NATIONAL DRUG AND ALCOHOLISM " TREATMENT UTILIZATION SURVEY ; NI (“YEA 5K NMIONN INSTITUTE ON ALCOHOL , )3 D ! ABUSE AND ‘ \ d u L" ALCOHOLISM | 0 September 1983 Comprehensive Report' / US. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUbIlC Health Servnce Alcohol. Drug Abuse. and Menta! Health AdmlnISIFaIIOn ‘mfll‘l-fl‘asfi .‘ <-=_ e .9" COMPREHENSIVE REPORT Data from the September 30, 1982 National Drug And Alcoholism Treatment Utilization Survey (NDATUS) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration Xhational Institute on Alcohol Abuse and Alcoholisni/* ‘ 5600 Fishers Lane Rockville, Maryland 20857 September 1983 TABLE OF CONTENTS H V5 82; 5' 1 a, 62 53 List of Text Tab1eSOOIOOOOOOIOIOO ..... .0.0.0.0.0.]?M6L...ICCOOICUIIOIIO : List Of Figures oooooo uoooo0000.00Cotto.0-otoOIto00.00000coo-00.00.000.000. List Of Appendix State TablesoluoioloouOOIOOOOOOIOODIOOOOOIDIOOOOOOOIIOCII High]ights.0.00.0000...O00.0.0.0.0I0.0...OOI.00....OIOOIOOOOIOOOOOOOIICOOO I. IntrodUCtionoono.ooIoa.to.0.0000..0Iconno.onoutolotooulooooolllcolooo II. Guide to Use of Data.OOOOOOOOOOOCO0.0...COOOOOIOCO'IOI...0.0.0.0....- III. Survey FindingSooout.0.uoIOu.00.oOto...oto.too.oclooooooooooootctoooo A. Nationa] PFOfile..-. nnnnnnnn .0.00......90......DOOOOCOOOIOIIOIOII <1 ogSmm-p-wKX—I Clients Served................................................ Client Demographic Characteristics............................ Staff Demographic Characteristics............................. Client/Staff Comparison....................................... Ownership of Alcoholism Treatment Units....................... Principal Population Served................................... Physical Environment of Alcoholism Treatment Units............ Specialized Programs.......................................... Types of Services Available................................... VB. Treatment Capacity and Ut-i1-izat‘ionOOOOOOCOIIOOOUOOOOIOOUODOOOIOOO mmhwmd 7. 8' Treatment Capacity and Utilization: National Totals........... Distribution of Clients by Type of Care....................... Distribution of Clients by Facility Location.................. Major Funding Source by Type of Care.......................... Major Funding Source by Facility Location..................... Capacity and Utilization of Units that Received ADMS Block Grant Funds................................................... Capacity and Utilization in Veterans Administration Units..... Summary.caOtoIno...onIoo.I.on...I...oncocoooooooocooooloolcoco \C. Funding.......................................................... mummwa—I Overall Funding............................................... The Impact of Funding Sources on Recipient Units.............. Funding and Treatment Utilization................... ..... ..... Client Distribution by Funding Source......................... Funding and 0wnership......................................... Funding and Client Characteristics............................ Funding and Client/Staff Ratios............................... Summary.OI.out.OIOtI...to0000..Iout...clotoooooocooootooooooo. iii Page DO Staffing...ococo...coo-000.00.00.00...out-oncno-ooou-couooooco 49 1. Distribution of Full-Time, Part-Time, Paid, and Volunteer Staff...................................................... 49 2. Separations................................................ 52 3. Discipline of Paid Staff................................... 54 4. Demographic Profiles....................................... 54 5. Population Served.......................................... 57 6. Summary.on...uo..0.0.0000.0000IaItoDoofiuouuoooooo'ouooooooo 57 E. Changes in Alcoholism Treatment Services, l979-l982........... 59 1. Decreases in Numbers of Units and Clients.................. 60 2. Changes in Ownership of Units.............................. 66 3. Changes in Sources of Funding.............................. 67 4. Funding Information Based on Panel Data.................... 68 5. Summary.to.uI.ot000.U000000.000Ioooloootoooo00.000.00.00... 69 F. Summary and Conclusions....................................... 70 . National Profile........................................... 70 . Treatment Capacity and Utilization......................... 71 Treatment Funding.......................................... 71 . Staffing in Alcoholism Treatment Units..................... 72 . Conclusions................................................ 72 m4>WN—‘ 0 Appendix A: State Tables Appendix B: 1982 NDATUS Fonn Appendix C: Glossary of Terms iv LIST OF TEXT TABLES TABLE PAGE I DISTRIBUTION OF UNITS REPORTING TO SURVEY BY FUNCTION AND ORIENTATION...ODOOOIOOCUOOOIOOOCODOUO ..... OOOOOOIOUOOOODO 10 2 ALCOHOLISM TREATMENT CAPACITY, CLIENTS IN TREATMENT AND UTILIZATION RATES - 24-HOUR CARE ONLY.................... 12 3 ALCOHOLISM TREATMENT CAPACITY, CLIENTS IN TREATMENT AND UTILIZATION RATES - LESS THAN 24-HOUR CARE ONLY.......... 13 4 DEMOGRAPHIC CHARACTERISTICS OF CLIENTS IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENTOOOODOOUCCOOO.‘OICOOCOIOOI 14 5 DEMOGRAPHIC CHARACTERISTICS OF STAFF IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT.......................... 16 5 OWNERSHIP CHARACTERISTICS OF UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT..0...I...ODOC....IOOIOIDOCOOOOOOOOCO 19 7 PRINCIPAL POPULATION SERVED IN UNITS PROVIDING ALCOHOLISM SERVICES ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE SERVICESOOIOOOCOC.0.OOOOCOOOOOOIOOOOOOJOII0.0.0... 20 8 PHYSICAL ENVIRONMENTS OF UNITS PROVIDING ALCOHOLISM SERVICES ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRIJG ABlJSE SERVICES.0..IOIUCOIOCI0.0.COIIOIIOOCCOIOOIODOIIOCO 22 9 DISTRIBUTION OF TYPES OF SERVICES PROVIDED BY ALCOHOLISM TREATMENT UNITS BY OwNERSHIP...‘ ..... OOQIOOOOOIOOO0.0IOOOOIIO 23 10 DISTRIBUTION OF CLIENTS IN TREATMENT BY TYPE OF CARE IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT....... 27 11 DISTRIBUTION OF CLIENTS IN TREATMENT BY FACILITY LOCATION IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT....,.. 28 12 NUMBER OF ALCOHOLISM TREATMENT UNITS, CAPACITY, UTILIZATION RATES BY MAJOR SOURCE OF FUNDING AND TYPE OF CARE............ 31 13 NUMBER OF ALCOHOLISM TREATMENT UNITS, CAPACITY, AND UTILIZA- TION RATES BY MAJOR SOURCE OF FUNDING AND FACILITY LOCATION.. 32 TABLE 14 15 16 17 I8 19 20 21 22 23 24 25 26 27 LIST OF TEXT TABLES (continued) PAGE ALCOHOLISM TREATMENT CAPACITY, CLIENTS IN TREATMENT AND UTILIZATION RATES BY LOCATION/TYPE OF CARE FOR UNITS RECEIVING ADMS BLOCK GRANT FUNDS............................... 34 AMOUNT AND PERCENTAGE OF FUNDING FOR ALL ALCOHOLISM TREATMENT UNITS BY SOURCE OF FUNDS AND OWNERSHIP....‘OOOOCOOOOOOOOOOOOCOI 39 NUMBER OF ALCOHOLISM TREATMENT UNITS SUPPORTED BY PERCENT FUNDING AND FUNDING SOURCE.O...I..0...0..IOO....COOOOOIOOOIOOOO 41 NUMBER OF ALCOHOLISM TREATMENT UNITS, CAPACITY, CLIENTS AND UTILIZATION RATE FOR EACH FUNDING SOURCE....................... 44 DISTRIBUTION OF CLIENTS IN TREATMENT BY FUNDING SOURCE IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PRO- VIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT............ 45 RACE/ETHNICITY AND SEX PROFILES OF CLIENTS AND DIRECT CARE STAFF IN SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES...... 47 NUMBER OF UNITS REPORTING RACE/ETHNICITY, AND SEX PROFILES OF CLIENTS AND DIRECT CARE STAFF IN SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES.C...C.0I00...OOCIUIUOOCOUIIIOUIO.O 48 DISTRIBUTION OF FULL-TIME AND PART-TIME PAID AND VOLUNTEER STAFF AND STAFF SEPARATIONS BY STAFF DISCIPLINE - UNITS PROVIDING ALCOHOLISM TREATMENT ONLYOOOOOIOCOOICOCCOOOOOCOOOI... 50 DISTRIBUTION OF FULL-TIME AND PART-TIME PAID AND VOLUNTEER STAFF AND STAFF SEPARATIONS BY STAFF DISCIPLINE - ALL ALCA)HOLISM TREATMENT UNITS.I0.0UOOOOOCOOOODOIOOOOOOOOOCOOOOOICO 53 NUMBER AND PERCENTAGE OF PAID FTE ALCOHOLISM TREATMENT STAFF BY STAFF DISCIPLINE IN SINGLE TYPE OF CARE UNITS............... 55 RACE/ETHNICITY AND SEX PROFILES 0F CLIENTS AND DIRECT CARE STAFF IN SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES - UNITS PROVIDING ALCOHOLISM TREATMENT ONLY...................... 56 PERCENTAGE OF FTE PAID ALCOHOLISM TREATMENT STAFF BY STAFF DISCIPLINE AND POPULATION SERVED.OI.IICC...OIOIOIOOOCCOCOCCCOOO 58 CHANGES IN CHARACTERISTICS OF ALCOHOLISM TREATMENT UNITS AND SOURCES OF FUNDING, 1979-1982...UJ...0.0IIOCOOOOOOOOOIOCIOCCCOO 61 CHANGES IN CLIENT CASELOADS IN ALL ALCOHOLISM TREATMENT UNITS, 1980-198200000000II0.0.0.0.....OOOOOOOOOOIOOIOIOODOOOCOOOOIOIOO 63 vi LIST OF TEXT TABLES (continued) TABLE PAGE 28 TOTAL FUNDING AND PERCENTAGE CHANGES FOR PANEL UNITS - SELECTED CATEGORIES, 1979-1982................................. 64 29 FUNDING TRENDS FOR PANEL UNITS - SELECTED CATEGORIES, 1979-1982....acoco.0.0000000.000000..000.0.IOIIOIOOOOIOOOOOIOII 65 vii FIGURE 1 LIST OF FIGURES PAGE PROPORTION OF TOTAL CLIENTS AND DIRECT CARE STAFF IN EACH RACE/ETHNICITY CATEGORY ALCOHOLISM ONLY UNITS.............................. 17 DISTRIBUTION OF CLIENTS IN TREATMENT BY TYPE OF CARE AND FACILITY LOCATION FOR ALL ALCOHOLISM TREATMENT UNITS....0.IOIOOOOOOOIOOOOOIOCIOI.0...... 30 AVERAGE UTILIZATION RATES BY TYPE OF CARE FOR ALL ALCOHOLISM TREATMENT UNITS AND FOR THOSE ALCOHOLISM UNITS RECEIVING ADM BLOCK GRANT FUNDS... 35 ALCOHOLISM TREATMENT FUNDING BY SOURCE............. 40 NUMBER OF ALCOHOLISM UNITS RECEIVING FUNDING AND AVERAGE FUNDING PER UNIT BY SOURCE OF FUNDS........ 43 FULL-TIME AND PART-TIME PAID STAFF BY DISCIPLINE IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY....... 51 viii TABLE A-I A-6 A-7 A-8 A-9 A-TD LIST OF STATE TABLES ALCOHOLISM PREVENTION UNITS REPORTING TO 1982 NDATUS BY ORIENTATION AND STATE NUMBER OF ALCOHOLISM ONLY AND COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT UNITS BY STATE CAPACITY, CLIENTS IN TREATMENT FOR ALCOHOLISM, AND UTILIZATION RATE BY STATE PERCENT DISTRIBUTION OF SEX AND AGE OF CLIENTS IN ALL UNITS PROVIDING ALCOHOLISM TREATMENT BY STATE RACE/ETHNICITY OF CLIENTS RECEIVING ALCOHOLISM TREATMENT SERVICES BY STATE NUMBER OF ALCOHOL TREATMENT UNITS IN SELECTED FUNDING CATEGORIES BY STATE TOTAL ALCOHOLISM TREATMENT FUNDING BY STATE CAPACITY AND ACTUAL CLIENTS IN TREATMENT BY TYPE OF CARE AND STATE HOSPITAL-BASED ALCOHOLISM TREATMENT CAPACITY BY TYPE OF CARE AND STATE NUMBER OF PAID AND VOLUNTEER STAFF, FULL-TIME EQUIVALENT STAFF AND PERCENT OF VOLUNTEER EFFORT IN ALCOHOLISM ONLY TREATMENT UNITS BY STATE TOTAL FUNDING AND PERCENT DISTRIBUTION OF THIRD PARTY PAYMENT FOR ALCOHOLISM TREATMENT BY STATE OWNERSHIP CHARACTERISTICS OF UNITS PROVIDING ALCOHOLISM TREATMENT BY STATE ix HIGHLIGHTS A total of 4,233 alcoholism treatment units responded to the l982 NDATUS. This number represents 90 percent of all known alcoholism treatment units in the United States at that time. Of the total, 64 percent were alcoho- lism treatment only units, and 36 percent provided treatment to both alco- holism and drug abuse clients. A total of $l,l23,l75,000 in alcoholism treatment funding was reported through the l982 NDATUS, an increase of l9 percent over 1980. There were 289,933 patients reported in treatment on September 30, l982, for an average caseload of 69 patients per treatment unit. There were 5l,607 clients receiving 24-hour care and 238,326 clients receiving less-than—24-hour care. The utilization rate for 24-hour-care services was 79.6 percent, somewhat less than the utilization rate of 85.9 percent for less-than-24-hour-care services. Third-party sources accounted for 40.2 percent of the total funding, up from 35.8 percent in l980. Eight hundred and ninety-five units reported ADMS Block Grant support and 27l units showed other ADMS funding support. Over 69,09Q c]j_ents were .being served by units that received some funding from ADMS Block Grants. About 78 percent of all clients were receiving outpatient care, 4 percent detoxification services, and l2 percent were in halfway houses 0r recovery homes. About 48 percent of all units were freestanding, 2l percent were in commu- nity mental health centers, and l2 percent in general hospitals, includ- ing Veterans Administration hospitals. c Sixty-five percent of the\ggltsaygge.classjwfied as n_pnprofit, _and 23 per- cent as State gr_ local _,government owned. The Veterans Administration supported 2. 4 percent of all units. Only 7 percent of the units were operated for profit and 5QA5/Apercent\awene,,in4/nonpngjjt «corporations: Client demographics showed that there were 70.9 percent white clients, l5.6 percent black and 9.3 percent Hispanic; ll.4 percent were under 2l and 6.9 percent were age 60 and over. Almost 78 percent of the patients were male. The majority of staff unembers were female (53%). There were 68,541 total staff reported by all alcoholism units, including paid and vol- untary, representing 52,776 full-time-equivalent staff. I. INTRODUCTION This is the third survey of a series to obtain data on alcoholism treat— ment units and their patients. The first National Drug and Alcoholism Treatment Utilization Survey (NDATUS) in which the National Institute on Alcohol Abuse and Alcoholism (NIAAA) participated was jointly conducted with the National Institute on Drug Abuse (NIDA) in 1979. The surveys were again conducted jointly in l980 and l982. The NDATUS is the largest and most comprehensive source of data regarding alcoholism treatment in the U.S. and includes both publicly and private- ly funded units. Each treatment unit was requested to report both treat- ment caseload and capacity on September 30, 1982, in addition to funding and staffing data for the entire fiscal year. The response rate from all the known treatment units was over 90 percent, or 4,233 units. Of those units, 2,729 provided alcoholism only treatment and 1,504 provided both alcoholism and drug treatment._ ” ' In addition to NIAAA and NIDA, both the Veterans Administration and the Federal Prison System cooperated in collecting data on their respective activities. The NDATUS is the only source of this type of drug abuse and alcoholism information available on a nationwide basis. The NDATUS provides State and Federal decision makers with the infonna- tion needed to l) plan and tnanage resources for alcoholism and drugli‘ treatment services, 2) provide baseline data on treatment utilization and staffing, and 3) determine funding trends at both the Federal and State levels. Data also are used to measure prevalence of alcoholism and for a variety of research needs. Besides treatment units, some other units offering prevention and other alcoholism related services participated in the survey in order to be listed in the National Direc- . tory of Drug Abuse and Alcoholism Treatment and Prevention Programs. This directory was prepared and provided to each State and unit partic- ipating in the survey. Quality control of data was emphasized to all participants in the survey; however, there are some questions regarding the funding data. Funding data are reported directly by each treatment unit and often treatment units are unsure of the source of funds received from the States. The total ADMS Block Grant funds reported, for example, are substantially less than the known amount distributed. Although the States reviewed the reports and performed some editing before submitting them for pro- cessing, the State and Block Grant funding data may be combined in some instances. Outpatient treatment capacity may be unreliable in some cases since that measure was based on a judgment of the unit staff. Also, data tables may show differing totals due to some units not reporting all data items. A separate Executive Report has been prepared earlier which provides an overview summary of the l982 NDATUS data. Section II of this report presents a guide to the use of the NDATUS data while Section III presents analyses of data on funding, treatment capacity and utilization, staff- ing, and comparisons of data from the l979, 1980 and 1982 NDATUS efforts. There are three appendices to this report. The tables in Appendix A present State-level information on such items as treatment capacity, funding, and utilization rates. These tables are included for those in- terested in making comparisons among the States. The reader is cautioned to compare State data carefully, as these data may vary according to the types of care or facility locations that are emphasized in particular States or regions. Appendix 8 contains a copy of the l982 NDATUS form, and Appendix C, a glossary of the terms used in the survey. - H. W ....__,, II. GUIDE TO USE OF DATA These NDATUS statistics can be used as guides to realistic planning when based on full understanding of the concepts underlying their measurement, the nature of the-samples upon which they are based, and the instruments used to collect them. The strengths and limitations of the NDATUS findings are shaped as much by these factors as by the nature of the phenomena they were developed to represent. This part provides a general methodological framework for ro ram and pglicy planning within which use of the NDATUS findings can be en anced. I is confined to those factors that affect the use of the 1982 NDATUS statistics appearing in tables throughout the report. Cautions regarding the use of specific measures are reserved for the sections in which they are discussed. There are two major considerations to bear in mind when interpreting the NDATUS findings. First, two different measures of client number, capac- ity, and utilization were used, one for 24-hour-care clients, the other for less-than-24-hour-care clients. Second, the data were collected from treatment units, not clients, although units reported client data. The ways in which the use of findings are affected by these two factors are considered for each in turn. Two Measures of Client Number, Capacity, and Utilization A primary objective of the NDATUS is to identify the number of active alcohol clients and the amount of alcoholism treatment capacity that is available for client use. An active client is defined as an individual who 1) had been admitted to the treatment unit and for whom a treatment plan had been developed, 2) had been seen on a scheduled appointment basis at least once during September 1982, and 3) had not been discharged from treatment (i.e., continued care was expected). Treatment capacity is defined as the maximum number of individuals who could have been enrolled as active clients as of September 30, 1982, given the unit's staffing, funding, and physical facility at that time. For 24—hour-care units, treatment capacity is defined as equal to the number of beds available at the unit. For units offering less-than— 24-hour care, treatment capacity reflects the maximum active caseload a unit could have carried. 'This maximum caseload depended upon such factors as the percentage of total staff hours devoted to direct client care, the average length of counseling sessions, and the frequency of client visits to the unit. Since these units have varying staff-client ratios, it is not possible to use a specific formula to figure the client capacity as a function of number of staff members. The following chart was used to assist units in estimating the client capacity of the 24-hour-care modalities, i.e., ambulatory medical detox, limited care (including day care) and outpatient services. l. Total number of 2. Estimate of the per— 3. hours each direct x centage of actual time = care staff member spent by each staff is scheduled to member in direct care work during a month. treatment. Available hours 4. Percent of time each 5. for direct care x staff member spent on = treatment. each type of treatment provided (if applicable). Total hours available 6. Estimate of average 7. for each type of + time spent with each treatment service. client currently receiving treatment for each type of service provided during the month. ll Available hours for direct care treatment for each staff member. Total hours available per staff member for each type of treatment service. These should be accumulated for all direct care staff. Treatment capacity for each type of service. See the NDATUS Instruction Manual for a more extensive explanation. Treatment utilization rates are derived from the number of active clients and client capaCity on September 30, 1982, as reported to the NDATUS. The following formula represents the procedure used to calculate utilization rates: Estimated number of active clients x 100 ”‘Estimated capacity Although the procedure is straightforward, care must be taken when compar- ing utilization rates across types of care; such rates are based on numerators and denominators that are sums of two differenct measures of active clients and client capacity. The chart below summarizes the differences between the two measures. The 24-hour-care measure is the less complex of the two measures. It is a measure of facility capacity as compared with the measure of service capacity represented by the less-than-24-hour-care measure. Not only do e concepts underlying the two measures vary, so do the types of treatment represented by each. Most important to bear in mind is the fact that different periods of time are represented by each of the measures. Concept Underlying Client the Measures Populations Types of Treatment The Measures A 1-day measure: 1. Facility 24-hour-care Medical detox A. Clients--patients capacity clients Social detox in bed on Sept. Facility Rehabilitation 30, 1982 utilization Custodial care B. Capacity--number of beds, Sept. 30, 1982 C. Utilization = A + B A 30 da measure: 2. Service Less-than- Ambulatory detox A. Ciients--clients capacity 24-hour- Limited Care active as of Service care clients Outpatient services Sept. 30, l982 utilization B. Capacity--staff time available divided by av. time with patients, Sept. 30, 1982 C. Utilization = A + B The 24—hour care measures represent true point prevalence statistics-- the number of active clients in beds and the number of beds available on September 30, 1982. The less-than-24-hour-care measures represent the cli nt caseload for the month of September, based on the number of active clients on the rolls but not necessarily present in the clinic on September 30. It cannot be assumed that the two statistics are comparable for the time period covered because inpatient care is not necessarily 1 month in duration. It varies with type of care, ’ ' and source of funding. The number of 24-hour-care clients on September 30 ’probably underrepresents the number of 24-hour—care clients during the month of September. However, some of the 24-hour-care clients on September 30 may have been active clients in outpatient facilities earlier in the month who had not yet been eliminated from the outpatient register. Studies on the average length of stay in the various types of 24-hour care and of the degree of overlap between the two measures are needed in order to improve the validity of the totals based on combined measures. Sums restricted to a single measure are more accurate and therefore can be used with greater confidence for planning purposes. Statistics represent- ing both types of sums are provided in Comprehensive Report tables for the Nation as well as for States. The number of 24-hour-care clients is probably a more precise statistic than the number of less-than-24-hour- care clients. Number of beds--occupied and unoccupied--is easier to count than number of hours of staff time and the average duration of client care. In the 1982 NDATUS, treatment units were asked to record the distribution of clients by ethnicity, age, and sex. Due to a shortage of space, the matrix provided in the questionnaire was designed to record the combined total number of clients in each of the demographic categories, based on sums of the two measures. The number of 24—hour-care clients and less- than-24-hour-care clients in these categories was not recorded. This makes it more difficult to evaluate differences between the two subpopu- lations or to compare changes in a single population over time. In 1982 there were nearly five times as many outpatients as there were 24-hour- care clients, owing perhaps to lower cost, less disruption of client's schedule, and better accessibility to outpatient services. An apparent difference in the total number of clients in each of two ethnic groups could reflect differences in proportions of inpatients and outpatients rather than differences in levels of need. Group X with 2,000 clients cannot be interpreted to have a greater need for treatment services than Group Y with 800 clients if 1,500 of Group X clients are outpatients and only 200 of Group Y clients are outpatients. Group Y also might have 2,000 clients, or more, if additional outpatient services were made available. Because there is a great need for information on client characteristics, the available data are presented in this report. However, users should exercise caution in their interpretation due to problems posed by the cross-measure totals. Similarly, changes in client number and capacity over time within specific populations are difficult to interpret when based on combined sums. For example, a loss of an outpatient service could result in a substantial decrease in capacity and number of clients. This'aécréase would be difficult to interpret if not based on single, comparable measures. A Census of Treatment Units It is important for the NDATUS user to remember that survey respondents are treatment units, not clients. Statistics on client and staff charac- teristics are aggregate data that represent attributes of treatment units. The characteristics of individual clients are not known; for example, a client's age, sex, ethnicity or source of treatment funding. The ques- tionnaire determines the number of American Indians and other racial/ ethnic groups served by respondent units as well as the number of clients in different age groups and the number of male and female clients served by a unit. The questionnaire also records the number of dollars received by a unit from different sources. Variables such as client and staff characteristics are only indirectly related to variables such as funding source. For example, Table 20 shows that 24.8 percent of all alcoholism treatment units that received ADMS Block Grant funds also reported they served American Indian clients. However, the data do not tell us whether or not the American Indian clients were the beneficiaries of ADMS funding. The NDATUS user can assess the nature of the relationship between two variables by referring 'to the questionnaire, appearing in Appendix B. _ 5 - Whenever data on two variables are recorded in the same matrix, their relationship is a direct one, e.g., number of clients and client capacity by type of care. But when data on two variables of interest are recorded in two different matrices, their relationship is an indirect one. They then must be considered to represent independent characteristics of the units, ones which may or may not be related. To conclude, the NDATUS data can serve many needs in planning and assessing treatment resources. In order to use the data appropriately, it will be important to keep in mind that there are two different procedures for estimating client numbers and that the NDATUS data represent the charac— teristics of units, not of individuals. III. SURVEY FINDINGS The findings of the 1982 NDATUS are discussed in this part in six sections. In Section A, a national profile of the alcoholism treatment network is presented. Section B describes treatment capacity and utilization infor- mation. Funding information is reported in Section C, and staffing information in Section D. An analysis of changes in alcoholism treatment between 1979 and 1982 is presented in Section E, based on several key data items reported to NDATUS. A summary of the findings and conclusions based on the survey is presented in Section F. A. NATIONAL PROFILE The response rate to the NDATUS in 1982 was nearly 90 percent, down slightly from the 92 percent in 1980 and the 93 percent attained in the first joint alcoholism and drug abuse survey conducted in 1979* This year's survey response rate is still well above the average for a voluntary nationwide questionnaire and is considered to be very high for a survey of this type. One important difference in methodology used in the 1982 survey was that trainings sessions were not held for each State representative for NDATUS. This may have affected the assignment of source for various types of unit funding. This and other factors that affect recording of information on funding sources are considered in further discussions in Section C. Nearly 7,500 alcoholism and drug abuse units responded to the NIAAA/NIDA- sponsored survey. The majority were treatment units; 661 were prevention units. In the alcoholism area, 4,233 treatment units, 535 alcoholism prevention units and 816 units which deliver other related alcoholism services contributed to the 1982 survey. A classification of all units responding to the survey by function and orientation is shown in Table 1. This report will discuss the findings resulting from an analysis of the alcoholism treatment units, some of which only serve alcoholic clients while others provide services to both alcohol and drug abusers. These latter units that provide both alcohol and drug treatment are referred to as combined units. 1. Clients Served A total of 289,933 clients were reported by the 4,233 alcoholism treatment units that responded to the 1982 NDATUS. Of these, 203,469 clients were reported by the 2,734 units that provide alcoholism services only; .the remaining 86,464 clients were reported by the 1,504 units thatyr ‘ provide combined alcohol and drug abuse treatment. Tables 2 and 3 display the type of care and facility locations for all alcoholism units responding to the survey. These tables ~distinguish clients in 24—hour care (Table 2) from clients in less-than-24-hour care (Table 3) in order to improve the validity of the client data. Because two different measures were used to calculate the number of clients, client capacity and treatment utilization rates, totals based on combined _ 9 - _0l_ TABLE 1 §‘ DISTRIBUTION OF UNITS REPORTING TO SURVEY BY FUNCTION AND ORIENTATION NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 UNIT ORIENTATION COMBINED ALCOHOLISM & UNIT FUNCTION ALCOHOLISM SERVICES DRUG ABUSE SERVICES DRUG SERVICES TOTAL TREATMENT 2,729 1,504 1,514 5,747 PREVENTION 182 353 126 661 OTHER SERVICES* 285 531 207 1,023 TOTAL UNITS 3,196 2,388 1,847 7,431 *Other services include all units other than those who either completed a treatment matrix or indicated that their principal function was prevention services, e.g. employee assistance referral programs. measures may be difficult to interpret. Both types of information are presented in subsequent discussions and tables. NDATUS users interested in further information on the two measures and on the limitations of com- bined totals sh0uld consult Part II of this report. Table 2 shows that 51,607 clients were reported to be receiving 24-hour care in alcoholism treatment facilities on September 30, l982. The estimated client capacity for 24-h0ur care was 64,796, making a treatment utilization rate of 79.6 percent. Table 3 shows that a total of 238,326 clients were reported to be active clients in less-than-24-hour-care alcoholism treatment as of September 30, l982. The reported capacity for less-than—24-hour care was 280,419 clients, making a utilization rate of 85.0 percent, somewhat higher than the 24—hour-care utilization rate. (See Part II for a discussion of procedures used to calculate utiliza- tion rates.) 2. Client Demographic Characteristics The 1982 NDATUS collected race/ethnicity, sex, and age information for clients reported in treatment by units that responded to the survey and for the staff providing direct care in alcoholism treatment facilities. Not all alcoholism treatment units provided the information requested, but over 95 percent of all clients in treatment were classified in terms of race/ethnicity, age, and sex. Table 4 presents the demographic characteristics of clients in treatment as reported by units that responded to the survey. It indicates that 283,169 (97.7%) of the 289,933 clients reported in treatment at the time of the 1982 survey were classified by race/ethnicity. Nhite clients represented 70.9 percent of all clients in treatment; blacks, 15.6 per- cent; Hispanics, 9.3 percent; American Indian and Alaskan Natives, 3.7 percent; and Asians, 0.3 percent. A total of 279,880 (96.5%) clients were classified by sex. In units that reported the sex of their clients, the Inajority of clients were males. Only 62,556, or 22.3 percent of all clients in units that reported sex data were females. The proportion of females has remained relatively unchanged from the 21.5 percent reported in 1980. Age data were reported for 277,502 (95.7%) of all clients in treat- ment. Most clients were 21 to 44 years of age (59.0%), with the next largest group being 45 to 59 years of age (22.5%). Over 80 percent of all clients in treatment (81.6%) were between the ages of 21 and 59, virtually unchanged from the 1980 survey. Alcoholism only and combined units displayed substantial differences in the race/ethnicity of the clients they served. Combined units reporting race/ethnicity data served white clients to a greater extent than alco- holism only units. While alcoholism only units reported that 68.6 percent of their clients were white, combined units reported that 76.2 percent of their clients were white. Another major difference in the race/ ethnicity data was the proportion of Hispanics served. Alcoholism only - 11 - -Zl— ALCOHOLISM TREATMENT CAPACITY. TABLE 2 CLIENTS IN TREATMENT AND UTILIZATION RATES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 24—HOUR CARE ONLY TYPE OF CARE DETox DETox CUSTODIAL MEDICAL SOCIAL REHAB DOMICILI- TOTALS* MODEL SETTING MODEL ARY LOCATION MODEL CLIENTS 5402 533 11485 164 17584 HOSPITAL CAPACITY 8418 708 14299 180 23605 UTIL. RATE 84.2 75.3 80.3 91.1 74.5 NO. OF UNITS 543 37 480 8 1068 CLIENTS 113 218 1004 77 1410 QUARTERNAY CAPACITY 144 259 1429 108 1940 HOUSE UTIL. RATE 78.5 83.4 70.3 71.3 72.7 No. OF UNITS 10 18 64 8 98 HALFNAY CLIENTS 130 778 11905 1835 14643 HOUSE/ CAPACITY 163 878 14182 2185 17406 RECOVERY UTIL. RATE 79.8 88.8 83.9 84.0 84,2 HOME No. OF UNITS 14 84 685 117 90 OTHER CLIENTS 1208 2882 8336 3574 15980 RESIDENTIAL CAPACITY 1223 3666 10331 4228 19443 FACILITY UTIL. RATE 98.8 78.1 80.7 84.5 32,2» NO. OF UNITS 78 222 338 83 719 CLIENTS OUTPATIENT CAPACITY FACILITY UTIL. RATE No. OF UNITS CLIENTS 432 921 632 1985 CORRECTIONAL CAPACITY 480 1081 836 2397 FACILITY UTIL. RATE 90.0 85.2 75.8 82. NO. OF UNITS 3 15 16 §4 CLIENTS 7285 4389 33851 6282 51607 TOTALS CAPACITY 10428 5509 41322 7537 64798 UTIL. RATE 69.9 79.7 81.4 83.3 79,6 No. OF UNITS 641 356 1526 229 2194 *The total number of clients and total client capacity are equal to the sums of the cells with- in the rows and columns. The total number of units, however, is less than the sums of the rows and columns because some units offer more than one type of care at one or more locations. TABLE 3 ALCOHOLISM TREATMENT CAPACITY, CLIENTS IN TREATMENT AND UTILIZATION RATES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 LESS THAN 24-HOUR CARE ONLY _€l_ TYPE OF CARE AMBULA- LIMITED . TORY CARE OUT- TOTALS* MEDICAL (INCLUDING PATIENT LOCATION DETox DAY CARE) SERVICES CLIENTS 237 5539 15495 21221 HOSPITAL CAPACITY 437 5702 19530 25 69 UTIL. RATE 65.7 97.1 79.3 33.1 NO. OF UNITS 12 45 137 244 CLIENTS I 142 414 556 QUARTERHAY CAPACITY 150 706 356 HOUSE UTIL. RATE 94.7 53.6 65,0 NO. OF UNITS 1 12 13 HALFUAY CLIENTS ‘ 269 147 1146 1562 HOUSE/ CAPACITY 236 170 1474 1930 RECOVERY UTIL. RATE 94.1 36.5 77.7 30.9 HOME NO. OF UNITS 2 14 43 59 OTHER CLIENTS 63 555 2663 3291 RESIDENTIAL CAPACITY ' 23 629 2763 3420 FACILITY UTIL. RATE 242.9 33.2 96.6 95.2 NO. OF UNITS 5 19 54 73 CLIENTS 732 5396 202774 203902 OUTPATIENT CAPACITY 1347 6743 237459 23§5i9 FACILITY UTIL. RATE 54.3 30.0 35.4 . NO. OF UNITS 62 112 2271 2445 CLIENTS 67 2627 2594 CORRECTIONAL CAPACITY 77 2913 2995 FACILITY UTIL. RATE 37.0 90.0 93,0 NO. OF UNITS 4 42 46 CLIENTS 1356 11346 225124 238326 TOTALS CAPACITY 2093 13471 264350 280419 UTIL. RATE 64.6 37.9 35.0 35,0 NO. OF UNITS 79 194 2532 2641 *The total number of clients and total Client capacity are equal to the sums of the cells within the rows and columns. The total number of units, however, is less than the sums of the rows and columns because some units offer more than one type of Care at one or more locations. —tl— TABLE 4 DEMOGRAPHIC CHARACTERISTICS OF CLIENTS IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 ALCOHOLISM-ONLY ’ COMBINED TOTAL CLIENT CHARACTERISTICS NUMBER (Z) NUMBER (X) NUMBER (2) RACE/ETHNICITY AMERICAN INDIAN 7662 3.8 2916 3.4 10578 3.7 ASIAN 649 .3 273 .3 922 .3 BLACK 32010 16.0 12255 14.6 44265 15.6 HISPANIC 22155 11.1 4419 5.2 26574 9.3 NHITE 137016 68.6 63814 76.2 200830 70.9 TOTAL 199492 100.0 83677 100.0 283169* 100.0 SEX MALE 156333 78.7 ,60991 75.0 217324 77.6 FEMALE 42294 21.2 20262 24.9 62556 22.3 TOTAL 198627 100.0 81253 100.0 279880* 100.0 AGE 18 AND UNDER 8042 4.0 5641 6 9 13683 4.9 19-20 11698 5.9 6465 8.0 18163 6.5 21-44 116198 59.0 47609 59.0 163807 59.0 45-59 46630 23.6 15923 19.7 62553 22.5 60-64 9872 5.0 3310 4.1 13182 4.7 65 AND OVER 4381 2.2 1733 2 1 6114 2.2 TOTAL 196821 100.0 80681 100.0 277502k 100.0 *Data on race/ethnicity were reported for 97.7 percent of the total 289,933 reported chents. Data on sex were reported for 96.5 percent of all clients and on age for 95.7 percent of them. units reported 22,155 Hispanics in treatment, or 11.1 percent of all clients in treatment in units. Combined treatment units reported 4,419 Hispanic clients, or only 5.2 percent of all clients in treatment. Alcoholism only units served 7,662 of the 10,578 American Indian/Alaskan Native clients reported to NDATUS (72.4%), 649 of the 922 Asians (70.1%), 32,0l0 of the 44,265 blacks (72.3%), 22,155 of the 26,574 Hispanics (83.4%), and 137,016 of the 200,830 whites (68.2%). Combined units which reported the sex of their clients served a higher proportion of females than did alcoholism only units. Females repre- sented 24.9 percent of all clients in combined units, but 21.2 percent of clients in alcoholism treatment only units. Combined units also reported a higher proportion of young clients than did alcoholism only units. Clients age 20 and under represented 14.9 percent of all clients in combined units, but only 9.9 percent of all clients in alcoholism only units. In contrast, alcoholism only units served a higher proportion of older clients. Clients age 45 and older represented 30.8 percent of all clients in alcoholism only units and 25.9 percent of the clients in treatment in combined units. 3. Staff Demographic Characteristics The demographic characteristics of direct care staff in treatment units that responded to the 1982 NDATUS are displayed in Table 5. Alcoholism only and combined treatment units reported a total direct care staff of 43,700. Most staff members were reported as white (34,329 or 78.6%), and females represented the majority of staff (23,503 or 53.7%). Combined units reported a greater percentage of white staff (80.l%) than did alcoholism only units (77.8%). The percentage of Hispanic staff reported by alcoholism only units (5.0%) was greater than the percentage of Hispanic staff reported by combined units (3.7%), but still considerably lower than the 11.1 percent of Hispanic clients in treatment. In the other race/ethnicity categories, the differences be- tween alcoholism only and combined units do not appear to be substantial. 4. Client/Staff Comparison Figure 1 compares the proportion of clients with the proportion of staff in each race/ethnicity category in alcoholism treatment only units. The proportion of clients categorized as white (68.6%) was substantially higher than the proportion categorized as black (16.0%), Hispanic (11.1%), American Indian/Alaskan Native and Asian categories (4.1%). The distri- bution of staff among the race/ethnicity categories followed a similar pattern, i.e., 77.8 percent of staff were classified as white compared to black (13.3%), Hispanic (5.0%), American Indian/Alaskan Native (2.5%) and Asian (1.1%). In the case of the Asian category, there were more than three times as many staff as clients in that category. The propor- tion of total staff was greater than the proportion of total clients by the indicated number of percentage points in the following categories: _ 15 _ _9l- TABLE 5 DEMOGRAPHIC CHARACTERISTICS OF STAFF IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 ALCOHOLISM-ONLY COMBINED TOTAL STAFF CHARACTERISTICS NUMBER (2) NUMBER (Z) NUMBER (2) RACE/ETHNICITY AMERICAN INDIAN 718 2.5 252 1.5 970 2.2 ASIAN 308 1.1 193 1.2 501 1.1 BLACK- 3719 13.3 2116 13.3 5835 13.3 HISPANIC 1414 5.0 593 3.7 2007 4.5 HHITE 21608 77.8 12721 80.1 34329 78.6 TOTAL 27767 100.0 15875 100.0 43642* 100.0 SEX MALE 12824 46.0 7373 46.4 20197 46,2 FEMALE 14995 53.9 8508 53.5 23503 53.7 TOTAL 27819 100.0 15881 100.0 43700* 100.0 *Data on race/ethnicity were reported for 99.0 percent of the total 44,098 reported staff. Data on sex were reported for 99.1 percent of all staff. -1l— FIGURE 1 Proportion of Total Clients and Direct Care Staff in Each Race/ Ethnicity Category 100 _ Alcoholism Only Units 90 — a: _ Ke (‘03 80 77.8 g . V //// g 70 _ 68.6 / % *3 Clients Staff on 6 6° ‘ E l2 50 - “5 CD 8 4o — E CD 0 B 30 — CL 20 - 16.0 13.3 11 1 10 e V/ / 5.0 3.8 2-5 1 1 White Black Hispanic Amer. |nd./ Asian Source: NDATUS. September 30, 1982 Race/ Ethnicity Alaskan Native white (9.2%) and Asian (.8%). The proportion of total staff was less than the proportion of clients by the indicated number of percentage points in the following categories: black (2.7%), Hispanic (6.1%), and American Indian/Alaskan Native (1.3%). There were less than half as many staff as clients in the Hispanic category. Asians represented the smallest race/ethnicity group reported in treatment, and the only category other than white in which the proportion of staff was larger than the proportion of clients reported. 5. Ownership of Alcoholism Treatment Units Table 6 displays the types of ownership that each unit reported. Almost two-thirds of the units (65.4%) reported that they operated under a nonprofit organizational structure. Slightly over one-fifth of the units were operated by State and local governments (22.8%). The rest of the units were owned by either profitmaking organizations (7.0%) or the Federal Government (4.8%). There was some variation in ownership struc— ture between units serving alcoholism clients and those serving both alcoholism and drug abuse clients. Treatment units serving both alco- holism and drug abuse clients had a greater tendency to report State and local government ownership than did units serving only alcoholism clients. —z#0f the combined treatment units, 29.0 percent were owned by State or local governments, whereas only 19.4 percent of the alcoholism treatment only units reported State or local government ownership. 6. Principal Population Served Table 7 presents data on the location of residence for the principal popu- lation served by units reporting to the 1982 NDATUS. The treatment units responding were asked which of the following categories best described the residence of the majority of their clients: inner city, other urban, suburban, or rural. The majority of the units reported the residence of their clients to be in either the other urban (1,50l units or 35.5%) or rural categories (1,194 units or 28.2%). Units Serving inner city clients numbered 754 or 17.8 percent; those serving suburban clients numbered 784 or 18.5 percent. The alcoholism treatment only units and the combined treatment units differed in certain categories in the principal populations they served. Alcoholism only units reported serving a higher proportion of other urban (36.3% vs. 34.0%), suburban (19.6% vs. 16.6%), and inner city (21.5% vs. 11.0%) clients. The noticeable difference occurred in regard to the rural population which represented 22.6 percent of the alcoholism only units compared to 38.4 percent of the combined units. Overall, 57.7 percent of alcoholism treatment only units served other urban or inner city populations. In contrast, only 45.2 percent of the combined treatment units served these populations. _ 18 - -6L— OWNERSHIP CHARACTERISTICS OF TABLE 6 UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 ALCOHOLISM-ONLY COMBINED TOTAL ONNERSHIP* NUMBER (2) NUMBER (2) NUMBER (2) TOTAL PROFIT 188 6.9 107 7.1 295 7.0 INDIVIDUAL 24 .9 13 .9 37 .9 PARTNERSHIP 24 .9 7 .5 31 .7 CORPORATION 140 5.1 87 5.8 227 5.4 TOTAL NON-PROFIT 1871 68.6 898 59.7 2769 65.4 CHURCH RELATED 133 4.9 44 2.9 177 4.2 NON-PROFIT 1619 59.3 775 51.5 2394 56.6 OTHER NON-PROFIT 119 4.4 79 5.3 198 4.7 TOTAL STATE/LOCAL GOV'T 529% 19.4 435 964 22.8 STATE GOV'T 157 5.8 195 13.0 352 8.3 COUNTY GOV'T 231 8.5 170 11.3 401 9.5 CITY GOV'T 62 2.3 17 1.1 79 1.9 CITY-COUNTY GOV'T 16 .6 12 .8 28 .7 HOSPITAL DISTRICT 12 .4 4 .3 16 .4 OTHER SUBSTATE GOV'T 51 1.9 37 2.5 88 2.1 TOTAL FEDERAL GOV'T 141 5.2 63 4.2 204 4.8 U.S. PUBLIC HEALTH SVC. 16 .6 9 .6 25 .6 ARMED FORCES 14 .5 26 1.7 40 .9 VETERAN'S ADMINISTR. 91 3.3 9 .6 100 2.4 FEDERAL PRISON SYSTEM 12 .8 12 .3 OTHER FEDERAL AGENCIES 20 .7 7 .5 27 .6 TOTAL 2729 100.0 1504 100.0 4233 100.0 *Type of organization legally responsible for the a1coh01ism treatment unit. -02— TABLE 7 PRINCIPAL POPULATION SERVED IN UNITS PROVIDING ALCOHOLISM SERVICES ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE SERVICES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 ALCOHOLISM‘ONLY COMBINED TOTAL POPULATION* NUMBER (2) NUMBER (Z) NUMBER (2) INNER CITY 587 21.5 167 11.0 754 17.8 OTHER URBAN 990 36.3 511 36.0 1501 35.5 SUBURBAN 535 19.6 249 16.6 784 18.5 RURAL 617 22.6 577 38.4 1194 28.2 TOTAL 2729 100.0 1504 100.0 4233 100.0 *The area where the majority of the clients served by a unit reside. fbr definitions of each of the types of principal population served. See glossary ‘97. 7. Physical Environment of Alcoholism Treatment Units The physical environments (i.e., the treatment environments in which care is administered) of the alcoholism treatment units that responded to the 1982 NDATUS are displayed in Table 8. Nearly 45 percent of the units are classified as freestanding, 21 percent are located in Community Mental Health Centers (CMHC), while almost 18 percent of the units reported that they were housed within some type of hospital. This table also shows the reported physical environment by the unit's orientation, i.e., whether it is an alcoholism only or a combined drug-alcoholism treatment unit. As indicated in the table, there are substantial differences in the physical environments of alcoholism treat- ment only and combined units. Alcoholism only units classified themselves more often as freestanding facilities (l,397 or 51.3%) than did the combined units (487 or 32.4%). Combined units were also more often located in CMHC's than were units that only offered alcoholism treatment. Nearly 35 percent of the combined units offered services at CMHC's in contrast to only 13 percent of the alcoholism only units. 8. Specialized Programs All units respOnding to the survey were asked to indicate on the list provided them any or all specialized programs offered at the facility. Examining the responses of only those units categorized as treatment units, it was learned that 426 units stated that they offered a specialized program for blacks, 477 units reported specialized services for Hispanics, and 1,128 listed their program as having specialized services for women. Specialized services for youth were listed by 1,266 units, for the elderly by 454 units and for public inebriates by 586 units. There were another 695 units which had specialized programs for other groups, including American Indians and employed alcoholics. 9. Types of Services Available Information on the types of services provided by alcoholism and drug abuse units responding to the questionnaire is available through the survey. Table 9 is limited to a distribution of units offering alcoholism treatment. Of course, units offering alcoholism treatment services to both alcoholics and drug abusers are included in this distribution and therefore some of the services may be received mainly by the drug population. This table also shows the ownership of the units providing the various services, namely, whether the unit is private for profit, nonprofit, State/local government controlled or federally operated. B. TREATMENT CAPACITY AND UTILIZATION The comparison of data on alcoholism treatment capacity and data on actual clients in treatment allows for the measurement of the utilization rate of treatment as it relates to the available capacity for all types of care. - 21 _ .22.. TABLE 8 PHYSICAL ENVIRONMENTS OF UNITS PROVIDING ALCOHOLISM SERVICES ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE SERVICES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 ALCOHOLISM—ONLY COMBINED TOTAL FACILITY NUMBER (2) NUMBER (2) NUMBER (2) COMMUNITY MENTAL HEALTH CENTER 366 13.4 524 34.9 890 21.0 MENTAL/PSYCHIATRIC HOSPITAL 95 3.5 83 5.5 178 4.2 GENERAL HOSPITAL (INCLUDING VA HOSPITAL) 390 14.3 117 7.8 507 12.0 OTHER SPECIALIZED HOSPITAL 48 1.8 21 1.4 69 1.6 CORRECTIONAL FACILITY 21 .8 47 3.1 68 1.6 FREE STANDING /”“ 1 FACILITY 1400 51.3 487 32.0 1887 \33:§ OTHER 409 15.0 225 15.0 634 15.0 TOTAL 2729 100.0 1504 100.0 4233 100.0 TABLE 9 DISTRIBUTION OF TYPES OF SERVICES PROVIDED BY ALCOHOLISM TREATMENT UNITS BY OWNERSHIP NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 | OWNERSHIP | State/ | Total For Non— Local Federal SERVICES | Units Profit Profit Govt. Govt. Individual therapy and/or counseling 4126 294 2695 934 203 Group therapy and/or counseling 3948 284 2571 892 201 Family therapy and/or counseling 3514 274 2227 843 170 Legal counseling and/or representation 318 12 208 64 34 Job counseling and placement 977 38 655 176 108 Vocational rehabilitation and skill training 677 41 387 160 89 Education 2273 191 1434 502 146 Psychological testing 1871 203 1064 473 131 Research/evaluation 965 74 579 209 103 Outreach 2338 120 1521 571 126 Aftercare followup 3238 238 2101 724 175 Child Care 96 5 68 19 4 TranSportation 1332 74 917 283 58 Staff training 2763 218 1762 612 171 Alternatives 873 66 546 209 52 Referral 3766 261 2441 879 185 Information 3314 235 2127 784 168 DWI program 1392 68 839 437 48 Physical examinations 1521 192 838 363 128 Intake and screening 3621 253 2334 838 196 Emergency care 1469 97 891 383 98 Other medical services 1085 129 575 273 108 Early intervention , 1890 149 1173 464 104 Employee assistance program 1235 127 726 279 103 Self help groups available 2285 174 1519 464 128 Occupational alcoholism program 553 64 338 107 44 Other 588 40 383 129 36 Note: The above represents services available at alcohol only and combined units and includes some services provided to drug clients. _ 23 - Program planners at the Federal and State levels use this information to compare the need for the types of care available to alcoholism clients and to assess the effectiveness of outreach programs. 'As noted in Part II, utilization rates for each type of care and treatment facility location are calculated by dividing the total number of clients in treatment by the total treatment capacity for all facilities in each category. The resulting proportion represents the extent to which the reported capacity for each type of care is being utilized. It is generally rec0gnized that a 100 percent utilization rate is rarely achieved and, in fact, probably is not appropriate. Furthermore, if treatment providers operated at capacity, they would not be able to provide emergency treatment or to properly process their caseload. Some utilization rates show greater than 100 percent because certain treatment units serve more clients than they are budgeted for during parts of the year, or outpatient capacity may be underreported. The figures used to calculate utilization rates are based on all alcoholism facilities that reported capacities for each type of care and facility location. In this survey, some facilities were allowed to report a client in treatment even though they could report no capacity for that particular type of care. These cases usually involved only one or two clients and were not used to calculate utilization rates. It should be noted that the data discussed in this section are those reported by each treatment unit that participated in the 1982 NDATUS. Units in which treatment capacity is defined by the number of beds avail— able (i.e., inpatient units) had little difficulty reporting this infor- mation, and the data for inpatient care are believed to be accurate. Outpatient facilities, on the other hand, reported their capacities based on individual staff judgments as to the number of clients that could be served, given the available resources and staff. Since outpa- tient facilities vary in their definition of actual clients in treatment, the data reported by these units may not be as accurate as those reported by inpatient facilities. See Part II for further discussion of the two types of measures of client number, capacity, and utilization. l. Treatment Capacity and Utilization: National Totals The total capacity for the 4,233 alcoholism only and combined treatment units that reported to the 1982 NDATUS was 345,215 clients. Treatment capacities, actual clients in treatment, utilization rates, and number of units are displayed for each type of care and unit location in Tables 2 and 3 as mentioned earlier. Similar information is shown by individual State in Appendix A, although not in the same depth of detail. It should be noted that the client and capacity row totals in Tables 2 and 3 may not always equal the sum of totals for each facility location because a small number of units did not categorize their clients by the types of care provided. 0f the seven types of care for which information was collected, out- patient services accounted for 77.6 percent (225,124) of total clients - 24 - and 76.7 percent (264,850) of the total capacity, making it the largest type of care provided by alcoholism treatment facilities. The utilization rates among types of care and facility locations varied considerably. The overall utilization rate for all types of care and facility locations was 84.0 percent. The highest utilization rate for type of care, regardless of facility location, was 87.9 percent, reported by the 194 units in the limited care (including day care) category. The lowest utilization rate for type of care was 64.6 percent, reported by units in the ambulatory medical detox category. The highest utilization rates for treatment location,1 regardless of type of care, were 86.8 percent for correctional facilities and 85.1 percent for outpatient,z£acjlities. The lowest utilization rate among treatment locations was reported for units in the quarterway house category (70.3%). The utilization rate for a particular type of care may be more meaningful when examined along with the rate for each facility location that reported the greatest proportion of treatment for each type of care. Outpatient services, representing the largest type of care, were provided most often in outpatient facilities (237,459 of a total outpatient services capacity of 264,850). The utilization rate for this type of care/facility location was 85.4 percent. _fiospitals reported the second largest treatment capac- ity available for outpatient services with a 6 percent lower rate of utilization of outpatient services than in outpatient facilities. How- ever, the outpatient capacity in hospital settings (19,530) accounted for only 7.4 percent of the total outpatient services capacity reported by all facilities. The rehabilitation model was the second largest type of care reported by facilities providing alcoholism services, with a total capacity of 41,322. Three types of facilities reported the majority of the capacity for treatment using this model. These were halfway houses or recovery homes (14,182 or 34.3%), hospitals (14,299 or 34.6%), and other residential facilities (10,331 or 25.0%). These three types of facilities together reported a total capacity of 38,812, representing 93.9 percent of the total capacity for treatment using the rehabilitation model. All three of these facilities reported utilization rates of over 80 percent. Halfway houses/recovery homes reported a utilization rate of 83.9 percent; other residential facilities, a rate of 80.7 percent; and hospitals, a rate of 80.3 percent. The type of care with the third largest capacity reported was limited care (including day care), 50.l percent of which was provided as outpatient facility and 42.3 percent of which was provided in hospitals. Hospitals providing limited care services reported 5,539 clients and a total bed capacity of 5,702. The utilization rate for limited care was 87.9 percent. 1The treatment environment in which a particular type of care is administered. - 25 _ Detoxification services featuring the social setting approach were re- ported most often by residential facilities other than halfway or quarter- way houses. Of the 3,666 beds available for this type of care in those facilities, 2,862 (78.l%) were being utilized on the survey date. Those facilities also reported the largest single capacity for care under the custodial domiciliary model (56.l% of the total capacity). Overall, ‘social setting detoxification units showed a 79.7 percent utilization. Ambulatory medical detox and limited care were the least frequently reported types of care. The majority of capacity for these two types was reported by outpatient facilities. Over 64 percent of the capacity reported for ambulatory medical detox (1,347 of 2,098) was provided at outpatient facilities. Utilization was 54.3 percent of the capacity reported in those facilities. More than 50 percent of the national capacity for limited care (6,743 of 13,47l) also was reported by outpatient facilities. The utilization rate for this type of care was 80.0 percent. 2. Distribution of Clients by Type of Care Table 10 displays the number and percentage of clients in treatment by type of care. Of the total clients in treatment, 77.6 percent (224,485 of 289,211) were reported as receiving outpatient services. Another ll.6 percent (33,568) received treatment under the rehabilitation model approach. There were 7,285 clients (2.5%) undergoing medical model detoxification; 4,389 (1.5%) receiving detoxification in social settings; and 6,282 (2.2%) being cared for in custodial domiciliary settings. Ambulatory medical detox clients numbered l,356 (0.5%), and clients receiving limited care (including day care) totaled ll,846 (4.1%). There were distinct differences between alcoholism only units and combined units in the distribution of their clients in the different types of care. As shown in Table l0, outpatient services formed a greater proportion of the types of care offered in combined units (86.2%) than they did in alcoholism only units (74.0%). But alcoholism only units accounted for larger proportions of clients in treatment in all other types of care except for medical detoxification. S \In summary, alcoholism treatment in the United States was reported as largely outpatient in character, with about 78 percent of the clients in treatment undergoing this type of care. Figure 2 illustrates the predom- i inance of outpatient care by displaying the distribution of clients in Z’treatment by both type of care and facility location. 3. Distribution of Clients bygFacility Location Table 11 displays the distribution of clients in treatment by facility location. This table reflects to some extent what was observed in terms of types of care in Table 1022;0utpatient facilities reported the most clients, 72.0 percent of total in treatment, and hospitals reported the next largest proportion of clients in treatment, with 13.5 percent. _ 25 _ .12. TABLE 10 DISTRIBUTION OF CLIENTS IN TREATMENT BY TYPE OF CARE IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 ALCOHOLISM-ONLY COMBINED TOTAL TYPE OF cARE NUMBER (2) NUMBER (2) NUMBER (2) DETox-MED. MODEL 4744 11.5 2541 24.2 7285 14.1 DETox-soc. MODEL 3660 8.9 729 6.9 4389 8.5 REHAB MODEL 27452 66-8 6189 59.0 33551 65.2 cgggggitkARY MODEL 5245 12.8 1037 9.9 6282 12.2 TOTAL - 24 HOUR CARE 411]] 100.0 10496 100.0 51507 100.0 AMBULATORY 110 MEDIcAL DETox 9 '7 247 .3 1356 .6 LIMITED cARE 1° _ . (INC. DAY CARE) 634 6 5 1212 1 6 11846 5.0 OUTPATIENT SERVIcEs 150615 92.8 74509 98.1 225124 94.4 TOTAL-LESS THAN 24 HOUR CARE 162358 100.0 75968 100.0 238326 100,.) - 82 _ TABLE 11 DISTRIBUTION OF CLIENTS IN TREATMENT BY FACILITY LOCATION IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30: 1982 ALCOHOLISM-ONLY COMBINED TOTAL FACILITY LOCATION NUMBER (X) NUMBER (2) NUMBER (2) HOSPITAL 32925 16.2 5980 6.9 38905 13.5 QUARTERNAY HOUSE 1599 .8 367 .4 1966 .7 HALFNAY HOUSE/ 14398 7.1 1805 2.1 16203 5.6 RECOVERY HOME OTHER RESIDENTIAL 14938 7.4 4257 4.9 19195 6.6 FACILITY OUTPATIENT FACILITY 136322 67.2 71941 83.4 208263 72.0 CORRECTIONAL FACILITY 2735 1.4 1944 2.3 4679 1.6 TOTAL 202917 100.0 86294 100.0 289211 100.0 i l i 1 l l ) l . Other residential facilities accounted for 6.6 percent of clients and halfway houses or recovery homes reported 5.6 percent of the total. The remainder were quarterway houses and correctional facilities. Table 11 also shows that the combined units provided treatment services in outpatient facilities in greater proportion than did alcoholism only units, similar to the findings for types of care. Combined units reported a total of 71,941 clients in treatment in outpatient facilities, which represented 83.4 percent of the clients reported by all combined facility locations. Alcoholism only units reported 136,322 clients in outpatient facilities; this figure represents only 67.2 percent of the clients at all alcoholism only facility locations. Residential facilities most often reported clients in treatment in units providing alcoholism treatment only. Alcoholism only units reported 14,938 clients in other residential facilities (7.4% of the total capac- ity), whereas combined units reported 4,257 clients (4.9% of the total capacity) in these types of facilities. Alcoholism only units, in addi- tion, reported almost eight times the proportion of clients at halfway houses or recovery homes as was reported by combined units and more than ‘\four times the proportion of clients receiving treatment in hospitals. \ 1\In conclusion, alcoholism only units accounted for 14.5 percent of all 1_ clients reported in treatment in halfway houses, recovery homes, and other residential facilities. Those types of facilities comprised only 7.0 percent of all clients in treatment in combined units. he distribution of clients by type of care and by facility location are isplayed in Figure 2. Q—i l 4. Major Funding Source By Type of Care Table 12 presents the number of units, capacity, and utilization rates of treatment units by major funding source and type of care. As expected, in all funding categories, units providing outpatient services were the most numerous and contained the largest amount of capacity. Rehabili- tation model units were the second most frequently reported type of unit with the next greatest amount of capacity. The average utilization rates of outpatient units ranged from 88.9 percent in those units receiving more than half their funding from State/local sources to 57.7 percent in units that were heavily dependent on private funding sources. Rehabil- itation model units reported utilization rates ranging from 85.6 percent in units receiving other Federal funds to 77.6 percent in units receiving private funds. 5. Major Funding Source By Facility Location Table 13 is similar to Table 12 except that funding information is pre- sented according to facility location rather than type of care. In all funding categories, outpatient facilities were the most numerous and has the largest client capacity. However, private sources and third-party -29— FIGURE 2 Distribution of Clients in Treatment by Type of Care and Facility Location for All Alcoholism Treatment Units Type of Care N—289,933 Outpatient| Services 77.6% Ambulatory Medical Detox (.5%) Limited Care (4.1%) Detox Social Setting (1.5%) Custodial Domiciliary Care (2.2%) Detox Medical Model (2.5%) Rehab Model 11.6% Facility Location N—289,933 Outpatient Facilities 72.0% Quarterway Houses (.7%) Correctional Facilities (1.6%) Halfway Houses/ Recovery Homes 5.6% Other Residential Facilities 6.6% Hospitals 13.5% Source: NDATUS, September 30. 1982 -30- '18- N TABLE 12 UMBER OF ALCOHOLISM TREATMENT UNITS, CAPACITY. AND UTILIZATION RATE BY MAJOR SOURCE OF FUNDING AND TYPE OF CARE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 TYPE OF CARE 24 HOUR CARE LESS THAN 24 HOUR CARE MAJOR SOURCE DETOX DETOX REHAB CUSTODIAL AMBULA- LIMITED OUTPATIENT OF FUNDING MEDICAL SOCIAL MODEL DOMICIL. TORY CARE SERVICES MODEL SETTING MODEL MED/DETOX >502 ADAMHA I OF UNITS 12 19 62 12 6 12 201 BLOCK GRANT CAPACITY 173 224 1672 300 37 152 18888 UTIL. RATE 2.202 .710 .831 .797 .486 .921 .855 >502 OTHER FEDERAL I OF UNITS 86 33 222 27 11 22 302 CAPACITY 1109 350 5693 858 211 2242 30883 UTIL. RATE .757 .686 .856 .795 .711 1.000 .848 >502 STATE/LOCAL I OF UNITS 199 225 613 92 34 101 1340 CAPACITY 3683 3696 17017 2591 1074 7435 127657 UTIL. RATE .748 .824 .823 .863 .654 .813 .889 >502 ANY PUBLIC I OF UNITS 334 303 1004 142 59 153 2034 CAPACITY 5461 4586 26970 4140 1470 11269 199456 UTIL. RATE .786 .824 .830 .840 .639 .852 .876 >501 PRIVATE I OF UNITS 221 40 399 60 12 31 394 CAPACITY 3481 604 10877 2623 522 859 53222 UTIL. RATE .544 .623 .776 .837 .728 .660 .757 >502 THIRD PARTY I OF UNITS 252 55 435 30 10 51 331 CAPACITY 4051 879 12092 563 396 4435 30116 UTIL. RATE .570 .691 .787 .803 .631 .930 .775 TOTAL I OF UNITS 558 344 1407 202 71 184 2435 CAPACITY 8965 5222 37916 6763 1992 12128 253009 UTIL. RATE .692 .798 .815 .839 .663 .839 .851 OTHER FEDERAL - THE SUM OF FUNDING REPORTED AS OTHER ADAMHA PROGRAM SUPPORT, OTHER FEDERAL» SOCIAL SERVICES BLOCK GRANT, AND PUBLIC HEALTH INSURANCE STATE/LOCAL ' THE SUM OF FUNDING REPORTED AS STATE, LOCAL, STATE/LOCAL FEES FOR SERVICE, AND PUBLIC HEALTH INSURANCE PUBLIC .7.IHE SUM OF FUNDING REPORTED AS ADAMHA BLOCK GRANT, OTHER ADAMHA, OTHER FEDERAL. STATE. LOCAL» STATE/LOCAL FEES, SOCIAL SERVICES BLOCK GRANT, PUBLIC WELFARE AND PUBLIC HEALTH INSURANCE PRIVATE - THE SUM OF FUNDING REPORTED AS PRIVATE DONATIONS, PRIVATE HEALTH INSURANCE, AND CLIENT FEES THIRD PARTY - THE SUM OF FUNDING REPORTED AS STATE/LOCAL FEES. SOCIAL SERVICES BLOCK GRANT, PUBLIC NELFARE, PUBLIC HEALTH INSURANCE AND PRIVATE HEALTH INSURANCE NUMBER OF ALCOHOLISM TREATMENT UNITS. TABLE 13 CAPACITY. BY MAJOR SOURCE OF FUNDING AND FACILITY LOCATION NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY AND UTILIZATION RATES ZS - SEPTE BER 30. 198 ALL ALCOHOLISM TREATMENT UNITS FACILITY LOCATION MAJOR‘SOUROE HOSPITAL QUARTERNAY HALFNAY OTHER OUTPATIENT CORRECTIONAL OF FUNDING HOUSE HOUSE RESIDENTIAL >502 ADAMHA 8 OF UNITS* 14 7 39 39 197 3 BLOCK GRANT CAPACITY 407 173 1272 839 19096 271 UTIL. RATE .889 .642 .823 1.103 .861 .819 >503 OTHER FEDERAL 8 OF UNITS 143 11 101 66 240 16 ' CAPACITY 12619 269 1924 1751 24362 764 UTIL. RATE .812 .736 .802 .883 .880 .725 >50Z STATE/LOCAL 8 OF UNITS 223 45 458 328 1282 46 CAPACITY 13932 1686 9839 10867 123616 3628 UTIL. RATE .832 .669 .853 .841 .884 .900 >502 ANY PUBLIC 8 OF UNITS 420 76 674 474 1881 66 CAPACITY 28879 2413 15041 14440 188347 4666 UTIL. RATE .819 .697 .843 .863 .876 .867 >502 PRIVATE I 0F UNITS 311 10 146 127 316 2 CAPACITY 14126 271 3544 6455 48083 40 UTIL. RATE .690 .782 .818 .789 .758 1.550 >501 THIRD PARTY I OF UNITS 356 15 159 109 250 2 CAPACITY 19293 419 3906 4647 24572 17 UTIL. RATE .740 .833 .815 .780 .789 .882 TOTAL 8 OF UNITS 735 87 820 601 2202 68 CAPACITY 43078 2714 18585 20895 236713 4706 UTIL. RATE .777 .704 .838 .840 .852 .873 OTHER FEDERAL - THE SUM OF FUNDING REPORTED AS OTHER ADAMHA PROGRAM SUPPORT. OTHER FEDERAL. SOCIAL SERVICES STATE/LOCAL PUBLIC PRIVATE THIRD PARTY” BLOCK GRANT. AND PUBLIC HEALTH INSURANCE THE SUM OF FUNDING REPORTED AS STATE. LOCAL. STATE/LOCAL FEES FOR SERVICE. AND PUBLIC HEALTH INSURANCE THE SUM OF FUNDING REPORTED AS ADAMHA BLOCK GRANT. OTHER ADAMHA. OTHER FEDERAL. STATE. LOCAL. STATE/LOCAL FEES. SOCIAL SERVICES BLOCK GRANT, PUBLIC WELFARE AND PUBLIC HEALTH INSURANCE THE SUM OF FUNDING REPORTED AS PRIVATE DONATIONS. PRIVATE HEALTH INSURANCE. AND CLIENT FEES ; THE SUM OF FUNDING REPORTED AS STATE/LOCAL FEES. SOCIAL SERVICES BLOCK GRANT. PUBLIC NELFARE. PUBLIC HEALTH INSURANCE AND PRIVATE HEALTH INSURANCE *The number of units in each cell are not mutually exclusive since some units delivered services at more than one facility location. Therefore they should not be summed across columns. sources provided support to more units in hospital locations than in out- patient locations. Among units reporting third-party funding, hospitals were the most numerous (40.0%). In contrast, hospitals composed only 4.7 percent of the units receiving ADMS Block Grant funds. Publicly- funded units (except units receiving other Federal funds) reported halfway houses as their second most common type of facility. Units supported by other Federal funds, as well as private units, reported hospitals to have the second largest client capacity reported. Utilization rates for outpatient facilities ranged from 88.4 percent in units reporting State/local funds to 75.8 percent in privately funded units. Other residential facilities reported utilization rates ranging from ll0.3 percent in ADMS Block Grant-funded units to 78.0 percent in units heavily supported by third-party sources. The average utilization rates reported by hospitals were highest in units supported by Block Grant funds (88.9%) and lowest in privately funded units (69.0%). 6. Capacity and Utilization in Units that Received ADMS Block Grant Funds. Table 14 displays the budgeted capacity, clients in treatment, and utili- zation rates for all facilities that reported receiving ADMS Block Grant funds. A total capacity of 81,949 was reported by 'those facilities. The number of clients in treatment reported was 69,ll3; thus, their overall utilization rate was 84.3 percent. As in Tables 2 and 3, the row totals for actual clients and client capacity may not equal the sum of the totals for each facility location because some units did not classify clients by particular types of care. As is the case for the Nation as a whole, most of the client capacity in units that reported ADMS Block Grant funds was in outpatient services. The total capacity for outpatient services, regardless of facility location, represented 85.9 percent of the client capacity reported by units that received block grant funding (70,420 of 81,949). The utili- zation rate for outpatient services was 84.5 percent. The second largest type of care reported by facilities receiving ADMS Block Grant funding was treatment under the rehabilitation model. The total capacity for this type of care was 5,183, or 6.3 percent of the total capacity reported. The utilization rate for rehabilitation model capacity was 82.7 percent. Figure 3 compares the utilization rates of units that reported receiving ADMS Block Grant funding with utilization rates based on data reported by all other units in the 1982 NDATUS sample. It shows that both types of detoxification services had higher utilization rates in units funded by ADMS Block Grants than they did in all units combined. Medical model detoxification care in units reporting ADMS Block Grant funding showed a utilization rate of 97.5 percent, as compared with the national rate of 69.9 percent for this type of care. The utilization rate of social setting detoxification ‘care for units that received ADMS Block Grant funding was 82.1 percent; the national utilization rate for this type of care was 79.7 percent. -178— ALCDHOLISM TREATMENT CAPACITY. TABLE 14 CLIENTS IN TREATMENT AND UTILIZATION RATES BY LOCATION/TYPE OF CARE FOR UNITS RECEIVING ADMS BLOCK GRANT FUNDS NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 TYPE OF CARE DETOX DETOX CUSTODIAL AMBULA- LIMITED MEDICAL SOCIAL REHAB DOMICILI- TORY CARE OUT- TOTALS* MODEL SETTING MODEL ARY MEDICAL (INCLUDING PATIENT LOCATION MODEL DETOX DAY CARE) SERVICES CLIENTS 455 106 316 141 1079 2097 HOSPITAL CAPACITY 651 135 395 210 1331 2722 UTIL. RATE 69.9 78.5 80.0 67.1 81.1 77.0 NO. OF UNITS 59 6 18 13 77 CLIENTS 13 22 242 26 178 481 QUARTERNAY CAPACITY 28 25 319 42 194 608 HOUSE UTIL. RATE 46.4 88.0 75.9 61.9 91.8 79.1 NO. OF UNITS 3 2 19 23 HALFNAY CLIENTS 30 203 2280 192 266 79 519 3569 HOUSE/ CAPACITY 42 247 2720 234 266 73 665 4247 RECOVERY UTIL. RATE 71.4 82.2 83.8 82.1 100.0 108.2 78.0 84.0 HOME NO. OF UNITS 4 22 127 20 1 16 169 OTHER CLIENTS 509 762 1388 594 58 69 732 4112 RESIDENTIAL CAPACITY 332 952 1690 664 17 80 793 4528 FACILITY UTIL. RATE 153.3 80.0 82.1 89.5 341 2 86.3 92.3 90.8 NO. OF UNITS 23 74 90 19 11 166 CLIENTS 367 1385 56630 58382 OUTPATIENT CAPACITY 704 1665 67340 69709 FACILITY UTIL. RATE 52.1 83.2 84.1 83.8 NO. OF UNITS 25 36 644 648 CLIENTS 27 62 12 6 365 472 CORRECTIONAL CAPACITY 25 61 20 10 337 453 FACILITY UTIL. RATE 108.0 101.6 60.0 60.0 108.3 104.2 . NO. OF UNITS 1 2 CLIENTS 1034 1093 4288 824 832 1539 59503 69113 TOTALS CAPACITY 1078 1359 5185 960 1197 1828 70660 82267 UTIL. RATE 95.9 80.4 82.7 85.8 69.5 84.2 84.2 84.0 NO. OF UNITS 87 104 243 29 47 685 895 *See discussion in Part.II-on problems in using totals. V 0/0 3. 3 AI .U 't R ' ' ’///// ASM é‘foik 2021?; Ends 8 __________ O O Facilities providing limited care (including day care) had a national utilization rate of 87.9 percent, but limited care in facilities receiving ADMS Block Grant funding had a somewhat smaller utilization rate of 84.5 percent. For the type of care with the largest client capacity, outpatient ser- vices, the utilization rate reported by units that received ADMS Block Grant funds was similar to that reported for all units. As indicated in Tables 2, 3 and 13, the total capacities for units receiving ADMS Block Grant funds in all facility locations that provided rehabilitation model, custodial domiciliary model, and ambulatory medical detoxification care were a lesser proportion of the national totals. The capacity for reha- bilitation model care in units receiving ADMS Block Grant funds (5,183) represented 12.5 percent of the national capacity of 41,322. For the custodial domiciliary model, the total capacity in units with ADMS Block Grant funds was 950, or 12.6 percent of the national total. For ambu- latory medical detoxification, client capacity was 1,184, or 56.4 percent of the national total. Finally, the treatment capacities for the majority of the types of care in units that reported ADMS Block Grant funding were utilized at about the same rate as they were in all units that reported to NDATUS. However, the utilization rates for detoxification services were somewhat higher in units that reported receiving ADMS Block Grant funding. 7. Capacity and Utilization in Veterans Administration Units 0f the 4,233 alcoholism treatment units participating in the NDATUS, 101 (2.4%) were owned, operated and funded by the Veterans Administration (VA). From the standpoints of funding and physical environment, VA units represent a distinctive type. The 96 VA units that reported funding data classified 100 percent of their funding as Federal, a total of $83.9 million. 0f the 101 units reporting to the NDATUS, 95 classified their physical environment as general hospital; only three classified their units as mental or psychiatric hospitals. There were 14,768 clients in treatment at the 101 VA units at the time of the September 1982 NDATUS. The VA units reported a total capacity of 16,761. This makes the overall utilization rate for VA units 88.1 percent, slightly higher than the 84.0 percent utilization rate for all units reporting to the NDATUS in 1982. Those clients treated in the 92 alco- holism treatment only units numbered 13,405 and represented 91 percent of all VA alcoholism clients. The most common type of care was out- patient services, which accounted for three-fourths (11,127 clients) of the treatment population. 8. Summary 0 Alcoholism treatment was reported most often on an outpatient basis. Nearly 225,000 clients were reported to receive outpatient services for alcohol abuse or alcoholism in 1982. - 35 - 0 Hospitals were the second largest providers of alcoholism care, with over 38,000 clients in treatment. 0 Alcoholism treatment in residential facilities was being provided to over 35,000 clients in l982. About half of these clients resided in halfway houses or recovery homes. 0 There were substantial differences between treatment units that provided alcoholism treatment only and units that provided both alcoholism and drug abuse treatment. As compared with alcoholism only units, combined units tended to report: A larger percentage of whites, females, and youths in their client population - More outpatient clients - More State or local government ownership - More rural clients - More provision of care in CMHC settings 0 Most clients were male (77.6%) and white (70.9%). Most staff were female (53.7%) and white (78.6%). C. FUNDING In this section of the report, the funding information reported to the NDATUS by the Nation's alcoholism treatment units is examined, including overall funding my source and the impact of individual funding sources. Several factors should be considered when interpreting the NDATUS funding information. The first is the fact that approximately 6 percent of the alcoholism treatment units that responded to NDATUS did not report funding information. Second is the probable underreporting of ADMS Block Grant funds (see section B—7). Probable underreporting could occur when ADMS Block Grant funds are distributed through several channels before reaching the units. A unit's staff could have been unaware of the original source of funding and thus could have attributed such funds to the State or other agencies. Other explanations for the differences between ADMS Block Grant funds allocated by the Federal Government and ADMS Block Grant funds reported to the NDATUS include the nonreporting of funds received by survey non- respondents and State administrative costs deducted before distribution of funds to treatment units. A final factor to consider when interpreting NDATUS data on funding is that the data represent more than a 12-month period. Units were instructed to report funding for the fiscal year observed by their unit that included the September 30, 1982, survey date. Publicly owned units observed their State's fiscal year, and all but eight of the States observed July 1- _37_ July 30 as the fiscal year. Privately owned units, however, do not have to observe the same fiscal year as the States in which they are located. The fact that the reported funds have a shifting base means that the possible impact of economic and political changes occurring in either 1981 or 1982 cannot be easily assessed using these data. It also means that alcoholism treatment funds reported by a State may not always agree with funds reported to the NDATUS since some private units may have a different fiscal year. This may account in part for a discrepancy between funding reported to the NDATUS by units within a State and funding based on surveys conducted by the State (see Table A-7). 1. Overall Funding Table 15 and Figure 4 present the distribution by source of the $1,123,175,000 for alcoholism treatment reported to the NDATUS. The $296.4 million from Private Health Insurance was the largest amount attributed to any single funding source (26.4 percent of total funding). When aggregated, all third-party payments amounted to $452.0 million, or 40.2 percent of total funding as compared to 35.8 percent in 1980. State governments were the second largest funding source, providing $235.8 million, or 21 percent of the funds reported, excluding fee-for- service funds. The total of $63 million reported as received from all ADAMHA sources represented 5.6 percent of all alcoholism treatment funding reported to the NDATUS. 2. The Impact of FundingASources on Recipient Units Table 16 shows the number of units reporting funds by source and the percentage of total funding that each source provided. The table clearly demonstrates that known funding from Federal sources was crucial to a substantial number of treatment units. The 895 units that reported ADMS Block Grant funding represent 22.4 percent of the 3,997 units that reported funding information. Of these 895 units, 269 (30.l%) received at least half of their funding from ADMS Block Grants; 89 of these reported that this source provided 80 percent or more of their total funding. Data from treatment units that received funds from State governments show State funds provided a large percentage of their total budget. 0f the 2,112 units reporting State funds, 56.5 percent (1,194) reported that State funds accounted for at least half of their total funding. Over one-fourth of State-funded units reported that State funds accounted for 80 percent or more of their total funding. Over half of the clients in treatment at the time of the survey (156,035) were being treated in units that received some State funding. This indicates State funding is critical to the provision of alcoholism treatment services. Treatment units that received funds from private health insurance tended to report that those funds constituted similar portions of their total budgets as found in the review of ADMS Block Grant funding. 0f the 1,136 units receiving funding from private health insurance, 341 (30.0%) re— ported that this funding accounted for at least 50 percent of their total revenue. Approximately 12.8 percent of units receiving funds from -38_ r -68- TABLE 15 AMOUNT AND PERCENTAGE OF FUNDING FOR ALL ALCOHOLISM TREATMENT UNITS BY SOURCE OF FUNDS AND OWNERSHIP (IN THOUSANDS OF DOLLARS) NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY - SEPTEMBER 30, I982 OWNERSHIP NON-PROFIT PROFIT STATE/LOCAL FEDERAL TOTAL GOVERNMENT - FUNDING SOURCE AMOUNT PERCENT AMOUNT PERCENT AMOUNT PERCENT AMOUNT PERCENT AMOUNT PERCENT ADAMHA Block Grant 35,047 5.5 71 .1 14,386 5.6 1,406 1.5 50,910 4.5 Other ADAMHA Program Support 9,504 1.5 3 2,526 1.0 100 .1 12,133 1.1 Other Federal Funds 12,807 2.0 561 .4 7,402 2.9 91,685 98.0 112,456 10.0 State Government 108,276 17.0 1,969 1.5 125,342 49.0 164 .2 235,751 21.1 Local Government 53,641 8.4 480 .4 54,057 21.1 76 .1 108,254 9.6 State/Local Govt. 38,044 6.0 232 .2 7,090 2.8 47 .1 45,413 4.0 Social Services Block Grant 11,376 1.8 120 .1 2,448 1.0 15 13,959 1.2 Public Welfare 14,764 2.3 1,426 1.1 2,056 .8 11 18,257 1.6 Public Health Insurance 48,565 7.6 15,479 11.4 13,877 5.4 77,922 6.9 Private Health Insurance 191,425 30.0 90,763 67.1 14,231 5.6 296,419 26.4 Total Third-Party Funding* 304,174 47.6 108,020 79.8 39,702 15.5 73 .1 451,970 40.2 Private Donations 27,187 4.3 850 .6 712 .3 5 28,754 2.6 Client Fees 76,984 12.1 22,115 16.3 11,167 4.4 6 110,272 9.8 Other 10,901 1.7 1,274 .9 50] .2 12,677 1.1 TOTAL 638,522 100.0 135,343 100.0 255,796' 100.0 93,514 100.0 1,123,175 100.0 # OF UNIIS REPORTING FUNDING 2,654 229 935 179 3997 *UNITS RECEIVING.EUNDS FROM ANY OF THE FOLLOWING SOURCES: GRANT, PUBLIC WELFARE, PUBLIC HEALTH INSURANCE, AND PRIVATE HEALTH INSURANCE. STATE/LOCAL GOVERNMENT FEES FOR SERVICE, SOCIAL SERVICES BLOCK FIGURE 4 Alcoholism Treatment Funding Total Reported Funding: $1 ,123,175,000 (3997 Units) TABLE 16 NUMBER OF ALCOHOLISM TREATMENT UNITS SUPPORTED BY PERCENT FUNDING AND FUNDING SOURCE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 PERCENTAGE OF FUNDING FUNDING SOURCE" TOTAL .01-19.99 20-39.99 40-49.99 50-59.99 60-79.99 80-100 UNITS ADAMHA BLOCK GRANT 340 228 58 67 113 89 895 OTHER ADAMHA PROGRAM SUPPORT 143 44 20 14 21 29 271 OTHER FEDERAL FUNDS 273 58 19 12 30 214 606 STATE GOVERNMENT 263 436 219 249 386 559 2112 LOCAL GOVERNMENT 684 367 107 96 110 166 1530 STATE/LOCAL GOVERNMENT FEES.FOR SERVICE 223 103 39 31 72 115 583 SOCIAL SERVICES BLOCK GRANT 150 76 29 19 35 13 322 PUBLIC WELFARE 346 62 7 6 12 8 441 PUBLIC HEALTH INSURANCE 548 109 26 15 30 12 740 PRIVATE HEALTH INSURANCE 631 124 40 56 140 145 1136 TOTAL THIRD PARTY FUNDING ** 823 310 108 91 204 502 2038 ' PRIVATE DONATIONS 786 138 33 23 21 76 1077 -> CLIENT FEES 1831 440 82 56 60 153 2622 '7 OTHER 293 20 8 4 8 14 347 l NOTE? UNITS RECEIVING FUNDS FROM MORE THAN ONE SOURCE ARE INCLUDED IN THE TOTALS FOR EACH OF THE SOURCES. IN ADDITION. UNITS NHICH REPORTED N0 FUNDING DATA ARE EXCLUDED FROM THE TABLE (3997 UNITS REPORTED FUNDING). Ki UNITS RECEIVING FUNDS FROM ANY OF THE FOLLONING SOURCES: STATE/LOCAL GOVERNMENT FEES FOR SERVICE, SOCIAL SERVICES BLOCK GRANT. PUBLIC NELFARE. PUBLIC HEALTH INSURANCE. AND PRIVATE HEALTH INSURANCE. private health insurance reported that they accounted for at least 80 percent of their total receipts. When aggregated, third-party sources accounted for at least half of the total funding of 797 units. That number represents 30 percent of all units receiving third—party funding. This compares with 38.7 percent reported in l980. The number of units receiving funding from each source and the average funding by funding sources is displayed in Figure 5. @3. Funding and Treatment Utilization Table 17 shows that the lowest treatment capacity was reported by units that indicated some public welfare or Federal funding; the highest treat- ment capacity was recorded by units that reported client fees as a source of funding. Also reporting high treatment capacities were units that either indicated some State or local dollars or private health insurance as sources of funding. Units that reported Federal, State or local sources of funding had higher utilization rates than units that reported private health insurance or client fees as sources of funding. Although the combined data in Table 17 are useful for some purposes, they may be misleading for others since the funding sources are not mutually exclusive. The patterns of combined-funding sources in public as compared with private units are discussed later is this section. 4. Client Distribution by Funding Source Table 18 shows the reported number of clients distributed by the units' funding sources. The NDATUS data cannot be used, however, to determine the number of clients whose treatment was funded by a particular source. (See Part II for details.) The greatest number of reported clients (56.3%) were in units that reported State dollars as a funding source. There were 222,126 clients in treatment in units that reported some third-party funding. Revenues from client fees were reported to contri bute to the support of units that reported a total of 187,643 clients. Units that reported three categories of Federal funds (ADMS Block Grants, other ADAMHA program support and other Federal funds) reported the smallest number of clients. .3 5. Funding and Ownership Table 15 mentioned earlier shows differences in 1982 funding patterns among the four major types of privately and publicly owned alcoholism treatment units (profit/proprietary, nonprofit, State/local, and Federal). Privately owned units accounted for 95 percent of the total $296.4 million in private health insurance reported by all units reporting to the NDATUS in l982. Only 77.6 percent of the 295 proprietary units reported funding information. Among those proprietary units reporting funds, 83.4 percent of the reported funds were provided by private health insurance and client fees. The fact that 67.1 percent of the funding reported by proprietary units came from private health insurance suggests that funding from this source was underreported. -42 .- -gv- Thousands of Dollars 275— 250‘ 225- 175- 150- 125?- 100- 75- 50- 25- FIGURE 5 Number of Alcoholism Units Receiving Funding and Average Funding per Unit by Source of Funds (in Thousand Dollars) $260.9 Private lnsur $185.6 Other Federal $105.3 $111.6 Public State $77.9 Insur. State/ $708 Local $43.3 $56.9 Local Fees Social ADAM HA Govt. $41.4 $42.1 Services $44.8 Block Public Client Block Other Grants $267 Welfare Fees Grant ADAMHA Private Dons. 1077 441 2622 322 271 f 895 1530 583 740 2112 606 1136 Number of Units Supported by Each Source Source: NDATUS. September 30, 1982 Vt - TABLE 17 NUMBER OF ALCOHOLISM TREATMENT UNITS. CAPACITY. FOR EACH FUNDING SOURCE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 CLIENTS AND UTILIZATION RATE UNITS REPORTING FUNDING BY SOURCE NUMBER OF TOTAL CAPACITY TOTAL NUMBER OF UTILIZATION FUNDING SOURCE UNITS OF UNITS CLIENTS IN UNITS RATE ADAMHA BLOCK GRANT 895 82.267 69.113 84.0 OTHER ADAMHA PROGRAM SUPPORT 271 25.275 21.505 85.0 OTHER FEDERAL FUNDS 606 56.891 49.542 87.0 STATE GOVERNMENT 2.112 180.220 156.035 86.5 LOCAL GOVERNMENT 1.530 140.968 123.278 87.4 STATE/LOCAL GOVERNMENT FEES FOR SERVICE 583 42.778 37.138 86.8 SOCIAL SERVICES BLOCK GRANT 322 22.657 19.569 86.3 PRIVATE DONATIONS 1.077 75.341 64.469 85.5 PUBLIC HELFARE 441 21.016 18.500 88.0 PUBLIC HEALTH INSURANCE 740 74.438 63.852 85.7 PRIVATE HEALTH INSURANCE 1.136 100.695 83.067 82.4 CLIENT FEES 2.622 224.937 187.643 83.4 OTHER 347 32.838 27.999 85.2 TOTAL 3.997* 330.319 277.353* 83.9 *Funding data were reported by 94.4 percent of the 4233 reporting units; these units serve 95.7 percent of the total 289.933 reported clients. -917- TABLE 18 DISTRIBUTION OF CLIENTS IN TREATMENT BY FUNDING SOURCE IN UNITS PROVIDING ALCOHOLISM TREATMENT ONLY AND UNITS PROVIDING COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 ALCOHOLISM-ONLY COMBINED TOTAL FUNDING SOURCE NUMBER (X) NUMBER (2) NUMBER (Z) ADAMHA BLOCK GRANT ‘ 42.313 21.7 26.800 32.7 69.113 24.9 OTHER ADAMHA PROGRAM SUPPORT 11.637 6.0 9.868 12.1 21.505 7.8 OTHER FEDERAL FUNDS 34.557 17.7 14.985 18.3 49.542 17.9 STATE GOVERNMENT 101.227 51.8 54.808 66.9 156.035 56.3 LOCAL GOVERNMENT 83.711 42.8 39.567 48.3 123.278 44.5 STATE/LOCAL GOVERNMENT FEES 25.617 13.1 11.521 14.1 37.138 13.4 SOCIAL SERVICES BLOCK GRANT 11.295 5.8 8.274 10.1 19.569 7.1 PUBLIC HELFARE 14.688 7.5 3.812 4.7 18.500 6.7 PUBLIC HEALTH INSURANCE 39.299 20.1 24.553 30.0 63.852 23.0 PRIVATE HEALTH INSURANCE 53.357 27.3 29.710 36.3 83.067 30.0 TOTAL THIRD PARTY FUNDING * 91.178 46.7 45.951 56.1 137.129 49.4 PRIVATE DONATIONS 48.670 24.9 15.799 19.3 64.469 23.2 CLIENT FEES 129.264 66.1 58.379 71.3 187.643 67.7 OTHER 18.094 9.3 9.905 12.1 27.999 10.1 UNDUPLICATED CLIENTS 195.461 100.0 81.892 100.0 277.353 100.0 * TOTAL THIRD PARTY FUNDING REPRESENTS A SUBTOTAL OF THE FIVE CATEGORIES DIRECTLY PRECEDING THAT ENTRY TABLE BASED ON 3964 UNITS REPORTING CLIENTS AND FUNDING SOURCES. The most striking contrast to the pattern of funding in profit-making units is provided by publicly funded units. 0f the 204 federally funded units, 87.7 percent reported funding information that showed 98.9 percent of all funds were provided by the Federal government. The remaining 2 percent came from public sources. The 935 State and local units that reported funding information (97.7 percent of the ones reporting to the NDATUS) showed a mixed pattern; only 10.3 percent of all their funding came from private sources; 70.1 percent from State or local sources; the remaining 19.6 percent came from other public sources. Sixty-six percent of the 4,233 alcoholism treatment units reporting in 1982 were owned by nonprofit organizations, 95.8 percent of which reported funding data. The pattern of funding among nonprofit units was the most eclectic of the ownership types: 36.3 percent from private sources; 31.4 percent from State or local government; the remainder from a variety of Federal sources. To conclude, third-party funding, the largest source of funds for both nonprofit (47.6%) and profitmaking organizations (79.8%) differs signi- ficantly between the two types of privately owned units. The use of private health insurance as a source of funding by the profitmaking organizations should be examined and perhaps adapted where possible to units with other types of ownership. Public health insurance is also an important source of funding for profitmaking organizations (11.4%), more so than in the nonprofit organizations (7.6%). Another large differ- ence between the nonprofit and profit organizations is the degree to which they are supported by Federal and State funds; nonprofits receive 9 percent; profitmaking organizations receive 5 percent. 6. Funding and Client Characteristics Table 19 presents the distribution of persons by race-ethnicity and age/sex by selected categories of funding. The four sources of funding are not necessarily exclusive. One notable finding is that relatively few blacks (7.9%) are served by units that receive more than 50 percent of their funding from private sources. The percentages within each age/ sex group are fairly stable across all sources of funding. 7. Funding and Client/Staff Ratios Table 20 presents the client-to-staff ratios by four sources of funding which are not necessarily exclusive. Units receiving over half of their total funding from private sources had the lowest client-to—staff ratio (5.6), while those units receiving any ADMS Block Grant funding had the highest ratio (l0.8). 8. Summary 0 Treatment units receiving funds from ADMS Block Grants, State, and aggregated third-party sources (especially private health insurance) are dependent on those sources for their continued operation. -46— TABLE 19 RACE/ETHNICITY AND SEX PROFILES OF CLIENTS AND DIRECT CARE STAFF IN SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 NUMERICAL DISTRIBUTION TOTAL NUMBER OF CLIENTS/STAFF IN UNITS REPORTING CHARACTERISTIC FOR BOTH CLIENTS AND STAFF CLIENT/STAFF ALL ADAMHA BLOCK OTHER FEDERAL ANY STATE/ >502 FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE/ETHNICITY AMERICAN INDIAN 10128 949 2573 181 4877 525 6793 608 1101 64 ASIAN 893 437 134 86 257 113 460 264 369 101 BLACK 41674 5351 10852 1249 11354 1314 30059 3525 4202 830 HISPANIC 25657 1885 8537 546 4265 393 18041 1368 5758 300 HHITE 189418 31062 45226 5589 44055 6333 131574 17667 41354 10398 TOTAL (3830 UNITS) 267770 39684 67322 7651 64808 8678 186927 23432 52784 11693 SEX MALE 205373 18449 51235 3692 52170 4354 140227 11331 41043 4687 FEMALE 59532 20986 15006 3861 12106 4288 44106 11855 11512 6980 TOTAL (3804 UNITS) 264905 39435 66241 7553 64276 8642 184333 23186 52555 11667 PERCENTAGE DISTRIBUTION TOTAL NUMBER OF CLIENTS/STAFF IN UNITS REPORTING CHARACTERISTIC FOR BOTH CLIENTS AND STAFF _ Lt _ CLIENT/STAFF ALL ADAMHA BLOCK OTHER FEDERAL ANY STATE/ >502 FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS SIAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE/ETHNICITY AMERICAN INDIAN 3.8 2.4 3.6 2.4 7.5 6.1 3.6 2.6 2 1 .6 ASIAN’ .3 1.1 .2 1.1 .4 1.3 .3 1.1 .7 .9 BLACK 15.6 13.5 16.1 16.3 17.5 15.1 16.1 15.0 6 0 7.1 HISPANIC 9.6 4.6 12.7 7.1 6.6 4.5 9.7 5.6 10.9 2.6 UNITE 70.7 76.3 67.2 73.1 66.0 73.0 70.4 75.4 76.4 66.9 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 0 100.0 5Ex MALE 77.5 46.6 77.4 46.9 61.2 50.4 76.1 46.9 76.1 40.2 FEMALE 22.5 53.2 22.7 51.1 16.6 49.6 23.9 51.1 21.9 59.6 TOTAL ” 'ioo.0 100.0 100.0 100 0 100.0 100.0 100.0 100.0 100.0 100.0 817- TABLE 20 NUMBER OF UNITS REPORTING RACE/ETHNICITY AND SEX PROFILES OF CLIENTS AND DIRECT CARE STAFF 1N SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. NUMERICAL DISTRIBUTION 1982 TOTAL NUMBER OF UNITS REPORTING CLIENT ALL ADAMNA BLOCK OTHER FEDERAL ANY STATE/ >502 FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE/ETHNICITY AMERICAN INDIAN 1033 343 211 73‘ 456 198 805 234 179 48 ASIAR“{ 256 294 50 60 113 166 183 194 75 73 BLACK 2284 1370 520 327 1027 682 1702 993 486 264 HISPANIC 1523 691 311 145 589 286 1154 521 317 127 HNITE 3647 3558 813 786 1541 1520 2792 2725 780 778 UNDUPLICATED TOTAL 3799 3799 850 850 1613 1613 2887 2887 791 791 SEX MALE 3663 3487 829 774 1577 1524 2774 2642 754 737 FEMALE 3086 3260 717 754 1341 1467 2380 2460 646 676 UNDUPLICATED TOTAL 3799 3799 850 850 1613 1613 2887 2887 791 791 PERCENTAGE DISTRIBUTION TOTAL NUMBER OF UNITS REPORTING CLIENT ALL ADAMHA BLOCK OTHER FEDERAL ANY STATE! >502 FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE/ETNNICITY AMERICAN INDIAN 27.2 9.0 24.8 8.6 28.3 12.3 27.9 8.1 22.6 6.1 ASIAN 6.7 7.7 5.9 7.1 7.0 10.3 6.3 6.7 9.5 9.2 BLACK 60.1 36.1 61.2 38.5 63.7 42.3 59.0 34.4 61.4 33.4 HISPANIC 40.1 18.2 36.6 17.1 36.5 17.7 40.0 18.1 40.1 16.1 NNITE 96.0 93.7 95.7 92.5 95.5 94.2 96.7 94.4 98.6 98. UNDUPLICATED TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 SEX MALE 96.4 91.8 97.5 91.1 97.8 94.5 96.1 91.5 95.3 93.2 FEMALE 81.2 85.8 84.4 88.7 83.1 91.0 82.4 85.2 81.7 85.5 UNDUPLICATED TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 o The largest single source of funding was reported as private health insurance ($2l8.4 million or 25.5% of total funding). 0 Aggregated third-party funding sources accounted for 40.2 percent of the total funding reported. 0 Units receiving more than 50 percent of their funding from private sources reported relatively low client/staff ratios. Those units also served a smaller percentage of blacks than units in any of the other funding categories examined. D. STAFFING This section of the report presents information on the staffing of treat- ment units that responded to the l982 NDATUS. Data are presented separ- ately for alcoholism treatment only units and combined units. Because staff in combined treatment units often work with both types of clients, it is not possible to determine whether data reported by combined units represent staff who work with alcoholism treatment clients, drug abuse treatment clients, or both types of clients. Therefore, most tables present data in units that provide alcoholism treatment only. l. Distribution of Full-Time, Part-Time, Paid, and Volunteer Staff As indicated in Table 21, the 2,734 units that provided only alcoholism treatment reported 44,098 positions to the l982 NDATUS. The 27,6l6 full- time paid positions reported in the survey constituted 62.6 percent of this total; the 9,926 part-time paid positions represented 22.5 percent. Full-time and part-time volunteers accounted for 4.8 percent and l0.0 percent of all employees, respectively. Figure 6 represents the distri- bution between full-time and part-time staff by discipline. By converting the number of hours worked by part-time employees to full- time equivalents (FTE's)2 and adding the total to the number of full-time positions, it is possible to determine the percentage of total manpower contributed by any single category of staff. Table 21 shows that the 2,734 alcoholism treatment only units that responded to the NDATUS reported 34,352 full-time equivalent workers (sum of full-time employees and part-time FTE's). Of this number, full—time paid emloyees constituted 80.4 percent; part-time paid employees, 11.4 percent; full-time volun- teers, 6.2 percent; and parttime volunteers, 2.0 percent. , In alcoholism treatment only units, the two categories of full-time coun- selors, those with counseling degrees and those without counseling degrees, together represented 33.5 percent of all full-time paid positions and 45.l percent of all full-time direct care positions. Direct care staff accounted for 74.4 percent of all full-time staff in those units. Ind- irect care staff--administrative staff, other support staff, and student trainees--accounted for the remaining 25.6 percent of all full-time staff. 2Full-time equivalent = number of hours worked per week e 35 hours per week. -49— 09— SEPTEMBER 30, TABLE 21 DISTRIBUTION OF FULL-TIME AND PART-TIME PAID AND VOLUNTEER STAFF AND STAFF SEPARATIONS BY STAFF DISCIPLINE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY 1982 UNITS PROVIDING ALCOHOLISM TREATMENT ONLY FULL‘TIME EMPLOYEES PART-TIME EMPLOYEES PAID VOLUNTEER PAID VOLUNTEER FULL-TIME PERCENT FULL-TIME PERCENT SEPA- STAFF DISCIPLINE NUMBER PERCENT NUMBER PERCENT NUMBER EQUIVALENT (FTE) NUMBER EQUIVALENT (FTE) RATIONS PHYSICIANS 516 1.9 1342 315.7 8.1 124 REGISTERED NURSES 2911 10.5 1415 649.8 16.6 497 OTHER MEDICAL 2372 8.6 799 396.2 10.2 483 PSYCHOLOGISTS/ MA AND ABOVE 800 2.9 642 186.1 4.8 113 SOCIAL NORKERS/ HS" AND ABOVE 1195 4.3 474 162.9 4.2 206 COUNSELORS-CREDENTIALED OR 5161 18.7 865 347.2 8.9 766 COUNSELING DEGREE COUNSELORS-OTNER 4103 14.9 1020 425.1 10.9 987 OTHER DIRECT CARE STAFF 3494 12.7 1479 69.4 1097 493.2 12.6 2952 459.8 65.5 827 TOTAL PAID DIRECT CARE STAFF 20552 74.4 1479 69.4 7654 2976.5 76.3 2952 459.8 65.5 4003 ADMINISTRATIVE OR SUPPORT STAFF 7064 25.6 652 30.6 2272 927.0 23.7 1473 242.0 34.5 1344 TOTAL 27616 100.0 2131 100.0 9926 3903.6 100.0 4425 701.8 100.0 5347 ®E_.—. mph—F Nwmv .om .mnEmem .mexDZ umeiow tan. :3“. W m3: Ram... “Rm 6502 w <5: W wfi o Hm_mo_oco>mn_ \\\\. 6>on< a Ems: moor wwmmm “Run 89:03 Ecom \ m o o 2999 w m: \afim \omm .. i K 5 W nxvmw. W $99. 5282 EEO \ \ mmmv Vi $5 $232 399$me k \ 53 \&N «OS 98 595 550 m 35 m fa \ §m 228,58 550 o owEmeomfizcmqu \omm $069500 W «on +35 toaasw m O can w>=m:w_c_EU< q _ — _ _ — _ A 9.5585 80m 000m 000v Doom OOON 000 _V rim ,5 .8252 2:0 E0859... Em=ocoo_< 9.539....— flE: :_ 05.985 3 .35 En...— 0E_.r can. ace 0E2. .3". m NEDGE ‘51 The distribution of part-time paid manpower (FTE's) in alcoholism treat- ment only units differed somewhat from the distribution of full-time paid staff. Approximately 19.8 percent of part-time FTE's, as compared with 33.5 percent of full-time paid staff, were reported in the counselor cate- gories. Further, 34.9 percent of part-time paid manpower was accounted for by the three medical staff categories.3 0f the full-time paid manpower, 21.0 percent was reported in the medical staff categories. Table 22 displays the summary staffing information reported by the 4,182 alcoholism treatment units reporting these data. All alcoholism treatment units (whether alone or combined with drug treatment) reported a total of 68,541 paid and volunteer positions. The 42,529 full-time paid posi- tions accounted for 62.0 percent of the total; the 16,099 paid part-time positions represented an additional 23.5 percent. Full-time and part—time volunteers accounted for 4.8 percent and 9.7 percent of all positions, respectively. Like units providing alcoholism treatment only, all alcoholism treatment units reported that 74.8 percent of full-time paid staff positions were in the direct care categories. The two counselor categories accounted for 33.0 percent of full-time paid manpower and 17.5 percent of part-time paid manpower. Medical staff acc0unted for 20.3 percent of full—time paid manpower and 35.2 percent of part-time paid manpower (FTE's). 2. Separations Tables 21 and 22 also diSplay the separations reported by units providing alcoholism only and all alcoholism treatment, respectively. Separations include all paid staff separations that occurred during the period October 1, 1981, through September 30, 1982. Table 21 shows that 74.9 percent of all separations in alcoholism only treatment units occurred within the total paid direct care staff, the remaining 25.1 percent were among administrative or support staff. Separations within the total paid direct care staff ranged from 2.3 per- cent for physicians to 18.5 percent for counselor/other, lending credi- bility to the stories of counselor burnout. Within each staff disci- pline, the rates ranged from 6.7 percent for physicians to 19.3 percent for counselors/other. Table 22 shows that 76.4 percent of all separations at any alcoholism unit, including alcoholism only and combined, occurred within the total paid direct care staff; the remaining 23.6 percent separations occurred among the administrative or support staff. Physicians had the lowest rate of separations, 2.7 percent, and counselors had the highest rate, 17.3 percent. Within each staff discipline, the rates ranged from 6.8 percent for physicians to 18.2 percent for counselor/other. 3Physicians, registered nurses, and other medical staff. -52 — TABLE 22 DISTRIBUTION OF FULL-TIME AND PART-TIME PAID AND VOLUNTEER STAFF AND STAFF SEPARATIONS BY STAFF DISCIPLINE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 ALL ALCOHOLISM TREATMENT UNITS FULL-TIME EMPLOYEES PART—TIME EMPLOYEES PAID VOLUNTEER ** PAID VOLUNTEER** STAFF DISCIPLINE NUMBER PERCENT NUMBER PERCENT NUMBER EgUIVILEET PE§$E§T NUMBER EngbALENT PfgggfiT R§¥§3N5* PHYSICIANS 807 1.9 detailed 2296 515-5 3-3 detailed . 211 REGISTERED NURSES 4293 10.1 inform‘tion 2148 941.3 15.9 info ion 788 OTHER MEDICAL 3533 8.3 1228 567.2 9.6 rIn]: 725 PSYCHOLOCISTS/ MA AND ABOVE 1556 3.7 “0‘ BVLilable 1241 344.7 5.8 “°t 3V lable 229 SOCIAL HORKERSI Msu AND ABOVE 2214 5.2 866 291.8 4.9 357 COUNSELORS—CREDEHTIALED OR 7895 18.6 1392 551.3 9.3 1160 COUNSELING DEGREE COUNSELORs-OTHER 6132 14.4 1427 579.7 9.8 1377 OTHER DIRECT CARE STAFF 5362 12.6 2316 70.8 1696 720.3 12.2 4325 689.0 64.5 1226 (A TOTAL DIRECT CARE STAFF 31792 74.8 2316 70.8 12294 4515.1 76.4 4325 689.0 64.5 6073 ‘0 ADMINISTRATIVE OR SUPPORT STAFF 10737 25.2 953 29-2 3805 1394.4 23.6 2319 379.9 35.5 1871 I TOTAL 42529 100.0 3269 100.0 16099 5909.5 100.0 6644 1068.9 100.0 7944 *Number of paid staff separated between October 1, 1981 and September 30, 1982. **Infonn8tion on staff discipline was not collected for volunteers. Note: Table based on the 4,182 units reporting staffing, 98.8 of the participating units. 3.3 Discipline of Paid Staff Table 23 displays the number and percentage of FTE paid staff in all units providing only a single type of alcoholism treatment (e.g., medical detoxification, outpatient, etc.). As indicated in this table, the number of paid FTE staff by type of care ranged from a total of eight FTE in ambulatory medical detoxification units to 9,795 FTE in outpatient services. Among staffing disciplines, the number of paid FTE ranged from a high of 12,131 or 25 percent in administrative/support staff to a low of 1,325 or 2.7 percent for physicians. The total direct care staff amounted to 36,303 persons or 74.9 percent of the total staff. 4. Demographic Profiles The race/ethnicity and sex distributions of clients and staff in alco- holism treatment only units are presented in Table 24. Some totals in this table may differ from the ones presented in other tables on alco- holism treatment only units in this report. Differences can result when alcoholism treatment only units do not report complete demographic infor- mation on their clients and paid direct care staff. However, demographic information was received on over 94 percent of the clients and on 90 per- ent of the paid direct care staff reported to the NDATUS by alcoholism treatment only units. For a unit to be included in this table, complete client and staff information for each characteristic must be available. The national totals for alcoholism treatment only units in Table 24 indicate that whites comprised 77.3 percent of the paid direct care staff and 68.4 percent of the reported clients; blacks, l3.6 percent of staff and l6.0 percent of clients; Hispanics 5.3 percent of staff and ll.4 percent of clients; American Indians, 2.8 percent of staff and 3.9 percent of clients; and Asians, l.l percent of staff and 0.3 percent of clients. These percentages are averages and thus may differ markedly from specific client and staff percentages indicated for units in speci- fic funding categories. Units that received ADMS Block Grant funds reported that 30.7 percent of their paid direct care staff and 37.9 percent of their clients belonged to a minority group. Units that received over 50 percent of their funds from private sources reported that 10.7 percent of their paid direct care staff and 22.3 percent of their clients belonged to a minority group. 0f the 25,389 paid direct care staff in alcoholism treatment only units for which sex identification information was received, 46.9 percent were males and 53.2 percent were females. In contrast, of the l88,778 clients for which sex identification information was received, 78.7 percent were males and 21.3 percent were females. The ratio of male staff members to female staff members was similar for all alcoholism treatment units in all funding categories except units reporting more than 50 percent of their funding from private sources. In those units, 60.5 percent of the total staff were females, and 39.5 percent were males. _99_ TABLE 23 NUMBER AND PERCENTAGE OF PAID FTE ALCOHOLISM TREATMENT STAFF BY STAFF DISCIPLINE IN SINGLE TYPE OF CARE UNITS NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 TYPE OF CARE 24-HOUR CARE LESS THAN 24-HOUR CARE DETOX DETOX CUSTODIAL AMBULATORY OUT- STAFFING MEDICAL SOCIAL REHAB DOMICIL. MEDICAL LIMITED PATIENT DISCIPLINE MODEL SETTING MODEL CARE DETOX CARE SERVICES FTE 2 FTE 7. FTE z FTE '4 FTE '4 FTE '4 FTE '4 PHYSICIANS 195 5.0 12 .8 216 2.2 8 .9 2 28.8 36 5.5 175 1.8 REGISTERED NURSES 905 23.3 86 5.3 844 8.6 25 2.6 1 11.9 31 4.8 221 2.3 OTHER MEDICAL 770 19.8 183 11.1 600 6.1 55 5.7 2 23.7 28 4.4 94 1.0 PSYCHOLOGISTS 71 1.8 20 1.2 220 2.3 19 2.0 1 11.9 18 2.9 783 8.0 SOCIAL NORKERS 111 2.9 17 1.0 292 3.0 19 2.0 76 11.8 1049 10.7 COUNSELORS - CREDENTIALLED 316 8.2 204 12.3 1579 16.1 140 14.3 1 11.9 106 16.4 2732 27.9 COUNSELORS - OTHER 248 6.4 406 24.6 1596 16.3 221 22.7 1 11.9 80 12.4 1776 18.1 OTHER DIRECT CARE 660 17.0 361 21.8 1598 16.3 186 19.1 41 6.3 330 3.4 ADMIN./SUPPDRT 604 15.6 362 21.9 2831 28.9 300 30.8 232 35.6 2632 26.9 TOTAL STAFF 3884 1654 9780 976 8 652 9795 TOTAL PERCENT 100.0 100.0 100.0 100.0 100.0 100.0 100.0 NO. OF UNITS 191 141 815 145 3 50 1847 Note: 75. 4 percent of the total 4 .233 reporting. rounding. **Totals include multiple as well as single type of care alcoholism treatment units. This table.. is based on a total of 3l92 single type of care alcoholism units with staffing information, Slight differences between totals and sum of FTE' 5 due to TABLE 24 RACE/ETHNICITY AND SEX PROFILES 0F CLIENTS AND DIRECT CARE STAFF IN SELECTED ALCOHOLISM TREATMENT FUNDING CATEGORIES NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 NUMERICAL DISTRIBUTION UNITS PROVIDING ALCOHOLISM TREATMENT ONLY -99.. TOTAL NUMBER OF CLIENTS/STAFF IN UNITS REPORTING CLIENT ALL ADAMHA BLOCK OTHER FEDERAL ANY STATE/ >50% FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE AMERICAN INDIAN 7431 707 1677 96 3447 380 4675 429 962 48 ASIAN 633 267 105 37 192 60 349 142 256 71 BLACK 30328 3464 6572 649 7663 892 21037 2187 3342 512 HISPANIC 21607 1342 7330 394 3518 266 15224 1000 4843 179 “NITE 129858 19683 25734 2651 28286 3930 83736 10346 32688 6743 TOTAL 189857 25463 41418 3827 43106 5528 125021 14104 42091 7553 SEX MALE 148489 11895 32078 1852 35539 2764 95719 6899 33218 2984 FEMALE 40289 13494 8832 1928 7416 2763 28260 7121 8923 4571 TOTAL 188778 25389 40910 3780 42955 5527 123979 14020 42141 7555 PERCENTAGE DISTRIBUTION TOTAL NUMBER OF CLIENTS/STAFF IN UNITS REPORTING CLIENT ALL ADAMHA BLOCK OTHER FEDERAL ANY STATE/ >502 FUNDING CHARACTERISTICS UNITS GRANT FUNDS FUNDS LOCAL FUNDS FROM PRIVATE SOURCES CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF CLIENTS STAFF RACE AMERICAN INDIAN 3.9 2.8 4.1 2.5 8.0 6.9 3.7 3.0 2.3 .6 ASIAN .3 1.1 .3 1.0 .5 1.1 .3 1.0 .6 .9 BLACK 16.0 13.6 15.9 17.0 17.8 16.1 16.8 15.5 7.9 6.8 HISPANIC 11.4 5.3 17.7 10.3 8.2 4.8 12.2 7.1 11.5 2.4 NHITE 68.4 77.3 62.1 69.3 65.6 71.1 67.0 73.4 77.7 89.3 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 SEX . MALE 78.7 46.9 78.4 49.0 82.7 50.0 77.2 49.2 78.8 39.5 FEMALE 21.3 53.2 21.6 51.0 17.3 50.0 22.8 50.8 21.2 60.5 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Table 19 presented client and staff demographic information reported by all alcoholism treatment units, including combined alcoholism and drug units. The race/ethnicity distributions reported by all alcoholism units were similar to those reported by alcoholism treatment only units in Table 24. The national totals for all alcoholisni treatment units show that whites accounted for 78.3 percent of all paid direct care staff and 70.7 percent of all clients. Blacks comprised 13.5 percent of direct care staff and 15.6 percent of clients; Hispanics, 4.8 percent of staff and 9.6 percent of clients; American Indians, 2.4 percent of staff and 3.8 percent of clients; and Asians, l.1 percent of staff and 0.3 percent of clients. 5. Population Served Table 25 displays the number and percentage of FTE paid staff by staff discipline and population served. In all staff disciplines, the greatest number of FTE paid staff were reported as serving other urban populations. This group of units reported total FTE staff of l8,535 or 38.3 percent. Next in order were units serving a suburban population with staff of ll,l05 FTE persons or 22.9 percent of total staff. Inner city and rural populations were served with total staffs of 9,504 or l9.6 percent and 9,289 FTE staff members or l9.2 percent of total staff respectively. Although the other urban category was served by the largest FTE paid staff, it also was represented by inore units (l,482) and served more clients than the other three population categories. The average number of FTE staff positions per unit among units serving other urban populations was l2.5. Units serving a principally suburban population had an average of l4.3 FTE staff. Inner city units reported an average of l2.8 FTE; units serving rural areas reported an average of 8.4 FTE per unit. 6. Summary 0 Nearly two-thirds of the 44,098 positions reported by alcoholism treatment only units were filled with full-time paid employees; fewer than one-quarter were part-time paid positions. 0 Volunteers accounted for l4.5 percent of all positions reported to the l982 NDATUS and 8.2 percent of the full-time equivalent staff. 0 Full-time equivalent positions in the 2,499 alcoholism treatment only units reporting staff information numbered 34,352, of which full-time paid employees constituted 80.4 percent. Full-time paid positions in the units providing any alcoholisni treatment and reporting staffing information constituted 80.6 percent of the total full-time equivalent positions reported. 0 In alcoholism only units, full-time positions exceed part-time positions in every category except physicians. 89- TABLE 25 PERCENTAGE OF FTE PAID ALCOHOLISM TREATMENT STAFF BY STAFF DISCIPLINE AND POPULATION SERVED NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30. 1982 POPULATION SERVED STAFF DISCIPLINE INNER CITY OTHER URBAN SUBURBAN RURAL TOTAL FTE '4 FTE '4 FTE '4 FTE 7' FTE x PHYSICIANS 252 2.7 521 2.8 330 3.0 220 2.4 1325 2.7 REGISTERED NURSES 795 8.4 2180 11.8 1578 14.2 680 7.3 5234 10.8 OTHER MEDICAL 841 8.9 1704 9.2 844 7.6 709 7.6 4100 8.5 PSYCHOLOGISTS 246 2.6 760 4.1 439 4.0 453 4.9 1900 3.9 SOCIAL HORKERS 433 4.6 895 4.8 619 5.6 557 6.0 2505 5.2 cOUNSELORS — cREDENTIALLED 1404 14.8 3268 17.6 1997 18.0 1775 19.1 8445 17.4 cOUNSELORs - OTHER 1623 17.1 2374 12.8 1303 11.7 1409 15.2 6710 13.9 OTHER DIRECT cARE 1326 14.0 2302 12.4 1178 10.6 1274 13.7 6081 12.6 ADMIN./SUPPORT 2580 27.1 4528 24.4 2814 25.3 2208 23.8 12131 25.0 TOTAL STAFF 9504 18535 11105 9289 48435 TOTAL PERCENT 100.0 100.0 100.0 100.0 100.0 NO. OF UNITS 743 1482 777 1180 4182 MEDICAL if 1889 ” 19I9 ’ 4463' '23.8 2753 24.8 1609 17.3 10660 22.0 NON-MEDICAL DIREcT cARE *2 5034 53.0 9600 51.8 5537 49.9 5471 58.9 25643 52.9 ADNIN./SUPPORT *3 2580 27.1 4528 24.4 2814 25.3 2208 23.8 12131 25.0 TOTAL STAFF 9504 18535 11105 9289 48435 TOTAL PERCENT 100.0 100.0 100.0 100.0 100.0 NO. OF UNITS 743 1482 777 1180 4182 *1 MEDICAL = PHYSICIANS. REGISTERED NURSES AND OTHER MEDICAL *2 NON-MEDICAL DIRECT CARE = PSYCHOLOGISTS/MA AND ABOVE, SOCIAL WORKERS/MSW AND ABOVE. CREDENTIALLED COUNSELORS AND/OR COUNSELING DEGREE, COUNSELORS OTHER. OTHER DIRECT CARE. *3 ADMINISTRATIVE/SUPPORT = ADMINISTRATIVE OR SUPPORT STAFF NOTE: THIS TABLE IS BASED ON 4.182 UNITS REPORTING STAFFING INFORMATION, 93,3 PERCENT OF THE TnTAI ll 13'! IIMITC Direct care staff accounted for 74.8 percent of all full-time employees. Full-time counselors with and without counseling degrees repre- sented 33.5 percent of all full-time positions and 45.0 percent of all full-time direct care positions. The three medical staff categories accounted for 35.8 percent of all part-time paid manpower. These were physicians, registered nurses, and other medical staff. The total number of separations reported in Fiscal Year l982 was equivalent to l3.5 percent of the total paid staff reported in September 1982. Administrative or support staff had the highest turnover rate; the separations in this category were equivalent to l0.5 percent of the total administrative or support staff reported and 3.6 percent of total paid staff. Although white clients comprised 68.4 percent of the total case- load, the paid direct care staff reported as white accounted for 77.3 percent of all staff. Hispanics accounted for only 5.3 percent of the total staff, whereas Hispanic clients comprised ll.4 percent of the total caseload. Units receiving ADMS Block Grant funds reported that 30.7 percent of their paid direct care staff and 37.9 percent of their clients belonged to a race/ethnic minority group. Units that received over 50 percent of their funding from private sources reported that l0.7 percent of their paid direct care staff and 22.3 percent of their clients belonged to a race/ethnic minority group. E. CHANGES IN ALCOHOLISM TREATMENT SERVICES, 1979-1982 Comparisons of findings fro"! the 1982 NDATUS effort with findings of two earlier ones (April 30, 1979, and September 30, 1980), appear to reflect the interplay of a number of processes. Those discussed in this section include: An overall decline in the number of alcohol treatment units; a decline in clients, especially less—than-24-hour-care clients. Growth in the number of units and clients in a small portion of the private sector; those units run for profit. Growth in funding sources, expecially as dollars from third- party payments. -59 - Evidence to support these observations is presented in Tables 26-29. Table 26 summarized changes in the characteristics of alcoholism treatment units reporting to the NDATUS, and changes in their sources of funding between 1979 and 1982. Changes in client caseloads between 1980 and 1982 are reported in Table 27. Data on sources of funding among a panel of units surveyed in each of the 3 years are reported in Tables 28 and 29. Because of the high reSponse rates in each year, changes in the character- istics of all reSponding treatment units should truly reflect major shift in national patterns of drug and alcoholism treatment. The response rate was 94 percent in the 1979 NDATUS, 93 percent in the 1980 NDATUS, and 90 percent in the current 1982 NDATUS. An effort was made by NIAAA between the 1979 and 1980 surveys to identify any existing alcoholism treatment units that may have been missed in 1979. This could explain some of the increases in the number of units and number of clients between 1979 and 1980, reported in Table 26. The 1980-1982 decreases, however, probably account for a real decline that occurred in response to changes in funding sources. These included the replacement of Federal formula, Uniform Act, and categorical grant funds with ADMS Block Grants to States; an increase in funding from State and local sources; and the growth of funds available through third-party payments and client fees. It is important to note, however, that some unspent formula and categorical grant funds were still available for use by the States at the time of the 1982 survey. The full impact of the ADMS Block Grants on the provision of alcoholism treatment services will not be seen until the next NDATUS. 1. Decreases in Numbers of Units and Clients Between 1980 and 1982, there was a 5.2 percent decrease in the number of reporting units that provided some type of alcoholism treatment (a decrease from 4,465 to 4,233 units). Table 26 shows that a 9.5 percent decrease in the number of units that only provided treatment for alcoholism was offset by a 3.8 percent increase in the number of units that provided both drug and alcoholism treatment services. Some of the increase in the number of combined units may reflect the conversion of alcoholism treat- ment only units to combined units, based on economic factors and/or State legislation. During the 3-l/2 years spanned by the surveys, the total number of alcoholism treatment units remained stable, a 1979-1980 increase compensating for the 1980-1982 decrease. The 1980-1982 decrease in the number of reporting alcoholism treatment units occurred mainly in settings that ordinarily provide outpatient services. Alcoholism treatment units situated in community health centers decreased by 8.0 percent (77 units less); those located in freestanding facilities by 17.7 percent (405 units less). To the contrary, the number of hospital-based alcoholism treatment units reporting to the NDATUS was on the increase; units in mental and psychiatric hospitals increased by 13 percent (21 units more); units in other specialized hospitals as well as general hospitals (including Veterans Administration hospitals) in- creased by 10 percent (54 units more). -60 - TABLE 2 6 CHANGES IN CHARACTERISTICS OF ALCOHOLISM TREATENT UNITS AND SOURCES OF FUNDING NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY, 1979-1982 Number Percent change Variable 1979 1980 1982 1979-1980 1980-1982 1979-1982 Characteristics of units Number of alcoholism treatment units re rtin to NDATUS _ Alcoholism treatment only 2,821 3,016 2,729 6.9 -9.5*' -3.3 Combined alcohol and drug 1r393. 1,449 X 1,504 3.6 3.8 ' 7.6 Total (4.219;; 4,465 A 4,233 5.3 -5.2 0.3 Physical environment of units reporting to NDATUS Community mental health centers 940 967 890 2.9 -8.0 5.3 Mental/psychiatric hospitals 164 157 178 -4.3 13.4 8.5 General hospitals (including VA hospitals) other specialized hospitals ' 5‘7 522 576 4'6 10'3 5'3 Halfway houses 612 - - - - - Free standing facilities 1,692 2,291 1,886 35.4 -17.7 11.5 Correctional facilities 62 78 68 25.8 -12.8 9.7 other 186 448 634 140.9 41.5 240.9 Not specified 16 2 1 - - - Note: "Other" is stated in the 1982 NDATUS Instruction Manual to describe any facility not included in the other categories; for example, office buildings or churches. The increase in the "other” category of units over the three years may be due in part to the fact that "halfway houses" were dropped as a category in the 1980 and 1982 surveys. Principal population served by units reporting to NDATUS Inner city 573 796 754 38.9 -5.3 31.6 Other urban Suburban :I' . . . . . . . . . . . . . . . 2,235 2,327 2,285 4.1 -1.8 2.2 Rural 1,411 1,342 1,194 -4.9 -11.0 -15.4 Note: "Principal population served" refers to the area of residence of the principal population served by the unit. rather than the actual location of the facility. Ownership of units reporting to NDATUS I. Total private (proprietary) 2,935 3,207 A. Total profit 199 248 Individual 14 38 Partnership 24 37 Corporation 161 173 B. Total non-profit 2,736 2,959 Church related 169 162 Non-profit 2,384 2,575 Other non-profit 183 222 _6'|_ 3,064 295 37 31 227 2,769 177 2,394 198 9.2 -4.5 24.6 19.0 8.2 -6.4 The response indicates the area where the majority of the population served reside, TlflBliE 26 CHANGES IN CHARACTERISTICS OF ALCO?0LIS? TREATMENT UNITS AND SOURCES OF FUNDING 3 cont nue _ 7 NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY, 1979-1982 r _W “ Number Percent change Variable I» 1979 1980 1982 1979-1980 1980-1982 1979~1982 ”VII. Total uglic 1,284 1,258 1,168 -2.0 -7.2 -9.0 A. Total State and local government ' 1,070 1,062 964 -0.7 -9.2 —9.9 State 372 347 352 County 550 477 401 City 84 75 79 City-County 44 43 28 Hospital 20 18 16 other substate (e.g., group of - 102 88 counties) 8. Total Federal 214 196 204 -8.4 4.1 -4.7 Us Public Health Service 22 16 25 Armed Forces 62 51 40 Veterans Administration 103 91 100 Federal prison 27 8 12 Other Federal - 30 27 Note: "Ownership" refers to the type of organization legally responsible for the organization of a unit. Source of Funding (in thousands of dollars) Federal NIMA Contracts/grants - 45,752 - - - - Formula funds 14,503 21,944 - 51.3 — - Uniform Act funds - 2,954 - - - - Other 43,532 - - - - - ADAMHA Block Grant - - 50,910 - - - Other program support - - 12,133 - - Other Federal 99,045 102,177 112,456 - - - Total Federal 157,080 172,826 175,499 10.0 1.5 11.7 Third art a ents State/local fees for service 12,423 37,574 45,413 202.5 20.9 265.6 Public welfare 13,315 12,501 18,257 -6.1 46.0 37.1 Public health insurance 61,171 67,395 77,922 10.2 15.6 27.4 Private health insurance 143,302 183,957 296,419 28.4 61.1 106.8 Title xx 24,868 35,356 - 42.2 - - Social Services Block Grant - - 13,959 - - - Total third party payments 255,079 336,783 451,970 32.0 34.2' 77.2 Other Private donations 34,139 22,058 28,754 -35.4 30.4: -15.8 Client fees 79,136 94,015 110,272 18.8 17.3 39.3 State Government 202,816 206,136 235,751 1.6 14.4 16.2 Local Government 73,933 96,969 108,254 31.2 11.6 46.4 Other - 11,782 12,677 - 7.6 - Total other 390,024 430,963 495,708 10.5 15.0 27.1 Total for all sources of funding 802,183 940,572 1,123,175 18.3 19.4 41.2 -62— TABLE 27 CHANGES IN CLIENT CASELOADS IN ALL ALCOHOLISM TREATMENT UNITS, 1980-1982* NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SFPTEMBER430; 1932 Number of Clients Percent change Variable 1980 1982 1980-1982 Number of clients 24-hour 53,502 51,607 -3.5 Less than 24-h0ur 253,672 238,326 -6.0 Client capacity 24-hour 67,144 64,796 -3.5 Less than 24-hour 301,077 280,419 -6.9 Treatment utilization rate 24-hour 79.7% 79.6% - Less than 24-hour 84.3% 85.0% - Number of clients in treatment by type of care 24-hour care Medical detoxification 7,327 7,285 -0.9 Social detoxification 4,289 4,389 2.2 Rehabilitation 37,171 33,651 -9.5 Custodial care 4,715 6,282 33.2 Less than 24-hour care Ambulatory medical detox 2,382 1,356 -43.7 Limited care 3,642 11,846 225.1 Outpatient services 247,648 225,124 -9.1 Number of clients in treatment by location of facility 24-hour care Hospital 17,531 17,584 0.3 Quarterway house 1,393 1,410 1.2 Halfway house/recovery home 16,349 14,648 -10.4 Other residential facility 13,588 15,980 17.6 Correctional facility 4,641 1,985 -57.2 Less than 24—hour care HOSpital 19,391 21,321 10.0 Quarterway house 247 556 125.9 Halfway house/recovery home 2,616 1,562 -40.3 Other residential facility 8,443 3,291 -61.0 Correctional facility 1,802 2,694 49.5 Outpatient facility only 221,173 208,902 -5.5 *A comparison of client caseloads is limited to 1980 and 1982 due to lack of comparability in reporting categories in 1979. of the types of care and facility locations. - 63 _ See the glossary for definitions TABLE 28 TOTAL FUNDING AND PERCENTAGE CHANGES FOR PANEL UNITS* - SELECTED CATEGORIES, 1979-1982 NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 FUNDING PERCENTAGE CHANGES CATEGORY (IN THOUSANDS OF DOLLARS) (ALL PDSITIVE) 1979 1980 1982 1979-1980 1980-1982 1979-1982 REGION NORTHEAST 54,210 68,994 82,059 27.3 18.9 51.4 SOUTH 98,239 121,301 143,428 23.5 18.2 46.0 NORTH CENTRAL 126,301 166,286 207,378 31.7 24.7 64.2 WEST 47,707 64,102 83,009 34.4 29.5 74.0 NEW YORK 42,956 46,573 53,546 8.4 15.0 24.7 CALIFORNIA 68,756 70,736 89,870 2.9 27.0 30.7 UNIT SIZE LESS IHAN 50 CLIENTS 188,246 244,004 294,373 29.6 20.6 56.4 50 TO 150 CLIENTS 134,556 153,986 195,073 14.6 26.7 45.2 MORE THAN 150 CLIENTS 115,367 140,002 169,842 21.4 21.3 47.2 TYPE OF CARE 24-HOUR CARE 204,803 269,705 316,344 31.7 17.3 54.5 LESS THAN 24-HOUR CARE 67,186 94,958 110,964 41.3 16.9 65.2 OWNERSHIP PUBLIC OWNERSHIP 180,294 211,574 238,521 17.3 12.7 32.3 PRIVATE OWNERSHIP 257,875 326,417 420,768 26.6 28.9 63.2 TYPE OF UNIT ALCOHOLISM- ONLY 350,688 435,939 525,336 24.3 20.5 49.8 COMBINED 87,481 102,052 133,954 16.7 31.3 53.1 TOTAL 438,169 537,991 659,289 22.8 22.5 50.5 *Based on 2,133 panel units, 50.4 percent of the 4,233 alcoholism treatment units reporting. 64- TABLE 29 FUNDING TRENDS FOR PANEL UNITS* - SELECTED CATEGORIES, 1979-1982 NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 FUNDING PERCENTAGE CHANGES FUNDING SOURCE (IN THOUSANDS OF DOLLARS) (ALL POSITIVE) 1979 1980 1982' 1979—1980 1980-1982 1979-1982 NIAAA FORMULA FUNDS 8,273 12,676 -- 53.2 -- -- OTHER NIAAA FUNDS 23,796 23,907 -- < .1 -- -- ADAMHA BLOCK GRANTS -- -— 27,408 -- -- -- OTHER ADAMHA FUNDS -- -- 6,135 -- -- -- OTHER FEDERAL 61,623 74,231 82,110 20.5 10.6 33.2 STATE 125,278 128,747 153,842 2.8 19.5 22.8 LOCAL 44,883 60,233 70,532 34.2 17.1 57.1 WELFARE 7,674 7,866 8,955 2.5 13.8 16.7 TITLE XX 15,573 21,137 -— 35.7 -- -- SOCIAL SERVICES BLOCK GRANT -- -- 8,694 -- -- -- PUBLIC INSURANCE 29,997 33,516 41,839 11.7 24.8 39.5 PRIVATE INSURANCE 72,779 86,543 136,132 18.9 57.3 87.0 STATE AND LOCAL FEES FOR SERVICE 7,211 23,352 34,010 223.8 45.6 371.6 CLIENT FEES 38,503 47,480 67,618 23.3 42.4 75.6 ALL OTHER 11,397 18,304 22,012 60.6 20.3 93.1 *Based on 2,133 panel units, 50.4 percent of the 4,233 alcoholism treatment units reporting . -65- The number of units serving rural populations steadily decreased between the 1979 and 1982 NDATUS efforts, making a total decrease of 15.4 percent (214 units less). The number of units serving inner city populations increased a pronounced 38.9 percent between the 1979 and 1980 surveys, but decreased 5.3 percent between the 1980 and 1982 surveys. There was no major swing in the number of units serving other urban and suburban areas over the 3—1/2 years Spanned by the surveys. NDATUS data from the 1980 and 1982 surveys reported in Table 27 show a decrease in the number of reported clients in treatment for alcoholism: a 3.5 percent decrease among 24-hour-care clients (1,923 less) and a 6.0 percent decrease among less-than-24-hour-care clients (15,346 less). Unit capacity decreased by comparable amounts: a 3.5 percent decrease in 24-hour-care capacity, and a 6.9 percent decrease in capacity for less than 24-hour care. Alcoholism treatment utilization rates—-the actual number of reported clients divided by the reported client capacity—- remained the same in both years. About 80 percent of 24-hour-care capacity was utilized. The largest 24-hour care decreases occurred among clients in rehabilita- tion programs in residential or hospital settings-~a 9.5 percent decrease or 3,520 clients less. A 9.1 percent decrease in the number of clients reported as receiving outpatient services (22,623 outpatients less) accounted for most of the 1980-1982 decrease in the number of less-than- 24-hour-care clients. The number of 24-hour-care clients treated in halfway houses or recovery homes decreased by 10.4 percent; the number of outpatients by 40.3 percent. This suggests that these community-based, peer-oriented residential facilities for recovering alcoholics are dimin- ishing as sources of care. 2. Changes in Ownership of Units Units in the three most recent NDATUS efforts were instructed to select one of 17 specified categories that best described the type of organization legally responsible for the operation of their unit. The 17 choices are listed under "Ownership of units reporting to the NDATUS" in Table 26. For purposes of analysis, these have been grouped into two major categories, each of which consists of two subcategories: publicly owned units (Federal, State or local) and privately owned units (profit, or propri- etary; nonprofit). The NDATUS data show that the majority of alcoholism treatment units are privately owned. Table 26 also shows that the proportions of private and public units among all reporting alcoholism treatment units remained relatively constant over the 3-1/2 years: between 70 and 72 percent of the units reported they were privately owned; 28 to 30 percent reported public ownership. ‘ Public units. From 83 to 84 percent of public units in the three surveys reported they were owned by State or local governments, or by a substate government such as a coalition of counties. The largest number of State - 66 _ or local units were owned by counties. The marked decrease of 27.1 percent in the number of county-owned units reporting to NDATUS accounts for a major portion of the decrease in publicly owned units between 1979 and 1982. alcoholism treatment units between 1979 and 1982. The exception was a 4.1 percent increase in the number of federally owned units, occurring between 1980 and 1982. However, this increase was represented by only eight units, more than offset by the 9.9 percent 1979-1982 decrease in the number of State and locally owned units (106 units less). Between 1980 and 1982, the number of 24-hour-care clients reported by units owned by State or local governments decreased a marked 33.7 percent; the number of less-than—24-hour-care clients decreased by 12.9 percent. Among units reporting Federal ownership, there was a minor decrease of 0.9 percent in the number of reported 24-hour-care clients but an 8.6 percent increase in the number of less-than-24—hour-care ones. Private units. Ninety percent or more of alcoholism treatment units in the private sector reported they were owned by nonprofit organizations in each of the three surveys. Although the proportion of proprietary units in the private sector was small, it continued to increase over the period, from 6.8 percent of reporting units in 1979 (199 units) to 7.7 percent in 1980 to 9.6 percent in 1982 (295 units). Countering the decrease in publicly owned units reporting to the NDATUS was an increase of 4.4 percent in the number of privately owned reporting sector was accounted for by a steady growth in the number of units owne .2' The data in Table 26 show a steady decrease in the number of publicly owned‘“ units between 1979 and 1982. _Much of the overall increase in the private:§k’// d by proprietary organizations. These increased by almost 50 percent be- tween 1979 and 1982, from 199 units to 295 units. The number of privately owned proprietary units declined 6.4 percent between 1980 and 1982, but this was offset by the earlier 8.2 percent increase between 1979 and 1980. Between 1980 and 1982, the number of 24-hour-care clients reported by proprietary units decreased by 2.0 percent but the number of less-than-24- hour—care clients increased by 15.6 percent. Non-profit units showed the same 2.0 percent decrease in the number of 24-hour-care clients but a 12.2 percent decrease in 'the number of less—than-24-hour-care clients. 3. Changes in Sources of Funding Table 26 also shows an overall increase of 41.2 percent between 1979 and 1982 in funds reported by alcoholism treatment units to the NDATUS, from $802.1 million in 1979 to 1,123.1 million in 1982. Federal dollars increased only 11.7 percent over this period. As a proportion of all reported funds, Federal funds dropped from 19.6 percent in 1979 to 15.6 percent in 1982. Funds attributed to- State and local governments as sources, on the other hand, increased substantially. There was a 46.4 percent increase in reported dollars provided by local governments and a 16.2 percent increase in State funds. - 67 _ Third-party payments were a major source of new funds, increasing 77.2 percent between 1979 and 1982, from 143.3 million dollars in 1979 to $296.4 million in 1982. The proportion of all reported alcoholism funds provided by third-party payments also increased, rising from 31.8 percent in 1979 to 40.2 percent in 1982. Two sources of private funding increased steadily over the period moni- tored by the NDATUS surveys: private health insurance and client fees. Private donations were the only source of funding from the private sector that decreased. Client fees as sources of funding increased 39.9 percent or $3l.1 million between 1979 and 1982. Reported third-party funds provided by private health insurance more than doubled, increasing from 143.3 million dollars in 1979 to 296.4 million dollars in 1982, an overall increase of 106.8 percent. Most of the increase occurred between 1980 and 1982. As a proportion of all reported third-party payments, private health insurance also became increasingly important, rising nearly ten percent from 56.2 percent of all reported third-party payments in 1979 to 65.6 percent 1982. The increase in private health insurance paralleled other increases in third-party payments. These included a 37.1 percent increase in public welfare, a 27.4 percent increase in public health insurance, and a 265.6 percent increase in State or local reimbursements. The dramatic growth in State and local fees for service represents a real difference of 33 million dollars, some of which may have been Block Grant money, the origin of which was unknown by local reporting units. Third-party pay- ments collectively increased 77.2 percent, from $255.1 million in 1979 to 452.0 million dollars in 1982. 4. Funding Information Based on Panel Data An NDATUS panel of 2,133 units includes 1) those alcoholism treatment units that responded to NDATUS in each of the years 1979, 1980, and 1982; 2) those units that responded to all NDATUS questions; and 3) those units that did not change their orientation during this period (that is, units in the panel did not convert from units that provided alcoholism treatment only to combined alcoholism and drug treatment units, or vice versa). The principal advantage of a panel is that it partially controls for artificial changes between 1979, 1980, and 1982 in the alcoholism treat- ment universe. For example, if an alcoholism treatment unit that reported to NDATUS in 1979 and 1980 still existed in 1982 but failed to respond to the survey, the data would indicate an artificial decrease in alcoholism treatment clients, funding, and staff. Similarly, if a unit that existed in 1979 failed to report to NDATUS in that year but reported in both 1980 and 1982, there would appear to be an artificial increase or expansion in the alcoholism treatment universe. There is, however, a major limitation to the NDATUS panel. It is comprised of only 50.4 percent of the alco- holism treatment units that responded to the 1982 NDATUS. The panel units are therefore much less representative of changes in the universe of alcoholism treatment units than are all units reporting to NDATUS, -68— 90 to 94 percent samples of all known alcoholism treatment units in the three years. Tables 28 and 29 report data on changes in funding among the panel units between 1979 and ,1982. Table 28 shows that the greatest increase in funding among panel units over this period occurred in the Nest (74.0 percent), in States other than California (30.7 percent). It also shows that funding reported by panel units classified as less-than-24-hour care increased 10 percent more than funding reported by 24-hour-care units. Of special significance is the finding reported in Table 28 that funding increased by 63.2 percent among panel units in the private sector, nearly double the 32.3 percent increase reported by public units in the panel. This finding is consistent with the observation that funding from private sources had increased substantially for all units surveyed (Table 26). Table 29 shows that client fees had become an even more important source of funding among panel units than among all alcoholism treatment units, increasing 75.6 percent between 1979 and 1982 as compared with the 39.3 percent increase in client fees noted for all reporting units (Table 26). Increases in funding from State and local fees for service were also greater among the panel units which reported an increase of 371.6 percent between 1979 and 1982 (Table 29) as compared with the 265.6 percent increase observed among all reporting units (Table 26). 5. Summary This comparison of the 1979, 1980, and 1982 NDATUS survey data indicates that the number of alcoholism treatment units has decreased recently as have the number of clients. During this same period, however, there appears to have been sustained growth in one small portion of the alco- holism treatment sector--the pr0prietary units run on a profit basis. These types of treatment units have increased in number by 48 percent (96 units) over the 3-1/2-year period. Although the proprietary units comprised only 6.9 percent of all responding units in 1982, their increase represents a consistent trend in contrast with the oscillations of units owned by federal and nonprofit organizations. Units owned by State and local governments showed a reverse trend, decreasing 9.9 percent over the 1979-1982 period. The increase in the number of proprietary units probably relates to the increasing availability of third-party payments as a source of revenues. In recent years, States have continued to pass legislation making health insurance for alcoholism treatment mandatory, thereby increasing the resources available for alcoholism treatment. Private health insurance increased by 106.8 percent between 1979 and 1982, and provided 26.4 percent of all reported funding in 1982 as compared with 17.8 percent in 1979. Ihg,4maigr;;g of funding reported by the proprietary units was, provided by priva health insurance which accounted for 67.1 percent of their total reported 1982 funding. Private health insurance also made a substantial contribution to the funding of nonprofit units in the private sector, accounting for 30 percent of their total funding in 1982.. _69- Future NDATUS surveys should further illuminate the degree to which ADMS Block Grants and third-party funding are affecting the nature and availa- bility of alcoholism treatment services. F. SUMMARY AND CONCLUSIONS The NDATUS achieved a high level of response representing 4,233 units providing treatment for alcohol-related problems. There were 2,729 units serving alcohol patients only while 1,504 reported serving both alcohol and drug patients. In addition, 535 prevention and 822 other service units reported. The rate of return for treatment units was over 90 percent but the total number of prevention units is unknown and hence no response rate can be calculated for that group. Both the number of clients and the total number of units reported in 1982 declined somewhat from the 1980 survey. Clients numbered 289,933 in 1982 compared to 307,174 in 1980, while the number of units reporting was 4,233 in 1982, down from 4,465 in 1980. The report conclusions will address each section in turn. 1. National Profile a. Facilities and types of care There were 203,469 clients being served in 2,729 alcohol only treatment units and 86,464 in combined units. Most of those patients were receiving outpatient care provided in a variety of facility types, mainly 2,271 outpatient facilities. However, 187 of the 855 hospitals also reported outpatients in their caseloads. Outpatient facilities reported the most clients (72%), with hospitals the next largest group (13.5%). The number of halfway houses and recovery homes almost equaled the number of hOSpitals with 850 reporting. A lesser number of other residential facilities responded, 636. The remaining facilities were quarterway houses (90) and correctional facilities (76). b. Client and staff demographics Those persons receiving care were predominantly male, white, and between the ages of 21 and 44. The percentage of females has changed little since 1980. Combined units served greater proportions of whites, females, and youth than did alcoholism only units. However, combined units reported a lower proportion of Hispanic clients. Combined units also reported a greater percentage of white staff and a smaller percentage of Hispanic staff than did alcoholism only units. Both types of units reported higher proportions of female staff than female clients and lower proportions of Hispanic staff com- pared to Hispanic clients. - 70 - 2. c. Ownership, principal population served, and physical environment of alcoholism treatment units The typical alcoholisni treatment unit was reported to be non- profit, serving urban clients, and established as a freestanding facility. The 65.5 percent of the units with nonprofit owner- ship include church-related units (4.2%), nonprofit corporations (56.6%) and others (4.7%). State and local government ownership also was substantial. Over 28 percent of the total caseload was classified by the units as largely rural (the principal population served). Community Mental Health Centers were cited as the location for 21 percent of all units. Treatment Capacity and Utilization Treatment capacity of 345,215, representing all modalities of care, was utilized at an 84 percent rate on the survey date. The highest utilization was shown in day care and outpatient services, the lowest in ambulatory detoxification. The utilization rates for detoxifi- cation services were somewhat higher in units that reported receiving over 50 percent ADMS Block Grant funds. Units with over 50 percent private funding generally showed the lowest utilization rates. Treatment Funding ADMS Block Grant funds, State funds, and third-party payments appear vital to the treatment units receiving those funds since they comprise a large portion of their total revenues. The largest single source of revenue for these units was private health insurance, with State Government funds ranking second. Private health insurance showed the most dramatic change, a 61 percent increase since 1980. Of units reporting ADMS Block Grants, 62 percent were outpatient in orientation and 19.1 percent were rehabilitation model units. Units reporting over 50 percent of their funds from Block Grants were mainly outpatient (197) with halfway houses and other residential care facilities showing 39 units each. Fourteen hospital-based units were supported at over a 50 percent level by Block Grants. Here again, Block Grant funds may have been underreported due to the reasons cited earlier. Even with 314 fewer units reporting funding information in 1982 over 1980, reported funding increased by almost $183 million. This resulted in an increase in the average funding per reporting unit from $218,180 to $281,000, an increase of 29 percent. Although only 51 percent (2,038) of the units reporting funding information received third-party funding, the aggregate funds from -7] _ this source represented 40 percent of all funding reported. State funding increased from $206,136,000 in 1980 to $235,751,000 with the percentage of total funding which it represents decreasing only slightly. Staffing in Alcoholism Treatment Units Although the total number of direct care staff dropped only 3 per- cent from 1980 to 1982, administrative staff decreased by 13 percent. Almost two-thirds of the staff held full-time paid positions; 14.8 percent were volunteers, representing about 8 percent of all FTE's. Hhite staff members exceeded the number of white clients by about 9 percent (77.3% vs. 68.4%). Over 50 percent of all staff were females, whereas only 21.5 percent of clients were females. Staff separations were greatest among alcoholism counselors, with admini- strative support staff separated at the next highest rate. Conclusions a. It appears there were fewer treatment units in 1982 than in 1980, since 5 percent fewer responded. It is unlikely that the reduc- tion was only the result of program consolidation, since there was also just over 5 percent fewer clients in treatment on the day of the survey. b. Outpatient services continue to dominate the type of care pro- vided, representing 77.6 percent of all services in 1982 as compared with 80.5 percent in 1980. c. Females continue to represent only about 22 percent of all clients in treatment. The fact that current studies show that alcohol abuse and alcoholism affect one-third to one-half of the U.S. female population suggests insufficient effort is being made to attract female alcohol abusers. d. Hispanic staff continue to underrepresent Hispanic clients in num- ber. More recruitment of Hispanic staff would seem appropriate. e. The proportion of female staff is much greater than the proportion of female clients. f. Staff separation rates were greatest among alcoholism counselors. The number of direct care staff has remained relatively stable but administrative staff levels have decreased, probably as a result of changing economic conditions. 9. Units receiving Block Grant funds, State funding, or third-party payments would be limited in their service if those funds were reduced. h. Alcoholism services to minorities will be jeopardized if Federal- based funding is not available. A larger proportion of minority -72.. clients and higher overall utilization rates are reported by units reporting Federal funding than by units in the private sector. Coverage in the area of private insurance has increased substan- tially. Significant increases in both private and public health insurance as sources of funding was noted in 1982. -73 - TABLE A—l ALCOHOLISM PREVENTION UNITS REPORTING TO 1982 NDATUS BY ORIENTATION AND STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, I982 Alcoholism Combined Alcoholism Combined State Only Units Total State Only Units Total Aflabama 4 4 8 Nebraska 0 2 2 Alaska 1 2 3 Nevada 0 4 4 Arizona 2 4 6 New Hampshire 0 O 0 Arkansas 1 3 4 New Jersey 6 1 7 California ‘VQW \“*3. ..... , “9 New Mexico 1 1 2 Colorado 1 18 19 New York 72 99 171 Connecticut 3 3 6 North Carolina 2 3 5 Delaware 0 1 1 North Dakota 0 0 O Dist. of Columbia 0 1 1 Ohio 13 10 23 Florida 6 7 13 Oklahoma 4 8 12 Georgia 0 O 0 Oregon 1 O 1 Hawaii 0 O 0 Pennsylvania 0 1 1 Idaho 0 0 0 Rhode Island 0 O 0 Illinois 5 10 15 South Carolina 0 O 0 Indiana 2 24 26 South Dakota 0 2 2 Iowa 1 3 4 Tennessee 0 4 4 Kansas 0 1 1 Texas 1 5 6 Kentucky 1 32 33 Utah 0 2 2 Louisiana 1 34 35 Vermont 0 1 1 Maine 0 0 0 Virginia 0 0 0 Maryland 1 2 3 Washington 2 1 3 Massachusetts 27 10 37 West Virginia 0 O 0 Michigan 12 36 48 Wisconsin 3 7 10 Minnesota 1 1 2 Wyoming 0 1 1 Mississippi 0 0 0 Guam 0 1 1 Missouri 1 1 2 Puerto Rico 0 O 0 Montana 0 0 0 Virgin Islands 1 0 1 NATIONAL TOTALS 182 353 535 SETSVI ELVIS V XIONHddV TABLE A—2 NUMBER OF ALCOHOLISM ONLY AND COMBINED ALCOHOLISM AND DRUG ABUSE TREATMENT UNITS BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 Alcoholism Combined Alcoholism Combined State Only Units Total State Only Units Total Alabama 31 12 43 Nebraska 41 12 53 Alaska 11 11 22 Nevada 22 16 38 Arizona 45 65 110 New Hampshire 6 14 20 '.Arkansas , 23 7 30 New Jersey 87 10 97 i/Cglifornia 302 W74» 376 7 New Mexico 32 13 45 (Colorado 104 19 123 New York 232 23 255 Connecticut 51 22 73 North Carolina 98 22 120 Delaware 11 3 14 North Dakota 6 10 16 Dist. of Columbia 16 3 19 Ohio 142 53 195 Florida 86 35 121 Oklahoma 23 19 42 Georgia 13 55 68 Oregon 71 14 85 Hawaii 9 6 15 Pennsylvania 50 72 122 Idaho 6 9 15 Rhode Island 10 5 15 Illinois 124 18 142 South Carolina 4 42 46 Indiana 14 32 46 South Dakota 21 14 35 Iowa 7 42 49 Tennessee 10 63 73 Kansas 27 38 65 Texas 105 77 182 Kentucky 8 103 111 Utah 21 24 45 Louisiana 14 67 81 Vermont 13 13 26 Maine 24 15 39 Virginia 35 27 62 Maryland 70 19 89 Washington 99 9 108 Massachusetts 170 15 185 Nest Virginia 6 15 21 Michigan 127 57 184 Wisconsin 44 106 150 Minnesota 113 22 135 Wyoming 6 8 14 Mississippi 30 46 76 Guam 0 1 1 Missouri 53 -- 53 Puerto Rico 11 22 33 Montana 43 4 47 Virgin Islands 2 1 3 NATIONAL TOTALS 2,729 1,504 4,233 TABLE A-3 CAPACITY, CLIENTS IN TREATMENT FOR ALCOHOLISM, AND UTILIZATION RATE BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 Actual Utilization Actual Utilization State Capacity Clients Rate State Capacity Clients Rate Alabama 1,932 1,632 84:5' Nebraska _ 3,598 3,278 91.1 Alaska 2,366 2,318 98.0 Nevada 1,296 963 74.3 Arizona 6,716 4,785 71.2 New Hampshire 1,000 959 95.9 Arkansas 2,238 1,750 78.2 New Jersey 7,833 6,806 86.9 California 46,752 38,202 81.7 New Mexico 2,659 3,136 117.9 Colorado 12,523 10,266 82.0 New York 28,357 24,788 87.4 Connecticut 3,759 3,185 84.7 North Carolina 9,705 7,742 79.8 Delaware 724 650 89.8 North Dakota 1,702 1,447 85.0 Dist. of Columbia 3,043 2,708 89.0 Ohio 11,676 9,811 84.0 Florida 12,133 11,008 90.7 Oklahoma 3,372 2,845 84.4 Georgia 6,873 4,964 72.2 Oregon 8,065 7,794 96.6 Hawaii 372 325 87.4 Pennsylvania 6,975 6,499 93.2 Idaho 1,433 961 67.1 Rhode Island 1,008 931 92.4 Illinois 9,867 8,891 90.1 South Carolina 3,809 3,237 85.0 Indiana 5,572 4,601 82.6 South Dakota 2,368 1,688 71.3 Iowa 2,139 1,579 73.8 Tennessee 4,215 3,067 72.8 Kansas 3,934 3,030 77.0 Texas 10,628 8,551 80.5 Kentucky 3,670 2,700 73.6 Utah 3,200 3,130 97.8 Louisiana 7,311 6,088 83.3 Vermont 1,225 1,327 108.3 Maine 3,277 2,734 83.4 Virginia 6,660 6,507 97.7 Maryland 9,118 9,098 99.8 Washington 11,043 8,823 79.9 Massachusetts 18,131 15,905 87.7 West Virginia 2,222 1,909 85.9 Michigan 15,689 10,853 69.2 Wisconsin 13,277 11,023 83.0 Minnesota 5,400 3,945 73.1 Wyoming 927 770 83.1 Mississippi 3,104 2,515 81.0 Guam 20 19 95.0 Missouri 2,372 2,199 92.7 Puerto Rico 5,970 4,352 72.9 Montana 1,826 1,546 91.1 Virgin Islands 131 93 71.0 NATIONAL TOTALS 345,215 289,933 84.0 4>mrm >1» vmxnmza chamecaHoz Om mmx >zc >mm ow nerzam Hz >rr czHam vmornozoer3 axm>azmza w< mq>am z>aHoz>r cxcm >20 >rnozoer3 me>43mza :HHrHN>aHoz mczmm ”we”: mmxmmv mdmflm & mmamdm _ x Hm m :aamw a Hmumo & Npubn * pmumo x mo m odmumam mm.o N.~ w.H mm.m wo.m m.m >gmmxm NH.H H.o mm.m mH.m NH.o m.m >wd~osm mu.w m.m m.o md.w Hm.a m.m >1xmzmmm mp.“ m.m m.u mo.o mm.o Hm.¢ omgwwouzmm mo.w m.» p.m mo.m m».m m.u nodowmao Hm.o m.w V.m op.p HV.H m.u noszmnflAncd wH.o p.m m.m mm.m mu.o o.H omfimzmwm HH.~ w.~ m.o mm.u Hp.o b.m cdmfi. 0* no#:3v*m Hm.» .H w.w VH.m No.© p.m «dowflam mw.o ~.m m.m mm.m mw.o Hp.w mmowmim mo.m ~.w $.m mu.o mu.o m.w Imzmii w~.o mm.m p.w mw.m Hm.“ p.o Hamzo mm.m m.m a.» mu.m mm.m m.o Hdawzoflm Nu.m m.m V.~ m#.H mo.m b.w Handmsm Hm.m m.~ Ho.“ mo.m HV.V m.m Hozm Hm.m ».o m.m mm.“ Hp.w m.m xmzwmm NV.V m.m m.m mm.m Ho.m w.m xmsdcnxk Hm.m m.¢ ».o mH.w Nw.u ».V roc¢m¢m3m NH.“ b.m m.o mm.» mm.w V.o 3mizm w>.o m.~ Hm.» n~.m NH.m m.w gawkgmza Hm.» ~.m m.m mm.u mm.» Hm.u gammmnzcmmflam NH.H p.w m.o mm.w mm.© m.m 2dn3dmm= mm.» m.m m.» mH.m Ho.o m.o zdssmmoam wo.w u.m m.o mH.m Hm.w N.m gimmAmmAuufl Ho.w w.p m.m mh.o mm.¢ o.o gimmocwd mw.o m.H “.0 mm.o Hm.H p.o gondmzm mm.H HH.c a.» mm.u H©.w m.u zmcwmmxm mm.m Ha.w m.m oo.~ Hw.m w.m zm.m mo.w mm.m m.o moCfi: omwodflam Ho.m m.u m.o mo.m mm.m m.H mocw: omxofim m>.m u.m o.w mu.w Hm.H V.m amzzmmmmm Hu.m A.o p.¢ mm.p mw.w a.» qumm Hm.p a.» m.o mm.m m».u HH.N Cfim: Hm.m c.w m.o mm.m Hm.» m.m aHoz>r aoa>r mm.» ».o m.m mo.~ mm.m m.© TABLE A-5 RACE/ETHNICITY 0F CLIENTS RECEIVING ALCOHOLISM TREATMENT SERVICES BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY - SEPTEMBER 30, 1982 Total Clients Race/Ethnicity American Indian/ State Alaskan Native Asian Black Hispanic White Alabama 1,632 * * 461 * l,l60 Alaska 2,269 1,051 * 41 * 1,147 Arizona 4,452 1,021 10 185 672 2,564 Arkansas 1,750 * * 459 * 1,276 California 37,542 870 422 4,172 8,824 23,254 Colorado 9,741 822 20 373 2,252 6,274 Connecticut 3,185 * * 604 217 2,349 Delaware 650 * * 108 * 530 Dist. of Columbia 2,708 * * 2,361 101 239 Florida 11,008 * * 1,742 633 8,605 Georgia 4,964 * * 1,333 * 3,618 Hawaii 325 * 122 * 10 185 Idaho 961 111 * * 34 811 Illinois 8,722 * * 1,937 451 6,261 Indiana 4,601 * * 517 39 4,035 Iowa 1,566 125 * 62 * 1,363 Kansas 2,878 130 0 213 126 2,409 Kentucky 2,378 * * 187 * 2,187 Louisiana 6,088 15 0 2,302 162 3,609 Maine 2,734 85 * 58 * 2,569 Maryland 9,098 127 15 2,844 22 6,090 Massachusetts 15,905 86 20 1,100 494 14,205 Michigan 10,814 256 42 1,776 169 8,571 Minnesota 3,945 325 * 163 * 3,406 Mississippi 2,291 * * 771 * 1,433 Missouri 2,088 17 0 310 14 1,747 Montana 1,546 287 * * * 1,247 TABLE A-5 (Continued) RACE/ETHNICITY OF CLIENTS RECEIVING ALCOHOLISM TREATMENT SERVICES BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY - SEPTEMBER 30, I982 Total Clients Race/Ethnicity American Indian/ State Alaskan Native Asian Black Hispanic White Nebraska 3,278 145 * 136 * 2,894 Nevada 862 109 * 43 * 666 New Hampshire 959 * * * * 947 New Jersey 6,675 * * 1,573 423 4,669 New Mexico 3,136 892 * * 1,309 888 New York 24,332 135 39 7,219 3,066 13,873 North Carolina 7,070 161 * 1,958 * 4,928 North Dakota 1,447 73 * * * 1,357 Ohio 9,649 15 10 1,360 110 8,154 Oklahoma 2,845 583 * 479 * 1,728 Oregon 7,537 809 37 181 298 6,212 Pennsylvania 6,499 * * 1,721 102 4,654 Rhode Island 835 * * 47 54 732 South Carolina 3,237 * * 903 * 2,319 South Dakota 1,688 428 * * * 1,252 Tennessee 2,894 * * 478 * 2,391 Texas 8,100 * * 1,052 1,314 5,659 Utah 2,026 267 * * 224 1,458 Vermont 1,327 * * * * 1,323 Virginia 6,390 * * 1,572 104 4,688 Washington 8,823 754 55 499 313 7,202 West Virginia 1,814 * * 153 * 1,659 Wisconsin 10,671 450 * 584 * 9,423 Wyoming 770 97 0 15 65 593 Guam 19 * 16 * * * Puerto Rico 4,349 O O 0 4,349 0 Virgin Islands 93 O 0 68 10 15 NATIONAL TOTALS 283,166 10,578 922 44,265 26,571 200,830 * FOR PRIVACY REASONS, SMALL FIGURES WHICH MIGHT IDENTIFY INDIVIDUAL PERSONS HAVE BEEN OMITTED FROM RACE/ETHNICITY CATEGORIES, HOWEVER THESE FIGURES ARE INCLUDED IN STATE AND NATIONAL TOTALS. TABLE A-6 NUMBER OF ALCOHOLISM TREATMENT UNITS IN SELECTED FUNDING CATEGORIES* BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 TOTAL NUMBER OF ALCOHOLISM UNITS REPORTING All ADMS Block Other Federal Any State/ > 50% Funding State Units Grant Funds Funds Local Funds From Private Source Alabama 41 10 16 31 3 Alaska 21 15 , 2 19 0 Arizona 107 74 53 84 13 Arkansas 29 8 26 23 0 California 355 38 125 210 119 Colorado 108 11 26 69 37 Connecticut 63 18 40 46 18 Delaware 14 2 13 12 2 Dist. of Columbia 17 2 10 8 2 Florida 114 70 49 89 17 Georgia 68 26 49 50 12 Hawaii 15 5 9 11 3 Idaho 15 4 4 10 4 Illinois 136 17 38 114 21 Indiana 45 12 26 35 9 Iowa 44 6 16 40 2 Kansas 64 3 24 54 14 Kentucky 110 78 58 81 9 Louisiana 67 11 19 50 8 Maine 39 11 20 37 6 Maryland 87 11 34 66 16 Massachusetts 176 9 39 142 25 Michigan 177 58 64 125 66 Minnesota 124 3 60 81 56 Mississippi 50 15 30 34 6 Missouri 53 8 9 49 2 Montana 47 0 12 42 3 TABLE A-6 (Continued) NUMBER OF ALCOHOLISM TREATMENT UNITS IN SELECTED FUNDING CATEGORIES* BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 TOTAL NUMBER OF ALCOHOLISM UNITS REPORTING All ADMS Block Other Federal Any State/ > 50% Funding State Units Grant Funds Funds Local Funds From Private Source Nebraska 52 3 14 47 12 Nevada 35 12 17 19 6 .New Hampshire 20 16 2 10 2 New Jersey 96 26 44 56 28 New Mexico 42 4 25 35 4 New York 234 8 108 187 27 North Carolina 114 46 54 97 21 North Dakota 15 3 8 8 8 Ohio 190 28 103 131 63 Oklahoma 40 5 16 31 5 Oregon 85 1 27 71 15 Pennsylvania 117 14 51 101 23 Rhode Island 13 3 6 8 3 South Carolina 45 8 10 41 4 South Dakota 35 19 26 25 7 Tennessee 69 42 45 52 17 Texas 166 14 45 128 45 Utah 44 20 15 40 3 Vermont 24 19 16 21 1 Virginia 58 21 43 44 6 Washington 101 28 41 78 20 West Virginia 21 9 14 19 2 Wisconsin 144 11 70 124 29 Wyoming 14 1 4 13 . 1 Guam 1 0 1 1 0 Puerto Rico 33 9 2 29 3 Virgin Islands 3 0 2 1 1 NATIONAL TOTALS 3,997 895 1,680 3,029 829 *NOT MUTUALLY EXCLUSIVE FUNDING CATEGORIES TABLE A-7 TOTAL ALCOHOLISM TREATMENT FUNDING DY STATE (IN THOUSANDS OF DOLLARS) 7 NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 No. of No. of Total Units Total Units Reported Reporting Reported Reporting State Funding Funding, State Funding Funding Alabama 10,748 4l Nebraska 12,081 52 Alaska 9,738 22 Nevada 6,620 35 Arizona 23,058 107 New Hampshire 2,457 20 Arkansas 4,544 29 New Jersey 28,178 96 California 113,327 355 New Mexico 11,188 42 Colorado 19,505 108 New York 102,640* 234 Connecticut 22,224 63 North Carolina 28,847 114 Delaware 1,489 14 North Dakota 6,727 15 District of Columbia 11,095 17 Ohio 82,401 190 Florida 31,975 114 Oklahoma 8,800 40 Georgia 32,527 68 Oregon 16,560 85 Hawaii 1,659 15 Pennsylvania 35,411 117 Idaho 3,109 15 Rhode Island 1,696 13 Illinois 46,432 136 South Carolina 7,362 45 Indiana 16,473 45 South Dakota 6,634 35 Iowa 10,240 44 Tennessee 13,468 69 Kansas 20,760 64 Texas 30,656 166 Kentucky 11,783 110 Utah 6,849 44 Louisiana 10,244 67 Vermont 3,288 24 Maine 9,508 39 Virginia 23,188 58 Maryland 18,699 87 Washington 29,428 101 Massachusetts 35,491 176 West Virginia 3,539 2T Michigan 42,861 177 Wisconsin 50,738 144 Minnesota 59,668 124 Wyoming 4,790 13 Mississippi 8,386 50 Guam 93 1 Missouri 13,787 53 Puerto Rico 2,939 33 Montana 7,126 47 Virgin Islands 208 3 *N.Y. STATE OFFICIALS ESTIMATE TOTAL ALCOHOLISM NATIONAL TOTALS $1,123,175 3,997 FUNDING OF $117,222,000; 14.6 MILLION MORE THAN THE TOTAL REPORTED BY UNITS SURVEYED THROUGH NDATUS. CAPACITY AND ACTUAL CLIENTS IN TREATMENT BY TYPE OF CARE AND STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY TABLE A-8 SEPTEMBER 30, 1982 24 Hour Care* L Less Than 24 Hour Care Actual | Actual State Capacity Clients | Capacity Clients Alabama 722 638 1,210 994 Alaska 209 203 2,157 2,115 Arizona 1,433 1,118 5,283 3,667 Arkansas 595 421 1,643 1,329 California 7,750 6,698 39,002 31,504 Colorado 1,900 1,535 10,623 8,731 Connecticut 1,202 916 2,557 2,269 Delaware 107 89 617 561 Dist. of Columbia 419 337 2,624 2,371 Florida 2,574 2,117 9,559 8,891 Georgia 1,206 843 5,667 4,121 Hawaii 151 126 221 199 Idaho 218 135 1,215 826 Illinois 1,951 1,589 7,916 7,302 Indiana 759 553 4,813 4,048 Iowa 496 398 1,643 1,181 Kansas 1,021 696 2,913 2,334 Kentucky 830 459 2,840 2,241 Louisiana 723 543 6,588 5,545 Maine 334 286 2,943 2,448 Maryland 1,246 1,029 7,872 8,069 Massachusetts 2,975 2,687 15,156 13,218 Michigan 2,534 1,519 13,153 9,334 Minnesota 3,244 2,492 2,156 1,453 Mississippi 929 734 2,175 1,781 Missouri 615 517 1,757 1,682 Montana 300 258 1,526 1,288 CAPACITY AND ACTUAL CLIENTS IN TREATMENT TABLE A-8 (Continued) BY TYPE OF CARE AND STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 24 Hour Care* Less Than 24 Hour Care Actual Actual State Capacity Clients Capacity Clients Nebraska 700 553 2,898 2,725 Nevada 442 331 854 632 New Hampshire 120 109 880 850 New Jersey 1,636 1,420 6,197 5,386 New Mexico 514 491 2,145 2,645 New York 4,694 3,757 23,663 21,031 North Carolina 1,947 1,511 7,758 6,231 North Dakota 354 255 1,348 1,192 0hio 2,397 1,911 9,279 7,900 Oklahoma 560 430 2,812 2,415 Oregon 771 588 7,294 7,206 Pennsylvania 1,540 1,166 5,435 5,333 Rhode Island 123 97 885 834 South Carolina 414 581 3,395 2,656 South Dakota 468 376 1,900 1,312 Tennessee 748 587 3,467 2,480 Texas 4,379 3,505 6,249 5,046 Utah 477 431 2,723 2,699 Vermont 164 118 1,061 1,209 Virginia 1,182 806 5,478 5,701 Washington 1,656 1,362 9,387 7,461 West Virginia 218 121 2,004 1,788 Wisconsin 2,426 1,812 10,851 9,211 Wyoming 254 214 673 556 Guam 0 0 20 19 Puerto Rico 159 139 5,813 4,213 Virgin Islands 10 0 121 93 NATIONAL TOTALS 64,796 51,607 280,419 238,326 *Includes detox (both medical and social), I/P Rehabilitation and Custodial domiciliary care beds. TABLE A—9 HOSPITAL-BASED ALCOHOLISM TREATMENT CAPACITY BY TYPE OF CARE AND STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, I982 Less Than Less Than State 24 Hr. Care 24 Hr. Care State 24 Hr. Care 24 Hr. Care Alabama 215 201 Nebraska 332 135 Alaska 21 21 Nevada 143 125 Arizona 100 0 New Hampshire 75 0 Arkansas 306 68 New Jersey 518 1,237 California 1,555 1,037 New Mexico 216 50 Colorado 312 273 New York 1,868 10,523 Connecticut 639 869 North Carolina 591 440 Delaware 43 40 North Dakota 348 81 District of Columbia 334 290 Ohio 1,231 424 Florida 738 415 Oklahoma 273 302 Georgia 798 108 Oregon 114 30 Hawaii 0 0 Pennsylvania 403 168 Idaho 41 100 Rhode Island 27 56 Illinois 779 406 South Carolina 38 85 Indiana 377 260 South Dakota 177 0 Iowa 239 10 Tennessee 320 620 Kansas 437 107 Texas 1,367 320 Kentucky 331 26 Utah 103 90 Louisiana 414 4 Vermont 61 463 Maine 167 269 Virginia 784 300 Maryland 326 1,210 Washington 730 0 Massachusetts 867 955 West Virginia 89 243 Michigan 1,425 1,781 Wisconsin 1,124 961 Minnesota 1,424 106 Wyoming 166 30 Mississippi 316 270 Guam 0 0 Missouri 181 158 Puerto Rico 30 0 Montana _92 24 Virgin Islands 0 0 NATIONAL TOTAL 23,605 25,691 NUMBER OF PAID AND VOLUNTEER STAFF, FULL—TIME EQUIVALENT STAFF AND PERCENT TABLE A-lO OF VOLUNTEER EFFORT IN ALCOHOLISM ONLY TREATMENT UNITS BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, I982 [ Full-Time Equivalents* Number of Number of Volunteer Percent of State Paid Staff Volunteer Staff | Paid Staff Staff Volunteer Effort** Alabama 349 17 298.6 12.7 4.l Alaska 181 1 180.5 1.0 0.6 Arizona 474 88 438.0 55.2 11.2 Arkansas 206 213 191.4 172.4 47.4 California 3,550 1,282 3,06l.6 723.1 19.1 Colorado 1,260 140 1,052.7 76.8 6.8 Connecticut 825 125 674.4 29.7 4.2 Delaware 50 12 41.5 7.2 14.8 Dist. of Columbia 218 52 193.4 20.9 9.8 Florida 1,155 145 977.4 72.6 6.9 Georgia 316 48 276.2 7.4 2.6 Hawaii 76 30 70.1 21.1 23.2 Idaho 79 7 69.3 3.5 4.8 Illinois 1,675 284 1,357.0 93.0 9.0 Indiana 254 37 196.3 19.5 1.2 Iowa 164 11 132.2 3.0 2.2 Kansas 457 46 411.1 22.8 5.3 Kentucky 60 7 52.5 4.8 8.4 Louisiana 113 29 100.9 23.7 19.0 Maine 366 184 308.4 18.8 5.7 Maryland 800 158 639.2 70.3 9.9 Massachusetts 2,185 323 1,603.6 119.1 6.9 Michigan 1,664 117 1,321.8 39.0 2.9 Minnesota 2,612 367 2,192.7 118.2 5.1 Mississippi 331 82 292.9 28.5 8.9 Missouri 562 74 491.5 64.3 11.5 Montana 215 51 174.8 30.2 14.7 TABLE A-lO (Continued) NUMBER OF PAID AND VOLUNTEER STAFF, FULL—TIME EQUIVALENT STAFF AND PERCENT OF VOLUNTEER EFFORT IN ALCOHOLISM ONLY TREATMENT UNITS BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 1, Full-Time Equivalents* Number of Number of | Volunteer Percent of State Paid Staff Volunteer Staff 1, Paid Staff Staff Volunteer Effort** Nebraska 504 69 451.6 10.9 2.4 Nevada 253 25 196.6 16.5 7.7 New Hampshire 57 0 45.1 0.0 0.0 New Jersey 997 420 843.9 133.1 13.6 New Mexico 468 106 443.1 57.8 11.5 New York 7,003 407 3,337.5 182.2 5.2 North Carolina 1,123 72 986.3 46.9 4.5 North Dakota 198 1 157.4 0.2 0.1 Ohio 2,435 702 1,966.1 173.5 8.1 Oklahoma 324 25 299.5 21.7 6.8 Oregon 642 181 512.6 63.3 11.0 Pennsylvania 1,384 92 898.4 25.5 2.8 Rhode Island 100 14 83.7 9.0 9.7 South Carolina 106 0 91.3 0.0 0.0 South Dakota 248 12 216.4 5.2 2.3 Tennessee 158 30 134.9 21.0 13.5 Texas 1,347 202 1,192.0 94.7 7.4 Utah 161 7 145.2 .9 0.6 Vermont 109 17 88.8 14.6 14.1 Virginia 597 88 541.5 28.5 5.0 Washington 1,358 129 1,057.0 49.2 4.4 West Virginia 82 3 79.8 2.2 2.7 Wisconsin 602 13 507.9 6.9 1.3 Wyoming 111 8 102.9 8.0 7.2 Guam -- -- -- -— -- Puerto Rico 240 0 228.0 0.0 0.0 Virgin Islands 15 3 9.8 0.1 1.0 NATIONAL TOTALS 40,819 6,556 31,417.3 2,730.7 8.0 *FULL-TIME EQUIVALENT (FTE) IS THE SUM OF THE NUMBER OF FULL—TIME WORKERS AND THE NUMBER OF PART-TIME WORKER-HOURS DIVIDED BY 35 HOURS PER WEEK. **PERCENT OF VOLUNTEER EFFORT IS DEFINED AS FTE VOLUNTEER STAFF DIVIDED BY THE SUM OF FTE PAID STAFF AND FTE VOLUNTEER STAFF. TABLE A-ll TOTAL FUNDING AND PERCENT DISTRIBUTION OF THIRD PARTY PAYMENT FOR ALCOHOLISM TREATMENT BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 | | Percentages Funds from | Social All Sources | Total Services Public Private (in Thousands) [ Third-Party State/Local Block Public Health Health State of Dollars 1 Payments* Govt. Fees Grant Welfare Insurance Insurance Alabama 10,748 37.2 2.2 1.2 1.8 31.9 Alaska 9,738 6.0 6.0 Arizona 23,058 38.7 1.3 .6 7.9 6.2 22.7 Arkansas 4,544 30,2 2.7 26.5 1.1 California 113,327 42.5 4.0 2.5 9.0 27.0 Colorado 19,505 17.5 6.7 .2 1.2 9.4 Connecticut 22,224 51.2 .6 2.8 4.1 3.5 40.1 Delaware 1,489 .1 .1 Dist. of Columbia 11,095 38.4 .5 15.6 22.3 Florida 31,975 12.5 2.2 .3 .5 1.9 7.5 Georgia 32,527 36.7 1.9 .1 3.1 31.8 Hawaii 1,659 6.5 4.2 2.3 .1 Idaho 3,109 14.9 8.4 1.0 5.6 Illinois 46,432 38.9 1.8 .5 7.2 29.3 Indiana 16,473 18.9 1.7 5.6 .3 1.6 9.8 Iowa 10,240 39.1 8.5 .8 .2 3.7 25.9 Kansas 20,760 40.8 1.0 .4 2.4 12.6 24.4 Kentucky 11,783 57.0 5.6 8.1 .1 6.3 36.9 Louisiana 10,244 10.1 .5 .5 .2 2.6 6.5 Maine 9,508 30.1 3.1 .6 .3 7.0 19.1 Maryland 18,699 40.5 .9 1.6 .8 16.8 20.4 Massachusetts 35,491 48.9 25.1 .7 1.2 2.0 19.9 Michigan 42,861 54.6 1.7 .9 2.2 7.7 42.0 Minnesota 59,668 50.0 4.6 3.2 3.7 6.3 32.2 Mississippi 8,386 28.5 2.8 16.0 2.2 7.5 Missouri 13,787 39.3 .1 39.2 Montana 7,126 33.5 .2 3.3 30.0 TABLE A-ll (Continued) TOTAL FUNDING AND PERCENT DISTRIBUTION OF THIRD PARTY PAYMENT FOR ALCOHOLISM TREATMENT BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, T982 : Percentages Funds from | Social All Sources 1 Total Services Public Private (in Thousands) | Third-Party State/Local Block Public Health Health State of Dollars | Payments* Govt. Fees Grant welfare Insurance Insurance Nebraska 12,081 51.3 10.9 .5 1.2 38.7 Nevada 6,620 41.7 .5 .7 10.8 29.7 New Hampshire 2,457 31.3 .2 31.0 New Jersey 28,178 51.0 1.8 2.4 .4 3.0 43.4 New Mexico 11,188 10.5 .8 2.1 7.6 New York 102,642 40.4 6.9 2.8 18.5 12.1 North Carolina 28,847 15.3 2.6 1.7 .1 1.5 9.4 North Dakota 6,727 65.9 .9 .4 2.8 61.7 Ohio 82,401 65.8 1.2 1.8 1.5 5.1 56.? Oklahoma 8,800 40.6 3.5 1.2 12.5 23.4 Oregon 16,560 17.1 2.3 1.7 4.0 9.1 Pennsylvania 35,411 59.4 5.3 1.2 12.1 40.8 Rhode Island 1,696 54.8 26.2 4.7 23.8 South Carolina 7,362 .8 .8 South Dakota 6,634 24.5 2.4 .1 1.4 20.6 Tennessee 13,468 39.4 1.7 .7 .1 5.0 32.0 Texas 30,656 27.2 6.5 .4 .4 3.6 16.3 Utah 6,849 27.0 5.7 2.3 1.0 1.1 17.0 Vermont 3,288 14.5 1.3 1.4 11.8 Virginia 23,118 18.8 1.2 2.6 .1 5.7 9.2 Washington 29,428 42.6 6.7 3.4 5.9 3.8 22.8 West Virginia 3,539 17.4 1.5 .3 .1 4.7 10.8 Wisconsin 50,738 53.4 3.9 .2 1.0 11.0 37.3 Wyoming 4,790 4.2 4.2 Guam 93 0.0 Puerto Rico 2,939 3.3 3.3 Virgin Islands 208 .2 .2 NATIONAL TOTALS 1,123,175 40.2 4.0 1.2 1.6 6.9 26.4 *TOTAL PERCENT MAY NOT BE EXACT SUM OF PARTS DUE TO ROUNDING ERRORS TABLE A-TZ ONNERSHIP* CHARACTERISTICS OF UNITS PROVIDING ALCOHOLISM TREATMENT BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, T982 OWNERSHIP All State/Local Federal State Units Profit Non-Profit Government Government Alabama 43 4 34 2 3 Alaska 22 0 3 l9 0 Arizona llO 5 84 9 12 Arkansas 30 0 27 3 0 , California 376 , 52 . H 242 , 58 24 ' Colorado "‘“" ’ “ ‘123 ‘T 29 79 IO 5 Connecticut 73 6 49 l7 l Delaware 14 0 4 l0 0 Dist. of Columbia 19 O 8 8 3 Florida 121 ll 88 l8 4 Georgia 68 5 9 49 5 Hawaii 15 0 13 1 l Idaho 15 3 8 3 l Illinois 142 5 l2l l2 4 Indiana 46 3 33 7 3 Iowa 49 0 4l 6 2 Kansas 65 3 48 ll 3 Kentucky Ill 3 l04 1 3 Louisiana 8l 8 17 52 4 Maine 39 0 35 3 l Maryland 89 7 37 43 2 Massachusetts 185 9 I62 9 5 Michigan 184 2l l4l 20 2 Minnesota 135 ll l04 l7 3 Mississippi 76 2 46 25 3 Missouri 53 3 43 5 2 Montana 47 0 3l l4 2 TABLE A-12 (Continued) OWNERSHIP* CHARACTERISTICS OF UNITS PROVIDING ALCOHOLISM TREATMENT BY STATE NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY SEPTEMBER 30, 1982 OWNERSHIP A11 State/Loca1 Federa1 State Units Profit Non-Profit Government Government Nebraska 53 1 36 13 3 Nevada 38 3 25 3 7 New Hampshire 20 1 13 5 1 New Jersey 97 3 66 24 4 New Mexico 45 1 33 8 3 New York 255 14 153 77 11 North Caro1ina 120 1 54 62 3 North Dakota 16 0 8 7 1 Ohio 195 13 147 31 4 Oklahoma 42 1 19 13 9 Oregon 85 6 53 23 3 Pennsy1vania 122 7 103 10 2 Rhode Is1and 15 1 11 1 2 South Caro1ina 46 0 8 36 2 South Dakotas 35 0 27 4 4 Tennessee 73 8 55 5 5 Texas 182 22 95 55 10 Utah 45 0 15 27 3 Vermont 26 0 22 3 1 Virginia 62 5 16 32 9 Washington 108 6 67 25 10 West Virginia 21 0 18 1 2 Wisconsin 150 12 95 38 5 Wyoming 14 O 10 2 2 Guam 1 O O 1 0 Puerto Rico 33 0 8 24 1 Virgin Is1ands 3 O 1 2 0 NATIONAL TOTALS 4,233 295 2,769 964 205 *ONNERSHIP REFERS TO THE TYPE OF ORGANIZATION LEGALLY RESPONSIBLE FOR THE ALCOHOLISM TREATMENT UNIT. APPENDIX B DEPARTMENT or HEALTH AND HUMAN SERVICES OMB No. 09300087 Pueuc HEALTH SERVICE Expim. #30133 ALCOHOL DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION ' NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY NDATUS I I I I I | I I (NDATUS) IDENTIFIER 1 SEPTEMBER 30. 1982 UNIT IDENTIFICATION AND DESCRIPTION FOR OFFICIAL USE ONLY Page 1 is to be completed by all reporting units. 337 1, (nosed 2. Duplicate A. IDENTIFICATION —- Review information on current NOATUS file. Enter new and/or corrected items only. 3- Inappropriate 'Clinic Name (Service Unit) Clinic Name (Service Unit) ' 2 Clinic Name (Service Unit) (continued) Clinic Name (Service Unit) (continued) 3 Street Address Street Address 4 Street Address (continued) Street Address (continued) 5 City State Zip Code City State Zip Code , I6 :7 a ' County Unit’s Telephone No. Ext. (if any) County Unit's Telephone No. Ext. (if any) , s _ 10 'III Mailing Address (if different from above Mailing Address (if different from above 12 Mailing Address (continued) Mailing Address (continued) '13 City State Zip Code City State Zip Code 14 'Is he LnitDirector's Name ‘ Unit Director's Name . 17 Diractor'sTeIephone No. Ext. (if any) Director's Telephone No. Ext. (if any) 18 19 .“rogrem Name (Administrative Unit) Program Name (Administrative Unit) '20 Program Name (Administrative Unit) (continued) Program Name (Administrative Unit) (continued) 21 8. UNIT' S ORIENTATION -— Enter in the box the number of the response that best describes this unit' s orientation. 366 3 (Select only one response.) Check here if this unit‘s E3 principal function' Is 1. Alcoholism services 2. Drug abuse services 3. Alcoholism and drug abuse services prevention services C.’ UNIT'SPHYSICAL ENVIRONMENT — Enter in the box the number of the response that best describes this unit's physical environment. 23 (Select only one response.) [)1 Community mental health center Other specialized hospital 7. Other 2. Mental/psychiatric hos ital 5. Correctlonal facility 3. General hospital, II‘ICIUI ing VA Hospitals 6. Free standing facility TIP POPULATION SERVED —- Enter in the box the number of the response that best describes the residence of the principal population served by this unit. (Select only one response.) 25 . 1. Inner city 2. Other urban 3. Suburban 4. Rural E. AEEOHOLISM/DRUE ABUSE SERVICES — Check all services provided directly at your facility. 6 1. Individual therapy and/or counseling 10. Outreach 19. Physical examinations 2. Group therapy and/or counseling 11. Aftercare followup 20. Intake and screening 3. Family therapy and/or counseling 12. Child care 21.. Emergency care - 13. Transportation 22. Other medical services 5. 14. Staff training 23. Early intervention ,6. 15. Alternatives 24. Employee assistance program 7. Education - 16. Referral 25. Self help groups available 6. Psychological testing 17. Information 26. Occupational alcoholism program 9. Research/evaluation ' 18. DWI program 27. Other E. SPECIALIZED PROGRAMS —- Check all specialized programs for any of the following population groups provided at your unit. g 1. Blacks 3. Women 5. Elderly 7. Not applicable 2. Hiwanics 4. Youth 6. Public inebriates 8. Other (3. OWNERSHIP —- Enter In the box the number of the response that best describes the type of organization legally responsible for the operation of this unit. 0 (Select only one response.) STATE LOCAL , FOR PROFIT NONPROFIT GOVERNMENT FEDERAL GOVERNMENT ' 1. Individual 4. Church related 7. State government 13. US. Public Health Service 2. Partnership 5. Nonprofit corporation 8. County government 14. Armed Forces 3. Corporation 6. Other nonprofit 9City government 15. Veterans Administration 10. City~county government 16. Federal Prison System 11 Hospital district 17. Other federal a ency 12 Other substate governments 18. Administrative ffice of the us. Courts ADM 535 Rev. 5-82 Page 1 NDATUSIDENTIFIER I I I I I I I II CLIENT POPULATION TREATED WITH ALCOHOLISM FUNDING This page is to be completed by all units providing treatment services to alcoholism clients. A. ACTUAL CLIENTS IN TREATMENT AND TREATMENT CAPACITY For each type of treatment provided at your unit, enter in the row labeled “ACTUAL" the total number of active clients in treatment as of September 30, 1982. Report all clients treated with alcoholism treatment funds, regardless of the source of funds. Do not include clients' parents, relatives, or friends. An active client is an individual who: (1) has been admitted to this treatment unit and for whom a treatment plan has been developed, (2) has been seen on a scheduled appointment basis at least once during September 1982, and (3) has not been discharged from treatment (i.e., continued care is expected to be given to this client). After entering the number of active clients, write in the treatment capacity for each type of care provided at your unit in the row labeled "CAPACITY". Your treatment capacity is the maximum number of individuals who could be enrolled as active clients as of September 30, 1982, given your unit's staffing, funding. and physical facility at that time. For inpatient and residential units, treatment capacity is equal to the number of beds availabie at the unit. For outpatient units, treatment capacity reflects the maximum active caseload a unit could carry. This maximum caseload would depend upon such factors as the percentage of total staff hours devoted to direct client care, the average length of counseling sessions, and the frequency of client visits to the unit. : TYPE OF 24-Houn CARE LESS THAN 24-Hour! CARE 7 CARE 1 LIMITED ‘ DETOX DETOX REHAB {2:53:33} A233? CARE OUT' » FACILITY MEDICAL SOCIAL MODEL ARV MEDICAL (INCLUD- PATIENT TOTALS LOCATION MODEL SETTING MODEL DETOX lNG SERVICES DAY CARE) 31 32 33 34 3E 36 37 33 I HOSPITAL Am“ . 39 46 41 42 43 44 5 4s CapaCIty 47 a 49 so 51 52 ST 54 OUARTERWAY Actual HOUSE . 55 56 57 59 59 so 61 62 Capacrty HALFWAY 63 64 65 65 67 63 5§ 7° HOUSE / Actual necovsny , 71 72 73 74 75 76 77 79 HOME Capactty OTHER Acme. 79 9'0 31 82 93 34 95 86 assmamw‘ 97 aa 99 so 91 92 93 94 FACILITY Capaciw 99 100 Wt 102 OUTPATIENT Actual FACIUTY ; 107 108 109 110 Capacity 113 115 116 117 119 CORRECTIONAL Actual FACILITY , 119 120 121 122 123 124 125 126 CapacIty 127 125 129 13?) 131 r 132 133 134 ‘ Actual TOTALS . 135 135 137 133 139 140 141 142 Capacity B. CLIENT CHARACTERISTICS OF ALCOHOLISM POPULATION — To the extent that this information is available, please enter the number of clients from your alcoholism treatment population as of September 30. 1982 that are in each of the categories below. NUMBER SEX CLIENTS CLIENT RACE/ETHNICITY OF CLIENTS AGE FEMALES American Indian or Alaskan Native ”’3 18 and under Asian or Pacific lslander 1“ 19—20 Black, not of Hispanic origin ”5 21-44 Hispanic 146 45—59 White. not of Hispanic origin ”7 50'64 TOTAL ‘48 65 and over TOTAL ADM 515 Rev. 5-82 Page 2 NDATUSIDENTIFIER I I I I I I I I I CLIENT POPULATION TREATED WITH DRUG ABUSE FUNDING This page is to be completed by all units providing treatment to drug abuse clients. A. ACTUAL CLIENTS IN TREATMENT AND TREATMENT CAPACITY For each type of treatment provided at your unit, enter in the row labeled "ACTUAL" the total number of active clients in treatment as of September 30, 1982. Report all clients treated with drug abuse treatment funds, regardless of the source of funds. 00 not include clients' parents, relatives, or friends. An active client is an individual who: (1) has been admitted to this treatment unit and for whom a treatment plan has been developed, (2) has been seen on a scheduled appointment basis at least once during September 1982, and (3) has not been discharged from treatment (i. e, continued care is expected to be given to this client) After entering the number of active clients, write in the capacity for each treatment modality and environment provided by your unit in the row labeled ”CAPACITY". Your treatment capacity is the maximum number of individuals who could be enrolled as active clients as of September 30, 1982, given your unit' 5 staffing, funding, and physical facility at that time. For inpatient and residential units, treatment capacity is equal to the number of beds available at the unit. For outpatient units, treatment capacity reflects the maximum active caseload a unit could carry. This maximum caseload would depend upon such factors as the percentage of total staff hours devoted to direct client care, the average length of counseling sessions, and the frequency of client visits to the unit. MODALITY ENVIRONMENT VOTALS DETOXIFICATION MAINTENANCE DRUG FREE OTHER MODALI‘IY' Is: 185 we 187 1 Actual PRISON 1:97 190 191 192 193 Capacity 194 {95 156 197 155 Actual HOSPITAL 799 200 201 202 20: Capacity 204 26? 266E 207 2d Actual RESIDENTIAL 210 211 212 21:1 Capacity ' 214 215 216 217 2121 Actual DAYCARE 219 220 221 222 22: Capacity 224 225 226 227 225 Actual OUTPATIENT 229 230 231 232 233 Capacity 234 235 236 237 235 Actual TOTALS 239 240 241 242 213 Capacity 'Specily other modality 244 B, CLIENT CHARACTERISTICS OF DRUG POPULATION — To the extent that this information is available, please enter the number of clients from your drug treatment population as of September 30, 1982 that are in each of the categories below. CLIENT RACE/ETHNICITY NUROAIEER SEX CLIENTS TOTAL CLIENTS AGE FEMALES American Indian or Alaskan Native 2‘5 18 80¢ under Asian or Pacific Islander 24‘ 19-20 Black, not of Hispanic origin 2‘7 21-44 Hispanic 2‘9 45-59 White. not ol Hispanic origin 2‘9 60-64 tom. 75° .65 and over I TOTAL ADM 515 Rev 5-62 . Page 3 NDATUSIDENTIFIER I I l I I I I [I FUNDING INFORMATION To be completed by all treatment units. Units unable to provide complete funding information are advised to contact their administrative office or agency for assistance. For each of the funding sources listed in Column 1 that provide financial support to the treatment unit. enter the following information in the matrix below reflecting the fiscal year in which the date of this survey, Sept. 30, 1982. occurs. 0 In Column 2, TOTAL ALCOHOL DOLLAR AMOUNT, enter the amount of funding allocated for alcoholism treatment during the current fiscal year. O In Column 3, TOTAL DRUG DOLLAR AMOUNT, enter the amount of funding allocated for drug abuse treatment during the current fiscal year. Jasmine Damage... Column 1 Column 2 Column 3 1. ADAMHA block grant 286 287 2. Other ADAMHA program support (including formula & uniform act) 288 239 3. Other Federal funds. e.g., from Federal Prison System, Bureau of 290 291 Community Health Services. Veterans Administration, etc. 4. State government 292 293 5. Local government, e.g., city, county 294 295 6. State/local government fees for service 296 297 7. Social Services Block Grant (formerly Title XX) 298 299 8. Private donations, e.g., charities, United Way 30° 301 9. Public welfare 302 303 10. Public health insurance, e.g., CHAMPUS, Medicaid, Medicare 304 305 11. Private health insurance, e.g., Blue Cross/Blue Shield 306 307 12. Client lees 308 309 13. Other (specify beg”) 310 an 312 313 TOTAL FUNDING TREATMENT UNIT STAFFING To be completed by all treatment units. A. For each category of staff, enter the total number of paid and volunteer employees who work at the alcoholism and/or drug abuse unit. All staff members who worked anytime during September are to be included. Under Separations, include all PAID staff separations that occur during the period Oct. 1, 1981 — Sept. 30, 1982. PAID STAFF VOLUNTEERS DIRECT CARE‘ SUPPORT ADMIN. Ps chl ist Social Counselors Other Admin. DIRECT OR ‘N be Ph .. Registered Other y A°°9d 5 Workers Credentialled Counselors Direct or CARE SUPPORT um r' y5icians Nurses Medical bean MSW and &/or Counseling Other Care Support STAFF STAFF a "9 Above Degree Staff Staff 'FUL‘LTIME 315 316 317 318 319 320 321 322 323 324 325 STAFF:_ Persons 326 327 328 329 330 331 332 333 334 335 335 ILessthan :32; 35 Hrs/Wk) STAFF’ Total 337 338 339 340 341 342 343 344 345 346 347 ’ Part time Hrs/Wk ’ 348 349 350 351 352 353 354 355 356 SEPARATIONS: 3.. RACE/ETHNICITY AND SEX FOR PAID STAFF INVOLVED IN DIRECT CLIENT CARE In eachof the categories listed below, enter the number of paid employees (both full time and part time) that describes your unit's direct care staff by race/ethnicity and sex. Do not include administrative or support staff. NUMBER OF NUMBER OF RACE/ETHNICITY DIRECT CARE SEX DIRECT STAFF CARE STAFF American Indian or Alaskan Native 357 ' Male 353 Asian or Pac-lic Islander 358 Female 354 Black. not of Hispanic origin 359 TOTAL 355 Hispanic 360 White. not of Hispanic origin 35‘ , . . . ’Total numbers a! full time and part time. pald direct care staff In A TOTAL 362 - should equal iota/s m B. 2311.5. GOVERNMENT PRINTING OFFICE: 582-3614663531 APPENDIX C Glossary of Terms Active Client - An individual who: (1) has been admitted to the treatment unit and for whom a treatment plan has been developed, (2) has been seen on a scheduled appointment basis at least once during September 1982, and (3) has not been discharged from treatment, i.e., continued care is expected to be given this client. ADAMHA Block Grant Funds — Funds received by the project through the State under the Alcohol and Mental Health and Drug Abuse Services Block Grants, Title XIX, Part B of the Omnibus Budget Reconcilitation Act of 1981 (P.L. 97—35). Administrative Staff - All personnel engaged in administrative duties except for those who have the training or credentials of the disciplines listed on the staffing matrix. Includes accountants, analysts, business managers, data coordinators, evaluators, research assistants, secretaries, et al. A physician or MSW social worker, for example, functioning as the unit director or administrative officer should be reported in PHYSICIANS or SOCIAL WORKERS, MSW and above, respectively. Ambulatory Medical Detox - See Detoxification. American Indian or Alaskan Native - A person having origins in any of the original people of North America. Asian or Pacific Islander - A person having origins in any of the original people of the Far East, Indian subcontinent, Southeast Asia, or the Pacific Islands. -Black, Not of Hispanic Origin - A person having origins in any of the people of sub-Saharan Africa or Haiti. Client - See Active Client. Client Fees - Direct payment to the treatment unit from clients for services received. May be proportioned on a sliding-scale based on client income. Community Mental Health Center - An institution operating under guidelines of the Community Mental Health Center Amendments Act of 1975 (P.L. 94-63) or under State or local legislation modeled after the act. The emphasis of CMHC's is on outpatient care, although they may provide inpatient, intermediate and emergency care. Correctional Facility - Includes adult or juvenile correctional institu- tions, re-entry and diversion facilities. Counselors, Credentialled and/or Counseling Degree: Graduates of an Associate of Arts or above degree program in counseling in an accredited institution of higher learning and/or persons who have been awarded State counselor certification. Counselors, Other: Staff members who function as counselors who (1) have a degree of any kind which is unrelated to counseling (includes Associate of Arts degree, B.A./B.S. or above in Sociology, Humanities, etc.), (2) have completed some counselor training courses or workshops (may be independent of degree program or State certification), or (3) have no counseling degree or training. Custodial/Domiciliary Model - Provision of food, shelter, and assistance in routine daily living on a long-term basis for persons with alcohol— related problems. Daycare — Treatment provided by a unit where the client resides outside of the unit. The client participates in a drug/alcohol abuse treatment program, with or without medication, according to a minimum attendance schedule as defined by the funding source (usually five or more hours per day, five or more days per week). The client has regularly assigned and supervised work functions (salaried or nonsalaried) at the unit. Detoxification (Alcohol) - Restoration of client sobriety through medical or nonmedical means under the supervision of trained personnel. Ambulatory Medical Detox — The use of medication under the super— vision of medical personnel to assist an individual to eliminate the effects of alcohol on the body in those cases where the client is neither confined to bed nor in an inpatient setting. Medical Model - The use of medication under the supervision of medical personnel to systematically reduce or eliminate the effects of alcohol on the body in a hospital or other 24—hour care facility. Social Setting - Restoration of client sobriety, on a drug—free basis, in a specialized nonmedical facility by trained personnel with physician services available when required. Detoxification (Drug) — When referring to drug abuse treatment, detoxifi- cation is the period of planned withdrawal from drug dependency supported by use of a prescribed medication. If methadone is being used, detoxifi— cation cannot exceed 21 days. When methadone detoxification exceeds 21 days, the treatment modality becomes maintenance. However, there are other types of detoxification which may exceed 21 days, such as sedative /hypnotic detoxification, which may last six weeks or longer. 'Direct Care Staff - Personnel whose role includes direct interaction with clients or patients during the provision of treatment services. Drug Free - A treatment regimen that does not include any chemical agent or medication as the primary part of the drug treatment. It is the treatment modality for withdrawal without medication. Temporary medica— tion may be prescribed in a drug free modality, e.g., short-term use of tranquilizers, but the primary treatment method is counseling (individ- ual, group, family, etc.), not chemotherapy. Environment — The setting in which the drug abuse client is treated. See also Daycare, Hospital, Outpatient, Prison, and Residential. Facility Location - The place at which a particular type of care is administered. Free Standing Facility — Is a service facility that is not physically located in a hospital, correctional facility, or mental health center. These are facilities that one would enter only to receive alcohol or drug services. Examples are most storefront clinics, halfway houses, quarter- way houses, and recovery homes. Full-Time Employee — An individual who works 35 or more hours per week. Funding Source - Includes all sources of operating funds for a treatment unit in effect during a twelve month time span which includes the survey date, (September 30, 1982). General Hospital, Including VA Hospitals - Non-specialized hospitals where the average length of stay for a patient is less than 30 days.’ A VA hospital is a hospital which operates under the auspices of the Veterans Administration. Halfway House/Recovery Home - A community based, peer group oriented, residential facility that provides food, shelter and supportive services (including vocational, recreational, social services) in a supportive non- drinking environment for ambulatory and mentally competent recovering alcoholics who may be re-entering the work force. It also provides or arranges for provision of appropriate treatment services. The recovery home concept is used mainly in California. Hispanic — A person of Cuban, Mexican, Puerto Rican, and all other Spanish cultures and origins, regardless of race (includes Central and South America and Spain). Hospital - An institution that provides 24 hour services for the diagnosis and treatment of patients through an organized medical or professional staff and permanent facilities that include inpatient beds, medical and nursing services. Clients residing in hospital settings should be receiv- ing services primarily for alcoholism and/or other drugs of abuse. Inner City - The older and more densely populated area of a large city usually housing a low-income population. Limited Care — Food, emergency shelter and alcoholism treatment services provided to clients who routinely do not stay overnight; includes day care. Maintenance — The continued administering and/or dispensing of methadone, L—alpha acetylmethadol (LAAM), or propoxyphene napsylate (Darvon~N), in conjunction with provision of appropriate social and medical services, at relatively stable dosage levels for a period in excess of 21 days as an oral substitute for heroin and other morphine-like drugs, for an individual dependent on heroin. This category also includes those clients who are being withdrawn from maintenance treatment. Medical Model Detox - See Detoxification. Mental/Psychiatric Hospital - A medical facility which offers short-term intensive inpatient treatment and prolonged inpatient treatment to persons suffering from a variety of mental or psychiatric disorders, including alcohol and drug-related disorders. Such facilities can be public or private. Modality - The primary treatment approach or regimen assigned to the client by the treatment unit staff. Modalities are differentiated by the type and extent of therapy and services administered to the client. See also Detoxification, Maintenance, Drug Free, and Other Modality. NDATUS Identifier - A unique identifier assigned to each respondent to the NDATUS system. This identifier consists of eight characters. The first two characters are the standard State postal abbreviation for the State in which a given unit is located. The remaining six characters are numeric. Other ADAMHA Program Support - Include here all other funds received for alcohol or drug abuse treatment from NIAAA, NIDA, or NIMH through direct project grants/contracts (including services and services research), Statewide Services Grants, State Alcohol Services Development Program, or Formula and Uniform Act Grants. Other Direct Care Staff - All direct care personnel who do not function as counselors and who do not have any of the preceding categories listed on the staffing matrix of the survey form. Ineludes the various thera— peutic specialties. Other Federal Funds - Funds made available to the States or treatment units from any other Federal Agency, e.g. Federal Prison System, Veterans Administration, Bureau of Community Health Services, Indian Health Service, etc. Other Medical - Includes licensed practical and vocational nurses, physicians' assistants, orderlies, pharmacists and other allied health professionals. Other Modality ~ Type of drug abuse treatment used that is other than detoxification, maintenance or drug free. Examples include acupuncture, transcendental meditation, etc. Must be specified and different from listed modalities. other Residential Facility - A live-in setting where nonmedical rehabilitative alcoholism services are available to residents in locations such as foster homes, group homes or boarding houses. See Quarterway House and Halfway House/Recovery Home. Other Specialized Hospital — Hospitals other than mental/psychiatric 'hospitals that emphasize the diagnosis and treatment of particular disorders, e.g., epilepsy, maternity, orthopedics, etc. Other Urban — The areas within the corporate limits of large cities other than the inner city area; or individual places of population, 2,500--50,000. Outpatient - Treatment provided by a unit where the client resides outside the facility. The client participates in a drug abuse treatment program with or without medication, and attends the treatment unit according to a predetermined schedule for services that include counseling and supportive services. Outpatient differs from daycare in that the outpatient client attends the treatment unit less frequently and does not have regularly assigned and supervised work functions at the unit. Outpatient Facility - An establishment or a distinct part of an establishment, which is primarily engaged in providing alcoholism services for persons who reside elsewhere. ' Outpatient Services - Evaluation and treatment, or assistance services, provided on a short—term basis to clients who reside elsewhere. Part-time Employee - An individual who works less than 35 hours per week. Physical Environment - The type of facility in which the unit is located. See Community Mental Health Center, Mental/Psychiatric Hospital, General Hospital, Other Specialized Hospital, Correctional Facility, and Free Standing Facility. Physicians - Persons with an M.D. or D.O. degree from an accredited 'medical school who are licensed by the State to practice medicine and/or psychiatry. Prevention - Those activities that are designed to prevent individuals and groups from becoming dependent on the regular use of alcohol and/or licit or illicit drugs. Available services may vary widely but are generally a530ciated with information, education, alternatives, and primary and early intervention activities, and may also encompass services such as literature distribution, media campaigns, clearinghouse activities, speaker's bureau, and school or peer group situations. These services may be directed at any segment of the population. Prison — A Federal, State or local unit where the client is incarcerated and participates in a treatment program within the correctional institution. Clients being treated in a secured hospital setting are entered under the ‘prison environment. Private Donations - Contributions from foundation grants, cash donations, cash value of donated goods, and contributions from United Way and other chari table ins ti tutions . Private Health Insurance — This category includes payments from Blue Cross—Blue Shield plans, other commercial insurance companies, and independent plans. Independent plans include employer- or employee- sponsored programs, health maintenance organizations, and private group clinics. Psychologists M. A. and above — Persons with a Master's or doctoral degree in Psychology from an accredited institution of higher learning. Individual may or may not need to be licensed by the State to practice psychology. Public Health Insurance — Benefits paid through Title XVIII (Medicare), XIX (Medicaid), or XVI (Supplemental Security Income, SSI). This category includes the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and the Civilian Health and Medical Program of the Veterans' Administration (CHAMP-VA) . Public Welfare - Medical or social service benefits or payments made available through local general assistance or general relief programs, including food stamps. Quarterway House - A non-medical residential alcoholism treatment facility that works closely with an accredited hospital. It provides post- detoxification alcoholism treatment, through the use of permanent facilities, professional personnel, residential bed care, ambulatory care and health-related services using intensive multi-model therapeutic regimes of often between 14—30 days. Registered Nurses - Nurses who graduated from a State approved nursing school and have passed the board examinations used to certify registered nurses. Includes nurse practitioners, and nurses with Associate, diploma, BSN or graduate level degrees. Rehabilitation Model - An approach which provides, in a residential setting or hospital, a planned program of professionally directed evaluation, care, treatment, or rehabilitation services for alcoholism. Residential - An environment where the client resides in a treatment unit other than a prison or hospital. Drug treatment halfway houses and therapeutic communities are included in this environment. .Rural — A place located outside of an urban or suburban area and having a -population of less than 2,500, i.e., a non—urban place. Social Services Blobk Grant — Funds provided to the project through the State under the Omnibus Budget Reconciliation Act of 1981 (P.L. 97~35) and directed at the goals of reducing or preventing drug and alcoholism dependency, rehabilitating individuals and families, providing for community based care and securing referral or admission for institutional care when other forms of care are not appropriate. Social Setting Detox — See Detoxification. Social Workers, MSW and above - Graduates of a Master's or Doctoral degree program from an accredited graduate school of social work. State Government - Funds provided by State legislation to provide treatment services on a program or unit level. The unit should not include State _ funds which originate as Block Grant funds from Federal sources, but matching funds for Federal monies should be included in this category. State/Local Government Fees for Service - State or local monies paid to programs or units as reimbursement for services provided to clients. State Postal Abbreviation - A standard two-character, alphabetic abbreviation for State name. See Appendix B. Suburban - The urbanized residential communities which are outside the corporate limits of a large central city but which are culturally and economically dependent on the central city. Support Staff — All non-administrative staff that are engaged in supportive tasks, such as cooks, dieticians, accountants, business managers, secretaries, security personnel, etc. Treatment ~ Formal organized services for persons who have abused alcohol and/or drugs. These services are designed to alter specific physical, mental, or social functions of persons under treatment by reducing client disability or discomfort, and ameliorate the signs or symptoms caused by alcohol and/or drug abuse. Treatment Capacity w The maximum number of individuals who could be enrolled as active clients as of September 30, 1982 given the unit's staffing, funding, and physical facility at that time. For residential and other 24-hour care units, treatment capacity is equal to the number of beds available at the unit. For outpatient units, treatment capacity reflects the maximum active caseload a unit could carry. This maximum caseload would depend upon such factors as the percentage of total staff hours devoted to direct client care, the average length of counseling sessions, and the frequency of client visits to the unit. Treatment Unit - A facility having: (1) a formal structured arrangement for alcohol or drug abuse treatment using alcohol or drug-specified personnel, and (2) a designated portion of the facility (or resources) for treatment services. A treatment unit must directly provide treatment ser« vices to clients at the facility's location. The unit usually offers some form of initial evaluation or diagnosis of its clients and thereafter, may include a wide range of different services, such as counseling, job placement, or other rehabilitation services. Type of Care — The method or approach used in the treatment and rehabilitation process. .white — A Caucasian person having origins in any of the people of Europe (includes Portugal), North Africa, or the Middle East. U.C. IEIKELEY LIIHAMES IIIIIIIIIIIII 4 (025555273