Substance Use Disorder: Reliable Data Needed for Substance Abuse Prevention and Treatment Block Grant Program
Fast Facts
Drug misuse has been a persistent U.S. public health issue. The Substance Abuse and Mental Health Services Administration administers grant programs that aim to expand access to treatment for substance use disorder.
To help evaluate 3 of the agency's largest grant programs, the agency looks at the number of individuals served. But that data is unreliable. Data for the Substance Abuse Prevention and Treatment Block Grant program, for example, includes some people not served by the program.
Reliable data would paint a more accurate picture of the grant programs' impact. Our recommendations address this.
Types of Drugs Involved in Overdose Deaths, 2002 through 2018
Highlights
What GAO Found
According to Substance Abuse and Mental Health Services Administration (SAMHSA) data, the number of substance use disorder (SUD) treatment facilities and services increased since 2009. However, potential gaps in treatment capacity remain. For example, SAMHSA data show that, as of May 2020, most counties did not have all levels of SUD treatment available, including outpatient, residential, and hospital inpatient services; nearly one-third of counties had no levels of treatment available. Stakeholders GAO interviewed said it is important to have access to each level for treating individuals with varying SUD severity.
Availability of Substance Use Disorder Treatment Levels, by County, as of May 2020
SAMHSA primarily relies on the number of individuals served to assess the effect of three of its largest grant programs on access to SUD treatment and recovery support services. However, GAO found the agency lacks two elements of reliable data—that they be consistent and relevant—for the number of individuals served under the Substance Abuse Prevention and Treatment Block Grant (SABG) program. For example, grantee reporting includes individuals served outside of the program, which limits this measure's relevance for program assessment of access. SAMHSA plans to implement data quality improvements for the SABG program starting in fiscal year 2021. However, the agency has not identified specific changes needed to improve the information it collects on individuals served. As SAMHSA moves forward with its plans, it will be important for it to identify and implement such changes. Doing so will allow SAMHSA to better assess whether the SABG program is achieving a key goal of improving access to SUD treatment and recovery services or whether changes may be needed.
Why GAO Did This Study
Treatment for SUD—the recurrent use of substances, such as illicit drugs, causing significant impairment—can help individuals reduce or stop substance use and improve their quality of life. SUDs, and in particular drug misuse, have been a persistent and long-standing public health issue in the United States.
Senate Report 115-289 contains a provision for GAO to review SUD treatment capacity. This report, among other things, describes what is known about SUD treatment facilities, services, and overall capacity; and examines the information SAMHSA uses to assess the effect of three grant programs on access to SUD treatment. GAO analyzed national SAMHSA data on SUD treatment facilities and providers, and reviewed studies that assessed treatment capacity. GAO also reviewed documentation for three of SAMHSA's largest grant programs available to states, and compared the agency's grant data quality to federal internal control standards. Finally, GAO interviewed SAMHSA officials and stakeholders, including provider groups.
Recommendations
GAO is recommending that SAMHSA identify and implement changes to the SABG program's data collection efforts to improve two elements of reliability—the consistency and relevance—of data collected on individuals served. SAMHSA concurred with this recommendation.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Substance Abuse and Mental Health Services Administration | The Assistant Secretary for Mental Health and Substance Use should identify and implement changes to the SABG program's data collection efforts to improve two elements of reliability—consistency and relevance—of data collected on the number of individuals who receive SUD treatment and recovery support services with funding from the SABG program. (Recommendation 1) |
SAMHSA concurred with this recommendation and has provided regular updates. Starting in June 2021, SAMHSA provided plans to assess the quality of SABG performance data, including the quality of data reported by grant recipients, agency use of that data, and the data collection process through a comprehensive SABG Data Quality Assessment Project. In September 2021, the agency began work with its contractors to gather information for the Project which was used to inform SABG statutory changes, modify program reporting requirements, and make upgrades to its Web Block Grant Application System (WebBGAS). In May 2023, SAMSHA provided evidence of the agency's subsequent steps to address concerns we raised about data inconsistency. For example, SAMHSA expanded grantee training and technical assistance to support grantees' understanding of SABG data requirements and reporting guidance and minimize reporting inconsistencies. SAMHSA also incorporated feedback from grantees regarding data consistency into SAMHSA's Data Strategy that is currently under review and planned for release by the agency. In addition, SAMHSA provided documentation that the agency took steps to address concerns we raised about the relevance of data collected on the number of persons served with SABG program funding. For example, SAMHSA added data review elements to its SABG compliance review protocol to assess the extent to which states' data infrastructure allow for identifying clients that are served with SABG funding separate from other sources of public funding, including Medicaid. The agency also modified the fiscal year 2022-2023 SABG application guidance to clarify state reporting on the number of individuals served by the SABG program. Finally, SAMHSA revised its SABG program guidance for fiscal year 2024-2025 to include a new requirement that states report the number of individuals who receive recovery support services-services that do not typically overlap with Medicaid. The actions SAMHSA has taken should provide more reliable information on the effect of the SABG program on access to substance use disorder treatment. More reliable information provides a better understanding of the extent to which the SABG program is achieving the agency's goals of expanding access to critical substance use treatment and recovery support services and supports the agency in making any adjustments to its approach in administrating the grant program. We consider SAMHSA's actions to meet the intent of our recommendation and therefore we are closing this recommendation as implemented.
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