Examining Substance Use Disorder Treatment Demand and Provider Capacity in a Changing Health Care System: Final Report. NOTES

12/05/2017

  1. SAMHSA did not count positive responses to NSDUH questions regarding treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient as specialty treatment.

  2. For the NSDUH SAMHSA defines specialty treatment based on the setting of care as described above. The N-SSATS universe is limited to specialty treatment facilities. These facilities have units or programs focused on provision of SUD treatment. Thus, facilities may not be defined as "specialty" in both surveys. For example, a general hospital or mental health center would not be included in the N-SSATS universe unless they have a treatment program or unit designated for SUD treatment. These settings are, however, consider specialty treatment for NSDUH.

  3. Stevens et al. (2017) found a 34 percent increase in opioid overdose-related admissions to hospital intensive care units between January 2009 and September 2015 in a study of 162 hospitals in 44 states.

  4. We define an FTE as 40 working hours per week.

  5. N-SSATS surveys the universe of specialty SUD treatment facilities. In 2016 the survey had a 91 percent response rate. Estimates are not adjusted for facility or item non-response.

  6. Utilization rate is calculated by dividing the number of clients in care by the total number of designated beds. The utilization rate will exceed 100 percent when clients are placed in beds not specifically designated for substance use treatment.

  7. The survey instrument is available at https://wwwdasis.samhsa.gov/dasis2/nssats/nssats_2016_q.pdf.

  8. SAMHSA did not include emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient in the definition of specialty settings.

  9. For the NSDUH SAMHSA defines specialty treatment based on the setting of care as listed above. The N-SSATS universe is limited to specialty treatment facilities. These facilities have units or programs focused on provision of SUD treatment. Thus, facilities may not be defined as "specialty" in both surveys. For example, a general hospital or mental health center would not be included in the N-SSATS universe unless they have a treatment program or unit designated for SUD treatment. These settings are, however, consider specialty treatment for NSDUH.

  10. We conducted a logistic regression using data from the 2009-2014 NSDUH to estimate the increase in the likelihood of receiving treatment that was associated with being enrolled in Medicaid relative to being uninsured. The regression controlled for age, gender, race/ethnicity, education level, household income, marital status, age of first alcohol/illicit drug use, cigarette use, criminal activity, health status, population density, work status, SUD type, and year. Holding all other characteristics constant at the average for the population, the regression analysis indicated that, at the margin, the likelihood of specialty SUD treatment for someone who was uninsured was 60 percent of that for an individual who was Medicaid insured.

  11. Utilization rate is calculated by dividing the number of clients in care by the total number of designated beds. The utilization rate will exceed 100 percent when clients are placed in beds not specifically designated for substance use treatment.