Depatiment of Health and Human Sefices 

OFFICE OF 

INSPECTOR GENERAL 

MEASURING DRUG ABUSE 

TREATMENT COSTS 

MANAGEMENT ADVISORY REPORT 
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services’ (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by three OIG operating components: the Office of Audit Services, the 

Office of Investigations, and the Office of Evaluation and Inspections. The OIG also informs 

the Secretary of HHS of program and management problems and recommends courses to 

correct them. 

OFFICE OF AUDIT SERVICES 

The OIGS Office of Audit Services (OAS) provides all auditing setices for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIGS Office of Investigations (01) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 

unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions, 

administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 

control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFICE OF EVALUATION AND INSPECTIONS 

The OIGS Office of Evaluation and Inspections (OEI) conducts short-term management and


program evaluations (called inspections) that focus on issues of concern to the Department,


the Congress, and the public. The findings and recommendations contained in these inspection


reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability,


and effectiveness of departmental programs.


OEI’S Atlanta Regional Office staff prepared this report under the direction of Jesse J.


Flowers, Regional Inspector General, and Chris Koehler, Deputy Regional Inspector General.


Principal OEI staff included:


ATLANTA HEADQUARTERS


Jim Wilson Ruth Folchman


Jacqueline Watkins


Betty Apt


To obtain a copy of this report, call the Atlanta Regional Office at (404) 331-4108.

Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

MEASURING DRUG ABUSE�

TREATMENT COSTS�

MANAGEMENT ADVISORY REPORT 

NOVEMBER 1992 0EI-04-91-00430

EXECUTIVE SUMMARY 

PURPOSE 

To show how effectively the Alcohol, Drug Abuse and Mental Health Administration 

measures costs for drug abuse treatment. 

BACKGROUND 

Public funding of drug abuse treatment programs is largely the responsibility of 

individual localities and States. Most Federal funding for drug abuse treatment has 

been provided by the Alcohol, Drug Abuse and Mental Health Administration 

(ADAMHA). At the time of our review, ADAMHA was undergoing an extensive 

reorganization, and effective October 1, 1992, was replaced by the Substance Abuse 

and Mental Health Services Administration (SAMHSA). ADAMHA reorganized to 

better distinguish its dual service and research missions by focusing on treatment and 

services through SAMHSA and shifting research activities to the National Institutes of 

Health (NIH). Throughout the repo~ we will refer to ADAMHA instead of 

SAMSHA since the review was conducted prior to the effective date of the 

reorganization. 

In 1981, ADAMHA changed its primary funding method from categorical grants to 

block grants. The funds were provided through the Alcohol, Drug Abuse and Mental 

Health services (ADMS) block grant program. Block grants allowed States greater 

flexibility and required less reporting than categorical grants. Under the block grant 

program, States were not required to furnish data such as costs of drug abuse 

treatment. With the recent reorganization, the block grant will be split into two 

separate grants: one for mental health services and one for substance abuse treatment 

and prevention services. 

Reliable cost data is needed so that decision-makers can plan effective treatment 

programs. Accordingly, Federal legislation was passed in 1988 which increased 

ADAMHA’s data ccjllection requirements and States’ block grant reporting 

requirements to correct ADAMHA’s lack of drug abuse treatment cost data. 

FINDINGS 

ALMMEL4 is required to collect drug abuse treatment costs. 

The Anti-Drug Abuse Act of 1988 (P.L. 100-690) amended title V of the Public 

Health Service Act to require ADAMHA to collect costs on different drug abuse 

treatment modalities. 
ADAMHA’s data collection system does not provide reliable data for measuring drug 

abuse treatment costs. 

ADAMHA’s three major sources of data on drug abuse treatment - the State Alcohol 

and Drug Abuse Profile (SADAP), the National Drug Abuse and Alcoholism 

Treatment Unit Survey (NDATUS) and Drug Abuse Services Research Survey 

(DSRS) - are flawed in their cost reporting and limit the completeness, accuracy and 

relevancy of cost data. The data sources do not distinguish between reimbursement 

and costs, include indirect costs and relate cost data to services provided. 

RECOMMENDATIONS 

Ultimately, ADAMHA should obtain precise costs on the various drug treatment 

programs it supports, Without such cost data, the Department’s ability to assess, plan 

and budget effective treatment programs is limited. However, ADAMHA has not 

required States and localities to furnish drug abuse treatment cost data. Accordingly, 

we recommend that ADAMI-IA 

1.	 Aggressively continue to incrementally build a system for measuring drug abuse 

treatment costs. 

Such data is essential for planning and budgeting effective drug abuse 

treatment services. To assure that reliable, useable cost data is available, 

ADAMHA should, as part of its ongoing efforts to establish and clearly define 

appropriate drug abuse treatment protocols: 

a)	 identify in accordance with commonly accepted accounting principles, all 

indirect and direct cost components of various drug abuse treatment 

protocols; 

b)	 develop cost standards for the different types of drug abuse treatment 

protocols; 

c)	 identify and use alternative methods for obtaining reliable drug abuse 

treatment costs; 

d)	 aggregate and summarize provider cost data to establish ranges and 

baselines; and 

e)	 periodically veri& cost data collected to assure its reliability (the cost of 

such validation could be limited through use of sampling techniques). 

ii 
2.	 As a condition of grant award, require that drug abuse treatment research and 

demonstration grantees who perform clinical effectiveness studies use Federal 

standards for collecting treatment cost data. 

ADAMHA’s Office for Treatment Improvement, the National Institute on Drug


Abuse, and others are aware of the problems created by lack of reliable drug abuse


treatment costs and they have remedial initiatives underway.


COMMENTS


We did not receive written comments from the Public Health Service (PHS).


However, in commenting orally, ADAMHA staff agreed with the findings, but stressed


that grantees lack capacity to capture cost data. We did receive written comments


from the Assistant Secretary for Planning and Evaluation and the Counsel to the


Secretary for Drug Abuse and Policy. They agreed that ADAMHA should continue


efforts to improve measurement of drug abuse treatment costs. However, the Counsel


to the Secretary did not believe that all grantees performing clinical effectiveness


studies should be required to collect treatment cost data. We have clarified that we


are not recommending this, but rather that those who do collect cost data should use


Federal standards,


... ul 
TABLE OF CONTENTS


EXECUTIVE SUMMARY 

~oDu~oN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s1 

mugs . . . . . . . . . . . . . . . . . . .+ . . . . .. ”. ”. .” ”o”o””o””””””o 00”.=-”-5


ADAMHAs Requirements for Data Collection . . . . . . . . . . . . . . . . . . . . . . . . 5


ADAMHA’s Data Collection System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5


RECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


E~NO~ . . . . . . . . . . . . . . . . . . . . . . . . . . . ..”” ”””” ”””” ”””” ”””. ”O”--$ 9


APPENDIX k~W~ONDH REPORT . . . . . . . . . . . . . . . . . . .. A-l 
--

INTRODUCTION


PURPOSE 

To show how effectively the Alcohol, Drug Abuse and Mental Health Administration 

measures costs for drug abuse treatment. 

BACKGROUND 

Evoiktion of Dug 11-eatrnentBqpuns 

Drug abuse treatment programs have evolved with changes in types of drugs used, 

composition of drug abuser populations, and definitions of drug abuse and addiction. 

In the early 1900s, drug abuse treatment was directed largely at cocaine and opium 

abusers with most treatment provided in medical settings. Between 1910 and 1920, 

public perception of drug abuse shifted from treatment of drug abuse as an illness to 

punishment of drug abuse as a crime. Enactment of the Harrison Narcotic Act in 

1914 signalled a change in approach to treatment of addiction by attempting to control 

the sale of drugs defined as narcotic. The U.S. Supreme Court decisions in 1914 and 

1916 restricted physicians’ authority to prescribe heroin for addicts. By 1923, the last 

public maintenance clinics for heroin addicts had closed. Thereafter, little change 

occurred until the 1960s. 

Throughout the 1950s and 1960s, drug addiction incidence increased. During the 

1960s, treatment practices changed and medical treatment again became the 

predominant method of coping with drug abuse. For example, the Public Health 

Service opened treatment hospitals for heroin addicts in Kentucky and Texas. Most 

treatment programs that began in the 1960s focused on abusers who used only heroin. 

In the 1970s, methadone maintenance and therapeutic treatment communities were 

used successfully for heroin addicts. However, as drugs such as cocaine and 

amphetamines were recognized to cause dependency, a new approach to treatment 

was adopted outpatient drug-free programs with emphasis on individual counseling. 

As a result, Federal, State and local government funding increased. Private funding 

for drug abuse treatment also increased in the late 1970s and 1980s as coverage 

became available by private health insurance programsl. 

From the 1980s to the present, Federal funding has increased both for treatment and 

prevention (enforcement and education). Private funding, along with State and local 

governments, continued to pay for most drug abuse treatment. In recent years, private 

coverage has begun to decline as insurance cost containment programs reduced 

coverage allowances for drug abuse treatment. 

1

Generally Accepted Drug Abuse Treatment Modalities 

Modalities can be defined as treatment setting and/or medical protocol used in 

treating drug dependency. Drug abuse treatment is now classified into four general 

modal~ies2: 

b Methadone Maintenance, 

b Outpatient non-methadone (drug-free) treatment, 

b Residential therapeutic communities (TC), and 

b Chemical Dependency (CD) units. 

In addition, some professionals consider drug detoxification to be a modality because it 

is generally the first step in the treatment process and it requires resources. 

However, some controversy exists over whether detoxification should be considered a 

distinct modality. For example, a September 1990 Institute of Medicine study, 

Treatirw Drug Problems, argued that detoxification is not a treatment modality. The 

study noted that, “Detoxification is seldom effective in itself as a modality for bringing 

about recovery from dependence, although it can be used as a gateway to other 

treatment modalities. Detoxification episodes are often hospital based and may begin 

with an emergency treatment of an overdose. However, clinicians generally advocate 

that, because of the narrow and short-term focus and very poor outcomes in terms of 

relapse to drug dependence, detoxification not be considered a modality of treatment 

in the same sense as methadone, TCS, outpatient nonmethadone, and CD programs.” 

Federal Agencies Ache In Dug Abuse lleatment 

Within the Department of Health and Human Services, at the time of our review, the


Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) had


responsibility for policy development and funding of State treatment programs.


Effective October 1, 1992, ADAMHA was replaced by the Substance Abuse and


Mental Health Services Administration (SAMHSA). The creation of SAMHSA was


an attempt to address concerns that the institutes within ADAMHA had shifted their


focus over the years from services development to biomedical research. SAMHSA will


focus on treatment and services for people who are mentally ill or chemically


dependent and will comprise three agencies: the Center for Substance Abuse


Treatment--formerly the Office of Treatment Improvement (OTI), the Center for


Substance Abuse--formerly the Office of Substance Abuse Prevention (OSAP), and a


newly created Center for Mental Health Services. Research activities formerly


conducted by ADAMHA’s three research institutes were transferred to the National


Institutes of Health (NIH). Throughout this report, we have referred to ADAMHA


instead of SAMSHA since the review was conducted prior to the effective date of the


reorganization.


2 
Also within the Department, the Drug Abuse Policy Office is located in the Office of 

the Secretary, increasing the visibility and policy attention given to drug abuse. The 

Assistant Secretaries for both Planning and Evaluation, and Management and Budget 

work closely together in providing oversight and policy direction in program 

expenditures. 

One other Federal agency plays an important policy role for drug abuse treatment. 

The White House Office of National Drug Control Policy (ONDCP) was created by 

the 1988 Anti-Drug Abuse Act and granted statutory authority to develop an annual 

National Drug Control Strategy. 

Riblk Funding for Drug Abuse i?7eatrnenlI+ograrns 

Public funding of drug abuse treatment programs is largely the responsibility of 

localities and individual States. In recent years, Federal roles in drug abuse treatment 

have been expanding. Most Federal funds for drug abuse treatment have been 

provided by ADAMHA through the Alcohol, Drug Abuse, and Mental Health Services 

(ADMS) block grant program. With the ADAMHA reorganization, the ADMS block 

grant was split into two grants: one for mental health services and one for substance 

abuse treatment and prevention services. The reorganization also modified the 

formula under which each state’s block grant allotment is determined providing that, 

through Fiscal Year 1994, no state may receive less than its Fiscal Year 1991 block 

grant allocation. Federal funding to States has increased significantly, representing 

about 20 percent of total funding for drug abuse treatment. The ADAMHA 

expenditures for Fiscal Year 1991 were approximately $638 million for drug abuse 

treatment. 

Until 1981, ADAMHA’s primary mechanism for funding drug abuse treatment was 

through categorical grants for drug abuse treatment. The categorical grant program 

allowed the Federal government to influence the design, implementation, and data 

collection methodologies for State and local drug abuse treatment programs. With the 

Omnibus Budget Reconciliation Act of 1981, the Congress consolidated all categorical 

treatment grants under the ADMS block grant program. The intent of the block grant 

program was to enable States to design their own treatment programs and allocate 

funds accordingly. Subsequent to development of the block grant program, a number 

of drug abuse treatment discretionary grant programs have been developed and 

targeted on special populations and needs. Conversion from categorical grants to 

block grants allowed the States greater flexibility, but reduced Federal access to drug 

abuse treatment data. 

3

METHODOIJ3GY 

We reviewed principal data collection surveys sponsored by ADAMHA to assess how 

well they satisfied certain criteria including cost, timeliness, completeness and 

verification. Our primary concern was to determine whether reliable data for 

establishing estimates on the costs of drug abuse treatment were present in the current 

principal surveys. 

Drug abuse treatment costs, for purposes of this report, are defined as direct and 

indirect costs related to clinical treatment of drug abusers. This report does not 

consider other costs such as those related to diminished productivity or social impact 

of drug abuse. 

In addition to reviewing existing data bases, we interviewed principal staff in 

ADAMHA’s Office for Treatment Improvement and the National Institute on Drug 

Abuse. 

Our review was conducted in accordance with the I!nterim Stmdarh for Inspectkms 

issued by the President’s Council on Integrity and Efficiency. 

4

FINDINGS


ADAMHAis
Required to Collect Drug Abuse Treatment Costs. 

The Anti-Drug Abuse Act of 1988 (P.L. 100-690) amended title V of the Public 

Health Service Act to require the Administrator of ADAMHA to collect costs on 

different treatment modalities. The Act requires: 

ADAMHA to consult with States and appropriate national organizations to 

develop uniform criteria for collecting drug abuse treatment cost datas; 

States to provide ADAMHA cost data required as a condition for receiving 

their block grantsG; 

ADAMHA to support research on comparable costs and efficacy of different 

treatment modalities; and 

ADAMHA to collect data each year on the national incidence and prevalence 

of the various forms of substance abuses. 

ADAMHA’s Data Collection System Does Not Provide Reliable Data for Measuring


Drug Abuse Treatment Costs.


Presently, ADAMHA has three major sources for data collection on drug abuse


treatment. We reviewed the reports from each source. The reports provide


important data, but each is flawed with regard to cost reporting. Specifically, as shown


below, the reports do not include costs of drug abuse treatment.


State Alcohol and Drug Abuse Profile: Congressional amendments to the 

ADMS block grant program in 1984 required the Department, in consultation 

with national interest groups, to develop model data collection criteria and 

formats to obtain national-level data on services provided, number and types of 

clients served, and total funding9. 

To develop and maintain the required data, the National Institute on Drug 

Abuse (NIDA) provides funds to the National Association of State Alcohol and 

Drug Abuse Directors, Inc. (NASADAD) for collecting and analyzing drug 

abuse treatment data. This system is widely known by its acronym, SADAP. 

States submit data on a voluntary basis. The data, however, is not verified and 

costs of drug abuse treatment are not obtained. 

5

--

--

National Drug Abuse and Alcoholism Treatment Unit Snvey In addition to 

information provided by SADAP, NIDA collects other drug abuse treatment 

data through the National Drug Abuse and Alcohol Treatment Survey 

(NDATUS). NIDA initiated the survey in 1974 and has repeated it 

intermittently since then, The National Drug Abuse Treatment Survey collects 

data on both private and public drug abuse treatment providers. It represents 

the most comprehensive collection of data from the census of drug abuse 

treatment providers, but it does not collect cost data it collects data on 

program funding. Further, NDATUS does not include all providers and does 

not verify the data. 

Drug Abuse SeMces Research Suxvey As a condition for continued funding of 

NDATUS for Fiscal Year 1990, the Office of Management and Budget and 

Office of National Drug Control Policy directed NIDA to undertake a separate 

and additional data collection effort the Drug Abuse Services Research 

Survey (DSRS)lO. The NIDA’s Financing and Services Research Branch 

gathered a range of data on provider services, clients in treatment, type of 

treatment staff, revenue, etc. This data collection effort was completed in April 

1991. DSRS surveyed a substantial number of providers of drug abuse 

treatment services, but captured limited aggregate costs and revenue data by 

modality. NIDA staff told us that requested information was not generally 

available on costs of treatment by modality at the provider level. NIDA’s data 

would be enhanced substantially by national reporting standards for collecting 

costs of treatment. 

In addition to the specific limitations of the data systems discussed above, there are 

two general problems with existing cost data. 

Costs Are Understated. In most cases, when financial data is collected, it 

reflects program funding or reimbursement, rather than treatment costs. For 

example, some States reimburse local programs and counties at less than 100 

percent of their actual costs of treatment. Furthermore, States do not always 

include indirect costs in drug abuse treatment allocation, resulting in further 

understating actual costs. 

Funding Data Do Not Relate To Services. Most cost information collected is 

not specifically related to the factors that affect costs, including the setting, type 

and intensity of services provided. Unless cost data is directly associated with 

treatment modality and level of services provided, it has limited utility to policy 

makers. 

6

--

--

--

RECOMMENDA~ONS


Ultimately, ADA.MHA should obtain precise costs on the various drug treatment 

programs it supports. Without such cost data, the Department’s ability to assess, plan 

and budget effective treatment programs is limited. However, ADAMHA has not 

required States and localities to furnish drug abuse treatment cost data. Accordingly, 

we recommend that ADAMHA 

1.	 Aggressively continue to incrementally build a system for measuring drug abuse 

treatment costs. 

Such data is essential for planning and budgeting effective drug abuse 

treatment services. To assure that reliable, useable cost data is available, 

ADAMHA should, as part of its ongoing efforts to establish and clearly define 

appropriate drug abuse treatment protocols: 

a)	 identify in accordance with commonly accepted accounting principles, all 

indirect and direct cost components of various drug abuse treatment 

protocols; 

b)	 develop cost standards for the different types of drug abuse treatment 

protocols; 

c)	 identify and use methods for obtaining reliable drug abuse treatment 

costs, such as: 

.- performing case-studies of providers with focus on units of service 

related to types of drug abuse and related costs; 

obtaining actual verified costs on a significant sample of providers 

for treatment of various types of drug abuse and types of services; 

identifying, analyzing and verifying the validity of existing drug 

treatment data collection systems to determine if such systems 

collect cost data and meet standards to be developed by 

AD/lMm, 

.- studying possible use of Medicaid data to measure drug abuse 

treatment costs since Medicaid is an entitlement program and 

cost data is a program requirement; and 

identifying private insurers and Health Maintenance 

Organizations who have drug abuse treatment cost data which 

they are willing to share with ADAMHA. 

‘7


__— — 
d)	 aggregate and summarize provider cost data to establish ranges and 

baselines; and 

e)	 periodically verify cost data collected to assure its reliability (the cost of 

such validation could be limited through use of sampling techniques). 

2.	 As a condition of grant awar~ require that drug abuse treatment research and 

demonstration grantees who perform clinical effectiveness studies use Federal 

standards for collecting treatment cost data. 

ADAMHA’s Office for Treatment Improvement, the National Institute on Drug


Abuse, and others are aware of the problems created by lack of reliable drug


treatment costs and they have remedial initiatives underway.


COMMENTS TO DR.AFP MANAGEMENT ADVISORY REPORT


In meetings with ADAMHA staff, they generally agreed with the management


advisory report. They expressed a desire that the report elaborate on their grantees


present lack of capacity to capture and report cost data. Our limited review did not


provide sufficient data for us to comment on grantees’ capacity to collect data. While


we understand the concern about capacity, we believe reliable program cost is


information grantees need to plan effective operations.


The Assistant Secretary for Planning and Evaluation (ASPE), and the Counsel to the


Secretary for Drug Abuse Policy commented on the draft management advisory


report. Although we have not received written comments from ADAMH~ we have


discussed the findings and recommendations with them.


The ASPE agreed with our recommendations, and asked about the reasonableness of


using NDATUS data for budgeting purposes. Since the NDATUS does not collect


cost data, we believe its use in developing budget estimates is limited. However, that


issue was not included in the scope of our inspection.


The Counsel to the Secretary for Drug Abuse Policy concurred with our


recommendation to incrementally build a system for measuring drug abuse treatment


costs but did not agree about mandating the collection of cost data through clinical


effectiveness studies. He suggested possible options for collecting treatment cost data


which ADAMHA plans to include in future demonstration programs, We agree there


are many other appropriate means of collecting data. We did not mean that all


grantees should be required to collect such data but that those who do should use


Federal standards.


8

ENDNOTES


1.� Jaffe and Musto, 1987 in Hubbard, R. 1989 DRUG ABUSE TREATMENT A National Study 

of lZ&etiveness.Chapel Hill, N.C. : University of North Carolina Press, 3-5. 

2.	 Gerstein and Harwood, et al. 1990. TREATING DRUG PROBLEMS. Committee for the 

Substance Abuse Coverage Study, Division of Health Care Services, INSTITUTE OF 

MEDICINE. Washington, D.C. : National Academy Press, 12. 

3. Unpublished. Fiscal Year 1991 Department of Health and Human Services, Anti-Dru~ Abuse 

m.	 ADAMHA’s Office for Treatment Improvement (OTI)- includes ADMS Block 

Grants, Waiting List Grants, Crisis Areas Grants, Treatment Improvement, OTI Management, 

Homeless Demonstration Grants and NIDA Research Demonstration Grants. Source is the 

Office of The Assistant Secretary for Management and Budget, Department of Health and 

Human Services. 

4.	 Section 2052 of the Anti-Drug Abuse Act (P.L. 100-690) amended Part A of title V of the 

Public Health Act by adding a new section-- Section 509D. Section 509D (c)(G) refers to 

“costs of the different types of treatment modalities.” 

5.	 Section 2052 of the Anti-Drug Abuse Act amended Part A of title V of the Public Health 

Service Act to add Section 509D(d) which specifies “consultation with the States and with 

appropriate national organizations, the Administrator shall develop uniform criteria for the 

collection of data...” 

6.	 Section 2034 of the Anti-Drug Abuse Act amended Section 1916(c) of the Public Health 

Service Act by adding sections (16)-(21). Section 1916(c)(2) specifies “The State agrees that 

the State will provide to the Secretaty any data required by the Secretary pursuant to section 

509D and will cooperate with the Secretary in the development of uniform criteria for the 

collection of data pursuant to such section.” 

7.	 Section 2012 of the Anti-Drug Abuse Act describes purposes of this Act. Section 2012(6) 

states as one of its purposes-- “to increase understanding about the extent of alcohol abuse and 

other forms of drug abuse by expanding data collection activities and supporting research on 

the comparative cost and efficaq of substance abuse prevention and treatment services.” 

8.	 Section 2052 of the Anti-Drug Abuse Act added Section 509D to the Public Health Service Act 

and specifies “Sec. 509D. (c)(2) Annual surveys shall be carried out in the collection of data 

under this section. Summaries and analyses of the data collected shall be made available to the 

public.” 

9.	 Kusserow, Richard P. 1989. An Assessment of Data Collection for Alcohol, Drug Abuse, and 

Mental Health SeMces. Washington, D.C. : Office of the Inspector General, 1-2. 

10.	 Batten, et al., Bigel Institute for Health Policy, Brandeis University, 1991. DRUG SERVICES 

RESEARCH SURVEY, Phase I Final Report: Non-Correctional Facilities, NIDA Contract 

Number 271-90-8319/1. 

9

APPENDIX A 

COMMENTS ON DRAFI’ REPORT 

A-1 
---

--

-.,.. ...,


4f 

2 PEP.4RT.MENTOF HE.\LTH& HIJ,MANSERVICES Otfice of the Swemfy 

--%’ ._-—
 , ‘.-.,.a L& Waslmgton. D.C. 20201 , 

Juli ] ] ]~	 LO “* 

/ 

PIW 

DIG-AS


DIG-EI 1/


To : Richard P. Kuss”erow	 DIG-01 ,/ 

/ e 

ASG36P Inspector General OGCJIG ,/
/


Exac
 F?.GK: Assistant Secretary for ~ATESENT ‘<~
 Fl~nning and Evaluation


5~~7~~~ :� GIG Mariagement Advisory Report: “Measuring Dmg Abuse


“rreat~ent costs,~~ OEI-04091-00430


Thank you for the opportunity to review the above named draft


management report. I think that the report helps to highlight


the limitations of the existing financial data on drug abuse 

treatment available to the Alcohol, Dng Abuse and Mental Health


Administration’s (~~), and provides constructive suggestions


for how to begin to improve our information.


It.will ‘cake some time, however, to imDrove the financial data 

available on drug treatment costs. Consequently, it would be 

helpful from a pclicy perspective if the report could include a 

discussion of how the existing National Drug and Alcohol 

Treatinent Utilization Suney (NDATUS) data available on funding 

sources can be used to develop budget estimates. As you are 

aware, we currently use this data to develop the estimates for 

the costs of drug treatment slots. It would be helpful to 

understand the reasonableness of such use and the limitations of 

the data for budgeting purposes. In addition, if you have 

suggestions for ways we can improve our estimating process using 

the existing available data sources this would also be of 

assistance. 

If you have any questions, please call Elise Smith at 245-1870. 

..


cc: Emilie Baebel ..-


.,
.


L

J@ “-”% 

DEPARTMENT OF IiE.4LTH& HUMAN SERVICES Counsel to ttteSecretary 

tor Drug Abuse Policy 

$.\ 

“%ni~ Wadwlgton,D.c. 20201 

July 30, 1992 

.


MEMORNJfYJktTO RUCHARDP.KUSSEROW


INSF~TOR GENERAL


A


FRCM:� MARKBARNES 

CO-TO THE~di, 

SUKECT: OIG Management A isory Report: “Measuring Drug Abuse 

- Treatment Costs”,!“ OE1-04-91-00430 

I have reviewed the above-mentioned draft report and concur in part with your


recommendations. I do not, however, concur with your second recommendation which 

seems to indicate that all grantees performing ciinical effectiveness studies must collect


treatment cost data. I suggest that we not mandate the cohction of treatment cost data 

through clinicai effectiveness studies. There are many more appropriate vehicies for 

the collection of treatment cost data.


With regard to the section on findings, I suggest that you inciude a short 

reference to the Services Research Outcome Study (SROS), a follow-up component to the 

Drug Abuse SeMces Research Sumey. It is my understanding that SROS will collect 

cost data on treatment sefvices. Additionally, I recommend that you cunsider mentioning


the ADMS block grant forms as an additional possible source of cost information.


Although the Slates are not currently required to complete the more detaiied set of 

forms, some States have agreed to comply on a voiuntary basis. For these Slates. the 

Office of Treatment Improvement has been able to collect some pertinent cost 

information.


Thank you for the opportunity to review this report. {fYOUhave any Westions! 

please fxntact either Sarah Vogeisberg or myself at (202) 690-6641. 

1(3 ~ 

mm t . . 

DIGAO d 

.-

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