Substance Abuse Treatment

About 25 percent of all VA patients discharged from inpatient settings in fiscal year 1995 were diagnosed with alcohol or drug abuse problems. VA estimates that it spent $2 billion--or about 12 percent of its total health care budget in fiscal year 1995--to treat veterans with substance abuse disorders. The VA health care system is now evaluating what services to offer and where to provide them. VA's new organizational structure, called the Veterans Integrated Service Network, replaces VA's central office and regional structure with 22 networks of hospitals and clinics. VA expects this consolidation and realignment to boost efficiency by trimming management layers, eliminating duplicative medical services, and making better use of available public and private resources. This report provides information on the (1) characteristics of veterans who receive substance abuse treatment, (2) services that VA offers to veterans with substance abuse problems, (3) methods that VA uses to monitor the effectiveness of its substance abuse treatment programs, (4) community services available to veterans who suffer from substance abuse disorders, and (5) implications of changing VA's current methods for delivering substance abuse treatment.

GAO found that: (1) in fiscal year 1995, VA substance abuse treatment units served about 180,000 veterans; (2) about one half of the inpatients were homeless at the time of admission and about one third had psychiatric disorders; (3) many of these veterans were chronically unemployed, had problems maintaining relationships, reported low incomes, or were criminal offenders; (4) VA provides a variety of treatment settings and approaches; (5) between fiscal years 1991 and 1996, VA funding for treatment increased from $407 million to $589 million to accommodate growth in the substance abuse treatment program; (6) VA lacks the necessary data to adequately measure and fully evaluate the efficacy of its many treatment programs and has primarily relied on utilization information and recidivism rates to monitor the quality of its substance abuse treatment programs; (7) VA is developing a performance monitoring system based on treatment outcome measures; (8) numerous non-VA substance abuse treatment programs are also available to and used by veterans; (9) many veterans treated in community-based public programs are like those treated in VA programs; (10) if VA stopped treating veterans for substance abuse, resulting societal costs may shift to welfare or other social services, other federal or state substance abuse treatment programs, and the criminal justice system; (11) VA cannot ascertain the implications of contracting for these services, since it lacks critical information on the health care needs of eligible veterans, the number of veterans who might seek care, and actual cost of treating veterans with substance abuse disorders; and (12) VA officials have not decided how substance abuse treatment services will be delivered and what outcome measures will be used to evaluate treatment and program effectiveness.