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 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 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. 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 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. 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. 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. 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). The expenditure data voluntarily submitted to NASADAD by state and local governments have a number of inherent limitations.