CHAPTER 1

DESCRIPTION OF THE TREATMENT EPISODE DATA SET

Introduction

This report presents the findings from the Treatment Episode Data Set (TEDS) for 1996. The report provides information on the demographic and substance use characteristics of the 1.5 million admissions to treatment for abuse of alcohol and other drugs reported in 1996 in facilities that reported to individual State administrative data systems.

TEDS, while representing a significant proportion of all admissions to substance abuse treatment, does not include all such admissions. 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 (see Chapter 4). Thus TEDS, while it does not represent all admissions to substance abuse treatment, does represent those admissions that constitute a burden on public funds. Most States are able to report all admissions to all eligible facilities, although some report only those admissions that were financed by public funds. States may report data from facilities that do not receive public funds, but generally do not because of the difficulty in obtaining data from these facilities. TEDS also does not generally include data on facilities that are operated by federal agencies. These include the Bureau of Prisons, the Department of Defense, the Indian Health Service, and the Veterans Administration.

The primary goal for TEDS is to monitor treatment episodes for substance abusers. Implicit in the concept of treatment is a planned, continuing treatment regimen. Thus TEDS does not attempt to include early intervention programs (considered as prevention programs). Crisis intervention facilities such as sobering-up stations and hospital emergency departments are generally not included in TEDS, although a State may opt to include such programs in its submissions to TEDS.

The TEDS system comprises data routinely collected by States in monitoring their individual substance abuse treatment systems. Selected data items from the individual State data files are converted to a standardized format consistent across States. These standardized data constitute TEDS. TEDS consists of a Minimum Data Set of 19 items collected by nearly all States, and a Supplemental Data Set of 15 items collected by some States. The Minimum Data Set includes demographic information; primary, secondary, and tertiary substances; their route of administration, frequency of use, and age of first use; source of referral to treatment; number of prior treatment episodes; and service type, including planned use of methadone. The Supplemental Data Set includes psychiatric, social, and economic measures. Definitions and classifications used in the Minimum and Supplemental Data Sets are detailed in Appendix A.

History

National-level data collection on admissions to substance abuse treatment was first mandated in 1972 under the Drug Abuse Office and Treatment Act, P.L. 92-255. This act initiated federal funding for drug treatment and rehabilitation, and required reporting on clients entering drug (but not alcohol) abuse treatment. The Client-Oriented Data Acquisition Process (CODAP) was developed to collect admissions and discharge data directly from federally funded drug treatment programs. (Programs for treatment of alcohol abuse were not included.) Reporting was mandatory for all such programs, and data were collected using a standard form. CODAP included all clients in federally-funded programs regardless of individual funding source. Reports were issued from 1973-81 based on data from 1,800-2,000 programs, representing some 200,000 annual admissions.

In 1981, collection of national-level data on admissions to substance abuse treatment was discontinued because of the introduction of the Alcohol and Drug Abuse and Mental Health Services (ADMS) Block Grant. The Block Grant transferred federal funding from individual programs to the States for distribution, and included no data reporting requirement. Participation in CODAP became voluntary, and although several states submitted data through 1984, the data were in no way nationally representative.

In 1988, the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690) established a revised Substance Abuse Prevention and Treatment (SAPT) Block Grant, and mandated federal data collection on clients receiving substance abuse treatment. The Treatment Episode Data Set (TEDS) data collection effort represents the federal response to this mandate. TEDS began in 1989 with the issue of three-year development grants to States. State participation in TEDS is to some extent voluntary--contingent on acceptance of SAPT Block Grant funds.

Interpretation of the Data

TEDS is an exceptionally large and powerful data set. Like all data sets, however, care must be taken that interpretation does not extend beyond the limitations of the data. Limitations fall into two broad categories: those related to the scope of the data collection system, and those related to the difficulties of aggregating data from the highly diverse State data collection systems. Limitations to be kept in mind while analyzing the TEDS data include:

• TEDS is an admission-based system, and TEDS admissions do not represent individuals. A given individual admitted to treatment twice within a given year would be counted as two admissions. Most States cannot, for reasons of confidentiality, identify clients with a unique ID assigned at the State level. Consequently TEDS is unable to follow individual clients through a sequence of treatment episodes.

• TEDS attempts to enumerate treatment episodes by distinguishing the initial admission of a client from his/her subsequent transfer to a different service type (for example, from residential treatment to outpatient) within a single continuous treatment episode. However, States differ greatly in their ability to identify transfers; some can distinguish transfers within providers but not across providers (see Chapter 4). For this report, all identifiable transfers have been excluded, but some admission records may in fact represent transfers, and therefore the number of admissions reported here probably overestimates the number of treatment episodes.

• The number and client mix of TEDS admissions does not represent the total national demand for substance abuse treatment, nor the prevalence of substance use in the general population.

• In reporting TEDS data, SAMHSA must balance timeliness of reporting with completeness of the data set. States rely on individual facilities reporting in a timely manner, then bundle the data and report it to SAMHSA at regular intervals. Admissions from facilities that report late to the States may appear in a later data submission to SAMHSA. Thus the number of admissions reported here for 1996 may be expected to increase by as much as 10 percent as data submissions are brought up to date. However, the additional submissions are unlikely to affect the percentage distributions that are the basis of this report.

• States continually review the quality of their data processing. When systematic errors are identified, States may revise or replace historical TEDS data files. While this process represents an improvement in the data system, the historical statistics in this report will differ slightly from those in earlier reports.

Considerations specific to this report include:

• The report includes initial client admissions records that were received and processed by SAMHSA through January 14, 1998.

• The report focuses on treatment admissions for substance abusers. Thus admissions for treatment as a codependent of a substance abuser are excluded. Records for identifiable transfers within a single treatment episode are also excluded.

• Records with partially complete data have been retained. Where records include missing or invalid data for a specific variable, that record is excluded from tabulations of that variable. The total number of admissions on which a percentage distribution is based is reported in each table.

• Primary alcohol admissions are characterized as Alcohol only or Alcohol with secondary drug. Alcohol with secondary drug indicates a primary alcohol admission with a specified secondary or tertiary drug. All other alcohol admissions are classified as Alcohol only.

• Cocaine admissions are classified according to route of administration as smoked and non-smoked. Smoked cocaine primarily represents crack or rock cocaine, but can also include cocaine hydrochloride (powder cocaine) when it is free-based. Non-smoked cocaine includes cocaine admissions where the route of administration is not reported, and thus the TEDS estimate of the proportion of admissions for smoked cocaine is conservative.

This page was last updated on December 30, 2008.

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.