This report presents results from the Treatment Episode Data Set (TEDS) for clients discharged from substance abuse treatment in 2004. The report provides information on treatment completion, length of stay in treatment, and demographic and substance abuse characteristics of approximately 1,000,000 discharges from alcohol or drug treatment in facilities that report to individual State administrative data systems.
The TEDS Discharge Data System was designed to enable TEDS to collect information on entire treatment episodes. States are asked to submit data for all discharges from substance abuse treatment. Discharge data, when linked to admissions data, represent treatment episodes that enable analyses of questions that cannot be answered with admissions data alone (e.g., the proportion of discharges who completed treatment and the average length of stay of treatment completers).
TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
TEDS does not include all admissions to substance abuse treatment. It includes data from facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services.
A total of 1,105,644 records for clients discharged in Year 2004 were submitted by 28 States. Ninety-five percent of these records
(n = 1,046,522) could be linked to a TEDS admission record from 2001, 2002, 2003, or 2004 [Tables 2.2a and 2.2b].
The primary substance reported at admission for 36 percent of all Year 2004 linked discharges was alcohol. Nineteen percent reported opiates, 16 percent reported marijuana, 14 percent reported cocaine, 10 percent reported stimulants, and 4 percent reported other substances [Table 2.1b].
Forty-four percent of Year 2004 linked discharges were from outpatient treatment, 21 percent were from detoxification, 11 percent were from intensive outpatient treatment, 9 percent were from long-term residential treatment, 8 percent were from short-term residential treatment, 6 percent were from methadone treatment, and 1 percent were from hospital residential treatment [Table 2.3b and Figure 2.1].
Among the 51,263 methadone discharges who reported reason for discharge, 62 percent were from outpatient treatment, 35 percent were from detoxification, 2 percent were from long-term residential treatment, 1 percent were from short-term residential treatment, and less than 1 percent were hospital residential treatment [Table 2.6].*
Treatment was completed by 40 percent of the Year 2004 discharges. Twelve percent of discharges were transferred to further treatment, 22 percent dropped out of treatment, 8 percent had treatment terminated by the facility, 1 percent had treatment terminated because of incarceration, less than 1 percent died, 8 percent failed to complete treatment for other reasons, and the reason for discharge was unknown for 9 percent of discharges [Table 2.4].*
The treatment completion rate for all discharges was highest among discharges from hospital residential treatment (69 percent), detoxification (62 percent), and short-term residential treatment (61 percent). Completion rates were lower in longer-term and less structured settings, at 43 percent for long-term residential treatment, 38 percent for intensive outpatient treatment, and 36 percent for outpatient treatment. The completion rate was lowest (17 percent) among discharges from methadone treatment [Table 2.5 and Figure 2.2].
The treatment completion rate for discharges from methadone treatment was 12 percent among discharges from methadone outpatient treatment and 22 percent among discharges from methadone detoxification. The completion rate for methadone clients was higher among the few discharges from more structured settings, at 64 percent for hospital residential treatment, 44 percent for short-term residential treatment, and 40 percent for long-term residential treatment [Table 2.6].
Among all non-methadone discharges, the median LOS was greatest for discharges from outpatient treatment (69 days), followed by long-term residential treatment (46 days) and intensive outpatient treatment (42 days). The median LOS for discharges from short-term residential treatment was 20 days; from hospital residential treatment, 11 days; and from detoxification, 3 days [Table 2.5].
Among non-methadone treatment completers, the median LOS showed the same pattern as among all discharges, but the median LOS was longer. It was greatest in outpatient treatment (104 days), followed by long-term residential treatment (79 days) and intensive outpatient treatment (52 days). The median LOS for treatment completers in short-term residential treatment was 25 days; for hospital residential treatment, 14 days; and for detoxification, 3 days [Table 2.5 and Figure 2.3].
Among all methadone discharges, the median LOS was 42 days. It was longest (115 days) among methadone outpatient discharges. The median LOS was 16 days among methadone detoxification discharges, and was between 7 days and 46 days for methadone discharges from the other service types [Table 2.6].
Among methadone discharges completing treatment, the median LOS was 28 days. It was longest (159 days) among methadone outpatient completers. The median LOS was 20 days among methadone detoxification completers, and was between 8 days and 63 days for methadone completers from the other service types [Table 2.6].
Two of the Reason for discharge categories, treatment completion and transfer to further substance abuse treatment, represent positive conclusions to a treatment episode. To examine the client characteristics associated with treatment completion or transfer to further treatment, univariate logistic regression and multiple conditional logistic regression were conducted for all service types combined and for each service type separately.**
In univariate analyses of discharges from all service types combined, all client characteristics were associated with treatment completion or transfer to further treatment [Table 2.7a].
In the multivariate analysis of discharges from all service types combined, all of the client characteristics remained significantly associated with treatment completion or transfer to further treatment. However, the association was weakened for most client characteristics when adjusted for the presence of the other client characteristics in the model [Table 2.7b and Figure 2.5]:
Primary substance. For all service types combined, alcohol (vs. other substances) as the primary substance remained the client characteristic most strongly associated with treatment completion or transfer to further treatment, but its influence fell from 90 percent in the univariate model to 77 percent when controlled for the other client characteristics.
Education. For all service types combined, discharges with 12 or more years of education (vs. those with less than 12 years) were 18 percent more likely to complete treatment or transfer to further treatment, down from 30 percent in the univariate analysis.
Age at admission. For all service types combined, those who were age 30 and older (vs. those less than age 30) were 15 percent more likely to complete treatment or transfer to further treatment, down from 28 percent in the univariate analysis.
Race/ethnicity. For all service types combined, non-Hispanic Whites (vs. other racial/ethnic groups) were 12 percent more likely to complete treatment or transfer to further treatment, down from 18 percent in the univariate analysis.
Employment status. For all service types combined, discharges who were employed full time or part time (vs. those who were unemployed or not in the labor force) were 6 percent more likely to complete treatment or transfer to further treatment, down from 17 percent in the univariate analysis.
Gender. For all service types combined, males (vs. females) were 5 percent more likely to complete treatment or transfer to further treatment, down from 15 percent in the univariate analysis.
Frequency of use. For all service types combined, discharges who had not used their primary substance in the month before treatment entry (vs. those who had used their primary substance during that time period) were 3 percent less likely to complete treatment or transfer to further treatment, compared to 12 percent less likely in the univariate analysis.
The association of two client characteristics, prior treatment and referral source, were strengthened slightly after adjustment for the other client characteristics in the model.
Prior treatment. For all service types combined, those who had never been in treatment before (vs. those who had been in treatment one or more times before) were 15 percent more likely to complete treatment or transfer to further treatment, an increase from 9 percent in the univariate analysis.
Referral source. For all service types combined, discharges referred to treatment through the criminal justice system (vs. those referred through other sources) were 5 percent more likely to complete treatment or transfer to further treatment, a slight increase from 3 percent in the univariate analysis.
For the multiple conditional logistic regression analyses of the different service types, a different set of predictors of treatment completion or transfer to further treatment was evident for each service type [Table 2.7b and Figure 2.5].
* Percentages do not sum to 100 percent because of rounding.
**To examine the client characteristics associated with substance abuse treatment completion or transfer to further treatment, the variables representing these characteristics were dichotomized. (See Tables 2.7a and 2.7b.) Univariate logistic regression was conducted for all service types combined and for each service type separately to test whether the client characteristic was related to completion of treatment or transfer to further treatment for that service type. Logistic regression yields an odds ratio, that is, the odds of one group completing treatment or transferring to further treatment over the odds of the other group completing treatment or transferring. For example, the odds ratio among all discharges combined for males completing treatment or transferring to further treatment versus females completing treatment or transferring is 1.150 (Table 2.7a). This can be expressed as a percentage; that is, male discharges were 15 percent more likely than female discharges to complete treatment or transfer to further treatment.
Many of the client characteristics are related to each other, and the univariate odds ratio can reflect that interrelatedness. For example, if both age and gender are related to treatment completion or transfer, and age is related to gender, then calculation of the univariate odds ratios for age and gender will effectively count some treatment completers twice (i.e., once in the age calculation and once in the gender calculation). To produce an odds ratio for age that is independent of (or adjusted for) the odds ratio for gender, and vice versa, a multivariate conditional logistic regression model is used. In this analysis, for each service type and for all service types combined, client characteristics that were associated with treatment completion or transfer to further treatment at the significance level of p < 0.05 were used in SAS software stepwise regression procedures (alpha = 0.001 to enter or remove).
Note: Age at first use was reported for 76 percent of all discharges, and for less than 85 percent of discharges from outpatient treatment, long-term residential treatment, detoxification, methadone outpatient treatment, and methadone detoxification. It was excluded from the logistic regression analyses.
SAMHSA, an agency in the Department of Health and Human Services, is the Federal
Government's lead agency for improving the quality and availability of
substance abuse prevention, addiction treatment, and mental health
services in the United States.
