Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities
Released: 1996-10-08T00:00:00

Letter

Background

The Anti-Drug Abuse Act of 1988 (P.L. 100-690) requires ONDCP to develop a national drug control strategy, in consultation with agency and department heads and others involved in drug control matters. With the President’s approval, this strategy is submitted annually to the Congress. In addition to long- and short-term objectives, it contains information on past and estimated future federal funding in support of efforts to reduce drug supply and demand.

Each year since 1983, state alcohol and drug agencies have voluntarily submitted data detailing the fiscal, client, and other aspects of their substance abuse programs to NASADAD. The state, county, and local governments’ expenditure data, including federal support, are analyzed and published by NASADAD under a contract with SAMHSA of HHS. Also, SAMHSA collects data on private funding for substance abuse treatment services through its survey of drug and alcohol treatment units.

The primary source of our information on contributions from private and community foundations has been the Foundation Center. The Foundation Center, established in 1956, is an independent, nonprofit service organization. Its mission is to foster public understanding of institutional philanthropy by collecting, organizing, analyzing, and disseminating information on foundations, corporate giving, and other topics.

The Federal Government Funds a Major Portion of Substance Abuse Treatment and Prevention Activities

The federal government provides a large portion of the financial support for substance abuse treatment and prevention activities. For fiscal year 1994, federal budget authority for treatment and prevention activities was $4.4 billion—a 59-percent increase over the 1990 amount. When adjusted for inflation, this equates to a 41.3-percent increase from 1990 through 1994. Three departments—HHS, VA, and Education—accounted for the vast majority of the 1994 budget authority. The substance abuse programs that federal agencies fund provide a variety of services; however, treatment programs received a much larger proportion of funding than prevention programs in 1994. It should be noted that the data we obtained may not accurately represent total federal support for treatment and prevention because some programs may have been omitted and much of the data has not been independently validated.

Federal Funding for Treatment and Prevention Has Increased Since Fiscal Year 1990

Federal funding for substance abuse treatment and prevention activities increased by $1.6 billion from fiscal year 1990 through 1994. During this time period, the number of federal agencies that reported funding for treatment and prevention programs rose from 12 to 16. Federal budget authority for fiscal year 1990 was $2.8 billion, but by fiscal year 1994 the funding amount had reached $4.4 billion. (See app. II for federal funding by agency for fiscal years 1990 through 1994.) The most recent data released by ONDCP show that fiscal year 1995 budget authority for treatment and prevention activities increased about $250 million over the 1994 amount. (See app. III.)

Comparing the funding in fiscal years 1990 and 1994, changes in the budget authority for substance abuse treatment and prevention activities varied widely among federal agencies. The largest dollar increase occurred in HHS’ budget, where budget authority increased by about $800 million, from $1.4 billion to $2.2 billion. This change accounted for about one-half of the total increase in federal funding over the 5-year period. Some of the growth can be attributed to the creation of substance abuse block grants and increased reimbursement for treatment services through Medicare and Medicaid.

The changes in funding for substance abuse treatment and prevention services among all 16 agencies ranged from a 196-percent increase to about a 27-percent decrease. The Department of Housing and Urban Development (HUD) had the highest percentage increase in funding. Its budget authority went from $106.5 million to $315 million—the bulk of which appeared to be for increases in drug elimination grants that fund drug prevention and control at public and Native American housing developments. The Department of Justice had the highest percentage decrease. Its budget authority declined from $133 million to about $98 million. Although some offices within Justice experienced increases in their budget authority, the Office of Justice Programs’ $50 million decrease resulted in Justice’s overall decline in funding for substance abuse treatment and prevention activities.

Three Departments Accounted for Most Funding in Fiscal Year 1994

Of the 16 agencies, 3 departments accounted for most of the federal funds that were available for substance abuse treatment and prevention activities in fiscal year 1994. The combined budget authority of HHS, Education, and VA was about $3.68 billion, or 83 percent of the total federal funding for substance abuse treatment and prevention activities for that year. HHS alone, which has the largest number of agencies with substance abuse treatment and prevention programs, accounted for about half of the fiscal year 1994 budget authority. SAMHSA, within HHS, provided more federal funding for substance abuse treatment and prevention activities than any other agency. SAMHSA’s fiscal year 1994 budget authority was about $1.4 billion. The National Institutes of Health (NIH), also within HHS, provided the next highest level of funding. Its fiscal year 1994 budget authority was $425.2 million. Figure 1 shows fiscal year 1994 budget authority for substance abuse treatment and prevention activities by agency.

Substance abuse treatment services received a larger proportion of federal budget authority than prevention services in fiscal year 1994. Treatment services accounted for $2.6 billion, or about 60 percent of the total federal funding available. (See fig. 2.)

Federal Programs Provide a Mixed Menu of Services for Targeted Populations

Federal agencies’ programs provide an array of substance abuse treatment services and prevention activities to a variety of targeted population groups. Treatment comprises an assortment of formal organized services for people who have abused alcohol, other drugs, or both. Treatment services can include diagnostic assessment; detoxification; and medical, psychiatric, and psychological counseling. Prevention activities focus on individuals who may be at risk for alcohol or other drug problems. These activities include providing information and education that increase knowledge of drug abuse and alternative drug-free life styles, encouraging communities to implement responses to drug use, and drug testing. One federal program that provides both treatment and prevention services is Head Start, which offers prevention activities for young children and supporting community-based activities for parents and other family members. Another example is the Pregnant and Postpartum Women and Infants program. In part, it funds demonstration programs that coordinate and link health promotion and treatment services for substance-using pregnant women and their young children. The program also supports treatment services in residential settings that permit infants and children to live with their substance-using mothers. Other programs also provide services for specific populations, such as high-risk youth; elementary, secondary, and postsecondary students; and veterans.

Some agencies fund programs whose primary objective is to provide substance abuse treatment and prevention activities. Other agencies’ programs include these activities as one component of a nonsubstance abuse program. For example, the main objective of the Department of Agriculture’s Special Supplemental Program for Women, Infants, and Children (WIC) program is to provide nutritious food and nutrition education to women and children who are considered to be at nutritional risk. As part of nutrition education, WIC counsels participants about the dangers of substance abuse. Program participants are also referred to substance abuse counseling, when appropriate. Appendix IV contains federal agencies’ funding levels for substance abuse treatment and prevention and brief descriptions of the federal programs that provided support for these services for fiscal year 1994.

Federal Data Limitations Affect Their Usefulness

ONDCP was the most comprehensive single source for information on federal substance abuse treatment and prevention funding and programs. However, ONDCP’s budget summary data are limited in their coverage of substance abuse programs and are not routinely subjected to large-scale verification. We observed that ONDCP does not always include alcohol treatment and prevention programs in its budget summaries. For example, no information on NIH’s National Institute on Alcohol Abuse and Alcoholism is included in NIH’s budget authority. Moreover, when we compared ONDCP’s data with federal agencies’ justifications of budget estimates prepared for congressional appropriations committees, the combined funding for three agencies differed by about $655 million in fiscal year 1994. According to ONDCP officials, the differences are due to the inclusion of alcohol-only programs in the agencies’ justification of estimates. ONDCP does not include alcohol-only programs in its budget summary because these programs are not “scored”—that is, categorized—as drug programs. Additionally, VA’s 1996 congressional budget justification did not include VA’s full complement of treatment programs. Data limitations also stem from the use of different methods of estimating the amount of program funding specifically used for substance abuse treatment and prevention and from different determinations of what constitutes a prevention or treatment program.

State, County, and Local Governments Spend More Than a Billion Dollars Annually

The combined contributions of state, county, and local governments constitute a sizable portion of the financial support for substance abuse treatment and prevention activities. In fiscal year 1994, these entities spent about $1.6 billion—most of which was used for treatment services. This fiscal year 1994 spending exceeded fiscal year 1990 expenditures by about 22 percent (about 8 percent when adjusted for inflation). Users of these data should note that total spending by state and local governments probably exceeds these reported expenditures.

State, County, and Local Government Spending Has Increased Since Fiscal Year 1990

In fiscal years 1990 through 1994, state, county, and local governments’ total expenditures increased overall for substance abuse treatment and prevention activities. Combined expenditures rose from $1.3 billion to about $1.6 billion—about a $300 million increase. (App. V shows state, county, and local governments’ annual expenditures and the percentage change from fiscal year 1990 through 1994.) On a percentage basis, there was more fluctuation in local governments’ spending than in state spending over the 5-year period. Also during this period, combined spending for substance abuse treatment consistently exceeded that for prevention. Although total treatment and prevention expenditures increased over the 5 years, spending for prevention actually decreased by about 1 percent while spending for treatment increased by 26 percent (these percentages equate to 12 and 11 percent, respectively, when adjusted for inflation) (see apps. VI and VII). In fiscal year 1994, treatment services accounted for more than 88 percent of total spending by the entities combined (see fig. 3).

State, County, and Local Governments’ Data Limitations Affect Their Usefulness

The expenditure data voluntarily submitted to NASADAD by state and local governments have a number of inherent limitations. One major limitation is that NASADAD asked states to submit expenditure data only for service providers that received at least some portion of their funding from the state alcohol and drug agency during the state’s fiscal year. The data therefore do not include information on providers that did not receive any funding from the state alcohol and drug agency, such as private for-profit agencies. As a result, the overall expenditure data submitted to NASADAD are conservative and probably underestimate total funding expenditures by state governments. Furthermore, state-reported expenditures are not verified by NASADAD; instead, NASADAD asks that states confirm that their data are correct.

For some states, complete information is not available on all sources of funding, even for service providers supported by state alcohol and drug agencies. In most of these instances, the amount of unavailable information is probably small. In addition, there are concerns about how consistently providers of treatment and prevention activities classify those activities given the varying interpretations of what constitutes “treatment” and “prevention.” The data are also limited by the variations in state fiscal years, raising questions about the appropriateness of comparing expenditures across states.

Data on Private Funding of Substance Abuse Treatment and Prevention Are Scarce

Comprehensive data on private funding of substance abuse treatment and prevention activities over time are sparse. The National Drug and Alcoholism Treatment Unit Survey (NDATUS), which compiled private contributions from various sources, focused on treatment only. NDATUS data show that private funding for substance abuse treatment services amounted to a little over $1 billion in 1993 (the latest year for which data were available). The largest source of private funding was third-party payments by health insurers and health maintenance organizations (about 55 percent of total private funding). Private donations, which included contributions from foundations, accounted for about 7 percent. (See table 1.)

Data on private donations from foundations show that the top 25 contributors awarded $39.4 million in grants for substance abuse treatment and prevention programs during 1993 and 1994 (the latest years for which grant data were available). The grant amounts ranged from $306,342 to about $18.5 million (see app. VIII). These grants were provided to nonprofit organizations in the United States and abroad to cover substance abuse treatment and prevention programs, including counseling, education, residential care facilities, halfway houses, support groups, family services, community programs, and services for children of drug-dependent parents. Grants were also awarded for medical research on substance abuse and media projects on substance abuse prevention. Population groups receiving the largest grant amounts were alcohol or drug abusers, children and youths, women and girls, economically disadvantaged individuals, offenders or ex-offenders, and minorities.

Private Data Have Major Limitations That Affect Their Usefulness

The private funding data we used had two significant limitations. First, the latest available NDATUS data on private funding sources were for substance abuse treatment only, and these data were for only 1 year—1993. Second, the response rates of treatment providers to the NDATUS survey were low. The response rates were 21.1 percent for third-party payments, 44.9 percent for client fees, and 15.4 percent for private donations.

Conclusions

Federal, state, county, and local governments and the private sector all provide funding for substance abuse treatment and prevention activities. The latest and best data available show that (1) the federal government has been a major contributor of funds, providing more than $4 billion in fiscal year 1994; (2) state and local governments spent a little more than $1.5 billion in their 1994 fiscal years; and (3) private funding exceeded $1 billion in 1993. According to the data we collected, the federal government increased its support for treatment and prevention activities from fiscal year 1990 through the end of fiscal year 1994 by about 60 percent. Over the same 5-year period, state, county, and local governments’ combined funding for treatment and prevention activities increased by about 22 percent.

Agency Comments

In commenting on a draft of this report, ONDCP concurred with our findings (see app. IX). NASADAD also commented on a draft of this report and agreed with the manner in which we dealt with data it provided on state, county, and local government expenditures. However, NASADAD commented that the changes in state expenditure levels we reported for the 1990 through 1994 time frame were influenced by the time period we chose to review. NASADAD noted that the fiscal year period 1985 through 1989 showed much higher increases in state expenditures. (See app. X.)

We are sending copies of this report to the Secretary of Health and Human Services; the Director of the Office of National Drug Control Policy; the Director of the Office of Management and Budget; the Executive Director of the National Association of State Alcohol and Drug Abuse Directors, Inc.; appropriate congressional committees; and other interested parties. We will also make copies available to others on request.

If you or your staff have any questions about this report, please call me at (202) 512-7119. Other major contributors to this report include James O. McClyde, Assistant Director; Jared Hermalin; Roy Hogberg; and Brenda James Towe.

Scope and Methodology

To determine the level of federal funding and what federal programs exist for substance abuse treatment and prevention activities, we used three data sources: (1) the Office of National Drug Control Policy’s (ONDCP) budget summaries from its National Drug Control Strategies, (2) federal agencies’ justifications of estimates for appropriations committees, and (3) the 1995 Catalog of Federal Domestic Assistance. We also interviewed ONDCP officials. Using the ONDCP budget summaries as our primary data source, we identified federal agencies that fund substance abuse treatment and prevention services and obtained funding data and program descriptions starting in fiscal year 1990. The latest ONDCP budget summary available at the time of our analysis contained actual budget authority for fiscal year 1994, budget estimates for fiscal year 1995, and budget requests for fiscal year 1996. We obtained additional funding data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) because information on its programs was either not included or not specifically identified in ONDCP’s budget summaries. The agencies’ justifications of estimates were of minimal use because, in most cases, they did not identify substance abuse treatment and prevention funding or provide a description of the programs. Where possible, we compared the justifications with ONDCP’s budget summaries. We reviewed the 1995 Catalog of Federal Domestic Assistance but made only minimal use of its data to fill gaps in program descriptions.

Information on state, county, and local governments’ spending specifically for substance abuse treatment and prevention activities was generated by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) from its computerized database. These data covered state fiscal years from 1990 through 1994 and are based on state-reported expenditures that are not verified by NASADAD. Instead, NASADAD requests that states confirm that their annually reported data are correct. We interviewed NASADAD officials and obtained their views on the state-reported data.

To obtain information on private sector funding, we contacted the Department of Health and Human Service’s (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) and numerous other organizations. These groups included the National Association of Addiction Treatment Providers, the Health Insurance Association of America, the American Hospital Association, the National Association of Public Hospitals, and the Center for Addiction and Substance Abuse at Columbia University. However, only SAMHSA provided private funding data for multiple sources. These data were collected in the National Drug and Alcoholism Treatment Unit Survey (NDATUS) of treatment providers and covered funding for treatment services in 1993—the latest year for which data were available. Published data on the private foundations that provided the most funding in grants to nonprofit organizations during 1993 and 1994 were obtained from the Foundation Center. We did not identify any data sources with comprehensive information on private funding of substance abuse prevention activities.

We did not verify the federal, state, and private data. The funding data we provide in this report have generally not been adjusted for inflation. In some instances, we did adjust for inflation when presenting changes in funding over time. We conducted our work from February through August 1996 in accordance with generally accepted government auditing standards.

Federal Budget Authority for Substance Abuse Treatment and Prevention Activities, Fiscal Years 1990-94

Administration for Children and Families Centers for Disease Control and Prevention Health Resources and Services Administration Alcohol, Drug Abuse, and Mental Health Administration (continued)

Special Supplemental Program for Women, Infants, and Children (WIC)

Bureau of International Narcotics and Law Enforcement National Highway Traffic Safety Administration Office of Territorial and International Affairs (Table notes on next page)

Percentage changes are not presented for agencies’ subunits.

Not applicable because there was no funding in 1 or more years.

Federal Budget Authority for Substance Abuse Treatment and Prevention Activities, Fiscal Years 1995-97

Administration for Children and Families Centers for Disease Control and Prevention Health Resources and Services Administration Special Supplemental Program for Women, Infants, and Children (WIC) (continued)

Federal Substance Abuse Treatment and Prevention Program Funding and Descriptions

This appendix provides information on the substance abuse treatment and prevention activities of various federal agencies. Included are funding information and program and activity descriptions. Not included are funding and program descriptions for agencies that devoted less than $1 million to treatment and prevention activities in fiscal year 1994. These agencies accounted for $1.8 million or 0.04 percent of total federal budget authority for that year. In some cases table totals do not add because of rounding.

Department of Veterans Affairs (VA)

Through the Veterans Health Administration, VA operates a network of substance abuse treatment programs in its medical centers, domiciliaries, and outpatient clinics.

Department of Education

Office of Elementary and Secondary Education Drug-Free Schools and Communities Act National Programs (including regional centers)

Safe and Drug-Free Schools and Communities Act Family and Community Endeavor Schools (FACES)

Office of Special Education and Rehabilitative Services, Rehabilitative Services Administration Office of Special Education Programs Grants for Infants and Families Special Education Special Purpose Funds National Institute on Disability and Rehabilitation Research Rehabilitation Research Training Centers and other programs The Drug-Free School and Communities Act expired at the end of fiscal year 1994; its authorization was extended under the Safe and Drug-Free Schools and Communities Act.

Program not in existence or program restructured into another program.

Office of Elementary and Secondary Education

Drug-Free Schools and Communities Act/Safe and Drug-Free Schools and Communities Act

The Safe and Drug-Free Schools and Communities Act extends the authorization for the Drug-Free Schools and Communities Act (which expired on Sept. 30, 1994) and broadens it to include activities to prevent violence as well as drug and alcohol use by youth. In 1994, the funds were used exclusively for alcohol, tobacco, and other drug-related prevention activities.

Safe Schools Act

In 1994, 90 percent of these funds were used to support grants to local educational agencies (LEA) with serious school crime, violence, and discipline problems. The projects are designed to combat those problems and thereby enhance school safety and promote better access to learning. The remaining funds were divided equally between national leadership activities and support for a national model city program in the District of Columbia, as authorized by the legislation. (Funding for this program is included in the national drug control budget because activities supported with these funds will have an impact on drug prevention as well as on violence prevention.)

Crime Control Act

Family and Community Endeavor Schools (FACES), a subset of the Crime Control Act, supports grants to LEAs and community-based organizations in high-poverty and high-crime areas for programs of integrated services to improve the academic and social development of at-risk students. (Funding for this program is included in the national drug control budget because activities supported with these funds will have an impact on drug prevention as well as on violence prevention.)

Office of Special Education and Rehabilitative Services, Rehabilitative Services Administration

Vocational Rehabilitation State Grants

This state grant program supports a wide range of services for individuals with disabilities, including those whose disabling condition is due to drug abuse, to prepare for and engage in gainful employment. Funds are allocated to states and territories on the basis of their population and per capita income. People with disabilities that result in a substantial impediment are eligible for assistance. Funds also support special demonstration programs that develop innovative methods and comprehensive service programs to help people with disabilities achieve satisfactory vocational outcomes.

Special Demonstrations

Special demonstration programs develop innovative methods and comprehensive service programs to help people with disabilities achieve satisfactory vocational outcomes. The program awards discretionary grants to states, agencies, and organizations to pay all or part of the costs of demonstrations, direct services, and related activities.

Office of Special Education Programs

Grants for Infants and Families

This state grant program supports development and implementation of statewide systems of early intervention for children up to 2 years old with disabilities. No specific information related to drug abuse intervention was provided in the ONDCP 1995 budget summary.

Special Education Special Purpose Funds

These funds support grants, contracts, and cooperative agreements with public agencies; private nonprofit organizations; and, in some cases, for-profit organizations. Activities include research, demonstrations, outreach, training, and technical assistance. No specific information related to drug abuse intervention was provided in the ONDCP 1995 budget summary.

National Institute on Disability and Rehabilitation Research

Rehabilitative Research Training Centers and Other Programs

Through various discretionary programs, the Institute supports research, demonstrations, and dissemination activities on issues relating to people of all ages with disabilities. No specific information related to drug abuse was provided in the ONDCP 1995 budget summary.

Program Administration

Program administration maintains Department of Education staff to administer programs with substance abuse treatment and prevention components.

Department of Housing and Urban Development (HUD)

Program not in existence or program restructured into another program.

Drug Elimination Grants/Community Partnership Against Crime Empowerment Zones and Enterprise Communities Crime Control Act (Local Partnership Act)

Program not in existence or program restructured into another program.

Drug Elimination Grants/Community Partnership Against Crime

Through this program, HUD provides grants to public housing authorities and Indian housing agencies to fight drug problems in their communities. Drug problems are addressed through a comprehensive approach involving enforcement, prevention, and treatment. The grants focus on many areas, including community policing, youth training, recreation, career planning, employment, substance abuse education and prevention; resident services, such as drug treatment or other appropriate social services that address the contributing factors of crime; and clearinghouse services, assessment and evaluation, and technical assistance and training.

Empowerment Zones and Enterprise Communities

Funds support programs to empower people and communities to work together to create jobs and opportunity. HUD applies four principles in making the Empowerment Zone and Enterprise Community designations: (1) economic opportunity, (2) sustainable community development, (3) community-based partnerships, and (4) strategic vision for change.

Crime Control Act (Local Partnership Act)

No details were provided for this program in the ONDCP 1995 budget summary.

Department of Justice

Bureau of Prisons

The Bureau has a comprehensive drug abuse treatment strategy with four components: drug abuse education, nonresidential drug abuse counseling services, residential drug abuse program, and community-transitional services programming. An estimated 30.5 percent of the sentenced inmate population is drug dependent and requires some type of drug abuse treatment program.

Drug Enforcement Administration

Neither the ONDCP budget summary nor the agency’s justification of estimates identified the prevention components.

Office of Justice Programs

Bureau of Justice Assistance

Through formula grant funds, the Bureau provides financial and technical assistance to state and local governments to control drug abuse and violent crime and improve the criminal justice system. States are required to prepare statewide antidrug and violent crime strategies. The Bureau also supports national and multistate programs such as the National Crime Prevention Campaign (McGruff the Crime Dog).

Bureau of Justice Statistics

The Bureau produces and disseminates drug-related data, including data on drug-use history of criminal offenders; offenders under the influence of alcohol or drugs; drug prosecution and sentencing of drug law violators; case processing of drug offenses; drug availability, prevention, and education classes in schools; drug and alcohol rehabilitation programs in the correctional community; and the relationship of drugs and crime. The Bureau also supports the Drugs and Crime Data Center and Clearinghouse, which provides a centralized source of information on drugs and crime.

National Institute of Justice

The Institute is the primary federal sponsor of research on crime and its control and is a central resource for information on innovative approaches in criminal justice. As mandated by the Anti-Drug Abuse Act of 1988, the Institute sponsors and conducts research, evaluates policies and practices, demonstrates promising new approaches, provides training and technical assistance, assesses new technology for criminal justice, and disseminates its findings to state and local practitioners and policymakers.

Office of Juvenile Justice and Delinquency Prevention

This agency has primary responsibility for addressing the needs of the juvenile justice system. Its goal is to aid in the prevention, reduction, and treatment of juvenile crime and delinquency and to improve the administration of juvenile justice by providing financial and technical support to state and local governments, public and private agencies, organizations, and institutions.

Community Policing

Program not in existence or program restructured into another program.

Program not in existence or program restructured into another program.

The program serves as a vehicle for the administration’s strategy to fight violent crime by increasing the number of state and local police officers; promoting the use of community policing techniques; and implementing police hiring, education, and training programs. The program primarily awards grants to state and local law enforcement agencies, state and local governments, and community groups to achieve its goals.

Department of Labor

Employment and Training Administration (Job Training Program)

Employment and Training Administration

The Department of Labor’s Employment and Training Administration administers job training programs, not substance abuse programs. The Administration believes that the positive results of its programs, in terms of enabling participants to acquire new skills and enhance employment ability, contribute to reducing the risk factors associated with substance abuse.

The Job Training Partnership Act (JTPA), 29 U.S.C. §1501 et seq., requires individual assessments for each program participant; specifically encourages outreach activities for individuals who face severe barriers to employment, such as drug and alcohol abuse; and sets as program goals coordination of JTPA programs with other community service organizations, such as drug and alcohol abuse prevention and treatment programs. JTPA also authorizes the Job Corps Alcohol and Other Drug Abuse component to screen trainees for drug and alcohol problems and provide prevention and intervention services.

Departmental Management

This program provides information on workplace substance abuse through continued development and operation of the Substance Abuse Information Database; data collection on the impact of substance abuse on productivity, safety, and health; support for the Substance Abuse Institute at the George Meany Center for Labor Studies; funding of the workplace model in the fiscal year 1996 Household Survey; and continued work with employer and employee groups to raise awareness of the problems of workplace substance abuse and what can be done to most effectively address those problems.

Department of Defense

The Department of Defense’s counterdrug strategy has among its objectives to reduce the demand for illegal drugs within the Department and its surrounding communities. The demand reduction program supports a counterdrug strategy of early drug abuse identification through testing and treatment of drug abusers and outreach programs for at-risk youth through the military departments and the National Guard Bureau. For community outreach pilot programs, congressional authorization is required to permit counterdrug funds to be spent on programs targeting youth outside the traditional Department community boundaries.

The Federal Judiciary

The U.S. Courts operate the Substance Abuse Treatment Program. Offenders in this program are referred by the Judiciary and the Bureau of Prisons. The basic goal of the program is to identify and treat substance abusers who are under the supervision of the U.S. Probation Office. The program tries to protect the community by helping these offenders stop their substance abuse.

Corporation for National Service

The Corporation for National Service administers programs that address the nation’s education, human service, public safety, and environmental needs through the activities of volunteers and that expand the involvement of volunteers in responding to a wide range of community needs, including drug abuse prevention, by reaching high-risk youth and the communities in which they live.

Social Security Administration

Referral and monitoring (Title XVI)

Demonstration projects (Title XVI)

Disability Insurance Trust Fund (Title II)

Program not in existence or program restructured into another program.

The Social Security Administration has placed restrictions on Disability Insurance and Supplemental Security Income benefits payments to individuals disabled by drug addiction or alcoholism and has established barriers to prevent a beneficiary from using benefits to support an addiction. In some cases, the Administration imposes treatment requirements on Disability Insurance beneficiaries and establishes referral and monitoring agreements in all states.

Department of Agriculture

Food and Consumer Services

Special Supplemental Program for Women, Infants, and Children (WIC)

WIC provides nutritious supplemental foods to low-income pregnant, postpartum, and breastfeeding women and to infants and children younger than age 5 who are determined by professionals such as physicians, nurses, and nutritionists to be at nutritional risk. Funds flow through participating state agencies to local agencies, which provide supplemental foods to WIC participants along with nutrition education, breastfeeding promotion, and health care referrals. As part of nutrition education, WIC counsels participants about the dangers of substance abuse, including smoking during pregnancy. When appropriate, participants are referred to drug abuse counseling.

Department of State

Bureau of International Narcotics and Law Enforcement Affairs

The ONDCP budget summary and the budget justification do not identify specific prevention program or activity dollars.

The Bureau develops, implements, and monitors U.S. international counternarcotics strategies and programs. The Bureau’s functions also include foreign policy formation and coordination, program management, and diplomatic initiatives.

Department of Transportation

Federal Aviation Administration

Neither ONDCP nor the agency’s justification of estimates identifies specific prevention components by budget expenditure. However, prevention descriptions are identified within the following FAA program listings.

Operations

The Federal Aviation Administration (FAA) provides regulatory oversight of the drug and alcohol misuse prevention programs administered by approximately 5,000 aviation industry entities and individual commercial operators. FAA also conducts random drug testing of employees who are designated to be in critical safety positions; reregisters aircraft and conducts periodic renewal of pilot certificates; provides investigative support to all federal, state, and local law enforcement agencies involved in drug enforcement actions; and develops and correlates flight plans and transponder codes to enhance communications between air route traffic control centers and U.S. Customs/Coast Guard facilities. This process assists in identifying airborne drug smugglers by using radar, posting aircraft lookouts, and tracking the movement of suspect aircraft.

Research, Engineering, and Development

This funding category supports the postmortem analysis of tissues and fluids from people involved in transportation accidents and incidents and assesses the effects of drugs on the performance of pilot and controller tasks.

Department of the Interior

Bureau of Indian Affairs

Office of Alcohol and Substance Abuse Prevention

The office coordinates substance abuse services among rehabilitation centers, emergency shelters, juvenile detention facilities, and community-based prevention and intervention programs.

Education

Each Bureau school has a substance abuse prevention program. The schools are allowed flexibility to design the most effective curriculum and counseling services to meet the needs of students.

Department of the Treasury

U.S. Secret Service

The U.S. Secret Service considers a portion of its costs for full-time- equivalent employees’ pay, benefits, and support to be attributable to drug enforcement activities. These activities include criminal investigations, task force involvement, employee and applicant drug testing, and protection involved in other drug-related activities.

Change in State, County, and Local Substance Abuse Treatment and Prevention Expenditures by State, Fiscal Years 1990-94

(continued)

Data were not available.

Percentage change could not be computed because data were not available.

State, County, and Local Substance Abuse Prevention Expenditures by State, Fiscal Years 1990-94

(continued)

Data were not available.

Percentage change could not be computed because data were not available.

State, County, and Local Substance Abuse Treatment Expenditures by State, Fiscal Years 1990-94

(continued)

Data were not available.

Percentage change could not be computed because data were not available.

Top 25 Foundations Contributing Grants to Substance Abuse Treatment and Prevention Programs, 1993-94

The Robert Wood Johnson Foundation Meadows Foundation, Inc.

Carnegie Corporation of New York The Aaron Diamond Foundation, Inc.

Hartford Foundation for Public Giving The Annie E. Casey Foundation Lettie Pate Evans Foundation, Inc.

Comments From the Office of National Drug Control Policy

Comments From the National Association of State Alcohol and Drug Abuse Directors

Related GAO Products

At-Risk and Delinquent Youth: Multiple Federal Programs Raise Efficiency Questions (GAO/HEHS-96-34, Mar. 6, 1996).

Drug Courts: Information on a New Approach to Address Drug-Related Crime (GAO/GGD-95-159BR, May 22, 1995).

Social Security: Disability Benefits for Drug Addicts and Alcoholics Are Out of Control (GAO/T-HEHS-94-101, Feb. 10, 1994).

Drug Use Among Youth: No Simple Answers to Guide Prevention (GAO/HRD-94-24, Dec. 29, 1993).

Indian Health Service: Basic Services Mostly Available; Substance Abuse Problems Need Attention (GAO/HRD-93-48, Apr. 9, 1993).

Community Based Drug Prevention: Comprehensive Evaluations of Efforts Are Needed (GAO/GGD-93-75, Mar. 24, 1993).

Adolescent Drug Use Prevention: Common Features of Promising Community Programs (GAO/PEMD-92-2, Jan. 16, 1992).

ADMS Block Grant: Drug Treatment Services Could Be Improved by New Accountability Program (GAO/HRD-92-27, Oct. 17, 1991).

Drug Treatment: State Prisons Face Challenges in Providing Services (GAO/HRD-91-128, Sept. 20, 1991).

Drug Treatment: Despite New Strategy, Few Federal Inmates Receive Treatment (GAO/HRD-91-116, Sept. 16, 1991).

Substance Abuse Treatment: Medicaid Allows Some Services but Generally Limits Coverage (GAO/HRD-91-92, June 13, 1991).

ADMS Block Grant: Women’s Set-Aside Does Not Assure Drug Treatment for Pregnant Women (GAO/HRD-91-80, May 6, 1991).

Drug Abuse: The Crack Cocaine Epidemic—Health Consequences and Treatment (GAO/HRD-91-55FS, Jan. 30, 1991).

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