Clients by Facility Ownership and Primary Focus
Clients by Substance Abuse Problem Treated
Clients Receiving Opioid Substitutes
This chapter describes key characteristics of clients in substance abuse treatment on October 1, 2000. 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 month and are still enrolled on the reference date. The major breakdowns used in this chapter are the two facility descriptors, ownership and primary focus. Ownership indicates the type of entity responsible for the operation of the facility: private for-profit; private non-profit; or government (Federal, State, local, or tribal). Primary focus indicates the type of services the facility primarily focuses on: substance abuse treatment services; mental health services; general health care; both substance abuse and mental health services; or other.
Table 4.1. Two-thirds of all clients in treatment on October 1, 2000 were in a facility focused on substance abuse treatment. An additional 23 percent were in a facility focused on treatment of both substance abuse and mental health. Approximately 6 percent of clients were in mental health facilities, while an additional 3 percent were in facilities with a general health care focus.
Fifty-five percent of all clients in treatment on October 1, 2000 were in private non-profit facilities. Private for-profit facilities accounted for 24 percent of substance abuse clients. The remaining 20 percent of clients were in government-owned facilities; more than half of these clients were in local government-owned facilities.
Tables 4.2a, 4.2b, and 4.2c. The 2000 N-SSATS requested data on clients in treatment on October 1, 2000 who received:
outpatient treatment services (non-intensive outpatient care, intensive outpatient care, out patient detoxification, and day treatment/par tial hospitalization program);
residential treatment (rehabilitation and detoxification);
hospital inpatient treatment (rehabilitation and detoxification).
The large majority of clients (89 percent) were enrolled in some type of outpatient care: non-intensive outpatient care (74 percent); intensive outpatient care (12 percent); partial hospitalization (2 percent); or outpatient detoxification (1 percent). Nine percent of clients were in residential rehabilitation. The remaining three categories (residential detoxification, hospital inpatient rehabilitation, and hospital inpatient detoxification) together accounted for 2 percent of clients.
Across the four main types of primary focus, 87 percent to 94 percent of substance abuse clients were receiving some type of outpatient care (non-intensive, intensive, detoxification, or partial hospitalization). Facilities with a primary focus of substance abuse treatment had the largest proportion of clients in residential care (12 percent in either residential rehabilitation or detoxification).
Table 4.3. On October 1, 2000, nearly half (48 percent) of all clients were in treatment for both alcohol and drug abuse. Twenty-nine percent were in treatment for drug abuse only, while the remaining 23 percent were in treatment for alcohol abuse only.
Private for-profit facilities did not follow this general pattern, demonstrating less disparity between the proportion of clients in treatment for both drug and alcohol abuse (39 percent) and drug abuse alone (37 percent). Department of Defense-owned facilities and tribal government-owned facilities had the largest percentages of clients being treated for alcohol abuse alone (72 percent and 43 percent, respectively). Indian Health Service facilities had the largest proportion of substance abuse clients in treatment for both alcohol and drug abuse (69 percent).
Generally, half of clients were in treatment for both alcohol and drug abuse, regardless of the facility’s primary focus. Facilities focused on substance abuse treatment had the lowest proportion of clients being treated for both alcohol and drugs (47 percent) and the highest proportion for drug only (34 percent). Among general health care focused facilities, the proportion of clients in treatment for drugs alone or alcohol alone was similar (24 percent and 26 percent, respectively). Facilities with a mental health focus or substance abuse and mental health focus both had roughly 20 percent of clients in treatment for drug abuse only and approximately 30 percent in treatment for alcohol abuse only.
Table 4.4. Facilities were asked whether they dispensed the opioid substitutes methadone and LAAM and, if so, how many clients received them. Nine percent (1,215 facilities) of all facilities reported dispensing opioid substitutes. Nearly half (46 percent) of all facilities that dispensed opioid substitutes were private non-profit, with an additional 39 percent private for-profit. Three-quarters of facilities providing opioid substitutes had substance abuse as their primary focus. Another 13 percent of facilities had substance abuse and mental health as their primary focus.
Overall, 178,212 clients in treatment (18 percent) were reported to be receiving either methadone or LAAM. Of the two, methadone was given to 97 percent of clients receiving an opioid substitute.
Almost half of clients (45 percent) receiving opioid substitutes were treated at private non-profit facilities and 43 percent were treated at private for-profit facilities. In terms of primary focus, 91 percent of clients were treated in facilities with a substance abuse focus. An additional five percent were treated in facilities focused on both substance abuse and mental health.
Facilities that dispensed opioid substitutes tended to specialize in this form of treatment; 77 percent of their clients received methadone or LAAM. In private facilities that dispensed opioid substitutes, the overwhelming majority of clients received these drugs (93 percent of clients in for-profit facilities and 75 percent of clients in non-profit facilities).
Of all facilities that dispensed opioid substitutes, those with a primary focus on substance abuse treatment had the largest proportion (83 percent) of clients receiving these drugs. The remaining facilities that dispensed opioid substitutes had between one-third and one-half of their clients receiving these drugs, depending on primary focus (33 percent for facilities with a mental health focus and 49 percent for facilities that focused equally on substance abuse and mental health).
