2. Trends in Facility and Client Characteristics

This chapter presents trends in facility and client characteristics for 1991-1998 (the survey was not conducted in 1994). It should be kept in mind, however, that the list frame, methods, and survey instrument have changed during this period.

Variability in the reporting level of facilities (i.e., reporting for each program, for each location, or for combined locations) is a critical factor in comparing the number of facilities over time. Each completed survey form is counted as a single reporting facility. As noted in Chapter 1, however, the level of reporting is sometimes decided by the State licensing/certification practices and sometimes by individual facility administrative policies and practices. Thus some facilities report aggregate data for more than one facility at the administrative or program level, and others report separately for each program at a specific location. Data on numbers of clients are not affected by differences in reporting level.

Since 1992, SAMHSA has made adjustments each year to the survey design, primarily to minimize non-response and to expand the survey coverage. Figure 1 is a time line detailing the major changes in survey scope and administration that may have affected the numbers of reporting facilities and clients. Beginning in 1992, SAMHSA expanded efforts to obtain information from non-responding facilities. A representative sample of non-respondents was contacted and administered an abbreviated version of the survey instrument via telephone. In 1993 and later years, this effort was extended to all non-responding facilities. This is reflected in the increased number of facilities seen in Tables 2.1-2.3. Beginning in 1995, changes in data collection methods enabled more complete identification of duplicate reporting by networks of facilities, causing a reduction in the total number of facilities. This was partially offset by SAMHSA's efforts to expand the reporting base prior to the 1997 UFDS. (Although facilities in the expanded reporting base were surveyed in 1995 and 1996, they were excluded from published reports until 1997). In 1997 only, facilities offering only DUI/DWI programs were excluded.

There was significant turnover in facilities responding to the 1997 and 1998 surveys (Table 2.1). Almost 35 percent of the 13,455 treatment facilities that responded to the 1998 UFDS did not participate in the 1997 survey. These 4,663 facilities accounted for 281,160 (27 percent) of the clients reported to be in treatment on October 1, 1998. This number is offset by the 2,068 facilities that responded to the 1997, but not the 1998, UFDS, yielding a net increase in 1998 of 2,595 facilities responding to the survey. The 4,663 facilities that were new to the survey in 1998 were smaller on average than those facilities responding in both years, with a median of 30 clients in treatment on October 1, compared with about 40 clients in treatment on October 1 for facilities responding in both years (38 clients in 1997 and 42 clients in 1998).

There were two primary reasons for the large increase in new facilities in 1998:

	•	SAMHSA continued to expand the survey coverage by identifying substance abuse treatment facilities not on the NMFI. The result was an addition of nearly 2,000 facilities to the NMFI prior to the 1998 UFDS survey. It is important to note that these additions were not necessarily new facilities, but were facilities not previously included in the UFDS survey.

	•	The response rate for the 1998 survey was about 5 percentage points higher than the rate in 1997. This is important because no adjustment for non-response is made in the survey data.

The number of clients reported to be in treatment on the reference date also increased substantially from 929,086 in 1997 to 1,038,378 in 1998. The majority of this increase can be attributed to the greater number of facilities participating in the 1998 UFDS. In fact, for the 8,792 facilities that participated in both the 1997 and 1998 UFDS surveys, the reported client counts increased only about 6,000 between 1997 and 1998.