Alabama's substance abuse treatment system serves over 21,000 clients annually. It relies on data from national surveys and the Alabama Substance Abuse Information System to understand who it serves and assess outcomes. The majority of clients are male, between 25-34, white, and being treated for drug rather than alcohol abuse. Most come from Jefferson, Mobile, and Montgomery counties. The average cost of treatment is $1,316 per client. Common treatment modalities include intensive outpatient, residential rehabilitation, and methadone maintenance. The system aims to measure outcomes like employment, housing stability, and abstinence from drugs and alcohol.

1. What We Know About SubstanceWhat We Know About Substance
Abuse Treatment in AlabamaAbuse Treatment in Alabama
Kristopher VilamaaKristopher Vilamaa
Director of Information ServicesDirector of Information Services
Alabama Department of Mental HealthAlabama Department of Mental Health
Substance Abuse Services DivisionSubstance Abuse Services Division

2. IntroductionsIntroductions
• Who Am I?
• Who Are You?
• Why Are You Here?
• What Makes You Unique?

3. Alabama’s Substance AbuseAlabama’s Substance Abuse
Treatment SystemTreatment System
• How Do We Know?
• Who Do We Serve?
• What Services Do They Get?
• Where Do They Get Them?
• What Does it Cost?
• What Are the Outcomes?

4. How Do We Know?How Do We Know?

5. How Do We Know?How Do We Know?
• NSDUH – National Survey on Drug Use and Health
• N-SSATS – National Survey of Substance Abuse
Treatment Services
– Surveys ALL providers registered with SAMHSA,
includes non-contract certified providers, VA,
military and hospital treatment providers
• TEDS – Treatment Episode Data Set
• ASAIS – Alabama Substance Abuse Information
System

6. Who Do We Serve?Who Do We Serve?
• FY2010
–21,610 Clients Admitted to Treatment
–24,676 Clients Served

7. Who Do We Serve? – Number of ClientsWho Do We Serve? – Number of Clients
0
5,000
10,000
15,000
20,000
25,000
NumberAdmittedtoTreatment
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year

8. Who Do We Serve? – Non-DMHWho Do We Serve? – Non-DMH
• N-SSATS Census
– 15,820 clients in service
• 8,781 in for-profit facilities
• 1,136 in federal government facilities (VA, DOD)
– 60% only being treated for drug abuse (not alcohol or mental health)

9. Who Do We Serve? - GenderWho Do We Serve? - Gender
Source: TEDS
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Gender of SA Clients
Female
Male

10. Who Do We Serve? - AgeWho Do We Serve? - Age
0
5
10
15
20
25
30
35
< 15 15-17 18-19 20-24 25-34 35-44 45+
Alabama USSource: 2010 – TEDS

11. Who Do We Serve? - RaceWho Do We Serve? - Race
0 10 20 30 40 50 60 70
American I ndian
African American
Whit e
Asian
Ot her
Two or More Races
Alabama US
Source: 2010 – TEDS

12. Who Do We Serve? - CountyWho Do We Serve? - County
• Top Residence Counties (FY2010 Clients Reported Served to ASAIS)
– Jefferson County – 23.4%
– Mobile County – 7.7%
– Montgomery County – 6.5%
– Madison County - 4.8%
– Tuscaloosa County – 4.6%
• Bottom Residence Counties
– Perry County – 0.1%
– Greene County – 0.1%
– Choctaw County – 0.1%
– Sumter County – 0.1%
– Washington County – 0.1%

13. Who Do We Serve? – Referral SourceWho Do We Serve? – Referral Source
0 10 20 30 40 50 60
Individual
Alcohol/ Drug Care
Provider
Ot her Healt hcare
Provider
School
Employer
Ot her Communit y
Referral
Criminal Just ice Referral
Alabama US
Source: 2010 – TEDS

14. Who Do We Serve? - SubstanceWho Do We Serve? - Substance
0 10 20 30 40 50
Alcohol
Cocaine/ Crack
Marijuana
Heroin
Non-Prescript ion Met hadone
Ot her Opiat es
Met hamphet amine
Ot her Amphet amines
Benzodiazepine
Alabama US
Source: 2010 – TEDS

15. 0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
SA Clients with Alcohol as Primary Drug
Alcohol Only Alcohol with Secondary

16. 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Cocaine as PrimaryDrug
Cocaine (Smoked) Cocaine (other route)

17. 0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Other Drugs
Marijuana Other Opiates Amphetamines

18. Source: TEDS 2006 Highlights - http://www.oas.samhsa.gov/teds2k6highlights/Tbl6b.htm
Who Do We Serve? – StateWho Do We Serve? – State
ComparisonComparison

19. Who Are We Missing?Who Are We Missing?
• NSDUH (2002-2004) – Needing, but not Receiving, Treatment for Illicit Drugs

20. Who Are We Missing?Who Are We Missing?
• NSDUH (2002-2004) – Needing, but not Receiving, Treatment for Alcohol

21. Who Are We Missing?Who Are We Missing?
• Same questions by catchment area (NSDUH 2002-2008)
– Needing but not Receiving Treatment for Illicit Drug Use ranged from
0.9% to 3.4%
– Needing but not Receiving Treatment for Alcohol Use ranged from
2.1% to 8.2%
• SAMHSA looked at another measure, people needing but not receiving
treatment in past year per $1 million of SAPTBG funding (2006)
– Lowest was Alaska = 1,723
– Highest was Maine = 6,070
– Alabama = 3,849
• Almost exactly in the middle

22. What Services Do They Get?What Services Do They Get?

23. What Services Do They Get?What Services Do They Get?
0 10 20 30 40 50 60 70
Hospit al I npat ient
Resident ial Det ox
Short -Term Resident ial
Long-Term Resident ial
I OP
OP
Ambulat ory Det ox
Alabama USSource: 2010 – TEDS

24. What Services Do They Get?What Services Do They Get?
• FY2010 – Reported
– 16,315 Assessments
– 4,940 days of Detoxification
– 108,316 days of Crisis Residential
– 52,550 days of Co-Occurring Residential
– 74,857 days of Residential Rehabilitation
– 863,000 hours of Group Counseling
– 29,000 hours of Case Management
– 25,894 hours of Individual Counseling
– 76,712 daily doses of Methadone

25. The PipelineThe Pipeline

26. Stoppages in PipelineStoppages in Pipeline
• Waiting
– Waiting for an Assessment
– Waiting for Treatment Admission
– Waiting for Transfer
• Loss of Communication
– Transfers who Do Not Enroll
– Lost to Contact from Waiting Lists
• Termination by Program
• Want to put hard numbers to each of these stoppages
– Need screenings on all clients who seek service
– Accurate updating of enrollments – including “No Contact”

27. Where Do They Get Them?Where Do They Get Them?
FY2010 – Clients Reported to DMH
• UAB Drug Free – 3,412 clients
• Aletheia House – 2,845 clients
• Alcohol and Drug Abuse Treatment – 1,961 clients
• Chemical Addictions Program – 1,837 clients
• Spectracare Health – 1,534 clients
• Altapointe Health Services – 1,192 clients
• Madison County Mental Health – 1,097 clients
• East Alabama Mental Health – 1,026 clients

28. Where Do They Get Them?Where Do They Get Them?
0 1000 2000 3000 4000 5000 6000 7000
Methadone/Buprenorphine
Intensive Outpatient
Regular Outpatient
Long-Term Residential
Rehabilitation
Short-Term
Day Treatment
Outpatient Detox
Residential Detox
Hospital Inpatient Detox

29. What Does it Cost?What Does it Cost?
• FY2010 – Cost by Level of Care
– Report a Variation of this for the Substance Abuse
Treatment and Prevention Block Grant
– Reflects the Level of Care at the time services were billed
– All LOCs add up to more than the bottom line number
served because of people who move between levels
• Overall Average Cost per Client
– $1,316.96

30. # Total $ % Cost/Client
Assessment
5419 $608,407.26 1.87% $
112.27
Clinically Managed High Intensity Residential (Crisis
Res)
3819 $8,687,920.47 26.71% $
2,274.9
2
Clinically Managed Low Intensity Residential (Res
Rehab)
1698 $6,468,266.38 19.88% $
3,809.3
4
HIV Only
4538 $607,675.53 1.87% $
133.91
Intensive Outpatient (IOP)
15610 $13,821,338.25 42.49% $
885.42
Medically Monitored Inpatient Detoxification (Detox)
922 $727,389.34 2.24% $
788.93
Opioid Maintenance Therapy (Methadone)
345 $869,685.05 2.67% $
2,520.8
3
Outpatient
1398 $738,253.00 2.27% $
528.08
Total
24700 $32,528,935.28 100.00% $
1,316.9

31. What are the Outcomes?What are the Outcomes?
• National Outcome Measures
– Standards established by the federal government to measure
effectiveness of mental health and substance abuse services
– Currently reported using the data from the assessment and discharge
summaries are:
• Employment
• Stable Housing
• Criminal Justice Involvement
• Change in Abstinence – Alcohol and Drug Use
• Social Support for Recovery

32. What are the Outcomes?What are the Outcomes?
Source: 2010 – TEDS

33. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
State
Average
Percentage of Clients Completing Treatment/Transferring to Another Program

34. -40%
-20%
0%
20%
40%
60%
80%
100%
State
Average
Change in Abstinence of Primary Drug

35. DiscussionDiscussion
• How can you find data?
– Services paid for by DMH/Medicaid
– Clients served by DMH
– Outcomes
– Number and types of Providers
– Needs Assessment

36. ResourcesResources
• NSDUH State Level Data
– http://oas.samhsa.gov/statesIndex.htm
• N-SSATS State Profiles
– http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_state_p
• TEDS State Profiles
– http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_ta
• Alabama Department of Mental Health
– http://mh.alabama.gov/SA/StatisticsAndPublications

37. Q&AQ&A

38. Contact MeContact Me
Kristopher VilamaaKristopher Vilamaa
Director of Information ServicesDirector of Information Services
Division of Mental Illness and Substance Abuse ServicesDivision of Mental Illness and Substance Abuse Services
Alabama Department of Mental HealthAlabama Department of Mental Health
kristopher.vilamaa@mh.alabama.govkristopher.vilamaa@mh.alabama.gov
(334) 242-3969(334) 242-3969