Drug Abuse Treatment:

Efforts Under Way to Determine Effectiveness of State Programs

HEHS-00-50: Published: Feb 15, 2000. Publicly Released: Feb 15, 2000.

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Pursuant to a congressional request, GAO reviewed the efforts by the Substance Abuse and Mental Health Services Administration (SAMHSA) and states to provide effective drug abuse treatment programs, focusing on: (1) activities supported by SAMHSA's Substance Abuse Prevention and Treatment (SAPT) block grant and Knowledge Development and Application (KDA) grant funds for drug abuse treatment; (2) SAMHSA and state mechanisms for monitoring fund use; and (3) SAMHSA and state efforts to determine the effectiveness of drug abuse treatment supported with SAPT block grant funds.

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 all states for treatment services funded through the SAPT block grant program; (3) the 16 states GAO surveyed reported that SAPT funds supported both 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 of the states GAO surveyed reported providing methadone treatment services almost exclusively on an outpatient basis; (6) SAMHSA spent another $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 grants 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) to monitor grantees' use of SAPT and KDA program funds, SAMHSA uses on-site reviews, reviews of independent financial audit reports, and application reviews; (9) these mechanisms are primarily 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; (11) SAMHSA primarily monitors states' compliance with certain statutory requirements for use of funds; (12) the states also monitor SAPT block grant funds using mechanisms similar to SAMHSA's; (13) they used the results of their monitoring efforts, in part, to make drug abuse treatment funding allocation decisions and determine technical assistance needs; (14) 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 arrangement; (15) nine of the 16 states that GAO surveyed have conducted such assessments, but the results vary from state to state; (16) SAMHSA officials believe that collecting uniform state-level client outcome and other performance data are critical to determining the effectiveness of state programs supported with SAPT block grant funds; and (17) however, this effort is not likely to result in uniform state data because some of the states reported that they would not be able to submit all of the requested data.

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