Admissions to and Discharges From Publicly Funded Substance Use Treatment
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), by Eagle Technologies, Inc., 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
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Recommended Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2018. Admissions to and Discharges From Publicly Funded Substance Use Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.
Center for Behavioral Health Statistics and Quality
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Room 15SEH03
Rockville, Maryland 20857
This report presents national- and state-level data from the Treatment Episode Data Set (TEDS) for admissions and discharges occurring in 2018, and trend data from 2008 to 2018. It summarizes demographic information and the characteristics and outcomes of treatment for alcohol and/or drug use among clients aged 12 years and older in facilities that report to individual state administrative data systems. Data include records for treatment admissions and discharges that were received and processed through November 18, 2019.1
TEDS records do not represent individuals; rather, each record represents a treatment episode. Thus, an individual admitted to treatment twice within a calendar year is counted as two admissions. Similarly, discharges during the year, regardless of when the admission occurred, are counted.
TEDS does not include all substance use treatments. It includes treatment admissions and discharges at facilities that are licensed or certified by a state substance abuse agency to provide care for people with a substance use disorder (or facilities that are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including federal block grant funds) for the provision of alcohol and/or drug treatment services. Additional information on the history and methodology of TEDS and this report, as well as important issues related to state data collection systems, are available in Appendix A.
It is important to note that percentages in charts, narrative lists, and tables may not sum to 100 percent due to rounding; figures in the narrative are expressed using the nearest whole number.
Admissions or discharges for which values were not collected, unknown, or missing are excluded from the numbers (nominator) and percentage base (denominator) except for substance use. For substance use variables (primary, secondary, and tertiary), unless otherwise noted, the category “other/none specified” consists of none, other stimulants, over-the-counter medications, other drugs, and responses that were missing, unknown, not collected, and invalid.
1For researchers interested in more detailed analysis, TEDS public use files are available for download from the Substance Abuse and Mental Health Data Archive, which can be accessed at https://datafiles.samhsa.gov. Summary data for individual states that have submitted the full year of data are available online through the Quick Statistics website at https://www.samhsa.gov/data/quick-statistics.
Highlights
In 2018, a total of 1,935,541 admissions aged 12 years and older were reported to TEDS by 48 states, the District of Columbia, and Puerto Rico. Georgia and Oregon did not report sufficient admissions for 2018 to be included in this report [Table 5.1a]. In prior years, admissions for the following states have also been excluded: Nebraska (2008); the District of Columbia, Mississippi, and Nebraska (2009); Nebraska (2010); Nebraska (2011); South Carolina (2014); Oregon (2015); Georgia and Oregon (2016); and Georgia and Oregon (2017).
In 2018, a total of 1,791,497 discharge records were reported to TEDS by 46 states, the District of Columbia, and Puerto Rico, of which 93 percent (or 1,666,366 records) can be linked to TEDS admissions aged 12 years and older between 2000 and 2018. Georgia, Oregon, Washington, and West Virginia did not report sufficient discharge data for 2018 to be included in this report [Tables 18.1a–b].
Several states reported significant decreases in the total number of TEDS admissions due to Medicaid expansion. Furthermore, some states are experiencing system challenges and were unable to report admissions aged 12–17 years.
Primary Substance Use at Admission
The most frequently reported primary substances in 2018 were opiates (34 percent), alcohol (29 percent), marijuana/hashish (12 percent), stimulants (10 percent), and cocaine (6 percent), collectively accounting for 91 percent of all admissions aged 12 years and older [Table 1.1b].
Alcohol
The proportion of admissions with alcohol use reported as the primary substance ranged between 38 and 41 percent from 2008 through 2012, before declining to 29 percent in 2018 [Table 1.1b].
The average age at admission among alcohol-only admissions was 43 years, whereas the average age among admissions for primary use of alcohol with secondary drug use was 40 years [Table 2.1b].
More than two thirds (70 percent) of alcohol-only admissions aged 12 years or older were Whites and 16 percent were Blacks or African Americans. Among admissions for primary alcohol with secondary drug use, 61 percent were Whites and 25 percent were Blacks or African Americans [Table 2.2b].
Among admissions aged 12 years or older that were admitted for primary use of alcohol only, 14 percent were of Hispanic or Latino origin. Hispanics or Latinos also accounted for 14 percent of admissions for primary alcohol use with secondary drug use aged 12 years or older [Table 2.2b].
Heroin
In 2008, 14 percent of admissions aged 12 years or older were for primary heroin use. In 2018, 26 percent of admissions aged 12 years or older were for primary heroin use [Table 1.1b].
For primary heroin admissions, the average age at admission was 37 years [Table 2.1b].
Whites accounted for 71 percent of primary heroin admissions aged 12 years and older in 2018, and Blacks or African Americans accounted for 17 percent [Table 2.2b].
Among admissions for primary heroin use aged 12 years or older, 14 percent were of Hispanic or Latino origin [Table 2.2b].
The proportion of admissions aged 12 years or older for primary use of opiates other than heroin increased from 6 percent in 2008 to 10 percent in 2011 and 2012, before declining to 8 percent in 2018 [Table 1.1b].
The average age at admission was 36 years among admissions for primary use of non-heroin opiates [Table 2.1b].
Whites accounted for 83 percent of primary non-heroin opiate admissions aged 12 years or older [Table 2.2b].
Marijuana/Hashish
The proportion of marijuana/hashish admissions aged 12 years and older ranged between
17 and 19 percent from 2008 to 2013, before declining to 12 percent in 2018 [Table 1.1b].
The average age at admission was 28 years among admissions for primary use of marijuana/ hashish [Table 2.1b].
Whites represented 51 percent of primary marijuana/hashish admissions aged 12 years or older, while Blacks or African Americans represented 34 percent [Table 2.2b].
Among admissions for primary marijuana/hashish use aged 12 years or older, 19 percent were of Hispanic or Latino origin [Table 2.2b].
Cocaine/Crack
The proportion of admissions for primary use of cocaine aged 12 years and older declined from 12 percent in 2008 to 6 percent in 2013, and ranged between 5 and 6 percent from 2014 to 2018 [Table 1.1b].
The average age at admission among primary smoked cocaine admissions was 44 years; among primary non-smoked cocaine admissions, the average age was 37 years [Table 2.1b].
Blacks or African Americans represented 51 percent of primary smoked cocaine admissions aged 12 years or older, and 41 percent were Whites. Among primary non-smoked cocaine admissions aged 12 years and older, 57 percent were White, and 30 percent were Black or African American [Table 2.2b].
Among admissions for primary smoked cocaine use aged 12 years or older, 9 percent were of Hispanic or Latino origin. Hispanics or Latinos also accounted for 18 percent of admissions for primary non-smoked cocaine use aged 12 years or older [Table 2.2b].
Methamphetamine/Amphetamines
The proportion of admissions for primary methamphetamine/amphetamines aged 12 years and older increase to 10 percent in 2018 from 6 percent in 2008 [Table 1.1b].
The average age at admission was 35 years for primary methamphetamine/amphetamine admissions [Table 2.1b].
Whites represented 78 percent of primary methamphetamine/amphetamine admissions aged 12 years and older, and 5 percent were Black or African American [Table 2.2b].
Among admissions for methamphetamine/amphetamine use aged 12 years or older, 16 percent were of Hispanic or Latino origin [Table 2.2b].
Trends in Substance Use Treatment Admissions
In each year between 2008 and 2018, the Middle Atlantic had the largest number of admissions among all Census divisions, followed by the South Atlantic division, except in 2014. The number of admissions in these two regions, respectively, were 394,715 and 378,535 in 2018. The lowest number of admissions was reported in the East South Central division, with 65,953 admissions in 2018 [Table 5.1a].
In each year between 2008 and 2017, the ratio of admissions per 100,000 population aged 12 years and older was highest in the New England and Middle Atlantic divisions, respectively. However, in 2018, the New England (1,388) and Mountain (1,328) divisions reported the highest ratio of admissions per 100,000 population aged 12 years and older [Table 5.1b].
Type of Treatment Service at Discharge
Of the 1,666,366 discharges aged 12 years and older in 2018 [Table 18.2b]:
43 percent were discharged from outpatient treatment,
16 percent were discharged from detoxification, and
12 percent were discharged from intensive outpatient treatment.
Reason for Discharge
Of the 1,666,366 discharges aged 12 years and older in 2018 [Table 19.3b]:
42 percent of the discharges completed treatment,
25 percent of the discharges dropped out of treatment, and
20 percent of the discharges were transferred to further treatment.
Treatment Completion by Type of Treatment Service
The treatment completion rate was 42 percent among discharges aged 12 years and older from all treatment service types combined. For the individual service types, treatment was completed by [Table 9.1]:
76 percent of discharges from hospital residential treatment,
62 percent of discharges from detoxification,
52 percent of discharges from short-term residential treatment,
44 percent of discharges from medication-assisted opioid detoxification, and
14 percent of discharges from outpatient medication-assisted opioid therapy.
Median Length of Stay (LOS)
The median LOS in treatment among discharges aged 12 years and older, by type of treatment service, was [Table 9.1]:
78 days for discharges from outpatient medication-assisted opioid therapy,
57 days for discharges from outpatient treatment,
42 days for discharges from intensive outpatient treatment,
42 days for discharges from long-term residential treatment, and
5 days for discharges from medication-assisted opioid detoxification.
Treatment Admissions per 100,000 Population, by State or Jurisdiction
In 2018, the ratio of treatment admissions per 100,000 population was higher for primary opiates than for primary use of alcohol. The admission ratio for primary opiates was 242 per 100,000 population aged 12 years and older, compared with 212 per 100,000 population for primary alcohol use. The ratio for primary marijuana/hashish use admissions was 85 per 100,000 population aged 12 years and older, and the ratio for methamphetamine/amphetamines admissions was 74 per 100,000 population aged 12 years and older [Table 6.2b and Figures 6–12].
Heroin and alcohol were the most frequently reported primary substances used among admissions in most Census divisions [Table 6.2b].
In 24 of the 50 reporting states and jurisdictions, the ratio of admissions per 100,000 population aged 12 years and older was higher for primary alcohol use than for primary opiate use. The following states had an admission ratio for primary use of a non-opiate substance which was greater than that for primary alcohol use: Alabama and North Carolina (marijuana/hashish); Arkansas, California, Hawaii, Idaho, Kansas, Kentucky, Nevada, North Dakota, Oklahoma, and Utah (methamphetamine/amphetamines) [Table 6.2b and Figures 6–12].
Reason for Discharge and Treatment Completion by State or Jurisdiction
In 23 of 48 states and jurisdictions, treatment completion rates were less than 42 percent [Table 19.3b].
Among discharges that completed treatment, the median length of stay in long-term residential treatment was 75 days; among discharges that completed intensive outpatient treatment, the median length of stay was 82 days. In six states, clients stayed in long-term residential treatment for a median of four months or longer (ranging between 123 and 181 days) [Table 20.1].
The median length of stay for discharges that completed outpatient medication-assisted opioid therapy was 143 days; in five states, clients stayed in treatment for a median of nine months or longer (ranging between 272 and 559 days) [Table 20.1].
2These drugs include non-prescription methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.
Chapter 1. Characteristics of Admissions: 2018
All Admissions Aged 12 Years and Older
The tables associated with this chapter present data on the characteristics of all admissions in 2018 aged 12 years and older, by primary substance use.
Opiates were the most frequently reported primary substances in 2018, accounting for 34 percent of all admissions aged 12 years and older [Table 1.1b].
In 2018, 76 percent of admissions aged 15 to 17 years were for primary marijuana/hashish use [Table 3.2b].
The average age for all admissions was 37 years; 6 percent of admissions were aged 12 to 20 years [Tables 2.1a–b].
Whites represented 67 percent of all admissions aged 12 years and older (41 percent were male and 26 percent were female). Blacks or African Americans represented 20 percent of all admissions (14 percent were male and 6 percent female) [Table 2.3b].
Among all admissions aged 12 years and older, 86 percent were not of Hispanic or Latino origin (55 percent were male and 32 percent female) [Table 2.3b].
Of all admissions, 41 percent reported no prior treatment episodes, 20 percent had one prior treatment episode, and 15 percent had five or more previous treatment episodes [Table 2.7b].
The two largest sources of referrals to treatment were self- or individual referrals (44 percent) and the courts/criminal justice system (27 percent) [Table 2.8b].
Most admissions (65 percent) received ambulatory treatment, 18 percent received detoxification (free-standing residential or hospital inpatient) treatment, and 17 percent received rehabilitation/ residential treatment [Table 2.9b].
Chapter 2. Type of Treatment Services: 2018
TEDS records the type of service to which clients are admitted for treatment. The major categories are broadly defined as ambulatory, rehabilitation/residential, and detoxification. In this report, admissions for which medication-assisted opioid therapy (i.e., therapy using methadone, buprenorphine, and/or naltrexone) was planned have been categorized as a separate type of treatment service.
Table 4.1c shows the type of treatment service received by primary substance used.
Ambulatory treatment services accounted for 52 percent of all admissions (41 percent in outpatient treatment and 11 percent in intensive outpatient treatment). Admissions for marijuana/ hashish (88 percent), methamphetamines/amphetamines (62 percent), sedatives (58 percent), cocaine (56 percent), and alcohol (53 percent) received ambulatory treatment services in greater proportion than all admissions combined.
Detoxification services accounted for 18 percent of all admissions (14 percent in free-standing residential treatment, 3 percent in hospital inpatient treatment, and less than 1 percent in ambulatory treatment). Among admissions for tranquilizers, 29 percent received detoxification, whereas 2 percent of marijuana/hashish admissions received detoxification.
Rehabilitation/residential treatment accounted for 15 percent of all admissions (9 percent in short-term treatment, 6 percent in long-term treatment, and less than 1 percent in hospital inpatient treatment). A greater proportion of admissions for cocaine, methamphetamine/amphetamines, tranquilizers, and alcohol (28, 26, 20, and 17 percent, respectively) received rehabilitation/ residential treatment services than among all admissions combined (15 percent).
Planned medication-assisted opioid therapy accounted for about 15 percent of all admissions (13 percent in outpatient treatment, 1 percent in detoxification treatment, and 2 percent in residential treatment). Medication-assisted opioid therapy was planned for 39 percent of primary opiate admissions.
Chapter 3. Trends in Substance Use Treatment Admissions Aged 12 Years and Older: 2008–2018
This chapter details trends in the annual numbers and rates of admissions aged 12 years and older between 2008 and 2018. Trend data are valuable for monitoring changing patterns in substance use treatment admissions.
Trends in Primary Substance Use: 2008–2018
Tables 1.1a–b and Figure 1. The number of all admissions aged 12 years and older decreased from 2,054,398 in 2008 to 1,935,541 in 2018. Between 2008 and 2018, five substance groups accounted for between 91 and 96 percent of the primary substances reported among treatment admissions aged 12 years and older: alcohol, opiates, marijuana/hashish, cocaine, and methamphetamine/amphetamines. However, the proportions of admissions by primary substance used changed considerably during the period for most substances.
Figure 1. Primary substance use at admission: 2008–2018
SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19.
Trends in Co-occurring Alcohol and Drug Use
Table 1.2. The concurrent use of alcohol and drugs continues to be a significant problem. Because TEDS collects a maximum of three substances used, rather than all substances used, alcohol use among polydrug users may be underreported.
Trends in Demographic Characteristics
Table 1.3b and Figure 2.Males represented 68 percent of admissions aged 12 years and older in 2008 and 64 percent in 2018. In 2018, 49 percent of the U.S. population aged 12 years and older was male.
The proportion of admissions aged 12 to 20 years decreased from 14 percent in 2008 to 6 percent in 2018.
The proportion of admissions aged 25 to 34 years increased from 26 percent in 2008 to 34 percent in 2018.
The proportion of admissions aged 50 years and older increased from 12 percent in 2008 to 19 percent in 2018.
Figure 2. Age at admission: TEDS 2008–2018 and U.S. population 2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. Population: U.S. Census Bureau, NC-EST2018-ALLDATA: Monthly Population Estimates by Age, Sex, Race, and Hispanic Origin for the United States: 20, June, 2019.
Table 1.4 and Figure 3.The racial and ethnic composition of admissions aged 12 years and older between 2008 and 2018 was as follows:
Whites increased from 65 percent of admissions in 2008 to 67 percent of admissions in 2018.
Blacks or African Americans declined from 22 percent of admissions in 2008 to 20 percent of admissions in 2018.
Admissions of Hispanic or Latino origin comprised between 14 and 15 percent of all admissions in each year between 2008 and 2018.
Admissions that were not of Hispanic or Latino origin comprised between 85 and 86 percent of all admissions in each year between 2008 and 2018.
Figure 3. Race of admissions: TEDS 2008–2018 and U.S. population 2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. Population: U.S. Census Bureau, NC-EST2018-ALLDATA: Monthly Population Estimates by Age, Sex, Race, and Hispanic Origin for the United States: 20, June, 2019.
Figure 4. Ethnicity of admissions: TEDS 2008–2018 and U.S. population 2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. Population: U.S. Census Bureau, NC-EST2018-ALLDATA: Monthly Population Estimates by Age, Sex, Race, and Hispanic Origin for the United States: 20, June, 2019.
Trends in Employment Status
Table 1.5a and Figure 5. Between 2008 and 2018, the proportion of admissions aged 18 years and older that were employed ranged between 22 and 29 percent; 62 percent of the U.S. population aged 18 years and older was employed in 2018.
Between 2008 and 2018, the proportion of admissions aged 18 years and older that were unemployed ranged between 37 and 42 percent.
Between 2008 and 2018, the proportion of admissions aged 18 years and older that were not in the labor force ranged between 34 and 38 percent.
In 2018, the proportion of admissions aged 18 years and older that were employed was
26 percent, whereas 62 percent of the U.S. population aged 18 years and older was employed.
In 2018, the proportion of admissions aged 18 years and older that were unemployed was
38 percent, whereas 2 percent of the U.S. population aged 18 years and older was unemployed.
In 2018, the proportion of admissions not in the labor force was 35 percent, similarly 36 percent of the U.S. population aged 18 years and older was not in the labor force.
Table 1.5b presents admissions aged 18 years and older per 100,000 population and employment status adjusted for age, gender, race, and ethnicity to the 2010 U.S. population.
The adjusted ratio of admissions that were employed declined from 213 per 100,000 population in 2008 to 168 per 100,000 population in 2018.
The adjusted ratio of admissions that were not in the labor force declined from 253 per 100,000 population in 2008 to 224 per 100,000 population in 2018.
Figure 5. Employment status among admissions aged 18 years and older: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. Employment: Bureau of Labor Statistics, Labor force Statistics from the Current Population Survey, retrieved February 14, 2020 from https://www.bls.gov/cps/cps_aa2018.htm.
Chapter 4. Treatment Admissions Aged 12 Years and Older, by State or Jurisdiction, Primary Substance Use, and Selected Characteristics: 2008–2018
The tables associated with this chapter present data on substance use treatment admissions aged 12 years and older between 2008 and 2018 by state or jurisdiction, primary substance use, and selected demographic characteristics.
As noted previously, comparisons among states and jurisdictions should be made with caution. Many factors affect comparability (e.g., facilities included, clients included, ability to track multi-service episodes, services offered, and completeness and timeliness of reporting). See Appendix A for a full discussion.
Tables 7.1a–7.50b present, for each state or jurisdiction that reported admissions to TEDS for 2018, the number and percentage distribution of admissions aged 12 years and older, by demographic characteristics (gender, age group, and race) and by primary substance.
The choropleth maps of the United States that comprise Figures 6–12 present, for each primary substance, admissions per 100,000 population between 2008 and 2018. The color palette and data in these maps are divided into five equal-sized parts, or quintiles [Tables 5.2b–5.8b].
Figure 6. Primary alcohol admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.2b for population sources.
Figure 7. Primary marijuana/hashish admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.3b for population sources.
Figure 8. Primary cocaine admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.4b for population sources.
Figure 9. Primary methamphetamine/amphetamine admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.5b for population sources.
Figure 10. Primary opiates (heroin and non-heroin) admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.6b for population sources.
Figure 11. Primary heroin admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.7b for population sources.
Figure 12. Primary non-heroin opiates/synthetics admissions per 100,000 population aged 12 years and older, by state or jurisdiction: 2008–2018
SOURCES: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19. See Table 5.8b for population sources.
Chapter 5. Discharge Data Overview for All Types of Treatment Services: 2018
Tables 18.2a–b present the type of treatment service at discharge, by state or jurisdiction, for 2018 discharges. There was considerable state-to-state variability in the combination of types of treatment services available and in the proportions discharged from each.
Figure 13 illustrates the distribution of 2018 discharges among various types of treatment services. The majority were discharged from a type of outpatient treatment service; 43 percent from outpatient treatment and 12 percent from intensive outpatient treatment. In addition, 16 percent were discharged from detoxification, 10 percent from short-term residential treatment, 7 percent from long-term residential treatment, 12 percent from medication-assisted opioid therapy or detoxification, and less than 1 percent from hospital residential treatment.
Figure 13. Type of treatment service at discharge: 2018
SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19.
Reason for Discharge by Type of Treatment Service
Table 9.1 and Figure 14 present the reason for discharge by type of treatment service. Note that in Table 9.1 and Figure 14, the other category includes data for death and incarceration; in Tables 19.3a through 19.5b, death and incarceration are shown separately.
Among all discharges in 2018, 42 percent completed treatment. Another 20 percent were transferred to further substance use treatment.
By type of treatment service, completion was reported in greatest proportion among discharges from hospital residential treatment (76 percent) and detoxification (62 percent).
Treatment dropout was reported in greatest proportion among discharges from outpatient medication-assisted opioid therapy (36 percent) followed by intensive and non-intensive outpatient treatment (26 percent).
Figure 14. Reason for discharge, by type of treatment service: 2018
SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19.
Median Length of Stay (LOS) by Type of Treatment Service and Reason for Discharge
Table 9.1.
The median length of stay (LOS) was longest for discharges from outpatient medication-assisted opioid therapy (78 days) and outpatient treatment (57 days).
The median LOS was shortest for discharges from detoxification (four days) and medication-assisted opioid detoxification (five days).
Figure 15.
The median LOS for discharges that completed treatment was longer than or equal to those that did not complete treatment, across all types of treatment service.
The median LOS among discharges that completed treatment was 143 days for outpatient medication-assisted opioid therapy, 82 days for intensive outpatient treatment, 75 days for long-term residential treatment, 71 days for outpatient treatment, 25 days for short-term residential treatment, 19 days for hospital residential treatment, seven days for medication-assisted opioid detoxification, and four days for detoxification.
Figure 15. Median length of stay (LOS), by reason for discharge and type of treatment service: 2018
MAOT = Medication-assisted opioid therapy.
SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 11.18.19.
Socio-Demographic and Substance Use Characteristics at Time of Admission
Tables 9.2a–b, 9.4a–b, and 9.6a–b summarize the number and percent distribution of characteristics at admission, by type of treatment service, for all discharges. Summary findings of the admission characteristics of all discharges combined include the following:
Males accounted for 64 percent of all discharges [Table 9.2b].
Of all discharges, 6 percent were aged 12 to 20 years at the time of admission, 18 percent were 25 to 29 years of age, and 18 percent were aged 50 years or older [Table 9.2b].
Whites accounted for 69 percent of all discharges and Blacks or African Americans accounted for 18 percent of all discharges [Table 9.2b].
Discharges of Hispanic or Latino origin accounted for 13 percent of all discharges [Table 9.2b].
Prior to the current episode, 61 percent of all discharges had at least one prior treatment episode [Table 9.2b].
Self- or individual referrals accounted for 44 percent of all discharges; 27 percent were referred to treatment through a criminal justice/DUI source [Table 9.2b].
Of discharges aged 18 years and older, 76 percent reported completing at least Grade 12 or a GED [Table 9.6b].
Treatment Completion
Tables 9.8a–b through 9.13a–b. Some general observations can be made about the characteristics at admission of episodes that resulted in treatment completion:
Of discharges aged 18 years and older, the treatment completion rate was 34 percent among those that completed between Grades 9 and 11; however, among those with four years of college, university, technical school, or a bachelor’s degree, the treatment completion rate was 48 percent [Table 9.12b].
The treatment completion rate among discharges aged 12 to 17 years, by primary substance use at admission, was highest for alcohol (44 percent); the next highest completion rates were for marijuana/hashish (36 percent) and opiates (35 percent) [Table 9.10b]. The treatment completion rates among discharges aged 18 years and older, by primary substance use at admission, were highest for alcohol (53 percent) followed by marijuana/hashish and stimulants (37 percent) [Table 9.12b].
The treatment completion rate was higher among discharges aged 18 years and older that reported being employed full-time at admission (46 percent) than among those that reported being unemployed or not in the labor force at admission (33 and 43 percent, respectively) [Table 9.12b].
The treatment completion rate was highest among American Indians or Alaska Natives (62 percent) followed by Asians (46 percent) and Whites (40 percent) [Table 9.8b].
Discharges of Hispanic or Latino origin completed treatment at a higher rate (44 percent) than discharges not of Hispanic or Latino origin (40 percent) [Table 9.8b].
Chapter 6. Treatment Discharges Aged 12 Years and Older, by Reason for Discharge and by State or Jurisdiction: 2018
The tables associated with this chapter present data on substance use treatment discharges in 2018 for admissions aged 12 years and older, by reason for discharge and by state or jurisdiction.
Tables 10.1–17.1 present, for each state or jurisdiction that reported discharges in 2018, the reason for discharge from outpatient treatment [Table 10.1], intensive outpatient treatment [Table 11.1], short-term residential treatment [Table 12.1], long-term residential treatment [Table 13.1], hospital residential treatment [Table 14.1], detoxification [Table 15.1], outpatient medication-assisted opioid therapy [Table 16.1], and medication-assisted opioid detoxification [Table 17.1].
Tables 18.1a–b through 25.2 present discharge information by state or jurisdiction.
Appendix A. About the Treatment Episode Data Set (TEDS)
This report presents results from the Treatment Episode Data Set (TEDS) on the demographic and substance use characteristics of admissions to substance use treatment, and for discharges from substance use treatment. The Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages the collection of TEDS data from the states and jurisdictions.
TEDS is a compilation of client-level data routinely collected by the individual state administrative data systems to monitor their substance use treatment systems. Generally, facilities that are required to report to the state substance abuse agency (SSA) are those that receive public funds and/or are licensed or certified by the SSA to provide substance use treatment (or are administratively tracked for other reasons).
The TEDS system comprises two major components: the Admissions Data Set and the Linked Discharge Data Set. The TEDS Admission Data Set includes client-level data on substance use treatment admissions from 1992 through the present. The TEDS Linked Discharge Data Set includes discharges that can be linked at a record level to admissions; it includes information from clients discharged in 2000 and later. For both data sets, selected data items from the individual state data files are converted to a standardized format consistent across states. These standardized data constitute TEDS.
The TEDS Admission Data Set consists of a Minimum Data Set of items collected by all states, and a Supplemental Data Set where individual data items are reported at the state’s option. The Minimum Data Set consists of 19 items that include:
demographic information
primary, secondary, and tertiary substances and their route of administration, frequency of use, and age at first use
source of referral to treatment
number of prior treatment episodes
type of treatment service, including planned use of medication-assisted opioid therapy
The Supplemental Data Set items include psychiatric, social, and economic measures. Some items from the Supplemental Data Set are included in the Linked Discharge Data Set to explore how the status changes between admission and discharge.
The TEDS Linked Discharge Data Set was designed to enable TEDS to collect information on entire treatment episodes. Discharge data, when linked to admission data, represent treatment episodes that enable analyses of questions that cannot be answered with admission data alone. Examples are the proportion of discharges that completed treatment and the average length of stay (LOS) among treatment completers.
History
National-level data collection on admissions to substance use treatment was first mandated in 1972 under the Drug Abuse Office and Treatment Act, P.L. 92-255. This act initiated federal funding for drug treatment and rehabilitation and required reporting on clients entering drug (but not alcohol) abuse treatment. The Client-Oriented Data Acquisition Process (CODAP) was developed to collect admission and discharge data directly from federally funded drug treatment programs. (Programs for treatment of alcohol use were not included.) Reporting was mandatory for all such programs and data were collected using a standard form. CODAP included all clients in federally-funded programs regardless of individual funding source. Reports were issued from 1973 to 1981 based on data from 1,800 to 2,000 programs, including some 200,000 annual admissions.
In 1981, the collection of national-level data on admissions to substance use treatment was discontinued because of the introduction of the Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant. The block grant transferred federal funding from individual programs to the states for distribution, and it included no data reporting requirement. Participation in CODAP became voluntary; although several states submitted data through 1984, the data were in no way nationally representative.
In 1988, the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690) established a revised Substance Abuse Prevention and Treatment (SAPT) Block Grant and mandated federal data collection on clients receiving treatment for either alcohol or drug use. The Treatment Episode Data Set (TEDS) data collection effort represents the federal response to this mandate. TEDS began in 1989 with the issue of three-year development grants to states.
State Data Collection Systems
TEDS is an exceptionally large and powerful data set that covers a significant proportion of all admissions to substance use treatment. TEDS is a compilation of data collected through the individual data collection systems of the state substance abuse agencies (SSAs) for substance use treatment. States have cooperated with the federal government in the data collection process, and substantial progress has been made toward developing a standardized data set. However, because each state system is unique, and each state has unique powers and mandates, significant differences exist among state data collection systems. These differences are compounded by evolving health care payment systems, and state-to-state comparisons must be made with extreme caution.
The number and client mix of TEDS admissions do not represent the total national demand for substance use treatment or the prevalence of substance use in the general population.
States differ widely in the amount of public funding available for substance use treatment and in the constraints placed on the use of funds. States may be directed to target special populations such as pregnant women or adolescents. Where funds are limited, states may be compelled to exercise triage in admitting persons to treatment, admitting only those with the most “severe” problems. In states with higher funding levels, a larger proportion of the population in need of treatment may be admitted, including the less severely impaired.
States may include or exclude reporting by certain sectors of the treatment population, and these sectors may change over time. For example, treatment programs based in the criminal justice system may or may not be administered through the SSA. Detoxification facilities, which can generate large numbers of admissions, are not uniformly considered treatment facilities and are not uniformly reported by all states.
Table A1 presents key characteristics of state data collection systems for 2018. However, these characteristics can change as state substance use treatment systems change, and thus may be responsible for some year-to-year variation within states.
Facilities included. The scope of facilities included in TEDS is affected by differences in state licensure, certification, and accreditation practices, and disbursement of public funds. Most SSAs require facilities that receive state/public funding (including federal block grant funds) for the provision of alcohol and/or drug treatment services to report data to the SSA. Generally, this funding is distributed by the SSA, but may be distributed by another public agency.
Some SSAs regulate private facilities, methadone clinics, and/or individual practitioners and require them to report TEDS data. Others do not because of the difficulty in obtaining data from these facilities, although these facilities may report voluntarily. Facilities operated by federal agencies (e.g., the Bureau of Prisons, the Department of Defense, and the Department of Veterans Affairs) generally do not report TEDS data to the SSA, although some facilities operated by the Indian Health Service are included. Hospital-based substance use treatment facilities are frequently not licensed through the SSA and do not report TEDS data. Correctional facilities (state prisons and local jails) are monitored by the SSA and report TEDS data in some states but not in others.
The primary goal of TEDS is to monitor the characteristics of clients admitted to planned, continuing treatment regimens. Thus, early intervention and crisis intervention programs that do not lead to enrollment in continued treatment are excluded from TEDS.
Clients included. About 56 percent of states reported data on all admissions to eligible facilities, although some reported only, or largely, admissions financed by public funds. TEDS is an admission-based system; therefore, TEDS admissions do not represent individuals. For example, an individual admitted to treatment twice within a calendar year is counted as two admissions.
Ability to track multi-service episodes. The goal for the TEDS system is to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different type of treatment service (e.g., from residential treatment to outpatient) within a single continuous treatment episode. Thus, TEDS records are ideally coded as admissions if they represent the initial treatment service in a treatment episode and as transfers if they represent a change in the type of treatment service or a change in provider without an interruption in treatment.
This requires, however, that clients be assigned unique IDs that can be linked across providers; not all states are legally and/or technologically able to do this. Most states can identify as transfers a change in the type of treatment service within the structure of a given provider; however, fewer can also identify a transfer involving a change of provider. Several states do not track transfers, but instead report as transfers those clients who are discharged and readmitted within a specified time period defined by each state.
Because some admission records, in fact, may represent transfers, the number of admissions reported probably overestimates the number of treatment episodes. Some states reported a limited data set on codependents of substance users entering treatment. On average, from 2007 through 2018, 89 percent of all records submitted were client admissions, 11 percent were client transfers, and less than 1 percent were codependents of substance users. For the linked discharges dataset, 86 percent of all records submitted were client admissions, 14 percent were client transfers, and less than 1 percent were codependents.
Services offered. A state’s mix of types of treatment service (e.g., outpatient, detoxification, residential, opioid therapy) can have a significant effect on its admission rate. There is higher client turnover and therefore more admissions in short-stay services such as detoxification than in long-stay services such as outpatient or long-term residential treatment. Admission rates for individual substances used may be affected as well (e.g., detoxification is more closely associated with alcohol or heroin use than with the use of other substances).
Completeness and timeliness of reporting. SAMHSA, in reporting national-level TEDS data, must balance timeliness of reporting and completeness of the data set. There may be a time lag in the publication of SAMHSA’s annual report because preparation cannot begin until states have completed their data submission for that year. States, in turn, rely on individual facilities to report in a timely manner so they can submit TEDS data to SAMHSA at regular intervals.
Admissions from facilities that report late to the states will appear in a later data submission to SAMHSA, so the number of annual admissions in a report may be higher in subsequent reports. The number of additional admissions is small because of the time lag in issuing the report. Thus the percentage distributions will change very little in subsequent reports, although Census division- and state-level data may change somewhat more for states with reporting delays.
States continually review and improve their data collection and processing. When systematic errors are identified, states may revise or replace historical TEDS data files. While this process represents an improvement in the data system, the historical statistics in this report will differ slightly from those in earlier reports. Therefore, public use files differ from year to year, making it difficult to replicate corresponding year reports.
Several states reported significant decreases in the total number of TEDS admissions due to Medicaid expansion. Furthermore, some states are experiencing system challenges and were unable to report admissions aged 12–17 years.
Tables A2 and A3 indicate the proportions of records by state or jurisdiction for which valid data were received for 2018. States are expected to report all variables in the Minimum Data Set (Table A2). Variables in the Supplemental Data Set are collected at each state’s option (Table A3).
Tables A4 and A5 indicate the proportions of records for which valid discharge data were received in 2018.
Table A6 indicates the denominators for computing per 100,000 population estimates in 2018.
Table A7 indicates the denominators for computing per 100,000 population estimates for employment status (Table 1.5b) in 2018.
Report-Specific Considerations
National substance use treatment admissions
This section of the report focuses on treatment admissions for substance use. Treatment admissions for codependents of substance use clients are excluded. Records for identifiable transfers within a single treatment episode are also excluded.
Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable other than primary, secondary, or tertiary substance, those records are excluded from tabulations of that variable. For substance use variables (primary, secondary, and tertiary), unless otherwise noted, the category “other/none specified” consists of none, other stimulants, over-the-counter medications, other drugs, and responses that were missing, unknown, not collected, and invalid. The total number of admissions on which a percentage distribution is based is reported in each table. The proportion of admissions for which the primary substance was “none reported” increased in 2017 and 2018. The reason for this increase in 2017 and 2018 is primarily due to data processing changes in Washington state. Similarly, in 2018, Arizona cannot ascertain primary, secondary, and tertiary substance use, because the state agency is unable to obtain such information from Medicaid claims.
The primary, secondary, and tertiary substance reported to TEDS are those substances that led to the treatment episode and not necessarily a complete enumeration of all drugs used at the time of admission.
Primary alcohol admissions are classified as alcohol only or alcohol with secondary drug use. The latter indicates a primary alcohol admission with a specified secondary and/or tertiary drug. All other primary alcohol admissions are classified as alcohol only.
Cocaine admissions are classified according to route of administration as smoked and other routes. Smoked cocaine primarily represents crack or rock cocaine, but can also include cocaine hydrochloride (powder cocaine) when it is free-based. Non-smoked cocaine includes all cocaine admissions where cocaine is injected, inhaled, or taken orally; it also includes admissions where the route of administration is unknown or not collected. Thus, the TEDS estimate of admissions for smoked cocaine is conservative.
Methamphetamine/amphetamine admissions include admissions for both substances, but are primarily for methamphetamine. In 2018, methamphetamine constituted about 96 percent of combined methamphetamine/amphetamine admissions.
National substance use treatment discharges
This section of the report focuses on treatment for substance use according to the type of treatment service. Thus, treatment admissions for codependents of substance use clients are excluded. Records for identifiable transfers within a single treatment episode are included.
Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable other than primary, secondary, or tertiary substance, those records are excluded from tabulations of that variable. For substance use variables (primary, secondary, and tertiary), unless otherwise noted, the category “other/none specified” consists of none, other stimulants, over-the-counter medications, other drugs, and responses that were missing, unknown, not collected, and invalid. The total number of discharges on which a percentage distribution is based is reported in each table.
Records with missing reason for discharge are excluded from this section of the report.
The total number of records on which a percentage distribution is based is reported in each table.
The primary, secondary, and tertiary substances reported to TEDS are those substances that led to the treatment episode and not necessarily a complete enumeration of all drugs used at the time of admission.
Stimulant admissions include methamphetamine, amphetamines, and other stimulants. However, most of these admissions are for methamphetamine or amphetamine abuse.
The data presented in this section of the report focus on treatment for substance use within the type of treatment service. They do not represent complete treatment episodes, as a single episode may involve stays in more than one type of treatment service. States are asked to submit a record for each initial admission to a treatment service, for each transfer from one service to another, and for a discharge corresponding to each admission or transfer.
The number of states reporting for treatment discharges shown in Tables 18.1 through 25.1 varies, because not all states reported discharges for every type of treatment service. The first table for each section of the discharge tables details the actual number of states reporting discharges from that type of treatment service.
Linkage of discharge records from 2018 to admission records from 2000 to 2018 means that the maximum length of stay (LOS) in treatment included in this report is 19 years. However, outpatient medication-assisted opioid therapy can have a much longer duration. Indeed, some admissions may receive this form of treatment indefinitely. Because this section includes data only on discharges, it will underestimate LOS in treatment for those receiving outpatient medication-assisted opioid therapy. Similarly, the number and proportion of treatment completers will reflect only those that have been discharged because treatment is complete and not those that successfully remain in long-term outpatient medication-assisted opioid therapy. In addition, the characteristics at admission of those admitted to and discharged from outpatient medication-assisted opioid therapy within 18 years may differ from those of admissions that remain in outpatient medication-assisted opioid therapy for longer than 18 years.
Age of first use (primary, secondary, and tertiary substance)
For drugs other than alcohol, these fields identify the age at which the client first used the respective substance. For alcohol, these fields record the age of first intoxication.
0—Indicates a newborn with a substance dependency disorder
1-95—Indicates the age at first use
Client or codependent/collateral
Specifies whether the admission record is for a substance use treatment client, or a person being treated for his/her codependency or collateral relationship with a substance user.
Client—Must meet all of the following criteria:
Has an alcohol or drug related disorder
Has completed the screening and intake process
Has been formally admitted for treatment or recovery service in an alcohol or drug treatment unit
Has his or her own client record
A person is not a client if he or she has completed only a screening or intake process or has been placed on a waiting list.
Codependent/collateral—Must meet all of the following criteria:
Has no alcohol or drug related disorder
Is seeking services because of concerns arising from his or her relationship with an alcohol or drug user
Has been formally admitted for service to a treatment unit
Has his or her own client record or has a record within a primary client record
Guidelines: Reporting of data for Codependent/collaterals is optional. If the state opts to report codependent/collateral clients, the mandatory fields are State code, Provider identifier, Client identifier, Client transaction type, Codependent/collateral, and Date of admission. Reporting of the remaining fields in the TEDS Minimum and Supplemental Data Sets is optional. For all items not reported, the data field should be coded with the appropriate "Not collected" or "Not applicable" code.
If a substance use client with an existing record in TEDS becomes a codependent, a new client record should be submitted indicating that the client has been admitted as a codependent, and vice versa.
If a record does not include a value for this field, it is assumed to be a substance use client record.
Date of admission
The day when the client receives his or her first direct treatment or recovery service. For transfers, this is the date when client receives his or her first direct treatment after the transfer has occurred.
Demographics
Age
Identifies client's age at admission. Derived from client's date of birth and date of admission.
0—Indicates a newborn with a substance dependency disorder
1-95—Indicates the age at admission
Education
Specifies the highest school grade (number of school years) completed by the client.
0—Less than one grade completed
1-25—Years of school (highest grade) completed. For General Equivalency Degree, use 12.
Guidelines: States that use specific categories for designating education level should map their codes to a logical number of years of school completed. For Associate's Degree, use 14. For Bachelor's Degree, use 16.
Employment status
Identifies the client's employment status at the time of admission or transfer.
Full time—Working 35 hours or more each week, including active duty members of the uniformed services
Part time—Working fewer than 35 hours each week
Unemployed—Looking for work during the past 30 days, or on layoff from a job
Not in labor force—Not looking for work during the past 30 days, or a student, homemaker, disabled, retired, or an inmate of an institution. Clients in this category are further defined in the TEDS Supplemental Data Set item Detailed not in labor force.
Guidelines: Seasonal workers are coded in this category based on their employment status at admission.
Ethnicity
Identifies client's specific Hispanic origin.
Cuban—Of Cuban origin, regardless of race
Hispanic (specific origin not specified)—Of Hispanic origin, but specific origin not known or not specified
Mexican—Of Mexican origin, regardless of race
Not of Hispanic origin
Other specific Hispanic—Of known Central or South American or any other Spanish cultural origin (including Spain), other than Puerto Rican, Mexican, or Cuban, regardless of race
Puerto Rican—Of Puerto Rican origin, regardless of race
Guidelines: If a state does not collect specific Hispanic detail, code Ethnicity for Hispanics as Hispanic (specific origin not specified).
Race
Specifies the client's race.
Alaska Native (Aleut, Eskimo, Indian)—Origins in any of the original people of Alaska
American Indian (other than Alaska Native)—Origins in any of the original people of North America and South America (including Central America) and who maintain cultural identification through tribal affiliation or community attachment
Asian or Pacific Islander—Origins in any of the original people of the Far East, the Indian subcontinent, Southeast Asia, or the Pacific Islands
Asian—Origins in any of the original people of the Far East, the Indian subcontinent, or Southeast Asia, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Philippine Islands, Thailand, and Vietnam
Native Hawaiian or Other Pacific Islander—Origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands
Black or African American—Origins in any of the black racial groups of Africa
White—Origins in any of the original people of Europe, North Africa, or the Middle East
Other single race—Client is not classified in any category above or whose origin group, because of area custom, is regarded as a racial class distinct from the above categories
Two or more races—For use when the state data system allows multiple race selection and more than one race is indicated
Guidelines: If a state does not distinguish between American Indian and Alaska Native, both should be coded as American Indian. If a state does not distinguish between Asian and Native Hawaiian or other Pacific Islander, both should be coded as Asian or Pacific Islander. For states that collect multiple races: a) when a single race is designated, the specific race code should be used; b) if the state collects a primary or preferred race along with additional races, the code for the primary/preferred race should be used; c) if the state uses a system such as an algorithm to select a single race when multiple races have been designated, the same system may be used to determine the race code for TEDS. When two or more races have been designated and neither
(b) nor (c) above apply, the TEDS code for Two or more races should be used.
Gender
Identifies the client’s biological sex.
Male
Female
Substance Use and Treatment Characteristics
Frequency of use (primary, secondary, and tertiary substances)
Identifies the frequency of use for the client’s primary, secondary, and tertiary substance use.
No use in the past month
1-3 times in the past month
1-2 times in the past week
3-6 times in the past week
Daily
Medication-assisted opioid therapy
Identifies whether the use of methadone, naltrexone, or buprenorphine is part of the client’s treatment plan.
Yes
No
Number of prior treatment episodes
Indicates the number of previous treatment episodes the client has received in any drug or alcohol program. Changes in service for the same episode (transfers) should not be counted as separate prior episodes.
0 previous episodes
1 previous episode
2 previous episodes
3 previous episodes
4 previous episodes
5 or more previous episodes
Guidelines: It is preferred that the number of prior treatments be a self-reporting field collected at the time of client intake. However, this data item may be derived from the state data system if the system has that capability and episodes can be counted for at least several years.
Principal source of referral
Describes the person or agency referring the client to the alcohol or drug use treatment program.
Individual (includes self-referral)—Includes the client, a family member, friend, or any other individual who would not be included in any of the following categories; includes self-referral due to pending DWI/DUI
Alcohol/drug use care provider—Any program, clinic, or other health care provider whose principal objective is treating clients with substance use disorder, or a program whose activities are related to alcohol or other drug use prevention, education, or treatment
Court/criminal justice referral/DUI/DWI—Any police official, judge, prosecutor, probation officer, or other person affiliated with a federal, state, or county judicial system. Includes referral by a court for DWI/DUI, clients referred in lieu of or for deferred prosecution, or during pretrial release, or before or after official adjudication. Includes clients on pre-parole, pre-release, work or home furlough, or TASC. Client need not be officially designated as “on parole.” Includes clients referred through civil commitment. Client referrals on this category are further defined in the TEDS Supplemental Data Set item Detailed criminal justice referral.
Employer/EAP—A supervisor or an employee counselor
Other community referral—Community or religious organization or any federal, state, or local agency that provides aid in the areas of poverty relief, unemployment, shelter, or social welfare. Self-help groups such as Alcoholics Anonymous (AA), Al-Anon, and Narcotics Anonymous (NA) are also included in this category. Defense attorneys are included in this category.
Other health care provider—A physician, psychiatrist, or other licensed health care professional; or a general hospital, psychiatric hospital, mental health program, or nursing home
School (educational)—A school principal, counselor, or teacher; or a student assistance program (SAP), the school system, or an educational agency
Substance use (primary, secondary, or tertiary)
Identifies the client’s primary, secondary, and tertiary substance use. Each Substance use (primary, secondary, and tertiary) has associated fields for Route of administration, Frequency of use, Age at first use, and the TEDS Supplemental Data Set item Detailed drug code.
Alcohol
Barbiturates—Amobarbital, pentobarbital, phenobarbital, secobarbital, etc.
Benzodiazepines—Includes alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, flunitrazepam, flurazepam, halazepam, lorazepam, oxazepam, prazepam, temazepam, triazolam, and other unspecified benzodiazepines
Cocaine/crack
Heroin
Inhalants—Includes chloroform, ether, gasoline, glue, nitrous oxide, paint thinner, etc.
Marijuana/hashish—Includes THC and any other cannabis sativa preparations
Methamphetamine
Non-prescription methadone
Other amphetamines—Includes amphetamines, MDMA, phenmetrazine, and other unspecified amines and related drugs
Other hallucinogens—Includes LSD, DMT, STP, hallucinogens, mescaline, peyote, psilocybin, etc.
Other non-barbiturate sedatives or hypnotics—Includes chloral hydrate, ethchlorvynol, glutethimide, methaqualone, and other non-barbiturate sedatives or hypnotics
Other non-benzodiazepine tranquilizers—Includes meprobamate and other non-benzodiazepine tranquilizers
Other opiates and synthetics—Includes buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects
Other stimulants—Includes methylphenidate and any other stimulants
Over-the-counter medications—Includes aspirin, cough syrup, diphenhydramine and other antihistamines, sleep aids, and any other legally obtained nonprescription medication
PCP—Phencyclidine
Other—Includes diphenylhydantoin/phenytoin, GHB/GBL, ketamine, etc.
None
Guidelines: Substance use are further defined in the TEDS Supplemental Data Set item Detailed drug code. For guidance on which specific substances to include in the substance categories, please refer to the detailed drug categories listed for Detailed drug code.
Data set considerations for Substance use and Route of administration:
For states that do collect Detailed drug code—Records may have duplicate Substance use and identical Route of administration if the corresponding Detailed drug codes are different or are ''multiple'' drug codes.
For states that do not collect Detailed drug code—A record may not have duplicate Substance use with identical Routes of administration.
Transaction type
Identifies whether a record is for an initial admission or a transfer/change in service. Note: Some states may use other terminology such as "initial admission" and "transfer admission" in place of "admission" and "transfer."
A—Admission
T—Transfer/change in service
Guidelines: For TEDS, a treatment episode is defined as that period of service between the beginning of treatment for drug or alcohol use and the termination of services for the prescribed treatment plan. The episode includes one admission (when services begin) and at least one discharge (when services end). Within a treatment episode, a client may transfer to a different service, facility, provider, program, or location. Each admission and transfer record should have an associated discharge record.
When it is feasible for the state to identify transfers, they should be reported as transfers in admissions data submissions. When admissions and transfers cannot be differentiated in a state data system, such changes in service or facility should be reported to TEDS as admissions.
Data set considerations for transfers:
All fields from the transfer record should be updated to reflect values at the time of transfer except the following fields, which must have the same values as in the associated (preceding) admission record: Client ID, Codependent/collateral, Date of birth, Sex, Race, and Ethnicity. If a field cannot be updated, it should be transmitted to TEDS with its value from the associated (preceding) admission record.
Date of admission is defined as the date services begin after the transfer to another service or facility.
Type of treatment service
Describes the type of service and treatment setting in which the client is placed at the time of admission or transfer.
Ambulatory, detoxification—Outpatient treatment services providing for safe withdrawal in an ambulatory setting (pharmacological or non-pharmacological)
Ambulatory, intensive outpatient—As a minimum, the client must receive treatment lasting two or more hours per day for three or more days per week
Ambulatory, non-intensive outpatient—Ambulatory treatment services including individual, family, and/or group services, and may include pharmacological therapies
Detoxification, 24-hour service, free-standing residential—24-hour per day services in a non-hospital setting providing for safe withdrawal and transition to ongoing treatment
Detoxification, 24-hour service, hospital inpatient—24-hour per day medical acute care services in a hospital setting for detoxification of persons with severe medical complications associated with withdrawal
Rehabilitation/residential, hospital (other than detoxification)—24-hour per day medical care in a hospital facility in conjunction with treatment services for alcohol and other drug use and dependency
Rehabilitation/residential, short-term (30 days or fewer)—Typically, 30 days or less of non-acute care in a setting with treatment services for alcohol and other drug use and dependency
Rehabilitation/residential, long-term (more than 30 days)—Typically, more than 30 days of non-acute care in a setting with treatment services for alcohol and other drug use and dependency; this may include transitional living arrangements such as halfway houses
Usual route of administration (primary, secondary, and tertiary substances)
These fields identify the usual route of administration of the respective substance use.
Inhalation
Injection (IV or intramuscular)
Oral
Smoking
Other
TEDS Supplemental Data Set
Days waiting to enter treatment
Indicates the number of days from the first contact or request for service until the client was admitted and the first clinical service was provided.
0-996—Number of days waiting
Guidelines: This item is intended to capture the number of days the client must wait to begin treatment because of program capacity, treatment availability, admissions requirements, or other program requirements. It should not include time delays caused by client unavailability or client failure to meet any requirement or obligation.
Detailed criminal justice referral
Provides more information about those clients who are coded as "Court/criminal justice referral/DUI/DWI" in the TEDS Minimum Data Set item Principal source of referral.
Diversionary program (e.g., TASC)
DUI/DWI
Other court (not state or federal)
Other recognized legal entity (e.g., local law enforcement agency, corrections agency, youth services, review board/agency)
Prison
Probation/parole
State/federal court
Other
Not applicable
Detailed drug code (primary, secondary, and tertiary substances)
Identifies, in greater detail, the drug use recorded in the TEDS Minimum Data Set item Substance use.
Provides more information about these clients who are coded as "Not in labor force" in the TEDS Minimum Data Set item Employment status.
Disabled
Homemaker
Inmate of institution (prison or institution that keeps a person, otherwise able, from entering the labor force)
Retired
Student
Other
Not applicable
DSM criteria diagnosis
Specifies the diagnosis of the substance use disorder from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Expected/actual primary source of payment
Identifies the primary source of payment for this treatment episode.
Blue Cross/Blue Shield
Medicaid
Medicare
Other government payments
Other health insurance companies
Self-pay
Worker's compensation
No charge (free, charity, special research, or teaching)
Other
Frequency of attendance at self-help programs
Records the number of times the client has attended a self-help program in the 30 days preceding the date of admission to treatment services.
No attendance in the past month
1-3 times in the past month
4-7 times in the past month
8-15 times in the past month
16-30 times in the past month
Some attendance in the past month, but frequency unknown
Health insurance
Specifies the client's health insurance (if any). The insurance may or may not cover alcohol or drug treatment.
Blue Cross/Blue Shield
Health maintenance organization (HMO)
Medicaid
Medicare
Private insurance (other than Blue Cross/Blue Shield or an HMO)
Other (e.g., TRICARE)
None
Living arrangements
Specifies whether the client is homeless, living with parents, in a supervised setting, or living on his or her own.
Dependent living—Clients living in a supervised setting such as a residential institution, halfway house, or group home, and children (under age 18) living with parents, relatives, or guardians, or in foster care
Homeless—Clients with no fixed address; includes shelters
Independent living—Clients living alone or with others without supervision
Marital status
Describes the client's marital status. The following categories are compatible with the U.S. Census.
Divorced
Never married—Includes clients whose only marriage was annulled
Now married—Includes those living together as married
Separated—Includes those separated legally or otherwise absent from spouse because of marital discord
Widowed
Number of arrests in 30 days prior to admission
Records the number of arrests in the 30 days preceding the date of admission to treatment services.
00-96—Number of arrests
Pregnant at admission
Specifies whether the client was pregnant at the time of admission.
Yes
No
Not applicable—Use this code for male clients
Co-occurring mental and substance use disorders
Identifies whether the client has a psychiatric disorder in addition to his or her alcohol or drug use disorder.
Yes
No
Source of income/support
Identifies the client's principal source of financial support. For children under 18, this field indicates the parents' primary source of income/support.
Disability
Public assistance
Retirement/pension
Wages/salary
Other
None
Veteran status
Identifies whether the client has served in the uniformed services (Army, Navy, Air Force, Marines, Coast Guard, Public Health Service Commissioned Corps, Coast and Geodetic Survey, etc.).
Yes
No
TEDS Linked Discharge Data Set
Date of discharge
The date when the client was formally discharged from the treatment facility or service. The date may be the same as the date of last contact. In the event of a change of service or provider within an episode of treatment, it is the date the service terminated or the date the treatment ended at a particular provider.
Date of last contact
The date when the client was last seen for a treatment. The date may be the same as the date of discharge. In the event of a change of service or provider within an episode of treatment, it is the date the client transferred to another service or provider.
Detailed not in labor force at admission/discharge
Records more detailed information about those clients who are coded as Not in labor force in the TEDS Minimum Data Set item Employment status.
Disabled
Homemaker
Inmate of institution (prison or institution that keeps a person, otherwise able, from entering the labor force)
Other
Retired
Student
Employment status at discharge
See TEDS Minimum Data Set item Employment status for definitions.
Frequency of attendance at self-help programs in 30 days prior to admission/discharge
Records the number of times the client has attended a self-help program in the 30 days preceding the date of admission to and discharge from treatment services.
No attendance in the past month
1-3 times in the past month
4-7 times in the past month
8-15 times in the past month
16-30 times in the past month
Some attendance in the past month, but frequency unknown
Frequency of use at discharge (primary, secondary, and tertiary substances)
See TEDS Minimum Data Set item Frequency of use for definitions.
Living arrangements at admission/discharge
Records whether the client is homeless, living with parents, in a supervised setting, or living on his or her own at the time of admission and discharge.
Dependent living—Clients living in a supervised setting such as a residential institution, halfway house, or group home, and children (under age 18) living with parents, relatives, or guardians or in foster care
Homeless—Clients with no fixed address; includes shelters
Independent living—Clients living alone or with others without supervision
Number of arrests in 30 days prior to admission/discharge
Records the number of arrests in the 30 days preceding the date of admission to and discharge from treatment services.
00-96—Number of arrests
Reason for discharge, transfer, or discontinuance of treatment
Indicates the outcome of treatment or the reason for transfer or discontinuance of treatment.
Death
Incarcerated—Jail, prison, house confinement
Left against professional advice (dropped out)—Client chose not to complete treatment program, with or without specific advice to continue treatment; includes clients who dropped out for unknown reasons and clients who did not receive a treatment service for some time and were discharged for administrative reasons
Terminated by facility—Treatment terminated by action of facility, generally because of client non-compliance or violation of rules, laws, or procedures (excludes client drop-out, incarceration, or client-motivated reason for discontinuance)
Transferred to another substance use program or facility—Client was transferred to another substance use treatment service type, program, provider, or facility; client may or may not have reported to the new program or facility
Treatment completed—All parts of the treatment plan or program were completed.
Other—Client moved, became ill, was hospitalized, or other reason somewhat out of client’s control
Unknown—Client status at discharge not known (e.g., record incomplete or lost); not to be used for clients who dropped out of treatment
Substance use at discharge (primary, secondary, or tertiary)
See TEDS Minimum Data Set item Substance use for definitions.
Type of treatment service at discharge
See TEDS Minimum Data Set item Type of treatment service for definitions.
Appendix C. 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., under Contract No. HHSS283201600001C.
Contributors and reviewers at Eagle, listed alphabetically, include Ngwatung Akamangwa, Anand Borse, Muluneh Desisa, Erin Doherty, Tsegereda Kifle, David Peabody, Marty van Duym, Doren Walker (Project Director), and John Zuwasti Curran. 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.