June 28, 2007

Admissions with Five or More Prior Episodes: 2005

Many individuals with alcohol or drug dependence are admitted to substance abuse treatment multiple times before they achieve long-term abstinence.¹ Data about multiple treatment episodes can be monitored with the Treatment Episode Data Set (TEDS), an annual compilation of data on the demographic characteristics and substance abuse problems of those admitted to substance abuse treatment, primarily at facilities that receive some public funding.² TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once during a single year.

Most substance abuse treatment admissions in 2005 were either first-time admissions (46 percent) or had between one and four previous treatment episodes (44 percent). The remaining 10 percent had five or more previous treatment episodes. This report compares admissions with five or more prior treatment episodes with first-time treatment admissions in 2005.

Substance abuse treatment clients with five or more prior treatment episodes were more likely than first-time admissions to report opiates as the primary substance of abuse³ (37 vs. 11 percent), while first-time admissions were more likely to report marijuana (22 vs. 5 percent) or stimulants (12 vs. 4 percent) (Figure 1). Over one third of both first-time admissions and those with five or more prior admissions reported alcohol as the primary substance of abuse (39 and 36 percent, respectively).

Figure 1. Primary Substance of Abuse, by Prior Admissions Group: 2005

Clients who were admitted with five or more prior substance abuse treatment episodes reported more frequent use of the primary substance of abuse than first-time admissions. About 61 percent of admissions with five or more prior treatment episodes reported daily use compared to 33 percent of first-time admissions. First-time admissions were correspondingly more likely than admissions with five or more prior treatment episodes to report no use in the past month (29 vs. 19 percent) or intermediate frequency of use (i.e., use in the past month but not on a daily basis) (38 vs. 20 percent).

Clients with five or more prior treatment episodes who were admitted to substance abuse treatment showed patterns of referrals to treatment and service settings⁴ that were distinctly different from first-time admissions. Clients with five or more prior treatment episodes were nearly twice as likely as first-time admissions to be self or individual referrals (i.e., referrals to treatment by the client or another individual) (49 vs. 28 percent), and less than half as likely to be referred by the criminal justice system (19 vs. 44 percent) (Figure 2).

Figure 2. Source of Referral, by Prior Admissions Group: 2005

Substance abuse treatment admissions with five or more treatment episodes were more likely than first-time admissions to be admitted to detoxification (34 vs. 15 percent) or to residential/rehabilitation service settings (19 vs. 15 percent); they were correspondingly less likely to be admitted to ambulatory treatment settings (47 vs. 70 percent).

Although there were no notable gender or racial/ethnic differences between first-time admissions and admissions with five or more prior substance abuse treatment episodes, there were distinct differences by other admissions characteristics.

Substance abuse treatment admissions with five or more prior treatment episodes were more likely than first-time admissions to face a variety of socioeconomic or other challenges. For example, nearly one quarter of admissions with five or more prior treatment episodes were homeless (24 percent) in contrast to less than one tenth of first-time admissions (8 percent).⁵ Admissions with five or more prior substance abuse treatment episodes were also more likely to report co-occurring psychiatric and substance abuse disorders (29 vs. 17 percent).⁶

Clients with five or more prior treatment episodes who were admitted to substance abuse treatment were considerably more likely than first-time admissions to be classified as "not in the labor force"⁷ (50 vs. 35 percent), and less likely to be employed full time (11 vs. 25 percent) (Figure 3). Differences in other employment categories were less pronounced; admissions with five or more prior admissions were less likely than first-time admissions to be employed part time and more likely to be unemployed.

Predictably, clients with five or more prior substance abuse treatment episodes were older, on average, than first-time admissions (38 vs. 32 years). Admissions with five or more prior treatment admissions were more likely than first-time admissions to be 35 to 49 years old (51 vs. 32 percent) or aged 50 or older (13 vs. 8 percent). By contrast, such admissions were less likely than first-time admissions to be younger than 18 (1 vs. 12 percent) or 18 to 25 years old (13 vs. 26 percent). The two admission groups were equally likely to be 26 to 34 years old (22 percent each).

Figure 3. Employment Status, by Prior Admissions Group: 2005

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.    Site Map | Contact Us | Accessibility | Privacy Policy | Freedom of Information Act  Disclaimer | Department of Health and Human Services | SAMHSA | White House | USA.gov * PDF formatted files require that Adobe Acrobat Reader® program is installed on your computer. Click here to download this FREE software now from Adobe. What's New Highlights Topics Data Drugs Pubs Short Reports Treatment Help Mail OAS