Chapter 1

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

Data Collection Procedures for the 2010 N-SSATS
Facility Selection for the 2010 N-SSATS Report
Survey Response Mode
Data Considerations and Limitations
Organization of the Report
Terminology

This report presents tabular information and highlights from the 2010 National Survey of Substance Abuse Treatment Services (N-SSATS), conducted between March and October 2010, with a reference date of March 31, 2010. It is the 33rd in a series of national surveys begun in the 1970s. The surveys were 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.⁴ The Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs N-SSATS.

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

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

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

http://findtreatment.samhsa.gov

Data Collection Procedures for the 2010 N-SSATS

Field period and reference date

The survey reference date for the 2010 N-SSATS was March 31, 2010. The field period was from March 31, 2010, through October 18, 2010.

Survey universe

The total N-SSATS facility universe was 17,204 treatment facilities. This included all 16,224 active treatment facilities on SAMHSA's I-SATS at a point 6 weeks before the survey reference date. (See Appendix A for a description of the I-SATS and N-SSATS survey coverage.) The survey universe also included 980 facilities that were added by State substance abuse agencies or otherwise discovered during the first 3 weeks of the survey.

Content

The 2010 N-SSATS questionnaire was a 13-page document with 40 numbered questions (see Appendix B). Topics included:

• Facility identification information
• Facility operating entity
• Facility focus of activity
• Type of care provided
  • Outpatient treatment services (regular outpatient treatment, intensive outpatient treatment, day treatment or partial hospitalization, detoxification, methadone/buprenorphine maintenance)
  • Residential (non-hospital) treatment services (long-term—more than 30 days, short-term—30 days or fewer, detoxification)
  • Hospital treatment services (inpatient treatment, inpatient detoxification)
• Services offered (assessment and pre-treatment services, counseling, pharmacotherapies, testing, transitional services, ancillary services)
  Clinical/therapeutic approaches
• Special programs or groups provided for specific client types
• Provision of services in sign language or in languages other than English
• Detoxification from alcohol, benzodiazepines, opiates, cocaine, methamphetamines, or other drugs, and routine use of medication during detoxification
  Client outreach (outreach to persons in the community who may need treatment, provision of a facility website)
• Licensure, certification, or accreditation agencies or organizations
• Standard operating procedures
• Payment options accepted, including use of a sliding fee scale and/or treatment at no charge
• Facility receipt of government funding
• Operation of an Opioid Treatment Program (OTP) certified by SAMHSA and offering maintenance and/or detoxification with methadone and/or buprenorphine
• Clients in treatment on March 31, 2010 (total, clients under age 18, clients receiving methadone, clients receiving buprenorphine)
• Annual admissions
• Percentage of clients in treatment on March 31, 2010, for abuse of both alcohol and drugs, alcohol abuse only, and drug abuse only
• Percentage of clients in treatment on March 31, 2010, with diagnosed co-occurring substance abuse and mental health disorders
• Number of beds designated for residential (non-hospital) and hospital inpatient substance abuse treatment on March 31, 2010

Data collection

Three data collection modes were employed, a secure web-based questionnaire, a paper questionnaire sent by mail, and a telephone interview. Initially, respondents could select either the web or paper mode to complete the survey. Six weeks before the survey reference date (March 31, 2010), 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 U.S. Postal Service. During the last week of March 2010, 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. Four 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, non-responding facilities were mailed a second questionnaire packet. About 4 to 5 weeks after the second questionnaire mailing, non-respondents 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 computer-assisted telephone interview (CATI).

Facility status and response rate

Table 1.1 presents a summary of response rate information. Questionnaires were mailed to a total of 17,204 facilities believed to be actively providing substance abuse treatment services. Of these facilities, 11 percent were found to be ineligible for the survey because they had closed or did not provide substance abuse treatment or detoxification. Of the remaining 15,390 facilities, 14,060 facilities (91.4 percent) completed the survey and 13,339 (86.7 percent) were eligible for this report.

Quality assurance

All 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.

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 non-response was minimized through careful editing and extensive follow-up. The item response rate for the 2010 N-SSATS averaged 98.5 percent across 192 separate items. Appendix C details item response rates and imputation procedures.

Facility Selection for the 2010 N-SSATS Report

Table 1.1. The N-SSATS questionnaire serves several purposes, as noted earlier. Three hundred sixty-nine of the 14,060 questionnaire respondents provided information but were deemed out of the scope of this report. They were excluded from the analyses presented here. The excluded facilities and reasons for exclusion fell into three categories:

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

An additional 352 facilities whose client counts were included in or "rolled into" other facilities' counts and whose facility characteristics were not reported separately were excluded from facility counts in this report. However, their client counts are included.

After the exclusion of 369 out-of-scope facilities and 352 rolled-up facilities, 13,339 eligible respondent facilities were included in the 2010 N-SSATS report.

Number of respondents reporting facility and client data

There were 13,339 eligible respondents to the 2010 N-SSATS. The breakdown of facility data and client counts reported by these respondents is summarized below.

• 11,996 facilities reported facility data and client counts for their own organizations.
• 536 facilities reported facility characteristics for themselves and provided client counts for their own facility and for 1,596 other facilities.
• 807 facilities reported facility characteristics only. Their client counts were reported by another facility.
  

Survey Response Mode

Figure 1. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since introduction of the option in 2002. The percentage of facilities responding via the web increased from 37 percent in 2006 to 61 percent in 2010. Mail response declined from 41 percent in 2006 to 26 percent in 2010. Telephone response, which represents follow-up of facilities that have not responded by mail or web, also declined, from 23 percent in 2006 to 13 percent in 2010.

Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data from the 2010 N-SSATS. Some general issues are listed below; other considerations are detailed in Appendix A. Considerations and limitations of specific data items are discussed where the data are presented.

• N-SSATS attempts to obtain responses from all known treatment facilities, but it is a voluntary survey. There was no adjustment for the 8.6 percent facility non-response.
• N-SSATS is a point-prevalence survey. It provides information on the substance abuse treatment system and its clients on the reference date. Client counts reported here do not represent annual totals. Rather, N-SSATS provides a "snapshot" of substance abuse treatment facilities and clients on an average day.
• Multiple responses were allowed for certain variables (e.g., services provided and specialized programs). Tabulations of these variables include the total number of facilities reporting each response.

Organization of the Report

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

• Chapter 2 presents trends in facility characteristics for 2006 to 2010.
• Chapter 3 presents trends in client characteristics for 2006 to 2010.
• Chapter 4 describes key characteristics of facilities and the programs and services they provided in 2010.
• Chapter 5 describes key characteristics of clients in substance abuse treatment on March 31, 2010.
• Chapter 6 presents State-level detail for most of the tables presented in Chapters 4 and 5.
• Appendix A provides additional information on N-SSATS, its history, and changes in the survey and survey universe over time.
• Appendix B contains the 2010 N-SSATS mail survey questionnaire.
• Appendix C contains information on item response and imputation.
  

Terminology

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

• Facility operation indicates the type of entity responsible for the operation of the facility:
  • Private for-profit
  • Private non-profit
  • Government­
    • Local, county, or community
    • State
    • Federal (Dept. of Veterans Affairs, Dept. of Defense, Indian Health Service, other)
    • Tribal
• Primary focus indicates the services the facility primarily provides:
  • Substance abuse treatment services
  • Mental health services
  • A mix of substance abuse treatment and mental health services
  • General health care
  • Other
• Clients in treatment were defined as:
  • Hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services at the facility on March 31, 2010
    and
  • Outpatient clients who were seen at the facility for a substance abuse treatment or detoxification service at least once during the month of March 2010, and who were still enrolled in treatment on March 31, 2010
    

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

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