2019 N-SSATS

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Work was performed under Contract No. HHSS283201600001C. The Contracting Officer’s Representative (COR) at SAMHSA/CBHSQ was Nichele Waller.

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

Public Domain Notice

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

Recommended Citation

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2019. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.

List of Tables

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Appendix A

Appendix C

List of Figures

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

Trends in Facility Characteristics

Trends in Client Characteristics

Facility Characteristics and Services

State Data

Highlights

This report presents results from the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other jurisdictions. It is important to note that values in charts, narrative lists, and percentage distributions are calculated using actual raw numbers and rounded for presentation in this report; calculations using rounded values may produce different results.

Trends in Facility and Client Characteristics 2009–2019

Facility Operation—March 29, 2019

Type of Care—March 29, 2019

Diagnosed Co-occurring Mental and Substance Use Disorders—March 29, 2019

Among clients in treatment, 55 percent were diagnosed with co-occurring substance use and mental disorders. In facilities operated by the Department of Defense, less than half of clients in treatment were diagnosed with co-occurring substance use and mental disorders (45 percent); however, facilities operated by the Department of Veterans Affairs reported the highest proportion of clients in treatment with diagnosed co-occurring substance use and mental disorders—73 percent—the highest among all types of facility operation [Table 5.4].

Facility Size and Utilization Rates—March 29, 2019

Medication-Assisted Opioid Treatment—March 29, 2019

Chapter 1. Description of the National Survey of Substance Abuse Treatment Services (N-SSATS)

The 2019 National Survey of Substance Abuse Treatment Services (N-SSATS) was conducted between March and December 2019, with a reference date of March 29, 2019. It is the 42nd in a series of national surveys begun in the 1970s. The surveys were designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other jurisdictions.³ 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 the N-SSATS. This report presents tabular information and highlights from the 2019 N-SSATS. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

N-SSATS is designed to collect information from all facilities in the United States, both public and private, that provide substance abuse treatment.⁴ (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 a mechanism for quantifying the dynamic characteristics and composition of the U.S. substance abuse treatment delivery system. N-SSATS collects multipurpose data that can be used to:

Data Collection Procedures for the 2019 N-SSATS

Field period and reference date

The survey reference date for the 2019 N-SSATS was March 29, 2019. The field period was from March 29, 2019, through December 17, 2019.

Survey universe

The 2019 N-SSATS facility universe totaled 19,795 facilities, including all 17,421 active treatment facilities on SAMHSA’s I-BHS at a point four weeks before the survey reference date and 2,374 facilities that were added by state substance abuse agencies or otherwise discovered during the data collection period.

Content

The 2019 N-SSATS questionnaire contained 37 numbered questions (see Appendix B for the paper version of the questionnaire). Topics included:

Data collection

There were three modes of data collection employed: a secure web-based questionnaire, a paper questionnaire sent by mail, and a telephone interview. About five weeks before the survey reference date of March 29, 2019, letters were mailed to all facilities to announce 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 2019, a data collection packet (including the SAMHSA cover letter, state-specific letter of endorsement, state profile, information on completing the survey on the web, and a sheet of frequently asked questions) was mailed to each facility. To ease the burden on respondents, many of the data items that typically do not change from year to year were prefilled in the web-based questionnaire for those facilities that had completed the 2018 survey. Respondents could also request a paper questionnaire be sent to them.

During the data collection phase, contract personnel were available to answer facilities’ questions concerning the survey. Support for facilities completing the questionnaire on the web was also available by e-mail. About three weeks after the initial data collection packet mailing, thank you/ reminder letters were sent to all facilities. Approximately nine weeks after the initial packet mailing, non-responding facilities were mailed a second packet. About one week after the second packet mailing, non-respondents received a reminder telephone call. A third packet containing a hard copy questionnaire was mailed about nine weeks after the second packet mailing. Those facilities that had not completed the survey by June 7, 2019, received reminder calls and were asked to complete the survey by computer-assisted telephone interview (CATI).

Quality assurance

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.

All mail questionnaires were reviewed manually for consistency and for missing data. Calls were made to facilities to resolve unclear responses and to obtain missing data. 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 non-response was minimized through editing and extensive follow-up. The item response rate for the 2019 N-SSATS averaged more than 99 percent across 329 separate items. Appendix C details item response rates and imputation procedures.

Facility status and response rate

Table 1.1 presents a summary of response rate information. There were 19,795 facilities in the survey universe. Of these facilities, 1,987 facilities (10 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 17,808 facilities, 16,275 facilities (91 percent) completed the survey and 15,961 (90 percent) were included in this report.

Table 1.1. N-SSATS facilities, by status and mode of response: 2019

	Number	Percent
Total facilities in universe	19,795	100.0
Closed/ineligible	1,987	10.0
Eligible	17,808	90.0

Total eligible	17,808	100.0
Non-respondents	1,533	8.6
Respondents	16,275	91.4
Excluded from report¹	213	1.2
Roll-up²	101	0.6
Included in report	15,961	89.6

Mode of response	15,961	100.0
Internet	14,338	89.8
Mail	1,450	9.1
Telephone	173	1.1

¹ Facilities excluded from the report included 125 non-treatment halfway houses, 55 solo practices not approved by the state agency for inclusion, and 33 facilities that treated incarcerated clients only. ² Facilities whose client counts were included in or “rolled into” other facilities’ counts and whose facility characteristics were not reported separately. SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2019.

Facility Selection for the 2019 N-SSATS Report

Table 1.1. The N-SSATS questionnaire is deliberately sent to some facilities that are excluded from this report, as explained below. For this cycle, 213 of the 16,275 questionnaire respondents provided information but were deemed out of the scope of this report and excluded from the analyses presented here. The excluded facilities and reasons for exclusion fell into three categories:

In addition to the facilities that were excluded from the report, there were 101 facilities whose client counts were included in or “rolled into” other facilities’ counts and whose facility characteristics were not reported separately. After the exclusion of 213 out-of-scope facilities and the roll-up of 101 facilities, 15,961 eligible respondent facilities remained to be included in the 2019 N-SSATS report.

Survey Response Mode

Figure 1. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since the option was introduced in 2002. The percentage of facilities responding via the web increased from 33 percent in 2005 to 90 percent in 2019. Mail response declined from 45 percent in 2005 to 1 percent in 2019. Telephone response, which represents follow-up of facilities that had not responded by mail or web, also declined, from 22 percent in 2005 to 9 percent in 2019.

Figure 1. Survey response mode: Percent, 2005–2019

Figure 1 is a stacked bar chart comparing the survey response modes between telephone, mail, and web responses from 2005 to 2019. More details can be found in the preceding text.

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 2019 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.

Organization of the Report

Terminology

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

Facility operation indicates the type of entity responsible for the operation of the facility:

To Chapter 1 Table

Chapter 2. Trends in Facility Characteristics

Number of Facilities

Table 2.1. The total number of substance abuse treatment facilities remained stable between 2009 and 2017 but increased from 2017 to 2019. There was considerable turnover from year to year in the individual facilities that responded to the survey: Between 82 and 91 percent of the facilities that responded to a survey had also responded to the previous year’s survey. Between 9 and 14 percent of the facilities from year to year closed, were no longer providing substance abuse treatment, or did not respond to the current year’s survey.

In 2019, there was a net increase of 1,152 facilities that responded to the survey and were included in the N-SSATS report, up from 14,809 facilities in 2018. Of the 15,961 facilities that responded to the 2019 survey and were included in this report, 82 percent had also responded to the 2018 survey, and 18 percent were new to the 2019 survey or did not respond in 2018. Of the facilities that responded in 2018, 12 percent had closed, were no longer providing substance abuse treatment, or did not respond in 2019.

Facility Operation

Table 2.2 and Figure 2. The operational structure of the substance abuse treatment system (i.e., the types of entities responsible for operating facilities) had some notable changes between 2009 and 2019.

Figure 2. Facility operation: Percent, 2009–2019

Figure 2 is a stacked bar comparing facility operation from 2009 and 2019 between tribal, federal, state, and local government facilities as well as private for-profit and private non-profit facilities. More details can be found in the preceding text.

Type of Care Offered⁶

Table 2.3–2.4 and Figure 3. The proportions of facilities that offered outpatient and hospital inpatient care were stable between 2009 and 2019, while the proportion that offered residential (non-hospital) care declined between 2009 and 2019. OTPs, certified by SAMHSA, provide MAT with methadone, buprenorphine, and naltrexone. Facilities with OTPs can be associated with any type of care. Facilities with OTPs made up 9 to 11 percent of all facilities between 2009 and 2019 [Table 2.4].

Figure 3. Facilities by type of care offered and facilities with opioid treatment programs: Percent, 2009–2019

Figure 3 is a bar chart comparing Facilities by type of care offered and facilities with opioid treatment programs from 2009 to 2019 amongst outpatient, residential (non-hospital), hospital inpatient, ond opioid treatment program (OTP) facilities. More details are discussed in the preceding text.

Facilities That Use MAT

Table 2.4. MAT includes the use of methadone or buprenorphine for the treatment of opioid use disorder (OUD) and the use of naltrexone for relapse prevention in OUD. Methadone for OUD is available only at the OTPs that are certified by SAMHSA’s Center for Substance Abuse Treatment.⁷Buprenorphine may be prescribed by physicians or other authorized medical practitioners (physicians, physician assistants, and nurse practitioners) who have received Drug Addiction Treatment Act of 2000 (DATA 2000) specific training and received a waiver to prescribe the medication for treatment of OUD; some of these authorized medical practitioners are affiliated with facilities (either OTPs or other). All medical practitioners with prescribing privileges can prescribe injectable naltrexone.

To Chapter 2 Tables

Chapter 3. Trends in Client Characteristics

Number of Clients

Table 3.1. The number of clients in treatment on the survey reference date increased by from 1,182,077 in 2009 to 1,460,706 in 2019.

Facility Operation

Table 3.1 and Figure 4. Within the categories of facility operation, the proportions of clients in treatment demonstrated some changes between 2009 and 2019.

Figure 4. Clients in treatment, by facility operation: Number (thousands), 2009–2019

Figure 4 is a stacked bar comparing clients in treatment in thousands, by facility operation from 2009 and 2019 between tribal, federal, state, and local government facilities as well as private for-profit and private non-profit facilities. More details can be found in the preceding text.

Type of Care Received

Table 3.2 and Figure 5. The proportions of clients in treatment for the major types of care—outpatient, residential (non-hospital), and hospital inpatient—were relatively stable between 2009 and 2019.

Figure 5. Clients in treatment, by type of care received: Percent, 2009–2019

Figure 5 is a bar chart comparing Clients in treatment, by type of care received from 2009 to 2019 amongst outpatient, residential (non-hospital), hospital inpatient, ond opioid treatment program (OTP) facilities. More details are discussed on the previous page.

Clients Receiving MAT

Table 3.2. Clients who were receiving methadone, buprenorphine, or naltrexone could be in any type of care—outpatient, residential (non-hospital), or hospital inpatient. Clients could receive methadone for OUD only in OTPs certified by SAMHSA to provide MAT with methadone and buprenorphine. However, clients could receive buprenorphine or naltrexone in any type of facility.

Substance Abuse Problem Treated

Table 3.3. The proportion of clients in treatment for the three broad categories of substance abuse problems—both alcohol and drug abuse, drug abuse alone, and alcohol abuse alone—demonstrated some changes between 2009 and 2019.

Clients Under the Age of 18 Years in Treatment

Table 3.4. The proportion of all clients who were under the age of 18 years declined from 84,326 in 2009 to 59,854 in 2019.

To Chapter 3 Tables

Chapter 4. Facility Characteristics and Services

Facility Operation and Type of Care

Table 2.2. Facilities were asked to designate the type of entity responsible for the operation of the facility.

Table 4.1b. Type of care offered consists 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 that offered the different types of care were:¹³

Approximately three quarters (77 percent) of private non-profit facilities provided outpatient care and about one third (29 percent) provided residential (non-hospital) care. In contrast, 87 percent of private for-profit facilities provided outpatient care and 18 percent provided residential (non-hospital) care.

Substance Abuse Treatment

Table 4.2. 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 mental and substance use disorders. On March 29, 2019:

Facility Size

Facilities with OTPs

Table 4.3. Facility size is defined by the number of clients in substance abuse treatment on the survey reference date. Facilities with OTPs reported a median of 261 clients in substance abuse treatment on March 29, 2019.

The median number of clients, by facility operation, ranged from 219 clients in facilities with OTPs operated by state governments to 525 clients in facilities with OTPs operated by tribal governments.

Facilities without OTPs

Table 4.4. Facility size is defined by the number of clients in substance abuse treatment on the survey reference date. The median number of clients in substance abuse treatment at a facility without an OTP (a non-OTP facility) on March 29, 2019, was 35 clients.

The median number of clients in facilities without an OTP ranged, by facility operation, from 28 clients in tribal government-operated facilities to 68 clients in facilities operated by the federal government.

Tables 4.5a–c. Facilities were sorted into five size groups based on the total number of clients in treatment on March 29, 2019: fewer than 15 clients, 15–29 clients, 30–59 clients, 60–119 clients, and 120 or more clients.

Table 4.5a. Outpatient facilities operated by the federal government reported client counts within the largest size class in greater proportion than outpatient facilities operated by other entities—35 percent of federally operated facilities had 120 or more clients in treatment on March 29, 2019, compared with 28 percent of all outpatient facilities.

Table 4.5b. Residential (non-hospital) facilities operated by tribal governments and by private for-profit organizations reported client counts within the smallest size class in greater proportion than residential (non-hospital) facilities operated by other entities: 62 percent and 57 percent, respectively, had fewer than 15 clients in treatment on March 29, 2019, compared with 43 percent of all residential (non-hospital) facilities.

Table 4.5c. Inpatient facilities operated by the federal government reported client counts within the smallest size class in greater proportion than inpatient facilities operated by other entities—77 percent had fewer than 15 clients in treatment on March 29, 2019, compared with 59 percent of all inpatient 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. There were 2,710 facilities that reported having 88,447 residential (non-hospital) beds designated for substance abuse treatment on March 29, 2019. The utilization rate was 95 percent, and ranged from 79 percent in facilities operated by local, county, or community governments to 176 percent in facilities operated by tribal governments.¹⁵

Table 4.7. There were 459 facilities that reported having 13,023 hospital inpatient beds designated for substance abuse treatment on March 29, 2019. The utilization rate was 87 percent, and ranged from 79 percent in facilities operated by private non-profit organizations to 176 percent in facilities operated by the federal government.¹⁶

Tables 4.6–4.7 and Figure 6 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with hospital inpatient beds (87 percent) had generally lower utilization rates than facilities with residential (non-hospital) beds (95 percent). Of facilities with residential (non-hospital) beds, 40 percent had utilization rates of between 91 and 100 percent; 11 percent had utilization rates above 100 percent. Of facilities with hospital inpatient beds, 22 percent had utilization rates between 91 and 100 percent, while 17 percent had utilization rates above 100 percent.

Figure 6. Residential (non-hospital) and hospital inpatient utilization rates: March 29, 2019

Figure 6 is a bar chart comparing residential (non-hospital) and hospital inpatient utilization rates as of March 29, 2019 divided into groups of 50% or less, 51% to 90%, 91% to 100%, and more than 100% between residential (non-hospital) and hospital inpatient utilization rates. Further details can be found in the text above the figure.

Services Provided

Table 4.8a. Facilities were asked about the types of services they provided. Services were grouped into the nine broad categories shown below.

Education and counseling services were provided by more than 99 percent of all facilities.

At least one pharmacotherapy was provided by 65 percent of all facilities; rates were higher in federal government-operated facilities (87 percent).

Clinical/Therapeutic Approaches

Table 4.10. Facilities were asked to indicate if they used any of 15 specific clinical/therapeutic approaches frequently.

MAT for Opioid Use Disorder

Table 4.11b. Facilities were asked about whether they treated opioid use disorder (OUD) and how MAT was used in the treatment they provided for OUD. In response, facilities reported the following:

Table 4.12. Facilities that used MAT for OUD were asked whether they offered the following medication services and to estimate the percentage of clients on MAT that received them.

Treatment of Alcohol Use Disorder

Tables 4.13 and 4.14b. Facilities were asked whether and how they treat alcohol use disorder (AUD). Overall, 90 percent of facilities treated AUD. The proportion of facilities that reported treating AUD without MAT was 19 percent. A third of facilities (33 percent) reported that they administer or prescribe disulfiram, naltrexone, or acamprosate; 48 percent of facilities reported that they treat clients with MAT using medications that originate elsewhere. When clients were treated with medications that originate elsewhere, the most common source was the client’s personal provider (40 percent); a business, contractual, or formal referral relationship with a prescribing entity (13 percent); or a prescribing entity in same network (10 percent).

Programs or Groups for Specific Client Types

Table 4.15b. Facilities were asked about the provision of substance use treatment programs or groups specifically tailored for categories of clients. Overall, 81 percent of facilities offered at least one substance use treatment program or group specifically tailored for a category of client. The proportions of facilities that provided specifically tailored substance use treatment programs or groups were:

Treatment Services in Sign Language for the Deaf and Hard-of-Hearing and in Languages Other Than English

Table 4.16b. Facilities were asked about the provision of substance abuse treatment services in sign language for the deaf and hard-of-hearing. 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.

Detoxification Services

Table 4.17. Facilities that provided detoxification services were asked to indicate whether they detoxified clients from specified substances, and whether medication was routinely used during detoxification. The number of facilities that provided any type of substance detoxification services was 3,508 from a total of 15,961 facilities.

Of the 3,508 facilities that offered detoxification, the proportions that offered detoxification from the following specific substances were: 95 percent for opioids, 71 percent for alcohol, 66 percent for benzodiazepines, 60 percent for cocaine, 60 percent for methamphetamines, and 14 percent for other substances. Medications were routinely used during detoxification in 90 percent of the facilities providing detoxification services.

Client Outreach

Table 4.18. Facilities were asked if they provided outreach to persons who may need treatment. Outreach to persons in the community who may need treatment was provided by 64 percent of all facilities and by 84 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; HFAP; and other national organizations or federal, state, or local agencies.¹⁹

Table 4.19b. Overall, 94 percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations.

The proportions of facilities reporting that they were licensed, certified, or accredited by specified agencies or organizations were 78 percent by a state substance abuse agency; 47 percent by a state department of health; 40 percent by a state mental health department; 29 percent by CARF; 23 percent by the Joint Commission; 5 percent by a hospital licensing authority; 4 percent by COA; 2 percent by NCQA; 1 percent by HFAP; and 4 percent by other national organizations or federal, state, or local agencies.

Table 4.20b. Facility licensing, certification, or accreditation was associated with the type of care offered. State substance abuse agencies licensed, certified, or accredited 79 percent of facilities that offered residential (non-hospital) treatment, 78 percent of facilities that offered outpatient treatment, and 59 percent of facilities that offered hospital inpatient treatment.

State mental health departments licensed, certified, or accredited 43 percent of facilities that offered outpatient treatment, 37 percent of hospital inpatient facilities, and 29 percent of residential (non-hospital) facilities.

Federally Qualified Health Centers

Table 4.21. Facilities were asked to indicate whether they were a Federally Qualified Health Center (FQHC). Of all 15,961 facilities included in the report, 1,427 facilities were Federally Qualified Health Centers. Most FQHCs provided outpatient care (89 percent). Residential (non-hospital) care and inpatient hospital care were provided by a smaller proportion of FQHCs—15 percent and 4 percent, respectively.

Payment Options

Table 4.22b. Facilities were asked to indicate whether they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about the use of a sliding fee scale and if they offered treatment at no charge or minimal payment to clients who could not pay.

A smaller proportion of facilities operated by federal and tribal governments reported that they accept cash or self-payment (43 and 42 percent, respectively) than did facilities operated by any other entity. Facilities operated by private for-profit organizations and by the federal government less frequently reported that they accept Medicaid, or a state-financed health insurance plan other than Medicaid, than facilities operated by any other entity.

A larger proportion of facilities operated by the Indian Health Service reported that they accept ITU (IHS/Tribal/Urban) funds (84 percent) than did facilities operated by any other entity.²⁰

Use of a sliding fee scale was reported by 58 percent of all facilities, ranging from 22 percent of facilities operated by tribal governments to 80 percent of facilities operated by local, county, or community governments.

Treatment at no charge or minimal payment for persons who cannot afford to pay was offered by 45 percent of all facilities, ranging from 21 percent of facilities operated by private for-profit organizations to 81 percent of facilities operated by tribal governments.

Facility Funding

Table 4.23. Facilities were asked if they receive federal, state, or local government funds or grants to support their substance abuse treatment programs.

Overall, 52 percent of facilities reported receiving government funds to support substance abuse treatment programs. The proportions were highest in facilities operated by tribal governments and by local, county, or community governments (88 percent each). Of facilities operated by private non-profit organizations, 72 percent reported that they receive public funds, whereas 18 percent of facilities operated by private for-profit organizations reported receiving public funds.

Facilities Using MAT

OTPs are certified by SAMHSA to provide MAT in the treatment of OUD. Currently, methadone and buprenorphine are the only opioid medications approved for the treatment of OUD. Injectable naltrexone is approved for relapse prevention in OUD. Only OTPs may use methadone for the treatment of OUD. Facilities with DATA 2000-waivered practitioners may prescribe buprenorphine. Any authorized personnel (physicians, physician assistants, etc.) may prescribe or administer injectable naltrexone.

Table 4.24a. There were 7,770 facilities that offered any type of MAT, of which 1,691 facilities had OTPs, 6,497 facilities offered buprenorphine for MAT, and 5,594 facilities offered injectable naltrexone for MAT.

Table 4.24b. The majority of facilities with OTPs that offered methadone only were operated by private for-profit organizations (65 percent). In contrast, facilities with OTPs operated by private non-profit organizations accounted for the majority of facilities that offered methadone and injectable naltrexone (82 percent).

Table 4.24b. Private for-profit organizations operated 61 percent of facilities with OTPs, and private non-profit organizations operated 32 percent of facilities with OTPs.

Table 4.25b. Most facilities with OTPs offered outpatient treatment (91 percent). Of facilities with OTPs, 89 percent offered outpatient methadone/buprenorphine maintenance or injectable naltrexone treatment and 42 percent offered outpatient detoxification.

Tables 4.20b and 4.26b. A larger proportion of facilities with OTPs than all facilities, combined, reported being licensed, certified, or accredited by a state department of health (63 vs. 47 percent), the Joint Commission (29 vs. 23 percent), CARF (67 vs. 29 percent), or a state substance abuse agency (89 vs. 78 percent).

Facility Smoking Policy

Table 4.27. Of the 15,933 facilities that responded to the question about smoking policies, 59 percent permitted smoking in designated outdoor areas, whereas 34 percent of facilities did not permit smoking anywhere outside or within any building.

Suicide Prevention-Related Services in Veterans Affairs Facilities

Table 4.28. Veterans Affairs (VA) facilities were asked what types of suicide prevention-related services they offered.

Among VA facilities, 90 percent provided evidence-based suicide prevention interventions, 95 percent provided suicide risk screening, and 95 percent provided suicide risk evaluation. All VA facilities reported offering suicide prevention-related services.

To Chapter 4 Tables

Chapter 5. Client Characteristics

This chapter describes key characteristics of the 1,460,706 clients in substance abuse treatment on March 29, 2019 [Table 5.1a]. Clients in treatment were defined as: (1) hospital inpatient and residential (non-hospital) clients receiving substance abuse treatment services on March 29, 2019, and (2) outpatient clients who were seen at the facility for substance abuse treatment or detoxification service at least once during the month of March 2019, and who were still enrolled in treatment on March 29, 2019.

Facility Operation and Type of Care

Table 5.1c. Facilities were asked to designate the type of entity responsible for the operation of the facility. On March 29, 2019, 50 percent of all clients were receiving treatment in facilities operated by private non-profit organizations and 40 percent were receiving treatment in facilities operated by private for-profit organizations. The remaining clients were receiving treatment in facilities operated by local, county, or community government (4 percent); the federal government (3 percent); state government (2 percent); or a tribal government (1 percent).

The majority of clients in outpatient methadone/buprenorphine maintenance or naltrexone treatment (60 percent) were in facilities operated by private for-profit organizations.

Table 5.1b. Facilities were asked how many clients in treatment on March 29, 2019, received specified subcategories of type of care within three broad categories.

Clients in Federally Qualified Health Centers

Table 5.2. FQHCs reported 144,854 clients in treatment on March 29, 2019. FQHC clients were reported in three broad types of care:

Clients at High Risk of Suicide at VA Facilities²¹

Table 5.3. VA facilities were asked about the number of clients in treatment on March 29, 2019, at high risk of suicide. Across all reporting VA facilities, the total number of clients at high risk of suicide in each type of care was as follows: 3,118 clients in outpatient treatment, 629 clients in hospital inpatient treatment, and 510 clients in residential (non-hospital) treatment.

Substance Abuse Treatment

Table 5.4. Facilities were asked to estimate the proportions of clients in treatment on March 29, 2019, by substance abuse problem treated (alcohol abuse only, drug abuse only, or both alcohol and drug abuse).

On March 29, 2019, 52 percent of clients were in treatment for drug abuse only, 33 percent were in treatment for both alcohol and drug abuse, and 14 percent were in treatment for alcohol abuse only.

By facility operation, the largest proportion of clients in treatment for abuse of both alcohol and drugs was in tribal government-operated facilities (52 percent). For abuse of drugs only, the largest proportion of clients was in facilities operated by private for-profit organizations (65 percent); for abuse of alcohol only, the largest proportion was in federal government-operated facilities (31 percent).

Clients Under the Age of 18 Years in Treatment

Table 5.5. Facilities were asked how many clients in treatment on March 29, 2019, were under the age of 18 years.

There were 59,854 clients under the age of 18 years in substance abuse treatment on March 29, 2019, of the total 1,460,706 clients in treatment on that date.

Of the 59,854 clients under the age of 18 years, 53,636 clients (90 percent) were in outpatient treatment, while 5,468 clients (9 percent) were in residential (non-hospital) treatment, and 750 clients (1 percent) were in hospital inpatient treatment.

Clients Receiving MAT for OUD

Tables 5.6a–b. Facilities were asked how many clients in treatment on March 29, 2019, received MAT for OUD for detoxification or maintenance purposes. MAT includes the use of methadone and buprenorphine for the treatment of OUD, and the use of naltrexone for relapse prevention in OUD. Methadone is available only at OTP facilities that are certified by SAMHSA’s Center for Substance Abuse Treatment. Buprenorphine may be prescribed by practitioners who have received DATA 2000-specific training and received a waiver to prescribe the medication for treatment of OUD; some of these practitioners are affiliated with facilities (either OTPs or other). All physicians or approved medical personnel with prescribing privileges can prescribe naltrexone.²²

Clients Receiving MAT for Alcohol Use Disorder

Table 5.7. Facilities that offered MAT for alcohol use disorder were asked how many clients in treatment on March 29, 2019, received disulfiram (Antabuse^®), naltrexone, or acamprosate for alcohol use disorder. By type of care, the total numbers of clients on March 29, 2019, that received each medication were as follows:

To Chapter 5 Tables

Chapter 6. State Data

This chapter breaks down data presented in earlier chapters by state or jurisdiction. The Chapter 6 tables correspond thematically to many of the tables presented in Chapters 4 and 5. Note that facilities operated by federal agencies are included in the states in which the facilities are located, although these facilities may have clients from other states.

Tables 6.2a–b present data on facilities and clients in treatment by state or jurisdiction for 2009 to 2019.

Tables 6.41 and 6.42 present the number of clients aged 18 years or older in treatment—according to substance abuse problem and receipt of medication-assisted opioid treatment, respectively—per 100,000 population, by state or jurisdiction.

Survey Response

Table 6.1. The overall response rate for the survey was 91 percent. Response rates in 35 states or jurisdictions equaled or surpassed the overall rate.

Trends

Tables 6.2a–b. California and New York had the largest numbers of both facilities and clients in treatment for every odd year from 2007 through 2019.²³ On March 29, 2019, California had 11 percent of all facilities and 7 percent of all clients, and New York had 6 percent of all facilities and 8 percent of all clients.

In terms of total numbers of facilities in every odd year from 2009 through 2019, Illinois and Florida ranked either third or fourth. Michigan, North Carolina, Pennsylvania, Texas, and Washington have also consistently ranked within the top 10.

In terms of total numbers of clients in every odd year from 2009 through 2019, Pennsylvania has ranked either third or fourth. Florida, Illinois, Massachusetts, and Maryland have also consistently ranked within the top 10.

Clients in Treatment per 100,000 Population Aged 18 Years and Older

Table 6.41 and Figures 7–8. Among those 18 years and older, there were 529 clients in treatment per 100,000 population on March 29, 2019. The ratio was highest for clients in treatment for drug abuse only (280 per 100,000 population), followed by both alcohol and drug abuse (174 per 100,000 population) and alcohol abuse only (75 per 100,000 population). Figure 7 maps each state or jurisdiction’s ratio of clients in treatment per 100,000 population by quartile in 2019. There are between 12 and 13 states in each quartile. Figure 8 maps the ratios of clients in treatment per 100,000 population for each state or jurisdiction by quartile in 2009. It has been included in this section for comparison.

Figure 7. Clients in treatment per 100,000 population aged 18 years and older: March 29, 2019

Figure 7 is a map of the united states comparing the divisions between Clients in treatment per 100,000 population aged 18 years and older as of March 29, 2019. A more detailed description can be found in the preceding text.

SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2019. Population: U.S. Census Bureau, Population Estimates, SCPRC-EST2019-18+POP-RES: Estimates of the Total Resident Population and Resident Population Age 18 Years and Older for the United States, States, and Puerto Rico: July 1, 2019. U.S. Census Bureau, International Programs, International Data Base, Last Updated: December 2019, Version: 12.0321.

Figure 8. Clients in treatment per 100,000 population aged 18 years and older: March 31, 2009

Figure 8 is a map of the united states comparing the divisions between Clients in treatment per 100,000 population aged 18 years and older as of March 29, 2009. A more detailed description can be found in the preceding text.

SOURCES: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2009. Population: U.S. Census Bureau, Population Estimates, State population dataset – SCPRC-EST2009-18+POP-RES: Estimates of the Total Resident Population and Resident Population Age 18 Years and Older for the United States, States, and Puerto Rico: July 1, 2009. U.S. Census Bureau, International Programs, International Data Base, Last Updated: December 2019, Version: 12.0321.

To Chapter 6 Tables

Appendix A. N-SSATS Background

Survey History

N-SSATS has evolved from national survey efforts begun in the 1970s by the National Institute on Drug Abuse (NIDA) to measure the scope and use of drug abuse treatment services in the United States. The sixth of these surveys, conducted in 1976, introduced the data elements and format that have formed the core of subsequent surveys. These include organizational focus, service orientation, services available, clients in treatment by type of care, and hospital inpatient/residential capacity. The 1976 survey, called the National Drug Abuse Treatment Utilization Survey, was repeated in 1977 and 1978.

In 1979, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) became a co-sponsor of the survey, alcoholism treatment facilities were added, and the study was re-named the National Drug and Alcoholism Treatment Utilization Survey. This survey was repeated in 1980 and 1982. In 1984, a one-page version called the National Alcoholism and Drug Abuse Program Inventory was used. In 1987, the full version of the survey was re-instated and re-named the National Drug and Alcoholism Treatment Unit Survey (NDATUS). NDATUS was conducted annually from 1989 to 1993.

In 1992, with the creation of SAMHSA, responsibility for conducting the survey shifted to SAMHSA’s Office of Applied Studies (now the Center for Behavioral Health Statistics and Quality). The survey was re-designed, and it was conducted annually as the Uniform Facility Data Set (UFDS) survey from 1995 to 1998. During these years, the survey was conducted by mail with telephone follow-up of non-respondents. The 1999 survey year was a transition year during which the survey was re-designed and an abbreviated telephone survey of treatment facilities was conducted. In 2000, a re-designed full mail survey was re-instated with telephone follow-up; it was re-named the National Survey of Substance Abuse Treatment Services (N-SSATS). The reference date for the annual survey had always been the end of September or beginning of October. After the 2000 survey, the reference date was changed to the end of March, and no survey was conducted during 2001.

In 2000, the use of an Internet-based questionnaire was tested; beginning in 2002, all facilities were offered the opportunity to respond via the Internet.

Since 2013, the full N-SSATS questionnaire (with client counts) has alternated with an abbreviated version of the questionnaire. The full questionnaire, fielded in odd-numbered years, collects data on programs and clients; in alternate (even-numbered) years, an abbreviated N-SSATS questionnaire collects the program information needed to update the substance abuse section of the Behavioral Health Treatment Services Locator and collects information on other facility-related topics.

N-SSATS in the Context of the Behavioral Health Services Information System (BHSIS)

N-SSATS is one of the components of SAMHSA’s Behavioral Health Services Information System (BHSIS). The core of BHSIS is the Inventory of Behavioral Health Services (I-BHS), a continuously updated, comprehensive listing of all known substance abuse treatment facilities and mental health treatment facilities. The other substance abuse component of BHSIS is the Treatment Episode Data Set (TEDS), a client-level database of admissions to and discharges from substance abuse treatment. 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.

I-BHS is the list frame for N-SSATS. Facilities in I-BHS fall into two general categories and are distinguished by the relationship of the facility to its state substance abuse agency. These categories are described below.

Treatment facilities approved by state substance abuse agencies

The largest group of facilities (17,087 in 2019) includes facilities that are licensed, certified, or otherwise approved by the state substance abuse agency to provide substance abuse treatment. State BHSIS representatives maintain this segment of I-BHS 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. The approved facility group also includes programs operated by federal agencies—the Department of Veterans Affairs (VA), the Department of Defense, the Indian Health Service—and opioid treatment programs certified by SAMHSA. I-BHS records for federally operated facilities are updated annually through lists provided by these agencies.

Treatment facilities not approved by state substance abuse agencies

This group of facilities (2,708 in 2019) represents the SAMHSA effort since the mid-1990s to make I-BHS 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. (See Special efforts to improve survey coverage.) State substance abuse agencies are given the opportunity to review these facilities and to add them to the state agency-approved list, if appropriate.

Survey Coverage

The use of I-BHS as the list frame for N-SSATS imposes certain constraints related to the unit of response and the scope of facilities included. In addition, the expansion of I-BHS in recent years to provide a more complete enumeration of substance abuse treatment facilities means that year-to-year comparisons of the numbers of facilities reporting to N-SSATS must be interpreted with caution.

Unit of response

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 state substance abuse agency, and are given separate I-BHS 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, reporting levels remain consistent from year to year. However, beginning in 1998, an emphasis was placed on collecting minimum information from all physical locations, and this resulted in an increase in the number of facilities.

Special efforts to improve survey coverage

The great majority of treatment facilities in I-BHS are administratively monitored by state substance abuse agencies. Therefore, the scope of facilities included in I-BHS is affected by differences in state systems of licensure, certification, accreditation, and the disbursement of public funds. For example, some state substance abuse agencies regulate private facilities and individual practitioners while others do not. In some states, hospital-based substance abuse treatment facilities are not licensed through the state substance abuse agency.

To address these differences, SAMHSA conducted a large-scale effort during 1995 and 1996 to identify substance abuse treatment facilities that, for a variety of reasons, were not on the inventory. About 15 source lists were examined, and facilities not on the inventory were contacted to ascertain whether or not they provided substance abuse treatment. As expected, this yielded a number of hospital-based and small private facilities that were not on the inventory. (These facilities were surveyed in 1995 and 1996, but they were not included in the published results of the survey until 1997.) Analysis of the results of this effort led to similar but more targeted updates before subsequent surveys. Potential new facilities are identified using data from infoUSA (formerly the American Business Index), the annual American Hospital Association survey, and SAMHSA’s National Mental Health Services Survey, the source lists that yielded the most new facilities in 1995 and 1996. Survey participants, who are asked to report all of the treatment facilities in their administrative networks, also identify additional facilities during the survey itself. All newly identified facilities are initially included as not approved by the state substance abuse agency. State substance abuse agencies are given the opportunity to review these facilities and to add them to the state agency-approved list, if appropriate.

Expansion of survey coverage to include all sites within networks at which treatment was provided yielded a net increase of about 2,600 facilities between 1997 and 1998. These additions were not necessarily new facilities, but were facilities not previously included in the survey as separate sites. Between 2009 and 2019, the number of facilities eligible for inclusion in this report varied between 13,513 and 15,961. The total number is deceptive, however. There was significant turnover as facilities closed and others opened (see Table 2.1).

Data collection

Until 1996, state substance abuse agencies distributed and collected the facility survey forms. Beginning in 1996, data collection was centralized; since that time, SAMHSA has mailed survey forms directly to and collected forms directly from the facilities and has conducted follow-up telephone interviews with the facility director or his/her designee. In 2000, SAMHSA introduced an online trial web version of the questionnaire for a few facilities in addition to the hard copy questionnaire. The web version of the questionnaire was fully implemented in 2002. The proportion of facilities using the web survey to respond to N-SSATS has increased steadily since its full inception in 2002.

Non-response

Beginning in 1992, SAMHSA expanded efforts to obtain information from non-responding facilities. A representative sample of non-respondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all non- responding 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. Between 2004 and 2018, use of these methods and intensive telephone follow-up resulted in an annual follow-up rate (i.e., facilities in the sample either completed the survey or were determined to be closed or otherwise ineligible) of 92 to 96 percent. In 2019, the final response rate, counting eligible facilities, was 91 percent.

Exclusions

In 1997, facilities offering only DUI/DWI programs were excluded; these facilities were reinstated in 1998.

Facilities operated by the Bureau of Prisons (BOP) were excluded from the 1997 survey and subsequent surveys because SAMHSA conducted a separate survey of correctional facilities.²⁴ During that survey, it was discovered that jails, prisons, and other organizations treating incarcerated persons only were poorly enumerated on the inventory. Beginning in 1999, these facilities were identified during the survey and excluded from analyses and public use data files.

I-BHS and N-SSATS are designed to include specialty substance abuse treatment facilities rather than individuals. Solo practitioners are listed on I-BHS and surveyed in N-SSATS only if the state substance abuse agency explicitly requests that they be included.

Beginning in 2000, halfway houses that did not provide substance abuse treatment were included on the inventory and in N-SSATS so that they could be listed in the National Directory of Drug and Alcohol Abuse Treatment Facilities (formerly the National Directory of Drug and Alcohol Abuse Treatment Programs) and on the Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov). These facilities are excluded from analyses and public use data files.

Changes in Survey Content

Table A1 shows the major content areas for the survey from 1998 to 2019. Since 1992, SAMHSA has made adjustments each year to the survey design, both to minimize non-response and to include areas of emerging interest. For example, questions on the number of clients in treatment receiving buprenorphine were added in 2004. Questions about clinical/therapeutic methods, standard practices, and Access to Recovery grants were added in 2007. Questions about facility smoking policy were added in 2011; questions about outpatient facility operating capacity were modified in 2012; questions about injectable naltrexone (Vivitrol^®) as a pharmacotherapy were added in 2011; questions about work activity and means to accomplish them, as well as the question asking for client counts of those prescribed extended-release injectable naltrexone (Vivitrol^®), were added in 2013; and in 2017, the questions asking for client counts of those prescribed Vivitrol^® were changed to request client counts of those receiving naltrexone for opioid use disorder.

There have also been changes within content areas. For example, in response to concerns about over-reporting of programs or groups for specific client types, the survey question was revised in 2003 to distinguish between those facilities that accepted specific client types and those facilities that offered specially designed programs or groups for that client type. As a result, the number and proportion of facilities offering programs or groups for each of the specified client types decreased. Surveys from 2003 and later are believed to more accurately represent the number and proportions of facilities providing programs or groups for the specified client types. In addition, over time, more categories have been added to the specific client types (e.g., persons who have experienced trauma, active duty military, and members of military families in 2012 and young adults, persons who have experienced sexual abuse, and persons who have experienced intimate partner violence, domestic violence in 2013). Because of the increase in client types, the question was split in 2013. The portion asking if specific client types were served was limited to adolescents, adult women, and adult men. In addition, programs or groups were described as “specifically tailored.” In 2014, the first part of the question was revised again to collect another level of detail (i.e., the age range of males and females served, if any). The client types of adolescents, adult women, and adult men were added back to the second part of the question.

Since 2013, the full N-SSATS questionnaire (with client counts) has alternated with an abbreviated version of the questionnaire. This abbreviated questionnaire, first introduced in 2014, collects the facility, program, and services information that are needed to update the Behavioral Health Treatment Services Locator. It omits Section B, which includes the client counts. Other changes to the 2014 questionnaire included reinstatement of the “primary focus” question, which had been dropped from the 2013 questionnaire; in addition, the question asking if a facility operates an opioid treatment program (OTP) was revised: The informational bullets describing OTPs were reworded, and the response categories were more explicit about whether or not the facility operates an OTP, as well as whether or not methadone and/or buprenorphine are used. In 2015, the OTP question was again revised to ask facilities how they treat opioid addiction; the response categories were even more specific about how they used, or did not use, methadone, buprenorphine, or extended-release injectable naltrexone (Vivitrol^®) and whether or not the facility was a federally certified OTP. In 2017, reference to Vivitrol^® was deleted, and the question referred simply to naltrexone.

Changes in the 2019 survey

In 2019, the question regarding services offered was revised by including three new categories (medical services, recovery support services, and education and counseling services), regrouping items from previous iterations of the survey, and adding new response options.

The 2019 questionnaire also introduced new questions about the sources of medication-assisted therapy (MAT) for opioid use disorder (OUD), as well as the estimated percentages of clients receiving these medication services. Section B of the 2019 survey was further enhanced with questions about the number of clients who received specific medications for alcohol use disorder (AUD) in each service setting.

An addendum to the 2019 questionnaire was also sent to VA facilities for purposes of collecting information about suicide prevention-related services offered.

To Table A.1

Appendix B. 2019 N-SSATS Questionnaire and VA Addendum

This appendix contains the hard copy version of the 2019 N-SSATS questionnaire. Facilities also had the option of responding to the questionnaire on the Internet. For those facilities that had not completed the survey after extensive follow-up efforts (see Chapter 1), the questionnaire was administered by computer-assisted telephone interview (CATI).

Of the responding eligible treatment facilities included in this report, 90 percent completed the questionnaire on the Internet, 9 percent completed it by CATI, and 1 percent completed it by mail [Table 1.1 and Figure 1].

Text versions of the Internet and CATI surveys are not included here because they are computer programs that contain complex skip patterns, are difficult to read, and are extremely long in text format.

To 2019 N-SSATS Questionnaire and VA Addendum PDF

Appendix C. Item Response for 2019 N-SSATS

This appendix contains Table C1, a list of item response rates for questions from the N-SSATS 2019 questionnaire. Item non-response was minimized through careful editing and extensive follow-up.

The item response rate for the 2019 N-SSATS averaged 99 percent across 329 separate response categories.

Item non-response was 10 percent or more for only five of 329 separate response categories.

When available, client values and admissions values from up to five previous surveys were used to impute the missing counts. If historical data were not available, 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, residential [non-hospital] detoxification, etc.) and summed to the larger service type totals (total hospital inpatient clients, total residential [non-hospital] clients, and total outpatient clients), and finally to total clients. For 2019, 54 imputations were done involving 12 facilities.

Several facilities report client counts for themselves (parent) as well as for other facilities (children) within their family of substance abuse treatment facilities. Instead of reporting only the aggregate client count, we attempted to disaggregate and redistribute or unroll the parent facilities’ total client count wherever possible to reflect the number of clients served by each facility within the family of facilities. Client counts reported by a parent facility were distributed among its children facilities based on the type of facilities and types of clients indicated by the family of facilities. Therefore, numbers reported may be an actual number reported by the facility itself or they may be an unrolled estimate based on the unrolling procedures. All totals sum to the actual reported numbers. For hospital inpatient care, 18 facilities and 148 clients were unrolled. For outpatient care, 1,436 facilities and 173,623 clients were unrolled. For residential care, 221 facilities and 4,086 clients were unrolled.

Table C1. Item response rates, by question number and description: 2019

Question number	Description	Response rate (%)
Q1-1	Facility offers intake, assessment, or referral	99.9
Q1-2	Facility offers detoxification	100.0
Q1-3	Facility offers substance use treatment	100.0
Q1-4	Facility offers treatment for co-occurring serious mental illness (SMI)/serious emotional disturbance (SED) and substance use disorders	100.0
Q1-5	Facility offers any other substance use services	99.7
Q1a-1	Facility offers mental health treatment services to substance abuse clients	100.0
Q1a-2	Facility offers mental health treatment services to clients other than substance abuse clients	100.0
Q1a-3	No clients offered mental health treatment services	100.0
Q2	Facility is a jail, prison, or other organization that exclusively treats incarcerated persons or juvenile detainees	100.0
Q3a-1	Facility offers detoxification from alcohol	99.0
Q3a-2	Facility offers detoxification from benzodiazepines	99.0
Q3a-3	Facility offers detoxification from cocaine	99.0
Q3a-4	Facility offers detoxification from methamphetamines	99.0
Q3a-5	Facility offers detoxification from opioids	99.0
Q3a-6	Facility offers detoxification from other substances	100.0
Q3b	Facility routinely uses medications during detoxification	98.8
Q5	Facility is a solo practice	99.8
Q6	Facility is a Federally Qualified Health Center (FQHC)	77.0
Q7	Primary focus of facility is substance use treatment services/mental health services/mix of mental health and substance use treatment services (neither is primary)/general health care/other	99.9
Q8	Facility operation/ownership	100.0
Q8a	Federal government agency operation/ownership	100.0
Q9	Facility offers hospital inpatient substance abuse services	100.0
Q9a-1	Facility offers hospital inpatient detoxification	100.0
Q9a-2	Facility offers hospital inpatient treatment	100.0
Q10	Facility offers residential (non-hospital) substance abuse services	100.0
Q10a-1	Facility offers residential detoxification	100.0
Q10a-2	Facility offers residential short-term treatment	100.0
Q10a-3	Facility offers residential long-term treatment	100.0
Q11	Facility offers outpatient services	100.0
Q11a-1	Facility offers outpatient detoxification	100.0
Q11a-2	Facility offers outpatient methadone/buprenorphine maintenance or naltrexone treatment	100.0
Q11a-3	Facility offers outpatient day treatment or partial hospitalization	100.0
Q11a-4	Facility offers intensive outpatient treatment	100.0
Q11a-5	Facility offers regular outpatient treatment	100.0
Q12-1	Facility offers screening for substance abuse	100.0
Q12-2	Facility offers screening for mental disorders	100.0
Q12-3	Facility offers comprehensive substance abuse assessment or diagnosis	100.0
Q12-4	Facility offers comprehensive mental health assessment or diagnosis (for example, psychological or psychiatric evaluation and testing)	100.0
Q12-5	Facility offers screening for tobacco use	100.0
Q12-6	Facility offers outreach to persons in the community who may need treatment	100.0
Q12-7	Facility offers interim services for clients when immediate admission is not possible	100.0
Q12-8	Facility offers professional interventionist/educational consultant	100.0
Q12-9	Facility does not offer any of these assessment and pre-treatment services	100.0
Q12-1	Facility offers drug and alcohol oral fluid testing	100.0
Q12-11	Facility offers breathalyzer or other blood alcohol testing	100.0
Q12-12	Facility offers drug or alcohol urine screening	100.0
Q12-13	Facility offers testing for hepatitis B (HBV)	100.0
Q12-14	Facility offers testing for hepatitis C (HCV)	100.0
Q12-15	Facility offers HIV testing	100.0
Q12-16	Facility offers STD testing	100.0
Q12-17	Facility offers TB screening	100.0
Q12-18	Facility offers testing for metabolic syndrome	100.0
Q12-19	Facility does not offer any of these testing services	100.0
Q12-20	Facility offers hepatitis A (HAV) vaccination	100.0
Q12-21	Facility offers hepatitis B (HBV) vaccination	100.0
Q12-22	Facility does not offer any of these medical services	100.0
Q12-23	Facility offers discharge planning	100.0
Q12-24	Facility offers aftercare/continuing care	100.0
Q12-25	Facility offers naloxone and overdose education	100.0
Q12-26	Facility offers outcome follow-up after discharge	100.0
Q12-27	Facility does not offer any of these transitional services	100.0
Q12-28	Facility offers mentoring/peer support	100.0
Q12-29	Facility offers self-help groups (for example, AA, NA, SMART Recovery)	100.0
Q12-30	Facility offers assistance in locating housing for clients	100.0
Q12-31	Facility offers employment counseling or training for clients	100.0
Q12-32	Facility offers assistance with obtaining social services (for example, Medicaid, WIC, SSI, SSDI)	100.0
Q12-33	Facility offers recovery coach	100.0
Q12-34	Facility does not offer any of these recovery support services	100.0
Q12-35	Facility offers HIV or AIDS education, counseling, or support	100.0
Q12-36	Facility offers hepatitis education, counseling, or support	100.0
Q12-37	Facility offers health education other than HIV/AIDS or hepatitis	100.0
Q12-38	Facility offers substance abuse education	100.0
Q12-39	Facility offers smoking/tobacco cessation counseling	100.0
Q12-40	Facility offers individual counseling	100.0
Q12-41	Facility offers group counseling	100.0
Q12-42	Facility offers family counseling	100.0
Q12-43	Facility offers marital/couples counseling	100.0
Q12-44	Facility offers vocational training or educational support (for example, high school coursework, GED preparation, etc.)	100.0
Q12-45	Facility does not offer any of these education and counseling services	100.0
Q12-46	Facility offers case management services	100.0
Q12-47	Facility offers social skills development	100.0
Q12-48	Facility offers childcare for clients’ children	100.0
Q12-49	Facility offers domestic violence—family or partner violence—services (physical, sexual, and emotional abuse)	100.0
Q12-50	Facility offers early intervention HIV	100.0
Q12-51	Facility offers transportation assistance to treatment	100.0
Q12-52	Facility offers mental health services	100.0
Q12-53	Facility offers acupuncture	100.0
Q12-54	Facility offers residential beds for clients’ children	100.0
Q12-55	Facility does not offer any of these ancillary services	100.0
Q12-56	Facility offers treatment for gambling disorder	100.0
Q12-57	Facility offers treatment for Internet use disorder	100.0
Q12-58	Facility offers treatment for other addiction disorder (non-substance abuse)	100.0
Q12-59	Facility does not offer any of these other services	100.0
Q12-60	Pharmacotherapies — disulfiram (Antabuse^®)	100.0
Q12-61	Pharmacotherapies — naltrexone (oral)	100.0
Q12-62	Pharmacotherapies — naltrexone (extended-release, injectable, for example, Vivitrol^®)	100.0
Q12-63	Pharmacotherapies — acamprosate (Campral^®)	100.0
Q12-64	Pharmacotherapies — nicotine replacement	100.0
Q12-65	Pharmacotherapies — non-nicotine smoking/tobacco cessation medications (for example, bupropion, varenicline)	100.0
Q12-66	Pharmacotherapies — medications for psychiatric disorders	100.0
Q12-67	Pharmacotherapies — methadone	100.0
Q12-68	Pharmacotherapies — buprenorphine with naloxone (for example, Suboxone^®, Bunavail^®, Zubsolv^®, Cassipa^®)	100.0
Q12-69	Pharmacotherapies — buprenorphine without naloxone	100.0
Q12-70	Pharmacotherapies — buprenorphine sub-dermal implant (Probuphine^®)	100.0
Q12-71	Pharmacotherapies — buprenorphine (extended-release, injectable, for example, Sublocade^®)	100.0
Q12-72	Pharmacotherapies — medications for HIV treatment (for example, antiretroviral medications such as tenofovir, efavirenz, emtricitabine, atazanavir, and lamivudine)	100.0
Q12-73	Pharmacotherapies — medications for hepatitis C (HCV) treatment (for example, sofosbuvir, ledipasvir, interferon, peginterferon, ribavirin)	100.0
Q12-74	Pharmacotherapies — lofexidine	100.0
Q12-75	Pharmacotherapies — clonidine	100.0
Q12-76	Does not offer any of these pharmacotherapy services	100.0
Q13-1	Does not treat opioid use disorder	100.0
Q13-2	Uses methadone or buprenorphine for pain management, emergency cases, or research purposes	100.0
Q13-3	Treats opioid use disorder, but it does not use medication-assisted treatment (MAT), nor does it accept clients using MAT to treat opioid use disorder	100.0
Q13-4	Accepts clients using MAT, but the medications originate from or are prescribed by another entity	100.0
Q13-5	Administers naltrexone to treat opioid use disorder	100.0
Q13-6	Prescribes buprenorphine to treat opioid use disorder through a DATA 2000-waivered provider	100.0
Q13-7	Federally certified opioid treatment program (OTP)	100.0
Q13a-1	Prescribing entity (of MAT for OUD) in network	99.9
Q13a-2	Business, contractual, or formal referral relationship with prescribing entity (of MAT for OUD)	99.9
Q13a-3	Client obtains their prescription/medication (of MAT for OUD) from their personal physician/health care provider	99.9
Q13a-4	Clients using MAT for OUD obtain medications from other entity	100.0
Q13b	Facility serves only opioid use disorder clients	100.0
Q13c-1	Provides maintenance services with methadone or buprenorphine	99.9
Q13c-2	Provides maintenance services with medically supervised withdrawal (or taper) after a period of stabilization	99.9
Q13c-3	Provides detoxification from opioids of abuse with methadone or buprenorphine	99.9
Q13c-4	Provides detoxification from opioids of abuse with lofexidine or clonidine	99.9
Q13c-5	Provides relapse prevention with naltrexone	99.9
Q13c-6	Provides other medication services	100.0
Q13c-7	Does not offer any of these medication services	99.9
Q13d-1	Approximate percentage of clients on MAT for OUD who receive maintenance services with methadone or buprenorphine	99.9
Q13d-2	Approximate percentage of clients on MAT for OUD who receive maintenance services with medically supervised withdrawal (or taper) after a period of stabilization	99.9
Q13d-3	Approximate percentage of clients on MAT for OUD who receive detoxification from opioids of abuse with methadone or buprenorphine	99.9
Q13d-4	Approximate percentage of clients on MAT for OUD who receive detoxification from opioids of abuse with lofexidine or clonidine	99.8
Q13d-5	Approximate percentage of clients on MAT for OUD who receive relapse prevention with naltrexone	99.9
Q13d-6	Approximate percentage of clients on MAT for OUD who receive other medication services	100.0
Q14-1	Facility does not treat alcohol use disorder	100.0
Q14-2	Facility treats alcohol use disorder, but does not use medication-assisted treatment (MAT) for alcohol use disorder, nor does it accept clients using MAT to treat alcohol use disorder	100.0
Q14-3	Facility accepts clients using MAT for alcohol use disorder, but the medications originate from or are prescribed by another entity	100.0
Q14-4	Facility administers/prescribes at least one of disulfiram (Antabuse^®), naltrexone, and/or acamprosate (Campral^®) for alcohol use disorder	100.0
Q14a-1	Prescribing entity (of MAT for AUD) in network	100.0
Q14a-2	Business, contractual, or formal referral relationship with the prescribing entity (of MAT for AUD)	100.0
Q14a-3	Client obtains their prescription/medication for AUD from their personal physician/health care provider	100.0
Q14a-4	Clients using MAT for AUD obtain medications from other entity	100.0
Q14b	Facility serves only alcohol use disorder clients	100.0
Q15	Substance abuse counseling used frequently	100.0
Q15-2	12-step facilitation used frequently	99.9
Q15-3	Brief intervention used frequently	99.9
Q15-4	CCognitive behavioral therapy used frequently	99.9
Q15-5	Dialectical behavior therapy used frequently	99.9
Q15-6	Contingency management/motivational incentives used frequently	99.9
Q15-7	Motivational interviewing used frequently	99.9
Q15-8	Trauma-related counseling used frequently	99.9
Q15-9	Anger management used frequently	99.9
Q15-10	Matrix Model used frequently	99.9
Q15-11	Community reinforcement plus vouchers used frequently	99.9
Q15-12	Rational emotive behavioral therapy (REBT) used frequently	99.9
Q15-13	Relapse prevention used frequently	99.9
Q15-14	Telemedicine/telehealth used frequently (including Internet, Web, mobile, and desktop programs)	99.9
Q15-15	Other treatment approach used frequently	100.0
Q15-16	None of these clinical/therapeutic approaches used frequently	99.9
Q16	Offers specially designed program or group intended exclusively for DUI/DWI or other drunk driver offenders	99.8
Q16a	Facility serves only DUI/DWI clients	99.8
Q17	Facility provides substance use treatment services in sign language for the deaf and hard-of-hearing	99.8
Q18	Facility provides substance use treatment services in a language other than English	99.9
Q18a	Who provides substance use treatment services in a language other than English?	99.9
Q18a-1	Staff counselors provide substance use treatment in Spanish	100.0
Q18a-2	Staff counselors provide substance use treatment in any other languages	100.0
Q18b-1	Staff counselors provide substance use treatment in Hopi	100.0
Q18b-2	SStaff counselors provide substance use treatment in Lakota	100.0
Q18b-3	Staff counselors provide substance use treatment in Navajo	100.0
Q18b-4	Staff counselors provide substance use treatment in Ojibwa	100.0
Q18b-5	Staff counselors provide substance use treatment in Yupik	100.0
Q18b-6	Staff counselors provide substance use treatment in other American Indian/Alaska Native language	100.0
Q18b-7	Staff counselors provide substance use treatment in Arabic	100.0
Q18b-8	Staff counselors provide substance use treatment in any Chinese language	100.0
Q18b-9	Staff counselors provide substance use treatment in Creole	100.0
Q18b-10	Staff counselors provide substance use treatment in Farsi	100.0
Q18b-11	Staff counselors provide substance use treatment in French	100.0
Q18b-12	Staff counselors provide substance use treatment in German	100.0
Q18b-13	Staff counselors provide substance use treatment in Greek	100.0
Q18b-14	Staff counselors provide substance use treatment in Hebrew	100.0
Q18b-15	Staff counselors provide substance use treatment in Hindi	100.0
Q18b-16	Staff counselors provide substance use treatment in Hmong	100.0
Q18b-17	Staff counselors provide substance use treatment in Italian	100.0
Q18b-18	Staff counselors provide substance use treatment in Japanese	100.0
Q18b-19	Staff counselors provide substance use treatment in Korean	100.0
Q18b-20	Staff counselors provide substance use treatment in Polish	100.0
Q18b-21	Staff counselors provide substance use treatment in Portuguese	100.0
Q18b-2	Staff counselors provide substance use treatment in Russian	100.0
Q18b-23	Staff counselors provide substance use treatment in Tagalog	100.0
Q18b-24	Staff counselors provide substance use treatment in Vietnamese	100.0
Q18b-25	Staff counselors provide substance use treatment in any other language	100.0
Q19-1	Females are served by this facility	100.0
Q19-1	Lowest age of females served	100.0
Q19-1	No minimum age of females served	100.0
Q19-1	Highest age of females served	100.0
Q19-1	No maximum age of females served	100.0
Q19-2	Males are served by this facility	100.0
Q19-2	Lowest age of males served	100.0
Q19-2	No minimum age of males served	100.0
Q19-2	Highest age of males served	99.9
Q19-2	No maximum age of males served	100.0
Q19a-1	Facility offers program or group specifically tailored for adolescents	99.9
Q19a-2	Facility offers program or group specifically tailored for young adults	99.9
Q19a-3	Facility offers program or group specifically tailored for adult women	99.9
Q19a-4	Facility offers program or group specifically tailored for pregnant/postpartum women	99.9
Q19a-5	Facility offers program or group specifically tailored for adult men	99.9
Q19a-6	Facility offers program or group specifically tailored for seniors or older adults	99.9
Q19a-7	Facility offers program or group specifically tailored for lesbian/gay/bisexual/transgender (LGBT) clients	99.9
Q19a-8	Facility offers program or group specifically tailored for veterans	99.9
Q19a-9	Facility offers program or group specifically tailored for active duty military	99.9
Q19a-10	Facility offers program or group specifically tailored for members of military families	99.9
Q19a-11	Facility offers program or group specifically tailored for criminal justice clients (other than DUI/DWI)	99.9
Q19a-12	Facility offers program or group specifically tailored for clients with co-occurring mental and substance use disorders	99.9
Q19a-13	Facility offers program or group specifically tailored for clients with co-occurring pain and substance use	99.9
Q19a-14	Facility offers program or group specifically tailored for clients with HIV or AIDS	99.9
Q19a-15	Facility offers program or group specifically tailored for clients who have experienced sexual abuse	99.9
Q19a-16	Facility offers program or group specifically tailored for clients who have experienced intimate partner violence, domestic violence	99.9
Q19a-17	Facility offers program or group specifically tailored for clients who have experienced trauma	99.9
Q19a-18	Facility offers program or group specifically tailored for any other types of clients	100.0
Q19a-19	No specifically tailored programs or groups are offered	99.9
Q20	Facility uses a sliding fee scale	99.8
Q20a	Availability of sliding fee scale included in online Locator/Directory	100.0
Q21	Facility offers treatment at no charge or minimal payment	99.7
Q21a	Availability of treatment at no charge or minimal payment included in online Locator/Directory	100.0
Q22	Facility receives federal, state, county, or local government funding or grants to support its substance use treatment programs	96.1
Q23-1	Facility does not accept payment (free treatment for all clients)	99.4
Q23-2	Facility accepts cash or self-payment	99.4
Q23-3	Facility accepts Medicare payments	99.4
Q23-4	Facility accepts Medicaid payments	99.4
Q23-5	Facility accepts state-financed health insurance plan other than Medicaid	99.4
Q23-6	Facility accepts federal military insurance	99.4
Q23-7	Facility accepts private health insurance	99.4
Q23-8	Facility accepts Indian Health Service/Tribal/Urban (ITU funds)	99.4
Q23-9	Facility accepts other types of client payments or insurance	100.0
Q24	Facility is a hospital, is located in a hospital, or is operated by a hospital	99.7
Q24a	Type of hospital	99.9
Q25	Facility operates transitional housing, halfway house, or sober home for substance abuse clients	100.0
Q26	Facility smoking policy	99.8
Q27-1	Licensed, certified, or accredited by state substance abuse agency	99.8
Q27-2	Licensed, certified, or accredited by state mental health department	99.8
Q27-3	Licensed, certified, or accredited by state health department	99.8
Q27-4	Licensed, certified, or accredited by hospital licensing authority	99.8
Q27-5	Accredited by the Joint Commission	99.8
Q27-6	Accredited by Commission on Accreditation of Rehabilitation Facilities (CARF)	99.8
Q27-7	Accredited by National Committee for Quality Assurance (NCQA)	99.8
Q27-8	Accredited by Council on Accreditation (COA)	99.8
Q27-9	Accredited by Healthcare Facilities Accreditation Program (HFAP)	99.8
Q27-10	Licensed, certified, or accredited by another national organization or federal, state, or local agency	100.0
Q28	Facility wants to be listed in SAMHSA’s online Behavioral Health Treatment Services Locator and in the National Directory of Drug and Alcohol Abuse Treatment Facilities	99.8
Q28a-1	Facility wants street address listed in the Locator/Directory	100.0
Q28a-2	Facility wants mailing address listed in the Locator/Directory	100.0
Q28a-3	Facility does not want either address listed in the Locator/Directory	100.0
Q28b	Facility wants selected information shared with Internet search engines	100.0
Q30	Client counts for only this facility, this facility plus others, none	100.0
Q30a	Total number of facilities included in reported client counts	100.0
Q31	Any patients received hospital inpatient substance abuse services on March 29, 2019	100.0
Q31a	Total number of hospital inpatient clients	100.0
Q31a-1	Number of hospital inpatient detoxification clients	99.9
Q31a-2	Number of hospital inpatient treatment clients	100.0
Q31b	Number of hospital inpatient clients under 18 years old	100.0
Q31c-1	Number of hospital inpatients who received methadone dispensed at this facility for OUD	99.7
Q31c-2	Number of hospital inpatients who received buprenorphine dispensed or prescribed at this facility for OUD	99.6
Q31c-3	Number of hospital inpatients who received naltrexone administered at this facility for OUD	99.9
Q31d-1	Number of hospital inpatients who received disulfiram (Antabuse^®) dispensed or prescribed at this facility for AUD	99.0
Q31d-2	Number of hospital inpatients who received naltrexone dispensed or prescribed at this facility for AUD	99.4
Q31d-3	Number of hospital inpatients who received acamprosate (Campral^®) dispensed or prescribed at this facility for AUD	98.6
Q31e	Number of hospital inpatient beds specifically designated for substance use treatment	87.7
Q32	Any clients received residential (non-hospital) substance abuse services on March 29, 2019	100.0
Q32a	Total number of residential clients	100.0
Q32a-1	Number of residential detoxification clients	100.0
Q32a-2	Number of residential short-term treatment clients	100.0
Q32a-3	Number of residential long-term treatment clients	100.0
Q32b	Number of residential clients under 18 years old	99.8
Q32c-1	Number of residential clients who received methadone dispensed at this facility for OUD	99.8
Q32c-2	Number of residential clients who received buprenorphine dispensed or prescribed at this facility for OUD	99.6
Q32c-3	Number of residential clients who received naltrexone administered at this facility for OUD	99.3
Q32d-1	Number of residential clients who received disulfiram (Antabuse^®) dispensed or prescribed at this facility for AUD	99.1
Q32d-2	Number of residential clients who received naltrexone dispensed or prescribed at this facility for AUD	99.1
Q32d-3	Number of residential clients who received acamprosate (Campral^®) dispensed or prescribed at this facility for AUD	99.0
Q32e	Number of residential beds specifically designated for substance use treatment	95.5
Q33	Any clients received outpatient substance abuse services during March 2019	100.0
Q33a	Total number of active clients receiving outpatient substance abuse services as of March 29, 2019	100.0
Q33a-1	Number of outpatient detoxification clients	100.0
Q33a-2	Number of outpatient methadone/buprenorphine maintenance or naltrexone treatment clients	100.0
Q33a-3	Number of outpatient day treatment or partial hospitalization clients	100.0
Q33a-4	Number of intensive outpatient treatment clients	100.0
Q33a-5	Number of regular outpatient treatment clients	100.0
Q33b	Number of outpatient clients under 18 years old	99.6
Q33c-1	Number of outpatient clients who received methadone dispensed at this facility for OUD	99.9
Q33c-2	Number of outpatient clients who received buprenorphine dispensed or prescribed at this facility for OUD	99.7
Q33c-3	Number of outpatient clients who received naltrexone administered at this facility for OUD	99.6
Q33d-1	Number of outpatient clients who received disulfiram (Antabuse^®) dispensed or prescribed at this facility for AUD	99.3
Q33d-2	Number of outpatient clients who received naltrexone dispensed or prescribed at this facility for AUD	99.2
Q33d-	Number of outpatient clients who received acamprosate (Campral^®) dispensed or prescribed at this facility for AUD	99.3
Q34-1	Percent of clients in treatment on March 29, 2019, for treatment of abuse of both alcohol and substances other than alcohol	95.8
Q34-2	Percent of clients in treatment on March 29, 2019, for treatment of abuse only of alcohol	95.8
Q34-3	Percent of clients in treatment on March 29, 2019, for treatment of abuse only of substances other than alcohol	95.8
Q35	Estimated percent of substance use treatment clients enrolled on March 29, 2019, who had a diagnosed co-occurring mental and substance use disorder	94.9
Q36	Estimated total number of admissions for substance use treatment in the most recent 12-month period for which data is available	96.4
QVA1-1	VA facility offers evidence-based suicide prevention interventions	97.8
QVA1-2	VA facility offers suicide risk screening	97.8
QVA1-3	VA facility offers suicide risk evaluation	97.8
QVA1-4	VA facility does not offer any of these suicide prevention-related services	97.8
QVA2-1	VA facility uses cognitive therapy for suicide prevention (CBT-SP)	100.0
QVA2-2	VA facility uses cognitive behavioral therapy (CBT)	100.0
QVA2-3	VA facility uses dialectic behavioral therapy (DBT)	100.0
QVA2-4	VA facility uses problem solving therapy (PST)	100.0
QVA2-5	VA facility uses safety planning/crisis response planning	100.0
QVA2-6	VA facility uses ketamine infusions	100.0
QVA2-7	VA facility uses lithium treatment	100.0
QVA2-8	VA facility uses clozapine treatment	100.0
QVA2-9	VA facility uses caring communications	100.0
QVA2-10	VA facility uses home support	100.0
QVA2-11	VA facility uses World Health Organization—Brief Intervention and Contact (WHO-BIC)	100.0
QVA2-12	VA facility uses gate keeper training	100.0
QVA2-13	VA facility uses lethal means safety counseling	100.0
QVA2-14	VA facility uses other evidence-based suicide prevention interventions	100.0
QVA3-1	VA facility uses or makes available the Columbia–Suicide Severity Rating Scale (C–SSRS) Screener	100.0
QVA3-2	VA facility uses or makes available Patient Health Questionnaire (PHQ-9) Item 9	100.0
QVA3-3	VA facility uses or makes available other standardized suicide risk screening tools	100.0
QVA4-1	VA facility uses or makes available the Columbia–Suicide Severity Rating Scale (C–SSRS)	100.0
QVA4-2	VA facility uses or makes available the Mini International Neuropsychiatric Interview (MINI)	100.0
QVA4-3	VA facility uses or makes available the VA Comprehensive Suicide Risk Evaluation (CSRE)	100.0
QVA4-4	VA facility uses or makes available the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)	100.0
QVA4-5	VA facility uses or makes available other standardized suicide risk evaluation tools	100.0
QVA5	Number of VA facility’s hospital inpatient clients identified as being at high risk of suicide	82.58
QVA6	Number of VA facility’s residential clients identified as being at high risk of suicide	87.3
QVA7	Number of VA facility’s outpatient clients identified as being at high risk of suicide	85.6
AA = Alcoholics Anonymous; AUD = alcohol use disorder; DUI/DWI = driving under the influence/driving while intoxicated or impaired; MAT = medication-assisted therapy; NA = Narcotics Anonymous; OUD = opioid use disorder; PTSD = post-traumatic stress disorder; TBI = traumatic brain injury; SED = serious emotional disturbance; SMART = Self-Management and Recovery Training; SMI = serious mental illness; VA = Veterans Affairs. SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2019. Addendum for Substance Abuse Veterans Affairs Facilities, March 29, 2019.

Appendix D. List of Contributors

This report was prepared for the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (HHS), by Eagle Technologies, Inc. Data collection was performed by Mathematica Policy Research. Work was performed by Eagle and Mathematica under Contract No. HHSS283201600001C.

Contributors and reviewers at Eagle, listed alphabetically, include Anand Borse, Erin Doherty, Shanshan Hao, Alicia McCoy, David Peabody, Parth Thakore, Doren Walker (Project Director), and John Zuwasti Curran, with additional support from Mathematica. Production of the report at SAMHSA was managed by Nichele Waller (COR). SAMHSA contributors and reviewers, listed alphabetically, include Herman Alvarado, Heydy Juarez, Sharon Liu, and Nichele Waller.

National Survey of Substance Abuse Treatment Services (N-SSATS): 2019

Data on Substance Abuse Treatment Facilities

Acknowledgments

Public Domain Notice

Recommended Citation

Electronic Access and Copies of Publication

Originating Office

List of Tables

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Appendix A

Appendix C

List of Figures

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

Trends in Facility Characteristics

Trends in Client Characteristics

Facility Characteristics and Services

State Data

Highlights

Trends in Facility and Client Characteristics 2009–2019

Facility Operation—March 29, 2019

Type of Care—March 29, 2019

Diagnosed Co-occurring Mental and Substance Use Disorders—March 29, 2019

Facility Size and Utilization Rates—March 29, 2019

Medication-Assisted Opioid Treatment—March 29, 2019

Chapter 1. Description of the National Survey of Substance Abuse Treatment Services (N-SSATS)

Data Collection Procedures for the 2019 N-SSATS

Field period and reference date

Survey universe

Content

Data collection

Quality assurance

Facility status and response rate

Facility Selection for the 2019 N-SSATS Report

Survey Response Mode

Data Considerations and Limitations

Organization of the Report

Terminology

Chapter 2. Trends in Facility Characteristics

Number of Facilities

Facility Operation

Type of Care Offered6

Facilities That Use MAT

Chapter 3. Trends in Client Characteristics

Number of Clients

Facility Operation

Type of Care Received

Clients Receiving MAT

Substance Abuse Problem Treated

Clients Under the Age of 18 Years in Treatment

Chapter 4. Facility Characteristics and Services

Facility Operation and Type of Care

Substance Abuse Treatment

Facility Size

Facilities with OTPs

Facilities without OTPs

Facility Capacity and Utilization Rates

Services Provided

Clinical/Therapeutic Approaches

MAT for Opioid Use Disorder

Treatment of Alcohol Use Disorder

Programs or Groups for Specific Client Types

Treatment Services in Sign Language for the Deaf and Hard-of-Hearing and in Languages Other Than English

Detoxification Services

Client Outreach

Facility Licensing, Certification, or Accreditation

Federally Qualified Health Centers

Payment Options

Facility Funding

Facilities Using MAT

Facility Smoking Policy

Suicide Prevention-Related Services in Veterans Affairs Facilities

Chapter 5. Client Characteristics

Facility Operation and Type of Care

Clients in Federally Qualified Health Centers

Clients at High Risk of Suicide at VA Facilities21

National Survey of Substance Abuse
Treatment Services (N-SSATS): 2019

Type of Care Offered⁶

Clients at High Risk of Suicide at VA Facilities²¹