National Survey of Substance Abuse Treatment Services (N-SSATS): 2009 Data on Substance Abuse Treatment Facilities DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Office of Applied Studies Acknowledgments This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies (OAS), by Synectics for Management Decisions, Inc. (Synectics), Arlington, Virginia. Data collection was performed by Mathematica Policy Research, Inc. (MPR), Princeton, New Jersey. Work by Synectics and Mathematica was performed under Contract No. 283-02-9026 (Deborah Trunzo, Project Officer). At Synectics, Doren H. Walker, Sar- bajit Sinha, Beatrice Blacklow, and Leigh Henderson were responsible for the content, analysis, and writing of the report. Public domAin notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Citation of the source is appreciated. Suggested citation: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS): 2009. Data on Substance Abuse Treatment Facilities, DASIS Series: S-54, HHS Publication No. (SMA) 10-4579, Rockville, MD, 2010. electronic Access to PublicAtion This publication may be downloaded from http://www.oas.samhsa.gov. Hard copies may be obtained from http://www.oas.samhsa.gov/copies.cfm. Or please call SAMHSA’s Health Information Network at: 1-877-SAMHSA-7 (1-877-726-4727) (English and Español) originAting office Office of Applied Studies Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Room 7-1044 Rockville, Maryland 20857 June 2010 ii Click Text to Link to Page tAble of contents List of Tables ...............................................................................................................................vii List of Figures ...........................................................................................................................xvii Highlights ........................................................................................................................................1 Chapter 1. Description of the National Survey of Substance Abuse Treatment Services (N-SSATS) ................................................................................................................................5 Data Collection Procedures for the 2009 N-SSATS ........................................................................6 Facility Selection for the 2009 N-SSATS Report ............................................................................8 Survey Response Mode ....................................................................................................................9 Data Considerations and Limitations .............................................................................................10 Organization of the Report ............................................................................................................10 Terminology ..................................................................................................................................11 Chapter 2. Trends in Facility Characteristics ..........................................................................13 Number of Facilities ......................................................................................................................13 Facility Operation ..........................................................................................................................14 Primary Focus of Facility ...............................................................................................................14 Type of Care Offered .....................................................................................................................15 Facilities with Opioid Treatment Programs ...................................................................................15 Chapter 3. Trends in Client Characteristics .............................................................................17 Facility Operation ..........................................................................................................................17 Primary Focus of Facility ...............................................................................................................18 Type of Care Received ...................................................................................................................19 Clients Receiving Methadone or Buprenorphine in Opioid Treatment Programs .........................19 Substance Abuse Problem Treated .................................................................................................19 Clients Under Age 18 in Treatment ...............................................................................................19 iii Click Text to Link to Page tAble of contents (continued) Chapter 4. Facility Characteristics and Services .....................................................................21 Facility Operation and Primary Focus ...........................................................................................21 Type of Care Offered .....................................................................................................................21 Client Substance Abuse Problem and Co-occurring Mental Health Disorders .............................22 Facility Size ...................................................................................................................................22 Facility Capacity and Utilization Rates .........................................................................................23 Services Provided ...........................................................................................................................24 Clinical/Therapeutic Approaches ...................................................................................................25 Programs or Groups for Specific Client Types ..............................................................................26 Services in Sign Language for the Hearing Impaired and in Languages Other than English .......26 Detoxification Services ..................................................................................................................27 Client Outreach ..............................................................................................................................27 Facility Licensing, Certification, or Accreditation .........................................................................27 Facility Standard Operating Procedures ........................................................................................28 Payment Options ............................................................................................................................29 Facility Funding .............................................................................................................................29 Facilities with Opioid Treatment Programs (OTPs) ......................................................................29 Counseling offered by Facilities ....................................................................................................30 Chapter 5. Client Characteristics ..............................................................................................31 Facility Operation and Primary Focus ..........................................................................................31 Type of Care ..................................................................................................................................32 Substance Abuse Problem and Co-occurring Mental Health Disorders ........................................32 Clients under Age 18 ......................................................................................................................33 Chapter 6. State Data ..................................................................................................................35 Survey Response ............................................................................................................................35 Trends .............................................................................................................................................35 Clients in Treatment per 100,000 Population Aged 18 and Older .................................................35 iv Click Text to Link to Page tAble of contents (continued) Tables .............................................................................................................................................37 Appendix A. N-SSATS Background ........................................................................................179 Survey History ............................................................................................................................179 N-SSATS in the Context of the Drug and Alcohol Services Information System (DASIS) ................................................................................................................................179 Survey Coverage ..........................................................................................................................180 Changes in Survey Content ..........................................................................................................182 Appendix B. 2009 N-SSATS Questionnaire ............................................................................185 Appendix C. Item Response and Imputation for N-SSATS 2009 ........................................203 v vi Click Text to Link to Page list of tAbles Chapter 1 1.1 N-SSATS facilities, by status and mode of response: 2009 .................................................8 Chapter 2 2.1 Facility turnover: 2005-2009. Number and percent distribution .......................................................................................38 2.2 Facility operation and primary focus of facility: 2005-2009. Number and percent distribution .......................................................................................39 2.3 Facilities by type of care offered, and facilities with Opioid Treatment Programs: 2005-2009. Number and percent ...........................................................................................................40 Chapter 3 3.1 Clients in treatment, by facility operation and primary focus of facility: 2005-2009. Number and percent distribution .......................................................................................41 3.2 Clients in treatment, by type of care received and clients receiving methadone or buprenorphine: 2005-2009. Number and percent distribution .......................................................................................42 3.3 Clients in treatment, by substance abuse problem and diagnosed co-occurring substance abuse and mental health disorders: 2005-2009. Number and percent ...........................................................................................................43 3.4 Clients under age 18 in treatment by type of care received, and clients under age 18 in treatment in facilities offering special programs or groups for adolescents: 2005-2009. Number and percent distribution .......................................................................................44 Chapter 4 4.1 Primary focus of facilities, by facility operation: 2009. Number and percent distribution .......................................................................................45 4.2a Type of care offered, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................46 vii List of tabLes (continued) 4.2b Type of care offered, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................47 4.3 Client substance abuse problem and co-occurring mental health disorders, by facility operation and primary focus of facility: March 31, 2009. Number and percent ...........................................................................................................48 4.4 Facility size, according to type of care offered, by facility operation and primary focus of facility: March 31, 2009. Median number of clients ..................................................................................................49 4.5 Facility size, in terms of number of clients, by facility operation and primary focus of facility: March 31, 2009. Number and percent distribution .......................................................................................50 4.6 Facility capacity and utilization of residential (non-hospital) care, by facility operation and primary focus of facility: March 31, 2009. Number, utilization rate, and percent distribution .............................................................51 4.7 Facility capacity and utilization of hospital inpatient care, by facility operation and primary focus of facility: March 31, 2009. Number, utilization rate, and percent distribution .............................................................52 4.8 Services provided, by facility operation: 2009. Number and percent ...........................................................................................................53 4.9 Services provided, by primary focus of facility: 2009. Number and percent ...........................................................................................................55 4.10 Clinical/therapeutic approaches, by frequency of use: 2009. Number and percent distribution .......................................................................................57 4.11a Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................58 4.11b Facilities offering special programs or groups for specific client types, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................59 4.12a Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................60 viii Click Text to Link to Page list of tAbles (continued) 4.12b Facilities offering services in sign language for the hearing impaired and in languages other than English, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................61 4.13 Facilities detoxifying clients, by substance, facility operation, and primary focus of facility: 2009. Number and percent ...........................................................................................................62 4.14 Facilities with client outreach, by facility operation and primary focus of facility: 2009. Number and percent ...........................................................................................................63 4.15a Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................64 4.15b Facility licensing, certification, or accreditation, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................65 4.16a Facility licensing, certification, or accreditation, by type of care offered: 2009. Number ..............................................................................................................................66 4.16b Facility licensing, certification, or accreditation, by type of care offered: 2009. Percent ................................................................................................................................67 4.17a Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................68 4.17b Facilities employing specific practices as part of their standard operating procedures, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................69 4.18a Facility payment options, by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................70 4.18b Facility payment options, by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................71 4.19 Facility funding, by facility operation and primary focus of facility: 2009. Number and percent ...........................................................................................................72 ix Click Text to Link to Page list of tAbles (continued) 4.20 Facilities with Opioid Treatment Programs (OTPs) and clients receiving medica- tion-assisted opioid therapy, by facility operation and primary focus of facility: March 31, 2009. Number and percent distribution .......................................................................................73 4.21a Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2009. Number ..............................................................................................................................74 4.21b Type of care offered in facilities with Opioid Treatment Programs (OTPs), by facility operation and primary focus of facility: 2009. Percent ................................................................................................................................75 4.22a Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2009. Number ..............................................................................................................................76 4.22b Facility licensing, certification, or accreditation of facilities with Opioid Treatment Programs (OTPs), by type of care offered: 2009. Percent ................................................................................................................................77 4.23 Facilities using counseling as part of their substance abuse treatment program, by primary focus of facility: March 31, 2009 Number ..............................................................................................................................78 Chapter 5 5.1 Clients in treatment, by primary focus of facility and facility operation: March 31, 2009. Number and percent distribution .......................................................................................79 5.2a Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2009. Number ..............................................................................................................................80 5.2b Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2009. Percent distribution (row percent) .....................................................................................81 5.2c Clients in treatment, according to type of care received, by facility operation and primary focus of facility: March 31, 2009. Percent distribution (column percent) ................................................................................82 x