Drug Abuse

The federal governments spends hundreds of millions of dollars on drug abuse treatment through the substance abuse prevention and treatment block grant program. Although the Substance Abuse and Mental Health Services Administration (SAMHSA) monitors state expenditures to determine whether block grant funds are used in accordance with statutory requirements, this type of monitoring is not designed to determine what impact state drug abuse treatment programs are having on the lives of clients. Some states are assessing the effectiveness of their treatment programs by using outcome indicators. SAMHSA officials believe that collecting uniform data on client outcomes at the state level is essential to determine the effectiveness of drug abuse treatment programs supported with federal money and to report the information to Congress. SAMHSA is trying to determine the availability of client outcome data from all states, and it has awarded grants to some states to help them improve their data collection systems. These efforts should help identify states' views on and some of the complexities associated with collecting and reporting outcome data. SAMHSA's efforts should help determine what additional actions are needed to get uniform reporting on the results of drug abuse treatment programs supported by the block grant program. This testimony summarizes the February 2000 report, GAO/HEHS-00-50.

GAO noted that: (1) about $581 million in SAMHSA's fiscal year (FY) 1996 grant funds was spent on drug abuse treatment activities; (2) more than $478 million was spent by the states for treatment services funded through the SAPT block grant program; (3) the 16 states GAO surveyed reported that SAPT funds supported residential and outpatient drug abuse treatment services, including detoxification and methadone maintenance; (4) for half of the states in GAO's survey, outpatient drug abuse treatment services accounted for 57 to 85 percent of their block grant expenditures; (5) all the states GAO surveyed reported providing methadone treatment services almost exclusively on an outpatient basis; (6) SAMHSA spent $25 million of the SAPT block grant for technical assistance and evaluation activities related to drug abuse treatment; (7) the remaining $78 million of SAMHSA's FY 1996 grant funds were KDA funds provided to community-based organizations, universities, and state and local government agencies to develop and disseminate information on promising drug abuse treatment practices; (8) SAMHSA monitors grantees' use of these funds through on-site reviews, reviews of independent financial audit reports, and application reviews; (9) these mechanisms are used to monitor grantees' compliance with program requirements, identify grantees' technical assistance needs, and provide grantees guidance for improving program operations; (10) the accountability system for the SAPT block grant is mostly based on a review of state expenditures designed to determine whether states comply with statutory spending requirements for use of funds, such as those that stipulate that a certain percentage of SAPT block grant funds be spent for alcohol prevention and treatment, drug prevention and treatment, and special populations; (11) SAMHSA's monitoring has not focused on the outcomes of the effectiveness of states' drug abuse treatment programs; (12) several state and SAMHSA efforts are under way to determine the effectiveness of drug abuse treatment programs using client outcome measures, such as drug use, employment, criminal activity, and living conditions; (13) nine of the 16 states have conducted such assessments, but the outcomes measured, populations assessed, methodologies used, and availability of results vary from state to state; (14) SAMHSA is funding a pilot effort to help 19 states develop and uniformly report on a core set of client outcomes; and (15) however, this effort is not likely to result in uniform state data because some of the states GAO surveyed reported that they are not collecting the requested data.