Because of the widespread use of federal data sources in SUD needs assessment, it is important to have an understanding of their characteristics and limitations. The following is an overview of the most frequently used data sources.
Substance Abuse and Mental Health Services Administration Data Sources
SAMHSA has several resources that are widely utilized in needs assessments. These include the NSDUH, the N-SSATS, the National Mental Health Services Survey (N-MHSS), the TEDS, Behavioral Health Barometer, Behavioral Health Treatment Services Locator, Buprenorphine Treatment Practitioner Locator, OTP Directory, and the Emergency Department Data.
Many of these data sources are maintained by the Center for Behavioral Health Statistics and Quality as part of the Behavioral Health Services Information System (BHSIS), though data collection for some of these data sources is contracted out (e.g., NSDUH is contracted to RTI International). The purpose of BHSIS, which was formerly known as the Drug and Alcohol Services Information System, is the operation of an integrated statistical data system that provides information at the national, state, and local levels on the facilities and services available for substance abuse and mental health treatment in the United States, and the characteristics of the people admitted to the treatment facilities.
The National Survey on Drug Use and Health (NSDUH), which has been conducted since 1971, is considered the primary data source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse and mental disorders in the United States civilian, non-institutionalized population, age 12 and older. Data is collected from persons who are residing in households, non-institutionalized group quarters (e.g., shelters, rooming houses, and dormitories) and civilians living on military bases. The annual survey generates estimates at the national, state, and sub-state levels.
The NSDUH utilizes a stratified multi-stage area probability sample that is designed to be representative of the United States and each of the 50 states and the District of Columbia. It is implemented using a coordinated sample design that is state-based, with an independent, multi-stage area probability sample within each state and the District of Columbia. As a result, states are viewed as the first level of stratification and as a variable for reporting estimates; then each state is stratified into approximately equally populated state sampling regions (SSRs) and selected within each SSRs are census block groups, dwelling units and within dwelling units up to two residents for the interviews. Results of the NSDUH are available as the Published NSDUH, which provides estimates at the state and sub-state levels produced using small area estimation methods and by pooling multiple years of data. For state-level estimates, two years of data are combined; for sub-state estimates, three years of data are combined.
The NSDUH has several limitations for purposes of needs assessment:
The design and methodology of the NSDUH have been modified in various ways over the years, which may impact the comparability of estimates from surveys collected in different time periods.
NSDUH is a household survey that relies on the sampled respondents to provide accurate and honest reports of their substance use and substance use treatment experiences.
The sample excludes active duty military members and persons who do not live in households (homeless persons not in shelters and persons in institutions such as jails or prisons, hospitals, or residential treatment facilities) during most of the quarter of the year in which they were interviewed.
To protect confidentiality, the Public Use Files of the NSDUH do not include geographic identifier; therefore, these files cannot be utilized to provide estimates at the region, state or sub-state levels or to produce related analyses. Estimates also cannot be obtained for variables that were stripped due to disclosure reasons.
The National Survey of Substance Abuse Treatment Services (N-SSATS) is an annual census of all public and private substance abuse treatment facilities in the United States. Participation in the N-SSATS is voluntary but the incentive for participation is the opportunity to be included in SAMHSA's online Behavioral Health Treatment Services Locator (discussed below). The information is collected at the site of delivery of services rather than from administrative entities such as licensing boards.
The N-SSATS collects data on: (1) characteristics of individual facilities such as services offered and types of treatment provided, and payment options; (2) client count information such as counts of clients served by service; (3) information regarding hospital and residential capacity, the number of treatment admissions in the past 12 months and a single-day client census; (4) the number of facilities that provide medication-assisted treatment (MAT) with methadone, buprenorphine, and/or naltrexone and the number of clients that receive these medications; and (5) general information such as licensure, certification, or accreditation and facility website availability. Information is collected from all 50 states, the District of Columbia, Puerto Rico, the Federated States of Micronesia, Guam, Palau, and the Virgin Islands.
Primary limitations of the N-SSATS for purposes of SUD treatment needs assessments are that it does not include data from private physicians who are not affiliated with a substance abuse treatment program or facility, and it excludes jails, prisons, or other correctional facilities that exclusively treat incarcerated clients.
The National Mental Health Services Survey (N-MHSS) is an annual survey of all known public and private mental health treatment facilities in the United States. Data is collected from facilities within the 50 states, the District of Columbia, and the U.S. territories. The surveys are forwarded to facilities included in the Behavioral Health Treatment Services Locator.
The annual surveys collect statistical information on the numbers and characteristics of known mental health treatment facilities. Beginning in 2014, every other year, data is also collected on the number and demographic characteristics of persons served in the treatment facilities as of specified survey reference date. The N-MHSS includes: public psychiatric hospitals; private psychiatric hospitals, non-federal general hospitals with separate psychiatric units; U.S. Department of Veterans Affairs (VA) medical centers; residential treatment centers for children; residential treatment centers for adults; outpatient or day treatment or partial hospitalization mental health facilities; and multi-setting (non-hospital) mental health facilities.
Like the N-SSATS, participation in the survey is voluntary and provides the opportunity to be included in the Behavioral Health Treatment Services Locator (discussed below). Data is collected via a secure web-based questionnaire, a paper questionnaire sent by mail, and a computer-assisted telephone interviewing.
The N-MHSS has the following limitations:
It excludes U.S. Department of Defense military treatment facilities, individual private practitioners or small group practices not licensed as a mental health clinic or center, and jails or prisons.
It excludes facilities that only provide any of the following services: crisis intervention services, psychosocial rehabilitation, cognitive rehabilitation, intake, referral, mental health evaluation, health promotion, psychoeducational services, transportation services, respite services, consumer-run/peer support services, housing services, and legal advocacy.
It excludes residential facilities whose primary function is other than specialty mental health treatment services.
The Treatment Episode Data Set (TEDS) a cooperative program between SAMHSA and state substance abuse agencies to collect data on substance use treatment services. TEDS was developed as a response to the 1988 Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments (P.L. 100-690), which established a revised SAPTBG and mandated federal data collection on clients receiving treatment for either alcohol or drug abuse.
TEDS collects data on the demographic and substance abuse characteristics of admissions to and discharges from substance abuse treatment for persons aged 12 and older. State laws require certain substance abuse treatment programs to report all their admissions and discharges to the state. In all states, treatment programs receiving any public funds are required to provide the data on both publicly and privately funded clients, and in some states, programs that do not receive public funds are required to provide data as well. Data are reported by approximately 10,000 facilities, programs, or administrative units in the 50 states, the District of Columbia, and Puerto Rico. Admission and discharge data are collected.
The following are limitations of the TEDS:
The facilities that report TEDS data are primarily those that receive State alcohol and/or drug agency funds for the provision of drug or alcohol services. Facilities that are often not included are those that do not receive funding through the Single State Authority, Indian Health Service facilities, or hospital-based programs.
VA and military treatment facilities are excluded.
Correctional facilities (state prisons and local jails) report TEDS data in some states but not in others.
There are state-level differences in the reporting of TEDS data. For example, some states only require facilities to report TEDS data for patients for whom treatment is publicly funded.
TEDS data represent admissions to or discharges from substance use treatment, not individuals. So, an individual admitted to treatment twice in a calendar year would be counted as two separate admissions. However, admission and discharge data from the TEDS can be combined using unique identifiers to estimate unique numbers of persons admitted to treatment.
Most of the data collected is self-reported by persons admitted for treatment; the recall of certain data (e.g., prior treatment or substances used) may be different depending on the saliency of the topic and the differences in the context within which the data are being collected.
The Behavioral Health Barometer provides state and national reports that provide a snapshot of behavioral health in the nation. Presented are data from SAMHSA data sources (NSDUH and N-SSATS) as well as other federal partners such as the CDC (the Youth Risk Behavior Surveillance System), and the National Institute on Drug Abuse (the Monitoring the Future survey). The reports also include data on the use of mental health and substance use treatment services by Medicare enrollees, as reported by the CMS.
The Behavioral Health Treatment Services Locator is updated annually using data from the N-SSATS and N-MHSS. The locator provides information for those seeking treatment facilities in the United States or U.S. territories for substance abuse/addiction and/or mental health problems. The locator is available at https://findtreatment.samhsa.gov/.
The Buprenorphine Treatment Practitioner Locator can be utilized to identify physicians who are certified to provide buprenorphine treatment to treat opioid addiction (e.g., heroin or prescription pain relievers) in a city, state, or zip code. The locator provides the provider's name, degree (i.e., medical doctor, nurse practitioner), and contact information (address and phone number). This locator is available at https://www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator.
The Opioid Treatment Program Directory can be used to find treatment programs that treat opioid addiction and dependence. The directory can be searched by state and provides the program names and contact information (address, phone and location on a map). This directory is located at http://dpt2.samhsa.gov/treatment/directory.aspx.
Emergency Department Data. Until 2011, SAMHSA collected data through the Drug Abuse Warning Network (DAWN), which was a public health surveillance system that monitored drug-related hospital emergency department visits to report on the impact of drug use, misuse, and abuse in metropolitan areas and across the nation. In its final year, DAWN collected data from metropolitan areas in 37 states (with complete coverage of 13 states) and covered one-third of the United States population. SAMHSA is re-establishing DAWN and data abstraction will begin in mid-2019.
DAWN produced annual estimates of drug-related visits to hospital emergency departments for the nation and for selected metropolitan areas. The 2011 data is available at https://www.samhsa.gov/data/emergency-department-data-dawn/reports.
SAMHSA is currently working with the National Center on Health Statistics on its new National Hospital Care Survey (NHCS). Through the NHCS, SAMHSA will receive data on drug-related emergency department visits and will publish them as SAMHSA's Emergency Department Surveillance System.
The primary limitation of the DAWN is that data from different times periods are not comparable due to changes in design and methodology.
Centers for Disease Control and Prevention Data Sources
CDC had several resources that are utilized in needs assessments. Two sources widely used in SUD needs assessments are the Behavioral Risk Factor Surveillance System (BRFSS) and the National Center for Health Statistics (NCHS).
The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone survey that collects state-level data about United States residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. The BRFSS was established in 1984 and now collects data in all 50 states, the District of Columbia and three U.S. territories. BRFSS completes more than 400,000 adult interviews per year. The BRFSS is considered a powerful tool for targeting and building health promotion activities.
The BRFSS is conducted by state health departments, who either use in-house interviewers or contract with telephone call centers or universities to administer the surveys continuously through the year. The states use a standardized core questionnaire, optional modules, and state-added questions. Annual BRFSS data can be downloaded at https://www.cdc.gov/brfss/annual_data/annual_data.htm. BRFSS prevalence data and topic specific data can be viewed at: https://www.cdc.gov/brfss/brfssprevalence/index.html.
National Center for Health Statistics (NCHS)
NCHS is the principal health statistics agency in the United States. Its mission is to provide statistical information that will guide actions and policies to improve the health of the American people. NCHS addresses the full spectrum of concerns in the health field from birth to death, including overall health status, lifestyle and exposure to unhealthful influences, the onset and diagnosis of illness and disability, and the use and financing of health care and rehabilitation services.
The NCHS provides data from various sources including population surveys (e.g., National Health Interview Survey), vital statistics (e.g., National Vital Statistics System), provider surveys, and historical surveys. The NCHS website provides publicly-available data that can be downloaded for analysis.
U.S. Census Bureau
Many needs assessments utilize data that is available from the U.S. Census Bureau such as the 2010 Census Data or the American Community Survey to describe population within states, census tracks or other and in some cases to compare that community to populations in other communities or states.
Bureau of Labor Statistics (BLS)
BLS data are widely used by needs assessments, especially those that address workforce issues. While the BLS is the primary source for estimates of future workforce demands, it is limited for purposes of SUD treatment needs assessments by the fact that it is occupational categories do not correspond well to classifications of the SUD workforce in sources such as licensing boards and scope of practice policies that are used for assessing current capacity.
Healthy People 2020
For the last three decades, Healthy People has provided ten-year national objectives for improving the health of all Americans. Healthy People 2020 was launched in December 2010 and has over 1,200 objectives to monitor and improve the health of Americans over the decade. The objectives are organized into 42 topic areas. DATA 2020 is an interactive tool that is available within the Office of Disease Prevention and Health Promotion which allows users to explore data and technical information related to Healthy People 2020 objectives. Many data sources are included within Data 2020 and can be explored at http://www.healthypeople.gov/2020/data-search/Data-Sources.
Data 2020 can be searched by topic (e.g., access to health services, health-related quality of life and well-being, mental health and mental disorders, substance abuse) and data source, and several of the needs assessments reviewed utilize this resource.