Highlights

This report presents results from the 2002 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. Selected findings are given below.

The N-SSATS facility response rate in 2002 was 96 percent [Table 1.1].
A total of 13,720 facilities responded to the survey and reported a one-day census of 1,136,287 clients receiving substance abuse treatment on March 29, 2002 [Tables 2.1 and 4.1].
There were 91,851 clients under age 18 in treatment on March 29, 2002, making up 8 percent of the total population in treatment on that date [Table 4.6].
In 2002, private non-profit facilities made up the bulk of the system (61 percent), followed by private for-profit (25 percent) and State or local government (11 percent) [Table 2.1].
Over half (51 percent) of all facilities had managed care contracts in 2002, as compared to 42 percent in 1996 [Table 2.3].
Outpatient treatment was the most widely available type of care, with regular outpatient care offered by 74 percent of all facilities and intensive outpatient care offered by 44 percent of all facilities. Day treatment/partial hospitalization services were offered by 15 percent of all facilities, outpatient detoxification by 12 percent, and outpatient methadone/LAAM maintenance by 7 percent. Residential rehabilitation was offered by 26 percent of all facilities, and hospital inpatient rehabilitation by 4 percent. Residential detoxification and hospital inpatient detoxification were offered by 8 percent and 7 percent of all facilities, respectively [Table 3.2b].
Nearly half of all facilities (49 percent) offered special programs for the dually diagnosed (clients with mental and substance abuse disorders). More than one-third of facilities had programs for adolescents (37 percent) [Table 3.9b].
Nearly half (48 percent) of all clients were in treatment for both alcohol and drug abuse. Thirty-one percent of clients were in treatment for drug abuse only, and 21 percent were in treatment for abuse of alcohol alone [Table 4.3].

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

Data Collection Procedures for the 2002 N-SSATS
      Field period and reference date
      Survey coverage
      Content
      Data collection
      Forms accounting and response rate
      Exclusions
      Number of respondents reporting facility and client data
      Quality assurance
      Item non-response

Methodology of Imputation of Missing Client Counts

Further Data Considerations and Limitations

Organization of the Report

Terminology

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This report presents tabular information and highlights from the 2002 National Survey of Substance Abuse Treatment Services (N-SSATS), conducted between March and October 2002, with a reference date of March 29, 2002. It is the 25th in a series of national surveys designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions.¹ The Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs N-SSATS.

N-SSATS is designed to collect information from all facilities²in the United States, both public and private, that provide substance abuse treatment. (Additional information on N-SSATS, its history, and changes in the survey and survey universe over time is provided in Appendix C.)

N-SSATS provides the mechanism for quantifying the dynamic character and composition of the U.S. substance abuse treatment delivery system. The objectives of N-SSATS are to collect multipurpose data that can be used to—

assist SAMHSA and State and local governments in assessing the nature and extent of services provided in State-supported and other treatment facilities and in forecasting treatment resource requirements;

update SAMHSA's Inventory of Substance Abuse Treatment Services (I-SATS), which includes all known drug and alcohol abuse treatment facilities;

analyze general treatment services trends and conduct comparative analyses for the nation, regions, and States;

generate the National Directory of Drug and Alcohol Abuse Treatment Programs, a compendium of facilities approved by State substance abuse agencies for the provision of substance abuse treatment; and

update the information in SAMHSA's Substance Abuse Treatment Facility Locator, a searchable database of facilities approved by State substance abuse agencies for the provision of substance abuse treatment. The Facility Locator is available on the Internet at:

http://findtreatment.samhsa.gov

Data Collection Procedures for the 2002 N-SSATS

Field period and reference date

The field period for the 2002 N-SSATS ran from March 2002 through October 2002, with a reference date of March 29, 2002.

Survey coverage

The 2002 survey was sent to all 18,204 active facilities that were on SAMHSA's Inventory of Substance Abuse Treatment Services (I-SATS; see Appendix C) as of about 6 weeks before the survey reference date. These facilities were contacted by mail. Facilities added by State substance abuse agencies or discovered during the survey prior to the second mailing were also included in the survey.

Content

The 2002 N-SSATS survey instrument was a 9-page document with 37 numbered questions (see Appendix A). Topics included:

Facility identification information
Ownership
Primary focus (substance abuse treatment services, mental health services, general health care, a mix of mental health and substance abuse treatment services, other)
Hotline operation
Services offered (assessment services, substance abuse therapy and counseling, pharmacotherapies, testing, transitional services, other services)
Special programs or groups provided (dually-diagnosed clients (mental and substance abuse disorders), adolescents, persons with HIV/AIDS, gays and lesbians, seniors/older adults, pregnant/postpartum women, women only, men only, criminal justice clients, DUI/DWI offenders, other)
Operation of an Opioid Treatment Program (OTP) certified by the Center for Substance Abuse Treatment, SAMHSA
Services for the hearing impaired
Services in languages other than English
Types of treatment provided
Hospital inpatient (detoxification, rehabilitation)
Non-hospital residential (detoxification, rehabilitation)
Outpatient (regular, intensive, day treatment/partial hospitalization, detoxification, methadone/LAAM maintenance)
Number of beds designated for non-hospital residential and hospital inpatient substance abuse treatment
Payment options
Managed care participation
Number of clients treated
Facility licensure, approval, certification, or accreditation

Data collection

Six weeks before the survey, letters were mailed to all facilities to alert them to expect the survey. An additional benefit of the letters was to update records with new address information returned from the post office. Data collection packets, including the questionnaire, SAMHSA cover letter, State-specific letters of endorsement, information on completing the survey on the Internet, and a sheet of Frequently Asked Questions were mailed to each facility. During the data collection phase, contract personnel were available to answer facilities' questions concerning the survey. Support in responding to questions for those facilities completing the questionnaire over the Internet was also available. Four to five weeks after the initial mailing, thank you/reminder letters were sent to all facilities. Approximately 8 weeks after the initial mailing, non-responding facilities were sent a second mailing. About four to five weeks after the second mailing, non-respondents received a reminder telephone call. Those facilities that had not responded within two to three weeks of the reminder call were telephoned and asked to complete the survey by telephone. The overall response rate was 96 percent.

Forms accounting and response rate

Summary response rate information is presented in Table 1.1. Questionnaires were mailed to a total of 18,204 facilities believed to offer substance abuse treatment services. Of these facilities, 15 percent were found to be ineligible for the survey because they had closed or were not providing substance abuse treatment on March 29, 2002. Of the remaining 15,459 facilities, 96 percent completed the survey.

Table 1.1 Survey forms accounting and response rates: N-SSATS 2002
	Number	Percent
Total facilities in survey	18,204	100.0
Closed/Ineligible	2,745	15.1
Eligible	15,459	84.9

Total eligible	15,459	100.0
Non-respondents	703	4.5
Respondents	14,756	95.5
Excluded from Report	654	4.2
Client data only¹	382	2.5
Included in Report	13,720	88.8

Mode of response	13,720	100.0
Mail	7,797	56.8
Telephone	3,126	22.8
Internet	2,797	20.4
¹Facilities for which client counts were reported by another facility, but no facility information was received from the facility itself.

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Exclusions

Of the 14,756 survey respondents, 654 facilities provided information to I-SATS but were deemed out of the scope of this report and were excluded from the analyses presented here (see Appendix C).

354 excluded facilities were jails, prisons, or other organizations that treated incarcerated clients only.
206 excluded facilities were solo practitioners. I-SATS and N-SSATS are designed to include facilities rather than individuals. Solo practitioners are listed and surveyed only if the State substance abuse agency explicitly requests that they be included. The excluded solo practitioners had not been identified for inclusion by the State substance abuse agency.
94 excluded facilities were halfway houses that did not provide substance abuse treatment. These facilities were included in the survey so that they could be listed in the Directory and on the Treatment Facility Locator, but were excluded from the analyses in this report.

An additional 382 facilities did not provide data on facility characteristics, although another facility provided their client counts. These were excluded from the facility counts in this report.

Number of respondents reporting facility and client data

Table 1.2. There were a total of 13,720 eligible respondents to the 2002 N-SSATS. The breakdown of these respondents with respect to their reporting of facility data and client counts is summarized below.

There were 11,969 facilities that reported both facility data and client counts for their own organization.

An additional 678 facilities reported on characteristics of their own facility and provided client counts for their own facility as well as other facilities. These 678 facilities reported client counts for a total of 2,732 facilities.

There were 1,039 facilities that reported facility characteristics only. Their client counts were reported by another facility.

There were 34 facilities that reported facility characteristics and client counts for their facility, but the number of other facilities for which they reported for was unknown.

Table 1.2 Number of facilities reporting client and/or facility data: N-SSATS 2002
Type of data reported	Number of facilities for which facility characteristics reported¹	Number of facilities for which client counts reported

Facility characteristics and client counts for responding facility only	11,969	11,969
Facility characteristics for responding facility only; client counts for responding facility and other facilities as well	678	2,732
Facility characteristics only (client counts reported by another facility)	1,039	0
Facility characteristics and client counts for responding facility, but number of other facilities reported for is unknown	34	34
¹Excludes 354 facilities treating incarcerated clients only, 206 non-State-approved solo practitioners, and 94 non-treatment halfway houses.

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Quality assurance

All mail questionnaires were reviewed for inconsistencies and missing data. Calls were made to facilities to obtain missing data and to clarify questionable responses. After data entry, automated quality assurance reviews were conducted. These incorporated the rules used in manual editing, plus consistency checks not readily implemented by manual review.

If facilities could not be reached during the edit callbacks, responses that were clearly in error were deleted and imputed.

Item non-response

Careful editing and extensive follow-up have minimized item non-response (Appendix B). There are instances of non-response in most data items, however, and some variables have an explicit Unknown response option. Missing data for client count variables (e.g., the number of clients in hospital inpatient, non-hospital residential, and outpatient treatment) were imputed.

For the remaining unimputed variables, facilities with missing values for a given variable were excluded from the tabulations using that variable. As a result, the number of treatment facilities on which tables are based may vary somewhat from table to table. The number of facilities actually reporting data is generally included on each table.

Methodology of Imputation of Missing Client Counts

A total of 232 facilities were missing client count values for one or more types of service (i.e., hospital inpatient detoxification, hospital inpatient rehabilitation, residential detoxification, etc.). A facility was given imputed values for a type of service if it reported that it provided the service but had not provided client counts for that service type. For example, if a facility reported that it provided hospital inpatient services and outpatient services, but not residential services, client values were imputed for the hospital inpatient and outpatient variables only. Missing values for the number of clients under age 18 and the number of hospital and/or residential beds were not imputed.

When available, client values from the 2000 NSSATS were used to impute the missing client counts on the 2002 N-SSATS. In all other cases, the average client value stratified by State and type of ownership was used to impute the missing client counts. If a facility were unique in its ownership category and State, values were imputed using average values for the State only. Client counts were imputed for each type of service (i.e., hospital inpatient detoxification, hospital inpatient rehabilitation, residential detoxification, etc.) and summed to the larger totals (total hospital inpatient, residential, and outpatient clients, and total clients).

Further Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data from the 2002 N-SSATS. Some of these are outlined above. Other general issues are listed below. Considerations and limitations of specific data items are discussed where the data are presented.

N-SSATS attempts to obtain responses from all known treatment facilities, but it is a voluntary survey. There is no adjustment for the approximately 4 percent facility non-response.
N-SSATS is a point-prevalence survey. It provides information on the substance abuse treatment system and its clients on the reference date. Client counts reported here do not represent annual totals. Rather, N-SSATS provides a "snapshot" of substance abuse treatment facilities and clients on an average day.
Multiple responses were allowed for certain variables (e.g., services provided and specialized programs). Tabulations of these variables include the total number of facilities reporting each response.

Organization of the Report

The balance of this report is organized into four analytic sections. Chapter 2 presents broad trends in facility characteristics for 1996 to 2002. Chapter 3 describes key characteristics of facilities and the programs and services they provide. Chapter 4 describes key characteristics of clients in substance abuse treatment on March 29, 2002. Finally, Chapter 5 presents State-level detail for most of the tables presented in Chapters 3 and 4.

Terminology

The majority of tables in the report are organized according to facility ownership/operation and the primary focus of the facility, and present data on the characteristics of facilities and clients in treatment at these facilities. Therefore, it is important to define these terms.

Ownership/operation indicates the type of entity owning or responsible for the operation of the facility: private for-profit, private non-profit, or government (Federal, State, local, or tribal).

Primary focus indicates the services the facility primarily provides: substance abuse treatment services, mental health services, general health care, a mix of mental health and substance abuse treatment services, and other.

Clients in treatment are defined as: 1) hospital inpatient and residential clients receiving treatment (and not discharged) on the reference date, and 2) outpatient clients who received treatment during the prior 30 days and were still enrolled on the reference date.

¹ The jurisdictions include the territories of American Samoa and Guam, the Federated States of Micronesia, the Republic of Palau, the Commonwealth of Puerto Rico, and the Virgin Islands of the United States.
² In this report, entities responding to N-SSATS are referred to as "facilities." As discussed later in the report, a "facility" may be a program-level, clinic-level, or multi-site respondent.

Highlights

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

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