ALCOHOL AND DRUG TREATMENT SERVICES 2015 Provided by the Alcohol and Drug Abuse Division (ADAD) Hawaiʻi Department of Health
EXECUTIVE SUMMARY This report focuses on alcohol and drug treatment services in Hawaiʻi during state fiscal year (FY) 2015. It only covers treatment services from agencies that were funded by the Alcohol and Drug Abuse Division (ADAD) of the Hawai i Department of Health. In FY 2015, ADAD funded 24 agencies offering services to adults at 57 sites, and 10 agencies providing services to adolescents at 107 sites. It is important to understand that the number and client mix of ADAD-funded treatment service admissions do not represent the total demand for substance abuse treatment or the prevalence of substance abuse in the general population. The levels and characteristics of treatment service admissions depend to some extent on the availability of state and federal funds. As funding levels rise, the percentage of the substance-abusing population admitted to treatment services generally increases. Moreover, funding criteria, which may change over time, affect the service modality utilized (e.g., residential, outpatient, or other type of treatment services) and client eligibility for services. This report describes the socio-demographic characteristics of the adolescents and adults who were admitted to substance abuse treatment programs. The use of different types of treatment services, funds expended on services, treatment outcomes and client follow-up status are also presented. In FY 2015, there were 5,086 admissions state-wide for treatment services. The most common source of referral for treatment admissions was self-referral, followed by the criminal justice system. Methamphetamine was the most frequently reported primary substance at the time of admission by adults seeking treatment (53% for adults 18 to 49 years and 46% for older adults 50 years and older), followed by alcohol (20% for adults and 40% for older adults). Marijuana was the primary substance for the majority of adolescents (64%), followed by alcohol (25%). The percentage of clients using each type of treatment service modality varied by age group. All adolescents who were 17 years old and younger were admitted to outpatient programs (Outpatient Treatment and Intensive Outpatient Treatment). For adults who were 18 years old and older, more than half of them (62% of adults and 52% of older adults) received various outpatient treatment services (Intensive Outpatient Treatment, Outpatient Treatment, and Methadone Maintenance programs). The remaining clients (38% of adults and 48% of older adults) were admitted to residential services (Residential, Therapeutic Living, and Residential Social Detoxification programs). More than $18 million in state and federal funds were spent on substance abuse treatment services during FY 2015. Of the total funds, nearly half (47%) were expended for Native Hawaiians and approximately 11% were used for services for pregnant and parenting women with children. More than three-fourths (77%) of the total funds were allocated to two treatment programs, Outpatient Treatment and Residential Treatment. A total of 3,787 clients were served in FY 2015. Half of the clients receiving treatment services were adolescents (50%). The largest group of clients came from the City and County of Honolulu (66%), followed by the counties of Maui (14%), Hawai i (14%), and Kaua i (6%). There were more male than female clients statewide (approximately 60% male vs. 40% female). More than two-fifths of those receiving services identified themselves as Native Hawaiians, including part-hawaiians (44%). 2
A total of 4,625 cases were either discharged from treatment services (3,442) or transferred to a different program (1,183) in FY 2015. Of the 3,442 discharged cases, 42% completed treatment with no drug use, 16% completed treatment with some drug use, 28% left before completing treatment, and the remainder were discharged for other reasons. The rate of completing treatment with no drug use varied greatly across treatment modalities. In FY 2015, the vast majority of clients (85%) from the Residential Social Detoxification modality completed treatment with no drug use. About a third of the clients (33%) from the Outpatient Treatment programs completed treatment with no drug use and 21% completed with some drug use. At the six-month follow-up in FY 2015, almost all adolescents (99%) were attending school and 67% of adults were employed. The majority of adolescents (64%) and adults (69%) reported not using any substances in the past 30 days prior to follow-up. The vast majority of adolescents and adults continued to have no arrests, no hospitalizations, and no emergency room visits since discharge. THE DATA AND THEIR LIMITATIONS The alcohol and drug treatment services data in this report are presented in the following three sections: Section A Services offered and funds expended Section B Client characteristics Section C Treatment service outcomes and follow-up Unless otherwise indicated, data are presented for the designated state fiscal year, which runs from July 1 of the preceding calendar year to June 30 of the calendar year (i.e., July 1, 2014 to June 30, 2015, for this report s fiscal year 2015 data). Data were drawn from the Web-based Infrastructure for Treatment Services (WITS) system input by each treatment service provider. With all data systems, there is a possibility of data entry and/or data collection errors. Note that data can vary depending on when data are drawn from the WITS system, as data entry may not occur in a timely manner. In addition, an individual being admitted to a treatment service program does not always mean that the individual receives an actual service. The individual may leave the program for various reasons before receiving it or may be transferred to another program. To reduce occurrences of such errors, ADAD and the University of Hawai i Center on the Family provided training to service providers each year. For admission data, every admission is considered as a separate count, and there is no differentiation between clients admitted once or more than once during a specified period. For this reason, the total number of admissions can contain a duplicated count of some individuals served. Client data, however, represent individuals with each client counted only once regardless of the number of times an individual was admitted. The total number of clients is therefore an unduplicated count of individuals served in a given year. Treatment Services Report 2015 3
It is important to understand that the number and client mix of ADAD-funded treatment service admissions do not represent the total demand for substance abuse treatment or the prevalence of substance abuse in the general population. The levels and characteristics of treatment service admissions depend to some extent on the availability of state and federal funds. As funding levels rise, the percentage of the substance-abusing population admitted to treatment services generally increases. Moreover, funding criteria, which may change over time, affect the service modality utilized (e.g., residential, outpatient, or other type of treatment services) and client eligibility for services. The classification of each category may not be the same as previous reports. (See a footnote for each definition when comparing with previous reports). Data on the primary substance used at the time of admission only represent the substances that led to the treatment episodes. They do not necessarily represent complete listings of all substances used at the time of admission. Treatment service discharges by modality of service are not strictly comparable because the modality of service offered upon admission varies depending on individual client needs. Percentages are rounded up to the first decimal in this report, resulting in total percentages ranging from 99.9 to 100.1 percent. Finally, caution should be used in interpreting statistics for which large amounts of data are missing (e.g., clients psychiatric status and follow-up at six months after discharge). 4
SECTION A. SERVICES OFFERED AND FUNDS EXPENDED This section presents the latest data from state fiscal year 2015 on the total number of treatment admissions. 1 It also presents admission information on age, county of residence, referral source, primary substance used at the time of admission, and service modality. In addition, information is included on the funds expended by different modalities of services and for special client groups. Figure A-1. Admissions by Age Group, FY 2015 9.5% 48.2% 42.3% Adolescents, 17 years and younger Adults, 18 to 49 years Older adults, 50 years and older In FY 2015, there were 5,086 admissions statewide for treatment services. Adults ages 18 to 49 were the largest client group to receive treatment services (48.2%), closely followed by adolescents (42.3%), and then by older adults age 50 and older (9.5%). 1 In this section, every admission is counted separately and no distinction is drawn between clients served once or more than once during a specified period. For this reason, the total number of admissions (duplicated count) should be at least equal to or can be greater than the total number of clients (unduplicated count) served during a particular year. Treatment Services Report 2015 5
Figure A-2. Admissions by County of Residence, FY 2015 ab 4.8% 15.4% 14.3% 65.4% C&C of Honolulu Hawai i County Kaua i County Maui County a Admissions of 36 individuals from out of state were excluded from the County of Residence calculations. b The sum of percentages is 99.9% due to rounding up to the first decimal in each category. The largest percentage of admissions (65.4%) was from the City & County of Honolulu (C&C of Honolulu), followed by the counties of Hawai i (15.4%), Maui (14.3%), and Kaua i (4.8%). 6
Figure A-3. Admissions by Source of Referral, FY 2015 ab 9.6% Individual (Self) 3.5% 9.7% Criminal Justice Child Protective Services 2.6% 49.4% Health Care Provider 25.2% School (Educational) Other a Criminal Justice includes the Intake Service Center of the Department of Public Safety. b The Other category includes referrals from employers, parents/family, friends/peers, other community referrals, and referrals from unknown sources. The most common source of referral was self-referral (49.4%). The criminal justice system referred approximately one-fourth (25.2%) of admissions. Schools (9.7%), health care providers (3.5%), child protective services (2.6%), and Other (9.6%) made up the remaining quarter of referrals. Treatment Services Report 2015 7
Figure A-4. Primary Substance Used at Admission, FY 2015 a 100% 90% 80% 70% 60% 11.1 11.8 9.7 0.7 24.7 45.8 52.7 Other 50% Methamphetamine 40% Alcohol 63.5 Marijuana 30% 19.6 39.6 20% 10% 0% 15.9 4.9 17 years & younger 18 to 49 years 50 years & older a The Other category includes cocaine/crack, heroin, and other drugs. Marijuana was the primary substance used for the majority of adolescents (63.5%), followed by alcohol (24.7%) at the time of admission. The majority of adults ages 18 to 49 (52.7%) reported methamphetamine, also known as ice, as the primary substance used at the time of admission, followed by alcohol (19.6%). For adults 50 years and older, the most frequently used primary substance was methamphetamine (45.8%), followed by alcohol (39.6%). 8
Figure A-5. Admissions by Modality of Services, FY 2015 a 100% 90% 80% 4.7 7.3 1.8 11.1 35.5 2.3 1.9 70% 20.0 Methadone Maintenance 60% 10.5 Therapeutic Living 50% Residential Social Detoxification 95.3 31.9 40% Residential Treatment 24.1 30% Intensive Outpatient Treatment 20% Outpatient Treatment 10% 27.9 25.8 0% 17 years & younger 18 to 49 years 50 years & older a The sum of percentages ranges from 100% to 100.1% due to rounding up to the first decimal in each category. The type of treatment services received differed by age group. Approximately three-fifths of adults ages 18 to 49 (61.6%) received outpatient treatment from various outpatient modalities (Intensive Outpatient Treatment, Outpatient Treatment, and Methadone Maintenance programs). The remaining 38.4% of clients were admitted to residential services (Residential, Therapeutic Living, and Residential Social Detoxification programs). Slightly more than half of older adults (52.2%) were admitted to outpatient services and the remaining 47.8% to residential services. In contrast, all adolescents were admitted to two types of outpatient programs (Intensive Outpatient Treatment and Outpatient Treatment). The vast majority (95.3%) were admitted to Outpatient Treatment. Treatment Services Report 2015 9
Table A-1. Funds Expended by Service Modality and Special Groups, FY 2015 a Service Modality Funds ($) Percent (%) Residential $5,985,531 33.2 Intensive Outpatient Treatment $1,778,970 9.9 Outpatient Treatment $7,855,566 43.6 Therapeutic Living $1,407,182 7.8 Methadone Maintenance $566,714 3.1 Residential Social Detoxification $432,416 2.4 Total $18,026,379 100 Special Groups b Native Hawaiians $8,537,998 47.4 Residential PPWC $1,177,865 6.5 Therapeutic Living PPWC $850,501 4.7 a Numbers were rounded to the nearest whole dollar. b The groups of Native Hawaiians and pregnant and parenting women with children (PPWC) are not mutually exclusive. More than $18 million in state and federal funds were expended for treatment services in FY 2015. The highest percentage of funds was expended on Outpatient Treatment (43.6%), followed by Residential Treatment (33.2%). About half of the total funds (47.4%) were spent on services for Native Hawaiians. 10
SECTION B. CLIENT CHARACTERISTICS This section presents the total number of clients in FY 2015 that ADAD-funded treatment agencies served. 2 It also includes such client characteristics as age, county of residence, gender, ethnicity, employment status, and special conditions when admitted to services. Figure B-1. Admissions by Age Group, FY 2015 8.0% 42.1% 49.9% Adolescents, 17 years and younger Adults, 18 to 49 years Older adults, 50 years and older The number of total clients served was 3,787 in FY 2015. The largest group of clients receiving services was adolescents (49.9%), followed by adults ages 18 to 49 (42.1%). 2 Unlike the number of admissions that can represent a duplicated count of services received by one individual, these data are based on clients and represent an unduplicated count of those individuals receiving services in a given year. Treatment Services Report 2015 11
Figure B-2. Admissions by County of Residence, FY 2015 ab 5.8% 14.4% C&C of Honolulu Hawai i County 14.0% 65.7% Kaua i County Maui County a Admissions of 21 individuals from out of state were excluded. b The sum of percentages is 99.9% due to round up to the first decimal in each category. The majority of clients came from the C&C of Honolulu (65.7%), followed by the counties of Maui (14.4%), Hawai i (14.0%), and Kaua i (5.8%). 12
Table B-1. Socio-Demographic Characteristics of Clients at Admission to Services, FY 2015 a Socio-Demographic Characteristics Number Percent Gender Male 2,291 60.5 Female 1,496 39.5 Total 3,787 100 Ethnicity Hispanic b 498 13.2 Hawaiian 1,659 43.8 Caucasian 649 17.1 Filipino 389 10.3 Japanese c 143 3.8 Samoan 134 3.5 Black 103 2.7 Portuguese 44 1.2 Mixed, not Hawaiian 75 2.0 Other Pacific Islander 330 8.7 Other Asian 99 2.6 Other d 162 4.3 Total e 3,787 100 Employment Status Employed 265 7.0 Unemployed/looking for work in past 30 days/laid off 758 20.0 Student 2,022 53.4 Other f 726 19.2 Unknown 16 0.4 Total 3,787 100 Treatment Services Report 2015 13
a Ethnicity information was collected in two separate ways: first by asking each client to identify if they were Hispanic or not, and then each client was asked to select an ethnic group from a list of ethnicities that did not include Hispanic. b There were 18 missing cases in the Hispanic category. As a result, the total number in the Hispanic category is different from the total number presented in this table. The total numbers for the Hispanic category is 3,769. The percentage of Hispanics was calculated based on the Hispanic-specific total number presented in this footnote. c Japanese includes Okinawan. d The Other ethnicity category includes American Indian, Aleutian/Eskimo, Other, and Unknown. There were 28 cases classified as Unknown. e Because of the duplicated count of Hispanic, the count was excluded from the total. f The Other category includes homemakers, retirees, individuals with disabilities, inmates in institutions, and others not in the labor force. More males (60.5%) than females received treatment services in FY 2015. Hawaiians (including part-hawaiians) were the largest group of clients (43.8%) who received treatment services, followed by Caucasians (17.1%). Together they made up more than three-fifths of all clients. Filipinos were the third largest group that received services (10.3%). Slightly more than one-fourth of clients were in the labor force: 7.0% were employed and 20.0% were unemployed or looking for work. The majority of clients (72.6%) were not in the labor force: students (53.4%) and other (19.2%). 14
Table B-2. Clients with Special Conditions at Admission to Services, FY 2015 Special Condition a Number Percent Homeless b 445 11.8 Pregnant 40 1.1 Methadone cases 25 0.7 Clients with five or more prior treatment episodes 32 0.8 Psychiatric problem in addition to alcohol/ drug problem c 490 12.9 a A client can be admitted with one or more of the special conditions. b Homeless includes individuals who are single and those with partners or parents. c Information is unknown for 24.0% of clients. In FY 2015, the two most prevalent special conditions among clients who received treatment services were: 1) a psychiatric problem in addition to an alcohol/drug problem (12.9%), and/or 2) homelessness (11.8%). Treatment Services Report 2015 15
SECTION C. TREATMENT SERVICE OUTCOMES AND FOLLOW-UP This section presents information on the types of discharge and transfer following treatment services and on the status of clients six months after discharge. 3 In FY 2015, a total of 4,625 cases were either discharged from treatment services (3,442 cases) or transferred to a different level of care for continued treatment in the same or at another agency (1,183 cases). Compared to 37.2% of adults transferred, less than 10% of adolescents (9.3%) were transferred within or outside the facility. Figure C-1. Types of Treatment Service Discharge, FY 2015 1.5% 28.0% 12.0% 42.0% Treatment Completed, No Drug Use Treatment Completed, Some Drug Use Non-compliance with Program Rules Left before Completing Treatment 16.4% Other Among the 3,442 discharged cases, approximately three-fifths (58.4%) of the discharged clients completed treatment with no drug use (42.0%) or with some drug use (16.4%). Slightly more than one-fourth (28.0%) left treatment before completion and 12.0% were discharged due to non-compliance with program rules. A very small percentage of clients (1.5%) in the Other category was discharged for medical reasons or incarcerated. 3 Note that the number of admissions reported earlier in this report does not match the number of discharges for the specified year. This is because clients admitted in a particular year may be discharged in the same or the following year. 16
Figure C-2. Types of Treatment Service Discharge by Age Group, FY 2015 ab 100% 90% 29.6 80% 0.1 3.1 26.4 Other 70% 8.1 Left before Completing 60% 16.0 Treatment 50% 24.0 8.6 Non-compliance with Program Rules 40% Treatment Completed, 30% Some Drug Use 20% 45.9 Treatment Completed, 38.2 No Drug Use 10% 0% Adolescents Adults a Adults includes both adults 18 to 49 years and older adults 50 years and older. b Other includes discharge due to medical reasons and incarceration. The patterns of discharge (not including transfer cases) differed between adolescents (1,746 clients) and adults (1,696 clients). Adults were more likely than adolescents to complete treatment with no drug use (45.9% of adults vs. 38.2% of adolescents) and also to be discharged due to non-compliance with program rules (16.0% vs. 8.1%, respectively). Compared to adults (8.6%), adolescents (24.0%) were more likely to complete treatment with some drug use. Treatment Services Report 2015 17
Table C-1. Types of Treatment Service Discharge or Transfer by Service Modality, FY 2015 Types of Treatment Service Discharge or Transfer Treatment Completed, No Drug Use Treatment Completed, Some Drug Use Transferred Within/ Outside Facility a Non-Compliance with Program Rules Left Before Completing Treatment Other b Total No. % No. % No. % No. % No. % No. % No. % Service Modality Residential Treatment c 17 3.1 - - 378 69.0 49 8.9 95 17.3 - - 548 100 Intensive Outpatient Treatment 143 16.9 16 1.9 374 44.2 134 15.8 154 18.2 25 3.0 846 100 Outpatient Treatment 869 33.2 546 20.8 353 13.5 197 7.5 638 24.4 17 0.6 2,620 100 Therapeutic Living c 33 22.1 - - 53 35.6 28 18.8 33 22.1 - - 149 100 Methadone Maintenance c - - - - - - - - - - - - 13 100 Residential Social Detoxification c 383 85.3 - - 21 4.7 - - 38 8.5 - - 449 100 a Transfer includes clients transferred to other programs of the same agency and cases referred to outside agencies for continued treatment. b Other includes clients discharged due to medical reasons or incarcerated. c Due to the small number of clients, their discharge or transfer type information is excluded. Among the total discharged and transferred cases in FY 2015, the percentage of clients who completed treatment with no drug use was highest among the Residential Social Detoxification programs (85.3%), followed by Outpatient Treatment programs (33.2%), and the Therapeutic Living programs (22.1%). The Outpatient Treatment programs also had the highest percentage of clients (20.8%) who completed treatment with some drug use. More than half of clients (69.0%) from Residential Treatment programs were transferred, followed by Intensive Outpatient Treatment programs (44.2%) and Therapeutic Living programs (35.6%). Among the treatment modalities, the Therapeutic Living programs had the highest percentage of clients who were discharged due to non-compliance with program rules (18.8%), followed by Intensive Outpatient Treatment programs (15.8%). 18
Table C-2. Client Status Six Months after Discharge by Age Group, 2015 Adolescents, 17 Years and younger No. % Adults, 18 Years and older No. % Status at Follow-up a Attending school 916 98.6 NA Employed part-time/full-time NA 369 66.8 No arrests since discharge 884 95.2 522 94.6 No substance use in 30 days prior to follow-up No new substance abuse treatment 593 63.8 382 69.2 808 87.0 449 81.3 No hospitalization 902 97.1 533 96.6 No emergency room visits 889 95.7 517 93.7 No psychological distress since discharge 798 85.9 469 85.0 Stable living arrangements 921 99.1 465 84.2 Total b 929-552 - a Information is presented only for clients with complete follow-up data. Therefore, the discharge data reported herein may not represent all of the clients who were discharged from treatment services. b Total number of clients from whom complete follow-up data are available. Within each year, this is the denominator for calculating the percentage values for each follow-up status. NA = not applicable. The identified status was not applicable to clients of the specified age group. In FY 2015, among the discharged adolescents with follow-up data, nearly all were in stable living arrangements (99.1%), attended school (98.6%), and had not been hospitalized (97.1%). Since discharge, most had no emergency room visits (95.7%), had not been arrested (95.2%), and had not received new substance treatment (87.0%) at the time of follow-up. In the 30 days prior to follow-up, 63.8% of adolescents had not used any abuse substances. A large majority of discharged adolescents (85.9%) had not suffered psychological distress. For the discharged adults who were successfully reached by follow-up in FY 2015, almost all (96.6%) had no hospitalizations since discharge. A great majority also had stable living arrangements (84.2%), had no emergency room visits (93.7%), had no arrests (94.6%), had not received new substance abuse treatment (81.3%), and reported no psychological distress (85.0%) since discharge at the time of follow-up. More than two-thirds were employed (66.8%) and had not used any abuse substances in the last 30 days (69.2%). Treatment Services Report 2015 19
ADAD-Funded Treatment Agencies, FY 2015 Agencies Offering Services to Adults Action with Aloha Alcoholic Rehabilitation Services of Hawai i, Inc. dba Hina Mauka (ARSH) Aloha House, Inc. Big Island Substance Abuse Council (BISAC) Bridge House, Inc. Care Hawaii, Inc. Child and Family Service Family Court First Circuit Ho omau Ke Ola Ka Hale Pomaika i Kline-Welsh Behavioral Health Foundation dba Sand Island Treatment Center Kū Aloha Ola Mau (formerly DASH) Malama Na Makua A Keiki Mental Health Kokua Ohana Makamae, Inc. Oxford House, Inc. Po ailani, Inc. The Institute for Human Services The Queen s Medical Center The Salvation Army dba The Salvation Army Addiction Treatment Services (ATS) The Salvation Army dba The Salvation Army Family Treatment Services (FTS) The Wai anae Coast Community Mental Health Center Waikiki Health Center Women in Need Agencies Offering Services to Adolescents Alcoholic Rehabilitation Services of Hawai i, Inc. dba Hina Mauka (ARSH) Aloha House, Inc. Big Island Substance Abuse Council (BISAC) Care Hawaii, Inc. Coalition for a Drug Free Hawaii Hale Ho okupa a Maui Youth and Family Services, Inc Ohana Makamae, Inc. The Institute for Family Enrichment Young Men s Christian Association (YMCA) Suggested Citation Kim, J., McGlone, K., Zhang, J., & Okano, S.Y. (2017). Alcohol and Drug Treatment Services in Hawai i, 2015. Honolulu: University of Hawai i, Center on the Family. This publication was made possible by the Substance Abuse Prevention and Treatment Block Grant 3B08TI010015-15S2 from the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment and by the U.S. Department of Agriculture (USDA), National Institute of Food and Agriculture (NIFA), Hatch Project HAW03022-H (managed by the University of Hawai i, College of Tropical Agriculture and Human Resources). For more information, please contact: Alcohol and Drug Abuse Division Department of Health 601 Kamokila Boulevard, Room 360 Kapolei, Hawai i 96707 (808) 692-7506 Center on the Family University of Hawai i at Mānoa 2515 Campus Road, Miller Hall 103 Honolulu, Hawai i 96822 (808) 956-4132 20