Abuse of illicit drugs results in significant public health, social, and economic consequences for the United States. For example, the Department of Justices National Drug Intelligence Center estimated that the economic impact of illicit drug use, including the costs of health care, crime, and lost productivity, was more than $193 billion in 2007. Furthermore, the scale of the problem has not improved over the past decade. An estimated 22.5 million Americans aged 12 or older were illicit drug users in 2011, representing 8.7 percent of this population, according to the National Survey on Drug Use and Health. In addition, illicit drug use rates among Americans aged 12 and older from 2009 through 2011 were among the highest since trend data were available in 2002.
Multiple federal departments, agencies, and components (collectively referred to as agencies) administer programs intended to prevent illicit drug use or treat the abuse of illicit drugs. These programs provide or fund a range of servicessuch as education and outreach activities, drug testing, medical evaluation, intervention, and therapyin order to discourage first-time drug use and to assist regular drug users to become and remain drug free. Of the 76 drug abuse prevention and treatment programs GAO reviewed in its March 2013 report, there was evidence of overlap across 59 programs (nearly 80 percent) because they can provide or fund at least one drug abuse prevention or treatment service that one or more other programs can also provide or fund, to similar population groups to reach similar program goals. The Office of National Drug Control Policy (ONDCP) is responsible for, among other things, overseeing and coordinating the implementation of national drug control policy, including drug abuse prevention and treatment program activities, across the federal government to address illicit drug use. ONDCP reported that about $10.1 billion was provided for drug abuse prevention and treatment programs in fiscal year 2012.
See Department of Justice, National Drug Intelligence Center, The Economic Impact of Illicit Drug Use on American Society (Washington, D.C.: April 2011). According to the report, 2007 is the most recent year for which data are available.
Overall illicit drug use includes the use of marijuana (including hashish), cocaine (including crack), heroin, hallucinogens, and inhalants as well as the nonmedical use of prescription drugs, such as pain relievers and sedatives. The 22.5 million represents individuals who reported that they used an illicit drug during the month prior to the survey interview. See Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings (Rockville, Md.: September 2012).
Federal agencies may administer these programs through a variety of means, including, but not limited to, grants to state, local, tribal, and nonprofit entities, contracts to service providers, or services directly provided to beneficiaries by the federal agency itself.
ONDCP was established by the Anti-Drug Abuse Act of 1988, Pub. L. No. 100-690, 102 Stat. 4181, to, among other things, enhance national drug control planning and coordination and represent the drug policies of the executive branch before Congress.
GAO reported in March 2013 that federal drug abuse prevention and treatment programs are fragmented across 15 federal agencies. In fiscal year 2012, about $4.5 billion was allocated to these 15 agencies that administer 76 programs that are, in all or in part, intended to prevent or treat illicit drug use or abuse. Specifically, GAO reported that:
In addition, GAO reported in March 2013 that there was overlap in the drug abuse prevention or treatment services of 59 of the 76 programs that GAO reviewed. For example:
A more in-depth analysis of two areas (prevention services for students and youth, and prevention and treatment services for offenders) found that all the agencies administering these programs took various efforts to coordinate overlapping programs or services where the programs had similar objectives, reducing the risk of duplication. Specifically, GAO reported:
In addition, officials from the Department of Education, ONDCP, and SAMHSA reported that some programs and the services they can provide or fund are distinct because they target specific subgroups among students and youth, or they differ in scope. For example, the 21st Century Community Learning Center program allows for additional uses of funds that are not related to drug abuse prevention, like after-school tutoring and mentoring, and does not require that grantees include drug abuse prevention as a program component. Officials from the Department of Education said this indicates a difference in scope from the Safe Schools/Healthy Students program, which requires grantees to include drug abuse prevention services as a main program component. These officials reported taking steps to identify opportunities for increasing efficiencies. For example, in its fiscal year 2013 budget justification, the Department of Education proposed consolidating several existing programs that seek to help schools provide activities involving alcohol, drug, and violence prevention. According to Department of Education officials, the consolidation would more effectively target resources and address the needs of grantees.
Although the agencies coordination efforts in these two areas were consistent with practices that GAO had previously reported federal agencies use to implement collaborative efforts, not all of the 76 programs surveyed are involved in coordination efforts with other federal agencies. Specifically, officials from 29 of the 76 programs surveyed reported that no staff representing their programs had coordinated with other federal agencies on drug abuse prevention or treatment programs in the year prior to GAOs survey. As GAO has previously reported, because fragmentation across agencies can create an environment in which programs are not delivered as efficiently and effectively as possible, coordination across government is essential. Therefore, there may be additional opportunities to implement interagency coordination efforts among the 29 programs that did not report any such efforts to identify potential efficiencies that better leverage available resources and minimize overlap and potential duplication.
Furthermore, GAO reported that although ONDCP coordinates efforts to develop and implement the National Drug Control Strategy (the Strategy) and budget, it has not systematically assessed drug abuse prevention and treatment programs to examine the extent of overlap and potential for duplication as well as opportunities for greater coordination. Officials from ONDCP and other agencies with whom GAO spoke reported that the StrategyONDCPs plan for reducing illicit drug use and its consequencesemphasizes the importance of coordinating efforts. For example, it designates lead and partner agencies for each of the activities in the Strategy and discusses the use of interagency working group meetings, both of which are used to coordinate Strategy implementation.
In addition, ONDCP officials stated that as part of the offices annual process for developing the National Drug Control Program Budget, they review prevention and treatment programs for which funding is requested to verify that they serve unique populations. However, the purpose of the budget process is to develop a consolidated funding request to implement the Strategy and help ensure that the Strategy has adequate resources rather than to identify overlap or duplication across all programs, or opportunities for coordination. Furthermore, the purpose of the interagency meetings and other efforts to facilitate coordination is to develop and implement the Strategy and not to identify overlap or duplication. Accordingly, ONDCP has not conducted a systematic assessment of all prevention and treatment programs, including those not captured in the budget, and the services they are allowed to provide to determine the extent to which they overlap and where opportunities exist to pursue coordination strategies to more efficiently use limited resources.
GAO also reported in March 2013 that ONDCP established the Performance Reporting System, which includes performance measures to monitor and assess collective agency progress toward achieving National Drug Control Strategy goals and objectives. The office plans to report on results for the first time in 2013. In addition, GAO reported that the 15 agencies administering the 76 drug abuse prevention and treatment programs had completed evaluations of 6 programs since 2007though 22 more program evaluations were under way or planned. While program evaluations allow for comprehensive assessments of whether programs are achieving desired results to help allocate scarce resources to effective interventions, among other things, they are generally not required. ONDCP and agency officials said that they have taken other steps to help ensure that programs are effective, including collecting and analyzing other program performance information or requiring or encouraging the programs to use evidence-based interventions to carry out their programs.
Standards for Internal Control in the Federal Governmenthighlights the importance of having access to operational and other data to determine whether programs are meeting goals for accountability and efficient use of resources. Additionally, the Standard for Project Management states that to ensure related projects are managed to achieve more benefits than could be achieved with stand-alone efforts, management should coordinate common activities or programs and the efficient use of resources across activities. This can include such efforts as mapping out how various activities across organizations will achieve the desired benefits.
For the purpose of its March 2013 report, GAO referred to programs that provide or fund drug abuse prevention and drug abuse treatment services as drug abuse prevention and treatment programs, including those programs that provide or fund services to support program objectives other than the prevention and treatment of drug abuse.
GAO focused its review on programs that administer drug abuse prevention or treatment services. Therefore, GAO excluded programs that, for example, exclusively focus on law enforcement or policy, conduct research, or fund overhead costs. In addition, GAO excluded programs that reimbursed drug abuse treatment services as part of a health benefit plan, such as the Department of Health and Human Services Medicare and Medicaid programs, which account for almost $4.5 billion of the $10.1 billion ONDCP reported was allocated for drug abuse prevention and treatment programs, and the Department of Defenses Defense Health Program, which includes military health benefit plans like TRICARE.
Program officials from 12 of the 20 programs reported that a combined total of around $30 million was obligated for their programs in fiscal year 2011 for drug abuse prevention or treatment services specifically. The remaining 8 programs were not able to provide obligation data specific to drug abuse prevention or treatment services.
To identify overlapthat is, programs providing similar drug abuse prevention or treatment services to similar beneficiaries with a similar goal or objectiveGAO administered a web-based questionnaire to drug abuse prevention and treatment program officials in the 15 agencies included in the review.
The term recidivism generally refers to the act of committing new criminal offenses after having been arrested or convicted of a crime. See GAO, Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts, GAO-12-53 (Washington, D.C.: Dec. 9, 2011).
These programs included 2 programs administered by the Department of Education; 1 program administered by the Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA); 1 program administered by ONDCP; 1 program administered jointly by the Department of Education, SAMHSA, and the Department of Justice; and 1 program administered jointly by SAMHSA and ONDCP.
These programs included 5 programs administered by the Office of Justice Programs (OJP); 4 programs administered by the Bureau of Prisons; 3 programs administered by SAMHSA, 2 programs jointly administered by OJP and SAMHSA; and 1 program administered by the Administrative Office of the United States Courts.
ONDCP is required annually to develop a National Drug Control Strategy, which sets forth a plan to reduce illicit drug use through programs intended to prevent or treat drug use or reduce the availability of illegal drugs. The 2010 National Drug Control Strategy is the inaugural strategy under President Obamas administration and is intended to be a 5-year strategy, with annual updates issued each year.
GAO reported on the National Drug Control Program Budget process in GAO, Office of National Drug Control Policy: Agencies View the Budget Process as Useful for Identifying Priorities, but Challenges Exist, GAO-11-261R (Washington, D.C.: May 2, 2011). Agencies included in the National Drug Control Program Budget are required to follow a detailed process in developing their annual budget submissions. Agencies submit to ONDCP the portion of their budget requests dedicated to drug control. ONDCP provides annual budget recommendations to these agencies that are intended to specifically delineate what priorities each agency is expected to fund in the coming year submission. Each fiscal year, ONDCP assesses the adequacy of agency budget submissions to implement the Strategy and certifies or decertifies the submissions based on its assessment.
Three of the 15 agencies in GAOs review had completed evaluations of 6 programs since 2007, and 8 agencies had started or planned 22 additional evaluations.
Evidence-based interventions are approaches to drug abuse prevention or treatment that are based in theory and have previously undergone scientific evaluation.
Project Management Institute, The Standard for Program Management (Newtown Square, Pa.: 2008).
ONDCP is uniquely situated to conduct an assessment across the 76 drug abuse prevention and treatment programs that GAO identified in its review, nearly 40 percent (29 programs) of which reported not having coordinated with other agencies on drug abuse prevention or treatment programs over the past year. GAOs analysis identified fragmentation and overlap across those 76 programs, which ONDCP could use, along with other information, to identify overlap and potential duplication and opportunities for coordination. Such an assessment would better position ONDCP to help ensure that federal agencies undertaking similar prevention and treatment efforts identify opportunities for increased efficiencies, such as using coordination mechanisms to mitigate the risk of duplication and reducing administrative burdens on grantees, and better leverage available resources. These mechanisms could include, for example, joint program administration, establishing interagency agreements, and sharing requests for grant applications.
Therefore, GAO recommended in March 2013 that the Director of ONDCP take the following action:
The potential financial benefit of this action cannot be known until an assessment is completed.
The information contained in this analysis is based on findings from products listed in the related GAO products section. To identify federal drug abuse prevention and treatment programs, GAO reviewed the fiscal year 2013 National Drug Control Program Budget and the National Drug Control Strategy, among other sources. In identifying these programs, GAO excluded programs that, for example, exclusively focus on law enforcement or policy, conduct research, or fund overhead costs, as well as programs that reimburse drug abuse prevention or treatment services as part of a health benefit plan. GAO distributed a web-based questionnaire to officials at the 15 agencies that administer these programs to collect information such as program purpose, services provided, and population served, and analyzed the responses for 76 programs to identify potential fragmentation, overlap, or duplication based on the framework established in GAOs previous work. The response rate for the questionnaire was 100 percent.
To gather additional information about the programs, GAO also reviewed relevant documents, such as completed program evaluations and agency policies and procedures, and interviewed agency officials who were responsible for overseeing the programs regarding areas of overlap and potential duplication and program evaluations that were completed, under way, or planned since 2007. To assess coordination efforts to reduce overlap or potential duplication, GAO analyzed questionnaire responses on agency efforts to coordinate drug abuse prevention and treatment programs and interviewed ONDCP and agency officials about actions taken to coordinate activities. GAO compared these reported actions to criteria for coordinating interagency efforts identified in our prior work. Table 12 in appendix IV lists the programs GAO identified that might have similar or overlapping objectives, provide similar services, or be fragmented across government missions. Overlap and fragmentation might not necessarily lead to actual duplication, and some degree of overlap and duplication may be justified.
See GAO, Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue, GAO-11-318SP (Washington, D.C.: Mar. 1, 2011) and 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP (Washington, D.C.: Feb. 28, 2012).
GAO defines program evaluations as individual, systematic studies to assess how well a program or programs are working.
GAO selected 2007 as the starting point in order to provide a long enough time frame to include evaluations that may take multiple years to complete.
GAO provided a draft of this report section, as well as the March 2013 report on which it is based, to ONDCP; the Departments of Health and Human Services, Justice, Education, Defense, Housing and Urban Development, Labor, Transportation, and Veterans Affairs; and the Federal Judiciary for review and comment. ONDCP agreed with GAOs recommendation to assess the extent of overlap and potential for duplication across federal drug abuse prevention and treatment programs and identify opportunities for increased coordination. In its comments on both this section and the report, ONDCP reiterated that GAO reported finding overlap but not actual instances of duplication among the drug prevention and treatment programs we reviewed. The office also made the points, with examples, that some overlapping programs (1) may not serve identical populations and may target different specific subgroups of a large population category, such as different types of youth age groups, and (2) may provide distinct services. GAO acknowledged these factors in our report, and maintains that this is why it is important to systematically review the extent of overlap among prevention and treatment programs, taking into account targeted subgroups and allowable services, to help ensure that they efficiently use limited resources to deliver these important services. ONDCP also reiterated, as GAO stated, that overlapping programs may provide positive benefits, such as reinforcing key prevention messages.
Further, the office agreed that coordination efforts among programs can help avoid duplication and maximize program effectiveness. This is consistent with GAOs report, which noted that overlap and fragmentation may not necessarily lead to duplication, but can create an environment in which programs are not delivered as efficiently and effectively as possible, and that coordination among programs helps to reduce the risk of duplication and increase efficiencies. ONDCP stated that while extensive coordination of prevention and treatment programs is already taking place, there is always room for improvement, and that it will work with agencies administering these programs to further enhance coordination. The Departments of Health and Human Services, Justice, Education, Defense, Transportation, and Housing and Urban Development provided technical comments on this section and the report, which were incorporated as appropriate.