Background: In 2012, 2.5 million people in the United States received substance abuse treatment (SAT) at a specialty facility. Drug- and alcohol-abusing populations have higher rates of mental health issues than the general population, and many suffer from direct and indirect physical health conditions caused or exacerbated by their substance abuse. Because substance use often impacts multiple aspects of an individual's life, clients often enter treatment with housing issues, employment problems, and damaged family or social relationships. Through the Recovery Support Strategic Initiative, the Substance Abuse and Mental Health Services Administration has identified Health, Home, Purpose, and Community as the four major dimensions that support recovery from substance abuse. Methods: The extent to which SAT facilities were providing recovery support services across each of the four dimensions of recovery was examined in the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) data. Results: In 2012, the Health recovery dimension was addressed by the majority of treatment facilities offering comprehensive substance abuse assessments or diagnoses (91%), mental health disorder screenings (68%), drug or alcohol urine screenings (84%), and substance abuse education (96%); 28% tested for HIV, 24% tested for hepatitis C, 22% tested for hepatitis B, and 21% tested for sexually transmitted diseases. The Home recovery dimension was addressed by SAT offering case management (80%), discharge planning (94%), and aftercare or continuing care services (84%); in addition, 49% assisted clients in locating housing. 74% of SAT offered social skills development and 62% used a sliding-fee scale in reflection of the Purpose recovery dimension, though only 37% offered employment counseling. The Community recovery dimension was addressed by the majority of treatment facilities offering individual, group, and family counseling (98, 93, and 82%, respectively) and community outreach (57%). Conclusion: Findings from this report indicate that the nation's substance abuse treatment facilities offered a range of services that reflect SAMHSA's four key recovery dimensions.

Introduction

In 2012, 2.5 million people in the United States received substance abuse treatment at a specialty facility.¹ For many individuals entering substance abuse treatment, substance abuse is not an isolated problem. Drug- and alcohol-abusing populations have higher rates of mental health issues than the general population,² and many suffer from direct and indirect physical health conditions caused or exacerbated by their substance abuse.³ Because substance use often impacts multiple aspects of an individual's life, clients often enter treatment with housing issues, employment problems, and damaged family or social relationships.⁴

Treatment outcomes have been shown to improve when clients receive tailored services that match and address their specific needs.^5,6,7 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines the term "recovery" as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.⁸ SAMHSA has identified four dimensions of recovery from substance abuse⁸:

1. Health: overcoming or managing one's disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and nonprescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional well-being;
2. Home: having a stable and safe place to live;
3. Purpose: participating in meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and having the independence, income, and resources to participate in society; and
4. Community: engaging in relationships and social networks that provide support, friendship, love, and hope.

This report uses data from the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) to examine the extent to which substance abuse treatment facilities were providing recovery support services across each of the four dimensions of recovery. N-SSATS is an annual, national survey of all known substance abuse treatment facilities, both public and private, that collects data on a wide range of services commonly offered by facilities. This report includes the data reported by 14,311 substance abuse treatment facilities.

Recovery Dimension 1: Health

Because recovery pathways reflect the distinct needs and goals of individual treatment clients,⁵ the Health dimension of recovery encompasses a wide range of services. As the largest category, Health-related services include assessment and pre-treatment services, testing services, use of pharmacotherapies, and supportive ancillary services.

Assessment and Pre-Treatment Services

The most common assessment and pre-treatment services provided by facilities were screening for substance abuse (95 percent) and comprehensive substance abuse assessment or diagnosis (91 percent) (Figure 1). A majority of facilities also provided screening for mental health disorders (68 percent). Over half of facilities provided screening for tobacco use (56 percent). Less than half of facilities provided comprehensive mental health assessment or diagnosis (47 percent) or interim services for clients when immediate admission was not possible (45 percent).

Figure 1

Substance abuse treatment facilities offering assessment and pre-treatment services in support of the Health recovery dimension: 2012

Testing Services

The majority of facilities offered drug or alcohol urine screening (84 percent) or breathalyzer or other blood alcohol testing (61 percent) (Figure 2). Communicable disease testing was provided by substantially smaller proportions of facilities. Specifically, 36 percent of facilities provided tuberculosis (TB) screening, 28 percent provided testing for HIV, 24 percent screened for hepatitis C, 22 percent screened for hepatitis B, and 21 percent tested for sexually transmitted diseases.

Figure 2

Substance abuse treatment facilities offering testing services in support of the Health recovery dimension: 2012

Pharmacotherapy Services

Medications for the treatment of psychiatric disorders were the most commonly provided pharmacotherapy (38 percent) (Table 1). About one-fifth of facilities provided nicotine replacement pharmacotherapy (22 percent) and 16 percent provided non-nicotine tobacco cessation medications. Less than 1 in 5 facilities offered pharmacotherapies used for alcohol and other substance abuse treatment, including oral naltrexone (18 percent), Antabuse^® (17 percent), Campral^® (17 percent), and Vivitrol^® (injectable naltrexone; 10 percent). One in five or fewer facilities offered medications, such as buprenorphine with naloxone (Suboxone^®; 20 percent), buprenorphine without naloxone (11 percent), or methadone (11 percent), which treat addiction to opioids such as heroin or prescription pain relievers like oxycodone.⁹

Table 1

Substance abuse treatment facilities offering pharmacotherapies in support of the Health recovery dimension: 2012.

Ancillary Services

The vast majority of facilities (96 percent) offered substance abuse education (Figure 3). Over half of facilities provided mental health services (62 percent); HIV or AIDS education, counseling, or support services (58 percent); and health education other than HIV/AIDS or hepatitis (53 percent). About 2 in 5 facilities offered smoking cessation counseling (39 percent), and over 1 in 4 facilities (27 percent) provided early intervention for HIV.

Figure 3

Substance abuse treatment facilities offering ancillary services in support of the Health recovery dimension: 2012

Recovery Dimention 2: Home

The second dimension of recovery is having a stable and safe place to live. Home-related services provided in 2012 primarily included supportive ancillary services as well as services that helped clients transition out of treatment.

Ancillary Services

Four in five facilities offered case management services (80 percent), and over half offered assistance with obtaining social services, such as Medicaid; Women, Infants, and Children; Supplemental Security Income; and Social Security Disability Income (57 percent) (Table 2). Nearly half of facilities (49 percent) provided assistance in locating housing for substance abuse treatment clients. Similar proportions of facilities offered transportation assistance to treatment (41 percent) and domestic violence services (40 percent).

Table 2

Substance abuse treatment facilities offering ancillary, transitional, and follow-up services in support of the Home recovery dimension: 2012.

Transitional and Follow-up Services

The majority of facilities offered discharge planning (94 percent) and aftercare or continuing care services (84 percent). Moreover, outcome follow-up after discharge was part of the standard operating procedures across 69 percent of facilities.

Recovery Dimension 3: Purpose

Participating in society through meaningful daily activities such as a job, school, or family caretaking is central to the Purpose dimension of recovery. Purpose-related services offered by facilities primarily included ancillary services. Since having the resources to participate in meaningful activities is also part of the Purpose dimension, services that assisted clients with paying for their treatment are also included.

Ancillary Services

In 2012, nearly three-quarters (74 percent) of facilities provided services in support of social skills development. Employment counseling or training for clients was offered by 37 percent of facilities (data not shown). Only 7 percent provided child care services (data not shown).

Payment Services

Over half of facilities (62 percent) used a sliding-fee scale to determine an appropriate charge for services based on their clients' economic situations (data not shown); 9 in 10 facilities (90 percent) accepted self-payment for substance abuse treatment (Figure 4). Nearly two-thirds (65 percent) of facilities accepted private health insurance, and over half (58 percent) accepted Medicaid. A third of facilities (33 percent) accepted Medicare or federal military insurance such as TRICARE or CHAMPVA.

Figure 4

Types of payment accepted at substance abuse treatment facilities in support of the Purpose recovery dimension: 2012

Recovery Dimension 4: Community

The role of Community in recovery refers to relationships and social networks that provide support, friendship, love, and hope. One way that treatment programs facilitate therapeutic networking, foster healthy relationships, and provide targeted services is to offer specially designed substance abuse treatment programs or groups for specified types of clients. In addition, Community-related services also included counseling, ancillary, and pre-treatment services.

Specially Designed Programs or Groups

Over a third (37 percent) of facilities offered a specially designed program or group for clients with co-occurring mental and substance abuse disorders (Figure 5). Over a quarter of facilities offered a special program or group for adult women (31 percent) or for adolescents (28 percent), and a quarter of facilities (25 percent) offered a special program or group for adult men. Nearly a quarter of facilities (23 percent) offered a specially designed program or group for criminal justice clients (other than DUI/DWI). Twelve percent of facilities offered a specially designed program or group for pregnant or postpartum women. Less than 1 in 10 facilities offered a specially designed program or group for persons with HIV or AIDS (8 percent); for veterans and seniors or older adults (both 7 percent); for lesbian, gay, bisexual, transgender, or questioning clients (6 percent); and for members of military families or active duty military (4 percent each).

Figure 5

Substance abuse treatment facilities offering specially designed programs or groups in support of the Community recovery dimension: 2012

Counseling Services

Counseling services can help clients in treatment with their addiction, as well as address interpersonal problems they are having with spouses, children, friends, and others in their social network. Virtually all facilities provided individual counseling (98 percent), and the majority provided group counseling or family counseling (93 and 82 percent, respectively) (Figure 6). Marital/couples counseling was provided by over half (59 percent) of all facilities.

Figure 6

Substance abuse treatment facilities offering specific types of counseling in support of the Community recovery dimension: 2012

Other Services

In 2012, over half of facilities provided outreach to persons in the community who may have needed treatment (57 percent; data not shown). Mentoring or peer support was provided by over half (52 percent) of facilities. Self-help groups (e.g., Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery) were offered by nearly half (47 percent) of facilities (data not shown).

Discussion

Findings from this report indicate that the nation's substance abuse treatment facilities offered a range of services that reflect SAMHSA's four key recovery dimensions: Health, Home, Purpose, and Community. The Health recovery dimension was addressed primarily through substance abuse screening and comprehensive substance abuse assessment or diagnosis, substance abuse education, and drug or alcohol urine screening. However, communicable disease testing, comprehensive mental health assessments or diagnoses, and the provision of mental disorder medications were less commonly offered. These may be areas in need of increased resources given the high rates of these problems in substance abuse treatment populations and research showing improved treatment outcomes when the needed medical and mental health services are received.^5,6,10

Several notable findings support the Home and Purpose recovery dimensions. Specifically, about half of facilities offered clients assistance with obtaining social services and locating housing, and most facilities provided transitional services such as discharge planning and aftercare or continuing care services. These services are critical as the provision of housing assistance and services that address aftercare needs have been shown to improve treatment outcomes.^11,12,13 Because services that address access barriers have been associated with reductions in post treatment substance use,¹³ it is notable that most facilities used a sliding-fee scale and accepted Medicaid. However, less than two-fifths of facilities offered employment counseling; given that employment has been shown to be an important component of treatment success and post-treatment recovery, this may be one area that treatment administrators may consider expanding.^11,12 Finally, the Community recovery dimension was primarily addressed through counseling, community outreach efforts, and mentoring or peer support.

Because individuals in treatment often face substantial challenges in addition to their substance abuse, it is important that facilities are equipped to address all four of the recovery dimensions to support enduring positive outcomes for their clients. Additional information on substance abuse recovery is available at the SAMHSA's Recovery Support Web site (http://www.samhsa.gov/recovery/). Individuals in need of substance abuse treatment can use SAMHSA's Behavioral Health Treatment Services Locator, which may be accessed at http://findtreatment.samhsa.gov/. Users can search the Locator for facilities by location and by specific characteristics, such as the types of services offered including payment assistance options, special programs/groups offered, and type of care.

Suggested Citation

Strashny, A. Recovery Services Provided by Substance Abuse Treatment Facilities in the United States. The CBHSQ Report: September 11, 2014. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.