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

What GAO Found

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. 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. 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. 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.

Why GAO Did This Study

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. 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.

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. 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. 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) 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. 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 . 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. 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.

For more information contact Linda T. Kohn at (202) 512-7114 or kohnl@gao.gov or Eileen R. Larence at (202) 512-8777 or larencee@gao.gov.