The Dasis Report (Drug and Alcohol Services Information System)
June 6, 2003

Variations in Substance Abuse Treatment Facilities by Number of Clients

In Brief
  • Facilities providing only detoxification were mostly small or very small

  • Larger facilities reported providing more types of services than smaller facilities

  • Very large facilities provided methadone/LAAM treatment five times more frequently than very small, small, or medium facilities

This report looks at facility size, as measured by the number of clients enrolled in treatment on a typical day, and reported to the National Survey of Substance Abuse Treatment Services (N-SSATS).1 N-SSATS is an annual survey of all facilities in the United States, both public and private, that provide substance abuse treatment.

Facilities and Clients
In all, 13,428 facilities responded to the N-SSATS in 2000. Most facilities answered for themselves alone, but some combined their data with data for other facilities in their administrative networks. This report is based on information from the 11,808 facilities that reported for themselves alone. These facilities were ranked by the number of clients treated on a typical day in hospital and residential facilities and enrolled in treatment on a typical day in outpatient facilities. Facilities were then divided into five groups of approximately 2,360 facilities each:
Type of Care
Hospital inpatient facilities, typically substance abuse treatment units within a general or psychiatric hospital, were mostly very small (60 percent) or small (23 percent); only 1 percent were very large (Figure 1). Two-thirds of residential facilities were very small or small facilities (32 and 35 percent, respectively). Outpatient facilities had lower proportions of very small and small facilities (both 17 percent).

Figure 1. Type of Care by Facility Size: 2000
Figure 1. Type of Care by Facility Size: 2000
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Ownership
Facilities owned by private organizations, whether non-profit or for-profit, were approximately evenly distributed by size, as were facilities owned by States. Facilities operated by local governments tended to be larger, with 17 percent very small, 15 percent small, 19 percent medium, 22 percent large, and 27 percent very large. Facilities owned by tribal governments were mostly very small or small (47 percent); only 13 percent were very large. Facilities operated by the Department of Defense were primarily very small (39 percent) or small (19 percent), while those operated by the Department of Veterans Affairs were mostly large (22 percent) or very large (50 percent). Trends were less apparent in other ownership categories.

Type of Treatment
Most of the facilities providing only detoxification services were very small or small (36 and 34 percent, respectively) (Figure 2). Facilities providing only rehabilitation services were distributed almost equally among facilities of each size. More than a third of the facilities providing both detoxification and rehabilitation were very large (36 percent).

Figure 2. Type of Treatment by Facility Size: 2000
Figure 2. Type of Treatment by Facility Size: 2000
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Managed Care
About half of small and very small facilities (49 percent) had a contract or other arrangement with a managed care entity. The proportion of facilities reporting managed care contracts among medium and large facilities was 56 percent, and among very large facilities 54 percent.

Public Funds
Fifty-one percent of very small, 62 percent of small, 63 percent of medium, 70 percent of large, and 74 percent of very large facilities reported receiving public funds.

Services Provided
Facilities were asked about the provision of 26 services, 12 of which were offered by at least 50 percent of the facilities (Table 1). In general, very small facilities provided on average 12 services, small facilities 13, medium facilities 14, large facilities 14, and very large facilities 15.

Table 1. Services Offered by at Least 50 Percent of Facilities by Facility Size: 2000
  Very Small Small Medium Large Very Large
Service Percent of Facilities
Individual Therapy 91 94 95 96 96
Comprehensive Substance Abuse Assessment 87 90 93 95 95
Group Therapy 76 89 93 93 92
Referral to Other Transitional Services 78 84 83 84 87
Discharge Planning 75 81 82 82 81
Drug/Alcohol Urine Screening 69 76 80 84 88
Relapse Prevention Groups 62 75 81 83 83
Family Counseling 72 74 79 81 77
Aftercare Counseling 68 73 79 83 80
Case Management Services 56 66 66 68 70
HIV/AIDS Education 43 52 55 57 65
Assistance with Obtaining Social Services 45 51 50 51 54
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Programs for Special Populations
Facilities were also asked about the provision of treatment groups and programs for nine special populations (Table 2). Larger facilities reported providing more programs for adolescents, persons with co-occurring disorders, persons with HIV/AIDS, pregnant/postpartum women, other groups of women only, and groups of men only.

Table 2. Facilities Providing Programs for Special Populations by Facility Size: 2000
  Very Small Small Medium Large Very Large
Special Populations Percent of Facilities
Adolescents 29 31 37 42 42
Persons with Co-occurring Disorders 45 47 50 50 55
Persons with HIV/AIDS 17 21 21 21 30
Gays/Lesbians 15 16 14 15 16
Seniors 18 18 16 17 19
Pregnant/Postpartum Women 17 18 18 20 29
Other Groups of Women Only 23 31 35 44 55
Groups of Men Only 21 30 33 38 41
Other 9 13 14 17 21
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Methadone/LAAM Treatment
Five percent of small and very small facilities, 4 percent of medium, and 7 percent of large facilities offered methadone/LAAM treatment, while 27 percent of very large facilities offered methadone/LAAM treatment. In general, the larger facilities offered methadone/LAAM maintenance, while the smaller facilities that offered methadone/LAAM treatment were most likely using it for detoxification purposes.

Treatment in Languages Other than English
The proportion of very small facilities that reported providing treatment in languages other than English was 19 percent, of small facilities 25 percent, medium 27 percent, large 33 percent, and very large facilities 44 percent.

Very Large Facilities
Fifty percent of very large facilities reported on average 137 clients, with a range of 105 to 184 clients; the other 50 percent reported on average 346 clients, with a range of 185 to 3,000 clients. Very large facilities with the smaller client counts differed substantially from those with the higher client numbers in several areas: providing treatment in languages other than English (35 vs. 53 percent); methadone/LAAM treatment (15 vs. 38 percent); testing for HIV (38 vs. 51 percent); testing for hepatitis (27 vs. 43 percent); testing for STDs (27 vs. 40 percent); pharmacotherapy (49 vs. 59 percent); transitional housing assistance (28 vs. 35 percent); programs for persons with AIDS/HIV (23 vs. 37 percent); and programs for pregnant/postpartum women (24 vs. 34 percent).

End Note
1Based on the survey response reference date, October 1, 2000.

The Drug and Alcohol Services Information System (DASIS) is an integrated data system maintained by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). One component of DASIS is the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual survey of all facilities in the United States, both public and private, that provide substance abuse treatment. N-SSATS was formerly known as the Uniform Facility Data Set (UFDS).

The DASIS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and RTI, Research Triangle Park, North Carolina.

Information and data for this report are based on data reported to N-SSATS for the survey reference date October 1, 2000.

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