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GAO-12-744R: 

July 6, 2012: 

The Honorable Dianne Feinstein: 
Chairman: 
The Honorable Charles E. Grassley: 
Co-Chairman: 
Caucus on International Narcotics Control: 
United States Senate: 

Subject: Drug Control: Initial Review of the National Strategy and 
Drug Abuse Prevention and Treatment Programs: 

An estimated 22.6 million Americans aged 12 or older were illicit drug 
users in 2010, representing 8.9 percent of the population aged 12 or 
older, according to the National Survey on Drug Use and Health. 
[Footnote 1] This represents the highest overall rate of illicit drug 
users among this population group since 2002, when the rate was 8.3 
percent. Abuse of illicit drugs results in significant social, public 
health, and economic consequences for the United States. For example, 
the economic impact of illicit drug use, including the costs of crime, 
health care, and lost productivity, was estimated at more than $193 
billion in 2007, the most recent year for which data were available. 
[Footnote 2] 

The Office of National Drug Control Policy (ONDCP) was established by 
the Anti-Drug Abuse Act of 1988 to, among other things, enhance 
national drug control planning and coordination and represent the drug 
policies of the executive branch before Congress.[Footnote 3] In this 
role, ONDCP provides advice and governmentwide oversight of drug 
programs and is responsible for coordinating drug control activities, 
including federal drug abuse prevention and treatment programs, and 
related funding across the federal government. ONDCP is required 
annually to develop the National Drug Control Strategy (Strategy), 
which sets forth a plan to reduce illicit drug use through prevention, 
treatment, and law enforcement programs, and to develop a Drug Control 
Budget for implementing the Strategy. ONDCP reported that for fiscal 
year 2012, about $25.2 billion was provided for drug control programs 
across 17 federal departments and independent agencies. Further, 
according to ONDCP, from 2004 to 2012 this signified an increase of 
$5.9 billion (about 31 percent) for drug control programs, including 
drug abuse prevention and treatment programs. 

The 2010 Strategy is the inaugural strategy guiding drug policy under 
President Obama's administration and, according to ONDCP officials, 
sought a comprehensive approach to drug policy, including an emphasis 
on drug abuse prevention and treatment efforts and the use of evidence-
based practices--approaches to prevention or treatment that are based 
in theory and have undergone scientific evaluation.[Footnote 4] Drug 
abuse prevention includes activities focused on discouraging the first-
time use of controlled substances and efforts to encourage those who 
have begun to use illicit drugs to cease their use. Treatment includes 
activities focused on assisting regular users of controlled substances 
to become drug free through such means as counseling services, 
inpatient and outpatient care, and the demonstration and provision of 
effective treatment methods. 

National Drug Control Program agencies (drug control 
agencies)[Footnote 5] follow a detailed process in developing their 
annual budget submissions for inclusion in the Drug Control Budget, 
which provides information on the funding that the executive branch 
requested for drug control to implement the Strategy.[Footnote 6] 
Agencies submit to ONDCP the portion of their annual budget requests 
dedicated to drug control, which they prepare as part of their overall 
budget submission to the Office of Management and Budget for inclusion 
in the President's annual budget request. ONDCP reviews the budget 
requests of the drug control agencies to determine if the agencies 
have acceptable methodologies for estimating their drug control 
budgets, and includes those that do in the Drug Control Budget. 
[Footnote 7] Agencies may administer programs that include drug abuse 
prevention and treatment activities but do not meet ONDCP's standards 
for having an acceptable budget estimation methodology. Such programs 
are not represented in the Drug Control Budget. 

Part of the 2010 Strategy is a long-term policy goal for increasing 
the emphasis on preventing and treating substance abuse. Multiple 
federal departments--and their component agencies, bureaus, divisions, 
and offices--and independent agencies (collectively referred to as 
agencies), administer drug abuse prevention and treatment programs, 
fund these programs, or both.[Footnote 8] The drug abuse prevention 
and treatment programs vary and may include grants to service 
providers, direct services, and education and outreach activities. For 
example, an agency's grant program may award block grants to grantees, 
such as states or local entities, to implement their own interventions 
through community-based drug abuse prevention or treatment programs, 
while direct service programs often entail interventions directly 
administered by an agency to a specific population. Drug abuse 
prevention and treatment programs target various populations and use a 
wide variety of interventions, which are strategies or approaches 
intended to prevent an undesirable outcome, such as abuse of an 
illicit drug; promote a desirable outcome, such as reducing the use of 
alcohol among youth; or alter the course of an existing condition, 
such as successful treatment of drug addiction. Some programs may be 
either jointly funded or administered by two or more agencies. 

In light of the increase in the rate of illicit drug use among 
Americans, efforts to oversee and coordinate the implementation of the 
Strategy and ensure that ONDCP and federal agencies invest in the most 
effective drug abuse prevention and treatment programs become more 
important. You asked us to determine the extent to which the 2010 
Strategy has been implemented, review the sources of funding for 
federal drug abuse prevention and treatment programs as well as 
federal agency efforts to coordinate their programs, and examine 
agencies' efforts to evaluate drug abuse prevention and treatment 
programs and ensure that they are effective. Specifically, in this 
report we (1) provide an initial review of the extent to which the 
2010 Strategy has been implemented, the extent to which ONDCP 
coordinates its implementation across drug control agencies, and how 
ONDCP assesses the effectiveness of the Strategy in preventing and 
reducing drug use; (2) review what agencies fund drug abuse prevention 
and treatment programs and how agencies coordinate their programs; and 
(3) provide an initial review of the extent to which federal agencies 
evaluate their drug abuse prevention and treatment programs and the 
extent to which agencies assess their programs' effectiveness. 

This is the first report in response to your request that we assess 
the implementation of the 2010 Strategy. This report describes the 
implementation approach, federal agencies' drug abuse prevention and 
treatment programs, and Department of Health and Human Services (HHS), 
Department of Justice (DOJ), and Department of Education (Education) 
efforts to assess the effectiveness of their drug abuse prevention and 
treatment programs. We will continue our work on these issues and plan 
to evaluate the extent to which the 2010 Strategy has been implemented 
and coordinated across agencies and how ONDCP assesses the 
effectiveness of the Strategy in preventing and reducing drug use. 

To outline the planned implementation approach and the different 
programs, we analyzed the 2010 Strategy and 2011 update, ONCDP 
documents on implementation progress, and implementation plans and 
reports from selected federal drug control agencies. We also 
interviewed officials from ONDCP and from HHS, DOJ, and the Department 
of Homeland Security (DHS) about strategy implementation efforts. 
[Footnote 9] To identify what federal agencies fund drug abuse 
prevention and treatment programs, we reviewed the fiscal year 2013 
Drug Control Budget that describes fiscal year 2012 allocations and 
interviewed ONDCP officials to confirm their process for developing 
the Drug Control Budget and their criteria for including agencies' 
programs in the budget.[Footnote 10] We determined that the fiscal 
year 2013 Drug Control Budget data are reliable for our purposes. 
Additionally, we reviewed documents regarding the drug abuse 
prevention and treatment programs of three national drug control 
agencies with some of the largest drug control budgets for prevention 
and treatment--HHS, DOJ, and Education--and interviewed officials from 
these agencies about their programs and about coordination efforts 
between agencies funding drug abuse prevention and treatment programs. 
To provide an assessment of federal agencies' efforts to date to 
assess the effectiveness of their drug abuse prevention and treatment 
programs, we interviewed officials from our selected national drug 
control agencies as well as experts in the field of drug abuse 
prevention and treatment. Enclosure I provides additional information 
on our scope and methodology. 

We conducted this performance audit from January 2012 through July 
2012 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Results in Brief: 

To implement the 2010 National Drug Control Strategy, ONDCP obtained 
input from drug control stakeholders to help ensure that they shared 
responsibility for implementation, established a new process to 
determine progress made, and reported that most action items in the 
Strategy were on track or complete as of November 2011. ONDCP 
officials stated that they developed the 2010 Strategy's seven 
objectives--for example, Strengthen Efforts to Prevent Drug Use in Our 
Communities--and 106 action items under these objectives through a 
consultative process with federal, state, and local drug control 
agencies and other stakeholders. Officials from the four agencies we 
spoke with as of April 2012 stated that ONDCP sought input from them 
to develop the Strategy and that as a result, existing agency 
priorities and activities are reflected in the Strategy. ONDCP 
officials stated that this alignment helps facilitate Strategy 
implementation. In August 2010, ONDCP initiated a process to track 
progress made on Strategy action items. As part of this process, ONDCP 
requested that each agency develop and submit (1) a plan for 
implementing each action item for which it has lead responsibility and 
(2) status updates on implementation progress when requested. ONDCP 
officials stated that they use this and other information to determine 
the implementation status of each of the action items and then share 
the results with lead agencies in order to motivate them to take steps 
to address items that are not on track, among other things. In 
November 2011, ONDCP reported that 84 percent of the 113 action items 
in the 2010 Strategy and 2011 update were on track or complete, while 
the remaining 16 percent were either delayed but progressing, facing 
budget issues, or at risk.[Footnote 11] ONDCP officials stated that 
this process to track and report on implementation progress helps hold 
agencies accountable for implementing action items. 

HHS, DOJ, and Education allocated nearly 85 percent of the funding for 
federal drug abuse prevention and treatment programs in the Drug 
Control Budget in fiscal year 2012. Of the approximately $10.1 billion 
allocated by federal agencies for drug abuse prevention and treatment 
programs in fiscal year 2012, HHS allocated approximately $8.3 billion 
and DOJ allocated approximately $186.1 million for prevention and 
treatment programs, while Education allocated about $64.9 million for 
prevention programs. These three agencies allocated funding to various 
drug abuse prevention and treatment programs, such as those that 
provide grants, education and outreach, and direct service, among 
others.[Footnote 12] HHS, DOJ, and Education primarily allocated 
funding to grant programs in fiscal year 2012, through which they 
awarded funding to states, communities, tribes, and other 
organizations to implement drug abuse prevention and treatment 
interventions. For example, the Substance Abuse and Mental Health 
Services Administration (SAMHSA) awards funds through the Substance 
Abuse Prevention and Treatment Block Grant Program to grantees to 
plan, carry out, and evaluate drug abuse prevention, early 
intervention, treatment, and recovery support services. Not less than 
20 percent of funds awarded under this program must be spent by 
SAMHSA's grantees for drug abuse education, counseling, and risk 
reduction activities.[Footnote 13] Officials from HHS, DOJ, and 
Education agencies also told us that they coordinate with each other, 
and other federal agencies, to deliver and fund drug abuse prevention 
and treatment programs through a variety of methods, including jointly 
administering programs, participating in working groups, and working 
together on an ad hoc basis. For example, officials from Education 
said they jointly administer and fund the Safe Schools/Healthy 
Students Initiative with HHS. DOJ is also a partner in this 
initiative, and collaboration among the three agencies is guided by an 
agreement that is signed annually by Education, HHS, and DOJ. 

HHS, DOJ, and Education assess the effectiveness of some of their 
grant programs by either requiring grantees to demonstrate the 
effectiveness of interventions they plan to use in their drug abuse 
prevention and treatment programs or giving preference to grant 
applicants that include interventions for which there is evidence of 
effectiveness in their applications for grants. Determining whether a 
program is effective involves evaluating the extent to which a program 
is meeting its goals. Both HHS and Education officials said that their 
agencies have requirements that grantees for some programs demonstrate 
the effectiveness of their planned drug abuse prevention or treatment 
interventions. For example, SAMHSA officials said that as a condition 
of funding, the agency requires, as part of its grant application 
process, that most grantees show that they will use evidence-based 
interventions in their programs. DOJ officials told us that during the 
grant application process for some programs, they give preference to 
applicants that include features that have been determined to be 
effective. HHS, DOJ, and Education have registries that include 
interventions related to drug abuse and prevention and treatment 
(among other topics) that are determined to be effective through 
research or evaluation, which grantees may use to document the 
effectiveness of their drug abuse prevention and treatment programs. 
We found that HHS, DOJ, and Education agency officials and other 
experts we spoke with reported various challenges in identifying 
interventions that are proven effective, including (1) availability of 
data needed to assess effectiveness, (2) ability to determine the 
impact of prevention interventions, and (3) applicability of 
interventions to different population groups other than the population 
for which the intervention was originally intended. For example, 
officials said that determining the impact of a prevention 
intervention can be difficult because it is often difficult to 
quantify something that did not happen--such as a youth's decision not 
to use an illicit drug--because of a preventive measure. 

To Implement the 2010 Strategy, ONDCP Obtained Stakeholder Input, 
Established a Process to Determine Progress, and Reported That Most 
Action Items Were on Track: 

ONDCP used input from drug control stakeholders to develop the 2010 
Strategy's objectives and action items to help ensure shared 
responsibility. ONDCP also established a process to determine 
implementation status, including requesting that agencies submit 
updates on progress made. In November 2011, ONDCP reported that 84 
percent of the 113 action items in the Strategy were on track or 
complete. 

ONDCP Sought Stakeholder Input to Help Develop Strategy Priorities and 
Ensure Shared Responsibility for Implementation: 

ONDCP officials stated that to help ensure successful implementation, 
the agency developed the Strategy through a consultative process with 
federal, state, and local drug control agencies and other 
stakeholders, including state and local leaders, such as governors, 
mayors, and law enforcement officials. According to these officials, a 
cross-agency effort was required to develop the Strategy because the 
drug control agencies have primary responsibility for its 
implementation and needed to be involved to ensure that they 
understood their implementation responsibilities. An ONDCP senior 
official stated that through its outreach efforts, ONDCP sought to 
instill a sense of shared ownership and buy-in from the drug policy 
community. Officials from ONDCP and the four agencies we spoke with as 
of April 2012 stated that ONDCP used input solicited through this 
consultative process to develop the seven objectives and 106 action 
items under these objectives in the Strategy.[Footnote 14] Further, to 
guide the implementation of federal drug policy activities in support 
of the Strategy, lead agencies and participating agencies were 
designated for each action item as a means to assign implementation 
responsibility. 

To help develop and implement the Strategy, ONDCP established, among 
other things, the Interagency Working Group on Demand Reduction (IWG) 
to bring together the 40 federal agencies involved in drug control 
activities. According to officials from ONDCP and the 4 agencies with 
whom we spoke, the IWG meetings were the primary forum for consulting 
with stakeholders to develop the Strategy.[Footnote 15] The Director 
of ONDCP stated in 2010 testimony before a House subcommittee that 
working group meetings were used as the foundation for the 2010 
Strategy and helped to formulate long-term policy goals for increasing 
the emphasis on preventing and treating substance abuse. The Director 
also noted that the IWG process highlighted programs that worked--
specifically, drug court programs, community-based antidrug 
coalitions, and corrections programs aimed at helping steer drug 
offenders toward productive lives.[Footnote 16] ONDCP incorporated 
these programs into the 2010 Strategy and helped identify 
implementation responsibilities for relevant drug policy agencies, all 
of which were included in the Strategy development process. For 
example, ONDCP established several action items relating to drug court 
programs under its Strategy objective to Break the Cycle of Drug Use, 
Crime, Delinquency, and Incarceration. The majority of lead 
implementation responsibilities were assigned to the Office of Justice 
Programs (OJP), whose officials agreed that these action items fell 
under OJP's mission areas and were appropriately assigned. Also, ONDCP 
continues to utilize the IWG to help implement the Strategy. For 
example, HHS officials said that an IWG meeting was convened in early 
2012 to discuss how to best address Strategy initiatives to help 
reduce synthetic drug production and use.[Footnote 17] 

Officials from the four agencies we spoke with as of April 2012 stated 
that as a result of ONDCP's consultative Strategy development process, 
existing agency priorities and activities are reflected in the 
Strategy. For example, Drug Enforcement Administration (DEA) officials 
stated that DEA included curbing prescription drug abuse as a priority 
in its drug enforcement efforts, which ONDCP, in turn, highlighted in 
the Strategy. ONDCP officials stated that such consistent alignments 
to the Strategy help facilitate its implementation. 

ONDCP Has Established New Mechanisms to Track Strategy Implementation 
and Reported That 84 Percent of Action Items Were on Track or Complete 
as of November 2011: 

ONDCP has established a unit and a new process to determine the 
implementation status of Strategy action items, as well as the 
Performance Reporting System that according to ONDCP officials, 
incorporates key performance measures to assess progress toward the 
objectives and goals of the Strategy. In November 2011, ONDCP reported 
that 84 percent of action items were on track or complete. 

Mechanisms to Track Strategy Implementation and Report Performance: 

ONDCP established the Delivery Unit and implemented a new process to 
track progress made on each Strategy action item. ONDCP officials 
stated that in August 2010, following the issuance of the 2010 
Strategy, ONDCP formed the Delivery Unit to help ensure the successful 
implementation of the action items in the Strategy. The unit reports 
to the Chief of Staff and consists of two staff members who support 
the unit as a collateral duty and perform responsibilities such as 
providing updates on implementation progress to ONDCP managers. 
Coinciding with the establishment of the Delivery Unit, the Director 
of ONDCP issued a letter to agency department heads to formally 
initiate the process for Strategy implementation. The letter requested 
that agencies develop and submit (1) a plan for implementing each 
action item for which they have lead responsibility and (2) status 
updates on implementation progress when requested, which are to 
address the objectives and milestones in the plan. The Delivery Unit 
established a template in the Office of Management and Budget's MAX 
Collect system to assist agencies in developing these submissions and 
to help ensure that the information provided is consistent across 
agencies.[Footnote 18] ONDCP officials stated that they use this 
information as part of their process to help hold agencies accountable 
for implementing Strategy action items. 

ONDCP's process to track progress made on Strategy action items relies 
to a great extent on the cooperation and assistance of implementing 
agencies. Because agency implementation plans are to include 
measurable objectives for implementing action items and key 
milestones, lead agencies are responsible for specifying the scope of 
the action items, such as the types of programs on which to focus, and 
how they are implemented. For example, the National Institute of 
Justice, which funds research on criminal justice issues, is the lead 
agency for the action item to Promote Best Practices as Alternatives 
to Incarceration, and has defined implementation through the 
objectives and milestones it established, as shown in figure 1. 

Figure 1: Strategy Action Item to Promote Best Practices as 
Alternatives to Incarceration and National Institute of Justice 
Objective and Milestones to Address It: 

[Refer to PDF for image: illustration] 

2010 Strategy description of action item to Promote Best Practices as 
Alternatives to Incarceration:  

Much more knowledge is needed about what works and what programs can 
be taken to scale for the large number of drug offenders who can be 
safely supervised in the community. OJP, in consultation with SAMHSA, 
will continue to promote innovation and evaluate those new and 
existing programs that hold the promise of reducing incarceration and 
maintaining public safety.  

National Institute of Justice objective for action item:  

Issue solicitation to study sentencing and community corrections 
policies and practices that promote effective community-based 
alternatives to incarceration without jeopardizing public safety.  

According to the solicitation, the National Institute of Justice 
anticipates that a total of $1 million will be available to fund 
awards for research. It also states that funding priority will be 
given to experimental research designs that use random selection and  
assignment of participants to experimental and control conditions.[A] 

National Institute of Justice 2011 milestones for action item: 
   
Milestone #1-—Begin work on grant for A Natural Experiment in Reform: 
Analyzing Drug Law Policy Change in New York State[B]. 
  
Target date: January 2011; 
Grant ends: December 2012. 

Milestone #2—Begin work on grant for Evidence-Based Screening and 
Assessment: A Randomized Trial of an Assessment Tool in Three New  
York City Drug Courts[C]. 

Target date: January 2011; 
Grant ends: June 2014. 

Source: GAO summary of Strategy action item description and National 
Institute of Justice implementation documents.     

[A] According to Office of Management and Budget guidance, randomized 
controlled trials--studies that randomly assign individuals or other 
units into experimental and control groups--are generally the highest-
quality, unbiased evaluations for demonstrating the actual impact of a 
program. 

[B] Vera Institute of Justice is studying the impact of recent changes 
to New York State drug laws that allow shorter sentences and 
alternatives to incarceration for certain felony drug charges. 
Research will, among other things, (1) compare recidivism outcomes for 
individuals charged with felony drug crimes before and after the 
reforms and (2) measure the reforms' impact by conducting a cost-
benefit analysis of changes to sentencing. The National Institute of 
Justice awarded Vera Institute of Justice a grant for $699,937 to 
conduct this research. 

[C] The National Institute of Justice awarded the Center for Court 
Innovation a grant for $389,093 to conduct this research. 

[End of figure] 

ONDCP officials stated that they assigned a staff member with issue-
area knowledge to each action item, who, among other things, reviews 
the agency's plan to ensure that it is sufficient to fulfill the 
action item and feasible given the resources and time available for 
implementation. 

As part of its process to track progress made on Strategy action 
items, ONDCP also relies on lead agencies to provide reports on 
implementation progress--based on their plans--in response to periodic 
Delivery Unit data calls and to consult with participating agencies in 
submitting these reports. However, our review of reports submitted as 
of November 2011 by our selected DOJ agencies--OJP and DEA--for the 11 
prevention and treatment action items for which they are responsible 
found that 2 of the reports for OJP-led action items did not provide 
any progress updates.[Footnote 19] While there is no formal mechanism 
to validate the information agencies provided through the system, 
Delivery Unit officials stated that ONDCP gains an understanding of 
the work agencies are doing through interagency working group 
meetings, agency budget submissions, and ongoing and informal 
communication with agency contacts. ONDCP officials stated that when 
an agency report lacks important information, the ONDCP staff person 
responsible for supporting the action item would, among other things, 
work with the lead agency to update the information in MAX Collect. 
Also, 2 of the 11 reports contained certifications that the lead 
agency consulted with colead and participating agencies and reached 
consensus on what was submitted, while the remaining 9 did not. 
According to ONDCP officials, this does not imply that participating 
agencies object to the plans or reports, but rather that some portions 
of the content may still be under discussion. They said that this may 
also be due to the timing of ONDCP's data solicitation in April 2012. 
Further, OJP and DEA officials stated that they coordinated with 
participating agencies, but that it can be challenging getting 
responses from them even if they do not object to the information 
submitted. These officials said that it would be helpful if each 
participating agency could certify that it was consulted in MAX 
Collect. ONDCP officials agreed that this could prove a useful 
addition. 

ONDCP uses the information collected from lead agencies to classify 
action items into five categories--complete, on track, delayed but 
progressing, facing budget issues, and at risk.[Footnote 20] 
Specifically, ONDCP officials stated that the Delivery Unit 
tentatively categorizes each action item and then forwards the 
categorization and relevant information to the staff member assigned 
to the action item to review, revise if necessary, and validate the 
unit's categorization. These officials said that this process draws 
heavily upon the expertise of the staff member, as well as the 
member's working relationships with lead agency contacts. ONDCP 
completed its first categorization of action items in November 2011 
and, according to officials, shared the results with lead agency 
contacts, which gives agencies credit for progress made and helps to 
motivate them, if needed, to take steps to address action items that 
are not on track. 

In addition to tracking the implementation status of action items, 
ONDCP recently established the Performance Reporting System that 
according to ONDCP officials, will provide strategic-level reporting 
on the performance of drug control programs across agencies. These 
officials said that the system has been in development since December 
2009 and will be used to begin assessing progress toward the 
Strategy's goals and objectives later this year. The April 2012 
Performance Reporting System report stated that the system will 
collect data from federal drug control agencies and from other sources 
in order to report on measurable outcomes that the Strategy seeks to 
achieve by 2015. In the Strategy, ONDCP established two main policy 
goals to be attained by 2015: (1) curtail illicit drug consumption in 
the United States and (2) improve the public health and public safety 
of the American people by reducing the consequences of drug abuse. 
[Footnote 21] ONDCP also established outcome measures to assess the 
effectiveness of the Strategy in accomplishing these goals, such as 15 
percent reductions in the number of chronic drug users, drug-induced 
deaths, and drug-related morbidity. ONDCP officials stated that the 
system was developed with input from some federal drug control 
agencies and incorporates new performance metrics that will be used to 
assess cross-agency progress toward the goals and seven objectives in 
the Strategy and provide feedback on how agencies' efforts are 
contributing to the Strategy. For example, under the Strategy 
objective to Strengthen Efforts to Prevent Drug Use in Our 
Communities, ONDCP established a new performance metric to increase 
the age of initiation for illicit drugs from an average of 17.6 years 
of age to 19.5 by 2015. According to the Performance Reporting System 
report, delaying the age of initiation is a sound indicator of the 
effectiveness of agency prevention initiatives that aim to reduce 
youth drug use. 

ONDCP's Categories Denoting Progress in Implementing Strategy Action 
Items and Steps Taken to Address Delays: 

ONDCP reported in November 2011 that 84 percent of the 113 action 
items in the 2010 Strategy and 2011 update were on track or complete, 
and stated that it has taken actions to help address those action 
items that were delayed or not progressing.[Footnote 22] Figure 2 
shows the number of action items in each of the ONDCP's five 
implementation status categories. 

Figure 2: Number of Action Items in ONDCP's Five Implementation Status 
Categories, as of November 2011: 

[Refer to PDF for image: pie-chart] 

On track: 81; 
Complete: 14; 
Delayed but progressing: 11; 
Facing budget issues: 6; 
At risk: 1. 

Source: GAO analysis of ONDCP data on the implementation status of 
Strategy action items. 

Notes: N=113. ONDCP defines the implementation status categories as 
follows: (1) Complete. The work specifically directed by the Strategy 
has been fulfilled. It does not imply that the larger goals the item 
supports have been entirely achieved or that work in progress in 
support of those goals should be halted. (2) On track. Implementation 
is under way, and the work being done is consistent with the 
fulfillment of the action item within the time frame specified. (3) 
Delayed but progressing. Work has started but has slowed or stalled, 
or the work being done is not ambitious enough to fulfill the action 
item in the time frame specified. (4) Facing budget issues. Work has 
stopped or been significantly impeded by funding shortfalls. (5) At 
risk. Work has never begun or has ceased. 

[End of figure] 

An example of an action item that ONDCP has categorized as complete is 
the ONDCP-led action item to Mobilize Parents to Educate Youth to 
Reject Drug Use. According to the description of the action item in 
the 2010 Strategy, the White House Office of Faith-Based and 
Neighborhood Partnerships is fostering greater engagement of fathers 
in the lives of their children, including initiatives to help fathers 
and mothers protect their children from drugs.[Footnote 23] It also 
states that SAMHSA continues to provide support for parents using 
evidence-based interventions. To complete this action item, the Office 
of Faith-Based and Neighborhood Partnerships, among other things, held 
regularly scheduled meetings with federal agencies to promote 
fatherhood-related activities, and ONDCP and HHS updated websites to 
help ensure that the most recent information on youth drug abuse was 
available to the parents. In contrast, in November 2011 ONDCP 
categorized the SAMHSA-led action item to Develop Prevention-Prepared 
Communities as facing budget issues. The description for this action 
item states that the new Prevention-Prepared Communities program will 
focus on youth to implement evidence-based prevention services through 
multiple venues and address common risk factors for substance abuse, 
among other things. It states that agencies will coordinate their 
grants and technical assistance such that communities and the youth in 
them are continuously surrounded by protective factors rather than 
protected only in a single setting or at a single age. HHS officials 
stated that the action item was not implemented because of lack of 
funding to award cooperative grants at the community and state levels. 
According to ONDCP and SAMHSA officials, SAMHSA's Strategic Prevention 
Framework, which is implemented through a state incentive grant 
program, incorporates elements of the Develop Prevention-Prepared 
Communities action item, such as an emphasis on community-based and 
data-driven prevention.[Footnote 24] 

ONDCP also reported on the implementation status of action items 
within each of the Strategy's seven objectives. (See fig. 3.) As of 
November 2011, 4 of the 10 action items in ONDCP's Strategy objective 
to improve information systems were complete, but 2 were facing budget 
issues. For example, the action item to Strengthen Drug Information 
Systems Focused on Arrestees and Incarcerated Individuals was among 
those that were facing budget issues. National Institute of Justice 
officials stated that the development of a new Arrestee Drug Abuse 
Monitoring program to collect better information on the extent of drug 
use among male arrestees was not funded.[Footnote 25] As a result, the 
National Institute of Justice and the Bureau of Justice Statistics 
have suspended planning efforts for this action item, such as 
developing a protocol for producing nationally representative 
estimates of drug use in the arrestee population. According to ONDCP 
officials, data on arrestees will still be collected, but efforts to 
improve the reliability of the data are on hold. ONDCP also reported 
that the majority of action items under its other six Strategy 
objectives were complete or on track. However, 3 of the 19 action 
items under the objective to Strengthen International Partnerships 
were delayed but progressing, and 1 of the action items--Promote 
Alternative Livelihoods for Coca and Opium Farmers--was at risk as of 
November 2011. This ONDCP-led action item calls for the U.S. Agency 
for International Development to continue supporting programs that 
provide, among other things, incentives to wean farmers away from 
illicit crop cultivation.[Footnote 26] The January 2012 report on 
implementation progress indicated that rural and agricultural 
development programs have yielded results, such as the creation of new 
jobs, infrastructure projects, and alternative crop cultivation. ONDCP 
officials stated that while the implementation of this action item was 
occurring, it was classified as at risk in November 2011 primarily 
because of the lack of a central point of contact within the U.S. 
Agency for International Development who could consolidate the input 
from its various regional bureaus and report on implementation efforts 
to ONDCP. These officials said that ONDCP and the U.S. Agency for 
International Development have since agreed that the solution was to 
have ONDCP consolidate the information received from the U.S. Agency 
for International Development's regional bureaus. 

Figure 3: Number of Action Items in ONDCP Implementation Status 
Categories by Strategy Objective, as of November 2011: 

[Refer to PDF for image: stacked horizontal bar graph] 

2010 National Drug Control Strategy objectives: 

Number of action items in ONDCP implementation status categories: 

Strengthen Efforts to Prevent Drug Use in Our Communities: 
Number of action items in ONDCP implementation status categories: 
Complete: 4; 
On track: 11; 
Delayed but progressing: 0; 
Facing budget issues: 3; 
At risk: 0. 

Seek Early Intervention Opportunities in Health Care: 
Number of action items in ONDCP implementation status categories: 
Complete: 0; 
On track: 9; 
Delayed but progressing: 1; 
Facing budget issues: 0; 
At risk: 0. 

Integrate Treatment for Substance Use Disorders Into Health Care, and 
Expand Support for Recovery: 
Number of action items in ONDCP implementation status categories: 
Complete: 1; 
On track: 10; 
Delayed but progressing: 3; 
Facing budget issues: 0; 
At risk: 0. 

Break the Cycle Of Drug Use, Crime, Delinquency, and Incarceration: 
Number of action items in ONDCP implementation status categories: 
Complete: 3; 
On track: 18; 
Delayed but progressing: 1; 
Facing budget issues: 1; 
At risk: 0. 

Disrupt Domestic Drug Trafficking and Production: 
Number of action items in ONDCP implementation status categories: 
Complete: 2; 
On track: 15; 
Delayed but progressing: 2; 
Facing budget issues: 0; 
At risk: 0. 

Strengthen International Partnerships: 
Number of action items in ONDCP implementation status categories: 
Complete: 0; 
On track: 15; 
Delayed but progressing: 3; 
Facing budget issues: 0; 
At risk: 1. 

Improve Information Systems for Analysis, Assessment, and Local 
Management: 
Number of action items in ONDCP implementation status categories: 
Complete: 4; 
On track: 3; 
Delayed but progressing: 1; 
Facing budget issues: 2; 
At risk: 0. 

Source: GAO analysis of ONDCP data on the implementation status of 
Strategy action items 

Note: ONDCP defines the implementation status categories as follows: 
(1) Complete. The work specifically directed by the Strategy has been 
fulfilled. It does not imply that the larger goals the item supports 
have been entirely achieved or that work in progress in support of 
those goals should be halted. (2) On track. Implementation is under 
way, and the work being done is consistent with the fulfillment of the 
action item within the time frame specified. (3) Delayed but 
progressing. Work has started but has slowed or stalled, or the work 
being done is not ambitious enough to fulfill the action item in the 
time frame specified. (4) Facing budget issues. Work has stopped or 
been significantly impeded by funding shortfalls. (5) At risk. Work 
has never begun or has ceased. 

[End of figure] 

According to ONDCP officials, causes of delays or lack of progress in 
implementing action items include lack of coordination among 
participating agencies, termination of programs, reorganization of 
staff, departure of key personnel, and the need for sufficient 
funding. These officials stated that the actions they have taken to 
address these issues include coordinating at the interagency level by, 
for example, bringing together action item partners; helping to 
establish contacts within other agencies; and highlighting issues in 
ONDCP's annual budget funding guidance that it provides to drug 
control agencies, which is intended to delineate Strategy priorities 
that agencies are expected to fund. They stated that ONDCP must rely 
on agencies to include its priorities in their budget submissions to 
ensure that the Strategy is adequately resourced. Each fiscal year, 
ONDCP assesses the adequacy of agency budget submissions to implement 
the Strategy and certifies or decertifies the submissions accordingly. 
[Footnote 27] 

ONDCP officials stated that the data on which their review of action 
items was based were collected in October 2011, and it is highly 
probable that there has been some movement among the categories since 
then. These officials told us that they plan to update their 
categorizations biannually, with the next review planned for mid-2012. 
To assess the extent to which the Strategy has been implemented, we 
will continue to analyze ONDCP and agency reports on implementation 
progress, including ONDCP's biannual update to its 2011 review of 
action items, and validate the results of this review. We will also 
continue to interview agency officials about actions taken to 
implement and coordinate Strategy action items and assess the effect 
of efforts to address implementation delays or lack of progress. In 
addition, our ongoing work will assess how ONDCP uses the Performance 
Reporting System and associated metrics to assess progress toward 
Strategy goals and objectives relating to prevention and treatment, 
what the metrics indicate about progress made, and agency perspectives 
on the system. 

HHS, DOJ, and Education Fund Multiple Drug Abuse Prevention and 
Treatment Programs and Coordinate through a Variety of Methods: 

Three agencies in the Drug Control Budget allocated nearly 85 percent 
of the funding to federal drug abuse prevention and treatment programs 
included in the Drug Control Budget in fiscal year 2012. Officials 
from HHS, DOJ, and Education agencies reported that they coordinate to 
provide drug abuse prevention and treatment programs through a variety 
of methods. 

Three Agencies in the Drug Control Budget Allocated Nearly 85 Percent 
of Funding to Several Types of Prevention and Treatment Programs in 
Fiscal Year 2012: 

HHS, DOJ, and Education allocated nearly 85 percent of the funding for 
federal drug abuse prevention and treatment programs in the Drug 
Control Budget in fiscal year 2012. Of the approximately $10.1 billion 
allocated by federal agencies for drug abuse prevention and treatment 
programs in fiscal year 2012, HHS allocated approximately $8.3 billion 
and DOJ allocated approximately $186.1 million for prevention and 
treatment programs, while Education allocated almost $64.9 million for 
prevention programs. Specifically, HHS allocated more than 80 percent 
of funding for the drug abuse prevention and treatment programs 
included in the Drug Control Budget. Of the HHS allocation, the 
Centers for Medicare & Medicaid Services allocated about 54 percent of 
the total funding in support of its drug abuse treatment services 
through the Medicare and Medicaid programs. (See fig. 4.) For 
additional information on drug abuse prevention and treatment funding 
allocated by agencies included in the Drug Control Budget in fiscal 
year 2012, see enclosure II. 

Figure 4: Percentages of Drug Abuse Prevention and Treatment Funding 
Allocated by Agencies Included in the Drug Control Budget in Fiscal 
Year 2012, by Agency: 

[Refer to PDF for image: pie-chart and sub-chart] 

Federal agency allocations: 
Department of Agriculture: 0.001%; 
Department of Labor: 0.065%; 
Department of Transportation: 0.191%; 
Court Services and Offender Supervision Agency for the District of 
Columbia: 0.524%; 
Department of Education: 0.641%; 
Office of National Drug Control Policy: 1.070%; 
Department of Justice: 1.839%; 
Federal Judiciary: 1.900%; 
Department of Defense: 2.491%; 
Department of Housing and Urban Development: 4.408%; 
Department of Veterans Affairs: 5.240%; 
Department of Health and Human Services: 81.629%: 
* Centers for Medicare and Medicaid Services: 54%; 
* Substance Abuse and Mental Health Services Administration: 31%; 
* National Institutes of Health: 13%; 
* Indian Health Service: 1.19%; 
* Health Resources and Services Administration: 0.22%. 

Source: GAO analysis of fiscal year 2012 allocated funding reported in 
the fiscal year 2013 Drug Control Budget. 

Note: Values may not add to 100 percent because of rounding. 

[End of figure] 

HHS, DOJ, and Education allocated funding to various types of drug 
abuse prevention and treatment programs, such as those that provide 
grants, education and outreach, and direct service, among other 
things.[Footnote 28] Table 1 identifies the number of drug abuse 
prevention and treatment programs that were allocated funding by each 
of these three agencies, by type of program. 

Table 1: Number of Drug Abuse Prevention and Treatment Programs 
Allocated Funding by the Departments of Health and Human Services, 
Justice, and Education That Are Included in the Drug Control Budget, 
by Type of Program, for Fiscal Year 2012: 

Agency[A]: Department of Health and Human Services[C]; 
Types of programs: 
Grant: 20[D]; 
Education and outreach: 8; 
Direct service: 0; 
Other[B]: 9; 
Total: 37. 

Agency[A]: Department of Justice; 
Types of programs: 
Grant: 5; 
Education and outreach: 1; 
Direct service: 4; 
Other[B]: 0; 
Total: 10. 

Agency[A]: Department of Education[E]; 
Types of programs: 
Grant: 1; 
Education and outreach: 0; 
Direct service: 0; 
Other[B]: 0; 
Total: 1. 

Agency[A]: Total; 
Types of programs: 
Grant: 26; 
Education and outreach: 9; 
Direct service: 4; 
Other[B]: 9; 
Total: 48. 

Source: GAO analysis of information from the Departments of Health and 
Human Services, Justice, and Education. 

Notes: For the purpose of our review, we define drug abuse prevention 
as activities focused on discouraging the first-time use of controlled 
substances and efforts to encourage those who have begun to use 
illicit drugs to cease their use. We define drug abuse treatment to 
include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. 

[A] We define agencies as federal departments and their component 
agencies, bureaus, divisions, and offices. 

[B] Other programs that include drug abuse prevention and treatment 
activities may involve, for example, certifying and maintaining 
quality assurance of laboratories that perform mandatory drug testing 
for federal and federally regulated employees. 

[C] We did not include the Centers for Medicare & Medicaid Services in 
our more detailed review of programs because it allocates funding to 
drug treatment services solely as part of eligible participants' 
medical services and does not fund or administer drug abuse prevention 
or treatment interventions or research. We include the National 
Institutes of Health's (NIH) drug abuse prevention and treatment 
research and development activities that are included in the Drug 
Control Budget in our analysis; however, NIH officials told us that 
the agency does not refer to its research and development activities 
as programs. 

[D] NIH officials told us that four of its activities provide research 
funding through contracts and cooperative agreements, in addition to 
grants. 

[E] The Department of Education is generally prohibited from using 
funds available under the Safe and Drug-Free Schools and Communities 
Act for drug treatment. See 20 U.S.C. § 7164. 

[End of table] 

We found that in fiscal year 2012, HHS, DOJ, and Education primarily 
allocated funding to grant programs through which they award funding 
to states, communities, tribes, and other organizations. These 
grantees then use the federal funds to implement program activities 
involving drug abuse prevention, drug abuse treatment, or both. For 
example: 

* SAMHSA makes grant awards to 50 states, nine territories (including 
the District of Columbia), and one Indian tribe through the Substance 
Abuse Prevention and Treatment Block Grant Program for grantees to 
plan, carry out, and evaluate drug abuse prevention, early 
intervention, treatment, and recovery support services provided for 
individuals, families, and communities affected by substance use 
disorders. Not less than 20 percent of funds awarded under this 
program must be spent by SAMHSA's grantees for drug abuse education, 
counseling, and risk reduction activities.[Footnote 29] 

* The Indian Health Service's (IHS) Urban Indian Health Program Title 
V 4-in-1 Grants program provides funding to urban Indian nonprofit 
organizations to serve urban American Indians and Alaska Natives 
affected by drug abuse through prevention and treatment programs. 

* OJP provides grant funding under the Second Chance Act Adult 
Offenders with Co-Occurring Substance Abuse and Mental Health 
Disorders program.[Footnote 30] Under this program, funding is 
available to grantees to implement or expand treatment programs for 
offenders with co-occurring substance abuse and mental health 
disorders that improve the provision of treatment for these 
individuals. 

Grant programs may also fund technical assistance and training 
activities for grantees. For example, Education awards grants for 
financial and technical assistance under its Safe and Supportive 
Schools program to state education authorities to support statewide 
measurement of, and targeted programmatic interventions to improve, 
conditions for learning in order to help schools improve student 
safety and reduce drug use. Grant programs may also fund drug abuse 
prevention and treatment research activities, such as the National 
Institutes of Health's (NIH) grants for basic and clinical 
neuroscience research, which are intended to expand the agency's 
understanding of the neurobiological, genetic, and behavioral factors 
that underlie drug abuse and addiction. 

HHS and DOJ also allocate funding to public education and outreach 
programs that are implemented directly by the agencies, which may 
distribute information to the public on specific types of drug use or 
disorders, or provide technical assistance and training. For example, 
SAMHSA's Center for the Application of Prevention Technologies 
provides technical assistance and training activities, among other 
activities, to build the ability of SAMHSA's grantees to implement 
prevention interventions. DOJ also allocates funding to direct service 
programs--programs in which an agency directly administers drug abuse 
prevention and treatment interventions to a defined population. For 
example, the Bureau of Prisons (BOP) provides drug abuse prevention 
and treatment services to the federal inmate population. 

Finally, HHS also allocates funding to several other programs that 
include drug abuse prevention and treatment activities. For example, 
SAMHSA allocates funding to the Mandatory Drug Testing program to 
certify and maintain quality assurance of laboratories that perform 
mandatory drug testing for federal and federally regulated employees. 

We also found that HHS and Education allocate funding to programs or 
program components that include drug abuse prevention and treatment 
activities that are not included in these agencies' submissions to the 
Drug Control Budget. Specifically, these programs include the Health 
Resources and Services Administration's (HRSA) Ryan White HIV/AIDS 
program and Health Center Program and Education's 21st Century 
Community Learning Centers program. Officials from HRSA told us that 
the Ryan White HIV/AIDS program is not included in the Drug Control 
Budget because the program does not directly award funding for drug 
abuse treatment, although drug abuse treatment may be one of the many 
services that eligible participants receive. HRSA officials also said 
that the agency does not identify the amount of funds spent on 
specific services until grantees report on how they expended grant 
funds.[Footnote 31] 

HRSA officials also identified a program in which its drug abuse 
prevention activities are not included in the Drug Control Budget, but 
its drug abuse treatment activities are included. Specifically, these 
officials said that funding for the HRSA Health Center Program's drug 
abuse treatment services is included in the Drug Control Budget 
because HRSA can determine the specific amount of funding that health 
center grantees spend on these services. However, HRSA officials said 
it is difficult to quantify the amount of funding used for prevention 
counseling services because they are provided as part of a clinician's 
standard medical services and not as a separate service identifiable 
by a grantee. As a result, the program's drug abuse prevention 
services are not included in the Drug Control Budget. Additionally, 
Education's 21st Century Community Learning Centers program is not 
included in the Drug Control Budget because officials told us that 
drug abuse prevention is only one of a large number of authorized uses 
for these funds. Officials also said that the agency does not have a 
viable, cost-effective methodology for compiling the data that would 
be used to estimate the amount of funds spent on drug abuse prevention 
in this program. 

ONDCP officials told us that they annually review programs and 
agencies that are not included in the budget to determine if it would 
be appropriate to include these programs in the next year's budget. 
For example, the Centers for Medicare & Medicaid Services was added to 
the fiscal year 2012 Drug Control Budget as part of ONDCP's efforts to 
restructure the budget and the agencies it includes. An ONDCP official 
told us that the agency does not estimate the amount of federal drug 
control funding that is not included in the Drug Control Budget. 
However, the official said that the agency is confident that the Drug 
Control Budget includes all federal drug control funding for programs 
that are related to drug control and for which agencies have an 
appropriate methodology to determine funding for inclusion in the Drug 
Control Budget. For a list of drug abuse prevention and treatment 
programs funded by HHS, DOJ, and Education that are either included or 
not included in the Drug Control Budget and details about these 
programs, see enclosure III. 

HHS, DOJ, and Education Officials Reported That They Coordinate to 
Provide Drug Abuse Prevention and Treatment Programs through a Variety 
of Methods: 

Officials from HHS, DOJ, and Education agencies told us they 
coordinate with each other and other federal agencies to deliver and 
fund drug abuse prevention and treatment programs through a variety of 
methods, including jointly administering programs, participating in 
working groups, and working together on an ad hoc basis--such as by 
building relationships with other agencies that support drug abuse 
prevention and treatment programs.[Footnote 32] Officials from HHS, 
DOJ, and Education agencies said that each agency coordinates with 
other federal agencies through the joint administration of programs. 
For example, SAMHSA provides all grant administration and management 
of services for the Drug Free Communities Program, which Congress 
authorizes and appropriates within the ONDCP budget, according to an 
interagency agreement guiding the relationship. ONDCP officials said 
that the agency has partnered with SAMHSA through an interagency 
agreement since 2005. Officials from OJP said that they issue a joint 
grant solicitation with SAMHSA--the Joint Adult Drug Court 
Solicitation--in which OJP provides primary funding for drug court 
management and operations, while SAMHSA officials reported that their 
agency provides funding for enhancement and expansion of substance 
abuse treatment services. Additionally, officials from Education said 
they jointly administer and fund the Safe Schools/Healthy Students 
Initiative with HHS. DOJ is also a partner in this initiative, and 
collaboration among the three agencies is guided by an agreement that 
is signed annually by Education, HHS, and DOJ. According to the 
agreement, the initiative is led, managed, and supported by the three 
agencies to support school and community partnerships with integrated 
systems that prevent drug abuse and violence. Other initiative 
activities include promoting the mental health of students, enhancing 
academic achievement, and creating safe and respectful school climates. 

Officials from HHS, DOJ, and Education agencies told us that another 
way in which they coordinate their drug abuse prevention and treatment 
program efforts is through interagency working groups. HHS, DOJ, and 
Education agency officials told us that they participate in ONDCP's 
IWG to collaborate on the development of the Strategy. HHS agency 
officials also told us they participate in sub-working groups within 
the IWG that meet to discuss specific drug abuse prevention and 
treatment topic areas. According to SAMHSA officials, participating in 
the IWG and its sub-working groups facilitates coordination between 
multiple federal agencies working on similar issues related to drug 
abuse prevention and treatment. 

HHS, DOJ, and Education officials also told us they participate in a 
variety of other federal agency working groups that also address drug 
abuse prevention and treatment activities. For example, officials from 
Education said that they participate in the Interagency Coordinating 
Committee on the Prevention of Underage Drinking, which is chaired by 
the Administrator of SAMHSA. The committee was formally established 
pursuant to the Sober Truth on Preventing Underage Drinking Act and 
focuses on guiding policy and program development across the federal 
government with respect to underage drinking.[Footnote 33] Education 
officials said that this group serves as a mechanism for coordinating 
federal efforts around the issue of underage drinking, and the group 
meets at least once a month to discuss activities across the federal 
government on the issue and how to better coordinate their efforts. In 
addition, officials from OJP and SAMHSA said that OJP initially 
convened an interagency working group--the Federal Consortium to 
Address the Substance Abusing Offender--which works to develop 
information for state and local officials to assist with effective 
drug abuse treatment protocols, communication and reporting 
strategies, data collection, and research on substance abusing 
offenders. SAMHSA now chairs this consortium, which includes 
representatives from agencies involved in addressing issues related to 
drug abuse and crime, including several component agencies from HHS 
and the National Highway Traffic Safety Administration. 

Finally, HHS, DOJ, and Education agency officials said they coordinate 
on an ad hoc basis with officials from other federal agencies to 
support drug abuse prevention and treatment activities. For example, 
NIH officials told us they meet regularly with officials from other 
federal agencies to share information on drug abuse prevention and 
treatment research, such as by participating in conferences held by 
ONDCP. Education officials told us that they worked with NIH's 
National Institute on Drug Abuse to promote National Drug Facts Week 
by publicizing the event to schools and school-based organizations. 
DOJ officials from BOP and OJP also said that they work with officials 
from the Department of Veterans Affairs to better understand how to 
serve veterans involved in the justice system who have drug abuse 
problems. 

Some HHS, DOJ, and Education Grant Programs Require or Give Preference 
to Grantees That Demonstrate Effective Interventions: 

Some HHS, DOJ, and Education grant programs either require grantees to 
demonstrate the effectiveness of the interventions they plan to use in 
drug abuse prevention and treatment programs or give preference to 
grant applicants that include interventions for which there is 
evidence of effectiveness in their grant applications. Program 
effectiveness involves the application of an evaluation method to 
determine whether a program is meeting its goals. HHS's SAMHSA 
officials said that as a condition of funding, the agency requires, as 
part of its grant application process, that most grantees show that 
they will use evidence-based interventions in their programs. These 
officials said grantees can meet this requirement by documenting that 
their interventions have been reviewed in the agency's National 
Registry of Evidence-Based Programs and Practices (NREPP) or in other 
sources that determine effectiveness of interventions. Registries 
supported by HHS, DOJ, and Education include interventions related to 
drug abuse prevention and treatment (among other topics) that are 
determined to be effective through research or evaluation by agency 
officials or their selected reviewers.[Footnote 34] NREPP, established 
by SAMHSA in 1997, reviews interventions to identify those that 
prevent or treat drug abuse, mental illness, or co-occurring disorders 
and promote mental health among individuals, communities, or 
populations. NREPP maintains a searchable online registry, which 
currently includes more than 230 drug abuse prevention and treatment 
and mental health promotion interventions that have been reviewed and 
rated by independent reviewers on their quality of research and 
readiness for dissemination to the public.[Footnote 35] 

Education officials also said that for the department's Safe Schools/ 
Healthy Students grant program, applicants are required to include 
detailed information in their applications that demonstrates that 
their proposed interventions are effective. Applicants may use any 
registry of evidence-based practices and programs, including NREPP or 
Education's What Works Clearinghouse (WWC), according to Education 
officials. The agency's Institute of Education Sciences developed the 
WWC online registry in 2002. It includes education interventions that 
have been reviewed and assessed for their evidence of effectiveness, 
including those that have drug abuse prevention as an outcome. 
[Footnote 36] This registry does not have a primary focus on drug 
abuse prevention interventions, and Education officials said that 
interventions in the WWC that focused solely on drug abuse prevention 
had not been updated since 2006, though they are still available in 
the WWC. According to Education officials, there are no plans to 
update the information on drug abuse in the WWC, as this is not one of 
Education's priority areas. 

DOJ officials told us that during the grant application process for 
some programs, they give preference to applicants that adopt 
interventions for their programs that include features that have been 
determined to be effective. DOJ gives Drug Court Program grant 
applicants greater consideration during review of grant applications 
when they demonstrate that a program's design is consistent with seven 
evidence-based program design features, which OJP considers to be 
indicators of an effective program. For example, evidence-based 
program design features include screening and assessment as well as 
monitoring activities. More specifically, the screening and assessment 
feature requires that applicants demonstrate an ability to screen 
promptly and systematically for all offenders potentially eligible for 
the drug court, identify the agency that will conduct this screening, 
and detail the procedures that will be used for screening. Monitoring 
involves the inclusion of a comprehensive plan to monitor drug court 
participants using random drug testing and community supervision, 
disseminate results efficiently to the drug court team, and 
immediately respond to noncompliance according to established program 
requirements. 

DOJ supports two registries that include interventions related to drug 
abuse prevention and treatment, which can be used as a resource for 
effective programs by grant applicants. OJP's CrimeSolutions.gov is an 
online registry established in 2011 that provides information on 
effective criminal justice programs, including interventions related 
to drug abuse, and had about 190 programs reviewed as of May 2012. 
[Footnote 37] These interventions include drug abuse prevention and 
education interventions, as well as drug abuse treatment, along with 
interventions related to drug and alcohol crimes and offenses. A 
second registry--the Model Programs Guide established in 2000 by the 
Office of Juvenile Justice and Delinquency Prevention--is a database 
that identifies effective programs to prevent and reduce juvenile 
delinquency and related risk factors, such as drug abuse.[Footnote 38] 

While agencies make efforts to ensure that grantees implement 
interventions that have proven to be effective, we found that HHS, 
DOJ, and Education agency officials and the other experts we spoke 
with reported various challenges in identifying interventions that are 
proven effective, including (1) availability of data needed to assess 
effectiveness, (2) ability to determine the impact of prevention 
interventions, and (3) applicability of interventions to different 
population groups. Agency officials and experts told us that local-
level data for assessing the effectiveness of interventions often are 
limited. For example, local data are often not available because of 
the high cost and intensive resources necessary for collection. If 
they are available, there are often gaps in the data--for example, 
data that are collected only every other year. Further, limited 
population-level information exits for smaller populations that may 
bear a disproportionate burden of drug abuse-related morbidity and 
mortality (i.e., American Indian and Alaska Native populations). In 
addition, officials said that determining the impact of a prevention 
intervention can be a challenge because it is often difficult to 
quantify something that did not happen--such as a youth's decision not 
to use illicit drugs--because of a preventive measure. 

Finally, effective interventions may not be applicable to all 
population groups. For example, officials from HHS's IHS reported that 
not all interventions that have demonstrated effectiveness in the 
general population take into consideration the cultural practices or 
needs of specific population groups. As a result, they may not be 
effective for populations--such as the American Indian and Alaska 
Native populations--that were not included in the original 
intervention. IHS officials stated that only two programs included in 
NREPP are specific to the populations that they serve.[Footnote 39] 
Moreover, IHS officials said that since so few evidence-based 
practices have been shown to be effective in the American Indian and 
Alaska Native population, and these practices may be cost prohibitive 
for small programs, community-based and culturally relevant practices 
are generally preferred. As part of our ongoing review, we plan to 
conduct additional work on agencies' efforts to assess program 
effectiveness, and to continue our work examining how these federal 
agencies evaluate their drug abuse prevention and treatment programs. 
For example, during our preliminary work we learned that SAMHSA was 
finalizing draft guidance on program evaluations across the agency 
that will provide information on what types of evaluations should be 
conducted as well as when and how they should be conducted. 

Agency Comments: 

We provided a draft of this report for comment to HHS, DOJ, Education, 
DHS, and ONDCP. ONDCP provided written comments, which are reprinted 
in enclosure IV. ONDCP generally concurred with the findings contained 
in the report, noting that as we reported, 84 percent of action items 
in its Strategy were on track or complete as of November 2011. 
Further, ONDCP said it is committed to expanding the number of 
programs impacting prevention and treatment that are included in the 
Drug Control Budget. For example, ONDCP recently added four programs 
to the Drug Control Budget for fiscal year 2013. HHS, DOJ, Education, 
and DHS did not provide formal written comments to be included in this 
report. Instead, these agencies--and ONDCP--provided technical 
comments that we incorporated as appropriate. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until 30 days 
from the report date. At that time, we will send copies to the 
appropriate congressional committees; the Secretaries of Health and 
Human Services, Education, and Homeland Security; the Attorney General 
and the Director of the Office of National Drug Control Policy. In 
addition, this report will be available at no charge on the GAO 
website at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact Linda T. Kohn at (202) 512-7114 or kohnl@gao.gov or Eileen R. 
Larence at (202) 512-8777 or larencee@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. Key contributors to this report are 
listed in enclosure V. 

Signed by: 

Linda T. Kohn: 
Director, Health Care: 

Signed by: 

Eileen Regan Larence: 
Director, Homeland Security and Justice Issues: 

Enclosures - 5. 

[End of section] 

Enclosure I: Scope and Methodology: 

To provide an initial review of the extent to which the 2010 National 
Drug Control Strategy (Strategy) has been implemented, we analyzed the 
2010 Strategy and 2011 update, Office of National Drug Control Policy 
(ONDCP) documents on implementation progress, and implementation plans 
and reports from selected federal drug control agencies that we 
received as of April 3, 2012. We also interviewed officials from ONDCP 
and selected agencies to obtain information on how ONDCP worked with 
agencies to develop the Strategy and assess implementation progress, 
as well as the status of Strategy implementation. Based on such 
factors as the number of Strategy action items for which agencies are 
responsible, the size of drug control budgets, and a balance of drug 
prevention, treatment, and law enforcement missions, we selected the 
following seven agencies to focus on in our review: 

* within the Department of Health and Human Services (HHS), the 
Substance Abuse and Mental Health Services Administration (SAMHSA), 
National Institutes of Health (NIH), and Centers for Disease Control 
and Prevention; 

* within the Department of Justice (DOJ), the Office of Justice 
Programs (OJP) and Drug Enforcement Administration (DEA); 

* within the Department of Homeland Security (DHS), U.S. Customs and 
Border Protection; and: 

* the Department of Education (Education). 

As of April 2012, we interviewed officials from the following four 
agencies: HHS, DHS, OJP, and DEA. Within OJP, we interviewed officials 
from the Office of Juvenile Justice and Delinquency Prevention, Bureau 
of Justice Assistance, Bureau of Justice Statistics, and National 
Institute of Justice. We are providing results of our initial review 
of the implementation of the Strategy, including how ONDCP worked with 
stakeholders to develop the Strategy and mechanisms ONDCP established 
to monitor implementation progress. As part of our ongoing review, we 
plan to conduct additional work on the extent to which the 2010 
Strategy has been implemented and coordinated across agencies and how 
ONDCP assesses the effectiveness of the Strategy in preventing and 
reducing drug use. 

To identify which federal agencies fund drug abuse prevention and 
treatment programs, we reviewed the fiscal year 2012 Drug Control 
Budget. In addition, to identify the amount of funding agencies 
allocated to these programs from available appropriations in fiscal 
year 2012, we reviewed the fiscal year 2013 Drug Control: 

Budget because it included additional information about allocated 
funding for fiscal year 2012.[Footnote 40] We also interviewed ONDCP 
officials to confirm their process for developing the Drug Control 
Budget and criteria for including programs in the budget. 
Additionally, we reviewed the drug abuse prevention and treatment 
programs of three national drug control agencies--HHS, DOJ, and 
Education--in more detail. We selected these agencies because they 
have some of the largest drug control budgets for drug abuse 
prevention and treatment activities, according to the fiscal year 2012 
Drug Control Budget.[Footnote 41] To obtain more detail about these 
agencies' programs, we identified component agencies within HHS, DOJ, 
and Education that fund drug abuse prevention and treatment programs 
included in the Drug Control Budget, collected program-specific 
information from these component agencies using a standard collection 
instrument, and interviewed agency officials responsible for these 
programs. The agencies we reviewed included: 

* within HHS, the Health Resources and Services Administration, Indian 
Health Service, NIH,[Footnote 42] and SAMHSA;[Footnote 43] 

* within DOJ, the Bureau of Prisons, DEA, and OJP (including officials 
from OJP's Bureau of Justice Assistance and Office of Juvenile Justice 
and Delinquency Prevention); and: 

* within Education, the Office of Elementary and Secondary Education. 

We also determined whether the agencies that we reviewed administered 
programs that included drug abuse prevention and treatment activities 
that do not meet ONDCP's standards for having an acceptable budget 
estimation methodology and therefore were not represented in the Drug 
Control Budget. We spoke with these officials to identify any 
limitations and resolve any discrepancies between the agencies' 
reported drug abuse prevention and treatment information and data and 
the fiscal year 2012 Drug Control Budget. We determined that the Drug 
Control Budget data are reliable for our purposes. Finally, to 
identify coordination efforts between agencies funding drug abuse 
prevention and treatment programs, we interviewed officials from HHS, 
DOJ, and Education agencies who oversee these programs and reviewed 
policies and related documents to identify these agencies' 
coordination efforts. 

To provide an initial review of the extent to which federal agencies 
assess the effectiveness of their drug abuse prevention and treatment 
programs, we interviewed officials from our selected national drug 
control agencies as well as experts in the field of drug abuse 
prevention and treatment. These experts included staff from the 
Community Anti-Drug Coalitions of America, National Academies of 
Science, National Association of State Alcohol/Drug Abuse Directors, 
RAND Drug Policy Research Center, RAND Promising Practices Network, 
and University of Colorado Blueprints for Violence Prevention, and a 
university-based prevention expert.[Footnote 44] We are providing 
initial results from our ongoing review of agencies' efforts to assess 
their programs' effectiveness. As part of our ongoing review, we plan 
to conduct additional work on HHS's, DOJ's, and Education's efforts to 
assess program effectiveness, and to continue work examining how these 
agencies evaluate their drug abuse prevention and treatment programs. 

We conducted this performance audit from January 2012 through July 
2012 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

[End of section] 

Enclosure II: Funding Allocated by Federal Agencies in the Drug 
Control Budget for Drug Abuse Prevention and Treatment Programs, 
Fiscal Year 2012: 

In fiscal year 2012, federal agencies included in the Drug Control 
Budget allocated approximately $10.1 billion in funding to support or 
provide drug abuse prevention and treatment services. Approximately 14 
percent of these funds, or almost $1.4 billion, was allocated for drug 
abuse prevention services and over 86 percent of these funds, or over 
$8.7 billion, for drug abuse treatment services.[Footnote 45] Of the 
funding allocated for drug abuse prevention and treatment services, 
the Department of Health and Human Services allocated approximately 
$8.3 billion and the Department of Justice allocated approximately 
$186.1 million for prevention and treatment programs, while the 
Department of Education allocated almost $64.9 million. (See table 2.) 

Table 2: Funding Allocated by Federal Agencies in the Drug Control 
Budget for Drug Abuse Prevention and Treatment Programs, Fiscal Year 
2012: 

Department or independent agency: Department of Agriculture[A]; 
Allocated funding, prevention programs: $0.1 million; 
Allocated funding, treatment programs: 0; 
Total: $0.1 million. 

Department or independent agency: Court Services and Offender 
Supervision Agency for the District of Columbia; 
Allocated funding, prevention programs: $18.8 million; 
Allocated funding, treatment programs: $34.2 million; 
Total: $53.1 million. 

Department or independent agency: Department of Defense; 
Allocated funding, prevention programs: $155.6 million; 
Allocated funding, treatment programs: $96.5 million; 
Total: $252.1 million. 

Department or independent agency: Department of Defense; Drug 
Interdiction and Counterdrug Activities; 
Allocated funding, prevention programs: $155.6 million; 
Allocated funding, treatment programs: 0; 
Total: $155.6 million. 

Department or independent agency: Department of Defense; Defense 
Health Program; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $96.5 million; 
Total: $96.5 million. 

Department or independent agency: Department of Education[B]; 
Allocated funding, prevention programs: $64.9 million; 
Allocated funding, treatment programs: 0; 
Total: $64.9 million. 

Department or independent agency: Federal Judiciary; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $192.2 million; 
Total: $192.2 million. 

Department or independent agency: Department of Health and Human 
Services; 
Allocated funding, prevention programs: $1.0173 billion; 
Allocated funding, treatment programs: $7.2413 billion; 
Total: $8.2586 billion. 

Department or independent agency: Department of Health and Human 
Services; Centers for Medicare & Medicaid Services; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $4.4674 billion; 
Total: $4.4674 billion. 

Department or independent agency: Department of Health and Human 
Services; Health Resources and Services Administration; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $18.1 million; 
Total: $18.1 million. 

Department or independent agency: Department of Health and Human 
Services; Indian Health Service; 
Allocated funding, prevention programs: $18.7 million; 
Allocated funding, treatment programs: $79.4 million; 
Total: $98.1 million. 

Department or independent agency: Department of Health and Human 
Services; National Institutes of Health; 
Allocated funding, prevention programs: $437.5 million; 
Allocated funding, treatment programs: $671.6 million; 
Total: $1.1092 billion. 

Department or independent agency: Department of Health and Human 
Services; Substance Abuse and Mental Health Services Administration; 
Allocated funding, prevention programs: $561.0 million; 
Allocated funding, treatment programs: $2.0048 million; 
Total: $2.5658 million. 

Department or independent agency: Department of Housing and Urban 
Development; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $446.0 million; 
Total: $446.0 million. 

Department or independent agency: Department of Justice; 
Allocated funding, prevention programs: $7.1 million; 
Allocated funding, treatment programs: $179.0 million; 
Total: $186.1 million. 

Department or independent agency: Department of Justice; Bureau of 
Prisons; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $93.5 million; 
Total: $93.5 million. 

Department or independent agency: Department of Justice; Drug 
Enforcement Administration; 
Allocated funding, prevention programs: $2.1 million; 
Allocated funding, treatment programs: 0; 
Total: $2.1 million. 

Department or independent agency: Department of Justice; Office of 
Justice Programs; 
Allocated funding, prevention programs: $5.0 million; 
Allocated funding, treatment programs: $85.5 million; 
Total: $90.5 million. 

Department or independent agency: Department of Labor; 
Allocated funding, prevention programs: $6.6 million; 
Allocated funding, treatment programs: 0; 
Total: $6.6 million. 

Department or independent agency: Office of National Drug Control 
Policy; 
Allocated funding, prevention programs: $98.6 million; 
Allocated funding, treatment programs: $9.6 million; 
Total: $108.2 million. 

Department or independent agency: Department of Transportation; 
Allocated funding, prevention programs: $19.3 million; 
Allocated funding, treatment programs: 0; 
Total: $19.3 million. 

Department or independent agency: Department of Transportation; 
Federal Aviation Administration; 
Allocated funding, prevention programs: $16.6 million; 
Allocated funding, treatment programs: 0; 
Total: $16.6 million. 

Department or independent agency: Department of Transportation; 
National Highway Traffic Safety Administration; 
Allocated funding, prevention programs: $2.7 million; 
Allocated funding, treatment programs: 0; 
Total: $2.7 million. 

Department or independent agency: Department of Veterans Affairs[C]; 
Allocated funding, prevention programs: 0; 
Allocated funding, treatment programs: $530.2 million; 
Total: $530.2 million. 

Department or independent agency: Total[D]; 
Allocated funding, prevention programs: $1.3883 billion; 
Allocated funding, treatment programs: $8.7290 billion; 
Total: $10.1173 billion. 

Source: GAO analysis of fiscal year 2012 allocated funding reported in 
the fiscal year 2013 Drug Control Budget. 

Notes: We used the fiscal year 2013 Drug Control Budget because it 
included additional information about the allocation of funding for 
fiscal year 2012. Although the Office of National Drug Control Policy 
refers to enacted funding in its Drug Control Budget, we use the term 
allocated funding. For the purpose of our review, we define drug abuse 
prevention as activities focused on discouraging the first-time use of 
controlled substances and efforts to encourage those who have begun to 
use illicit drugs to cease their use. We define drug abuse treatment 
to include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. 

[A] The Department of Agriculture allocates funding to drug abuse 
prevention programs through the U.S. Forest Service. 

[B] The Department of Education is generally prohibited from using 
funds available under the Safe and Drug-Free Schools and Communities 
Act for drug treatment. See 20 U.S.C. § 7164. 

[C] The Department of Veterans Affairs allocates funding to drug abuse 
treatment programs through the Veterans Health Administration. 

[D] The total amount in each column represents the sum of department 
and independent agency activities. Columns may not add to 
corresponding totals because of rounding. 

[End of table] 

[End of section] 

Enclosure III: Overview of Drug Abuse Prevention and Treatment 
Programs Allocated Funding by Three Agencies, Fiscal Year 2012: 

The Department of Health and Human Services, Department of Justice, 
and Department of Education reported that the agencies allocated 
funding to a variety of drug abuse prevention and treatment programs 
in fiscal year 2012, including grants, education and outreach, and 
direct service programs. Tables 3 through 6 provide an overview of 
these programs. 

Table 3: Department of Health and Human Services Drug Abuse Prevention 
and Treatment Programs Allocated Funding, Fiscal Year 2012: 

Health Resources and Services Administration: 

Program: Health Center Program[A]; 
Program activities: Prevention and treatment; 
Program type: Grant; 
Targeted beneficiaries: Medically underserved areas and populations; 
Program description: Delivers comprehensive primary health care, 
including drug abuse prevention and treatment, to vulnerable 
populations. Grantees include public and nonprofit private entities, 
including tribal, faith-based, and community-based organizations. 

Program: Ryan White HIV/AIDS Program[B]; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Persons living with HIV/AIDS; 
Program description: Addresses the unmet care and treatment needs of 
persons living with HIV/AIDS who are uninsured or underinsured and 
have limited or no resources to pay for HIV/AIDS health care and vital 
health-related support services, such as drug abuse treatment. 
Grantees include states, territories, and community-based and 
nonprofit organizations. 

Indian Health Service: 

Program: Alcohol and Substance Abuse Program; 
Program activities: Prevention and treatment; 
Program type: Other; 
Targeted beneficiaries: American Indian and Alaska Native youth and 
adults; 
Program description: Provides alcohol and drug abuse prevention, 
educational, and treatment services through federal, tribal, and urban 
Indian health facilities through an integrated behavioral health 
approach to prevent or reduce the incidence of alcoholism and drug 
abuse in American Indian/Alaska Native communities. 

Program: Methamphetamine and Suicide Prevention Initiative; 
Program activities: Prevention and treatment; 
Program type: Other; 
Targeted beneficiaries: American Indian and Alaska Native youth and 
adults; 
Program description: Supports community-based pilot projects that 
promote the expansion of existing and development of new 
methamphetamine and suicide prevention and treatment programs that use 
evidence-based and practice-based models created and managed by 
communities. 

Program: Urban Indian Health Program Title V 4-in-1 Grants; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: American Indian and Alaska Native youth and 
adults; 
Program description: Provides funding to nonprofit urban Indian health 
programs to carry out alcohol and substance inpatient and outpatient 
treatment, counseling, and referrals for service. 

Substance Abuse and Mental Health Services Administration (SAMHSA): 

Program: Access to Recovery; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: All populations requiring recovery support 
services; 
Program description: Provides funds for grantees, including states, 
tribes, and tribal organizations, to carry out voucher programs that 
expand drug abuse treatment capacity and promote choice among clinical 
treatment and recovery support providers in order to facilitate 
recovery from drug abuse. 

Program: Addiction Technology Transfer Centers (ATTC); 
Program activities: Treatment; 
Program type: Education and outreach; 
Targeted beneficiaries: Drug addiction treatment workforce; 
Program description: Funds ATTCs, which disseminate evidence-based and 
promising practices information to drug addiction treatment and 
recovery professionals, among others, through technical assistance, 
training events, educational and training materials, and web-based 
resources. 

Program: Center for the Application of Prevention Technologies; 
Program activities: Prevention; 
Program type: Education and outreach; 
Targeted beneficiaries: SAMHSA grantees; 
Program description: Promotes behavioral health promotion technologies 
through training and technical assistance activities to develop the 
skills, knowledge, and expertise of grantees' prevention workforces. 

Program: Children and Family Programs; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Adolescents and their families/primary 
caregivers; 
Program description: Addresses gaps in drug abuse services by 
providing services to adolescents and their families/primary 
caregivers using previously proven effective practices that are family 
centered. Grantees include domestic and private nonprofit entities, 
such as state and local governments, tribal organizations, 
universities and colleges, and faith-based organizations. 

Program: Criminal Justice Activities; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Adolescents and adults with drug abuse 
disorders, co-occurring drug abuse and mental disorders, or both; 
Program description: Provides a coordinated and comprehensive 
continuum of programs and services to help program beneficiaries 
recover their lives and become productive, responsible, law-abiding 
citizens. Activities include grant programs that focus on diversion, 
alternatives to incarceration, and reentry from incarceration. Grant 
program applicants include entities such as misdemeanor or felony 
adult criminal courts, juvenile or adult courts, family/child 
dependency courts, and entities that are tribal, state, or local 
government proxies. 

Program: Fetal Alcohol Spectrum Disorders; 
Program activities: Prevention; 
Program type: Education and outreach; 
Targeted beneficiaries: Women of childbearing age; 
Program description: Identifies and disseminates information about 
innovative techniques and effective strategies for preventing fetal 
alcohol spectrum disorders and increasing functioning and quality of 
life for individuals and their families affected by these disorders. 

Program: Health Surveillance and Program Support; 
Program activities: Prevention and treatment; 
Program type: Other; 
Targeted beneficiaries: Not applicable; 
Program description: Provides funding for personnel costs, building 
and facilities, equipment, supplies, administrative costs, and 
associated overhead to support SAMHSA programmatic activities, such as 
drug abuse prevention and treatment programs, and funding for SAMHSA 
national data collection and survey systems. 

Program: Mandatory Drug Testing; 
Program activities: Prevention; 
Program type: Other; 
Targeted beneficiaries: Workplace institutions; 
Program description: Provides funding for the accreditation and 
ongoing quality assurance of laboratories that perform mandatory drug 
testing for federal and nonfederal employees. The program also 
provides the Workplace Helpline, a toll-free telephone service for 
business and industry that answers questions about drug abuse in the 
workplace. 

Program: Military Families; 
Program activities: Prevention and treatment; 
Program type: Education and outreach; 
Targeted beneficiaries: Servicemembers, veterans, and their families; 
Program description: Establishes policy academies that help states and 
territories strengthen their behavioral health care systems and 
services for military families, such as drug abuse prevention and 
treatment programs, through the development of interagency strategic 
plans and technical assistance to facilitate the implementation of 
those plans. 

Program: Minority AIDS; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Racial and ethnic minorities; women, including 
women with children; adolescents; injection drug users; and 
individuals who have been released from prison within the past 2 years; 
Program description: Awards funds to community-based organizations for 
the delivery of drug abuse treatment and related HIV/AIDS services 
that target one or more high-risk, substance-abusing populations. 
Grantees include community-based organizations. 

Program: Minority Fellowship Program; 
Program activities: Prevention and treatment; 
Program type: Education and outreach; 
Targeted beneficiaries: Minority professionals available to serve 
populations of ethnic minorities with drug abuse and mental health 
disorders; 
Program description: Seeks to improve the quality of drug abuse and 
mental health prevention and treatment delivered to ethnic minorities 
by providing stipends to graduate students to increase the number of 
culturally competent behavioral health professionals who teach, 
administer, conduct services research, and provide direct drug abuse 
and mental health services to underserved minority populations. 

Program: Opioid Treatment Programs; 
Program activities: Treatment; 
Program type: Other; 
Targeted beneficiaries: Adults with substance abuse disorders; 
Program description: Provides pharmacotherapy and counseling as set 
forth under 42 C.F.R. Part 8 for the treatment of opioid dependency. 

Program: Performance and Quality Information Systems; 
Program activities: Prevention and treatment; 
Program type: Other; 
Targeted beneficiaries: Not applicable; 
Program description: Provides funding to support the agency's new 
initiative focusing on data, outcomes, and quality, including 
improving the collection of data for drug abuse and mental disorders. 

Program: Pregnant and Postpartum Women; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Pregnant and postpartum women; 
Program description: Expands the availability of comprehensive, 
residential substance abuse treatment, prevention, and recovery 
support services for pregnant and postpartum women and their minor 
children, including services for nonresidential family members of both 
the women and the children. Grantees include public and private 
nonprofit entities, including state and local governments and tribes 
and tribal organizations. 

Program: Public Awareness and Support; 
Program activities: Prevention and treatment; 
Program type: Education and outreach; 
Targeted beneficiaries: General public; 
Program description: Provides funding to support SAMHSA's public 
communications to increase awareness on drug abuse issues, behavioral 
health, and mental disorders. 

Program: Recovery Community Services Program; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: People with a history of alcohol problems, 
drug abuse problems, or both who are seeking recovery; 
Program description: Responds to the need for community-based recovery 
support services that help prevent drug abuse relapse and promote long-
term recovery by designing and delivering peer-to-peer recovery 
support services. Provides grants to domestic public and private 
nonprofit entities. 

Program: Science and Service Program Coordination; 
Program activities: Prevention; 
Program type: Education and outreach; 
Targeted beneficiaries: States, federally recognized tribes, 
communities, and grantees; 
Program description: Provides technical assistance and training to 
states, tribes, communities, and grantees around substance abuse 
prevention. 

Program: Screening, Brief Intervention, and Referral to Treatment; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Adults seeking care in a variety of settings; 
Program description: Provides grants, in the form of cooperative 
agreements, to general medical and primary health care organizations, 
including hospitals, trauma centers, and health clinics, to integrate 
drug abuse screening, brief intervention, referral, and treatment 
services within these settings. 

Program: Sober Truth on Preventing Underage Drinking Act; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: Youth; 
Program description: Provides grants to organizations that are 
receiving or have received grant funds under the Drug-Free Communities 
Act of 1997 to supplement their current prevention efforts and 
strengthen collaboration and coordination among stakeholders in order 
to achieve a reduction in underage drinking in their communities. 

Program: Special Initiatives Outreach; 
Program activities: Treatment; 
Program type: Education and outreach; 
Targeted beneficiaries: Drug addiction treatment workforce; 
Program description: Funds special initiatives, including the 
Historically Black Colleges and Universities Center for Excellence, 
which promotes leadership development for African Americans in the 
drug abuse and mental health professions. 

Program: Strategic Prevention Framework; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: State, tribal, territorial, and local 
communities; 
Program description: Provides resources to grantees, which include 
states, federally recognized tribes, and U.S. territories, to prevent 
the onset and reduce the progression of drug abuse, including 
childhood and underage drinking; reduce drug abuse-related problems; 
and build prevention capacity and infrastructure at the state, tribal, 
territorial, and community levels. 

Program: Strengthening Treatment Access and Retention; 
Program activities: Treatment; 
Program type: Other; 
Targeted beneficiaries: States; 
Program description: An infrastructure cooperative agreement program 
that promotes state-level implementation of process improvement 
methods by providing grants to states to improve access to and 
retention in outpatient drug abuse treatment. 

Program: Substance Abuse/Minority AIDS Initiative; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: Youth and adult minority populations; 
Program description: Supports efforts to increase access to drug abuse 
and HIV prevention services for the highest-risk and hardest-to-serve 
racial and ethnic minority populations. Provides grants to community-
level public and private nonprofit entities. 

Program: Targeted Capacity Expansion - General; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: SAMHSA grantees; 
Program description: Provides funding to expand or enhance a 
community's ability to provide rapid, strategic, comprehensive, 
integrated, community-based responses to a specific, well-documented 
drug abuse problem. 

Program: Treatment Systems for Homeless; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Homeless individuals; 
Program description: Enables communities to expand and strengthen 
their drug abuse treatment services for homeless individuals with drug 
abuse disorders. Grantees include domestic public and private 
nonprofit entities. 

Source: GAO analysis of Department of Health and Human Services 
information. 

Notes: For the purpose of our review, we define drug abuse prevention 
as activities focused on discouraging the first-time use of controlled 
substances and efforts to encourage those who have begun to use 
illicit drugs to cease their use. We define drug abuse treatment to 
include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. 

[A] According to Health Resources and Services Administration 
officials, funding for prevention services in the Health Center 
Program is not included in the Drug Control Budget because it is 
difficult to quantify the amount of funding that is allocated 
specifically to prevention services. 

[B] According to Health Resources and Services Administration 
officials, funding for the Ryan White HIV/AIDS Program is not included 
in the Drug Control Budget because the program does not directly award 
funding for drug abuse treatment, although drug abuse treatment may be 
one of many services that eligible participants receive. 

[End of table] 

Table 4: Department of Health and Human Services Drug Abuse Prevention 
and Treatment Research and Development Efforts Allocated Funding, 
Fiscal Year 2012: 

National Institutes of Health (NIH): 

Research and development efforts: Basic and Clinical Neuroscience 
Research; 
Research and development efforts: Prevention and treatment; 
Research activities: Grant, contract, cooperative agreement; 
Research type: Animal/human adults and youth; 
Research description: At NIH's National Institute of Drug Abuse 
(NIDA), the basic and clinical neuroscience programs work together to 
expand our understanding of the neurobiological, genetic/epigenetic, 
and behavioral factors that underlie drug abuse and addiction. 
Specifically, they examine which variables influence risk of drug 
abuse, addiction, and drug-related disorders; how drug exposure and 
addiction alter the brain, including the effects of drugs on the 
expression or silencing of genes; and how resultant changes affect 
brain function and consequent behaviors. 

Research and development efforts: Clinical Trials Network; 
Research and development efforts: Treatment; 
Research activities: Grant, contract, cooperative agreement; 
Research type: Human adults and youth; 
Research description: Within NIH, NIDA's National Drug Abuse Treatment 
Clinical Trials Network (CTN) comprises 13 research nodes and more 
than 240 individual community treatment programs in 38 states, plus 
the District of Columbia and Puerto Rico. The CTN develops and tests 
treatment protocols for drug abuse and addiction and related 
conditions, such as comorbid mental health disorders and HIV, testing 
the real-world effectiveness of promising medication and behavioral 
approaches with diverse patient populations and community treatment 
providers. It also serves as a research training platform and helps 
NIDA respond to emerging public health threats. 

Research and development efforts: Epidemiology, Services and 
Prevention Research; 
Research and development efforts: Prevention and treatment; 
Research activities: Grant, contract, cooperative agreement; 
Research type: Human adults and youth; 
Research description: At NIH's NIDA, this program area supports 
integrated approaches to understand and address the interactions 
between individuals and environments that contribute to drug abuse and 
related problems. Large surveys and surveillance networks that monitor 
drug-related issues exemplify programs supported by this NIDA 
division. Program efforts help identify substance abuse trends 
locally, nationally, and internationally; guide development of 
responsive interventions for a variety of populations; and determine 
optimal service delivery in real-world settings. 

Research and development efforts: Intramural Research Program; 
Research and development efforts: Prevention and treatment; 
Research activities: Other; 
Research type: Animal/human adults and youth; 
Research description: The Intramural Research Program performs cutting-
edge research within a coordinated multidisciplinary framework. The 
program attempts to (1) elucidate the nature of the addictive process; 
(2) determine the potential use of emerging new therapies for 
substance abuse, both pharmacological and psychosocial; and (3) 
establish the long-term consequences of drug abuse on systems and 
organs, with particular emphasis on the brain and its development, 
maturation, function, and structure. In addition, the program supports 
the HIV/AIDS Pathophysiology and Addiction Medications Discovery 
Program. 

Research and development efforts: Pharmacotherapies and Medical 
Consequences; 
Research and development efforts: Treatment; 
Research activities: Grant, contract, cooperative agreement; 
Research type: Animal/human adults and youth; 
Research description: At NIH's NIDA, this program area is responsible 
for medication development aimed at helping people recover from drug 
abuse and addiction and sustain abstinence, and includes development 
of nonaddictive pain medications. It capitalizes on research showing 
the involvement of different brain systems in drug abuse and 
addiction, beyond the reward circuit, to develop medications in 
response to a variety of newly defined targets. This program area also 
seeks means to address the medical consequences of drug abuse and 
addiction, including infectious diseases, such as HIV. 

Research and development efforts: Research Management and Support; 
Research and development efforts: Prevention and treatment; 
Research activities: Other; 
Research type: Not applicable; 
Research description: Activities provide administrative, budgetary, 
logistical, and scientific support in the review, award, and 
monitoring of research grants, training awards, and research and 
development contracts. Additionally, the functions of Research and 
Management Support encompass strategic planning, coordination, and 
evaluation of NIDA's programs, regulatory compliance, international 
coordination, and liaison with other federal agencies, Congress, and 
the public. 

Research and development efforts: Underage Drinking; 
Research and development efforts: Prevention and treatment; 
Research activities: Grant; 
Research type: Generally individuals under the age of 21; 
however, some follow-up studies assessing consequences of child or 
adolescent alcohol use do go beyond age 21; 
Research description: Research activities include studies on the 
epidemiology of underage drinking and related consequences and the 
etiology of underage drinking, including genetic and environmental 
factors that either protect against or increase risk, and studies 
assessing the consequences of child and adolescent alcohol use, such 
as the effects on the developing brain, and on prevention 
interventions and treatment interventions. 

Source: GAO analysis of Department of Health and Human Services 
information. 

Notes: For the purpose of our review, we define drug abuse prevention 
as activities focused on discouraging the first-time use of controlled 
substances and efforts to encourage those who have begun to use 
illicit drugs to cease their use. We define drug abuse treatment to 
include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. We present information on 
the Department of Health and Human Services' drug abuse prevention and 
treatment research and development activities separately from that 
agency's drug abuse prevention and treatment programs because NIH 
officials told us that the agency does not classify its research and 
development activities as programs. 

[End of table] 

Table 5: Department of Justice Drug Abuse Prevention and Treatment 
Programs Allocated Funding, Fiscal Year 2012: 

Program: Bureau of Prisons (BOP); Program description: [Empty]. 

Program: Community Transition Treatment; 
Program activities: Prevention and treatment; 
Program type: Direct service; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center; 
Program description: Ensures continuation of drug abuse treatment that 
is to provide inmates support as they adjust to community living. 

Program: Drug Education; 
Program activities: Prevention; 
Program type: Direct service; 
Targeted beneficiaries: Inmates who meet criteria for drug abuse 
education; 
Program description: Encourages offenders with a history of drug use 
to review the choices they have made and the consequences of their 
choices, including their choice to use drugs. Drug abuse education 
takes the offender through the cycle of drug use and crime and offers 
compelling evidence of how continued drug use can lead to further 
criminality and related consequences. 

Program: Nonresidential Drug Abuse Treatment; 
Program activities: Treatment; 
Program type: Direct service; 
Targeted beneficiaries: Inmates with minor or low-level substance 
abuse impairment or with longer sentences who are in need of treatment 
and are awaiting placement in the residential program, among others; 
Program description: Provides nonresidential drug abuse treatment at 
every BOP institution, and is a flexible program designed to meet the 
specialized treatment needs of the inmate. 

Program: Residential Drug Abuse Treatment; 
Program activities: Treatment; 
Program type: Direct service; 
Targeted beneficiaries: Inmates who meet diagnostic criteria for 
substance use disorder; 
Program description: Provides intensive drug abuse treatment to 
inmates diagnosed with a drug use disorder. 

Drug Enforcement Administration (DEA): 

Program: Demand Reduction Program; 
Program activities: Prevention; 
Program type: Education and outreach[A]; 
Targeted beneficiaries: States, schools, and communities; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Supports 23 special agents with demand reduction collateral 
duties. These agents serve as demand reduction coordinators supporting 
DEA's law enforcement efforts by developing strategic alliances with 
prevention, treatment, and community coalitions, as well as working in 
partnership with other federal, state, and local government agencies. 

Office of Justice Programs: 

Program: Drug Court Program; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Offenders; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Provides financial and technical assistance to states, state 
courts, local courts, units of local government, and Indian tribal 
governments to develop and implement drug courts that effectively 
integrate evidence-based drug abuse treatment, mandatory drug testing, 
sanctions and incentives, and transitional services in a judicially 
supervised court setting with jurisdiction over drug-abusing offenders. 

Program: Enforcing Underage Drinking Laws; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: Community and youth; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Supports and enhances efforts by states and local jurisdictions 
to reduce the availability of alcohol to minors. The program 
encourages close partnerships between law enforcement agencies and 
community groups involved in preventing and intervening in underage 
drinking. 

Program: Residential Substance Abuse Treatment; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Offenders; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Assists states and units of local government in developing and 
implementing residential substance abuse treatment programs in state 
and local correctional and detention facilities. 

Program: Second Chance Act Adult Offenders with Co-occurring Substance 
Abuse and Mental Health Disorders; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Offenders; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Provides funding to state, local, and federally recognized 
tribal entities to implement and expand offender treatment programs 
for offenders with co-occurring substance abuse and mental health 
disorders. These programs should improve the provision of treatment 
for adult individuals (18 years and over) being treated for co-
occurring substance abuse and mental health disorders within prisons 
and jails, and include both pre-and postrelease programming for every 
program participant. 

Program: Second Chance Act Family-Based Adult Offender Substance Abuse 
Treatment Program, Planning and Demonstration Projects; 
Program activities: Treatment; 
Program type: Grant; 
Targeted beneficiaries: Offenders; 
Targeted beneficiaries: Inmates transferred to a residential reentry 
center: Inmates who meet criteria for drug abuse education: Inmates 
with minor or low-level substance abuse impairment or with longer 
sentences who are in need of treatment and are awaiting placement in 
the residential program, among others: Inmates who meet diagnostic 
criteria for substance use disorder: Drug Enforcement Administration 
(DEA): Awards funds to state and local agencies and federally 
recognized tribal entities to develop and implement comprehensive and 
collaborative strategies that address the challenges posed by reentry 
to increase public safety and reduce recidivism. 

Source: GAO analysis of Department of Justice information. 

Notes: For the purpose of our review, we define drug abuse prevention 
as activities focused on discouraging the first-time use of controlled 
substances and efforts to encourage those who have begun to use 
illicit drugs to cease their use. We define drug abuse treatment to 
include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. 

[A] DEA officials reported that the program does not currently engage 
in outreach activities because of reductions in program funding. 

[End of table] 

Table 6: Department of Education Drug Abuse Prevention Programs 
Allocated Funding, Fiscal Year 2012: 

Program: 21st Century Community Learning Centers[A]; 
Program activities: Prevention; 
Program type: Grant; 
Targeted beneficiaries: Prekindergarten through 12th grade students; 
Program description: Enables communities to establish or expand 
centers that provide additional student learning opportunities to 
complement and reinforce the regular school-day program of 
participating students, such as drug and violence prevention 
activities. 

Program: Safe and Drug-Free Schools and Communities National 
Activities; 
Program activities: Prevention; 
Program type: Grant[B]; 
Targeted beneficiaries: Primarily kindergarten through 12th grade 
students; however, the program also serves some college students; 
Program description: Provides funding to local education agencies and 
a variety of public or private entities for activities designed to 
prevent the illegal use of drugs by and violence among, and promote 
safety and discipline for, students. Activities may include the 
development and dissemination of drug and violence prevention programs 
and activities, technical assistance to grantees to build capacity to 
develop effective drug and violence prevention programs, and the 
collection of data on the incidence and prevalence of drug use and 
violence in schools. 

Source: GAO analysis of Department of Education information. 

Notes: For the purpose of our review, we define drug abuse prevention 
as activities focused on discouraging the first-time use of controlled 
substances and efforts to encourage those who have begun to use 
illicit drugs to cease their use. We define drug abuse treatment to 
include activities focused on assisting regular users of controlled 
substances to become drug free through such means as counseling 
services, inpatient and outpatient care, and demonstration and 
provision of effective treatment methods. 

[A] According to Department of Education officials, this program is 
not included in the Drug Control Budget because of the lack of an 
appropriate budget methodology. 

[B] Department of Education officials said that this program also 
provides technical assistance that is targeted to institutions of 
higher education. 

[End of table] 

[End of section] 

Enclosure IV: Comments from the Office of National Drug Control Policy: 

Executive Office of The President: 
Office of National Drug Control Policy: 
Washington, DC 20503: 

June 22, 2012: 

Linda T. Kohn: 
Director, Health Care: 
Government Accountability Office: 
441 G Street, NW: 
Washington, DC 20548: 

Dear Ms. Kohn: 

Thank you for your interim report entitled Drug Control: Initial 
Review of the National Drug Control Strategy and Drug Abuse Prevention 
and Treatment Programs. Please consider this letter as our response to 
be included in the report. 

The interim report provides an insightful description of how this 
Administration involves both governmental and community stakeholders 
in developing the National Drug Control Strategy. The interim report 
also highlights the Delivery Unit, a new information tracking 
mechanism ONDCP devised to ensure Strategy goals are fulfilled and to 
facilitate the participation or interagency partners in the 
development of future Strategies. 

In the report, GAO recognizes the great strides this Administration 
has made in obtaining input from a broad spectrum or prevention and 
treatment stakeholders in the process for setting the Strategy's drug 
control priorities. The interim report also notes that an entire 
chapter of the Strategy is devoted to improving information systems to 
facilitate implementation. ONDCP's extensive involvement of Federal 
drug control agencies in the development of the priorities has 
contributed to a strong degree of collaboration in their 
implementation. Eighty-four percent of the action items set forth in 
the Strategy were on track or complete as of November 2011. 

I think it is also important for me to make you aware of our future 
efforts. I am pleased about the Administration's continued commitment 
to expand the programs impacting prevention and treatment that arc 
included in the National Drug Control Budget. The Department of 
Housing and Urban Development's Continuum of Care, the Department of 
Labor's Employment and Training Administration, the Department of 
Defense's Defense Health Program, and the Department of Health and 
Human Services' Administration for Children and Families were added to 
the budget in FY 2013. 

In the area of early intervention and treatment, we continue to expand 
Screening, Brief Intervention, and Referral to Treatment services to 
reach more Americans in the health care system, and we are providing 
more patients in health centers across the Nation with access to 
substance use disorder treatment services. ONDCP works with Federal 
agencies, state and local governments, tribes, and national 
organizations to foster the development of recovery-oriented systems 
andd services and to remove legal and regulatory barriers to recovery. 

Thank you again for the efforts you and your staff put forth in 
preparing this helpful description of the processes involved in the 
development and implementation of the National Drug Control Strategy. 
We look forward to working with GAO on the remainder of this important 
project. 

Sincerely, 

Signed by: 

R. Gil Kerlikowske: 
Director: 

[End of section] 

Enclosure V: GAO Contacts and Staff Acknowledgments: 

GAO Contacts: 

Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov: 
Eileen R. Larence, (202) 512-8777 or larencee@gao.gov: 

Staff Acknowledgments: 

In addition to the contacts named above, David Alexander, Assistant 
Director; Karen Doran, Assistant Director; Mary Catherine Hult, 
Assistant Director; George Bogart; Willie Commons III; Susan Czachor; 
Emily Goodman; Cathy Hamann; C. Jenna Sondhelm; and Johanna Wong made 
key contributions to this report. 

[End of section] 

Footnotes: 

[1] Illicit drug use includes marijuana, hashish, cocaine (including 
crack), heroin, hallucinogens, inhalants, or prescription-type 
psychotherapeutics used nonmedically. See Department of Health and 
Human Services Substance Abuse and Mental Health Services 
Administration, Results from the 2010 National Survey on Drug Use and 
Health: Summary of National Findings (Rockville, Md.: September 2011). 

[2] See Department of Justice National Drug Intelligence Center, The 
Economic Impact of Illicit Drug Use on American Society (Washington, 
D.C.: April 2011). 

[3] Pub. L. No. 100-690, §§ 1002, 1003, 102 Stat. 4181, 4182. This 
law, as amended, was repealed on September 30, 1997, by Pub. L. No. 
100-690, § 1009, 108 Stat. 1995 (1994). Congress again established 
ONDCP effective October 21, 1998. Office of National Drug Control 
Policy Reauthorization Act of 1998, Pub. L. No.105-277, div. C, title 
VII, §§ 703, 704, 112 Stat. 2681, 2681-671, 2681-672 (codified as 
amended at 21 U.S.C. §§ 1701 to 1712) (provisions pertaining to 
referenced functions codified as amended at 21 U.S.C. §§ 1702 and 
1703). Pursuant to § 715 of this law (codified as amended at 21 U.S.C. 
§ 1712), provisions relating to ONDCP were "repealed" effective 
September 30, 2010. However, ONDCP has continued to operate pursuant 
to continued funding provided by Congress. Department of Defense and 
Full-Year Continuing Appropriations Act, 2011, Pub. L. No. 112-10, 125 
Stat. 38 (2011), and the Consolidated Appropriations Act, 2012, Pub. 
L. No. 112-74, 125 Stat. 786 (2012). 

[4] For the 2010 Strategy, ONDCP changed its approach and moved from 
publishing a 1-year Strategy to publishing a 5-year Strategy, which is 
to be updated annually. The annual updates are to provide an 
implementation progress report as well as an opportunity to make 
adjustments to goals to reflect policy changes. 

[5] A National Drug Control Program agency is any agency, defined at 
the department or independent agency level, that is responsible for 
implementing any aspect of the Strategy, including any agency that 
receives federal funds to implement any aspect of the Strategy, 
subject to certain exceptions for agencies engaged in intelligence 
activities or activities funded by the Department of Justice. See 21 
U.S.C. § 1701(7). 

[6] See 21 U.S.C. § 1703(c).ONDCP prepares a budget proposal it refers 
to as the National Drug Control Budget Summary. For the purpose of 
this report, we refer to this proposal as the Drug Control Budget. 

[7] An acceptable methodology relies on availability of empirical data 
at the agencies for estimating their drug control budgets. These data 
include determining which portion of an agency's funding is for drug 
control programs or activities versus non-drug control programs. See 
GAO, Office of National Drug Control Policy: Agencies View the Budget 
Process as Useful for Identifying Priorities, but Challenges Exist, 
[hyperlink, http://www.gao.gov/products/GAO-11-261R] (Washington, 
D.C.: May 2, 2011). 

[8] A program may be defined as an activity, project, function, or 
policy with an identifiable purpose or set of objectives. See GAO, 
Designing Evaluations: 2012 Revision, [hyperlink, 
http://www.gao.gov/products/GAO-12-208G] (Washington, D.C.: January 
2012). We consider a program with an identifiable purpose or objective 
relating to drug abuse prevention or treatment as a drug abuse 
prevention or treatment program for the purpose of this report, 
regardless of whether the program has other identifiable purposes or 
objectives. 

[9] Specifically, as of April 2012, we interviewed officials from the 
following four agencies: HHS, DHS, the Office of Justice Programs, and 
the Drug Enforcement Administration. We selected the agencies to focus 
on in our review based on a range of factors, including the number of 
Strategy action items for which agencies are responsible and the size 
of their drug control budgets. 

[10] ONDCP refers to these funds as enacted funding in the Drug 
Control Budget, while in this report we use the term allocated 
funding. At the beginning of a fiscal year, agencies may allocate 
certain amounts from available appropriations for specific programs. 
However, to the extent that an appropriation has not identified a 
particular amount for a specific program, an agency may reallocate 
unobligated funds from that program to another during the course of a 
fiscal year. To the extent other statutory authority results in makes 
mandatory funding for programs that may include drug abuse prevention 
and treatment, such as Medicare and Medicaid, we also include these as 
allocated funds. 

[11] ONDCP developed 106 action items for the 2010 Strategy and 
combined 2 action items and added 8 action items in the 2011 Strategy. 

[12] The allocation of an amount to a specific program does not 
indicate that funds in that amount were actually spent on the program. 

[13] See 42 U.S.C. § 300x-22(a). 

[14] The objectives are (1) Strengthen Efforts to Prevent Drug Use in 
Our Communities; (2) Seek Early Intervention Opportunities in Health 
Care; (3) Integrate Treatment for Substance Use Disorders into Health 
Care, and Expand Support for Recovery; (4) Break the Cycle of Drug 
Use, Crime, Delinquency, and Incarceration; (5) Disrupt Domestic Drug 
Trafficking and Production; (6) Strengthen International Partnerships; 
and (7) Improve Information Systems for Analysis, Assessment, and 
Local Management. In addition to the 106 action items in the 2010 
Strategy, ONDCP combined 2 and added 8 action items in the 2011 
Strategy. 

[15] According to ONDCP, participation in the IWG meetings was open to 
any interested agency and included representation from the Drug 
Enforcement Administration and the DHS's U.S. Customs and Border 
Protection. ONDCP also stated that all law enforcement agencies had 
opportunities to provide input on the development of the 2010 
Strategy, such as providing comments on the outline and then drafts of 
the Strategy. 

[16] ONDCP's Fiscal Year 2011 National Drug Control Budget: Are We 
Still Funding the War on Drugs, Before the Subcommittee on Domestic 
Policy of the H. Comm. on Oversight and Government Reform, 111th Cong. 
12 (2010) (statement of R. Gil Kerlikowske, Director, Office of the 
National Drug Control Policy). 

[17] In the 2012 update to the Strategy, ONDCP highlighted the use of 
two synthetic drugs, synthetic marijuana (often known as K2 or Spice) 
and bath salt products. Synthetic marijuana consists of plant 
materials that have been laced with substances that users claim mimic 
the primary psychoactive ingredient in marijuana, and bath salts 
contain man-made chemicals related to amphetamines. 

[18] The MAX Information System is used to support the Office of 
Management and Budget's federal management and budget processes. MAX 
Collect is a data collection and publishing tool within the system. 

[19] As of April 3, 2012, ONDCP had provided all of the implementation 
status reports for prevention and treatment action items submitted by 
our selected DOJ agencies, OJP and DEA. We also had spoken with 
officials in both of these agencies to gain a better understanding of 
the information included in these reports. Agencies have since updated 
the information in their MAX Collect reports in response to a data 
call from ONDCP in April 2012. 

[20] ONDCP provided the following definitions of its categories: (1) 
Complete. The work specifically directed by the Strategy has been 
fulfilled. It does not imply that the larger goals the item supports 
have been entirely achieved or that work in progress in support of 
those goals should be halted. (2) On track. Implementation is under 
way, and the work being done is consistent with the fulfillment of the 
action item within the time frame specified. (3) Delayed but 
progressing. Work has started but has slowed or stalled, or the work 
being done is not ambitious enough to fulfill the action item in the 
time frame specified. (4) Facing budget issues. Work has stopped or 
been significantly impeded by funding shortfalls. (5) At risk. Work 
has never begun or has ceased. 

[21] The Strategy must contain a plan for reducing the consequences of 
illicit drug use, including national health care costs and drug-
related crime and criminal activity. See 21 U.S.C. § 1705(a)(2)(A) 
(vii). 

[22] ONDCP reported on its action item categorizations at an 
interagency meeting in November 2011 with HHS, DOJ, DHS, and other 
agencies to discuss progress toward implementing the Strategy. 

[23] The Office of Faith-Based and Neighborhood Partnerships works to 
form partnerships between the federal government and faith-based and 
neighborhood organizations to more effectively serve Americans in need. 

[24] In its report on HHS's fiscal year 2011 appropriation bill, the 
Senate Committee on Appropriations did not recommend funding for the 
Develop Prevention-Prepared Communities initiative because it believed 
the proposal would be redundant given the work of SAMHSA's 
Partnerships for Success program, which includes implementation of the 
Strategic Prevention Framework. S. Rep. No. 111-243, at 138 (2010) 
(the bill under consideration did not become law). 

[25] According to ONDCP's 2010 Arrestee Drug Abuse Monitoring II 
annual report, data from this program are essential to any 
comprehensive discussion of drug use because they represent a group of 
drug users not well represented in any other survey--males 18 years 
and older at the point of their involvement in the criminal justice 
system. The report shows that these drug users consume drugs at a 
substantially higher frequency than individuals traditionally surveyed. 

[26] The U.S. Agency for International Development provides economic, 
development, and humanitarian assistance around the world in support 
of the foreign policy goals of the United States. 

[27] We reported on the Drug Control Budget process in [hyperlink, 
http://www.gao.gov/products/GAO-11-261R]. If ONDCP determines that an 
agency's fall budget submission is adequate to implement the Strategy, 
ONDCP issues a written notice stating that the agency's drug budget is 
certified. If ONDCP determines that an agency's fall budget submission 
is inadequate, ONDCP issues a written notice stating that the agency's 
drug budget is decertified, and the agency is required to submit a 
revised budget, which is to include the funding levels and specific 
initiatives that would make the budget request adequate to implement 
the Strategy. ONDCP provides a copy of the decertification to the 
Senate and the House of Representatives and the appropriate 
congressional committees. 

[28] The allocation of an amount to a specific program does not 
indicate that funds in that amount were actually spent on the program. 

[29] See 42 U.S.C. § 300x-22(a). 

[30] This program is authorized under the Second Chance Act of 2007, 
which authorizes grants to states, units of local government, 
territories, and Indian tribes to, among other things, improve the 
provision of drug treatment to adult offenders in prisons and jails 
and reduce the use of drugs by long-term substance abusers through the 
completion of parole or court supervision of long-term substance 
abusers. See Pub. L. No. 110-199, § 201(a), 122 Stat. 657, 678 
(codified at 42 U.S.C. § 17521(a)). 

[31] HRSA officials also said that grantees assess service needs in 
their communities and, as a result, may allocate funding for substance 
abuse treatment based on the needs assessment. Grantees are required 
to report expenditures of program funding by type of service annually. 

[32] We did not examine coordination activities for all programs or 
federal agencies, nor did we review all coordination efforts by ONDCP. 
We will examine coordination activities more fully as part of our 
ongoing work. 

[33] Pub. L. No. 109-422, § 2, 120 Stat. 2890 (2006) (codified at 42 
U.S.C. § 290bb-25b(c)). 

[34] These registries are intended to provide the public, including 
grantees and policymakers, with a centralized repository of 
scientifically based information on interventions. The registries 
target different population groups and types of interventions and have 
varying requirements that interventions must meet in order to be 
included. 

[35] According to NREPP, the registry does not include an exhaustive 
list of interventions, and inclusion in the registry does not 
constitute an endorsement. Those who have developed an intervention 
may nominate their interventions for review and inclusion in NREPP. 
See [hyperlink, http://www.nrepp.samhsa.gov]. 

[36] See [hyperlink, http://ies.ed.gov/ncee/wwc]. 

[37] OJP identifies programs for review and inclusion in 
CrimeSolutions.gov through literature searches of relevant databases, 
journals, and publications or nominations from experts, practitioners, 
or others. The registry rates programs as effective, promising, or 
having no effects. See [hyperlink, http://www.crimesolutions.gov]. 
CrimeSolutions.gov is not an exhaustive list of all justice-related 
programs, and a program's inclusion on the site does not constitute an 
endorsement by DOJ, according to information on the website. 

[38] See [hyperlink, http://www.ojjdp.gov/mpg/]. 

[39] IHS officials told us that the agency has created an inventory of 
evidence-based practices, promising practices, local efforts, 
resources, and policies for health services occurring in American 
Indian and Alaska Native communities, schools, work sites, health 
centers, and hospitals. See [hyperlink, http://www.ihs.gov/oscar/]. 

[40] ONDCP refers to these funds as enacted funding in the Drug 
Control Budget, while in this report we use the term allocated 
funding. At the beginning of a fiscal year, agencies may allocate 
certain amounts from available appropriations for specific programs. 
However, to the extent that an appropriation has not identified a 
particular amount for a specific program, an agency may reallocate 
unobligated funds from that program to another during the course of a 
fiscal year. To the extent other statutory authority results in 
mandatory funding for programs that may include drug abuse prevention 
and treatment, such as Medicare and Medicaid, we also include these as 
allocated funds. 

[41] Education is generally prohibited from using funds available 
under the Safe and Drug-Free Schools and Communities Act for drug 
treatment. See 20 U.S.C. § 7164. 

[42] In contrast to federal agencies that implement drug prevention 
and treatment programs, NIH supports the conduct of research to 
develop and test prevention and treatment interventions. The goal of 
this research is to establish an evidence base of effective 
interventions that can be implemented on a broader scale by other 
agencies. 

[43] We included the Centers for Medicare & Medicaid Services in our 
review of HHS agencies' allocations for drug abuse prevention and 
treatment programs. However, we did not include the Centers for 
Medicare & Medicaid Services in our more detailed review of programs 
because it allocates funding to drug treatment services solely as part 
of eligible participants' medical services and does not fund or 
administer drug abuse prevention or treatment interventions or 
research. 

[44] We identified subject matter experts from our review of relevant 
literature and during interviews with identified experts. 

[45] Funding allocated for federal drug abuse prevention and treatment 
programs makes up approximately 40 percent of the funding allocated by 
agencies included in the Drug Control Budget in fiscal year 2012. This 
amount of allocated funding is approximately consistent with fiscal 
year 2011 levels. The other activities included in the remaining 
approximately 60 percent of the budget include domestic law 
enforcement, interdiction, and international drug control activities--
also known as supply reduction activities. 

[End of section] 

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