United States General Accounting Office

GAO Report to Congressional Requesters

March 1997 DRUG CONTROL

Observations on

Elements of the

Federal Drug Control

Strategy

GAO/GGD-97-42

GAO United States

General Accounting Office

Washington, D.C. 20548

General Government Division

B-275944 

March 14, 1997

The Honorable Frank R. Wolf

Chairman, Subcommittee on

 Transportation and Related Agencies

Committee on Appropriations

House of Representatives

The Honorable John Edward Porter

Chairman, Subcommittee on Labor, Health

 and Human Services, and Education

Committee on Appropriations

House of Representatives

The federal government’s investment in the war on drugs has grown to

over $15 billion in fiscal year 1997. Yet the availability of drugs on U.S.

streets and the number of persons using illegal drugs continue to be

serious problems. We have reported many times over the past decade on

federal antidrug efforts. This report responds to your October 30, 1996,

request that we provide information to help Congress examine and

improve the federal government’s drug control1

 strategy.

Specifically, this report (1) identifies findings of current research on

promising approaches in drug abuse prevention targeted at school-age

youth; (2) describes promising drug treatment strategies for cocaine

addiction; (3) summarizes our recent work assessing the effectiveness of

international efforts to reduce illegal drug availability, including

interdiction; (4) assesses whether the U.S. Coast Guard’s performance

measures for its antidrug activities conform to the principles of the

Government Performance and Results Act of 1993 (GPRA); and

(5) summarizes several of our recent products on federal drug preventionand treatment-related efforts.

Background In 1995, an estimated 22.7 million Americans had used at least one illicit

drug in the past year—17.8 million had used marijuana, 3.7 million had

used cocaine; and 428,000 had used heroin.2

 From 1992 to 1995, there was

1

As defined in the Anti-Drug Abuse Act of 1988, P.L. 100-690, “drug control” is any activity conducted

by a national drug control program agency involving supply reduction and demand reduction. Supply

reduction includes international drug control; foreign and domestic drug enforcement intelligence;

interdiction; and domestic drug law enforcement, including law enforcement directed at drug users.

Demand reduction includes drug abuse education, prevention, treatment, research, and rehabilitation.

2

National Household Survey on Drug Abuse: Population Estimates 1995, Substance Abuse and Mental

Health Services Administration, 1996.

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a pronounced rise in the estimated drug use rates among school-age

youths—the estimated rate of marijuana use by 8th grade students

increased from 7.2 percent to 15.8 percent; the estimated rate of marijuana

use by 10th graders rose from 15.2 percent to 28.7 percent; and for 12th

graders, the estimated rate of marijuana use increased from 21.9 percent

to 34.7 percent. According to the Office of National Drug Control Policy

(ONDCP) social costs of illegal drug use were estimated at $67 billion

annually. In addition, ONDCP reported that in the 1990s there were 100,000

drug-related deaths, approximately 20,000 deaths per year.3

In 1988, Congress created ONDCP to lead the nation’s war on drugs. The

federal budget for drug abuse control climbed from $1.5 billion in fiscal

year 1981 to about $15.1 billion in fiscal year 1997.4

 Approximately

$1.8 billion of the over $15 billion authorized by Congress to implement

the 1996 national drug control strategy is devoted to international

programs with the goals of shielding U.S. air, land, and sea frontiers from

the drug threat; breaking foreign drug sources of supply; and destroying

international drug-trafficking organizations. (A more complete discussion

of the national drug control strategy goals is in app. I.)

In 1988, we provided Congress with an overview of the drug problem and

the federal response.5

 The report described the drug problem in the 1980s

nationally and in six major cities where drug problems were among the

worst in the nation. In 1993, in conjunction with our report on the

reauthorization of ONDCP,

6

 we summarized the results of our work to date

on U.S. antidrug efforts and the participation of federal, state, and local

agencies in the national drug control strategy. These two reports identified

the immensity of the challenges facing the antidrug effort, challenges that

range from helping foreign governments break their dependence on

drug-related revenues to helping drug users in this country turn away from

what they may see as the allure of drugs.

We recommended in our 1993 report that ONDCP,

7

 as the coordinator of the

federal drug control effort, (1) develop additional measures to assess

3

The National Drug Control Strategy, 1996. Office of National Drug Control Policy, Washington, D.C.

4

In constant 1987 dollars. National Drug Control Strategy: 1996. Office of National Drug Control Policy,

Washington, D.C.

5

Controlling Drug Abuse: A Status Report (GAO/GGD-88-39, Mar. 1, 1988).

6

Drug Control: Reauthorization of the Office of National Drug Control Policy (GAO/GGD-93-144, Sept.

29, 1993).

7

GAO/GGD-93-144.

Page 2 GAO/GGD-97-42 Drug Control
B-275944 

progress in reducing drug use, (2) develop performance measures to

evaluate the contributions made by major components of current antidrug

efforts and significant new initiatives, and (3) incorporate these measures

into annual drug control strategies.

GPRA was enacted in 1993 to, among other things, improve performance

measurement by federal agencies. It provides a useful framework for

assessing the effectiveness of federal drug control efforts. It requires

agencies to set goals, measure performance, and report on their

accomplishments. Under GPRA, it is envisioned that federal agencies will

move away from their concentration on traditional workload measures,

such as staffing and activity levels, and move toward a focused assessment

of their results.

Results in Brief Recent research points to two types of promising drug prevention

approaches for school-age youth. The first approach emphasizes drug

resistance skills, generic problem-solving/decisionmaking training, and

modification of attitudes and norms that encourage drug use (the

psychosocial approach). The second approach involves the coordinated

use of multiple societal institutions, such as family, community, and

schools, for delivering prevention programs (the comprehensive

approach.) Both approaches have reduced student drug use as well as

strengthened the individual’s ability to resist drugs in both short- and

longer-term programs.

Three approaches have been found to be potentially promising in the

treatment of cocaine use. These approaches include (1) avoidance or

better management of drug-triggering situations (relapse prevention

therapy); (2) exposure to community support programs, drug sanctions,

and necessary employment counseling (community

reinforcement/contingency management); and (3) use of a coordinated

behavioral, emotional, and cognitive treatment approach (neurobehavioral

therapy). Drug abuse clients using these approaches have maintained

extended periods of cocaine abstinence and greater retention in treatment

programs.

While these prevention and treatment approaches have shown promising

outcomes in some programs, sufficient evaluative research has not been

done to test their effectiveness and their applicability among different

populations in varied settings. This research should help policymakers

better focus efforts and resources in an overall drug control strategy.

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Despite some successes, United States and host countries’ efforts have not

materially reduced the availability of drugs in the United States for several

reasons. First, international drug-trafficking organizations have become

sophisticated, multibillion dollar industries that quickly adapt to new U.S.

drug control efforts. Second, the United States faces other significant and

long-standing obstacles, such as inconsistent funding for U.S. international

drug control efforts, competing foreign policy objectives, organizational

and operational limitations, and a lack of ways to tell whether or how well

counternarcotics efforts are contributing to the goals and objectives of the

national drug control strategy, which results in an inability to prioritize the

use of limited resources. Third, in drug-producing and transit countries,

counternarcotics efforts are constrained by competing economic and

political policies, inadequate laws, limited resources and institutional

capabilities, and internal problems such as terrorism, corruption, and civil

unrest.

Although there is no panacea for resolving all of the problems associated

with illegal drug trafficking, in our February 1997 report,8

 we

recommended that the Director of ONDCP: (1) complete the development of

a long-term plan with meaningful performance measures and multiyear

funding needs that are linked to the goals and objectives of the

international drug control strategy; (2) at least annually, review the

progress made and adjust the plan, as appropriate; (3) enhance support for

the increased use of intelligence and technology to improve U.S. and other

nations’ efforts to reduce supplies of and interdict illegal drugs; and

(4) lead in developing a centralized lessons-learned data system to aid

agency planners and operators in developing more effective counterdrug

efforts.

Measuring the effectiveness of U.S. antidrug activities has been a

continuing problem in assessing the results of the national drug control

strategy. In reauthorizing ONDCP in 1993, Congress specified that ONDCP’s

performance measurement system should assess changes in drug use, drug

availability, the consequences of drug use, drug treatment capacity, and

the adequacy of drug treatment systems. To implement the statutory

requirements, which are consistent with recommendations in our 1993

report,9 ONDCP is developing national-level measures of drug control

performance.

8

Drug Control: Long-Standing Problems Hinder U.S. International Efforts (GAO/NSIAD-97-75, Feb. 27,

1997).

9

GAO/GGD-93-144.

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B-275944 

Similarly, the Coast Guard is developing performance measures to assess

the results of its antidrug activities. It appears from our review of the

Coast Guard’s strategic and performance plans that it has taken steps

toward conforming with certain GPRA principles. However, it is too soon to

tell whether performance measurement systems being developed by ONDCP

and the Coast Guard will be fully consistent with the results-oriented

principles of GPRA.

Objectives, Scope,

and Methodology

In responding to your request, we adopted the following approach in

meeting the objectives agreed upon with the Subcommittees.

We identified and summarized findings and conclusions from our recent,

relevant reports and testimonies that examined U.S. antidrug programs

and activities, including international initiatives and domestic measures,

aimed at interdicting illegal drugs and reducing drug use through

prevention or treatment. We identified and reviewed selected literature on

drug prevention and drug treatment research and evaluated syntheses of

research literature, including data on program outcomes, to identify

promising approaches in drug abuse prevention that focus on school-age

youth. (See app. II for additional information on the methodology we

used.)

To obtain information on the U.S. Coast Guard’s performance measures

for its antidrug activities, we interviewed officials responsible for

managing the Coast Guard’s drug interdiction program and reviewed key

agency documents such as the Coast Guard’s preliminary performance

plans (for implementing the GPRA). We compared the Coast Guard’s

performance measurement plans with GPRA to determine whether they

conform to the principles of the act.

We did our review from November 1996 to January 1997 in accordance

with generally accepted government auditing standards. We obtained

comments on a draft of this report from ONDCP. These comments are

discussed at the end of this letter.

Two Drug Prevention

Approaches Show

Promise Among

School-Age Youth

Recent research demonstrates basically two types of prevention

approaches that show promise when used in programs with school-age

youths. The first approach emphasizes individual drug resistance skills,

generic problem-solving/decisionmaking training, and modification of

attitudes and norms that encourage drug use (the psychosocial approach).

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The second approach involves the use of multiple societal institutions

(e.g., schools, families, media, and community), working together in

collaborative fashion, to achieve a multicomponent approach to

prevention (the comprehensive approach).10 These approaches have been

used in several notable programs. However, the extent to which these

promising approaches yield results in a wide range of community settings

remains an open question.

The major aim of drug abuse prevention programs is to prevent the initial

use of both illicit and nonprescribed legal drugs and avert subsequent

drug-related problems (like AIDS and other sexually transmitted diseases.)

For youths already experimenting with drugs, or using them on a

recreational basis, prevention programs may be aimed at early screening

and intervention activities, with the end goal of eliminating drug use, or at

least long-term cessation.

In addition, drug prevention programs have focused on strengthening the

individual’s ability to resist drugs. This has taken the form of helping

individuals to minimize the drug “risk factors” in their lives as well as

building up their psychological “protective factors.” Risk factors that have

been related to an individual’s subsequent drug use activity include a

variety of personal, social, and community factors, including societal

norms favorable to drug use, easy access to drugs, and favorable parental

attitudes toward drug use. Enhancing one’s coping skills, problem-solving

ability, and self-esteem, however, provides some alternative means of

strengthening the individual’s protection or resilience to drug use in

high-risk situations.

The strategies used in prevention programs can be classified by three

interventions (universal, selective, and indicated) that target different

audiences: (1) universal interventions are directed at the general

population, (2) selective intervention strategies target individuals or

subgroups at risk for drug abuse, and (3) indicated interventions are

directed at individuals who already are using drugs but have not yet met

the criteria for a diagnostic disorder. Prevention activities can be

conducted in school settings, in peer groups, within the family context, or

within the larger community.

Drug prevention activities can encompass a wide array of functions. They

include the provision of information and education classes or training

10Institute of Medicine, Pathways of Addiction: Opportunities in Drug Abuse Research (Washington,

D.C.: National Academy Press), 1996, pp. 141-145.

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B-275944 

programs to enhance one’s knowledge of drug abuse and alternative

lifestyles, teaching skills to cope with or manage potential high-risk drug

situations, enhancing generic skills for the solution of general life

problems and decisionmaking, as well as encouraging communities to

implement societalwide institutional approaches to drug problems.

The following features are associated with positive outcomes in many

studies of prevention programs: (1) increasing awareness of the social

influences that promote drug use (for example, peer pressure);

(2) modifying societal norms or expectations concerning drug use; and

(3) targeting multiple aspects of youths’ lives through use of school,

family, peer, and community factors.

Drug prevention programs that use the psychosocial and comprehensive

approaches have shown promising results among school-age youth in

reducing drug use and strengthening the individual’s ability to resist drugs.

Although information dissemination, effective education, and alternatives

to drug use are approaches that have been used in prevention programs,

they have not been shown to be consistently effective when utilized

individually. However, they have been included in promising

comprehensive approaches to drug prevention.

Our review of the research on drug prevention programs that have

outcome data revealed several programs that show promise when using

the psychosocial or comprehensive approach. Some of the most notable

psychosocial and comprehensive drug programs include (1) the

Adolescent Alcohol Prevention Trial (psychosocial), which demonstrated

that the increase in initial use of marijuana for intervention participants

was 65-percent less than that of a comparison control group at 1 year

follow-up and 23-percent less than control group participants for alcohol;

(2) the Life Skills Training Program (psychosocial) showed 44 percent

fewer intervention participants reported use of three drugs over a

specified period of time, as compared to control group participants; and

(3) the Midwestern Prevention Project—also known as Project Star or

I-Star (comprehensive), showed a 20- to 40-percent net reduction in the

use of two drugs by school-age youth over a 3-year period.

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B-275944 

Three Approaches

Show Promise in the

Treatment of Cocaine

Abuse and

Dependency

Three approaches have been found to be potentially promising in the

treatment of cocaine abuse and dependency:

• “Relapse prevention” provides users with the ability to better recognize

drug “triggering” events, places, people and situations, and helps

individuals develop better coping strategies to resist their specific triggers.

• “Community reinforcement/contingency management” consists of several

community-oriented components, including the participation of the

client’s family member or significant other in the treatment process;

management incentives or rewards for drug abstinence; employment

counseling when needed; and encouragement of participation in

recreational activities as health alternatives to a drug-free lifestyle.

• “Neurobehavioral therapy” consists of a comprehensive behavioral,

emotional, and cognitive treatment approach, utilizing individual therapy,

drug education, and self-help group involvement. According to research

results, each approach has demonstrated positive outcome results with

regard to extended periods of cocaine abstinence and greater client

retention in treatment.

The National Institute on Drug Abuse (NIDA) has also supported the testing

of 20 major drugs in the treatment of cocaine. However, no medication has

been shown to be consistently effective in the treatment of cocaine, and

no medication has been submitted to the Food and Drug Administration

for approval for this purpose.

Attaining abstinence is a major goal of drug treatment. Once initial

abstinence is attained, efforts are directed toward maintaining continued

abstinence over more extended periods of time. Individual objectives of

treatment can include the social and personal rehabilitation of the

individual (including improved health and reduced psychological

problems), enhancement of familial relationships, reduction of criminal

behavior and resolution of legal problems, improved coping skills, and

attainment of educational and occupational aspirations.

The range of treatment services can include diagnostic assessment,

detoxification (when necessary), medication, counseling, drug education,

psychotherapy, case management, and self-help group participation. The

Institute of Medicine (IOM) and others have identified four types of

treatment modalities in which these services are delivered: (1) outpatient

methadone maintenance facilities (primarily for opiate users),

(2) outpatient nonmethadone or drug-free facilities, (3) chemical

Page 8 GAO/GGD-97-42 Drug Control
B-275944 

dependency programs, and (4) long-term residential therapeutic

communities.

Our review of recent cocaine treatment research identifies several

programs that have shown positive outcome results using

cognitive/behavioral therapies. For example, one relapse prevention

program11 showed cocaine dependent clients were able to remain

abstinent at least 70 percent of the time while in treatment. A community

reinforcement/contingency management program12 showed that

42 percent (or almost half) of the participating cocaine-dependent clients

were able to achieve nearly 4 months of continuous abstinence. And a

neurobehavioral program13 showed that more than a third (38 percent) of

the clients were abstinent from the drug at the 6-month follow-up.

Experts Say

Additional Research

Is Needed for Drug

Abuse Prevention and

Treatment

Regardless of early positive results in certain drug abuse prevention and

treatment approaches, research experts suggest that additional research is

needed to better identify and understand elements of effective prevention

and treatment. They say substantiating early program results through

further research and evaluation is an important step in advancing

promising drug prevention and treatment approaches. It is also important

in helping policymakers to better direct the nation’s efforts and resources

toward reducing or eliminating drug abuse or dependency.

Prevention initiatives for future research that NIDA, IOM, and others have

mentioned include (1) the utility of booster sessions in extending positive

program outcomes, (2) determining the mix of approaches that yield the

most significant outcome results, and (3) how best to disseminate positive

findings to the larger community, and (4) assessing those types of

approaches that work best for different population groups. Future cocaine

treatment initiatives mentioned include (1) identifying improved or

additional cognitive/behavioral strategies to reduce relapse, (2) testing the

effectiveness and safety of new medications to prevent or reduce drug

intake, and (3) identifying the necessary components of

cognitive/behavioral strategies and medications that lead to successful

outcomes.

11Kathleen Carroll and others, “Psychotherapy and Pharmacotherapy for Ambulatory Cocaine

Abusers,” Archives of General Psychiatry, 51 (1994), 177-187.

12Stephen Higgins and others, “Achieving Cocaine Abstinence With a Behavioral Approach,” American

Journal of Psychiatry, 150:5 (1993), 763-69.

13Stephen Shoptaw and others, “The Matrix Model of Outpatient Stimulant Abuse Treatment: Evidence

of Efficacy,” Journal of Addictive Diseases, 13:4 (1994), 129-41.

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See appendix II for a detailed description of the results of our review of

selected literature on drug prevention for school-age youth and cocaine

treatment approaches.

Summary of Selected

GAO Products on

Federal Preventionand

Treatment-Related

Efforts

Recognizing the link between drugs and crime, Congress authorized

federal grants-in-aid to states and localities to assist them in addressing

drug-related crime in their communities. We have reported on three such

programs during the past few years—drug courts, Operation Weed and

Seed, and Treatment Alternatives to Street Crime (TASC).

Title V of the Violent Crime Control and Law Enforcement Act of 1994

authorized the award of federal grants to states and localities to establish

drug courts. In 1995, we reported that (1) in exchange for dismissed

charges or reduced sentences, drug-using, primarily nonviolent defendants

were being diverted to drug courts where judges monitor their progress

through frequent status hearings; (2) drug court programs varied in length,

participant eligibility, funding, and other practices; (3) as of March 1995,

there were at least 37 drug courts operating nationwide; (4) 33 of these

drug courts had accepted over 20,000 defendants; (5) most drug courts did

not accept offenders with prior violent convictions, and none accepted

those currently charged with a violent offense; and (6) drug courts had not

been operating long enough to determine their overall effectiveness.14

Operation Weed and Seed is a Department of Justice grant program. Its

strategy is to support community-based, multiagency efforts to weed out

crime from targeted neighborhoods, then seed the site with a variety of

programs and resources to prevent crime from recurring. In 1994, we

reported that (1) community involvement was important to the program’s

effectiveness and long-term success; (2) community residents at local sites

needed to be involved in/control steering committees and help design and

implement activities; (3) the emphasis on activities varied at local levels

and community policing was a strong component of many programs;

(4) weeding efforts had removed criminals from communities and

increased interagency cooperation; (5) program officials believed that

Justice should increase its funding for seeding activities so that seeding

and weeding activities would have equal funding; (6) Justice had

established guidelines to monitor program funds and compliance with its

policies and also an interagency work group to coordinate social services

agencies’ recommendations on seeding programs and exchange

14Drug Courts: Information on a New Approach to Address Drug-Related Crime (GAO/GGD-95-159BR,

May 22, 1995).

Page 10 GAO/GGD-97-42 Drug Control
B-275944 

information; and (7) the program’s management structure provided for

federal, state, local, private agency, and citizen participation.15

The TASC program is an offender case management program designed to

link drug-using offenders within the criminal justice system to

community-based drug abuse treatment as an alternative or supplement to

criminal penalties. In a 1993 report, we concluded that TASC appeared

promising as a way to help reduce offender drug use. The TASC program

model incorporated many elements that had been found to contribute to

effective drug abuse treatment, including (1) coordinating criminal justice

and treatment efforts, (2) providing incentives to enter treatment,

(3) matching offenders with the most appropriate treatment, and

(4) monitoring with drug testing.16 (See Related GAO Products at the end of

this report for a list of other products on treatment and prevention.)

Obstacles to U.S.

International Drug

Control Efforts

Over the past 10 years, U.S. agencies involved in counternarcotics efforts

have attempted to reduce the supply and availability of illegal drugs in the

United States by implementing the U.S. international drug control strategy.

Although these efforts have achieved some successes, we found that the

flow of cocaine, heroin, and other illegal drugs into the United States

continues, and the availability of drugs and the cultivation of drug crops

have not been reduced.17

Between 1988 and 1995, illegal drug cultivation and drug-related activities

increased throughout South America, Mexico, the Caribbean, Southeast

Asia, and other countries. The total net area of cultivation for coca leaf

and opium poppy increased. Between 1988 and 1995, about 56,000

hectares18 of coca plants were eradicated. However, while the areas under

cultivation have fluctuated from year to year, farmers planted new coca

faster than existing crops were eradicated. Thus, the net area under

cultivation increased from 186,000 hectares to 214,800 hectares, or by

about 15 percent.19 Also during this period, the amount of opium poppy

under cultivation increased by over 46,000 hectares, or by about

15Weed and Seed: Program Objectives (GAO/GGD-94-128R, May 10, 1994).

16Drug Control: Treatment Alternatives Program for Drug Offenders Needs Stronger Emphasis

(GAO/GGD-93-61, Feb. 11, 1993).

17GAO/NSIAD-97-75.

18One hectare equals 2.47 acres.

19According to officials at the Department of State, initial information indicates that, during 1996,

significant reductions occurred in the amount of coca under cultivation in Peru.

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B-275944 

25 percent. Moreover, Drug Enforcement Administration (DEA) and

National Narcotics Intelligence Consumers Committee data on the

availability of illegal drugs, as measured by the average price and purity of

the drugs, showed that the price and purity of cocaine have remained

relatively constant since 1988. According to a DEA official, all other factors

being equal, had the United States achieved substantial success in

reducing supply, and demand remained constant, the prices of these drugs

would have increased, and the purity would have decreased.

The amount of cocaine and heroin seized between 1990 and 1995 had little

impact on the availability of illegal drugs in the United States in satisfying

estimated U.S. demand. In 1996, the National Narcotics Intelligence

Consumers Committee estimated the potential cocaine production for

1995 at about 780 metric tons, of which about 230 metric tons were seized

worldwide. The remaining amount was more than enough to meet U.S.

demand, which was estimated at about 300 metric tons per year. Heroin

production in 1995 was estimated to be over 300 metric tons, while

seizures were about 32 metric tons, and U.S. demand was between 10 and

15 metric tons.

When confronted with threats to their activities, drug-trafficking

organizations use a variety of techniques to quickly change their modes of

operation, thus avoiding capture of their personnel and seizure of their

illegal drugs. For example, when air interdiction efforts have proven

successful, traffickers have increased their use of maritime and overland

transportation routes. According to recent U.S. government reports, even

after the capturing or killing of several drug cartel leaders in Colombia and

Mexico, other leaders or organizations soon filled the void, and adjusted

their areas of operations.

In carrying out its foreign policy, the United States seeks to promote U.S.

business and trade, improve human rights, and support democracy as well

as reduce the flow of illegal drugs into the United States. These objectives

compete for attention and resources, and U.S. officials must make tough

choices about which to pursue more vigorously. As a result of U.S. foreign

policy decisions, counternarcotics issues have often received less

attention than other objectives. Our work has shown the difficulties in

balancing counternarcotics and other U.S. foreign policy objectives.

Sometimes, resources are shifted to satisfy other policy objectives. For

example, as we reported in 1995, $45 million originally intended for

counternarcotics assistance for cocaine source countries was

reprogrammed by the Department of State to assist Haiti’s democratic

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B-275944 

transition.20 A similar diversion occurred in the early 1990s, when U.S.

Coast Guard assets in the Caribbean were reallocated from

counternarcotics missions to the humanitarian mission of aiding emigrants

in their mass departures from Cuba and Haiti.

We have reported that in some cases the United States has not adequately

controlled the use of U.S. counternarcotics assistance and it was unable to

ensure that the assistance was used as intended. Despite legislative

requirements mandating controls over U.S.-provided assistance, we found

instances of inadequate oversight of counternarcotics funds. For example,

between 1991 and 1994, we issued three products in which we concluded

that U.S. officials lacked sufficient oversight of aid to ensure that it was

being used effectively and as intended in Peru and Colombia.21 In 1996, we

reported that the government of Mexico had misused U.S.-provided

counternarcotics helicopters when it used them to transport Mexican

military personnel during the 1994 uprising in the Mexican state of

Chiapas.22

During this period, we reported on other significant long-standing

obstacles faced by the United States in its international drug control

efforts, including the inconsistency in the amount of funds applied to

international drug control programs, difficulty in obtaining bilateral and

multilateral donor support for U.S. drug control efforts, and organizational

and operational limitations. For example, several of our products have

identified problems involving competing priorities and interagency

rivalries, lack of operational coordination, and inadequate staffing of joint

interagency task forces.

Regarding obstacles confronting foreign governments’ antidrug efforts, we

have repeatedly reported that narcotics-related corruption is a

long-standing problem in U.S. and foreign governments’ efforts to reduce

drug-trafficking activities. For example, we reported in 1991 and 1993 that

corruption in Colombia and Peru—two of the countries most significantly

involved in producing and shipping cocaine—had spread throughout the

civilian governments, the military force, and the police force and that even

though the governments were attempting to reduce corruption, its

20Drug War: Observations on U.S. International Drug Control Efforts (GAO/T-NSIAD-95-194, Aug. 1,

1995).

21Drug War: Observations on Counternarcotics Aid to Colombia (GAO/NSIAD-91-296, Sept. 30, 1991);

The Drug War: U.S. Programs in Peru Face Serious Obstacles (GAO/NSIAD-92-36, Oct. 21, 1991); and

The Drug War: Colombia Is Implementing Antidrug Efforts, but Impact Is Uncertain

(GAO/T-NSIAD-94-53, Oct. 5, 1993).

22Drug Control: Counternarcotics Efforts in Mexico (GAO/NSIAD-96-163, June 12, 1996).

Page 13 GAO/GGD-97-42 Drug Control
B-275944 

pervasiveness made such action difficult.23 We also reported that

corruption remained a serious, widespread problem in Colombia and

Mexico, the two countries most significantly involved in producing and

shipping cocaine.24 In March 1996, the State Department reported that

persistent corruption within Mexico continued to undermine both police

and law enforcement operations. Drug-related corruption also remained

widespread, although to a lesser extent, throughout several island nations

in the Caribbean25 and in Bolivia and Peru.

The governments involved in drug eradication and control have other

problems that cause competition for limited resources. As we reported in

1988, six drug-producing countries’ efforts to curtail drug cultivation were

constrained by political, economic, and/or cultural problems that far

exceeded counternarcotics program managers’ abilities to resolve.26 Many

of the source countries lacked the political will necessary to reduce coca

and opium poppy cultivation partly because drug trafficking contributes to

their economies. Also, as we reported in 1992, severe economic problems

in Brazil, Ecuador, and Venezuela limited these governments’ ability to

devote the resources needed to develop effective drug control efforts.27

Internal strife in the source countries is yet another problem that

competes for resources. For example, two primary source

countries—Peru and Colombia—must allocate scarce funds to support

military and other internal defense operations to combat guerilla groups,

which negatively affect counternarcotics operations. In Peru, for example,

we reported that terrorist activities had hampered antidrug efforts.28

Inadequate resources and institutional capabilities of these and other

foreign countries have limited arrests and convictions of drug traffickers.

For example, in 1991 we reported that the lack of resources and

adequately trained police personnel hindered Panama’s ability to address

drug-trafficking and money-laundering activities.29 Also, in 1994 we

23The Drug War: Observations on Counternarcotics Programs in Colombia and Peru

(GAO/T-NSIAD-92-2, Oct. 23, 1991) and The Drug War: Colombia Is Undertaking Antidrug Programs,

but Impact Is Uncertain (GAO/NSIAD-93-158, Aug. 10, 1993).

24Drug War: Observations on the U.S. International Drug Control Strategy (GAO/T-NSIAD-95-182, June

27, 1995) and Drug Control: Counternarcotics Efforts in Mexico (GAO/NSIAD-96-163, June 12, 1996).

25Drug Control: U.S.Interdiction Efforts in the Caribbean Decline (GAO/NSIAD-96-119, Apr. 17, 1996).

26Controlling Drug Abuse: A Status Report (GAO/GGD-88-39, Mar. 1, 1988).

27The Drug War: Extent of Problems in Brazil, Ecuador, and Venezuela (GAO/NSIAD-92-226, June 5,

1992).

28The Drug War: U.S. Programs in Peru Face Serious Obstacles (GAO/NSIAD-92-36, Oct. 21, 1991).

29The War on Drugs: Narcotics Control Efforts in Panama (GAO/NSIAD-91-233, June 16, 1991).

Page 14 GAO/GGD-97-42 Drug Control
B-275944 

reported that Central American countries did not have the resources or

institutional capability to combat drug trafficking and depended heavily on

U.S. counternarcotics assistance.30 Our more recent work indicates that

these problems have persisted over time. For example, we reported in

1995 that the Colombian national police had only 10 helicopters available

for interdiction and eradication operations in the entire country.31

There is no easy remedy for overcoming all of the obstacles posed by

drug-trafficking activities. International drug control efforts aimed at

stopping the production of illegal drugs and drug-related activities in the

source and transit countries are only one element of an overall balanced

national drug control strategy. Alone, these efforts will not likely solve the

U.S. drug problem. Overcoming many of the long-standing obstacles to

reducing the supply and smuggling of illegal drugs requires a long-term

commitment. As stated in our February 1997 report,32 we believe the

United States can improve the effectiveness of planning and implementing

its current international drug control efforts by (1) developing a multiyear

plan with measurable goals and objectives and a multiyear funding plan;

(2) at least annually, review the progress made and adjust the plan, as

appropriate; (3) enhance support for the increased use of available

intelligence and technologies and increasing intelligence and technology,

and (4) lead in developing a centralized “lessons-learned” data system to

aid agency planners and operators in developing more effective

counterdrug efforts.

Summary of Our Work

on Federal Domestic

Drug Interdiction

Programs

We have reported over the past few years on various aspects of domestic

drug interdiction. For example, criminal activities such as illegal drug

sales produce a tremendous amount of currency that would be regarded as

suspicious unless it was disguised as legitimate through various money

laundering schemes. Consequently, U.S. efforts to combat money

laundering rely heavily upon the reporting of transactions involving large

amounts of cash. In March 1994, we reported that the Customs Service

was aware of the impact of currency smuggling on drug control efforts and

at that time had increased national oversight of and emphasis given to

outbound inspection programs to interdict unreported currency.33

30Drug Control: Interdiction Efforts in Central America Have Had Little Impact on the Flow of Drugs

(GAO/NSIAD-94-233, Aug. 2, 1994).

31Drug War: Observations on U.S. International Drug Control Efforts (GAO/T-NSIAD-95-194, Aug. 1,

1995).

32GAO/NSIAD-97-75.

33Money Laundering: U.S. Efforts to Fight It Are Threatened by Currency Smuggling (GAO/GGD-94-73,

Mar. 9, 1994).

Page 15 GAO/GGD-97-42 Drug Control
B-275944 

Experts estimate that most of the cocaine entering the United States

enters from Mexico across the southwest border. For example, it has been

estimated that between 50 and 70 percent of the cocaine smuggled into the

United States transits through Mexico, entering primarily by land across

the southwest border. We concluded that the Immigration and

Naturalization Service’s (INS) 1994 national strategy for gaining control of

the nation’s borders had affected drug smuggling in that smugglers began

rerouting drugs from San Diego and El Paso to other southwest border

areas.34

We also examined INS’ role in the Organized Crime Drug Enforcement Task

Force program, which is designed to be a comprehensive, multiagency

attack on drug-related and money laundering enterprises. Nine federal

agencies, including INS, and various state and local organizations

comprised individual task forces. The task forces were to use the special

skills and expertise of all participating agencies and rely on the

jurisdictional authority of those agencies. We reported in July 199435 that

when carrying out task force investigations, INS contributed its

alien-related expertise and its jurisdictional authority to apprehend and

remove criminal alien drug traffickers from the country.

Difficulties in

Measuring Agencies’

Antidrug Performance

In a 1990 report,36 we pointed out the difficulties in measuring the

effectiveness of drug interdiction activities. For example, we noted that

while agencies generally view the number or amounts of seizures as an

indicator of program success, a decrease in seizures does not necessarily

mean that a program was less effective than it was previously or less

effective than other programs making more seizures.

We took this concern one step further in our 1993 report on the

reauthorization of ONDCP.

37 We found that national strategies contained

inadequate measures for assessing the contributions of component

programs for reducing the nation’s drug problems and recommended that,

as part of its reauthorization of ONDCP, Congress direct the agency to

develop better performance measures. In reauthorizing ONDCP in 1993,

34Border Control: Revised Strategy Is Showing Some Positive Results (GAO/GGD-95-30, Dec. 29, 1994).

35INS Drug Task Force: Federal Agencies Supportive of INS Efforts (GAO/GGD-94-143, July 7, 1994).

36Drug Interdiction: Funding Continues to Increase but Program Effectiveness Is Unknown

(GAO/GGD-91-10, Dec. 11, 1990).

37Drug Control: Reauthorization of the Office of National Drug Control Policy (GAO/GGD-93-144, Sept.

29, 1993).

Page 16 GAO/GGD-97-42 Drug Control
B-275944 

Congress specified that ONDCP’s performance measurement system should

assess changes in drug use, drug availability, the consequences of drug

use, drug treatment capacity, and the adequacy of drug treatment systems.

ONDCP has been working toward this end since our 1993 report. In 1994,

ONDCP began efforts to measure the international supply reduction

components of the national drug control strategy. In early 1996, ONDCP

decided to expand this effort to all drug control programs and activities.

As of January 1997, ONDCP had convened working groups composed of

representatives from all federal drug control agencies as well as from

state, local, and private entities to develop national level measures of drug

control performance. ONDCP plans to submit proposed national

performance measures to federal agencies involved in national drug

control efforts for comment by the summer of 1997.

We reported in September 1996 that the Customs Service was developing

some nontraditional measures to use in assessing the effectiveness of its

drug interdiction activities.38 In addition to the traditional measures of

seizures, arrests, indictments, and convictions, Customs began measuring

the reduction in the number of drug smugglers who attempt to race a

drug-laden vehicle through a port of entry, and the ratio of seizures to

examinations conducted for cargo and passengers. In addition, Customs is

estimating the number of persons violating U.S. laws at major air and land

ports.

The Coast Guard has taken steps toward conforming with certain GPRA

principles. It has defined its performance goal as “reducing the amount of

illegal drugs entering the country through maritime routes by 25 percent

over 5 years.” It plans to gather data to compare the amount of drugs it

seizes with estimates of the amount of drugs produced in source countries

and shipped to the United States via maritime routes.

However, agency officials recognize that challenges remain. The Coast

Guard has developed preliminary performance plans that reflect a need for

additional work in three areas: (1) developing goals and ways of achieving

them, (2) developing data to measure the results of its actions, and

(3) identifying wide variety of constraints that could influence the

effectiveness of its antidrug activities. (See app. III for more details on the

Coast Guard’s performance measures.)

38Customs Service: Drug Interdiction Efforts (GAO/GGD-96-189BR, Sept. 26, 1996).

Page 17 GAO/GGD-97-42 Drug Control
B-275944 

Conclusions ONDCP and several other agencies are developing measures of the results of

their antidrug activities. Used together, these measures could provide

information congressional and executive branch decisionmakers need to

assess program performance and make judgments about future funding

levels. It is important to consider both ONDCP and operational agency data

together because results achieved by one agency in reducing the use of

drugs may be offset by less favorable results by another agency. For

example, increased Customs Service inspections and use of technology to

detect drugs being smuggled through ports of entry may cause smugglers

to seek other routes; this would put more pressure on drug interdiction

activities of other agencies, such as the Coast Guard. Experts say

substantiating outcome results through further research and evaluation is

an important step in advancing promising drug prevention and treatment

approaches. It is also important in helping policymakers to better focus

efforts and resources on proven effective drug abuse prevention and

treatment programs.

It is too soon to tell whether the measures being developed by ONDCP and

each agency participating in implementing the U.S. drug control strategy

will be adequate for assessing results. Congressional and agency officials

will need to review several years of data before they can assess whether

changes in funding or allocation of resources would improve the results

being achieved.

Agency Comments On January 31, 1997, we provided a draft of this report for comment to the

Director, Office of National Drug Control Policy; the Secretary of

Transportation; and the Commandant of the U.S. Coast Guard. Between

February 7 and 14, 1997, officials from ONDCP and the U.S. Coast Guard

provided comments on this draft by teleconference. On February 7, 1997,

Department of Transportation officials provided their comments by

electronic mail. Officials from all three organizations generally agreed with

the information presented in the report and provided technical comments

that we incorporated where appropriate.

We are sending copies of this report to the Ranking Minority Members of

your Subcommittees, the Director of ONDCP, the Secretary of

Transportation, and the Commandant of the U.S. Coast Guard. We will

also make copies available to others upon request.

Page 18 GAO/GGD-97-42 Drug Control
B-275944 

The major contributors to this report are listed in appendix IV. If you or

your staffs have any questions on this report, please call me on

(202) 512-8777.

Norman J. Rabkin

Director, Administration

 of Justice Issues

Page 19 GAO/GGD-97-42 Drug Control
Contents

Letter 1

Appendix I 

Background

22

Appendix II 

Drug Abuse

Prevention and

Treatment

27

Introduction 27

Scope and Methodology 28

The Nature and Objectives of Drug Prevention and Treatment 30

The Types of Prevention Approaches Currently Being Used for

School-Age Youths

34

The Types of Approaches Currently Being Used to Treat Cocaine

Addiction

42

Additional Research Initiatives Identified for Prevention and

Treatment Effectiveness

52

Appendix III 

Coast Guard Has

Made Progress, but

Challenges Remain in

Developing Antidrug

Strategic and

Performance Plans

55

Coast Guard Has Made Progress Toward Implementing GPRA

Principles

56

Measuring Results of Drug Interdiction Presents Challenges 56

Appendix IV 

Major Contributors to

This Report

61

Related GAO Products 64

Tables Table I.1: Federal Drug Control Spending by Function, FYs

1995-1997

22

Table I.2: U.S. Retail Price Range for 1 Kilogram of Cocaine,

1988-1995

25

 Table II.1: Types of Prevention Approaches 34

Page 20 GAO/GGD-97-42 Drug Control
Contents

Table II. 2: Methodology and Results of Illustrative School-Age

Prevention Programs

36

Table II.3: Methodology and Results of Illustrative

Cognitive-Behavioral Studies

44

Figures Figure I.1: Percentage of Drug Control Funds by Agency, 1997 24

Figure I.2: Average U.S. Rate of Purity of Cocaine, 1988-1995 25

Figure I.3: Adolescent Illicit Drug Use, 1991-1996 26

Abbreviations

ATP Adolescent Transitions Program

CSAP Center for Substance Abuse Prevention

CSAT Center for Substance Abuse Treatment

DEA Drug Enforcement Administration

DOJ Department of Justice

FBI Federal Bureau of Investigation

GPRA Government Performance and Results Act

HHS Department of Health and Human Services

HIV Human Immunodeficiency Virus

INS Immigration and Naturalization Service

IPR interpersonal relations

IOM Institute of Medicine

NIDA National Institute on Drug Abuse

NIJ National Institute of Justice

ONDCP Office of National Drug Control Policy

SAMHSA Substance Abuse and Mental Health Services Administration

SFP Strengthening Families Program

SSDP Seattle Social Development Project

TASC Treatment Alternatives to Street Crime

VA Department of Veterans Affairs

Page 21 GAO/GGD-97-42 Drug Control
Appendix I 

Background

The United States has developed a multifaceted drug control strategy

intended to reduce the supply and demand for illegal drugs. The 1996 U.S.

drug control strategy includes five goals: (1) motivate America’s youth to

reject illegal drugs and substance abuse; (2) increase the safety of U.S.

citizens by substantially reducing drug-related crime and violence;

(3) reduce health, welfare, and crime costs resulting from illegal drug use;

(4) shield America’s air, land, and sea frontiers from the drug threat; and

(5) break foreign and domestic drug sources of supply. For fiscal year

1997, the President requested $15.1 billion for programs designed to attain

the strategy’s goals. Table I.1 lists federal drug control spending by

function for fiscal years 1995 to 1997.

Table I.1: Federal Drug Control Spending by Function, FYs 1995-1997

FY 1996-1997 change

Dollars in millions

FY 1995

actual

FY 1996

estimatea

President’s FY

1997 request Amount Percent

Drug function

Criminal justice system $6,545.4 $7,105.1 $7,790.5 $685.4 9.6%

Drug treatment 2,692.0 2,679.4 2,908.7 229.3 8.6%

Drug prevention 1,559.1 1,430.1 1,591.6 161.5 11.3%

International 295.8 319.5 400.5 81.0 25.4%

Interdiction 1,280.1 1,339.4 1,437.2 97.8 7.3%

Research 542.2 569.6 559.2 –10.4 –1.8%

Intelligence 336.6 340.4 375.9 35.4 10.4%

Total $13,251.2 $13,783.5 $15,063.5 $1,280.0 9.3%

Function areas

Demand reductionb $4,691.9 $4,571.9 $4,970.6 $398.7 8.7%

Percentage 35% 33% 33%

Domestic law enforcement $6,983.3 $7,552.8 $8,255.3 $702.5 9.3%

Percentage 53% 55% 55%

International $295.8 $319.5 $400.5 $81.0 25.4%

Percentage 2% 2% 3%

Interdiction $1,280.1 $1,339.4 $1,437.2 $97.8 7.3%

Percentage 10% 10% 10%

Total $13,251.2 $13,783.5 $15,063.5 $1,280.0 9.3%

Supply/demand split

Supply $8,559.2 9,211.6 $10,093.0 $881.4 9.6%

Percentage 65% 67% 67%

(continued)

Page 22 GAO/GGD-97-42 Drug Control
Appendix I 

Background

FY 1996-1997 change

Dollars in millions

FY 1995

actual

FY 1996

estimatea

President’s FY

1997 request Amount Percent

Demand $4,691.9 4,571.9 $4,970.6 $398.7 8.7

Percentage 35% 33% 33%

Total $13,251.2 13,783.5 $15,063.5 $1,280.0 9.3%

Demand components

Prevention (w/research) $1,738.7 $1618.6 $1,783.3 $164.7 10.2%

Treatment (w/research) $2,953.2 $2,953.3 $3,187.3 $234.0 7.9%

Demand research, total $440.8 $462.4 $470.2 $7.9 1.7%

Note: Detail may not add to totals due to rounding.

aIncludes the administration’s proposed adjustments to fiscal year 1996 continuing resolution

levels.

bDemand reduction refers to any activity intended to reduce the demand for drugs such as

through drug abuse treatment, education, prevention, research, and rehabilitation. Supply

reduction refers to any enforcement activity intended to reduce the supply or use of drugs, such

as through international drug control initiatives, foreign and domestic drug enforcement

intelligence, interdiction of drugs destined for the United States, and domestic law enforcement,

including enforcement directed at users.

Source: The National Drug Control Strategy: 1996, ONDCP.

Figure I.1 shows the level of federal involvement in drug control efforts.

Page 23 GAO/GGD-97-42 Drug Control
Appendix I 

Background

Figure I.1: Percentage of Drug Control

Funds by Agency, 1997

47.4% • Justice

15.3%•

HHS

•

7.4%

Treasury

•

7.0%

VA

•22.9%

Others

Source: ONDCP.

According to the DEA Administrator, if demand does not change, a

depressed price and elevated purity often signal an increased availability

of a specific drug; on the other hand, increased price and declining purity

indicate decreased availability of that drug. As can be seen in table I.2, the

lower end price of cocaine remained the same, while the higher range

price increased from 1988 to 1992. But from 1993 to 1995, the price of

cocaine declined. Figure I.2 shows that the purity of cocaine has remained

relatively constant since 1988.

Page 24 GAO/GGD-97-42 Drug Control
Appendix I 

Background

Table I.2: U.S. Retail Price Range for 1

Kilogram of Cocaine, 1988-1995 Year National price range

1988 $11,000-$34,000

1989 $11,000-$35,000

1990 $11,000-$40,000

1991 $11,000-$40,000

1992 $11,000-$42,000

1993 $10,500-$40,000

1994 $10,500-$40,000

1995 $10,500-$36,000

Source: DEA and the National Narcotics Intelligence Consumers Committee.

Figure I.2: Average U.S. Rate of Purity

of Cocaine, 1988-1995 Percent

0

10

20

30

40

50

60

70

80

90

100

1988 1989 1990 1991 1992 1993 1994 1995

Year

Kilograms

Grams

Source: DEA.

Illegal drug use—particularly the use of cocaine and heroin—represents a

continuing health and safety problem in the United States. While the level

Page 25 GAO/GGD-97-42 Drug Control
Appendix I 

Background

of consumption of illicit drugs has remained relatively stable during recent

years, a great deal of concern has arisen from the Monitoring the Future,

1996 survey’s findings discussed earlier that drug use by youth in grades 8,

10, and 12 has increased since 1992. According to ONDCP, an upsurge in

drug use by teens reflects the need to refocus and reinvigorate prevention

efforts.

Figure I.3: Adolescent Illicit Drug Use,

1991-1996 Percent

0

5

10

15

20

25

30

35

40

45

1991 1992 1993 1994 1995 1996

Year

8th Grade

10th Grade

12th Grade

Source: Monitoring the Future, National Institute on Drug Abuse, 1996.

Page 26 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

Introduction Drug and alcohol abuse continues to be a major problem facing our

society. In 1995, among the general population, about 22.7 million

individuals were estimated to have used at least one illicit drug in the past

year—17.8 million used marijuana, 3.7 million used cocaine, and 428,000

used heroin.39 The highest illicit drug use rate among adolescents

continues to be their use of alcohol. In 1995, about 74 percent of high

school seniors surveyed had consumed alcohol in the past year.4041

From 1992 to 1995, the estimated rate of marijuana use in the general

population increased from 7.9 to 8.4 percent. The rate of cocaine use,

although still considered to be of epidemic proportions, declined from 2.1

to 1.7 percent. There was a pronounced rise in the drug use rates among

school-age youths during this period. The rate of marijuana use by 8th

grade students in the past year more than doubled, from 7.2 percent to

15.8 percent; use by 10th graders rose from 15.2 percent to 28.7 percent;

and for 12th graders, the rate of marijuana use increased from 21.9 percent

to 34.7 percent. The rate of alcohol use remained above 70 percent

throughout the period for 12th graders. Increases in students’ past-year

drug use were also found for 11 other drug types.

To help combat drug abuse and reduce the demand for drugs in the United

States, federal, state, and local governments and the private sector fund

prevention and treatment programs. From fiscal year 1990 through 1994,

federal funding for drug prevention and treatment activities increased

from $2.8 billion to $4.4 billion. Combined state, county, and local

expenditures increased from about $1.3 billion to about $1.6 billion.

Although data on private sector funding are very limited, available sources

indicate funding of more than $1 billion for treatment in 1993.42

In light of the high prevalence of drug use in the United States and the

human and financial investment in fighting drug abuse, congressional

members are interested in knowing what drug prevention and treatment

strategies are being employed to address the drug use problem. This

appendix discusses

39National Household Survey on Drug Abuse: Population Estimates 1995, Substance Abuse and Mental

Health Services Administration, 1996.

40In all states, the purchase and public possession of alcohol beverages by a person who is less than 21

years of age is illegal. Throughout this report, the use of the term “drug abuse” can also include

alcohol.

41Monitoring the Future, National Institute on Drug Abuse, 1996.

42Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities

(GAO/HEHS-97-12, Oct. 8, 1996).

Page 27 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

• the nature and objectives of drug prevention and treatment,

• the types of prevention approaches currently being used and promising

prevention practices for school-age youths,

• the types of cocaine treatment approaches currently being used and

promising treatment practices for those abusing or addicted to cocaine,

and

• future research initiatives needed to enhance our knowledge base of

prevention and treatment effectiveness.

Scope and

Methodology

To determine the objectives of drug prevention and treatment, the range of

prevention and treatment strategies and approaches being used, and the

future research initiatives needed to increase the knowledge base on the

effectiveness of prevention and treatment, we identified and reviewed

selected literature on drug prevention and treatment research. The

documents we reviewed included (1) Institute of Medicine (IOM)

publications, (2) the Secretary of the Department of Health and Human

Services’ (HHS) third triennial report to the Congress on drug abuse

research, (3) the National Institute on Drug Abuse’s (NIDA) series of

research monographs, (4) Substance Abuse and Mental Health Services

Administration (SAMHSA) monographs, and (5) relevant government

contractor reports as well as journal publications by major experts in drug

prevention and treatment.

To identify promising drug prevention approaches for school-age youths,

we first conducted a literature search of prevention practices during the

period 1990 to 1995, using medical, social, psychological, and educational

reference sources. We extracted and reviewed from the drug prevention

literature 10 syntheses written by known experts in the field. The authors

reviewed and summarized the evidence of promising prevention

approaches used in programs for youths. We also reviewed the supporting

outcome data provided for each program to determine the level of

evidence behind an author’s designation of a program as promising. In the

syntheses in which data either were not provided or were not adequate,

we obtained supplementary information from principal investigators who

had implemented the prevention approach. This supplementary

information was obtained from journal publications, reports, and working

drafts. We cited the drug prevention programs as promising if the

approach met one of the following criteria that we developed:

Page 28 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

• the group receiving the experimental intervention demonstrated

significantly better outcome results than control groups not receiving the

approach;43 or

• in cases where the intervention had no comparison or control group,

outcome results were markedly better (by at least 10 percent) than initial

baseline scores.

In addition to these criteria, we sought approaches with follow-up periods

of at least 6 months. We combined a standardized statistical criterion with

our professional methodological judgment in developing the criteria.

To identify promising treatment approaches for cocaine abuse, we used

information from our June 1996 report.44 For that report, we identified

studies with current reportable data on two major outcome

variables—drug abstinence and treatment retention. We reviewed the

treatment literature published between 1991 and 1995; examined Center

for Substance Abuse Treatment (CSAT) and NIDA agency records of

cocaine-related grants awarded during that time period; and, as necessary,

contacted project investigators for additional information.

The approximately 65 cocaine-related grants supported by CSAT were still

in progress when the report was being written; neither abstinence nor

retention outcome data were available to judge the promise of their

ongoing work. Many of the NIDA longitudinal cocaine-supported studies

were also in progress. Promising practices, and their supportive findings,

were therefore identified from available NIDA abstinence and retention

study data, cocaine treatment outcome studies published during the 5-year

period, and documents of unpublished results from federal drug agencies.

For analytical purposes, we classified the treatment intervention types as

either cognitive and behavioral or pharmacological. In making

determinations about which treatment approaches proved promising, we

gave due consideration to the appropriateness of research design.

This appendix is not intended to provide an exhaustive evaluation of the

drug prevention and treatment literature, nor is it to assess the qualitative

methodology of each study we reviewed. Rather, the primary objective is

to identify drug abuse prevention approaches for school-age youths and

43To assess whether the experimental intervention group outcome results were statistically better than

those of the control group participants, we determined whether principal investigators used

“significance” testing and then assessed the results of those tests. Experimental group findings were

judged to be “significantly better” when the probability of this occurrence by chance alone was less

than 5 times in 100 (p < .05).

44Cocaine Treatment: Early Results From Various Approaches (GAO/HEHS-96-80, June 7, 1996).

Page 29 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

cocaine abuse or dependency treatment approaches that appear promising

and provide illustrative examples of these approaches.

The Nature and

Objectives of Drug

Prevention and

Treatment

In October 1996, we reported that federal, state, county, and local

governments and the private sector contribute billions of dollars annually

to support drug prevention and treatment activities. The latest data

available from the Office of National Drug Control Policy (ONDCP) show

that federal funding alone was $4.7 billion in fiscal year 1995. At least 16

federal departments and agencies provide funding for drug abuse

prevention and treatment programs. Three departments accounted for 81.9

percent of fiscal year 1995 funding—HHS, the Department of Veterans

Affairs (VA), and the Department of Education—provided approximately

$2.3 billion, $967 million, and $584 million, respectively.

The federal agencies fund an array of drug abuse prevention and treatment

programs for a variety of targeted population groups. For instance, within

HHS, SAMHSA’s Center for Substance Abuse Prevention (CSAP) sponsors the

Community Partnership program, the Community Coalition program, and

the High Risk Youth program. The Veterans Health Administration

operates a network of substance abuse treatment programs in its medical

centers, domiciliaries, and outpatient clinics. And within the Department

of Education, the Safe and Drug-Free Schools and Communities Act

includes funding to prevent youth violence as well as drug and alcohol use.

These and other federal programs provide a broad range of drug abuse

prevention and treatment activities and services.

Prevention

The Nature of Prevention

Activities

Drug abuse prevention activities focus on the general population as well as

individuals who may be at risk for alcohol or other drug problems. These

activities include (1) providing information and education that increase

knowledge of drug abuse and alternative drug-free lifestyles; (2) teaching

skills to resist drug influences, solve problems, and make decisions;

(3) developing interventions to control the sale and distribution of illegal

drugs; and (4) encouraging communities to implement responses to drug

use. Prevention activities can be differentiated, according to NIDA, into

three distinct types commonly referred to as universal, selective, and

indicated. A description of these types follows.

Page 30 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

Universal drug abuse prevention interventions are directed at the general

population and employ a variety of integrated activities, including social

resistance education in the schools, antidrug media campaigns, parent

skills training, antidrug coalitions at the neighborhood level, and antidrug

policies at the state and local levels. The objective of the universal strategy

is to alter social, psychological, and environmental factors that may

influence drug prevalence and drug outcomes at the community level.

Selective drug abuse prevention interventions are directed at individuals

or subgroups who are at risk of developing drug abuse behaviors. The

objective of a selective prevention intervention is to reduce “risk factors”

and enhance “protective factors” related to drug use onset and the

progression to abuse and dependence.

Indicated drug abuse prevention interventions are targeted to individuals

who use one or more drugs but who do not yet meet diagnostic criteria for

a drug disorder. Drug users with mental health disorders may be targeted

as well. The objective of indicated interventions is to interrupt the

progression from drug use to drug abuse, addiction, and social

dysfunctionality.

Goals and Objectives of

Prevention Programs

The major goals of drug prevention programs are to prevent or eliminate

drug use and to avert drug-related problems (such as sexually transmitted

diseases and tuberculosis). But many prevention intervention initiatives

also identify and address the “intermediate” factors, which have been

found, or are perceived, to be related to drug use. These are often referred

to as the “risk” and “protective” factors.

1. Reduction of individual “risk factors” focuses on trying to minimize the

negative effect of factors that impinge on one’s life that have been shown

or theorized to be related to drug use. These factors include availability of

drugs, community norms favorable to drug use, extreme economic

deprivation, family history of problem drug use, favorable parental

attitudes and involvement in problem drug use, early and persistent

antisocial behavior, academic failure, alienation and rebellion, and friends

who engage in problem behavior.

2. Enhancement of “protective factors” focuses on increasing an

individual’s resilience in dealing with potentially high-risk situations (such

as dysfunctional families, schools, and communities). The drug prevention

research field has hypothesized that more resilient individuals are less

likely to engage in drug use. Increased resiliency in youths may be

Page 31 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

described under seven major factors—optimism, empathy, insight,

intellectual competence, self-esteem, direction or mission, and

determination and perseverance. The coping or life skills associated with

these seven factors are emotional management skills, interpersonal social

skills, intrapersonal reflective skills, academic and job skills, ability to

restore self-esteem, planning and life skills, and problem-solving ability.

3. Reduction of environmental and societal risk factors focuses on

prevention approaches that seek to reduce the availability illegal and

nonprescriptive legal drugs (for example, higher penalties for sale and

distribution in and around schools).

Prevention programs are conducted in a variety of settings. For school-age

youths, drug prevention activities can occur in the classroom, peer

support groups, the home setting, and the community (using the media,

youth groups, and community leaders), or in a combination of these

settings. For adults, drug prevention can be extended to the workplace.

Treatment

The Nature of Treatment

Activities

Treatment activities are designed to benefit individuals who have not been

exposed to or dissuaded by drug abuse prevention programs and have not

been able to abstain or control drug use on their own. Drug treatment

traditionally has been reserved for drug abusers, or individuals dependent

on drugs who require more intensive therapy, and pharmacological

medications. The services drug treatment programs provide may include

diagnostic assessment, detoxification, pharmacological dosing, and

medical, psychiatric, and psychological counseling and psychotherapy.

Goals and Objectives of

Treatment Programs

The major goals of drug treatment programs are to achieve initial client

abstinence and then to maintain such abstinence over time. Individual

treatment objectives vary by the type of treatment intervention sought and

the nature and severity of a client’s problem. Common objectives include

(1) detoxification, when necessary; (2) use of self-help groups (for

example, Alcoholics Anonymous and Narcotics Anonymous) throughout

treatment and aftercare; (3) social or personal habilitation or

rehabilitation (including a focus on improved health and a reduction in

psychiatric disorders and psychological problems); (4) better relations

with family and significant others; (5) development of a lifestyle free of

drugs; (6) avoidance of others using drugs; (7) taking steps toward the

attainment of educational and occupational aspirations; (8) a reduction in

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Drug Abuse Prevention and Treatment

criminal behavior and resolution of legal problems; and (9) improved

personal circumstances (including enhanced coping skills, family and

social support systems, and ability to provide for basic needs). The longer

a client remains in treatment, the greater the possibility of a successful

outcome.

Drug treatment can be administered in different ways and in both inpatient

and outpatient settings. IOM and others identify four types of treatment

modalities in the form of programs and settings.45 The four

modalities—outpatient methadone maintenance, outpatient

nonmethadone and drug-free, chemical dependency, and residential

therapeutic communities are described as follows:

1. Outpatient methadone maintenance is specifically for the group of

clients who are dependent on narcotics, particularly heroin, and who are

able to benefit from the use of methadone as a “substitute” drug.

Methadone is used to ease withdrawal symptoms, reduce heroin craving,

and improve the psychological functioning of the individual.

2. Outpatient nonmethadone and drug-free facilities offer diverse

purposes, programs, and staffing. Generally, clients are seen 1 or 2 days a

week for individual and group counseling sessions. Self-help groups are

thought to be an essential program component. Medication and assistance

with educational, vocational, and health and housing concerns are offered

in some programs.

3. Chemical dependency programs represent the type of inpatient modality

most often assumed by the private sector. Treatment consists of a

psychiatric and psychosocial evaluation, a drug education component,

individual and group therapy, self-help group participation, and aftercare

planning in an intensive outpatient or a residential setting.

4. Residential therapeutic communities incorporate programs that are

designed for the severely dependent clients whose social and occupational

functioning warrant rehabilitative or habilitative care. Therapeutic

communities perceive drug abuse as a deviant behavior that limits one’s

personality development and is associated with chronic deficits in the

individual’s social, educational, and economic skills. Reality-oriented

group and individual psychotherapy with definitive client roles and

responsibilities are provided in a very structured living arrangement. Over

45Institute of Medicine, Treating Drug Problems, vol. 1 (Washington, D.C.: National Academy Press,

1990); Research Triangle Institute, Data Tables Comparing Crack and Cocaine Users to Other Drug

Users Entering Drug Treatment, unpublished manuscript.

Page 33 GAO/GGD-97-42 Drug Control
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an approximate 6- to 24-month inpatient stay, therapeutic community

programs focus on preparing an individual for reentry into society.

The Types of

Prevention

Approaches Currently

Being Used for

School-Age Youths

Drug prevention strategies generally include one or more approaches

designed to prevent or reduce drug use, some of which include helping

participants deal with other problems in their lives. The strategies

commonly used have been categorized under five different

approaches—information dissemination, affective education, alternative

approaches, social influence, and personal and social skills. The social

influence and personal and social skills approaches both address

psychosocial factors; therefore, for purposes of this report, we refer to

these as the “psychosocial” approach. Also, we include another

approach—the comprehensive approach—to categorize multicomponent

prevention activities involving the participation of two or more social

institutions. (See table II.1 for a description of each approach.)

Table II.1: Types of Prevention

Approaches Approach Strategy

Information dissemination Provision of factual information on drugs

presented through instruction, discussion,

audio-visual presentation, display, posters,

pamphlets, or group programs

Affective education Promotes individual’s personal and social

development with focus on improving

one’s self-understanding and acceptance,

enhancing interpersonal relationships, and

attaining needs-satisfaction through

existing social institutions

Alternative approaches to drugs Engagement in alternative activities in

nondrug surroundings as a means of

limiting one’s probability of drug

use—such as sports, hobbies, and

community service

Psychosocial Teaching specific skills for resisting drug

influences (e.g., familial, peer, and media

influences) as well as generic skills for

generally coping with life (e.g.,

problem-solving and decisionmaking skills)

Comprehensivea A multicomponent intervention involving

the participation of several social

institutions, including the schools, families,

community organizations, and the media

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aThe term “comprehensive” has been utilized by IOM, CSAP, and other experts in the field. Yet it

can be defined in different ways. IOM and CSAP, for example, have used the term when referring

to coordinated, communitywide interventions. The Seattle Social Development Research Group

and Oregon Social Learning Center have used the term to refer to the cooperation or interaction

of multiple target groups from various social institutions, such as the school, family and

neighborhood. Selected references include: Institute of Medicine, Pathways of Addiction:

Opportunities in Drug Abuse Research (Washington, D.C. National Academy Press, 1996), p.

141, and William Hansen, “School-based Substance Abuse Prevention: A Review of the State of

the Art in Curriculum, 1980-1990,” Health Education Research, 7 (1992), 403-40.

Although these prevention approaches or strategies can be used for all

ages, they are most often used with youths because youths are very

susceptible to peer group and media influences that might encourage

negative behaviors. Because youths are apt to experiment with alcohol

and drugs, it is important to introduce prevention strategies early in their

lives.

Two Prevention

Approaches Show Promise

Among School-Age Youths

Of the five drug prevention approaches described in table II.1, the

psychosocial and comprehensive approaches have shown more promise

for reducing drug use and risk factors and for enhancing protective factors

among school-age youths. While the three other approaches have not been

shown to be consistently effective when used individually, they have been

included in promising comprehensive approaches.

Our review of selected literature syntheses identified several prevention

programs that had definitive positive outcome results when using the

psychosocial and comprehensive approaches as their core prevention

strategy. Although the two approaches can be applied in a variety of

settings, the programs cited in the research literature we reviewed were

school-based or had a family or community focus. HHS and the Department

of Education also recognize some of these programs as noteworthy in

decreasing drug use and risk factors.

Programs Incorporating the

Psychosocial Approach Show

Promise

The psychosocial approach appears to have some promise, as evidenced

by positive outcome data for the five illustrative programs using this

approach in table II.2. Outcome results point to reductions in drug use and

risk factors as well as enhanced protective factors.

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Table II. 2: Methodology and Results of

Illustrative School-Age Prevention

Programs Study Study description S

Psychosocial approaches

1. Life Skills Training Prevention Programa 3-year school-based intervention

consisting of 15 7th-grade sessions, 10

8th-grade sessions, and 5 9th-grade

sessions

R

2. Project ALERTb In 20 schools receiving the intervention

curriculum, classes taught by teacher

alone or by teacher and an older teen; 10

control schools did not receive the

curriculum; the curriculum had 11 lessons,

8 7th-grade sessions, and 3 8th-grade

booster sessions

B

a

s

3. Generic Skills Interventionc 15-session curriculum for grade 7 with 8

8th-grade booster sessions

M

4. Adolescent Alcohol Prevention Triald 4 experimental conditions: normative

education and resistance skill training,

provided either separately or together

R

3

5. Interpersonal Relations Programe InterPersonal Relations (IPR) classes met

daily for a full semester (55 minutes per

day for 4.5 months)

H

f

s

t

m

g

Comprehensive approaches

6. Seattle Social Development Project

(SSDP)f

6-year elementary school intervention

consisting of teacher training each year

and parent training in grades 1, 2, 3, 5,

and 6

S

r

s

s

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Sample design (size)

Setting and target

population Prevention outcome Investigator affiliation

Randomized trial (n = 3,597) School-based: 7th-9th

graders from 56 New York

state schools

At 12th-grade follow-up, 44% fewer

treatment students used all 3 gateway

drugs once a month or more compared to

controls; 66% fewer treatment students

used all 3 substances once a week or more

Cornell University, New

York, New York

Blocking by district, restricted

and randomized assignment of

schools (n = more than 4,000)

School-based: 7th- and

8th-grade students from 30

diverse California and

Oregon schools

At 15-month follow-up, significantly fewer

students in experimental intervention

groups anticipated using marijuana in the

future compared to controls; experimental

subjects also were significantly more likely

to believe that marijuana and cigarette use

can bring immediate and negative social

consequences and result in drug

dependence

RAND, Santa Monica,

California

Matched assignment (n = 757) School-based: 7th and 8th

graders from 6 New York

City schools with more than

85% minority student bodies

At 9th-grade follow-up, drinking frequency,

amount of alcohol consumed, and intention

to drink beer or wine were lower in the 2

experimental groups relative to controls;

students in experimental groups used

drug-refusal skills more often than controls

Cornell University, New

York, New York

Random assignment (n =

3,011)

School-based: 7th-grade

students in 12 Los Angeles

and Orange County junior

high schools

At 1-year follow-up, classes receiving

normative education had significantly

reduced rates of marijuana use and

alcohol and cigarette consumption relative

to controls; average increase in initial

incidence of marijuana use for normative

group was 64.5% less than controls,

22.5% less in the case of alcohol

Wake Forest University,

Winston-Salem, North

Carolina

High-risk students assigned

first come first served to

special IPR experimental

training; control group

matched to experimental

group (n = 146)

School-based: high-risk

9th-12th graders from

Northwest urban high

school serving

predominantly white,

middle-class students

IPR program participants demonstrated

significantly decreased drug use, fewer

school disciplinary actions, fewer

problems with family and friends, lower

dropout rate, and higher grade point

average relative to controls

University of Washington,

Seattle, Washington

School assignment; student

randomization (n = 598

students completing high

school: the 6th-year follow-up)

School-based: 1st-6th

graders in Seattle public

schools in high crime rate

areas; their teachers and

parents

By 6-year follow-up, group receiving

intervention demonstrated significantly

greater school commitment and

attachment, fewer school problem

behaviors, less alcohol use, less violent

behavior, and fewer sexual partners

compared to controls

University of Washington,

Seattle, Washington

(continued)

Page 37 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

Study Study description S

7. Midwestern Prevention Project, known

locally as Project Star or I-Starg

Social influence approach school-based

component plus media, parent, and

community organization programs and

drug use policy changes; 11-13-session

school program followed by 5 session

boosters

T

K

I

8. Safe Haven Program (a cultural version of

the Strengthening Families Program, SFP)h

Focus of the intervention for the 6 to 12

year old children was on risk and

protective factors. The parental and adult

family intervention targeted both drug use

and family management, communication

issues in 12 weekly structured sessions

Q

n

g

9. Adolescent Transitions Program (ATP)i 4 experimental conditions: parent focus

(developing effective, noncoercive family

management practices), teen focus

(enhancing adolescent self-regulation,

competence), parent and teen focus, and

self-directed group that received only the

materials; 12 weekly 90-minute sessions

R

e

q

(

10. Project Northlandj Experimental curricula consisting of 3

years of parental involvement and

education programs, behavioral curricula,

peer participation, and community task

force activity

2

s

t

c

Page 38 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

Sample design (size)

Setting and target

population Prevention outcome Investigator affiliation

Two-group design (n = 5,400

Kansas City, 3,192

Indianapolis)

School- and

community-based: 6th or

7th graders in 50 Kansas

City schools and 57

Indianapolis schools

20%-40% net change in 2 drugs over 3

years for program participants

University of Southern

California, Los Angeles,

California

Quasi-experimental design,

nonequivalent comparison

group (n = 88)

Family-focused: 6- to

12-year-old children

substance using parents

were admitted to a Detroit

drug treatment center;

effectiveness of the Safe

Haven Program compared

families of low and high

substance use

At follow-up, parents in both the high and

low substance abuse groups reported

significant decreases in drug use for

themselves and their families; children in

high substance abuse group showed

significant reductions in school problems,

aggression, delinquency, and hyperactivity

University of Utah, Salt Lake

City, Utah; Detroit City

Health Department,

Michigan

Random assignment to

experimental intervention,

quasi-experimental control

(n = 158)

Family-focused and

neighborhood based: 

6th- to 8th-grade high-risk

adolescents and their

families

At 1-year follow-up, mothers in parent and

teen group reported significantly less

family conflict than controls and significant

reductions in adolescent problem

behavior; teen focus intervention had

negative effect

Oregon Social Learning

Center, Eugene, Oregon

20 school districts blocked by

size and randomized to either

the experimental or the control

condition (n = 1,901)

Communitywide: 6th-8th

graders and their

communities in mostly rural,

lower middle-class

Minnesota

Students in experimental intervention

districts had significantly lower tendency

to use alcohol by the end of 8th grade;

among baseline nonusers of alcohol,

percentage of students reporting

marijuana and cigarette use was also

significantly lower in the intervention

districts at 8th-grade follow-up;

intervention group significantly more likely

to report being able to resist alcohol at a

party or dance

University of Minnesota,

Minneapolis, Minnesota

aSources for the Life Skills Training Prevention Program are Gilbert J. Botvin, “Preventing

Adolescent Drug Abuse Through Life Skills Training: Intervention Approach and Evaluation

Results,” Community Epidemiology Work Group (CEWG), June 1996, 451-459; and Gilbert J.

Botvin et al., “Long-term Follow-up Results of a Randomized Drug Abuse Prevention Trial in a

White Middle-Class Population,” Journal of the American Medical Association, 273:14 (1995),

1106-12.

bThe source for Project ALERT is Phyllis L. Ellickson, Robert M. Bell, and Ellen R. Harrison,

“Changing Adolescent Propensities to Use Drugs: Results from Project ALERT,” Health Education

Quarterly, 20:2 (summer 1993), 227-42.

cThe source for the Generic Skills Intervention program is Gilbert J. Botvin et al., “Effectiveness of

Culturally Focused and Generic Skills Training Approaches to Alcohol and Drug Abuse

Prevention Among Minority Adolescents: Two-Year Follow-Up Results,” Psychology of Addictive

Behaviors, 9:3 (1995), 183-94.

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dThe source for the Adolescent Alcohol Prevention Trial is William B. Hansen and John W.

Graham, “Preventing Alcohol, Marijuana, and Cigarette Use Among Adolescents: Peer Pressure

Resistance Training Versus Establishing Conservative Norms,” Preventive Medicine, 20 (1991),

414-30.

eThe source for the Interpersonal Relations Program is Leona L. Eggert et al., “Effects of a

School-Based Prevention Program for Potential High School Dropouts and Drug Abusers,”

International Journal of the Addictions, 25:7 (1990), 773-801.

f

The sources for the Seattle Social Development Project are an unpublished document by J.

David Hawkins et al. entitled “Promoting Academic Success and Preventing Crime in Urban

America: Six-Year Follow-Up Effects of the Seattle Social Development Project” and a set of

unpublished 6-year follow-up documents from Hawkins et al. provided to GAO on November 28,

1996. The principal investigator of the SSDP considers this program comprehensive because it is

a cooperative program that targets students, parents, and teachers and seeks to change the

entire school environment.

gThe sources for the Midwestern Prevention Project are an unpublished draft by Mary Ann Pentz

entitled “Preventing Drug Abuse Through the Community: Multi-component Programs Make the

Difference” and Mary Ann Pentz’s “Benefits of Integrating Strategies in Different Settings.”

hAlthough the program might not necessarily include several social institutions, the Safe Haven

Program follows a comprehensive, family-focused curriculum in that it includes three

components: (1) children’s skills training; (2) parent training; and (3) if needed, community

support services such as child care, meals, transportation, and support with basic needs

(groceries and clothing). The source for the Safe Haven Program is G. Aktan, K. L. Kumpfer, and

C. Turner, “The Safe Haven Program: Effectiveness of a Family Skills Training Program for

Substance Abuse Prevention With Inner City African-American Families,” International Journal of

the Addictions, 31 (1996), 158-75.

i

While The ATP program does not necessarily involve a multiple of social institutions, it is a

family-focused program that has a comprehensive strategy because it includes parents and

adolescents as well as community wraparound services if needed, such as family therapy, case

management, transportation, and food services. The source for the Adolescent Transitions

Program is Thomas J. Dishion and David W. Andrews, “Preventing Escalation Problem Behaviors

with High-Risk Young Adolescents: Immediate and 1-Year Outcomes,” Journal of Consulting and

Clinical Psychology, 63:4 (1995), 538-48.

j

The source for Project Northland is Cheryl L. Perry et al., “Project Northland: Outcomes of a

Communitywide Alcohol Use Prevention Program During Early Adolescence,” American Journal of

Public Health, 86:7 (1996), 956-65.

Illustrations of successful psychosocial programs include the Life Skills

Training Program46 and the Adolescent Alcohol Prevention Trial.47

Three-year follow-up results of a randomized trial of more than 3,500 7th

to 9th grade students showed 66 percent fewer program participants using

three drugs (alcohol, tobacco, and marijuana) at least once a week,

46Gilbert J. Botvin, “Preventing Adolescent Drug Abuse Through Life Skills Training: Intervention

Approach and Evaluation Results,” Community Epidemiology Work Group (CEWG), June 1996,

451-459; and Gilbert J. Botvin et al., “Long-term Follow-up Results of a Randomized Drug Abuse

Prevention Trial in a White Middle-Class Population,” Journal of the American Medical Association,

273:14 (1995), 1106-12.

47William B. Hansen and John W. Graham, “Preventing Alcohol, Marijuana, and Cigarette Use Among

Adolescents: Peer Pressure Resistance Training Versus Establishing Conservative Norms,” Preventive

Medicine, 20 (1991), 414-30.

Page 40 GAO/GGD-97-42 Drug Control
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compared with control group participants not receiving the intervention. A

1-year follow-up of approximately 3,000 California 7th graders

participating in the Adolescent Alcohol Prevention Trial demonstrated that

the increase in the initial incidence of marijuana use for the experimental

group was 65-percent less than control group participants and 23-percent

less than control group participants for initial alcohol use.

Common features of these programs include increasing awareness of the

social influences that promote drug use, modifying normative expectations

concerning drug use, teaching skills for resisting drug use pressures, and

teaching more generic personal and interpersonal problem-solving skills.

All the programs we cite as using the psychosocial approach are delivered

in the school setting and target students in grades 7 through 12.

Programs Incorporating the

Comprehensive Approach

Show Promise

The comprehensive approach also appears to show some promise, as

illustrated by the five programs using this approach (see table II.2). In one

program, the Seattle Social Development Project,48 6-year follow-up results

demonstrated that elementary school students participating in the full

parent-teacher intervention had significantly fewer annual school problem

behaviors than control group participants (4.77 problems versus 3.36

problems), drank less alcohol (15 percent of experimental subjects drank

10 times per year or more compared with 25 percent for control group

participants), had a lower lifetime prevalence of violent delinquency

(60 percent versus 48 percent), and had fewer sexual partners (50 percent

versus 62 percent.) Likewise, in the Midwestern Prevention Project (also

known as Project Star or I-Star)49 3-year follow-up results demonstrated a

20-to 40-percent net change in two drugs for program participants.

While some of the multicomponent interventions are centered on a school

setting, others tend to be family focused and address both parent and child

behaviors. For example, the Safe Haven Program achieved reductions in

family drug use as well as significant student reductions in school problem

behavior, aggression, and delinquency.

48J. David Hawkins and others, “Promoting Academic Success and Preventing Crime in Urban America:

Six-Year Follow-Up Effects of the Seattle Social Development Project” and a set of unpublished 6-year

follow-up documents from Hawkins and others provided to us on November 28, 1996.

49Mary Ann Pentz,”Preventing Drug Abuse Through the Community: Multi-Component Programs Make

the Difference” and Mary Ann Pentz “Benefits of Integrating Strategies in Different Settings,” in

A. Elster, S. Panzarine, and K. Holt (eds.). American Medical Association State of the Art Conference

on Adolescent Health Promotion Proceedings: National Center for Education in Maternal and Child

Health, Arlington, VA, 1993, pp. 15-34.

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Common features of programs using a comprehensive approach included

multistrategies to target multiple aspects of youths’ lives, such as the

individual, family, peer group, school, and community. We discussed the

importance of comprehensive approaches in community-based adolescent

drug prevention programs in our January 1992 report.50 Although no

definitive evidence was available at the time to demonstrate the

effectiveness of the community prevention programs we reviewed, we

reported that the comprehensive strategy was a feature present in the

most promising programs or at least those that appeared to be making

more headway than others.51 The comprehensive approaches addressed

multiple dimensions of youths’ lives (such as the individual, family, peer

group, school, and community) and used a variety of services.

Federal Agencies

Recognize Programs as

Noteworthy

NIDA and CSAP, within HHS, and the Department of Education recognized as

noteworthy several of the drug prevention programs we cite from the

literature as having positive outcome results (for example, the Adolescent

Alcohol Prevention Trial, Life Skills Training, the Midwestern Prevention

Project, and the Seattle Social Development Project). The agencies

recognized these programs because they have either demonstrated

decreases in drug use and the risk factors that lead to drug use or they

have shown an increase in the protective factors promoting drug-free

lifestyles. In addition to the programs we cite in table II.2, numerous other

programs (such as Project PRIDE, GAPS, and the Youth Gang Drug

Prevention Program) have been cited as effective or exemplary in

reducing risks for drug use among adolescents. However, according to

NIDA, some of these science-based drug abuse prevention interventions and

principles are not being widely used in schools and communities across

the country.

The Types of

Approaches Currently

Being Used to Treat

Cocaine Addiction

Drug treatment strategies have a common goal of eliminating, or at least

reducing, an individual’s drug abuse. The strategies in use incorporate

various approaches and modalities as a means of treating drug abusers or

drug-dependent individuals. Although different approaches have been

used, IOM has adopted a paradigm that distinguishes drug abuse treatment

50Adolescent Drug Use Prevention: Common Features of Promising Community Programs

(GAO/PEMD-92-2, Jan. 16, 1992).

51CSAP is currently conducting a national evaluation of the Community Partnership Demonstration

Program the agency supports. According to CSAP, national results of this effort should be available in

1998.

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Drug Abuse Prevention and Treatment

approaches as falling under the rubric of pharmacotherapy or

psychosocial treatment.

Pharmacotherapies involve the use of medications to deal with client

overdose, detoxification, dependence, and relapse prevention. Methadone,

for example, is the prime pharmacotherapy determined to be useful in the

treatment of heroin. However, none of the major medications tested have

proven effective consistently in the treatment of cocaine.

Psychosocial treatment includes counseling, different forms of

psychotherapy, cognitive skill development, and contingency

management. Counseling is oriented toward the effective management of

specific, concrete problems, while psychotherapy attempts to help a client

deal with more dysfunctional cognitive and behavioral processes. The use

of acupuncture represents a new strategy in the treatment of drug

addiction.

Research suggests that psychosocial treatment offers a promising

approach to treating cocaine abuse and dependency. Within the

psychosocial treatment rubric, cognitive and behavioral therapies are

showing promise in cocaine treatment research. As we reported in

June 1996, data from a review of the literature show positive results in the

use of three cognitive and behavioral approaches to cocaine treatment.52

Because cocaine therapies are still in their early stages of development,

treatment outcome results cannot be generalized to all cocaine users.

Three Cognitive-Behavioral

Treatments Show Promise

in Outpatient Settings

Early research indicates that relapse prevention, community

reinforcement and contingency management, and neurobehavioral therapy

are potentially promising cocaine-addiction treatment approaches for

cocaine abusers and cocaine-dependent clients. These approaches appear

to promote extended periods of client abstinence and treatment retention

in outpatient treatment settings. Table II.3 provides an overview of

cognitive and behavioral study methodologies and results.

52Cocaine Treatment: Early Results From Various Approaches (GAO/HEHS-96-80, June 7, 1996).

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Table II.3: Methodology and Results of

Illustrative Cognitive-Behavioral

Studies

Study group (publication date) Study period S

Relapse prevention

1. Carroll and others (1994)a 12 weeks R

2. Carroll and others (1991)b 12 weeks R

3. Washton and Stone-Washton (1993)c About 28 weeks C

a

4. Wells and others (1994)d 24 weeks A

a

Community reinforcement and contingency management

5. Higgins and others (1991)e 12 weeks C

a

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Sample design (size) Client diagnosis/demographics Treatment outcome Investigator affiliation

Random (n = 121) Clients met criteria for cocaine

dependence

average age: 29

male: 79%

white: about 50% 

unemployed: about 40%

single/divorced: about 70%

at least high school graduate: about 80%

Cocaine-abstinent at least 70% of the

time in treatment

Yale University,

New Haven, Connecticut

Random (n = 42) Clients met criteria for both cocaine

abuse and dependence

average age: 27

male: 67%

white: 67%

average years of education: 13

54% of high-severity cocaine users

were able to attain at least 3 weeks of

continuous abstinence; only 9% of

high-severity cocaine users receiving

standard psychotherapy could achieve

this

Yale University,

New Haven, Connecticut

Consecutive

admissions (n = 60)

Clients met criteria for severe

psychoactive drug dependence (85%

were cocaine addicts)

average age: about 35

male: about 80%

white: about 70%

employed: about 90%

More than 60% abstinent from cocaine

during 6-to- 24-month follow-up period

Washton Institute,

New York, New York

Alternative

assignment (n = 110)

Cocaine was primary drug of choice

average age: 29

male: 64%

white: 84%

employed full time for past 3 years: 68%

average years of education: 13

Average number of days of cocaine use

cut by 71% within 6 months

University of

Washington, Seattle,

Washington

Consecutive

admissions (n = 25)

Clients met criteria for cocaine

dependence

average age: 29

education ≥12 years: 46% employed:

62%

single: 54%

46% were continuously abstinent from

cocaine for 8 treatment weeks

University of Vermont,

Burlington, Vermont

(continued)

Page 45 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

Study group (publication date) Study period S

6. Higgins and others (1993)f 24 weeks R

Contingency management only

7. Silverman and others (1994, 1995)g 12 weeks F

o

u

w

t

Neurobehavioral therapy

8. Shoptaw and others (1994)h 12 months R

9. Rawson and others (1993)i 6 months O

10. Rosenblum and others (1994)j 6 months R

11. Magura and others (1994)k 6 months R

(

Page 46 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

Sample design (size) Client diagnosis/demographics Treatment outcome Investigator affiliation

Random (n = 38) Clients met criteria for cocaine

dependence

average age: 29

male: 89%

white: 100%

unmarried: 89%

completed high school: 63%

employed: 42%

42% were continuously abstinent from

cocaine for 16 treatment weeks

University of Vermont,

Burlington, Vermont

Frequency

of cocaine- positive

urine during initial 5

weeks of methadone

therapy (n = 37)

Clients met criteria for heroin and

cocaine dependence

average age: 36

black: 26%

married: 16%

completed at least high school: 74%

employed full time: 47%

Nearly 50% of the clients receiving

vouchers for cocaine-free urine

remained continuously abstinent from

cocaine for 7 to 12 weeks

Johns Hopkins University,

Baltimore, Maryland

Random (n = 146) Clients met criteria for stimulant abuse or

dependence

average age: 31

male: 84%

white: 63%

Hispanic: 25%

average years of education: 13

unmarried: 78%

36% remained continuously abstinent

from cocaine for at least 8 treatment

weeks; 38% were abstinent from

cocaine at 6-month follow-up

Matrix Institute,

Los Angeles, California

Open trial (n = 486) Cocaine-using clients

average age: 30

male: 74%

white: 76%

average years of education: 14

single: 54%

At least 40% at two treatment sites

remained continuously abstinent from

cocaine through 6 months of treatment

Matrix Institute,

Los Angeles, California

Random (n = 77) Methadone clients who met criteria for

cocaine dependence

age 24 to 43: 87%

Hispanic: 64%

black: 31%

unemployed: 77%

married/common law: 38%

completed at least high school: 42%

Clients attending 3 to 19 sessions

reduced past-month cocaine use by

5%; those attending 85 to 133 sessions

reduced past-month cocaine use by

60%

National Development

and Research Institutes,

Inc.,

New York, New York

aThe source for Carroll and others is Kathleen Carroll et al., “Psychotherapy and

Pharmacotherapy for Ambulatory Cocaine Abusers,” Archives of General Psychiatry, 51 (1994),

177-87.

Page 47 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

bThe source for Carroll and others is Kathleen Carroll et al., “A Comparative Trial of

Psychotherapies for Ambulatory Cocaine Abusers: Relapse Prevention and Interpersonal

Psychotherapy,” American Journal of Drug and Alcohol Abuse, 17:3 (1991), 229-47.

cThe source for Washton and Stone-Washton is Arnold Washton and Nannette Stone-Washton,

“Outpatient Treatment of Cocaine and Crack Addiction: A Clinical Perspective,” National Institute

on Drug Abuse Research Monograph #135 (Rockville, Md.: National Institute on Drug Abuse,

1993), pp. 15-30.

dThe source for Wells and others is Elizabeth Wells et al., “Outpatient Treatment for Cocaine

Abuse: A Controlled Comparison of Relapse Prevention and Twelve-Step Approaches,” American

Journal of Drug and Alcohol Abuse, 20:1 (1994), 1-17.

eThe source for Higgins and others is Stephen Higgins et al., “A Behavioral Approach to

Achieving Initial Cocaine Abstinence,” American Journal of Psychiatry, 148:9 (1991), 1218-24. To

test the accuracy of self-reported client data, researchers at the University of Vermont compared

self-reports to urine test results. In 98 percent of the cases in which a client indicated nonuse,

urinalysis data confirmed the report.

f

The source for Higgins and others is Stephen Higgins et al., “Achieving Cocaine Abstinence With

a Behavioral Approach,” American Journal of Psychiatry, 150:5 (1993), 763-69.

gThe sources for Silverman and others are K. Silverman et al., “Differential Reinforcement of

Sustained Cocaine Abstinence in Intravenous Polydrug Abusers,” in L. S. Harris (ed.), Problems

of Drug Dependence 1994: Proceedings of the 56th Annual Scientific Meeting, The College on

Problems of Drug Dependence. National Institute on Drug Abuse Research Monograph 153

(Rockville, Md.: National Institute on Drug Abuse Research, 1995), p. 212, and K. Silverman et al.,

“Voucher-Based Reinforcement of Cocaine Abstinence: Effects of Reinforcement Schedule,” in

L. S. Harris (ed.), Problems of Drug Dependence 1995: Proceedings of the 57th Annual Scientific

Meeting, The College on Problems of Drug Dependence. National Institute on Drug Abuse

Research Monograph, in press. Also cited in NIDA Notes, 10:5 (September-October 1995), 10

and 14.

hThe source for Shoptaw and others is Steven Shoptaw et al., “The Matrix Model of Outpatient

Stimulant Abuse Treatment: Evidence of Efficacy,” Journal of Addictive Diseases, 13:4 (1994),

129-41.

i

The source for Rawson and others is Richard Rawson et al., “Neurobehavioral Treatment for

Cocaine Dependency: A Preliminary Evaluation,” Cocaine Treatment: Research and Clinical

Perspectives. National Institute on Drug Abuse Research Monograph #135 (Rockville, Md.:

National Institute on Drug Abuse, 1993), pp. 92-115.

j

The source for Rosenblum and others is Andrew Rosenblum et al., “Treatment Intensity and

Reduction in Drug Use for Cocaine-Dependent Methadone Patients: A Dose Response

Relationship.” A prior version of this paper was presented at the American Society of Addiction

Medicine Annual Conference, New York, N.Y., April 1994.

k

The source for Magura and others is Stephen Magura et al., “Neurobehavioral Treatment for

Cocaine-Using Methadone Patients: A Preliminary Report,” Journal of Addictive Diseases, 13:4

(1994), 143-60.

Relapse Prevention Relapse prevention provides users with the ability to recognize triggering

events, places, people, and situations, and it develops alternative coping

strategies that help the user resist those specific triggers. Clients who

received relapse prevention treatment have demonstrated favorable

abstinence rates not only during the period of treatment but also during

Page 48 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

follow-up periods as well. Client retention results also appear to be

favorable. For example, cocaine-dependent clients participating in a

12-week Yale University program53 focusing on relapse prevention were

able to remain abstinent from cocaine at least 70 percent of the time while

in treatment. A year after treatment, gains were still evident: clients

receiving relapse prevention treatment and a placebo medication were

reported to have used cocaine, on average, fewer than 3 days in the past

month.

Positive outcome results were also found in a program conducted by the

Washton Institute in New York:54 more than 60 percent of the primarily

middle-class, cocaine-addicted clients attending the program were

abstinent from cocaine during the 6- to 24-month follow-up period.

Similarly, in the Seattle area,55 cocaine-using clients cut their average

number of days of cocaine use by 71 percent within 6 months.

Among high-severity cocaine addicts participating in another Yale

program,56 54 percent receiving relapse prevention therapy were able to

attain at least 3 weeks of continuous abstinence, while only 9 percent of

those receiving the interpersonal psychotherapy could remain abstinent

for that period of time.

Retention rates of clients in programs were also favorable: 67 percent of

the relapse prevention clients completed the entire 12-week Yale program,

and more than 70 percent completed the Washton program.

Community Reinforcement

and Contingency

Management

Community reinforcement and contingency management programs are

intended to help the client achieve initial abstinence as well as an

extended drug-free lifestyle. The therapy consists of several key

community-oriented components, including the participation of a client’s

family member or friend in the treatment process; management incentives

53Kathleen Carroll et al., “Psychotherapy and Pharmacotherapy for Ambulatory Cocaine Abusers,”

Archives of General Psychiatry, 51 (1994), 177-87.

54Arnold Washton and Nannette Stone-Washton, “Outpatient Treatment of Cocaine and Crack

Addiction: A Clinical Perspective,” National Institute on Drug Abuse Research Monograph #135

(Rockville, Md.: National Institute on Drug Abuse, 1993), pp. 15-30.

55Elizabeth Wells et al., “Outpatient Treatment for Cocaine Abuse: A Controlled Comparison of Relapse

Prevention and Twelve-Step Approaches,” American Journal of Drug and Alcohol Abuse, 20:1 (1994),

1-17.

56Kathleen Carroll et al., “A Comparative Trial of Psychotherapies for Ambulatory Cocaine Abusers:

Relapse Prevention and Interpersonal Psychotherapy,” American Journal of Drug and Alcohol Abuse,

17:3 (1991), 229-47.

Page 49 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

or rewards for drug abstinence; employment counseling when needed; and

the encouragement of client participation in recreational activities as

pleasurable, healthy alternatives to drug use. Community reinforcement

and contingency management therapy teaches clients about the

consequences of their actions and aims to strengthen family and social

ties.

Almost half (46 percent) of the cocaine-dependent clients participating in

a 12-week community reinforcement and contingency management

program at the University of Vermont57 were able to remain continuously

abstinent from cocaine through 2 months of treatment. When the program

was extended to 24 weeks,58 42 percent of the participating

cocaine-dependent subjects were able to achieve 4 months of continuous

abstinence. By comparison, only 5 percent of those in the control group

receiving drug abuse counseling alone could remain continuously

abstinent for the entire 4 months.

A year after clients began treatment, community reinforcement and

contingency management effects were still evident—65 to 74 percent of

those in the community reinforcement group reported 2 or fewer days of

cocaine use in the past month. Only 45 percent of those in the control

group achieved such gains.

Contingency management was also studied independently in an inner-city

Baltimore program.59 Positive results were found when tying the 12-week

voucher reward system to cocaine drug testing. Nearly half of the

cocaine-abusing and cocaine-dependent clients (who were also heroin

users) given vouchers for cocaine-free urine test results were able to

remain continuously abstinent for 7 to 12 weeks. Among clients receiving

vouchers unpredictably—not tied to urine test results—only one client

achieved abstinence for more than 2 weeks.

57Stephen Higgins et al., “A Behavioral Approach to Achieving Initial Cocaine Abstinence,” American

Journal of Psychiatry, 148:9 (1991), 1218-24.

58Stephen Higgins et al., “Achieving Cocaine Abstinence With a Behavioral Approach,” American

Journal of Psychiatry, 150:5 (1993), 763-69.

59K. Silverman et al., “Differential Reinforcement of Sustained Cocaine Abstinence in Intravenous

Polydrug Abusers,” in L. S. Harris (ed.), Problems of Drug Dependence 1994: Proceedings of the 56th

Annual Scientific Meeting, The College on Problems of Drug Dependence. National Institute on Drug

Abuse Research Monograph 153 (Rockville, Md.: National Institute on Drug Abuse Research, 1995), p.

212, and K. Silverman et al., “Voucher-Based Reinforcement of Cocaine Abstinence: Effects of

Reinforcement Schedule,” in L. S. Harris (ed.), Problems of Drug Dependence 1995: Proceedings of the

57th Annual Scientific Meeting, The College on Problems of Drug Dependence. National Institute on

Drug Abuse Research Monograph, in press. Also cited in NIDA Notes, 10:5 (September-October 1995),

10 and 14.

Page 50 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

Client retention in treatment programs was also high. Within the Vermont

community reinforcement and contingency management group, 85 percent

of the clients completed the 12-week program, compared with only

42 percent of those in the 12-step drug counseling control group. The

24-week program was completed by about five times as many clients in the

community reinforcement group as those receiving drug counseling

therapy (58 percent versus 11 percent).

Neurobehavioral Therapy Neurobehavioral therapy is a comprehensive, 12-month outpatient

treatment approach that includes individual therapy, drug education,

client stabilization, and self-help group involvement. Five major stages of

recovery are distinguished during the treatment process with emphasis on

addressing the client’s behavioral, emotional, cognitive, and relational

problems at each stage of recovery.

Several programs have demonstrated that a neurobehavioral therapeutic

approach can also be effective in promoting cocaine abstinence and

treatment retention. Thirty-six percent of the cocaine-abusing and

cocaine-dependent clients participating in a neurobehavioral therapy

program through the Matrix Institute in California60 succeeded in

remaining continuously abstinent from cocaine for at least 8 consecutive

weeks while in treatment. Follow-up results obtained 6 months after

treatment entry showed that 38 percent of these clients still tested drug

free. In a separate examination of two neurobehavioral outpatient

treatment sites,61 at least 40 percent of the cocaine clients in each site

remained continuously abstinent through the entire 6-month course of

therapy.

Given the high rate of cocaine use among methadone clients, the

neurobehavioral model was adapted in New York for use among

methadone clients meeting the diagnostic criteria for cocaine dependence.

In an intensive 6-month program,62 a strong relationship was found

between the number of sessions attended and cocaine use reduction.

Clients attending 3 to 19 sessions experienced a 5-percent reduction in

60Steven Shoptaw et al., “The Matrix Model of Outpatient Stimulant Abuse Treatment: Evidence of

Efficacy,” Journal of Addictive Diseases, 13:4 (1994), 129-41.

61Richard Rawson et al., “Neurobehavioral Treatment for Cocaine Dependency: A Preliminary

Evaluation,” Cocaine Treatment: Research and Clinical Perspectives. National Institute on Drug Abuse

Research Monograph #135 (Rockville, Md.: National Institute on Drug Abuse, 1993), pp. 92-115.

62Andrew Rosenblum et al., “Treatment Intensity and Reduction in Drug Use for Cocaine-Dependent

Methadone Patients: A Dose Response Relationship.” A prior version of this paper was presented at

the American Society of Addiction Medicine Annual Conference, New York, New York, April 1994.

Page 51 GAO/GGD-97-42 Drug Control
Appendix II 

Drug Abuse Prevention and Treatment

cocaine use during the previous month. Those attending 85 to 133 sessions

experienced a 60-percent reduction in their past 30-day use of cocaine. In

another New York study63 with cocaine-addicted methadone clients,

individuals receiving neurobehavioral treatment demonstrated a

significant decrease in cocaine use between entering treatment and

6-month follow-up; the control group showed no statistically significant

decrease.

Neurobehavioral retention rates also proved favorable. In the California

study of two treatment sites, clients were retained an average of about 5

months and 3 months; in the other California study, the average length of

stay for cocaine users was about 4-1/2 months. For the first New York

study, a total of 61 percent of the cocaine-dependent methadone clients

completed the initial 6-month cocaine treatment regimen.

Additional Research

Initiatives Identified

for Prevention and

Treatment

Effectiveness

In our literature search, we found that early research has demonstrated

that psychosocial and comprehensive approaches to drug prevention have

led to decreased use of drugs among school-age youths as well as

reductions in risk factors and the enhancement of protective factors.

Relapse prevention, community reinforcement and contingency

management, and neurobehavioral therapy have resulted in increased

abstinence and extended periods of treatment retention among

cocaine-abusing and dependent clients. Although these research results in

the 1990s demonstrate promising approaches to drug prevention for

school-age youths and treatment for cocaine abuse and dependence, some

of these strategies have not been tried, tested, and evaluated in different

settings, for different target populations, in various combinations, and

over long periods of time. Therefore, there is still a wide array of research

initiatives that can be pursued to better understand what promise these

approaches hold for effectively preventing, reducing, or treating drug

problems. Some of the prevention initiatives suggested by IOM and cocaine

treatment initiatives recommended by cocaine abuse experts follow.

Additional treatment initiatives can be found in our 1996 cocaine

treatment report.64

Prevention Testing the utility of booster sessions. Prevention training programs

frequently take place over the course of only one or two grades (for

63Stephen Magura et al., “Neurobehavioral Treatment for Cocaine-Using Methadone Patients: A

Preliminary Report,” Journal of Addictive Diseases, 13:4 (1994), 143-60.

64Cocaine Treatment: Early Results From Various Approaches (GAO/HEHS-96-80, June 7, 1996).

Page 52 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

example, Project ALERT takes place in the 7th and 8th grades). While we

have seen that immediate, or short-term, outcome results can be quite

promising, positive successes can begin to fade as other negative stimuli

and pressures confront the individual. Booster sessions have been shown

in limited trials to reinforce initial training sessions and help maintain

positive outcome findings. However, because boosters are infrequently

used, there is limited supporting evidence on the appropriate content of

booster sessions for different age groups. Such knowledge is important for

maintaining positive prevention and treatment outcome gains over time.

Determining the mix of program components that yield the most

significant outcome results. Outcome results of various promising

practices have shown that sizable percentages of the intervention group

had not become drug users at the time of the follow-up. Whether these

results can be substantially improved with a different mix of prevention

approaches and program components remains to be demonstrated.

Evaluating how best to disseminate positive findings to the larger

community. In many instances, the promising practice prevention

programs supported by the federal government are not being adopted at

the local level. Further research is, therefore, necessary to determine how

best to market the more effective prevention programs to the user

community.

Assessing the types of program approaches that work best for different

target populations, in diverse environmental settings, with varying

trainers. Many prevention programs have been evaluated only with

restricted target audiences (for example, 7th graders in a limited

geographic area) by the principal investigator and staff. The extent to

which one can generalize from these prevention approaches remains to be

determined. Also, further research directed at how these programs can be

modified for various target groups, while maintaining the essential

components of the intervention program, is needed. In addition, the effect

that trainers other than the principal investigator will have on the outcome

results will broaden the knowledge base of the widespread applicability of

these approaches.

Treatment Identifying improved additional cognitive/behavioral strategies to reduce

relapse. Additional study of the promising treatment approaches is

warranted to (1) identify optimal sanction systems to be used in

contingency management practices, (2) obtain a more in-depth

Page 53 GAO/GGD-97-42 Drug Control
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Drug Abuse Prevention and Treatment

understanding of the triggers that promote drug use, and (3) identify the

appropriate intensities and durations of treatment necessary for the

successful implementation of each of the promising practices. The results

of this research could lead to increasing a client’s ability to avoid relapse

and, thereby, minimize substance abuse third-party payments.

Testing the effectiveness and safety of new medications to prevent or

reduce drug intake. Advancement in the pharmacological area rests on a

better understanding of brain functioning, the immune system, and actions

of the specific illicit drugs. This requires further development and testing

of medications to (1) block a drug’s toxicity and aid in the withdrawal

process, (2) reduce craving for the drug, and (3) inhibit the euphoric

“high” induced by the drug. With the craving reduced and the euphoric

high diminished, it follows that the use of the drug will decline.

Identifying the necessary components of promising cognitive/behavioral

strategies and medications that lead to successful outcomes. This is of

particular importance when disseminating these model cocaine treatment

practices to the local practitioner. The practitioner may have little time to

be trained, may need to streamline use of the approach down to its bare

essentials to fit in with other schedule requirements, and may need to

know where local adaptations can be incorporated.

Substantiating outcome results through further research and evaluation is

an important step in advancing promising drug prevention and treatment

approaches. It is also important in helping policymakers to better focus

efforts and resources on proven effective drug abuse prevention and

treatment programs. In light of federal efforts to establish national goals in

an overall drug strategy and to assess results through program

performance measures and evaluation, definitive research can be an

important prerequisite to focusing and maximizing the use of federal

resources.

Page 54 GAO/GGD-97-42 Drug Control
Appendix III 

Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

A component of the Department of Transportation, the Coast Guard is the

federal agency primarily responsible for providing many maritime services

and enforcing related laws and regulations. Its staff and equipment are

involved in multimissions that range from national security to

environmental protection. For fiscal year 1997, the Coast Guard’s budget is

about $3.84 billion.

The Coast Guard is the lead federal agency for maritime drug interdiction.

It shares lead responsibility with the U.S. Customs Service for air

interdiction. The Coast Guard’s antidrug authority covers domestic waters

(12 miles from U.S. shores), including navigable waters of the United

States and international waters. Where bilateral agreements permit, the

Coast Guard has special jurisdiction in foreign waters. For fiscal year 1997,

the Coast Guard estimated that its budget for antidrug activities is about

$336 million.

The Coast Guard has made progress in developing antidrug performance

measures that conform with GPRA requirements; however, challenges

remain. Government Performance and Results Act (GPRA) requires federal

agencies65 to develop two types of plans—a strategic plan66 by the end of

fiscal year 1997 and annual performance plans,67 the first of which is to

cover fiscal year 1999. The Coast Guard’s preliminary plans represent a

start at incorporating a results-oriented approach to drug interdiction, but

as could be expected at this early date, they also reflect a need for

additional work. The Coast Guard has recognized three areas that require

more attention:

• developing data to measure the results of antidrug actions,

• developing goals and ways of achieving them, and

65Under GPRA, “agency” is defined as an executive department, a government corporation, and an

independent establishment. The Coast Guard is implementing GPRA in support of the Department of

Transportation.

66Under GPRA, a strategic plan is the starting point for agencies to set annual goals for programs and

to measure the performance of the programs in achieving those goals. GPRA requires each federal

agency to develop strategic plans that cover a period of at least 5 years and include the agency’s

missions statement; identify the agency’s long-term strategic goals; and describe how the agency

intends to achieve those goals through its activities and though its human, capital, information, and

other resources.

67The annual performance plan provides the direct linkage between the strategic goals outlined in the

agency’s strategic plan and what managers and employees do day-to-day. The plan is to contain the

performance goals the agency will use to gauge its progress toward accomplishing its strategic goals

and identify the performance measures the agency will use to assess its progress.

Page 55 GAO/GGD-97-42 Drug Control
Appendix III 

Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

• identifying the wide variety of constraints that could influence the Coast

Guard’s ability to deter the flow of drugs into the United States via

maritime routes.

Coast Guard Has

Made Progress

Toward Implementing

GPRA Principles

The Coast Guard has taken action toward implementing the principles of

GPRA for its antidrug activities. Under GPRA, the Coast Guard has defined its

results-oriented performance goal as “reducing the amount of illegal drugs

entering the country through maritime routes by 25 percent over five

years.” The primary indicator it plans to use in measuring progress toward

achieving this goal is data comparing the amount of drugs seized and

deterred with the amount bound for the United States via maritime routes.

The Coast Guard also plans to use a variety of secondary indicators, such

as surveillance coverage and intercept rates.68

The preliminary goal and indicators show progress in conforming with

certain GPRA principles in that the goal covers a period of 5 years, is results

oriented, and is potentially measurable. However, as the next sections

discuss, Coast Guard efforts at conforming with the full extent of GPRA is a

work in progress.

Measuring Results of

Drug Interdiction

Presents Challenges

GPRA requires agencies to measure the results of their programs. Measuring

the results of drug-control actions is difficult because data on illegal drugs

entering the country are more difficult to develop than data on most legal

commodities. Without knowing how much was shipped or what got

through, the amount of contraband seized does not yield a meaningful

measure of effectiveness. The ONDCP-sponsored Semiannual Interagency

Assessment of Cocaine Movement has made some progress in developing

estimates on the amount of cocaine entering the United States via surface,

air, and maritime routes. The Coast Guard is using these data as a primary

indicator of its antidrug activities. If reasonably accurate, these data could

aid the Coast Guard in measuring the results of its cocaine interdiction

program. According to an ONDCP official, ONDCP is working with the

intelligence components of federal agencies involved in foreign and

domestic drug control programs to develop a comprehensive baseline on

heroin production and trafficking. Developing a heroin flow model will be

part of this project.

68The Coast Guard defines “surveillance coverage” as the area covered divided by the area assigned per

24-hour period. It defines “intercept” as directing the movement of a Coast Guard asset to the scene of

an identified target to support the collection of additional information and to take further action, if

appropriate. The “interception rate” is defined as the number of intercepts divided by the number of

intercepts attempted.

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Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

A second factor that makes the measurement of results difficult is that of

separating the impact of the Coast Guard’s actions from those of other

agencies. For example, a decrease in the amount of drugs entering the

United States via maritime routes could be the result of greater efforts by

other federal agencies to control drugs in the source country, lower

domestic demand due to demand-reduction efforts, or better intelligence

rather than Coast Guard interdiction efforts. In this regard, Coast Guard

officials recognize that measures showing the overall result of the U.S.

drug control effort are needed. For example, they stated that placing

additional resources in key choke points could result in reduced

smuggling activity in one area; however, smugglers may still ship drugs to

the United States through other transportation means or routes. Thus,

while the actions of one agency may result in success in its area of

responsibility, only interagency measures of effectiveness and the

attendant data would provide a basis to gauge the success of the total U.S.

effort.

Coast Guard Officials

Acknowledge That

Developing Goals and

Methods for Achieving

Them Still Need to Be

Refined

Coast Guard officials acknowledge that complying with the GPRA

requirements to develop results-oriented performance goals and to

identify methods of achieving them is a work-in-progress. Coast Guard

officials indicated that the extent to which they reduce illegal drugs

entering the United States via maritime routes over the next 5 years is

largely dependent on additional resources. Coast Guard officials expect

that additional resources and assets will deter smugglers from using a

particular route, cause them to stop smuggling entirely, or result in

interdiction of about 90 percent of all maritime smuggling traffic in

high-risk areas (if the Coast Guard has a “contact rate” of 40 percent with

the smuggling community).69 The officials base this expectation on a 1989

study that collected opinions from convicted smugglers on their view of

the risk level that would stop them from smuggling drugs.70 Coast Guard

officials believe that a greater presence and interdiction actions in targeted

areas will result in smugglers’ perception that the chances of being caught

are high, contributing to the deterrence or interdiction of about 90 percent

of smuggling traffic in target areas.

69According to Coast Guard officials, they have not developed an estimate of the amount of additional

resources needed to achieve a 40-percent “contact rate”; however, they plan to determine this amount

in the future. The Coast Guard defines “contact rate” as the frequency with which Coast Guard assets

make contact with maritime traffic in targeted areas, including interdiction and boarding known or

suspected smugglers. According to the Coast Guard, it currently has a contact rate of 12 percent,

which results in deterrence or interdiction of 29 percent of smugglers using maritime routes.

70Measuring Deterrence - Approach and Methodology, Rockwell International Special Investigations,

Inc., Decisions Science Applications, Sumner Associates, Oct. 27, 1989.

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Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

Information from another study suggests that more resources make a

difference in reducing the supply of illegal drugs coming into the United

States, but the difference may not be significant. A recent study conducted

for ONDCP examined the impact of more resources in disrupting the flow of

drugs in the transit zone.71 The study estimated that smugglers

successfully moved about 560 tons of cocaine in the transit zone in 1994,

and it evaluated the potential impact of committing an additional

$200 million and $500 million to the transit zone. It projected that

smugglers would successfully move 470 metric tons (11-percent reduction)

in the transit zone under the $200 million option and that they would

successfully move 430 metric tons (16-percent reduction) under the

$500 million option. According to the study, “given that annual U.S.

cocaine consumption is less than 300 tons, the impact of the additional

resources in the transit zone does not seem significant enough to affect

U.S. drug use.”

On the basis of this analysis, the study concluded that “[i]t does not appear

that the potential benefit of decreased trafficker smuggling success rate in

the transit zone is significant enough to warrant additional resources.” The

study noted that the federal policy challenge is not only to determine the

benefits from direct investment in the transit zone but also to consider

whether the investment of a similar level of resources elsewhere in the

drug strategy might produce even more benefits.72 The study, however,

contained several methodological limitations, including a low level of

confidence in its predictions and a limited scope, such as not analyzing the

potential benefits of investing resources in the source countries.

Coast Guard officials generally agreed with the analysis in the study but

disagreed with the conclusions. Officials agreed that the amount of

cocaine deterred in the transit zone would total about 90 metric tons, or an

11-percent reduction, if an additional $200 million were to be committed to

the transit zone. Unlike the study, Coast Guard officials believe that this

level of reduction would be a good return on the investment. Officials

pointed out that at the time of the study, the additional resources

71The National Drug Control Strategy, 1996: Program, Resources, and Evaluation. Office of National

Drug Control Policy, Washington, D.C., pp. 48-51.

72The study suggested the following order of priority if funding is increased: (1) increase intelligence,

which because of its relative low cost has the greatest leverage and is critical for responding to the

maritime threat; (2) improve disruption capability because, without it, law enforcement would be

unable to respond to the targets identified by increased and improved intelligence; and (3) increase

detection and monitoring to fill geographic gaps and ensure an ability to link intelligence and

disruption capability.

Page 58 GAO/GGD-97-42 Drug Control
Appendix III 

Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

($200 million) needed for this level of reduction was only about

1.6 percent of the total federal antidrug budget.

Coast Guard Officials

Identify Constraints Other

Than Funding That Affect

Their Antidrug Efforts

GPRA requires an identification of key factors external to the agency and

beyond its control that could significantly affect the achievement of its

goals and objectives. In developing its preliminary plans, the Coast Guard

has identified the level of resources as a primary factor that influences its

ability to achieve the goal that it ultimately establishes. However,

identifying and interdicting maritime drug smuggling is affected by other

constraints as well. Following are several constraints that the Coast Guard

says also affect its antidrug efforts:

• Covering large geographic areas is problematic. When smugglers use

maritime routes, they may not ship the drugs directly to the United States,

but instead they may ship the drugs to Mexico or Central American

countries and then to the United States via land or air routes. An estimated

180 metric tons of cocaine are transported annually from Colombia to

Mexico or other Central American countries via maritime routes in the

eastern Pacific Ocean, according to the ONDCP-sponsored Semiannual

Interagency Assessment of Cocaine Movement. Coast Guard officials

stated that this is an area of concern because success in deterring drugs in

the Caribbean could result in more smuggling activity in the Pacific. Coast

Guard officials noted that unlike the Caribbean, where specific routes and

choke points have been identified, interdiction and deterrence in the

eastern Pacific presents greater challenges because of the size of the area.

• Sovereignty constraints. Coast Guard officials cited sovereignty issues

with foreign-flag vessels as another factor that complicates their antidrug

efforts. Coast Guard officials stated that bilateral maritime

counternarcotic agreements are being sought with countries such as

Colombia, Jamaica, Mexico, Barbados, and Nicaragua.73 According to

Coast Guard officials, these agreements provide them with greater

flexibility to carry out their antidrug activities. Such agreements outline

the criteria for boarding and pursuing foreign-flag vessels. Also, they may

authorize the Coast Guard to fly over foreign airspace, to order suspect

aircraft to land in the host nation, to investigate suspect vessels in foreign

waters, or authorize the Coast Guard to conduct other law enforcement

activities, such as boardings, in foreign waters.

73By December 1996, antidrug bilateral agreements had been signed with 16 countries: Antigua and

Barbuda, Bahamas, Belize, Dominica, Dominican Republic, Grenada, Haiti, Netherlands Antilles,

Panama, St. Kitts and Nevis, St. Lucia, St. Vincent/Grenadines, Trinidad and Tobago, Turks and Caicos,

United Kingdom, and Venezuela.

Page 59 GAO/GGD-97-42 Drug Control
Appendix III 

Coast Guard Has Made Progress, but

Challenges Remain in Developing Antidrug

Strategic and Performance Plans

• Increasing use of technology by smugglers. Coast Guard officials also

noted that smugglers are using more sophisticated means to conceal and

transport drugs, such as the use of global positioning systems and

camouflaged vessels to avoid detection. According to Coast Guard

officials, the use of the positioning systems allows traffickers to determine

airdrop coordinates prior to departure, thus reducing the amount of radio

communication needed. Officials noted that the increasing use of

technology makes it more difficult to gather the information needed to

track and interdict the shipment of illegal drugs through the Caribbean

because traffickers can detect whether they are being followed.

Page 60 GAO/GGD-97-42 Drug Control
Appendix IV 

Major Contributors to This Report

General Government

Division, Washington,

D.C.

Weldon McPhail, Assistant Director, Administration of Justice

 Issues

Richard B. Groskin, Evaluator-in-Charge

Carolyn S. Ikeda, Senior Evaluator

Dennise R. Stickley, Evaluator

David P. Alexander, Senior Social Science Analyst

Pamela V. Williams, Communications Analyst

Health, Education,

and Human Services

Division, Washington,

D.C.

Bernice Steinhardt, Director, Health Financing and

 Public Health Issues

James O. McClyde, Assistant Director, Health Financing

 and Public Health Issues

Jared Hermalin, Senior Evaluator

National Security and

International Affairs

Division, Washington,

D.C.

Jess T. Ford, Associate Director, International Relations and

 Trade

Allen C. Fleener, Senior Evaluator

Resources,

Community, and

Economic

Development

Division, Washington,

D.C.

John H. Anderson, Jr., Director, Transportation and

 Telecommunications Issues

Seattle Field Office Randall B. Williamson, Assistant Director,

 Transportation and Telecommunications Issues

Neil T. Asaba, Senior Evaluator

Office of the General

Counsel, Washington,

D.C.

Nancy Finley, Senior Attorney

Page 61 GAO/GGD-97-42 Drug Control
Page 62 GAO/GGD-97-42 Drug Control
Page 63 GAO/GGD-97-42 Drug Control
Related GAO Products74

1996 Substance Abuse Treatment: VA Programs Serve Psychologically and

Economically Disadvantaged Veterans (GAO/HEHS-97-6, Nov. 5, 1996).

Drug and Alcohol Abuse: Billions Spent Annually for Treatment and

Prevention Activities (GAO/HEHS-97-12, Oct. 8, 1996).

Customs Service: Drug Interdiction Efforts (GAO/GGD-96-189BR, Sept. 26,

1996).

Drug Control: U.S. Heroin Control Efforts in Southeast Asia

(GAO/T-NSIAD-96-240, Sept. 19, 1996).

Drug Control: Observations on Counternarcotics Activities in Mexico

(GAO/T-NSIAD-96-239, Sept. 12, 1996.)

Terrorism and Drug Trafficking: Technologies for Detecting Explosives

and Narcotics (GAO/NSIAD/RCED-96-252, Sept. 4, 1996).

Substance Abuse Surveys (GAO/HEHS-96-179R, July 19, 1996).

Drug Control: Observations on Counternarcotics Efforts in Mexico

(GAO/T-NSIAD-96-182, June 12, 1996).

Drug Control: Counternarcotics Efforts in Mexico (GAO/NSIAD-96-163,

June 12, 1996).

Cocaine Treatment: Early Results From Various Approaches

(GAO/HEHS-96-80, June 7, 1996).

Drug Control Observations on U.S. Interdiction in the Caribbean

(GAO/T-NSIAD-96-171, May 23, 1996).

Drug Control: U.S. Interdiction Efforts in the Caribbean Decline

(GAO/NSIAD-96-119, Apr. 17, 1996).

Terrorism and Drug Trafficking: Threats and Roles of Explosives and

Narcotics Detection Technology (GAO/NSIAD/RCED-96-76BR, Mar. 27, 1996).

At-Risk and Delinquent Youth: Multiple Federal Programs Raise Efficiency

Questions (GAO/HEHS-96-34, Mar. 6, 1996).

74For a list of GAO’s federal drug control products issued before January 1, 1993 (covering fiscal years

1988 through 1993), see Drug Control: Reauthorization of the Office of National Drug Control Policy

(GAO/GGD-93-144, Sept. 29, 1993).

Page 64 GAO/GGD-97-42 Drug Control
Related GAO Products74

Drug Control: U.S. Heroin Program Encounters Many Obstacles in

Southeast Asia (GAO/NSIAD-96-83, Mar. 1, 1996).

1995 Review of Assistance to Colombia (GAO/NSIAD-96-62R, Dec. 12, 1995).

Drug War: Observations on U.S. International Drug Control Efforts

(GAO/T-NSIAD-95-194, Aug. 1, 1995)

Treatment of Hardcore Cocaine Users (GAO/HEHS-95-179R, July 31, 1995).

Drug War: Observations on the U.S. International Drug Control Strategy

(GAO/T-NSIAD-95-182, June 27, 1995).

Drug Courts: Information on a New Approach to Address Drug-Related

Crime (GAO/GGD-95-159BR, May 22, 1995).

Honduras: Continuing U.S. Military Presence at Soto Cano Base Is Not

Critical (GAO/NSIAD-95-39, Feb. 8, 1995).

1994 Border Control: Revised Strategy Is Showing Some Positive Results

(GAO/GGD-95-30, Dec. 29, 1994).

Drug Activity in Haiti (GAO/OSI-95-6R, Dec. 28, 1994).

Drug Control: U.S. Antidrug Efforts in Peru’s Upper Huallaga Valley

(GAO/NSIAD-95-11, Dec. 7, 1994).

U.S. Postal Service: Drug Investigation Data (GAO/GGD-95-29FS, Dec. 6, 1994).

Drug Control: U.S. Drug Interdiction Issues in Latin America

(GAO/T-NSIAD-95-32, Oct. 7, 1994).

Drug Control in Peru (GAO/NSIAD-94-186R, Aug. 16, 1994).

Drug Control: U.S. Counterdrug Activities in Central America

(GAO/T-NSIAD-94-251, Aug. 2, 1994).

Drug Control: Interdiction Efforts in Central America Have Had Little

Impact on the Flow of Drugs (GAO/NSIAD-94-233, Aug. 2, 1994).

Page 65 GAO/GGD-97-42 Drug Control
Related GAO Products74

INS Drug Task Force Activities: Federal Agencies Supportive of INS Efforts

(GAO/GGD-94-143, July 7, 1994).

Disability Benefits for Addicts (GAO/HEHS-94-178R, June 8, 1994).

Social Security: Major Changes Needed for Disability Benefits for Addicts

(GAO/HEHS-94-128, May 13, 1994).

Weed and Seed: Program Objectives (GAO/GGD-94-128R, May 10, 1994).

Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children

(GAO/HEHS-94-89, Apr. 4, 1994).

Money Laundering: The Volume of Currency Transaction Reports Filed

Can and Should Be Reduced (GAO/GGD-94-113, Mar. 15, 1994).

Money Laundering: U.S. Efforts to Fight It Are Threatened by Currency

Smuggling (GAO/GGD-94-73, Mar. 9, 1994).

Money Laundering: Project Gateway (GAO/GGD-94-91R, Feb. 15, 1994).

Social Security: Disability Benefits for Drug Addicts and Alcoholics Are

Out of Control (GAO/HEHS-94-101, Feb. 10, 1994).

Residential Care: Some High-Risk Youth Benefit, but More Study Needed

(GAO/HEHS-94-56, Jan. 28, 1994).

1993 Drug Use Among Youth: No Simple Answers to Guide Prevention

(GAO/HRD-94-24, Dec. 29, 1993).

Border Management: Dual Management Structure at Entry Ports Should

End (GAO/T-GGD-94-34, Dec. 10, 1993).

Illicit Drugs: Recent Efforts to Control Chemical Diversion and Money

Laundering (GAO/NSIAD-94-34, Dec. 8, 1993).

Financial Management: Customs’ Accountability for Seized Property and

Special Operations Advances Was Weak (GAO/AIMD-94-6, Nov. 22, 1993).

Drug Control: The Office of National Drug Control Policy—Strategies

Need Performance Measures (GAO/T-GGD-94-49, Nov. 15, 1993).

Page 66 GAO/GGD-97-42 Drug Control
Related GAO Products74

Money Laundering: Characteristics of Currency Transaction Reports Filed

in Calendar Year 1992 (GGD-94-45FS, Nov. 10, 1993).

Money Laundering: Progress Report on Treasury’s Financial Crimes

Enforcement Network (GAO/GGD-94-30, Nov. 8, 1993).

Mandatory Minimum Sentences: Are They Being Imposed and Who Is

Receiving Them? (GAO/GGD-94-13, Nov. 4, 1993).

Drug Control: Expanded Military Surveillance Not Justified by Measurable

Goals or Results (GAO/T-NSIAD-94-14, Oct. 5, 1993).

The Drug War: Colombia Is Implementing Antidrug Efforts, but Impact Is

Uncertain (GAO/T-NSIAD-94-53, Oct. 5, 1993).

Drug Control: Reauthorization of the Office of National Drug Control

Policy (GAO/GGD-93-144, Sept. 29, 1993).

Drug Control: DOD Operated Aerostat Ship Although Conferees Denied

Funds (GAO/NSIAD-93-213, Sept. 10, 1993).

Drug Control: Heavy Investment in Military Surveillance Is Not Paying Off

(GAO/NSIAD-93-220, Sept. 1, 1993).

The Drug War: Colombia Is Undertaking Antidrug Programs, But Impact Is

Uncertain (GAO/NSIAD-93-158, Aug. 10, 1993).

Confronting the Drug Problem: Debate Persists on Enforcement and

Alternative Approaches (GAO/GGD-93-82, July 1, 1993).

Customs Service and INS: Dual Management Structure for Border

Inspections Should Be Ended (GAO/GGD-93-111, June 30, 1993).

Drug Use Measurement: Strengths, Limitations, and Recommendations for

Improvement (GAO/PEMD-93-18, June 25, 1993).

Drugs: International Efforts to Attack a Global Problem (GAO/NSIAD-93-165,

June 23, 1993).

Money Laundering: The Use of the Bank Secrecy Act Reports by Law

Enforcement Could Be Increased (GAO/T-GGD-93-31, May 26, 1993).

Page 67 GAO/GGD-97-42 Drug Control
Related GAO Products74

Drug Control: Revised Drug Interdiction Approach Is Needed in Mexico

(GAO/NSIAD-93-152, May 10, 1993).

War on Drugs: Federal Assistance to State and Local Drug Enforcement

(GAO/GGD-93-86, Apr. 29, 1993).

Indian Health Service: Basic Services Mostly Available; Substance Abuse

Problems Need Attention (GAO/HRD-93-48, Apr. 9, 1993).

Drug Control: Coordination of Intelligence Activities (GAO/GGD-93-83BR,

Apr. 2, 1993).

Drug Education: Limited Progress in Program Evaluation (GAO/T-PEMD-93-2,

Mar. 31, 1993).

Community-Based Drug Prevention: Comprehensive Evaluations of Efforts

Are Needed (GAO/GGD-93-75, Mar. 24, 1993).

Needle Exchange Programs: Research Suggests Promise as an AIDS

Prevention Strategy (GAO/HRD-93-60, Mar. 23, 1993).

U.S. Customs Service Performance Indicators (GAO/AFMD-93-47R, Mar. 10,

1993).

Drug Control: Increased Interdiction and Its Contribution to the War on

Drugs (GAO/T-NSIAD-93-4, Feb. 25, 1993).

Drug Control: Treatment Alternatives to Street Crime (GAO/GGD-93-61,

Feb. 11, 1993).

Drug Control: Status Report on Counterdrug Technology Development

(GAO/NSIAD-93-104, Jan. 28, 1993).

(186765) Page 68 GAO/GGD-97-42 Drug Control
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