Highlights

This report presents results from the 2006 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of 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 2006 was 96.5 percent. Thirty-five States or jurisdictions had response rates that equalled or surpassed the overall rate [Tables 1.1 and 6.1].
• A total of 14,577 facilities completed the survey. The 13,771 facilities eligible for this report had a one-day census of 1,130,881 clients enrolled in substance abuse treatment on March 31, 2006 [Tables 1.1 and 3.1].
  
• There were 91,873 clients under age 18 in treatment on March 31, 2006, making up 8 percent of the total population in treatment on that date [Table 6.4a and 6.4b].
  

Trends in Facility and Client Characteristics

• The number of reporting facilities remained relatively constant between 2002 and 2006. There were 13,720 reporting facilities in 2002 and 13,771 facilities in 2006. The number of clients in treatment on the survey reference date decreased by less than 1 percent over the same period, from 1,136,287 in 2002 to 1,130,881 in 2006 [Tables 2.2 and 3.1 and Figure 11].
• Facilities operated by private non-profit organizations made up the bulk of the treatment system, ranging from 59 to 61 percent of all facilities between 2002 and 2006, and were at 59 percent on March 31, 2006. Private for-profit facilities made up from 24 to 28 percent of all facilities between 2002 and 2006, and were at 28 percent on March 31, 2006. Facilities operated by local governments accounted for 7 to 8 percent of all facilities between 2002 and 2006, and by State governments, 3 percent. Facilities operated by Federal governments made up 2 percent of all facilities between 2002 and 2006. The proportion of facilities operated by tribal governments was unchanged at 1 percent between 2002 and 2006 [Table 2.2 and Figure 1].
  
• The proportion of clients in facilities operated by private non-profit organizations remained constant between 2002 and 2006 at 55 to 56 percent, although the total number of clients in these facilities decreased. The proportion of clients in private for-profit facilities increased from 26 percent in 2002 to 29 percent on March 31, 2006. The proportions of clients in local and Federal government-operated facilities fell between 2002 and 2006­, while the proportions in State and tribal government-operated facilities remained constant [Table 3.1 and Figure 5].
  
• Eighty-nine percent of all clients in treatment on March 31, 2006, were in outpatient treatment, 10 percent were in non-hospital residential treatment, and 1 percent were in hospital inpatient treatment. These proportions were nearly the same as they were in 2002 [Table 3.2 and Figure 6].
  
• The number and proportion of clients receiving methadone increased from 225,500 (20 percent of all clients) in 2002 to 258,752 clients (23 percent of all clients) in 2006 [Table 3.2 and Figure 6].
• Between 2002 and 2006, the proportion of facilities with managed care agreements or contracts generally declined. Forty-seven percent of facilities had agreements or contracts with managed care organizations in 2006, a decline from 51 percent in 2002. On March 31, 2006, 49 percent of all clients were in facilities with managed care agreements or contracts, a decline from 53 percent of all clients in 2002 [Tables 2.4 and 3.4 and Figures 3 and 7].
• The proportion of clients in treatment for both drug and alcohol abuse made up just under half of all clients between 2002 and 2006, ranging from 46 to 48 percent. The proportion of clients treated for drug abuse only increased from 31 percent in 2002 to 35 percent in 2006. The proportion of clients treated for alcohol abuse only declined from 21 percent in 2002 to 18 percent in 2006 [Table 3.3].

Clients under Age 18

• On March 31, 2006, there were 91,873 clients under age 18 in treatment. Clients under age 18 made up 8 percent of all clients in every year from 2002 through 2006 [Tables 6.4a and 6.4b].
• The majority of clients under age 18 were in treatment facilities with special programs or groups for adolescents. On March 31, 2006, 84 percent of all clients under age 18 were in treatment facilities with special programs or groups for adolescents [Table 3.5].

Facility Operation

• On March 31, 2006, 55 percent of all clients in treatment were in facilities operated by private non-profit organizations, which made up 59 percent of all facilities. Private for-profit organizations reported 29 percent of all clients, and made up 28 percent of all facilities. Facilities operated by local governments accounted for 8 percent of all clients, and made up 7 percent of all facilities. State government-operated facilities reported 4 percent of all clients, and made up 3 percent of all facilities. Facilities operated by the Federal government accounted for 3 percent of all clients, and made up 2 percent of all facilities. Facilities operated by tribal governments accounted for 1 percent of all clients, and made up 1 percent of all facilities [Tables 4.1 and 5.1].
  

Primary Focus

• On March 31, 2006, 62 percent of facilities (with 68 percent of all clients in treatment) reported that providing substance abuse treatment services was their primary focus of activity. A mix of mental health and substance abuse treatment services was the primary focus of 27 percent of facilities, treating 25 percent of clients. Eight percent of facilities, with 5 percent of all clients, reported the provision of mental health services as their primary focus. General health care was the primary focus of 2 percent of facilities, treating 1 percent of clients [Tables 4.1 and 5.1].

Type of Care

• On March 31, 2006, there were 1,008,915 clients (89 percent of all clients) in outpatient treatment, which was offered by 81 percent of all facilities. On the same date, there were 107,790 clients (10 percent of all clients) in non-hospital residential treatment, which was offered by 28 percent of all facilities. On March 31, 2006, there were 14,176 clients (1 percent of all clients) in hospital inpatient treatment, which was offered by 7 percent of all facilities [Tables 4.2b, 5.2a, and 5.2b].¹
  - Regular outpatient care was offered by 74 percent of all facilities and had 52 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Intensive outpatient care was offered by 45 percent of all facilities and had 11 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Outpatient day treatment/partial hospitalization was provided by 15 percent of all facilities and had 2 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Outpatient detoxification was offered by 12 percent of facilities and had 1 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Outpatient methadone maintenance was offered by 10 percent of all facilities and had 22 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Non-hospital residential long-term treatment (more than 30 days) was offered by 23 percent of all facilities and had 7 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Non-hospital residential short-term care (30 days or less) was offered by 12 percent of all facilities and had 2 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Non-hospital residential detoxification was offered by 7 percent of all facilities and had less than 1 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Hospital inpatient detoxification was offered by 6 percent of all facilities, and had less than 1 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].
  - Hospital inpatient treatment was offered by 5 percent of all facilities and had less than 1 percent of all clients in treatment on March 31, 2006 [Tables 4.2b and 5.2b].

Client Substance Abuse Problem

• On March 31, 2006, nearly half (46 percent) of all clients were in treatment for both alcohol and drug abuse. Approximately one-third (35 percent) of clients were in treatment for drug abuse only, and 18 percent were in treatment for abuse of alcohol alone [Table 5.3].
• Nationwide, there were 457 clients in treatment per 100,000 population aged 18 and older on March 31, 2006. The rate was highest for persons with both alcohol and drug problems (209 per 100,000), followed by drug abuse only (163 per 100,000), and alcohol abuse only (85 per 100,000) [Table 6.28].

Facilities with Opioid Treatment Programs (OTPs)

• Opioid Treatment Programs (OTPs) were available at 9 percent of all substance abuse treatment facilities on March 31, 2006, and clients receiving methadone accounted for 23 percent of all clients in treatment [Tables 2.3 and 3.2].
• Forty-five percent of OTPs were operated by private for-profit organizations, compared to 28 percent of all substance abuse treatment facilities [Tables 4.1 and 4.17].
  
• Outpatient methadone maintenance was most likely to be offered by facilities operated by the Federal government (19 percent) and by private for-profit organizations (17 percent) [Table 4.2b].
• Facilities with OTPs were likely to be dedicated almost entirely to medication-assisted therapy; that is, treatment with methadone or buprenorphine. Overall, 86 percent of clients in facilities with OTPs were receiving methadone or buprenorphine on March 31, 2006 [Table 4.17].
  

Facility Size

• The median number of clients in substance abuse treatment at a facility on March 31, 2006, was 40 [Table 4.4].
• There was little difference in facility size by facility operation, but there were differences by the primary focus of the facility. Facilities with a primary focus on the provision of mental health services tended to be smaller than facilities focused on the provision of substance abuse treatment. Only 9 percent of facilities with a mental health focus had 120 or more clients in treatment on March 31, 2006, and 40 percent had fewer than 15 clients in treatment on that date. In contrast, 23 percent of facilities with a substance abuse treatment focus had 120 or more clients in treatment, while 17 percent had fewer than 15 clients in treatment [Table 4.5].
  

Facility Capacity and Utilization Rates

• On March 31, 2006, 91 percent of all non-hospital residential beds and 90 percent of all hospital inpatient beds designated for substance abuse treatment were in use [Tables 4.6 and 4.7].
• Facilities with non-hospital residential beds had generally higher utilization rates than facilities with hospital inpatient beds. Fifty-two percent of facilities with non-hospital residential beds had utilization rates of 91 to 100 percent or more, while only 29 percent of facilities with hospital inpatient beds had utilization rates in that range [Tables 4.6 and 4.7].

Programs or Groups for Specific Client Types

• Most facilities (83 percent) offered specially designed programs or groups exclusively for specific client types. Special programs or groups for clients with co-occurring mental health and substance abuse disorders were offered by 37 percent of facilities, for adult women by 32 percent, for adolescents by 32 percent, for driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI) offenders by 31 percent, for criminal justice clients by 28 percent, and for adult men by 25 percent. Less frequently offered were programs or groups for pregnant or postpartum women (14 percent), persons with HIV or AIDS (10 percent), seniors or older adults (7 percent), and gays or lesbians (6 percent) [Table 4.8b].
  

Services in Sign Language and in Languages Other than English

• Substance abuse treatment services in sign language for the hearing impaired were offered in 29 percent of all facilities [Table 4.11b].
• Substance abuse treatment services in a language other than English could be provided by staff counselors, on-call interpreters, or both, and were provided in 45 percent of all facilities. Of the facilities offering these services, 45 percent reported that the services were provided by staff counselors only. Thirty-six percent used only on-call interpreters, and 19 percent used both staff counselors and on-call interpreters. Among facilities using staff counselors to provide substance abuse treatment services in languages other than English, Spanish was the most commonly reported language, provided in 27 percent of all facilities [Table 4.11b].
  
• Treatment services in American Indian/Alaska Native languages were offered in 1 percent of facilities overall. However, 31 percent of facilities operated by the Indian Health Service and 24 percent of facilities operated by tribal governments offered these services [Table 4.11b].
  

Payment Options

• A sliding fee scale for substance abuse treatment charges was used by 63 percent of all facilities. More than half (53 percent) of all facilities offered treatment at no charge to eligible clients who could not pay, and 4 percent provided treatment at no charge to all clients [Table 4.12b].
  

Facility Licensing, Certification, or Accreditation

• Ninety-five percent of all facilities reported that they were licensed, certified, or accredited by one or more agencies or organizations. Most facilities (81 percent) named the State substance abuse agency, 40 percent listed the State public health department/board of health, and 34 percent listed the State mental health department [Table 4.13b].
  

Facility Funding

• Fifty-nine percent of all facilities received Federal, State, or local government funds for the provision of substance abuse treatment services [Table 4.15].

Client Outreach

• Almost one-fifth (17 percent) of all facilities reported that they operated a hotline responding to substance abuse problems [Table 4.16].
  
• Almost two-thirds of all facilities (64 percent) had web sites providing information about their substance abuse treatment programs [Table 4.16].

¹Facility percentages sum to more than 100 percent because a facility could provide more than one type of care.

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