The Drug and Alcohol Services Information System Report

August 23, 2002

Distance to Substance Abuse Treatment Facilities among Those with Alcohol Dependence or Abuse

In Brief

  • Adults with alcohol dependence or abuse in the United States lived an average of 3.2 miles from a substance abuse treatment facility in the year 2000
  • More than 100,000 adults with alcohol dependence or abuse nationwide lived more than 30 miles from a substance abuse treatment facility
  • Treatment tended to be more geographically accessible in the Northeast and West compared with the Midwest and South

One important component of access to health care is geographic accessibility, or how difficult it is for someone to travel for treatment.1 This report examines measures of geographic accessibility to substance abuse treatment by analyzing the distance between the location of substance abuse treatment facilities and the location of those who could benefit from alcohol treatment, that is, those identified as meeting the criteria for alcohol dependence or abuse as presented in DSM-IV.2

Data from the Inventory of Substance Abuse Treatment Services (I-SATS), a component of the Drug and Alcohol Services Information System (DASIS), were used to identify the location of treatment facilities nationwide. I-SATS is a listing of the names and addresses of all known public and private substance abuse treatment facilities in the United States and its territories. These data were geocoded and linked to geocoded individual data on adults identified as having alcohol dependence or abuse by the 2000 National Household Survey on Drug Abuse (NHSDA). The distances between the geographic center of the survey respondent’s zip code and the addresses of the closest 100 treatment facilities were computed.3 Distance measures are presented for the four U.S. Census Bureau regions (Northeast, Midwest, South, and West)4 and by urbanicity. The urbanicity measure has the following values.5
  • Large central metro—Central counties of metropolitan areas of 1 million population or more.
    •
  • Large fringe metro—Fringe counties of metropolitan areas of 1 million population or more.
    •
  • Small metro—Counties in metropolitan areas of less than 1 million population.
    •
  • Non-metro counties with city—Non-metropolitan counties with an urban population of 2,500 or more.
    •
  • Non-metro counties without city—Completely rural counties and those with less than 2,500 urban population.
Distance to the Nearest Treatment Facility
According to the 2000 NHSDA, some 10 million adults in the United States had alcohol dependence or abuse. On average, an adult with alcohol dependence or abuse lived about 3.2 miles from a substance abuse treatment facility. Figures 1 and 2 show that this distance varied by geographic location. An adult with alcohol dependence or abuse would have had to travel only 2.4 miles in the Northeast, but about 4.3 miles in the South (Figure 1). Adults with alcohol dependence or abuse living in large central metro areas would have had to travel 1.7 miles to reach the nearest facility, on average, while those in non-metro counties without a city would have had to travel 13 miles (Figure 2).

Figure 1. Average Distance to Nearest Treatment Facility for Adults with DSM-IV Alcohol Dependence or Abuse, U.S. and by Region: 2000 Figure 2. Average Distance to Nearest Treatment Facility for Adults with DSM-IV Alcohol Dependence or Abuse, by Urbanicity: 2000
Figure 1. Average Distance to Nearest Treatment Facility for Adults with DSM-IV Alcohol Dependence or Abuse, U.S. and by Region: 2000 Figure 2. Average Distance to Nearest Treatment Facility for Adults with DSM-IV Alcohol Dependence or Abuse, by Urbanicity: 2000
Source: 2000 SAMHSA Inventory of Substance Abuse Treatment Services (I-SATS) and 2000 National Household Survey on Drug Abuse (NHSDA).

Treatment Facilities within Specific Distances
About 42 percent of adults with alcohol dependence or abuse nationwide lived within 1 mile of a treatment facility in the year 2000 (Figure 3). Some 82 percent lived within 5 miles of a treatment facility, and 99 percent lived within 30 miles of one. However, more than 100,000 adults with alcohol dependence or abuse nationwide lived more than 30 miles from a substance abuse treatment facility.
Figure 3. Percent of Adults with Alcohol Dependence or Abuse within Selected Distances to the Nearest Treatment Facility, U.S. and by Region: 2000
Figure 3. Percent of Adults with Alcohol Dependence or Abuse within Selected Distances to the Nearest Treatment Facility, U.S. and by Region: 2000
Source: 2000 SAMHSA Inventory of Substance Abuse Treatment Services (I-SATS) and 2000 National Household Survey on Drug Abuse (NHSDA).

The distances adults with alcohol dependence or abuse would have had to travel to reach a substance abuse treatment facility also varied by geographic location. In the South, only 32 percent of adults with alcohol dependence or abuse lived within 1 mile of a treatment facility compared with more than 45 percent of those in the Northeast and West (Figure 3). Only 9 percent of adults with alcohol dependence or abuse who lived in non-metro counties without a city lived within 1 mile of a treatment facility, while 49 percent of large central metro dwellers did (Figure 4).
Figure 4. Percent of Adults with Alcohol Dependence or Abuse within Selected Distances to the Nearest Treatment Facility, by Urbanicity: 2000
Figure 4. Percent of Adults with Alcohol Dependence or Abuse within Selected Distances to the Nearest Treatment Facility, by Urbanicity: 2000
Source: 2000 SAMHSA Inventory of Substance Abuse Treatment Services (I-SATS) and 2000 National Household Survey on Drug Abuse (NHSDA).

Number of Treatment Facilities within 15 Miles
Individuals requiring substance abuse treatment may have a variety of needs, and a given individual may have a better outcome in a specific type of program. For that reason, the availability of a number of substance abuse treatment facilities nearby may promote better outcomes. Most adults with alcohol dependence or abuse in the United States had a choice of at least two facilities within 15 miles, although the percentage varied across the country (Figure 5). While at least 95 percent of adults with alcohol dependence or abuse in the Northeast and West had two or more facilities within 15 miles, fewer than 90 percent of those in the Midwest and South had such a choice. The same pattern held for a choice of 10 or more facilities. In the Northeast and West, at least 79 percent had a choice among 10 or more facilities within 15 miles. In the Midwest and South, fewer than 65 percent of adults with alcohol dependence or abuse could choose from at least 10 facilities.

The number of facilities in the vicinity varies by urbanicity as well (Figure 6). Almost all adults with alcohol dependence or abuse in large central metro areas had at least two treatment facilities within 15 miles. The same was true for nearly 44 percent of adults with alcohol dependence or abuse who resided in non-metro counties without a city. In addition, while 95 percent of adults with alcohol dependence or abuse residing in large central metro areas could choose from among 10 facilities, none of those in non-metro counties without a city could do so.

Figure 5. Percent of Adults with Alcohol Dependence or Abuse, by Number of Treatment Facilities within 15 Miles, U.S. and by Region: 2000 Figure 6. Percent of Adults with Alcohol Dependence or Abuse, by Number of Treatment Facilities within 15 Miles and Urbanicity: 2000
Figure 5. Percent of Adults with Alcohol Dependence or Abuse, by Number of Treatment Facilities within 15 Miles, U.S. and by Region: 2000 Figure 6. Percent of Adults with Alcohol Dependence or Abuse, by Number of Treatment Facilities within 15 Miles and Urbanicity: 2000
Source: 2000 SAMHSA Inventory of Substance Abuse Treatment Services (I-SATS) and 2000 National Household Survey on Drug Abuse (NHSDA).

End Notes
1Pechansky, R., & Thomas, J.W. (1981). The Concept of Access: Definition and Relationship to Consumer Satisfaction. Medical Care 19(2), 127-140.
2American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV (4th ed.). Washington, DC: Author.
3The longitude and latitude of the geographic center of the respondent’s zip code were used, instead of the respondent’s actual address, to protect respondent confidentiality. Straight line distance has been shown to be highly correlated with actual travel time. For a discussion, see Fortney, J., Thill, J.C., Zhang, M., Duan, N., & Rost, K. (2001). Provider Choice and Utility Loss Due to Selective Contracting in Rural and Urban Areas. Medical Care Research and Review 58(1), 60-75.
4The four regions, as designated by the U. S. Census Bureau, are: Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania); Midwest (Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, Kansas); South (Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, Texas); and West (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska, Hawaii).
5Based on Butler, M.A., & Beale, C.L. (1994, September). Rural and Urban Continuum Codes for Metro and NonMetro Counties, 1993. U.S. Department of Agriculture. AGES 9428, U.S. Department of Agriculture, Economic Research Service.

The Drug and Alcohol Services Information System (DASIS) is an integrated data system maintained by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). One component of DASIS is the Inventory of Substance Abuse Treatment Services (I-SATS). I-SATS is an electronic national inventory of organized substance abuse treatment facilities in the United States and its territories. Before 2000, the I-SATS was known as the National Master Facility Inventory. I-SATS is maintained by OAS/SAMHSA in cooperation with the States.

The National Household Survey on Drug Abuse (NHSDA) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2000 data are based on information obtained from nearly 72,000 persons aged 12 or older, including more than 25,000 youths aged 12 to 17. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The DASIS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and RTI, Research Triangle Park, North Carolina.

To locate the drug and alcohol abuse treatment programs nearest you go to:
http://findtreatment.samhsa.gov/facilitylocatordoc.htm

Other substance abuse reports are available at:
http://www.oas.samhsa.gov


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This page was last updated on December 31, 2008.