Drug Abuse Treatment:
Data Limitations Affect the Accuracy of National and State Estimates of Need
HEHS-98-229: Published: Sep 15, 1998. Publicly Released: Sep 15, 1998.
- Full Report:
Pursuant to a congressional request, GAO reviewed the need for drug abuse treatment, focusing on: (1) the Substance Abuse and Mental Health Services Administration's (SAMHSA) efforts to estimate drug abuse treatment need on a national basis, including estimates of subpopulations, and possible limitations of these efforts; and (2) state estimates of drug abuse treatment need.
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.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: SAMHSA officials reported that they are implementing an action plan developed in response to GAO's recommendation. Based on this plan, SAMHSA informed states of GAO's findings and recommendations and their plan for responding, and began conducting quality control checks of data reported in states' block grant applications. A reference was made to SAMHSA's actions in response to GAO's report in the agency's final fiscal year 2001 performance plan.
Recommendation: In keeping with its goal of improving state reporting, the Administrator, SAMHSA, should develop an action plan for how the agency will increase states' reporting of accurate, complete, and consistent treatment need data in block grant applications and include a summary of these actions in the Department of Health and Human Services' year 2000 performance plan.
Agency Affected: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration