Introduction
This report presents results from the Treatment Episode Data Set (TEDS) for 2000, and trend data for 1992-2000. The report provides information on the demographic and substance abuse characteristics of the approximately 1.6 million annual admissions to treatment for abuse of alcohol and drugs in facilities that report to individual State administrative data systems. The Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA), coordinates and manages collection of TEDS data from the States.
The TEDS system is comprised of two major components, the Admissions Data System and the Discharge Data System. The TEDS Admissions Data System is an established program that has been operational for over 10 years. It includes data on treatment admissions that are routinely collected by States to monitor their individual substance abuse treatment systems. The TEDS Discharge Data System is relatively new. For both data systems, 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 Admissions Data System consists of a Minimum Data Set collected by all States, and a Supplemental Data Set collected by some States. 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
Service type, including planned use of methadone
The Supplemental Data Set includes 15 items that include psychiatric, social, and economic measures.
The TEDS Discharge Data System was designed to enable TEDS to collect information on entire treatment episodes. Discharge data, when linked to admissions data, represent treatment episodes that enable analyses of questions that cannot be answered with admissions data alone. Currently about 20 States are submitting discharge data or are actively preparing to submit data. Enlistment of States into the system is ongoing, with participation by all States that collect discharge data expected by the end of 2003.
Definitions and classifications used in the Admissions Minimum and Supplemental Data Sets and the Discharge Data Set are detailed in the Appendix.
National-level data collection on admissions to substance abuse 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 abuse 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 1973-1981 based on data from 1,800-2,000 programs, including some 200,000 annual admissions.
In 1981, collection of national-level data on admissions to substance abuse 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 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 abuse. The Treatment Episode Data Set (TEDS) data collection effort represents the Federal response to this mandate. TEDS began in 1989 with the issue of 3-year development grants to States.
TEDS is one of the three components of SAMHSA’s Drug and Alcohol Services Information System (DASIS). DASIS is the primary source of national data on substance abuse treatment. The core component of DASIS is the Inventory of Substance Abuse Treatment Services (I-SATS), a continuously-updated comprehensive listing of all known public and private substance abuse treatment facilities. The third component of DASIS is the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of the location, characteristics, services offered, and utilization of alcohol and drug abuse treatment facilities in I-SATS. A unique ID number assigned to each I-SATS facility is used in the collection of client-level data (TEDS) and facility-level data (N-SSATS). Together, they provide national- and State-level information on the numbers and characteristics of individuals admitted to alcohol and drug treatment and describe the facilities that deliver care to those individuals.
TEDS includes facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons), and that are required by the States to provide TEDS client-level data.
TEDS, while comprising a significant proportion of all admissions to substance abuse treatment, does not include all such admissions. TEDS is a compilation of facility data from State administrative systems. The scope of facilities included in TEDS is affected by differences in State licensure, certification, accreditation, and 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. Some State substance abuse agencies track correctional facilities (State prisons and local jails), while others do not.
In general, facilities reporting TEDS data receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services (see Chapter 4). Most States are able to report all admissions to all eligible facilities, although some report only admissions financed by public funds. States may report data from facilities that do not receive public funds, but generally do not because of the difficulty in obtaining data from these facilities. TEDS generally does not include data on facilities operated by Federal agencies, including the Bureau of Prisons, the Department of Defense, and the Department of Veterans Affairs. However, some facilities operated by the Indian Health Service are included.
The primary goal of TEDS is to monitor the characteristics of treatment episodes for substance abusers. Implicit in the concept of treatment is a planned, continuing treatment regimen. Thus TEDS does not include early intervention programs that are considered to be prevention programs. Crisis intervention facilities such as sobering-up stations and hospital emergency departments generally are not included in TEDS, although a State may opt to include such programs in its submissions to TEDS.
TEDS is an exceptionally large and powerful data set. Like all data sets, however, care must be taken that interpretation does not extend beyond the limitations of the data. Limitations fall into two broad categories: those related to the scope of the data collection system, and those related to the difficulties of aggregating data from highly diverse State data collection systems.
Limitations to be kept in mind while analyzing TEDS admissions data include:
TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
TEDS attempts to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different service type (for example, from residential treatment to outpatient) within a single continuous treatment episode. However, States differ greatly in their ability to identify transfers; some can distinguish transfers within providers but not across providers (see Chapter 4 and Table 4.1). Some admission records in fact may represent transfers, and therefore the number of admissions reported probably overestimates the number of treatment episodes.
The number and client mix of TEDS admissions do not represent the total national demand for substance abuse treatment or the prevalence of substance abuse in the general population.
The primary, secondary, and tertiary substances of abuse 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.
States continually review the quality of their data 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.
Considerations specific to this report include:
The report includes admissions records for calendar years 1992-2000
that were received and processed by SAMHSA through April 1, 2002. SAMHSA, in reporting
national-level TEDS data, must balance timeliness of reporting and completeness of the
data set. This can result in a time lag in the publication of annual data because
preparation of the report is delayed until nearly all States have completed their data
submission for that year. Summary statistics for 2001 for those States that have completed
their 2001 submissions are available on-line at:
www.DrugAbuseStatistics.samhsa.gov.
(Click on DASIS.)
States rely on individual facilities to report in a timely manner so they can in turn report data to SAMHSA at regular intervals. Admissions from facilities that report late to the States may appear in a later data submission to SAMHSA. Thus the number of admissions reported for 2000 may increase by 5 percent or more as submissions of 2000 data continue. However, additional submissions are unlikely to have a significant effect on the percentage distributions that are the basis of this report.
The report focuses on treatment admissions for substance abusers. Thus admissions for treatment as a codependent of a substance abuser 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, that record is excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.
Variables in the Supplemental Data Set (Tables 3.6-3.9) are not collected by all States. States that did not collect a specific variable are excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.
Primary alcohol admissions are characterized as alcohol only or alcohol with secondary drug. Alcohol with secondary drug indicates a primary alcohol admission with a specified secondary drug. All other alcohol admissions are classified as alcohol only.
Cocaine admissions are classified according to route of administration as smoked and other route. 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 cocaine admissions where the route of administration is not reported. Thus the TEDS estimate of admissions for smoked cocaine is conservative.
Methamphetamine/amphetamine admissions include admissions for both substances, but are primarily for methamphetamine. Four States (Arkansas, Connecticut, Oregon, and Texas) do not distinguish between methamphetamine and amphetamine admissions. However, for the States that make this distinction, methamphetamine constitutes about 94 percent of combined methamphetamine/amphetamine admissions.
For this report, secondary and tertiary substances (see Appendix) are grouped and referred to as secondary substances.
Tables 2.3-2.7 and 4.5 and Figures 3-7 show trends in State admission
rates. Data were not submitted for one or more years in some States or jurisdictions
because of changes to their data collection systems. These States were: Arizona
(1992-1997), the District of Columbia (1992-1993), Indiana (1997), Kentucky (1992-1996),
Mississippi (1992-1994), West Virginia (1994, 1997-1998, and 2000), and Wyoming
(1995-1996).
In five States, significant changes in the clients or facilities reported to TEDS from
1995-2000 resulted in changes in the number of admissions large enough to influence
trends. For these States, rates are not indicated on Figures 3-7 for the years affected:
New Mexico (2000), Ohio (1999-2000), Texas (1992-1995), Virginia (1996-2000), and West
Virginia (1996). The actual data reported, however, are included in all tables.