oversight

Drug Control: Initial Review of the National Strategy and Drug Abuse Prevention and Treatment Programs

Published by the Government Accountability Office on 2012-07-06.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

United States Government Accountability Office
Washington, DC 20548



           July 6, 2012

           The Honorable Dianne Feinstein
           Chairman
           The Honorable Charles E. Grassley
           Co-Chairman
           Caucus on International Narcotics Control
           United States Senate

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

           An estimated 22.6 million Americans aged 12 or older were illicit drug users in 2010,
           representing 8.9 percent of the population aged 12 or older, according to the
           National Survey on Drug Use and Health. 1 This represents the highest overall
           rate of illicit drug users among this population group since 2002, when the rate was
           8.3 percent. Abuse of illicit drugs results in significant social, public health, and
           economic consequences for the United States. For example, the economic impact of
           illicit drug use, including the costs of crime, health care, and lost productivity, was
           estimated at more than $193 billion in 2007, the most recent year for which data
           were available. 2

           The Office of National Drug Control Policy (ONDCP) was established by the 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. 3 In this role, ONDCP provides advice and governmentwide
           oversight of drug programs and is responsible for coordinating drug control activities,
           1
            Illicit drug use includes marijuana, hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or
           prescription-type psychotherapeutics used nonmedically. See Department of Health and Human Services
           Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug
           Use and Health: Summary of National Findings (Rockville, Md.: September 2011).
           2
            See Department of Justice National Drug Intelligence Center, The Economic Impact of Illicit Drug Use on
           American Society (Washington, D.C.: April 2011).
           3
            Pub. L. No. 100-690, §§ 1002, 1003, 102 Stat. 4181, 4182. This law, as amended, was repealed on
           September 30, 1997, by Pub. L. No. 100-690, § 1009, 108 Stat. 1995 (1994). Congress again established
           ONDCP effective October 21, 1998. Office of National Drug Control Policy Reauthorization Act of 1998, Pub. L.
           No.105-277, div. C, title VII, §§ 703, 704, 112 Stat. 2681, 2681-671, 2681-672 (codified as amended at 21 U.S.C.
           §§ 1701 to 1712) (provisions pertaining to referenced functions codified as amended at 21 U.S.C. §§ 1702 and
           1703). Pursuant to § 715 of this law (codified as amended at 21 U.S.C. § 1712), provisions relating to ONDCP
           were “repealed” effective September 30, 2010. However, ONDCP has continued to operate pursuant to
           continued funding provided by Congress. Department of Defense and Full-Year Continuing Appropriations Act,
           2011, Pub. L. No. 112-10, 125 Stat. 38 (2011), and the Consolidated Appropriations Act, 2012, Pub. L. No. 112-
           74, 125 Stat. 786 (2012).



                                                                                         GAO-12-744R Drug Control
including federal drug abuse prevention and treatment programs, and related
funding across the federal government. ONDCP is required annually to develop the
National Drug Control Strategy (Strategy), which sets forth a plan to reduce illicit
drug use through prevention, treatment, and law enforcement programs, and to
develop a Drug Control Budget for implementing the Strategy. ONDCP reported
that for fiscal year 2012, about $25.2 billion was provided for drug control programs
across 17 federal departments and independent agencies. Further, according to
ONDCP, from 2004 to 2012 this signified an increase of $5.9 billion (about
31 percent) for drug control programs, including drug abuse prevention and
treatment programs.

The 2010 Strategy is the inaugural strategy guiding drug policy under President
Obama’s administration and, according to ONDCP officials, sought a comprehensive
approach to drug policy, including an emphasis on drug abuse prevention and
treatment efforts and the use of evidence-based practices—approaches to
prevention or treatment that are based in theory and have undergone scientific
evaluation. 4 Drug abuse prevention includes activities focused on discouraging the
first-time use of controlled substances and efforts to encourage those who have
begun to use illicit drugs to cease their use. Treatment includes activities focused on
assisting regular users of controlled substances to become drug free through such
means as counseling services, inpatient and outpatient care, and the demonstration
and provision of effective treatment methods.

National Drug Control Program agencies (drug control agencies)5 follow a detailed
process in developing their annual budget submissions for inclusion in the Drug
Control Budget, which provides information on the funding that the executive branch
requested for drug control to implement the Strategy. 6 Agencies submit to ONDCP
the portion of their annual budget requests dedicated to drug control, which they
prepare as part of their overall budget submission to the Office of Management and
Budget for inclusion in the President’s annual budget request. ONDCP reviews the
budget requests of the drug control agencies to determine if the agencies have
acceptable methodologies for estimating their drug control budgets, and includes
those that do in the Drug Control Budget. 7 Agencies may administer programs that
include drug abuse prevention and treatment activities but do not meet ONDCP’s
standards for having an acceptable budget estimation methodology. Such programs
are not represented in the Drug Control Budget.
4
 For the 2010 Strategy, ONDCP changed its approach and moved from publishing a 1-year Strategy to
publishing a 5-year Strategy, which is to be updated annually. The annual updates are to provide an
implementation progress report as well as an opportunity to make adjustments to goals to reflect policy changes.
5
 A National Drug Control Program agency is any agency, defined at the department or independent agency
level, that is responsible for implementing any aspect of the Strategy, including any agency that receives federal
funds to implement any aspect of the Strategy, subject to certain exceptions for agencies engaged in intelligence
activities or activities funded by the Department of Justice. See 21 U.S.C. § 1701(7).
6
 See 21 U.S.C. § 1703(c).ONDCP prepares a budget proposal it refers to as the National Drug Control Budget
Summary. For the purpose of this report, we refer to this proposal as the Drug Control Budget.
7
 An acceptable methodology relies on availability of empirical data at the agencies for estimating their drug
control budgets. These data include determining which portion of an agency’s funding is for drug control
programs or activities versus non-drug control programs. See GAO, Office of National Drug Control Policy:
Agencies View the Budget Process as Useful for Identifying Priorities, but Challenges Exist, GAO-11-261R
(Washington, D.C.: May 2, 2011).



2                                                                                GAO-12-744R Drug Control
Part of the 2010 Strategy is a long-term policy goal for increasing the emphasis on
preventing and treating substance abuse. Multiple federal departments—and their
component agencies, bureaus, divisions, and offices—and independent agencies
(collectively referred to as agencies), administer drug abuse prevention and
treatment programs, fund these programs, or both. 8 The drug abuse prevention and
treatment programs vary and may include grants to service providers, direct
services, and education and outreach activities. For example, an agency’s grant
program may award block grants to grantees, such as states or local entities, to
implement their own interventions through community-based drug abuse prevention
or treatment programs, while direct service programs often entail interventions
directly administered by an agency to a specific population. Drug abuse prevention
and treatment programs target various populations and use a wide variety of
interventions, which are strategies or approaches intended to prevent an undesirable
outcome, such as abuse of an illicit drug; promote a desirable outcome, such as
reducing the use of alcohol among youth; or alter the course of an existing condition,
such as successful treatment of drug addiction. Some programs may be either jointly
funded or administered by two or more agencies.

In light of the increase in the rate of illicit drug use among Americans, efforts to
oversee and coordinate the implementation of the Strategy and ensure that ONDCP
and federal agencies invest in the most effective drug abuse prevention and
treatment programs become more important. You asked us to determine the extent
to which the 2010 Strategy has been implemented, review the sources of funding for
federal drug abuse prevention and treatment programs as well as federal agency
efforts to coordinate their programs, and examine agencies’ efforts to evaluate drug
abuse prevention and treatment programs and ensure that they are effective.
Specifically, in this report we (1) provide an initial review of the extent to which the
2010 Strategy has been implemented, the extent to which ONDCP coordinates its
implementation across drug control agencies, and how ONDCP assesses the
effectiveness of the Strategy in preventing and reducing drug use; (2) review what
agencies fund drug abuse prevention and treatment programs and how agencies
coordinate their programs; and (3) provide an initial review of the extent to which
federal agencies evaluate their drug abuse prevention and treatment programs and
the extent to which agencies assess their programs’ effectiveness.

This is the first report in response to your request that we assess the implementation
of the 2010 Strategy. This report describes the implementation approach, federal
agencies’ drug abuse prevention and treatment programs, and Department of Health
and Human Services (HHS), Department of Justice (DOJ), and Department of
Education (Education) efforts to assess the effectiveness of their drug abuse
prevention and treatment programs. We will continue our work on these issues and
plan to evaluate the extent to which the 2010 Strategy has been implemented and
coordinated across agencies and how ONDCP assesses the effectiveness of the
Strategy in preventing and reducing drug use.

8
 A program may be defined as an activity, project, function, or policy with an identifiable purpose or set of
objectives. See GAO, Designing Evaluations: 2012 Revision, GAO-12-208G (Washington, D.C.: January 2012).
We consider a program with an identifiable purpose or objective relating to drug abuse prevention or treatment
as a drug abuse prevention or treatment program for the purpose of this report, regardless of whether the
program has other identifiable purposes or objectives.



3                                                                             GAO-12-744R Drug Control
To outline the planned implementation approach and the different programs, we
analyzed the 2010 Strategy and 2011 update, ONCDP documents on
implementation progress, and implementation plans and reports from selected
federal drug control agencies. We also interviewed officials from ONDCP and from
HHS, DOJ, and the Department of Homeland Security (DHS) about strategy
implementation efforts. 9 To identify what federal agencies fund drug abuse
prevention and treatment programs, we reviewed the fiscal year 2013 Drug Control
Budget that describes fiscal year 2012 allocations and interviewed ONDCP officials
to confirm their process for developing the Drug Control Budget and their criteria for
including agencies’ programs in the budget. 10 We determined that the fiscal year
2013 Drug Control Budget data are reliable for our purposes. Additionally, we
reviewed documents regarding the drug abuse prevention and treatment programs
of three national drug control agencies with some of the largest drug control budgets
for prevention and treatment—HHS, DOJ, and Education—and interviewed officials
from these agencies about their programs and about coordination efforts between
agencies funding drug abuse prevention and treatment programs. To provide an
assessment of federal agencies’ efforts to date to assess the effectiveness of their
drug abuse prevention and treatment programs, we interviewed officials from our
selected national drug control agencies as well as experts in the field of drug abuse
prevention and treatment. Enclosure I provides additional information on our scope
and methodology.

We conducted this performance audit from January 2012 through July 2012 in
accordance with generally accepted government auditing standards. Those
standards require that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and conclusions based on
our audit objectives. We believe that evidence obtained provides a reasonable basis
for our findings and conclusions based on our audit objectives.

Results in Brief

To implement the 2010 National Drug Control Strategy, ONDCP obtained input from
drug control stakeholders to help ensure that they shared responsibility for
implementation, established a new process to determine progress made, and
reported that most action items in the Strategy were on track or complete as of
November 2011. ONDCP officials stated that they developed the 2010 Strategy’s
seven objectives—for example, Strengthen Efforts to Prevent Drug Use in Our
Communities—and 106 action items under these objectives through a consultative
process with federal, state, and local drug control agencies and other stakeholders.

9
 Specifically, as of April 2012, we interviewed officials from the following four agencies: HHS, DHS, the Office of
Justice Programs, and the Drug Enforcement Administration. We selected the agencies to focus on in our review
based on a range of factors, including the number of Strategy action items for which agencies are responsible
and the size of their drug control budgets.
10
  ONDCP refers to these funds as enacted funding in the Drug Control Budget, while in this report we use the
term allocated funding. At the beginning of a fiscal year, agencies may allocate certain amounts from available
appropriations for specific programs. However, to the extent that an appropriation has not identified a particular
amount for a specific program, an agency may reallocate unobligated funds from that program to another during
the course of a fiscal year. To the extent other statutory authority results in makes mandatory funding for
programs that may include drug abuse prevention and treatment, such as Medicare and Medicaid, we also
include these as allocated funds.



4                                                                                GAO-12-744R Drug Control
Officials from the four agencies we spoke with as of April 2012 stated that ONDCP
sought input from them to develop the Strategy and that as a result, existing agency
priorities and activities are reflected in the Strategy. ONDCP officials stated that this
alignment helps facilitate Strategy implementation. In August 2010, ONDCP initiated
a process to track progress made on Strategy action items. As part of this process,
ONDCP requested that each agency develop and submit (1) a plan for implementing
each action item for which it has lead responsibility and (2) status updates on
implementation progress when requested. ONDCP officials stated that they use this
and other information to determine the implementation status of each of the action
items and then share the results with lead agencies in order to motivate them to take
steps to address items that are not on track, among other things. In November 2011,
ONDCP reported that 84 percent of the 113 action items in the 2010 Strategy and
2011 update were on track or complete, while the remaining 16 percent were either
delayed but progressing, facing budget issues, or at risk. 11 ONDCP officials stated
that this process to track and report on implementation progress helps hold agencies
accountable for implementing action items.

HHS, DOJ, and Education allocated nearly 85 percent of the funding for federal drug
abuse prevention and treatment programs in the Drug Control Budget in fiscal year
2012. Of the approximately $10.1 billion allocated by federal agencies for drug
abuse prevention and treatment programs in fiscal year 2012, HHS allocated
approximately $8.3 billion and DOJ allocated approximately $186.1 million for
prevention and treatment programs, while Education allocated about $64.9 million
for prevention programs. These three agencies allocated funding to various drug
abuse prevention and treatment programs, such as those that provide grants,
education and outreach, and direct service, among others. 12 HHS, DOJ, and
Education primarily allocated funding to grant programs in fiscal year 2012, through
which they awarded funding to states, communities, tribes, and other organizations
to implement drug abuse prevention and treatment interventions. For example, the
Substance Abuse and Mental Health Services Administration (SAMHSA) awards
funds through the Substance Abuse Prevention and Treatment Block Grant Program
to grantees to plan, carry out, and evaluate drug abuse prevention, early
intervention, treatment, and recovery support services. Not less than 20 percent of
funds awarded under this program must be spent by SAMHSA’s grantees for drug
abuse education, counseling, and risk reduction activities. 13 Officials from HHS,
DOJ, and Education agencies also told us that they coordinate with each other, and
other federal agencies, to deliver and fund drug abuse prevention and treatment
programs through a variety of methods, including jointly administering programs,
participating in working groups, and working together on an ad hoc basis. For
example, officials from Education said they jointly administer and fund the Safe
Schools/Healthy Students Initiative with HHS. DOJ is also a partner in this initiative,
and collaboration among the three agencies is guided by an agreement that is
signed annually by Education, HHS, and DOJ.

11
   ONDCP developed 106 action items for the 2010 Strategy and combined 2 action items and added 8 action
items in the 2011 Strategy.
12
  The allocation of an amount to a specific program does not indicate that funds in that amount were actually
spent on the program.
13
    See 42 U.S.C. § 300x-22(a).



5                                                                               GAO-12-744R Drug Control
HHS, DOJ, and Education assess the effectiveness of some of their grant programs
by either requiring grantees to demonstrate the effectiveness of interventions they
plan to use in their drug abuse prevention and treatment programs or giving
preference to grant applicants that include interventions for which there is evidence
of effectiveness in their applications for grants. Determining whether a program is
effective involves evaluating the extent to which a program is meeting its goals. Both
HHS and Education officials said that their agencies have requirements that
grantees for some programs demonstrate the effectiveness of their planned drug
abuse prevention or treatment interventions. For example, SAMHSA officials said
that as a condition of funding, the agency requires, as part of its grant application
process, that most grantees show that they will use evidence-based interventions in
their programs. DOJ officials told us that during the grant application process for
some programs, they give preference to applicants that include features that have
been determined to be effective. HHS, DOJ, and Education have registries that
include interventions related to drug abuse and prevention and treatment (among
other topics) that are determined to be effective through research or evaluation,
which grantees may use to document the effectiveness of their drug abuse
prevention and treatment programs. We found that HHS, DOJ, and Education
agency officials and other experts we spoke with reported various challenges in
identifying interventions that are proven effective, including (1) availability of data
needed to assess effectiveness, (2) ability to determine the impact of prevention
interventions, and (3) applicability of interventions to different population groups
other than the population for which the intervention was originally intended. For
example, officials said that determining the impact of a prevention intervention can
be difficult because it is often difficult to quantify something that did not happen—
such as a youth’s decision not to use an illicit drug—because of a preventive
measure.

To Implement the 2010 Strategy, ONDCP Obtained Stakeholder Input,
Established a Process to Determine Progress, and Reported That Most Action
Items Were on Track

ONDCP used input from drug control stakeholders to develop the 2010 Strategy’s
objectives and action items to help ensure shared responsibility. ONDCP also
established a process to determine implementation status, including requesting that
agencies submit updates on progress made. In November 2011, ONDCP reported
that 84 percent of the 113 action items in the Strategy were on track or complete.

ONDCP Sought Stakeholder Input to Help Develop Strategy Priorities and Ensure
Shared Responsibility for Implementation

ONDCP officials stated that to help ensure successful implementation, the agency
developed the Strategy through a consultative process with federal, state, and local
drug control agencies and other stakeholders, including state and local leaders, such
as governors, mayors, and law enforcement officials. According to these officials, a
cross-agency effort was required to develop the Strategy because the drug control
agencies have primary responsibility for its implementation and needed to be
involved to ensure that they understood their implementation responsibilities. An
ONDCP senior official stated that through its outreach efforts, ONDCP sought to


6                                                            GAO-12-744R Drug Control
instill a sense of shared ownership and buy-in from the drug policy community.
Officials from ONDCP and the four agencies we spoke with as of April 2012 stated
that ONDCP used input solicited through this consultative process to develop the
seven objectives and 106 action items under these objectives in the Strategy. 14
Further, to guide the implementation of federal drug policy activities in support of the
Strategy, lead agencies and participating agencies were designated for each action
item as a means to assign implementation responsibility.

To help develop and implement the Strategy, ONDCP established, among other
things, the Interagency Working Group on Demand Reduction (IWG) to bring
together the 40 federal agencies involved in drug control activities. According to
officials from ONDCP and the 4 agencies with whom we spoke, the IWG meetings
were the primary forum for consulting with stakeholders to develop the Strategy. 15
The Director of ONDCP stated in 2010 testimony before a House subcommittee that
working group meetings were used as the foundation for the 2010 Strategy and
helped to formulate long-term policy goals for increasing the emphasis on preventing
and treating substance abuse. The Director also noted that the IWG process
highlighted programs that worked—specifically, drug court programs, community-
based antidrug coalitions, and corrections programs aimed at helping steer drug
offenders toward productive lives. 16 ONDCP incorporated these programs into the
2010 Strategy and helped identify implementation responsibilities for relevant drug
policy agencies, all of which were included in the Strategy development process. For
example, ONDCP established several action items relating to drug court programs
under its Strategy objective to Break the Cycle of Drug Use, Crime, Delinquency,
and Incarceration. The majority of lead implementation responsibilities were
assigned to the Office of Justice Programs (OJP), whose officials agreed that these
action items fell under OJP’s mission areas and were appropriately assigned. Also,
ONDCP continues to utilize the IWG to help implement the Strategy. For example,
HHS officials said that an IWG meeting was convened in early 2012 to discuss how
to best address Strategy initiatives to help reduce synthetic drug production and
use. 17



14
  The objectives are (1) Strengthen Efforts to Prevent Drug Use in Our Communities; (2) Seek Early Intervention
Opportunities in Health Care; (3) Integrate Treatment for Substance Use Disorders into Health Care, and Expand
Support for Recovery; (4) Break the Cycle of Drug Use, Crime, Delinquency, and Incarceration; (5) Disrupt
Domestic Drug Trafficking and Production; (6) Strengthen International Partnerships; and (7) Improve
Information Systems for Analysis, Assessment, and Local Management. In addition to the 106 action items in the
2010 Strategy, ONDCP combined 2 and added 8 action items in the 2011 Strategy.
15
  According to ONDCP, participation in the IWG meetings was open to any interested agency and included
representation from the Drug Enforcement Administration and the DHS’s U.S. Customs and Border Protection.
ONDCP also stated that all law enforcement agencies had opportunities to provide input on the development of
the 2010 Strategy, such as providing comments on the outline and then drafts of the Strategy.
16
  ONDCP’s Fiscal Year 2011 National Drug Control Budget: Are We Still Funding the War on Drugs, Before the
Subcommittee on Domestic Policy of the H. Comm. on Oversight and Government Reform, 111th Cong. 12
(2010) (statement of R. Gil Kerlikowske, Director, Office of the National Drug Control Policy).
17
  In the 2012 update to the Strategy, ONDCP highlighted the use of two synthetic drugs, synthetic marijuana
(often known as K2 or Spice) and bath salt products. Synthetic marijuana consists of plant materials that have
been laced with substances that users claim mimic the primary psychoactive ingredient in marijuana, and bath
salts contain man-made chemicals related to amphetamines.



7                                                                              GAO-12-744R Drug Control
Officials from the four agencies we spoke with as of April 2012 stated that as a result
of ONDCP’s consultative Strategy development process, existing agency priorities
and activities are reflected in the Strategy. For example, Drug Enforcement
Administration (DEA) officials stated that DEA included curbing prescription drug
abuse as a priority in its drug enforcement efforts, which ONDCP, in turn, highlighted
in the Strategy. ONDCP officials stated that such consistent alignments to the
Strategy help facilitate its implementation.

ONDCP Has Established New Mechanisms to Track Strategy Implementation and
Reported That 84 Percent of Action Items Were on Track or Complete as of
November 2011

ONDCP has established a unit and a new process to determine the implementation
status of Strategy action items, as well as the Performance Reporting System that
according to ONDCP officials, incorporates key performance measures to assess
progress toward the objectives and goals of the Strategy. In November 2011,
ONDCP reported that 84 percent of action items were on track or complete.

        Mechanisms to Track Strategy Implementation and Report Performance

ONDCP established the Delivery Unit and implemented a new process to track
progress made on each Strategy action item. ONDCP officials stated that in August
2010, following the issuance of the 2010 Strategy, ONDCP formed the Delivery Unit
to help ensure the successful implementation of the action items in the Strategy. The
unit reports to the Chief of Staff and consists of two staff members who support the
unit as a collateral duty and perform responsibilities such as providing updates on
implementation progress to ONDCP managers. Coinciding with the establishment of
the Delivery Unit, the Director of ONDCP issued a letter to agency department
heads to formally initiate the process for Strategy implementation. The letter
requested that agencies develop and submit (1) a plan for implementing each action
item for which they have lead responsibility and (2) status updates on
implementation progress when requested, which are to address the objectives and
milestones in the plan. The Delivery Unit established a template in the Office of
Management and Budget’s MAX Collect system to assist agencies in developing
these submissions and to help ensure that the information provided is consistent
across agencies. 18 ONDCP officials stated that they use this information as part of
their process to help hold agencies accountable for implementing Strategy action
items.

ONDCP’s process to track progress made on Strategy action items relies to a great
extent on the cooperation and assistance of implementing agencies. Because
agency implementation plans are to include measurable objectives for implementing
action items and key milestones, lead agencies are responsible for specifying the
scope of the action items, such as the types of programs on which to focus, and how
they are implemented. For example, the National Institute of Justice, which funds
research on criminal justice issues, is the lead agency for the action item to Promote

18
  The MAX Information System is used to support the Office of Management and Budget’s federal management
and budget processes. MAX Collect is a data collection and publishing tool within the system.



8                                                                         GAO-12-744R Drug Control
Best Practices as Alternatives to Incarceration, and has defined implementation
through the objectives and milestones it established, as shown in figure 1.


Figure 1: Strategy Action Item to Promote Best Practices as Alternatives to Incarceration and National
Institute of Justice Objective and Milestones to Address It




a
 According to Office of Management and Budget guidance, randomized controlled trials—studies that randomly assign
individuals or other units into experimental and control groups—are generally the highest-quality, unbiased evaluations for
demonstrating the actual impact of a program.
b
 Vera Institute of Justice is studying the impact of recent changes to New York State drug laws that allow shorter sentences
and alternatives to incarceration for certain felony drug charges. Research will, among other things, (1) compare recidivism
outcomes for individuals charged with felony drug crimes before and after the reforms and (2) measure the reforms’ impact by
conducting a cost-benefit analysis of changes to sentencing. The National Institute of Justice awarded Vera Institute of Justice
a grant for $699,937 to conduct this research.
c
 The National Institute of Justice awarded the Center for Court Innovation a grant for $389,093 to conduct this research.


ONDCP officials stated that they assigned a staff member with issue-area
knowledge to each action item, who, among other things, reviews the agency’s plan
to ensure that it is sufficient to fulfill the action item and feasible given the resources
and time available for implementation.

As part of its process to track progress made on Strategy action items, ONDCP also
relies on lead agencies to provide reports on implementation progress—based on
their plans—in response to periodic Delivery Unit data calls and to consult with
participating agencies in submitting these reports. However, our review of reports
submitted as of November 2011 by our selected DOJ agencies—OJP and DEA—for
the 11 prevention and treatment action items for which they are responsible found
that 2 of the reports for OJP-led action items did not provide any progress updates. 19
While there is no formal mechanism to validate the information agencies provided
through the system, Delivery Unit officials stated that ONDCP gains an
understanding of the work agencies are doing through interagency working group
meetings, agency budget submissions, and ongoing and informal communication

19
  As of April 3, 2012, ONDCP had provided all of the implementation status reports for prevention and treatment
action items submitted by our selected DOJ agencies, OJP and DEA. We also had spoken with officials in both
of these agencies to gain a better understanding of the information included in these reports. Agencies have
since updated the information in their MAX Collect reports in response to a data call from ONDCP in April 2012.



9                                                                                          GAO-12-744R Drug Control
with agency contacts. ONDCP officials stated that when an agency report lacks
important information, the ONDCP staff person responsible for supporting the action
item would, among other things, work with the lead agency to update the information
in MAX Collect. Also, 2 of the 11 reports contained certifications that the lead agency
consulted with colead and participating agencies and reached consensus on what
was submitted, while the remaining 9 did not. According to ONDCP officials, this
does not imply that participating agencies object to the plans or reports, but rather
that some portions of the content may still be under discussion. They said that this
may also be due to the timing of ONDCP’s data solicitation in April 2012. Further,
OJP and DEA officials stated that they coordinated with participating agencies, but
that it can be challenging getting responses from them even if they do not object to
the information submitted. These officials said that it would be helpful if each
participating agency could certify that it was consulted in MAX Collect. ONDCP
officials agreed that this could prove a useful addition.

ONDCP uses the information collected from lead agencies to classify action items
into five categories—complete, on track, delayed but progressing, facing budget
issues, and at risk. 20 Specifically, ONDCP officials stated that the Delivery Unit
tentatively categorizes each action item and then forwards the categorization and
relevant information to the staff member assigned to the action item to review, revise
if necessary, and validate the unit’s categorization. These officials said that this
process draws heavily upon the expertise of the staff member, as well as the
member’s working relationships with lead agency contacts. ONDCP completed its
first categorization of action items in November 2011 and, according to officials,
shared the results with lead agency contacts, which gives agencies credit for
progress made and helps to motivate them, if needed, to take steps to address
action items that are not on track.

In addition to tracking the implementation status of action items, ONDCP recently
established the Performance Reporting System that according to ONDCP officials,
will provide strategic-level reporting on the performance of drug control programs
across agencies. These officials said that the system has been in development since
December 2009 and will be used to begin assessing progress toward the Strategy’s
goals and objectives later this year. The April 2012 Performance Reporting System
report stated that the system will collect data from federal drug control agencies and
from other sources in order to report on measurable outcomes that the Strategy
seeks to achieve by 2015. In the Strategy, ONDCP established two main policy
goals to be attained by 2015: (1) curtail illicit drug consumption in the United States
and (2) improve the public health and public safety of the American people by
reducing the consequences of drug abuse. 21 ONDCP also established outcome

20
  ONDCP provided the following definitions of its categories: (1) Complete. The work specifically directed by the
Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved
or that work in progress in support of those goals should be halted. (2) On track. Implementation is under way,
and the work being done is consistent with the fulfillment of the action item within the time frame specified.
(3) Delayed but progressing. Work has started but has slowed or stalled, or the work being done is not ambitious
enough to fulfill the action item in the time frame specified. (4) Facing budget issues. Work has stopped or been
significantly impeded by funding shortfalls. (5) At risk. Work has never begun or has ceased.
21
  The Strategy must contain a plan for reducing the consequences of illicit drug use, including national health
care costs and drug-related crime and criminal activity. See 21 U.S.C. § 1705(a)(2)(A) (vii).



10                                                                               GAO-12-744R Drug Control
measures to assess the effectiveness of the Strategy in accomplishing these goals,
such as 15 percent reductions in the number of chronic drug users, drug-induced
deaths, and drug-related morbidity. ONDCP officials stated that the system was
developed with input from some federal drug control agencies and incorporates new
performance metrics that will be used to assess cross-agency progress toward the
goals and seven objectives in the Strategy and provide feedback on how agencies’
efforts are contributing to the Strategy. For example, under the Strategy objective to
Strengthen Efforts to Prevent Drug Use in Our Communities, ONDCP established a
new performance metric to increase the age of initiation for illicit drugs from an
average of 17.6 years of age to 19.5 by 2015. According to the Performance
Reporting System report, delaying the age of initiation is a sound indicator of the
effectiveness of agency prevention initiatives that aim to reduce youth drug use.

        ONDCP’s Categories Denoting Progress in Implementing Strategy Action
        Items and Steps Taken to Address Delays

ONDCP reported in November 2011 that 84 percent of the 113 action items in the
2010 Strategy and 2011 update were on track or complete, and stated that it has
taken actions to help address those action items that were delayed or not
progressing. 22 Figure 2 shows the number of action items in each of the ONDCP’s
five implementation status categories.




22
 ONDCP reported on its action item categorizations at an interagency meeting in November 2011 with HHS,
DOJ, DHS, and other agencies to discuss progress toward implementing the Strategy.



11                                                                         GAO-12-744R Drug Control
Figure 2: Number of Action Items in ONDCP’s Five Implementation Status Categories, as of November
2011




Notes: N=113. ONDCP defines the implementation status categories as follows: (1) Complete. The work specifically directed
by the Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved or that
work in progress in support of those goals should be halted. (2) On track. Implementation is under way, and the work being
done is consistent with the fulfillment of the action item within the time frame specified. (3) Delayed but progressing. Work has
started but has slowed or stalled, or the work being done is not ambitious enough to fulfill the action item in the time frame
specified. (4) Facing budget issues. Work has stopped or been significantly impeded by funding shortfalls. (5) At risk. Work has
never begun or has ceased.


An example of an action item that ONDCP has categorized as complete is the
ONDCP-led action item to Mobilize Parents to Educate Youth to Reject Drug Use.
According to the description of the action item in the 2010 Strategy, the White House
Office of Faith-Based and Neighborhood Partnerships is fostering greater
engagement of fathers in the lives of their children, including initiatives to help
fathers and mothers protect their children from drugs. 23 It also states that SAMHSA
continues to provide support for parents using evidence-based interventions. To
complete this action item, the Office of Faith-Based and Neighborhood Partnerships,
among other things, held regularly scheduled meetings with federal agencies to
promote fatherhood-related activities, and ONDCP and HHS updated websites to
help ensure that the most recent information on youth drug abuse was available to
the parents. In contrast, in November 2011 ONDCP categorized the SAMHSA-led
action item to Develop Prevention-Prepared Communities as facing budget issues.
The description for this action item states that the new Prevention-Prepared
Communities program will focus on youth to implement evidence-based prevention
services through multiple venues and address common risk factors for substance
abuse, among other things. It states that agencies will coordinate their grants and
technical assistance such that communities and the youth in them are continuously
surrounded by protective factors rather than protected only in a single setting or at a

23
  The Office of Faith-Based and Neighborhood Partnerships works to form partnerships between the federal
government and faith-based and neighborhood organizations to more effectively serve Americans in need.



12                                                                                         GAO-12-744R Drug Control
single age. HHS officials stated that the action item was not implemented because of
lack of funding to award cooperative grants at the community and state levels.
According to ONDCP and SAMHSA officials, SAMHSA’s Strategic Prevention
Framework, which is implemented through a state incentive grant program,
incorporates elements of the Develop Prevention-Prepared Communities action
item, such as an emphasis on community-based and data-driven prevention. 24

ONDCP also reported on the implementation status of action items within each
of the Strategy’s seven objectives. (See fig. 3.) As of November 2011, 4 of the
10 action items in ONDCP’s Strategy objective to improve information systems were
complete, but 2 were facing budget issues. For example, the action item to
Strengthen Drug Information Systems Focused on Arrestees and Incarcerated
Individuals was among those that were facing budget issues. National Institute of
Justice officials stated that the development of a new Arrestee Drug Abuse
Monitoring program to collect better information on the extent of drug use among
male arrestees was not funded. 25 As a result, the National Institute of Justice and the
Bureau of Justice Statistics have suspended planning efforts for this action item,
such as developing a protocol for producing nationally representative estimates of
drug use in the arrestee population. According to ONDCP officials, data on arrestees
will still be collected, but efforts to improve the reliability of the data are on hold.
ONDCP also reported that the majority of action items under its other six Strategy
objectives were complete or on track. However, 3 of the 19 action items under the
objective to Strengthen International Partnerships were delayed but progressing,
and 1 of the action items—Promote Alternative Livelihoods for Coca and Opium
Farmers—was at risk as of November 2011. This ONDCP-led action item calls for
the U.S. Agency for International Development to continue supporting programs that
provide, among other things, incentives to wean farmers away from illicit crop
cultivation. 26 The January 2012 report on implementation progress indicated that
rural and agricultural development programs have yielded results, such as the
creation of new jobs, infrastructure projects, and alternative crop cultivation. ONDCP
officials stated that while the implementation of this action item was occurring, it was
classified as at risk in November 2011 primarily because of the lack of a central point
of contact within the U.S. Agency for International Development who could
consolidate the input from its various regional bureaus and report on implementation
efforts to ONDCP. These officials said that ONDCP and the U.S. Agency for
International Development have since agreed that the solution was to have ONDCP
consolidate the information received from the U.S. Agency for International
Development’s regional bureaus.
24
  In its report on HHS’s fiscal year 2011 appropriation bill, the Senate Committee on Appropriations did not
recommend funding for the Develop Prevention-Prepared Communities initiative because it believed the
proposal would be redundant given the work of SAMHSA’s Partnerships for Success program, which includes
implementation of the Strategic Prevention Framework. S. Rep. No. 111-243, at 138 (2010) (the bill under
consideration did not become law).
25
  According to ONDCP’s 2010 Arrestee Drug Abuse Monitoring II annual report, data from this program are
essential to any comprehensive discussion of drug use because they represent a group of drug users not well
represented in any other survey—males 18 years and older at the point of their involvement in the criminal
justice system. The report shows that these drug users consume drugs at a substantially higher frequency than
individuals traditionally surveyed.
26
  The U.S. Agency for International Development provides economic, development, and humanitarian
assistance around the world in support of the foreign policy goals of the United States.



13                                                                            GAO-12-744R Drug Control
Figure 3: Number of Action Items in ONDCP Implementation Status Categories by Strategy Objective, as
of November 2011




Note: ONDCP defines the implementation status categories as follows: (1) Complete. The work specifically directed by the
Strategy has been fulfilled. It does not imply that the larger goals the item supports have been entirely achieved or that work in
progress in support of those goals should be halted. (2) On track. Implementation is under way, and the work being done is
consistent with the fulfillment of the action item within the time frame specified. (3) Delayed but progressing. Work has started
but has slowed or stalled, or the work being done is not ambitious enough to fulfill the action item in the time frame specified.
(4) Facing budget issues. Work has stopped or been significantly impeded by funding shortfalls. (5) At risk. Work has never
begun or has ceased.


According to ONDCP officials, causes of delays or lack of progress in implementing
action items include lack of coordination among participating agencies, termination
of programs, reorganization of staff, departure of key personnel, and the need for
sufficient funding. These officials stated that the actions they have taken to address
these issues include coordinating at the interagency level by, for example, bringing
together action item partners; helping to establish contacts within other agencies;
and highlighting issues in ONDCP’s annual budget funding guidance that it provides
to drug control agencies, which is intended to delineate Strategy priorities that
agencies are expected to fund. They stated that ONDCP must rely on agencies to
include its priorities in their budget submissions to ensure that the Strategy is
adequately resourced. Each fiscal year, ONDCP assesses the adequacy of agency
budget submissions to implement the Strategy and certifies or decertifies the
submissions accordingly. 27



27
  We reported on the Drug Control Budget process in GAO-11-261R. If ONDCP determines that an agency’s fall
budget submission is adequate to implement the Strategy, ONDCP issues a written notice stating that the
agency’s drug budget is certified. If ONDCP determines that an agency’s fall budget submission is inadequate,
ONDCP issues a written notice stating that the agency’s drug budget is decertified, and the agency is required to
submit a revised budget, which is to include the funding levels and specific initiatives that would make the budget
request adequate to implement the Strategy. ONDCP provides a copy of the decertification to the Senate and the
House of Representatives and the appropriate congressional committees.



14                                                                                          GAO-12-744R Drug Control
ONDCP officials stated that the data on which their review of action items was based
were collected in October 2011, and it is highly probable that there has been some
movement among the categories since then. These officials told us that they plan to
update their categorizations biannually, with the next review planned for mid-2012.
To assess the extent to which the Strategy has been implemented, we will continue
to analyze ONDCP and agency reports on implementation progress, including
ONDCP’s biannual update to its 2011 review of action items, and validate the results
of this review. We will also continue to interview agency officials about actions taken
to implement and coordinate Strategy action items and assess the effect of efforts to
address implementation delays or lack of progress. In addition, our ongoing work will
assess how ONDCP uses the Performance Reporting System and associated
metrics to assess progress toward Strategy goals and objectives relating to
prevention and treatment, what the metrics indicate about progress made, and
agency perspectives on the system.

HHS, DOJ, and Education Fund Multiple Drug Abuse Prevention and
Treatment Programs and Coordinate through a Variety of Methods

Three agencies in the Drug Control Budget allocated nearly 85 percent of the
funding to federal drug abuse prevention and treatment programs included in the
Drug Control Budget in fiscal year 2012. Officials from HHS, DOJ, and Education
agencies reported that they coordinate to provide drug abuse prevention and
treatment programs through a variety of methods.

Three Agencies in the Drug Control Budget Allocated Nearly 85 Percent of Funding
to Several Types of Prevention and Treatment Programs in Fiscal Year 2012

HHS, DOJ, and Education allocated nearly 85 percent of the funding for federal drug
abuse prevention and treatment programs in the Drug Control Budget in fiscal year
2012. Of the approximately $10.1 billion allocated by federal agencies for drug
abuse prevention and treatment programs in fiscal year 2012, HHS allocated
approximately $8.3 billion and DOJ allocated approximately $186.1 million for
prevention and treatment programs, while Education allocated almost $64.9 million
for prevention programs. Specifically, HHS allocated more than 80 percent of
funding for the drug abuse prevention and treatment programs included in the Drug
Control Budget. Of the HHS allocation, the Centers for Medicare & Medicaid
Services allocated about 54 percent of the total funding in support of its drug abuse
treatment services through the Medicare and Medicaid programs. (See fig. 4.) For
additional information on drug abuse prevention and treatment funding allocated by
agencies included in the Drug Control Budget in fiscal year 2012, see enclosure II.




15                                                           GAO-12-744R Drug Control
Figure 4: Percentages of Drug Abuse Prevention and Treatment Funding Allocated by Agencies Included
in the Drug Control Budget in Fiscal Year 2012, by Agency




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


HHS, DOJ, and Education allocated funding to various types of drug abuse
prevention and treatment programs, such as those that provide grants, education
and outreach, and direct service, among other things. 28 Table 1 identifies the number
of drug abuse prevention and treatment programs that were allocated funding by
each of these three agencies, by type of program.




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



16                                                                              GAO-12-744R Drug Control
Table 1: Number of Drug Abuse Prevention and Treatment Programs Allocated Funding by the
Departments of Health and Human Services, Justice, and Education That Are Included in the Drug
Control Budget, by Type of Program, for Fiscal Year 2012

                                                                                Types of programs
            a                                                                                                                   b
    Agency                                         Grant         Education and outreach                    Direct service   Other       Total
    Department of Health and
                   c                                        d
    Human Services                                     20                                           8                  0        9         37
    Department of Justice                                 5                                         1                  4            -     10
                                     e
    Department of Education                               1                                          -                  -           -      1
    Total                                               26                                          9                  4        9         48
Source: GAO analysis of information from the Departments of Health and Human Services, Justice, and Education.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use
of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug
abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through
such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment
methods.
a
We define agencies as federal departments and their component agencies, bureaus, divisions, and offices.
b
 Other programs that include drug abuse prevention and treatment activities may involve, for example, certifying and
maintaining quality assurance of laboratories that perform mandatory drug testing for federal and federally regulated
employees.
c
 We did not include the Centers for Medicare & Medicaid Services in our more detailed review of programs because it allocates
funding to drug treatment services solely as part of eligible participants’ medical services and does not fund or administer drug
abuse prevention or treatment interventions or research. We include the National Institutes of Health’s (NIH) drug abuse
prevention and treatment research and development activities that are included in the Drug Control Budget in our analysis;
however, NIH officials told us that the agency does not refer to its research and development activities as programs.
d
 NIH officials told us that four of its activities provide research funding through contracts and cooperative agreements, in
addition to grants.
e
The Department of Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and
Communities Act for drug treatment. See 20 U.S.C. § 7164.


We found that in fiscal year 2012, HHS, DOJ, and Education primarily allocated
funding to grant programs through which they award funding to states, communities,
tribes, and other organizations. These grantees then use the federal funds to
implement program activities involving drug abuse prevention, drug abuse treatment,
or both. For example:

•      SAMHSA makes grant awards to 50 states, nine territories (including the District
       of Columbia), and one Indian tribe through the Substance Abuse Prevention and
       Treatment Block Grant Program for grantees to plan, carry out, and evaluate
       drug abuse prevention, early intervention, treatment, and recovery support
       services provided for individuals, families, and communities affected by
       substance use disorders. Not less than 20 percent of funds awarded under this
       program must be spent by SAMHSA’s grantees for drug abuse education,
       counseling, and risk reduction activities. 29

•      The Indian Health Service’s (IHS) Urban Indian Health Program Title V 4-in-1
       Grants program provides funding to urban Indian nonprofit organizations to serve
       urban American Indians and Alaska Natives affected by drug abuse through
       prevention and treatment programs.



29
    See 42 U.S.C. § 300x-22(a).



17                                                                                                               GAO-12-744R Drug Control
•    OJP provides grant funding under the Second Chance Act Adult Offenders with
     Co-Occurring Substance Abuse and Mental Health Disorders program. 30 Under
     this program, funding is available to grantees to implement or expand treatment
     programs for offenders with co-occurring substance abuse and mental health
     disorders that improve the provision of treatment for these individuals.

Grant programs may also fund technical assistance and training activities for
grantees. For example, Education awards grants for financial and technical
assistance under its Safe and Supportive Schools program to state education
authorities to support statewide measurement of, and targeted programmatic
interventions to improve, conditions for learning in order to help schools improve
student safety and reduce drug use. Grant programs may also fund drug abuse
prevention and treatment research activities, such as the National Institutes of
Health’s (NIH) grants for basic and clinical neuroscience research, which are
intended to expand the agency’s understanding of the neurobiological, genetic, and
behavioral factors that underlie drug abuse and addiction.

HHS and DOJ also allocate funding to public education and outreach programs that
are implemented directly by the agencies, which may distribute information to the
public on specific types of drug use or disorders, or provide technical assistance and
training. For example, SAMHSA’s Center for the Application of Prevention
Technologies provides technical assistance and training activities, among other
activities, to build the ability of SAMHSA’s grantees to implement prevention
interventions. DOJ also allocates funding to direct service programs—programs in
which an agency directly administers drug abuse prevention and treatment
interventions to a defined population. For example, the Bureau of Prisons (BOP)
provides drug abuse prevention and treatment services to the federal inmate
population.

Finally, HHS also allocates funding to several other programs that include drug
abuse prevention and treatment activities. For example, SAMHSA allocates funding
to the Mandatory Drug Testing program to certify and maintain quality assurance of
laboratories that perform mandatory drug testing for federal and federally regulated
employees.

We also found that HHS and Education allocate funding to programs or program
components that include drug abuse prevention and treatment activities that are not
included in these agencies’ submissions to the Drug Control Budget. Specifically,
these programs include the Health Resources and Services Administration’s (HRSA)
Ryan White HIV/AIDS program and Health Center Program and Education’s 21st
Century Community Learning Centers program. Officials from HRSA told us that the
Ryan White HIV/AIDS program is not included in the Drug Control Budget because
the program does not directly award funding for drug abuse treatment, although drug
abuse treatment may be one of the many services that eligible participants receive.

30
  This program is authorized under the Second Chance Act of 2007, which authorizes grants to states, units of
local government, territories, and Indian tribes to, among other things, improve the provision of drug treatment to
adult offenders in prisons and jails and reduce the use of drugs by long-term substance abusers through the
completion of parole or court supervision of long-term substance abusers. See Pub. L. No. 110-199, § 201(a),
122 Stat. 657, 678 (codified at 42 U.S.C. § 17521(a)).



18                                                                               GAO-12-744R Drug Control
HRSA officials also said that the agency does not identify the amount of funds spent
on specific services until grantees report on how they expended grant funds. 31

HRSA officials also identified a program in which its drug abuse prevention activities
are not included in the Drug Control Budget, but its drug abuse treatment activities
are included. Specifically, these officials said that funding for the HRSA Health
Center Program’s drug abuse treatment services is included in the Drug Control
Budget because HRSA can determine the specific amount of funding that health
center grantees spend on these services. However, HRSA officials said it is difficult
to quantify the amount of funding used for prevention counseling services because
they are provided as part of a clinician’s standard medical services and not as a
separate service identifiable by a grantee. As a result, the program’s drug abuse
prevention services are not included in the Drug Control Budget. Additionally,
Education’s 21st Century Community Learning Centers program is not included in
the Drug Control Budget because officials told us that drug abuse prevention is only
one of a large number of authorized uses for these funds. Officials also said that the
agency does not have a viable, cost-effective methodology for compiling the data
that would be used to estimate the amount of funds spent on drug abuse prevention
in this program.

ONDCP officials told us that they annually review programs and agencies that are
not included in the budget to determine if it would be appropriate to include these
programs in the next year’s budget. For example, the Centers for Medicare &
Medicaid Services was added to the fiscal year 2012 Drug Control Budget as part of
ONDCP’s efforts to restructure the budget and the agencies it includes. An ONDCP
official told us that the agency does not estimate the amount of federal drug control
funding that is not included in the Drug Control Budget. However, the official said
that the agency is confident that the Drug Control Budget includes all federal drug
control funding for programs that are related to drug control and for which agencies
have an appropriate methodology to determine funding for inclusion in the Drug
Control Budget. For a list of drug abuse prevention and treatment programs funded
by HHS, DOJ, and Education that are either included or not included in the Drug
Control Budget and details about these programs, see enclosure III.

HHS, DOJ, and Education Officials Reported That They Coordinate to Provide Drug
Abuse Prevention and Treatment Programs through a Variety of Methods

Officials from HHS, DOJ, and Education agencies told us they coordinate with each
other and other federal agencies to deliver and fund drug abuse prevention and
treatment programs through a variety of methods, including jointly administering
programs, participating in working groups, and working together on an ad hoc
basis—such as by building relationships with other agencies that support drug abuse
prevention and treatment programs. 32 Officials from HHS, DOJ, and Education

31
  HRSA officials also said that grantees assess service needs in their communities and, as a result, may allocate
funding for substance abuse treatment based on the needs assessment. Grantees are required to report
expenditures of program funding by type of service annually.
32
  We did not examine coordination activities for all programs or federal agencies, nor did we review all
coordination efforts by ONDCP. We will examine coordination activities more fully as part of our ongoing work.



19                                                                             GAO-12-744R Drug Control
agencies said that each agency coordinates with other federal agencies through the
joint administration of programs. For example, SAMHSA provides all grant
administration and management of services for the Drug Free Communities
Program, which Congress authorizes and appropriates within the ONDCP budget,
according to an interagency agreement guiding the relationship. ONDCP officials
said that the agency has partnered with SAMHSA through an interagency
agreement since 2005. Officials from OJP said that they issue a joint grant
solicitation with SAMHSA—the Joint Adult Drug Court Solicitation—in which OJP
provides primary funding for drug court management and operations, while
SAMHSA officials reported that their agency provides funding for enhancement and
expansion of substance abuse treatment services. Additionally, officials from
Education said they jointly administer and fund the Safe Schools/Healthy Students
Initiative with HHS. DOJ is also a partner in this initiative, and collaboration among
the three agencies is guided by an agreement that is signed annually by Education,
HHS, and DOJ. According to the agreement, the initiative is led, managed, and
supported by the three agencies to support school and community partnerships with
integrated systems that prevent drug abuse and violence. Other initiative activities
include promoting the mental health of students, enhancing academic achievement,
and creating safe and respectful school climates.

Officials from HHS, DOJ, and Education agencies told us that another way in which
they coordinate their drug abuse prevention and treatment program efforts is through
interagency working groups. HHS, DOJ, and Education agency officials told us that
they participate in ONDCP’s IWG to collaborate on the development of the Strategy.
HHS agency officials also told us they participate in sub-working groups within the
IWG that meet to discuss specific drug abuse prevention and treatment topic areas.
According to SAMHSA officials, participating in the IWG and its sub-working groups
facilitates coordination between multiple federal agencies working on similar issues
related to drug abuse prevention and treatment.

HHS, DOJ, and Education officials also told us they participate in a variety of other
federal agency working groups that also address drug abuse prevention and
treatment activities. For example, officials from Education said that they participate
in the Interagency Coordinating Committee on the Prevention of Underage Drinking,
which is chaired by the Administrator of SAMHSA. The committee was formally
established pursuant to the Sober Truth on Preventing Underage Drinking Act and
focuses on guiding policy and program development across the federal government
with respect to underage drinking. 33 Education officials said that this group serves as
a mechanism for coordinating federal efforts around the issue of underage drinking,
and the group meets at least once a month to discuss activities across the federal
government on the issue and how to better coordinate their efforts. In addition,
officials from OJP and SAMHSA said that OJP initially convened an interagency
working group—the Federal Consortium to Address the Substance Abusing
Offender—which works to develop information for state and local officials to assist
with effective drug abuse treatment protocols, communication and reporting
strategies, data collection, and research on substance abusing offenders. SAMHSA
now chairs this consortium, which includes representatives from agencies involved
33
 Pub. L. No. 109-422, § 2, 120 Stat. 2890 (2006) (codified at 42 U.S.C. § 290bb-25b(c)).



20                                                                            GAO-12-744R Drug Control
in addressing issues related to drug abuse and crime, including several component
agencies from HHS and the National Highway Traffic Safety Administration.

Finally, HHS, DOJ, and Education agency officials said they coordinate on an ad hoc
basis with officials from other federal agencies to support drug abuse prevention and
treatment activities. For example, NIH officials told us they meet regularly with
officials from other federal agencies to share information on drug abuse prevention
and treatment research, such as by participating in conferences held by ONDCP.
Education officials told us that they worked with NIH’s National Institute on Drug
Abuse to promote National Drug Facts Week by publicizing the event to schools and
school-based organizations. DOJ officials from BOP and OJP also said that they
work with officials from the Department of Veterans Affairs to better understand how
to serve veterans involved in the justice system who have drug abuse problems.

Some HHS, DOJ, and Education Grant Programs Require or Give Preference to
Grantees That Demonstrate Effective Interventions

Some HHS, DOJ, and Education grant programs either require grantees to
demonstrate the effectiveness of the interventions they plan to use in drug abuse
prevention and treatment programs or give preference to grant applicants that
include interventions for which there is evidence of effectiveness in their grant
applications. Program effectiveness involves the application of an evaluation method
to determine whether a program is meeting its goals. HHS’s SAMHSA officials said
that as a condition of funding, the agency requires, as part of its grant application
process, that most grantees show that they will use evidence-based interventions in
their programs. These officials said grantees can meet this requirement by
documenting that their interventions have been reviewed in the agency’s National
Registry of Evidence-Based Programs and Practices (NREPP) or in other sources
that determine effectiveness of interventions. Registries supported by HHS, DOJ,
and Education include interventions related to drug abuse prevention and treatment
(among other topics) that are determined to be effective through research or
evaluation by agency officials or their selected reviewers. 34 NREPP, established by
SAMHSA in 1997, reviews interventions to identify those that prevent or treat drug
abuse, mental illness, or co-occurring disorders and promote mental health among
individuals, communities, or populations. NREPP maintains a searchable online
registry, which currently includes more than 230 drug abuse prevention and
treatment and mental health promotion interventions that have been reviewed and
rated by independent reviewers on their quality of research and readiness for
dissemination to the public. 35




34
  These registries are intended to provide the public, including grantees and policymakers, with a centralized
repository of scientifically based information on interventions. The registries target different population groups
and types of interventions and have varying requirements that interventions must meet in order to be included.
35
  According to NREPP, the registry does not include an exhaustive list of interventions, and inclusion in the
registry does not constitute an endorsement. Those who have developed an intervention may nominate their
interventions for review and inclusion in NREPP. See http://www.nrepp.samhsa.gov.



21                                                                                GAO-12-744R Drug Control
Education officials also said that for the department’s Safe Schools/Healthy Students
grant program, applicants are required to include detailed information in their
applications that demonstrates that their proposed interventions are effective.
Applicants may use any registry of evidence-based practices and programs,
including NREPP or Education’s What Works Clearinghouse (WWC), according to
Education officials. The agency’s Institute of Education Sciences developed the
WWC online registry in 2002. It includes education interventions that have been
reviewed and assessed for their evidence of effectiveness, including those that have
drug abuse prevention as an outcome. 36 This registry does not have a primary focus
on drug abuse prevention interventions, and Education officials said that
interventions in the WWC that focused solely on drug abuse prevention had not
been updated since 2006, though they are still available in the WWC. According to
Education officials, there are no plans to update the information on drug abuse in the
WWC, as this is not one of Education’s priority areas.

DOJ officials told us that during the grant application process for some programs,
they give preference to applicants that adopt interventions for their programs that
include features that have been determined to be effective. DOJ gives Drug Court
Program grant applicants greater consideration during review of grant applications
when they demonstrate that a program’s design is consistent with seven evidence-
based program design features, which OJP considers to be indicators of an effective
program. For example, evidence-based program design features include screening
and assessment as well as monitoring activities. More specifically, the screening and
assessment feature requires that applicants demonstrate an ability to screen
promptly and systematically for all offenders potentially eligible for the drug court,
identify the agency that will conduct this screening, and detail the procedures that
will be used for screening. Monitoring involves the inclusion of a comprehensive plan
to monitor drug court participants using random drug testing and community
supervision, disseminate results efficiently to the drug court team, and immediately
respond to noncompliance according to established program requirements.

DOJ supports two registries that include interventions related to drug abuse
prevention and treatment, which can be used as a resource for effective programs
by grant applicants. OJP’s CrimeSolutions.gov is an online registry established in
2011 that provides information on effective criminal justice programs, including
interventions related to drug abuse, and had about 190 programs reviewed as of
May 2012. 37 These interventions include drug abuse prevention and education
interventions, as well as drug abuse treatment, along with interventions related to
drug and alcohol crimes and offenses. A second registry—the Model Programs
Guide established in 2000 by the Office of Juvenile Justice and Delinquency
Prevention—is a database that identifies effective programs to prevent and reduce
juvenile delinquency and related risk factors, such as drug abuse. 38
36
 See http://ies.ed.gov/ncee/wwc.
37
  OJP identifies programs for review and inclusion in CrimeSolutions.gov through literature searches of relevant
databases, journals, and publications or nominations from experts, practitioners, or others. The registry rates
programs as effective, promising, or having no effects. See http://www.crimesolutions.gov. CrimeSolutions.gov is
not an exhaustive list of all justice-related programs, and a program’s inclusion on the site does not constitute an
endorsement by DOJ, according to information on the website.
38
 See http://www.ojjdp.gov/mpg/.



22                                                                                GAO-12-744R Drug Control
While agencies make efforts to ensure that grantees implement interventions that
have proven to be effective, we found that HHS, DOJ, and Education agency
officials and the other experts we spoke with reported various challenges in
identifying interventions that are proven effective, including (1) availability of data
needed to assess effectiveness, (2) ability to determine the impact of prevention
interventions, and (3) applicability of interventions to different population groups.
Agency officials and experts told us that local-level data for assessing the
effectiveness of interventions often are limited. For example, local data are often not
available because of the high cost and intensive resources necessary for collection.
If they are available, there are often gaps in the data—for example, data that are
collected only every other year. Further, limited population-level information exits for
smaller populations that may bear a disproportionate burden of drug abuse-related
morbidity and mortality (i.e., American Indian and Alaska Native populations). In
addition, officials said that determining the impact of a prevention intervention can be
a challenge because it is often difficult to quantify something that did not happen—
such as a youth’s decision not to use illicit drugs—because of a preventive measure.

Finally, effective interventions may not be applicable to all population groups. For
example, officials from HHS’s IHS reported that not all interventions that have
demonstrated effectiveness in the general population take into consideration the
cultural practices or needs of specific population groups. As a result, they may not
be effective for populations—such as the American Indian and Alaska Native
populations—that were not included in the original intervention. IHS officials stated
that only two programs included in NREPP are specific to the populations that they
serve. 39 Moreover, IHS officials said that since so few evidence-based practices
have been shown to be effective in the American Indian and Alaska Native
population, and these practices may be cost prohibitive for small programs,
community-based and culturally relevant practices are generally preferred. As part of
our ongoing review, we plan to conduct additional work on agencies’ efforts to
assess program effectiveness, and to continue our work examining how these
federal agencies evaluate their drug abuse prevention and treatment programs. For
example, during our preliminary work we learned that SAMHSA was finalizing draft
guidance on program evaluations across the agency that will provide information on
what types of evaluations should be conducted as well as when and how they
should be conducted.

Agency Comments

We provided a draft of this report for comment to HHS, DOJ, Education, DHS, and
ONDCP. ONDCP provided written comments, which are reprinted in enclosure IV.
ONDCP generally concurred with the findings contained in the report, noting that as
we reported, 84 percent of action items in its Strategy were on track or complete as
of November 2011. Further, ONDCP said it is committed to expanding the number of
programs impacting prevention and treatment that are included in the Drug Control
Budget. For example, ONDCP recently added four programs to the Drug Control

39
  IHS officials told us that the agency has created an inventory of evidence-based practices, promising practices,
local efforts, resources, and policies for health services occurring in American Indian and Alaska Native
communities, schools, work sites, health centers, and hospitals. See http://www.ihs.gov/oscar/.



23                                                                              GAO-12-744R Drug Control
Budget for fiscal year 2013. HHS, DOJ, Education, and DHS did not provide formal
written comments to be included in this report. Instead, these agencies—and
ONDCP—provided technical comments that we incorporated as appropriate.
                                        –––––
As agreed with your offices, unless you publicly announce the contents of this report
earlier, we plan no further distribution until 30 days from the report date. At that time,
we will send copies to the appropriate congressional committees; the Secretaries of
Health and Human Services, Education, and Homeland Security; the Attorney
General and the Director of the Office of National Drug Control Policy. In addition,
this report will be available at no charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact
Linda T. Kohn at (202) 512-7114 or kohnl@gao.gov or Eileen R. Larence at
(202) 512-8777 or larencee@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last page of
this report. Key contributors to this report are listed in enclosure V.




Linda T. Kohn
Director, Health Care




Eileen Regan Larence
Director, Homeland Security and Justice Issues

Enclosures – 5




24                                                             GAO-12-744R Drug Control
Enclosure I

                              Scope and Methodology

To provide an initial review of the extent to which the 2010 National Drug Control
Strategy (Strategy) has been implemented, we analyzed the 2010 Strategy and
2011 update, Office of National Drug Control Policy (ONDCP) documents on
implementation progress, and implementation plans and reports from selected
federal drug control agencies that we received as of April 3, 2012. We also
interviewed officials from ONDCP and selected agencies to obtain information on
how ONDCP worked with agencies to develop the Strategy and assess
implementation progress, as well as the status of Strategy implementation. Based on
such factors as the number of Strategy action items for which agencies are
responsible, the size of drug control budgets, and a balance of drug prevention,
treatment, and law enforcement missions, we selected the following seven agencies
to focus on in our review:
•    within the Department of Health and Human Services (HHS), the Substance
     Abuse and Mental Health Services Administration (SAMHSA), National Institutes
     of Health (NIH), and Centers for Disease Control and Prevention;

•    within the Department of Justice (DOJ), the Office of Justice Programs (OJP) and
     Drug Enforcement Administration (DEA);

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

•    the Department of Education (Education).

As of April 2012, we interviewed officials from the following four agencies: HHS,
DHS, OJP, and DEA. Within OJP, we interviewed officials from the Office of Juvenile
Justice and Delinquency Prevention, Bureau of Justice Assistance, Bureau of
Justice Statistics, and National Institute of Justice. We are providing results of our
initial review of the implementation of the Strategy, including how ONDCP worked
with stakeholders to develop the Strategy and mechanisms ONDCP established to
monitor implementation progress. As part of our ongoing review, we plan to conduct
additional work on the extent to which the 2010 Strategy has been implemented and
coordinated across agencies and how ONDCP assesses the effectiveness of the
Strategy in preventing and reducing drug use.

To identify which federal agencies fund drug abuse prevention and treatment
programs, we reviewed the fiscal year 2012 Drug Control Budget. In addition, to
identify the amount of funding agencies allocated to these programs from available
appropriations in fiscal year 2012, we reviewed the fiscal year 2013 Drug Control




25                                                          GAO-12-744R Drug Control
Enclosure I

Budget because it included additional information about allocated funding for fiscal
year 2012. 1 We also interviewed ONDCP officials to confirm their process for
developing the Drug Control Budget and criteria for including programs in the
budget. Additionally, we reviewed the drug abuse prevention and treatment
programs of three national drug control agencies—HHS, DOJ, and Education—in
more detail. We selected these agencies because they have some of the largest
drug control budgets for drug abuse prevention and treatment activities, according to
the fiscal year 2012 Drug Control Budget. 2 To obtain more detail about these
agencies’ programs, we identified component agencies within HHS, DOJ, and
Education that fund drug abuse prevention and treatment programs included in the
Drug Control Budget, collected program-specific information from these component
agencies using a standard collection instrument, and interviewed agency officials
responsible for these programs. The agencies we reviewed included.

•    within HHS, the Health Resources and Services Administration, Indian Health
     Service, NIH, 3 and SAMHSA; 4

•    within DOJ, the Bureau of Prisons, DEA, and OJP (including officials from OJP’s
     Bureau of Justice Assistance and Office of Juvenile Justice and Delinquency
     Prevention); and

•    within Education, the Office of Elementary and Secondary Education.

We also determined whether the agencies that we reviewed administered programs
that included drug abuse prevention and treatment activities that do not meet
ONDCP’s standards for having an acceptable budget estimation methodology and
therefore were not represented in the Drug Control Budget. We spoke with these
officials to identify any limitations and resolve any discrepancies between the
agencies’ reported drug abuse prevention and treatment information and data and
the fiscal year 2012 Drug Control Budget. We determined that the Drug Control
Budget data are reliable for our purposes. Finally, to identify coordination efforts
1
 ONDCP refers to these funds as enacted funding in the Drug Control Budget, while in this report we use the
term allocated funding. At the beginning of a fiscal year, agencies may allocate certain amounts from available
appropriations for specific programs. However, to the extent that an appropriation has not identified a particular
amount for a specific program, an agency may reallocate unobligated funds from that program to another during
the course of a fiscal year. To the extent other statutory authority results in mandatory funding for programs that
may include drug abuse prevention and treatment, such as Medicare and Medicaid, we also include these as
allocated funds.
2
 Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and
Communities Act for drug treatment. See 20 U.S.C. § 7164.
3
 In contrast to federal agencies that implement drug prevention and treatment programs, NIH supports the
conduct of research to develop and test prevention and treatment interventions. The goal of this research is to
establish an evidence base of effective interventions that can be implemented on a broader scale by other
agencies.
4
 We included the Centers for Medicare & Medicaid Services in our review of HHS agencies’ allocations for drug
abuse prevention and treatment programs. However, we did not include the Centers for Medicare & Medicaid
Services in our more detailed review of programs because it allocates funding to drug treatment services solely
as part of eligible participants’ medical services and does not fund or administer drug abuse prevention or
treatment interventions or research.



26                                                                                GAO-12-744R Drug Control
Enclosure I

between agencies funding drug abuse prevention and treatment programs, we
interviewed officials from HHS, DOJ, and Education agencies who oversee these
programs and reviewed policies and related documents to identify these agencies’
coordination efforts.

To provide an initial review of the extent to which federal agencies assess the
effectiveness of their drug abuse prevention and treatment programs, we
interviewed officials from our selected national drug control agencies as well as
experts in the field of drug abuse prevention and treatment. These experts included
staff from the Community Anti-Drug Coalitions of America, National Academies of
Science, National Association of State Alcohol/Drug Abuse Directors, RAND Drug
Policy Research Center, RAND Promising Practices Network, and University of
Colorado Blueprints for Violence Prevention, and a university-based prevention
expert. 5 We are providing initial results from our ongoing review of agencies’ efforts
to assess their programs’ effectiveness. As part of our ongoing review, we plan to
conduct additional work on HHS’s, DOJ’s, and Education’s efforts to assess program
effectiveness, and to continue work examining how these agencies evaluate their
drug abuse prevention and treatment programs.

We conducted this performance audit from January 2012 through July 2012 in
accordance with generally accepted government auditing standards. Those
standards require that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and conclusions based on
our audit objectives. We believe that evidence obtained provides a reasonable basis
for our findings and conclusions based on our audit objectives.




5
 We identified subject matter experts from our review of relevant literature and during interviews with identified
experts.



27                                                                                GAO-12-744R Drug Control
Enclosure II

    Funding Allocated by Federal Agencies in the Drug Control Budget for Drug
          Abuse Prevention and Treatment Programs, Fiscal Year 2012

In fiscal year 2012, federal agencies included in the Drug Control Budget allocated
approximately $10.1 billion in funding to support or provide drug abuse prevention
and treatment services. Approximately 14 percent of these funds, or almost
$1.4 billion, was allocated for drug abuse prevention services and over 86 percent of
these funds, or over $8.7 billion, for drug abuse treatment services. 1 Of the funding
allocated for drug abuse prevention and treatment services, the Department of
Health and Human Services allocated approximately $8.3 billion and the Department
of Justice allocated approximately $186.1 million for prevention and treatment
programs, while the Department of Education allocated almost $64.9 million. (See
table 2.)




1
 Funding allocated for federal drug abuse prevention and treatment programs makes up approximately
40 percent of the funding allocated by agencies included in the Drug Control Budget in fiscal year 2012. This
amount of allocated funding is approximately consistent with fiscal year 2011 levels. The other activities included
in the remaining approximately 60 percent of the budget include domestic law enforcement, interdiction, and
international drug control activities—also known as supply reduction activities.



28                                                                               GAO-12-744R Drug Control
Enclosure II

Table 2: Funding Allocated by Federal Agencies in the Drug Control Budget for Drug Abuse Prevention
and Treatment Programs, Fiscal Year 2012

    U.S. dollars in millions
                                                                                 Allocated funding,                      Allocated funding,
    Department or independent agency                                           prevention programs                     treatment programs        Total
                                       a
    Department of Agriculture                                                                              $0.1                           -      $0.1
    Court Services and Offender Supervision
    Agency for the District of Columbia                                                                    18.8                      $34.2      $53.1
    Department of Defense                                                                                155.6                        96.5     $252.1
         Drug Interdiction and Counterdrug Activities                                                    155.6                            -    $155.6
         Defense Health Program                                                                                    -                  96.5      $96.5
                                      b
    Department of Education                                                                                64.9                           -     $64.9
    Federal Judiciary                                                                                              -                 192.2     $192.2
    Department of Health and Human Services                                                           1,017.3                      7,241.3    $8,258.6
         Centers for Medicare & Medicaid Services                                                                  -               4,467.4    $4,467.4
         Health Resources and Services
         Administration                                                                                            -                  18.1      $18.1
         Indian Health Service                                                                             18.7                       79.4      $98.1
         National Institutes of Health                                                                   437.5                       671.6    $1,109.2
         Substance Abuse and Mental Health
         Services Administration                                                                         561.0                     2,004.8    $2,565.8
    Department of Housing and Urban Development                                                                    -                 446.0     $446.0
    Department of Justice                                                                                   7.1                      179.0     $186.1
         Bureau of Prisons                                                                                         -                  93.5      $93.5
         Drug Enforcement Administration                                                                    2.1                           -      $2.1
         Office of Justice Programs                                                                         5.0                       85.5      $90.5
    Department of Labor                                                                                     6.6                           -      $6.6
    Office of National Drug Control Policy                                                                 98.6                         9.6    $108.2
    Department of Transportation                                                                           19.3                           -     $19.3
         Federal Aviation Administration                                                                   16.6                           -     $16.6
         National Highway Traffic Safety
         Administration                                                                                     2.7                           -      $2.7
    Department of Veterans Affairs             c
                                                                                                                   -                 530.2     $530.2
    Total   d
                                                                                                    $1,388.3                      $8,729.0 $10,117.3
Source: GAO analysis of fiscal year 2012 allocated funding reported in the fiscal year 2013 Drug Control Budget.

Notes: We used the fiscal year 2013 Drug Control Budget because it included additional information about the allocation of
funding for fiscal year 2012. Although the Office of National Drug Control Policy refers to enacted funding in its Drug Control
Budget, we use the term allocated funding. For the purpose of our review, we define drug abuse prevention as activities
focused on discouraging the first-time use of controlled substances and efforts to encourage those who have begun to use illicit
drugs to cease their use. We define drug abuse treatment to include activities focused on assisting regular users of controlled
substances to become drug free through such means as counseling services, inpatient and outpatient care, and demonstration
and provision of effective treatment methods.
a
    The Department of Agriculture allocates funding to drug abuse prevention programs through the U.S. Forest Service.
b
The Department of Education is generally prohibited from using funds available under the Safe and Drug-Free Schools and
Communities Act for drug treatment. See 20 U.S.C. § 7164.
c
The Department of Veterans Affairs allocates funding to drug abuse treatment programs through the Veterans Health
Administration.
d
 The total amount in each column represents the sum of department and independent agency activities. Columns may not add
to corresponding totals because of rounding.




29                                                                                                                     GAO-12-744R Drug Control
Enclosure III

     Overview of Drug Abuse Prevention and Treatment Programs Allocated
                 Funding by Three Agencies, Fiscal Year 2012

The Department of Health and Human Services, Department of Justice, and
Department of Education reported that the agencies allocated funding to a variety of
drug abuse prevention and treatment programs in fiscal year 2012, including grants,
education and outreach, and direct service programs. Tables 3 through 6 provide an
overview of these programs.

Table 3: Department of Health and Human Services Drug Abuse Prevention and Treatment Programs
Allocated Funding, Fiscal Year 2012

                  Program       Program        Targeted
Program           activities    type           beneficiaries      Program description
Health Resources and Services Administration
Health Center     Prevention    Grant          Medically          Delivers comprehensive primary health
        a
Program           and treatment                underserved        care, including drug abuse prevention
                                               areas and          and treatment, to vulnerable populations.
                                               populations        Grantees include public and nonprofit
                                                                  private entities, including tribal, faith-
                                                                  based, and community-based
                                                                  organizations.
Ryan White        Treatment     Grant          Persons living     Addresses the unmet care and treatment
HIV/AIDS                                       with HIV/AIDS      needs of persons living with HIV/AIDS
       b
Program                                                           who are uninsured or underinsured and
                                                                  have limited or no resources to pay for
                                                                  HIV/AIDS health care and vital health-
                                                                  related support services, such as drug
                                                                  abuse treatment. Grantees include
                                                                  states, territories, and community-based
                                                                  and nonprofit organizations.
Indian Health Service
Alcohol and       Prevention    Other          American Indian    Provides alcohol and drug abuse
Substance Abuse   and treatment                and Alaska         prevention, educational, and treatment
Program                                        Native youth and   services through federal, tribal, and
                                               adults             urban Indian health facilities through an
                                                                  integrated behavioral health approach to
                                                                  prevent or reduce the incidence of
                                                                  alcoholism and drug abuse in American
                                                                  Indian/Alaska Native communities.
Methamphetamine Prevention    Other            American Indian    Supports community-based pilot projects
and Suicide     and treatment                  and Alaska         that promote the expansion of existing
Prevention                                     Native youth and   and development of new
Initiative                                     adults             methamphetamine and suicide
                                                                  prevention and treatment programs that
                                                                  use evidence-based and practice-based
                                                                  models created and managed by
                                                                  communities.
Urban Indian      Prevention    Grant          American Indian    Provides funding to nonprofit urban
Health Program                                 and Alaska         Indian health programs to carry out
Title V 4-in-1                                 Native youth and   alcohol and substance inpatient and
Grants                                         adults             outpatient treatment, counseling, and
                                                                  referrals for service.




30                                                                        GAO-12-744R Drug Control
Enclosure III

                   Program      Program      Targeted
Program            activities   type         beneficiaries       Program description
Substance Abuse and Mental Health Services Administration (SAMHSA)
Access to          Treatment    Grant        All populations     Provides funds for grantees, including
Recovery                                     requiring           states, tribes, and tribal organizations, to
                                             recovery support    carry out voucher programs that expand
                                             services            drug abuse treatment capacity and
                                                                 promote choice among clinical treatment
                                                                 and recovery support providers in order
                                                                 to facilitate recovery from drug abuse.
Addiction          Treatment    Education    Drug addiction      Funds ATTCs, which disseminate
Technology                      and outreach treatment           evidence-based and promising practices
Transfer Centers                             workforce           information to drug addiction treatment
(ATTC)                                                           and recovery professionals, among
                                                                 others, through technical assistance,
                                                                 training events, educational and training
                                                                 materials, and web-based resources.
Center for the     Prevention   Education    SAMHSA              Promotes behavioral health promotion
Application of                  and outreach grantees            technologies through training and
Prevention                                                       technical assistance activities to develop
Technologies                                                     the skills, knowledge, and expertise of
                                                                 grantees’ prevention workforces.
Children and       Treatment    Grant        Adolescents and     Addresses gaps in drug abuse services
Family Programs                              their               by providing services to adolescents and
                                             families/primary    their families/primary caregivers using
                                             caregivers          previously proven effective practices that
                                                                 are family centered. Grantees include
                                                                 domestic and private nonprofit entities,
                                                                 such as state and local governments,
                                                                 tribal organizations, universities and
                                                                 colleges, and faith-based organizations.
Criminal Justice   Treatment    Grant        Adolescents and     Provides a coordinated and
Activities                                   adults with drug    comprehensive continuum of programs
                                             abuse disorders,    and services to help program
                                             co-occurring drug   beneficiaries recover their lives and
                                             abuse and           become productive, responsible, law-
                                             mental disorders,   abiding citizens. Activities include grant
                                             or both             programs that focus on diversion,
                                                                 alternatives to incarceration, and reentry
                                                                 from incarceration. Grant program
                                                                 applicants include entities such as
                                                                 misdemeanor or felony adult criminal
                                                                 courts, juvenile or adult courts,
                                                                 family/child dependency courts, and
                                                                 entities that are tribal, state, or local
                                                                 government proxies.
Fetal Alcohol      Prevention   Education    Women of            Identifies and disseminates information
Spectrum                        and outreach childbearing age    about innovative techniques and
Disorders                                                        effective strategies for preventing fetal
                                                                 alcohol spectrum disorders and
                                                                 increasing functioning and quality of life
                                                                 for individuals and their families affected
                                                                 by these disorders.




31                                                                        GAO-12-744R Drug Control
Enclosure III

                    Program       Program       Targeted
Program             activities    type          beneficiaries       Program description
Health              Prevention    Other         Not applicable      Provides funding for personnel costs,
Surveillance and    and treatment                                   building and facilities, equipment,
Program Support                                                     supplies, administrative costs, and
                                                                    associated overhead to support
                                                                    SAMHSA programmatic activities, such
                                                                    as drug abuse prevention and treatment
                                                                    programs, and funding for SAMHSA
                                                                    national data collection and survey
                                                                    systems.
Mandatory Drug      Prevention    Other         Workplace           Provides funding for the accreditation
Testing                                         institutions        and ongoing quality assurance of
                                                                    laboratories that perform mandatory drug
                                                                    testing for federal and nonfederal
                                                                    employees. The program also provides
                                                                    the Workplace Helpline, a toll-free
                                                                    telephone service for business and
                                                                    industry that answers questions about
                                                                    drug abuse in the workplace.
Military Families   Prevention    Education    Servicemembers, Establishes policy academies that help
                    and treatment and outreach veterans, and   states and territories strengthen their
                                               their families  behavioral health care systems and
                                                               services for military families, such as
                                                               drug abuse prevention and treatment
                                                               programs, through the development of
                                                               interagency strategic plans and technical
                                                               assistance to facilitate the
                                                               implementation of those plans.
Minority AIDS       Treatment     Grant         Racial and ethnic   Awards funds to community-based
                                                minorities;         organizations for the delivery of drug
                                                women, including    abuse treatment and related HIV/AIDS
                                                women with          services that target one or more high-
                                                children;           risk, substance-abusing populations.
                                                adolescents;        Grantees include community-based
                                                injection drug      organizations.
                                                users; and
                                                individuals who
                                                have been
                                                released from
                                                prison within the
                                                past 2 years.
Minority            Prevention    Education    Minority             Seeks to improve the quality of drug
Fellowship          and treatment and outreach professionals        abuse and mental health prevention and
Program                                        available to serve   treatment delivered to ethnic minorities
                                               populations of       by providing stipends to graduate
                                               ethnic minorities    students to increase the number of
                                               with drug abuse      culturally competent behavioral health
                                               and mental           professionals who teach, administer,
                                               health disorders     conduct services research, and provide
                                                                    direct drug abuse and mental health
                                                                    services to underserved minority
                                                                    populations.
Opioid Treatment    Treatment     Other         Adults with     Provides pharmacotherapy and
Programs                                        substance abuse counseling as set forth under 42 C.F.R.
                                                disorders       Part 8 for the treatment of opioid
                                                                dependency.




32                                                                          GAO-12-744R Drug Control
Enclosure III

                      Program       Program       Targeted
Program               activities    type          beneficiaries        Program description
Performance and       Prevention    Other         Not applicable       Provides funding to support the agency’s
Quality               and treatment                                    new initiative focusing on data,
Information                                                            outcomes, and quality, including
Systems                                                                improving the collection of data for drug
                                                                       abuse and mental disorders.
Pregnant and          Treatment     Grant         Pregnant and         Expands the availability of
Postpartum                                        postpartum           comprehensive, residential substance
Women                                             women                abuse treatment, prevention, and
                                                                       recovery support services for pregnant
                                                                       and postpartum women and their minor
                                                                       children, including services for
                                                                       nonresidential family members of both
                                                                       the women and the children. Grantees
                                                                       include public and private nonprofit
                                                                       entities, including state and local
                                                                       governments and tribes and tribal
                                                                       organizations.
Public Awareness      Prevention    Education    General public        Provides funding to support SAMHSA’s
and Support           and treatment and outreach                       public communications to increase
                                                                       awareness on drug abuse issues,
                                                                       behavioral health, and mental disorders.
Recovery              Treatment     Grant         People with a        Responds to the need for community-
Community                                         history of alcohol   based recovery support services that
Services Program                                  problems, drug       help prevent drug abuse relapse and
                                                  abuse problems,      promote long-term recovery by designing
                                                  or both who are      and delivering peer-to-peer recovery
                                                  seeking recovery     support services. Provides grants to
                                                                       domestic public and private nonprofit
                                                                       entities.
Science and           Prevention    Education    States, federally     Provides technical assistance and
Service Program                     and outreach recognized            training to states, tribes, communities,
Coordination                                     tribes,               and grantees around substance abuse
                                                 communities,          prevention.
                                                 and grantees
Screening, Brief      Treatment     Grant         Adults seeking       Provides grants, in the form of
Intervention, and                                 care in a variety    cooperative agreements, to general
Referral to                                       of settings          medical and primary health care
Treatment                                                              organizations, including hospitals,
                                                                       trauma centers, and health clinics, to
                                                                       integrate drug abuse screening, brief
                                                                       intervention, referral, and treatment
                                                                       services within these settings.
Sober Truth on        Prevention    Grant         Youth                Provides grants to organizations that are
Preventing                                                             receiving or have received grant funds
Underage                                                               under the Drug-Free Communities Act of
Drinking Act                                                           1997 to supplement their current
                                                                       prevention efforts and strengthen
                                                                       collaboration and coordination among
                                                                       stakeholders in order to achieve a
                                                                       reduction in underage drinking in their
                                                                       communities.
Special Initiatives   Treatment     Education    Drug addiction        Funds special initiatives, including the
Outreach                            and outreach treatment             Historically Black Colleges and
                                                 workforce             Universities Center for Excellence, which
                                                                       promotes leadership development for
                                                                       African Americans in the drug abuse and
                                                                       mental health professions.




33                                                                              GAO-12-744R Drug Control
Enclosure III

                             Program                Program              Targeted
    Program                  activities             type                 beneficiaries      Program description
    Strategic                Prevention             Grant                State, tribal,     Provides resources to grantees, which
    Prevention                                                           territorial, and   include states, federally recognized
    Framework                                                            local              tribes, and U.S. territories, to prevent the
                                                                         communities        onset and reduce the progression of
                                                                                            drug abuse, including childhood and
                                                                                            underage drinking; reduce drug abuse-
                                                                                            related problems; and build prevention
                                                                                            capacity and infrastructure at the state,
                                                                                            tribal, territorial, and community levels.
    Strengthening    Treatment                      Other                States             An infrastructure cooperative agreement
    Treatment Access                                                                        program that promotes state-level
    and Retention                                                                           implementation of process improvement
                                                                                            methods by providing grants to states to
                                                                                            improve access to and retention in
                                                                                            outpatient drug abuse treatment.
    Substance                Prevention             Grant                Youth and adult    Supports efforts to increase access to
    Abuse/Minority                                                       minority           drug abuse and HIV prevention services
    AIDS Initiative                                                      populations        for the highest-risk and hardest-to-serve
                                                                                            racial and ethnic minority populations.
                                                                                            Provides grants to community-level
                                                                                            public and private nonprofit entities.
    Targeted Capacity Treatment                     Grant                SAMHSA             Provides funding to expand or enhance a
    Expansion –                                                          grantees           community’s ability to provide rapid,
    General                                                                                 strategic, comprehensive, integrated,
                                                                                            community-based responses to a
                                                                                            specific, well-documented drug abuse
                                                                                            problem.
    Treatment                Treatment              Grant                Homeless           Enables communities to expand and
    Systems for                                                          individuals        strengthen their drug abuse treatment
    Homeless                                                                                services for homeless individuals with
                                                                                            drug abuse disorders. Grantees include
                                                                                            domestic public and private nonprofit
                                                                                            entities.
Source: GAO analysis of Department of Health and Human Services information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use
of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug
abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through
such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment
methods.
a
 According to Health Resources and Services Administration officials, funding for prevention services in the Health Center
Program is not included in the Drug Control Budget because it is difficult to quantify the amount of funding that is allocated
specifically to prevention services.
b
 According to Health Resources and Services Administration officials, funding for the Ryan White HIV/AIDS Program is not
included in the Drug Control Budget because the program does not directly award funding for drug abuse treatment, although
drug abuse treatment may be one of many services that eligible participants receive.




34                                                                                                   GAO-12-744R Drug Control
Enclosure III

Table 4: Department of Health and Human Services Drug Abuse Prevention and Treatment Research and
Development Efforts Allocated Funding, Fiscal Year 2012

Research and
development          Research         Research   Research
efforts              activities       type       subjects           Research description
National Institutes of Health (NIH)
Basic and Clinical   Prevention   Grant,      Animal/human adults   At NIH’s National Institute of Drug
Neuroscience         and          contract,   and youth             Abuse (NIDA), the basic and clinical
Research             treatment    cooperative                       neuroscience programs work together
                                  agreement                         to expand our understanding of the
                                                                    neurobiological, genetic/epigenetic,
                                                                    and behavioral factors that underlie
                                                                    drug abuse and addiction.
                                                                    Specifically, they examine which
                                                                    variables influence risk of drug abuse,
                                                                    addiction, and drug-related disorders;
                                                                    how drug exposure and addiction
                                                                    alter the brain, including the effects of
                                                                    drugs on the expression or silencing
                                                                    of genes; and how resultant changes
                                                                    affect brain function and consequent
                                                                    behaviors.
Clinical Trials      Treatment    Grant,      Human adults and      Within NIH, NIDA’s National Drug
Network                           contract,   youth                 Abuse Treatment Clinical Trials
                                  cooperative                       Network (CTN) comprises
                                  agreement                         13 research nodes and more than
                                                                    240 individual community treatment
                                                                    programs in 38 states, plus the
                                                                    District of Columbia and Puerto Rico.
                                                                    The CTN develops and tests
                                                                    treatment protocols for drug abuse
                                                                    and addiction and related conditions,
                                                                    such as comorbid mental health
                                                                    disorders and HIV, testing the real-
                                                                    world effectiveness of promising
                                                                    medication and behavioral
                                                                    approaches with diverse patient
                                                                    populations and community treatment
                                                                    providers. It also serves as a
                                                                    research training platform and helps
                                                                    NIDA respond to emerging public
                                                                    health threats.
Epidemiology,        Prevention   Grant,      Human adults and      At NIH’s NIDA, this program area
Services and         and          contract,   youth                 supports integrated approaches to
Prevention           treatment    cooperative                       understand and address the
Research                          agreement                         interactions between individuals and
                                                                    environments that contribute to drug
                                                                    abuse and related problems. Large
                                                                    surveys and surveillance networks
                                                                    that monitor drug-related issues
                                                                    exemplify programs supported by this
                                                                    NIDA division. Program efforts help
                                                                    identify substance abuse trends
                                                                    locally, nationally, and internationally;
                                                                    guide development of responsive
                                                                    interventions for a variety of
                                                                    populations; and determine optimal
                                                                    service delivery in real-world settings.




35                                                                        GAO-12-744R Drug Control
Enclosure III

Research and
development        Research      Research      Research
efforts            activities    type          subjects           Research description
Intramural         Prevention   Other       Animal/human adults   The Intramural Research Program
Research Program   and                      and youth             performs cutting-edge research within
                   treatment                                      a coordinated multidisciplinary
                                                                  framework. The program attempts to
                                                                  (1) elucidate the nature of the
                                                                  addictive process; (2) determine the
                                                                  potential use of emerging new
                                                                  therapies for substance abuse, both
                                                                  pharmacological and psychosocial;
                                                                  and (3) establish the long-term
                                                                  consequences of drug abuse on
                                                                  systems and organs, with particular
                                                                  emphasis on the brain and its
                                                                  development, maturation, function,
                                                                  and structure. In addition, the
                                                                  program supports the HIV/AIDS
                                                                  Pathophysiology and Addiction
                                                                  Medications Discovery Program.
Pharmacotherapies Treatment     Grant,      Animal/human adults   At NIH’s NIDA, this program area is
and Medical                     contract,   and youth             responsible for medication
Consequences                    cooperative                       development aimed at helping people
                                agreement                         recover from drug abuse and
                                                                  addiction and sustain abstinence, and
                                                                  includes development of nonaddictive
                                                                  pain medications. It capitalizes on
                                                                  research showing the involvement of
                                                                  different brain systems in drug abuse
                                                                  and addiction, beyond the reward
                                                                  circuit, to develop medications in
                                                                  response to a variety of newly defined
                                                                  targets. This program area also seeks
                                                                  means to address the medical
                                                                  consequences of drug abuse and
                                                                  addiction, including infectious
                                                                  diseases, such as HIV.
Research           Prevention   Other       Not applicable        Activities provide administrative,
Management and     and                                            budgetary, logistical, and scientific
Support            treatment                                      support in the review, award, and
                                                                  monitoring of research grants, training
                                                                  awards, and research and
                                                                  development contracts. Additionally,
                                                                  the functions of Research and
                                                                  Management Support encompass
                                                                  strategic planning, coordination, and
                                                                  evaluation of NIDA’s programs,
                                                                  regulatory compliance, international
                                                                  coordination, and liaison with other
                                                                  federal agencies, Congress, and the
                                                                  public.




36                                                                     GAO-12-744R Drug Control
Enclosure III

 Research and
 development                    Research             Research             Research
 efforts                        activities           type                 subjects           Research description
 Underage Drinking             Prevention         Grant              Generally individuals   Research activities include studies on
                               and                                   under the age of 21;    the epidemiology of underage
                               treatment                             however, some follow-   drinking and related consequences
                                                                     up studies assessing    and the etiology of underage drinking,
                                                                     consequences of child   including genetic and environmental
                                                                     or adolescent alcohol   factors that either protect against or
                                                                     use do go beyond        increase risk, and studies assessing
                                                                     age 21                  the consequences of child and
                                                                                             adolescent alcohol use, such as the
                                                                                             effects on the developing brain, and
                                                                                             on prevention interventions and
                                                                                             treatment interventions.
Source: GAO analysis of Department of Health and Human Services information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use
of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug
abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through
such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment
methods. We present information on the Department of Health and Human Services’ drug abuse prevention and treatment
research and development activities separately from that agency’s drug abuse prevention and treatment programs because
NIH officials told us that the agency does not classify its research and development activities as programs.




37                                                                                                GAO-12-744R Drug Control
Enclosure III

Table 5: Department of Justice Drug Abuse Prevention and Treatment Programs Allocated Funding,
Fiscal Year 2012

                 Program                           Targeted
Program          activities       Program type     beneficiaries         Program description
Bureau of Prisons (BOP)
Community        Prevention and   Direct service   Inmates transferred Ensures continuation of drug abuse
Transition       treatment                         to a residential    treatment that is to provide inmates
Treatment                                          reentry center      support as they adjust to
                                                                       community living.
Drug Education   Prevention       Direct service   Inmates who meet      Encourages offenders with a
                                                   criteria for drug     history of drug use to review the
                                                   abuse education       choices they have made and the
                                                                         consequences of their choices,
                                                                         including their choice to use drugs.
                                                                         Drug abuse education takes the
                                                                         offender through the cycle of drug
                                                                         use and crime and offers
                                                                         compelling evidence of how
                                                                         continued drug use can lead to
                                                                         further criminality and related
                                                                         consequences.
Nonresidential   Treatment        Direct service   Inmates with minor    Provides nonresidential drug abuse
Drug Abuse                                         or low-level          treatment at every BOP institution,
Treatment                                          substance abuse       and is a flexible program designed
                                                   impairment or with    to meet the specialized treatment
                                                   longer sentences      needs of the inmate.
                                                   who are in need of
                                                   treatment and are
                                                   awaiting placement
                                                   in the residential
                                                   program, among
                                                   others
Residential Drug Treatment        Direct service   Inmates who meet      Provides intensive drug abuse
Abuse                                              diagnostic criteria   treatment to inmates diagnosed
Treatment                                          for substance use     with a drug use disorder.
                                                   disorder
Drug Enforcement Administration (DEA)
Demand           Prevention       Education and    States, schools, Supports 23 special agents with
                                           a
Reduction                         outreach         and              demand reduction collateral duties.
Program                                            communities      These agents serve as demand
                                                                    reduction coordinators supporting
                                                                    DEA’s law enforcement efforts by
                                                                    developing strategic alliances with
                                                                    prevention, treatment, and community
                                                                    coalitions, as well as working in
                                                                    partnership with other federal, state,
                                                                    and local government agencies.




38                                                                          GAO-12-744R Drug Control
Enclosure III

                            Program                                  Targeted
    Program                 activities                Program type   beneficiaries       Program description
    Office of Justice Programs
    Drug Court              Treatment                 Grant          Offenders        Provides financial and technical
    Program                                                                           assistance to states, state courts, local
                                                                                      courts, units of local government, and
                                                                                      Indian tribal governments to develop
                                                                                      and implement drug courts that
                                                                                      effectively integrate evidence-based
                                                                                      drug abuse treatment, mandatory drug
                                                                                      testing, sanctions and incentives, and
                                                                                      transitional services in a judicially
                                                                                      supervised court setting with
                                                                                      jurisdiction over drug-abusing
                                                                                      offenders.
    Enforcing               Prevention                Grant          Community and Supports and enhances efforts by
    Underage                                                         youth         states and local jurisdictions to reduce
    Drinking Laws                                                                  the availability of alcohol to minors.
                                                                                   The program encourages close
                                                                                   partnerships between law enforcement
                                                                                   agencies and community groups
                                                                                   involved in preventing and intervening
                                                                                   in underage drinking.
    Residential             Treatment                 Grant          Offenders        Assists states and units of local
    Substance                                                                         government in developing and
    Abuse                                                                             implementing residential substance
    Treatment                                                                         abuse treatment programs in state and
                                                                                      local correctional and detention
                                                                                      facilities.
    Second Chance           Treatment                 Grant          Offenders        Provides funding to state, local, and
    Act Adult                                                                         federally recognized tribal entities to
    Offenders with                                                                    implement and expand offender
    Co-occurring                                                                      treatment programs for offenders with
    Substance                                                                         co-occurring substance abuse and
    Abuse and                                                                         mental health disorders. These
    Mental Health                                                                     programs should improve the provision
    Disorders                                                                         of treatment for adult individuals (18
                                                                                      years and over) being treated for co-
                                                                                      occurring substance abuse and mental
                                                                                      health disorders within prisons and
                                                                                      jails, and include both pre- and
                                                                                      postrelease programming for every
                                                                                      program participant.
    Second Chance           Treatment                 Grant          Offenders        Awards funds to state and local
    Act Family-                                                                       agencies and federally recognized
    Based Adult                                                                       tribal entities to develop and implement
    Offender                                                                          comprehensive and collaborative
    Substance                                                                         strategies that address the challenges
    Abuse                                                                             posed by reentry to increase public
    Treatment                                                                         safety and reduce recidivism.
    Program,
    Planning and
    Demonstration
    Projects
Source: GAO analysis of Department of Justice information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use
of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug
abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through
such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment
methods.
a
 DEA officials reported that the program does not currently engage in outreach activities because of reductions in program
funding.



39                                                                                           GAO-12-744R Drug Control
Enclosure III

Table 6: Department of Education Drug Abuse Prevention Programs Allocated Funding, Fiscal Year 2012

                               Program                            Targeted
    Program                    activities            Program type beneficiaries          Program description
    21st Century               Prevention            Grant        Prekindergarten        Enables communities to establish
    Community                                                     through 12th grade     or expand centers that provide
                     a
    Learning Centers                                              students               additional student learning
                                                                                         opportunities to complement and
                                                                                         reinforce the regular school-day
                                                                                         program of participating students,
                                                                                         such as drug and violence
                                                                                         prevention activities.
    Safe and Drug-             Prevention            Grantb       Primarily              Provides funding to local education
    Free Schools and                                              kindergarten through   agencies and a variety of public or
    Communities                                                   12th grade students;   private entities for activities
    National Activities                                           however, the           designed to prevent the illegal use
                                                                  program also serves    of drugs by and violence among,
                                                                  some college           and promote safety and discipline
                                                                  students               for, students. Activities may include
                                                                                         the development and dissemination
                                                                                         of drug and violence prevention
                                                                                         programs and activities, technical
                                                                                         assistance to grantees to build
                                                                                         capacity to develop effective drug
                                                                                         and violence prevention programs,
                                                                                         and the collection of data on the
                                                                                         incidence and prevalence of drug
                                                                                         use and violence in schools.
Source: GAO analysis of Department of Education information.

Notes: For the purpose of our review, we define drug abuse prevention as activities focused on discouraging the first-time use
of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. We define drug
abuse treatment to include activities focused on assisting regular users of controlled substances to become drug free through
such means as counseling services, inpatient and outpatient care, and demonstration and provision of effective treatment
methods.
a
 According to Department of Education officials, this program is not included in the Drug Control Budget because of the lack of
an appropriate budget methodology.
b
 Department of Education officials said that this program also provides technical assistance that is targeted to institutions of
higher education.




40                                                                                           GAO-12-744R Drug Control
Enclosure IV

          Comments from the Office of National Drug Control Policy




41                                                   GAO-12-744R Drug Control
Enclosure IV




42             GAO-12-744R Drug Control
Enclosure V

                   GAO Contacts and Staff Acknowledgments

GAO Contacts

Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov
Eileen R. Larence, (202) 512-8777 or larencee@gao.gov

Staff Acknowledgments

In addition to the contacts named above, David Alexander, Assistant Director;
Karen Doran, Assistant Director; Mary Catherine Hult, Assistant Director;
George Bogart; Willie Commons III; Susan Czachor; Emily Goodman;
Cathy Hamann; C. Jenna Sondhelm; and Johanna Wong made key
contributions to this report.




(291009)




43                                                         GAO-12-744R Drug Control
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