Addiction Treatment Admissions in the United States: Everyone, meet TEDS

Dirk Hanson

What a difference a decade makes.

Do you know what drug use trends are ongoing?Between 1998 and 2008, addiction treatment admissions in the U.S. increased markedly for methamphetamine (crystal meth), prescription opiates, and marijuana. Treatment admissions for alcohol and cocaine declined over the same period, while heroin admissions remained roughly the same.

The Treatment Episode Data Set (TEDS), which the Substance Abuse and Mental Health Services Administration (SAMHSA) uses to compile its report, includes only those addiction treatment facilities that receive state alcohol or drug agency funds, and which are represented in state administrative data systems. Despite this caveat, the TEDS study matters, because states use reports of this kind to shift limited resources from one treatment focus to another, based on demand.

Overall, the total number of addiction treatment admissions for substance abuse in the United States increased by 11% over the ten-year period, to a total of 1,893,640. A good thing, right? Well, not exactly. Considering that the U.S. population aged 12 and older grew at roughly the same rate—11%—addiction treatment rates in 2008 remained virtually the same as they were in 1998. Net result: little demonstrable progress, despite ten years of concerted effort, in bringing more addicts into formal treatment programs.

Drug-By Drug analysis of addiction treatment data

But the numbers on a drug-by-drug basis do reveal some apparent shifts in drug use over the decade in question. (Bear in mind that the drug in question is the primary drug listed at treatment admission, while many if not most addicts are polydrug users.)

Many of these trends are already well documented (like in our recent Monitoring The Future article), but the TEDS numbers sharpen the picture considerably:

–The treatment admission rate for alcohol was 15% lower in 2008. (318 per 100,000 Vs. 372 per 100,000.)
Possibly this is the result of a growing preference for prescription drugs among younger users. For today’s weekend warriors, a few tabs of Vicodin may be standing in for the traditional six-pack. Still, at 318 admissions per 100,000, no illicit drug even comes close to equaling the treatment rates associated with alcohol.

–The treatment admission rate for opiates other than heroin (oxycontin, vicodin, etc.) was 400% higher in 2008, at 45 per 100,000 than in 1998 (9 per 100,000).
That’s right, 400%! Four times as many admissions for prescription drugs in 2008 versus 1998! Rates increased in every year, and in every census jurisdiction, from 1998 through 2008.

— The treatment admission rate for marijuana was 31% higher in 2008, at 130 per 100,000 population aged 12 and older, than in 1998 (99 per 100,000).
It is difficult to interpret this finding, since so many conflicting trends are at play. The medical marijuana movement, and the near miss in California on marijuana legalization, may have conduced toward greater experimentation among addiction-prone people. Alternatively, the decade under scrutiny was marked by a significant increase in court-ordered treatment, resulting in an unknown number of mandatory admissions of non-addicted recreational pot users who ran afoul of the law during that period. In California at least, that number should be relatively low since carrying anything under one ounce of marijuana has been downgraded to an infraction punishable by a ticket with no arrest or criminal consequences.

-The treatment admission rate for cocaine was 23% lower in 2008, at 88 per 100,000 than in 1998 (114 per 100,000).
Declines were similar across the board, in all nine primary U.S. Census divisions. The bloom is definitely off the rose for cocaine and crack. One obvious reason: Crystal meth continues to serve as a cheap, long-lasting, and widely available alternative.

–The treatment admission rate for methamphetamine/amphetamine was 53% higher in 2008, at 49 per 100,000 than in 1998 (32 per 100,000).
This is clearly bad business, but hardly breaking news. However, a closer look reveals that addiction treatment admission rates for speed peaked in 2005—and have been declining ever since. This finding is in line with other government surveys indicating a trend towards prescription opiates, and away from first-line stimulants like cocaine and meth. The peak admission rate in 2005 was 70 people out every 100,000 adults. Which, when you think about it, is appallingly high. (Remember, we are not talking about usage here, only formal admissions to treatment programs.)

–The treatment admission rate for heroin was 3% lower in 2008 (110 per 100,000) than in 1998 (113 per 100,000).
However, heroin admission rates peaked at a rate of 122 admissions per 100,000 in 2002 before beginning the present decline. The timing of the downturn suggests not so much an abandonment of heroin, but rather a substitution of prescription opiate products like oxycontin and fentanyl for traditional street heroin.

State-By-State treatment breakdown

A state-by-state perusal of the data also yields interesting results. Overall, approximately one in four treatment admissions comes from New York, New Jersey, or Pennsylvania—the three states making up the census region known as the Middle Atlantic. When alcohol is the primary drug at admission, the region of the Midwest stretching from Minnesota and North Dakota to Kansas and Missouri leads the pack. The mid-Atlantic coast continues to be plagued by heroin, judging by states that bucked the overall decline in heroin admissions.

Marijuana admissions in 2008 clustered in the central U.S. and a few western states, including Oregon. Meanwhile, the Pacific Coast states—Washington, Oregon, California, and Alaska—continue to experience crystal meth/amphetamine admission rates twice as high as the rest of the country. And prescription opiate admission rates were highest in New England, Kentucky, Tennessee, Alabama, and Mississippi. Oxycontin’s nickname, “hillbilly heroin,” is not hard to figure out.


DEPARTMENT OF HEALTH AND HUMAN SERVICES – Substance Abuse and Mental Health Services Administration (SAMHSA)

Treatment Episode Data Set (TEDS) 1998-2008: State Admissions to Substance Abuse Treatment Service

4 responses to “Addiction Treatment Admissions in the United States: Everyone, meet TEDS”

  1. This author is suspect. He runs another web site Addiction Inbox where he is highly biased for his own commercial interest and censors ideas that make him uncomfortable.

    He is not interested in evidence but in promoting his own addict ideology and business. Typical.

    • My experience with Dirk has been good actually, but everyone is entitled to his/her own opinion. The notion that any of us make money from writing these blogs is comical though.

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