Why This Area Is Important

Abuse of illicit drugs results in significant public health, social, and economic consequences for the United States. For example, the Department of Justice’s 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.[1] 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.[2] 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.[3] These programs provide or fund a range of services—such as education and outreach activities, drug testing, medical evaluation, intervention, and therapy—in 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.[4] ONDCP reported that about $10.1 billion was provided for drug abuse prevention and treatment programs in fiscal year 2012.

What GAO Found

GAO reported in March 2013 that federal drug abuse prevention and treatment programs are fragmented across 15 federal agencies.[1] 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.[2] Specifically, GAO reported that:

• 22 programs were drug abuse prevention programs, that is, programs that provide services, allocate funding, or allow for activities focused on discouraging the first-time use of controlled substances—specifically illicit drugs and the problematic use of alcohol—and encouraging those who have begun to use controlled substances to cease their use;
   
• 21 programs were drug abuse treatment programs, that is, programs that provide services, allocate funding, or allow for activities focused on identifying and assisting users of controlled substances—specifically illicit drugs and the problematic use of alcohol—to become drug-free and remain drug-free;
   
• 13 programs were drug abuse prevention and treatment programs; and
   
• 20 programs were neither drug abuse prevention nor treatment programs, but programs that may provide or fund drug abuse prevention or treatment services to support other program objectives, such as promoting housing stability within low-income communities.[3]

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.[4] For example:

• Officials from 6 of the 76 programs reported that their programs can provide or fund drug abuse prevention services for students and youth in order to support program goals of preventing drug use and abuse among young people. For example, officials from all six programs reported that they can provide or fund services to conduct outreach and educate youth on drug use.
   
• Officials from 15 programs reported that their programs can provide or fund many of the same prevention and treatment services to the offender population—that is, those individuals involved in the criminal justice system—in order to support program goals of identifying and meeting the treatment needs of offenders and providing services to reduce recidivism and facilitate reentry.[5] For example, 12 of the 15 programs can provide or fund medical evaluations and different forms of therapy, including individual and family therapy.
   
• Officials from 9 other programs reported that they can provide or fund drug abuse prevention and treatment services to multiple population groups in support of program goals to expand the capacities of state- and community-level entities to respond to and prevent drug abuse. These services include youth education, family education and support services, and public outreach activities.

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:

• Prevention services for students and youth. Although officials from all 6 programs reported that they can provide or fund services to conduct outreach and educate youth on drug use, the risk of duplication among these programs is low because of coordination efforts taken by the administering agencies to improve efficiencies.[6] For example, using an interagency agreement, the Department of Education jointly administers the Safe Schools/Healthy Students program with the Departments of Justice and Health and Human Services to provide complementary educational, mental health, and law enforcement services to prevent youth violence and drug use. Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) and ONDCP maintain an interagency agreement to jointly administer the Drug Free Communities Support program. Officials from SAMHSA explained that the agreement defines the roles and responsibilities of the two agencies, and establishes agreed-upon standard operating procedures.

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.

• Prevention and treatment services for offenders. Officials from the 4 agencies overseeing the 15 programs that can provide or fund some of the same prevention and treatment services to the offender population also cited coordination efforts to help ensure that programs provide complementary services to this population, which can minimize the risk of potential duplication.[7] For example, according to Office of Justice Programs (OJP) and SAMHSA officials, SAMHSA funding for drug courts is used for treatment services, while OJP funding for drug courts is used for administrative or case management purposes. While OJP resources are not restricted from funding the same treatment services SAMHSA can fund, officials from both agencies said that they use multiple coordination mechanisms to help minimize the risk of duplication. For example, OJP and SAMHSA jointly administer two programs. Additionally, officials from OJP and SAMHSA reported that their programs specifically serve offenders in the state and local justice systems, while the four programs administered by the Bureau of Prisons and the one program administered by the Administrative Office of the United States Courts target offenders who are or were incarcerated in federal prisons. Officials from the Bureau of Prisons and the Administrative Office of the United States Courts reported that the two agencies regularly share information and coordinate on prerelease planning for inmates in federal prisons and on transitioning inmates from prison to court-ordered drug testing and treatment after release, or vice-versa.

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.[8] 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 GAO’s 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.[9] 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 Strategy—ONDCP’s plan for reducing illicit drug use and its consequences—emphasizes the importance of coordinating efforts.[10] 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 office’s 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.[11] 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 2007—though 22 more program evaluations were under way or planned.[12] 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.[13]

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.[14] 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.[15] This can include such efforts as mapping out how various activities across organizations will achieve the desired benefits.

Actions Needed

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. GAO’s 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:

• assess the extent of overlap and potential for duplication across federal drug abuse prevention and treatment programs and identify opportunities for increased coordination to help agencies take actions to increase efficiencies and better leverage their resources. ONDCP could use the results of GAO’s analysis in the March 2013 report as a starting point for this assessment.

The potential financial benefit of this action cannot be known until an assessment is completed.

How GAO Conducted Its Work

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 GAO’s previous work.[1] 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[2] 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.[3] 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.[4] 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.

Agency Comments & GAO Contact

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 GAO’s 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 GAO’s 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.

For additional information about this area, contact Eileen Larence at (202) 512-8777, or larencee@gao.gov, or Linda Kohn at (202) 512-7114, or kohnl@gao.gov.

Related Products