OFFICE OF 

NATIONAL DRUG 

CONTROL POLICY

Office Could Better 

Identify Opportunities 

to Increase Program 

Coordination

Report to Congressional Requesters

March 2013

GAO-13-333

United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-13-333, a report to 

congressional requesters. 

March 2013

OFFICE OF NATIONAL DRUG CONTROL POLICY

Office Could Better Identify Opportunities to 

Increase Program Coordination

Why GAO Did This Study

ONDCP is responsible for coordinating 

implementation of drug control policy 

across the federal government to 

address illicit drug use. ONDCP 

developed the 2010 Strategy, which 

sets forth a 5-year plan to reduce illicit 

drug use through programs intended to 

prevent or treat drug abuse or reduce 

the availability of drugs. GAO was 

asked to review Strategy 

implementation and drug abuse 

prevention and treatment programs. 

This report assesses, among other 

things, the extent to which progress 

has been made toward achieving 

Strategy goals; ONDCP has 

mechanisms in place to monitor 

progress; fragmentation, overlap, and 

duplication exist across prevention and 

treatment programs; and ONDCP and 

federal agencies coordinate efforts to 

reduce the potential for unnecessary 

overlap or duplication. GAO analyzed 

the Strategy and its updates, available 

data on progress toward achieving 

Strategy goals, and documents about 

ONDCP’s monitoring mechanisms. 

GAO also analyzed data from 

questionnaires sent to the 15 federal 

agencies that administer prevention 

and treatment programs that collected 

information on services provided and 

coordination efforts. 

What GAO Recommends

GAO recommends that ONDCP 

assess the extent of overlap and the 

potential for duplication across federal 

programs engaged in drug abuse 

prevention and treatment activities and 

identify opportunities for increased 

coordination. ONDCP concurred and 

stated that it will work with agencies 

administering these programs to 

further enhance coordination. 

What GAO Found

The Office of National Drug Control Policy (ONDCP) and federal agencies have 

not made progress toward achieving most of the goals articulated in the 2010 

National Drug Control Strategy (the Strategy), but are reported to be on track to 

implement most Strategy action items intended to support these goals. ONDCP 

established seven Strategy goals related to reducing illicit drug use and its 

consequences by 2015. As of March 2013, GAO’s analysis showed that of the 

five goals for which primary data on results are available, one shows progress 

and four show no progress. For example, no progress has been made on 

reducing drug use among 12- to 17-year-olds by 15 percent. This is primarily due 

to an increase in the rate of reported marijuana use, offset by decreases in the 

rates of reported use of other drugs. Nevertheless, ONDCP reported that 107 of 

the 112 action items in the Strategy are complete or on track. ONDCP officials 

stated that implementing these action items is necessary but may not be 

sufficient to achieve Strategy goals. 

ONDCP primarily intends to address the extent of progress in achieving Strategy 

goals through its new Performance Reporting System (PRS)—a monitoring 

mechanism intended to provide specific, routine information on progress toward 

Strategy goals and help identify factors for performance gaps and options for 

improvement. ONDCP officials stated that they plan to report on PRS results for 

the first time in 2013. They also said that they plan to assess the system’s 

reliability and effectiveness. This could help increase accountability for improving 

results and identify ways to bridge the gap that currently exists between the lack 

of progress toward Strategy goals and the strong progress made on 

implementing Strategy actions. 

Drug abuse prevention and treatment programs are fragmented across 15 

federal agencies and provide some overlapping services, which could increase 

the risk of duplication. Specifically, GAO identified overlap in 59 of the 76

programs included in its review. These programs could provide or fund one or 

more drug abuse prevention or treatment service that at least one other program 

could also provide or fund, either to similar population groups or to reach similar 

program goals. Such fragmentation and overlap may result in inefficient use of 

resources among programs providing similar services.

GAO’s prior work has found that inefficiencies created by fragmentation and 

overlap can be minimized through coordination. However, many prevention and 

treatment programs that GAO surveyed did not report coordination efforts, and 

ONDCP has not assessed the extent of overlap, duplication, and coordination. 

Agency officials who administer the 21 programs that GAO reviewed in detail—

programs for youth and offenders—reported making various efforts to coordinate 

program activities, but 29 of 76 (about 40 percent) surveyed programs reported 

no coordination with other federal agencies on drug abuse prevention or 

treatment activities. Moreover, ONDCP has not assessed all drug abuse 

prevention or treatment programs to identify the extent of overlap and potential 

duplication and any opportunities for coordination. Such an assessment would 

better position ONDCP to help ensure that agencies better leverage and more 

efficiently use limited resources. 

View GAO-13-333. For more information, 

contact Eileen Larence at (202) 512-8777 or 

larencee@gao.gov or Linda Kohn at (202) 

512-7114 or kohnl@gao.gov.
Page i GAO-13-333 Office of National Drug Control Policy

Letter 1 

Background 7

Results Show Lack of Progress on Strategy Goals, although 

Implementation of Most Action Items Is Complete or On Track; 

ONDCP Established a New Mechanism to Monitor Progress 13

Drug Abuse Programs Are Fragmented and Overlapping; Many 

Reported That They Did Not Coordinate, and ONDCP Has Not 

Assessed Extent of Overlap and Coordination Opportunities 21

Agencies We Reviewed Have Completed Few Program Evaluations, 

with Three Looking at Program Effectiveness, but Have Taken 

Other Steps to Ensure Programs Are Effective 35

Conclusions 41

Recommendation for Executive Action 42

Agency Comments and Our Evaluation 42

Appendix I Relatively Few Studies Have Assessed the Effect of Societal 

Factors on Youth Marijuana Use, and These Studies Had 

Limitations 45

Appendix II Objectives, Scope, and Methodology 54

Appendix III Fiscal Year 2011 Obligations for Drug Abuse Prevention and 

Treatment Programs in Our Review 63

Appendix IV Information about Completed Program Evaluations Conducted by 

Agencies in Our Review 69

Appendix V Comments from the Office of National Drug Control Policy 72

Appendix VI GAO Contacts and Staff Acknowledgments 75

Contents 
Page ii GAO-13-333 Office of National Drug Control Policy

Tables

Table 1: 2010 National Drug Control Strategy Goals and Progress 

toward Meeting Them, as of March 2013 14

Table 2: Drug Abuse Prevention or Treatment Programs or 

Activities Administered by Selected 15 Federal Agencies in 

Fiscal Year 2011, by Type of Program 23

Table 3: Drug Control Agency Programs with Evaluations 

Completed, Under Way, or Planned since 2007, as of 

November 2012 36

Table 4: Medical Marijuana Laws Studies and Their Findings 

Regarding Effect on Youth Marijuana Use 48

Table 5: Decriminalization Studies and Their Findings Regarding 

Effect on Youth Marijuana Use 49

Table 6: Studies on the Association between Media and Youth 

Marijuana Use 50

Table 7: Descriptive Studies on Media and Youth Marijuana Use 51

Figures

Figure 1: 2010 National Drug Control Strategy Goals, Objectives, 

and Action Items 9

Figure 2: Federal Funding Allocated to Drug Abuse Prevention and 

Treatment Programs by 15 Selected Agencies, Fiscal Year 

2012 11

Figure 3: Number of Action Items in Office of National Drug 

Control Policy (ONDCP) Implementation Status 

Categories by National Drug Control Strategy Objective, 

as of July 2012 17

Figure 4: Overlapping Prevention Services Provided to the Student 

and Youth Population, Fiscal Year 2011 25

Figure 5: Overlapping Treatment Services Provided to the Offender 

Population, Fiscal Year 2011 27
Page iii GAO-13-333 Office of National Drug Control Policy

Abbreviations

AOUSC Administrative Office of the United States Courts

BOP Bureau of Prisons

DEA Drug Enforcement Administration

DOD Department of Defense

DOJ Department of Justice

DOT Department of Transportation

ETA Education and Training Administration

FAA Federal Aviation Administration

HHS Department of Health and Human Services

HRSA Health Resources and Services Administration

HUD Department of Housing and Urban Development

IHS Indian Health Service

NHTSA National Highway Traffic Safety Administration

OJP Office of Justice Programs

ONDCP Office of National Drug Control Policy

PRS Performance Reporting System

SAMHSA Substance Abuse and Mental Health Services 

Administration

SUD substance use disorder

VA Department of Veterans Affairs

VHA Veterans Health Administration

This is a work of the U.S. government and is not subject to copyright protection in the 

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Page 1 GAO-13-333 Office of National Drug Control Policy

United States Government Accountability Office

Washington, DC 20548

March 26, 2013

The Honorable Dianne Feinstein

Chairman

The Honorable Charles Grassley

Co-Chairman

Caucus on International Narcotics Control

United States Senate

Illicit drug use endangers public health and safety and depletes financial 

resources, and the scale of the problem has not improved over the past 

decade. An estimated 22.5 million Americans aged 12 or older were illicit 

drug users in 2011, representing 8.7 percent of this population, according 

to the National Survey on Drug Use and Health.1 In addition, illicit drug 

use rates among Americans aged 12 and older from 2009 through 2011 

were among the highest since trend data were available in 2002. Abuse 

of illicit drugs results in significant public health, social, and economic 

consequences for the United States. For example, the Department of 

Justice’s (DOJ) National Drug Intelligence Center estimated that the 

economic impact of illicit drug use, including the costs of health care, 

crime, and lost productivity, was more than $193 billion in 2007.2

The Office of National Drug Control Policy (ONDCP) is responsible for, 

among other things, overseeing and coordinating implementation of 

national drug control policy across the federal government to address 

illicit drug use.

 

3 In this role, ONDCP is required annually to develop a 

National Drug Control Strategy (the Strategy),4

 

1

Illicit drug use includes the use of marijuana (including hashish), cocaine (including 

crack), heroin, hallucinogens, and inhalants, as well as the nonmedical use of prescription 

drugs, such as pain relievers and sedatives. The 22.5 million represents individuals who 

reported that they used an illicit drug during the month prior to the survey interview. See 

Department of Health and Human Services Substance Abuse and Mental Health Services 

Administration, Results from the 2011 National Survey on Drug Use and Health: Summary 

of National Findings (Rockville, Md.: September 2012). 

which sets forth a 

comprehensive plan to reduce illicit drug use through programs intended 

2

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

Illicit Drug Use on American Society (Washington, D.C.: April 2011). According to the 

report, 2007 is the most recent year for which data are available.

3

21 U.S.C. § 1702(a)(2).

4

21 U.S.C. §§ 1703(b), 1705(a).

 
 

Page 2 GAO-13-333 Office of National Drug Control Policy

to prevent or treat drug use or reduce the availability of illegal drugs, as 

well as to develop a National Drug Control Program Budget proposal for 

implementing the Strategy.5 ONDCP reported that about $25.2 billion was 

provided for drug control programs in fiscal year 2012. Of this, $10.1 

billion, or 40 percent, was allocated to prevention and treatment 

programs.6

Nineteen federal departments, agencies, and components (collectively 

referred to as agencies) funded a range of drug abuse prevention and 

treatment programs included in the fiscal year 2013 Drug Control Budget. 

As we previously reported, the range of programs across federal 

agencies could result in a fragmented service system, with more than one 

federal agency involved in the same broad area of national interest.

Specifically, these programs are intended, in all or in part, to 

prevent the initiation of illicit drug use or treat the abuse, or problematic 

use, of illicit drugs and provide or fund such services as outreach efforts 

to discourage first-time drug use and assessment and intervention to 

assist regular users to become drug-free. 

7

You asked us to review an array of issues related to the Strategy and 

drug abuse prevention and treatment programs. In July 2012, we issued a 

Such a system could lead to some programs offering similar services and 

serving similar populations, and thus to inefficiencies in program 

administration and service delivery across the federal government. In light 

of the rate of illicit drug use among Americans and the nation’s current 

budgetary constraints, efforts to oversee progress toward achieving 

national drug policy goals, coordinate drug control program activities to 

mitigate potential inefficiencies, and conduct evaluations of program 

effectiveness become increasingly important.

 

5

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

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

as the Drug Control Budget.

6

The remaining $15.1 billion was allocated to domestic law enforcement, interdiction, and 

other programs intended to reduce the availability of illegal drugs.

7

GAO, Opportunities to Reduce Potential Duplication in Government Programs, Save Tax 

Dollars, and Enhance Revenue, GAO-11-318SP (Washington, D.C.: Mar. 1, 2011). 
 

Page 3 GAO-13-333 Office of National Drug Control Policy

report with the results of our initial review of these issues.8

To address the first objective, we analyzed the 2010 Strategy and 2011 

and 2012 annual updates; ONDCP documentation about its Performance 

Reporting System and associated performance measures, which are 

intended to measure progress toward achieving Strategy objectives; and 

implementation plans and reports from selected federal drug control 

agencies. Specifically, we selected the following seven agencies to 

include in our assessment of Strategy implementation and performance 

measures: within the Department of Health and Human Services (HHS), 

the Substance Abuse and Mental Health Services Administration 

(SAMHSA), National Institutes of Health, and Centers for Disease Control 

and Prevention; within DOJ, the Office of Justice Programs (OJP) and the 

Drug Enforcement Administration; within the Department of Homeland 

Security, Customs and Border Protection; and the Department of 

Education (Education).

This final 

report reflects our completed work and addresses the extent to which (1) 

progress has been made toward achieving Strategy goals and ONDCP 

has mechanisms in place to monitor progress; (2) fragmentation, overlap, 

and duplication exist across drug abuse prevention and treatment 

programs, and ONDCP and federal agencies coordinate efforts to reduce 

the potential for overlap or duplication; and (3) federal agencies that have 

drug abuse prevention and treatment programs conduct evaluations of 

these programs, including assessments of program effectiveness. We

also reviewed what available research suggests about the potential effect 

of societal factors, such as state laws allowing the use of marijuana for 

medical purposes, on youth drug use. Appendix I summarizes the results 

of this work.

9

 

8

GAO, Drug Control: Initial Review of the National Strategy and Drug Abuse Prevention 

and Treatment Programs, 

We selected these agencies to reflect a range in 

the number of Strategy activities for which agencies are responsible, the 

size of agency drug control budgets, and prevention, treatment, and 

GAO-12-744R (Washington, D.C.: July 6, 2012). We reported 

that ONDCP established a process to monitor progress on implementing the Strategy and 

described agency funding for drug abuse prevention and treatment programs, among 

other things. 

9

The National Institutes of Health includes the National Institute on Drug Abuse and the 

National Institute on Alcohol Abuse and Alcoholism. OJP includes the Bureau of Justice 

Assistance, Bureau of Justice Statistics, National Institute of Justice, and Office of 

Juvenile Justice and Delinquency Prevention.
 

Page 4 GAO-13-333 Office of National Drug Control Policy

supply reduction missions.10 While these seven agencies are not 

representative of all drug control agencies, they are responsible for 

implementing a majority of activities in the Strategy and provided a range 

of perspectives about its implementation and progress. We also 

interviewed officials from ONDCP and these agencies to obtain 

information about progress on the Strategy’s goals, implementation of the 

Strategy, and mechanisms to monitor progress. We compared these 

documents and information with criteria for performance management

indentified in our prior work.

11

To address the second objective, we assessed 76 drug abuse prevention 

and treatment programs that provide or fund prevention and treatment 

services, such as education and outreach activities, drug testing, and 

intervention. We excluded programs that, for example, exclusively 

conduct research, fund overhead costs, or reimburse services as part of a 

health benefit plan.

Finally, we interviewed seven drug policy 

experts to discuss their perspectives on the Strategy and performance 

management. We selected these experts based on our review of drug 

policy literature, their expertise in drug policy issues and work conducted 

in this area, and recommendations from these and other researchers. The 

information we obtained cannot be generalized to other experts; however, 

they provided us with a range of views about the Strategy and ONDCP’s 

monitoring mechanisms. 

12

 

10Supply reduction includes any activity or program conducted by a National Drug Control 

Program agency that is intended to reduce the availability or use of illegal drugs in the 

United States or abroad. See 21 U.S.C. § 1701(11). This includes, for example, activities 

to enforce drug control laws and reduce the production or trafficking of illicit drugs. Also, 

under 21 U.S.C. § 1701(7), the term “National Drug Control Program agency” means any 

agency that is responsible for implementing any aspect of the National Drug Control 

Strategy, including any agency that receives federal funds to implement any aspect of the 

National Drug Control Strategy, subject to certain exceptions regarding intelligence 

agencies. 

These 76 programs are administered by 15 of the 

19 agencies that are included in the fiscal year 2013 Drug Control 

11See for example GAO, Tax Administration: IRS Needs to Further Refine Its Tax Season 

Performance Measures, GAO-03-143, (Washington, D.C.: Nov. 22, 2002). 

12We excluded, for example, programs such as those administered by HHS’s National 

Institutes of Health, which funds and disseminates scientific research on drug abuse 

prevention and treatment but does not provide direct services to individuals. We also 

excluded the Department of Defense’s Health Program, which includes military health 

benefit plans.
 

Page 5 GAO-13-333 Office of National Drug Control Policy

Budget.13 We distributed a questionnaire to program officials at these 15 

agencies to collect information on program activities in fiscal year 2011, 

such as program purpose, allowable services provided, and population 

served.14 We received responses to all the questionnaires we distributed, 

for a 100 percent response rate, and analyzed information for 76 

prevention and treatment programs. To assess the reliability of the 

information we received, we incorporated questions about the reliability of 

data on the programs’ obligated funds, performed internal reliability 

checks, and conducted follow-up as necessary with agency officials. As a 

result, we determined that the data used in our report were sufficiently 

reliable for our purposes. We analyzed responses to identify potential 

fragmentation, overlap, or duplication based on criteria established in our 

previous work.15 To assess coordination efforts, we analyzed 

questionnaire responses regarding agency efforts to coordinate drug 

abuse prevention and treatment program activities. We also analyzed the 

2010 Strategy and interviewed ONDCP and agency officials about actions 

taken to coordinate these activities. We compared these reported actions 

with criteria for coordinating interagency efforts identified in our prior 

work.16

 

13We excluded 4 of the agencies included in the budget for varying reasons. For example, 

we excluded HHS’s Centers for Medicare and Medicaid Services, which accounted for 

almost $4.5 billion of the $10.1 billion allocated to prevention and treatment programs in 

fiscal year 2012, because it administers federal health benefit programs that reimburse 

drug prevention and treatment services but does not directly provide them. We also 

excluded the Court Services and Offender Supervision Agency for the District of Columbia 

because it was created to supervise District of Columbia code offenders and functions 

primarily as a local agency. Federal agencies we included may administer programs 

through a variety of means, including, but not limited to, grants to state, local, tribal, and 

nonprofit entities; contracts with services providers; or services directly provided to 

beneficiaries by the federal agency itself. 

 

14We collected information on activities conducted in fiscal year 2011 because it was the 

most recently completed fiscal year at the time we administered the survey. In addition, 

we collected information on all services that programs may provide, not just those that are 

currently provided. 

15GAO-11-318SP and GAO, 2012 Annual Report: Opportunities to Reduce Duplication, 

Overlap and Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP

(Washington, D.C.: Feb. 28, 2012).

16For example, GAO, Results-Oriented Government: Practices That Can Help Enhance 

and Sustain Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 

21, 2005) and GAO-12-1022. 
 

Page 6 GAO-13-333 Office of National Drug Control Policy

To address the third objective, we analyzed documents, such as 

completed program evaluations and agency policies and procedures, and 

interviewed officials from the 15 agencies who are responsible for 

overseeing the programs included in the second objective to identify the 

number of program evaluations completed, under way, or planned since 

2007.17 We selected 2007 as the starting point for our review in order to 

provide a long enough time frame to include evaluations that may take 

multiple years to complete. We reviewed completed evaluations to 

determine whether these evaluations included assessments of 

effectiveness (i.e., determining the extent to which a program is achieving 

its objectives) described in our prior work in this area.18

Finally, to describe the available research about the potential effect of 

societal factors on drug use among youth—individuals 17 years old and 

under—we conducted a literature search to identify studies, published as 

of June 2012, that addressed the following: (1) state laws allowing the 

use of marijuana for medical purposes, (2) marijuana decriminalization, 

and (3) the favorable portrayal of drugs in the media on youth drug use.

We also 

interviewed ONDCP officials responsible for Strategy implementation to 

obtain their perspectives on how program evaluations were used to 

inform policy and resource allocation decisions. In addition, through our 

review of agency documents and interviews, we identified other ways in 

which agencies are attempting to ensure that programs are effective. 

19

 

17We define “program evaluations” as individual, systematic studies to assess how well a 

program or programs are working. 

We reviewed the studies on medical marijuana laws and decriminalization 

from our initial search results and identified those that met our established 

criteria for these factors, such as using comparison groups or statistical 

analysis to assess their effects. We selected the studies on medical 

marijuana laws and marijuana decriminalization to include in this report 

based on the sufficiency of their methodologies; therefore, our results 

cannot be generalized to all research about the potential effect of these 

factors on youth drug use. The media studies we identified did not assess 

the effect of prodrug messages on youth drug use, but we included them 

because they provide useful context regarding the portrayal of drugs in 

18GAO, Designing Evaluations: 2012 Revision, GAO-12-208G (Washington, D.C.: January 

2012).

19Marijuana decriminalization refers to the reduction in penalties for marijuana possession.
 

Page 7 GAO-13-333 Office of National Drug Control Policy

the media. Additional information about our scope and methodology is 

included in appendix II. 

We conducted this performance audit from July 2012 to March 2013 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 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. 

ONDCP was established by the Anti-Drug 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.20 In 

this role, the office is responsible for (1) developing a national drug 

control policy, (2) developing and applying specific goals and 

performance measurements to evaluate the effectiveness of national drug 

control policy and National Drug Control Program agencies’ programs, (3) 

overseeing and coordinating the implementation of the national drug 

control policy, and (4) assessing and certifying the adequacy of the 

budget for National Drug Control Programs.21

 

20ONDCP was created and authorized through January 21, 1994, by the National 

Narcotics Leadership Act of 1988 (codified at 21 U.S.C. 1501 et seq.), in title 1 of the AntiDrug Abuse Act of 1988, Pub. L. No. 100-690, 102 Stat. 4181. ONDCP has continued to 

operate since the conclusion of its first authorization through multiple reauthorizations or 

as a result of legislation providing continued funding.

 

2121 U.S.C. § 1702(a). We reported on the Drug Control Budget process in 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). 

Agencies included in the Drug Control Budget are required to follow a detailed process in 

developing their annual budget submissions. Agencies submit to ONDCP the portion of 

their budget requests dedicated to drug control. ONDCP provides annual budget 

recommendations to these agencies that are intended to specifically delineate what 

priorities each agency is expected to fund in the coming year submission. Each fiscal 

year, ONDCP assesses agency budget submissions to implement the Strategy and 

certifies them if deemed adequate, or otherwise decertifies them. 

Background 

Office of National Drug 

Control Policy 
 

Page 8 GAO-13-333 Office of National Drug Control Policy

The 2010 Strategy is the inaugural strategy guiding drug policy under 

President Obama’s administration. According to ONDCP officials, it 

sought a comprehensive approach to drug policy, including an emphasis 

on drug abuse prevention and treatment efforts and the use of evidencebased practices or interventions—approaches to prevention or treatment 

that are based in theory and have undergone scientific evaluation.22

ONDCP established two overarching policy goals in the 2010 Strategy for 

(1) curtailing illicit drug consumption and (2) improving public health by 

reducing the consequences of drug abuse, and seven subgoals under 

them that delineate specific quantitative outcomes to be achieved by 

2015, such as reducing drug-induced deaths by 15 percent.

For 

the 2010 Strategy, ONDCP changed its approach and moved from 

publishing a 1-year Strategy to publishing a 5-year Strategy, which 

ONDCP is to update annually. The annual updates, which ONDCP has 

issued for 2011 and 2012, are to provide an implementation progress 

report as well as an opportunity to make adjustments to reflect policy 

changes. 

23 To support 

the achievement of these two policy goals and seven subgoals 

(collectively referred to as goals), the Strategy and annual updates 

include seven strategic objectives. These objectives are to be achieved 

by implementing 112 action items, with lead and participating agencies 

designated for each action item.24

 

22ONDCP also developed several supplemental strategies to complement the Strategy, 

including the 2011 Prescription Drug Abuse Plan, the 2011 National Southwest Border 

Counternarcotics Strategy, the 2012 National Northern Border Counternarcotics Strategy, 

and the 2011 Strategy to Combat Transnational Organized Crime. We focused on the 

2010 National Drug Control Strategy and annual updates because they are the primary 

documents that comprehensively outline the administration’s drug control policy and 

goals. 

See figure 1 for additional details. 

23When developing the Strategy, ONDCP identified data sources for each of the seven 

subgoals, such as SAMHSA’s National Survey on Drug Use and Health.

24ONDCP developed 106 action items for the 2010 Strategy and combined 2 action items 

and added 8 action items in the 2011 Strategy update. In July 2012, ONDCP officials 

reported that they combined 2 additional action items. 
 

Page 9 GAO-13-333 Office of National Drug Control Policy

Figure 1: 2010 National Drug Control Strategy Goals, Objectives, and Action Items

a

Thirty-day prevalence is defined as having used within the past 30 days.

 bLifetime prevalence is defined as having ever used. 

c

Morbidity refers to incidence of disease.
 

Page 10 GAO-13-333 Office of National Drug Control Policy

We previously reported that ONDCP developed the objectives and action 

items in the Strategy through a consultative process with drug control 

agencies and other stakeholders because these agencies have primary 

responsibility for implementing them.25 The objectives represent broad 

policy areas, such as prevention, treatment, and domestic law 

enforcement, and collectively contribute to all of the Strategy’s goals. The 

action items under each objective represent the activities needed to 

accomplish the objective and may highlight specific drug control program 

activities or call for agencies to perform a specific task, such as preparing 

a report on the health risks of youth drug abuse. 

The Strategy’s drug abuse prevention and treatment objectives are 

supported by action items implemented through programs across multiple 

agencies. Specifically, the 15 federal agencies we selected to include in 

our review collectively allocated about $4.5 billion in fiscal year 2012 to 

programs that provide drug abuse prevention and treatment services 

(drug abuse prevention and treatment programs)26 as shown in figure 2.27

 

25See 

 

GAO-12-744R for additional information on the Strategy development process.

26Specifically, on the basis of ONDCP guidance, we defined a drug abuse prevention 

program as a federal program that provides services, allocates funding, or allows for 

activities focused on discouraging the first-time use of controlled substances—specifically 

illicit drugs and the problematic use of alcohol—and encouraging those who have begun 

to use controlled substances to cease their use. We defined a drug abuse treatment 

program as a federal program that provides services, allocates funding, or allows for 

activities focused on identifying and assisting users of controlled substances—specifically 

illicit drugs and the problematic use of alcohol—to become drug-free and remain drugfree. 

27Seventy-six prevention and treatment programs within these 15 agencies were included 

in our review of fragmentation, overlap, and duplication. We did not include supply 

reduction programs in this review. 

Drug Abuse Prevention 

and Treatment Programs
 

Page 11 GAO-13-333 Office of National Drug Control Policy

Figure 2: Federal Funding Allocated to Drug Abuse Prevention and Treatment Programs by 15 Selected Agencies, Fiscal Year 

2012 

Note: 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. The amounts 

represent fiscal year 2012 funding that these agencies allocated to their prevention and treatment 

programs as reported in the fiscal year 2013 Drug Control Budget and include funding for programs 

that were excluded from our review. For example, Department of Defense funding includes $90.4 

million for the Defense Health Program, which we excluded from our review because it reimburses for 

services as part of a military health benefit. The 15 agencies include both departments and 

components, based on how funding was reported in the Drug Control Budget. For example, within the 

Department of Justice, the Office of Justice Programs, the Drug Enforcement Administration, and the 
 

Page 12 GAO-13-333 Office of National Drug Control Policy

Bureau of Prisons were counted as 3 agencies and the Department of Veterans Affairs was counted 

as 1 agency. Percentages represent the proportion of the total $4.5 billion that these agencies 

allocated to prevention and treatment activities. See appendix III for descriptions of programs within 

each of the agencies. 

In 2010, Congress directed us to conduct routine investigations to identify 

programs, agencies, offices, and initiatives with duplicative goals and 

activities within departments and government wide and report annually to 

Congress.28 In March 2011 and February 2012, we issued our first two 

annual reports to Congress in response to this requirement.29

• Fragmentation occurs when more than one federal agency (or more 

than one organization within an agency) is involved in the same broad 

area of national interest. 

On the 

basis of the framework established in these reports, we used the following 

definitions for assessing drug abuse prevention and treatment programs:

• Overlap occurs when fragmented agencies or programs have similar 

goals, engage in similar activities or strategies to achieve them, or 

target similar beneficiaries. 

• Duplication occurs when two or more agencies or programs are 

engaged in the same activities or provide the same services to the 

same beneficiaries.

 

28Pub. L. No. 111-139, § 21, 124 Stat. 8, 29-30 (2010) (codified in 31 U.S.C. § 712 Note). 

29See GAO-11-318SP and GAO-12-342SP. 

Our Work on 

Fragmentation, Overlap, 

and Duplication
 

Page 13 GAO-13-333 Office of National Drug Control Policy

Our analysis indicates that ONDCP and federal agencies have not made 

progress toward achieving four of five goals established in the 2010 

Strategy for which primary data are available. However, ONDCP reported 

strong progress in implementing most of the action items in the Strategy 

intended to support achievement of these goals. ONDCP officials stated 

that implementing these action items is necessary but may not be 

sufficient to achieve Strategy goals. ONDCP’s Performance Reporting 

System (PRS) is a new monitoring mechanism intended to provide more 

specific, routine information on progress and help identify causal factors 

for performance gaps and options for improvement. According to ONDCP 

officials, the office plans to report on PRS results for the first time in 2013 

and assess the system’s reliability and effectiveness, which could help 

increase accountability for improving results and identify ways to bridge 

the gap between the lack of progress toward Strategy goals and the 

strong progress on implementing actions in the Strategy.

ONDCP officials responsible for overseeing the development of the 2010 

Strategy stated that they established the Strategy’s seven quantitative 

goals based in part on the availability and quality of data sources to 

measure the effects of drug control policy and what they considered could 

realistically be achieved within designated time frames, among other 

things.30 Nonetheless, these officials said that the goals are aggressive 

given that drug use trends for some of the measures were increasing 

prior to their establishment. As of March 2013, our analysis indicates that 

of the five goals for which data on results were available, one shows 

progress and four show either no change or movement away from the 

2015 goals—for example, drug-induced deaths have increased, instead 

of decreased, from the 2009 baseline, as shown in table 1.31

 

30The 2010 Strategy notes that the seven goals do not capture some highly important 

effects of drug policy, such as reducing drug-motivated robberies and assaults, because 

current information systems are not sufficient to measure whether goals are being 

achieved. The Strategy includes an objective to improve information systems for analysis, 

assessment, and local management to address this issue.

 

31As of March 2013, 2009 baselines and results for 2010 to 2012 were not available for 

two of the goals because information from primary data sources was not available. 

ONDCP officials stated that 2015 results for all measures are to be available in 2016 to 

determine if the Strategy met its goals.

Results Show Lack of 

Progress on Strategy 

Goals, although 

Implementation of 

Most Action Items Is

Complete or On 

Track; ONDCP 

Established a New 

Mechanism to 

Monitor Progress 

Results Show Lack of 

Progress toward Achieving 

Strategy Goals
 

Page 14 GAO-13-333 Office of National Drug Control Policy

Table 1: 2010 National Drug Control Strategy Goals and Progress toward Meeting Them, as of March 2013

2010 Strategy goals 2007 2008a 2009 

(baseline)

2010

(new 

Strategy) 2011 2012

2015 

(goal)b

Progress 

from baseline 

to goal

Goal 1: Curtail illicit drug consumption in America

1. Decrease the 30-day 

prevalence of drug use 

among 12- to 17-year-olds by 

15 percent 9.6% 9.3% 10.1% 10.1% 10.1% 8.6% No change

2. Decrease the lifetime 

prevalence of eighth graders 

who have used drugs, 

alcohol, or tobacco by 15 

percent 

Illicit drugs

19.0% 19.6% 19.9% 21.4% 20.1% 18.5% 16.9%

Movement 

toward goal

Alcohol 38.9% 38.9% 36.6% 35.8% 33.1% 29.5% 31.1% Met goal

Tobacco 22.1% 20.5% 20.1% 20.0% 18.4% 15.5% 17.1% Met goal

3. Decrease the 30-day 

prevalence of drug use 

among young adults aged 18-

25 by 10 percent 19.8% 19.7% 21.4% 21.6% 21.4% 19.3% No change

4. Reduce the number of 

chronic drug users by 15 

percent c 

No data 

available

Goal 2: Improve the public health and public safety of the American people by reducing the consequences of drug abuse

5. Reduce drug-induced 

deaths by 15 percent 38,371 38,649 39,147 40,393 33,275

Movement away 

from goal

6. Reduce drug-related 

morbidity by 15 percent

d

 

Emergency room visits for 

drug misuse and abuse 1,883,280 1,999,877 2,070,451 2,301,050 1,759,883 

Movement away 

from goal

HIV infections attributable 

to drug use 7,600 6,400 5,300 5,500 4,505 

Movement away 

from goal

7. Reduce the prevalence of 

drugged driving by 10 

percent 16.3% e 14.7%

No data 

available

Source: GAO analysis of data from the following sources for these measures: (1) Substance Abuse and Mental Health Administration’s 

(SAMHSA) National Survey on Drug Use and Health; (2) National Institute of Drug Abuse’s Monitoring the Future; (3) What America’s 

Users Spend on Illegal Drugs; (4) Centers for Disease Control and Prevention’s National Vital Statistics System; (5) SAMHSA’s Drug 

Abuse Warning Network drug-related emergency room visits; (6) Centers for Disease Control and Prevention data on HIV infections 

attributable to drug use; and (7) National Highway Traffic Safety Administration’s National Roadside Survey. 

a

Data from 2007 and 2008 are included to show trends for these measures prior to the 2009 

baselines. 

b

Goals for 2015 were established by calculating 10 to 15 percent decreases, as applicable, from the 

2009 baselines.

c

The data source for this measure is a report entitled What America’s Users Spend on Illegal Drugs, 

which is sponsored by ONDCP. The most recent report was released in June 2012 and provides data 
 

Page 15 GAO-13-333 Office of National Drug Control Policy

from 1998 through 2006. According to ONDCP officials, the baseline for this measure will be 

established when updated results through 2010 are available in May 2013.

d

Strategy goals call for decreases in the prevalence or numbers of drug use, drug users, or 

consequences of drug use. Movement away from goals indicates that the results for these measures 

have increased from the 2009 baseline or are trending in the opposite direction of the 2015 goals.

e

According to ONDCP officials, the primary data source for this measure is the National Roadside 

Survey conducted by the National Highway Traffic Safety Administration. The most recent survey in 

2007 was the first to include an estimate of the prevalence of drugged driving. It found that 16.3 

percent of weekend, nighttime drivers tested positive for the presence of at least one illicit drug or 

medication (with the ability to impair). Results of the next survey are expected in 2014. Accordingly, 

ONDCP officials stated that 2007 is the baseline year for this measure. These officials said that 

SAMHSA’s National Survey on Drug Use and Health, which also measures the prevalence of 

drugged driving, serves as a secondary data source to the National Roadside Survey. 

ONDCP and federal drug control agencies have made progress toward 

achieving the goal for decreasing the lifetime prevalence of eighth 

graders who have used drugs, alcohol, or tobacco, which consists of 

three separate measures.32 In addition, while results from the primary 

data source for the goal to reduce drugged driving are not available, 

results from ONDCP’s secondary data source indicate progress toward 

achieving this goal.33

 

32Specifically, as of 2012, they have met the 2015 goals for reducing alcohol and tobacco 

use and made progress toward the goal for reducing illicit drug use. 

However, progress has not been made on the other 

four goals for which primary data are available. For example, the 30-day 

prevalence of reported drug use among 12- to 17-year-olds has not 

changed from the 2009 baseline to 2011. According to the data source for 

this measure—SAMHSA’s National Survey on Drug Use and Health—this 

is due primarily to an increase in the rate of reported marijuana use, offset 

by decreases in the rates of reported non-medical use of prescription 

drugs and inhalants. The survey indicates that marijuana accounts for 

almost 80 percent of illicit drug use among 12- to 17-year-olds. In 

addition, drug-related morbidity, as measured by the number of 

emergency room visits for drug misuse and abuse and HIV infections 

attributable to drug use, increased from 2009 to 2010 and is higher than 

the established goals for these measures. The data source for the 

number of emergency room visits for drug misuse and abuse—

33The secondary data source for this measure—the National Survey on Drug Use and 

Health—indicates a reported decrease in driving under the influence of illicit drugs during

the past year from 4.2 percent in 2009 to 3.7 percent in 2011 (about a 12 percent 

reduction). These rates are based on self-reported responses. In contrast, ONDCP’s 

primary data source for this measure—the National Roadside Survey—is based on either 

oral fluid or blood tests of nighttime drivers.
 

Page 16 GAO-13-333 Office of National Drug Control Policy

SAMHSA’s Drug Abuse Warning Network—indicates that misuse and 

abuse of prescription drugs accounted for the majority of these visits in 

2010 (58 percent).34 

In August 2010, ONDCP instituted a process to track the implementation 

status of action items established to achieve the objectives, and ultimately 

the goals, of the Strategy.35 Agencies that have lead responsibility for 

implementing action items submit progress reports to ONDCP on an 

annual basis. The office reviews these updates and information from 

other sources, such as interagency meetings and agency budget 

submissions, and classifies action items into five categories—complete, 

on track, delayed but progressing, facing budget issues, and at risk.36

Despite the lack of progress we found toward meeting the Strategy’s 

goals, ONDCP reported in its most recent publication of results in July 

2012 that 96 percent (107 of 112) of the action items are complete or on 

track, as shown in figure 3.37

 

34According to one of the drug policy experts we interviewed who stated that he was 

involved in the development of the Strategy’s goals, each goal generally targets 

reductions in the use of specific drugs. The expert stated, for example, that the goals 

related to youth and young adult drug use primarily target marijuana use, while the goals 

related to drug-related deaths and morbidity primarily target the use of cocaine, heroin, 

and prescription drugs.

 

35We previously reported on ONDCP’s process to determine the implementation status of 

action items in GAO-12-744R. 

36We reviewed ONDCP’s categorizations for a nonprobability sample of 24 out of 82 

action items led by ONDCP and our seven selected agencies. Although we cannot 

generalize the results to all action items led by these agencies, we generally agreed with 

ONDCP’s characterization of the implementation statuses of the action items we 

reviewed. 

37ONDCP officials stated that in order to better support the development of the annual 

Strategy update by providing the latest information about the progress of the action items, 

the next published review of action items will be released in April 2013, prior to the 

Strategy being released. They said that they continuously monitor the implementation 

status of action items between publication dates.

ONDCP Monitors Progress 

on Implementing Strategy 

Action Items and Reported 

That Most Are Complete or 

on Track 
 

Page 17 GAO-13-333 Office of National Drug Control Policy

Figure 3: Number of Action Items in Office of National Drug Control Policy (ONDCP) Implementation Status Categories by 

National Drug Control Strategy Objective, as of July 2012

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. 

We previously reported in July 2012 that ONDCP monitors and reports on 

the implementation status of action items to, among other things, help 

hold agencies accountable for implementing the action items; give credit 

to agencies for progress made; and motivate them, if needed, to take 
 

Page 18 GAO-13-333 Office of National Drug Control Policy

steps to address delays.38 Officials we interviewed from all seven 

agencies we selected stated that Strategy action items reflect their 

already existing priorities or activities. According to ONDCP officials, this 

alignment helps facilitate implementation. ONDCP officials stated that the 

implementation of Strategy action items is necessary to achieve Strategy 

goals but may not be sufficient. According to these officials, a variety of 

factors could affect achievement of these goals, such as worsening 

economic conditions, changing demographics, or changing social or 

political environments; the passage of state laws that decriminalize 

marijuana use or allow its use for medical purposes; failure to obtain 

sufficient resources to address drug control problems; insufficient 

commitment from agency partners; and the need for new action items that 

include initiatives or activities beyond those that are under way or 

planned.39 ONDCP officials stated that the PRS is to provide more 

specific information about where the Strategy is on or off track and 

prompt diagnostic reviews to identify causal factors contributing to any 

problems identified, as discussed below.

In April 2012, ONDCP established the PRS to monitor and assess 

progress toward meeting Strategy goals and objectives, and the office 

issued a report (the PRS report) describing the system with the 2012 

Strategy update. The PRS includes interagency performance measures 

and targets under each Strategy objective.40

 

38See 

For example, one of the six 

performance measures under the objective to strengthen efforts to 

prevent drug use in our communities is the average age of initiation for all 

illicit drug use, which has a 2009 baseline of 17.6 years of age and a 

2015 target of 19.5 years of age. Similarly, one of the four performance 

measures under the objective to seek early intervention opportunities in 

health care is the percentage of respondents, aged 12 to 17, who have 

used prescription-type drugs nonmedically in the past year. This measure 

has a 2009 baseline of 7.7 percent and a 2015 target of 6.5 percent. 

According to ONDCP officials, the PRS augments ONDCP’s current 

GAO-12-744R for more information about how ONDCP shares and uses 

information regarding the implementation status of Strategy action items.

39See app. I for our review of available research on the effect of medical marijuana laws 

and marijuana decriminalization on youth drug use.

40ONDCP refers to the measures as interagency measures because they were developed 

to reflect the contributions of more than one agency. 

ONDCP Has a New System 

in Place to Monitor 

Progress toward Goals and 

Plans to Define How the 

System Will Be Used to 

Assess Progress and 

Review Its Effectiveness
 

Page 19 GAO-13-333 Office of National Drug Control Policy

method of examining performance by allowing the office to assess the 

effectiveness of interagency efforts to achieve the Strategy’s objectives.41

We assessed PRS measures and found them to be generally consistent 

with attributes of effective performance management identified in our prior 

work as important for ensuring performance measures demonstrate 

results and are useful for decision making.

ONDCP officials stated that they plan to release the results of the PRS 

measures for the first time in 2013. According to the PRS report, system 

information is to be used to inform budget formulation and resource 

allocation, Strategy implementation, and policy making, among other 

things. 

42 For example, the PRS 

measures are clear, have limited overlap, and have measurable targets. 

Specifically, the measures are clearly stated, with descriptions included in

the 2012 PRS report, and all 26 of them have or are to have numerical 

targets. In addition, the measures were developed with input from 

stakeholders through an interagency working group process, which 

included participants from Education, DOJ, and HHS, among others.

43

The PRS report states that the system is to provide early warning about 

progress toward achieving Strategy objectives. However, it does not 

clearly define how progress toward 2015 targets for PRS measures is to 

be assessed and what actions are to be taken if intermediate results are 

not on track to meet these targets. ONDCP officials stated that they plan 

to provide information about the process to assess intermediate 

According to the PRS report, the working groups brainstormed candidate 

performance measures for each Strategy objective and assessed them 

based on criteria such as being clear, quantifiable, and valid indicators for 

the objective. The groups also identified data sources, such as national 

surveys on drug use and treatment services, to use to report on these 

measures and evaluated the data sources to determine if they were 

unbiased and collected data routinely, among other things. 

 

41ONDCP’s current method of assessing performance relies primarily on ONDCP’s review 

of data agencies report for performance metrics that they established for individual drug 

control programs, as well as program budget justifications and evaluations, among other 

things. 

42See GAO-03-143. 

43The PRS report stated that five working groups were established and assigned Strategy 

objectives. Each working group held meetings to develop and refine measures and targets 

for the objectives. 
 

Page 20 GAO-13-333 Office of National Drug Control Policy

performance results in the PRS report that is to be issued in 2013. These 

officials said that the report is still in development, but that for each PRS 

measure, they plan to compare the linear trend line from the baseline to 

the 2015 target with results to date; examine auxiliary data sources, such 

as other relevant national surveys, to refine the assessment; and work 

with interagency subject area experts to arrive at a final assessment.44

ONDCP officials stated that when results are determined to not be on 

track to meet 2015 targets, the PRS is to serve as a trigger for an 

interagency review of potential causes of performance gaps and options 

for improvement. These proposed actions are consistent with leading 

practices that we have previously identified regarding using intermediate 

goals and measures to show progress or contributions to intended results 

and clearly documenting significant events to help ensure that 

management directives are carried out.45

According to ONDCP officials, information collected through the PRS is to 

provide valuable insights to help identify where the Strategy is on track 

and when further problem solving and evaluation are needed. However, 

the system is still in its early stages and, as of March 2013, operational 

information is not available to evaluate its effectiveness. ONDCP officials 

stated that as part of the annual process to assess PRS results, they plan 

to review the measures to determine the extent to which they reliably 

capture agency performance and whether there is a need to modify 

them.

 

46

 

44ONDCP officials stated that they plan to refine the trend lines used to assess progress 

as more data become available in future years. ONDCP officials stated that they are still 

developing their assessment process and did not wish to provide additional details 

because the 2013 PRS report has yet to be issued. 

Further, the 2012 PRS report states that ONDCP plans to 

continue to improve measures as better data sources become available. 

Officials said that they plan to address any modification of the measures 

in the 2013 PRS report. According to these officials, ONDCP plans to 

assess the effectiveness of the PRS more comprehensively to determine 

45GAO, Agency Performance Plans: Examples of Practices That Can Improve Usefulness 

to Decisionmakers, GAO/GGD/AIMD-99-69, (Washington D.C.: Feb. 26,1999), and 

Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1 

(Washington, D.C.: November 1999). According to these standards, the documentation 

should appear in management directives, administrative policies, or operating manuals.

46ONDCP officials stated that they are still developing how they specifically plan to review 

the measures and did not wish to provide additional details because the 2013 PRS report 

has yet to be issued. 
 

Page 21 GAO-13-333 Office of National Drug Control Policy

how well it is working and whether any adjustments need to be made 

after the system has been operational for a longer period of time. Such 

actions are consistent with Standards for Internal Control in the Federal 

Government which calls for reviewing established performance measures 

to validate their propriety and integrity.47

ONDCP’s plans to clearly define and document its performance 

assessment process and evaluate how well the PRS and its measures 

are working should help increase accountability for improving results and 

enhance the system’s effectiveness as a mechanism to monitor progress 

toward Strategy goals and objectives and assess where further action is 

needed to improve progress. These actions could also help ONDCP 

identify ways to bridge the gap between the lack of progress toward 

Strategy goals and the reported strong progress agencies are making in 

implementing action items intended to facilitate the achievement of those 

goals. 

 

Drug abuse prevention and treatment programs are fragmented across 

15 federal agencies that funded or administered 76 programs in fiscal 

year 2011, and we identified overlap in 59 of these programs. Agency 

officials who administer programs in two areas that we reviewed in 

detail—that is, programs for youth and programs for offenders—reported 

making various efforts to coordinate program activities, which, according 

to our previous work, can minimize the risk of duplication. However, 29 of 

76 (about 40 percent) surveyed programs reported no coordination with 

other federal agencies on drug abuse prevention or treatment activities. 

ONDCP has not assessed all drug abuse prevention or treatment 

programs to identify the extent of overlap and potential duplication and 

opportunities for coordination. 

 

47GAO/AIMD-00-21.3.1. 

Drug Abuse Programs 

Are Fragmented and 

Overlapping; Many 

Reported That They 

Did Not Coordinate, 

and ONDCP Has Not 

Assessed Extent of 

Overlap and 

Coordination 

Opportunities 
 

Page 22 GAO-13-333 Office of National Drug Control Policy

Federal drug abuse prevention and treatment programs are fragmented 

across 15 federal agencies that administered 76 programs in fiscal year 

2011. Agencies reported that they administered four types of programs, 

specifically: 

• 22 programs were drug abuse prevention programs; 

• 21 programs were drug abuse treatment programs;

• 13 programs were both drug abuse prevention and treatment 

programs; and

• 20 programs were neither drug abuse prevention nor treatment 

programs, but programs that may provide or fund drug abuse 

prevention or treatment services to support other program 

objectives.48

Table 2 provides the number of these types of programs within the 15 

federal agencies, and appendix III provides additional information on the 

programs each agency administered in fiscal year 2011. 

 

48For the purpose of our review, we collectively refer to these programs as drug abuse 

prevention and treatment programs. This includes those 20 programs that may provide or 

fund drug abuse prevention or treatment services to support other program objectives. 

Drug Abuse Programs Are 

Fragmented across 15 

Federal Agencies, and 

Many Are Overlapping, 

Which May Result in 

Inefficiencies 
 

Page 23 GAO-13-333 Office of National Drug Control Policy

Table 2: Drug Abuse Prevention or Treatment Programs or Activities Administered by Selected 15 Federal Agencies in Fiscal 

Year 2011, by Type of Program

Department Agency

Number of programs, by type of program

Drug abuse 

prevention 

program

Drug abuse 

treatment 

program

Drug abuse 

prevention and 

treatment 

program

Neither, but 

program may 

include drug 

abuse prevention 

or treatment 

activities 

Total number of 

programs

DOD 5 1 1 7 

DOJ BOP 3 1 4 

DEA 1 1 

OJP 1 4 1 6 

DOT FAA 3 3 

NHTSA 1 1 

Education 1 2 3 a

Executive Office of 

the President

b

ONDCP 2 1 3 

Federal Judiciary AOUSC 1 1 

HHS HRSA 2 2 

IHS 5 5 

SAMHSA 13 10 6 5 34

HUD 3 3 

Labor ETA 1 1 

VA VHA 2 2 

Total 22 21 13 20 76

Source: GAO analysis of questionnaire responses from 15 federal agencies.

AOUSC = Administrative Office of the 

United States Courts

HUD = Department of Housing and 

Urban Development

BOP = Bureau of Prisons IHS = Indian Health Service

DEA =

DOD =

Drug Enforcement Administration

Department of Defense

NHTSA = National Highway Traffic Safety 

Administration

DOJ = Department of Justice OJP = Office of Justice Programs

DOT =

ETA =

FAA =

Department of Transportation

Education and Training 

Administration

Federal Aviation Administration

ONDCP =

SAMHSA =

Office of National Drug Control 

Policy

Substance Abuse and Mental 

Health Services Administration

HHS = Department of Health and 

Human Services

VA =

VHA =

Department of Veterans Affairs

Veterans Health Administration

HRSA = Health Resources and Services 

Administration 

Notes: For the purpose of our review, we defined a drug abuse prevention program as a federal 

program that provides services, allocates funding, or allows for activities focused on discouraging the 

first-time use of controlled substances—specifically illicit drugs and the problematic use of alcohol—
 

Page 24 GAO-13-333 Office of National Drug Control Policy

and encouraging those who have begun to use controlled substances to cease their use. We defined 

a drug abuse treatment program as a federal program that provides services, allocates funding, or 

allows for activities focused on identifying and assisting users of controlled substances—specifically 

illicit drugs and the problematic use of alcohol—to become drug-free and remain drug-free. 

a

Under 20 U.S.C. § 7164, funds may not be used for medical services, drug treatment, or 

rehabilitation, except for pupil services or referral to treatment for students who are victims of, or 

witnesses to, crime or who illegally use drugs with regard to Safe and Drug-Free Schools and 

Communities. Under 20 U.S.C. § 7175, with regard to 21st Century Community Learning Centers, 

each eligible entity that receives an award may use the award funds to carry out a broad array of 

before and after school activities that advance student academic achievement that are listed in the 

statute. 

b

For the purpose of our review, we assessed the activities of Education’s Safe and Supportive 

Schools and Safe Schools/Healthy Students programs separately; according to officials from 

Education, they are considered to be activities within a single program—the Safe and Drug-Free 

Schools and Communities National Activities. 

Furthermore, we identified overlap among the prevention and treatment 

programs we reviewed. As we have previously reported, overlapping 

programs can lead to target populations being eligible for similar services 

through multiple programs. However, overlapping programs are not 

necessarily duplicative, if the services provided and the populations 

served differ in meaningful ways.49

 

49See GAO, Science, Technology, Engineering, and Mathematics Education: Strategic 

Planning Needed to Better Manage Overlapping Programs across Multiple Agencies,

Of the programs we reviewed, 59 of 

the 76 programs (nearly 80 percent) are overlapping because they can 

provide or fund at least one drug abuse prevention or treatment service 

that at least one other program can provide or fund, either to similar 

population groups or to reach similar program goals. For example, six 

programs reported that they can provide or fund drug abuse prevention 

services for students and youth in order to support program goals of 

preventing drug use and abuse among young people. All six of the 

programs reported that they can provide or fund services to conduct 

outreach and educate youth on drug use. In addition, all of these 

programs also reported that they can provide or fund other similar 

services—such as public advertising and media campaigns or workplace 

education and training—with at least one other program. (See fig. 4.) 

GAO-12-108 (Washington, D.C.: Jan. 20, 2012). 
 

Page 25 GAO-13-333 Office of National Drug Control Policy

Figure 4: Overlapping Prevention Services Provided to the Student and Youth Population, Fiscal Year 2011 

Notes: We defined “drug abuse prevention services” as activities focused on discouraging the firsttime use of controlled substances—specifically illicit drugs and the problematic use of alcohol—and 

encouraging those who have begun to use controlled substances to cease their use. Programs 

included in this table reported providing drug abuse prevention services to support program goals of 

preventing drug use and abuse among young people. Other drug abuse programs included in our 

review may also provide drug abuse prevention services to students and youths to achieve the 

program’s primary objectives. For example, the Department of Labor’s Job Corps program provides 

prevention services to students and youths for the purpose of workforce development. 

a

Education and the Substance Abuse and Mental Health Services Administration (SAMHSA) jointly 

fund and manage the Safe Schools/Healthy Students program. In addition, for the purpose of our 

review, we assessed the activities of Education’s Safe and Supportive Schools and Safe 

Schools/Healthy Students programs separately; according to officials from Education, they are 

considered to be activities within a single program–the Safe and Drug-Free Schools and 

Communities National Activities. 

b

This program is managed by SAMHSA and funded by the Office of National Drug Control Policy 

(ONDCP). According to ONDCP officials, Drug Free Communities coalitions are allowed to participate 

in and provide media on drug abuse prevention, but the program itself is not a public advertising or 

media campaign. 

In addition, 15 programs reported that they can provide or fund many of 

the same prevention and treatment services provided to the offender 
 

Page 26 GAO-13-333 Office of National Drug Control Policy

population, that is, those individuals involved in the criminal justice 

system. Specifically, these programs reported that they can provide or 

fund many of the same treatment services in order to support similar 

program goals of identifying and meeting the treatment needs of 

offenders and providing services to reduce recidivism and facilitate 

reentry.50

 

50The term “recidivism” generally refers to the act of committing new criminal offenses 

after having been arrested or convicted of a crime. See GAO, Adult Drug Courts: Studies 

Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure 

Revision Efforts, 

For example, 12 of the 15 programs can provide or fund 

medical evaluations and different forms of therapy, including individual 

and family therapy, as shown in figure 5. 

GAO-12-53 (Washington, D.C.: Dec. 9, 2011). 
 

Page 27 GAO-13-333 Office of National Drug Control Policy

Figure 5: Overlapping Treatment Services Provided to the Offender Population, Fiscal Year 2011 
 

Page 28 GAO-13-333 Office of National Drug Control Policy

Note: We defined “drug abuse treatment services” as activities focused on identifying and assisting 

users of controlled substances, specifically illicit drugs and the problematic use of alcohol, to become 

drug free and remain drug free. 

In addition, programs with the goals of (1) expanding state and 

community capacity to prevent drug abuse and (2) addressing underage 

drinking also demonstrated overlap. For example, 9 programs reported 

that they can provide or fund drug abuse prevention and treatment 

services to almost all population groups listed in our survey in support of 

program goals to expand the capacities of state- and community-level 

entities to prevent drug abuse. Prevention services that could be provided 

by these programs included youth education, family education and 

support services, and public outreach activities. Furthermore, 4 programs 

with the goal of reducing underage drinking also reported providing 

similar types of prevention services, including youth education and public 

outreach activities. 

Fragmentation and overlap in some programs have resulted from agency 

efforts to meet specific areas of national need, among other things. For 

example, SAMSHA officials told us that DOJ’s and states’ expansion of 

funding for drug courts in the 1980s resulted in a strain on the number of 

community substance abuse treatment services available to drug courts. 

SAMHSA recognized the need for additional funding in this area and 

began to fund the expansion and enhancement of substance abuse 

treatment services specifically available to drug courts. In addition, having 

multiple programs that can provide similar services to similar beneficiaries 

can help to fill gaps in services for beneficiaries. However, this 

fragmentation and overlap could also make it challenging to develop a 

coordinated federal approach to providing drug abuse prevention and 

treatment services because of the number of different federal agencies 

involved, and could result in potential inefficiencies among programs 

providing similar services. Specifically, our body of work on fragmentation 

and overlap has found that agencies often can realize a range of benefits, 

such as improved customer service and decreased administrative 

burdens and cost savings from addressing issues related to 

fragmentation and overlap, as we discuss below.51 

 

51See GAO-11-318SP and GAO-12-342SP. 
 

Page 29 GAO-13-333 Office of National Drug Control Policy

Agency officials who administer programs in two areas that we reviewed 

in more detail—specifically, programs for youth and programs for 

offenders—reported making various efforts to coordinate overlapping 

program activities or services, which can serve to minimize the risk of 

duplication.52

• Prevention services for student and youth: While 6 programs that 

provide services to youth are overlapping, the risk of potential 

duplication among these programs may be low because of

interagency coordination efforts.

However we found that not all programs surveyed reported 

coordinating with other federal agencies on drug abuse prevention or 

treatment activities in the year prior to our survey. For those areas that we 

reviewed in more detail, we found the following: 

53

 

52See GAO, Managing for Results: GPRA Modernization Act Implementation Provides 

Important Opportunities to Address Government Challenges, 

Officials overseeing these 

programs from Education, ONDCP, and SAMHSA reported that the 

agencies coordinate to improve program efficiencies. For example, 

using an interagency agreement, Education jointly administers the 

Safe Schools/Healthy Students program with DOJ and HHS to 

provide complementary educational, mental health, and law 

enforcement services to help prevent youth violence and drug use. 

Similarly, SAMHSA and ONDCP maintain an interagency agreement 

to jointly administer the Drug Free Communities Support program. 

Officials from SAMHSA said that the agreement defines the roles and 

GAO-11-617T (Washington, 

D.C.: May 10, 2011). 

53These programs included 2 programs administered by Education; 1 program 

administered by SAMHSA; 1 program administered by ONDCP; 1 program administered 

jointly by Education, SAMHSA, and DOJ; and 1 program administered jointly by SAMHSA 

and ONDCP. 

Many Programs Reported 

That They Do Not 

Coordinate, and ONDCP 

Has Not Assessed the 

Extent of Overlap and 

Identified Coordination 

Opportunities to Help 

Improve Efficiencies 

Coordination Efforts in Two 

Areas with Overlap Helped 

Minimize Risk of Duplication, 

but Not All Programs Reported 

Such Efforts 
 

Page 30 GAO-13-333 Office of National Drug Control Policy

responsibilities of the two agencies, and establishes agreed-upon 

standard operating procedures. 

In addition, officials from Education, ONDCP, and SAMHSA reported 

that some programs and the services they can provide or fund are 

distinct because they target specific subgroups among students and 

youth, or they differ in scope. For example, the 21st Century 

Community Learning Center program allows for additional uses of 

funds that are not related to drug abuse prevention, like tutoring and 

mentoring, and does not require that grantees include drug abuse 

prevention as a program component. Officials from Education said 

that this indicates a difference in scope from the Safe Schools/Healthy 

Students program, which requires grantees to include drug abuse 

prevention services as a main program component. These officials 

also reported taking steps to identify opportunities for increasing 

efficiencies. For example, in its fiscal year 2013 budget justification, 

Education proposed consolidating several existing programs that seek 

to help schools provide programs and activities including alcohol, 

drug, and violence prevention. According to Education officials, the 

consolidation would more effectively target resources and address the 

needs of grantees. 

• Prevention and treatment services for offenders: Officials from the 

four agencies overseeing the programs that can provide or fund 

treatment and prevention services to the offender population also said 

that the agencies conduct coordination efforts to help ensure that

programs provide complementary services to this population, which 

can minimize the risk for potential duplication.54

 

54These programs included 5 programs administered by OJP, 4 programs administered by 

the Bureau of Prisons, 3 programs administered by SAMHSA, 2 programs jointly 

administered by OJP and SAMHSA, and 1 program administered by the Administrative 

Office of the United States Courts. 

OJP and SAMHSA 

officials reported that both agencies coordinate to ensure that these 

programs provide funding for different program elements. For 

example, according to OJP and SAMHSA officials, SAMHSA funding 

for drug courts is used for treatment services, while OJP funding for 

drug courts is used for administrative or case management purposes. 

While OJP is not restricted from funding the same treatment services 

SAMHSA can fund, officials from both agencies said that they use 

multiple coordination mechanisms to help minimize the risk of 

potential duplication. For example, OJP and SAMHSA jointly 

administer two drug court programs. For the agencies’ other programs 
 

Page 31 GAO-13-333 Office of National Drug Control Policy

serving offenders that are not jointly administered, SAMHSA officials 

told us they share requests for grant applications and information on 

potential awardees with OJP officials to ensure that grants are not 

awarded to the same grantee for the same purpose. We also 

previously reported that program overlap is minimal and the risk of 

potential duplication is low among OJP’s and SAMHSA’s offender 

programs that assist former inmates or inmates preparing for release 

from federal, state, and local correctional facilities.55

Additionally, officials from OJP and SAMHSA reported that their 

programs specifically serve offenders in the state and local justice 

systems, while the Bureau of Prisons and the Administrative Office of 

the United States Court’s programs specifically serve offenders who 

are or were incarcerated in federal prisons, which results in these 

programs having a low risk for duplication. In addition, these officials 

reported that the two agencies regularly share information and 

coordinate on prerelease planning for inmates in federal prisons and 

on transitioning inmates from prison to court-ordered drug testing and 

treatment after release, or vice versa. 

 

Coordination efforts among the programs included in the two areas we 

reviewed in detail were consistent with practices that we have previously 

reported federal agencies use to implement collaborative efforts.56 These 

efforts could address crosscutting issues that may reduce potentially 

duplicative, overlapping, or fragmented efforts. However, 29 of the 76 

programs (about 40 percent) surveyed reported no coordination with 

other federal agencies on drug abuse prevention or treatment activities. 

As we have previously reported, because fragmentation across agencies 

can create an environment in which programs are not delivered as 

efficiently and effectively as possible, coordination across government is 

essential.57

 

55Services funded by these programs included substance abuse, housing, and mental or 

behavioral health. GAO, Inmate Reentry Programs: Enhanced Information Sharing Could 

Further Strengthen Coordination and Grant Management, 

Therefore, there may be additional opportunities to implement 

interagency coordination efforts among the programs that did not report 

GAO-13-93 (Washington, DC: 

Dec. 14, 2012). 

56See GAO, Managing for Results: Key Considerations for Implementing Interagency 

Collaborative Mechanisms, GAO-12-1022 (Washington, D.C.: Sept. 27, 2012). 

57See GAO, Homelessness: Fragmentation and Overlap in Programs Highlight the Need 

to Identify, Assess, and Reduce Inefficiencies, GAO-12-491 (Washington, D.C.: May 10, 

2012). 
 

Page 32 GAO-13-333 Office of National Drug Control Policy

any of these efforts, to identify potential efficiencies that better leverage 

available resources and minimize overlap and potential duplication.

While ONDCP has identified activities related to the development and 

implementation of the Strategy and Drug Control Budget that promote 

coordination, it has not systematically assessed all drug abuse prevention 

or treatment programs to examine the extent of overlap and potential for 

duplication and identified opportunities for coordination among programs 

to more efficiently use limited resources. According to ONDCP officials, 

the office’s current processes are sufficient to determine the extent of 

overlap and potential for duplication. Specifically, officials from ONDCP 

and other agencies with whom we spoke reported that they have made 

efforts to promote coordination through the Strategy, which emphasizes 

the importance of agencies collaborating on the Strategy’s goals.58

However, the purpose of the interagency meetings and other efforts to 

facilitate coordination is to develop and implement the Strategy and not to 

identify overlap or potential duplication. Furthermore, the purpose of the 

budget process is to develop a consolidated funding request to implement 

the Strategy and help ensure that the Strategy is adequately resourced 

rather than to identify overlap or potential duplication across all programs. 

Accordingly, ONDCP has not conducted a systematic assessment of all 

federal drug abuse prevention and treatment programs, including those 

not captured in the budget, and the services they are allowed to provide 

to determine the extent to which they overlap and where opportunities 

exist to pursue coordination strategies in order to more efficiently use 

In 

addition, ONDCP officials stated that as part of the office’s annual 

process for developing the National Drug Control Budget submission, 

they review prevention and treatment programs for which funding is 

requested to verify that the programs serve unique needs and 

populations. ONDCP officials stated that their familiarity with the 

programs and information obtained from outreach at the programmatic 

level and interagency meetings, among other things, help in this review. 

 

58For example, ONDCP designates lead and partner agencies for each of the activities in 

the Strategy and discusses the use of interagency working group meetings, both of which 

are used to coordinate Strategy implementation. 

ONDCP Has Not Assessed the 

Extent of Overlap and 

Duplication among Drug Abuse 

Programs and Identified 

Agency Opportunities for 

Coordination
 

Page 33 GAO-13-333 Office of National Drug Control Policy

limited resources.59 Further, ONDCP officials stated that there is no 

overlap among these programs, but our analysis of prevention and 

treatment services identified overlap in 59 of them. Standards for Internal 

Control in the Federal Government highlights the importance of having 

access to operational and other data to determine whether programs are 

meeting goals for accountability and efficient use of resources.60

Additionally, The Standard for Project Management states that to ensure 

related projects are managed to achieve more benefits than could be 

achieved with stand-alone efforts, management should coordinate 

common activities or programs and the efficient use of resources across 

activities.61

Further, our previous work on characteristics of effective national 

strategies states that such strategies should include mechanisms for 

coordinating agency implementation efforts, which could entail the 

identification of specific processes for coordination.

This can include such efforts as mapping out how various 

activities across organizations are to achieve desired benefits. 

62

 

59Some of the programs included in our review of 76 programs are not included in the 

Drug Control Budget. For example, Education’s 21st Century Community Learning 

Centers program is not included in the Drug Control Budget because Education officials 

told us that the drug abuse prevention is one of a large number of authorized uses of 

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 reviews the budget requests of 

drug control agencies to determine if the agencies have acceptable methodologies for 

estimating their drug control budgets, and includes those that do in the National Drug 

Control Budget. 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 nondrug 

control programs. See 

As discussed 

earlier, officials from 29 of the 76 programs (about 40 percent) surveyed 

reported that they did not participate in any coordination efforts over the 

GAO-11-261R. ONDCP officials also told us that they are working 

with officials from Education to develop additional information on drug prevention activities 

in the 21st Century Community Learning Centers program including (1) the number of 

local centers that provide drug prevention activities, (2) the number of students served by 

those centers, and (3) the amount of 21st Century Community Learning Centers funds 

received by those centers.

60GAO/AIMD-00-21.3.1. 

61The Project Management Institute, The Standard for Program Management (Newtown 

Square, PA: 2008). 

62See GAO, Combating Terrorism: Evaluation of Selected Characteristics in National 

Strategies Related to Terrorism, GAO-04-408T (Washington, D.C.: Feb. 3, 2004). 
 

Page 34 GAO-13-333 Office of National Drug Control Policy

past year. Additionally, there may be other opportunities for improved 

efficiencies among agencies that have some coordination efforts in place. 

For example, while SAMHSA and OJP officials have made efforts to 

provide complementary drug court services, a SAMHSA official stated 

that a drug court awardee using SAMHSA funds to provide treatment 

services and OJP funds to administer the drug court still must meet 

complex, separate reporting requirements to each agency for such things 

as budget and performance management information. Our previous work 

has shown that fragmented services with separate agency requirements 

can be burdensome, difficult, and costly for service providers.63 ONDCP 

is uniquely situated to conduct an assessment across the 76 programs 

engaged in drug abuse prevention and treatment activities to identify the 

extent of overlap and potential for duplication and prospective processes 

for coordination. ONDCP could use the results of our analysis as a 

starting point for conducting this assessment. Such actions would better 

position ONDCP to help ensure that federal agencies undertaking similar 

prevention and treatment efforts identify opportunities for increased 

efficiencies, such as using coordination mechanisms to mitigate the risk 

of duplication and reducing administrative burdens on grantees, and 

better leverage available resources. These mechanisms could include, for 

example, joint program administration established through interagency 

agreements, sharing requests for grant applications, or joint performance 

measurement reporting among programs serving the same grant or 

cooperative agreement awardees.64 

 

63See GAO, Homelessness: Fragmentation and Overlap in Programs Highlight the Need 

to Identify, Assess, and Reduce Inefficiencies, GAO-12-491 (Washington, D.C.: May 10, 

2012). 

64For more information on the mechanisms that the federal government can use to lead 

and implement interagency coordination, see GAO-12-1022. 
 

Page 35 GAO-13-333 Office of National Drug Control Policy

While agencies in our review had completed few program evaluations 

since 2007, in part because of funding constraints, more are under way or 

planned. ONDCP officials stated that because few programs have 

completed program evaluations, they rely on a range of available 

performance information, including agency performance metric data, to 

inform development and implementation of the Strategy. In addition, 

agency officials said that they have taken other steps to help ensure that 

programs supporting the Strategy are effective, such as requiring or 

encouraging the use of interventions—drug abuse prevention or 

treatment practices—in their programs for which there is research or 

evidence that the interventions work. 

Program evaluations allow for comprehensive assessments of whether 

programs are achieving desired results to help allocate scarce resources 

to effective interventions, among other things.65 Program evaluation is 

closely related to performance measurement and reporting;66

 

65For more information about program evaluations, see 

evaluations 

have been used to supplement performance reporting by measuring 

results that are too difficult or expensive to assess annually or by 

exploring why program goals were not met. Program evaluations can tell 

agencies how well their programs are working, suggest options for 

improving program performance, and assist in program management. 

However, the drug control agencies in our review had completed few 

program evaluations since 2007, although more are under way or 

planned. Specifically, we found that 3 of the 15 agencies had completed 

evaluations of 6 programs since 2007, which accounts for about 8 percent 

of the 76 drug abuse prevention and treatment programs included in our 

review, and 8 agencies had started or planned 22 additional program 

GAO-12-208G. 

66Performance measurement is the systematic ongoing monitoring and reporting of 

program accomplishments, particularly progress toward preestablished goals or 

standards. Performance measures or indicators may address program staffing and 

resources, the type or level of program activities conducted, the direct products or 

services delivered by a program, or the direct results of those products and services.

Agencies We 

Reviewed Have 

Completed Few 

Program Evaluations, 

with Three Looking at 

Program 

Effectiveness, but 

Have Taken Other 

Steps to Ensure 

Programs Are 

Effective

Agencies in Our Review 

Have Completed Few 

Program Evaluations, but 

More Are Under Way or 

Planned
 

Page 36 GAO-13-333 Office of National Drug Control Policy

evaluations.67

Table 3: Drug Control Agency Programs with Evaluations Completed, Under Way, or Planned since 2007, as of November 

2012

See table 3 for the 9 agencies with program evaluations for 

one or more of their programs. 

Program Program type

Status of evaluation

a Completed Under way Planned

Administrative Office of the United States Courts

Court Ordered Substance Abuse Testing and 

Treatment 

Treatment X 

Department of Defense

Substance Abuse Rehabilitation Program Treatment X 

Navy Alcohol and Drug Abuse Prevention Prevention X 

Department of Education

Safe Schools/Healthy Students Prevention b X 

Indian Health Services

Methamphetamine Suicide Prevention Initiative Prevention and treatment X 

Substance Abuse and Mental Health Services 

Administration

Substance Abuse Prevention and Treatment Block 

Grant

Prevention and treatment X 

Underage Drinking Prevention Education Initiative Prevention XX X c

State Screening, Brief Intervention, and Referral to 

Treatment

Prevention and treatment X 

Targeted Capacity Expansion General—Grants to 

Expand Care Coordination Using Health Information 

Technology

Neither prevention nor treatment, but 

may include prevention or treatment 

activities

X 

Assertive Adolescent and Family Treatment Prevention and treatment X 

Homeless Grants for the Benefit of Homeless 

Individuals

Treatment X 

Minority AIDS Initiative Targeted Capacity 

Expansion

Prevention and treatment X 

 

67We examined program evaluations conducted by agencies in our review or on behalf of 

these agencies. An agency, through a program office or a research, policy, or evaluation 

office, may conduct studies internally, or it may direct or fund a study to be conducted 

externally by an independent consulting firm, research institute, or independent oversight 

agency or an agency’s inspector general.
 

Page 37 GAO-13-333 Office of National Drug Control Policy

Program Program type

Status of evaluation

a Completed Under way Planned

Minority HIV/AIDSd

 Minority HIV Prevention

 

 Capacity Building Initiative

 Ready to Respond

Prevention X 

Strategic Prevention Framework State Incentive 

Grants

Prevention XXc

Fetal Alcohol Spectrum Disorders Center of 

Excellence

Prevention X 

Bureau of Prisons

Residential Drug Abuse Treatment Treatment X 

Office of Justice Programs

Drug Courts Treatment X XX X c

Enforcing Underage Drinking Laws Prevention X X 

Residential Substance Abuse Treatment Treatment X 

Office of National Drug Control Policy

Drug Free Communities Support Program Prevention e X 

Department of Veterans Affairs

Substance Use Disorder Outpatient Program and 

Substance Use Disorder Residential Program

Treatment f X 

Total 6 18 4 

Source: GAO analysis of agency information.

Notes: We define a completed evaluation as one that has been published, while an evaluation that is 

under way is one that is currently being conducted or has been published as an interim report with the 

intention of publishing a final version in the future. We define a planned evaluation as one that will 

begin at a future date.

a

Program type is prevention, treatment, prevention and treatment, or neither prevention nor treatment, 

but may include prevention or treatment activities.

b

Education and SAMHSA jointly fund and manage the Safe Schools/Healthy Students program. 

SAMHSA funds and has the lead on implementing the evaluation.

c

Indicates two evaluations completed or under way for the same program. 

d

SAMHSA is conducting one cross-site evaluation of the Minority HIV/AIDS program, which includes 

the Minority HIV Prevention, Capacity Building Initiative, and the Ready to Respond programs.

e

SAMHSA manages this program, but ONDCP funds it. ONDCP is funding and managing the 

program evaluation.

f

Indicates one evaluation was completed for both programs. 

Some evaluations’ results may be used to assess a programs’ 

effectiveness, while other results may examine the quality or progress of 

program implementation. In reviewing the six completed evaluations, we 

found that three directly examined program effectiveness: OJP’s Drug 

Courts Program, the Department of Veterans Affairs’ Substance Use 
 

Page 38 GAO-13-333 Office of National Drug Control Policy

Disorder Outpatient Program and Substance Use Disorder Residential 

Program, and SAMHSA’s Substance Abuse Prevention and Treatment 

Block Grant Program.68 The three other evaluations assessed aspects of 

how the programs were implemented, and were SAMHSA’s Underage 

Drinking Prevention Education Initiative (2008 evaluation and 2010 

evaluation), and SAMHSA’s Assertive Adolescent and Family Treatment 

Program.69

SAMHSA, the HHS agency that administers 34 of the 76 programs (45 

percent) that were included in our review, is developing guidelines for 

conducting standard program evaluations across the agency.

Appendix IV provides more information about these six 

evaluations.

70

Officials from five of the six agencies that had not conducted 

evaluations—HHS’s Health Resources and Services Administration 

(HRSA), the Department of Housing and Urban Development, the 

Department of Labor, and the Federal Aviation Administration and 

National Highway Traffic Safety Administration within the Department of 

Transportation—said they did not conduct them largely because drug 

Under the 

new guidelines, program evaluation will consist of three phases: (1) 

conceptualization and planning prior to making a funding announcement 

for grants or other types of awards, in which evaluation planning and 

resource allocation will occur; (2) evaluation design and implementation; 

and (3) postevaluation dissemination and closeout activities. Additionally, 

SAMHSA has tasked an agency evaluation team with establishing criteria 

to determine who should conduct program evaluations. SAMHSA officials 

said that they expect to fully implement the new guidelines in 2014, and 

they will apply to all programs being evaluated after this date.

 

68ONDCP has conducted an assessment of its High Intensity Drug Trafficking Areas 

program. However, analysis of drug abuse prevention and treatment activities was not the 

focus of this assessment and, therefore, we did not include it in our review. 

69Agency officials noted that for some programs that provide grants, individual grantees 

may conduct small-scale evaluations as a condition of the grant to examine how well a 

specific grantee is implementing a program at a specific site. For example, Education’s 

Safe Schools/Healthy Students grantees are required to complete an evaluation as a 

condition of the grant. We did not review program evaluations conducted by individual 

grantees, as this was outside the scope of our work.

70SAMHSA describes itself as the nation’s lead agency for information on behavioral 

health services—including drug abuse prevention and treatment. SAMHSA’s mission is to 

reduce the impact of substance abuse and mental illness on America’s communities.
 

Page 39 GAO-13-333 Office of National Drug Control Policy

abuse prevention and treatment were not the main focus of the program, 

or funding was not available for an evaluation.71

Officials from four agencies also cited the lack of funding or other 

resources as another reason why program evaluations have not been 

completed, started, or planned. For example, officials from HRSA’s Ryan 

White HIV/AIDS program said that the program’s evaluation requirement 

and its associated funding were eliminated when the program was 

reauthorized in 2006. As a result, HRSA officials said the agency has not 

conducted an evaluation of the entire Ryan White HIV-AIDS program 

since 2006.

Officials from three of the 

agencies said that while program evaluations may be conducted that look 

at other features of the programs, the evaluations may not examine any 

drug abuse prevention and treatment activities. For example, officials 

from the Department of Labor’s Job Corps program and from the 

Department of Housing and Urban Development said that since their 

programs focus on other areas, namely employment and homelessness, 

drug abuse prevention and treatment were not included in any program 

evaluation activities. 

72

ONDCP and agency officials said that they have collected and analyzed 

other program performance information or required or encouraged the 

programs to use evidence-based interventions, which are approaches to 

prevention or treatment that are based in theory and have undergone 

scientific evaluation. ONDCP officials responsible for implementing the 

Strategy said that the agency uses the results of program evaluations, 

when available, to help develop and implement the Strategy and budget. 

Because few programs have completed program evaluations, they also 

use a range of available performance information, including agency 

performance data collected to meet GPRA Modernization Act of 2010 

 

71One of the six agencies, DOJ’s Drug Enforcement Administration, said that it did not 

conduct evaluations because its program was a small education program designed to 

increase awareness about the dangers associated with using illegal drugs.

72While HRSA has not conducted a program evaluation of the entire program, HRSA 

officials stated that the agency initiates two to three studies each year about various 

aspects of the Ryan White HIV-AIDS program. For example, officials said that the agency 

is currently conducting a study to assess factors that affect enrollment and management 

of the program’s AIDS Drug Assistance Program in light of waiting lists for AIDS Drug 

Assistance Program services.

ONDCP and Agencies 

Have Taken Other Steps to 

Help Ensure That 

Programs Supporting the 

Strategy Are Effective
 

Page 40 GAO-13-333 Office of National Drug Control Policy

requirements, and other agency data when developing and implementing 

the Strategy and budget.73 Additionally, we reported in July 2012 that 

agencies may 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.74

Officials from seven agencies with whom we spoke said that they do not 

prescribe the specific evidence-based interventions that must be used in 

their grant programs, but rather rely on grantees to identify the most 

appropriate evidence-based interventions based on client needs. For 

example, Indian Health Service officials noted that there are many 

evidence-based practices that would be appropriate, depending on 

various characteristics, such as the population being served or a 

community’s specific alcohol or drug abuse problem, and grantees must 

be able to use the interventions most suited for their specific situations. 

Additionally, HRSA officials said that because their Health Center and 

Ryan White HIV/AIDS programs are not direct drug abuse prevention or 

treatment programs, they rely on professionals in their delivery care 

settings to provide the appropriate services for drug abuse prevention or 

treatment. Other agencies that directly offer prevention or treatment 

services said that they require those programs to incorporate specific, 

evidence-based interventions in their services. For example, according to 

a Department of Veterans Affairs official, the department’s treatment 

guidelines for its substance use disorder inpatient and outpatient 

treatment programs incorporate the elements of evidence-based 

For example, we reported that 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. 

 

73Pub. L. No. 111-352, 124 Stat. 3866 (2011). The GPRA Modernization Act of 2010

amends the Government Performance and Results Act of 1993, Pub. L. No. 103-62, 107 

Stat. 285 (1993), which established a statutory framework for performance management 

and accountability, including the requirement that federal agencies set goals and report 

annually on progress toward these goals and program evaluation findings.

74GAO-12-744R. 
 

Page 41 GAO-13-333 Office of National Drug Control Policy

treatment that are outlined in a national consensus standards report 

published by the National Quality Forum.75 

The public health, social, and economic consequences of illicit drug use, 

coupled with the constrained fiscal environment of recent years, highlight 

the need to ensure that federal programs efficiently and effectively use 

their resources to address this problem. ONDCP has developed a 5-year 

Strategy to reduce illicit drug use and its consequences, but our analysis 

shows lack of progress toward achieving four of the Strategy’s five goals 

for which primary data are available. ONDCP established the PRS in April 

2012 to monitor progress toward the Strategy’s goals and objectives and 

provide information to guide efforts to meet these goals. While this is 

promising, ONDCP does not plan to report on results until later in 2013, 

and until then, operational information is not available to evaluate its 

effectiveness. 

A wide range of federal drug abuse prevention and treatment programs 

support the achievement of the Strategy’s goals. While some 

fragmentation and overlap of program services may be beneficial, they 

also entail potential inefficiencies that programs may not be able to afford 

in this era of resource constraints. Because of its responsibility for 

coordinating implementation of national drug control policy across the 

federal government, ONDCP is uniquely situated to conduct an 

assessment to identify overlap and potential duplication among

prevention and treatment programs and coordination opportunities. Our 

work has identified specific areas of fragmentation and overlap of 

services among these programs that could be used by ONDCP, along 

with other information such as results from agencies’ program evaluation 

efforts, to help agencies begin or improve coordination efforts to help 

reduce or eliminate potential inefficiencies. For example, ONDCP could 

identify the causes for the lack of coordination among the 29 agencies 

that reported conducting no coordination and further examine the overlap 

we identified in programs focused on capacity building and underage 

alcohol use, as a starting point for a broader assessment across federal 

agencies. Such an assessment would better position ONDCP to identify 

opportunities for increased efficiencies, such as using coordination 

 

75See National Quality Forum, National Voluntary Consensus Standards for the Treatment 

of Substance Use Conditions: Evidence Based Treatment Practices (Washington, D.C.: 

2007).

Conclusions 
 

Page 42 GAO-13-333 Office of National Drug Control Policy

mechanisms to mitigate the risk of duplication, and help ensure that 

federal agencies undertaking similar prevention and treatment efforts 

better leverage available resources to achieve Strategy goals.

To identify opportunities to increase efficiencies and therefore better 

leverage agency prevention and treatment resources, we recommend 

that the Director of ONDCP assess the extent of overlap and potential for 

duplication across federal programs engaged in drug abuse prevention 

and treatment activities and identify opportunities for increased 

coordination. ONDCP could use our work as a starting point for this 

assessment. 

We provided a draft of this report to ONDCP; the Departments of Health 

and Human Services, Justice, Education, Defense, Housing and Urban 

Development, Labor, Transportation, Veterans Affairs, and Homeland 

Security; and the Federal Judiciary for review and comment. ONDCP 

provided written comments, which are reprinted in appendix V and 

summarized below. ONDCP concurred with our recommendation, and 

also provided perspectives on overlap among drug abuse prevention and 

treatment programs and progress toward achieving Strategy goals. 

In its comments, ONDCP reiterated that we reported finding overlap but 

not actual instances of duplication among the drug prevention and 

treatment programs we reviewed. The office also made the points, with 

examples, that some overlapping programs (1) may not serve identical 

populations and may target different specific subgroups of a large 

population category, such as different types of youth age groups, and (2) 

may provide distinct services. We acknowledged these factors in our 

report, and maintain that this is why it is important to systematically 

review the extent of overlap among prevention and treatment programs, 

taking into account targeted subgroups and allowable services, to help 

ensure that they efficiently use limited resources to deliver these 

important services. ONDCP also reiterated, as we stated, that 

overlapping programs may provide positive benefits, such as reinforcing 

key prevention messages. Further, the office agreed that coordination 

efforts among programs can help avoid duplication and maximize 

program effectiveness. This is consistent with our report, which noted that 

overlap and fragmentation may not necessarily lead to duplication, but 

can create an environment in which programs are not delivered as 

efficiently and effectively as possible, and that coordination among 

programs helps to reduce the risk of duplication and increase efficiencies. 

Recommendation for 

Executive Action

Agency Comments

and Our Evaluation
 

Page 43 GAO-13-333 Office of National Drug Control Policy

ONDCP stated that while extensive coordination of prevention and 

treatment programs is already taking place, there is always room for 

improvement, and that it will work with agencies administering these 

programs to further enhance coordination. 

With regard to progress toward achieving Strategy goals, ONDCP stated 

that it is important to analyze trends for each drug category separately 

and noted that we recognized this in our discussion of ONDCP’s goal to 

reduce drug use among 12- to 17-year-olds by 15 percent by 2015. As 

the report states, marijuana accounts for almost 80 percent of drug use in 

this age group, and the lack of progress on this goal is due primarily to an 

increase in the rate of reported marijuana use, offset by decreases in the 

rates of other drug use. We also state that misuse and abuse of 

prescription drugs is the primary factor for one of the measures for the 

goal to reduce drug-related morbidity by 15 percent, which also shows 

lack of progress. Finally, ONDCP noted, as we did in the report, that while 

results from the primary data source for the goal to reduce drugged 

driving by 10 percent are not available, results from ONDCP’s secondary 

data source indicate progress. 

ONDCP and the Departments of Health and Human Services, Justice, 

Education, Defense, Transportation, and Housing and Urban 

Development provided technical comments on this report 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 selected congressional 

committees; the Director of ONDCP; Secretaries of Health and Human 

Services, Education, Defense, Housing and Urban Development, Labor, 

Transportation, Veterans Affairs, and Homeland Security; Attorney 

General; Director of the Administrative Office of United States Courts; and 

other interested parties. In addition, the report will be available at no 

charge on GAO’s website at http://www.gao.gov. If you or your staff have 
 

Page 44 GAO-13-333 Office of National Drug Control Policy

any questions about this report, please contact Eileen R. Larence at (202) 

512-8777 or larencee@gao.gov or Linda T. Kohn at (202) 512-7114 or 

kohnl@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 appendix VI. 

Eileen R. Larence

Director, Homeland Security and Justice

Linda T. Kohn

Director, Health Care
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 45 GAO-13-333 Office of National Drug Control Policy

Prior studies have found that a number of factors may affect marijuana 

use among youth, that is, individuals 17 years old and under. For 

example, we reported in 1993 that several risk factors were associated 

with marijuana use based on our review of a national longitudinal survey.1

Specifically, we found that young people who had reported that they 

engaged in delinquent activities, such as running away from home, 

truancy, fighting, and theft, were more likely to have used marijuana; 

however, we also noted that underlying factors may be associated with 

both drug use and delinquent activities. More recently, in 2000, a metaanalysis of 101 longitudinal studies from around the world identified a 

number of risk factors that predicted future marijuana use, including the 

availability of illicit drugs and guns, family history of antisocial behavior, 

positive attitudes toward substance use, low perceived risk of drug use, 

and rebelliousness.2

 

Other factors, including state laws and changing attitudes and social 

norms regarding drugs, may also affect drug use. We examined studies 

on three of these other factors, which we refer to as societal factors, 

which may affect youth marijuana use. Specifically, we examined studies 

that addressed: (1) the passage of laws allowing for the use of marijuana 

for medical purposes (medical marijuana laws); (2) the reduction in 

penalties for marijuana possession (decriminalization); and (3) the 

favorable portrayal of drugs in the media (prodrug media), such as 

movies, television, music, and music videos. For instance, a number of 

states have passed varying degrees of laws related to the production, 

 

1

GAO, Drug Use Among Youth: No Simple Answers to Guide Prevention, 

GAO/HRD-94-24 (Washington, D.C.: Dec. 29, 1993). Our review included a multivariate 

analysis of the National Longitudinal Study of Youth.

2

According to this study, a meta-analysis is a method of combining findings from many 

studies and allows researchers to use similar results from many studies to gain an 

understanding of an issue, in this case, the strength of the relationship between proposed 

risk factors and marijuana use. The majority of the data in this meta-analysis (73 of 101) 

came from studies conducted in the United States. The remaining studies were conducted 

internationally, such as in Canada, Great Britain, Australia, and New Zealand. See W.

Hansen, S. Giles, and M. Fearnow-Kenney (Eds.). Improving Effectiveness. Greensboro, 

NC: Tanglewood Research, Inc (2000).

Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Review of Studies on the 

Effect of Societal Factors 

on Youth Marijuana Use 
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 46 GAO-13-333 Office of National Drug Control Policy

possession, or use of marijuana for varying purposes.3 In addition, 

separate from laws that may allow for the use of marijuana for certain 

medical purposes, some states and local governments have taken 

actions to reduce or eliminate certain criminal penalties for the 

possession of small amounts of the drug. Finally, some speculate 

whether media depictions of illicit drugs influence youth drug use. For 

example, according to one study, frequent viewing of media messages 

may increase the likelihood of the adoption of ideas or beliefs reflected in 

the media portrayals, which may influence subsequent behaviors, such as 

the use of illicit substances.4

Through searches of databases, Internet websites, and other sources 

available as of June 2012, we identified 476 documents that addressed 

possible factors relating to youth drug use, including the societal factors 

described above, as well as others such as alcohol use and mental 

illness.5

 

3

According a report issued on November 2012 by the Congressional Research Service, 

18 states and the District of Columbia have enacted provisions that, in various ways, 

exempt qualified individuals from state criminal prosecution and various state civil 

penalties for marijuana-related offenses. See Congressional Research Service, Medical 

Marijuana: The Supremacy Clause, Federalism, and the Interplay between State and 

Federal Laws. (Washington, D.C.: Nov. 9, 2012).

We reviewed these documents to determine if the studies met 

our literature review criteria, which required that the study (1) address one 

of the three societal factors included in our review, specifically medical 

marijuana laws, decriminalization, or prodrug media; (2) report results on 

U.S. youth (age 17 and under); (3) have a national or multiple state 

scope; and (4) assess the effect of the factor on youth marijuana use 

through the use of methods such as comparison groups or statistical 

analyses. We identified 10 studies that assessed the effect of medical 

marijuana laws or decriminalization. We also identified 10 studies on 

prodrug media that focused on U.S. youth; however, 4 of the latter 10 

studies did not have a national or multiple state scope, and none of these 

4

Enid L. Gruber et al. “Alcohol, Tobacco, and Illicit Substances in Music Videos: A Content 

Analysis of Prevalence and Genre.” Journal of Adolescent Health, vol. 37 (2005): 81-83.

5

Specifically, we (1) conducted key word searches of social science research databases, 

such as Academic One File, Education Resources Information Center, Dissertation 

Abstracts Online, the National Academies, Social Sciences Abstracts, ProQuest, and 

WorldCat; (2) searched public health-related and think tank websites, such as those of the 

American Public Health Association and RAND; (3) reviewed bibliographies; and (4) asked 

public health researchers to identify potential studies for our review, as well as any 

potential challenges in reviewing these studies.
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 47 GAO-13-333 Office of National Drug Control Policy

10 studies assessed the effect of media on youth marijuana use. 

Specifically, 4 assessed the association between media and youth 

marijuana use, and 6 provide descriptive statistics on, for example, the 

prevalence of drugs and prodrug representations in various forms of 

media. While these studies may not assess the effect of media on youth 

marijuana use or include a national or a multiple state scope, we included 

them because they provide useful context regarding the portrayal of drugs 

in the media. Two social scientists and, as applicable, a statistician 

reviewed each of the 20 studies to determine whether the design, 

implementation, and analyses of the study were sufficiently sound to 

support the study’s results and conclusions based on generally accepted 

social science principals.6 On the basis of these reviews, we excluded 3 

studies on medical marijuana laws and 1 study on decriminalization. 

Below, we provide information on 2 medical marijuana studies, 4 

decriminalization studies, and the 10 media studies from our review.7

The studies that assessed the effect of medical marijuana laws that met 

our review criteria found mixed results on effects of the laws on youth 

marijuana use. These studies are described in table 4 below. One 

potential limitation to these studies may be the variation in implementation 

of medical marijuana laws across states. We discuss this and other 

potential limitations, as well as the ways that some studies addressed this 

issue, later in this appendix. 

We 

selected these studies on medical marijuana laws and marijuana 

decriminalization to include in this report based on the sufficiency of their 

methodologies; therefore, our results cannot be generalized to all 

research about the potential effect of these factors on youth drug use. 

 

6

Social science research standards are discussed in the scientific literature. For example, 

see Thomas D. Cook, and Donald T. Campbell, Quasi-experimentation: Design and 

Analysis Issues for Field Settings (Boston: Houghton Mifflin, 1990); William R. Shadish, 

Thomas D. Cook, Donald T. Campbell, Experimental and Quasi-Experimental Designs for 

Generalized Causal Inference (Boston: Houghton Mifflin, 2002); and GAO, Design 

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

7

The Substance Abuse and Mental Health Services Administration (SAMHSA) is 

conducting an examination of marijuana use rates and the differences between states with 

and without medical marijuana laws or lenient enforcement or prosecution of marijuana 

possession. SAMHSA expects to release the report in 2013.

Medical Marijuana Laws 

Studies 
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 48 GAO-13-333 Office of National Drug Control Policy

Table 4: Medical Marijuana Laws Studies and Their Findings Regarding Effect on Youth Marijuana Use

Study title, author(s), and source Overall finding and summary of study

Title: “Adolescent Marijuana Use from 2002 to 2008: 

Higher in States with Medical Marijuana Laws, 

Cause Still Unclear.” 

a

Author(s) and source: Melanie M. Wall et al. Annals 

of Epidemiology, vol. 21, no.9 (September 2011): 

714-716.

Overall finding: Higher use and lower perceived risk

Years: 2002-2008

Scope: National

Data source: National Survey on Drug Use and Health

The study found that between 2002 and 2008, adolescent marijuana use was 

higher and perception of its riskiness lower in states with medical marijuana 

laws compared with states without such laws.

b

Title: “Do Medical Marijuana Laws Increase 

Marijuana Use? Replication Study and Extension.”

Author(s) and source: Sam Harper, Erin C. Strumpf, 

and Jay S. Kaufman. Annals of Epidemiology, vol. 

22, no.3 (March 2012): 207-212.

Overall finding: Little or no effect

Years: 2002-2009

Scope: National

Data source: National Survey on Drug Use and Health

The study found that after controlling for unmeasured state characteristics, 

such as differences in social norms regarding drug use, there was little 

evidence that passing medical marijuana laws in the 16 states that had passed 

such laws at the time of the study increased marijuana use among youths in 

those states.

Source: GAO analysis. 

a

Year refers to the years during which the data were collected.

b

The National Survey on Drug Use and Health is an annual nationwide survey involving interviews 

with approximately 70,000 randomly selected individuals aged 12 and older. The Substance Abuse 

and Mental Health Services Administration (SAMHSA), a component of the U.S. Department of 

Health and Human Services, funds and oversees the project. 

Three of the four studies that assessed the effect of marijuana 

decriminalization that met our review criteria found little to no effect of the 

laws on youth marijuana use. These studies, as well as one study that 

found an increase, are described in table 5. One potential limitation to 

these studies is that all four studies contained data on marijuana use that 

had been collected in 1990 or earlier, which may mean that their findings 

are not applicable to current youth drug use patterns; however, we 

included them in our review because they provide useful information 

regarding the previous effects of decriminalization. We discuss this and 

other potential limitations later in this appendix.

Decriminalization Studies
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 49 GAO-13-333 Office of National Drug Control Policy

Table 5: Decriminalization Studies and Their Findings Regarding Effect on Youth Marijuana Use

Study title, author(s), and source Overall finding and summary of study

Title: “Decriminalization of Marijuana and the 

Demand for Alcohol, Marijuana, and Cocaine.”

a

Author(s) and source: Clifford F. Thies and Charles 

A. Register. The Social Science Journal, vol. 30, no. 

4 (1993): 385-399.

Overall finding: Little or no effect

Years: 1984-1988

Scope: National

Data source: National Longitudinal Survey of Youth 1979

On the basis of its review of a national longitudinal survey, this study found no 

strong evidence that the decriminalization of marijuana in 11 states affected the 

reported frequency of marijuana use as compared with the frequency of use by 

individuals in states that had not decriminalized marijuana. 

b

Title: Marijuana Decriminalization: The Impact on 

Youth 1975-1980.

Author(s) and source: Lloyd D. Johnston, Jerald G. 

Bachman, and Patrick M. O’Malley. Ann Arbor, 

Michigan: Institute for Social Science Research, 

1981.

Overall finding: Little or no effect

Years: 1975-1980

Scope: National

Data source: Monitoring the Future Survey

This study found that decriminalization had virtually no effect either on 

marijuana use or on related attitudes and beliefs about marijuana use among 

high school seniors in the 7 states that had decriminalized the possession of 

small amounts of marijuana at the time of the study.

c

Title: The Demand for Cocaine and Marijuana by 

Youth. 

Author(s) and source: Frank J. Chaloupka, Michael 

Grossman, and John A. Tauras. Cambridge, 

Massachusetts: National Bureau of Economic 

Research, 1998.

Overall finding: Little or no effect

Years: 1982-1989

Scope: National

Data source: Monitoring the Future Survey

Based on its review of a nationally-representative survey of high school 

seniors, this study found that, for youth residing in states that had eliminated 

criminal sanctions for the possession of small amounts of marijuana, 

decriminalization appeared to have no effect on either the probability of past 

month marijuana use or on the number of occasions marijuana users 

consumed marijuana in the past year or month.

Title: Marijuana Decriminalization: What Does It 

Mean in the United States? 

Author(s) and source: Rosalie Liccardo Pacula, 

Jamie F. Chriqui, and Joanna King. Cambridge, 

Massachusetts: National Bureau of Economic 

Research, 2003.

Overall finding: Increase

Year: 1990

Scope: National

Data source: National Education Longitudinal Study of 1988

This study found that being from a state that had decriminalized marijuana was 

a statistically significant factor in whether the high school sophomores in a 

nationally representative survey reported using marijuana in the past month.

d

Source: GAO analysis. 

a

Year refers to the years during which the data were collected.

b

The National Longitudinal Survey of Youth 1979 consists of a nationally representative sample of 

approximately 12,000 youths who were 14 to 22 years old when they were first surveyed in 1979. 

Individuals were surveyed annually through 1994 on a variety of topics, including education, 

employment, and alcohol and drug use. 

c

Monitoring the Future is an ongoing annual survey of approximately 50,000 American middle and 

high school students funded from grants from the National Institutes of Health. 

d

The National Education Longitudinal Study of 1988, administered by the National Center for 

Education Statistics, included a nationally representative sample of eighth graders first surveyed in 

the spring of 1988. This study based its findings off a 1990 follow-up survey.
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 50 GAO-13-333 Office of National Drug Control Policy

None of the studies we identified on prodrug media assessed whether 

exposure to prodrug media caused changes in marijuana or other drug 

use. Of the 10 studies we identified that address prodrug media, 4 

assessed the association between such media and youth marijuana use 

(see table 6). Three of the four studies found that exposure to various 

forms of media (e.g., rap music, music, and media depicting the positive 

aspects of marijuana use) were associated with higher rates of marijuana 

or other drug use. The fourth study found that information obtained from 

the Internet changed reported drug-using behavior, but did not determine 

whether marijuana or other drug use increased or decreased as a result. 

Table 6: Studies on the Association between Media and Youth Marijuana Use

Study title, author(s), and source Summary of study

Title:” A Prospective Study of Exposure to Rap Music 

Videos and African-American Female Adolescence.”

Author(s) and source: Gina M. Wingood et al. 

American Journal of Public Health, vol. 93, no. 3 

(March 2003): 437-439.

This 2003 study, based on a group of 522 African-American adolescent 

females, found that after controlling for other factors, such as age and 

employment status, participants who had greater exposure to rap music videos 

were 1.5 times more likely to report that they had used drugs over the 12-

month follow-up period, but the study did not examine causality. The results of 

this study cannot be generalized to any larger population.

Title: “Media Exposure and Marijuana and Alcohol 

Use Among Adolescents.”

Author(s) and source: Brian A. Primack et al. 

Substance Use & Misuse, vol. 44, no. 5 (2009): 722-

739.

This 2009 study, based on high school students at one school, found that, after 

controlling for multiple demographic and environmental factors, self-reported 

marijuana use was independently associated with, but not necessarily caused 

by, increased music exposure. The results of this study cannot be generalized 

to any larger population.

Title: ”Media and Marijuana: A Longitudinal Analysis 

of News Media Effects on Adolescents' Marijuana 

Use and Related Outcomes, 1977-1999.

Author and source: Jo Ellen Stryker. Journal of 

Health Communication, vol. 8 (2003): 305-328.

This 2003 study used a nationally representative survey of high school 

students, but included data from 1977 through 1999, which may not reflect the 

current content of media. This study found that media depicting the negative 

aspects of marijuana use were related to higher rates of drug abstinence (and 

therefore, lower rates of drug use). The study also found, but to a lesser extent, 

that media depicting the positive aspects of marijuana use were related to 

lower rates of drug abstinence (and therefore higher rates of drug use).

Title: “The Internet and Psychoactive Substance Use 

Among Innovative Drug Users.”

a

Author(s) and source: Edward W. Boyer, Michael 

Shannon, and Patricia L. Hibberd. Pediatrics, vol. 

115, no. 2 (February 2005): 302-305.

This 2005 study, which included 12 youths, found that participants reported 

that reviewing information obtained from the Internet changed their drug-using 

behavior, such as using drugs they believed to be “safe” or avoiding drugs they 

believed to be addictive, but the study did not determine whether marijuana or 

other drug use increased or decreased as a result. The results of this study 

cannot be generalized to any larger population.

Source: GAO analysis. 

a

Specifically, the study found that media coverage (as measured by the number of news stories on 

marijuana from the Associated Press) accounted for approximately 3 percent of variation in drug 

abstinence rates. However, while significant, the small percentage of variance explained in the 

statistical tests may be indicative of the limited effect of media on self-reported drug use behaviors 

and attitudes.

Six of the 10 studies that addressed prodrug media provided descriptive 

statistics on, for example, the prevalence of drugs and prodrug 

representations in various forms of media. Five of these studies described 

Media Studies 
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 51 GAO-13-333 Office of National Drug Control Policy

the nature and frequency of illicit drugs in various forms of media, 

including movies, television, music videos, and music. The media content 

from these studies ranges from 1996 through 2005, and may not reflect 

the current content of media. Some of the findings from these descriptive 

studies are described in table 7.

Table 7: Descriptive Studies on Media and Youth Marijuana Use

Media type Study findings

Movies Illicit drugs, including marijuana, cocaine, and heroin, among others, appeared in 22 percent of the 200 most 

popular movie rentals in 1996 and 1997, of which 26 percent showed explicit, graphic portrayals of their 

preparation or ingestion. Of the movies showing illicit drugs, marijuana appeared most frequently (51 percent of 

movies).

Television

a

Illicit drugs, which included controlled substances such as marijuana, cocaine, and heroin, among others, were 

mentioned or seen in 20 percent of all episodes of the 42 top-rated television shows during October and 

November 1998. However, illicit drug use was seen in only 3 percent of these episodes overall.

Music videos

b

One study found that substances of one kind or another, such as alcohol, marijuana, and prescription 

medications, were found in 45 percent of 258 music videos included in a 6-week period across three cable 

television channels in 2000.c A more recent study, conducted in 2001, found that illicit substances, along with drug 

paraphernalia and abusable substances such as glue or spray canisters, were present in 13 percent of the 359 

music videos included in a 3-week random sample from two cable television channels. The study also found that 

substance use was more often seen in rap and hip hop music videos.d

Music

While illicit substances were absent in pop 

music videos, they were at least three times as likely to be present in rap and hip hop videos as compared with 

rock and rhythm and blues videos.

One hundred and sixteen of the 279 (or 41 percent) most popular songs in 2005 included a reference to 

substance use, including alcohol, marijuana, tobacco, and other illicit, prescription, or nonspecific substances. 

Alcohol was the most frequently referenced (24 percent), followed by marijuana (14 percent).

Source: GAO analysis. 

e

a

Donald F. Roberts et al. Substance Use in Popular Movies and Music. Washington, D.C.: Office of 

National Drug Control Policy and Department of Health and Human Services, 1999. 

b

Peter G. Christenson, Lisa Henriksen, and Donald F. Roberts. Substance Use in Popular Prime Time 

Television. Washington, D.C.: Office of National Drug Control Policy, 2000. 

c

Donald F. Roberts et al. Substance Use in Popular Music Videos. Washington, D.C.: Office of 

National Drug Control Policy, 2002. 

d

Enid L. Gruber et al. “Alcohol, Tobacco, and Illicit Substances in Music Videos: A Content Analysis of 

Prevalence and Genre.” Journal of Adolescent Health, vol. 37 (2005): 81-83. 

e

Brian A. Primack et al. “Content Analysis of Tobacco, Alcohol, and Other Drugs in Popular Music.”

Archives of Pediatrics and Adolescent Medicine, vol. 162, no. 2 (February 2008): 169-175. 

The sixth study assessed the perceived value of “the media” and other 

sources as credible providers of drug information, based on anonymous 

interviews with 223 high school students across two states. This study 

found that adolescents reported listening to their parents and teachers the 

most about drugs and alcohol, as compared with movie, television, music, 
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 52 GAO-13-333 Office of National Drug Control Policy

or sports celebrities, but the results of this study cannot be generalized to 

a larger population.8

We identified several challenges related to inherent difficulties in 

analyzing this subject matter or with the study designs that may limit the 

generalizability of these studies. For example, a study’s design may have 

been sufficiently sound to support the study’s results and conclusions, but 

it could have used old data, which may mean that the study’s findings are 

not applicable to current youth drug use patterns. We describe these 

limitations below:

• Variation in implementation of medical marijuana laws: Office of 

National Drug Control Policy (ONDCP) officials stated that states 

implement medical marijuana laws differently and that these 

differences may influence the effect of the laws on youth marijuana 

use. For example, according to these officials, some states enacted 

laws where medical marijuana has had a very visible presence 

throughout the state, while other states’ laws have low visibility or 

have not been implemented yet. Further, ONDCP officials stated that 

some studies incorrectly looked at the changes in marijuana use 

before and after medical marijuana laws are passed instead of before 

and after such laws are implemented. The officials noted that this is 

an important distinction because the implementation of medical 

marijuana laws after passage can be a lengthy process. ONDCP 

officials also noted that the states that eventually passed medical 

marijuana laws tended to have higher rates of youth marijuana use 

before such laws were passed. However, some of the studies we 

reviewed attempted to account for these issues in their study designs. 

For example, one study used a model that controlled for unmeasured 

state characteristics that do not change over time, such as differences 

in social norms, and that might affect marijuana use and the likelihood 

of a state passing a medical marijuana law.9

• Self-reported data: As we have previously reported, research about 

drug use among youth is limited, in part, because most studies rely on 

 

8

Daniel M. Mayton, Elizabeth A. Nagel, and Reese Parker. “The Perceived Effects of Drug 

Messages on Use Patterns in Adolescents.” Journal of Drug Education, vol. 20, no. 4 

(1990): 305-318. 

9

Sam Harper, Erin C. Strumpf, and Jay S. Kaufman. “Do Medical Marijuana Laws Increase 

Marijuana Use? Replication Study and Extension.” Annals of Epidemiology, vol. 22, no.3 

(March 2012): 207-212. 

Study Limitations and Inherent 

Challenges 
Appendix I: Relatively Few Studies Have 

Assessed the Effect of Societal Factors on 

Youth Marijuana Use, and These Studies Had 

Limitations

Page 53 GAO-13-333 Office of National Drug Control Policy

self-reported data, and low estimates are likely because drug use is 

illegal. 10

• Use of historical data: While 4 of the 10 studies on the effect of or 

association between societal factors and youth marijuana use data 

collected since 2000 (2 medical marijuana and 2 media studies), the 

remainder of the studies used older data (the oldest being collected in 

1975). In particular, all 4 studies on decriminalization, as well as 2 of 

the media studies, contained data on marijuana use that had been 

collected before 2000, which may mean that their findings are not 

applicable to current youth drug use patterns.

For example, youth may be unlikely to report their drug use 

in the survey for fear of negative repercussions, regardless of whether 

the results of the survey are shared with law enforcement. For our 

analysis, all of the 6 studies on the effects of medical marijuana laws 

or decriminalization on youth marijuana use as well as the 4 studies 

on the association between media and youth marijuana use employ 

self-reported data.

 

10GAO/HRD-94-24. 
Appendix II: Objectives, Scope, and 

Methodology

Page 54 GAO-13-333 Office of National Drug Control Policy

This report addresses the following objectives:

1. To what extent has progress has been made toward achieving 

Strategy goals and does ONDCP have mechanisms in place to 

monitor progress?

2. To what extent does fragmentation, overlap, and duplication exist 

across drug abuse prevention and treatment programs, and do 

ONDCP and federal agencies coordinate efforts to reduce the 

potential for unnecessary overlap or duplication?

3. To what extent do federal agencies that have drug abuse prevention 

and treatment programs conduct evaluations of these programs, 

including assessments of program effectiveness? 

In addition, we provide information on what the available research 

suggests about the potential effect of societal factors, such as state laws 

allowing the use of marijuana for medical purposes, on youth drug use.

To assess progress toward Strategy goals and the extent to which 

ONDCP has mechanisms in place to monitor progress, we analyzed the 

2010 Strategy and 2011 and 2012 annual updates, the National Drug 

Control Budget, and ONDCP documentation about its Performance 

Reporting System and associated performance measures. We also 

analyzed ONDCP documents on the implementation status of Strategy 

action items and implementation plans and reports from selected federal 

drug control agencies. In addition, we analyzed agency budget 

justifications and strategic plans. We also reviewed information provided 

by ONDCP and publicly available data sources, such as the National 

Survey on Drug Use and Health, to determine progress toward Strategy 

goals. 

On the basis of such factors as the number of Strategy action items for 

which agencies are responsible, the size of agency drug control budgets, 

and inclusion of a balance of drug prevention, treatment, and supply 

reduction 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, 

National Institutes of Health—specifically, the National Institute on 

Drug Abuse and the National Institute on Alcohol Abuse and 

Alcoholism—and Centers for Disease Control and Prevention; 

Appendix II: Objectives, Scope, and 

Methodology 

Assessing Progress toward 

Strategy Goals and 

Mechanisms to Monitor 

Progress
Appendix II: Objectives, Scope, and 

Methodology

Page 55 GAO-13-333 Office of National Drug Control Policy

• within the Department of Justice (DOJ), the Office of Justice 

Programs (OJP)— specifically, the Bureau of Justice Assistance, 

Bureau of Justice Statistics, National Institute of Justice, and Office of 

Juvenile Justice and Delinquency Prevention—and Drug Enforcement 

Administration; 

• within the Department of Homeland Security, U.S. Customs and 

Border Protection; and 

• the Department of Education (Education). 

While these seven agencies are not representative of all federal drug 

control agencies, they are responsible for implementing a majority of 

activities in the Strategy and provide a range of perspectives about 

Strategy implementation and progress. Specifically, our selected 

agencies and ONDCP have lead implementation responsibilities for 

approximately 70 percent of the 112 action items in the Strategy. We also 

interviewed officials from ONDCP and these agencies to obtain 

information about progress on the Strategy’s goals, the Performance 

Reporting System, how ONDCP monitors progress on Strategy objectives 

and action items, the implementation status of these action items, and the 

effect of the Strategy on agencies’ drug control activities. We compared 

the information we obtained from documents and agency officials about 

the Strategy and ONDCP’s monitoring mechanisms with criteria for 

performance management identified in our prior work.1 We also reviewed 

ONDCP’s categorizations for a nonprobability sample of 24 out of 82 

action items led by ONDCP and our seven selected agencies to validate 

ONDCP’s characterization of their implementation statuses. Although we 

cannot generalize the results to all action items led by these agencies, 

this allowed us to determine the extent to which we agreed with ONDCP’s 

categorizations of the action items we reviewed. Finally, we interviewed 

seven drug policy experts to discuss their perspectives on the Strategy 

and performance management. We selected these experts based on our 

review of drug policy literature, their expertise in drug policy issues and 

work conducted in this area, and recommendations from these and other 

researchers. The information from these seven policy experts cannot be 

generalized to other experts; however, they provided us with a range of 

views about the Strategy and ONDCP’s monitoring mechanisms. 

 

1

See for example GAO-03-143 and GAO/GGD/AIMD-99-69. 
Appendix II: Objectives, Scope, and 

Methodology

Page 56 GAO-13-333 Office of National Drug Control Policy

To identify federal drug abuse prevention and drug abuse treatment 

programs, and programs that include drug abuse prevention or treatment 

activities, we developed a preliminary list based on the agencies included 

in our previous work in this area and a review of ONDCP and agency 

information, such as the fiscal year 2013 National Drug Control Budget, 

the 2010 National Drug Control Strategy, and publically available 

information on agency websites.2 We also reviewed the Catalogue of 

Federal Domestic Assistance. On the basis of ONDCP guidance, we

defined a drug abuse prevention program as a federal program that 

provides services, allocates funding, or allows for activities focused on 

discouraging the first-time use of controlled substances—specifically illicit 

drugs and the problematic use of alcohol—and encouraging those who 

have begun to use controlled substances to cease their use. We defined 

a drug abuse treatment program as a federal program that provides 

services, allocates funding, or allows for activities focused on identifying 

and assisting users of controlled substances—specifically illicit drugs and 

the problematic use of alcohol—to become drug-free and remain drugfree.3

We focused our review on programs that directly administer or fund drug 

abuse prevention or treatment programs, or programs that include these 

activities, and therefore excluded programs that, for example, exclusively 

focus on law enforcement or policy, conduct research, or fund overhead 

costs. In addition, we also excluded programs that reimbursed drug 

abuse treatment services as part of a health benefit plan, such as HHS’s 

Medicare and Medicaid programs and the Department of Defense’s 

 

 

2

See GAO-12-744R. 

3

See ONDCP Circular: Budget Formulation, May 2007. ONDCP issued this circular to the 

heads of executive departments and establishments, and it provides instructions for 

preparing agency drug control budgets to be submitted to ONDCP for review and inclusion 

in the consolidated National Drug Control Budget. 

Assessing Fragmentation, 

Overlap, and Duplication 

across Drug Abuse 

Prevention and Treatment 

Programs and Agency 

Coordination Efforts

Identifying Programs 
Appendix II: Objectives, Scope, and 

Methodology

Page 57 GAO-13-333 Office of National Drug Control Policy

Defense Health Program, which includes military health benefit plans like 

TRICARE.4

Next, we shared our preliminary list of programs with agency officials and 

asked them to verify that the included programs met our criteria and if any 

should be added or deleted. During initial meetings with agency officials, 

we asked them to clarify program names, descriptions, and services 

offered. We used the information obtained to make additional refinements 

to the list of agencies and programs included in our review. For example, 

some programs were removed from the list because they were no longer 

in operation in fiscal year 2012 or were part of a larger program already 

listed, and other programs were added. We also excluded one additional 

agency from our review. Specifically, we excluded the Court Services and 

Offender Supervision Agency for the District of Columbia because its 

programs are primarily for residents of the District of Columbia. Thus the 

number of agencies in the scope of this study decreased from 16 to 15. 

After completing these refinements our list identified a total of 95 

programs. 

Our initial review determined that 3 of 19 agencies included in 

the National Drug Control Budget for funding drug abuse prevention and 

treatment programs did not administer programs that met our scope of 

review. As a result, we excluded these agencies from our review. In total, 

our initial search identified 91 potential programs that 16 federal agencies 

administered. 

To obtain program-specific information, we sent a total of 95 web-based 

questionnaires to the 15 agencies included in our review.5

 

4

TRICARE is the health care program serving military service members, retirees, and their 

families. 

These 

questionnaires are described in detail below. We included several 

screening questions in the questionnaire to further verify that programs 

met our definition of a drug abuse prevention program, drug abuse 

treatment program, or a program that includes these activities, and were 

in operation in fiscal year 2012. Fourteen programs did not pass our 

screening questions and therefore were excluded from our analysis. We 

also removed 4 programs from our analysis after reviewing the responses 

and determining that the program did not meet one or more of our criteria 

5

Seven of these programs were jointly administered by two or more federal agencies. For 

these programs, we sent the agency that is primarily responsible for the day-to-day 

operations of the program the questionnaire for completion 
Appendix II: Objectives, Scope, and 

Methodology

Page 58 GAO-13-333 Office of National Drug Control Policy

for inclusion, and consolidated the responses of 1 program at the request 

of agency officials. In total, 76 programs were included in our final 

analysis of questionnaire responses. 

We developed a web-based questionnaire to collect detailed information 

on federal drug abuse prevention and drug abuse treatment programs, 

and programs that include these activities, for fiscal year 2011. The 

questionnaire included questions on program objectives, target groups 

served, services provided, and coordination activities with other federal

agencies. We also collected data on program obligations—defined as 

definite commitments that create a legal liability of the government for the 

payment of goods and services ordered or received—as available, for 

fiscal year 2011. Specifically, we asked programs to provide the amount 

of federal funds obligated specifically for their drug abuse prevention or 

treatment activities, and the total amount of federal funds obligated for all 

program activities in fiscal year 2011. In many cases, programs were not 

able to provide data on funds obligated specifically for their drug abuse 

prevention or treatment activities because agency officials told us that 

they did not report budgetary data at this level, among other reasons.6

To minimize errors arising from differences in how questions may be 

interpreted and to reduce variability in responses, we conducted pretests 

with four agencies and 6 programs from July to August 2012. To ensure 

that we obtained a variety of perspectives on our questionnaire, we 

selected programs that differed in program scope, services provided, and 

target groups served. We included budget staff as well as program 

officials in the pretest to ensure budget-related terms in the survey were 

understandable. An independent reviewer also reviewed a draft of the 

questionnaire prior to its administration. After completing the pretests, we 

administered the survey to 95 programs. We received completed surveys 

for 95 programs, for a 100 percent response rate.

 

7

 

6

As a result of not having complete data at this level, when reporting this information, we 

noted which programs were not able to provide this information by marking it as “not 

available.” 

We also made 

telephone calls to officials and sent them follow-up e-mail messages, as 

necessary, to clarify their responses or obtain additional information. 

7

We consolidated questionnaire responses for SAMHSA’s Substance Abuse and Mental 

Health block grant program at the request of agency officials. As a result, we ultimately 

received responses for 94 unique programs.

Developing and Administering 

the Questionnaire on Federal 

Drug Abuse Prevention and 

Drug Abuse Treatment 

Programs 
Appendix II: Objectives, Scope, and 

Methodology

Page 59 GAO-13-333 Office of National Drug Control Policy

We used standard descriptive statistics to analyze responses to the 

questionnaire. Because this was not a sample survey, there were no 

sampling errors. To minimize other types of errors, commonly referred to 

as nonsampling errors, and to enhance data quality, we employed survey 

design practices in the development of the survey and in the collection, 

processing, and analysis of the survey data. For instance, as previously 

mentioned, we pretested the questionnaire with federal officials to 

minimize errors arising from differences in how questions might be 

interpreted and to reduce variability in responses. We further reviewed 

the questionnaire to ensure the ordering of sections was appropriate and 

that the questions within each section were clearly stated and easy to 

comprehend. To reduce nonresponse, another source of nonsampling 

error, we sent out e-mail reminder messages to encourage officials to 

complete the questionnaire. In reviewing the questionnaire data, we 

performed automated checks to identify inappropriate answers. We 

further reviewed the data for missing or ambiguous responses and 

followed up with agency officials when necessary to clarify their 

responses. To assess the reliability of obligations data, we incorporated 

questions about the reliability of the programs’ data systems and if there 

were any limitations to reporting the data. On the basis of our application 

of recognized survey design practices and follow-up procedures, we 

determined that the data were of sufficient quality for our purposes. All 

data analysis programs were also independently verified by a data 

analyst for accuracy. 

To determine the extent of fragmentation, overlap, and duplication, we 

compared data from the 76 drug abuse prevention and treatment 

programs to review the types of services offered across the federal

government and used the following definitions from our prior work:

• Fragmentation occurs when more than one federal agency (or more 

than one organization within an agency) is involved in the same broad 

area of national interest. 

• Overlap occurs when fragmented agencies or programs have similar 

goals, engage in similar activities or strategies to achieve them, or 

target similar beneficiaries. 

Determining the Extent of 

Fragmentation, Overlap, and 

Duplication
Appendix II: Objectives, Scope, and 

Methodology

Page 60 GAO-13-333 Office of National Drug Control Policy

• Duplication occurs when two or more agencies or programs are 

engaged in the same activities or provide the same services to the 

same beneficiaries.8

To determine the extent of fragmentation, we used the questionnaire data 

to identify the number of agencies that deliver similar types of drug abuse 

prevention and treatment programs. To determine the potential for 

overlap, we identified the number of programs with similar goals that 

provided similar services to similar populations. We also conducted an indepth analysis of two areas—prevention services for students and youths 

and treatment services for the offender populations—to further assess the 

potential for overlap among these programs. We selected these areas 

because of the number of programs and extent of overlap in these areas. 

For those areas in which we completed our in-depth review, we also 

determined the potential for duplication by reviewing programmatic 

information and holding meetings with program staff to determine whether 

the programs were providing the same services to the same beneficiaries. 

To assess coordination efforts to reduce the potential for unnecessary 

overlap or duplication, we analyzed questionnaire responses from the 76 

programs regarding agency efforts to coordinate drug abuse prevention 

and treatment program activities. We also analyzed the 2010 Strategy

and interviewed ONDCP and agency officials about actions taken to 

coordinate activities. We compared these reported actions with criteria for 

coordinating interagency efforts, internal controls, and desirable 

characteristics of effective national strategies identified in our prior work.9

To identify which of the 76 drug abuse prevention and treatment 

programs at the 15 agencies included in our review had program 

evaluations, including assessments of effectiveness, we first conducted 

Internet and library searches to identify any reports or other documents 

that described evaluations that had been completed or for which interim 

 

8

Specifically, we used these definitions for assessing drug abuse prevention and 

treatment programs based on the framework established in two previous reports, 

GAO-11-318SP and GAO-12-342SP. 

9

See GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005), 

GAO-12-1022, GAO/AIMD-00-21.3.1, and GAO-04-408T. 

Assessing Evaluations of 

Drug Abuse Prevention 

and Treatment Programs
Appendix II: Objectives, Scope, and 

Methodology

Page 61 GAO-13-333 Office of National Drug Control Policy

reports had been issued since 2007.10 We then interviewed or received 

written responses from agency officials responsible for administering the 

76 programs, in which they confirmed the evaluations that we found 

through our searches and identified additional evaluations of the 

programs that had been completed, were under way or had interim 

reports completed, or were planned since 2007. We selected 2007 as the 

starting point for our review in order to provide a long enough time frame 

to include evaluations that may take multiple years to complete. We 

obtained copies of all completed program evaluations and reviewed each 

to determine whether these evaluations included assessments of 

effectiveness (i.e., determining the extent to which a program is achieving 

its objectives) as described in our Designing Evaluations: 2012 Revision, 

which provides guidance on evaluation methodologies.11

We conducted this performance audit from July 2012 to March 2013 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 

For each 

program evaluation, we reviewed its objectives, scope, and any 

description of how its findings were used by the agency. Furthermore, we 

interviewed agency officials about factors affecting the lack of program 

evaluation. We also reviewed agency documents and interviewed agency 

officials to identify whether the agencies took other steps to help ensure 

that their programs are effective, such as requiring programs or their 

grantees to use evidence-based interventions, and whether the agencies 

prescribed specific evidence-based interventions that must be used in 

their programs. We also interviewed ONDCP officials to determine how 

program evaluations were used to inform policy and resource allocation 

decisions. 

 

10We define “program evaluations” as individual, systematic studies to assess how well a 

program or programs are working. Program evaluations can be designed to answer a 

range of questions about programs to assist decision making by program managers and 

policymakers. An evaluation can assess an entire program or focus on an initiative within 

a program. Although evaluation of a federal program typically examines a broader range

of activities than a single project, agencies may evaluate individual projects to seek to 

indentify effective practices or interventions. 

11GAO, Designing Evaluations: 2012 Revision, GAO-12-208G (Washington, D.C.: January 

2012).
Appendix II: Objectives, Scope, and 

Methodology

Page 62 GAO-13-333 Office of National Drug Control Policy

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. 
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 63 GAO-13-333 Office of National Drug Control Policy

Agency or subagency Program name Program description

Fiscal year 2011 

obligations for drug 

abuse prevention and 

treatment activities a

Department of 

Defense (DOD)

Drug Demand Reduction Program $118,078,000 b

DOD civilian agencies

b

Civilian Employee Drug-Free 

Workplace Program

Prevention

National Guard Bureau

b

National Guard Bureau Prevention, 

Treatment, and Outreach Program

Prevention

U.S. Air Force

b

Air Force Drug Demand Reduction Prevention 

U.S. Army

b

Army Substance Abuse Program Prevention and treatment

U.S. Marine Corps

b

Marine Corps Community Services 

Substance Abuse Program

Prevention

U.S. Navy

b

Navy Alcohol and Drug Abuse 

Prevention

Prevention

Substance Abuse Rehabilitation 

Program 

b

Treatment Not available

Department of Justice

c

Bureau of Prisons $92,500,000

Community Transitional Drug Abuse 

Treatment

d

Treatment Not available

Drug Abuse Education

d

Prevention and treatment Not available

Non-residential Drug Abuse 

Treatment

d

Treatment Not available

Residential Drug Abuse Treatment

d

Treatment Not available

Drug Enforcement 

Administration 

d

Demand Reduction Program Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities 

$2,085,000

Office of Justice 

Programs 

e

Drug Courts Treatment Not available

Enforcing Underage Drinking Laws

c

Prevention $16,968,000

Justice and Mental Health 

Collaboration Program

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities

Not available

Residential Substance Abuse 

Treatment

c

Treatment Not available

Second Chance Act Adult Offenders 

with Co-Occurring Substance Abuse 

and Mental Health Disorders

c

Treatment Not available

Second Chance Act Family-Based

Adult Offender Substance Abuse 

Treatment Program, Planning, and 

Demonstration Projects

c

Treatment Not available

Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

c
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 64 GAO-13-333 Office of National Drug Control Policy

Agency or subagency Program name Program description

Fiscal year 2011 

obligations for drug 

abuse prevention and 

treatment activities a

Department of Transportation

Federal Aviation 

Administration 

Employee Drug and Alcohol Testing 

Program 

Neither a prevention nor a treatment

program, but may include prevention 

or treatment activities

$469,241

Flight Attendant Drug And Alcohol 

Program 

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $269,241

Human Intervention Motivation Study Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $200,000

National Highway 

Traffic Safety 

Administration

Drug Impaired Driving Program Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $2,688,000

Department of Education

21st Century Community Learning 

Centers

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities Not available f c

Safe and Supportive Schools Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities

g

Not available f

Safe Schools/Healthy Students

c

Prevention g Not available

Executive Office of the President

c

Office of National Drug 

Control Policy

Anti-Doping Activities Prevention $8,982,000

High Intensity Drug Trafficking Areas Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $2,848,424

Youth Drug Prevention Media 

Program 

Prevention

$39,000,000

Federal Judiciary

e

Administrative Office of 

the United States 

Courts

Court Ordered Substance Abuse 

Testing and Treatment

Treatment

$48,053,914

Department of Health and Human Services

Health Resources and 

Services Administration

Health Center Program Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities Not available

Ryan White HIV/AIDS

c

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities Not availablec
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 65 GAO-13-333 Office of National Drug Control Policy

Agency or subagency Program name Program description

Fiscal year 2011 

obligations for drug 

abuse prevention and 

treatment activities a

Indian Health Service Urban Indian Health Program Title V 

4-in-1 grants

Prevention and treatment

$4,500,000

Alcohol and Substance Abuse Self 

Determination Contracts

Prevention and treatment

$194,409,000

Methamphetamine and Suicide 

Prevention Initiative

Prevention and treatment

$16,358,000

Youth Regional Treatment Centers Prevention and treatment $18,450,189

Tele-behavioral Health Activities

e

Prevention and treatment Not available

Substance Abuse and 

Mental Health Services 

Administration 

(SAMHSA) 

c

Access to Recovery Treatment $98,954,000

Assertive Adolescent and Family 

Treatment

Prevention and treatment

$4,198,000

Capacity Building Initiative Prevention $8,097,080

Center for the Application of 

Prevention Technologies

Prevention

$10,977,264

Community-based Coalition 

Enhancement Grants

Prevention

$4,912,052

Drug Free Communities Mentoring 

Program 

Prevention

$2,391,168

Drug Free Communities Support 

Program 

Prevention

$83,845,306

Ex-Offender Reentry Treatment $16,373,000

Fetal Alcohol Spectrum Disorders 

Center for Excellence

Prevention

$9,830,206

Grants to Serve Young Children and 

Families Affected by 

Methamphetamine

Prevention and treatment

$4,148,000

Historically Black Colleges and 

Universities Grant

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $300,000

Homeless Grants for the Benefit of 

Homeless Individuals

Treatment

$35,946,000

Minority AIDS Initiative Targeted 

Capacity Expansion

Prevention and treatment

$53,934,000

Minority HIV Prevention Prevention $20,048,037

National Adult Oriented Media Public 

Service Campaign

Prevention

$1,096,735

Native American Center for 

Excellence

Prevention

$1,031,475

Partnership for Success Prevention $11,500,000
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 66 GAO-13-333 Office of National Drug Control Policy

Agency or subagency Program name Program description

Fiscal year 2011 

obligations for drug 

abuse prevention and 

treatment activities a

Physician Clinical Support System 

Project—Buprenorphine 

Neither a prevention or treatment 

program, but may include prevention 

or treatment activities $494,000

Physician Clinical Support System 

Project—Opioid 

Neither a prevention or treatment 

program, but may include prevention 

or treatment activities $500,000

Residential Treatment for Pregnant 

and Post Partum Women

Prevention and treatment

$14,377,000

Ready to Respond Prevention $10,435,218

Recovery Community Services 

Program 

Treatment

$5,236,000

Screening, Brief Intervention, and 

Referral to Treatment—Medical 

Schools/Residency

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $6,152,000

State Screening, Brief Intervention 

and Referral to Treatment

Prevention and treatment

$44,141,000

Strategic Prevention Framework State 

Incentive Grants

Prevention

$53,872,449

Substance Abuse Prevention and 

Treatment Block Grant 

Prevention and treatment

$1,441,962,000

Targeted Capacity Expansion 

General—Grants to Expand Care 

Coordination Using Health Information 

Technology

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities

$8,033,000

Targeted Capacity Expansion 

General—Recovery Oriented 

Systems of Care

Treatment

$4,380,000

Targeted Capacity Expansion 

General—Technology Assisted Care

Treatment

$2,291,000

Treatment Drug Courts—Adults 

(SAMHSA only)

Treatment

$4,897,000

Treatment Drug Courts—Juvenile 

(SAMHSA only)

Treatment

$3,355,000

Treatment Drug Courts—Adult (joint

with the Bureau of Justice Assistance)

Treatment

$7,282,000

Treatment Drug Courts—Juvenile 

(joint with the Office of Juvenile 

Justice and Delinquency Prevention)

Treatment

$398,000

Underage Drinking Prevention 

Education Initiative

Prevention

$3,039,738
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 67 GAO-13-333 Office of National Drug Control Policy

Agency or subagency Program name Program description

Fiscal year 2011 

obligations for drug 

abuse prevention and 

treatment activities a

Department of Housing and Urban Development

Emergency Solutions Grants Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities Not available

Supportive Housing Program 

c

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities Not available

Housing Opportunities for Persons 

with AIDS

c

Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities

Not availablec

Department of Labor

Employment Training 

Administration 

Job Corps Neither a prevention nor a treatment 

program, but may include prevention 

or treatment activities $6,600,000

Department of Veterans Affairs

Veterans Health 

Administration 

Substance Use Disorder Outpatient 

Program 

Treatment

$581,646

Substance Use Disorder Residential 

Program 

Treatment 

$68,132

Source: GAO analysis of agency data. 

a

For the purpose of our review, we identified a drug abuse prevention program as a federal program 

that provides services, allocates funding, or allows for activities focused on discouraging the first-time 

use of controlled substances—specifically illicit drugs and the problematic use of alcohol—and 

encouraging those who have begun to use controlled substances to cease their use. We defined a 

drug abuse treatment program as a federal program that provides services, allocates funding, or 

allows for activities focused on identifying and assisting users of controlled substances—specifically 

illicit drugs and the problematic use of alcohol—to become drug-free and remain drug-free. 

b

The Drug Demand Reduction program funds, at least in part, the National Guard Bureau Prevention, 

Treatment, and Outreach program; the Air Force Drug Demand Reduction program; the Army 

Substance Abuse Program; the Marine Corps Substance Abuse Program; and the Navy Alcohol and 

Drug Abuse Prevention program, as well as drug testing for the department’s civilian employees. The 

military services use Drug Demand Reduction program funds to provide drug abuse prevention 

services, including drug testing, education, and outreach. The Drug Demand Reduction Program 

does not fund drug abuse treatment services or services related to the prevention or treatment of 

alcohol abuse. However, the military services may use other funding sources to provide those

services. For example, the U.S. Army uses funds from its Operations and Maintenance Account to 

provide some drug abuse treatment services.

c

We requested that surveyed programs provide the total amount of federal funds obligated 

specifically for drug abuse prevention and treatment activities in fiscal year 2011. For those agencies 

that were unable to provide this information, we reported that this information was not available. 

Program officials reported that they were unable to provide the total amount of federal funds obligated 

specifically for their program’s drug abuse prevention or treatment activities in fiscal year 2011 for a 

variety of reasons, such as that the programs do not collect this type of budgetary data. 

d

The Bureau of Prisons reported obligations for its drug abuse prevention and treatment programs in 

total, but was not able to report obligations for individual programs.

e

Agency officials reported these figures as estimated obligations.
Appendix III: Fiscal Year 2011 Obligations for 

Drug Abuse Prevention and Treatment 

Programs in Our Review

Page 68 GAO-13-333 Office of National Drug Control Policy

f

Under 20 U.S.C. § 7164, funds may not be used for medical services, drug treatment, or 

rehabilitation, except for pupil services or referral to treatment for students who are victims of, or 

witnesses to, crime or who illegally use drugs with regard to Safe and Drug-Free Schools and 

Communities. Under 20 U.S.C. § 7175, with regard to 21st Century Community Learning Centers, 

each eligible entity that receives an award may use the award funds to carry out a broad array of 

before and after school activities that advance student academic achievement that are listed in the 

statute. 

g

For the purpose of our review, we assessed the activities of Education’s Safe and Supportive 

Schools and Safe Schools/Healthy Students programs separately; according to officials from 

Education, they are considered to be activities within a single program–the Safe and Drug-Free 

Schools and Communities National Activities. 
Appendix IV: Information about Completed 

Program Evaluations Conducted by Agencies 

in Our Review

Page 69 GAO-13-333 Office of National Drug Control Policy

We found that the agencies included in our review have completed six 

evaluations of drug abuse prevention and treatment programs since 

2007, three of which examined effectiveness and three of which 

examined program implementation. The completed program evaluations 

that included assessments of effectiveness examined the following: 

• Office of Justice Program’s (OJP) Drug Courts Program.

1

• The Department of Veterans Affairs’ (VA) Substance Use Disorder 

Outpatient Program and Substance Use Disorder Residential 

Program.

The study 

examined 23 adult drug courts across the United States and 

compared them with 6 sites in the same geographic areas. The 

evaluation focused on four main issues: (1) whether drug courts 

reduce drug use and other problems associated with drug abuse, (2) 

how drug courts work, (3) how offender attitudes and behaviors 

change when they are exposed to drug courts and how these 

changes help explain the effectiveness of drug courts, and (4) 

whether drug courts generate cost savings. OJP officials told us that 

as a result of the study, the major findings of the evaluation were 

translated into seven evidence-based design features that OJP is 

including in drug court grant solicitations. When making awards, OJP 

gives priority to applicants that include the seven design features in 

their proposals, as OJP considers these design features to be 

indicators of an effective program. The seven design features are (1) 

screening and assessment, (2) target population (3) procedural and 

distributive justice, (4) judicial interaction, (5) monitoring, (6) treatment 

and other services, and (7) relapse prevention, aftercare, and 

community integration. 

2

 

1

Urban Institute Justice Policy Center, The Multi-Site Adult Drug Court Evaluation: 

Executive Summary, a report prepared for the Department of Justice (November 2011).

GAO assessed this evaluation in 

The study looked at the quality of VA substance abuse and 

mental health care for veterans diagnosed with substance use 

disorder (SUD) or one or more other mental health conditions. The 

evaluation asked the following questions: (1) To what extent is VA 

achieving the program outcomes for veterans with SUD or other 

mental health conditions? (2) How do the outcomes for VA patients 

GAO-12-53 and found it to be well done analytically and 

one of the most comprehensive studies of drug courts to date. For more information about 

drug court program evaluations and effectiveness, see GAO-12-53. 

2

Altarum Institute and RAND Health, Veterans Health Administration Mental Health 

Program Evaluation Capstone Report, a report prepared for the Department of Veterans 

Affairs (2011).

Appendix IV: Information about Completed 

Program Evaluations Conducted by Agencies 

in Our Review
Appendix IV: Information about Completed 

Program Evaluations Conducted by Agencies 

in Our Review

Page 70 GAO-13-333 Office of National Drug Control Policy

compare with outcomes for comparable veterans treated in non-VAfunded care? (3) How does the availability of care compare across 

Veterans Health Administration medical centers? (4) When there is a 

diagnosis of SUD and a mental health condition, are both conditions 

being managed? (5) What factors influence the use of VA specialty 

mental health services by veterans whose condition is a result of or 

aggravated by their service? (6) How widespread is the use of the 

strongest evidence-based models of care for SUD and the other 

mental health diagnoses? The study identified areas for further 

research and recommended strategies to improve SUD and mental 

health care in VA. 

• Substance Abuse and Mental Health Services Administration’s 

(SAMHSA) Substance Abuse Prevention and Treatment Block Grant 

Program.

3

The other completed program evaluations examined:

The study assessed the extent to which this program is 

effective, functioning as intended, and achieving desired outcomes. 

The program provides funds to 50 states, nine territories (including the 

District of Columbia), and one Indian tribe for activities to prevent and 

treat substance abuse. The evaluation examined (1) the processes 

and activities by which states implement the legislative and policy 

requirements of the Substance Abuse Prevention and Treatment 

Block Grant program, (2) activities associated with the federal 

administration of the program and how they support program 

implementation and accountability, (3) state system processes and 

capacity for the collection and submission of data on block grantfunded activities, (4) specified outcomes associated with states’ 

treatment and prevention services, and (5) the ways in which states 

used and leveraged program funds. The study identified program 

successes, as well as challenges and areas for improvement. 

• SAMHSA’s Underage Drinking Prevention Education Initiative.

4

 

3

Altarum Institute, Independent Evaluation of the Substance Abuse Prevention and 

Treatment (SAPT) Block Grant (BG) Program Final Evaluation Report, a report prepared 

for SAMHSA (2009).

Two 

evaluations examined implementation and perceived outcomes of 

4 ICF Macro, 2008 Town Hall Meetings: Mobilizing Communities to Prevent and Reduce 

Underage Alcohol Use Evaluation Report, a report prepared for the Substance Abuse and 

Mental Health Services Administration (2009), and ICF Macro and University Research 

Company, LLC, 2010 Town Hall Meetings: Mobilizing Communities to Prevent and 

Reduce Underage Alcohol Use, a report prepared for the Substance Abuse and Mental 

Health Services Administration (2011). 
Appendix IV: Information about Completed 

Program Evaluations Conducted by Agencies 

in Our Review

Page 71 GAO-13-333 Office of National Drug Control Policy

2008 and 2010 Town Hall meetings intended to raise public 

awareness of underage drinking and engage communities in its 

prevention. The evaluation also reviewed the barriers and challenges 

in planning and convening the Town Hall meetings. The evaluations 

reviewed, among other things, changes over time in the numbers of 

Town Hall meetings held and participation by community-based 

organizations. The evaluations also examined Town Hall attendees 

and presenters and the settings, formats, and contents of the Town 

Halls. Officials from SAMHSA, which administers the program, said 

they would use the evaluation results to shape future program 

proposals and inform and improve technical assistance and training 

activities. SAHMSA plans to share the results with participants and 

use the results in presentations on best practices. 

• SAMHSA’s Assertive Adolescent and Family Treatment Program.

5

 

5

Advocates for Human Potential, Inc. Program Evaluation for the Assertive Adolescent 

and Family Treatment (AAFT) Program, Final Report, a report prepared for SAMHSA 

(September 14, 2012).

 

The study focused on the third cohort of Assertive Adolescent and 

Family Treatment Program grant recipients and had two overarching 

goals: (1) to document the program implementation process, and (2) 

to explore how implementation supports, such as training and 

technical assistance for the clinical and assessment components of 

the project, guide how the funded programs evolve. The report 

findings addressed the characteristics of agency, staff, and clients and 

their relationship with program implementation, grantees’ use of 

implementation activities, implementation barriers, strategies used 

and lessons learned, and the overall impact of the program on 

program sites and their clients.
Appendix V: Comments from the Office of 

National Drug Control Policy

Page 72 GAO-13-333 Office of National Drug Control Policy

Appendix V: Comments from the Office of 

National Drug Control Policy
Appendix V: Comments from the Office of 

National Drug Control Policy

Page 73 GAO-13-333 Office of National Drug Control Policy
Appendix V: Comments from the Office of 

National Drug Control Policy

Page 74 GAO-13-333 Office of National Drug Control Policy
Appendix VI: GAO Contacts and Staff 

Acknowledgments

Page 75 GAO-13-333 Office of National Drug Control Policy

Eileen R. Larence, (202) 512-8777 or larencee@gao.gov

Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov

In addition to the contacts named above, Karen Doran, Assistant Director; 

Mary Catherine Hult, Assistant Director; David Alexander; Willie 

Commons III; Elizabeth Curda; Susan Czachor; Lorraine Ettaro; Michele 

Fejfar; Jill Lacey; Kelly Liptan; Emily Loriso; Linda Miller; Erin O’Brien; 

Dae Park; Emily Ryan; C. Jenna Sondhelm; and Johanna Wong made 

significant contributions to the work.

Appendix VI: GAO Contacts and Staff 

Acknowledgments 

GAO Contacts 

Staff 

Acknowledgments 

(441084)
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