Drug Abuse Treatment

The federal government provides about $3 billion annually for drug abuse prevention and treatment activities. Reliable assessments of treatment need--at the national, state, and local levels--are essential to accurately targeting treatment services. Although the Substance Abuse and Mental Health Services Administration (SAMHSA) is trying to improve its national estimates through the expansion of the National Household Survey on Drug Abuse, the survey is still likely to underestimate treatment need. For example, the survey excludes certain groups at high risk of drug use, such as the homeless and prisoners, and does not identify a large enough sample of certain subpopulations, such as pregnant women, to adequately estimate treatment need among these groups. At the same time, the survey's reliance on self-reported data likely results in underreported drug use. Also, the goals of the State Treatment Needs Assessment Program--to help states develop estimates of treatment need and improve state reporting of need data--have not been fully accomplished. Even though states are required to provide estimates of treatment need as part of their block grant applications, not all states report this information and some of the data reported are inaccurate. SAMHSA recognizes the need to increase state reporting and has set a target for increasing the number of states that provide the information. It also recognizes that the overall quality of the data reported is problematic. SAMHSA has not indicated, however, how it will increase state reporting or improve the quality of the data reported by states in block grant applications.

GAO noted that: (1) SAMHSA's national estimates of drug abuse treatment need are primarily derived from the agency's National Household Survey on Drug Abuse (NHSDA); (2) while NHSDA is the principal measure of the prevalence of illicit drug use in the United States, SAMHSA and others have recognized that certain survey limitations affect the accuracy of need estimates, which may result in an underestimate of treatment need; (3) NHSDA's reliance on self-reported data likely results in underreported drug use; (4) to compensate for these limitations, in 1996, SAMHSA developed a method for assessing treatment need that adjusts NHSDA prevalence data with other data sources, including crime reports and treatment facility data; (5) SAMHSA estimated that in 1995, about 8.9 million people in the United States needed treatment for an illicit drug, compared to its estimate of 6.9 million derived solely from NHSDA data; (6) beginning in 1999, SAMHSA will expand NHSDA to provide better national drug use estimates of subpopulations and to provide state estimates of prevalence and treatment need; (7) in any case, these adjustments will only partially correct NHSDA's limitations and are likely to still result in an underestimate of treatment need; (8) states use various methods to develop estimates of treatment need, which are used to help make planning and resource allocation decisions; (9) states are required to report these estimates in applications for federal block grant funds for substance abuse prevention and treatment; (10) GAO's review of fiscal year (FY) 1997 block grant applications show that not all states submitted such data, and of those that did, some submitted incomplete or inaccurate data; (11) according to SAMHSA, the incomplete and inaccurate data are due, in part, to states' lack of sufficient data and resources to complete block grant applications; (12) in response to prior concerns about the lack of state and substate estimates of treatment need, the State Treatment Needs Assessment Program (STNAP), administered by the Center for Substance Abuse Treatment (CSAT), was initiated in 1992; (13) under 3-year contracts with CSAT, states are provided financial and technical assistance for conducting needs assessments and developing estimates of treatment need to include in their block grant applications; and (14) SAMHSA has established the improvement of state STNAP needs assessment reporting as a goal in its FY 1999 performance plan.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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