"While it is generally assumed that polydrug use is a hard-to-treat condition, results from large treatment outcome studies in Europe show significant reductions in multiple drug use among highly problematic users. Nevertheless, managing the care of problem polydrug users requires long-term treatment planning with attention to individual needs and multidisciplinary teams working together with flexible and sometimes innovative treatment options."

"• Admissions for primary abuse of alcohol with secondary abuse of drugs represented 18 percent of TEDS admissions aged 12 and older in 2012 [Table 1.1b].
"• The average age at admission for primary alcohol with secondary drug abuse was lower, at 37 years, than for abuse of alcohol alone (41 years) [Table 2.1a].
"• Non-Hispanic Whites accounted for 58 percent of admissions for primary alcohol with secondary drug abuse (41 percent were males and 17 percent were females). Non-Hispanic Blacks made up 23 percent of admissions (18 percent were males and 6 percent were females) [Table 2.3a].
"• Almost half (45 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 93 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5].
"• Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (35 vs. 46 percent) [Table 2.5].
"• Among admissions referred to treatment by the criminal justice/DUI source, admissions for alcohol with secondary drug abuse were more likely than alcohol-only admissions to have been referred to treatment as a condition of probation/parole (30 vs. 17 percent) [Table 2.6].
"• Among admissions for alcohol with secondary drug abuse, marijuana and smoked cocaine were the most frequently reported secondary substances (25 percent and 8 percent, respectively) [Table 3.8]."

"Facilities were asked to estimate the proportions of clients in treatment on March 30, 2012, by substance abuse problem treated (alcohol abuse only, drug abuse only, or both alcohol and drug abuse).
"• On March 30, 2012, 44 percent of clients were in treatment for both alcohol and drug abuse, 38 percent were in treatment for drug abuse only, and 18 percent were in treatment for alcohol abuse only.
"• By facility operation, the highest proportion of clients in treatment for abuse of both alcohol and drugs was in tribal government-operated facilities (57 percent). For abuse of drugs only, the highest proportion of clients was in private for-profit facilities (51 percent); for abuse of alcohol only, the highest proportion was in federal-operated facilities (35 percent).
"• At facilities with a primary focus of substance abuse treatment services, 40 percent of clients were in treatment for abuse of both alcohol and drugs. Facilities with other foci of services reported similar proportions of clients in treatment for abuse of both alcohol and drugs (45 to 56 percent)."

"In 2004, about 642,000 State prisoners were drug dependent or abusing in the year before their admission to prison. An estimated 258,900 of these inmates (or 40%) had taken part in some type of drug abuse program (table 10). These inmates were more than twice as likely to report participation in selfhelp or peer counseling groups and education programs (35%) than to receive drug treatment from a trained professional (15%).
"In Federal prison, a higher percentage of drug dependent or abusing inmates (49%) reported taking part in some type of drug abuse programs. Nearly 1 in 3 took part in drug abuse education classes, and 1 in 5 had participated in self-help or peer counseling groups. Overall, 17% took part in drug treatment programs with a trained professional, and 41% had participated in other drug abuse programs."

Available Treatment Capacity and Services Offered

"Facilities were asked to report the number of residential (non-hospital) and hospital inpatient beds designated for substance abuse treatment. Utilization rates were calculated by dividing the number of residential (non-hospital) or hospital inpatient clients by the number of residential (non-hospital) or hospital inpatient designated beds. Because substance abuse treatment clients may also occupy non-designated beds, utilization rates could be more than 100 percent.
"• Table 4.6. Some 2,401 facilities (23 percent) reported outpatient operational capacity under 80 percent, 3,628 facilities (34 percent) reported outpatient operational capacity between 80 and 94 percent, 3,818 facilities (36 percent) reported outpatient operational capacity between 95 and 105 percent and 727 facilities (7 percent) reported operational capacity above 105 percent.
"• Table 4.7. Some 3,281 facilities reported having 107,888 residential (non-hospital) beds designated for substance abuse treatment on March 30, 2012. The utilization rate11 was 96 percent, and ranged from 86 percent in facilities operated by local governments to 112 percent in facilities operated by tribal governments.
"• Table 4.8. Some 731 facilities reported having 11,280 hospital inpatient beds designated for substance abuse treatment on March 30, 2012. The utilization rate12 was 111 percent, and ranged from 79 percent in facilities operated by the state government to 2,000 percent in facilities operated by tribal governments. By facility focus, utilization rates ranged from 88 percent in facilities primarily focused on general health care to 165 percent in facilities focused on mental health services.
"• Tables 4.7 and 4.8 and Figure 7 show the distribution of facility-level utilization rates for residential (non-hospital) beds and for hospital inpatient beds. Facilities with residential (non-hospital) beds had generally higher utilization rates than facilities with hospital inpatient beds. Forty-eight percent of facilities with residential (non-hospital) beds had utilization rates of 91 to 100 percent and 10 percent had utilization rates above 100 percent. Twenty-nine percent of facilities with hospital inpatient beds had utilization rates of 91 to 100 percent while 16 percent had utilization rates above 100 percent."

"Facilities were asked about the provision of treatment programs or groups specially designed for specific client types. Overall, 82 percent of facilities offered at least one special program or group to serve a specific client type."

^{1: Facilities treating incarcerated persons only were excluded from this report.
2: Persons who have experienced trauma, active duty military, and the military families categories appeared for the first time in the 2012 questionnaire.}

"Facilities were asked to indicate whether or not they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about the use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.
"• The proportions of all facilities reporting acceptance of specific payment options were:
"  • Cash or self-payment  90 percent
"  • Private health insurance  65 percent
"  • Medicaid  58 percent
"  • State-financed health insurance  40 percent
"  • Medicare  33 percent
"  • Federal military insurance  33 percent
"• Facilities operated by federal and tribal governments were least likely to accept cash or self-payment (41 and 42 percent, respectively). Private for-profit and federal government-operated facilities were less likely to accept Medicare, Medicaid, or state-financed health insurance than were facilities operated by private non-profits and state, local, or tribal governments.
"• Acceptance of Access to Recovery vouchers was reported in 35 states or jurisdictions. The proportion of facilities accepting Access to Recovery vouchers ranged from 2 percent in Utah to 74 percent in Idaho [Table 6.19b].16
"• Use of a sliding fee scale was reported by 62 percent of all facilities, ranging from 18 percent of facilities operated by the federal government to 82 percent of facilities operated by local governments.
"• Facilities operated by tribal governments were the most likely to accept IHS/63817 contract care funds (70 percent).
"• Treatment at no charge for persons who cannot afford to pay was offered by 50 percent of all facilities, ranging from 21 percent of private for-profit facilities to 84 percent of facilities operated by tribal governments."

Barriers to Treatment Access

"Increasing evidence suggests that distance, which can impact travel times to outpatient treatment settings, can have a significant effect on OSAT service utilization. Fortney et al. [22] studied 106 clients receiving treatment for depression and found that increased travel time from providers was significantly associated with making fewer visits and a greater likelihood of receiving less effective care [22]. Similarly, Beardsley et al. [21] focused on the distance traveled by 1,735 clients to various outpatient treatment programs in an urban setting. They found that distance is strongly correlated with treatment completion and higher retention rates; specifically, clients who traveled less than one mile (less than 1.6 kilometers) were more likely to complete treatment than those who traveled farther [21]."

"The relationship between access to responsive services and treatment completion rates among Latinos points to a serious need for greater geographic proximity to Spanish-language services for this population. Although testing treatment outcomes is not the focus of this paper, it should be noted that studies suggest that linguistic preferences significantly impact the treatment process among Latinos, indirectly contributing to treatment outcomes [5,19,25,26]. In particular, engaging clients in their native language during the intake process increases treatment retention and compliance, which are highly associated with treatment completion and improvements in posttreatment drug use. Similarly, studies have found that limited availability of bilingual treatment services is highly associated with high attrition rates from substance abuse treatment among Latinos when compared to other racial/ethnic groups [27-30].
"Highlighting potential barriers to health care access, such as distance to treatment, is of importance as past studies indicate that treatment completion rates are affected by transportation issues related to distance to outpatient treatment sources [31]. In particular, low-income individuals with significant transportation and communication challenges would be at a considerable disadvantage in terms of addressing their substance abuse issues."