GAO

United States General Accounting Office

Report to the Subcommittee on Criminal 

Justice, Drug Policy and Human 

Resources, Committee on Government 

Reform, House of Representatives

February 2000 DRUG ABUSE 

TREATMENT

Efforts Under Way to 

Determine 

Effectiveness of State 

Programs

GAO/HEHS-00-50

Page 1 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Contents

Letter 3

Appendixes Appendix I: Objectives, Scope, and Methodology 28

Appendix II: History and Administration of SAMHSA 30

Appendix III: KDA Grant Programs and Funding for Drug Abuse

Treatment 37

Appendix IV: State Program Assessments 40

Tables Table 1: Characteristics of SAMHSA’s Major Drug Abuse

Treatment Studies 20

Table 2: States’ Client Outcome Assessment Activities 22

Table 3: SAMHSA’s Administrative Expenses, Fiscal Year 1999 

Appropriation 31

Table 4: Selected SAMHSA Contracts for Technical Assistance

and Program Evaluation, Fiscal Year 1999, by Agency and

Program 32

Table 5: SAMHSA’s Staffing Levels by Program, as of

December 1999 35

Figures Figure 1: Percentage of SAMHSA’s Drug Abuse Treatment

Expenditures for SAPT Block Grant and KDA Grant Programs,

Fiscal Year 1996 9

Figure 2: Percentage of Surveyed State Agencies’ Total

Expenditures for Drug Abuse Treatment Services by

Funding Source, Fiscal Year 1996 10

Figure 3: Percent of SAPT Block Grant Expenditures for

Methadone Services, Fiscal Year 1996 12
Contents

Page 2 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Abbreviations

ADATSA Alcoholism and Drug Addiction Treatment and Support Act

HHS Department of Health and Human Services

KDA Knowledge Development and Application

NIDA National Institute on Drug Abuse

SAMHSA Substance Abuse and Mental Health Services Administration

SAPT Substance Abuse Prevention and Treatment

TASC Treatment Alternatives to Street Crime

TOPPS Treatment Outcomes and Performance Pilot Studies

TOPPS II Treatment Outcomes and Performance Pilot Studies 

Enhancement
Page 3 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

United States General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-281927 Letr

February 15, 2000

The Honorable John L. Mica

Chairman

The Honorable Patsy Mink

Ranking Minority Member

Subcommittee on Criminal Justice, Drug Policy

 and Human Resources

Committee on Government Reform

House of Representatives

Drug abuse continues to be a major national problem and concern. 

National survey data show that in 1998, 13.6 million Americans reported 

that they had used an illicit drug in the past month. The cost of drug abuse 

to society—which includes costs for health care, drug addiction prevention 

and treatment, drug-related crime prevention, and lost resources resulting 

from reduced worker productivity or death—is estimated at $67 billion 

annually. For treatment-related programs, the federal government spent 

more than $3.2 billion in fiscal year 1998.1

 To better understand how federal 

funds are used, you asked us to describe efforts by the Substance Abuse 

and Mental Health Services Administration (SAMHSA) and states to 

provide effective drug abuse treatment programs. Specifically, you asked 

us to describe (1) activities supported by SAMHSA’s Substance Abuse 

Prevention and Treatment (SAPT) block grant and Knowledge 

Development and Application (KDA) grant funds for drug abuse treatment; 

(2) SAMHSA and state mechanisms for monitoring fund use; and (3) 

SAMHSA and state efforts to determine the effectiveness of drug abuse 

treatment supported with SAPT block grant funds.

Our work on SAPT program activities included a survey of the 16 states 

that received at least $25 million for their fiscal year 1996 SAPT block grant 

award: California, Florida, Georgia, Illinois, Indiana, Maryland, 

Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, 

Pennsylvania, Texas, Virginia, and Washington. We interviewed selected 

respondents on their use of these funds for residential and outpatient drug 

1

The $3.2 billion represents funding from eight federal agencies: the Federal Judiciary; the 

Departments of Health and Human Services, Veterans Affairs, Defense, Education, Housing 

and Urban Development, and Justice; and the Office of National Drug Control Policy.
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abuse treatment services, including detoxification and methadone 

maintenance. We asked states to exclude their use of SAPT block grant 

funds for activities other than drug abuse treatment, such as alcohol 

treatment and prevention from their survey responses. We also interviewed 

officials in SAMHSA’s Center for Substance Abuse Treatment, Office of 

Program Services, and Office of Applied Studies, and reviewed documents 

they provided on SAPT and KDA activities funded with drug abuse 

treatment dollars.

Although the 16 states we surveyed represented about 60 percent of SAPT 

block grant drug abuse treatment expenditures for services, the results of 

our survey are not necessarily generalizable to all states. Our review 

focused on expenditures of fiscal year 1996 drug abuse treatment funds 

because, at the time of our review, it was the latest year for which complete 

expenditure data from SAMHSA and the states on the SAPT block grant 

were available. Also, some survey states provided estimates of drug abuse 

treatment expenditures because they could not separate drug from alcohol 

abuse treatment services or could not isolate SAPT block grant 

expenditures from their total drug abuse treatment expenditures. (See app. 

I for a detailed description of our scope and methodology.) We did our 

work from January 1999 to January 2000 in accordance with generally 

accepted government auditing standards.

Results in Brief The federal government has made a considerable investment in states’ drug 

abuse treatment programs, and although there is currently little 

information on their effectiveness, SAMHSA and some states have efforts 

under way to measure these programs’ outcomes. About $581 million in 

SAMHSA’s fiscal year 1996 grant funds was spent on drug abuse treatment 

activities. Of these funds, more than 80 percent ($478 million) was spent by 

all states for treatment services funded through the SAPT block grant 

program. The 16 states we surveyed reported that SAPT funds supported 

both residential and outpatient drug abuse treatment services, including 

detoxification and methadone maintenance. For half of the states in our 

survey, outpatient drug abuse treatment services accounted for 57 to 85 

percent of their block grant expenditures; the average of the remaining 

states’ expenditures for outpatient services was 31 percent. All of the states 

we surveyed reported providing methadone treatment services almost 

exclusively on an outpatient basis. SAMHSA spent another $25 million of 

the SAPT block grant for technical assistance and evaluation activities 

related to drug abuse treatment. The remaining $78 million of SAMHSA’s 

fiscal year 1996 grants were KDA funds provided to community-based 
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organizations, universities, and state and local government agencies to 

develop and disseminate information on promising drug abuse treatment 

practices.

To monitor grantees’ use of SAPT and KDA program funds, SAMHSA uses 

on-site reviews, reviews of independent financial audit reports, and 

application reviews. These mechanisms are primarily used to monitor 

grantees’ compliance with program requirements, identify grantees’ 

technical assistance needs, and provide grantees guidance for improving 

program operations. The current accountability system for the SAPT block 

grant is mostly based on a review of state expenditures. As a result, 

SAMHSA primarily monitors states’ compliance with certain statutory 

requirements for use of funds, such as those that stipulate that a certain 

percentage be used to treat special populations. The states we surveyed 

also reported that they monitor SAPT block grant funds provided to third 

parties, including counties and providers, using mechanisms similar to 

SAMHSA’s. They used the results of their monitoring efforts, in part, to 

make drug abuse treatment funding allocation decisions and determine 

technical assistance needs.

Several state and SAMHSA efforts are under way to determine the 

effectiveness of drug abuse treatment programs using client outcome 

measures, such as drug use, employment, criminal activity, and living 

arrangement. Nine of the 16 states that we surveyed have conducted such 

assessments, but the outcomes measured, populations assessed, 

methodologies used, and availability of results vary from state to state. 

SAMHSA officials believe that collecting uniform state-level client outcome 

and other performance data is critical to determining the effectiveness of 

state programs supported with SAPT block grant funds. Consequently, 

SAMHSA is funding a pilot effort to help 19 states develop and uniformly 

report on a core set of client outcomes. SAMHSA has also asked all states 

to voluntarily report client outcome data in their fiscal year 2000 block 

grant application. However, this effort is not likely to result in uniform state 

data because some of the states we surveyed reported that they would not 

be able to submit all of the requested data because they are not currently 

collecting it.

Background In 1995, SAMHSA estimated that about 8.9 million people in the United 

States needed treatment for serious drug abuse problems, including drug 

dependence, heavy drug use, or injection drug use. Drug abuse treatment is 

typically provided in residential or outpatient settings and uses 
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pharmacotherapy, psychosocial/behavioral therapy, or both. 

Pharmacotherapy relies on medications to interfere with the euphoric 

effects or manage the withdrawal symptoms and cravings experienced with 

illicit drug use. One widely used medication is methadone, an opioid 

agonist that blocks or interferes with the euphoria of heroin, morphine, and 

other opiate drugs and suppresses withdrawal symptoms and cravings 

between treatment doses. Psychosocial/behavioral therapy may include 

skills training and a variety of counseling approaches, including individual, 

family, or group counseling.

SAMHSA, an agency within the Department of Health and Human Services 

(HHS), has primary responsibility for supporting substance abuse 

treatment and prevention activities. (See app. II for a detailed description 

of SAMHSA’s role, program staffing, and budget authority.) SAMHSA 

awards 95 percent of SAPT block grant funds to states and U.S. territories 

to fund local drug and alcohol abuse treatment and prevention programs 

and retains 5 percent for program evaluation and other administrative 

purposes. State awards are determined by a statutory formula based on 

several factors, including a state’s personal income data, taxable resources, 

population estimates, and service costs. To obtain a block grant, a state 

must submit to SAMHSA for review and approval an annual application 

that includes a discussion of how the state intends to comply with the 

various block grant requirements.

States have broad discretion in how they distribute SAPT block grant funds 

to cities, counties, and service providers; the services they support; and the 

specific amount allocated to drug abuse treatment. SAPT block grant 

legislation specifies that at least 35 percent of the state block grant award 

be used for alcohol prevention and treatment activities and 35 percent be 

used for other drug abuse prevention and treatment activities. The 

remaining 30 percent can be used at the state’s discretion for drug 

programs, alcohol programs, or both. Further, states are required to satisfy 

certain statutory set-aside requirements for allocating a portion of SAPT 

funds for special populations, such as pregnant and postpartum women 

and their children, and, in certain states, to provide early intervention 

services for those with HIV.

SAPT block grant legislation requires that 5 percent of the SAPT block 

grant be set aside at the federal level to support data collection, program 

evaluation, and technical assistance to the states. For example, this setaside funds four major surveys required by the Public Health Service Act: 

the National Household Survey on Drug Abuse, the Drug Abuse Warning 
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Network, the Drug Abuse Services Information System, and the Alcohol 

and Drug Services Survey. These surveys are intended to provide 

information for formulating substance abuse policy and evaluating the 

performance of programs and activities supported with federal funds. 

Another study supported by the set-aside, the Services Research Outcome 

Study, is a national study that used client outcome measures to assess the 

effectiveness of drug abuse treatment.

The KDA program is SAMHSA’s discretionary grant program that replaced 

the demonstration grant program in 1996.2

 KDA program grants are 

designed to bridge the gap between knowledge and practice in order to 

transfer research findings to community practitioners and to provide new, 

more efficient ways to deliver services. Funds are provided to communitybased organizations, universities, and state and local government agencies 

for developing and promoting effective approaches to providing substance 

abuse treatment services as well as prevention and mental health services. 

The KDA program is also used to expand the availability of treatment 

services for specific locations and populations. KDA topics are determined 

based on assessments of research and needs in the field as well as input 

from drug abuse experts, providers, clinicians, and congressional offices. 

Grant proposals are screened, peer reviewed, and scored based on criteria 

that include the proposed methodology for addressing the KDA topic as 

well as the populations to be researched.

2

SAMHSA’s demonstration grant program was part of an effort to establish a system for 

developing, documenting, and disseminating successful approaches to prevent and treat 

substance abuse and mental illness. The KDA effort emerged from the demonstration grant 

program and, according to SAMHSA officials, uses more rigorous evaluation methods and 

focuses on developing findings that can be adopted in other treatment settings.
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The Government Performance and Results Act of 1993 (Results Act)—

enacted to increase federal program effectiveness and accountability—

requires federal agencies to set program goals, measure performance, and 

report to the Congress on their accomplishments. SAMHSA develops 

performance goals for the SAPT block grant program as part of HHS’ 

Results Act reporting. In 1995, HHS requested that the National Academy of 

Science’s National Research Council convene an expert panel to examine 

and report on the technical issues involved in establishing performance 

measures in 10 program areas, including substance abuse treatment. The 

conclusions and recommendations from the report that resulted from this 

effort were used to support SAMHSA’s current efforts to develop and 

collect state-level client outcome data.3

Drug Abuse Treatment 

Funds Support 

Services, Technical 

Assistance, and 

Evaluation

Fiscal year 1996 expenditures for drug abuse treatment activities funded by 

SAMHSA’s SAPT block grant and KDA grant programs totaled $581 million. 

About 82 percent of these expenditures supported outpatient and 

residential treatment services and methadone maintenance—the 

pharmacotherapy treatment most widely used for heroin and other opiate 

addictions. For the 16 states we surveyed, outpatient services accounted 

for almost half of their SAPT block grant drug abuse treatment 

expenditures. The remaining 18 percent of SAMHSA’s grant funds for drug 

abuse treatment activities supported technical assistance and program 

evaluation funded by the SAPT block grant set-aside and the development 

and dissemination of information on promising treatment practices funded 

by the KDA grant program.

SAPT Block Grant 

Accounted for Most of 

SAMHSA’s Grant Funds 

Used for Drug Abuse 

Treatment

In fiscal year 1996, about $581 million in SAMHSA grant funds supported 

activities related to drug abuse treatment. State SAPT block grant 

expenditures accounted for about $478 million,4

 and the SAPT set-aside for 

technical assistance contracts and program evaluation efforts accounted 

for another $25 million. The remaining $78 million supported KDA grants 

for programs designed to develop promising treatment practices that can 

3

Assessment of Performance Measures for Public Health, Substance Abuse, and Mental 

Health, National Research Council, 1997.

4

In addition to state expenditures for drug abuse treatment, states spent about $681 million 

in SAPT block grant awards to support alcohol treatment, primary prevention, tuberculosis 

and HIV early intervention services, and administration.
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be used to improve the provision of substance abuse treatment services 

and disseminate information to the public and treatment community. 

(See fig. 1.)

Figure 1: Percentage of SAMHSA’s Drug Abuse Treatment Expenditures for SAPT 

Block Grant and KDA Grant Programs, Fiscal Year 1996

In addition to block grant funds, states use other revenue sources to fund 

drug abuse treatment services, including state funds; other federal funds, 

such as Medicaid; and county funds and insurance payments. The 

proportion of total drug abuse treatment expenditures accounted for by 

SAPT block grant expenditures varied considerably among the states we 

surveyed (see fig. 2). For example, New York reported that SAPT block 

grant expenditures accounted for 18 percent of its total reported funds for 

drug abuse treatment compared with 76 percent reported by Indiana. 

Expenditure data reported by the states we surveyed result from drug 

abuse treatment funds that flow through the state agency responsible for 

administering the SAPT block grant. In some states, other agencies also 

fund drug abuse treatment.

SAPT Set-Aside

KDA

SAPT Block Grant Awards

4%

14%

82%
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Figure 2: Percentage of Surveyed State Agencies’ Total Expenditures for Drug 

Abuse Treatment Services by Funding Source, Fiscal Year 1996

Note: Florida, Illinois, Massachusetts, Michigan, North Carolina, Ohio, and Washington provided 

estimates of fiscal year 1996 drug abuse treatment expenditures by funding source. Pennsylvania is 

not included. Pennsylvania officials reported that drug abuse treatment expenditure information was 

not available for other federal, state, and other funding sources because, aside from the SAPT block 

grant, they do not track drug abuse treatment expenditures separately from alcohol treatment 

expenditures. The officials stated that estimates could be constructed using client information but that 

such estimates would not take into consideration potential variations in the cost of treating alcohol 

versus drug abuse. 

a

“Other” refers to funds other than state and federal funds, such as county funds and insurance 

payments. 

b

“Other federal” refers to federal funds other than SAPT block grant funds, such as Medicaid.

0

20

40

60

80

100

Cailfornia

Florida

Georgia

Illinois

Indiana

Maryland

Massachusetts

Michigan

New Jersey

New York

North Carolina

Ohio

Texas

Virginia

Washington

Othera

State

Other Federalb

SAPT

Percentage
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Most States’ SAPT Block 

Grant Funds for Drug Abuse 

Treatment Were Used for 

Outpatient Services

The 16 states we surveyed reported spending a total of about $300 million 

of SAPT block grant funding on drug abuse treatment, which included, for 

example, detoxification and methadone maintenance in residential and 

outpatient settings. The largest portion of reported drug abuse treatment 

expenditures was for services in outpatient settings, which can vary from 

psychotherapy to group counseling and may include pharmacological 

treatment. Of the 16 states surveyed, 14 reported spending SAPT block 

grant funds on outpatient services: 8 states spent between 57 and 85 

percent of funds on these services; the average of the 6 remaining states’ 

expenditures for outpatient services was 31 percent.5

All of the states we surveyed reported that SAPT block grant expenditures 

supported methadone treatment, which is the pharmacotherapy treatment 

most widely used for heroin addiction. Methadone maintenance generally 

requires clients to receive daily methadone dosages that can continue for 

several years and, in some cases, may last a lifetime. The states we 

surveyed reported providing methadone maintenance almost exclusively as 

an outpatient service. Of the 16 states surveyed, 14 reported spending a 

total of $42.7 million of fiscal year 1996 SAPT block grant funds for 

methadone provided on an outpatient basis.6

 SAPT block grant 

expenditures for methadone services ranged from 2 percent to about 50 

percent of total block grant expenditures for drug abuse treatment (see fig. 

3). This range in expenditures is an example of the flexibility states have in 

determining the services supported by SAPT block grant funds.

5

The remaining two states did not report the portion of SAPT block grant funds spent on 

outpatient services.

6

Michigan and North Carolina state officials reported that they could not provide 

information on methadone expenditures supported with SAPT block grant funds because 

methadone expenditures could not be disaggregated from other SAPT block grant 

expenditures for drug abuse treatment.
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Figure 3: Percent of SAPT Block Grant Expenditures for Methadone Services, Fiscal 

Year 1996

Note: Illinois, New Jersey, Ohio, Pennsylvania, and Washington officials provided estimates of SAPT 

block grant expenditures for methadone services. Michigan and North Carolina did not provide data on 

these expenditures and were, therefore, not included.

0

10

20

30

40

50

Cailfornia

Florida

Georgia

Illinois

Indiana

Maryland

Massachusetts

New Jersey

New York

Ohio

Pennsylvania

Texas

Virginia

Washington

Percentage
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SAMHSA Uses SAPT Block 

Grant Set-Aside Funds to 

Support Technical 

Assistance

SAMHSA spent about $25 million of the fiscal year 1996 SAPT block grant 

set-aside to provide technical assistance to states and for program 

evaluation activities related to drug abuse treatment. About 93 percent of 

these funds supported technical assistance activities, including $11 million 

for technical assistance contracts and $12 million for the State Treatment 

Needs Assessment Program; the remaining $2 million supported program 

evaluation activities. At the request of states, SAMHSA uses technical 

assistance contracts to provide a wide range of activities, which include 

conducting training seminars, redesigning treatment policies and 

procedures, and assisting states in establishing cost-effective treatment 

models. SAMHSA developed the State Treatment Needs Assessment 

Program to help states better allocate treatment funds, enhance and 

sustain states’ capabilities to assess treatment need, and improve states’ 

reporting of their needs assessments in block grant applications. In 

September 1998, we reported that some state officials have found this 

program useful for targeting resources and enhancing service delivery. 

However, states have been slow in developing the capacity to assess need 

and to report results developed from the program in their SAPT block grant 

applications.7

SAMHSA’s KDA Grant Funds 

Identify and Promote 

Promising Treatment 

Practices

SAMHSA awarded $78 million of fiscal year 1996 KDA discretionary grants 

to determine the effectiveness of selected treatment practices, expand the 

availability of treatment services for specific locations and populations, 

and promote the adoption of best practices and treatment techniques. KDA 

funds supported grants and cooperative agreements to 111 communitybased organizations, universities, and state and local government agencies 

in support of 13 specific drug abuse treatment programs in fiscal year 1996. 

In fiscal year 1998, KDA treatment expenditures increased to about $98 

million supporting 27 specific programs.8

 (See app. III for a description of 

KDA programs funded in fiscal years 1996 and 1998.) KDA programs 

funded in these years include the following:

7

Drug Abuse Treatment: Data Limitations Affect the Accuracy of National and State 

Estimates of Need (GAO/HEHS-98-229, Sept. 15, 1998).

8

Final results have not been reported on the effectiveness of selected treatment practices 

for specific KDA programs.
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• Wraparound Services to evaluate the effect that services such as child 

care, vocational training, and transportation have on the effectiveness of 

treatment services.

• Marijuana−Adults to evaluate the effectiveness of brief treatment 

interventions for marijuana dependence and relapse and determine 

whether these interventions are effective for individuals from differing 

socioeconomic, racial, and ethnic backgrounds.

• Pregnant and Postpartum Women to expand the availability of 

comprehensive treatment services for pregnant and postpartum women 

and their children.

• Rural Remote and Culturally Distinct Populations to provide 

treatment services for harder-to-reach populations and serve as a model 

program for Alaskan Natives, American Indians, and Native Hawaiians.

• Addiction Technology Transfer Centers to promote the transfer of 

promising treatment practices to drug abuse treatment providers.

To help improve the overall quality of substance abuse treatment and 

facilitate the adoption of practices that have been identified as effective 

treatment approaches, SAMHSA develops and publishes best practice 

guidelines. For example, SAMHSA developed treatment improvement 

protocols by bringing together clinicians, researchers, policymakers, and 

other federal and nonfederal experts to identify and reach consensus on 

promising treatment practices. The published protocols recommend 

strategies to enhance treatment services for individuals with coexisting 

mental health and substance abuse disorders; offer guidelines for the 

design and delivery of effective treatment services for adolescents; and 

offer guidelines for planning, providing, and evaluating detoxification 

services. SAMHSA also developed a protocol to assist state agencies in 

developing, implementing, and managing outcome monitoring systems for 

increasing accountability for treatment expenditures. The treatment 

improvement protocols are being evaluated by an independent contractor 

to determine their effectiveness. SAMHSA also publishes technical 

assistance publications, which compile materials gathered from various 

federal, state, programmatic, and clinical sources that provide guidance 

and information related to providing substance abuse treatment services.

SAMHSA coordinates its KDA efforts with the National Institutes of 

Health’s National Institute on Drug Abuse (NIDA). Coordination activities 

include periodic meetings to ensure that NIDA research is considered in 

the development, application, and dissemination of KDA information on 

promising treatment practices. For example, the KDA programs related to 

adolescent treatment, methamphetamine abuse treatment, and 
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interventions for marijuana abusers reflect clinical research originally 

funded by NIDA. These KDA programs test NIDA research to establish the 

effectiveness of treatment approaches and to identify and address barriers 

to the use of these approaches in different communities and with different 

populations. SAMHSA and NIDA also use interagency agreements to draw 

on each other’s expertise and avoid duplication of effort. SAMHSA also 

routinely involves NIDA in selecting treatment improvement protocol 

topics to ensure that they do not duplicate activities funded by the National 

Institutes of Health and in reviewing the protocols before publication. 

Further, NIDA grantees participate on the consensus panels for the 

development of the treatment improvement protocols. SAMHSA officials 

said that they also coordinate with the National Institute on Alcohol Abuse 

and Alcoholism.

Several Mechanisms 

Are Used to Monitor 

SAPT Block Grant and 

KDA Grant Funds 

SAMHSA uses on-site reviews, reviews of independent financial audit 

reports required by the Single Audit Act, and reviews of grant applications 

to monitor grantees’ use of SAPT and KDA funds and their compliance with 

program requirements. The accountability system for SAPT block grant 

funds is primarily based on whether states spend SAPT funds as required 

by federal law. SAMHSA is statutorily mandated to use on-site reviews to 

ensure states comply with requirements for the use of funds, such as the 

”maintenance of effort” requirement, which stipulates that states must 

maintain a certain level of expenditures for drug abuse treatment. On-site 

reviews are also used to identify grantees’ technical assistance needs and 

provide guidance and recommendations to grantees for improving program 

operations. States, which distribute SAPT block grant funds to third parties 

such as treatment providers, reported using a variety of mechanisms to 

monitor third-party use of SAPT block grant funds. These mechanisms 

include site visits, management information systems, cost and activity 

reports, fiscal audits, and independent peer reviews. Most of the surveyed 

states reported using the results of their monitoring activities to, in part, 

make funding allocations and determine technical assistance needs.

On-Site Reviews Used to 

Monitor Compliance 

and Identify Technical 

Assistance Needs

SAMHSA is statutorily required to conduct on-site reviews to monitor SAPT 

block grant expenditures in at least 10 states each fiscal year. SAMHSA 

contracts with an independent firm to conduct these on-site reviews at the 

state and local levels. These reviews examine grantees’ fiscal monitoring of 

providers and compliance with SAPT block grant requirements that include 

maintaining a certain level of state expenditures for drug abuse treatment 

and spending a certain percentage of funds on services for pregnant and 
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postpartum women and their children. In practice, each state receives a 

review on average once every 3 years, and the review is generally 

conducted by one or two persons over a 5-day period. Although the on-site 

review process includes collecting and reviewing documents describing 

agency and program operations, the primary component of the review is a 

series of interviews conducted with state and local program officials. After 

the on-site review, the contractor works with SAMHSA program staff and 

state officials to develop a report detailing the contractor’s findings. 

SAMHSA does not currently collect corrective action plans from states or 

track states’ responses to identified deficiencies to determine if 

deficiencies are resolved. SAMHSA officials said that corrective action 

plans and SAMHSA’s monitoring of them are needed, but the agency has not 

yet decided how it will address this issue. 

SAMHSA uses the results from the on-site reviews to identify states’ 

technical assistance needs. For example, Ohio’s 1999 review resulted in 

two technical assistance recommendations: (1) develop utilization review 

guidelines for monitoring grantees and (2) provide training on SAPT block 

grant set-aside requirements for funding tuberculosis and HIV services. 

States must initiate requests for technical assistance, which SAMHSA 

provides through contractors that include experts who specialize in 

treatment service issues. In addition to on-site compliance reviews, 

SAMHSA project officers periodically conduct site visits to states and local 

treatment providers, identifying technical assistance needs and providing 

program guidance.

For the KDA program, SAMHSA officials told us that project officers 

monitor grantees through site visits as well as conference calls and other 

regular meetings. The goal of monitoring KDA programs is to provide 

technical assistance and to ensure achievement of program goals. Project 

officers will conduct a site visit if a grantee is not making adequate 

progress toward meeting KDA project goals. Project officers discuss 

difficulties that the grantee is encountering and assist in determining a plan 

of action for addressing problems, which may include a recommendation 

for technical assistance. Project officers also work collaboratively with 

study sites to oversee project design, analysis, and reporting of results.
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Reviews of Audit Reports 

and Grant Applications Are 

Also Used to Monitor 

Compliance

SAMHSA also reviews grantees’ annual financial audits and grant 

applications to ensure compliance with program requirements. According 

to SAMSHA officials, the agency’s primary fiscal monitoring mechanism for 

grantees is the agency’s review of annual financial audit reports required by 

the Single Audit Act. In general, the single audit is designed to determine if 

a grantee’s financial statements are fairly presented and grant funds are 

managed in accordance with applicable laws and program requirements. 

Under criteria established in the act, independent auditors use expenditure 

limits and risk-based guidelines to identify the programs that will be 

audited.9

 Therefore, if a grantee’s SAPT or KDA program expenditures in a 

given year fall below the audit threshold of $300,000—or 3 percent of total 

federal expenditures—the program is generally not audited in that year. In 

1997, 13 SAPT block grantees were not audited.

SAMHSA officials reported using their reviews of independent financial 

audit reports to identify grantees that need to take corrective actions to 

come into compliance with program requirements. For example, if an audit 

report includes recommendations for resolving findings related to grantee 

noncompliance, SAMHSA will request a corrective action plan from the 

grantee for each recommendation and review grantee submissions for 

adequate responses. If a grantee does not submit an audit report or correct 

audit findings in a timely manner, or material accounting and financial 

weaknesses are repeated in audit reports, SAMHSA has the authority to 

suspend or terminate the grant award, or require the grantee to submit 

additional financial reports as a condition of receiving additional grant 

funds.

9

These guidelines, which took effect for fiscal years ending on or after June 30, 1997, include 

a review of a program’s oversight, including monitoring or other reviews conducted by 

oversight entities, current and prior audit experience, and the inherent risk of the program.
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SAMHSA also uses its review of grantee applications to monitor SAPT 

block grant program compliance. SAMHSA project officers are responsible 

for reviewing SAPT block grant applications to determine if states have 

complied with statutory requirements, such as set-asides for special 

populations and maintenance of effort. SAMHSA, however, has approved 

some states’ applications without addressing their reported maintenance of 

effort shortfalls.10 Audit report and on-site review findings as well as a 

subsequent internal review of grantees’ fiscal years 1994 through 1996 

block grant applications identified seven states that reported 

noncompliance with maintenance of effort requirements. If a state fails to 

comply with the maintenance of effort requirement, SAMHSA can reduce 

the state’s block grant award by the amount of the shortfall or request a 

determination of material compliance from the Secretary of HHS. SAMHSA 

can also grant a waiver if the state has experienced a financial crisis. 

SAMHSA, however, did not follow appropriate procedures when states 

reported maintenance of effort shortfalls in their block grant applications. 

In August 1998, SAMHSA developed a plan to improve its oversight of 

maintenance of effort issues, which includes making maintenance of effort 

compliance the highest priority for initial staff review, initiating weekly 

status reports on states with compliance issues, and conducting internal 

quarterly assurance meetings to review SAPT block grant documentation.

States’ Mechanisms to 

Monitor Use of SAPT Block 

Grant Funds Are Similar to 

SAMHSA’s

The states we surveyed reported using a variety of mechanisms to monitor 

the use of SAPT block grant funds provided to third parties, such as 

counties and treatment providers. Many of these mechanisms were similar 

to those used by SAMHSA. Of the 16 states surveyed, 12 reported using onsite visits, financial audits of providers, management information systems, 

and cost and activity reports. The remaining four states used at least two of 

these mechanisms. Some states reported that these mechanisms were used 

specifically to monitor provider billing procedures, quality of care, and 

providers’ compliance with SAPT block grant program requirements.

Most of the surveyed states reported that the results of their monitoring 

were used to determine provider and service contracting, funding 

allocations, and technical assistance needs. For example, Texas reported 

10The state’s principal agency for drug abuse treatment is required to maintain aggregate 

drug abuse treatment expenditures at a level that is not less than the average level of such 

expenditures for the 2-year period preceding the fiscal year for which the state is applying 

for the grant.
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delaying funding or suspending contracts for providers who were not 

compliant with program requirements. Washington state officials reported 

that monitoring results have been used to identify priority populations for 

receiving treatment services. Georgia officials reported that monitoring 

results have been used to establish policies for staff training and a process 

for allocating treatment funds. 

SAMHSA and States 

Are Using Client 

Outcome Data to 

Determine the 

Effectiveness of Drug 

Abuse Treatment 

Services

Several efforts are under way to determine whether states receiving SAPT 

block grant funds are supporting effective drug abuse treatment programs. 

Some states are conducting studies using client outcome measures to 

assess the effectiveness of their programs. While SAMHSA has supported 

national studies that suggest drug abuse treatment is beneficial in reducing 

drug use, increasing employment, and reducing criminal activity, SAMHSA 

does not currently know the outcomes of states’ drug abuse treatment 

programs supported with SAPT block grant funds. To determine the effect 

states’ programs are having on drug abuse, SAMHSA believes it is critical to 

collect uniform state-level client outcome data. Therefore, the agency is 

currently conducting a pilot study with 19 states to collect such data. 

SAMHSA has also initiated an effort to have states voluntarily report client 

outcome data in their block grant applications. However, this effort has 

limitations because states do not collect data in the same way; some states 

do not collect the data SAMHSA requested; and, according to SAMHSA 

officials, some states lack the capacity to collect and report the data.

SAMHSA-Funded National 

Studies Suggest Benefits of 

Drug Abuse Treatment 

SAMHSA has funded two national studies that suggest drug abuse 

treatment is effective at improving outcomes, such as decreasing drug use, 

criminal activity, and unemployment. The Services Research Outcome 

Study is the first national study of substance abuse treatment outcomes to 

include a representative sample of drug abuse treatment programs in rural, 

suburban, and urban locations.11 The National Treatment Improvement 

Evaluation Study, a 5-year study, examined the effectiveness of treatment 

provided in public programs supported by SAMHSA. While these two 

studies relied on self-reported data as the primary data collection method, 

11SAMHSA also funded the Alcohol and Drug Services Study, a national study to obtain 

information on substance abuse treatment facilities and patients. This study is a 

continuation of the Services Research Outcome Study and provides more detailed 

information on the organization of the national treatment system and the effectiveness and 

cost-effectiveness of treatment. However, final results from this study are not yet available.
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they also used methods to validate study results. Table 1 summarizes the 

characteristics of the two studies and the results of selected outcome 

measures.

Table 1: Characteristics of SAMHSA’s Major Drug Abuse Treatment Studies

a

The Services Research Outcome Study’s client sample was derived from a sample of treatment 

facilities identified in the Drug Services Research Survey, a prior study. Therefore, when the Services 

Research Outcome Study is viewed as a longitudinal study (that captures the facilities sample from the 

Drug Services Research Survey as well as its completed cases), its cumulative response rate is 38 

percent—the product of the studies’ response rates.

In addition to national studies, SAMHSA is trying to develop state-level data 

about drug abuse treatment effectiveness. The results of this effort will be 

Services Research Outcome Study

National Treatment Improvement Evaluation 

Study

Study characteristics

Population 1,799 people, representing a 65-percent 

simple response rate and a 38-percent 

cumulative response ratea

4,411 people, representing 67 percent of the total 

number of clients in the study sample

Measurement time frame 5 years before treatment compared to 5 

years after treatment

1 month or 1 year before treatment compared to 1 

month or 1 year after treatment

Treatment service Hospital inpatient, residential, outpatient 

methadone, outpatient nonmethadone

Methadone, drug-free outpatient, short- and longterm residential, correctional

Outcome measures and results

Drug use A 21-percent overall reduction in the number 

of people using any illicit drug following 

treatment.

Drug use declined by about 50 percent for as long 

as 1 year following treatment.

Criminal activity Between 23- and 38-percent reduction for 

most crimes, including theft, drug sales, 

prostitution, drunk driving, and weapon use.

Significant decreases in multiple indicators of 

criminal involvement, such as a 64-percent 

decrease in arrests and a 78-percent decrease in 

selling drugs.

Employment No appreciable change in the rate of fulltime employment for clients discharged from 

treatment.

Rate of employment increased by 19 percent, and 

those on welfare decreased by almost 11 percent.

Living arrangement Improved housing was secured and custody 

of children regained after treatment.

Homelessness decreased by 43 percent.

Physical health (Not measured.) Alcohol and drug-related medical visits declined by 

53 percent.

Mental health Suicide attempts declined following 

treatment.

Mental health problems declined by 35 percent, 

and inpatient mental health declined by 28 percent.

Sexual activity (Not measured.) Sex for money or drugs decreased by 56 percent, 

and sex with an intravenous drug user decreased 

by 51 percent.
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used to monitor and report to the Congress the performance and success of 

individual states’ drug abuse treatment programs supported with SAPT 

funds. While there is no specific statutory requirement for states to collect 

and report outcome data on the results of their treatment programs 

supported with SAPT block grant funds, SAMHSA officials stated that 

having such data is essential in determining the effect state programs have 

on the agency’s mission of improving health and reducing illness, death, 

disability, and costs to society.

States’ Efforts to Assess 

Effectiveness Vary but Show 

Benefits of Drug Abuse 

Treatment

Most states we surveyed have conducted outcome assessments of drug 

abuse treatment since 1994, including special studies and ongoing 

performance measurement, but their assessments vary in the outcomes 

measured, populations assessed, methodologies used, and availability of 

results. Seven of the 16 states we surveyed—Florida, Maryland, New York, 

North Carolina, Ohio, Texas, and Washington—reported that they have 

been mandated by state legislation to assess the outcomes of their drug 

abuse treatment activities. For example, North Carolina is required to 

establish and report performance outcomes that include abstinence from 

drug use. In Washington, the governor holds the Secretary of the state’s 

Department of Social and Health Services accountable for achieving drug 

abuse treatment outcomes that are specifically outlined in the performance 

contract of the state’s director for alcohol and substance abuse. All states 

we surveyed plan to begin assessing treatment programs using outcome 

measures by the year 2002.

Of the 16 states surveyed, 9 reported having completed at least one 

outcome assessment and of them, 7 reported they had completed specific 

client outcome studies (see table 2). Seven of the nine states reported they 

use performance measurement data to assess drug abuse treatment 

effectiveness on an ongoing basis.
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Table 2: States’ Client Outcome Assessment Activities

These states generally use a number of outcome measures to assess their 

drug abuse treatment efforts, including abstinence, drug use, employment, 

mental and physical health, living arrangement, and criminal activity. 

However, the indicators for measuring these outcomes varied. For 

example, Ohio measures criminal activity in terms of rearrests, 

incarcerations, and probation violations. California measures criminal 

activity using several indicators that include the number of times a drug 

abuser sold or helped sell drugs, had sex for money or drugs, broke into a 

house or vehicle, or used a weapon. In addition, the surveyed states’ 

assessments varied in terms of target populations, purpose, time frames, or 

other methodological issues.

Of the nine states that reported conducting outcome assessments, six−

California, Florida, North Carolina, Ohio, Texas, and Washington−reported 

benefits as a result of drug abuse treatment.12 (See app. IV for details of the 

six states’ outcome assessments.) For example, California has conducted a 

large-scale study that showed treatment reduced drug use by about 40 

percent and criminal activity by about 66 percent. Washington reported 

that its study of treatment for impoverished populations showed that 

States reporting 

completed outcome 

assessments

Conducted specific client

outcome study (number of

studies)

Continually assess client

outcomes using performance

measurement data

California X (1)

Florida X (1) X

Georgia X (3) X

New York X

North Carolina X (3) X

Ohio X (5)

Texas X (1) X

Virginia X

Washington X (11) X

12Georgia and New York did not provide results from their assessments; Virginia officials 

stated that the results from their performance outcome measurement system were 

ambiguous due to inconsistent data elements across programs and problems with linking 

the information with the state’s management information system.
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quarterly earnings of clients receiving treatment were more than twice the 

earnings of clients not receiving treatment and that health care costs for 

clients receiving treatment decreased by nearly 50 percent. According to 

SAMHSA, the National Association of State Alcohol and Drug Abuse 

Directors, and substance abuse experts, Washington and New York are 

examples of states from which lessons could be learned about measuring 

the effectiveness of drug abuse treatment using client outcomes. For 

example, Washington’s data system uses Social Security numbers to track 

clients, enabling the state to integrate self-reported data with secondary 

databases, including state employment and welfare rolls, to provide 

objective data for measuring client outcomes.13 Washington reported 

conducting 12 outcome assessment activities since 1994 and using client 

identifiers and integrative techniques for the past 7 to 8 years. New York 

officials reported using an integrated program monitoring and evaluation 

system since 1995 to assess the performance of all drug abuse treatment 

providers. This system uses 12 performance measures, including 

abstinence and employment, and has an established set of minimum 

performance standards. Drug abuse treatment providers who do not meet 

the standards are required to develop an action plan to meet the minimum 

performance standards.

SAMHSA’s Pilot Effort 

Assists 19 States in 

Developing and Collecting 

Uniform State Outcome 

Data

SAMHSA has initiated efforts to improve existing state data systems to 

make them comparable for performance measurement. Specifically, in 

1997, SAMHSA developed the Treatment Outcomes and Performance Pilot 

Studies (TOPPS) to help states develop or enhance their management 

information systems and outcome monitoring systems for evaluating 

clients receiving treatment. In 1998, SAMHSA created a grant program to 

further this effort—the Treatment Outcomes and Performance Pilot 

Studies Enhancement (TOPPS II)—which is being conducted under 

cooperative agreements with 19 states,14 including 9 that we surveyed. 

TOPPS II aims to help the pilot states collect information on SAPT-funded 

treatment services and monitor a core set of substance abuse treatment 

effectiveness measures. Several of the states we surveyed reported this 

13Washington law allows the use of Social Security numbers to track clients; however, some 

states prohibit the use of these identifiers because of privacy and access concerns.

14The 19 states that applied and were selected to participate in TOPPS II are Arizona, 

Arkansas, California, Connecticut, Illinois, Iowa, Kentucky, Maryland, Massachusetts, 

Missouri, New Hampshire, New Jersey, New York, Oklahoma, Rhode Island, Texas, Utah, 

Virginia, and Washington.
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program as part of their assessment efforts to measure drug abuse 

treatment effectiveness.

While the TOPPS initiative supported individually designed state studies to 

assess treatment effectiveness, TOPPS II supports a consensus-developed 

set of common client outcome measures of treatment effectiveness and 

incorporation of these measures into the databases of participating states. 

Both SAMHSA and the states participating in TOPPS II agreed on a core set 

of outcome measures that include substance abuse, health services 

utilization, self-help participation, pregnancy and status of children, 

employment status, living arrangements, and criminal behavior. As a 

condition of receiving funding through TOPPS II, each of the 19 

participating states is required to report to SAMHSA on each of these 

measures of treatment effectiveness. The TOPPS II study will issue interim 

and final reports that summarize developments and findings in the state 

and interstate evaluations. States are to report final results to SAMHSA in 

September 2001.

SAMHSA’s Effort to Collect 

Outcome Data From All 

States Will Not Provide 

Uniform Data

SAMHSA is asking states to voluntarily report on a core set of outcome 

measures—drug use, criminal activity, employment status, and living 

arrangements—in the fiscal year 2000 SAPT block grant application.15 For 

programs supported with SAPT block grant funds, SAMHSA is asking 

states to report the percent change in each measure that has occurred 

between admission and discharge for clients completing treatment, by age 

and race/ethnicity, using specific indicators such as arrests and 

homelessness.16 Further, SAMHSA is asking states to report the source of 

the data, reasons for not being able to report the data, and whether 

information is available to measure outcomes after treatment is completed.

SAMHSA’s effort to have all states voluntarily report outcome data in their 

fiscal year 2000 SAPT block grant application, however, will not yield 

consistent and uniform data across states because some states reported 

that they are not currently collecting all the outcome data that SAMHSA is 

requesting. Of the 16 states we surveyed, 8 plan to report data on some of 

15SAMHSA’s core set of outcome measures also include alcohol use.

16One expert we spoke with stated that it is also important to collect a core set of clinical 

data at client admissions to help establish an evaluation database and that such a database 

could be helpful in standardizing treatment approaches and training of personnel in the drug 

abuse treatment field.
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the outcome measures; 4 of these states—California, Maryland, New York, 

and Washington—are participating in SAMHSA’s TOPPS II program. For 

example, Georgia officials stated that they will report outcome information 

to SAMHSA in the fiscal year 2000 block grant application but do not have 

the data needed to report outcomes by race and age as requested by 

SAMHSA. The remaining eight states we surveyed reported that they will 

not or are unsure whether they will report the outcome information 

because they are not currently collecting much of the data SAMHSA 

requested.

SAMHSA officials are still reviewing applications and said that they are 

unsure of the extent to which states will report complete and consistent 

client outcome information in their SAPT block grant applications. 

SAMHSA plans to use the information it collects to identify states’ ability to 

report outcome data, such as the availability of state outcome data, the 

complexities of measuring client outcomes, and states’ infrastructure 

needs for measuring outcomes. SAMHSA officials stated that improving 

states’ ability to collect client outcomes and requiring them to report on a 

uniform set of measures would enhance SAMHSA’s ability to obtain 

uniform and consistent client outcome data across states. In November 

1999, HHS’ general counsel, together with SAMHSA officials, determined 

that the Secretary of HHS has the authority to require such information for 

administering the program. However, according to SAMHSA officials, it is 

highly unlikely that the states could currently report the quality of data 

needed to make accurate program assessments.

Conclusions The federal government invests hundreds of millions of dollars for drug 

abuse treatment through the SAPT block grant program. While SAMHSA 

monitors state expenditures to determine whether block grant funds are 

used in accordance with statutory requirements, this type of monitoring is 

not designed to determine the effect state drug abuse treatment programs 

are having on client outcomes. Assessing the effectiveness of drug abuse 

treatment is important in ensuring federal and state accountability for 

program results. Some states are assessing the effectiveness of their 

treatment programs using various outcome indicators. SAMHSA officials 

believe that the collection of uniform state-level client outcome data is 

essential for determining the effectiveness of drug abuse treatment 

programs supported with federal funds and for reporting the information to 

the Congress. SAMHSA is trying to determine the availability of client 

outcome data from all states and has awarded grants to some states to help 

improve their data collection systems. These efforts should help identify 
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states’ views about and some of the complexities associated with collecting 

and reporting client outcome data. SAMHSA’s efforts should also help to 

determine what additional actions are needed to get uniform state 

reporting on the results of drug abuse treatment programs supported with 

SAPT block grant funds.

Agency and Other 

Comments

We provided a draft of this report to SAMHSA and the 16 states we 

surveyed. SAMHSA officials said that the report provided an accurate and 

thorough review of the agency’s SAPT block grant and KDA grant 

programs. SAMHSA and some of the 14 states that responded to our 

request for comments had additional information, clarifications, and 

technical comments, which we incorporated where appropriate.

As agreed with your office, unless you publicly announce its contents 

earlier, we plan no further distribution of this report until 5 days from the 

date of this letter. At that time, we will send copies to the Honorable Donna 

E. Shalala, Secretary of HHS; the Honorable Nelba Chavez, Administrator 

of SAMHSA; officials of the state substance abuse agencies we surveyed; 

appropriate congressional committees; and other interested parties. We 

will also make copies available to others upon request.

Please contact me at (202) 512-7119 or James O. McClyde, Assistant 

Director, at (202) 512-7152, if you or your staff have any questions. Other 

major contributors to this report were Veronica Henry and Janina Johnson.

Janet Heinrich 

Associate Director, Health Financing

 and Public Health Issues
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Page 28 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Appendix I

Objectives, Scope, and Methodology ApApenednxidexiIs

In response to congressional concern about how federal drug abuse 

treatment funds are accounted for and whether they support effective drug 

abuse treatment programs, we were asked to describe the activities 

supported by SAMHSA’s SAPT block grant and KDA grant funds for drug 

abuse treatment, the mechanisms SAMHSA and states have in place to 

monitor fund use, and SAMHSA and state efforts to determine the 

effectiveness of drug abuse treatment supported with SAPT block grant 

funds.

To conduct our work on SAMHSA’s SAPT block grant program, we 

surveyed 16 states—California, Florida, Georgia, Illinois, Indiana, 

Maryland, Massachusetts, Michigan, New Jersey, New York, North 

Carolina, Ohio, Pennsylvania, Texas, Virginia, and Washington—and 

conducted follow-up interviews with selected respondents. We selected 

these states because they received at least $25 million for their fiscal year 

1996 SAPT block grant award; further, substance abuse experts and 

knowledgeable officials identified some of these states as having wellestablished systems for collecting outcome data and assessing their drug 

abuse treatment programs. Our review focused on expenditures of fiscal 

year 1996 drug abuse treatment funds because it is the most recent year for 

which complete expenditure data are available on the SAPT block grant 

from SAMHSA and the states. States have 2 years to spend their SAPT 

block grant award and generally report expenditures in the third year.

Through our survey and interviews, we collected information on (1) 

grantees’ expenditures for the different categories of drug abuse treatment 

services states report in their annual SAPT block grant applications—

residential, outpatient, detoxification, and methadone; (2) the mechanisms 

used to monitor the use of these grant expenditures; and (3) assessments of 

drug abuse treatment effectiveness conducted since 1994 using client 

outcomes, including measuring performance on an ongoing basis or 

through periodic special studies. We asked states to exclude their use of 

SAPT block grant funds for other activities, such as alcohol treatment and 

prevention, from their survey responses.

We also interviewed officials in SAMHSA’s Center for Substance Abuse 

Treatment, Office of Program Services, and Office of Applied Studies, and 

reviewed documents they provided on (1) SAPT block grant and KDA grant 

activities funded with drug abuse treatment dollars; (2) mechanisms 

SAMHSA uses to monitor grantees’ use of funds and compliance with 

program requirements; (3) efforts to assess the effectiveness of treatment 

using client outcomes; and (4) SAMHSA’s administrative expenses, 
Appendix I

Objectives, Scope, and Methodology

Page 29 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

including contracts and staffing levels. In addition, we obtained the views 

of officials at the National Association of State Alcohol and Drug Abuse 

Directors and experts in the substance abuse research community on 

assessing the effectiveness of drug abuse treatment using client outcomes.

Although the 16 states we selected to survey represented about 70 percent 

of fiscal year 1996 SAPT block grant awards and 60 percent of SAPT block 

grant drug abuse treatment expenditures for services, the results of our 

survey are not necessarily generalizable to the nation. Also, some survey 

states provided estimates of drug abuse treatment expenditures because 

they could not separate drug from alcohol abuse treatment services or 

could not isolate SAPT block grant expenditures from their total drug 

abuse treatment expenditures. We did not independently verify the 

accuracy of grantees’ drug abuse treatment expenditures. However, we 

compared some of the expenditure data reported in our survey with 

grantee expenditures reported to SAMHSA in their approved SAPT block 

grant applications and found no material differences. We did our work from 

January 1999 to January 2000 in accordance with generally accepted 

government auditing standards.
Page 30 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Appendix II

History and Administration of SAMHSA ApendxiI

In October 1992, the Congress established SAMHSA under Public Law 102-

321 to strengthen the nation’s health care delivery system for prevention 

and treatment of substance abuse and mental illnesses. Specifically, 

SAMHSA was to develop national goals and model programs; coordinate 

federal policy related to providing prevention and treatment services; and 

evaluate the process, outcomes, and community impact of prevention and 

treatment services. Before 1992, the major federal substance abuse and 

mental health delivery services and research activities were combined 

under one agency, the Alcohol, Drug Abuse, and Mental Health 

Administration. In the 1992 legislation, the Congress created SAMHSA to 

administer the services portion of the former agency and transferred its 

research components to the National Institutes of Health to be carried out 

by the National Institute on Alcohol Abuse and Alcoholism, NIDA, and the 

National Institute of Mental Health.

Since 1992, SAMHSA’s budget has remained relatively stable at about $2 

billion each year. SAMHSA’s fiscal year 1999 budget was about $2.5 billion 

for substance abuse treatment and prevention and mental health services. 

About $1.6 billion was for the SAPT block grant program—95 percent of 

which is allocated to states and local governments. SAMHSA allocated 

another $329 million to fund prevention and treatment discretionary grant 

programs. A portion of SAMHSA’s budget is appropriated for administrative 

expenses—about 6 percent ($155 million) for fiscal year 1999. The majority 

of the administrative expense appropriation supports contractual services 

that include technical assistance and program evaluation activities. 

Administrative expenses also support personnel compensation. As of 

December 1999, SAMHSA employed a total of 538 people, who are centrally 

located in the Washington, D.C., metropolitan area. The remaining 

administrative funds support costs related to travel, communications, 

printing, supplies, and rental payments. Table 3 lists SAMHSA’s fiscal year 

1999 appropriated amounts for administrative expenses; table 4 describes 

selected SAMHSA fiscal year 1999 contracts for technical assistance and 

program evaluation; and table 5 lists SAMHSA’s staffing levels by program 

as of December 1999.
Appendix II

History and Administration of SAMHSA

Page 31 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Table 3: SAMHSA’s Administrative Expenses, Fiscal Year 1999 Appropriation

a

Excludes about $62 million in contractual services related to SAMHSA’s block grant set-asides, drug 

surveys, and program evaluation; includes indirect costs estimated at 19.5 percent, with contractor 

fees of 5.1 percent.

Source: HHS Fiscal Year 2000 Substance Abuse and Mental Health Services Administration 

Justification of Estimates for Appropriations Committees.

Administrative expenses

Fiscal year 1999

appropriation

Personnel compensation and benefits $47,031,000

Printing and reproduction 3,608,000

Communications, utilities, and miscellaneous charges 1,401,000

Travel 1,199,000

Supplies and materials 392,000

Transportation of things 105,000

Rental payments 40,000

Other contractual servicesa 101,576,000

Total $155,352,000
Appendix II

History and Administration of SAMHSA

Page 32 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Table 4: Selected SAMHSA Contracts for Technical Assistance and Program Evaluation, Fiscal Year 1999, by Agency and 

Program

Contractor Description Amount

Center for Substance Abuse Treatment

SAPT Block Grant

Johnson, Bassin & Shaw, 

Inc., Silver Spring, Md.

Help states prepare technical assistance plans to resolve deficiencies identified in 

on-site technical reviews, and improve linkages between the drug abuse treatment 

system and other social service systems.

$5,686,113

Health Systems Research, 

Inc. Washington, D.C.

Provide technical assistance to maintain the Treatment Improvement Exchange 

database, logistical assistance for meetings, and editorial expertise for reports and 

documents.

1,088,632

KDA/Targeted Capacity Expansion

R.O.W. Sciences, Inc., 

Rockville, Md.

Provide technical assistance and support of KDA grants funded in fiscal years 

1996 through 1998 and 2000 through 2002, and ongoing demonstration programs 

of the Center for Substance Abuse Treatment’s Division of Practice and Systems 

Development.

3,635,571

CDM/JBS Joint Venture, 

Chevy Chase, Md.

Establish a program to ensure that knowledge developed by projects funded by the 

Center for Substance Abuse Treatment is disseminated to substance abuse 

treatment and related fields.

3,504,201

Johnson, Bassin & Shaw, 

Inc., Silver Spring, Md.

Provide support for a coordinating center to facilitate transfer of business and 

management technology to organizations and entities that make up the public 

sector treatment system.

3,298,997

Caliber Associates, Fairfax, 

Va.

Primarily provide support for the Residential Women and Children, Pregnant and 

Postpartum Women and Children, and HIV Outreach programs’ cross-site 

evaluation initiatives, and provide selected technical assistance to KDA grantees.

3,234,270

Caliber Associates, Fairfax, 

Va.

Provide a wide array of data management and scientific support across various 

programmatic and evaluation activities, including grants, cooperative agreements, 

and contracts.

2,767,868

Birch & Davis Associates, 

Inc., Silver Spring, Md.

Provide technical assistance for the Targeted Capacity Expansion cross-site 

evaluation, including support for implementing data collection systems, conducting 

data analyses, and preparing reports.

1,970,758

Johnson, Bassin & Shaw, 

Inc., Silver Spring, Md.

Develop a field evaluation of the treatment improvement protocols in order to 

assess treatment provider awareness and implementation, and to evaluate the 

effects of the protocols on the process and outcomes of addiction treatment.

1,597,259

The Medstat Group, Inc., 

Washington, D.C.

Develop an integrated database of mental health and substance abuse treatment 

services spending estimates that will allow for comparisons to national health 

expenditures.

1,379,585

Continued
Appendix II

History and Administration of SAMHSA

Page 33 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Center for Substance Abuse Prevention

SAPT Block Grant

Johnson, Bassin & Shaw, 

Inc., Silver Spring, Md.

Provide technical assistance to states on complying with SAPT block grant 

requirements and developing systems to administer successful and cost-effective 

prevention services, and support on-site monitoring of states’ block grant funds 

and programs.

3,584,997

Research Foundation, John 

Jay College, CUNY, New 

York, N.Y.

Assist with developing and disseminating knowledge about what works in 

prevention and making available to states and the field useful tools for developing 

prevention plans, making resource allocation decisions, implementing appropriate 

and effective prevention programs, and satisfying demands for public 

accountability.

3,469,057

Macro International, Inc., 

Calverton, Md.

Assist states in the development of data systems designed to monitor prevention 

service delivery. 

1,333,586

KDA

CRP, Inc., Washington, D.C. This contract carries out the Corporate Alliance on Drug Education earmark, which 

has been included within the center’s budget for the past several years. It also 

provides SAMHSA logistical support, including training and technical assistance 

on evaluating prevention programs. 

1,703,145

Caliber Associates, Fairfax, 

Va.

Assist the Center for Substance Abuse Prevention with coordinating program data 

and producing analytic reports. Contract also includes monitoring and analyzing 

performance measurements.

1,498,708

EMT Associates Inc., 

Folsom, Calif.

Conduct a process and outcome evaluation of 47 high-risk substance abuse 

prevention programs for youth, funded in 1994 and 1995.

1,168,057

The CDM Group, Inc., 

Chevy Chase, Md.

Assist with developing, collecting, and analyzing outcome measures across 

Workplace Managed Care program grantees; support the planning, development, 

and implementation of a series of specialized work groups and meetings on 

workplace issues.

1,086,895

Center for Mental Health Services

Children’s Programs

American Institute for 

Research, Washington, 

D.C.

Provide grantees of the Comprehensive Community Mental Health Services for 

Children and Their Families Program with training and technical assistance for 

developing community-based and family-focused services and integrating child 

and family services into local comprehensive systems of care. 

3,947,394

Macro International, Inc., 

Calverton, Md.

Assess the effectiveness of the systems of care created by the Comprehensive 

Community Mental Health Services Program for Children and Adolescents, as 

required by statute. This funding was for evaluations of 26 grantees.

3,127,160

Macro International, Inc., 

Calverton, Md.

Assess the effectiveness of the systems of care created by the Comprehensive 

Community Mental Health Services Program for Children and Adolescents, as 

required by statute. This funding was for evaluations of 20 grantees.

2,274,583

Vanguard Communications 

of Falls Church, 

Washington, D.C.

Develop and implement a community-based, local and national marketing 

campaign, and disseminate campaign messages and products to reduce the 

mental health stigma.

2,091,988

Macro International, Inc., 

Calverton, Md.

Continue the evaluation of the Comprehensive Community Mental Health Services 

Program for Children and Adolescents focusing on services for children and 

adolescents with serious emotional disturbances.

1,346,466

Contractor Description Amount

Continued from Previous Page
Appendix II

History and Administration of SAMHSA

Page 34 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Note: These contracts represent $64 million, or 64 percent, of contracts SAMHSA specifically identified 

for technical assistance and program evaluation and account for those contracts in fiscal year 1999 

whose dollar values are $1 million or greater. There were 95 other contracts with values less than $1 

million funded in fiscal year 1999.

American Institute for 

Research, Washington, 

D.C.

Evaluate children’s mental health in urban communities, including state 

commitments to mental health services programs and integration of familycentered concepts and teaching strategies in medical education.

1,064,853

KDA

The Gallup Organization, 

Rockville, Md.

Provide support for the School Violence Prevention grantee sites by developing 

products and activities to communicate with primary and secondary target 

audiences, and enhance awareness, understanding, and application of strategies 

aimed at school violence prevention and healthy child development.

2,006,000

R.O.W. Sciences, Inc., 

Rockville, Md.

Evaluate the Access to Community Care and Effective Services and Support 

Demonstration Program for Homeless Persons with Serious Mental Health 

Illnesses.

1,399,880

Mental Health Block Grant

Masimax Resources, Inc., 

Rockville, Md.

Provide support for the Mental Health Statistical Improvement Program, 

specifically the policy group, operations of task forces, regional and decision 

application groups, and further development of the managed care data system.

1,196,093

Office of Program Services

Orkand Corporation, Falls 

Church, Va.

Provide support for local area network operation, microcomputer technical 

services, software training, ADP technical studies, and database administration.

1,449,921

Office of Applied Studies

Westat, Inc., Rockville, Md. Assess the value of the Drug Abuse Warning Network in relation to the needs of its 

users and make recommendations for an alternative design.

1,000,000

Office of Planning and Program Coordination

MayaTech Corporation, 

Silver Spring, Md.

Provide technical, administrative, and logistical support for peer review meetings 

that evaluate grant applications and contract proposals.

1,000,000

Contractor Description Amount

Continued from Previous Page
Appendix II

History and Administration of SAMHSA

Page 35 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Table 5: SAMHSA’s Staffing Levels by Program, as of December 1999

Program and activity Executive staff

Grade-level staff

(GS-1 to GS-15)

Commissioned

officers Total

Center for Substance Abuse Treatment

KDA/targeted capacity expansion 0 55 4 59

SAPT block granta 0 21 5 26

Public communicationsb 0 7 07

Program support 0 6 0 6

Program planning/advisory councils 0 10 1 11

Center management 2 4 0 6

Total staffing 2 103

(16 GS-15s; 26 GS-14s; 32

GS-13s; and 29 GS-12s or

lower)

10 115

Center for Substance Abuse Prevention

KDA/targeted capacity expansion/high-risk youth 1 33 2 36

SAPT block granta 0 19 1 20

Other substance abuse programsc 0 17 0 17

Public communicationsb 0 21 1 22

Program support 0 4 0 4

Program planning/advisory councils 0 11 1 12

Center management 1 5 1 7

Total staffing 2 110

(11 GS-15s; 29 GS-14s; 36

GS-13s; and 34 GS-12s or

lower)

6 118

Center for Mental Health Services

KDA 0 42 2 44

Mental health block granta 1 12 0 13

Children’s program 0 10 0 10

Homeless programsd 0 2 02

Protection advocacy 0 1 0 1

Other mental health programse 0 11 1 12

Public communicationsb 0 10 3 13

Program support 0 8 1 9

Center management 1 7 1 9

Continued
Appendix II

History and Administration of SAMHSA

Page 36 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

a

The number of staff assigned to block grant programs represents only those staff who work directly on 

the programs in the centers’ divisions of state programs. However, numerous other staff support block 

grant programs directly or indirectly, including statistical staff who calculate state allocations and 

budget support, grants management, and audit staff.

b

Includes development of program materials, prevention communications, public information 

clearinghouses, public service messages.

c

Includes minority health concerns, workplace programs, and managed care programs.

d

Includes Projects for Assistance in Transition From Homelessness Program, a formula grant program.

e

Includes emergency programs, clinical training pay back, monitoring, managed care, surgeon 

general’s report, and bioterrorism.

f

Conducted within the Division of Extramural Activities, Policy, and Review.

g

Includes minority health program, women’s health program, HIV/AIDS program, managed care 

program, and alcohol program.

h

Includes equal employment programs.

i

Includes grants management, contracts management, financial management, information resources 

management, human resources management, and administrative services.

Total staffing 2 103

(12 GS-15s; 27 GS-14s; 29

GS-13s; and 35 GS-12s or

lower)

8 113

Office of the Administrator

Operating division/public communicationsb 0 12 0 12

Grants/contract reviewf 0 10 3 13

Other operating division/crosscutting programsg 0 19 1 20

Program planning/coordination 1 8 0 9

Operating division managementh 3 16 0 19

Total staffing 4 65

(13 GS-15s; 14 GS-14s; 14

GS-13s; and 24 GS-12s or

lower)

4 73

Other SAMHSA Offices

Office of Program Servicesi 1 91

(7 GS-15s; 14 GS-14s; 26

GS-13s; and 44 GS-12s or

lower)

0 92

Office of Applied Studies 1 26

(6 GS-15s; 11 GS-14s; 5

GS-13s; and 4 GS-12s or

lower)

0 27

Total 12 498 28 538

Program and activity Executive staff

Grade-level staff

(GS-1 to GS-15)

Commissioned

officers Total

Continued from Previous Page
Page 37 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Appendix III

KDA Grant Programs and Funding for Drug 

Abuse Treatment ApendxiI

Fiscal year 1996 Fiscal year 1998

Program Description Grantees Funding Grantees Funding

Target Cities Help metropolitan areas increase the effectiveness of 

treatment delivery by developing a model infrastructure 

to expand and coordinate local health care and social 

service delivery systems with specialized addiction 

treatment networks.

10 $20,340,000 7 $1,526,448

Targeted Capacity 

Expansion

Address gaps in treatment capacity by supporting rapid 

and strategic responses to demands for substance 

abuse treatment services.

a a 41 23,731,977

Recovery 

Community Support

Foster participation of those who are recovering from 

substance abuse in the development of substance abuse 

treatment services and programs, policies, and quality 

assurance activities at the state and local levels.

a a 19 3,661,892

Wraparound 

Services

Evaluate the benefits and cost-effectiveness of these 

services as they relate to substance abuse treatment 

given changes in health care financing, including 

managed care.

1 1,196,733 1 2,004,823

Welfare-to-Work Study the effectiveness of a program for substancebusing women eligible for Temporary Assistance to 

Needy Families to receive treatment for alcohol and/or 

drug addiction and to become employed.

a a 1 300,000

Residential Women 

and Children

Establish a more effective continuum of care by 

integrating substance abuse services with general health 

care, providing comprehensive services for addicted 

women and their children.

26 16,524,873 15 13,804,411

Pregnant and 

Postpartum Women

Expand the availability of comprehensive treatment 

services for pregnant and postpartum women and their 

children with alcohol and other drug use problems.

17 14,875,127 4 2,893,776

Violence Against 

Women

Generate and apply empirical knowledge about the 

development and effectiveness of an integrated systems 

approach for assisting women with co-occurring 

disorders and their children.

a a 9 5,229,228

Starting Early 

Starting Smart

Test the effectiveness of integrating mental health and 

substance abuse prevention and treatment services with 

primary health care or early childhood service settings 

for children from birth to age 7 and their families.

a a 12 2,575,567

Children’s Mental 

Health Services

Adjunct to the Criminal Justice Networks Program to 

provide supplemental funds to existing Center for Mental 

Health Services’ programs that support communitybased substance abuse and mental health services for 

children and families.

a a 1 99,749

Addiction 

Technology Transfer 

Centers

Network of centers to ensure that treatment 

professionals have the latest information on best 

practices and treatment techniques.

11 7,148,339 15 7,565,505

Continued
Appendix III

KDA Grant Programs and Funding for Drug 

Abuse Treatment

Page 38 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Criminal Justice 

Treatment Networks

Link metropolitan justice agencies with substance abuse 

treatment networks and related health, mental health, 

and social services agencies.

7 6,074,987 7 8,148,230

Criminal Justice Jail 

Diversion

Support the evaluation of the relative effectiveness of a 

variety of pre- and post-booking police diversion and 

criminal justice intervention models for individuals with 

co-occurring disorders.

a a 7 2,999,999

HIV Outreach Modify behavior and reduce the incidence of HIV and 

related diseases by targeting high-risk substance 

abusers and their partners.

11 3,406,999 a a

HIV/AIDS Cost 

Study

Collaboration among six federal agencies to study 

integrated mental health, substance abuse, and primary 

medical HIV treatment interventions.

a a 9 950,000

Managed Care−

Vulnerable 

Populations

Enhance knowledge about how managed care in the 

public sector affects the provision of substance abuse 

and mental health services.

7 3,234,846 6 3,357,520

Managed Care−

Adolescents

Examine the effects on cost, utilization, and outcomes of 

different models of managed care for adolescents with 

substance abuse problems.

a a 7 4,177,676

Managed Care−

Alcohol Services

Evaluate the effectiveness of alcoholism services 

delivery in a managed care environment. a a 1 199,999

Rural Remote and 

Culturally Distinct 

Populations

Deliver treatment services in innovative ways to hard-toreach populations and to serve as a model program to 

be replicated for Alaskan Natives, Native Americans, and 

Native Hawaiians. 3 1,765,000 3 2,018,782

Farm Resource 

Center

Supplemental funding to the Center for Mental Health 

Services to continue and augment mental health and 

substance abuse treatment services and enhance 

outreach to rural, coal mining, and farm populations in 

West Virginia and Illinois, especially to those who are 

poor, disabled, or elderly and to child-bearing women. a a 1 50,000

Marijuana−Adults Examine the efficacy of brief treatment interventions for 

marijuana dependence and whether these treatments 

are effective in diverse populations with a higher 

proportion of minority representation. 4 1,288,805 4 1,844,311

Marijuana−

Adolescents

Examine the effectiveness of treatment for marijuanadependent youth, comparing five promising approaches 

that vary in orientation, duration, mode of delivery, and 

cost. a a 5 3,219,164

Methamphetamine 

Treatment

Test the replicability of specific nonresidential programs 

for the treatment of methamphetamine abuse and their 

cost-effectiveness. a a 8 3,024,100

Fiscal year 1996 Fiscal year 1998

Program Description Grantees Funding Grantees Funding

Continued from Previous Page
Appendix III

KDA Grant Programs and Funding for Drug 

Abuse Treatment

Page 39 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

a

Program not funded.

Homelessness 

Prevention

Document homelessness prevention models for 

individuals with serious mental illness and substance 

abuse disorders who are homeless, formerly homeless, 

or at risk for homelessness and who have had contact 

with the mental health or substance abuse treatment 

system. 12 1,040,695 8 1,826,921

Disaster Assistance Provide expanded substance abuse treatment services 

during a natural disaster. 1 663,708 a a

Campus Develop a model comprehensive program for the 

treatment of substance abuse in the national capital 

area. 1 600,000 a a

Minority Fellowship Provide doctoral-level training to increase the number of 

professionals qualified to develop and implement 

services for underserved ethnic populations with mental 

health and substance abuse problems. a a 4 340,000

Exemplary 

Programs−

Adolescents 

Identify those regimens for treating adolescent heroin 

abusers that appear to be exemplary and may be useful 

for further replication and dissemination. a a 5 2,116,079

Community Action 

Grants

Support the adoption of exemplary practices for Hispanic 

adults and adolescents with mental health or substance 

abuse problems. a a 3 442,944

Conference Grant Support domestic conferences for knowledge synthesis 

and dissemination. a a 7 309,066

Total 111 $78,160,112 210 $98,418,167

Fiscal year 1996 Fiscal year 1998

Program Description Grantees Funding Grantees Funding

Continued from Previous Page
Page 40 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Appendix IV

State Program Assessments ApendxiIV

State and program

Client 

populations 

Treatment 

services Selected outcome measures and results

California

California Drug and Alcohol 

Treatment Assessment

All clients All services • Drug use declined by 40 percent.

• Employment results not conclusive.

• Hospital admissions reduced by 33 percent.

• Criminal activity declined by 66 percent.

Florida

Ongoing performance 

measurement system

All clients All services • Abstinence for 65 percent of children and 61 percent of 

adults.

• Employment achieved by 63.4 percent.

Evaluation of Substance Abuse 

Treatment Outcomes

Adults Residential, 

outpatient

• 11 percent of clients completing treatment who were drug 

free at discharge reported a substance abuse problem, 

compared to 26 percent of clients who did not complete 

treatment.

• 70 percent of clients who completed treatment were 

employed, compared to 58 percent of clients who did not 

complete treatment.

North Carolina

Ongoing performance 

measurement system

All clients Outpatient, case 

management

• Declines in drug use improved significantly.

• Abstinence improved significantly.

• Employment modestly improved.

• Mental health moderately improved.

• Living arrangement modestly improved.

TOPPS All clients Outpatient • Drug use declined substantially for each type of substance.

• Medical overnight stays reduced by 4 percent, and 

emergency room visits reduced by 18 percent. 

• Psychiatric overnight stays reduced by 16 percent.

Perinatal and Maternal 

Substance Abuse Treatment 

Initiative

Pregnant and 

postpartum 

women and 

adolescents

Prenatal treatment • 73 percent of clients had full-term births; 13 percent of births 

born at very low birth weight.

Treatment Alternatives to Street 

Crime (TASC)

Criminal justice All services • Abstinence occurred for 48 percent at discharge.

• Drug use for those still using drugs was less often.

• 82 percent had no arrests while in the program.

Methadone Treatment Quality 

Assurance System

Narcotic addicted Methadone • Abstinence from injected drug use for 94 percent.

• Drug use urine screens for opiates negative for 79 percent; 

for cocaine, 88 percent.

• Employment full-time for 54 percent.

• No medical overnight stays for 93 percent, and no 

emergency room visits for 82 percent.

• No arrests in the past 12 months for 95 percent.

Continued
Appendix IV

State Program Assessments

Page 41 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Ohio

TASC Court-referred 

juveniles

All treatment • Abstinence occurred for 76 percent of discharges.

• Drug use testing negative for 92 percent.

• Rearrest rate: 7 percent.

TASC Court-referred 

adults

All treatment • Abstinence occurred for 47 percent of discharges.

• Drug use urine testing negative for 88 percent; for breath 

testing, 91 percent.

• Employment obtained and improved for 1,017 clients, or 46 

percent of discharges.

• Living arrangement stable for 1,132, or 51 percent of 

discharges

Analysis of Adult TASC Court-referred 

adults 

Counseling, 

urinalysis

• Criminal activity significantly lower for clients completing the 

program.

Arrest and Reincarceration 

Following Prison Release

Adult male felons Therapeutic 

community

• Rearrests were slightly reduced among participants.

Tapestry Therapeutic 

Community; Our Awareness of 

Self Increases Success 

Therapeutic Community

Female and male 

incarcerated 

felons

Residential, other 

drug abuse 

treatment

• Women had lower rearrests; males, no difference.

Texas

Treatment Research Institute Adults Residential, 

outpatient

• Abstinence achieved by 56 to 61 percent for alcohol and 

other drugs.

• Employment achieved by 51 to 64 percent.

Treatment Alternatives to 

Incarceration Program

Adult criminals Outpatient • Criminal activity decreased the longer the stay in treatment.

Statewide Treatment Outcome 

Data

Adults Detoxification, 

residential, 

outpatient, 

methadone

• Abstinence occurred for 72 percent of clients.

• Drug use reduced for 64 percent.

• Employment gained by 33 percent.

• Arrest rate at followup was 5 percent.

Washington

Cost Savings in Medicaid 

Medical Expenses

Indigents Intensive inpatient, 

outpatient 

• Physical health costs $4,500 less than for untreated clients 

over 5-year period.

Alcoholism and Drug Addiction 

Treatment and Support Act 

(ADATSA): Economic Benefits 

and Costs

Indigents Intensive inpatient, 

outpatient, 

residential 

• Employment earnings more than double that of untreated 

clients.

• Physical health costs decreased by nearly 50 percent for 

treated clients.

ADATSA Treatment Outcomes: 

Employment and Cost 

Avoidance

Indigents Intensive inpatient, 

outpatient, 

vocational training

• Employment earnings for those who completed training 

nearly doubled.

• Physical health costs were less than half that of nontreated 

clients.

Employment Outcomes of 

Indigent Clients Receiving 

Alcohol and Drug Treatment

Indigents Intensive inpatient, 

outpatient, 

recovery house

• Employment earnings increased on average by $1.30 for 

every day of inpatient care received.

State and program

Client 

populations 

Treatment 

services Selected outcome measures and results

Continued from Previous Page
Appendix IV

State Program Assessments

Page 42 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Employment Outcomes of 

Chemical Dependency 

Treatment and Additional 

Vocational Services

Indigent Intensive inpatient, 

outpatient, 

vocational training

• Employment earnings were higher for 46 percent of clients 

who completed vocational services.

Substance Abuse, Treatment, 

and Birth Outcomes for 

Pregnant and Postpartum 

Women

Pregnant and 

postpartum 

women

Prenatal treatment, 

prenatal and 

postpartum 

diagnosis, 

Medicaid

• Overall rate of low birth weights for infants whose mothers 

were treated was lowered by 2.9 percent.

Evaluation of Pioneer Center 

North

Mentally ill, 

chemically 

addicted, and 

involuntary 

chemical 

dependency 

treatment

Residential 

(nonhospital)

• Mental health services declined after treatment 7 to 25 

percent.

• Physical health costs decreased between $2.2 million and 

$1.1 million for those who received treatment.

Division of Alcohol and 

Substance Abuse One-year 

Adolescent Outcomes Report

Adolescents Intensive inpatient 

(nonhospital), 

outpatient

• Abstinence achieved for 6 months on average by about 40 

percent of clients.

• Number of drug substances used dropped by about 3.

• Mental health problems decreased from 42 percent to 29 

percent in psychiatric symptoms.

• Physical health problems decreased from 17 percent to 11 

percent in medical hospitalization and 42 percent to 28 

percent in emergency room visits.

• Criminal activity decreased in arrest for misdemeanors by 25 

percent, felonies by 23 percent, and drug violations by 24 

percent.

Division of Alcohol and 

Substance Abuse 18-Month 

Adolescent Outcomes Report

Adolescents Intensive inpatient 

(nonhospital), 

outpatient

• Abstinence was achieved for 6 months on average by about 

45 percent of the clients.

• Employment absenteeism or tardiness dropped by 33 

percent.

• Mental health problems decreased by 17 percent in major 

depressive syndromes and by 14 percent in suicide 

attempts.

• Physical health problems decreased in emergency room 

visits.

• Criminal activity decreased in drug dealing, theft, and 

prostitution by 48 percent. 

Treatment Outcome Evaluation: 

Youth Admitted to Residential 

Chemical Dependency 

Treatment Under the Provisions 

of the “Becca” Bill

Youth Intensive inpatient 

(nonhospital)

• Abstinence was achieved for 40 percent 3 months after 

treatment.

• Drug use prevalence decreased by 46 percent for 

marijuana.

• Criminal activity decreased in selling drugs by 51 percent, 

breaking and entering by 39 percent.

Adolescent Treatment Outcome 

Study Report

Adolescents Intensive inpatient 

(nonhospital)

• Abstinence occurred for two-thirds of the sample at 6 

months.

• Criminal activity decreased fourfold for felony arrests after 1 

year.

State and program

Client 

populations 

Treatment 

services Selected outcome measures and results

Continued from Previous Page
Appendix IV

State Program Assessments

Page 43 GAO/HEHS-00-50 Assessing Drug Abuse Treatment

Adolescent Treatment Outcome 

Study Report: Six-Month 

Follow-up of Clients Referred by 

the Juvenile Justice System, 

Those Served by Schools, as 

Well as Those Whose Parents 

Currently Abuse Substances

Adolescents 

referred by court 

or juvenile justice 

system

Intensive inpatient 

(nonhospital)

• Abstinence occurred for 5 percent more court-referred 

clients than others.

• Criminal activity decreased significantly for abstinent clients 

compared to relapsed clients.

State and program

Client 

populations 

Treatment 

services Selected outcome measures and results

Continued from Previous Page

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