GAO-12-744R Drug Control

United States Government Accountability Office

Washington, DC 20548

July 6, 2012

The Honorable Dianne Feinstein

Chairman

The Honorable Charles E. Grassley

Co-Chairman

Caucus on International Narcotics Control

United States Senate

Subject: Drug Control: Initial Review of the National Strategy and Drug Abuse

Prevention and Treatment Programs

An estimated 22.6 million Americans aged 12 or older were illicit drug users in 2010, 

representing 8.9 percent of the population aged 12 or older, according to the 

National Survey on Drug Use and Health.1 This represents the highest overall 

rate of illicit drug users among this population group since 2002, when the rate was 

8.3 percent. Abuse of illicit drugs results in significant social, public health, and 

economic consequences for the United States. For example, the economic impact of 

illicit drug use, including the costs of crime, health care, and lost productivity, was 

estimated at more than $193 billion in 2007, the most recent year for which data 

were available.2

The Office of National Drug Control Policy (ONDCP) was established by the AntiDrug Abuse Act of 1988 to, among other things, enhance national drug control 

planning and coordination and represent the drug policies of the executive branch 

before Congress.3

 

1

Illicit drug use includes marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or 

prescription-type psychotherapeutics used nonmedically. See Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug 

Use and Health: Summary of National Findings (Rockville, Md.: September 2011). 

In this role, ONDCP provides advice and governmentwide 

oversight of drug programs and is responsible for coordinating drug control activities, 

2

See Department of Justice National Drug Intelligence Center, The Economic Impact of Illicit Drug Use on 

American Society (Washington, D.C.: April 2011).

3

Pub. L. No. 100-690, §§ 1002, 1003, 102 Stat. 4181, 4182. This law, as amended, was repealed on 

September 30, 1997, by Pub. L. No. 100-690, § 1009, 108 Stat. 1995 (1994). Congress again established 

ONDCP effective October 21, 1998. Office of National Drug Control Policy Reauthorization Act of 1998, Pub. L. 

No.105-277, div. C, title VII, §§ 703, 704, 112 Stat. 2681, 2681-671, 2681-672 (codified as amended at 21 U.S.C. 

§§ 1701 to 1712) (provisions pertaining to referenced functions codified as amended at 21 U.S.C. §§ 1702 and 

1703). Pursuant to § 715 of this law (codified as amended at 21 U.S.C. § 1712), provisions relating to ONDCP 

were “repealed” effective September 30, 2010. However, ONDCP has continued to operate pursuant to 

continued funding provided by Congress. Department of Defense and Full-Year Continuing Appropriations Act, 

2011, Pub. L. No. 112-10, 125 Stat. 38 (2011), and the Consolidated Appropriations Act, 2012, Pub. L. No. 112-

74, 125 Stat. 786 (2012).
2 GAO-12-744R Drug Control

including federal drug abuse prevention and treatment programs, and related 

funding across the federal government. ONDCP is required annually to develop the 

National Drug Control Strategy (Strategy), which sets forth a plan to reduce illicit 

drug use through prevention, treatment, and law enforcement programs, and to 

develop a Drug Control Budget for implementing the Strategy. ONDCP reported 

that for fiscal year 2012, about $25.2 billion was provided for drug control programs 

across 17 federal departments and independent agencies. Further, according to 

ONDCP, from 2004 to 2012 this signified an increase of $5.9 billion (about 

31 percent) for drug control programs, including drug abuse prevention and 

treatment programs.

The 2010 Strategy is the inaugural strategy guiding drug policy under President 

Obama’s administration and, according to ONDCP officials, sought a comprehensive 

approach to drug policy, including an emphasis on drug abuse prevention and 

treatment efforts and the use of evidence-based practices—approaches to 

prevention or treatment that are based in theory and have undergone scientific 

evaluation.4 Drug abuse prevention includes activities focused on discouraging the 

first-time use of controlled substances and efforts to encourage those who have 

begun to use illicit drugs to cease their use. Treatment includes activities focused on 

assisting regular users of controlled substances to become drug free through such 

means as counseling services, inpatient and outpatient care, and the demonstration 

and provision of effective treatment methods.

National Drug Control Program agencies (drug control agencies)5 follow a detailed 

process in developing their annual budget submissions for inclusion in the Drug 

Control Budget, which provides information on the funding that the executive branch 

requested for drug control to implement the Strategy.6 Agencies submit to ONDCP 

the portion of their annual budget requests dedicated to drug control, which they 

prepare as part of their overall budget submission to the Office of Management and 

Budget for inclusion in the President’s annual budget request. ONDCP reviews the 

budget requests of the drug control agencies to determine if the agencies have 

acceptable methodologies for estimating their drug control budgets, and includes 

those that do in the Drug Control Budget.7

 

4

For the 2010 Strategy, ONDCP changed its approach and moved from publishing a 1-year Strategy to 

publishing a 5-year Strategy, which is to be updated annually. The annual updates are to provide an 

implementation progress report as well as an opportunity to make adjustments to goals to reflect policy changes.

Agencies may administer programs that 

include drug abuse prevention and treatment activities but do not meet ONDCP’s 

standards for having an acceptable budget estimation methodology. Such programs 

are not represented in the Drug Control Budget.

5

A National Drug Control Program agency is any agency, defined at the department or independent agency 

level, that is responsible for implementing any aspect of the Strategy, including any agency that receives federal 

funds to implement any aspect of the Strategy, subject to certain exceptions for agencies engaged in intelligence 

activities or activities funded by the Department of Justice. See 21 U.S.C. § 1701(7).

6

See 21 U.S.C. § 1703(c).ONDCP prepares a budget proposal it refers to as the National Drug Control Budget 

Summary. For the purpose of this report, we refer to this proposal as the Drug Control Budget. 

7

An acceptable methodology relies on availability of empirical data at the agencies for estimating their drug 

control budgets. These data include determining which portion of an agency’s funding is for drug control 

programs or activities versus non-drug control programs. See GAO, Office of National Drug Control Policy: 

Agencies View the Budget Process as Useful for Identifying Priorities, but Challenges Exist, GAO-11-261R

(Washington, D.C.: May 2, 2011).
3 GAO-12-744R Drug Control

Part of the 2010 Strategy is a long-term policy goal for increasing the emphasis on 

preventing and treating substance abuse. Multiple federal departments—and their 

component agencies, bureaus, divisions, and offices—and independent agencies 

(collectively referred to as agencies), administer drug abuse prevention and 

treatment programs, fund these programs, or both.8 The drug abuse prevention and 

treatment programs vary and may include grants to service providers, direct 

services, and education and outreach activities. For example, an agency’s grant 

program may award block grants to grantees, such as states or local entities, to 

implement their own interventions through community-based drug abuse prevention 

or treatment programs, while direct service programs often entail interventions 

directly administered by an agency to a specific population. Drug abuse prevention 

and treatment programs target various populations and use a wide variety of 

interventions, which are strategies or approaches intended to prevent an undesirable 

outcome, such as abuse of an illicit drug; promote a desirable outcome, such as 

reducing the use of alcohol among youth; or alter the course of an existing condition, 

such as successful treatment of drug addiction. Some programs may be either jointly 

funded or administered by two or more agencies.

In light of the increase in the rate of illicit drug use among Americans, efforts to 

oversee and coordinate the implementation of the Strategy and ensure that ONDCP 

and federal agencies invest in the most effective drug abuse prevention and 

treatment programs become more important. You asked us to determine the extent 

to which the 2010 Strategy has been implemented, review the sources of funding for 

federal drug abuse prevention and treatment programs as well as federal agency 

efforts to coordinate their programs, and examine agencies’ efforts to evaluate drug 

abuse prevention and treatment programs and ensure that they are effective. 

Specifically, in this report we (1) provide an initial review of the extent to which the 

2010 Strategy has been implemented, the extent to which ONDCP coordinates its 

implementation across drug control agencies, and how ONDCP assesses the 

effectiveness of the Strategy in preventing and reducing drug use; (2) review what 

agencies fund drug abuse prevention and treatment programs and how agencies 

coordinate their programs; and (3) provide an initial review of the extent to which 

federal agencies evaluate their drug abuse prevention and treatment programs and 

the extent to which agencies assess their programs’ effectiveness.

This is the first report in response to your request that we assess the implementation 

of the 2010 Strategy. This report describes the implementation approach, federal 

agencies’ drug abuse prevention and treatment programs, and Department of Health 

and Human Services (HHS), Department of Justice (DOJ), and Department of 

Education (Education) efforts to assess the effectiveness of their drug abuse 

prevention and treatment programs. We will continue our work on these issues and 

plan to evaluate the extent to which the 2010 Strategy has been implemented and 

coordinated across agencies and how ONDCP assesses the effectiveness of the 

Strategy in preventing and reducing drug use.

 

8

A program may be defined as an activity, project, function, or policy with an identifiable purpose or set of 

objectives. See GAO, Designing Evaluations: 2012 Revision, GAO-12-208G (Washington, D.C.: January 2012). 

We consider a program with an identifiable purpose or objective relating to drug abuse prevention or treatment 

as a drug abuse prevention or treatment program for the purpose of this report, regardless of whether the 

program has other identifiable purposes or objectives. 
4 GAO-12-744R Drug Control

To outline the planned implementation approach and the different programs, we 

analyzed the 2010 Strategy and 2011 update, ONCDP documents on 

implementation progress, and implementation plans and reports from selected 

federal drug control agencies. We also interviewed officials from ONDCP and from 

HHS, DOJ, and the Department of Homeland Security (DHS) about strategy 

implementation efforts.9 To identify what federal agencies fund drug abuse 

prevention and treatment programs, we reviewed the fiscal year 2013 Drug Control 

Budget that describes fiscal year 2012 allocations and interviewed ONDCP officials 

to confirm their process for developing the Drug Control Budget and their criteria for 

including agencies’ programs in the budget.10 We determined that the fiscal year 

2013 Drug Control Budget data are reliable for our purposes. Additionally, we 

reviewed documents regarding the drug abuse prevention and treatment programs 

of three national drug control agencies with some of the largest drug control budgets 

for prevention and treatment—HHS, DOJ, and Education—and interviewed officials 

from these agencies about their programs and about coordination efforts between 

agencies funding drug abuse prevention and treatment programs. To provide an 

assessment of federal agencies’ efforts to date to assess the effectiveness of their 

drug abuse prevention and treatment programs, we interviewed officials from our 

selected national drug control agencies as well as experts in the field of drug abuse 

prevention and treatment. Enclosure I provides additional information on our scope 

and methodology.

We conducted this performance audit from January 2012 through July 2012 in 

accordance with generally accepted government auditing standards. Those 

standards require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions based on 

our audit objectives. We believe that evidence obtained provides a reasonable basis 

for our findings and conclusions based on our audit objectives.

Results in Brief

To implement the 2010 National Drug Control Strategy, ONDCP obtained input from 

drug control stakeholders to help ensure that they shared responsibility for 

implementation, established a new process to determine progress made, and 

reported that most action items in the Strategy were on track or complete as of 

November 2011. ONDCP officials stated that they developed the 2010 Strategy’s 

seven objectives—for example, Strengthen Efforts to Prevent Drug Use in Our 

Communities—and 106 action items under these objectives through a consultative 

process with federal, state, and local drug control agencies and other stakeholders. 

 

9

Specifically, as of April 2012, we interviewed officials from the following four agencies: HHS, DHS, the Office of 

Justice Programs, and the Drug Enforcement Administration. We selected the agencies to focus on in our review 

based on a range of factors, including the number of Strategy action items for which agencies are responsible 

and the size of their drug control budgets. 

10ONDCP refers to these funds as enacted funding in the Drug Control Budget, while in this report we use the 

term allocated funding. At the beginning of a fiscal year, agencies may allocate certain amounts from available 

appropriations for specific programs. However, to the extent that an appropriation has not identified a particular 

amount for a specific program, an agency may reallocate unobligated funds from that program to another during 

the course of a fiscal year. To the extent other statutory authority results in makes mandatory funding for 

programs that may include drug abuse prevention and treatment, such as Medicare and Medicaid, we also 

include these as allocated funds. 
5 GAO-12-744R Drug Control

Officials from the four agencies we spoke with as of April 2012 stated that ONDCP 

sought input from them to develop the Strategy and that as a result, existing agency 

priorities and activities are reflected in the Strategy. ONDCP officials stated that this 

alignment helps facilitate Strategy implementation. In August 2010, ONDCP initiated 

a process to track progress made on Strategy action items. As part of this process, 

ONDCP requested that each agency develop and submit (1) a plan for implementing 

each action item for which it has lead responsibility and (2) status updates on 

implementation progress when requested. ONDCP officials stated that they use this 

and other information to determine the implementation status of each of the action 

items and then share the results with lead agencies in order to motivate them to take 

steps to address items that are not on track, among other things. In November 2011, 

ONDCP reported that 84 percent of the 113 action items in the 2010 Strategy and 

2011 update were on track or complete, while the remaining 16 percent were either 

delayed but progressing, facing budget issues, or at risk.11 ONDCP officials stated 

that this process to track and report on implementation progress helps hold agencies 

accountable for implementing action items.

HHS, DOJ, and Education allocated nearly 85 percent of the funding for federal drug 

abuse prevention and treatment programs in the Drug Control Budget in fiscal year 

2012. Of the approximately $10.1 billion allocated by federal agencies for drug 

abuse prevention and treatment programs in fiscal year 2012, HHS allocated 

approximately $8.3 billion and DOJ allocated approximately $186.1 million for 

prevention and treatment programs, while Education allocated about $64.9 million 

for prevention programs. These three agencies allocated funding to various drug 

abuse prevention and treatment programs, such as those that provide grants, 

education and outreach, and direct service, among others.12 HHS, DOJ, and 

Education primarily allocated funding to grant programs in fiscal year 2012, through 

which they awarded funding to states, communities, tribes, and other organizations 

to implement drug abuse prevention and treatment interventions. For example, the 

Substance Abuse and Mental Health Services Administration (SAMHSA) awards 

funds through the Substance Abuse Prevention and Treatment Block Grant Program 

to grantees to plan, carry out, and evaluate drug abuse prevention, early 

intervention, treatment, and recovery support services. Not less than 20 percent of 

funds awarded under this program must be spent by SAMHSA’s grantees for drug 

abuse education, counseling, and risk reduction activities.13

 

11ONDCP developed 106 action items for the 2010 Strategy and combined 2 action items and added 8 action 

items in the 2011 Strategy.

Officials from HHS, 

DOJ, and Education agencies also told us that they coordinate with each other, and 

other federal agencies, to deliver and fund drug abuse prevention and treatment 

programs through a variety of methods, including jointly administering programs, 

participating in working groups, and working together on an ad hoc basis. For 

example, officials from Education said they jointly administer and fund the Safe 

Schools/Healthy Students Initiative with HHS. DOJ is also a partner in this initiative, 

and collaboration among the three agencies is guided by an agreement that is 

signed annually by Education, HHS, and DOJ.

12The allocation of an amount to a specific program does not indicate that funds in that amount were actually 

spent on the program. 

13See 42 U.S.C. § 300x-22(a). 
6 GAO-12-744R Drug Control

HHS, DOJ, and Education assess the effectiveness of some of their grant programs 

by either requiring grantees to demonstrate the effectiveness of interventions they 

plan to use in their drug abuse prevention and treatment programs or giving 

preference to grant applicants that include interventions for which there is evidence 

of effectiveness in their applications for grants. Determining whether a program is 

effective involves evaluating the extent to which a program is meeting its goals. Both 

HHS and Education officials said that their agencies have requirements that 

grantees for some programs demonstrate the effectiveness of their planned drug 

abuse prevention or treatment interventions. For example, SAMHSA officials said 

that as a condition of funding, the agency requires, as part of its grant application 

process, that most grantees show that they will use evidence-based interventions in 

their programs. DOJ officials told us that during the grant application process for 

some programs, they give preference to applicants that include features that have 

been determined to be effective. HHS, DOJ, and Education have registries that 

include interventions related to drug abuse and prevention and treatment (among 

other topics) that are determined to be effective through research or evaluation, 

which grantees may use to document the effectiveness of their drug abuse 

prevention and treatment programs. We found that HHS, DOJ, and Education 

agency officials and other experts we spoke with reported various challenges in 

identifying interventions that are proven effective, including (1) availability of data 

needed to assess effectiveness, (2) ability to determine the impact of prevention 

interventions, and (3) applicability of interventions to different population groups 

other than the population for which the intervention was originally intended. For 

example, officials said that determining the impact of a prevention intervention can 

be difficult because it is often difficult to quantify something that did not happen—

such as a youth’s decision not to use an illicit drug—because of a preventive 

measure.

To Implement the 2010 Strategy, ONDCP Obtained Stakeholder Input, 

Established a Process to Determine Progress, and Reported That Most Action 

Items Were on Track

ONDCP used input from drug control stakeholders to develop the 2010 Strategy’s 

objectives and action items to help ensure shared responsibility. ONDCP also 

established a process to determine implementation status, including requesting that 

agencies submit updates on progress made. In November 2011, ONDCP reported 

that 84 percent of the 113 action items in the Strategy were on track or complete.

ONDCP Sought Stakeholder Input to Help Develop Strategy Priorities and Ensure 

Shared Responsibility for Implementation

ONDCP officials stated that to help ensure successful implementation, the agency 

developed the Strategy through a consultative process with federal, state, and local 

drug control agencies and other stakeholders, including state and local leaders, such 

as governors, mayors, and law enforcement officials. According to these officials, a 

cross-agency effort was required to develop the Strategy because the drug control 

agencies have primary responsibility for its implementation and needed to be 

involved to ensure that they understood their implementation responsibilities. An 

ONDCP senior official stated that through its outreach efforts, ONDCP sought to 
7 GAO-12-744R Drug Control

instill a sense of shared ownership and buy-in from the drug policy community. 

Officials from ONDCP and the four agencies we spoke with as of April 2012 stated 

that ONDCP used input solicited through this consultative process to develop the 

seven objectives and 106 action items under these objectives in the Strategy.14

Further, to guide the implementation of federal drug policy activities in support of the 

Strategy, lead agencies and participating agencies were designated for each action 

item as a means to assign implementation responsibility.

To help develop and implement the Strategy, ONDCP established, among other 

things, the Interagency Working Group on Demand Reduction (IWG) to bring 

together the 40 federal agencies involved in drug control activities. According to 

officials from ONDCP and the 4 agencies with whom we spoke, the IWG meetings 

were the primary forum for consulting with stakeholders to develop the Strategy.15

The Director of ONDCP stated in 2010 testimony before a House subcommittee that 

working group meetings were used as the foundation for the 2010 Strategy and 

helped to formulate long-term policy goals for increasing the emphasis on preventing 

and treating substance abuse. The Director also noted that the IWG process 

highlighted programs that worked—specifically, drug court programs, communitybased antidrug coalitions, and corrections programs aimed at helping steer drug 

offenders toward productive lives.16 ONDCP incorporated these programs into the 

2010 Strategy and helped identify implementation responsibilities for relevant drug 

policy agencies, all of which were included in the Strategy development process. For 

example, ONDCP established several action items relating to drug court programs 

under its Strategy objective to Break the Cycle of Drug Use, Crime, Delinquency, 

and Incarceration. The majority of lead implementation responsibilities were 

assigned to the Office of Justice Programs (OJP), whose officials agreed that these 

action items fell under OJP’s mission areas and were appropriately assigned. Also, 

ONDCP continues to utilize the IWG to help implement the Strategy. For example, 

HHS officials said that an IWG meeting was convened in early 2012 to discuss how 

to best address Strategy initiatives to help reduce synthetic drug production and 

use.17

 

14The objectives are (1) Strengthen Efforts to Prevent Drug Use in Our Communities; (2) Seek Early Intervention 

Opportunities in Health Care; (3) Integrate Treatment for Substance Use Disorders into Health Care, and Expand 

Support for Recovery; (4) Break the Cycle of Drug Use, Crime, Delinquency, and Incarceration; (5) Disrupt 

Domestic Drug Trafficking and Production; (6) Strengthen International Partnerships; and (7) Improve 

Information Systems for Analysis, Assessment, and Local Management. In addition to the 106 action items in the 

2010 Strategy, ONDCP combined 2 and added 8 action items in the 2011 Strategy. 

15According to ONDCP, participation in the IWG meetings was open to any interested agency and included 

representation from the Drug Enforcement Administration and the DHS’s U.S. Customs and Border Protection. 

ONDCP also stated that all law enforcement agencies had opportunities to provide input on the development of 

the 2010 Strategy, such as providing comments on the outline and then drafts of the Strategy.

16ONDCP’s Fiscal Year 2011 National Drug Control Budget: Are We Still Funding the War on Drugs, Before the 

Subcommittee on Domestic Policy of the H. Comm. on Oversight and Government Reform, 111th Cong. 12 

(2010) (statement of R. Gil Kerlikowske, Director, Office of the National Drug Control Policy). 

17In the 2012 update to the Strategy, ONDCP highlighted the use of two synthetic drugs, synthetic marijuana 

(often known as K2 or Spice) and bath salt products. Synthetic marijuana consists of plant materials that have 

been laced with substances that users claim mimic the primary psychoactive ingredient in marijuana, and bath 

salts contain man-made chemicals related to amphetamines.
8 GAO-12-744R Drug Control

Officials from the four agencies we spoke with as of April 2012 stated that as a result 

of ONDCP’s consultative Strategy development process, existing agency priorities 

and activities are reflected in the Strategy. For example, Drug Enforcement 

Administration (DEA) officials stated that DEA included curbing prescription drug 

abuse as a priority in its drug enforcement efforts, which ONDCP, in turn, highlighted 

in the Strategy. ONDCP officials stated that such consistent alignments to the 

Strategy help facilitate its implementation.

ONDCP Has Established New Mechanisms to Track Strategy Implementation and 

Reported That 84 Percent of Action Items Were on Track or Complete as of 

November 2011

ONDCP has established a unit and a new process to determine the implementation 

status of Strategy action items, as well as the Performance Reporting System that 

according to ONDCP officials, incorporates key performance measures to assess 

progress toward the objectives and goals of the Strategy. In November 2011, 

ONDCP reported that 84 percent of action items were on track or complete.

Mechanisms to Track Strategy Implementation and Report Performance

ONDCP established the Delivery Unit and implemented a new process to track 

progress made on each Strategy action item. ONDCP officials stated that in August 

2010, following the issuance of the 2010 Strategy, ONDCP formed the Delivery Unit 

to help ensure the successful implementation of the action items in the Strategy. The 

unit reports to the Chief of Staff and consists of two staff members who support the 

unit as a collateral duty and perform responsibilities such as providing updates on 

implementation progress to ONDCP managers. Coinciding with the establishment of 

the Delivery Unit, the Director of ONDCP issued a letter to agency department 

heads to formally initiate the process for Strategy implementation. The letter 

requested that agencies develop and submit (1) a plan for implementing each action 

item for which they have lead responsibility and (2) status updates on 

implementation progress when requested, which are to address the objectives and 

milestones in the plan. The Delivery Unit established a template in the Office of 

Management and Budget’s MAX Collect system to assist agencies in developing 

these submissions and to help ensure that the information provided is consistent 

across agencies.18 ONDCP officials stated that they use this information as part of 

their process to help hold agencies accountable for implementing Strategy action 

items.

ONDCP’s process to track progress made on Strategy action items relies to a great 

extent on the cooperation and assistance of implementing agencies. Because 

agency implementation plans are to include measurable objectives for implementing 

action items and key milestones, lead agencies are responsible for specifying the 

scope of the action items, such as the types of programs on which to focus, and how 

they are implemented. For example, the National Institute of Justice, which funds 

research on criminal justice issues, is the lead agency for the action item to Promote 

 

18The MAX Information System is used to support the Office of Management and Budget’s federal management 

and budget processes. MAX Collect is a data collection and publishing tool within the system.
9 GAO-12-744R Drug Control

Best Practices as Alternatives to Incarceration, and has defined implementation 

through the objectives and milestones it established, as shown in figure 1.

Figure 1: Strategy Action Item to Promote Best Practices as Alternatives to Incarceration and National 

Institute of Justice Objective and Milestones to Address It

a

According to Office of Management and Budget guidance, randomized controlled trials—studies that randomly assign 

individuals or other units into experimental and control groups—are generally the highest-quality, unbiased evaluations for 

demonstrating the actual impact of a program.

b

Vera Institute of Justice is studying the impact of recent changes to New York State drug laws that allow shorter sentences 

and alternatives to incarceration for certain felony drug charges. Research will, among other things, (1) compare recidivism 

outcomes for individuals charged with felony drug crimes before and after the reforms and (2) measure the reforms’ impact by 

conducting a cost-benefit analysis of changes to sentencing. The National Institute of Justice awarded Vera Institute of Justice 

a grant for $699,937 to conduct this research.

c

The National Institute of Justice awarded the Center for Court Innovation a grant for $389,093 to conduct this research.

ONDCP officials stated that they assigned a staff member with issue-area 

knowledge to each action item, who, among other things, reviews the agency’s plan 

to ensure that it is sufficient to fulfill the action item and feasible given the resources 

and time available for implementation.

As part of its process to track progress made on Strategy action items, ONDCP also 

relies on lead agencies to provide reports on implementation progress—based on 

their plans—in response to periodic Delivery Unit data calls and to consult with 

participating agencies in submitting these reports. However, our review of reports 

submitted as of November 2011 by our selected DOJ agencies—OJP and DEA—for 

the 11 prevention and treatment action items for which they are responsible found 

that 2 of the reports for OJP-led action items did not provide any progress updates.19

 

19As of April 3, 2012, ONDCP had provided all of the implementation status reports for prevention and treatment 

action items submitted by our selected DOJ agencies, OJP and DEA. We also had spoken with officials in both 

of these agencies to gain a better understanding of the information included in these reports. Agencies have 

since updated the information in their MAX Collect reports in response to a data call from ONDCP in April 2012.

While there is no formal mechanism to validate the information agencies provided 

through the system, Delivery Unit officials stated that ONDCP gains an 

understanding of the work agencies are doing through interagency working group 

meetings, agency budget submissions, and ongoing and informal communication 
10 GAO-12-744R Drug Control

with agency contacts. ONDCP officials stated that when an agency report lacks 

important information, the ONDCP staff person responsible for supporting the action 

item would, among other things, work with the lead agency to update the information 

in MAX Collect. Also, 2 of the 11 reports contained certifications that the lead agency 

consulted with colead and participating agencies and reached consensus on what 

was submitted, while the remaining 9 did not. According to ONDCP officials, this 

does not imply that participating agencies object to the plans or reports, but rather 

that some portions of the content may still be under discussion. They said that this 

may also be due to the timing of ONDCP’s data solicitation in April 2012. Further, 

OJP and DEA officials stated that they coordinated with participating agencies, but 

that it can be challenging getting responses from them even if they do not object to 

the information submitted. These officials said that it would be helpful if each 

participating agency could certify that it was consulted in MAX Collect. ONDCP 

officials agreed that this could prove a useful addition.

ONDCP uses the information collected from lead agencies to classify action items 

into five categories—complete, on track, delayed but progressing, facing budget 

issues, and at risk.20 Specifically, ONDCP officials stated that the Delivery Unit 

tentatively categorizes each action item and then forwards the categorization and 

relevant information to the staff member assigned to the action item to review, revise 

if necessary, and validate the unit’s categorization. These officials said that this 

process draws heavily upon the expertise of the staff member, as well as the 

member’s working relationships with lead agency contacts. ONDCP completed its 

first categorization of action items in November 2011 and, according to officials, 

shared the results with lead agency contacts, which gives agencies credit for 

progress made and helps to motivate them, if needed, to take steps to address 

action items that are not on track.

In addition to tracking the implementation status of action items, ONDCP recently 

established the Performance Reporting System that according to ONDCP officials, 

will provide strategic-level reporting on the performance of drug control programs 

across agencies. These officials said that the system has been in development since 

December 2009 and will be used to begin assessing progress toward the Strategy’s 

goals and objectives later this year. The April 2012 Performance Reporting System 

report stated that the system will collect data from federal drug control agencies and 

from other sources in order to report on measurable outcomes that the Strategy 

seeks to achieve by 2015. In the Strategy, ONDCP established two main policy 

goals to be attained by 2015: (1) curtail illicit drug consumption in the United States 

and (2) improve the public health and public safety of the American people by 

reducing the consequences of drug abuse.21

 

20ONDCP provided the following definitions of its categories: (1) Complete. The work specifically directed by the 

Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved 

or that work in progress in support of those goals should be halted. (2) On track. Implementation is under way, 

and the work being done is consistent with the fulfillment of the action item within the time frame specified. 

(3) Delayed but progressing. Work has started but has slowed or stalled, or the work being done is not ambitious 

enough to fulfill the action item in the time frame specified. (4) Facing budget issues. Work has stopped or been 

significantly impeded by funding shortfalls. (5) At risk. Work has never begun or has ceased.

ONDCP also established outcome 

21The Strategy must contain a plan for reducing the consequences of illicit drug use, including national health 

care costs and drug-related crime and criminal activity. See 21 U.S.C. § 1705(a)(2)(A) (vii).
11 GAO-12-744R Drug Control

measures to assess the effectiveness of the Strategy in accomplishing these goals, 

such as 15 percent reductions in the number of chronic drug users, drug-induced 

deaths, and drug-related morbidity. ONDCP officials stated that the system was 

developed with input from some federal drug control agencies and incorporates new 

performance metrics that will be used to assess cross-agency progress toward the 

goals and seven objectives in the Strategy and provide feedback on how agencies’ 

efforts are contributing to the Strategy. For example, under the Strategy objective to 

Strengthen Efforts to Prevent Drug Use in Our Communities, ONDCP established a 

new performance metric to increase the age of initiation for illicit drugs from an 

average of 17.6 years of age to 19.5 by 2015. According to the Performance 

Reporting System report, delaying the age of initiation is a sound indicator of the 

effectiveness of agency prevention initiatives that aim to reduce youth drug use.

ONDCP’s Categories Denoting Progress in Implementing Strategy Action 

Items and Steps Taken to Address Delays

ONDCP reported in November 2011 that 84 percent of the 113 action items in the 

2010 Strategy and 2011 update were on track or complete, and stated that it has 

taken actions to help address those action items that were delayed or not 

progressing.22 Figure 2 shows the number of action items in each of the ONDCP’s 

five implementation status categories.

 

22ONDCP reported on its action item categorizations at an interagency meeting in November 2011 with HHS, 

DOJ, DHS, and other agencies to discuss progress toward implementing the Strategy.
12 GAO-12-744R Drug Control

Figure 2: Number of Action Items in ONDCP’s Five Implementation Status Categories, as of November 

2011

Notes: N=113. ONDCP defines the implementation status categories as follows: (1) Complete. The work specifically directed 

by the Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved or that 

work in progress in support of those goals should be halted. (2) On track. Implementation is under way, and the work being 

done is consistent with the fulfillment of the action item within the time frame specified. (3) Delayed but progressing. Work has 

started but has slowed or stalled, or the work being done is not ambitious enough to fulfill the action item in the time frame 

specified. (4) Facing budget issues. Work has stopped or been significantly impeded by funding shortfalls. (5) At risk. Work has 

never begun or has ceased.

An example of an action item that ONDCP has categorized as complete is the 

ONDCP-led action item to Mobilize Parents to Educate Youth to Reject Drug Use. 

According to the description of the action item in the 2010 Strategy, the White House 

Office of Faith-Based and Neighborhood Partnerships is fostering greater 

engagement of fathers in the lives of their children, including initiatives to help 

fathers and mothers protect their children from drugs.23

 

23The Office of Faith-Based and Neighborhood Partnerships works to form partnerships between the federal 

government and faith-based and neighborhood organizations to more effectively serve Americans in need.

It also states that SAMHSA 

continues to provide support for parents using evidence-based interventions. To 

complete this action item, the Office of Faith-Based and Neighborhood Partnerships, 

among other things, held regularly scheduled meetings with federal agencies to 

promote fatherhood-related activities, and ONDCP and HHS updated websites to 

help ensure that the most recent information on youth drug abuse was available to 

the parents. In contrast, in November 2011 ONDCP categorized the SAMHSA-led 

action item to Develop Prevention-Prepared Communities as facing budget issues. 

The description for this action item states that the new Prevention-Prepared 

Communities program will focus on youth to implement evidence-based prevention 

services through multiple venues and address common risk factors for substance 

abuse, among other things. It states that agencies will coordinate their grants and 

technical assistance such that communities and the youth in them are continuously 

surrounded by protective factors rather than protected only in a single setting or at a 
13 GAO-12-744R Drug Control

single age. HHS officials stated that the action item was not implemented because of 

lack of funding to award cooperative grants at the community and state levels. 

According to ONDCP and SAMHSA officials, SAMHSA’s Strategic Prevention 

Framework, which is implemented through a state incentive grant program, 

incorporates elements of the Develop Prevention-Prepared Communities action 

item, such as an emphasis on community-based and data-driven prevention.24

ONDCP also reported on the implementation status of action items within each 

of the Strategy’s seven objectives. (See fig. 3.) As of November 2011, 4 of the 

10 action items in ONDCP’s Strategy objective to improve information systems were 

complete, but 2 were facing budget issues. For example, the action item to 

Strengthen Drug Information Systems Focused on Arrestees and Incarcerated 

Individuals was among those that were facing budget issues. National Institute of 

Justice officials stated that the development of a new Arrestee Drug Abuse 

Monitoring program to collect better information on the extent of drug use among

male arrestees was not funded.25 As a result, the National Institute of Justice and the 

Bureau of Justice Statistics have suspended planning efforts for this action item, 

such as developing a protocol for producing nationally representative estimates of 

drug use in the arrestee population. According to ONDCP officials, data on arrestees 

will still be collected, but efforts to improve the reliability of the data are on hold. 

ONDCP also reported that the majority of action items under its other six Strategy 

objectives were complete or on track. However, 3 of the 19 action items under the 

objective to Strengthen International Partnerships were delayed but progressing, 

and 1 of the action items—Promote Alternative Livelihoods for Coca and Opium 

Farmers—was at risk as of November 2011. This ONDCP-led action item calls for 

the U.S. Agency for International Development to continue supporting programs that 

provide, among other things, incentives to wean farmers away from illicit crop 

cultivation.26

 

24In its report on HHS’s fiscal year 2011 appropriation bill, the Senate Committee on Appropriations did not 

recommend funding for the Develop Prevention-Prepared Communities initiative because it believed the 

proposal would be redundant given the work of SAMHSA’s Partnerships for Success program, which includes 

implementation of the Strategic Prevention Framework. S. Rep. No. 111-243, at 138 (2010) (the bill under 

consideration did not become law). 

The January 2012 report on implementation progress indicated that 

rural and agricultural development programs have yielded results, such as the 

creation of new jobs, infrastructure projects, and alternative crop cultivation. ONDCP 

officials stated that while the implementation of this action item was occurring, it was 

classified as at risk in November 2011 primarily because of the lack of a central point 

of contact within the U.S. Agency for International Development who could 

consolidate the input from its various regional bureaus and report on implementation 

efforts to ONDCP. These officials said that ONDCP and the U.S. Agency for 

International Development have since agreed that the solution was to have ONDCP 

consolidate the information received from the U.S. Agency for International 

Development’s regional bureaus.

25According to ONDCP’s 2010 Arrestee Drug Abuse Monitoring II annual report, data from this program are 

essential to any comprehensive discussion of drug use because they represent a group of drug users not well 

represented in any other survey—males 18 years and older at the point of their involvement in the criminal 

justice system. The report shows that these drug users consume drugs at a substantially higher frequency than 

individuals traditionally surveyed.

26The U.S. Agency for International Development provides economic, development, and humanitarian 

assistance around the world in support of the foreign policy goals of the United States.
14 GAO-12-744R Drug Control

Figure 3: Number of Action Items in ONDCP Implementation Status Categories by Strategy Objective, as 

of November 2011

Note: ONDCP defines the implementation status categories as follows: (1) Complete. The work specifically directed by the 

Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved or that work in 

progress in support of those goals should be halted. (2) On track. Implementation is under way, and the work being done is 

consistent with the fulfillment of the action item within the time frame specified. (3) Delayed but progressing. Work has started 

but has slowed or stalled, or the work being done is not ambitious enough to fulfill the action item in the time frame specified. 

(4) Facing budget issues. Work has stopped or been significantly impeded by funding shortfalls. (5) At risk. Work has never 

begun or has ceased.

According to ONDCP officials, causes of delays or lack of progress in implementing 

action items include lack of coordination among participating agencies, termination 

of programs, reorganization of staff, departure of key personnel, and the need for 

sufficient funding. These officials stated that the actions they have taken to address 

these issues include coordinating at the interagency level by, for example, bringing 

together action item partners; helping to establish contacts within other agencies; 

and highlighting issues in ONDCP’s annual budget funding guidance that it provides 

to drug control agencies, which is intended to delineate Strategy priorities that 

agencies are expected to fund. They stated that ONDCP must rely on agencies to 

include its priorities in their budget submissions to ensure that the Strategy is 

adequately resourced. Each fiscal year, ONDCP assesses the adequacy of agency 

budget submissions to implement the Strategy and certifies or decertifies the 

submissions accordingly.27

 

27We reported on the Drug Control Budget process in GAO-11-261R. If ONDCP determines that an agency’s fall 

budget submission is adequate to implement the Strategy, ONDCP issues a written notice stating that the 

agency’s drug budget is certified. If ONDCP determines that an agency’s fall budget submission is inadequate, 

ONDCP issues a written notice stating that the agency’s drug budget is decertified, and the agency is required to 

submit a revised budget, which is to include the funding levels and specific initiatives that would make the budget 

request adequate to implement the Strategy. ONDCP provides a copy of the decertification to the Senate and the 

House of Representatives and the appropriate congressional committees.
15 GAO-12-744R Drug Control

ONDCP officials stated that the data on which their review of action items was based 

were collected in October 2011, and it is highly probable that there has been some 

movement among the categories since then. These officials told us that they plan to 

update their categorizations biannually, with the next review planned for mid-2012. 

To assess the extent to which the Strategy has been implemented, we will continue 

to analyze ONDCP and agency reports on implementation progress, including 

ONDCP’s biannual update to its 2011 review of action items, and validate the results 

of this review. We will also continue to interview agency officials about actions taken 

to implement and coordinate Strategy action items and assess the effect of efforts to 

address implementation delays or lack of progress. In addition, our ongoing work will 

assess how ONDCP uses the Performance Reporting System and associated 

metrics to assess progress toward Strategy goals and objectives relating to 

prevention and treatment, what the metrics indicate about progress made, and 

agency perspectives on the system.

HHS, DOJ, and Education Fund Multiple Drug Abuse Prevention and 

Treatment Programs and Coordinate through a Variety of Methods

Three agencies in the Drug Control Budget allocated nearly 85 percent of the 

funding to federal drug abuse prevention and treatment programs included in the 

Drug Control Budget in fiscal year 2012. Officials from HHS, DOJ, and Education 

agencies reported that they coordinate to provide drug abuse prevention and 

treatment programs through a variety of methods.

Three Agencies in the Drug Control Budget Allocated Nearly 85 Percent of Funding 

to Several Types of Prevention and Treatment Programs in Fiscal Year 2012

HHS, DOJ, and Education allocated nearly 85 percent of the funding for federal drug 

abuse prevention and treatment programs in the Drug Control Budget in fiscal year 

2012. Of the approximately $10.1 billion allocated by federal agencies for drug 

abuse prevention and treatment programs in fiscal year 2012, HHS allocated 

approximately $8.3 billion and DOJ allocated approximately $186.1 million for 

prevention and treatment programs, while Education allocated almost $64.9 million 

for prevention programs. Specifically, HHS allocated more than 80 percent of 

funding for the drug abuse prevention and treatment programs included in the Drug 

Control Budget. Of the HHS allocation, the Centers for Medicare & Medicaid 

Services allocated about 54 percent of the total funding in support of its drug abuse 

treatment services through the Medicare and Medicaid programs. (See fig. 4.) For 

additional information on drug abuse prevention and treatment funding allocated by 

agencies included in the Drug Control Budget in fiscal year 2012, see enclosure II.
16 GAO-12-744R Drug Control

Figure 4: Percentages of Drug Abuse Prevention and Treatment Funding Allocated by Agencies Included 

in the Drug Control Budget in Fiscal Year 2012, by Agency

Note: Values may not add to 100 percent because of rounding.

HHS, DOJ, and Education allocated funding to various types of drug abuse 

prevention and treatment programs, such as those that provide grants, education 

and outreach, and direct service, among other things.28 Table 1 identifies the number 

of drug abuse prevention and treatment programs that were allocated funding by 

each of these three agencies, by type of program.

 

28The allocation of an amount to a specific program does not indicate that funds in that amount were actually 

spent on the program. 
17 GAO-12-744R Drug Control

Table 1: Number of Drug Abuse Prevention and Treatment Programs Allocated Funding by the 

Departments of Health and Human Services, Justice, and Education That Are Included in the Drug 

Control Budget, by Type of Program, for Fiscal Year 2012 

Types of programs

Agencya Grant Education and outreach Direct service Otherb Total

Department of Health and 

Human Servicesc 20d 8 0 9 37

Department of Justice 5 1 4 - 10

Department of Educatione 1 - - - 1 

Total 26 9 4 9 48

Source: GAO analysis of information from the Departments of Health and Human Services, Justice, and Education.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use 

of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug 

abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through 

such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment 

methods.

a

We define agencies as federal departments and their component agencies, bureaus, divisions, and offices.

b

Other programs that include drug abuse prevention and treatment activities may involve, for example, certifying and 

maintaining quality assurance of laboratories that perform mandatory drug testing for federal and federally regulated 

employees.

c

We did not include the Centers for Medicare & Medicaid Services in our more detailed review of programs because it allocates 

funding to drug treatment services solely as part of eligible participants’ medical services and does not fund or administer drug 

abuse prevention or treatment interventions or research. We include the National Institutes of Health’s (NIH) drug abuse 

prevention and treatment research and development activities that are included in the Drug Control Budget in our analysis; 

however, NIH officials told us that the agency does not refer to its research and development activities as programs.

d

NIH officials told us that four of its activities provide research funding through contracts and cooperative agreements, in 

addition to grants.

e

The Department of Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and 

Communities Act for drug treatment. See 20 U.S.C. § 7164.

We found that in fiscal year 2012, HHS, DOJ, and Education primarily allocated 

funding to grant programs through which they award funding to states, communities, 

tribes, and other organizations. These grantees then use the federal funds to 

implement program activities involving drug abuse prevention, drug abuse treatment, 

or both. For example:

• SAMHSA makes grant awards to 50 states, nine territories (including the District 

of Columbia), and one Indian tribe through the Substance Abuse Prevention and 

Treatment Block Grant Program for grantees to plan, carry out, and evaluate 

drug abuse prevention, early intervention, treatment, and recovery support 

services provided for individuals, families, and communities affected by 

substance use disorders. Not less than 20 percent of funds awarded under this 

program must be spent by SAMHSA’s grantees for drug abuse education, 

counseling, and risk reduction activities.29

• The Indian Health Service’s (IHS) Urban Indian Health Program Title V 4-in-1 

Grants program provides funding to urban Indian nonprofit organizations to serve 

urban American Indians and Alaska Natives affected by drug abuse through 

prevention and treatment programs.

 

29See 42 U.S.C. § 300x-22(a).
18 GAO-12-744R Drug Control

• OJP provides grant funding under the Second Chance Act Adult Offenders with 

Co-Occurring Substance Abuse and Mental Health Disorders program.30 Under 

this program, funding is available to grantees to implement or expand treatment 

programs for offenders with co-occurring substance abuse and mental health 

disorders that improve the provision of treatment for these individuals.

Grant programs may also fund technical assistance and training activities for 

grantees. For example, Education awards grants for financial and technical 

assistance under its Safe and Supportive Schools program to state education 

authorities to support statewide measurement of, and targeted programmatic 

interventions to improve, conditions for learning in order to help schools improve 

student safety and reduce drug use. Grant programs may also fund drug abuse 

prevention and treatment research activities, such as the National Institutes of 

Health’s (NIH) grants for basic and clinical neuroscience research, which are 

intended to expand the agency’s understanding of the neurobiological, genetic, and 

behavioral factors that underlie drug abuse and addiction.

HHS and DOJ also allocate funding to public education and outreach programs that 

are implemented directly by the agencies, which may distribute information to the 

public on specific types of drug use or disorders, or provide technical assistance and 

training. For example, SAMHSA’s Center for the Application of Prevention 

Technologies provides technical assistance and training activities, among other 

activities, to build the ability of SAMHSA’s grantees to implement prevention 

interventions. DOJ also allocates funding to direct service programs—programs in 

which an agency directly administers drug abuse prevention and treatment 

interventions to a defined population. For example, the Bureau of Prisons (BOP) 

provides drug abuse prevention and treatment services to the federal inmate 

population.

Finally, HHS also allocates funding to several other programs that include drug 

abuse prevention and treatment activities. For example, SAMHSA allocates funding 

to the Mandatory Drug Testing program to certify and maintain quality assurance of 

laboratories that perform mandatory drug testing for federal and federally regulated 

employees.

We also found that HHS and Education allocate funding to programs or program 

components that include drug abuse prevention and treatment activities that are not 

included in these agencies’ submissions to the Drug Control Budget. Specifically, 

these programs include the Health Resources and Services Administration’s (HRSA) 

Ryan White HIV/AIDS program and Health Center Program and Education’s 21st 

Century Community Learning Centers program. Officials from HRSA told us that the 

Ryan White HIV/AIDS program is not included in the Drug Control Budget because 

the program does not directly award funding for drug abuse treatment, although drug 

abuse treatment may be one of the many services that eligible participants receive. 

 

30This program is authorized under the Second Chance Act of 2007, which authorizes grants to states, units of 

local government, territories, and Indian tribes to, among other things, improve the provision of drug treatment to 

adult offenders in prisons and jails and reduce the use of drugs by long-term substance abusers through the 

completion of parole or court supervision of long-term substance abusers. See Pub. L. No. 110-199, § 201(a), 

122 Stat. 657, 678 (codified at 42 U.S.C. § 17521(a)). 
19 GAO-12-744R Drug Control

HRSA officials also said that the agency does not identify the amount of funds spent 

on specific services until grantees report on how they expended grant funds.31

HRSA officials also identified a program in which its drug abuse prevention activities 

are not included in the Drug Control Budget, but its drug abuse treatment activities 

are included. Specifically, these officials said that funding for the HRSA Health 

Center Program’s drug abuse treatment services is included in the Drug Control 

Budget because HRSA can determine the specific amount of funding that health 

center grantees spend on these services. However, HRSA officials said it is difficult 

to quantify the amount of funding used for prevention counseling services because 

they are provided as part of a clinician’s standard medical services and not as a 

separate service identifiable by a grantee. As a result, the program’s drug abuse 

prevention services are not included in the Drug Control Budget. Additionally, 

Education’s 21st Century Community Learning Centers program is not included in 

the Drug Control Budget because officials told us that drug abuse prevention is only 

one of a large number of authorized uses for these funds. Officials also said that the 

agency does not have a viable, cost-effective methodology for compiling the data 

that would be used to estimate the amount of funds spent on drug abuse prevention 

in this program.

ONDCP officials told us that they annually review programs and agencies that are 

not included in the budget to determine if it would be appropriate to include these 

programs in the next year’s budget. For example, the Centers for Medicare & 

Medicaid Services was added to the fiscal year 2012 Drug Control Budget as part of 

ONDCP’s efforts to restructure the budget and the agencies it includes. An ONDCP 

official told us that the agency does not estimate the amount of federal drug control 

funding that is not included in the Drug Control Budget. However, the official said 

that the agency is confident that the Drug Control Budget includes all federal drug 

control funding for programs that are related to drug control and for which agencies 

have an appropriate methodology to determine funding for inclusion in the Drug 

Control Budget. For a list of drug abuse prevention and treatment programs funded 

by HHS, DOJ, and Education that are either included or not included in the Drug 

Control Budget and details about these programs, see enclosure III.

HHS, DOJ, and Education Officials Reported That They Coordinate to Provide Drug 

Abuse Prevention and Treatment Programs through a Variety of Methods

Officials from HHS, DOJ, and Education agencies told us they coordinate with each 

other and other federal agencies to deliver and fund drug abuse prevention and 

treatment programs through a variety of methods, including jointly administering 

programs, participating in working groups, and working together on an ad hoc 

basis—such as by building relationships with other agencies that support drug abuse 

prevention and treatment programs.32

 

31HRSA officials also said that grantees assess service needs in their communities and, as a result, may allocate 

funding for substance abuse treatment based on the needs assessment. Grantees are required to report 

expenditures of program funding by type of service annually. 

Officials from HHS, DOJ, and Education 

32We did not examine coordination activities for all programs or federal agencies, nor did we review all 

coordination efforts by ONDCP. We will examine coordination activities more fully as part of our ongoing work. 
20 GAO-12-744R Drug Control

agencies said that each agency coordinates with other federal agencies through the 

joint administration of programs. For example, SAMHSA provides all grant 

administration and management of services for the Drug Free Communities 

Program, which Congress authorizes and appropriates within the ONDCP budget, 

according to an interagency agreement guiding the relationship. ONDCP officials 

said that the agency has partnered with SAMHSA through an interagency 

agreement since 2005. Officials from OJP said that they issue a joint grant 

solicitation with SAMHSA—the Joint Adult Drug Court Solicitation—in which OJP 

provides primary funding for drug court management and operations, while 

SAMHSA officials reported that their agency provides funding for enhancement and 

expansion of substance abuse treatment services. Additionally, officials from 

Education said they jointly administer and fund the Safe Schools/Healthy Students

Initiative with HHS. DOJ is also a partner in this initiative, and collaboration among 

the three agencies is guided by an agreement that is signed annually by Education, 

HHS, and DOJ. According to the agreement, the initiative is led, managed, and 

supported by the three agencies to support school and community partnerships with 

integrated systems that prevent drug abuse and violence. Other initiative activities 

include promoting the mental health of students, enhancing academic achievement, 

and creating safe and respectful school climates.

Officials from HHS, DOJ, and Education agencies told us that another way in which 

they coordinate their drug abuse prevention and treatment program efforts is through 

interagency working groups. HHS, DOJ, and Education agency officials told us that 

they participate in ONDCP’s IWG to collaborate on the development of the Strategy. 

HHS agency officials also told us they participate in sub-working groups within the 

IWG that meet to discuss specific drug abuse prevention and treatment topic areas. 

According to SAMHSA officials, participating in the IWG and its sub-working groups 

facilitates coordination between multiple federal agencies working on similar issues 

related to drug abuse prevention and treatment.

HHS, DOJ, and Education officials also told us they participate in a variety of other 

federal agency working groups that also address drug abuse prevention and 

treatment activities. For example, officials from Education said that they participate 

in the Interagency Coordinating Committee on the Prevention of Underage Drinking, 

which is chaired by the Administrator of SAMHSA. The committee was formally 

established pursuant to the Sober Truth on Preventing Underage Drinking Act and 

focuses on guiding policy and program development across the federal government 

with respect to underage drinking.33

 

33Pub. L. No. 109-422, § 2, 120 Stat. 2890 (2006) (codified at 42 U.S.C. § 290bb-25b(c)). 

Education officials said that this group serves as 

a mechanism for coordinating federal efforts around the issue of underage drinking, 

and the group meets at least once a month to discuss activities across the federal 

government on the issue and how to better coordinate their efforts. In addition, 

officials from OJP and SAMHSA said that OJP initially convened an interagency 

working group—the Federal Consortium to Address the Substance Abusing 

Offender—which works to develop information for state and local officials to assist 

with effective drug abuse treatment protocols, communication and reporting 

strategies, data collection, and research on substance abusing offenders. SAMHSA 

now chairs this consortium, which includes representatives from agencies involved 
21 GAO-12-744R Drug Control

in addressing issues related to drug abuse and crime, including several component 

agencies from HHS and the National Highway Traffic Safety Administration.

Finally, HHS, DOJ, and Education agency officials said they coordinate on an ad hoc 

basis with officials from other federal agencies to support drug abuse prevention and 

treatment activities. For example, NIH officials told us they meet regularly with 

officials from other federal agencies to share information on drug abuse prevention 

and treatment research, such as by participating in conferences held by ONDCP. 

Education officials told us that they worked with NIH’s National Institute on Drug 

Abuse to promote National Drug Facts Week by publicizing the event to schools and 

school-based organizations. DOJ officials from BOP and OJP also said that they 

work with officials from the Department of Veterans Affairs to better understand how 

to serve veterans involved in the justice system who have drug abuse problems.

Some HHS, DOJ, and Education Grant Programs Require or Give Preference to 

Grantees That Demonstrate Effective Interventions

Some HHS, DOJ, and Education grant programs either require grantees to 

demonstrate the effectiveness of the interventions they plan to use in drug abuse 

prevention and treatment programs or give preference to grant applicants that 

include interventions for which there is evidence of effectiveness in their grant 

applications. Program effectiveness involves the application of an evaluation method 

to determine whether a program is meeting its goals. HHS’s SAMHSA officials said 

that as a condition of funding, the agency requires, as part of its grant application 

process, that most grantees show that they will use evidence-based interventions in 

their programs. These officials said grantees can meet this requirement by 

documenting that their interventions have been reviewed in the agency’s National 

Registry of Evidence-Based Programs and Practices (NREPP) or in other sources 

that determine effectiveness of interventions. Registries supported by HHS, DOJ, 

and Education include interventions related to drug abuse prevention and treatment 

(among other topics) that are determined to be effective through research or 

evaluation by agency officials or their selected reviewers.34 NREPP, established by 

SAMHSA in 1997, reviews interventions to identify those that prevent or treat drug 

abuse, mental illness, or co-occurring disorders and promote mental health among 

individuals, communities, or populations. NREPP maintains a searchable online 

registry, which currently includes more than 230 drug abuse prevention and 

treatment and mental health promotion interventions that have been reviewed and 

rated by independent reviewers on their quality of research and readiness for 

dissemination to the public.35

 

34These registries are intended to provide the public, including grantees and policymakers, with a centralized 

repository of scientifically based information on interventions. The registries target different population groups 

and types of interventions and have varying requirements that interventions must meet in order to be included.

35According to NREPP, the registry does not include an exhaustive list of interventions, and inclusion in the 

registry does not constitute an endorsement. Those who have developed an intervention may nominate their 

interventions for review and inclusion in NREPP. See http://www.nrepp.samhsa.gov.
22 GAO-12-744R Drug Control

Education officials also said that for the department’s Safe Schools/Healthy Students 

grant program, applicants are required to include detailed information in their 

applications that demonstrates that their proposed interventions are effective. 

Applicants may use any registry of evidence-based practices and programs, 

including NREPP or Education’s What Works Clearinghouse (WWC), according to 

Education officials. The agency’s Institute of Education Sciences developed the 

WWC online registry in 2002. It includes education interventions that have been 

reviewed and assessed for their evidence of effectiveness, including those that have 

drug abuse prevention as an outcome.36 This registry does not have a primary focus 

on drug abuse prevention interventions, and Education officials said that 

interventions in the WWC that focused solely on drug abuse prevention had not 

been updated since 2006, though they are still available in the WWC. According to 

Education officials, there are no plans to update the information on drug abuse in the 

WWC, as this is not one of Education’s priority areas.

DOJ officials told us that during the grant application process for some programs, 

they give preference to applicants that adopt interventions for their programs that 

include features that have been determined to be effective. DOJ gives Drug Court 

Program grant applicants greater consideration during review of grant applications 

when they demonstrate that a program’s design is consistent with seven evidencebased program design features, which OJP considers to be indicators of an effective 

program. For example, evidence-based program design features include screening 

and assessment as well as monitoring activities. More specifically, the screening and 

assessment feature requires that applicants demonstrate an ability to screen 

promptly and systematically for all offenders potentially eligible for the drug court, 

identify the agency that will conduct this screening, and detail the procedures that 

will be used for screening. Monitoring involves the inclusion of a comprehensive plan 

to monitor drug court participants using random drug testing and community 

supervision, disseminate results efficiently to the drug court team, and immediately 

respond to noncompliance according to established program requirements.

DOJ supports two registries that include interventions related to drug abuse 

prevention and treatment, which can be used as a resource for effective programs 

by grant applicants. OJP’s CrimeSolutions.gov is an online registry established in 

2011 that provides information on effective criminal justice programs, including 

interventions related to drug abuse, and had about 190 programs reviewed as of 

May 2012.37 These interventions include drug abuse prevention and education 

interventions, as well as drug abuse treatment, along with interventions related to 

drug and alcohol crimes and offenses. A second registry—the Model Programs 

Guide established in 2000 by the Office of Juvenile Justice and Delinquency 

Prevention—is a database that identifies effective programs to prevent and reduce 

juvenile delinquency and related risk factors, such as drug abuse.38

 

36See http://ies.ed.gov/ncee/wwc. 

37OJP identifies programs for review and inclusion in CrimeSolutions.gov through literature searches of relevant 

databases, journals, and publications or nominations from experts, practitioners, or others. The registry rates 

programs as effective, promising, or having no effects. See http://www.crimesolutions.gov. CrimeSolutions.gov is 

not an exhaustive list of all justice-related programs, and a program’s inclusion on the site does not constitute an 

endorsement by DOJ, according to information on the website. 

38See http://www.ojjdp.gov/mpg/. 
23 GAO-12-744R Drug Control

While agencies make efforts to ensure that grantees implement interventions that 

have proven to be effective, we found that HHS, DOJ, and Education agency 

officials and the other experts we spoke with reported various challenges in 

identifying interventions that are proven effective, including (1) availability of data 

needed to assess effectiveness, (2) ability to determine the impact of prevention 

interventions, and (3) applicability of interventions to different population groups. 

Agency officials and experts told us that local-level data for assessing the 

effectiveness of interventions often are limited. For example, local data are often not 

available because of the high cost and intensive resources necessary for collection. 

If they are available, there are often gaps in the data—for example, data that are 

collected only every other year. Further, limited population-level information exits for 

smaller populations that may bear a disproportionate burden of drug abuse-related 

morbidity and mortality (i.e., American Indian and Alaska Native populations). In 

addition, officials said that determining the impact of a prevention intervention can be 

a challenge because it is often difficult to quantify something that did not happen—

such as a youth’s decision not to use illicit drugs—because of a preventive measure.

Finally, effective interventions may not be applicable to all population groups. For 

example, officials from HHS’s IHS reported that not all interventions that have 

demonstrated effectiveness in the general population take into consideration the 

cultural practices or needs of specific population groups. As a result, they may not 

be effective for populations—such as the American Indian and Alaska Native 

populations—that were not included in the original intervention. IHS officials stated 

that only two programs included in NREPP are specific to the populations that they 

serve.39 Moreover, IHS officials said that since so few evidence-based practices 

have been shown to be effective in the American Indian and Alaska Native 

population, and these practices may be cost prohibitive for small programs, 

community-based and culturally relevant practices are generally preferred. As part of 

our ongoing review, we plan to conduct additional work on agencies’ efforts to 

assess program effectiveness, and to continue our work examining how these 

federal agencies evaluate their drug abuse prevention and treatment programs. For 

example, during our preliminary work we learned that SAMHSA was finalizing draft 

guidance on program evaluations across the agency that will provide information on 

what types of evaluations should be conducted as well as when and how they 

should be conducted.

Agency Comments

We provided a draft of this report for comment to HHS, DOJ, Education, DHS, and 

ONDCP. ONDCP provided written comments, which are reprinted in enclosure IV. 

ONDCP generally concurred with the findings contained in the report, noting that as 

we reported, 84 percent of action items in its Strategy were on track or complete as 

of November 2011. Further, ONDCP said it is committed to expanding the number of 

programs impacting prevention and treatment that are included in the Drug Control 

Budget. For example, ONDCP recently added four programs to the Drug Control 

 

39IHS officials told us that the agency has created an inventory of evidence-based practices, promising practices, 

local efforts, resources, and policies for health services occurring in American Indian and Alaska Native 

communities, schools, work sites, health centers, and hospitals. See http://www.ihs.gov/oscar/. 
24 GAO-12-744R Drug Control

Budget for fiscal year 2013. HHS, DOJ, Education, and DHS did not provide formal 

written comments to be included in this report. Instead, these agencies—and 

ONDCP—provided technical comments that we incorporated as appropriate.

– – – – – 

As agreed with your offices, unless you publicly announce the contents of this report 

earlier, we plan no further distribution until 30 days from the report date. At that time, 

we will send copies to the appropriate congressional committees; the Secretaries of 

Health and Human Services, Education, and Homeland Security; the Attorney 

General and the Director of the Office of National Drug Control Policy. In addition, 

this report will be available at no charge on the GAO website at http://www.gao.gov. 

If you or your staff have any questions about this report, please contact 

Linda T. Kohn at (202) 512-7114 or kohnl@gao.gov or Eileen R. Larence at 

(202) 512-8777 or larencee@gao.gov. Contact points for our Offices of 

Congressional Relations and Public Affairs may be found on the last page of 

this report. Key contributors to this report are listed in enclosure V.

Linda T. Kohn

Director, Health Care

Eileen Regan Larence

Director, Homeland Security and Justice Issues

Enclosures – 5 
Enclosure I

25 GAO-12-744R Drug Control

Scope and Methodology 

To provide an initial review of the extent to which the 2010 National Drug Control 

Strategy (Strategy) has been implemented, we analyzed the 2010 Strategy and 

2011 update, Office of National Drug Control Policy (ONDCP) documents on 

implementation progress, and implementation plans and reports from selected 

federal drug control agencies that we received as of April 3, 2012. We also 

interviewed officials from ONDCP and selected agencies to obtain information on 

how ONDCP worked with agencies to develop the Strategy and assess 

implementation progress, as well as the status of Strategy implementation. Based on 

such factors as the number of Strategy action items for which agencies are 

responsible, the size of drug control budgets, and a balance of drug prevention, 

treatment, and law enforcement missions, we selected the following seven agencies 

to focus on in our review:

• within the Department of Health and Human Services (HHS), the Substance 

Abuse and Mental Health Services Administration (SAMHSA), National Institutes 

of Health (NIH), and Centers for Disease Control and Prevention;

• within the Department of Justice (DOJ), the Office of Justice Programs (OJP) and 

Drug Enforcement Administration (DEA);

• within the Department of Homeland Security (DHS), U.S. Customs and Border 

Protection; and

• the Department of Education (Education).

As of April 2012, we interviewed officials from the following four agencies: HHS, 

DHS, OJP, and DEA. Within OJP, we interviewed officials from the Office of Juvenile 

Justice and Delinquency Prevention, Bureau of Justice Assistance, Bureau of 

Justice Statistics, and National Institute of Justice. We are providing results of our 

initial review of the implementation of the Strategy, including how ONDCP worked 

with stakeholders to develop the Strategy and mechanisms ONDCP established to 

monitor implementation progress. As part of our ongoing review, we plan to conduct 

additional work on the extent to which the 2010 Strategy has been implemented and 

coordinated across agencies and how ONDCP assesses the effectiveness of the 

Strategy in preventing and reducing drug use.

To identify which federal agencies fund drug abuse prevention and treatment 

programs, we reviewed the fiscal year 2012 Drug Control Budget. In addition, to 

identify the amount of funding agencies allocated to these programs from available 

appropriations in fiscal year 2012, we reviewed the fiscal year 2013 Drug Control 
Enclosure I

26 GAO-12-744R Drug Control

Budget because it included additional information about allocated funding for fiscal 

year 2012.1 We also interviewed ONDCP officials to confirm their process for 

developing the Drug Control Budget and criteria for including programs in the 

budget. Additionally, we reviewed the drug abuse prevention and treatment 

programs of three national drug control agencies—HHS, DOJ, and Education—in 

more detail. We selected these agencies because they have some of the largest 

drug control budgets for drug abuse prevention and treatment activities, according to 

the fiscal year 2012 Drug Control Budget.2 To obtain more detail about these 

agencies’ programs, we identified component agencies within HHS, DOJ, and 

Education that fund drug abuse prevention and treatment programs included in the 

Drug Control Budget, collected program-specific information from these component 

agencies using a standard collection instrument, and interviewed agency officials 

responsible for these programs. The agencies we reviewed included.

• within HHS, the Health Resources and Services Administration, Indian Health 

Service, NIH,3 and SAMHSA;4

• within DOJ, the Bureau of Prisons, DEA, and OJP (including officials from OJP’s 

Bureau of Justice Assistance and Office of Juvenile Justice and Delinquency 

Prevention); and

• within Education, the Office of Elementary and Secondary Education.

We also determined whether the agencies that we reviewed administered programs 

that included drug abuse prevention and treatment activities that do not meet 

ONDCP’s standards for having an acceptable budget estimation methodology and 

therefore were not represented in the Drug Control Budget. We spoke with these 

officials to identify any limitations and resolve any discrepancies between the 

agencies’ reported drug abuse prevention and treatment information and data and 

the fiscal year 2012 Drug Control Budget. We determined that the Drug Control 

Budget data are reliable for our purposes. Finally, to identify coordination efforts 

 

1

ONDCP refers to these funds as enacted funding in the Drug Control Budget, while in this report we use the 

term allocated funding. At the beginning of a fiscal year, agencies may allocate certain amounts from available 

appropriations for specific programs. However, to the extent that an appropriation has not identified a particular 

amount for a specific program, an agency may reallocate unobligated funds from that program to another during 

the course of a fiscal year. To the extent other statutory authority results in mandatory funding for programs that 

may include drug abuse prevention and treatment, such as Medicare and Medicaid, we also include these as 

allocated funds.

2

Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and 

Communities Act for drug treatment. See 20 U.S.C. § 7164.

3

In contrast to federal agencies that implement drug prevention and treatment programs, NIH supports the 

conduct of research to develop and test prevention and treatment interventions. The goal of this research is to 

establish an evidence base of effective interventions that can be implemented on a broader scale by other 

agencies.

4

We included the Centers for Medicare & Medicaid Services in our review of HHS agencies’ allocations for drug 

abuse prevention and treatment programs. However, we did not include the Centers for Medicare & Medicaid 

Services in our more detailed review of programs because it allocates funding to drug treatment services solely 

as part of eligible participants’ medical services and does not fund or administer drug abuse prevention or 

treatment interventions or research. 
Enclosure I

27 GAO-12-744R Drug Control

between agencies funding drug abuse prevention and treatment programs, we 

interviewed officials from HHS, DOJ, and Education agencies who oversee these 

programs and reviewed policies and related documents to identify these agencies’ 

coordination efforts.

To provide an initial review of the extent to which federal agencies assess the 

effectiveness of their drug abuse prevention and treatment programs, we 

interviewed officials from our selected national drug control agencies as well as 

experts in the field of drug abuse prevention and treatment. These experts included 

staff from the Community Anti-Drug Coalitions of America, National Academies of 

Science, National Association of State Alcohol/Drug Abuse Directors, RAND Drug 

Policy Research Center, RAND Promising Practices Network, and University of 

Colorado Blueprints for Violence Prevention, and a university-based prevention 

expert.5 We are providing initial results from our ongoing review of agencies’ efforts 

to assess their programs’ effectiveness. As part of our ongoing review, we plan to 

conduct additional work on HHS’s, DOJ’s, and Education’s efforts to assess program 

effectiveness, and to continue work examining how these agencies evaluate their 

drug abuse prevention and treatment programs.

We conducted this performance audit from January 2012 through July 2012 in 

accordance with generally accepted government auditing standards. Those 

standards require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions based on 

our audit objectives. We believe that evidence obtained provides a reasonable basis 

for our findings and conclusions based on our audit objectives. 

 

5

We identified subject matter experts from our review of relevant literature and during interviews with identified 

experts. 
Enclosure II

28 GAO-12-744R Drug Control

Funding Allocated by Federal Agencies in the Drug Control Budget for Drug 

Abuse Prevention and Treatment Programs, Fiscal Year 2012

In fiscal year 2012, federal agencies included in the Drug Control Budget allocated 

approximately $10.1 billion in funding to support or provide drug abuse prevention 

and treatment services. Approximately 14 percent of these funds, or almost 

$1.4 billion, was allocated for drug abuse prevention services and over 86 percent of 

these funds, or over $8.7 billion, for drug abuse treatment services.1 Of the funding 

allocated for drug abuse prevention and treatment services, the Department of 

Health and Human Services allocated approximately $8.3 billion and the Department 

of Justice allocated approximately $186.1 million for prevention and treatment 

programs, while the Department of Education allocated almost $64.9 million. (See 

table 2.)

 

1

Funding allocated for federal drug abuse prevention and treatment programs makes up approximately 

40 percent of the funding allocated by agencies included in the Drug Control Budget in fiscal year 2012. This 

amount of allocated funding is approximately consistent with fiscal year 2011 levels. The other activities included 

in the remaining approximately 60 percent of the budget include domestic law enforcement, interdiction, and 

international drug control activities—also known as supply reduction activities.
Enclosure II

29 GAO-12-744R Drug Control

Table 2: Funding Allocated by Federal Agencies in the Drug Control Budget for Drug Abuse Prevention 

and Treatment Programs, Fiscal Year 2012

U.S. dollars in millions

Department or independent agency

Allocated funding, 

prevention programs

Allocated funding, 

treatment programs Total

Department of Agriculturea $0.1 - $0.1

Court Services and Offender Supervision 

Agency for the District of Columbia 18.8 $34.2 $53.1

Department of Defense 155.6 96.5 $252.1

Drug Interdiction and Counterdrug Activities 155.6 - $155.6

Defense Health Program - 96.5 $96.5

Department of Educationb 64.9 - $64.9

Federal Judiciary - 192.2 $192.2

Department of Health and Human Services 1,017.3 7,241.3 $8,258.6

Centers for Medicare & Medicaid Services - 4,467.4 $4,467.4

Health Resources and Services 

Administration - 18.1 $18.1

Indian Health Service 18.7 79.4 $98.1

National Institutes of Health 437.5 671.6 $1,109.2

Substance Abuse and Mental Health 

Services Administration 561.0 2,004.8 $2,565.8

Department of Housing and Urban Development - 446.0 $446.0

Department of Justice 7.1 179.0 $186.1

Bureau of Prisons - 93.5 $93.5

Drug Enforcement Administration 2.1 - $2.1

Office of Justice Programs 5.0 85.5 $90.5

Department of Labor 6.6 - $6.6

Office of National Drug Control Policy 98.6 9.6 $108.2

Department of Transportation 19.3 - $19.3

Federal Aviation Administration 16.6 - $16.6

National Highway Traffic Safety 

Administration 2.7 - $2.7

Department of Veterans Affairsc - 530.2 $530.2

Totald $1,388.3 $8,729.0 $10,117.3

Source: GAO analysis of fiscal year 2012 allocated funding reported in the fiscal year 2013 Drug Control Budget.

Notes: We used the fiscal year 2013 Drug Control Budget because it included additional information about the allocation of 

funding for fiscal year 2012. Although the Office of National Drug Control Policy refers to enacted funding in its Drug Control 

Budget, we use the term allocated funding. For the purpose of our review, we define drug abuse prevention as activities 

focused on discouraging the first-time use of controlled substances and efforts to encourage those who have begun to use illicit 

drugs to cease their use. We define drug abuse treatment to include activities focused on assisting regular users of controlled 

substances to become drug free through such means as counseling services, inpatient and outpatient care, and demonstration 

and provision of effective treatment methods.

a

The Department of Agriculture allocates funding to drug abuse prevention programs through the U.S. Forest Service.

b

The Department of Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and 

Communities Act for drug treatment. See 20 U.S.C. § 7164.

c

The Department of Veterans Affairs allocates funding to drug abuse treatment programs through the Veterans Health 

Administration.

d

The total amount in each column represents the sum of department and independent agency activities. Columns may not add 

to corresponding totals because of rounding.
Enclosure III

30 GAO-12-744R Drug Control

Overview of Drug Abuse Prevention and Treatment Programs Allocated 

Funding by Three Agencies, Fiscal Year 2012

The Department of Health and Human Services, Department of Justice, and 

Department of Education reported that the agencies allocated funding to a variety of 

drug abuse prevention and treatment programs in fiscal year 2012, including grants, 

education and outreach, and direct service programs. Tables 3 through 6 provide an 

overview of these programs.

Table 3: Department of Health and Human Services Drug Abuse Prevention and Treatment Programs 

Allocated Funding, Fiscal Year 2012

Program

Program 

activities

Program 

type

Targeted 

beneficiaries Program description

Health Resources and Services Administration

Health Center 

Programa Prevention 

and treatment

Grant Medically 

underserved 

areas and 

populations

Delivers comprehensive primary health 

care, including drug abuse prevention 

and treatment, to vulnerable populations. 

Grantees include public and nonprofit 

private entities, including tribal, faithbased, and community-based 

organizations.

Ryan White 

HIV/AIDS 

Programb

Treatment Grant Persons living 

with HIV/AIDS

Addresses the unmet care and treatment 

needs of persons living with HIV/AIDS 

who are uninsured or underinsured and 

have limited or no resources to pay for 

HIV/AIDS health care and vital healthrelated support services, such as drug 

abuse treatment. Grantees include

states, territories, and community-based 

and nonprofit organizations. 

Indian Health Service 

Alcohol and 

Substance Abuse 

Program 

Prevention 

and treatment

Other American Indian 

and Alaska 

Native youth and 

adults

Provides alcohol and drug abuse 

prevention, educational, and treatment 

services through federal, tribal, and 

urban Indian health facilities through an 

integrated behavioral health approach to 

prevent or reduce the incidence of 

alcoholism and drug abuse in American 

Indian/Alaska Native communities.

Methamphetamine 

and Suicide 

Prevention 

Initiative

Prevention 

and treatment

Other American Indian 

and Alaska 

Native youth and 

adults

Supports community-based pilot projects 

that promote the expansion of existing 

and development of new 

methamphetamine and suicide 

prevention and treatment programs that 

use evidence-based and practice-based 

models created and managed by 

communities.

Urban Indian 

Health Program 

Title V 4-in-1 

Grants

Prevention Grant American Indian 

and Alaska 

Native youth and 

adults

Provides funding to nonprofit urban 

Indian health programs to carry out 

alcohol and substance inpatient and 

outpatient treatment, counseling, and 

referrals for service. 
Enclosure III

31 GAO-12-744R Drug Control

Program

Program 

activities

Program 

type

Targeted 

beneficiaries Program description

Substance Abuse and Mental Health Services Administration (SAMHSA)

Access to 

Recovery

Treatment Grant All populations 

requiring 

recovery support 

services

Provides funds for grantees, including 

states, tribes, and tribal organizations, to 

carry out voucher programs that expand 

drug abuse treatment capacity and 

promote choice among clinical treatment 

and recovery support providers in order 

to facilitate recovery from drug abuse.

Addiction 

Technology 

Transfer Centers 

(ATTC) 

Treatment Education 

and outreach

Drug addiction 

treatment 

workforce 

Funds ATTCs, which disseminate 

evidence-based and promising practices 

information to drug addiction treatment 

and recovery professionals, among 

others, through technical assistance, 

training events, educational and training 

materials, and web-based resources.

Center for the 

Application of 

Prevention 

Technologies 

Prevention Education 

and outreach

SAMHSA 

grantees

Promotes behavioral health promotion 

technologies through training and 

technical assistance activities to develop 

the skills, knowledge, and expertise of 

grantees’ prevention workforces.

Children and 

Family Programs

Treatment Grant Adolescents and 

their 

families/primary 

caregivers

Addresses gaps in drug abuse services 

by providing services to adolescents and 

their families/primary caregivers using 

previously proven effective practices that 

are family centered. Grantees include 

domestic and private nonprofit entities, 

such as state and local governments, 

tribal organizations, universities and 

colleges, and faith-based organizations. 

Criminal Justice 

Activities

Treatment Grant Adolescents and 

adults with drug 

abuse disorders, 

co-occurring drug 

abuse and 

mental disorders, 

or both

Provides a coordinated and 

comprehensive continuum of programs 

and services to help program 

beneficiaries recover their lives and 

become productive, responsible, lawabiding citizens. Activities include grant 

programs that focus on diversion, 

alternatives to incarceration, and reentry 

from incarceration. Grant program 

applicants include entities such as 

misdemeanor or felony adult criminal 

courts, juvenile or adult courts, 

family/child dependency courts, and 

entities that are tribal, state, or local 

government proxies. 

Fetal Alcohol 

Spectrum 

Disorders 

Prevention Education 

and outreach 

Women of 

childbearing age

Identifies and disseminates information 

about innovative techniques and 

effective strategies for preventing fetal 

alcohol spectrum disorders and 

increasing functioning and quality of life 

for individuals and their families affected 

by these disorders.
Enclosure III

32 GAO-12-744R Drug Control

Program

Program 

activities

Program 

type

Targeted 

beneficiaries Program description

Health 

Surveillance and 

Program Support

Prevention 

and treatment

Other Not applicable Provides funding for personnel costs, 

building and facilities, equipment, 

supplies, administrative costs, and 

associated overhead to support 

SAMHSA programmatic activities, such 

as drug abuse prevention and treatment 

programs, and funding for SAMHSA 

national data collection and survey 

systems.

Mandatory Drug 

Testing

Prevention Other Workplace 

institutions 

Provides funding for the accreditation 

and ongoing quality assurance of 

laboratories that perform mandatory drug 

testing for federal and nonfederal 

employees. The program also provides 

the Workplace Helpline, a toll-free 

telephone service for business and 

industry that answers questions about 

drug abuse in the workplace.

Military Families Prevention 

and treatment

Education 

and outreach

Servicemembers, 

veterans, and 

their families

Establishes policy academies that help 

states and territories strengthen their 

behavioral health care systems and 

services for military families, such as 

drug abuse prevention and treatment 

programs, through the development of 

interagency strategic plans and technical 

assistance to facilitate the 

implementation of those plans.

Minority AIDS Treatment Grant Racial and ethnic 

minorities; 

women, including 

women with 

children; 

adolescents; 

injection drug 

users; and 

individuals who 

have been 

released from 

prison within the 

past 2 years.

Awards funds to community-based 

organizations for the delivery of drug 

abuse treatment and related HIV/AIDS 

services that target one or more highrisk, substance-abusing populations. 

Grantees include community-based 

organizations.

Minority 

Fellowship 

Program 

Prevention 

and treatment

Education 

and outreach

Minority 

professionals 

available to serve 

populations of 

ethnic minorities 

with drug abuse 

and mental 

health disorders

Seeks to improve the quality of drug 

abuse and mental health prevention and 

treatment delivered to ethnic minorities 

by providing stipends to graduate 

students to increase the number of 

culturally competent behavioral health 

professionals who teach, administer, 

conduct services research, and provide 

direct drug abuse and mental health 

services to underserved minority 

populations.

Opioid Treatment 

Programs 

Treatment Other Adults with 

substance abuse 

disorders

Provides pharmacotherapy and 

counseling as set forth under 42 C.F.R.

Part 8 for the treatment of opioid 

dependency. 
Enclosure III

33 GAO-12-744R Drug Control

Program

Program 

activities

Program 

type

Targeted 

beneficiaries Program description

Performance and 

Quality 

Information 

Systems

Prevention 

and treatment

Other Not applicable Provides funding to support the agency’s 

new initiative focusing on data, 

outcomes, and quality, including 

improving the collection of data for drug 

abuse and mental disorders.

Pregnant and 

Postpartum 

Women

Treatment Grant Pregnant and 

postpartum 

women

Expands the availability of 

comprehensive, residential substance 

abuse treatment, prevention, and 

recovery support services for pregnant 

and postpartum women and their minor 

children, including services for 

nonresidential family members of both 

the women and the children. Grantees 

include public and private nonprofit 

entities, including state and local 

governments and tribes and tribal 

organizations.

Public Awareness 

and Support

Prevention 

and treatment

Education 

and outreach

General public Provides funding to support SAMHSA’s 

public communications to increase 

awareness on drug abuse issues, 

behavioral health, and mental disorders.

Recovery 

Community 

Services Program

Treatment Grant People with a 

history of alcohol 

problems, drug 

abuse problems, 

or both who are 

seeking recovery

Responds to the need for communitybased recovery support services that 

help prevent drug abuse relapse and 

promote long-term recovery by designing 

and delivering peer-to-peer recovery 

support services. Provides grants to 

domestic public and private nonprofit 

entities.

Science and 

Service Program 

Coordination

Prevention Education 

and outreach

States, federally 

recognized 

tribes, 

communities, 

and grantees

Provides technical assistance and 

training to states, tribes, communities, 

and grantees around substance abuse 

prevention.

Screening, Brief 

Intervention, and 

Referral to 

Treatment

Treatment Grant Adults seeking 

care in a variety 

of settings

Provides grants, in the form of 

cooperative agreements, to general 

medical and primary health care 

organizations, including hospitals, 

trauma centers, and health clinics, to 

integrate drug abuse screening, brief

intervention, referral, and treatment 

services within these settings.

Sober Truth on 

Preventing 

Underage 

Drinking Act 

Prevention Grant Youth Provides grants to organizations that are 

receiving or have received grant funds 

under the Drug-Free Communities Act of 

1997 to supplement their current 

prevention efforts and strengthen 

collaboration and coordination among 

stakeholders in order to achieve a 

reduction in underage drinking in their 

communities.

Special Initiatives 

Outreach

Treatment Education 

and outreach

Drug addiction 

treatment 

workforce 

Funds special initiatives, including the 

Historically Black Colleges and 

Universities Center for Excellence, which 

promotes leadership development for 

African Americans in the drug abuse and 

mental health professions.
Enclosure III

34 GAO-12-744R Drug Control

Program

Program 

activities

Program 

type

Targeted 

beneficiaries Program description

Strategic 

Prevention 

Framework 

Prevention Grant State, tribal, 

territorial, and 

local 

communities

Provides resources to grantees, which 

include states, federally recognized 

tribes, and U.S. territories, to prevent the 

onset and reduce the progression of 

drug abuse, including childhood and 

underage drinking; reduce drug abuserelated problems; and build prevention 

capacity and infrastructure at the state, 

tribal, territorial, and community levels. 

Strengthening 

Treatment Access 

and Retention

Treatment Other States An infrastructure cooperative agreement 

program that promotes state-level 

implementation of process improvement 

methods by providing grants to states to 

improve access to and retention in 

outpatient drug abuse treatment.

Substance 

Abuse/Minority 

AIDS Initiative

Prevention Grant Youth and adult 

minority 

populations

Supports efforts to increase access to 

drug abuse and HIV prevention services 

for the highest-risk and hardest-to-serve 

racial and ethnic minority populations. 

Provides grants to community-level 

public and private nonprofit entities.

Targeted Capacity 

Expansion – 

General 

Treatment Grant SAMHSA 

grantees

Provides funding to expand or enhance a 

community’s ability to provide rapid, 

strategic, comprehensive, integrated, 

community-based responses to a 

specific, well-documented drug abuse 

problem.

Treatment 

Systems for 

Homeless

Treatment Grant Homeless 

individuals

Enables communities to expand and 

strengthen their drug abuse treatment 

services for homeless individuals with 

drug abuse disorders. Grantees include 

domestic public and private nonprofit 

entities. 

Source: GAO analysis of Department of Health and Human Services information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use 

of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug 

abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through 

such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment 

methods.

a

According to Health Resources and Services Administration officials, funding for prevention services in the Health Center 

Program is not included in the Drug Control Budget because it is difficult to quantify the amount of funding that is allocated 

specifically to prevention services.

b

According to Health Resources and Services Administration officials, funding for the Ryan White HIV/AIDS Program is not 

included in the Drug Control Budget because the program does not directly award funding for drug abuse treatment, although 

drug abuse treatment may be one of many services that eligible participants receive.
Enclosure III

35 GAO-12-744R Drug Control

Table 4: Department of Health and Human Services Drug Abuse Prevention and Treatment Research and 

Development Efforts Allocated Funding, Fiscal Year 2012

Research and 

development 

efforts 

Research 

activities

Research 

type

Research 

subjects Research description

National Institutes of Health (NIH)

Basic and Clinical 

Neuroscience 

Research

Prevention 

and 

treatment

Grant, 

contract, 

cooperative 

agreement 

Animal/human adults 

and youth

At NIH’s National Institute of Drug 

Abuse (NIDA), the basic and clinical 

neuroscience programs work together 

to expand our understanding of the 

neurobiological, genetic/epigenetic, 

and behavioral factors that underlie 

drug abuse and addiction. 

Specifically, they examine which 

variables influence risk of drug abuse, 

addiction, and drug-related disorders; 

how drug exposure and addiction 

alter the brain, including the effects of 

drugs on the expression or silencing 

of genes; and how resultant changes 

affect brain function and consequent 

behaviors.

Clinical Trials 

Network

Treatment Grant, 

contract, 

cooperative 

agreement

Human adults and 

youth

Within NIH, NIDA’s National Drug 

Abuse Treatment Clinical Trials 

Network (CTN) comprises 

13 research nodes and more than 

240 individual community treatment 

programs in 38 states, plus the 

District of Columbia and Puerto Rico. 

The CTN develops and tests 

treatment protocols for drug abuse 

and addiction and related conditions, 

such as comorbid mental health 

disorders and HIV, testing the realworld effectiveness of promising 

medication and behavioral 

approaches with diverse patient 

populations and community treatment 

providers. It also serves as a 

research training platform and helps 

NIDA respond to emerging public 

health threats.

Epidemiology, 

Services and 

Prevention 

Research

Prevention 

and 

treatment 

Grant, 

contract, 

cooperative 

agreement

Human adults and 

youth

At NIH’s NIDA, this program area 

supports integrated approaches to 

understand and address the 

interactions between individuals and 

environments that contribute to drug 

abuse and related problems. Large 

surveys and surveillance networks 

that monitor drug-related issues 

exemplify programs supported by this 

NIDA division. Program efforts help 

identify substance abuse trends 

locally, nationally, and internationally; 

guide development of responsive 

interventions for a variety of 

populations; and determine optimal 

service delivery in real-world settings.
Enclosure III

36 GAO-12-744R Drug Control

Research and 

development 

efforts 

Research 

activities

Research 

type

Research 

subjects Research description

Intramural 

Research Program

Prevention 

and 

treatment

Other Animal/human adults 

and youth

The Intramural Research Program 

performs cutting-edge research within 

a coordinated multidisciplinary 

framework. The program attempts to 

(1) elucidate the nature of the 

addictive process; (2) determine the 

potential use of emerging new 

therapies for substance abuse, both 

pharmacological and psychosocial; 

and (3) establish the long-term 

consequences of drug abuse on 

systems and organs, with particular 

emphasis on the brain and its 

development, maturation, function, 

and structure. In addition, the 

program supports the HIV/AIDS 

Pathophysiology and Addiction

Medications Discovery Program.

Pharmacotherapies 

and Medical 

Consequences

Treatment Grant, 

contract, 

cooperative 

agreement

Animal/human adults 

and youth

At NIH’s NIDA, this program area is 

responsible for medication 

development aimed at helping people 

recover from drug abuse and 

addiction and sustain abstinence, and 

includes development of nonaddictive 

pain medications. It capitalizes on 

research showing the involvement of 

different brain systems in drug abuse 

and addiction, beyond the reward 

circuit, to develop medications in 

response to a variety of newly defined 

targets. This program area also seeks 

means to address the medical 

consequences of drug abuse and 

addiction, including infectious 

diseases, such as HIV.

Research 

Management and 

Support

Prevention 

and 

treatment

Other Not applicable Activities provide administrative, 

budgetary, logistical, and scientific 

support in the review, award, and 

monitoring of research grants, training 

awards, and research and 

development contracts. Additionally, 

the functions of Research and 

Management Support encompass 

strategic planning, coordination, and 

evaluation of NIDA’s programs, 

regulatory compliance, international 

coordination, and liaison with other 

federal agencies, Congress, and the 

public.
Enclosure III

37 GAO-12-744R Drug Control

Research and 

development 

efforts 

Research 

activities

Research 

type

Research 

subjects Research description

Underage Drinking Prevention 

and 

treatment

Grant Generally individuals 

under the age of 21; 

however, some followup studies assessing 

consequences of child 

or adolescent alcohol 

use do go beyond 

age 21

Research activities include studies on 

the epidemiology of underage 

drinking and related consequences 

and the etiology of underage drinking, 

including genetic and environmental 

factors that either protect against or 

increase risk, and studies assessing 

the consequences of child and 

adolescent alcohol use, such as the 

effects on the developing brain, and 

on prevention interventions and 

treatment interventions.

Source: GAO analysis of Department of Health and Human Services information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use 

of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug 

abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through 

such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment 

methods. We present information on the Department of Health and Human Services’ drug abuse prevention and treatment 

research and development activities separately from that agency’s drug abuse prevention and treatment programs because 

NIH officials told us that the agency does not classify its research and development activities as programs.
Enclosure III

38 GAO-12-744R Drug Control

Table 5: Department of Justice Drug Abuse Prevention and Treatment Programs Allocated Funding, 

Fiscal Year 2012

Program

Program 

activities Program type

Targeted 

beneficiaries Program description

Bureau of Prisons (BOP)

Community 

Transition

Treatment

Prevention and 

treatment

Direct service Inmates transferred 

to a residential 

reentry center

Ensures continuation of drug abuse 

treatment that is to provide inmates 

support as they adjust to 

community living.

Drug Education Prevention Direct service Inmates who meet 

criteria for drug 

abuse education

Encourages offenders with a 

history of drug use to review the 

choices they have made and the 

consequences of their choices, 

including their choice to use drugs. 

Drug abuse education takes the 

offender through the cycle of drug 

use and crime and offers 

compelling evidence of how 

continued drug use can lead to 

further criminality and related 

consequences.

Nonresidential 

Drug Abuse 

Treatment

Treatment Direct service Inmates with minor 

or low-level 

substance abuse 

impairment or with 

longer sentences 

who are in need of 

treatment and are 

awaiting placement 

in the residential 

program, among 

others

Provides nonresidential drug abuse 

treatment at every BOP institution, 

and is a flexible program designed 

to meet the specialized treatment 

needs of the inmate.

Residential Drug 

Abuse 

Treatment

Treatment Direct service Inmates who meet 

diagnostic criteria 

for substance use 

disorder

Provides intensive drug abuse 

treatment to inmates diagnosed 

with a drug use disorder. 

Drug Enforcement Administration (DEA)

Demand 

Reduction 

Program 

Prevention Education and 

outreacha States, schools, 

and 

communities

Supports 23 special agents with 

demand reduction collateral duties. 

These agents serve as demand 

reduction coordinators supporting 

DEA’s law enforcement efforts by 

developing strategic alliances with 

prevention, treatment, and community 

coalitions, as well as working in 

partnership with other federal, state, 

and local government agencies.
Enclosure III

39 GAO-12-744R Drug Control

Program

Program 

activities Program type

Targeted 

beneficiaries Program description

Office of Justice Programs

Drug Court 

Program 

Treatment Grant Offenders Provides financial and technical 

assistance to states, state courts, local 

courts, units of local government, and 

Indian tribal governments to develop 

and implement drug courts that 

effectively integrate evidence-based

drug abuse treatment, mandatory drug 

testing, sanctions and incentives, and 

transitional services in a judicially 

supervised court setting with 

jurisdiction over drug-abusing 

offenders.

Enforcing 

Underage 

Drinking Laws

Prevention Grant Community and 

youth 

Supports and enhances efforts by 

states and local jurisdictions to reduce 

the availability of alcohol to minors. 

The program encourages close 

partnerships between law enforcement 

agencies and community groups 

involved in preventing and intervening 

in underage drinking.

Residential 

Substance 

Abuse 

Treatment

Treatment Grant Offenders Assists states and units of local 

government in developing and 

implementing residential substance 

abuse treatment programs in state and 

local correctional and detention 

facilities.

Second Chance 

Act Adult 

Offenders with 

Co-occurring 

Substance 

Abuse and 

Mental Health 

Disorders 

Treatment Grant Offenders Provides funding to state, local, and 

federally recognized tribal entities to 

implement and expand offender 

treatment programs for offenders with 

co-occurring substance abuse and 

mental health disorders. These 

programs should improve the provision 

of treatment for adult individuals (18 

years and over) being treated for cooccurring substance abuse and mental 

health disorders within prisons and 

jails, and include both pre- and 

postrelease programming for every 

program participant.

Second Chance 

Act FamilyBased Adult 

Offender 

Substance 

Abuse 

Treatment 

Program, 

Planning and 

Demonstration 

Projects 

Treatment Grant Offenders Awards funds to state and local 

agencies and federally recognized 

tribal entities to develop and implement 

comprehensive and collaborative 

strategies that address the challenges 

posed by reentry to increase public 

safety and reduce recidivism.

Source: GAO analysis of Department of Justice information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use 

of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug 

abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through

such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment 

methods.

a

DEA officials reported that the program does not currently engage in outreach activities because of reductions in program 

funding.
Enclosure III

40 GAO-12-744R Drug Control

Table 6: Department of Education Drug Abuse Prevention Programs Allocated Funding, Fiscal Year 2012

Program

Program 

activities Program type

Targeted 

beneficiaries Program description

21st Century 

Community 

Learning Centersa 

Prevention Grant Prekindergarten 

through 12th grade 

students

Enables communities to establish 

or expand centers that provide 

additional student learning 

opportunities to complement and 

reinforce the regular school-day 

program of participating students, 

such as drug and violence 

prevention activities.

Safe and DrugFree Schools and 

Communities 

National Activities

Prevention Grantb Primarily 

kindergarten through 

12th grade students; 

however, the 

program also serves 

some college 

students

Provides funding to local education 

agencies and a variety of public or 

private entities for activities 

designed to prevent the illegal use 

of drugs by and violence among, 

and promote safety and discipline 

for, students. Activities may include 

the development and dissemination 

of drug and violence prevention 

programs and activities, technical 

assistance to grantees to build 

capacity to develop effective drug 

and violence prevention programs, 

and the collection of data on the 

incidence and prevalence of drug 

use and violence in schools.

Source: GAO analysis of Department of Education information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use 

of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug 

abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through 

such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment 

methods.

a

According to Department of Education officials, this program is not included in the Drug Control Budget because of the lack of 

an appropriate budget methodology.

b

Department of Education officials said that this program also provides technical assistance that is targeted to institutions of 

higher education.
Enclosure IV

41 GAO-12-744R Drug Control

Comments from the Office of National Drug Control Policy
Enclosure IV

42 GAO-12-744R Drug Control
Enclosure V

43 GAO-12-744R Drug Control

GAO Contacts and Staff Acknowledgments

GAO Contacts

Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov

Eileen R. Larence, (202) 512-8777 or larencee@gao.gov

Staff Acknowledgments

In addition to the contacts named above, David Alexander, Assistant Director; 

Karen Doran, Assistant Director; Mary Catherine Hult, Assistant Director; 

George Bogart; Willie Commons III; Susan Czachor; Emily Goodman; 

Cathy Hamann; C. Jenna Sondhelm; and Johanna Wong made key 

contributions to this report.

(291009)
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