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Block Grant Reporting Section

CFDA 93.959 Substance Abuse 

Prevention and Treatment Block Grant

(SABG)

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration
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Table of Contents 

Section A. Introduction ...................................................................................................................4

Section B. Annual Update ...............................................................................................................7

SABG Table 1 - Priority Areas and Annual Performance Indicators – Progress Report ......................................... 7

Section C. State Agency Expenditure Reports...................................................................................8

SABG Table 2 - State Agency Expenditure Report ...............................................................................................10

Table 3a SABG – Syringe Services Program .........................................................................................................13

Table 3b SABG - Syringe Services Program..........................................................................................................14

SABG Table 4 - State Agency SABG Expenditure Compliance Report..................................................................15

SABG Table 5a SABG Primary Prevention Expenditures Checklist.......................................................................16

SABG Table 5b - SABG Primary Prevention Expenditures by Institute of Medicine (IOM) Categories................19

SABG Table 5c (Requested) - SABG Primary Prevention Targeted ......................................................................20

SABG/MHBG Table 6 - Non-Direct-Services/System Development.....................................................................22

SABG Table 7 – State Entity Inventory.................................................................................................................25

Description of Calculations for MOE Tables 8a and 8b .......................................................................................26

SABG Table 8a - Maintenance of Effort for State Expenditures for SUD Prevention and Treatment .................27

SABG Table 8b - Expenditures for Services to Pregnant Women and Women with Dependent Children ..........28

Section D. Populations and Services Report...................................................................................29

SABG Table 9 - Prevention Strategy Report.........................................................................................................31

SABG Table 10 – Treatment Utilization Matrix....................................................................................................32

SABG Table 11 - Unduplicated Count of Persons Served for Alcohol and other Drug Use..................................34

SABG Table 12 - SABG Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) in 

Designated States................................................................................................................................................36

SABG Table 13 - Charitable Choice – Required....................................................................................................37

Performance Data and Outcomes.......................................................................................................................38

Treatment Performance Measures .....................................................................................................................38

Prevention Performance Measures.....................................................................................................................39

SABG Table 14 – TREATMENT PERFORMANCE MEASURE EMPLOYMENT\EDUCATION STATUS (From Admission 

to Discharge)........................................................................................................................................................41

SABG Table 14 - State Description of Stability in Housing Data Collection .........................................................41

SABG Table 15–TREATMENT PERFORMANCE MEASURE STABILITY OF HOUSING (From Admission to Discharge)

.............................................................................................................................................................................43

SABG Table 15 - State Description of Employment\Education Status Data Collection (SABG) ...........................43

SABG Table 16– TREATMENT PERFORMANCE MEASURE CRIMINAL JUSTICE INVOLVEMENT (From Admission to 

Discharge)............................................................................................................................................................45

SABG Table 16 - State Description of Criminal Involvement Data Collection......................................................45

SABG Table 17 - State Description of Alcohol Use Data Collection .....................................................................47

SABG Table 18 – PERFORMANCE MEASURE CHANGE IN ABSTINENCE -- OTHER DRUG USE (From Admission to 

Discharge)............................................................................................................................................................49

SABG Table 18 - State Description of Other Drug Use Data Collection ...............................................................49

SABG Table 19 – PERFORMANCE MEASURE CHANGE IN SOCIAL SUPPORT OF RECOVERY (From Admission to 

Discharge)............................................................................................................................................................51

SABG Table 19 - State Description of Social Support of Recovery Data Collection .............................................51

SABG Table 20: RETENTION Length of Stay (in Days) of Clients Completing Treatment.....................................53

Section E: Performance Indicators and Accomplishments ..............................................................54

SABG TABLE 21– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY - ABSTINENCE 

FROM DRUG USE/ALCOHOL USE .........................................................................................................................56

MEASURE: 30-DAY USE........................................................................................................................................56
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SABG TABLE 22– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY - ABSTINENCE 

FROM DRUG USE/ALCOHOL USE .........................................................................................................................58

MEASURE: PERCEPTION OF RISK/HARM OF USE................................................................................................. 58

SABG TABLE 23– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY - ABSTINENCE 

FROM DRUG USE/ALCOHOL USE .........................................................................................................................59

MEASURE: AGE OF FIRST USE ..............................................................................................................................59

SABG TABLE 24– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY - ABSTINENCE 

FROM DRUG USE/ALCOHOL USE .........................................................................................................................61

MEASURE: PERCEPTION OF DISAPPROVAL/ATTITUDES ......................................................................................61

SABG TABLE 25– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: EMPLOYMENT/EDUCATION....................63

MEASURE: PERCEPTION OF WORKPLACE POLICY................................................................................................63

SABG TABLE 26– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: EMPLOYMENT/EDUCATION....................63

MEASURE: AVERAGE DAILY SCHOOL ATTENDANCE RATE ...................................................................................63

SABG TABLE 27 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND CRIMINAL JUSTICE ..............64

MEASURE: ALCOHOL-RELATED TRAFFIC FATALITIES ........................................................................................... 64

SABG TABLE 28– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND CRIMINAL JUSTICE...............64

MEASURE: ALCOHOL- AND DRUG-RELATED ARRESTS.........................................................................................64

SABG TABLE 29 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: SOCIAL CONNECTEDNESS.......................65

MEASURE: FAMILY COMMUNICATIONS AROUND DRUG AND ALCOHOL USE ....................................................65

SABG TABLE 30 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: RETENTION.............................................66

MEASURE: PERCENTAGE OF YOUTH SEEING, READING, WATCHING, OR LISTENING TO A PREVENTION 

MESSAGE .............................................................................................................................................................66

SABG Table 31 – SUBSTANCE ABUSE PREVENTION Individual-Based Programs and Strategies—Number of 

Persons Served by Age, Gender, Race, and Ethnicity ..........................................................................................69

SABG Table 32 – SUBSTANCE ABUSE PREVENTION Population-Based Programs and Strategies—Number of 

Persons Served by Age, Gender, Race, and Ethnicity ..........................................................................................71

SABG Table 33 (Optional) – SUBSTANCE ABUSE PREVENTION............................................................................72

Number of Persons Served by Type of Intervention ...........................................................................................72

SABG Table 34 – Substance Abuse Prevention....................................................................................................73

Evidence-Based Programs and Strategies by Type of Intervention.....................................................................73

SABG Table 34– SUBSTANCE ABUSE PREVENTION..............................................................................................74

Number of Evidence-Based Programs and Strategies by Type of Intervention...................................................74

SABG Table 35 – Total SUBSTANCE ABUSE PREVENTION Number of Evidence Based Programs/Strategies and 

Total SABG Dollars Spent on SUBSTANCE ABUSE PREVENTION Evidence-Based Programs/Strategies..............74
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Section A. Introduction 

Section 1942(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 

U.S.C. § 300x-52(a)) requires the Secretary of the Department of Health and Human 

Services, acting through the Administrator of the Substance Abuse and Mental Health 

Services Administration (SAMHSA), to determine the extent to which states1 have 

implemented the State Plan for the preceding fiscal year. The purpose of the Substance 

Abuse Prevention and Treatment Block Grant (SABG) Annual Report is to provide 

information to assist the Secretary in making this determination.

States are required to prepare and submit an annual report that includes expenditure 

summaries for (1) the state fiscal year (SFY) immediately preceding the federal fiscal 

year for which the state is applying for funds; and (2) the obligation and expenditure 

period of the Substance Abuse Prevention and Treatment Block Grant (SABG) Notice of 

Award (NoA) subject to CSAT compliance review (Compliance Award), in the format 

provided in this guidance. The SABG Annual Report will address the purposes for which 

the SABG funds were expended, the SABG sub-recipients, and the authorized activities 

funded, and services purchased with such funds.

Particular attention should be given to the progress made toward accomplishing the 

goals and performance indicators identified in the states’ and jurisdictions’ plans. 

All States are required to prepare and submit their respective SABG Annual Reports 

utilizing SAMHSA’s Web Block Grant Application System (BGAS). Annual reports must 

be received by SAMHSA not later than December 1 in order for a state or jurisdiction to 

receive its fiscal year SABG NoA. If a receipt date falls on a weekend or federal 

holiday, the receipt date for a report will be the next business day. The following 

schedule provides specific due dates for the SABG Annual Reports, MHBG 

Implementation Reports and the Annual Synar Reports:

Due Dates for SA ONLY and MHBG/SABG Applications

FY for which 

the state is 

applying for 

funds

2020

2021

Application

Due

9/3/2019

9/1/2020

Plan

Due

Yes

No*

Planning 

Period

7/1/19 – 

6/30/21

NA

SABG 

Report 

Due

12/1/2019

Compliance 

Year is 

2017

12/1/2020

Compliance

Synar 

Report

Due

12/31/2019

12/31/2020

 

1 The term “state” means each of the several states, the District of Columbia and each of the territories of the United States. The 

term “territories of the United States” means each of the Commonwealth of Puerto Rico, Virgin Islands, American Samoa, 

Commonwealth of the Northern Marianas Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands and the 

Republic of Palau.
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FY for which 

the state is 

applying for 

funds

Application

Due

Plan

Due

Planning 

Period

SABG 

Report 

Due

Year is 

2018

Synar 

Report

Due

Receipt Dates for Reports

Applicable FY

2020

2021

SABG Annual 

Report

12/01/2019

12/01/2020

MHBG 

Implementation 

Report

12/01/2019

12/01/2020

Annual Synar 

Report

12/31/2019

12/31/2020

States are required to prepare and submit an annual report comprised of the following 

sections: 

Section B: Annual Update - In this section, states are required to provide a brief review 

of the extent to which their respective plans were implemented, and the progress toward 

the priorities and goals identified in the SABG plan covering SFY 2019 and 2020. The 

report should also include a brief review of areas that the state identified in that SABG 

plan as needing improvement and changes that the state or jurisdiction proposed to 

achieve the goals established for the priorities.

Section C: State Agency Expenditure Reports - In this section, states must provide 

information regarding expenditures for authorized activities and services for substance 

misuse prevention, substance use disorder 2 (SUD) treatment and recovery. The state 

must provide a description of SABG expenditures for authorized activities to prevent 

substance misuse and treat SUDs and related services for tuberculosis, and, if it is a 

“designated State,” a description of SABG expenditures for early intervention services 

for regarding the human immunodeficiency virus (EIS/HIV). In addition, the state must 

identify the SABG expenditures made available to intermediaries, administrative service 

organizations, and community and faith-based organizations that received amounts 

from the SABG to provide authorized activities to prevent and treat SUDs.

Section D: Populations and Services Reports - In this section, states must provide 

specific information regarding the number of individuals that were served with SABG 

funds. In addition, states should provide specific information regarding the services 

these individuals received.

 

2 The term “substance use disorder” means substance-related and addictive disorders as described in the Diagnostic and Statistical 

Manual of Mental Disorders , Fifth Edition, Arlington, VA, American Psychiatric Association, 2013.
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Section E: Performance Indicators and Accomplishments - In this section of the report, 

states are required to complete the Performance Indicator tables. Performance 

indicators should be reported using the table format provided in this document. The 

purpose of the performance indicator tables is to show progress made over time as 

measured by SAMHSA’s National Outcome Measures (NOMS) for substance misuse 

prevention, SUD treatment and recovery. 
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Section B. Annual Update

The information states entered into SABG Table 1 in the planning section of the 

2020/2021 Behavioral Health Assessment and Plan will automatically populate cells 1 - 

6 in the progress report table below. States are required to indicate whether each firstyear performance target/outcome measurement identified in 6.b below (from the 

202/2021 Plan) was “Achieved” or “Not Achieved” in Cell 7, Report of Progress toward 

Goal Attainment. If a target was not achieved, a detailed explanation must be provided, 

as well as the remedial steps proposed to meet the target.

SABG Table 1 - Priority Areas and Annual Performance Indicators – Progress Report

1. Priority Area:

2. Priority Type (SAP, SAT, MHS):

3. Population(s) (SMI, SED, FEP, PWWDC, PP, PWID (formerly IVDUs), EIS/HIV, 

TB, OTHER): 

4. Goal of the Priority Area:

5. Strategies to Attain the Goal:

6. Annual Performance Indicators to Measure Goal Success:

Indicator #1:

a) Baseline measurement (Initial data collected prior to the first-year 

target/outcome): 

b) First-year target/outcome measurement (Progress – end of SFY 2020):

c) Second-year target/outcome measurement (Final – end of SFY 2021):

d) Data source: 

e) Description of data:

f) Data issues/caveats that affect outcome measures:

7. Report of Progress toward Goal Attainment:

First-year target: ___ Achieved _____ Not Achieved (If not achieved, explain why.) 

Reason why target was not achieved, and changes proposed to meet target:
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Section C. State Agency Expenditure Reports

States are required to provide information regarding SABG and state funds expended 

for authorized activities to prevent and treat SUDs and for related public health services, 

e.g., tuberculosis services (TB) and, if applicable, early intervention services regarding 

the human immunodeficiency virus (EIS/HIV). Please complete the tables described 

below:

SABG Table 2 - State Agency Expenditure Report This table provides a report of 

SABG and state expenditures by the principal agency of a state, i.e., single state 

agency (SSA), during the state fiscal year immediately preceding the federal fiscal year 

for which the state is applying for funds. Expenditures to be reported are for authorized 

activities to prevent and treat SUDs pursuant to section 1921 of Title XIX, Part B, 

Subpart II of the Public Health Service (PHS) Act (42 U.S.C. § 300x-21); tuberculosis 

services; early intervention services regarding the human immunodeficiency virus 

(EIS/HIV), if applicable; pursuant to section 1924(b) of Title XIX, Part B, Subpart II of the 

PHS Act (42 U.S.C. § 300x-24(b)); and administration pursuant to section 1931(a)(2) of 

Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-31(a)(2)). In column A, 

the applicable federal fiscal years’ SABG funds expended during the state fiscal year 

should be included.

SABG Table 3 – Syringe Services Program. This table provides a report of SABG 

expenditures for elements of syringe services programs carried out by SABG subrecipients as described in the guidance disseminated by the Office of HIV/AIDS and 

Infectious Disease Policy, the Centers for Disease Control and Prevention, National 

Center on HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV Prevention 

and SAMHSA. The authorization to expend federal funds for elements of a syringe 

services program is subject to an authorization in the annual appropriations’ bill(s).

SABG Table 4 - SABG State Agency Expenditure Compliance Report This table 

provides a report of expenditures for authorized activities to prevent and treat SUDs 

associated with a SABG Notice of Award (NoA) for the applicable fiscal year. It covers 

the two-year obligation and expenditure period.

SABG Table 5a- SABG Primary Prevention Expenditures Checklist. This table provides 

a report of primary prevention expenditures associated with a SABG NoA for the 

applicable fiscal year. It covers the two-year obligation and expenditure period. Table 5a 

excludes Expenditures for Systems Development/Non-Direct Service Activities (formerly 

known as Resource Development expenditures).

SABG Table 5b- SABG Primary Prevention Expenditures by IOM Category This table 

provides a report of primary prevention expenditures by Institute of Medicine (IOM) 

categories associated with a SABG NoA for the applicable fiscal year. It covers the twoyear obligation and expenditure period. Table 5b excludes Expenditures for Systems 

Development/Non-Direct Service Activities (formerly known as Resource Development 

expenditures).
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SABG Table 5c - SABG Primary Prevention Targeted Priorities This requested table 

provides a report of actual state primary prevention priorities and special population 

categories on which the state expended primary prevention funds from the SABG NoA 

for the applicable fiscal year.

SABG Table 6 – Expenditures for System Development/Non-Direct Service Activities 

This table provides a report of expenditures from the SABG NoA for system 

development and non-direct service activities that were supported by the SABG. NoA 

for the applicable fiscal year

SABG Table 7 – SABG Statewide Entity Inventory This table provides a report of the 

SABG sub-recipients including community- and faith-based organizations which 

provided SUD prevention activities and treatment services, as well as 

intermediaries/administrative service organizations. Table 7 excludes Expenditures for 

Systems Development/Non-Direct Service Activities (formerly known as Resource 

Development expenditures).

SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse 

Prevention and Treatment This table provides a report of aggregate state expenditures 

by the SSA for authorized activities to prevent and treat SUDs during the state fiscal 

year immediately preceding the federal fiscal year for which the state is applying for 

funds.

SABG Table 8b - Base and Maintenance of Effort for Expenditures for Services to 

Pregnant Women and Women with Dependent Children This table provides a report of 

SABG and/or state funds pursuant to 42 U.S.C. § 300x-22(b) and 45 CFR § 

96.124(c)(3) expended to establish new programs or expand the capacity of existing 

programs designed to serve pregnant women and women with dependent children and 

the services required pursuant to 45 CFR § 96.124(e) to address the treatment and 

recovery needs of such women during the state fiscal year immediately preceding the 

federal fiscal year for which the state is applying for funds.
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SABG Table 2 - State Agency Expenditure Report

State Identifier:

Report Period – From: To:

(Include ONLY funds expended by the executive branch agency administering the Substance Abuse Block Grant)

Source of Funds

ACTIVITY

(See instructions for using 

Row 1.)

A.

Substanc

e Abuse 

Block 

Grant

B.

Mental 

Health 

Block 

Grant

C.

Medicaid

(Federal, 

State, and 

local)

D.

Other 

Federal 

Funds

(e.g., ACF 

(TANF), 

CDC, CMS 

(Medicare) 

SAMHSA, 

etc.)

E.

State 

funds

F.

Local funds

(excluding 

local

Medicaid)

G.

Other

Substance Abuse 

Prevention (Other than

Primary Prevention) and 

Treatment

Pregnant Women and 

Women with Dependent 

Children 

All Other

Primary Prevention

Tuberculosis Services
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ACTIVITY

(See instructions for using 

Row 1.)

A.

Substanc

e Abuse 

Block 

Grant

B.

Mental 

Health 

Block 

Grant

C.

Medicaid

(Federal, 

State, and 

local)

D.

Other 

Federal 

Funds

(e.g., ACF 

(TANF), 

CDC, CMS 

(Medicare) 

SAMHSA, 

etc.)

E.

State 

funds

F.

Local funds

(excluding 

local

Medicaid)

G.

Other

Early Intervention Services 

Regarding the Human 

Immunodeficiency Virus 

(EIS/HIV) *

Administration (excluding 

program / provider level 

administration)

Total
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This table provides a report of SABG and state expenditures by the SSA during the 

state fiscal year immediately preceding the federal fiscal year for which the state is 

applying for funds for authorized activities to prevent and treat SUDs. For detailed 

instructions, refer to those in the Block Grant Application System (BGAS).

Step 1

•Request a Determination of Need from the CDC

•Go to : http://www.cdc.gov/hiv/risk/ssps-jurisdictions.html to determine 

state eligibility

Step 2

•Modify the 2018-2019 Plan to expend FFY 2016 and/or FFY 2017* funds and 

support an existing SSP or establich a new SSP

•Include proposed protocols, timeline for implementation, and overall budget

•Submit planned expenditures and agency information on Table A listed below

Step 3

•Obtain State Project Officer Approval

•Collect all SSP information on Table B listed below to be reported in the FFY 

2019 SABG report due December 1, 2018.
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Table 3a SABG – Syringe Services Program

Report period

From:

To:

State Identifier: 

Syringe 

Services

Program 

(SSP) 

Agency 

Name

Main 

Address of 

SSP

Dollar 

amount of 

SABG 

funds used 

for SSP

SUD 

Treatment 

Provider

(Yes or No) 

# of 

locations

(include any 

mobile 

locations)

Narcan® 

Provided

(Yes or No)
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Table 3b SABG - Syringe Services Program

Report Period – From To:

State Identifier:

Expenditure Category:

Syringe 

Services 

Program 

Name

# of 

unique 

individ

uals 

served

HIV

Testing

(Please 

enter total 

number of 

individuals 

served)

ONSITEtestingREFERRAL to testing

Treatment 

for 

substance 

use 

conditions

(Please enter 

total number 

of individuals 

served)

ONSITE treatmentREFERRAL to treatment

Treatment 

for 

physical 

health

(Please 

enter total 

number of 

individuals 

served)

ONSITE treatmentREFERRAL to treatment

STD 

Testing

(Please 

enter total 

number of 

individuals 

served) ONSITE testing REFERRAL to 

testing

Hep C

(Please 

enter total 

number of 

individuals 

served) ONSITE testing REFERRAL to 

testing
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SABG Table 4 - State Agency SABG Expenditure Compliance Report

This table provides a description of SABG expenditures for authorized activities to 

prevent and treat SUDs. For detailed instructions, refer to those in BGAS. Only one 

column is to be filled in each year.

State Identifier:

Expenditure Category

FY 2016 SA

Block Grant 

Award

FY 2017 SA

Block Grant 

Award

1. Substance Abuse Prevention* and Treatment

2. Primary Prevention

2. Early Intervention Services Regarding the Human 

Immunodeficiency Virus (EIS/HIV)**

3. Tuberculosis Services

5. Administration (excluding program / provider level)

6. Total

*Prevention other than Primary Prevention

** Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 

96.128(b) for the applicable federal fiscal year should enter information in this row. This 

may include a state or states that were previously considered “designated states” during 

any of the three prior federal fiscal years for which a state was applying for a grant. See

EIs/HIV policy change in SABG Annual Report instructions. 
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SABG Table 5a SABG Primary Prevention Expenditures Checklist

The State or jurisdiction must complete either SABG Table 5a and/or 5b. There are six 

primary prevention strategies typically funded by principal agencies administering the 

SABG. Expenditures within each of the six strategies or Institute of Medicine Model 

(IOM) should be directly associated with the cost of completing the activity or task. For 

example, information dissemination may include the cost of developing pamphlets, the 

time of participating staff and/or the cost of public service announcements, etc. If a 

state or jurisdiction employs strategies not covered by these six categories, please 

report them under “Other,” each in a separate row.

State Identifier:

Report Period – From: To:

Strategy A

IOM Target

B.

SAPT 

Block 

Grant

C.

Other 

Federal

D.

State

E.

Local

F.

Other

1. Information 

Dissemination

Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

2. Education Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

3. Alternatives Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

4. Problem 

Identification 

and Referral

Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $
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Strategy A 

IOM Target

B.

SAPT 

Block 

Grant

C.

Other 

Federal

D.

State

E.

Local

F.

Other

5. CommunityBased 

Processes

Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

6. 

Environmental

Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

7. Section 

1926-Tobacco

Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

8. Other Universal $ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Unspecified $ $ $ $ $

9. Total $ $ $ $ $

Section 1926 – Tobacco: Costs associated with the Synar Program Pursuant to the 

January 19, 1996 federal regulation “Tobacco Regulation for Substance Abuse 

Prevention and Treatment Block Grants, Final Rule” (45 CFR § 96.130), a state may not 

use the SABG to fund the enforcement of its statute, except that it may expend funds 

from its primary prevention set aside of its Block Grant allotment under 45 CFR § 

96.124(b)(1) for carrying out the administrative aspects of the requirements, such as the 

development of the sample design and the conducting of the inspections. States should 

include any non-SABG funds* that were allotted for Synar activities in the appropriate 

columns under 7 below.
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*Please list all sources, if possible (e.g.., Centers for Disease Control and Prevention, 

Block Grant, foundations, etc.)
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SABG Table 5b - SABG Primary Prevention Expenditures by Institute of Medicine (IOM) 

Categories

The state or jurisdiction must complete SABG Table 5b if it chooses to report SUD 

primary prevention activities utilizing the IOM Model of Universal, Selective and 

Indicated. Indicate how much funding supported each of the IOM classifications of 

Universal, Selective, or Indicated. Include all funding sources (e.g., Centers for Disease 

Control and Prevention Block Grant, foundations). For detailed instructions, refer to 

those in the Block Grant Application System (BGAS).

Report Period – From: To:

State Identifier: 

Activity

FY 2014 

SA Block 

Grant 

Award

Other 

Federal

State 

Funds

Local 

Funds Other

Universal Direct $ $ $ $ $

Universal 

Indirect

$ $ $ $ $

Selective $ $ $ $ $

Indicated $ $ $ $ $

Column Total $ $ $ $ $

Total SABG 

Award

$ $

Planned 

Primary 

Prevention

Percentage

% %
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SABG Table 5c (Requested) - SABG Primary Prevention Targeted

The purpose of the first table is for the state or jurisdiction to identify the substance 

and/or categories of substances it identified through its needs assessment and then 

addressed with primary prevention set-aside dollars from the FY 2016 SABG NoA. The 

purpose of the second table is to identify each special population the state or jurisdiction 

selected as a priority for primary prevention set-aside expenditures.

SABG Primary Prevention Targeted Priorities 1

Targeted Substances Yes No

Alcohol

Tobacco

Marijuana

Prescription Drugs

Cocaine

Heroin

Inhalants

Methamphetamine

Synthetic Drugs (i.e. Bath 

salts, Spice, K2)

SABG Primary Prevention Targeted Priorities 2

Targeted Populations Yes No

Students in College

Military Families

LGBTQ

American Indians/Alaska 

Natives

African American

Hispanic

Homeless

Native Hawaiian/Other 

Pacific Islanders
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Targeted Populations Yes No

Asian

Rural

Underserved Racial and 

Ethnic Minorities
Page 22

SABG/MHBG Table 6 - Non-Direct-Services/System Development

Proposed Categories for Expenditures for System Development/Non-DirectService Activities

Expenditures in the following categories of activities may involve the time of State or 

sub-State personnel, or may be funded through contracts, grants, or agreements with 

other entities. Expenditures may come from the administrative funds and/or program 

funds (but may not include the HIV set-aside funds). Please utilize the following 

categories to describe the types of expenditures your state supports with BG funds, and 

if the preponderance of the activity fits within a category.

We understand that a particular activity may cross categories but try to identify the 

primary purpose or goal of the activity. For example, a state may utilize BG funds to 

train personnel to conduct fidelity assessments of evidence-based practices. While this 

could fall under either training/education and/or quality assurance/improvement – the 

primary purpose is to assure the implementation of EBPs, so that expenditure would 

most likely be captured under quality assurance/improvement.

Information systems – This includes collecting and analyzing treatment data as well 

as prevention data under the SABG in order to monitor performance and outcomes. 

Costs for electronic health records and other health information technology also fall 

under this category.

Infrastructure Support – This includes activities that provide the infrastructure to 

support services but for which there are no individual services delivered. Examples 

include the development and maintenance of a crisis-response capacity, including 

hotlines, mobile crisis teams, web-based check-in groups (for medication, treatment, reentry follow-up), drop-in centers, and respite services. 

Partnerships, community outreach, and needs assessment – This includes state, 

regional, and local personnel salaries prorated for time and materials to support 

planning meetings, information collection, analysis, and travel. It also includes the 

support for partnerships across state and local agencies, and tribal 

governments. Community/network development activities, such as marketing, 

communication, and public education, and including the planning and coordination of 

services, fall into this category, as do needs-assessment projects to identify the scope 

and magnitude of the problem, resources available, gaps in services, and strategies to 

close those gaps.

Planning Council Activities – This includes those supports for the performance of a 

Mental Health Planning Council under the MHBG, a combined Behavioral Health 

Planning Council, or (OPTIONAL) Advisory Council for the SABG. 

Quality assurance and improvement – This includes activities to improve the overall 

quality of services, including those activities to assure conformity to acceptable 

professional standards, adaptation and review of implementation of evidence-based 

practices, identification of areas of technical assistance related to quality outcomes, 
Page 23

including feedback. Administrative agency contracts to monitor service-provider quality 

fall into this category, as do independent peer-review activities.

Research and evaluation – This includes performance measurement, evaluation, and 

research, such as services research and demonstration projects to test feasibility and 

effectiveness of a new approach as well as the dissemination of such information. 

Training and education– This includes skill development and continuing education for 

personnel employed in local programs as well as partnering agencies, as long as the 

training relates to either substance use disorder service delivery (prevention, treatment 

and recovery) for SABG and services to adults with SMI or children with SED for

MHBG. Typical costs include course fees, tuition, and expense reimbursements to 

employees, trainer(s) and support staff salaries, and certification expenditures.

State Identifier:

Report Period – From: To:

Activity A. MHBG B. SABG 

Treatment

C. SABG 

Prevention

D. SABG 

Combined *

1. Information Systems $ $ $ $

2. Infrastructure Support $ $ $ $

3. Partnerships, community 

outreach, and needs 

assessment

$ $ $ $ 

4. Planning Council Activities 

(MHBG required, SABG 

optional)

$ $ $ $ 

5.Quality assurance and 

improvement $ $ $ $ 

6. Research and Evaluation $ $ $ $

7.Training and Education $ $ $ $

8.Total $ $ $ $

Please enter the total amount of the block grant expended for each activity.
Page 24

Combined refers to funds both treatment and prevention portions of the SABG for 

overarching activities.
Page 25

SABG Table 7 – State Entity Inventory

This table provides a report of the sub-recipients of SABG funds including community- and faith-based organizations 

which provided SUD prevention activities and treatment services, as well as intermediaries/administrative service 

organizations. Table 7 excludes system development/non-direct service expenditures. For detailed instructions, see 

those in BGAS.

State Identifier:

Report Period – From: To:

Source of Funds – SAPT Block Grant (A – F)

Entity

Number

I-BHS ID

(formerly

I-SATS)

Area 

Served

(Statewide 

or SubState 

Planning 

Area)

Provider

/Progra

m Name

Street

Addres

s 

City State Zip A - All 

SA

Block 

Grant 

Funds

B -

Preventi

on (other 

than 

Primary 

Preventio

n) and 

Treatme

nt 

Services

C –

Pregnant 

Women 

and 

Women 

with 

Depende

nt 

Children

D -

Primary 

Prevent

ion

E -

Early 

Interven

tion 

Service

s for 

HIV

F -

Syringe 

Service

s 

Progra

m 

$ $ $ $ $ $

$ $ $ $ $ $

Total $ $ $ $ $ $
Page 26

Description of Calculations for MOE Tables 8a and 8b

Please provide a description of the amounts and methods used to calculate the 

following: 

(a) total Single State Agency (SSA) expenditures for SUD prevention and 

treatment as required by:

a. 42 U.S.C. § 300x-30 and 45 CFR § 96.124(f)(4) 

(b) the base and, for 1994 and subsequent fiscal years, report the federal 

and state expenditures for services to pregnant women and women with 

dependent children as required by:

42 U.S.C. § 300x-22(b)(1) and 45 CFR § 96.122(f)(5)(ii)(A)
Page 27

SABG Table 8a - Maintenance of Effort for State Expenditures for SUD Prevention and 

Treatment

This Maintenance of Effort table provides a description of non-federal expenditures for 

authorized activities to prevent and treat substance abuse flowing through the Single 

State Agency (SSA) during the state fiscal year immediately preceding the federal fiscal 

year for which the state is applying for funds. (Dates given are for the FY 2017 SABG 

Report. For the FY 2018 SABG report, increase each year by one.)

For detailed instructions, see those in BGAS.

State Identifier:

Report Period – From: To:

Period

(A)

Expenditures

(B)

B1 (2014) + B2 (2015)

2 

(C)

SFY 2017

(1)

SFY 2018

(2)

SFY 2019

(3)

Are the expenditure amounts reported in Column B “actual” expenditures for the fiscal 

years involved?

Yes No

SFY 2017

SFY 2018

SFY 2019

If any estimated expenditures are provided, please indicate when “actual” expenditure 

data will be submitted to SAMHSA: ___/___/_____ (Date Format: mm/dd/yyyy) 

Did the state or jurisdiction have any non-recurring expenditures as described in 42 

U.S.C. § 300x-30(b) for a specific purpose which were not included in the MOE 

calculation?

Yes____ No ___ If yes, specify the amount and the State fiscal year 

___________
Page 28

Did the state or jurisdiction include these funds in previous year MOE calculations? 

Yes___ No___

When did the State or Jurisdiction submit an official request to SAMHSA to exclude 

these funds from the MOE calculations? ___/___/___ (date format: mm/dd/yyyy)

SABG Table 8b - Expenditures for Services to Pregnant Women and Women with 

Dependent Children

This table provides a report of all statewide, non-federal funds expended on specialized 

treatment and related services which meet the SABG requirements for pregnant women 

and women with dependent children during the state fiscal year immediately preceding 

the federal fiscal year for which the state is applying for funds. (Dates given are for the 

FY 2017 SABG Report. For the FY 2018 SABG Report, increase each year (other than 

the base year) by one.)

For detailed instructions, see those in BGAS.

State Identifier:

Report Period – From: To:

Period Total Women’s Base

(A)

Total Expenditures

(B)

1994

2017

2018

2019 
Page 29

Section D. Populations and Services Report

States are required to provide information regarding individuals that are served by the 

SSA in SABG Tables 9 through 13.

SABG Table 9 - Prevention Strategy Report This table requires additional information 

(pursuant to Section 1929 of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 

300x-29) about the primary prevention activities conducted by the entities listed on 

SABG Table 7, State Entity Inventory, Column D. It seeks further information on the 

specific strategies and activities being funded by the principal agency of the state which 

address the sub-populations at risk for alcohol, tobacco, and other drug (ATOD) 

use/abuse.

SABG Table 10 - Treatment Utilization Matrix This table is intended to capture the 

count of persons with initial admissions and subsequent admission(s) to an episode of 

care (as defined in the Behavioral Health Services Information System (BHSIS), 

formerly known as the Drug and Alcohol Services Information System (DASIS), 

Treatment Episode Data Set (TEDS) standards (see TEDS data) during the state fiscal 

year immediately preceding the federal fiscal year for which the state is applying for 

funds.

SABG Table 11 - Number of Persons Served (Unduplicated Count) for Alcohol and 

Other Drug Use. This table provides an aggregate profile of the unduplicated number of 

admissions and persons for services funded through the SABG during the state fiscal 

year immediately preceding the federal fiscal year for which the state is applying for 

funds. States are to provide this information on all programs by age, gender, and 

race/ethnicity. States are to report whether the values reported come from a clientbased system(s) with unique client identifiers.

SABG Table 12 – SABG Designated States and Early Intervention Services Regarding 

the Human Immunodeficiency Virus. This table requires designated states as defined in 

section 1924(b)(2) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x24(b)(2)), to provide information on Early Intervention Services Regarding the Human 

Immunodeficiency Virus (EIS/HIV) provided during the state fiscal year immediately 

preceding the federal fiscal year for which the state is applying for funds.

SABG Table 13 - Charitable Choice This table requires states to provide information 

regarding compliance with section 1955 of Title XIX, Part B, Subpart III of the PHS Act 

(42 U.S.C. § 300x-65) and the Charitable Choice Provisions and Regulations; Final 

Rule (42 CFR Part 54) during the state fiscal year immediately preceding the federal 

fiscal year for which the state is applying for funds. Each section of this table requires 

that the state respond appropriately to identify the manner in which they have complied 

with the requirements related to authorizing legislation and implementing regulation. 

States should report on the number of clients referred, due to religious objection, from 
Page 30

faith and community-based programs to appropriate alternative providers. If no 

alternate referrals were made, enter zero. 
Page 31

SABG Table 9 - Prevention Strategy Report

This table requires additional information (pursuant to Section 1929 of Title XIX, Part B,

Subpart II of the PHS Act (42 U.S.C.§ 300x-29) about the primary prevention activities 

conducted by the entities listed on SABG Table 7. For detailed instructions, see those 

in BGAS. Prevention Strategy Report Risk-Strategies.

State Identifier:

Report Period – From: To:

Column A (Risks) Column B 

(Strategies) Column C (Providers)

Children of Substance 

Abusers [1]

Pregnant Women / Teens [2]

Drop-Outs [3]

Violent and Delinquent 

Behavior [4]

Mental Health Problems [5]

Economically Disadvantaged 

[6]

Physically Disabled [7]

Abuse Victims [8]

Already Using Substances [9]

Homeless and/or Runaway 

Youth [10]

Other, Specify [11]
Page 32

SABG Table 10 – Treatment Utilization Matrix

This table is intended to capture the count of persons with initial admissions and 

subsequent admission(s) to an episode of care. For detailed instructions, see those in 

BGAS.

State Identifier:

Report Period – From: To:

NOTES:

1. Number of Admissions (A) ≥ Number of Persons Served (B)

2. Costs per Person = C+D+E

Level of Care

Number

of 

Admissions

(A)

Number of

Persons 

Served

(B)

Mean Cost 

of Services

(C)

Median Cost 

of Services

(D)

Standard 

Deviation 

of Cost

(E)

Detoxification (24-Hour Care)

1. Hospital 

Inpatient

$ $ $

2. FreeStanding 

Residential

$ $ $

Rehabilitation/Residential

3. Hospital 

Inpatient

$ $ $

4.Short-term (up 

to 30 days)

$ $ $

5. Long-term 

(over 30 days)

$ $ $

Ambulatory (Outpatient)

6. Outpatient $ $ $

7. Intensive 

Outpatient

$ $ $

8. Detoxification $ $ $

Opioid Replacement Therapy

9. ORT 

Detoxification

$ $ $
Page 33

Level of Care

Number

of 

Admissions

(A)

Number of

Persons 

Served

(B)

Mean Cost 

of Services

(C)

Median Cost 

of Services

(D)

Standard 

Deviation 

of Cost

(E)

10. Opioid

Replacement 

Therapy
Page 34

SABG Table 11 - Unduplicated Count of Persons Served for Alcohol and other Drug Use

This table provides an aggregate profile of the unduplicated number of admissions and persons for services funded 

through the SABG. For detailed instructions, see those in BGAS.

Report Period – From: To:

State Identifier:

Number of Persons Served (unduplicated count) for Alcohol and Other Drug Use in State Funded Services by 

Age, Sex and Race/Ethnicity

Age

A.

Total

B. 

White

(M/F)

C. Black or 

African 

American

(M/F)

D. Native 

Hawaiian/

other 

Pacific 

Islander

(M/F)

E.

Asian

(M/F)

F.

American 

Indian/Al

askan 

Native

(M/F)

G.

More 

Than 

One 

Race 

Reported

(M/F)

H.

Unknown

(M/F)

I.

Not 

Hispanic 

or Latino

(M/F)

J.

Hispanic 

or Latino

(M/F)

17 and 

under

18-24

25-44

45-64

65 and 

over

Total

Pregnant 

Women
Page 35

Numbers of Persons Served who were admitted in a Period Prior to the 12-

month reporting Period

Number of persons served outside of the levels of care described on SABG 

Table 10

Are the values reported in this table generated from a client-based system with 

unique client identifiers? (Yes or No)
Page 36

SABG Table 12 - SABG Early Intervention Services Regarding the Human 

Immunodeficiency Virus (EIS/HIV) in Designated States

Report Period – From: To:

State Identifier:

1. Number of EIS/HIV 

projects among SABG subrecipients in the state:

2. Total number of 

individuals tested through 

SABG sub-recipient EIS/HIV 

projects:

3. Total number of HIV tests 

conducted with SABG 

EIS/HIV funds:

4. Total number of tests that 

were positive for HIV:

5. Total number of 

individuals who prior to the 

12-month reporting period 

were unaware of their HIV 

infection:

6. Total number of HIVinfected individuals who were 

diagnosed and referred into 

treatment and care during 

the 12-month reporting 

period

Identify barriers, including state laws and regulations, that exist in carrying out HIV 

testing services:

Statewide: _____ Rural: _____
Page 37

SABG Table 13 - Charitable Choice – Required

Under Charitable Choice Provisions; Final Rule (42 CFR Part 54), states, local 

governments, and religious organizations, such as SAMHSA grant recipients, must: (1) 

ensure that religious organizations that are providers provide to all potential and actual 

program beneficiaries (services recipients) notice of their right to alternative services; 

(2) ensure that religious organizations that are providers refer program beneficiaries to 

alternative services; and (3) fund and/or provide alternative services. The term 

“alternative services” means services determined by the state to be accessible and 

comparable and provided within a reasonable period of time from another substance 

abuse provider (“alternative provider”) to which the program beneficiary (services 

recipient) has no religious objection. The purpose of this table is to document how the 

state is complying with these provisions.

Notice to Program Beneficiaries – Check all that apply:

□ Used model notice provided in final regulations.

□ Used notice developed by state (please attach a copy to the Report)

□ State has disseminated notice to religious organizations that are providers.

□ State requires these religious organizations to give notice to all potential 

beneficiaries.

Referrals to Alternative Services – Check all that apply:

□ State has developed specific referral system for this requirement.

□ State has incorporated this requirement into existing referral system(s).

□ SAMHSA’s Behavioral Health Treatment Locator is used to help identify 

providers.

□ Other networks and information systems are used to help identify providers. 

□ State maintains record of referrals made by religious organizations that are 

providers.

______Enter the total number of referrals to other substance abuse providers 

(“alternative providers”) necessitated by religious objection, as defined above, made 

during the State fiscal year immediately preceding the federal fiscal year for which the 

state is applying for funds. Provide the total only. No information on specific referrals is 

required. If no alternative referrals were made, enter zero.

Provide a brief description (one paragraph) of any training for local governments and/or 

faith-based and/or community organizations that are providers on these requirements.
Page 38

Performance Data and Outcomes

SAMHSA is interested in demonstrating program accountability and efficacy through the 

National Outcome Measures (NOMs). The NOMs are intended to document the 

performance of federally supported programs and systems of care.

Treatment Performance Measures

SABG Table 14 Employment/Education Status This table describes the status of 

adult clients served by the public SUD treatment service systems in terms of 

employment and education status. The Employment\Education Status Form seeks 

information on clients who are employed or who are students (full-time or part-time) 

(prior 30 days) at admission and discharge.

SABG Table 15 Stability of Housing This table requests information regarding the 

number of individuals in a stable living environment as collected by the most recent 

assessment in the reporting period. Specifically, information is collected on the 

individual’s last known living situation.

SABG Table 16 Criminal Justice Involvement This table requests information 

regarding the clients’ involvement in the criminal justice system. Specifically, the table 

requests information to measure the change in number of arrests over time.

SABG Table 17 Change in Abstinence - Alcohol Use This table seeks information 

regarding alcohol abstinence. Specifically, information is collected on the number of 

clients with no alcohol use (all clients regardless of primary problem) at admission and 

discharge.

SABG Table 18 Change in Abstinence - Other Drug Use This table collects 

information regarding clients’ change in abstinence with drugs of abuse other than 

alcohol. This table seeks to collect information on clients with no other drug use (all 

clients regardless of primary problem) at admission and discharge.

SABG Table 19 Change in Social Support of Recovery This table seeks to measure 

the change in clients’ social support of recovery. Specifically, this form collects 

information regarding the number of clients participating in self-help groups at 

admission and discharge.

SABG Table 20 Retention This table collects information regarding retention. 

Specifically, this table collects information regarding the length of stay of clients 

completing treatment.
Page 39

Prevention Performance Measures

SABG Table 20 Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: 

30 Day Use. This table seeks information regarding 30 day use of alcohol, tobacco and 

other drugs.

SABG Table 22 Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: 

Perception of Risk/Harm of Use. This table seeks information regarding the individuals’ 

perceived risk of harming themselves with alcohol, tobacco and other drugs.

SABG Table 23 Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: 

Age of First Use. This table seeks information regarding the age of first use of alcohol, 

cigarettes and other drugs.

SABG Table 24 Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: 

Perception of Disapproval/Attitudes. This table seeks information regarding the general 

public perception or attitude regarding use of alcohol, cigarettes and other drugs. 

SABG Table 25 Employment/Education; Measure: Perception of Workplace Policy. This 

table reports the percent of individuals who would be more likely to work for an 

employer conducting random drug and alcohol tests.

SABG Table 26 Employment/Education; Measure: Average Daily School Attendance 

Rate. This table collects information regarding the average daily school attendance. 

SABG Table 27 Crime and Criminal Justice; Measure: Alcohol-Related Traffic 

Fatalities. This table collects information regarding the number of alcohol-related traffic 

fatalities divided by the total number of traffic fatalities and multiplied by 100.

SABG Table 28 Crime and Criminal Justice; Measure: Alcohol and Drug Related 

Arrests. This table collects information regarding alcohol- and drug-related arrests. 

SABG Table 29 Social Connectedness; Measure: Family Communications around Drug 

and Alcohol Use. This table provides information regarding the percent of youth 

reporting having talked with a parent and the percent of parents reporting that they have 

talked to their child around alcohol and drug use.

SABG Table 30 Retention; Measure: Percentage of Youth Seeing, Reading, Watching, 

or Listening to a Prevention Message. This table collects information regarding the 

percent of youth reporting having been exposed to prevention message.

SABG Table 31 Individual-Based Programs and Strategies; Measure: Number of 

Persons Served By Age, Gender, Race, and Ethnicity. This table provides information 

on the number of persons served by individual-based programs and strategies. This 

includes practices and strategies with identifiable goals designed to change behavioral 

outcomes among a definable population or within a definable geographic area. 
Page 40

SABG Table 32 Population-Based Programs and Strategies; Measure: Number of 

Persons Served By Age, Gender, Race, and Ethnicity. This table provides information 

regarding the number of persons by age, gender, race, and ethnicity that participated in 

population-based programs. Population-based programs and strategies include 

planned and deliberate goal-oriented practices, procedures, processes, or activities that 

have identifiable outcomes achieved with a sequence of steps subject to monitoring and 

modification.

SABG Table 33 Number of Persons Served by Type of Intervention. This table seeks to 

measure information on access and capacity of intervention programs. Specifically, this 

form collects information on the number of persons served by type of Intervention. 

Interventions include activities, practices, procedures, processes, programs, services, 

and strategies.

SABG Table 34 Number of Evidence-Based Programs by Types of Intervention. This 

table collects information on the number of evidence-based programs and strategies by 

type of intervention.

SABG Table 35 Number of Evidence-based Programs and Strategies, and Total SABG 

Funds Spent on Evidence-Based Programs/ Strategies. 
Page 41

SABG Table 14 – TREATMENT PERFORMANCE MEASURE EMPLOYMENT\EDUCATION 

STATUS (From Admission to Discharge)

Most recent year for which data are available: _____________

Employment\Education Status – Clients 

employed or student (full-time or part-time) 

(prior 30 days) at admission vs. discharge 

Number of clients employed or student (fulltime and part-time) [numerator] 

Total number of clients with non-missing values 

on employment\student status [denominator]

Percent of clients employed or student (fulltime and part-time) 

Admission

Clients 

(T1)

Discharge 

Clients 

(T2) 

SABG Table 14 - State Description of Stability in Housing Data Collection

STATE 

CONFORMANCE 

TO INTERIM 

STANDARD

State Description of Stability in Housing Data Collection (SABG Table 

15): 

States should detail exactly how this information is collected. Where 

data and methods vary from interim standard, variance should be 

described.

DATA SOURCE What is the source of data for SABG Table 15 (select all that apply):

□ Client self-report □ Client self-report confirmed by another source

□ collateral source □ Administrative data source □ Other Specify

___________________

EPISODE OF 

CARE

How is the admission/discharge basis defined for SABG Table 15 

(Select one) □ Admission is on the first date of service, prior to which 

no service has been received for 30 days AND discharge is on the last 

date of service, subsequent to which no service has been received for 

30 days 

□ Admission is on the first date of service in a Program/Service 

Delivery Unit and Discharge is on the last date of service in a 

Program/Service Delivery Unit

□ Other Specify ___________________________________________

_________________________________________________________

DISCHARGE 

DATA 

COLLECTION

How was discharge data collected for SABG Table 15 (select all that 

apply)

□ Not applicable, data reported on form is collected at time period other 

than discharge→ Specify:

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ 

(specify) months Post- □ admission □ discharge □ other ______ 
Page 42

□ Discharge data is collected for the census of all (or almost all) clients 

who were admitted to treatment □ Discharge data is collected for a 

sample or all clients who were admitted to treatment □ Discharge

records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of 

clients who were admitted for treatment 

RECORD 

LINKING

Was the admission and discharge data linked for SABG Table 15 

(select all that apply): 

□ Yes, all clients at admission were linked with discharge data using an 

Unique Client Identifier (UCID)

Select type of UCID □ Master Client Index or Master Patient Index, 

centrally assigned □ Social Security Number (SSN) □ Unique client ID 

based on fixed client characteristics (such as date of birth, gender, 

partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID 

□ No, State Management Information System does not utilize UCID that 

allows comparison of admission and discharge data on a client specific 

basis (data developed on a cohorts basis) or State relied on other data 

sources for post admission data □ No, admission and discharge 

records were matched using probabilistic record matching.

IF DATA IS 

UNAVAILABLE

If data is not reported, why is the state unable to report (select all that 

apply): □ Information is not collected at admission □ Information is not 

collected at discharge □ Information is not collected by the categories 

requested □ State collects information on the indicator area but utilizes 

a different measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing criminal justice 

involvement status data on all clients, if data is not currently available. 

Plans should also discuss barriers, resource needs and estimates of 

cost.
Page 43

SABG Table 15–TREATMENT PERFORMANCE MEASURE STABILITY OF HOUSING (From 

Admission to Discharge)

Most recent year for which data are available: _____________

Clients living in a stable living situation (prior 30 days) 

at admission vs. discharge 

Number of clients living in a stable situation [numerator] 

Total number of clients with non-missing values on living 

arrangements [denominator] 

Percent of clients in a stable living situation 

Admission

Clients 

(T1)

Discharge 

Clients 

(T2)

SABG Table 15 - State Description of Employment\Education Status Data Collection 

(SABG) 

STATE 

CONFORMANCE TO 

INTERIM 

STANDARD

State Description of Employment\Education Data Collection 

(SABG Table 15):

States should detail exactly how this information is collected. 

Where data and methods vary from interim standard, variance 

should be described.

DATA SOURCE What is the source of data for SABG Table 15 (select all that 

apply):

□ Client self-report □ Client self-report confirmed by another 

source→□ collateral source □ Administrative data source □ 

Other Specify __________________

EPISODE OF CARE How is the admission/discharge basis defined for SABG Table 

15 (Select one) □ Admission is on the first date of service, prior 

to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no 

service has been received for 30 days 

□ Admission is on the first date of service in a Program/Service 

Delivery Unit and Discharge is on the last date of service in a 

Program/Service Delivery Unit

□ Other Specify 

___________________________________________

__________________________________________________

DISCHARGE DATA 

COLLECTION

How was discharge data collected for SABG Table 15 (select 

all that apply)

□ Not applicable, data reported on form is collected at time 

period other than discharge→ Specify:
Page 44

□ In-treatment data ___ days post-admission, OR □ Follow-up 

data ___ (specify) months Post- □ admission □ discharge □ 

other ______ 

□ Discharge data is collected for the census of all (or almost 

all) clients who were admitted to treatment □ Discharge data 

is collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the 

case of early dropouts) are created for all (or almost all) clients 

who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % 

of clients who were admitted for treatment 

RECORD LINKING Was the admission and discharge data linked for table 15 

(select all that apply): 

□ Yes, all clients at admission were linked with discharge data 

using an Unique Client Identifier (UCID)

Select type of UCID □ Master Client Index or Master Patient 

Index, centrally assigned □ Social Security Number (SSN) □ 

Unique client ID based on fixed client characteristics (such as 

date of birth, gender, partial SSN, etc.) □ Some other Statewide 

unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize 

UCID that allows comparison of admission and discharge data 

on a client specific basis (data developed on a cohorts basis)

or State relied on other data sources for post admission data □ 

No, admission and discharge records were matched using 

probabilistic record matching.

IF DATA IS 

UNAVAILABLE

If data is not reported, why is State unable to report (select all 

that apply): 

□ Information is not collected at admission □ Information is not 

collected at discharge □ Information is not collected by the 

categories requested □ State collects information on the 

indicator area but utilizes a different measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing 

employment\student status data on all clients, if data is not 

currently available. Plans should also discuss barriers, 

resource needs and estimates of cost.
Page 45

SABG Table 16– TREATMENT PERFORMANCE MEASURE CRIMINAL JUSTICE 

INVOLVEMENT (From Admission to Discharge)

Most recent year for which data are available: _____________

Clients without arrests (any charge) (prior 30 days) at 

admission vs. discharge 

Number of Clients without arrests [numerator] 

Total number of clients with non-missing values on 

arrests [denominator]

Percent of clients without arrests 

Admission

Clients 

(T1)

Discharge 

Clients 

(T2)

SABG Table 16 - State Description of Criminal Involvement Data Collection

STATE 

CONFORMANCE TO 

INTERIM 

STANDARD

State Description of Criminal Involvement Data Collection 

(SABG Table 16): 

States should detail exactly how this information is collected. 

Where data and methods vary from interim standard, variance 

should be described.

DATA SOURCE What is the source of data for SABG Table 16 (select all that 

apply):

□ Client self-report □ Client self-report confirmed by another 

source→□ collateral source □ Administrative data source □ 

Other Specify __

EPISODE OF CARE How is the admission/discharge basis defined for SABG Table 

16 (Select one) □ Admission is on the first date of service, 

prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which 

no service has been received for 30 days 

□ Admission is on the first date of service in a 

Program/Service Delivery Unit and Discharge is on the last 

date of service in a Program/Service Delivery Unit

□ Other Specify ________

DISCHARGE DATA 

COLLECTION

How was discharge data collected for SABG Table 16 (select 

all that apply)

□ Not applicable, data reported on form is collected at time 

period other than discharge→ Specify:

□ In-treatment data ___ days post-admission, OR □ Follow-up 

data ___ (specify) months Post- □ admission □ discharge □ 

other ______ 

□ Discharge data is collected for the census of all (or almost 

all) clients who were admitted to treatment □ Discharge data 

is collected for a sample or all clients who were admitted to 
Page 46

treatment □ Discharge records are directly collected (or in the 

case of early dropouts) are created for all (or almost all) clients 

who were admitted to treatment 

□ Discharge records are not collected for approximately ___ 

% of clients who were admitted for treatment 

RECORD LINKING Was the admission and discharge data linked for SABG Table 

16 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data 

using an Unique Client Identifier (UCID)

Select type of UCID □ Master Client Index or Master Patient 

Index, centrally assigned □ Social Security Number (SSN) □ 

Unique client ID based on fixed client characteristics (such as 

date of birth, gender, partial SSN, etc.) □ Some other 

Statewide unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize 

UCID that allows comparison of admission and discharge data 

on a client specific basis (data developed on a cohorts basis) 

or State relied on other data sources for post admission data □ 

No, admission and discharge records were matched using 

probabilistic record matching.

IF DATA IS 

UNAVAILABLE

If data is not reported, why is State unable to report (select all 

that apply): □ Information is not collected at admission □ 

Information is not collected at discharge □ Information is not 

collected by the categories requested □ State collects 

information on the indicator area but utilizes a different 

measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing criminal 

justice involvement status data on all clients, if data is not 

currently available. Plans should also discuss barriers, 

resource needs and estimates of cost.
Page 47

SABG Table 17 - State Description of Alcohol Use Data Collection

STATE 

CONFORMANCE 

TO INTERIM 

STANDARD

State Description of Alcohol Use Data Collection (SABG Table 

17): 

State should detail exactly how this information is collected. 

Where data and methods vary from interim standard, variance 

should be described.

DATA SOURCE What is the source of data for SABG Table 17 (select all that 

apply):

□ Client self-report □ Client self-report confirmed by another 

source→ □ urinalysis, blood test or other biological assay □ 

collateral source

□ Administrative data source □ Other Specify

___________________

EPISODE OF 

CARE

How is the admission/discharge basis defined for SABG Table 17 

(Select one) □ Admission is on the first date of service, prior to 

which no service has been received for 30 days AND discharge is 

on the last date of service, subsequent to which no service has 

been received for 30 days 

□ Admission is on the first date of service in a Program/Service 

Delivery Unit and Discharge is on the last date of service in a 

Program/Service Delivery Unit

□ Other Specify 

___________________________________________

DISCHARGE 

DATA 

COLLECTION

How was discharge data collected for SABG Table 17 (select all 

that apply)

□ Not applicable, data reported on form is collected at time period 

other than discharge→ Specify:

□ In-treatment data ___ days post-admission, OR □ Follow-up 

data ___ (specify) months Post- □ admission □ discharge □ other 

______ 

□ Discharge data is collected for the census of all (or almost all) 

clients who were admitted to treatment □ Discharge data is 

collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the 

case of early dropouts) are created for all (or almost all) clients 

who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of 

clients who were admitted for treatment 

RECORD 

LINKING

Was the admission and discharge data linked for SABG Table 17 

(select all that apply): 

□ Yes, all clients at admission were linked with discharge data 

using an Unique Client Identifier (UCID)
Page 48

Select type of UCID □ Master Client Index or Master Patient 

Index, centrally assigned □ Social Security Number (SSN) □ 

Unique client ID based on fixed client characteristics (such as 

date of birth, gender, partial SSN, etc.) □ Some other Statewide 

unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize 

UCID that allows comparison of admission and discharge data on 

a client specific basis (data developed on a cohort’s basis) or 

State relied on other data sources for post admission data □ No, 

admission and discharge records were matched using 

probabilistic record matching.

IF DATA IS 

UNAVAILABLE

If data is not reported, why is State unable to report (select all that 

apply): □ Information is not collected at admission □ Information

is not collected at discharge □ Information is not collected by the 

categories requested □ State collects information on the indicator 

area but utilizes a different measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing abstinence -

alcohol use status data on all clients, if data is not currently 

available. Plans should also discuss barriers, resource needs 

and estimates of cost.
Page 49

SABG Table 18 – PERFORMANCE MEASURE CHANGE IN ABSTINENCE -- OTHER DRUG 

USE (From Admission to Discharge)

Most recent year for which data are available: _____________

Drug Abstinence – Clients with no drug use (all clients 

regardless of primary problem) (use Any Drug Use in last 

30 days field) at admission vs. discharge. 

Number of Clients abstinent from illegal drugs [numerator] 

Total number of clients with non-missing values on “used any 

drug” variable [denominator] *

Percent of clients abstinent from drugs 

Admission

Clients 

(T1)

Discharge 

Clients 

(T2)

*If State does not have a "used any drug" variable, calculate instead using frequency of 

use variables for all primary, secondary, or tertiary problem codes in which the coded 

problem is Drugs (e.g., TEDS Codes 01-04)

SABG Table 18 - State Description of Other Drug Use Data Collection

STATE 

CONFORMANCE TO 

INTERIM 

STANDARD

State Description of Other Drug Use Data Collection (SABG 

Table 18): 

States should detail exactly how this information is collected. 

Where data and methods vary from interim standard, variance 

should be described.

DATA SOURCE What is the source of data for SABG Table 18 (select all that 

apply):

□ Client self-report □ Client self-report confirmed by another 

source→□ urinalysis, blood test or other biological assay □ 

collateral source

□ Administrative data source □ Other Specify

___________________

EPISODE OF CARE How is the admission/discharge basis defined for SABG Table 

18 (Select one) □ Admission is on the first date of service, prior 

to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which 

no service has been received for 30 days 

□ Admission is on the first date of service in a Program/Service 

Delivery Unit and Discharge is on the last date of service in a 

Program/Service Delivery Unit

□ Other Specify 

___________________________________________

DISCHARGE DATA 

COLLECTION

How was discharge data collected for SABG Table 18 (select 

all that apply)
Page 50

□ Not applicable, data reported on form is collected at time 

period other than discharge→ Specify:

□ In-treatment data ___ days post-admission, OR □ Follow-up 

data ___ (specify) months Post- □ admission □ discharge □ 

other ______ 

□ Discharge data is collected for the census of all (or almost 

all) clients who were admitted to treatment □ Discharge data is 

collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the 

case of early dropouts) are created for all (or almost all) clients 

who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % 

of clients who were admitted for treatment 

RECORD LINKING Was the admission and discharge data linked for SABG Table 

18 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data 

using an Unique Client Identifier (UCID)

Select type of UCID □ Master Client Index or Master Patient 

Index, centrally assigned □ Social Security Number (SSN) □ 

Unique client ID based on fixed client characteristics (such as 

date of birth, gender, partial SSN, etc.) □ Some other 

Statewide unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize 

UCID that allows comparison of admission and discharge data 

on a client specific basis (data developed on a cohorts basis) 

or State relied on other data sources for post admission data □ 

No, admission and discharge records were matched using 

probabilistic record matching.

IF DATA IS

UNAVAILABLE

If data is not reported, why is State unable to report (select all 

that apply): □ Information is not collected at admission □ 

Information is not collected at discharge □ Information is not 

collected by the categories requested □ State collects 

information on the indicator area but utilizes a different 

measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing abstinence 

– drug use status data on all clients, if data is not currently 

available. Plans should also discuss barriers, resource needs 

and estimates of cost.
Page 51

SABG Table 19 – PERFORMANCE MEASURE CHANGE IN SOCIAL SUPPORT OF 

RECOVERY (From Admission to Discharge)

Most recent year for which data are available: _____________

Social Support of Recovery – Clients 

participating in self-help groups (e.g., AA, NA, 

etc.) (prior 30 days) at admission vs. discharge 

Number of clients participating in self-help (AA NA 

meetings attended, etc.) [numerator] 

Total number of Admission and Discharge clients 

with non-missing values on self-help activities 

[denominator] 

Percent of clients participating in self-help activities 

Admission 

Clients 

(T1)

Discharge 

Clients 

(T2)

SABG Table 19 - State Description of Social Support of Recovery Data Collection

STATE 

CONFORMANCE 

TO INTERIM 

STANDARD

State Description of Social Support of Recovery Data Collection 

(SABG Table 19):

States should detail exactly how this information is collected. 

Where data and methods vary from interim standard, variance 

should be described.

DATA SOURCE What is the source of data for SABG Table 19 (select all that 

apply):

□ Client self-report □ Client self-report confirmed by another 

source→ 

□ collateral source □ Administrative data source 

□ Other Specify ___________________

EPISODE OF CARE How is the admission/discharge basis defined for SABG Table 

19 (Select one) □ Admission is on the first date of service, prior 

to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no 

service has been received for 30 days 

□ Admission is on the first date of service in a Program/Service 

Delivery Unit and Discharge is on the last date of service in a 

Program/Service Delivery Unit

□ Other Specify 

___________________________________________

DISCHARGE DATA 

COLLECTION

How was discharge data collected for SABG Table 19 (select all 

that apply)

□ Not applicable, data reported on form is collected at time 

period other than discharge→ Specify:
Page 52

□ In-treatment data ___ days post-admission, OR □ Follow-up 

data ___ (specify) months Post- □ admission □ discharge □ 

other ______ 

□ Discharge data is collected for the census of all (or almost all) 

clients who were admitted to treatment □ Discharge data is 

collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the 

case of early dropouts) are created for all (or almost all) clients 

who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % 

of clients who were admitted for treatment 

RECORD LINKING Was the admission and discharge data linked for SABG Table 

19 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data 

using an Unique Client Identifier (UCID)

Select type of UCID □ Master Client Index or Master Patient 

Index, centrally assigned □ Social Security Number (SSN) □ 

Unique client ID based on fixed client characteristics (such as 

date of birth, gender, partial SSN, etc.) □ Some other Statewide 

unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize 

UCID that allows comparison of admission and discharge data 

on a client specific basis (data developed on a cohort’s basis) 

or State relied on other data sources for post admission data □ 

No, admission and discharge records were matched using 

probabilistic record matching.

IF DATA IS 

UNAVAILABLE

If data is not reported, why is State unable to report (select all 

that apply): □ Information is not collected at admission □ 

Information is not collected at discharge □ Information is not 

collected by the categories requested □ State collects 

information on the indicator area but utilizes a different 

measure.

DATA PLANS IF 

DATA IS NOT 

AVAILABLE

State must provide time-framed plans for capturing self-help 

participation status data on all clients, if data is not currently 

available. Plans should also discuss barriers, resource needs 

and estimates of cost.
Page 53

SABG Table 20: RETENTION Length of Stay (in Days) of Clients Completing Treatment

Most recent year for which data are available: _____________

Level of Care

Detoxification (24-hour care)

1. Hospital 

Inpatient

2. Free-Standing 

Residential

Rehabilitation/Residential

3. Hospital 

Inpatient

4. Short-term

(up to 30 days)

5. Long-term

(over 30 days)

Ambulatory (Outpatient)

6. Outpatient

7. Intensive 

Outpatient

8. Detoxification

Opioid Replacement Therapy

9. ORT Detox

10. Opioid 

Replacement 

Therapy

Average

(Mean)

Median

(Median)

Interquartile Range
Page 54

Section E: Performance Indicators and Accomplishments 

Tables 21 – 30 Prevention Performance Measures

Introduction

The National Outcome Measures (NOMs) are a set of domains and measures that the 

Substance Abuse and Mental Health Services Administration (SAMHSA) uses to 

accomplish its vision and to meet all of its federal reporting requirements, thus reducing 

burden and redundancy for grantees.

The NOMs Data Collection and Reporting tables are to be completed as part of the 

state's annual SABG application. For Tables 21-25 and 27-30, the compliance year is 

calendar year (CY) 2017 (note that pre-populated NOMs from the National Survey on 

Drug Use and Health (NSDUH) reflect pooled data from CYs 2016-2017. For substance 

abuse prevention NOMs Table 26, the compliance year is School Year 2017.

For purposes of this section, unless otherwise noted, the term "state" refers to states, 

territories, and the one Native American tribe that receive SABG funding.

Tables 21 through 30 Information

A. Pre-populated Data

CSAP and the states have agreed that the state-level reporting requirement for the 

NOMs listed in Tables 21-30 will be fulfilled through the use of extant data from sources 

including the National Survey on Drug Use and Health (NSDUH), the Fatality Analysis 

Reporting System (FARS) of the National Highway Traffic Safety Administration, the 

Uniform Crime Report (UCR) of the Federal Bureau of Investigation, and the National 

Center for Education Statistics (NCES) of the U.S. Department of Education. These prepopulated state-level NOMs will meet most of the state-level NOMs reporting 

requirements for the prevention portion of the SABG funding. These data will be prepopulated into the data tables by CSAP.

NOMs Domain - Reduced Morbidity Abstinence from Drug Use/Alcohol Use 

• Table 21: 30-Day Use 

• Table 22: Perception of Risk/Harm of Use 

• Table 23: Age of First Use 

• Table 24: Perception of Disapproval/Attitudes NOMs Domain - Employment/Education 

• Table 25: Perception of Workplace Policy 

• Table 26: Average Daily School Attendance Rate

NOMs Domain - Crime and Criminal Justice 

• Table 27: Alcohol-Related Traffic Fatalities 

• Table 28: Alcohol- and Drug-Related Arrests

NOMs Domain - Social Connectedness 
Page 55

• Table 29: Family Communications Around Drug and Alcohol Use

NOMs Domain - Retention 

• Table 30: Youth Seeing, Reading, Watching, or Listening to a Prevention Message 

In this block grant application, pre-populated data are automatically provided to fulfill the 

majority of the reporting requirements. 

Territories and Native American tribes for which there are no NSDUH, FARS, UCR, 

and/or NCES data will not be required to report on those measures on those measures, 

but will be encouraged to provide substitute data in Column D.

B. Supplemental Data 

States may also wish to provide additional data related to the NOMs. The data can be 

included in the block grant appendix. When describing the supplemental data, states 

should provide any relevant Web addresses (URLs) that provide links to specific state 

data sources. 

D. Instructions for Completing Forms

Column A: Measure - The SAMHSA-defined measure for the domain listed. 

Column B: Question/Response 

• Source Survey Item: For Table 21-25, 29, and 30, the source is the NSDUH. For 

Tables 26-28 other "archival" sources are identified. The specific language used for 

each item is provided. 

• Response Option: The range of responses that are provided for the survey item. 

• Outcome Reported: The specific responses that are included in the calculation 

provided for the item. 

• Age: The age range for which the responses are provided. 

Column C: Pre-populated Data - Pre-populated data are provided; see letter A, Prepopulated data. 

Column D: Approved Substitute Data – Grantees for which there are no NSDUH, 

FARS, UCR and/or NCES data will be able to voluntarily enter data for the items in this 

column. Substitute data is not allowed for grantees with pre-populated data.
Page 56

SABG TABLE 21– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED 

MORBIDITY - ABSTINENCE FROM DRUG USE/ALCOHOL USE

MEASURE: 30-DAY USE

A. 

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

1. 30-day 

Alcohol 

Use

Source Survey Item : NSDUH 

Questionnaire. “Think specifically about the 

past 30 days, that is, from [DATEFILL] 

through today. During the past 30 days, on 

how many days did you drink one or more 

drinks of an alcoholic beverage?” 

[Response option: Write in a number 

between 0 and 30.]

Outcome Reported: Percent who reported 

having used alcohol during the past 30 

days.

Ages 12–20 – CY 2016-2017

Ages 21+ - CY 2016-2017

2. 30-day 

Cigarette 

Use

Source Survey Item: NSDUH 

Questionnaire: “During the past 30 days, 

that is, since [DATEFILL], on how many 

days did you smoke part or all of a 

cigarette?” [Response option: Write in a 

number between 0 and 30.]

Outcome Reported: Percent who reported 

having smoked a cigarette during the past 

30 days.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

3. 30-day 

Use of 

Other 

Tobacco 

Products

Source Survey Item: NSDUH 

Questionnaire: “During the past 30 days, 

that is, since [DATEFILL], on how many 

days did you use [other tobacco 

products3]

†?” [Response option: Write in a 

number between 0 and 30.]

Outcome Reported: Percent who reported 

having used a tobacco product other than 

 

3 NSDUH asks separate questions for each tobacco product. The number provided combines responses to all questions about 

tobacco products other than cigarettes
Page 57

A. 

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

cigarettes during the past 30 days, 

calculated by combining responses to 

questions about individual tobacco 

products (cigars, smokeless tobacco, pipe 

tobacco).

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

4. 30-day 

Use of 

Marijuana

Source Survey Item: NSDUH 

Questionnaire: “Think specifically about the 

past 30 days, from [DATEFILL] up to and 

including today. During the past 30 days, 

on how many days did you use marijuana 

or hashish?” [Response option: Write in a 

number between 0 and 30.]

Outcome Reported: Percent who reported 

having used marijuana or hashish during 

the past 30 days.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

5. 30-day 

Use of 

Illicit 

Drugs 

Other Than 

Marijuana

Source Survey Item: NSDUH 

Questionnaire: “Think specifically about the 

past 30 days, from [DATEFILL] up to and 

including today. During the past 30 days, 

on how many days did you use [any other 

illegal drug]4?”

Outcome Reported: Percent who reported 

having used illegal drugs other than 

marijuana or hashish during the past 30 

days, calculated by combining responses 

to questions about individual drugs (heroin, 

cocaine, hallucinogens, inhalants, 

methamphetamine, and misuse of 

prescription drugs).

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

 

4 NSDUH asks separate questions for each illegal drug. The number provided combines responses to all questions about illegal 

drugs other than marijuana or hashish.
Page 58

SABG TABLE 22– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED 

MORBIDITY - ABSTINENCE FROM DRUG USE/ALCOHOL USE

MEASURE: PERCEPTION OF RISK/HARM OF USE

A.

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

1. 

Perception 

of Risk 

from 

Alcohol

Source Survey Item: NSDUH 

Questionnaire: “How much do people risk 

harming themselves physically and in 

other ways when they have five or more 

drinks of an alcoholic beverage once or 

twice a week?” [Response options: No 

risk, slight risk, moderate risk, great risk]

Outcome Reported: Percent reporting 

moderate or great risk.

Ages 12–20 - CY 2016-2017

Ages 21+ - CY 2016-2017

2. 

Perception 

of Risk 

from 

Cigarettes

Source Survey Item: NSDUH 

Questionnaire: “How much do people risk 

harming themselves physically and in 

other ways when they smoke one or more 

packs of cigarettes per day?” [Response 

options: No risk, slight risk, moderate risk, 

great risk]

Outcome Reported: Percent reporting 

moderate or great risk.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

3. 

Perception 

of Risk 

from 

Marijuana

Source Survey Item: NSDUH 

Questionnaire: “How much do people risk 

harming themselves physically and in 

other ways when they smoke marijuana 

once or twice a week?” [Response 

options: No risk, slight risk, moderate risk, 

great risk]

Outcome Reported: Percent reporting 

moderate or great risk.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017
Page 59

SABG TABLE 23– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED 

MORBIDITY - ABSTINENCE FROM DRUG USE/ALCOHOL USE

MEASURE: AGE OF FIRST USE

A.

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

1. Age at 

First Use of 

Alcohol

Source Survey Item: NSDUH 

Questionnaire: “Think about the first time

you had a drink of an alcoholic beverage. 

How old were you the first time you had a 

drink of an alcoholic beverage? Please do 

not include any time when you only had a 

sip or two from a drink.” [Response option: 

Write in age at first use.]

Outcome Reported: Average age at first 

use of alcohol.

Ages 12–20 - CY 2016-2017

Ages 21+ - CY 2016-2017

2. Age at 

First Use of 

Cigarettes

Source Survey Item: NSDUH 

Questionnaire: “How old were you the first 

time you smoked part or all of a cigarette?” 

[Response option: Write in age at first use.]

Outcome Reported: Average age at first 

use of cigarettes.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

3. Age at 

First Use of 

Tobacco 

Products 

Other Than

Cigarettes

Source Survey Item: NSDUH 

Questionnaire: “How old were you the first 

time you used [any other tobacco 

product]†?” [Response option: Write in age 

at first use.]

Outcome Reported: Average age at first 

use of tobacco products other than 

cigarettes.

Ages 12–17 - CY 2016-2017

Ages 18+ CY 2016-2017

4. Age at 

First Use of 

Source Survey Item: NSDUH 

Questionnaire: “How old were you the first 
Page 60

A.

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

Marijuana 

or Hashish

time you used marijuana or hashish?” 

[Response option: Write in age at first use.]

Outcome Reported: Average age at first 

use of marijuana or hashish.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

5. Age at 

First Use of 

Heroin

Source Survey Item: NSDUH 

Questionnaire: “How old were you the first 

time you used heroin?” [Response option: 

Write in age at first use.]

Outcome Reported: Average age at first 

use of heroin.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

6. Age at 

First Misuse

of 

Prescription 

Pain 

Relievers 

Among Past 

Year 

Initiates

Source Survey Item: NSDUH 

Questionnaire: “How old were you the first 

time you used [specific pain reliever]‡ in a 

way a doctor did not direct you to use 

it?” [Response option: Write in age at first

use.]

Outcome Reported: Average age at first 

misuse of prescription pain relievers 

among those who first misused prescription 

pain relievers in the last 12 months.

Ages 12–17 - CY 2016-2017

Ages 18+ - CY 2016-2017
Page 61

SABG TABLE 24– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED 

MORBIDITY - ABSTINENCE FROM DRUG USE/ALCOHOL USE

MEASURE: PERCEPTION OF DISAPPROVAL/ATTITUDES

A.

Measure

1. Disapproval 

of Cigarettes

2. Perception 

of Peer 

Disapproval of 

Cigarettes

3. Disapproval 

of Using 

Marijuana 

Experimentally

4. Disapproval 

of Using 

B.

Question/Response

Source Survey Item: NSDUH 

Questionnaire: “How do you feel about 

someone your age smoking one or 

more packs of cigarettes a day?” 

[Response options: Neither approve 

nor disapprove, somewhat disapprove, 

strongly disapprove]

Outcome Reported: Percent somewhat

or strongly disapproving.

Ages 12–17 - CY 2016-2017

Source Survey Item: NSDUH 

Questionnaire: “How do you think your 

close friends would feel about you 

smoking one or more packs of 

cigarettes a day?” [Response options: 

Neither approve nor disapprove, 

somewhat disapprove, strongly 

disapprove]

Outcome Reported: Percent reporting 

that their friends would somewhat or 

strongly disapprove.

Ages 12–17 - CY 2016-2017

Source Survey Item: NSDUH 

Questionnaire: “How do you feel about 

someone your age trying marijuana or 

hashish once or twice?” [Response 

options: Neither approve nor 

disapprove, somewhat disapprove, 

strongly disapprove]

Outcome Reported: Percent somewhat 

or strongly disapproving.

Ages 12–17 - CY 2016-2017

Source Survey Item: NSDUH 

Questionnaire: “How do you feel about 

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any
Page 62

A.

Measure

B.

Question/Response

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

Marijuana 

Regularly

5. Disapproval 

of Alcohol

someone your age using marijuana 

once a month or more?” [Response 

options: Neither approve nor 

disapprove, somewhat disapprove, 

strongly disapprove]

Outcome Reported: Percent somewhat 

or strongly disapproving.

Ages 12–17 - CY 2016-2017

Source Survey Item: NSDUH 

Questionnaire: “How do you feel about 

someone your age having one or two 

drinks of an alcoholic beverage nearly 

every day?” [Response options: Neither 

approve nor disapprove, somewhat 

disapprove, strongly disapprove]

Outcome Reported: Percent somewhat 

or strongly disapproving.

Ages 12–20 - CY 2016-2017
Page 63

SABG TABLE 25– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: 

EMPLOYMENT/EDUCATION 

MEASURE: PERCEPTION OF WORKPLACE POLICY

A.

Measure

Perception 

of 

Workplace 

Policy

B.

Question/Response

Source Survey Item: NSDUH 

Questionnaire: “Would you be more or less 

likely to want to work for an employer that 

tests its employees for drug or alcohol use 

on a random basis? Would you say more 

likely, less likely, or would it make no 

difference to you?” [Response options: 

More likely, less likely, would make no 

difference]

Outcome Reported: Percent reporting that 

they would be more likely to work for an 

employer conducting random drug and 

alcohol tests.

Ages 15–17 - CY 2016-2017

Ages 18+ - CY 2016-2017

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

SABG TABLE 26– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: 

EMPLOYMENT/EDUCATION

MEASURE: AVERAGE DAILY SCHOOL ATTENDANCE RATE

A.

Measure

Average 

Daily 

School 

Attendance 

Rate

B.

Source

Source: National Center for Education 

Statistics, Common Core of Data: The 

National Public Education Finance Survey

available for download at 

http://nces.ed.gov/ccd/stfis.asp

Measure calculation: Average daily 

attendance (NCES defined) divided by 

total enrollment and multiplied by 100. 

CY 2017

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any
Page 64

SABG TABLE 27 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND 

CRIMINAL JUSTICE

MEASURE: ALCOHOL-RELATED TRAFFIC FATALITIES

A.

Measure

AlcoholRelated 

Traffic 

Fatalities

B.

Source

Source: National Highway Traffic Safety 

Administration Fatality Analysis Reporting 

System

Measure calculation: The number of 

alcohol-related traffic fatalities divided by 

the total number of traffic fatalities and 

multiplied by 100.

CY 2017

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

SABG TABLE 28– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND 

CRIMINAL JUSTICE

MEASURE: ALCOHOL- AND DRUG-RELATED ARRESTS

A.

Measure

Alcoholand DrugRelated 

Arrests

B.

Source

Source: Federal Bureau of Investigation 

Uniform Crime Reports

Measure calculation: The number of 

alcohol- and drug-related arrests divided by 

the total number of arrests and multiplied 

by 100.

CY 2017

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any
Page 65

SABG TABLE 29 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: SOCIAL 

CONNECTEDNESS

MEASURE: FAMILY COMMUNICATIONS AROUND DRUG AND ALCOHOL USE

A. 

Measure

1. Family 

Communications 

Around Drug 

and Alcohol Use 

(Youth)

2. Family 

Communications 

Around Drug 

and Alcohol Use 

(Parents of 

children aged 

12–17)

B.

Question/Response

Source Survey Item: NSDUH 

Questionnaire: “Now think about the 

past 12 months, that is, from 

[DATEFILL] through today. During 

the past 12 months, have you talked 

with at least one of your parents 

about the dangers of tobacco, 

alcohol, or drug use? By parents, we 

mean either your biological parents, 

adoptive parents, stepparents, or 

adult guardians, whether or not they 

live with you.” [Response options: 

Yes, No]

Outcome Reported: Percent 

reporting having talked with a parent.

Ages 12–17 - CY 2016-2017

Source Survey Item: NSDUH 

Questionnaire: “During the past 12 

months, how many times have you 

talked with your child about the 

dangers or problems associated with 

the use of tobacco, alcohol, or other 

drugs5? [Response options: 0 times, 

1 to 2 times, a few times, many 

times]

Outcome Reported: Percent of 

parents reporting that they have 

talked to their child.

Ages 18+ - CY 2016-2017

C.

Prepopulated 

Data

D.

Supplemental 

Data, if any

 

5

NSDUH does not ask this question of all sampled parents. It is a validation question posed to parents of 12- to 17-year-old survey 

respondents. Therefore, the responses are not representative of the population of parents in a State. The sample sizes are often too 

small for valid reporting.
Page 66

SABG TABLE 30 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: RETENTION

MEASURE: PERCENTAGE OF YOUTH SEEING, READING, WATCHING, OR LISTENING 

TO A PREVENTION MESSAGE

Measure

Exposure 

to 

Prevention 

Messages

Question/Response

Source Survey Item: NSDUH 

Questionnaire: “During the past 12 

months, do you recall [hearing, reading, or 

watching an advertisement about the 

prevention of substance use]6?” 

Outcome Reported: Percent reporting 

having been exposed to prevention 

message.

Ages 12–17 - CY 2016-2017

Prepopulated 

Data

Supplemental 

Data, if any

 

6 This is a summary of four separate NSDUH questions each asking about a specific type of prevention message delivered within a 

specific context.
Page 67

SABG Tables 31-35 – Reporting Period

Reporting Period - Start and End Dates for Information Reported on SABG Tables 31, 

32, 33, 34, and 35.

The following chart is for collecting information on the reporting periods for the data 

entered in Tables 31-35. Please note that the correct reporting period for Tables 

31-34 is the Calendar Year (CY) which coincides with the reporting period for the 

pre-populated prevention NOMs in Tables 21-30. We understand that some states 

have reported on the state fiscal year (SFY) or federal fiscal year (FFY) for these 

tables in past SABG Reports. If your state is unable to report on the calendar

year, please indicate in this footnote why you are unable to report on the calendar 

year and the steps the state intends to take to make calendar year reporting 

possible in future years. Note that the correct reporting period for Table 35 is the 

SABG compliance period that coincides with the reporting period for Tables 4, 5a, 

5b, 6 and 7.

Rows 1 through 5 each correspond to a single form in the current year's application 

among the following five tables: 31, 32, 33, 34 and 35. 

Column A: Enter the reporting period start date. 

Column B: Enter the reporting period end date. 

The date format to be entered in columns A and B should be month/day/year, as 

follows. 

• Month: enter 2 digits (e.g. January = 01; December = 12) 

• Day: enter 2 digits (e.g. 1st of the month = 01; 15th of the month = 15) 

• Year: enter all 4 digits (e.g. 2012, 2013)

Reporting Period Start and End Dates for Information Reported on

SABG Tables 31, 32, 33, 34 and 35

Please indicate the reporting period 

for each of the following NOMS.

Tables A. Reporting Period

Start Date

B. Reporting Period

End Date

SABG Table 31 

Individual-Based Programs and 

Strategies – Number of Persons 

Served by Age, Gender, Race, and 

Ethnicity

mm/dd/yyyy mm/dd/yyyy

SABG Table 32

Population-Based Programs and 

Strategies – Number of Persons 

Served by Age, Gender, Race, and 

Ethnicity

mm/dd/yyyy mm/dd/yyyy

SABG Table 33 (Optional) mm/dd/yyyy mm/dd/yyyy
Page 68

Number of Persons Served by Type of 

Intervention

SABG Table 34

Number of Evidence-Based Programs 

and Strategies by Type of Intervention

mm/dd/yyyy mm/dd/yyyy

SABG Table 35

Total Number of Evidence-Based 

Programs and Total SABG Dollars 

Spent on Evidence-Based 

Programs/Strategies

mm/dd/yyyy mm/dd/yyyy
Page 69

General Questions Regarding Prevention NOMS Reporting

Question 1: Describe the data collection system you used to collect the NOMs data 

(e.g., MDS, DbB, KIT Solutions, manual process).

Question 2: Describe how your State’s data collection and reporting processes record a 

participant’s race, specifically for participants who are more than one race.

Indicate whether the State added those participants to the number for each applicable 

racial category or whether the State added all those participants to the More Than One 

Race subcategory.

SABG Table 31 – SUBSTANCE ABUSE PREVENTION Individual-Based Programs and 

Strategies—Number of Persons Served by Age, Gender, Race, and Ethnicity

Category Total

A. Age

0–4

5–11

12–14

15–17

18–20

21–24

25–44

45–64

65 and Over

Age Not Known

B. Gender

Male

Female

Gender Not Known

C. Ethnicity

Hispanic or Latino 

Not Hispanic or Latino

Ethnicity Unknown

D. Race
Page 70

White

Black or African American

Native Hawaiian/other Pacific Islander

Asian

American Indian/Alaska Native

More Than One Race (not OMB required)

Race Not Known or Other (not OMB 

required)
Page 71

SABG Table 32 – SUBSTANCE ABUSE PREVENTION Population-Based Programs and 

Strategies—Number of Persons Served by Age, Gender, Race, and Ethnicity

Category Total

A. Age

0–4

5–11

12–14

15–17

18–20

21–24

25–44

45–64

65 and Over

Age Not Known

B. Gender

Male

Female

Gender Not Known

C. Race

White

Black or African American

Native Hawaiian/other Pacific Islander

Asian

American Indian/Alaska Native

More Than One Race (not OMB required)

Race Not Known or Other (not OMB 

required)

D. Ethnicity

Hispanic or Latino 

Not Hispanic or Latino

Ethnicity unknown
Page 72

SABG Table 33 (Optional) – SUBSTANCE ABUSE PREVENTION 

Number of Persons Served by Type of Intervention

Number of persons Served by Individual or Populations-based Program or 

Strategy

Intervention Type

A.

Individual-Based

Programs and Strategies

B.

Population-Based 

Programs and 

Strategies

1. Universal Direct

2. Universal Indirect

3. Selective

4. Indicated

5. Total
Page 73

SABG Table 34 – Substance Abuse Prevention 

Evidence-Based Programs and Strategies by Type of Intervention

Definition of Evidence-Based Programs and Strategies: The guidance document for the 

Strategic Prevention Framework State Incentive Grant, Identifying and Selection 

Evidence-based Interventions, provides the following definition for evidence-based 

programs:

• Inclusion in a Federal List or Registry of evidence-based interventions

• Being Reported (with positive effects) in a peer-reviewed journal

• Documentation of effectiveness based on the following guidelines: 

o Guideline 1: The intervention is based on a theory of change that is 

documented in a clear logic or conceptual model; and

o Guideline 2: The intervention is similar in content and structure to 

interventions that appear in registries and/or the peer-reviewed literature; 

and

o Guideline 3: The intervention is supported by documentation that it has 

been effectively implemented in the past, and multiple times, in a manner 

attentive to Identifying and Selecting Evidence-Based Interventions 

scientific standards of evidence and with results that show a consistent 

pattern of credible and positive effects; and

o Guideline 4: The intervention is reviewed and deemed appropriate by a 

panel of informed prevention experts that includes: well-qualified 

prevention researchers who are experienced in evaluating prevention 

interventions similar to those under review; local prevention practitioners; 

and key community leaders as appropriate, e.g., officials from law 

enforcement and education sectors or elders within indigenous cultures.

1. Describe the process the State will use to implement the guidelines included in the 

above definition

2. Describe how the State collected data on the number of programs and strategies. 

What is the source of the data?
Page 74

SABG Table 34– SUBSTANCE ABUSE PREVENTION 

Number of Evidence-Based Programs and Strategies by Type of Intervention

A.

Universal

Direct

B.

Universal

Indirect

C.

Universal

Total

D.

Selective

E.

Indicated

F.

Total

1. Number of 

Evidence-Based 

Programs and 

Strategies Funded

2. Total number of 

Programs and 

Strategies Funded

3. Percent of 

Evidence-Based 

Programs and 

Strategies

SABG Table 35 – Total SUBSTANCE ABUSE PREVENTION Number of Evidence Based 

Programs/Strategies and Total SABG Dollars Spent on SUBSTANCE ABUSE 

PREVENTION Evidence-Based Programs/Strategies

Total Number of 

Evidence-Based 

Programs/Strategies for 

IOM Category below:

Total SAPT Block Grant Dollars

Spent on evidence-based 

Programs/Strategies

Universal Direct Total # $

Universal Indirect Total # $

Selective Total # $

Indicated Total # $

Unspecified Total# $

Total EBPs: Total Dollars Spent: $