Highlights

This report presents key results from the 1992 NDATUS survey plus comparisons to prior surveys going back to 1980. NDATUS is the only national census of specialty substance abuse (i.e. alcohol or other drugs) treatment providers. It seeks information from all free-standing facilities that treat only substance abuse, and from specialized substance abuse units within multi-purpose health care institutions (for example, hospitals). Providers report information about all of their clients in treatment on a specific reference day. They also report data that describe other aspects of their treatment operations. A forthcoming Main Findings report will summarize all 1992 NDATUS results. The focus here is on selected data that were most consistently reported in 1992 and in prior surveys.

In addition to the highlights listed below, there are two broad findings concerning the structure of the specialty treatment industry. First, excluding growth in total clients over time, broad characteristics of providers and clients show either stability or gradual change between 1980 and 1992. Seeing the direction of changes or no change helps to understand how specialty treatment has responded to changes in the population needing treatment and to funding constraints. The observed stability or gradual change also provides reassurance that the NDATUS reporting system has been relatively consistent over this period.

Second, large differences exist among the States in terms of the number of clients in treatment as a proportion of the general population, in patterns of substances abused by clients, and in the mix of outpatient versus 24-hour care. These differences may reflect many factors such as the number of substance abusers, the types of substances abused, and the availability of funds to pay for treatment. To some extent, they may also reflect State reporting practices.

Clients in Treatment

• Across the U.S., there were an estimated 945 thousand clients in specialty substance abuse treatment on September 30, 1992. The geographic distribution of clients by county is shown in Figure 1.

• There were 432 clients for every 100,000 people in the general population above the age of 12. However, this rate varied by State and by region [see Figure 2]. For example, it was about twice as high in the West (656) than in the South (293). Among the States, Washington had the highest rate (781) and Arkansas the lowest (148).

Substances of Abuse

• NDATUS classifies clients into 3 groups: alcohol only, drug only, or both. Among clients in treatment, abuse of alcohol and illicit drugs (such as cocaine, opiates, and marijuana) together was the most common pattern of substance abuse across the U.S. --- 38% of clients abused both alcohol and drugs. A slightly smaller fraction (37%) abused only alcohol; and a smaller fraction (25%) abused only drugs.
• Substance abuse patterns vary by region and by State. In the West, alcohol abuse alone was found among the highest share of clients (52%). The greatest proportion of alcohol-only clients was found in West Virginia (73%) and the lowest was in Massachusetts (13%).
• Substance abuse patterns among clients varied across the four census regions. The proportion of alcohol-only clients was highest (52%) in the West and lowest in the Northeast (21%). The proportion of drug-only clients was highest in the Northeast (34%) and lowest in Midwest (19%). The proportion abusing both alcohol and drugs was about the same in the Northeast (44%), the South and the Midwest (43%), and lowest in the West (27%).
• Substance abuse patterns varied more widely among the States. The highest proportion of alcohol-only clients was reported in West Virginia (73%), followed by California and South Dakota (60%) and Vermont (59%). The highest proportion of drug-only clients was reported in New York (44%), followed by Arizona and Nevada (40%). The highest proportion of clients abusing both alcohol and drugs was reported in Massachusetts (73%), followed by Minnesota (60%), Texas (58%), and Oklahoma (57%).

Client Demographics

• Whites accounted for the largest share of clients (60%) in 1992, followed by blacks (22%) and Hispanics (15%). Black and Hispanic clients were over-represented in the treatment population compared to the general population (12% and 10%, respectively).
• Similarly, while the national rate of clients in treatment was 432 per 100,000 population (aged 12 and over), the rates for blacks and Hispanics were higher than for whites (850, 608, and 348 per 100,000, respectively).
• The racial and ethnic composition of clients has changed little between 1980 and 1992. The proportion of whites declined from 63% in 1980. The proportion of Hispanics rose slightly from 13%, and the proportion of blacks rose one percentage point from 21%.
• There was a relative increase in the number of women in treatment. Between 1980 and 1992, their share increased from 25% to 29% of all NDATUS clients. Conversely, men went from 75% in 1980 to 71% in 1992.
• There has been a gradual aging of clients in treatment. While most clients (75%) in 1992 were between the ages of 21 and 44, since 1987 the fastest growing segment was between the ages of 35 and 44. This age group increased from 23% to 28% of all clients over these 5 years.

Providers' Institutional Setting

• Over half (54%) of clients in 1992 were treated in free-standing facilities that offer only outpatient substance abuse services. Most remaining clients were treated in community mental health centers (16%), general hospitals (10%), and free-standing residential facilities (7%).
• Free-standing outpatient facilities experienced gradual yet pronounced growth since 1980. Clients treated in these facilities increased from 40% in 1980 to 54% in 1992.

Treatment Services

• Outpatient services, offered in all institutional settings, accounted for 87% of all clients. The other broad category of services is 24-hour or round-the-clock care. Outpatient clients were mostly in drug-free programs (75%), but some also received methadone (12%). Outpatient services may include the same services that are delivered in 24-hour care, although outpatient treatment episodes are typically less intensive and are stretched out over a longer period of time.
• There was wide variation in treatment services offered in different States. Minnesota and Mississippi had the smallest share of clients in outpatient care (less than 70%) and the greatest share of clients in 24-hour care (greater than 30%). Conversely, Kentucky, Maryland, Michigan, and Rhode Island had more than 93% of clients in outpatient care and less than 7% in 24-hour care.
• From 1980 to 1992, there was a gradual shift in patients to outpatient services. The share of clients in outpatient treatment went up from 84% in 1980 to 87% in 1992, while the share receiving 24-hour care declined from 16% to 13%.

Providers With Private Funding Exclusively

• Limited funding data permit comparison between all providers and a subset that report only private funding (20% of all providers and 18% of all clients). In 1992, providers with private funding exclusively had more excess capacity. They used 70% of their outpatient capacity and 58% of their 24-hour capacity, compared to an average of 80% and 76% (respectively) for all providers. The overall average was higher because publicly funded providers had less excess capacity.
• Between 1980 and 1992, privately-funded-only providers treated a higher share of clients who were male, white, and Hispanic than did all providers. Conversely, they treated proportionally fewer blacks and women.
• Over this time period, privately-funded-only providers shifted more rapidly than others from 24-hour to outpatient services. In 1980, 20% of their daily clients were in 24-hour care; in 1992, it had dropped to 9%. For all (mostly publicly funded) providers, this proportion declined from 16% to 13%. Two factors may explain this more rapid shift by the private sector: 1) faster conversion to managed care systems, and 2) diversion of severe cases requiring inpatient treatment to publicly funded providers.

By presenting these and other findings, this Advance Report helps Federal and State policy makers to track developments in substance abuse treatment. The forthcoming Main Findings report will include a complete set of NDATUS results plus more detailed client information from treatment admissions records reported to the Client Data System (CDS).

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