Examining Substance Use Disorder Treatment Demand and Provider Capacity in a Changing Health Care System: Initial Findings Report. Notes

09/30/2015

  1. Here an SUD is defined as meeting diagnostic criteria for substance abuse or dependence based on survey response.

  2. According to NSDUH between 2013 and 2014 the point estimate for number of individuals who received any specialty treatment in the past year rose from 2,466,000 to 2,606,000, an increase of 140,000 individuals. However, this increase is not statistically significant (SAMHSA 2015e).

  3. Treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient is not considered specialty treatment.

  4. NSDUH uses face-to-face audio, computer-assisted self-interviews to collect data on the currency and frequency of illicit drug and alcohol use, problems/symptoms associated with alcohol and/or drug use, and receipt of alcohol and/or drug treatment. The sample frame excludes active military personnel, United States citizens living abroad, residents of institutional settings (for example, prisons, hospitals, and nursing homes), and homeless individuals not living in a shelter at the time of the survey.

  5. The N-SSATS is primarily a web-based survey. N-SSATS is a census of all known, public and private, facilities that provide substance abuse treatment. It excludes those programs located in jails or prisons, serving only incarcerated clients, and solo practitioners (unless a state substance abuse agencies specifically requests to include them).

  6. This report intends to provide a comprehensive view of SUD treatment services provided nationally. Although the Treatment Episodes Dataset (TEDS) data include extensive information on SUD treatment admissions, these data were not used in the current report because the set of admissions represented in TEDS varies by state (for example some states report admissions regardless of source of payment while others report only publicly funded admissions).

  7. Illicit use of psychotherapeutics includes the non-medical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.

  8. Here an SUD is defined as meeting diagnostic criteria for substance abuse or dependence based on survey response.

  9. Estimates for 2014 from SAMHSA (2015e).

  10. In a given state, solo practitioners may be included in the N-SSATS if a state substance abuse agency specifically requests their inclusion.

  11. Care in this setting may be residential (52 percent), outpatient (40 percent) or inpatient (8 percent).

  12. Pre-ACA estimates--looking at either all of 2013, September 2013, or the third quarter of 2013--indicate that between 18 percent and 21 percent of Americans were uninsured, After its implementation--using estimates for either the first quarter of 2014, March 2014, or the first half of 2014--the numbers decreased to between 13 percent and 18 percent.

  13. Beronio et al. (2013) used data from the 2011 Medical Loss Ratio filings and a 2011 study comparing benefits in small group products to state and federal employee plans to estimate the number of insured individuals who would gain SUD coverage through ACA provisions.

  14. SAMHSA developed projections in two stages (SAMHSA 2014c). First, baseline projections in absence of important laws affecting spending such as the ACA were developed. Then the projections were adjusted to reflect the effects of this legislation. The baseline projection methods included disaggregating historical spending into growth factors (for example, population growth, change in users per population, and change in intensity of use per user or technology change), projecting growth factors responsible for increases in spending through 2020 and developing forecasts of provider spending from projected factors through 2020. Adjustments associated with ACA legislation were developed through two approaches: (1) Simulating the health care costs of users moving from one insurer to another, due to the expansion of Medicaid and the introduction of insurance marketplaces; and (2) calculating the differences in growth in the National Health Expenditure Accounts for all-health spending with and without the effects of the ACA and applying these differences to the growth rates for spending in the baseline.

  15. This is slightly lower than the 26 million projected in the latest CBO projections (CBO 2014).

  16. See Finkelstein et al. (2011), page 22.

  17. In 2003, Maine enacted mental health parity coverage law and the Dirigo Health Reform Act. DirigoChoice was launched in 2004. Massachusetts enacted a major health care reform law in 2006. Vermont passed its parity law in 1997 and the Vermont Blueprint for Health, a strategic planning tool to specifically address the increasing costs of chronic diseases, was enacted in 2004.

  18. Licensing or certification requirements for SUD professionals vary across states. States that require SUD treatment professionals to be licensed have a legal authority that reviews each applicant's qualifications and grants licenses to applicants meeting the state's requirements for licensure in a given professional category. Licensed individuals are permitted to provide services within the scope of practice of the license for the given state. Professional certification is similar to licensure in that an authoritative body reviews an applicant's qualifications and certifies that an applicant meets all requirements; however certification is distinct from licensure in that the certifying body may not have legal authority associated with medical practice in a particular state.

  19. Detailed information on the state requirements for each type of professional can be found in NASADAD (2013) Table 8.

  20. It is possible for facilities to operate above capacity by serving individuals with SUD treatment needs in beds that are not specifically designated for SUD treatment.

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