.8)
Gender
Male 1,547,122 (1,490,533-1,601,757) 66.4 (64.0-68.8) 1,481,409 (1,425,719-1,535,107) 66.5 (64.0-68.9)
Female 782,205 (727,570-838,794) 33.6 (31.2-36.0) 745,792 (692,093-801,481) 33.5 (31.1-36.0)
Years of Education
0 to 8 Years 124,535 (103,651-149,344) 5.3 (4.4-6.4) 120,412   (99,848-144,924) 5.4 (4.5-6.5)
9 to 11 Years 637,582 (585,425-692,541) 27.4 (25.1-29.7) 601,457 (551,082-654,639) 27.0 (24.7-29.4)
12 (High School/GED) 767,158 (711,634-824,806) 32.9 (30.6-35.4) 732,236 (678,112-788,482) 32.9 (30.4-35.4)
More than 12 800,052 (738,853-863,568) 34.3 (31.7-37.1) 773,094 (712,999-835,459) 34.7 (32.0-37.5)
* Low precisions; no estimate reported.
NA = not available.
1 TEDs States exclude Alabama, Alaska, the District of Columbia, and Georgia, which submitted no or incomplete data for one or more of the 3 years (2007-2009).
Table C.2.1.1 Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in California: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 270,380 (217,949-335,282) 100.0 (NA) 231,884 100.0
Modality
Hospital Inpatient   61,393 (41,213-87,673)   22.7 (15.2-32.4)            0     0.0
Residential
   Rehabilitation—Inpatient
116,577   (90,542-144,100)   43.1 (33.5-53.3)   59,748   25.8
Outpatient 196,215 (168,891-218,445)   72.6 (62.5-80.8) 185,277   79.9
Outpatient Rehabilitation 159,760 (131,689-185,799)   59.1 (48.7-68.7)         NA     NA
Mental Health Center or
   Facility—Outpatient
  90,693   (65,806-119,494)   33.5 (24.3-44.2)         NA     NA
Substance
Marijuana   72,698 (52,370-97,391)   26.9 (19.4-36.0)   78,099   33.7
Cocaine (including crack)   59,888 (41,478-83,489)   22.1 (15.3-30.9)   57,900   25.0
Heroin   32,835 (17,791-57,695)   12.1   (6.6-21.3)   43,253   18.7
Prescription Drugs   87,986   (66,965-111,973)   32.5 (24.8-41.4)   14,982     6.5
Methamphetamine         NA       NA     84,423   36.4
Inhalants   23,816 (13,139-41,761)     8.8   (4.9-15.4)        301     0.1
Hallucinogens   33,893 (20,385-54,403)   12.5   (7.5-20.1)        432     0.2
Alcohol 196,818 (171,581-217,592)   72.8 (63.5-80.5)   92,013   39.7
Route of Administration
Injection   13,667   (6,153-29,329)     5.1   (2.3-10.9)   44,650   19.3
Age
12 to 17   16,250 (10,796-24,201)     6.0 (4.0-9.0)   30,827   13.3
18 to 24   40,712 (30,753-53,180)   15.1 (11.4-19.7)   34,071   14.7
25 to 34   66,279 (46,070-91,728)   24.5 (17.0-33.9)   54,786   23.6
35 to 44   72,362 (51,846-97,379)   26.8 (19.2-36.0)   53,469   23.1
45 or Older * *-* * *-*   58,731   25.3
Race/Ethnicity
Not Hispanic or Latino 173,609 (148,221-196,355)   64.2 (54.8-72.6) 150,186   64.8
White 136,540 (109,796-163,179)   50.5 (40.6-60.4)   95,197   41.1
Black/African American   28,515 (13,897-55,203)   10.5   (5.1-20.4)   36,508   15.7
American Indian/Alaska Native        559    (170-1,837)     0.2 (0.1-0.7)     3,340     1.4
Asian/Pacific Islander     6,487   (2,279-17,945)     2.4 (0.8-6.6)     5,796     2.5
Two or More Races     1,507    (544-4,144)     0.6 (0.2-1.5)     3,586     1.5
Other         NA       NA       5,759     2.5
Hispanic or Latino   96,771   (74,025-122,159)   35.8 (27.4-45.2)   81,692   35.2
Gender
Male 197,816 (170,815-219,668)   73.2 (63.2-81.2) 147,382   63.6
Female   72,565 (50,712-99,565)   26.8 (18.8-36.8)   84,395   36.4
Years of Education
0 to 8 Years   18,488   (8,694-37,727)     6.8   (3.2-14.0)   21,044     9.2
9 to 11 Years   67,198 (46,831-92,747)   24.9 (17.3-34.3)   80,007   34.8
12 (High School/GED)   93,892   (68,923-122,410)   34.7 (25.5-45.3)   89,471   38.9
More than 12   90,802   (64,254-121,835)   33.6 (23.8-45.1)   39,292   17.1
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.2 Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Florida: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 138,035 (111,991-170,067) 100.0 (NA) 67,305 100.0
Modality
Hospital Inpatient   41,357 (28,561-56,906)   30.0 (20.7-41.2)       NA     NA
Residential
   Rehabilitation—Inpatient
  75,006 (59,768-89,678)   54.3 (43.3-65.0) 17,147   25.5
Outpatient   96,878   (81,200-109,739)   70.2 (58.8-79.5) 54,981   81.7
Outpatient Rehabilitation   76,541 (61,604-90,797)   55.5 (44.6-65.8)       NA     NA
Mental Health Center or
   Facility—Outpatient
  54,583 (40,486-70,062)   39.5 (29.3-50.8)       NA     NA
Substance
Marijuana   46,947 (35,357-60,113)   34.0 (25.6-43.5) 32,122   47.7
Cocaine (including crack)   42,730 (31,047-56,489)   31.0 (22.5-40.9) 19,667   29.2
Heroin   15,499   (8,451-27,193)   11.2   (6.1-19.7)   2,526     3.8
Prescription Drugs   39,401 (29,164-51,531)   28.5 (21.1-37.3) 13,601   20.2
Methamphetamine         NA       NA     1,500     2.2
Inhalants   12,791   (7,076-22,336)     9.3   (5.1-16.2)      113     0.2
Hallucinogens   21,136 (13,657-31,667)   15.3   (9.9-22.9)      313     0.5
Alcohol   92,517   (77,046-105,710)   67.0 (55.8-76.6) 31,404   46.7
Route of Administration
Injection     7,125   (2,951-16,479)     5.2   (2.1-12.0)   3,519     5.2
Age
12 to 17     6,109 (3,862-9,572)     4.4 (2.8-6.9) 14,337   21.3
18 to 24   23,714 (17,737-31,184)   17.2 (12.8-22.6) 12,925   19.2
25 to 34   24,882 (16,695-35,895)   18.0 (12.1-26.0) 15,795   23.5
35 to 44   31,524 (21,361-44,672)   22.8 (15.5-32.4) 12,422   18.5
45 or Older             * *-*        * *-* 11,826     17.6
Race/Ethnicity
Not Hispanic or Latino 122,051 (111,735-128,661)   88.4 (80.9-93.2) 58,916   87.5
White   95,793   (80,380-108,594)   69.4 (58.2-78.7) 43,424   64.5
Black/African American             * *-*        * *-* 14,035   20.9
American Indian/Alaska Native        378      (85-1,658)     0.3 (0.1-1.2)      242     0.4
Asian/Pacific Islander          71   (10-510)     0.1 (0.0-0.4)      285     0.4
Two or More Races     1,656    (533-5,061)     1.2 (0.4-3.7)      927     1.4
Other         NA       NA            2     0.0
Hispanic or Latino   15,983   (9,374-26,300)   11.6   (6.8-19.1)   8,387   12.5
Gender
Male   90,529   (75,256-103,778)   65.6 (54.5-75.2) 42,432   63.0
Female   47,506 (34,257-62,779)   34.4 (24.8-45.5) 24,873   37.0
Years of Education
0 to 8 Years     7,844   (3,055-19,084)     5.7   (2.2-13.8)   8,231   12.4
9 to 11 Years   23,275 (15,793-33,336)   16.9 (11.4-24.2) 20,733   31.4
12 (High School/GED)   58,930 (43,879-75,029)   42.7 (31.8-54.4) 22,765   34.4
More than 12   47,986 (34,938-62,932)   34.8 (25.3-45.6) 14,403   21.8
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.3 Numbers and Percentage Distributions and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Illinois: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 95,950   (79,400-115,911) 100.0 (NA) 69,483 100.0
Modality
Hospital Inpatient 29,032 (22,048-37,116)   30.3 (23.0-38.7)          9     0.0
Residential
   Rehabilitation—Inpatient
35,672 (27,374-44,841)   37.2 (28.5-46.7) 22,214   32.0
Outpatient 78,661 (70,560-84,593)   82.0 (73.5-88.2) 55,424   79.8
Outpatient Rehabilitation 64,105 (54,443-72,487)   66.8 (56.7-75.5)       NA     NA
Mental Health Center or
   Facility—Outpatient
35,930 (27,412-45,345)   37.4 (28.6-47.3)       NA     NA
Substance
Marijuana 21,963 (15,414-30,250)   22.9 (16.1-31.5) 28,155   40.5
Cocaine (including crack) 20,703 (13,927-29,586)   21.6 (14.5-30.8) 21,292   30.6
Heroin 14,848   (8,522-24,552)   15.5   (8.9-25.6) 16,750   24.1
Prescription Drugs 16,345 (11,162-23,275)   17.0 (11.6-24.3)   3,915     5.6
Methamphetamine       NA       NA     2,035     2.9
Inhalants      876    (331-2,296)     0.9 (0.3-2.4)        98     0.1
Hallucinogens   2,826 (1,187-6,571)     2.9 (1.2-6.8)      237     0.3
Alcohol 64,788 (55,811-72,598)   67.5 (58.2-75.7) 40,392   58.1
Route of Administration
Injection   4,508   (1,771-10,976)     4.7   (1.9-11.5)   5,280     7.6
Age
12 to 17   6,154 (4,354-8,627)     6.4 (4.5-9.0)   7,871   11.3
18 to 24 18,503 (14,150-23,805)   19.3 (14.7-24.8) 12,383   17.8
25 to 34 23,161 (16,823-30,951)   24.1 (17.5-32.3) 15,749   22.7
35 to 44 23,386 (15,962-32,845)   24.4 (16.6-34.2) 16,892   24.3
45 or Older          * *-*        * *-* 16,588   23.9
Race/Ethnicity
Not Hispanic or Latino 86,282 (80,207-90,181)   89.9 (83.6-94.0) 62,942   90.6
White 61,176 (51,735-69,627)   63.8 (53.9-72.6) 33,319   48.0
Black/African American 23,029 (15,755-32,308)   24.0 (16.4-33.7) 27,723   39.9
American Indian/Alaska Native      367      (76-1,738)     0.4 (0.1-1.8)      377     0.5
Asian/Pacific Islander      666    (128-3,384)     0.7 (0.1-3.5)      285     0.4
Two or More Races   1,044    (511-2,120)     1.1 (0.5-2.2)       NA     NA
Other       NA       NA     1,238     1.8
Hispanic or Latino   9,668   (5,769-15,743)   10.1   (6.0-16.4)   6,509     9.4
Gender
Male 58,839 (50,155-66,833)   61.3 (52.3-69.7) 46,007   66.2
Female 37,110 (29,117-45,795)   38.7 (30.3-47.7) 23,476   33.8
Years of Education
0 to 8 Years   6,679   (3,384-12,742)     7.0   (3.5-13.3)   5,628     8.1
9 to 11 Years 26,043 (18,417-35,384)   27.1 (19.2-36.9) 24,046   34.6
12 (High School/GED) 32,604 (24,500-41,820)   34.0 (25.5-43.6) 27,429   39.5
More than 12 30,624 (22,600-39,946)   31.9 (23.6-41.6) 12,379   17.8
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.4 Numbers and Percentage Distributions of and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Michigan: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 102,203   (85,273-122,445) 100.0 (NA) 57,956 100.0
Modality
Hospital Inpatient   31,536 (23,372-41,066)   30.9 (22.9-40.2)          0     0.0
Residential
   Rehabilitation—Inpatient
  42,576 (34,371-51,260)   41.7 (33.6-50.2) 16,068   27.7
Outpatient   83,182 (75,861-88,827)   81.4 (74.2-86.9) 47,111   81.3
Outpatient Rehabilitation   69,051 (60,311-76,738)   67.6 (59.0-75.1)       NA     NA
Mental Health Center or
   Facility—Outpatient
  36,636 (29,150-44,864)   35.8 (28.5-43.9)       NA     NA
Substance
Marijuana   30,961 (25,233-37,357)   30.3 (24.7-36.6) 24,265   41.9
Cocaine (including crack)   21,637 (15,780-28,940)   21.2 (15.4-28.3) 15,536   26.8
Heroin   17,563 (11,109-26,669)   17.2 (10.9-26.1)   8,961   15.5
Prescription Drugs   19,520 (14,391-25,936)   19.1 (14.1-25.4)   8,716   15.0
Methamphetamine         NA       NA        889     1.5
Inhalants     4,288 (2,276-7,937)     4.2 (2.2-7.8)        72     0.1
Hallucinogens     8,916   (5,482-14,186)     8.7   (5.4-13.9)      194     0.3
Alcohol   72,224 (64,280-79,101)   70.7 (62.9-77.4) 36,489   63.0
Route of Administration
Injection     7,862   (4,428-13,587)     7.8   (4.4-13.4)   6,638   11.5
Age
12 to 17     5,887 (4,163-8,265)     5.8 (4.1-8.1)   3,287     5.7
18 to 24   21,204 (17,033-26,084)   20.7 (16.7-25.5) 12,815   22.1
25 to 34   26,745 (20,068-34,704)   26.2 (19.6-34.0) 15,445   26.6
35 to 44   25,258 (17,898-34,411)   24.7 (17.5-33.7) 13,085   22.6
45 or Older   23,109 (15,205-33,536)   22.6 (14.9-32.8) 13,324   23.0
Race/Ethnicity
Not Hispanic or Latino   99,141   (96,658-100,531)   97.0 (94.6-98.4) 56,001   96.6
White   75,827 (66,506-83,402)   74.2 (65.1-81.6) 38,392   66.2
Black/African American   21,134 (13,706-31,169)   20.7 (13.4-30.5) 15,138   26.1
American Indian/Alaska Native        371      (97-1,412)     0.4 (0.1-1.4)      713     1.2
Asian/Pacific Islander          62     (9-453)     0.1 (0.0-0.4)      124     0.2
Two or More Races     1,746    (718-4,185)     1.7 (0.7-4.1)      492     0.8
Other         NA       NA     1,141     2.0
Hispanic or Latino     3,063 (1,672-5,546)     3.0 (1.6-5.4)   1,955     3.4
Gender
Male   64,931 (57,228-72,012)   63.5 (56.0-70.5) 38,052   65.7
Female   37,272 (30,192-44,976)   36.5 (29.5-44.0) 19,905   34.3
Years of Education
0 to 8 Years     3,670 (1,937-6,846)     3.6 (1.9-6.7)   2,583     4.5
9 to 11 Years   21,674 (16,380-28,118)   21.2 (16.0-27.5) 16,703   28.8
12 (High School/GED)   48,091 (39,563-56,790)   47.1 (38.7-55.6) 27,088   46.7
More than 12   28,769 (21,383-37,522)   28.1 (20.9-36.7) 11,581   20.0
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.5 Numbers and Percentage Distributions of and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in New York: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 207,852 (168,643-256,032) 100.0 (NA) 245,898 100.0
Modality
Hospital Inpatient   82,690   (62,528-104,671)   39.8 (30.1-50.4)   32,967   13.4
Residential
   Rehabilitation—Inpatient
  79,602   (60,152-101,038)   38.3 (28.9-48.6)   69,899   28.4
Outpatient 179,942 (159,857-192,432)   86.6 (76.9-92.6) 192,140   78.1
Outpatient Rehabilitation 162,380 (141,452-178,099)   78.1 (68.1-85.7)         NA     NA
Mental Health Center or
   Facility—Outpatient
  98,199   (77,642-119,216)   47.2 (37.4-57.4)         NA     NA
Substance
Marijuana   68,063 (50,104-88,834)   32.7 (24.1-42.7) 105,248   42.8
Cocaine (including crack)   71,082 (51,600-93,517)   34.2 (24.8-45.0)   74,947   30.5
Heroin            * *-*        * *-*   56,745   23.1
Prescription Drugs   30,547 (20,378-44,584)   14.7   (9.8-21.4)   25,250   10.3
Methamphetamine         NA       NA          966     0.4
Inhalants     7,101   (2,573-18,866)     3.4 (1.2-9.1)        164     0.1
Hallucinogens   25,154 (14,132-42,869)   12.1 (6.8-20.6)        834     0.3
Alcohol 151,346 (134,531-165,518)   72.8 (64.7-79.6) 158,708   64.5
Route of Administration
Injection            * *-*        * *-*   27,753   11.3
Age
12 to 17   10,505   (7,199-15,214)     5.1 (3.5-7.3)   13,321     5.4
18 to 24   26,549 (19,071-36,392)   12.8   (9.2-17.5)   38,614   15.7
25 to 34   44,941 (32,024-61,253)   21.6 (15.4-29.5)   55,911   22.7
35 to 44   53,897 (37,661-74,084)   25.9 (18.1-35.6)   65,813   26.8
45 or Older   71,960 (51,656-95,373)   34.6 (24.9-45.9)   72,239   29.4
Race/Ethnicity
Not Hispanic or Latino            * *-*        * *-* 191,765   78.0
White   95,182   (75,706-115,296)   45.8 (36.4-55.5) 110,148   44.8
Black/African American   49,915 (34,151-70,022)   24.0 (16.4-33.7)   73,898   30.1
American Indian/Alaska Native            * *-*        * *-*     1,500     0.6
Asian/Pacific Islander     3,367      (826-13,232)     1.6 (0.4-6.4)     1,530     0.6
Two or More Races     3,455 (1,354-8,679)     1.7 (0.7-4.2)         NA     NA
Other         NA       NA       4,688     1.9
Hispanic or Latino            * *-*        * *-*   54,131   22.0
Gender
Male 157,938 (138,414-173,341)   76.0 (66.6-83.4) 179,552   73.0
Female   49,914 (34,511-69,438)   24.0 (16.6-33.4)   66,344   27.0
Years of Education
0 to 8 Years   10,605   (4,046-26,418)     5.1   (1.9-12.7)   18,692     7.6
9 to 11 Years   68,177 (50,307-88,816)   32.8 (24.2-42.7)   74,000   30.1
12 (High School/GED)   52,695 (38,415-70,087)   25.4 (18.5-33.7)   91,380   37.2
More than 12   76,375 (58,179-96,589)   36.7 (28.0-46.5)   61,812   25.1
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.6 Numbers and Percentage Distributions of and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Ohio: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 96,729   (80,240-116,564) 100.0 (NA) 105,443 100.0
Modality
Hospital Inpatient 32,877 (24,613-42,287)   34.0 (25.4-43.7)        564     0.5
Residential
   Rehabilitation—Inpatient
43,643 (35,474-52,092)   45.1 (36.7-53.9)   10,177     9.7
Outpatient 80,818 (74,155-85,804)   83.6 (76.7-88.7)   99,827   94.7
Outpatient Rehabilitation 69,303 (61,543-75,930)   71.6 (63.6-78.5)         NA     NA
Mental Health Center or
   Facility—Outpatient
46,136 (37,329-55,093)   47.7 (38.6-57.0)         NA     NA
Substance
Marijuana 30,456 (23,255-38,712)   31.5 (24.0-40.0)   48,674   46.2
Cocaine (including crack) 18,171 (11,644-27,187)   18.8 (12.0-28.1)   27,719   26.3
Heroin 10,365   (6,019-17,253)   10.7   (6.2-17.8)   10,085     9.6
Prescription Drugs 22,759 (16,349-30,721)   23.5 (16.9-31.8)   11,877   11.3
Methamphetamine       NA       NA       1,083     1.0
Inhalants   5,090 (2,528-9,973)     5.3   (2.6-10.3)        171     0.2
Hallucinogens   8,780   (4,852-15,357)     9.1   (5.0-15.9)        515     0.5
Alcohol 72,771 (65,140-79,059)   75.2 (67.3-81.7)   65,335   62.0
Route of Administration
Injection   4,761 (2,453-9,030)     5.0 (2.6-9.4)     8,573     8.1
Age
12 to 17   6,659 (4,848-9,079)     6.9 (5.0-9.4)   11,141   10.6
18 to 24 20,046 (15,473-25,547)   20.7 (16.0-26.4)   23,488   22.3
25 to 34 24,734 (17,984-32,958)   25.6 (18.6-34.1)   29,493   28.0
35 to 44 21,756 (15,425-29,736)   22.5 (15.9-30.7)   21,723   20.6
45 or Older 23,533 (15,289-34,348)   24.3 (15.8-35.5)   19,598   18.6
Race/Ethnicity
Not Hispanic or Latino 92,651 (87,774-94,926)   95.8 (90.7-98.1)   76,064   98.2
White 75,876 (67,354-82,451)   78.4 (69.6-85.2)   57,191   73.8
Black/African American 13,314   (8,506-20,217)   13.8   (8.8-20.9)   17,589   22.7
American Indian/Alaska Native          * *-*        * *-*        213     0.3
Asian/Pacific Islander          * *-*        * *-*        136     0.2
Two or More Races      623    (280-1,379)     0.6 (0.3-1.4)          40     0.1
Other       NA       NA          894     1.2
Hispanic or Latino   4,078 (1,802-8,954)     4.2 (1.9-9.3)     1,388     1.8
Gender
Male 66,490 (59,249-72,894)   68.7 (61.3-75.4)   67,304   63.8
Female 30,239 (23,835-37,479)   31.3 (24.6-38.7)   38,138   36.2
Years of Education
0 to 8 Years   6,666   (3,672-11,791)     6.9   (3.8-12.2)     7,915     7.5
9 to 11 Years 26,408 (18,942-35,475)   27.3 (19.6-36.7)   32,537   31.0
12 (High School/GED) 32,451 (24,935-40,942)   33.5 (25.8-42.3)   42,048   40.0
More than 12 31,203 (23,724-39,757)   32.3 (24.5-41.1)   22,606   21.5
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.7 Numbers and Percentage Distributions of and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Pennsylvania: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 108,068   (89,934-129,814) 100.0 (NA) 46,990 100.0
Modality
Hospital Inpatient   39,888 (30,364-50,460)   36.9 (28.1-46.7)      864     1.8
Residential
   Rehabilitation—Inpatient
  45,613 (36,358-55,404)   42.2 (33.6-51.3) 16,198   34.5
Outpatient   98,705   (90,299-103,343)   91.3 (83.6-95.6) 38,358   81.6
Outpatient Rehabilitation   85,424 (75,355-93,013)   79.0 (69.7-86.1)       NA     NA
Mental Health Center or
   Facility—Outpatient
  44,414 (35,599-53,791)   41.1 (32.9-49.8)       NA     NA
Substance
Marijuana   31,431 (23,583-40,635)   29.1 (21.8-37.6) 16,116   34.3
Cocaine (including crack)   28,519 (20,944-37,651)   26.4 (19.4-34.8) 10,843   23.1
Heroin   28,647 (22,020-36,424)   26.5 (20.4-33.7)   7,401   15.8
Prescription Drugs   29,220 (21,171-38,958)   27.0 (19.6-36.0)   7,557   16.1
Methamphetamine         NA       NA        293     0.6
Inhalants     6,328   (3,439-11,382)     5.9   (3.2-10.5)        90     0.2
Hallucinogens   10,424   (6,706-15,879)     9.6   (6.2-14.7)      335     0.7
Alcohol   69,157 (60,219-77,279)   64.0 (55.7-71.5) 25,865   55.0
Route of Administration
Injection   12,611   (8,276-18,786)   11.8   (7.8-17.6)   5,643   12.0
Age
12 to 17     6,575 (4,864-8,836)     6.1 (4.5-8.2)   4,916   10.5
18 to 24   24,755 (19,574-30,830)   22.9 (18.1-28.5) 11,515   24.5
25 to 34   20,803 (14,547-28,917)   19.2 (13.5-26.8) 12,020   25.6
35 to 44   20,598 (13,022-31,137)   19.1 (12.0-28.8)   9,766   20.8
45 or Older   35,337 (25,626-46,646)   32.7 (23.7-43.2)   8,773   18.7
Race/Ethnicity
Not Hispanic or Latino 104,362   (99,900-106,426)   96.6 (92.4-98.5) 36,000   92.8
White   88,838 (81,002-94,777)   82.2 (75.0-87.7) 28,974   74.7
Black/African American   11,439   (6,617-19,113)   10.6   (6.1-17.7)   6,329   16.3
American Indian/Alaska Native        210      (30-1,483)     0.2 (0.0-1.4)      126     0.3
Asian/Pacific Islander            * *-*        * *-*        83     0.2
Two or More Races     3,486 (1,383-8,532)     3.2 (1.3-7.9)       NA     NA
Other         NA       NA        488     1.3
Hispanic or Latino     3,706 (1,642-8,168)     3.4 (1.5-7.6)   2,795     7.2
Gender
Male   63,230 (52,741-73,051)   58.5 (48.8-67.6) 31,938   68.0
Female   44,838 (35,017-55,327)   41.5 (32.4-51.2) 15,052   32.0
Years of Education
0 to 8 Years     7,237   (3,494-14,434)     6.7   (3.2-13.4) 23,719   57.1
9 to 11 Years   27,763 (20,546-36,460)   25.7 (19.0-33.7)   5,257   12.7
12 (High School/GED)   37,151 (28,052-47,451)   34.4 (26.0-43.9)   9,520   22.9
More than 12   35,917 (27,146-45,915)   33.2 (25.1-42.5)   3,016     7.3
* Low precisions; no estimate reported.
NA = not available.
Table C.2.1.8 Numbers and Percentage Distributions of and Confidence Intervals of Numbers and Percentage Distributions of Treatment and Demographic Characteristics among Persons Who Received Substance Use Treatment from Specialty Treatment Programs in the Past Year in Texas: NSDUH 2005 to 2010 and TEDS 2007 to 2009
  NSDUH
2005 to 2010 Average
TEDS
2007 to 2009 Average
Number (95% CI) Percentage
(95% CI)
Number Percentage
Total 84,936   (65,807-109,593) 100.0 (NA) 41,930 100.0
Modality
Hospital Inpatient 32,372 (23,776-41,945)   38.1 (28.0-49.4)          1     0.0
Residential
   Rehabilitation—Inpatient
42,993 (33,079-52,850)   50.6 (38.9-62.2) 16,796   40.1
Outpatient 64,137 (54,523-71,462)   75.5 (64.2-84.1) 28,841   68.8
Outpatient Rehabilitation 58,752 (48,979-66,849)   69.2 (57.7-78.7)       NA     NA
Mental Health Center or
   Facility—Outpatient
         * *-*        * *-*       NA     NA
Substance
Marijuana 36,841 (27,989-46,221)   43.4 (33.0-54.4) 18,947   45.2
Cocaine (including crack) 37,937 (28,829-47,486)   44.7 (33.9-55.9) 14,208   33.9
Heroin          * *-*        * *-*   4,345   10.4
Prescription Drugs          * *-*        * *-*   6,526   15.6
Methamphetamine       NA       NA     5,774   13.8
Inhalants   8,079   (3,892-15,889)     9.5   (4.6-18.7)      103     0.2
Hallucinogens 15,619   (9,699-23,998)   18.4 (11.4-28.3)      167     0.4
Alcohol 56,751 (47,801-64,468)   66.8 (56.3-75.9) 20,150   48.1
Route of Administration
Injection   3,176 (1,267-7,700)     3.8 (1.5-9.1)   6,102   14.6
Age
12 to 17 11,045   (7,191-16,524)   13.0   (8.5-19.5)   6,476   15.4
18 to 24 21,180 (14,656-29,394)   24.9 (17.3-34.6)   8,038   19.2
25 to 34 26,640 (18,414-36,524)   31.4 (21.7-43.0) 12,096   28.8
35 to 44          * *-*        * *-*   8,477   20.2
45 or Older          * *-*        * *-*   6,843   16.3
Race/Ethnicity
Not Hispanic or Latino          * *-*        * *-* 26,252   62.9
White 40,555 (31,400-49,891)   47.7 (37.0-58.7) 18,883   45.2
Black/African American          * *-*        * *-*   6,937   16.6
American Indian/Alaska Native          * *-*        * *-*      268     0.6
Asian/Pacific Islander          * *-*        * *-*      164     0.4
Two or More Races      522    (157-1,715)     0.6 (0.2-2.0)       NA     NA
Other       NA       NA         NA     NA
Hispanic or Latino          * *-*        * *-* 15,508   37.1
Gender
Male 53,940 (43,859-62,797)   63.5 (51.6-73.9) 25,158   60.0
Female 30,995 (22,139-41,077)   36.5 (26.1-48.4) 16,771   40.0
Years of Education
0 to 8 Years   7,440   (3,942-13,523)     8.8   (4.6-15.9)   5,309   12.7
9 to 11 Years 32,918 (23,733-43,151)   38.8 (27.9-50.8) 12,542   30.0
12 (High School/GED)          * *-*        * *-* 15,798   37.8
More than 12          * *-*        * *-*   8,167   19.5
* Low precisions; no estimate reported.
NA = not available.
Table C.2.2 Single-Day Treatment Counts for Alcohol or Drug Specialty Treatment1 and Confidence Intervals for Estimates of Hospitals Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2008 to 2010 Combined (October 1 Counts),1 NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment Counts
NSDUH
October 1
2008 to 2010
Number (95% CI)
NSDUH
Average Day
2007 to 20092,3
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 1,434,851 (1,278,112-1,610,688) 1,196,460 (1,066,843-1,341,740) 532,109 1,153,617 1,139,670
Census Regions
Northeast 278,998 (212,738-365,732) 258,055 (204,829-325,015) 158,461    285,374    280,460
Midwest 308,811 (246,380-386,949) 250,503 (202,868-309,260) 146,006    232,093    230,012
South 442,619 (360,482-543,359) 342,547 (274,530-427,337)   76,031    312,156    307,163
West 404,423 (317,497-514,938) 345,355 (272,608-437,367) 151,610    323,994    322,034
Eight Largest States
California 201,700 (133,352-304,722) 152,925 (100,457-232,583)   68,868    139,043    138,179
Florida 75,198   (45,902-123,044) 85,986   (53,239-138,693)   15,646      51,470      50,566
Illinois 71,469   (44,539-114,507) 44,802 (28,032-71,538)   13,794      44,902      44,536
Michigan 57,947 (41,724-80,416) 46,804 (31,818-68,788)   12,552      42,676      42,539
New York 110,008   (66,014-182,993) 100,975   (68,315-149,107)   80,054    117,075    115,100
Ohio 50,830 (33,095-77,990) 36,628 (24,087-55,658)   25,825      36,847      36,418
Pennsylvania 53,555 (35,397-80,956) 69,628   (47,989-100,928)   20,791      47,438      46,977
Texas 66,942   (43,044-104,038) 14,796   (7,643-28,634)     7,972      40,171      39,351
* Low precisions; no estimate reported.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. NSDUH "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43. "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and those for whom the substance for which they were treated is unknown are included.
2 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
3 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.3 Single-Day Treatment Counts for Alcohol-Only1 Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment
Counts
NSDUH
Average Day
2007 to 20092,3,4
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 438,665 (354,848-542,237) 102,587 216,832 213,888
Census Regions
Northeast 62,203 (39,206-98,660)   29,575   40,791   39,797
Midwest 119,873   (85,141-168,729)   33,600   51,728   51,276
South 115,758   (75,675-177,030)   14,860   49,639   48,617
West 140,831   (91,146-217,499)   24,552   74,674   74,198
Eight Largest States
California 66,572   (31,492-140,547)     6,318   26,723   26,542
Florida 44,493 (21,906-90,230)     2,186     8,257     8,007
Illinois 11,406   (5,730-22,691)     2,599   10,225   10,137
Michigan 19,371 (12,153-30,860)     3,042   10,290   10,265
New York 20,683   (8,702-49,108)   13,131   14,976   14,614
Ohio 19,160   (9,980-36,751)     5,086     7,220     7,133
Pennsylvania 19,886   (9,614-41,091)     5,521     7,016     6,935
Texas * *-*      901     5,552     5,405
* Low precisions; no estimate reported.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 "Alcohol-only" refers to treatment for only alcohol. Individuals in treatment for both alcohol and drugs are excluded.
2 Single-day treatment counts are based on the day of interview for NSDUH Average Day and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. NSDUH "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
3 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
4 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.4 Single-Day Treatment Counts for Drug-Only1 Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment
Counts
NSDUH
Average Day
2007 to 20092,3,4
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 314,806 (261,637-378,764) 217,502 414,845 411,654
Census Regions
Northeast 97,849   (67,687-141,410)   69,718 119,474 118,266
Midwest 58,025 (40,557-83,005)   47,552   70,447   69,944
South 96,577   (71,220-130,950)   31,364 128,149 127,076
West 62,355 (40,565-95,831)   68,868   96,774   96,368
Eight Largest States
California 12,431   (5,587-27,650)   43,397   50,213   50,025
Florida 20,276   (9,042-45,427)     7,968   20,407   20,176
Illinois 20,963 (10,179-43,125)     5,733   16,527   16,381
Michigan 13,789   (6,657-28,537)     4,691   14,111   14,082
New York 41,299 (20,561-82,846)   32,482   47,811   47,363
Ohio 2,825 (1,032-7,736)     7,139     8,731     8,651
Pennsylvania 29,081 (16,239-52,028)     9,451   19,470   19,350
Texas 7,298   (2,503-21,263)     4,285   15,212   15,079
* Low precision; no estimate reported.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
2 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
3 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
4 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.5 Single-Day Treatment Counts for Alcohol and Drug1 Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment
Counts
NSDUH
Average Day
2007 to 20092,3,4
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 397,732 (333,100-474,879) 198,971 521,940 514,128
Census Regions
Northeast 95,774   (66,769-137,339)   58,799 125,109 122,397
Midwest 63,211 (44,017-90,760)   61,125 109,918 108,793
South 120,097   (86,271-167,162) 26,589 134,368 131,470
West 118,650   (83,717-168,117)   52,359 152,545 151,468
Eight Largest States
California 62,306   (36,309-106,851)   18,946   62,106   61,612
Florida 20,697   (7,506-56,981)     4,759   22,805   22,382
Illinois 10,257   (3,264-32,181)     5,450   18,149   18,018
Michigan 12,358   (6,473-23,578)     4,797   18,275   18,192
New York 37,728 (22,958-61,964)   34,431   54,287   53,123
Ohio 14,343   (7,164-28,694)   11,086   20,896   20,634
Pennsylvania 19,697 (10,850-35,733)     5,819   20,953   20,691
Texas 4,414 (2,000-9,741)     2,786   19,407   18,867
* Low precisions; no estimate reported.
NA = not available.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 "Alcohol and drug" refers to treatment received for both alcohol and at least one other drug at the time of admission. Individuals in treatment for alcohol only or drugs only are excluded.
2 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
3 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
4 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.6 Single-Day Treatment Counts for Primary Alcohol with Secondary Drug1 Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment
Counts
NSDUH
Average Day
2007 to 20092,3,4
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 165,571 (125,368-218,657) 86,898 NA NA
Census Regions
Northeast 29,702 (17,237-51,170) 25,999 NA NA
Midwest 22,992 (13,365-39,551) 28,262 NA NA
South 48,171 (27,795-83,470) 11,281 NA NA
West 64,707   (39,526-105,899) 21,357 NA NA
Eight Largest States
California 32,873 (14,906-72,444)   6,137 NA NA
Florida 942    (202-4,405)   1,676 NA NA
Illinois * *-*   2,165 NA NA
Michigan 5,865   (2,385-14,418)   2,211 NA NA
New York 13,487   (6,648-27,349) 14,990 NA NA
Ohio 9,785   (3,892-24,579)   5,360 NA NA
Pennsylvania 6,558   (2,581-16,654)   2,879 NA NA
Texas 1,724    (412-7,206)      857 NA NA
* Low precisions; no estimate reported.
NA = not available.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 "Primary alcohol" refers to alcohol as the main substance of abuse at the time of admission. Individuals in treatment for alcohol only are included.
2 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
3 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
4 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.7 Single-Day Treatment Counts for Primary Drug with Secondary Alcohol1 Specialty Treatment and Confidence Intervals for Estimates of Single-Day Treatment Counts Overall and by Census Regions and for the Eight Largest States: NSDUH 2007 to 2009 Combined (Average-Day Counts), TEDS 2007 to 2009 Combined, and N-SSATS 2007 to 2009 Combined
Single-Day
Treatment
Counts
NSDUH
Average Day
2007 to 20092,3,4
Number (95% CI)
TEDS
March 30 or March 31
2007 to 2009
N-SSATS –
All Facilities
March 30 or March 31
2007 to 2009
N-SSATS –
Hospitals Excluded
March 30 or March 31
2007 to 2009
Total United States 228,813 (180,823-289,525) 111,973 NA NA
Census Regions
Northeast 62,724   (39,192-100,356)   32,800 NA NA
Midwest 40,219 (25,051-64,560)   32,863 NA NA
South 71,926   (47,048-109,944)   15,308 NA NA
West 53,943 (33,305-87,352)   31,002 NA NA
Eight Largest States
California 29,433 (14,255-60,741)   12,809 NA NA
Florida 19,754   (6,874-56,680)     3,083 NA NA
Illinois 9,889   (3,023-32,302)     3,285 NA NA
Michigan 6,493   (2,581-16,325)     2,586 NA NA
New York 21,043 (10,759-41,130)   19,441 NA NA
Ohio 4,558   (1,831-11,340)     5,726 NA NA
Pennsylvania 13,139   (6,105-28,252)     2,940 NA NA
Texas 2,691 (1,070-6,766)     1,929 NA NA
* Low precision; no estimate reported.
NA = not available.
NOTE 1: Not all States report to TEDS. Counts for NSDUH and N-SSATS do not exclude data from States not reporting to TEDS for a given year.
NOTE 2: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies. TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 "Primary drug" refers to a substance, other than alcohol, that is the main substance of abuse at the time of admission. Individuals in treatment for drugs only are included.
2 Single-day treatment counts are based on a reference date of October 1 for NSDUH and March 30 or March 31 for N-SSATS and TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS and TEDS data are based on the data file from the previous year. "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
3 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
4 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
Table C.2.8 Alcohol and Drug Single-Day Specialty Treatment Counts, by State: NSDUH 2008 to 2010 Combined (October 1 Counts)
Region/State Single-Day Treatment Counts 2008 to 2010 NSDUH (October 1)1
Alcohol or Drug Treatment2
(95% CI)
Total United States 1,434,851 (1,278,112-1,610,688)
Region
Northeast    278,998 (212,738-365,732)
Midwest    308,811 (246,380-386,949)
South    442,619 (360,482-543,359)
West    404,423 (317,497-514,938)
State
Alabama      10,174   (2,877-35,807)
Alaska        3,233 (1,777-5,869)
Arizona      24,100 (12,106-47,869)
Arkansas      12,534   (6,967-22,508)
California    201,700 (133,352-304,722)
Colorado        8,122   (5,235-12,597)
Connecticut      18,141   (8,425-38,914)
Delaware        4,275 (2,321-7,857)
District of Columbia        6,595   (2,851-15,107)
Florida      75,198   (45,902-123,044)
Georgia      38,037 (16,266-88,614)
Hawaii        8,947   (3,687-21,557)
Idaho        7,268   (3,058-17,190)
Illinois      71,469   (44,539-114,507)
Indiana      35,512 (16,882-74,411)
Iowa      11,354   (5,117-25,120)
Kansas        3,737   (1,048-13,289)
Kentucky      24,995 (11,541-53,897)
Louisiana      11,082   (4,975-24,635)
Maine        5,197   (2,271-11,855)
Maryland      21,663   (6,923-67,338)
Massachusetts      30,053 (13,584-66,253)
Michigan      57,947 (41,724-80,416)
Minnesota       6,997   (1,507-32,333)
Mississippi        4,241   (1,168-15,354)
Missouri        6,651   (1,722-25,619)
Montana        9,976   (5,345-18,528)
Nebraska        8,816   (4,202-18,432)
Nevada      21,791   (9,937-47,472)
New Hampshire        4,030 (1,662-9,742)
New Jersey      48,740   (22,777-103,868)
New Mexico      12,422   (8,179-18,841)
New York    110,008   (66,014-182,993)
North Carolina      53,620   (22,841-125,187)
North Dakota        2,493 (1,027-6,025)
Ohio      50,830 (33,095-77,990)
Oklahoma      15,785   (7,429-33,437)
Oregon      22,825 (11,847-43,838)
Pennsylvania      53,555 (35,397-80,956)
Rhode Island        5,650   (2,808-11,333)
South Carolina      36,396 (20,764-63,595)
South Dakota        2,892 (1,535-5,440)
Tennessee      14,280   (5,910-34,426)
Texas      66,942   (43,044-104,038)
Utah      20,646   (9,339-45,352)
Vermont        3,623 (1,857-7,045)
Virginia      34,037 (13,620-84,653)
Washington      61,301   (32,739-114,261)
West Virginia      12,763   (5,350-30,245)
Wisconsin      50,112   (20,235-122,943)
Wyoming        2,093 (1,063-4,112)
* Low precision; no estimate reported.
1 Single-day treatment counts are based on a reference date of October 1 for NSDUH. "Treatment" includes treatment received at a hospital, drug rehabilitation facility, or mental health facility. Nonspecialty treatment data are excluded from total counts. NSDUH October 1 single-day treatment counts are derived from TX43.
2 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and those for whom the substance for which they were treated is unknown are included.
Table C.2.9 Alcohol and Drug Single-Day Specialty Treatment Counts (Average Day), by State: NSDUH 2007 to 2009 Combined
Region/State Single-Day Treatment Counts 2007 to 2009 NSDUH
(Average Day)1,2
Alcohol or
Drug
Treatment3
Alcohol-
Only
Treatment4
Drug-Only
Treatment4
Primary
Alcohol with
Secondary
Drug
Treatment5
Primary
Drug with
Secondary
Alcohol
Treatment5
Unknown
Substance for
Which
Treatment
Was Received
Total United States 1,196,460 438,665 314,806 165,571 228,813 45,257
Region
Northeast    258,055   62,203   97,849   29,702   62,724   2,229
Midwest    250,503 119,873   58,025   22,992   40,219   9,394
South    342,547 115,758   96,577   48,171   71,926 10,115
West    345,355 140,831   62,355   64,707   53,943 23,518
State
Alabama      19,472     5,273     6,345     4,453     3,401          0
Alaska        4,454     2,782        292        733        621        26
Arizona      36,508   16,379     2,423   10,553     2,792   4,362
Arkansas        9,908     3,718     1,079        857     2,358   1,896
California    152,925   66,572   12,431   32,873   29,433 11,616
Colorado      15,481     9,441     1,426     2,948     1,626        40
Connecticut      23,901   13,531     7,430            *     2,940          0
Delaware        6,997     1,873     4,233        430        189      271
District of Columbia        7,276        529     2,821          61     3,648      217
Florida      85,986   44,493   20,276        942   19,754      520
Georgia      13,657     1,981     1,925     7,038     2,713          0
Hawaii        3,526     1,039     2,169        318            *          0
Idaho        7,021     2,429     1,678        134     2,254      526
Illinois      44,802   11,406   20,963            *     9,889   2,177
Indiana      36,762   15,015     7,169     4,372     7,367   2,838
Iowa        7,155     4,596     2,125        182        253          0
Kansas        6,561     3,144            *            *     2,247   1,117
Kentucky      20,374     7,028     9,073     1,173     2,659      440
Louisiana      14,833        464   10,303            *     4,065          0
Maine        5,692     1,532     1,917        285     1,958          0
Maryland      31,574   20,365     5,119        415     4,694      981
Massachusetts      13,505     1,010     4,190     5,639     2,517          0
Michigan      46,804   19,371   13,789     5,865     6,493   1,286
Minnesota      14,101     9,636     2,964        428     1,073          0
Mississippi        3,144            *     1,473            *     1,671          0
Missouri      16,492   10,109     2,786        712     2,885          0
Montana        3,187     1,254        503        245     1,186          0
Nebraska        7,923     1,272     3,263        349     1,460   1,579
Nevada      16,373        274   10,002     1,531     4,566          0
New Hampshire        7,206     2,194     1,574        521     2,916          0
New Jersey      26,385     1,616     6,009     2,172   16,587          0
New Mexico        8,172     1,320     4,232     1,381     1,240          0
New York    100,975   20,683   41,299   13,487   21,043   1,266
North Carolina      10,758        548     7,554     1,979        678          0
North Dakota        1,395        858        188        155          95        99
Ohio      36,628   19,160     2,825     9,785     4,558      299
Oklahoma      16,062     2,777     3,294     7,232     2,759          0
Oregon      41,771   16,674   14,897     1,478     4,478   4,244
Pennsylvania      69,628   19,886   29,081     6,558   13,139      964
Rhode Island        7,924        881     4,583        958     1,502          0
South Carolina      14,965     4,689     5,060     2,861     2,356          0
South Dakota        2,211        727        446        775        262          0
Tennessee      27,553     3,173     4,308     5,883   12,916   1,273
Texas      14,796            *     7,298     1,724     2,691   2,245
Utah        8,664        743     2,399     3,911        640      970
Vermont        2,840        870     1,766          81        122          0
Virginia      37,955   14,707     4,611   12,976     3,391   2,270
Washington      44,516   20,927     9,524     8,072     4,259   1,735
West Virginia        7,238     3,303     1,806        146     1,984          0
Wisconsin      29,669   24,578     1,455            *     3,636          0
Wyoming        2,756        997        382        527        850          0
* Low precision; no estimate reported.
1 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
2 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
3 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and those for whom the substance for which they were treated is unknown are included.
4 "Alcohol-only" refers to treatment for only alcohol. "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
5 "Primary alcohol" refers to alcohol as the main substance of abuse at the time of admission (individuals in treatment for alcohol only are included). "Primary drug" refers to a substance, other than alcohol, that is the main substance of abuse at the time of admission (individuals in treatment for drugs only are included).
Table C.2.9CI 95% Confidence Intervals for Estimates of Alcohol and Drug Single-Day Specialty Treatment Counts (Average Day), by State: NSDUH 2007 to 2009 Combined
Region/State Single-Day Treatment Counts 2007 to 2009 NSDUH (Average Day)1,2
Alcohol or Drug
Treatment3
Alcohol-Only
Treatment4
Drug-Only
Treatment4
Primary Alcohol with
Secondary Drug
Treatment5
Primary Drug with
Secondary Alcohol
Treatment5
Unknown Substance
for Which Treatment
Was Received
Total US (1,066,843-1,341,740) (354,848-542,237) (261,637-378,764) (125,368-218,657) (180,823-289,525) (29,579-69,242)
Region
Northeast (204,829-325,015) (39,206-98,660)   (67,687-141,410) (17,237-51,170)   (39,192-100,356)    (791-6,279)
Midwest (202,868-309,260)   (85,141-168,729) (40,557-83,005) (13,365-39,551) (25,051-64,560)   (4,104-21,503)
South (274,530-427,337)   (75,675-177,030)   (71,220-130,950) (27,795-83,470)   (47,048-109,944)   (4,919-20,800)
West (272,608-437,367)   (91,146-217,499) (40,565-95,831)   (39,526-105,899) (33,305-87,352) (12,060-45,856)
State
Alabama   (9,868-38,331)   (1,254-22,100)   (2,341-17,172)      (608-32,400)      (875-13,192) (0-0)
Alaska (2,302-8,585) (1,147-6,720)      (74-1,152)      (192-2,790)    (216-1,784)     (3-191)
Arizona (21,321-62,383)   (4,753-56,137)    (874-6,712)   (2,778-39,917)    (817-9,533)   (1,341-14,172)
Arkansas   (4,494-21,783)   (1,132-12,183)    (374-3,114)    (114-6,442)      (386-14,353)      (247-14,468)
California (100,457-232,583)   (31,492-140,547)   (5,587-27,650) (14,906-72,444) (14,255-60,741)   (3,739-36,062)
Colorado   (8,028-29,805)   (3,842-23,152)    (432-4,707)      (414-20,925)      (220-12,004)     (5-298)
Connecticut   (9,591-59,130)   (4,065-44,705)   (2,885-19,088) *-* (1,012-8,528) (0-0)
Delaware   (3,225-15,090)    (601-5,813)   (1,348-13,178)      (58-3,187)      (34-1,049)   (78-937)
District of Columbia   (4,576-11,535)      (71-3,902) (1,150-6,888)   (12-301) (1,761-7,529)      (29-1,627)
Florida   (53,239-138,693) (21,906-90,230)   (9,042-45,427)    (202-4,405)   (6,874-56,680)      (73-3,716)
Georgia   (4,359-42,674)      (264-14,824)      (255-14,498)   (1,049-47,039)      (367-20,002) (0-0)
Hawaii (1,427-8,690)    (298-3,614)    (579-8,092)      (43-2,330) *-* (0-0)
Idaho   (3,863-12,735)    (692-8,498)    (634-4,437)      (18-1,012)    (722-7,015)      (71-3,903)
Illinois (28,032-71,538)   (5,730-22,691) (10,179-43,125) *-*   (3,023-32,302)      (407-11,630)
Indiana (19,797-68,075)   (5,201-43,193)   (2,541-20,196)   (1,030-18,529)   (1,850-29,240)      (376-21,336)
Iowa   (3,079-16,593)   (1,434-14,682)    (576-7,822)      (24-1,368)      (33-1,921) (0-0)
Kansas   (3,025-14,204)      (867-11,373) *-* *-*      (718-7,021)    (263-4,741)
Kentucky   (8,493-48,646)   (1,025-47,723)   (3,564-23,047)    (159-8,656)    (856-8,248)      (60-3,249)
Louisiana   (6,265-34,999)      (64-3,356)   (3,544-29,847) *-*      (857-19,213) (0-0)
Maine   (3,013-10,732)    (397-5,896)    (860-4,270)      (69-1,181)    (524-7,289) (0-0)
Maryland (18,626-53,418) (10,214-40,515)   (1,843-14,196)      (56-3,091)      (875-25,081)    (228-4,210)
Massachusetts   (4,562-39,852)    (140-7,284)      (581-30,101)      (774-40,876)      (340-18,566) (0-0)
Michigan (31,818-68,788) (12,153-30,860)   (6,657-28,537)   (2,385-14,418)   (2,581-16,325)    (178-9,258)
Minnesota   (5,258-37,684)   (2,369-38,992) (1,111-7,900)      (58-3,152)    (257-4,480) (0-0)
Mississippi      (758-12,993) *-*      (198-10,943) *-*      (224-12,411) (0-0)
Missouri   (7,407-36,639)   (2,966-34,330)    (867-8,941)      (97-5,249) (1,158-7,183) (0-0)
Montana (1,892-5,363)    (461-3,402)    (138-1,825)   (82-729)    (505-2,778) (0-0)
Nebraska   (3,606-17,345)    (514-3,142)      (986-10,757)      (47-2,586)    (199-10,656)    (286-8,688)
Nevada   (8,316-32,116)      (59-1,277)   (3,742-26,603)    (353-6,634)   (1,560-13,330) (0-0)
New Hampshire   (4,091-12,663)    (673-7,139)    (520-4,754)      (70-3,877) (1,070-7,924) (0-0)
New Jersey (10,159-68,282)    (363-7,186)   (1,720-20,971)    (525-8,977)   (4,027-67,948) (0-0)
New Mexico   (3,449-19,283)    (475-3,662)      (991-17,944)    (302-6,294)    (283-5,431) (0-0)
New York   (68,315-149,107)   (8,702-49,108) (20,561-82,846)   (6,648-27,349) (10,759-41,130)    (312-5,125)
North Carolina   (4,333-26,678)      (73-4,127)   (2,274-25,052)    (469-8,341)      (91-5,021) (0-0)
North Dakota    (498-3,893)    (173-4,239)   (58-609)   (71-338)   (13-704)   (13-732)
Ohio (24,087-55,658)   (9,980-36,751) (1,032-7,736)   (3,892-24,579)   (1,831-11,340)      (55-1,629)
Oklahoma   (7,662-33,564)      (750-10,262)      (858-12,608)   (1,760-29,545)    (767-9,908) (0-0)
Oregon (21,397-81,046)   (5,722-48,269)   (3,981-55,216)    (529-4,131)   (1,688-11,863)   (1,066-16,837)
Pennsylvania   (47,989-100,928)   (9,614-41,091) (16,239-52,028)   (2,581-16,654)   (6,105-28,252)    (203-4,564)
Rhode Island   (3,689-16,928)    (236-3,286)   (1,847-11,322)    (146-6,228)    (402-5,591) (0-0)
South Carolina   (7,096-31,487)      (618-35,305)   (1,296-19,694)      (384-21,235)      (313-17,641) (0-0)
South Dakota (1,041-4,686)    (233-2,271)    (121-1,637)    (135-4,444)      (62-1,113) (0-0)
Tennessee (10,963-68,907)      (423-23,728)      (880-21,042)      (805-42,716)   (3,645-45,553)    (292-5,541)
Texas   (7,643-28,634) *-*   (2,503-21,263)    (412-7,206) (1,070-6,766)      (315-15,978)
Utah   (4,534-16,525)    (106-5,181)    (743-7,733)      (890-17,103)    (153-2,670)    (132-7,127)
Vermont (1,510-5,331)    (192-3,923)    (900-3,460)   (15-455)   (16-915) (0-0)
Virginia   (12,741-112,184)     (1,995-107,051)   (1,170-18,150)   (4,661-36,044)   (1,135-10,124)      (447-11,516)
Washington (22,388-88,160)   (7,337-59,414)   (3,309-27,349)   (2,370-27,422)      (955-18,950)      (229-13,108)
West Virginia   (3,698-14,135)   (1,050-10,358)    (486-6,691)      (20-1,087)    (493-7,963) (0-0)
Wisconsin (10,950-79,842)   (7,724-77,598)    (315-6,708) *-*      (484-27,215) (0-0)
Wyoming (1,495-5,068)    (321-3,086)    (110-1,321)    (142-1,954)    (441-1,637) (0-0)
* Low precision; no estimate reported.
1 NSDUH average-day single-day counts are derived from the single-day question (TX07) and from the question on outcome of last treatment (TX38 where the response option is still in treatment).
2 Data are subset to the following categories from TX25: (1) hospital as an outpatient, (2) inpatient at a residential drug or alcohol rehabilitation facility, (3) outpatient at a residential drug or alcohol rehabilitation facility, and (4) outpatient at a mental health center or facility.
3 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and those for whom the substance for which they were treated is unknown are included.
4 "Alcohol-only" refers to treatment for only alcohol. "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
5 "Primary alcohol" refers to alcohol as the main substance of abuse at the time of admission (individuals in treatment for alcohol only are excluded). "Primary drug" refers to a substance, other than alcohol, that is the main substance of abuse at the time of admission (individuals in treatment for drugs only are excluded).
Table C.2.10 Alcohol and Drug Single-Day Specialty Treatment Counts, by State: TEDS 2007 to 2009 Combined
Region/State Single-Day Treatment Counts 2007 to 2009 TEDS—(March 30 or March 31)1
Alcohol or
Drug
Treatment2
Alcohol-Only
Treatment3
Drug-Only
Treatment3
Primary
Alcohol with
Secondary
Drug
Treatment4
Primary
Drug with
Secondary
Alcohol
Treatment4
No Substance
Use at
Admission
Reported
Total United States 532,109 102,587 217,502 86,898 111,973 13,148
Region
Northeast 158,461   29,575   69,718 25,999   32,800      370
Midwest 146,006   33,600   47,552 28,262   32,863   3,730
South   76,031   14,860   31,364 11,281   15,308   3,218
West 151,610   24,552   68,868 21,357   31,002   5,831
State
Alabama         NA         NA         NA       NA         NA       NA
Alaska         NA         NA         NA       NA         NA       NA
Arizona   14,710     2,159     4,546   1,360     1,608   5,037
Arkansas     5,186        975     2,239      729     1,196        48
California   68,868     6,318   43,397   6,137   12,809      207
Colorado   11,211     2,526     4,181   1,877     2,628          0
Connecticut   10,661     1,214     5,956   1,243     2,090      158
Delaware     2,290        170        904      288        787      140
District of Columbia         NA         NA         NA       NA         NA       NA
Florida   15,646     2,186     7,968   1,676     3,083      140
Georgia         NA         NA         NA       NA         NA      734
Hawaii     2,133        295        718      363        724        33
Idaho     2,043        509        899      226        407          2
Illinois   13,794     2,599     5,733   2,165     3,285        12
Indiana   18,724     4,027     5,960   4,203     4,317      218
Iowa     8,470     2,290     1,874   1,853     2,442        11
Kansas     6,923     1,317     1,633   1,710     2,263          0
Kentucky     6,366     1,061     2,638   1,153     1,345      169
Louisiana     5,463        770     2,338      911     1,358        85
Maine     4,610        919     2,364      679        644          4
Maryland   20,375     4,166     9,332   2,641     4,234          2
Massachusetts   14,802     3,801     5,633   2,612     2,673        83
Michigan   12,552     3,042     4,691   2,211     2,586        22
Minnesota     8,525     2,628     1,914   1,999     1,900        84
Mississippi     3,418        587     1,114      569        638      510
Missouri   11,260     2,149     4,383   1,566     2,528      633
Montana     2,371        528        291      894        658          0
Nebraska     2,529        743        550      662        468      106
Nevada     2,833        570     1,233      406        623          1
New Hampshire     1,666        490        426      349        315        86
New Jersey   19,413     3,224   10,305   2,257     3,623          4
New Mexico     1,338        383        546    156          94    159
New York   80,054   13,131   32,482 14,990   19,441          9
North Carolina     3,695        473     1,543      810        813        56
North Dakota        982        310        197      240        235          0
Ohio   25,825     5,086     7,139   5,360     5,726   2,515
Oklahoma     5,808        990     2,614   1,035     1,089        81
Oregon   17,611     5,839     4,501   3,555     3,716          0
Pennsylvania   20,791     5,521     9,451   2,879     2,940          0
Rhode Island     3,788        542     2,232      405        584        26
South Carolina     7,283     2,550     2,417   1,283     1,024          9
South Dakota     3,049     1,045        427   1,036        488        54
Tennessee     1,436        282        713      214        224          3
Texas     7,972        901     4,285      857     1,929          0
Utah     5,662        853     2,635      772     1,399          2
Vermont     2,676        731        870      584        491          0
Virginia   11,282     1,798     2,970   2,276     2,858   1,380
Washington   20,703     3,819     5,433   5,100     5,963      388
West Virginia     4,027     1,586     1,766      372        301          1
Wisconsin     9,157     4,728     1,577   1,726     1,053        74
Wyoming     2,125        752        488      510        373          1
* Low precisions; no estimate reported.
NOTE 1: Reporting for Alabama, Alaska, the District of Columbia, and Georgia was incomplete for 2007 to 2009.
NOTE 2: TEDS collects data primarily from publicly funded facilities and does not include data from federally operated facilities.
1 Single-day treatment counts are based on a reference date of March 30 or March 31 for TEDS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, TEDS data are based on the data file from the previous year.
2 "Alcohol-only" refers to treatment for only alcohol. "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
3 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, both alcohol and drugs, and with no substance use at admission reported are included.
4 "Primary alcohol" refers to alcohol as the main substance of abuse at the time of admission (individuals in treatment for alcohol only are excluded). "Primary drug" refers to a substance, other than alcohol, that is the main substance of abuse at the time of admission (individuals in treatment for drugs only are excluded).
Table C.2.11 Alcohol and Drug Single-Day Specialty Treatment Counts (All Facilities), by State: N‑SSATS 2007 to 2009 Combined
Region/State Single-Day Treatment Counts 2007 to 2009 N-SSATS—All Facilities
(March 30 or March 31)1
Alcohol-Only
Treatment2
Drug-Only
Treatment2
Alcohol or Drug
Treatment3
Alcohol and Drug
Treatment4
Total United States 216,832 414,845 1,153,617 521,940
Region
Northeast   40,791 119,474    285,374 125,109
Midwest   51,728   70,447    232,093 109,918
South   49,639 128,149    312,156 134,368
West   74,674   96,774    323,994 152,545
State
Alabama     1,353     8,583      14,895     4,959
Alaska     1,015        454        3,103     1,634
Arizona     7,960     9,181      29,445   12,304
Arkansas        508     1,362        3,676     1,806
California   26,723   50,213    139,043   62,106
Colorado   13,628     6,968      35,410   14,814
Connecticut     3,006   12,961      24,941     8,974
Delaware        624     1,345        4,024     2,055
District of Columbia        639     2,431        4,881     1,810
Florida     8,257   20,407      51,470   22,805
Georgia     2,797     8,041      18,115     7,277
Hawaii        642     1,421        4,226     2,163
Idaho        805        823        3,871     2,243
Illinois   10,225   16,527      44,902   18,149
Indiana     5,838   10,765      29,598   12,996
Iowa     1,933     1,548        7,500     4,019
Kansas     2,261     2,507      10,526     5,759
Kentucky     4,454     5,648      20,413   10,312
Louisiana     1,518     4,907      12,553     6,128
Maine     1,765     3,739        9,840     4,336
Maryland     5,294   17,476      37,732   14,962
Massachusetts     7,020   13,953      38,445   17,473
Michigan   10,290   14,111      42,676   18,275
Minnesota     3,390     3,850      13,859     6,619
Mississippi     1,217     1,495        5,852     3,140
Missouri     2,958     6,628      19,329     9,744
Montana        865        568        3,359     1,926
Nebraska     1,178        973        5,081     2,930
Nevada     1,990     2,882        9,406     4,534
New Hampshire        698     1,916        4,826     2,212
New Jersey     3,933   15,015      30,339   11,391
New Mexico     3,198     4,098      14,599     7,304
New York   14,976   47,811    117,075   54,287
North Carolina     4,971   11,475      28,498   12,052
North Dakota        578        286        2,308     1,444
Ohio     7,220     8,731      36,847   20,896
Oklahoma     2,398     4,189      12,579     5,993
Oregon     5,104     6,447      23,205   11,654
Pennsylvania     7,016   19,470      47,438   20,953
Rhode Island     1,440     3,402        8,115     3,272
South Carolina     3,047     6,106      14,874     5,720
South Dakota        897        303        2,845     1,645
Tennessee     1,833     7,000      13,135     4,301
Texas     5,552   15,212      40,171   19,407
Utah     1,744     4,064      12,191     6,383
Vermont        936     1,208        4,355     2,210
Virginia     4,042     7,012      20,627     9,573
Washington     9,959     9,106      42,998   23,933
West Virginia     1,134     5,460        8,661     2,068
Wisconsin     4,960     4,220      16,621     7,441
Wyoming     1,042        548        3,136     1,546
* Low precisions; no estimate reported.
NA = not available.
NOTE: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies.
1 Single-day treatment counts are based on a reference date of March 30 or March 31 for N-SSATS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS data are based on the data file from the previous year.
2 "Alcohol-only" refers to treatment for only alcohol. "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
3 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, and both alcohol and drugs are included.
4 "Alcohol and drug" treatment refers to alcohol and at least one drug as main substance of abuse at the time of admission (individuals in treatment for alcohol only or drugs only are excluded).
Table C.2.12 Alcohol and Drug Single-Day Specialty Treatment Counts, by State: N-SSATS 2007 to 2009 Combined, Hospitals Excluded
Region/State Single-Day Treatment Counts 2007 to 2009 N-SSATS—Hospitals Excluded
(March 30 or March 31)1
Alcohol-Only
Treatment2
Drug-Only
Treatment2
Alcohol or Drug
Treatment3
Alcohol and Drug
Treatment4
Total United States 213,888 411,654 1,139,670 514,128
Region
Northeast   39,797 118,266    280,460 122,397
Midwest   51,276   69,944    230,012 108,793
South   48,617 127,076    307,163 131,470
West   74,198   96,368    322,034 151,468
State
Alabama     1,320     8,557      14,699     4,822
Alaska     1,009        454        3,093     1,631
Arizona     7,878     9,101      29,060   12,081
Arkansas        504     1,358        3,635     1,774
California   26,542   50,025    138,179   61,612
Colorado   13,601     6,956      35,322   14,765
Connecticut     2,925   12,828      24,534     8,781
Delaware        618     1,340        3,998     2,040
District of Columbia        631     2,417        4,830     1,782
Florida     8,007   20,176      50,566   22,382
Georgia     2,718     7,973      17,777     7,086
Hawaii        641     1,421        4,225     2,163
Idaho        792        820        3,831     2,220
Illinois   10,137   16,381      44,536   18,018
Indiana     5,755   10,696      29,185   12,734
Iowa     1,923     1,542        7,468     4,004
Kansas     2,261     2,507      10,524     5,757
Kentucky     4,386     5,566      20,036   10,084
Louisiana     1,481     4,868      12,255     5,906
Maine     1,747     3,721        9,731     4,263
Maryland     5,245   17,384      37,446   14,817
Massachusetts     6,829   13,688      37,554   17,038
Michigan   10,265   14,082      42,539   18,192
Minnesota     3,349     3,834      13,742     6,560
Mississippi     1,181     1,416        5,592     2,995
Missouri     2,940     6,512      19,146     9,694
Montana        846        550        3,257     1,861
Nebraska     1,174        969        5,058     2,915
Nevada     1,979     2,873        9,361     4,510
New Hampshire        675     1,911        4,792     2,205
New Jersey     3,736   14,844      29,472   10,892
New Mexico     3,179     4,081      14,533     7,273
New York   14,614   47,363    115,100   53,123
North Carolina     4,884   11,362      28,022   11,776
North Dakota        567        280        2,258     1,411
Ohio     7,133     8,651      36,418   20,634
Oklahoma     2,371     4,164      12,479     5,945
Oregon     5,081     6,431      23,134   11,622
Pennsylvania     6,935   19,350      46,977   20,691
Rhode Island     1,422     3,386        8,061     3,252
South Carolina     3,003     6,055      14,608     5,550
South Dakota        876        297        2,737     1,564
Tennessee     1,780     6,953      12,871     4,139
Texas     5,405   15,079      39,351   18,867
Utah     1,729     4,049      12,135     6,357
Vermont        913     1,175        4,240     2,152
Virginia     3,958     6,961      20,382     9,463
Washington     9,905     9,065      42,827   23,856
West Virginia     1,125     5,448        8,615     2,042
Wisconsin     4,896     4,195      16,401     7,310
Wyoming     1,017        543        3,077     1,517
* Low precisions; no estimate reported.
NA = not available.
NOTE: N-SSATS collects information from public and private facilities and includes facilities operated by Federal agencies.
1 Single-day treatment counts are based on a reference date of March 30 or March 31 for N-SSATS. Because the reference date for NSDUH is October 1 of the prior year in other tables, for consistency across tables, N-SSATS data are based on the data file from the previous year. Data from hospitals are excluded.
2 "Alcohol-only" refers to treatment for only alcohol. "Drug-only" refers to treatment for only drugs. Individuals in treatment for both drugs and alcohol are excluded.
3 "Alcohol or drug treatment" refers to treatment for either alcohol or drugs. Individuals in treatment for alcohol only, drugs only, and both alcohol and drugs are included.
4 "Primary alcohol" refers to alcohol as the main substance of abuse at the time of admission (individuals in treatment for alcohol only are included). "Primary drug" refers to a substance, other than alcohol, that is the main substance of abuse at the time of admission (individuals in treatment for drugs only are included).
Table C.2.13 Substance Use Treatment Annual Admissions, by State: N-SSATS 2007 to 2009 and TEDS 2007 to 2009
Region/State Annual Admissions
N-SSATS1 TEDS
2007 2008 2009 Average 2007 2008 2009 Average
Total United States2 3,561,249 3,501,429 3,388,214 3,483,632 1,908,360 1,989,703 1,962,281 1,953,448
Region2
Northeast    866,936    844,623    816,054    842,538    471,231    470,851    481,195    474,426
Midwest    864,322    859,041    832,660    852,008    617,247    629,301    614,696    620,415
South    903,846    898,677    851,628    884,717    364,685    424,533    425,094    404,771
West    926,145    899,088    887,869    904,367    455,197    465,018    441,296    453,837
State
Arizona      84,122      93,644      81,967      86,578      21,160      20,971      19,217      20,449
Arkansas      15,825      15,659      14,404      15,296      15,012      28,518      24,607      22,712
California    409,490    384,456    374,331    389,426    202,725    202,473    181,799    195,666
Colorado    105,838      95,528      97,222      99,529      79,384      85,776      88,014      84,391
Connecticut      75,445      70,770      62,649      69,621      44,757      47,177      46,067      46,000
Delaware      11,023      12,751      10,072      11,282        8,424        7,935        7,784        8,048
Florida    200,668    194,113    177,832    190,871      52,657      80,962      79,343      70,987
Hawaii      10,473      10,321      14,338      11,711        6,969        7,374        7,245        7,196
Idaho      11,092      12,097      13,937      12,375        3,697        6,200        6,562        5,486
Illinois    162,908    169,079    159,908    163,965      71,067      76,433      71,262      72,921
Indiana      74,835      79,666      72,427      75,643      29,021      19,084      18,004      22,036
Iowa      35,776      35,216      34,764      35,252      26,927      26,261      30,711      27,966
Kansas      35,520      34,372      35,245      35,046      15,016      16,777      19,123      16,972
Kentucky      63,528      69,877      65,328      66,244      24,076      22,148      21,474      22,566
Louisiana      47,858      42,975      41,866      44,233      24,427      25,289      28,084      25,933
Maine      23,900      25,450      24,387      24,579      15,977      15,624      14,592      15,398
Maryland      84,458      85,370      85,285      85,038      67,404      65,656      62,820      65,293
Massachusetts    157,547    143,613    144,492    148,551      91,916      83,267      84,948      86,710
Michigan    153,853    148,290    140,976    147,706      66,934      65,363      64,259      65,519
Minnesota      76,338      72,273      74,954      74,522      49,537      49,861      51,991      50,463
Mississippi      25,059      20,921      18,360      21,447        8,241        8,742        8,022        8,335
Missouri      73,485      65,231      68,278      68,998      47,254      49,243      52,503      49,667
Montana      16,216      14,331      14,529      15,025        9,681        7,474        7,353        8,169
Nebraska      30,329      22,872      22,771      25,324      16,509      16,252      16,001      16,254
Nevada      25,022      29,513      24,439      26,325        9,852        9,372        9,908        9,711
New Hampshire      11,628      10,983      11,497      11,369        5,641        6,214        6,348        6,068
New Jersey      80,479      83,779      84,469      82,909      60,471      65,574      69,155      65,067
New Mexico      47,089      36,214      48,098      43,800      11,967      11,515        9,960      11,147
New York    324,570    326,976    315,611    322,386    308,588    314,573    313,568    312,243
North Carolina      88,199      94,930    102,795      95,308      23,339      38,391      53,620      38,450
North Dakota      12,029      12,039      13,929      12,666        2,421        2,519        2,439        2,460
Ohio    124,125    122,050    116,160    120,778    100,951    104,889    110,771    105,537
Oklahoma      37,171      31,811      36,410      35,131      16,461      16,974      16,930      16,788
Oregon      71,458      75,154      62,607      69,740      52,370      53,126      50,268      51,921
Pennsylvania    158,532    169,899    160,796    163,076      70,400      76,955      62,094      69,816
Rhode Island      17,566      15,438      15,975      16,326      11,359      11,404      10,784      11,182
South Carolina      49,779      49,862      51,069      50,237      26,329      27,184      27,874      27,129
South Dakota      15,455      15,340      14,220      15,005      15,774      15,064      15,002      15,280
Tennessee      52,819      55,578      37,440      48,612      10,295        9,906      10,242      10,148
Texas    137,961    135,141    128,632    133,911      44,578      45,771      46,180      45,510
Utah      36,316      37,746      37,781      37,281      14,180      14,561      14,882      14,541
Vermont      14,655      12,133      12,786      13,191        8,138        8,513        7,140        7,930
Virginia      72,071      70,674      62,179      68,308      31,488      33,751      30,023      31,754
Washington      99,166      98,708    108,417    102,097      38,073      39,726      39,862      39,220
West Virginia      17,427      19,015      19,956      18,799      11,954      13,306        8,091      11,117
Wisconsin      72,283      68,195      62,423      67,634      29,820      29,105      29,129      29,351
Wyoming        9,863      11,376      10,203      10,481        5,139        6,450        6,226        5,938
* Low precisions; no estimate reported.
1 N-SSATS annual admission counts reflect past year admissions reported on the last working day of March in the given year.
2 Both TEDS and N-SSATS total and regional counts exclude Alabama, Alaska, the District of Columbia, and Georgia, which had incomplete TEDS reporting.
Table C.3.1 Number of Persons Aged 12 or Older Who Needed Treatment for an Illicit Drug or Alcohol Problem in the Past Year and Number Who Received Specialty Treatment in the Past Year (NSDUH 2008-2010 Average), Number Who Received Treatment in the Past Year (TEDS 2007-2009 Average), and Percentage Who Needed Treatment but Did Not Receive Specialty Treatment (NSDUH 2008-2010 Averages in Numerator and Denominator; TEDS 2007-2009 Average in Numerator and NSDUH 2008-2010 Average in Denominator), by State
State Needed
Treatment
(NSDUH)
Received Specialty Treatment (NSDUH) Received
Treatment
(TEDS)
Percentage Who Needed but Did
Not Receive Specialty Treatment
(NSDUH numerator)
Percentage Who Needed but
Did Not Receive Treatment
(TEDS numerator)
Number (95% CI)
TOTAL 23,349,410 2,504,756 (2,327,260-2,695,644) 1,928,578 89.3 91.7
Alabama      309,405      39,669 (22,140-70,822)            NA 87.2   NA
Alaska        61,252      10,699   (7,584-15,059)            NA 82.5   NA
Arizona      545,866      59,897 (38,643-92,635)      33,319 89.0 93.9
Arkansas      176,939      18,193 (10,753-30,711)      15,922 89.7 91.0
California   3,030,951    249,134 (184,605-335,966)    231,884 91.8 92.3
Colorado      431,203      32,767 (19,087-56,117)      70,061 92.4 83.8
Connecticut      300,019      40,885 (27,316-61,053)      36,123 86.4 88.0
Delaware        67,244      11,771   (7,463-18,503)        7,453 82.5 88.9
District of Columbia        65,445      10,924   (7,038-16,886)            NA 83.3   NA
Florida   1,364,860    151,979 (106,418-216,773)      67,305 88.9 95.1
Georgia      576,774      46,244 (25,207-84,650)            NA 92.0   NA
Hawaii      116,179        7,600   (4,599-12,536)        8,201 93.5 92.9
Idaho      127,473      18,156 (11,614-28,297)        7,379 85.8 94.2
Illinois      969,671      94,855   (71,006-126,619)      69,483 90.2 92.8
Indiana      476,373      65,797 (44,053-98,072)      31,935 86.2 93.3
Iowa      230,973      18,700 (11,494-30,368)      33,263 91.9 85.6
Kansas      212,605      20,094 (13,983-28,842)      23,354 90.5 89.0
Kentucky      278,503      38,083 (22,433-64,451)      18,215 86.3 93.5
Louisiana      285,554      14,704   (8,126-26,568)      25,875 94.9 90.9
Maine        86,597        9,139   (5,965-13,983)      15,330 89.4 82.3
Maryland      393,354      55,980 (32,625-95,712)      65,657 85.8 83.3
Massachusetts      599,763      70,925   (43,879-114,293)      64,212 88.2 89.3
Michigan      818,312    119,216   (92,732-153,124)      57,956 85.4 92.9
Minnesota      471,298      49,102 (29,571-81,293)      46,907 89.6 90.0
Mississippi      162,640        9,133   (4,749-17,536)        9,774 94.4 94.0
Missouri      420,259      51,896 (32,991-81,452)      49,768 87.7 88.2
Montana        94,371      12,284   (8,374-17,977)        8,891 87.0 90.6
Nebraska      143,709      10,855   (5,821-20,181)      13,428 92.4 90.7
Nevada      254,807      30,852 (17,283-54,797)      12,166 87.9 95.2
New Hampshire      115,540      13,188   (8,633-20,104)        6,252 88.6 94.6
New Jersey      591,094      55,380 (30,746-99,479)      87,880 90.6 85.1
New Mexico      171,126      16,248 (11,357-23,215)        8,964 90.5 94.8
New York   1,592,684    199,350 (146,927-270,167)    245,898 87.5 84.6
North Carolina      594,986      69,300   (40,337-118,731)      33,285 88.4 94.4
North Dakota        48,314        4,187 (2,297-7,609)        3,334 91.3 93.1
Ohio      896,518      93,027   (71,957-120,190)    105,443 89.6 88.2
Oklahoma      291,919      32,774 (21,233-50,479)      20,203 88.8 93.1
Oregon      380,614      67,452 (45,904-98,798)      66,029 82.3 82.7
Pennsylvania      963,583    119,627   (92,614-154,403)      46,990 87.6 95.1
Rhode Island      111,993      15,941 (10,671-23,743)      11,809 85.8 89.5
South Carolina      401,640      45,182 (28,022-72,644)      31,929 88.8 92.1
South Dakota        71,782        6,287 (4,399-8,973)      12,724 91.2 82.3
Tennessee      420,987      29,096 (14,980-56,367)      11,096 93.1 97.4
Texas   1,662,813      85,456   (61,773-118,165)      41,930 94.9 97.5
Utah      151,162      26,550 (19,441-36,215)      17,136 82.4 88.7
Vermont        52,753        6,605 (4,500-9,677)        9,305 87.5 82.4
Virginia      623,305      76,198   (38,861-148,570)      36,925 87.8 94.1
Washington      499,336      82,471   (54,480-124,517)      60,606 83.5 87.9
West Virginia      128,160      24,063 (13,318-43,230)      13,456      * 89.5
Wisconsin      467,391      61,104 (37,332-99,691)      26,371 86.9 94.4
Wyoming        39,311        5,735 (3,545-9,250)        7,152 85.4 81.8
* Low precision; this estimate would ordinarily be suppressed.
NOTE: For NSDUH, respondents were classified as needing treatment for an illicit drug problem if they met at least one of three criteria during the past year: (1) dependent on illicit drugs; (2) abuse of illicit drugs; or (3) received treatment for illicit drug use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient], or mental health center). Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, based on data from original questions not including methamphetamine use items added in 2005 and 2006.


Acknowledgments


This report was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle Institute), Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. HHSS283200800004C.


References


American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

Center for Behavioral Health Statistics and Quality. (2011a). Treatment Episode Data Set (TEDS): 1999-2009. National admissions to substance abuse treatment services (HHS Publication No. SMA 11-4646, DASIS Series: S-56). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://wwwdasis.samhsa.gov/teds09/teds2k9nweb.pdf

Center for Behavioral Health Statistics and Quality. (2011b). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 11-4658, NSDUH Series H-41). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Center for Behavioral Health Statistics and Quality. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 12-4713, NSDUH Series H-44). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Center for Behavioral Health Statistics and Quality. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 13-4795, NSDUH Series H-46). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Chermack, S. T., Fuller, B. E., & Blow, F. C. (2000). Predictors of expressed partner and non-partner violence among patients in substance abuse treatment. Drug and Alcohol Dependence, 58, 43-54.

Deville, J. C., & Särndal, C. E. (1992). Calibration estimators in survey sampling. Journal of the American Statistical Association, 87, 376-382.

Folsom, R. E., & Singh, A. C. (2000). The generalized exponential model for sampling weight calibration for extreme values, nonresponse, and poststratification. In Proceedings of the 2000 Joint Statistical Meetings, American Statistical Association, Survey Research Methods Section, Indianapolis, IN (pp. 598-603). Alexandria, VA: American Statistical Association.

Han, B., Clinton-Sherrod, M., Gfroerer, J., Pemberton, M. R., & Calvin, S. L. (2011). CBHSQ Data Review: State and sociodemographic variations in substance abuse treatment need and receipt in the United States. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavior Health Statistics and Quality.

Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64, 830-842.

Hser, Y. I., Hoffman, V., Grella, C. E., & Anglin, M. D. (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry, 58, 503-508.

Johnson, E. O., & Schultz, L. (2005). Forward telescoping bias in reported age of onset: An example from cigarette smoking. International Journal of Methods in Psychiatric Research, 14(3), 119-129.

Kubiak, S. P., Arfken, C. L, Swartz, J. A., & Koch, A. L. (2006). Treatment at the front end of the criminal justice continuum: The association between arrest and admission into specialty substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy, 1, 20. doi:10.1186/1747-597X-1-20. Retrieved from http://www.substanceabusepolicy.com/content/1/1/20

Manly, B. F. J. (1986). Multivariate statistical methods: A primer. London, England: Chapman and Hall.

Mansell, D., Penk, W., Hankin, C. S., Lee, A., Spiro, A., Skinner, K. M., Hsieh, J., & Kazis, L. E. (2006). The illness burden of alcohol-related disorders among VA patients: The Veterans Health Study. Journal of Ambulatory Care Management, 29, 61-70.

Mertens, J. R., Lu, Y. W., Prathasarathy, S., Moore, C., & Weisner, C. M. (2003). Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: Comparison with matched controls. Archives of Internal Medicine, 163, 2511-2517.

O'Brien, C. P., & McLellan, A. T. (1996). Myths about the treatment of addiction. Lancet, 347, 237-240.

Office of Applied Studies. (2000). Substance abuse treatment in adult and juvenile correctional facilities: Findings from the Uniform Facility Data Set 1997 Survey of Correctional Facilities (Drug and Alcohol Services Information System Series S-9; HHS Publication No. SMA 00-3380). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (NSDUH Series H-28, HHS Publication No. SMA 05-4062). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2010). State estimates of substance use from the 2007-2008 National Surveys on Drug Use and Health (NSDUH Series H-37, HHS Publication No. SMA 10-4472). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Management and Budget. (1997). Revisions to the standards for the classification of Federal data on race and ethnicity. Federal Register, 62(210), 58781-58790. Retrieved from http://www.whitehouse.gov/omb/fedreg/1997standards.html

RTI International. (2010). 2008 National Survey on Drug Use and Health: Methodological resource book (prepared for the Substance Abuse and Mental Health Services Administration, Contract No. 283-2004-00022, Deliverable No. 39). Research Triangle Park, NC: Author.

RTI International. (2013). 2011 National Survey on Drug Use and Health: Methodological resource book (prepared for the Substance Abuse and Mental Health Services Administration, Contract No. HHSS283200800004C, Deliverable No. 39). Research Triangle Park, NC: Author.

Rubin, D. B. (1986). Statistical matching using file concatenation with adjusted weights and multiple imputations. Journal of Business and Economic Statistics, 4(1), 87-94.

Singh, A., Grau, E., & Folsom, R., Jr. (2001). Predictive mean neighborhood imputation with application to the person-pair data of the National Survey on Drug Abuse. In Proceedings of the 2001 Joint Statistical Meetings, American Statistical Association, Survey Research Methods Section, Atlanta, GA (CD-ROM). Alexandria, VA: American Statistical Association.

Singh, A., Grau, E., & Folsom, R., Jr. (2002). Predictive mean neighborhood imputation for NHSDA substance use data. In J. Gfroerer, J. Eyerman, & J. Chromy (Eds.), Redesigning an ongoing national household survey: Methodological issues (HHS Publication No. SMA 03-3768, pp. 111-133). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

Stein, J. A., Dixon, E. L., & Nyamathi, A. M. (2008). Effects of psychosocial and situational variables on substance abuse among homeless adults. Psychology of Addictive Behaviors, 22, 410-416.


End Notes


1 RTI International is a trade name of Research Triangle Institute.

2 Current treatment was assessed in NSDUH using two questions: (TX07) [IF TX02 = 1 OR DK/REF] Are you currently receiving treatment or counseling for your [TXFILL1]?; and (TX38) [IF TX25 = 1 -8 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you received at [FILL IN ANSWER FROM TX25]? [IF TX25 = DK/REF OR TX25 = 9 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you received? (when response = you are still in treatment).

3 For States that collect data on multiple races: (a) when a single race was designated, the specific race code was used; (b) if the State collects a primary or preferred race along with additional races, the code for the primary/preferred race was used; and (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 was used to determine the race code for TEDS. When two or more races were designated and neither (b) nor (c) applied, the TEDS code for Two or more races was used.

4 Percentages of employment status using the NSDUH data are computed among all persons aged 12 or older; persons aged 12 to 17 are reported in the "other" category.

5 The comparison of insurance coverage was restricted to differences in the percentages of those who were insured versus those who were uninsured due to differences between TEDS and NSDUH in the categories of insurance types provided.

6 Treatment at the time of the interview was assessed in NSDUH using two questions: (TX07) [IF TX02 = 1 OR DK/REF] Are you currently receiving treatment or counseling for your [TXFILL1]?; and (TX38) [IF TX25 = 1 -8 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you received at [FILL IN ANSWER FROM TX25]? [IF TX25 = DK/REF OR TX25 = 9 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you received? (when response = you are still in treatment).

7 Focus of treatment was assessed in NSDUH using a series of questions: e.g., for alcohol (TX26) [IF (AL01 = 1 OR ALREF = 1) AND TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of alcohol? [IF (AL01 = 1 OR ALREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of alcohol?; and for marijuana/hashish (TX27) [IF (MJ01 =1 OR MJREF = 1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of marijuana or hashish? [IF (MJ01 = 1 OR MJREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of marijuana or hashish?

8 Specific State reporting requirements for the 2007 to 2009 TEDS are available in CBHSQ (2011a).

9 The jurisdictions include American Samoa, the territory of Guam, the Federated States of Micronesia, the Republic of Palau, the Commonwealth of Puerto Rico, and the Virgin Islands of the United States.

10 SAE is a hierarchical Bayes modeling technique used to make State-level estimates for approximately 20 measures related to substance use. For more details, see the State Estimates of Substance Use from the 2005-2006 National Surveys on Drug Use and Health (Hughes, Sathe, & Spagnola, 2008; available as a PDF at http://www.samhsa.gov/data/NSDUH.aspx).


The CBHSQ Data Review is published periodically by the Center for Behavioral Health Statistics and Quality, SAMHSA. All material appearing in this report is in the public domain and may be copied without permission from SAMHSA. This report is available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail Jonaki.Bose@samhsa.hhs.gov or call 240-276-1212.