Analysis of Nebraskan Admissions to Publicly Funded Substance Treatment Centers in 2017 by Core-Based Statistical Areas copy

RURAL DRUG ADDICTION
RESEARCH CENTER
ANALYSIS OF NEBRASKAN ADMISSIONS TO PUBLICLY FUNDED SUBSTANCE
TREATMENT CENTERS IN 2017 BY CORE-BASED STATISTICAL AREAS
Patrick Habecker & Ryan Herrschaft
RDAR 2-20
EXECUTIVE SUMMARY
The Treatment Episode Data Set (TEDS) tracks both admissions and discharges from substance use treatment facilities
in the United States of America. Treatment facilities in Nebraska that receive public funds from the state substance abuse
agency are required to submit information for the TEDS.
We analyze TEDS data to look at differences in substances reported at admission in Nebraska between Metropolitan corebased
statistical areas (CBSA) counties, Micropolitan CBSA counties, and counties that are Outside CBSA areas. Nebraska
has four Metropolitan CBSAs: Omaha, Lincoln, Grand Island, and Sioux City. Micropolitan counties include towns such
as: Kearney, Hastings, Norfolk, and Columbus. A full description of how Metro and Micro CBSA counties are defined is
included in this report.
In 2017, 52.61% of all admissions to treatment centers were in Metropolitan CBSAs (Omaha, Lincoln, Grand Island, Sioux
City). The remainder of admissions were in Micropolitan or were Outside both Metro and Micro areas. Almost 30% of
admissions were in areas Outside of Metro and Micro CBSA counties.
Metropolitan, Micropolitan, and Outside CBSA areas have different admission profiles for the substances that are listed
at admission. This report looks at both how often a substance is listed in all admissions (the percent) and the rate of a
substance being listed per 100,000 Nebraskans age 10 or older.
When we look at the statewide and across state numbers, there are a clear top three substances that are listed at admission
for treatment: alcohol, marijuana, and methamphetamine. When looking at only primary substances at admission,
these three substances are the primary substance in 87.55% of all admissions in Nebraska in 2017 (alcohol 56.32%,
methamphetamine 21.51%, marijuana 9.72%).
Alcohol is listed more frequently in Metro and Outside CBSA areas than Micro areas. However, the rates of alcohol being
listed per 100,000 Nebraskans age 10 or older are fairly similar between Metro and Micro areas, and much higher in
Outside CBSA areas. Overall, alcohol is the most commonly listed substance at admission.
Marijuana and Methamphetamine are more frequently listed in Micro areas by percent of admissions compared to Metro
and Outside areas. However, when looking at rates of listing per 100,000 Nebraskans age 10 or older Micro and Outside
areas are quite similar and the Metro rates are lower than both Micro and Outside CBSA areas.
Other substances are listed at admission, but none appear in more than 10% of admissions. The complete distribution and
rate of these substances is provided in the full report.
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A FEW POINTS ON TEDS DATA, DEFINITIONS, AND OUR ANALYSIS
What is TEDS?
The Treatment Episode Data Set (TEDS) tracks both admissions and discharges from substance use treatment facilities in
the United States of America. People who are admitted or discharged multiple times in a year are counted for each instance
or episode. When reviewing reports or other data products based on the TEDS the unit of analysis is admissions and not
persons. This is an important distinction to keep in mind as individual TEDS reports may represent the same person at
different time points in the year. The TEDS is jointly administered by the Substance Abuse and Mental Health Services
Administration (SAMHSA) which is part of the U.S. Department of Health & Human Services. You can learn more about
TEDS at the SAMHSA website linked here and download the data that we used for this report.
Where does TEDS data come from?
Treatment facilities in Nebraska that receive public funds from the state substance abuse agency are required to submit
information for the TEDS. These facilities provide information (such as gender and age) for each admission as well as
information on what substances lead to each admission episode.
What does TEDS data not include?
Treatment facilities that do not receive public funding from the state or federal government are not required to submit
information to TEDS. Private facilities may voluntarily report this information, but none did so in Nebraska for 2017.
How are we Defining Metropolitan, Micropolitan, and Outside CBSA Areas?
The TEDS system reports if an admission occurred within a Core-Based Statistical Area (CBSA), and provides a unique code
for each CBSA in the United States. We then classify those individual CBSA areas as Metropolitan, Micropolitan, or Outside
a CBSA and combine them into our three categories. CBSA areas are defined by the U.S. Census Bureau and use measures
of population, county boundaries, and social and economic ties between counties around a population core. These are not
strictly urban-rural classifications as county boundaries can encompass areas that are both rural and urban.
A metropolitan CBSA will have a core population of at least 50,000 people. A micropolitan CBSA has a population of at least
10,000, but less than 50,000 people. Outlying counties are added to a CBSA if at least 25% of workers living in that county
work in the central counties or if at least 25% of the employment in the outlying county is occupied by workers who live in
the central counties. Counties in a state that are not part of a CBSA are referred to as Outside Core Based Statistical Areas.
You can read more about the technical specifications of the Core-Based Statistical Areas here.
Metropolitan CBSA areas in Nebraska in 2017 cover the cities of Omaha, Lincoln, Grand Island, and overflow from Sioux
City, Iowa. These regions include the following counties: Washington, Douglas, Sarpy, Cass, Saunders, Lancaster, Seward,
Hall, Howard, Merrick, Dakota, and Dixon.
Micropolitan CBSA areas in Nebraska in 2017 cover the cities of Scottsbluff, North Platte, Lexington, Kearney, Hastings,
Norfolk, Columbus, Fremont, and Beatrice. These regions include the following counties: Scotts Bluff, Sioux, Banner, Lincoln,
McPherson, Logan, Dawson, Gosper, Buffalo, Kearney, Adams, Madison, Stanton, Pierce, Platte, Dodge, and Gage.
Outside CBSA areas in Nebraska in 2017 are the remaining 64 counties in Nebraska that are not in Metro or Micro areas.
Population Rates
Official TEDS reports often include the primary rate of admissions per 100,000 people who are 12 or older in a given area,
whether it is a state, region, or nation. To replicate these rates of admissions in the CBSA divisions we need access to the
number of people in each county of the state who are 12 and older. This information is not included in the TEDS file. Using
US Census resources we have not been able to find that exact data at the county level. Instead we calculate our rates as per
100,000 people who are 10 or older in a given area. As a result, our calculated statewide rates will appear lower than what is
reported by TEDS because we are using a larger population size.
What are Primary, Secondary, and Tertiary Substances?
Up to three substances can be listed at admission to a treatment facility. These are the reported substances that led to a given
treatment episode and are listed with an implied order of primary (first), secondary (second), and tertiary (third). However,
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if an admission has more than three substances involved there is no record of a 4th, 5th, or more substances. We use these
listings in two different ways for our report. First, we report on the primary substance only. This reporting ignores secondary
and tertiary substances and focuses only on the first substance listed. This is follows how official TEDS reports show stateby-state
percentages and rates for only the primary substance reported. We also report on all of the substances reported for
an admission by looking at the primary, secondary, and tertiary together. This shows the prevalence of all three reported
substances in admission episodes and gives us a sense of how often a given substance is recorded as contributing towards a
treatment admission. Although there is likely to be a lot of overlap between substances listed for admission and substances
used by a person, we do not equate the two. Because we are limited to only three reportable substances, and substances are
asked as they determine a current admission episode, it is unwise to generalize admissions substance profiles to all substance
use.
What is included in the “Other” substance category?
TEDS reports on quite a few substances that we count as “Other” in this report. The substances in this category are: inhalants,
over the counter medications, barbiturates, other non-benzodiazepine tranquilizers, other stimulants, other hallucinogens,
PCP, non-prescription methadone, other non-barbiturate sedatives/hypnotics, other amphetamines, and other drugs. Full
reporting of these substances at the overall state level can be found in the official reports for the 2017 TEDS. To see these
substances as the CBSA level you will need to use the original data and conduct the analysis yourself. If you need a place to
start on this you can use our R code we used to create this report which is linked at the end of the report.
PRIMARY SUBSTANCES AT ADMISSION
Percent Admissions which List Substance as Primary - Statewide
We first focus on the statewide distribution of substances that are listed as the primary substance at admission to treatment
in Nebraska in 2017. TEDS reports that there were 13,467 admissions to treatment facilities in Nebraska that received public
funds in 2017. Figure 1 shows that 56.32% of these admissions listed alcohol as the primary substance. Marijuana was listed
as the primary substance for 9.72% of admissions, and methamphetamine for 21.51% of admissions. Synthetic opioids were
listed for 2.75% of admissions, cocaine or crack cocaine was listed in 1.19% of admissions, heroin was listed for 0.69% of
admissions, and benzodiazepine was listed for 0.38% of admissions. For 2.46% of admissions a different substance (“other”)
was listed as the primary substance. Our use of “other” will not match the standard TEDS reporting as we combined quite
a few smaller categories. You can see a complete list of the substances that are in our “other” category in the preceding
paragraph. This is the only category we combined from the typical TEDS reporting. In 4.92% of the admissions there was no
substance listed (“none”) as a primary substance.
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Percent Admissions which List Substance as Primary – Across CBSA Regions
In Figure 2, we show the percent of primary substances at admission for each of three possible CBSA region types: Metro,
Mico, or Outside CBSA. In brief, Metro CBSA are regions with a county core of 50,000 people or more; Micro CBSA regions
have a county core of 10,000 to 49,999 people, and Outside CBSA regions have less than 10,000 people or were not classified.
We refer to these areas as Metro, Micro, and Outside.
Alcohol was the primary substance for 62.17% of Metro admissions, 33.92% of Micro admissions, and 59.76% of Outside
admissions in 2017 in Nebraska. Marijuana was the primary substance for 7.58% of Metro admissions, 16.37% of Micro
admissions, and 9.42% of Outside admissions. Methamphetamine was the primary substance for 17.66% of Metro admissions,
34.36% Micro admissions, and 20.43% of Outside admissions. Other substances accounted for a much smaller proportion of
the primary admissions in all three areas. Synthetic opioids were the primary substance for 2.91% of Metro admissions, 3.18%
of Micro admissions, and 2.22% of Outside admissions. Cocaine or crack cocaine were the primary substance for 1.13% of
Metro admissions, 0.53% of Micro admissions, and 1.71% of Outside admissions. Heroin was the primary substance for
0.75% of Metro admissions, 0.73% of Micro admissions, and 0.56% of Outside admissions. Benzodiazepine was the primary
substance for 0.44% of Metro admissions, 0.53% of Micro admissions, and 0.18% of Outside admissions. Our combined
“Other” primary substances were 1.89% of Metro admissions, 4.68% of Micro admissions, and 2.09% of Outside admissions.
The primary substance of “None” was listed for 5.36% of Metro admissions, 5.7% of Micro admissions, and 3.62% of Outside
admissions.
Rate of Primary Substance at Admission per 100,000 Nebraskans Age 10 or Older - Statewide
It is also useful to consider the rate of primary substances in admissions per 100,000 people in an area. We calculate our
rates as per 100,000 people who are 10 and older in Nebraska in 2017 using US Census data. Because TEDS does not track
admissions for those younger than 12 our rates are slightly lower than what you would see in the official TEDS report. Figure
3 shows that in 2017 there were 458.43 primary alcohol admissions per every 100,000 people age 10 and older in Nebraska.
There were 79.13 marijuana admissions, 175.12 methamphetamine admissions, and 22.43 synthetic opioid admissions per
100,000 people age 10 and older in Nebraska. The cocaine and crack cocaine admission rate was 9.67, and there were 5.62
heroin admissions, and 3.08 benzodiazepine admissions per 100,000 people age 10 and older in Nebraska.
Rate of Primary Substance at Admission per 100,000 Nebraskans Age 10 or Older – Across CBSA Regions
In Figure 4 we show the rate of primary substances at admission per 100,000 Nebraskans age 10 an older for each of three
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possible CBSA region types. In brief, Metro CBSA are regions with a county core of 50,000 people or more; Micro CBSA
regions have a county core of 10,000 to 49,999 people, and Outside CBSA regions have less than 10,000 people or were not
classified. We refer to these areas as Metro, Micro, and Outside.
The primary admissions rate for alcohol was 409.87 in Metro areas, 293.57 in Micro areas, and 793 in Outside areas. The
Marijuana rate was 49.97 in Metro areas, 141.67 in Micro areas, and 125.07 in Outside areas. The rate for Methamphetamine
was 116.4 in Metro areas, 297.45 in Micro areas, and 271.1 in Outside areas. The rate for synthetic opioids was 19.17 in Metro
areas, 27.49 in Micro areas, and 29.41 in Outside areas. The cocaine and crack cocaine admissions rate was 7.44 in Metro
areas, 4.58 in Micro areas, and 22.65 in Outside areas. The heroin admission rate was 4.93 in Metro areas, 6.34 in Micro
areas, and 7.44 in Outside areas. The benzodiazepine admission rate was 2.88 in Metro areas, 4.58 in Micro areas, and 2.37
in Outside areas. Other substances listed as a primary were combined in one “other” category. The rate of admission for this
combined category is 12.47 in Metro areas, 40.53 in Micro areas, and 27.72 in outside areas per 100,000 Nebraskans age 10
or older.
ALL LISTED SUBSTANCES AT ADMISSION
Percent Admissions where Substance was Listed – Statewide
We now look at the percent of admissions that included a substance in either a primary, secondary, or tertiary role. This
approach is less restrictive than focusing only on primary substances. We view this as an indicator of how common a
substance is at admission. However, even when looking at all three listed substances we cannot say this shows all substances
being used, as only three different substances can be listed per admission.
When we look at the entire state of Nebraska we see that alcohol was listed in 69.74% of admissions in 2017 (Figure 5).
Marijuana was listed in 33.7% of admissions and methamphetamine was listed in 31.8% of admissions. Synthetic opioids
were listed in 6.01% of admissions and cocaine and crack cocaine was listed in 4.62% of admissions. Heroin was listed in
1.57% of admissions and benzodiazepine was listed in 1.5% of admissions. Our combined “other” substance category was
listed in 5.16% of admissions to publicly funded treatment facilities in Nebraska in 2017.
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Figure 6 shows that alcohol was listed as either a primary, secondary, or tertiary substance in 72.53% of Metro admissions,
56.39% of Micro admissions, and 73.05% of Outside admissions. Marijuana was listed in 27.47% of Metro admissions, 50.77%
of Micro admissions, and 34.28% of Outside admissions. Methamphetamine was listed in 26.21% of Metro admissions,
49.59% of Micro admissions, and 30.74% of Outside admissions.
Synthetic opioids were listed in 5.49% of Metro admissions, 8.96% of Micro admissions, and 5.12% of Outside admissions.
Cocaine and crack cocaine were listed in 4.47% of Metro admissions, 4.4% of Micro admissions, and 5.02% of Outside
admissions. Heroin was listed in 1.62% of Metro admissions, 2.2% of Micro admissions, and 1.07% of Outside admissions.
Benzodiazepine was listed in 1.45% of Metro admissions, 2% of Micro admissions, and 1.27% of Outside admissions. Our
combined “other” category was listed in 3.81% of Metro admissions, 9.08% of Micro admissions, and 5.15% of Outside
admissions.
Rate of Substance Listed at Admission per 100,000 Nebraskans Age 10 or Older – Statewide
In Figure 7 we show the rate at which a substance was listed at admission as either a primary, secondary, or tertiary substance
per 100,000 Nebraskans age 10 or older. The rate of alcohol being listed at admissions was 567.72. The rate for marijuana is
274.37 and for methamphetamine was 258.84. Synthetic opioids were listed at a rate of 48.96 and cocaine/crack cocaine was
listed at a rate of 37.6 per 100,000 Nebraskans age 10 or older. Heroin was listed at a rate of 12.75 and benzodiazepine was
listed at a rate of 12.21 per 100,000 Nebraskans age 10 or older. Our combined “other” category was listed at a rate of 42.01
per 100,000 Nebraskans age 10 or older in the 2017.
Rate of Substance Listed at Admission per 100,000 Nebraskans Age 10 or Older – Across CBSA Regions
In Figure 8 we look at the rates of a substance being listed as either a primary, secondary, or tertiary substance per 100,000
Nebraskans age 10 or older in 2017 in each of the three CBSA regions. The admissions rate for alcohol was 478.16 in Metro
areas, 488.11 in Micro areas, and 969.45 in Outside areas. The marijuana admissions rate was 181.07 in Metro areas, 439.47
in Micro areas, and 454.98 in Outside areas. The methamphetamine rate was 172.79 in Metro areas, 429.25 in Micro areas,
and 407.99 in Outside areas per 100,000 Nebraskans age 10 or older. The synthetic opioid rate is 36.19 in Metro areas, 77.53
in Micro areas, and 67.94 in Outside areas. The cocaine / crack cocaine rate is 29.5 in Metro areas, 38.06 in Micro areas,
and 66.59 in Outside areas. The heroin rate is 10.7 in Metro areas, 19.03 in Micro areas, and 14.2 in Outside areas. The
benzodiazepine rate is 9.58 in Metro areas, 17.27 in Micro areas, and 16.9 in Outside areas. Our combined “other” category
was listed at a rate of 25.12 in Metro areas, 78.59 in Micro areas, and 68.28 in Outside areas per 100,000 Nebraskans age 10
or older.
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WHAT CAN WE LEARN FROM THIS?
How are admissions numbers spread across CBSA regions?
Of the 13,467 admissions to publicly funded treatment facilities in Nebraska in 2017, 52.61% were in Metro CBSA areas
such as Omaha, Lincoln, and Grand Island (7,085 admissions total). The other admissions were in either Micro CBSA areas
such as Norfolk or Scottsbluff (18.24%, 2,456 admissions) or in Outside CBSA areas (29.15%, 3,926 admissions). Just over
half of admissions to treatment facilities in Nebraska in 2017 were in Metro CBSA areas. A combined 47.39% of admissions
were outside of Metro areas and almost 30% were outside of both Metro and Micro areas. This spread presents a challenge to
treatment plans that may focus solely on the Metro areas of Nebraska.
What substances are most frequently listed at admission to treatment?
When we look at the statewide and across state numbers there are a clear top three substances that are listed at admission for
treatment: alcohol, marijuana, and methamphetamine. When looking at only primary substances at admission, these three
substances are the primary substance in 87.55% of all admissions in Nebraska in 2017 (alcohol 56.32%, methamphetamine
21.51%, marijuana 9.72%). When we consider all substances listed and not just the primary, these three substances remain
the most commonly listed (i.e. alcohol 69.74%, marijuana 33.7%, methamphetamine 31.8%). The increase in the percent
of marijuana being listed at all, compared to just primary listing, suggests that marijuana is more frequently listed as a
secondary/tertiary substance than as a primary substance.
Synthetic opioids and cocaine or crack cocaine are present in a much smaller percentage of admissions in Nebraska, typically
5-7% of admissions each when looking at all substances, or 2-3% when considering primary substances only. Heroin and
benzodiazepine percentages are smaller still, listed as a primary substance in less than 1% of admissions, and less than 2%
among all substances listed at admission.
Comparing Metro to Micro CBSA Areas
Admissions in Micro CBSAs have lower percent listing of alcohol than in Metro admissions. The difference is 28.25 percentage
points lower in Micro when looking only at primary substances and 16.14 percentage points lower when considering all
listings. The rate of primary alcohol admissions per 100,000 Nebraskans age 10 or older was 1.4 times greater in Metro
compared to Micro areas, but slightly lower in Metro areas compared to Micro areas when looking at all listing of alcohol.
The percent of admissions that list marijuana and methamphetamine were higher in Micro CBSA areas compared to Metro
CBSA areas. This difference is particularly considerable for methamphetamine which was 16.7 percentage points higher for
primary listings and 23.38 percentage points higher for any listing in Micro CBSA areas. The difference in rates per 100,000
Nebraskans age 10 or older for these two substances was also considerable. In Micro areas, the primary admissions rate for
marijuana was 2.84 times greater than in Metro areas (a difference in the rate of 91.7). The rate for all listings of marijuana
was 2.43 times greater in Micro compared to Metro areas per 100,000 Nebraskans age 10 or older (a difference in the rate of
258.4). The rate of admissions for methamphetamine in Micro areas compared to Metro follows a similar pattern. Primary
methamphetamine admissions rates are 2.56 times higher in Micro areas compared to Metro and were 2.48 times higher for
all listings of methamphetamine in Micro compared to Metro CBSAs.
Comparing Metro to Outside CBSA Areas
Metro and Outside CBSA areas were closer in the percent of substances that are reported as a primary substance, or for any
substance, than what we see between Metro and Micro CBSAs. However, there were some sizeable differences in the rates of
substances reported at admissions between Metro and Outside CBSA areas. There was a small 2.41 percentage point increase
in admissions listing alcohol as a primary substance at admission in Metro areas compared to Outside CBSAs. When we look
at the percent of alcohol among all listings at admission, the difference was only 0.52 percentage points higher in Outside
CBSAs compared to Metro. Although the proportions of admissions listing alcohol are similar across Metro and Outside
CBSAs, the rates per 100,000 Nebraskans age 10 and older were roughly 2 times higher in Outside CBSAs compared to Metro
for both primary and all alcohol admissions.
The admissions percentages were also similar for marijuana and methamphetamine between Metro and Outside areas.
Outside areas have primary admission percentages that were 1.84 points higher for marijuana and 2.77 points higher for
methamphetamine than in Metro areas. The difference was larger when looking at all substances listed. In Outside CBSA areas
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the percent of admissions listing marijuana was 6.81 points higher and the percent of admissions listing methamphetamine
was 4.53 points higher than in Metro CBSAs. When we look at the rates of these substances being listed per 100,000
Nebraskans age 10 and older, we see that the rates in Outside areas were approximately 2.5 times higher than the rates for
marijuana and methamphetamine in Metro areas.
Comparing Micro to Outside CBSA Areas
Alcohol was listed less frequently in Micro areas compared to Outside CBSA areas. The difference was 25.84 percentage
points lower for alcohol as a primary listing in Micro areas and 16.66 points lower for any listing of alcohol in Micro areas.
The rates of alcohol listed at admission per 100,000 Nebraskans age 10 or older was 2-3 times lower in Micro areas than in
Outside areas.
Marijuana and methamphetamine were listed with a higher percentage in Micro areas than in Outside areas. Micro areas
had primary admission percentages of marijuana that are 6.95 percentage points higher than in Outside areas, and were
16.49 points higher when looking at any listing of marijuana. The rates per 100,000 Nebraskans over the age of 10 were also
higher in Micro areas, 1.13 times higher for the primary listing and 1.03 times lower for any listing of marijuana compared
to Outside areas. Methamphetamine was listed as the primary substance in 34.36% of Micro admissions in 2017 which was
13.93 points higher than it was in Outside areas. This gap was 18.85 points wide and in the same direction when looking at
any listing of methamphetamine in admissions in 2017. The rate of admissions per 100,000 Nebraskans over the age of 10 was
higher in Micro than Outside CBSA areas for methamphetamine as well. The primary methamphetamine admissions rate
was 1.1 times higher and the any methamphetamine rate is 1.05 times higher in Micro CBSAs compared to Outside CBSAs.
LIMITATIONS
The TEDS has several limitations worth noting. First, only admissions to facilities receiving public funding are included. For
Nebraska, we do not know if privately funded facilities see different distributions of substances than publicly funded facilities.
Second, because TEDS limits reporting to only three substances, we do not see the full range of polysubstance use among
those admitted to treatment facilities. However, in Table 1 we show that only 18% of admissions statewide listed three
substances. It is only for these cases that we might be missing detail on the full range of substances that led to an admissions
episode. When we look at this for the CBSA types we see that there are more admissions that list three substances in Micro
areas (29%), followed by Outside areas (18%), and Metro areas (14%).
Third, TEDS shows only part of the total population of people that use substances, those that enter a treatment facility by
choice or by order. It is a profound mistake to equate distributions of reported substances among TEDS admissions with the
same patterns of substances being used among all Nebraskans. Further, we are treating admissions equally here, when there
is a large range of substance use patterns and reasons to be in treatment.
Fourth, the CBSA areas that we use in this report often cross state borders. We restrict our reporting to only admissions in
the state of Nebraska. The Metro CBSA that is Omaha-Council Bluffs only includes data from the Nebraska counties of that
Metro area. We also only include Nebraska counties from the Sioux City Metro area and do not include the counties in South
Dakota or Iowa.
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CONCLUSIONS
Just over half of the admission to publicly funded substance facilities in Nebraska in 2017 were in the Metropolitan CBSA areas
and almost 30% of admissions were in Outside Areas, or not in Metro and Micro CBSA areas. There are also different profiles
of substances reported at admissions to these facilities when comparing Metropolitan, Micropolitan, and areas Outside
of CBSAs. Alcohol appeared in a smaller percent of admissions in Micropolitan admissions compared to Metropolitan
and Outside areas. Marijuana and methamphetamine both appeared in a larger percent of admissions in Micropolitan
(especially) and Outside CBSA areas compared to Metropolitan areas. When adjusting admissions per 100,000 Nebraskans
age 10 or older, we see that either Micropolitan or Outside CBSA areas have higher rates for every substance than what is
seen in Metropolitan admissions.
Metropolitan and Micropolitan areas are anchored around a core city or town where treatment resources can be concentrated.
The Outside CBSA area is defined as both smaller towns and being less engaged socially and economically with the Micro
and Metro areas of the state. The Outside CBSA area has a considerable share of treatment admissions, but may have unique
challenges due to lower population and greater dispersion across a larger land area in Nebraska.
RESOURCES
1. More information on the Treatment Episode Data Set (TEDS) can be found at the SAMHSA website.
2. You can download the TEDS data file used in this report and data for other years at this website.
3. You can read more about how the Core-Based Statistical Areas are defined at this website.
4. You can learn about how to retrieve US Census Data and replicate the analysis presented in this report by using the R
syntax which is available at this website.
CONTACT
Patrick Habecker, Research Assistant Professor, Rural Drug Addiction Research Center
Email: phabecker2@unl.edu | Website: rdar.unl.edu
This work is supported by the National Institute of General Medical Sciences of the National Institutes of Health
[P20GM130461] and the Rural Drug Addiction Research Center at the University of Nebraska-Lincoln. The content is solely
the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or
the University of Nebraska.
The University of Nebraska does not discriminate based on race, color, ethnicity, national origin, sex, pregnancy, sexual
orientation, gender identity, religion, disability, age, genetic information, veteran status, marital status, and/or political
affiliation in its programs, activities, or employment.
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