Addiction Medicine: Closing the Gap between Science and Practice

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whether a respondent met clinical criteria for a
past-month addiction diagnosis involving
nicotine are based on the Nicotine Dependence
Syndrome Scale (NDSS).^4 The NDSS measures
five dimensions of nicotine dependence based
on symptoms and characteristics outlined in the
DSM-IV.^5 The NDSS was designed for adult
smokers; although an adolescent version of the
NDSS has been developed,^6 the NSDUH uses
the adult version.


CASA Columbia analyzed NSDUH data on
individuals ages 12 and older living in U.S.
households to examine the risky use of tobacco,
alcohol, illicit drugs and controlled prescription
drugs; addiction involving these substances; the
prevalence of co-occurring health conditions;
and rates of risky use and addiction among those
who had past-year involvement in the justice
system.


Treatment Episode Data Set


The Treatment Episode Data Set (TEDS),
sponsored by the U.S. Department of Health and
Human Services’ Substance Abuse and Mental
Health Services Administration (SAMHSA),
provides information on the demographic and
substance use characteristics of the
approximately 2.0 million annual admissions in
2009 to addiction treatment programs in
facilities that report to individual state
administrative data systems. TEDS does not
include all treatment admissions. Rather, it
includes admissions to facilities that are licensed
or certified by the designated state substance
abuse agency to provide treatment (or are
administratively tracked by the agency for other
reasons). Facilities reporting TEDS data
generally are those that receive state alcohol
and/or other drug agency funds (including
Federal Block Grant funds) for the provision of
addiction treatment services; states report on all
admissions to programs receiving public funds
and on admissions to private facilities for which
they have data. TEDS is an admissions-based
system and TEDS admissions do not represent
individuals. Thus, an individual admitted to
treatment twice within a calendar year would be
counted as two admissions.


The scope of admissions included in TEDS is
affected by differences in state reporting
practices, varying definitions of treatment
admission, availability of public funds and
public funding constraints. For example,
treatment programs based in the criminal justice
system may or may not be administered through
the state substance abuse agency.
Detoxification facilities, which can generate
large numbers of admissions, are not uniformly
considered treatment facilities and are not
uniformly reported by all states.

Facilities operated by federal agencies (e.g., the
Bureau of Prisons, the Department of Defense
and the Department of Veterans Affairs)
generally do not report TEDS data to the state
substance abuse agency, although some
facilities operated by the Indian Health Service
are included. Hospital-based addiction
treatment facilities frequently are not licensed
through the state substance abuse agency and do
not report TEDS data. Correctional facilities
(state prisons and local jails) are monitored by
the state substance abuse agency and report
TEDS data in some states but not in others.

In addition to admissions data, TEDS has a
separate data set for patient discharges from
addiction treatment. The discharge variables
include treatment completion, length of stay,
substances of addiction, type of services offered,
demographic information and other data about
those ages 12 and older who were discharged
from addiction treatment facilities in 2008.

CASA Columbia analyzed TEDS admissions
data for the years 2002 through 2009 to
characterize the sources of referral, types of
treatment and primary substances involved in
the addiction of individuals ages 11 and older, as
well as TEDS discharge data from 2008 to
assess the completion and dropout rates for
treatment admissions. (Note that after 2009,
TEDS only reported admissions for those ages
12 and older).
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