The Drug and Alcohol Services Information System (DASIS) is, SAMHSA tells us, “the primary source of national data on substance abuse treatment” (http://oas.samhsa.gov/dasis.htm#teds2). It has three components: the National Survey of Substance Abuse Treatment Services (N-SSATS), The Treatment Episode Data Set (TEDS) and the Inventory of Substance Abuse Treatment Services (I-SATS).

N-SSATS is used to generate the I-SATS. That is, the survey is used to generate data to populate the putative listing of substance treatment facilities. The survey is sent to “facilities.” Solo practitioners are specifically excluded, neither surveyed as part of N-SSATS nor included within I-SATS unless the State substance abuse agency explicitly requests their inclusion. What this means, to refer to my analogy above, is that we have a survey and listing of Interstate highways, but no other roads are included.

TEDS is where we start to run into problems. Every year, treatment episode information is studied with respect to each of the facilities that report to individual state administrative data systems. One recent report, for example, noted that 64 percent of primary heroin admissions reported injection as the route of administration. Smoked cocaine represented 71 percent of all primary cocaine admissions in 2006, another part of the report detailed.

Is this information important or useful to anyone other than the facilities themselves? If I were a substance treatment facility, I would surely want to know what my customer demographics are; how to best arrange for staffing; how to determine the “industry trends” so that I can plan and prepare for the future; and how to determine competitive strategies. If I’m not a substance treatment facility, I’m not certain that any of this information is meaningful.

There are several thousand solo physicians in the country who practice addiction medicine. There are thousands more who do not focus on addiction, but who are well versed in the topic and therefore treat it when presented with it. There are tens of thousands of non-physician healthcare professionals who practice in a solo capacity to treat those with addiction.

There are also many public and private health centers which are not addiction treatment facilities but which provide such treatment since a high percentage of their patients suffer from addiction. The vast majority of addiction treatment takes place away from substance treatment “facilities.” Why? Because it has to. The facilities are almost all restricted from delivering ongoing and indefinite care despite addictive illness being chronic and lifelong. Therefore, both before and after treatment within the facility, care for addiction is being administered by the long-term treatment location. Further, looking only at my own practice, I send only a small minority of new addiction intakes to a designated treatment facility. Most are treated from my office in an ambulatory manner. I imagine this is true for most of my colleagues as well.

So, if the bulk of treatment for addiction takes place away from designated facilities, what meaning do statistics that reflect only those patients who are in such trouble that they end up in a state-designated facility have? The numbers do not reflect the actual epidemiology of the disease, but rather, reflect a population from a certain subset of the overall spectrum. Severe cases are not reflected since they’re being treated in general hospitals for hepatic disease, cardiac infections, or dementia. Mild to moderate cases are not reflected; they’re the folks being seen individually in the outpatient offices throughout the country.

The statistics, therefore, do not apply to the bulk of those with addictive disease or to the bulk of locations providing treatment for addiction. An enormous amount of money is undoubtedly spent on maintaining, updating, and staffing DASIS on an annual basis. This is incredibly puzzling. I could not find any similar government expense for other chronic illnesses.

There is no extensive study and database of hypertension treatment facilities that excludes all the individual physicians who treat hypertension on a daily basis. No studies have been conducted of blood pressure statistics among patients only of medium sized community facilities with an expectation that such statistics would be found universally useful. Cost-effective treatment for diabetes is a crucial goal given the economic costs of that illness on an annual basis. And yet, there have been no studies that I could find that exclude the important care given by the patient’s own physician on a longitudinal basis for diabetes.

If DASIS is to have any meaning – either as a source of epidemiologic information regarding substance use, or as a source of information for people with addiction who are attempting to locate a treatment location — it absolutely must include primary addiction treatment sources. Without doing so, it is focused on a minority of patients being seen at a minority of the possible treatment locations. Once you have a non-representative minority being studied, your data are no longer applicable to the overall population, in this case either of patients or of treatment centers. The bottom line is that taxpayer money is being tossed into studies of questionable value and which certainly shouldn’t be perceived as the “primary source of national data on substance abuse treatment.”

To those who would argue that the information is better than nothing, we have to return to my highway analogy. My study demonstrated that 60 percent of the vehicles observed were commercial (often weighing in excess of several tons) and were travelling at a rate of 65 m.p.h. Please tell me how this is at all meaningful to a city planner responsible for maintaining streets for the bicycles and cars primarily seen within a typical town.
I’m happy to hear feedback from you at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

This column represents his personal opinion and does not imply any position or policy taken by either the AMA or ASAM.

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