Chapter 4

Facility Characteristics and Services

Facility Operation and Primary Focus
Type of Care Offered
Client Substance Abuse Problem and Co-occurring Mental Health Disorders
Facility Size
Facility Capacity and Utilization Rates
Services Provided
Clinical/Therapeutic Approaches
Programs or Groups for Specific Client Types
Services in Sign Language for the Hearing Impaired and in Languages Other than English
Detoxification Services
Client Outreach
Facility Licensing, Certification, or Accreditation
Facility Standard Operating Procedures
Payment Options
Facility Funding
Facilities with Opioid Treatment Programs (OTPs)
Counseling Offered by Facilities

This chapter outlines key characteristics of facilities and programs in 2010.

Facility Operation and Primary Focus

Table 4.1. Facilities were asked to designate the type of entity responsible for the operation of the facility. They were also asked to designate the facility’s primary focus of activity.

Type of Care Offered

Table 4.2b. Type of care offered was made up of three broad categories (outpatient, residential [non-hospital], and hospital inpatient), each with several subcategories. A facility could offer more than one type of care. The proportions of all facilities offering the different types of care were:¹¹

Almost three quarters (74 percent) of private non-profit facilities provided outpatient care and more than one third (34 percent) provided residential (non-hospital) care. In contrast, 92 percent of private for-profit facilities provided outpatient care and 12 percent provided residential (non-hospital) care.

Client Substance Abuse Problem and Co-occurring Mental Health Disorders

Table 4.3. Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring substance abuse and mental health disorders.

• Almost all facilities (92 percent) had clients in treatment for both alcohol and drug abuse on March 31, 2010. Eighty-two percent had clients in treatment for drug abuse only, and 79 percent had clients in treatment for alcohol abuse only.
• Most facilities (89 percent) also had clients in treatment with co-occurring substance abuse and mental health disorders on March 31, 2010.
  

Facility Size

Table 4.4. Facility size is defined by the number of clients in substance abuse treatment. The median number of clients in substance abuse treatment at a facility on March 31, 2010, was 43 clients.

• The median number of clients ranged from 35 in facilities operated by tribal governments to 67 in facilities operated by the Federal government.
• The median number of clients ranged from 24 clients in facilities with a primary focus of mental health services to 46 in those with a primary focus of providing substance abuse treatment services.
• By type of care, the median¹² number of clients in treatment on March 31, 2010, was:
  
  

Table 4.5. Facilities were sorted into five size groups based on the total number of clients in treatment on March 31, 2010. The smallest facilities were defined as having fewer than 15 clients and the largest as having 120 clients or more.

• Facilities operated by the Federal government were generally larger than facilities operated by other entities—34 percent had 120 clients or more in treatment on March 31, 2010, compared to 22 percent of all facilities.
• Facilities whose primary focus was the provision of mental health services tended to be smaller than facilities with other foci of activity—­40 percent had fewer than 15 clients in treatment on March 31, 2010, compared to 19 percent of all facilities.

Facility Capacity and Utilization Rates

Facilities were asked to report the number of residential (non-hospital) and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of residential (non-hospital) or hospital inpatient clients by the number of residential (non-hospital) or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates could be more than 100 percent.

• Table 4.6. Some 3,194 facilities reported having 109,406 residential (non-hospital) beds designated for substance abuse treatment on March 31, 2010. The utilization rate¹³ was 91 percent, and ranged from 85 percent in private for-profit facilities to 96 percent in facilities operated by local, county, or community governments.
• Table 4.7. Some 726 facilities reported having 12,551 hospital inpatient beds designated for substance abuse treatment on March 31, 2010. The utilization rate¹⁴ was 92 percent, and ranged from 79 percent in facilities operated by Federal or local governments to 241 percent in facilities operated by tribal governments. By facility focus, utilization rates ranged from 85 percent in facilities primarily focused on substance abuse treatment services to 106 percent in facilities focused on a mix of mental health and substance abuse treatment services.
• Tables 4.6 and 4.7 and Figure 7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds.
  
  Forty-eight percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent, while 26 percent of facilities with hospital inpatient beds had utilization rates in that range.
  

Services Provided

Tables 4.8 and 4.9. Facilities were asked about the types of services they provided. Services were grouped into the six broad categories shown below.

• Assessment and pre-treatment services were offered by 98 percent of all facilities.
  • Screening for substance abuse was provided by 93 percent of all facilities.
  • Comprehensive substance abuse assessment or diagnosis was provided by 90 percent of all facilities.
  • Screening for mental health disorders was provided by 63 percent of all facilities; rates were higher in facilities primarily focused on mental health services (94 percent), facilities with a mixed focus of substance abuse treatment and mental health services (91 percent), and facilities primarily focused on general health care (89 percent).
  • Comprehensive mental health assessment or diagnosis was provided by 43 percent of all facilities; rates were higher in facilities primarily focused on mental health services (90 percent) and facilities with a mixed focus of substance abuse treatment and mental health services (77 percent).
  • Outreach to persons in the community who may need treatment was provided by 52 percent of all facilities but by 79 percent of tribal government-operated facilities.
  • Interim services for clients when immediate admission was not possible were provided by 40 percent of all facilities but by 74 percent of Federal government facilities.
• Testing services were provided by 88 percent of all facilities.
  • Drug or alcohol urine screening was provided by 84 percent of all facilities.
  • Breathalyzer or other blood alcohol testing was provided by 60 percent of all facilities but by 80 percent of Federal government-operated facilities.
  • Testing for each of TB, HIV, hepatitis B and C, and STDs was provided by between 20 and 34 percent of all facilities but by 85 to 86 percent of facilities with a primary focus of general health care.
• Transitional services were provided by 96 percent of all facilities.
  • Discharge planning was provided by 93 percent of all facilities.
  • Aftercare/continuing care was provided by 81 percent of all facilities.
• Pharmacotherapies were provided by 49 percent of all facilities; rates were higher in facilities primarily focused on general health care (88 percent) and by Federal government-operated facilities (84 percent).
  • Medications for psychiatric disorders were the most frequently available pharmacotherapies—in 35 percent of all facilities and in 79 percent of facilities primarily focused on general health care.
• Ancillary services were provided by 99 percent of all facilities.
  • Substance abuse education was provided by 95 percent of all facilities.
  • Case management services were provided by 77 percent of all facilities.
  • Mental health services were provided by 57 percent of all facilities; rates were higher in facilities with a primary focus of mental health services (97 percent), facilities providing a mixed focus of substance abuse treatment and mental health services (92 percent), and facilities with a primary focus of general health care (89 percent).
    

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate whether they used any of 12 specific clinical/therapeutic approaches.

• Two approaches were each used always or often by nearly all facilities:
  • Substance abuse counseling was used always or often by 95 percent of facilities.
  • Relapse prevention was used always or often by 85 percent of facilities.
• A number of approaches were used at least sometimes (always, often, or sometimes) by more than half of facilities:
  • Cognitive-behavioral therapy was used at least sometimes by 92 percent of facilities.
  • Motivational interviewing was used at least sometimes by 87 percent of facilities.
  • Anger management was used at least sometimes by 84 percent of facilities.
  • Brief intervention was used at least sometimes by 82 percent of facilities.
  • 12-step facilitation was used at least sometimes by 80 percent of facilities.
  • Trauma-related counseling was used at least sometimes by 67 percent of facilities.
  • Contingency management/motivational incentives were used at least sometimes by 58 percent of facilities.
• Some approaches were used rarely or never, or were unfamiliar to the respondent, for more than half of all facilities:
  • Rational emotive behavioral therapy was used rarely or never by 37 percent of facilities, and it was unfamiliar to an additional 14 percent of facilities.
  • The matrix model was used rarely or never by 38 percent of facilities, and it was unfamiliar to an additional 24 percent of facilities.
  • Community reinforcement plus vouchers was used rarely or never by 55 percent of facilities, and it was unfamiliar to an additional 32 percent of facilities.
    

Programs or Groups for Specific Client Types

Table 4.11b. Facilities were asked about the provision of treatment programs or groups specially designed for specific types of client. Overall, 80 percent of facilities offered at least one special program or group to serve a specific client type.

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

Table 4.12b. Facilities were asked about the provision of substance abuse treatment services in sign language for the hearing impaired. They were also asked if treatment was provided in languages other than English, if this treatment was provided by a staff counselor or by an on-call interpreter, and in what languages staff counselors provided treatment.

• Substance abuse treatment services in sign language for the hearing impaired were offered in 28 percent of all facilities. Facilities operated by local and State governments were most likely to offer these services (47 and 39 percent, respectively). Facilities with a primary focus of mental health services or a mixed focus of substance abuse treatment and mental health services (39 and 34 percent, respectively) were the most likely to offer services in sign language.
• Substance abuse treatment services in languages other than English were provided in 42 percent of all facilities, ranging from 20 percent of Federal government-operated facilities to 52 percent of local government-operated facilities.
• Forty-three percent of facilities providing services in languages other than English used staff counselors who spoke other languages; another 23 percent of facilities used both staff counselors and on-call interpreters.
• In those facilities where staff counselors provided services in languages other than English, Spanish was the most frequently spoken language (at 94 percent of facilities), although other languages were spoken at 24 percent of facilities. Services in American Indian/Alaska Native languages were provided by 3 percent of these facilities overall but by 95 percent of those operated by tribal governments, and by 100 percent of those operated by the Indian Health Service.
  

Detoxification Services

Table 4.13. Facilities that provided detoxification services were asked to indicate whether they detoxified clients from specified substances, and whether medication was routinely used during detoxification.

Client Outreach

Tables 4.14 and 4.9. Facilities were asked whether they had a website providing information about their substance abuse treatment programs.

• Websites providing information about a facility's substance abuse treatment programs were maintained by 76 percent of all facilities. Website availability ranged from 44 percent among facilities operated by tribal governments or the Federal government to 84 percent among private non-profit facilities.
• Outreach to persons in the community who may need treatment was provided by 52 percent of all facilities but by 79 percent of tribal government-operated facilities.
  

Facility Licensing, Certification, or Accreditation

Facilities were asked to report licensure, certification, or accreditation by specified agencies or organizations. These included the State substance abuse agency, State mental health department, State department of health, hospital licensing authority, the Joint Commission, CARF, NCQA, COA, and other State or local agency or organization.¹⁶

• Table 4.15b. Overall, 95 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. The proportions of facilities reporting the specified agencies or organizations were:
  

• Table 4.16b. Facility licensing, certification, or accreditation was associated with the type of care offered.
  • The State substance abuse agency licensed, certified, or accredited 82 percent each of facilities offering outpatient treatment and residential (non-hospital) treatment but only 58 percent of facilities offering hospital inpatient treatment.
  • The State mental health department licensed, certified, or accredited 45 percent of hospital inpatient facilities but only 37 percent of outpatient facilities and 28 percent of residential (non-hospital) facilities.
  • Facilities offering hospital inpatient treatment were more likely than facilities offering other types of care to report licensure, certification, or accreditation by the following:

Facility Standard Operating Procedures

Table 4.17b. Facilities were asked to indicate whether they followed specified practices as part of their standard operating procedure. All the standard practices listed were used by two-thirds or more of all facilities.

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

Payment Options

Table 4.18b. Facilities were asked to indicate whether they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.

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

• Facilities operated by Federal and tribal governments were least likely to accept cash or self-payment (42 and 43 percent, respectively). Private for-profit and Federal government-operated facilities were less likely to accept Medicare, Medicaid, or State-financed health insurance than were facilities operated by private non-profits and State, local, or tribal governments.
• Acceptance of Access to Recovery vouchers was reported in 14 States. The proportion of facilities accepting Access to Recovery vouchers ranged from 7 percent in Florida to 54 percent in Idaho [Table 6.19b].¹⁷
• Use of a sliding fee scale was reported by 62 percent of all facilities, ranging from 16 percent of facilities operated by the Federal government to 81 percent of facilities operated by local governments.
• Treatment at no charge for persons who cannot afford to pay was offered by 50 percent of all facilities, ranging from 21 percent of private for-profit facilities to 80 percent of facilities operated by tribal governments.
  

Facility Funding

Table 4.19. Facilities were asked if they received Federal, State, or local government funds or grants to support their substance abuse treatment programs.

• Overall, 60 percent of facilities reported receiving government funds to support substance abuse treatment programs. The proportions were highest in facilities operated by local or tribal governments (87 and 89 percent, respectively). Seventy-four percent of programs operated by private non-profit organizations reported receiving public funds compared to 22 percent of facilities operated by private for-profit organizations.  

Facilities with Opioid Treatment Programs (OTPs)

Opioid Treatment Programs (OTPs) are certified by SAMHSA to provide medication-assisted therapy in the treatment of opioid addiction. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of opioid addiction.

• Tables 2.3, 3.2, and 4.20. Clients receiving methadone or buprenorphine in OTPs accounted for 26 percent of all clients in treatment on March 31, 2010, although OTPs were available in only 1,166 (9 percent) of all substance abuse treatment facilities.
• Tables 4.1 and 4.20. Private for-profit organizations operated 53 percent of OTPs but only 30 percent of all substance abuse treatment facilities.
• Table 4.20. Of the 304,656 clients receiving medication-assisted opioid therapy in OTPs, 98 percent (298,170) received methadone. Of the 27,456 clients receiving buprenorphine, only 24 percent (6,486 clients) received it in facilities with OTPs.
  • More than half (53 percent) of clients receiving methadone were in private for-profit facilities compared to 41 percent of clients receiving buprenorphine in an OTP facility. Most (93 percent) of the clients receiving methadone were in facilities whose primary focus was the provision of substance abuse treatment services.
  • Clients receiving buprenorphine in an OTP facility were more likely than clients receiving methadone to be in Federal government-operated facilities (14 vs. 1 percent).
  • Facilities whose primary focus was the provision of substance abuse treatment services accounted for 70 percent of buprenorphine clients in OTP facilities. Twenty-five percent of buprenorphine clients in OTP facilities were treated in facilities providing a mix of substance abuse treatment and mental health services.
• Table 4.21b. Most facilities with OTPs offered outpatient treatment (93 percent). Eighty-nine percent offered outpatient methadone/buprenorphine maintenance and 49 percent offered detoxification.
• Table 4.22b. OTPs were more likely than all facilities combined [Table 4.16b] to be licensed, certified, or accredited by a State department of health (60 vs. 41 percent), the Joint Commission (30 vs. 19 percent), or CARF (65 vs. 22 percent).

Counseling Offered by Facilities

Table 4.23. Individual counseling was the most frequently reported form of counseling, by 98 percent of facilities, and marital/couples counseling was reported least frequently, by 60 percent of facilities.

⁹ Percentages do not sum to 100 percent because of rounding.
¹⁰ Data for the Federal agencies specified in the survey (the Department of Veterans Affairs, the Department of Defense, the Indian Health Service, and other unspecified Federal agencies) are detailed in the tables.
¹¹ Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.
¹² The median number of clients for the main categories of type of care (outpatient, residential, and hospital inpatient) can be greater than the median for any of the subcategories because a facility can provide more than one subcategory of the main types of care.
¹³ Residential (non-hospital) utilization rates are based on a subset of 3,046 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
¹⁴ Hospital inpatient utilization rates are based on a subset of 490 facilities that reported for themselves alone and that reported numbers greater than zero for both designated beds and clients.
¹⁵ Facilities treating incarcerated persons only were excluded from this report; see Chapter 1.
¹⁶ Joint Commission: formerly JCAHO (Joint Commission on Accreditation of Healthcare Organizations); CARF: formerly Commission on Accreditation of Rehabilitation Facilities; NCQA: National Committee for Quality Assurance; and COA: Council on Accreditation.
¹⁷ Access to Recovery vouchers were available only in AK, AZ, CA, CO, CT, DC, FL, HI, IA, ID, IL, IN, LA, MI, MO, MT, NJ, NM, OH, OK, RI, TN, TX, WA, WI, and WY. See table 6.19a for number of facilities accepting ATR vouchers by State.

To Chapter 4 Tables

Table of Contents