October 1, 2004

Many of those with alcohol and drug dependence are admitted to treatment multiple times before they achieve long-term abstinence.¹ In 2002, approximately 1.9 million admissions to substance abuse treatment were reported to the Treatment Episode Data Set (TEDS). TEDS categorizes treatment admissions according to the number of prior treatment episodes: no prior episodes, one to four prior episodes, or five or more prior episodes. Most of the admissions in 2002 were either first-time admissions (44 percent) or had between one and four previous treatment episodes (45 percent). The remaining 11 percent had five or more previous treatment episodes. This report compares the admissions with five or more prior treatment episodes with first-time treatment admissions.

Substances of Abuse

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Substance abuse admissions reporting five or more previous treatment episodes were more likely to report opiates (36 percent) as their primary substance of abuse² than were first-time admissions (10 percent) (Figure 1). They were less likely to report primary marijuana (4 vs. 22 percent) or stimulants (2 vs. 9 percent) than first-time admissions. More than 40 percent of both groups reported alcohol as their primary substance of abuse. The percentage of admissions in both groups reporting cocaine was also similar (first-time admissions 11 percent; admissions with five or more prior treatment episodes 14 percent).

Figure 1. Primary Substance of Abuse, by Number of Prior Treatment Episodes: 2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

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Characteristics of Admissions

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In 2002, about 70 percent of both first-time admissions and admissions with five or more previous treatment episodes were male. First-time admissions and admissions with five or more previous treatment episodes had similar percentages of White admissions (60 and 62 percent, respectively) and Black admissions (22 and 21 percent, respectively). Hispanic admissions accounted for 13 percent of both groups.

Although sex and racial/ethnic distributions were similar for both groups, the mean age at the time of admission differed. Predictably, admissions with five or more prior treatment episodes tended to be older than first-time admissions-38 years old versus 31 years old.

Substance abuse treatment admissions with five or more previous treatment episodes were less likely to be working than first-time admissions. Only 17 percent of admissions with five or more prior treatment episodes were employed full- or part-time compared with 38 percent of first-time admissions, and 28 percent were looking for work compared with 32 percent of first-time admissions (Figure 2). More than half of admissions with five or more prior treatment episodes were not in the labor force compared with only 30 percent of first-time admissions.

Figure 2. Employment Status, by Number of Prior Treatment Episodes: 2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

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Treatment Characteristics

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Substance abuse admissions with five or more prior treatment episodes were less frequently referred by the criminal justice system (16 percent) than first-time admissions (47 percent) (Figure 3). However, admissions with five or more prior treatment episodes were more likely than first-time admissions to have been self- or individually referred (52 vs. 27 percent) or to have been referred by an alcohol or drug abuse provider (18 vs. 6 percent).

Figure 3. Referral Source, by Number of Prior Treatment Episodes: 2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

First-time substance abuse admissions had a lower rate of admission to rehabilitation/residential treatment (14 percent) than admissions with five or more prior treatment episodes (20 percent) (Figure 4). While admissions with five or more prior treatment episodes were most frequently in ambulatory treatment (45 percent), the rate was much lower than among first-time admissions (72 percent). These admissions were more likely than first-time admissions to be admitted to detoxification (35 vs. 14 percent).

Figure 4. Treatment Setting, by Number of Prior Treatment Episodes: 2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

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Trends, 1992-2002

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Between 1992 and 2002, the proportion of admissions with five or more prior treatment episodes increased very slightly from 10 percent of all treatment admissions to 11 percent. While the average age and racial/ethnic make-up of these admissions remained stable during this time, the percentage of females among admissions with five or more previous treatment episodes increased from 27 percent to 30 percent.

The distribution of primary substances of abuse among admissions with five or more prior treatment episodes changed somewhat between 1992 and 2002. During this time, the proportion of admissions with five or more prior treatment episodes that reported alcohol as their primary substance of abuse declined from 54 percent in 1992 to 42 percent in 2002. A similar decline (59 to 43 percent) occurred during this period for all admissions, regardless of the number of prior treatment episodes. Among admissions with five or more prior treatment episodes, the percentage reporting opiates as their primary substance of abuse increased from 30 percent in 1992 to 36 percent in 2002. Again, this trend was similar to the trend among all admissions, although the percentage of admissions reporting opiates was notably lower throughout the entire time period (12 percent in 1992; 18 percent in 2002).

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End Notes

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¹ Hser, Y.I., Anglin, M.D., Grella, C., Longshore, D., and Prendergast, M.L. (1997). Drug treatment careers. A conceptual framework and existing research findings. Journal of Substance Abuse Treatment, 14(6), 543-58.
²The primary substance of abuse is the main substance reported at the time of admission.

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 Treatment Episode Data Set (TEDS). TEDS is a compilation of data on the demographic characteristics and substance abuse problems of those admitted for substance abuse treatment. The information comes primarily from facilities that receive some public funding. Information on treatment admissions is routinely collected by State administrative systems and then submitted to SAMHSA in a standard format. Approximately 1.9 million records are included in TEDS each year. TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once. The DASIS 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 a trade name of Research Triangle Institute). Information and data for this issue are based on data reported to TEDS through March 1, 2004. Access the latest TEDS reports at: http://www.oas.samhsa.gov/dasis.htm Access the latest TEDS public use files at: http://www.oas.samhsa.gov/SAMHDA.htm Other substance abuse reports are available at: http://www.oas.samhsa.gov

The DASIS 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 on-line: http://www.oas.samhsa.gov. Citation of the source is appreciated.

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