September 2, 2010 |
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Addressing the substance use treatment needs of a diverse population necessitates a diverse system of care with treatment options designed to meet the unique needs and preferences of clients. The beneficial role that faith and spirituality play in the programs designed to treat and promote recovery from substance abuse has long been acknowledged, making faith-based organizations an important component of the treatment system.1 Faith-based organizations have a long history of providing services to individuals within their communities, and the last decade has brought increased collaboration between faith-based organizations and the Federal Government. The Office of Faith-Based and Community Initiatives established in 2001 and its successor, the Office of Faith-Based and Neighborhood Partnerships established in 2009, emphasize and facilitate the partnership between faith-based organizations and the government in addressing societal problems. Understanding the characteristics of faith-based substance abuse treatment facilities provides community leaders and policy makers with a more complete picture of the treatment services available in their communities.
The National Survey of Substance Abuse Treatment Services (N-SSATS) can be used to examine substance abuse treatment facilities that were affiliated with a religious organization (hereafter referred to as "faith-based facilities"). This report examines the characteristics of these treatment facilities in the United States in 2008 and makes selected comparisons to facilities not affiliated with a religious organization (hereafter referred to as "non-faith-based facilities"). Substance abuse treatment facilities that were located in or operated by hospitals are excluded from the analysis. Thus, the focus of this report is the remaining 527 faith-based and 10,170 non-faith-based facilities that were not affiliated with hospitals.Facility Characteristics
All faith-based facilities were privately operated, either by a non-profit or for-profit organization. Faith-based facilities were more likely than non-faith-based facilities to be operated by a private non-profit organization (93.9 vs. 63.1 percent), and 6 times less likely to be operated by a private for-profit organization (6.1 vs. 36.9 percent).
Faith-based facilities served fewer clients on a typical day than non-faith-based facilities. On the survey reference date of March 31, 2008, there was an average of 74 clients enrolled in faith-based facilities compared with an average of 88 clients enrolled in non-faith-based facilities.2
When examined by region, 33.0 percent of faith-based facilities were located in the Midwest. Smaller proportions were located in the West (23.7 percent), South (21.9 percent), and Northeast (21.3 percent).
Primary Focus and Type of Care
N-SSATS collects information on the primary focus of the treatment provided by facilities, and categorizes this focus into five main types—substance abuse treatment services, mental health services, mix of mental health and substance abuse treatment services (neither is primary), general health care, and other. Faith-based facilities were more likely than non-faith-based facilities to focus primarily on providing substance abuse treatment services (69.3 vs. 63.7 percent) and were less likely to provide a mix of mental health and substance abuse treatment (21.8 vs. 28.9 percent) (Figure 1).
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Percentages may not sum to 100 percent due to rounding. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Primary Focus | Faith-Based Facility | Non-Faith-Based Facility |
---|---|---|
Substance Abuse Treatment Services | 69.3% | 63.7% |
Mix of Mental Health and Substance Abuse Treatment Services | 21.8% | 28.9% |
Mental Health Services | 5.1% | 5.7% |
General Health Care | 0.2% | 0.5% |
Other | 3.6% | 1.1% |
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Percentages may not sum to 100 percent due to rounding. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
N-SSATS also collects information on the type of substance abuse treatment offered by facilities. Some facilities provide one type of care while others provide a combination of types. Outpatient-only treatment was the most common type of care provided by faith-based facilities, although they were less likely than non-faith-based facilities to provide only this type of care (49.0 vs. 71.6 percent). Faith-based facilities were almost twice as likely as non-faith-based facilities to offer non-hospital residential treatment only (34.9 vs. 18.8 percent) or both outpatient and non-hospital residential treatment (15.2 vs. 8.4 percent).
Services Offered
Faith-based facilities provided a range of assessment and pre-treatment services that were generally similar to those provided by non-faith-based facilities. Most faith-based facilities offered screening for substance abuse (88.7 percent) and comprehensive substance abuse assessment or diagnosis (82.0 percent), and more than half provided community outreach (61.8 percent) (Table 1). Faith-based facilities were less likely than non-faith-based facilities to provide screening for mental health disorders (52.3 vs. 60.4 percent) or comprehensive mental health assessment or diagnosis (33.7 vs. 40.3 percent).
Service | Percent of Faith-Based Services | Percent of Non-Faith-Based Services |
---|---|---|
Assessment and Pre-treatment Services | ||
Screening for Substance Abuse | 88.7% | 92.7% |
Comprehensive Substance Abuse Assessment or Diagnosis | 82.0% | 89.6% |
Outreach to Persons in the Community Who May Need Treatment | 61.8% | 50.6% |
Screening for Mental Health Disorders | 52.3% | 60.4% |
Interim Services for Clients When Immediate Admission Is Not Possible | 39.2% | 39.8% |
Comprehensive Mental Health Assessment or Diagnosis | 33.7% | 40.3% |
Testing | ||
Drug or Alcohol Urine Screening | 81.9% | 81.8% |
Breathalyzer or Other Blood Alcohol Testing | 56.9% | 57.1% |
TB Screening | 29.2% | 30.0% |
HIV Testing | 27.3% | 24.3% |
Screening for Hepatitis C | 18.6% | 18.2% |
Screening for Hepatitis B | 16.9% | 17.1% |
STD Testing | 12.9% | 16.0% |
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Similar proportions of faith-based and non-faith-based facilities offered testing services. Most faith-based facilities offered drug or alcohol urine screening (81.9 percent), and the majority offered breathalyzer or other blood alcohol testing (56.9 percent). A relatively small percentage provided communicable disease testing, ranging from 12.9 percent that provided STD testing to 29.2 percent that provided TB screening.
Most faith-based facilities offered transitional and ancillary services such as substance abuse education (92.8 percent), discharge planning (87.6 percent), aftercare or continuing care (76.3 percent), case management (75.4 percent), and social skills development (71.5 percent) (Table 2). Faith-based facilities were more likely than non-faith-based facilities to offer self-help groups (57.4 vs. 45.0 percent), assistance with obtaining social services (56.2 vs. 50.8 percent), mentoring/peer support (56.0 vs. 47.4 percent), transportation assistance (47.6 vs. 35.2 percent), and employment counseling or training (47.4 vs. 35.8 percent). In addition to these ancillary or transitional services, faith-based facilities were more than twice as likely as non-faith-based facilities to provide a halfway house or other transitional housing (24.1 vs. 10.4 percent).
Service | Percent of Faith-Based Facilities |
Percent of Non-Faith-Based Facilities |
---|---|---|
Transitional Services | ||
Discharge Planning | 87.6% | 92.2% |
Aftercare/Continuing Care | 76.3% | 82.6% |
Ancillary Services | ||
Substance Abuse Education | 92.8% | 94.7% |
Case Management Services | 75.4% | 77.2% |
Social Skills Development | 71.5% | 68.9% |
Self-help Groups | 57.4% | 45.0% |
Assistance with Obtaining Social Services | 56.2% | 50.8% |
Mentoring/Peer Support | 56.0% | 47.4% |
HIV or AIDS Education, Counseling, or Support | 50.2% | 54.7% |
Health Education Other than HIV/AIDS | 49.3% | 47.9% |
Assistance in Locating Housing for Clients | 48.9% | 44.4% |
Mental Health Services | 48.9% | 53.0% |
Transportation Assistance to Treatment | 47.6% | 35.2% |
Employment Counseling or Training for Clients | 47.4% | 35.8% |
Domestic Violence—Family or Partner Violence Services | 37.1% | 36.3% |
Early Intervention for HIV | 23.0% | 24.4% |
Child Care for Clients’ Children | 11.1% | 7.8% |
Residential Beds for Clients’ Children | 7.6% | 4.1% |
Acupuncture | 3.3% | 4.1% |
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
About one quarter (28.1 percent) of all faith-based facilities provided pharmacotherapies, or medication-assisted treatment, compared with 40.2 percent of non-faith-based facilities. Among both facility types, medication for the treatment of psychiatric disorders was the most commonly provided pharmacotherapy. However, faith-based facilities were less likely than non-faith-based facilities to provide this service (21.3 vs. 27.4 percent). They were also less likely to operate a certified Opioid Treatment Program (OTP) (1.1 vs. 8.4 percent).
Counseling and Therapeutic Approaches
Similar proportions of faith-based and non-faith-based facilities offered specific types of counseling. Most faith-based facilities offered individual (97.0 percent) and group (91.5 percent) counseling, and the majority offered family counseling (72.5 percent). Marital or couples counseling was offered by nearly half of faith-based facilities (45.2 percent).
N-SSATS collects information on the frequency that specific clinical or therapeutic approaches are offered by substance abuse treatment facilities. Similar proportions of faith-based and non-faith-based facilities offered most of these clinical or therapeutic approaches "always" or "often." However, faith-based facilities were more likely than non-faith-based facilities to "always" or "often" use the 12-step facilitation (64.0 vs. 56.0 percent) or anger management (54.6 vs. 40.1 percent) and less likely to use motivational interviewing (49.3 vs. 54.6 percent) (Table 3).
Clinical/Therapeutic Approach | Percent of Faith-Based Facilities |
Percent of Non-Faith-Based Facilities |
---|---|---|
Substance Abuse Counseling | 94.5% | 97.3% |
Relapse Prevention | 88.7% | 89.3% |
Cognitive-behavioral Therapy | 65.1% | 66.7% |
12-step Approach | 64.0% | 56.0% |
Anger Management | 54.6% | 40.1% |
Motivational Interviewing | 49.3% | 54.6% |
Brief Intervention | 38.7% | 35.1% |
Contingency Management/Motivational Incentives | 33.1% | 29.6% |
Trauma-related Counseling | 24.2% | 21.5% |
Rational Emotive Behavioral Therapy (REBT) | 19.6% | 19.2% |
Matrix Model | 16.4% | 20.1% |
Community Reinforcement Plus Vouchers | 10.9% | 6.2% |
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Programs or Groups for Specific Client Types
Specialty programs are designed to serve the needs of specific populations in treatment, such as adolescents or criminal justice clients. Nearly three quarters (73.6 percent) of faith-based facilities offered at least one special program or group to serve a specific client type; the majority offered a specially designed program or group for adolescents (61.2 percent) (Table 4). Faith-based facilities were more likely than non-faith-based facilities to offer a special program or group for adult women (49.1 vs. 37.6 percent) or adult men (40.8 vs. 30.2 percent).
Client Type | Percent of Faith-Based Facilities |
Percent of Non-Faith-Based Facilities |
---|---|---|
Adolescents | 61.2% | 60.9% |
Adult Women | 49.1% | 37.6% |
Adult Men | 40.8% | 30.2% |
Clients with Co-occurring Mental and Substance Use Disorders | 35.0% | 38.0% |
Criminal Justice Clients | 29.8% | 32.1% |
Pregnant or Postpartum Women | 19.4% | 17.3% |
Persons with HIV or AIDS | 10.8% | 10.7% |
Senior or Older Adults | 10.0% | 7.3% |
Specially Designed Programs or Groups for Any Other Types of Clients | 7.4% | 9.3% |
Gays or Lesbians | 7.1% | 6.4% |
Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Payment
Faith-based facilities were more likely than non-faith-based facilities to offer treatment at no charge to clients who could not afford to pay (59.4 vs. 45.2 percent). They were also more likely to provide free treatment to all clients (10.6 vs. 3.4 percent) (Figure 2). Most faith-based facilities accepted cash or self-payments (83.2 percent); less than half accepted private health insurance (47.3 percent) or Medicaid (45.9 percent), and less than one third accepted other State-financed health insurance (30.6 percent), Medicare (24.5 percent), Access to Recovery (ATR) vouchers3 (24.2 percent), or Federal military insurance such as TRICARE or Champ VA (22.0 percent).
* See End Note 3. Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Payment Methods | Non-Faith-Based Facility | Faith-Based Facility |
---|---|---|
Cash or Self-payment | 91.3% | 83.2% |
Private Health Insurance | 61.2% | 47.3% |
Medicaid | 50.8% | 45.9% |
State-Financed Plan Other than Medicaid | 38.4% | 30.6% |
Medicare | 29.1% | 24.5% |
Access to Recovery (ATR) Vouchers* | 26.0% | 24.2% |
Federal Military Insurance | 29.7% | 22.0% |
No Payment Accepted (Free Treatment for All Clients) | 3.4% | 10.6% |
Other | 3.4% | 5.5% |
* See End Note 3. Note: Includes faith-based and non-faith-based facilities not located in or operated by a hospital. Source: 2008 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS). |
Discussion
Faith-based facilities are an important component of the substance abuse treatment system. Like other facilities, those that are faith-based offer a wide array of services and programs designed to support recovery and address the needs of substance abuse clients. However, faith-based and non-faith-based facilities did differ in a number of ways. Of particular note, faith-based facilities were more likely than non-faith-based facilities to offer free treatment to persons who could not afford the costs associated with substance abuse treatment and were also more likely to offer free treatment to all clients. Thus, faith-based facilities may help to fill gaps in access to treatment by providing services to individuals who otherwise might not be able to obtain them. Policymakers and treatment advocates need to ensure that communities are aware of this and that resources are available to faith-based facilities so they can continue to provide free and low-cost care.
It is also important to improve communication about specific services that are offered because faith-based facilities were more likely than non-faith-based facilities to offer some types of services (such as providing halfway or transitional housing and self-help groups) and less likely to offer other types of services (such as screening for or comprehensive assessment/diagnosis of mental health disorders). Information on the services offered by faith-based facilities, as well as the similarities and differences between faith-based and non-faith-based facilities, may help persons seeking treatment to make more informed decisions regarding their care and help health professionals to make referrals to treatment.
End Notes
1 Substance Abuse and Mental Health Services Administration. (2009). Faith-Based and Community Initiative (FBCI) background. Retrieved February 25, 2010, from http://www.samhsa.gov/FBCI/background.aspxSuggested Citation
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (September 2, 2010). The N-SSATS Report: Substance Abuse Treatment Facilities Affiliated with a Religious Organization. Rockville, MD.
The National Survey of Substance Abuse Treatment Services (N-SSATS) is an annual survey of all substance abuse treatment facilities in the United States, both public and private, that are known to the Substance Abuse and Mental Health Services Administration (SAMHSA). N-SSATS is one component of the Drug and Alcohol Services Information System (DASIS), an integrated data system maintained by the Office of Applied Studies, SAMHSA. N-SSATS collects three types of information from facilities: characteristics of individual facilities such as services offered and types of treatment provided, primary focus of the facility, and payment options; client count information such as counts of clients served by service type and number of beds designated for treatment; and general information such as licensure, certification, or accreditation and facility website availability. In 2008, N-SSATS collected information from 13,688 facilities from all 50 States, the District of Columbia, Puerto Rico, the Federated States of Micronesia, Guam, Palau, and the Virgin Islands. Information and data for this report are based on data reported to N-SSATS for the survey reference date March 31, 2008. The N-SSATS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and by RTI International in Research Triangle Park, North Carolina (RTI International is the trade name of Research Triangle Institute). Information on the most recent N-SSATS is available in the following publication: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2009). National Survey of Substance Abuse Treatment Services (N-SSATS): 2008. Data on Substance Abuse Treatment Facilities (DASIS Series: S-49, HHS Publication No. (SMA) 09-4451). Rockville MD: Author. Access the latest N-SSATS reports
at: http:/oas.samhsa.gov/dasis.htm Access the latest N-SSATS public use files at: http://samhsa.gov/data/SAMHDA.htm Other substance abuse reports are available at: http://oas.samhsa.gov |
The N-SSATS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, e-mail: shortreports@samhsa.hhs.gov.
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