SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
DRUG CONTROL BUDGET

I. RESOURCE SUMMARY

(Program Level in Millions)

¹ Consistent with ONDCP guidance, the entire Substance Abuse Block Grant, including funds expended for activities related to alcohol is included in the Drug Budget. The Block Grant is distributed 20 percent to Prevention and 80 percent to Treatment.

² Consistent with ONDCP guidance, all SAMHSA Program Management funding is included. Program Management is distributed 20 percent to Prevention and 80 percent to Treatment.

³ Total FY 2005 Drug Control Funds shown reflect an increase of $97.813 million in CSAT PRNS, a decrease in CSAP PRNS of $2.440 million, an increase in the Substance Abuse Prevention and Treatment Block Grant of $53.089 million, and a program management increase of $0.540 million. Includes funds provided from the PHS Evaluation program, as follows: $74.2 million in FY 2003, $95.2 million in FY 2004, and $99.5 million in FY 2005.

⁴ Includes PHS Evaluation funds.

II. PROGRAM SUMMARY

SAMHSA supports the National Drug Control Strategy through a broad range of programs focusing on prevention and treatment of the abuse of illicit drugs. These programs, which include Block Grant funding as well as funding from the discretionary Programs of Regional and National Significance, are administered through the Center for Substance Abuse Prevention (CSAP) and the Center for Substance Abuse Treatment (CSAT).

Center for Substance Abuse Prevention

CSAP's mission is to bring effective prevention programs to all communities in order to reduce substance abuse. That mission will be accomplished through the Strategic Prevention Framework, which incorporates SAMHSA's strategic goals of Accountability, Capacity, and Effectiveness. The Strategic Prevention Framework incorporates a five step community development model: (1) organize the community to profile needs, including community readiness; (2) mobilize the community and build the capacity to address needs and plan for sustainability; (3) develop the prevention action (evidence-based activities, programs, strategies, and policies); (4) implement the prevention plan; and (5) conduct ongoing evaluation for quality improvement and outcomes. CSAP is in the process of realigning its programs to support the Strategic Prevention Framework.

• Capacity: In addition to funds provided from the 20% Block Grant set-aside, CSAP has implemented several program efforts targeted to increasing the capacity of States and communities to provide effective substance abuse prevention services. The State Incentive Grants (SIGs), and especially the new Strategic Prevention Framework SIG, are designed to address the specific and immediate prevention service capacity needs within States and communities. SIG grants represent a comprehensive effort to improve the quality and availability of effective evidence-based prevention services and help states and communities to address and close gaps in prevention services.

• Effectiveness: CSAP prevention activities support the identification and promotion of model and promising prevention programs, primarily through the National Registry of Effective Programs (NREP). CSAP's objective is to significantly increase the number of identified model programs and the number of communities implementing evidence-based prevention programs. Many of the programs identified as models have been adapted to meet the specific needs of diverse target populations.

• Accountability: CSAP promotes accountability throughout all of its activities by requiring the evaluation of prevention programs to demonstrate their outcomes. The SAPT Block Grant set-aside supports the development of State data infrastructure and also supports oversight of Synar Amendment implementation requiring States to enact and enforce laws to reduce the availability of tobacco products to minors by prohibiting the sale and distribution of tobacco products to persons under 18.

Center for Substance Abuse Treatment

In partnership with other federal agencies and organizations, state and local governments, and faith-based and community-based substance abuse treatment and primary care providers, CSAT's goals are to: 1) increase the availability of clinical treatment and recovery support services commensurate with need; 2) improve and strengthen substance abuse clinical treatment and recovery support organizations and systems; and 3) transfer knowledge gained from research into effective practices.

• Capacity: The SAPT Block Grant is CSAT's primary program to support State alcohol and drug abuse treatment activities. Funding is allocated by formula to the States, and approximately 80 percent is used in support of treatment services (including up to 5 percent for state administration). CSAT also provides additional discretionary funding through Programs of Regional and National Significance (PRNS), including Targeted Capacity Expansion (TCE) treatment service programs. TCE programs focus on reducing substance abuse treatment need by supporting rapid and strategic responses to demands for substance abuse treatment services. Response to treatment capacity problems may include communities with serious, emerging drug problems or communities struggling with unmet need.

• Effectiveness: CSAT promotes effectiveness through best practice programs, which help communities and providers to identify, adapt, implement, and evaluate best practices. Programs include activities to bridge the gap between knowledge and practice by promoting the adoption of best practices, and by ensuring that services availability meets targeted needs. These programs also are used to disseminate information about systems and practices shown to be most effective.

• Accountability: CSAT and the Office of Applied Studies (OAS) spend approximately 80 percent of the SAPT Block Grant federal set-aside for the collection and analysis of national data, the development of state data systems (including the development and maintenance of baseline data on incidence and prevalence as well as the development of outcome measures on the effectiveness of treatment programs), technical assistance, and program evaluations.

III. METHODOLOGY - This section does not apply to SAMHSA.

IV. BUDGET SUMMARY

2004 PROGRAM
The total drug control budget supported by the FY 2004 Conference Action is $2.49 billion.

Prevention

A total of $198.5 million is available for prevention Programs of Regional and National Significance (PRNS) activities. This represents an increase of $1.3 million from the previous fiscal year. CSAP will realign resources based upon the Strategic Prevention Framework (SPF), utilizing a variety of programs. Examples of priorities for the new funding and for reinvesting funds from expiring projects include:

• Strategic Prevention Framework State Incentive Grants (SPF SIG), which will support States in their efforts to implement the five step Strategic Prevention Framework community development model.

• An Underage Alcohol Use initiative, supporting a comprehensive approach through the State Incentive Grants program. The initiative will involve public and private partners. Epidemiological data will guide the effort, which will implement proven approaches.
  

• Start the SPF SIG State Infrastructure program to assist States in their ability to collect data.

Treatment

A total of $419.2 million is available for treatment PRNS activities and $1.78 billion is available for the SAPT Block Grant.

• Targeted Capacity Expansion programs: The FY 2004 Conference Action reflects a PRNS net increase of $102.0 million over the previous fiscal year, most of which ($99.4 million) will be used to support the new Access to Recovery (ATR) program. As envisioned, ATR will be a voucher program administered through the States. The initiative would allow individuals seeking clinical treatment and recovery support services to exercise choice among qualified community provider organizations, including those that are faith-based. An initial assessment will be conducted for each individual to determine the appropriate level of service for that individual, which would include a range of possibilities including recovery support services, brief interventions, and more intensive clinical treatment.

• SAPT Block Grant: A total of $1.78 billion is available for the SAPT Block Grant. This represents an increase of $25.2 million over the previous fiscal year. This will provide modest increases in all State and territory allocations, and an increase of $1.3 million for the federal set-aside.

2005 Request

A total of $2.64 billion is requested for the drug control budget in FY 2005, including $713.1 million for SAMHSA/CSAP/CSAT PRNS funding, $1.83 billion for the Substance Abuse Prevention and Treatment Block Grant (SAPT) Block Grant, and $92.46 for SAMHSA Program Management. This represents a net increase of $149.0 million over FY 2004.

Prevention

The FY 2005 request for SAMHSA/CSAP PRNS is $196.0 million, reflecting a program reduction of $2.4 million over FY 2004. Since no new PRNS funding is requested for FY 2004, CSAP proposes to reinvest funds from expiring projects as follows:

• In FY 05, CSAP intends to continue to focus strongly on underage drinking initiatives, including a new Service to Science grant program and expansion of `Reach Out Now'.

• In order to increase States' capacity to evaluate the progress and utilization of their Programs of Regional and National Significance funds and their Substance Abuse Prevention Block Grant funds, CSAP plans to expand the SPF SIG State Infrastructure program begun in FY 2004.

Treatment

The FY 2005 request reflects an increase of $97.8 million in SAMHSA/CSAT PRNS funds and a $53.1 million increase for the SAPT Block Grant.

• unding for the Access to Recovery initiative that began in FY 2004 will be increased to $200 million in FY 2005. The new PRNS funding will be combined with $99.4 million in continuation funds from the FY 2004 ATR base, and $2.8 million from other expiring CSAT grants.

• $53.1 million in SAPT Block Grant funds will provide increases for all States and territories, and an additional $2.7 million for the federal set-aside. Data infrastructure support for States will be a priority.

V. PERFORMANCE

Summary

This section is drawn from the FY 2005 Budget Submission and Performance Plan, the FY 2003 Performance Report, and the FY 2004 and FY 2005 PART reviews. The table includes conclusions from the PART assessment: scores on program purpose, strategic planning, management, and results achieved are synthesized into an overall rating of the program's effectiveness. Also included is a comparison of targets and achievements from the GPRA documents listed above, for the latest year for which data are available. The outcome-oriented measures and selected output measures presented indicate how program performance is being monitored.

The PART reviews determined that the substance abuse programs play an important role in supporting substance abuse treatment and prevention services in States, territories and communities. The primary criticism generated by the PART reviews was the lack of outcome measures and targets, without which programs could not demonstrate effectiveness. SAMHSA, recognizing that many States do not collect outcome information in a consistent manner, is working with them to identify common outcome and process measures as well as common methodologies for data collection. SAMHSA also continues to assist States in developing their data infrastructures. The new plan for the Block Grant program - Performance Partnership Grants - should improve State accountability while increasing State flexibility. This model requires States to collect data on core client outcome indicators. SAMHSA also expects to develop baselines for cost bands for different types of prevention and treatment programs by October 2005. CSAT's Targeted Capacity Expansion program's web-based performance measurement system has now enabled that program to demonstrate considerable success in achieving desired treatment outcomes.

CSAP Program Accomplishments: CSAP programs include the 20% Prevention Set-aside from the Substance Abuse Prevention and Treatment (SAPT) Block Grant, and Programs of Regional and National Significance.

SAPT Block Grant 20% Prevention Set-aside

Discussion

• The FY 2005 PART review recognized that the SAPT Block Grant is the only federal program that provides funds to every State to support Statewide substance abuse treatment and prevention services. It also noted that the program is developing new outcome measures. The PART review concluded that the SAPT Block Grant's primary shortcoming was the lack of outcome measures and long-term targets, making it difficult to demonstrate results. At present, States are not collecting uniformly-defined information on the results or outcomes of the program.

• Proposed changes for the Block Grant will increase State flexibility and accountability through the Performance Partnership Grants (PPGs). PPGs would mandate State collection of core outcome measures, including drug use. SAMHSA is working with States to identify and implement common outcome measures and consistent data collection techniques.

PRNS Programs

CSAP PRNS programs have not yet been reviewed through the PART process. The largest PRNS program is the State Incentive Grants (SIG) program, CSAP's mechanism for building prevention capacity. The number of science-based programs implemented by local sub-recipients in SIG states is the key program performance measure: increases in such programs are expected to lead to greater effectiveness of prevention services. The number of evidence-based programs implemented by the SIG program for FY 02 was 1055, slightly higher than the target (977). This performance is based on 29 States reporting. SIG states have also been successful in leveraging prevention funds: some states have leveraged, through matching funds, up to 10 times the Federal grant amount.

CSAT Program Accomplishments: CSAT programs include the Substance Abuse Prevention and Treatment Block Grant and Programs of Regional and National Significance.

SAPT Block Grant - Treatment

Discussion

• The FY 2005 PART review recognized that the SAPT Block Grant is the only federal program that provides funds to every State to support statewide substance abuse treatment and prevention services. It also noted that the program has adopted new long-term outcome measures and annual outcome and output measures. The primary shortcomings identified through the PART review of the SAPTBG were the lack of outcome measures and long-term targets. While CSAT is funding incentives to States to improve these data, States vary considerably in their ability to provide outcome data.

• SAMHSA is undergoing a transition to Performance Partnership Grants (PPGs), in which all States will be required to provide outcome information that can be aggregated to monitor program performance. The draft PPG Report to Congress, which is nearing final preparation for submission to HHS, lists a small set of core measures for substance abuse treatment and prevention. These will be used for increased accountability.

• An efficiency measure has been developed to monitor and improve cost effectiveness.

• State satisfaction levels with CSAT's customer service continue to be high, with data showing 91% in FY 00, 91% in FY 01, and 95% in FY 02.

CSAT PRNS Program

Discussion

• The PART review found that the PRNS makes a unique contribution, as PRNS service programs are designed specifically to fill gaps. While State and local governments support drug treatment, neither focuses on regional or emerging problems. PRNS programs also include unique training, communications, and certification efforts.

• The 1997 National Treatment Improvement Evaluation Study indicated that the program's demonstration grants were effective. No evaluation has been conducted since this study. However, evaluations of the Screening and Brief Intervention, Referral and Treatment Program and Access to Recovery programs are being initiated to continue evaluation of major CSAT PRNS programs.

• The table above reflects success in meeting FY 2003 targets. Target numbers have been increased for FY 2004 and FY 2005 from the FY 2003 levels. The program's web-based system to collect and report outcome information from its grantees is a useful model for other SAMHSA programs.

• The PART review did not include the new Access to Recovery (ATR) program that will begin in FY 2004.

Substance Abuse Treatment - Estimate of Persons Served (Admissions)
FY 2003 - FY 2005

Footnotes:

¹ Youth Residential average cost per admission was developed by CSAT for the FY 2002 President's Budget. It has been increased by inflation for each subsequent fiscal year, using the updated CPI-U (percent change, year over year, seasonally adjusted CPI for all urban customers) based on the FY 2004 President's Budget, Mid-Session Review, July 15, 2003.

² Youth Non-Residential, All Other Discretionary, and SAPT Block Grant average costs per admission reflect the average cost from the Alcohol and Drug Services Study (Revised), released by OAS, SAMHSA, on August 12, 2003. The outyear average admission costs have been inflated by the CPI-U from the FY 1997 base year of the study through FY 2005.

³ An expert panel convened by CSAT in October 2002 developed an average cost per admission for the Screening, Brief Intervention, Referral, and Treatment (SBIRT) program. This cost has been increased for inflation in the outyears. In an effort to maximize early start-up and minimize start-up delays for this new program, the RFA included award criteria favoring those already implementing or those who could quickly start-up Screening, Brief Intervention, Referral and Treatment programs.

⁴ Average cost per admission for the FY 2004 Access to Recovery (ATR) program was derived from the OMB estimate that a $200 million program would support treatment for 100,000 persons. This same estimate has been used in FY 2005.

⁵ Estimated admissions have been determined by "scoring" program funds as follows:

Best Practices: 50%
Discretionary Treatment Programs (TCE): 100%
SAPT Block Grant: 51%

⁶ CSAT has continued to assess methods to improve the predictability between funding and the number of persons served (admissions) and development of implementing strategies as they are identified. In FY 2003, CSAT work in this area focused on devising a formula by which costs per person supported by discretionary grants could be estimated. CSAT has published cost bands for the major modalities funded by CSAT, as well as the formula for estimation of per person costs. In addition, CSAT has implemented a performance accountability data system which includes estimates of per person costs and has designed and implemented guidelines for project officers related to the monitoring of costs and number of persons to be served. Early in FY 2004, CSAT should be able to produce estimates of costs per person served by its discretionary portfolio in the major modalities directly from grantee data. CSAT has also proposed including these cost bands as part of the FY 2004 block grant applications for states.

⁷ CSAT is aware that part of the lack of predictability of the number of persons to be served by the budget line is related to the lack of clarity about the extent to which services delivered to each person are wholly supported by CSAT discretionary dollars or multiple types of funding streams, including CSAT funding. In FY 2004, CSAT plans to test the feasibility of estimating the likelihood of multiple funding streams, and if feasible methods can be identified, a pilot test of the methods will be considered.

See Also:

HIV/AIDS - Programs Overview
HIV/AIDS Programs
HIV/AIDS by Functional Category