Fast Facts

Drug misuse has been a persistent U.S. public health issue. The Substance Abuse and Mental Health Services Administration administers grant programs that aim to expand access to treatment for substance use disorder.

To help evaluate 3 of the agency's largest grant programs, the agency looks at the number of individuals served. But that data is unreliable. Data for the Substance Abuse Prevention and Treatment Block Grant program, for example, includes some people not served by the program.

Reliable data would paint a more accurate picture of the grant programs' impact. Our recommendations address this.

Types of Drugs Involved in Overdose Deaths, 2002 through 2018

Chart of drugs that cause the most drug overdose deaths

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Highlights

What GAO Found

According to Substance Abuse and Mental Health Services Administration (SAMHSA) data, the number of substance use disorder (SUD) treatment facilities and services increased since 2009. However, potential gaps in treatment capacity remain. For example, SAMHSA data show that, as of May 2020, most counties did not have all levels of SUD treatment available, including outpatient, residential, and hospital inpatient services; nearly one-third of counties had no levels of treatment available. Stakeholders GAO interviewed said it is important to have access to each level for treating individuals with varying SUD severity.

Availability of Substance Use Disorder Treatment Levels, by County, as of May 2020

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SAMHSA primarily relies on the number of individuals served to assess the effect of three of its largest grant programs on access to SUD treatment and recovery support services. However, GAO found the agency lacks two elements of reliable data—that they be consistent and relevant—for the number of individuals served under the Substance Abuse Prevention and Treatment Block Grant (SABG) program. For example, grantee reporting includes individuals served outside of the program, which limits this measure's relevance for program assessment of access. SAMHSA plans to implement data quality improvements for the SABG program starting in fiscal year 2021. However, the agency has not identified specific changes needed to improve the information it collects on individuals served. As SAMHSA moves forward with its plans, it will be important for it to identify and implement such changes. Doing so will allow SAMHSA to better assess whether the SABG program is achieving a key goal of improving access to SUD treatment and recovery services or whether changes may be needed.

Why GAO Did This Study

Treatment for SUD—the recurrent use of substances, such as illicit drugs, causing significant impairment—can help individuals reduce or stop substance use and improve their quality of life. SUDs, and in particular drug misuse, have been a persistent and long-standing public health issue in the United States.

Senate Report 115-289 contains a provision for GAO to review SUD treatment capacity. This report, among other things, describes what is known about SUD treatment facilities, services, and overall capacity; and examines the information SAMHSA uses to assess the effect of three grant programs on access to SUD treatment. GAO analyzed national SAMHSA data on SUD treatment facilities and providers, and reviewed studies that assessed treatment capacity. GAO also reviewed documentation for three of SAMHSA's largest grant programs available to states, and compared the agency's grant data quality to federal internal control standards. Finally, GAO interviewed SAMHSA officials and stakeholders, including provider groups.

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Recommendations

GAO is recommending that SAMHSA identify and implement changes to the SABG program's data collection efforts to improve two elements of reliability—the consistency and relevance—of data collected on individuals served. SAMHSA concurred with this recommendation.

Recommendations for Executive Action

Agency Affected Recommendation Status
Substance Abuse and Mental Health Services Administration The Assistant Secretary for Mental Health and Substance Use should identify and implement changes to the SABG program's data collection efforts to improve two elements of reliability—consistency and relevance—of data collected on the number of individuals who receive SUD treatment and recovery support services with funding from the SABG program. (Recommendation 1)
Open
SAMHSA concurred with this recommendation and has provided regular updates. In June 2021, SAMHSA reported that in the next Substance Abuse Prevention and Treatment Block Grant (SABG) program performance period (August 31, 2021 through August 30, 2022), the agency plans to assess the quality of SABG performance data, including the quality of the data reported by grant recipients, agency use of the data, and the data collection process. The agency also intends to develop a decision support tool that will enable the combination of analysis with prediction capabilities leading to more efficient programmatic decision making. SAMHSA anticipates that these activities will better enable the agency to collect more consistent and relevant data; thus, improving reliability of the data collected on the number of individuals receiving SUD treatment and recovery support services as well as data collected for other performance measures and indicators. We will continue to monitor the agency's progress implementing activities that would address the recommendation and provide updates when the agency takes further action.

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