Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities

Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities (Letter Report, 10/08/96, GAO/HEHS-97-12).

Pursuant to a congressional request, GAO provided information on the financial support provided for substance abuse and treatment activities by federal, state, and local governments and the private sector.

GAO found that: (1) federal funding for substance abuse treatment and prevention activities for fiscal year (FY) 1994 totalled $4.4 billion; (2) the Departments of Health and Human Services, Education, and Veterans Affairs provided 83 percent of total federal funding for treatment and prevention activities for FY 1994; (3) many federal programs targeted specific population groups and provided a wide range of treatment and prevention services; (4) state, county, and local governments' total expenditures for treatment and prevention activities amounted to $1.6 billion for FY 1994; (5) private funding for substance abuse treatment totalled $1 billion in 1993; (6) the financial information provided by federal, state, and local governments underestimated the total amount spent on drug abuse and prevention services because they did not report all sources of contributions; (7) treatment services received the greater portion of funding from all entities; and (8) from FY 1990 to 1994, the federal government increased its financial support for treatment and prevention activities by 60 percent and state, county, and local governments' combined funding for treatment and prevention activities increased by 22 percent.

--------------------------- Indexing Terms -----------------------------

REPORTNUM: HEHS-97-12 TITLE: Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities DATE: 10/08/96 SUBJECT: Drug treatment Drug abuse Appropriated funds Alcohol or drug abuse problems Alcohol abuse Federal aid programs State aid Local governments IDENTIFIER: Medicare Program Medicaid Program Special Supplemental Food Program for Women, Infants, and Children Head Start Program National Drug and Alcoholism Treatment Unit Survey WIC

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Cover ================================================================ COVER

Report to Congressional Requesters

October 1996

DRUG AND ALCOHOL ABUSE - BILLIONS SPENT ANNUALLY FOR TREATMENT AND PREVENTION ACTIVITIES

GAO/HEHS-97-12

Substance Abuse Funding

(108288)

Abbreviations =============================================================== ABBREV

AIDS - acquired immunodeficiency syndrome CARE - Ryan White Comprehensive AIDS Resources Emergency Act CSAP - Center for Substance Abuse Prevention CSAT - Center for Substance Abuse Treatment FAA - Federal Aviation Administration FACES - Family and Community Endeavor Schools HHS - Department of Health and Human Services HIV - human immunodeficiency virus HUD - Department of Housing and Urban Development IDU - injecting drug users JTPA - Job Training Partnership Act LEA - local education agency NASADAD - National Association of State Alcohol and Drug Abuse Directors NDATUS - National Drug and Alcoholism Treatment Unit Survey NIAAA - National Institute on Alcohol Abuse and Alcoholism NIDA - National Institute on Drug Abuse NIH - National Institutes of Health ONDCP - Office of National Drug Control Policy SAMHSA - Substance Abuse and Mental Health Services Administration VA - Department of Veterans Affairs WIC - Department of Agriculture's Special Supplemental Program for Women, Infants, and Children

Letter =============================================================== LETTER

B-274061

October 8, 1996

The Honorable Bob Livingston Chairman, Committee on Appropriations House of Representatives

The Honorable John Edward Porter Chairman, Subcommittee on Labor, Health and Human Services, Education and Related Agencies Committee on Appropriations House of Representatives

Drug and alcohol abuse are major problems confronting America.\1 In 1994, more than 25 million people were estimated to have used an illicit drug in the past year; 3.9 million used cocaine, and about 350,000 used heroin. A large proportion of illicit drug users are marijuana users. Additionally, about 140 million people aged 12 and older were estimated to have used alcohol in the past year, and about 73 percent of high school seniors surveyed had consumed alcohol in the past year. To help combat substance abuse, federal, state, and local governments and the private sector fund treatment and prevention activities. As the Congress makes decisions about appropriating funds for such activities, information about the relative contributions of the various government and private funding sources for these treatment and prevention activities is not routinely available to it.

This report responds to your request for information that provides a broader picture of the financial support provided for substance abuse treatment and prevention activities. Specifically, you asked us to use available data sources to determine the total funding reported to be provided by federal, state, and local governments and the private sector. You also asked that we include descriptions of substance abuse programs and activities that are federally funded and the populations they serve.

To provide funding information on substance abuse treatment and prevention activities, we obtained information on (1) federal budget authority\2 for fiscal years 1990 through 1994 from the Office of National Drug Control Policy (ONDCP); (2) expenditure data for state, county, and local governments for fiscal years 1990 through 1994 from the National Association of State Alcohol and Drug Abuse Directors (NASADAD); and (3) 1993 private funding for treatment services from the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as information on the top foundation contributors for 1993 and 1994 from the Foundation Center. To obtain descriptions of federal programs and target populations, we used ONDCP's budget summaries as our primary source of information. These data were the latest available from the sources mentioned above. Even though federal and state fiscal periods often differ, to be as consistent as possible, we analyzed funding data reported for fiscal years 1990 through 1994.

Although the data contained in this report were the latest and most comprehensive that were readily available, they do not reflect the total contributions of public and private sources that fund substance abuse treatment and prevention activities.\3 For example, federal data do not include alcohol-only programs; state and county expenditure data represent only those programs that receive funds from state alcohol and drug abuse agencies; and private sector funding is for treatment services only. (See app. I for a detailed description of our scope and methodology.)

-------------------- \1 Throughout this report, "drug and alcohol abuse" is referred to as "substance abuse."

\2 Budget authority is the authority provided by law to enter into financial obligations that will result in immediate or future outlays involving federal government funds.

\3 Our three primary data sources (ONDCP, NASADAD, and SAMHSA) use different methods of collecting and reporting data, and they do not include all possible sources of funding for substance abuse prevention and treatment activities.

RESULTS IN BRIEF ------------------------------------------------------------ Letter :1

Federal, state, county, and local governments and the private sector together reported contributing several billion dollars annually to substance abuse treatment and prevention programs, with a large portion going to treatment services. However, this estimate probably understates the total amounts because these entities do not report their total contributions to treatment and prevention activities. From fiscal year 1990 through 1994, federal funding jumped from $2.8 billion to $4.4 billion, with the Departments of Health and Human Services (HHS), Veterans Affairs (VA), and Education accounting for about 83 percent of this amount. Combined state, county, and local expenditures increased from about $1.3 billion to about $1.6 billion.\4 Although data on private sector funding for substance abuse treatment are very limited, available sources indicate funding of more than $1 billion in 1993.

Numerous programs in 16 federal agencies cover a broad range of treatment and prevention services and often target specific populations, such as youths, women, and veterans. Generally, treatment services include diagnostic assessment, detoxification, and counseling. Prevention activities usually include providing information and education about alternatives to and consequences of alcohol abuse and illicit drug use. Examples of federal programs that provide treatment, prevention, or both services include the Pregnant and Postpartum Women and Infants program and the Safe and Drug-Free Schools and Communities program.

-------------------- \4 Because fiscal year periods can differ among federal, state, county, and local governments, this dollar range is as precise as possible.

BACKGROUND ------------------------------------------------------------ Letter :2

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

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

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

THE FEDERAL GOVERNMENT FUNDS A MAJOR PORTION OF SUBSTANCE ABUSE TREATMENT AND PREVENTION ACTIVITIES ------------------------------------------------------------ Letter :3

The federal government provides a large portion of the financial support for substance abuse treatment and prevention activities. For fiscal year 1994, federal budget authority for treatment and prevention activities was $4.4 billion--a 59-percent increase over the 1990 amount.\5 \6 When adjusted for inflation, this equates to a 41.3-percent increase from 1990 through 1994. Three departments--HHS, VA, and Education--accounted for the vast majority of the 1994 budget authority. The substance abuse programs that federal agencies fund provide a variety of services; however, treatment programs received a much larger proportion of funding than prevention programs in 1994. It should be noted that the data we obtained may not accurately represent total federal support for treatment and prevention because some programs may have been omitted and much of the data has not been independently validated.

-------------------- \5 The total federal government funding for efforts to reduce drug and alcohol use in fiscal year 1994 was about $12.2 billion. Activities other than treatment and prevention include, for example, law enforcement and international activities.

\6 In this report, we use a fiscal year's actual budget authority as reported in the following year's national drug control strategy budget summary. For example, fiscal year 1990's actual budget authority was taken from the 1991 National Drug Control Strategy's budget summary. According to ONDCP officials, these amounts do not reflect adjustments made in subsequent years due to congressional action and program changes. Prior years' actual budget authority will continue to be subjected to adjustments that reflect these types of changes. Each year, ONDCP updates prior year actual budget authority figures in the historical tables included in the strategy's appendix.

FEDERAL FUNDING FOR TREATMENT AND PREVENTION HAS INCREASED SINCE FISCAL YEAR 1990 ---------------------------------------------------------- Letter :3.1

Federal funding for substance abuse treatment and prevention activities increased by $1.6 billion from fiscal year 1990 through 1994. During this time period, the number of federal agencies that reported funding for treatment and prevention programs rose from 12 to 16. Federal budget authority for fiscal year 1990 was $2.8 billion, but by fiscal year 1994 the funding amount had reached $4.4 billion. (See app. II for federal funding by agency for fiscal years 1990 through 1994.) The most recent data released by ONDCP show that fiscal year 1995 budget authority for treatment and prevention activities increased about $250 million over the 1994 amount.\7 (See app. III.)

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

The changes in funding for substance abuse treatment and prevention services among all 16 agencies ranged from a 196-percent increase to about a 27-percent decrease.\8 The Department of Housing and Urban Development (HUD) had the highest percentage increase in funding. Its budget authority went from $106.5 million to $315 million--the bulk of which appeared to be for increases in drug elimination grants that fund drug prevention and control at public and Native American housing developments. The Department of Justice had the highest percentage decrease. Its budget authority declined from $133 million to about $98 million. Although some offices within Justice experienced increases in their budget authority, the Office of Justice Programs' $50 million decrease resulted in Justice's overall decline in funding for substance abuse treatment and prevention activities.

-------------------- \7 ONDCP's 1996 National Drug Control Strategy contains fiscal year 1995 actual federal budget authority, the 1996 estimate, and the President's 1997 request for substance abuse treatment and prevention activities. Although ONDCP released its 1996 strategy before we issued this report, its data are not included in our analysis of federal funding.

\8 When adjusted for inflation, the percentages range from a 162-percent increase to a 35-percent decrease.

THREE DEPARTMENTS ACCOUNTED FOR MOST FUNDING IN FISCAL YEAR 1994 ---------------------------------------------------------- Letter :3.2

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

Figure 1: Treatment and Prevention Funding by Federal Agency , Fiscal Year 1994

(See figure in printed edition.)

Note: In addition, the Small Business Administration devoted $200,000 to prevention activities.

Source: ONDCP, 1995 National Drug Control Strategy Budget Summary (Washington, D.C.: ONDCP, 1995).

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

Figure 2: Proportion of Total Federal Funding for Treatment Versus Prevention, Fiscal Year 1994

(See figure in printed edition.)

Source: ONDCP, 1995 National Drug Control Strategy Budget Summary (Washington, D.C.: ONDCP, 1995).

FEDERAL PROGRAMS PROVIDE A MIXED MENU OF SERVICES FOR TARGETED POPULATIONS ---------------------------------------------------------- Letter :3.3

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

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

FEDERAL DATA LIMITATIONS AFFECT THEIR USEFULNESS ---------------------------------------------------------- Letter :3.4

ONDCP was the most comprehensive single source for information on federal substance abuse treatment and prevention funding and programs. However, ONDCP's budget summary data are limited in their coverage of substance abuse programs and are not routinely subjected to large-scale verification. We observed that ONDCP does not always include alcohol treatment and prevention programs in its budget summaries. For example, no information on NIH's National Institute on Alcohol Abuse and Alcoholism is included in NIH's budget authority. Moreover, when we compared ONDCP's data with federal agencies' justifications of budget estimates prepared for congressional appropriations committees, the combined funding for three agencies differed by about $655 million in fiscal year 1994.\9 According to ONDCP officials, the differences are due to the inclusion of alcohol-only programs in the agencies' justification of estimates. ONDCP does not include alcohol-only programs in its budget summary because these programs are not "scored"--that is, categorized--as drug programs. Additionally, VA's 1996 congressional budget justification did not include VA's full complement of treatment programs. Data limitations also stem from the use of different methods of estimating the amount of program funding specifically used for substance abuse treatment and prevention and from different determinations of what constitutes a prevention or treatment program.

-------------------- \9 Only SAMHSA, VA, and the Indian Health Service's justifications of estimates for fiscal year 1996 included detailed substance abuse treatment and prevention funding data that allowed for comparisons with ONDCP's budget summaries.

STATE, COUNTY, AND LOCAL GOVERNMENTS SPEND MORE THAN A BILLION DOLLARS ANNUALLY ------------------------------------------------------------ Letter :4

The combined contributions of state, county, and local governments constitute a sizable portion of the financial support for substance abuse treatment and prevention activities. In fiscal year 1994, these entities spent about $1.6 billion--most of which was used for treatment services.\10 This fiscal year 1994 spending exceeded fiscal year 1990 expenditures by about 22 percent (about 8 percent when adjusted for inflation). Users of these data should note that total spending by state and local governments probably exceeds these reported expenditures.

-------------------- \10 Throughout the discussion of state, county, and local governments' expenditures, the District of Columbia and U.S. territories are counted as states unless otherwise noted.

STATE, COUNTY, AND LOCAL GOVERNMENT SPENDING HAS INCREASED SINCE FISCAL YEAR 1990 ---------------------------------------------------------- Letter :4.1

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

Figure 3: Percentage of State, County, and Local Substance Abuse Expenditures for Treatment and Prevention Activities, Fiscal Year 1994

(See figure in printed edition.)

STATE, COUNTY, AND LOCAL GOVERNMENTS' DATA LIMITATIONS AFFECT THEIR USEFULNESS ---------------------------------------------------------- Letter :4.2

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

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

DATA ON PRIVATE FUNDING OF SUBSTANCE ABUSE TREATMENT AND PREVENTION ARE SCARCE ------------------------------------------------------------ Letter :5

Comprehensive data on private funding of substance abuse treatment and prevention activities over time are sparse. The National Drug and Alcoholism Treatment Unit Survey (NDATUS), which compiled private contributions from various sources, focused on treatment only.\11 NDATUS data show that private funding for substance abuse treatment services amounted to a little over $1 billion in 1993 (the latest year for which data were available). The largest source of private funding was third-party payments by health insurers and health maintenance organizations (about 55 percent of total private funding). Private donations, which included contributions from foundations, accounted for about 7 percent. (See table 1.)

Table 1

Private Funding Sources for Substance Abuse Treatment Services, 1993

Number of Total funding treatment (dollars in units Private funding source thousands) reporting\ -------------------------- -------------- -------------- Private third-party $581,536 3,111 payments\a Client fees\b 400,736 5,164 Private donations\c 73,198 1,775 ========================================================== Total $1,055,470 7,178\d ---------------------------------------------------------- \a Third-party payments include funds paid by insurers and health maintenance organizations.

\b Client fees include direct payments made by clients to treatment providers for client services.

\c Private donations include contributions from foundations.

\d Of the 11,496 treatment providers surveyed, 7,178 reported funding from at least one of the three private sources; some providers received funding from more than one private source.

Source: Office of Applied Studies, NDATUS (Washington, D.C.: HHS, Public Health Service, SAMHSA, 1993).

Data on private donations from foundations show that the top 25 contributors awarded $39.4 million in grants for substance abuse treatment and prevention programs during 1993 and 1994 (the latest years for which grant data were available).\12 The grant amounts ranged from $306,342 to about $18.5 million (see app. VIII). These grants were provided to nonprofit organizations in the United States and abroad to cover substance abuse treatment and prevention programs, including counseling, education, residential care facilities, halfway houses, support groups, family services, community programs, and services for children of drug-dependent parents. Grants were also awarded for medical research on substance abuse and media projects on substance abuse prevention. Population groups receiving the largest grant amounts were alcohol or drug abusers, children and youths, women and girls, economically disadvantaged individuals, offenders or ex-offenders, and minorities.

-------------------- \11 Sponsored by SAMHSA's Office of Applied Studies, NDATUS is a census of substance abuse treatment units in the United States and U.S. territories. Funding data are reported for a 12-month period.

\12 The Foundation Center, Grants for Alcohol and Drug Abuse (New York: The Foundation Center, 1995-96).

PRIVATE DATA HAVE MAJOR LIMITATIONS THAT AFFECT THEIR USEFULNESS ---------------------------------------------------------- Letter :5.1

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

CONCLUSIONS ------------------------------------------------------------ Letter :6

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

AGENCY COMMENTS ------------------------------------------------------------ Letter :7

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

---------------------------------------------------------- Letter :7.1

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

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

Sarah F. Jaggar Director, Health Services Quality and Public Health Issues

SCOPE AND METHODOLOGY =========================================================== Appendix I

To determine the level of federal funding and what federal programs exist for substance abuse treatment and prevention activities, we used three data sources: (1) the Office of National Drug Control Policy's (ONDCP) budget summaries from its National Drug Control Strategies, (2) federal agencies' justifications of estimates for appropriations committees, and (3) the 1995 Catalog of Federal Domestic Assistance. We also interviewed ONDCP officials. Using the ONDCP budget summaries as our primary data source, we identified federal agencies that fund substance abuse treatment and prevention services and obtained funding data and program descriptions starting in fiscal year 1990. The latest ONDCP budget summary available at the time of our analysis contained actual budget authority for fiscal year 1994, budget estimates for fiscal year 1995, and budget requests for fiscal year 1996.\13 We obtained additional funding data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) because information on its programs was either not included or not specifically identified in ONDCP's budget summaries. The agencies' justifications of estimates were of minimal use because, in most cases, they did not identify substance abuse treatment and prevention funding or provide a description of the programs. Where possible, we compared the justifications with ONDCP's budget summaries. We reviewed the 1995 Catalog of Federal Domestic Assistance but made only minimal use of its data to fill gaps in program descriptions.

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

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

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

-------------------- \13 ONDCP did not produce a budget summary for fiscal year 1993 that would have contained actual fiscal year 1992 budget authority.

FEDERAL BUDGET AUTHORITY FOR SUBSTANCE ABUSE TREATMENT AND PREVENTION ACTIVITIES, FISCAL YEARS 1990-94 ========================================================== Appendix II

(Millions of dollars)

Percent age change FY FY 1990 FY 1991 FY 1993 FY 1994 1990- Agency actual actual actual actual 94\a ------------- ------- ------- ------- ------- ------- HHS $1,437. $1,918. $2,121. $2,222. 54.6 9 4 0 9 Administratio 0 106.3 88.9 89.8 \b,c n for Children and Families Centers for 25.2 29.3 31.2 36.6 \b Disease Control and Prevention Health Care 170.0 190.5 231.9 231.8 \b Financing Administrati on Health 0 0 20.9 33.4 \b,c Resources and Services Administrati on Indian Health 32.8 35.3 44.9 43.3 \b Service National 0 0 404.2 425.2 \b,c Institutes of Health\d SAMHSA 0 0 1,299.0 1,362.8 \b,c Alcohol, Drug 1,168.4 1,557.0 0 0 \b,c Abuse, and \e \f Mental Health Administrati on Human 39.5 0 0 0 \b,c Development Services Family 2.0 0 0 0 \b,c Support Administrati on Veterans 305.6 473.1 905.1 854.1 179.5 Affairs Education 602.8 683.1 700.9\g 598.8\h -0.7 Housing and 106.5 150.0 175.0 315.0 195.8 Urban Development Justice 133.3 117.6 118.8 97.8 -26.6 Bureau of 8.0 10.7 21.1 21.6 \b Prisons Drug 2.2 2.2 1.9 2.9 \b Enforcement Administrati on Office of 123.1 104.7 95.8 73.3 \b Justice Programs Labor 46.0 67.6 65.1 91.1 98.0 Defense 83.4 86.5 100.1 88.8 6.5 The Federal 0 34.6 40.7 63.0 \c Judiciary Corporation 0 0 9.7 28.2 \c for National Service Social 0 0 0 18.8 \c Security Administrati on Agriculture 0 0 12.9 14.6 \c Special 0 0 12.9 14.6 \b,c Supplemental Program for Women, Infants, and Children (WIC) U.S. Forest 0 0 0 0 \b,c Service State 5.4 7.1 5.0 9.9 83.3 Agency for 5.4 7.1 0 0 \b,c International Development Bureau of 0 0 5.0 9.9 \b,c International Narcotics and Law Enforcement Transportatio 9.1 7.3 30.8 7.4 -18.7 n Federal 9.1 7.3 7.8 7.4 \b Aviation Administrati on National 0 0 23.0 0 \b,c Highway Traffic Safety Administrati on Interior 3.0 4.2 5.0 5.7 90.0 Bureau of 2.2 3.1 3.6 4.1 \b Indian Affairs Bureau of 0.3 0.3 0.4 0.4 \b Land Management National Park 0.4 0.4 0.4 0.4 \b Service Office of 0.1 0.4 0.6 0.8 \b Territorial and Internationa l Affairs Treasury 0 0 0 4.6 \c U.S. Secret 0 0 0 4.6 \b,c Service Small 0 0.1 0.2 0.2 \c Business Administrati on ACTION 10.5 12.5 0 0 \c U.S. Courts 31.9 0 0 0 \c ========================================================== Total $2,775. $3,562. $4,290. $4,420. 59.3 4 1 3 9 ========================================================== Total in 1994 $3,127. $3,847. $3,975. $4,420. 41.3 dollars 9 1 5 9 ---------------------------------------------------------- Note: ONDCP did not produce a budget summary for 1993 that would have contained fiscal year 1992 actual budget authority.

\a Percentage changes are not adjusted for inflation.

\b Percentage changes are not presented for agencies' subunits.

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

\d All funding was used to sponsor treatment and prevention research.

\e Includes $285.8 million for treatment and prevention research.

\f Includes $336.3 million for treatment and prevention research.

\g Includes $1.5 million for treatment research.

\h Includes $1.5 million for treatment research.

Source: ONDCP, National Drug Control Strategy Budget Summaries (Washington, D.C.: ONDCP, 1991, 1992, 1994, and 1995).

FEDERAL BUDGET AUTHORITY FOR SUBSTANCE ABUSE TREATMENT AND PREVENTION ACTIVITIES, FISCAL YEARS 1995-97 ========================================================= Appendix III

(Millions of dollars)

FY 95 FY 96 FY 97 Agency actual estimate request ---------------------- ---------- ---------- ---------- ========================================================== HHS $2,276.4 $2,019.2 $2,300.7 Administration for 91.3 44.9 82.6 Children and Families Centers for Disease 44.5 44.1 61.1 Control and Prevention Health Care Financing 252.2 290.0 320.0 Administration Health Resources and 36.4 41.5 43.3 Services Administration Indian Health Service 42.8 42.8 42.8 National Institutes of 436.9 458.4 466.3 Health\a SAMHSA 1,372.3 1,097.5 1,284.6 ========================================================== Veterans Affairs 966.5 1,009.1 1,056.0 ========================================================== Education 584.0\b 618.1\b 658.8\c ========================================================== Housing and Urban 300.8 290.0 290.0 Development ========================================================== Justice 121.4 150.0 160.0 Bureau of Prisons 22.2 23.9 25.2 Drug Enforcement 3.1 2.7 3.4 Administration Office of Justice 96.1 123.4 131.4 Programs ========================================================== Labor 60.0 60.9 60.9 ========================================================== Defense 89.2 85.2 83.2 ========================================================== The Federal Judiciary 67.8 72.3 80.7 ========================================================== Corporation for 25.6 32.9 38.5 National Service ========================================================== Social Security 148.9 196.4 202.8 Administration ========================================================== Agriculture 14.0 15.1 15.4 Special Supplemental 13.9 15.0 15.3 Program for Women, Infants, and Children (WIC) U.S. Forest Service 0.1 0.1 0.1 ========================================================== Transportation 8.6 9.1 9.5 Federal Aviation 8.6 9.1 9.5 Administration ========================================================== Interior 4.7 4.0 4.1 Bureau of Indian 3.2 3.2 3.2 Affairs Bureau of Land 0.4 0.4 0.4 Management National Park Service 0.3 0.3 0.4 Office of Insular 0.8 0.1 0.1 Affairs ========================================================== Treasury 4.7 5.4 5.2 U.S. Secret Service 4.7 5.4 5.2 ========================================================== Small Business 0.1 0.1 0.1 Administration ========================================================== Total $4,672.7 $4,567.8 $4,965.9 ---------------------------------------------------------- Note: Although this appendix presents data from ONDCP's 1996 budget summary, we did not use these data elsewhere in our report because the budget summary was published after the data collection and analysis phases of our work were completed.

\a All funding was used to sponsor treatment and prevention research.

\b Includes $1.9 million for treatment research.

\c Includes $800,000 for treatment research.

Source: ONDCP, National Drug Control Strategy, 1996: Program, Resources, and Evaluation (Washington, D.C.: ONDCP, 1996).

FEDERAL SUBSTANCE ABUSE TREATMENT AND PREVENTION PROGRAM FUNDING AND DESCRIPTIONS ========================================================== Appendix IV

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

HHS -------------------------------------------------------- Appendix IV:1

ADMINISTRATION FOR CHILDREN AND FAMILIES ------------------------------------------------------ Appendix IV:1.1

Table IV.1

Administration for Children and Families Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $57.5 $62.4 $72.7 Treatment 32.2 32.2 32.3 ========================================================== Total $89.8 $94.5 $104.8 ----------------------------------------------------------

Table IV.2

Administration for Children and Families Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Consolidated Runaway $14.6 $14.5 $14.5 and Homeless Youth Youth Gang/Youth 10.6 10.5 10.5 Initiative Abandoned Infants 14.5 14.4 14.4 Assistance Emergency Protection/ 19.0 19.0 19.0 Community-Based Resource Centers Head Start 25.0 25.0 26.0 Temporary Child Care/ 6.0 5.9 5.9 Crisis Nurseries Crime Control Act: \a 5.2 14.5 Community Schools Youth Services and Supervision Grant Program (Title III) ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

CONSOLIDATED RUNAWAY AND HOMELESS YOUTH ---------------------------------------------------- Appendix IV:1.1.1

The program's goal is to establish and operate local centers to address the immediate needs of runaway and homeless youth and their families, including temporary shelter, food, clothing, and counseling. (Note: Program description is based on the 1995 Catalog of Federal Domestic Assistance.)

YOUTH GANG/YOUTH INITIATIVE ---------------------------------------------------- Appendix IV:1.1.2

This program aims to (1) prevent and reduce the participation of youth in gangs that engage in illicit drug-related activities and to prevent youth abuse of drugs; (2) help coordinate activities of local police departments, education, employment, and social service agencies; (3) provide information on the treatment and rehabilitation options available to youth; (4) coordinate support between schools and state and federal governments; and (5) provide technical assistance to organizations. (Note: Program description is based on the 1995 Catalog of Federal Domestic Assistance.)

ABANDONED INFANTS ASSISTANCE ---------------------------------------------------- Appendix IV:1.1.3

The program's goal is to prevent the abandonment of infants and young children and to identify and address their needs. Of special concern are those infants and young children who have been infected with the human immunodeficiency virus (HIV) or who have been prenatally exposed to the virus or a dangerous drug. (Note: Program description is based on the 1995 Catalog of Federal Domestic Assistance.)

EMERGENCY PROTECTION/COMMUNITY-BASED RESOURCE CENTERS ---------------------------------------------------- Appendix IV:1.1.4

The Emergency Protection program was consolidated with the Community-Based Resource Centers program in fiscal year 1995. Together, they offer a range of child abuse and neglect prevention activities, including services for children of substance-abusing families.

HEAD START ---------------------------------------------------- Appendix IV:1.1.5

Substance abuse, along with illiteracy and unemployment, is a major barrier to the self-sufficiency of Head Start families. Head Start funds are used to provide substance abuse prevention and other community-based services to parents and other family members of children enrolled in Head Start as well as literacy and unemployment services.

TEMPORARY CHILD CARE/CRISIS NURSERIES ---------------------------------------------------- Appendix IV:1.1.6

The program's goals are to support, develop, and expand respite care for infants and children, including those who are drug-exposed and those who have acquired immunodeficiency syndrome (AIDS) or AIDS-related conditions, and to support crisis nurseries for abused and neglected children, including those from substance-abusing families.

CRIME CONTROL ACT: COMMUNITY SCHOOLS YOUTH SERVICES AND SUPERVISION GRANT PROGRAM (TITLE III) ---------------------------------------------------- Appendix IV:1.1.7

The program supports school-based, after-school programs in areas of significant poverty and juvenile delinquency. Activities include supervised sports; extracurricular and academic programs; and access to health care services, including substance abuse prevention and treatment.

CENTERS FOR DISEASE CONTROL AND PREVENTION ------------------------------------------------------ Appendix IV:1.2

Table IV.3

Centers for Disease Control and Prevention Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $36.6 $44.5 $50.0 Treatment 0 0 0 ========================================================== Total $36.6 $44.5 $50.0 ----------------------------------------------------------

Table IV.4

Centers for Disease Control and Prevention Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- AIDS Drug Counseling $36.6 $44.5 $50.0 ---------------------------------------------------------- Funds provide services for injecting drug users (IDU), including HIV counseling, testing, referral, and partner notification services for IDUs in drug treatment centers and other facilities, and health education and risk reduction efforts directed at IDUs not in treatment.

HEALTH CARE FINANCING ADMINISTRATION ------------------------------------------------------ Appendix IV:1.3

Table IV.5

Health Care Financing Administration Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention 0 0 0 Treatment $231.8 $252.2 $290.0 ========================================================== Total $231.8 $252.2 $290.0 ----------------------------------------------------------

Table IV.6

Health Care Financing Administration Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Medicaid $181.8 $202.2 $230.0 Medicare 50.0 50.0 60.0 ----------------------------------------------------------

MEDICAID ---------------------------------------------------- Appendix IV:1.3.1

The funds are used to provide drug abuse treatment for Medicaid-eligible individuals. Medicaid drug treatment expenditures are primarily for care received in hospitals and in specialized drug treatment facilities.

MEDICARE ---------------------------------------------------- Appendix IV:1.3.2

Medicare funding pays for inpatient hospital treatment of episodes of alcohol or drug abuse as well as some medical services in outpatient settings for Medicare-eligible individuals.

HEALTH RESOURCES AND SERVICES ADMINISTRATION ------------------------------------------------------ Appendix IV:1.4

Table IV.7

Health Resources and Services Administration Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention 0 0 0 Treatment $33.4 $36.4 $41.5 ========================================================== Total $33.4 $36.4 $41.5 ----------------------------------------------------------

Table IV.8

Health Resources and Services Administration Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Ryan White CARE Act $33.4 $36.4 $41.5 (Drug Component) ---------------------------------------------------------- The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act supports the provision of health care services (treatment and counseling) for drug-addicted people with AIDS in substance abuse treatment settings. Funds support state- and locally administered programs that provide a network of health care and support services for people living with HIV infection and AIDS, especially the uninsured.

INDIAN HEALTH SERVICE ------------------------------------------------------ Appendix IV:1.5

Table IV.9

Indian Health Service Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $4.3 $3.5 $3.7 Treatment 39.0 39.3 41.3 ========================================================== Total $43.3 $42.8 $45.0 ---------------------------------------------------------- Note: Totals in the agency's justification of estimates, which vary from those provided by ONDCP, are as follows: fiscal year 1994, $87.6 million; fiscal year 1995, $91.4 million; and fiscal year 1996, $96.0 million.

Table IV.10

Indian Health Service Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Alcohol and Substance $43.3 $42.8 $45.0 Abuse Program ---------------------------------------------------------- The program funds such activities as adolescent regional treatment centers, community rehabilitation and aftercare, training and community education, health promotion and disease prevention, the Navajo rehabilitation program, urban programs, contract health services, and the construction of regional treatment centers.

NATIONAL INSTITUTES OF HEALTH (NIH) ------------------------------------------------------ Appendix IV:1.6

Table IV.11

NIH Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention Research $174.8 $179.0 $185.5 Treatment Research 250.4 258.7 266.8 ========================================================== Total $425.2 $437.7 $452.3 ----------------------------------------------------------

Table IV.12

NIH Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Basic Biomedical $78.5 $83.9 $86.8 Neuro-Behavioral 63.6 69.8 73.0 Prevention-Specific 60.0 61.4 63.6 Treatment-Specific 128.1 133.2 137.4 Epidemiology 32.9 34.1 34.8 Training 7.9 0 0 Intramural 24.0 24.7 25.5 Resource Management 30.1 30.6 31.3 and Support ----------------------------------------------------------

BASIC BIOMEDICAL RESEARCH ---------------------------------------------------- Appendix IV:1.6.1

Biomedical research is used to better understand the addiction process, specifically the mechanisms by which cellular structure affects the function of neurotransmitter receptors and other proteins. Studies can now focus on the precise means by which specific drug receptors are regulated, with implications for discerning possible genetic predispositions to addiction and individual differences in response to treatment.

NEURO-BEHAVIORAL RESEARCH ---------------------------------------------------- Appendix IV:1.6.2

Brain imaging studies make it possible to assess cognitive functioning, feelings of euphoria/dysphoria, and levels of drug craving. Expanding these efforts will aid the development of effective drug abuse medications as well as prophylactic measures for combating and preventing drug abuse. Imaging techniques are promising as diagnostic tools for identifying individuals at high risk for drug abuse and for targeting specific treatment strategies.

PREVENTION-SPECIFIC RESEARCH ---------------------------------------------------- Appendix IV:1.6.3

The National Institute on Drug Abuse's (NIDA) prevention initiatives focus on at-risk youth groups, such as runaways, school dropouts, adolescents showing psychiatric disturbance, unmarried pregnant women, parenting youth, juvenile delinquents, and individuals in the sex trade. Research will continue on the biological and developmental vulnerability to drug addiction, including such studies as the role of genetic factors, the impact of the environment on drug abuse vulnerability, and the impact of behavioral and psychological factors that increase or decrease the likelihood of addiction. Drug treatment is an important avenue for preventing the spread of HIV/AIDS. Outreach activities that bring addicts into treatment and encourage HIV/AIDS risk reduction behavior among those who do not enter treatment will continue.

TREATMENT-SPECIFIC RESEARCH ---------------------------------------------------- Appendix IV:1.6.4

NIDA is continuing to expand its program of controlled testing of promising psychobehavioral therapies. Therapies shown to be most efficacious under ideal conditions will then be tested in community settings. Research will also focus on how best to target services to the needs of special populations, including those in underserved geographic areas. Support will continue for studies of special clinical problems presented by drug abusers with infectious diseases. In addition to synthesizing and testing novel medications for treating cocaine dependence, the medications development program will support a basic research effort to improve understanding of the molecular features of other drug receptors.

EPIDEMIOLOGY ---------------------------------------------------- Appendix IV:1.6.5

NIDA is continuing to support research on the incidence, prevalence, and adverse consequences of illicit drug use. Community-based epidemiologic and ethnographic research is intended to reach youth and other high-risk groups for whom prevention can yield the greatest benefits.

TRAINING, INTRAMURAL, AND RESOURCE MANAGEMENT AND SUPPORT ---------------------------------------------------- Appendix IV:1.6.6

No information was provided in the ONDCP 1995 budget summary.

SPECIFIC INFORMATION ON NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM AND NATIONAL INSTITUTE ON DRUG ABUSE ---------------------------------------------------- Appendix IV:1.6.7

ONDCP budget summaries do not include funds for alcohol-only programs. Therefore, the alcohol-only programs of NIAAA are not captured in table IV.11. NIDA and NIAAA provided the specific information in table IV.13.

Table IV.13

NIDA and NIAAA Budget Authority Specifics

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual actual request ---------------------- ---------- ---------- ---------- National Institute on Drug Abuse ---------------------------------------------------------- Prevention Research \a $91.2 $96.5 Treatment Research \a 198.4 208.6

National Institute on Alcohol Abuse and Alcoholism ---------------------------------------------------------- Prevention Research $35.0 36.4 37.8 Treatment Research 33.0 28.5 30.1 ---------------------------------------------------------- \a Data were not readily available given the short time frame.

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) ------------------------------------------------------ Appendix IV:1.7

Table IV.14

SAMHSA Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $435.6 $430.5 $415.7 Treatment 927.2 942.3 990.0 ========================================================== Total $1,362.8 $1,372.8 $1,405.7 ---------------------------------------------------------- Note: Totals in the agency's justification of estimates, which vary from those provided by ONDCP, are as follows: fiscal year 1994 actual, $1,670.8 million; fiscal year 1995 estimate, $1,695.1 million; and fiscal year 1996 request, $1,746.8 million. The differences could be attributed, at least in part, to ONDCP's decision not to account for alcohol-only programs.

Table IV.15

SAMHSA Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request\a ---------------------- ---------- ---------- ---------- Center for Substance Abuse Prevention ---------------------------------------------------------- High Risk Youth $63.3 $66.8 \a Pregnant and 43.4 20.9 \a Postpartum Women and Infants Community Prevention 114.7 114.7 \a (Partnership) Public Education and 10.8 13.5 \a Dissemination Training 14.5 16.0 \a Other Demonstrations 6.6 6.6 \a ========================================================== CSAP total $253.5 $238.6 \a

Center for Substance Abuse Treatment ---------------------------------------------------------- Crisis Areas/Target $34.8 $35.5 \a Cities

Treatment Improvement ---------------------------------------------------------- Pregnant/Postpartum 54.2 64.2 \a Women Critical Populations 43.7 23.6 \a Criminal Justice 34.0 37.5 \a Treatment Campus 4.1 \b \a Comprehensive 27.5 31.3 \a Community Treatment Program Training 5.4 5.6 \a AIDS Demonstrations, 21.2 18.0 \a Training, and Outreach Substance Abuse Block 834.3 877.1 \a Grant Treatment Capacity 15.3 6.7 \a Expansion Program ========================================================== CSAT total $1,074.6 $1,099.5 \a ========================================================== Program Management $34.7 $34.7 $33.2 ---------------------------------------------------------- \a In fiscal year 1996, SAMHSA's current prevention and treatment demonstrations were to have been combined to form the SAMHSA Consolidated Substance Abuse Demonstration and Training Cluster.

\b Program not in existence or program restructured into another program.

Table IV.16

SAMHSA Consolidated Substance Abuse Demonstration and Training Cluster Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Substance Abuse \a \a $919.8 Performance Partnership Substance Abuse \a \a 452.8 Training and Demonstration ---------------------------------------------------------- \a Program not in existence.

CENTER FOR SUBSTANCE ABUSE PREVENTION (CSAP) ---------------------------------------------------- Appendix IV:1.7.1

High Risk Youth: The program provides funding to public and nonprofit private entities to demonstrate and evaluate comprehensive strategies to prevent and reduce the use of alcohol, tobacco, and other drugs among youth at high risk for such behavior. Components of the High Risk Youth program include the projects that demonstrate and evaluate comprehensive strategies to prevent substance abuse-related violence among or affecting youth aged 6 through 14 and specifically tailored to the prevention needs of adolescent females.

Pregnant and Postpartum Women and Infants: This demonstration program targets the substance abuse problems of pregnant and postpartum women and infants. It is intended to develop innovative, community-based models for the coordination of service systems that link health promotion and treatment services for substance-using pregnant women and their young children.

Community Prevention (Partnership): These demonstrations are designed to assist communities in developing comprehensive, coordinated prevention initiatives, including the formation of public and private sector partnerships that are responsive to local, state, and multistate needs. The demonstrations support communitywide, locally identified programs and empower communities to solve their alcohol and other drug problems. Community Partnership grants are awarded to communities for establishing coalitions of organizations (parents, schools, academia, business, industry, government, and professionals) to plan and implement comprehensive prevention efforts.

Public Education and Dissemination: The program provides alcohol and other drug information and training to providers and individuals in schools, workplaces, and communities. Public education initiatives serve a special need both by involving the public and by building and maintaining support for prevention. The National Clearinghouse for Alcohol and Drug Information is CSAP's primary dissemination channel.

Training: Community prevention training programs provide specialized skills and strategies to Partnership grantees, other prevention coalitions and communities, and state and territorial and Native American tribal agencies working to reduce alcohol and other drug problems. Community resource building, violence prevention, and cultural diversity serve as the primary focus for these training programs. Medical education grants provide appropriate clinical prevention training for health professionals in advanced degree training programs.

Other Demonstrations: These demonstration programs were not clearly defined in the source documents.

CENTER FOR SUBSTANCE ABUSE TREATMENT (CSAT) ---------------------------------------------------- Appendix IV:1.7.2

Crisis Areas/Target Cities: A series of intergovernmental cooperative agreements has been designed to improve treatment systems in metropolitan areas. The agreements also link and integrate alcohol and other drug services with disease prevention, primary health, mental health, labor, education, and the justice systems. Through the establishment of central intake, assessment, and referral systems, this initiative facilitates better matching of patients to treatment and more rapid referral to treatment services.

Treatment Improvement:

Pregnant/Postpartum Women: Comprehensive treatment services in residential settings permit infants and children to live with their substance-using mothers. Components of these programs include assessment, crisis stabilization, substance abuse treatment, treatment for children perinatally exposed to alcohol and other drugs, primary health care, prenatal and postnatal health care, and education and counseling related to AIDS and other sexually transmitted diseases. These programs also address domestic violence; sexual abuse; psychological, legal, and employment issues; and parenting skills.

Critical Populations: These treatment initiatives target outpatient treatment services for a variety of populations, including women and children in or at risk of being in the child welfare system, adolescents, racial and ethnic minorities, and people in rural areas. These initiatives improve physical, emotional, and social functioning; increase educational levels and vocational development; and reduce relapse rates.

Criminal Justice: The program supports and evaluates demonstration projects that offer a wide range of diversion-to-treatment concepts and treatment for high-risk probation and parole clients. Innovative projects involve intensive day treatment centers and case management/supervision models. Under these models, links are developed to family and critical community resources, including education and job placement, mental health services, and housing and related social services.

Treatment Campus: Two campus projects, one in Secaucus, New Jersey, and the other in Houston, Texas, provide a range of state-of-the-art treatment methods and associated social services in settings where several treatment providers share central intake, recreational, and commissary facilities. This demonstration model allows for the comparison and evaluation of alternative approaches to treatment.

Comprehensive Community Treatment Program: The program supports a wide array of substance abuse treatment initiatives designed to improve the effectiveness and comprehensiveness of treatment services. The Rural, Remote, and Culturally Distinct Populations initiative supports substance abuse and/or dependence intervention, treatment, and recovery services for individuals with culturally distinct characteristics. Other initiatives support collaborations with agencies to deliver health care and substance abuse treatment services in rural areas; support substance abuse treatment at four Job Corps Centers across the country; fund projects to develop a manual on a specific clinical intervention for treating homeless individuals with co-occurring mental health and substance abuse disorders; and fund the Models of Managed Care for Supplemental Security Income Beneficiaries program.

Training: The program provides funds for Addiction Training Centers to develop and maintain a network responsible for cultivating and training a cadre of health and allied health practitioners devoted to addiction treatment and recovery. It allows coordination among universities, state and local government programs, and the nonprofit addiction treatment field.

AIDS Demonstrations, Training, and Outreach: The AIDS Health Care Worker Training initiative focuses on the relationships among substance abuse, HIV/AIDS, tuberculosis, and sexually transmitted diseases in an effort to develop knowledge about and competency-based training in the provision of treatment services. Collaborations with the Health Resources and Services Administration support an AIDS Linkage demonstration designed to strengthen the links among and integration of the primary health care, alcohol, substance abuse, HIV/AIDS, and mental health treatment systems. This initiative supports activities to create comprehensive, community-based model programs to better serve the needs of distinct populations (injecting drug users; other high-risk substance abusers; their sexual partners; and, particularly, substance abusers who are members of critical populations). AIDS Outreach Demonstrations support outreach and appropriate service links for the target populations.

Substance Abuse Block Grant: The President's proposed fiscal year 1996 budget restructures the Substance Abuse Prevention and Treatment Block Grant into the Substance Abuse Performance Partnership. The proposed legislation assumes maintenance of key requirements, earmarks, and set-asides from the old law.

Treatment Capacity Expansion Program: Before this program expired in fiscal year 1995, its function, in part, was to expand the capacity of treatment programs.

DEPARTMENT OF VETERANS AFFAIRS (VA) -------------------------------------------------------- Appendix IV:2

Table IV.17

VA Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $0.3 $0.8 $0.8 Treatment 853.8 886.6 928.6 ========================================================== Total $854.1 $887.4 $929.4 ---------------------------------------------------------- Note: VA's justification of estimates identified obligations for fiscal year 1994 as $551.4 million, for fiscal year 1995 as $563.3 million, and for fiscal year 1996 as $586.5 million. The budget justification did not identify these amounts as actual or estimated.

Table IV.18

VA Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Substance Abuse $854.1 $887.4 $929.5 Treatment Program ---------------------------------------------------------- Through the Veterans Health Administration, VA operates a network of substance abuse treatment programs in its medical centers, domiciliaries, and outpatient clinics.

DEPARTMENT OF EDUCATION -------------------------------------------------------- Appendix IV:3

Table IV.19

Department of Education Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $490.6 $487.8 $510.0 Treatment 108.2 117.4 117.7 ========================================================== Total $598.8 $605.2 $627.7 ----------------------------------------------------------

Table IV.20

Department of Education Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Office of Elementary and Secondary Education ----------------------------------------------------------

Drug-Free Schools and Communities Act ---------------------------------------------------------- State Grants $369.5 \a \a School Personnel 13.6 \a \a Training Grants National Programs 59.5 \a \a (including regional centers) Emergency Grants 24.6 \a \a

Safe and Drug-Free Schools and Communities Act ---------------------------------------------------------- State Grants \a 457.0 465.0 National Programs \a 25.0 35.0 Safe Schools Act 20.0 0 \b

Crime Control Act ---------------------------------------------------------- Family and Community \b 2.2 6.2 Endeavor Schools (FACES)

Office of Special Education and Rehabilitative Services, Rehabilitative Services Admi ---------------------------------------------------------- Vocational 79.0 82.2 84.8 Rehabilitation State Grants Special Demonstrations 1.3 1.3 0

Office of Special Education Programs ---------------------------------------------------------- Grants for Infants and 25.3 31.6 31.6 Families Special Education 2.1 1.8 1.2 Special Purpose Funds

National Institute on Disability and Rehabilitation Research ---------------------------------------------------------- Rehabilitation 0.4 0.4 0.4 Research Training Centers and other programs

Program Administration ---------------------------------------------------------- Administration 3.6 3.8 4.0 ---------------------------------------------------------- \a The Drug-Free School and Communities Act expired at the end of fiscal year 1994; its authorization was extended under the Safe and Drug-Free Schools and Communities Act.

\b Program not in existence or program restructured into another program.

OFFICE OF ELEMENTARY AND SECONDARY EDUCATION ------------------------------------------------------ Appendix IV:3.1

DRUG-FREE SCHOOLS AND COMMUNITIES ACT/SAFE AND DRUG-FREE SCHOOLS AND COMMUNITIES ACT ---------------------------------------------------- Appendix IV:3.1.1

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

SAFE SCHOOLS ACT ---------------------------------------------------- Appendix IV:3.1.2

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

CRIME CONTROL ACT ---------------------------------------------------- Appendix IV:3.1.3

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

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, REHABILITATIVE SERVICES ADMINISTRATION ------------------------------------------------------ Appendix IV:3.2

VOCATIONAL REHABILITATION STATE GRANTS ---------------------------------------------------- Appendix IV:3.2.1

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

SPECIAL DEMONSTRATIONS ---------------------------------------------------- Appendix IV:3.2.2

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

OFFICE OF SPECIAL EDUCATION PROGRAMS ------------------------------------------------------ Appendix IV:3.3

GRANTS FOR INFANTS AND FAMILIES ---------------------------------------------------- Appendix IV:3.3.1

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

SPECIAL EDUCATION SPECIAL PURPOSE FUNDS ---------------------------------------------------- Appendix IV:3.3.2

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

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH ------------------------------------------------------ Appendix IV:3.4

REHABILITATIVE RESEARCH TRAINING CENTERS AND OTHER PROGRAMS ---------------------------------------------------- Appendix IV:3.4.1

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

PROGRAM ADMINISTRATION ------------------------------------------------------ Appendix IV:3.5

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

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) -------------------------------------------------------- Appendix IV:4

Table IV.21

HUD Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $290.0 $295.4 $290.3 Treatment 25.0 5.4 \a ========================================================== Total $315.0 $300.8 $290.3 ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

Table IV.22

HUD Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Drug Elimination $265.0 $290.0 $290.0 Grants/Community Partnership Against Crime Empowerment Zones and 50.0 10.8 \a Enterprise Communities Crime Control Act \a \a 0.3 (Local Partnership Act) ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

DRUG ELIMINATION GRANTS/COMMUNITY PARTNERSHIP AGAINST CRIME ---------------------------------------------------- Appendix IV:4.0.1

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

EMPOWERMENT ZONES AND ENTERPRISE COMMUNITIES ---------------------------------------------------- Appendix IV:4.0.2

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

CRIME CONTROL ACT (LOCAL PARTNERSHIP ACT) ---------------------------------------------------- Appendix IV:4.0.3

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

DEPARTMENT OF JUSTICE -------------------------------------------------------- Appendix IV:5

BUREAU OF PRISONS ------------------------------------------------------ Appendix IV:5.1

Table IV.23

Bureau of Prisons Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention 0 0 0 Treatment $21.6 $22.2 $23.9 ========================================================== Total $21.6 $22.2 $23.9 ----------------------------------------------------------

Table IV.24

Bureau of Prisons Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Drug abuse treatment $21.6 $22.2 $23.9 ---------------------------------------------------------- The Bureau has a comprehensive drug abuse treatment strategy with four components: drug abuse education, nonresidential drug abuse counseling services, residential drug abuse program, and community-transitional services programming. An estimated 30.5 percent of the sentenced inmate population is drug dependent and requires some type of drug abuse treatment program.

DRUG ENFORCEMENT ADMINISTRATION ------------------------------------------------------ Appendix IV:5.2

Table IV.25

Drug Enforcement Administration Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $2.9 $3.2 $3.1 Treatment 0 0 0 ========================================================== Total $2.9 $3.2 $3.1 ---------------------------------------------------------- Neither the ONDCP budget summary nor the agency's justification of estimates identified the prevention components.

OFFICE OF JUSTICE PROGRAMS ------------------------------------------------------ Appendix IV:5.3

Table IV.26

Office of Justice Programs Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $33.6 $81.9 $48.4 Treatment 39.7 78.8 70.6 ========================================================== Total $73.3 $160.7 $119.0 ----------------------------------------------------------

Table IV.27

Office of Justice Programs Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Bureau of Justice $73.3 $160.7 $119.0 Assistance, Bureau of Justice Statistics, National Institute of Justice, and Office of Juvenile Justice and Delinquency Prevention ----------------------------------------------------------

BUREAU OF JUSTICE ASSISTANCE ---------------------------------------------------- Appendix IV:5.3.1

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

BUREAU OF JUSTICE STATISTICS ---------------------------------------------------- Appendix IV:5.3.2

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

NATIONAL INSTITUTE OF JUSTICE ---------------------------------------------------- Appendix IV:5.3.3

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

OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION ---------------------------------------------------- Appendix IV:5.3.4

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

COMMUNITY POLICING ------------------------------------------------------ Appendix IV:5.4

Table IV.28

Community Policing Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention \a $182.0 $314.0 Treatment 0 0 0 ========================================================== Total 0 $182.0 $314.0 ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

Table IV.29

Community Policing Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Community Policing \a $182.0 $314.0 ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

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

DEPARTMENT OF LABOR -------------------------------------------------------- Appendix IV:6

Table IV.30

Department of Labor Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $91.1 $93.5 $80.4 Treatment 0 0 0 ========================================================== Total $91.1 $93.5 $80.4 ----------------------------------------------------------

Table IV.31

Department of Labor Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Employment and $88.9 $91.4 $78.3 Training Administration (Job Training Program) Departmental 2.1 2.1 2.1 management ----------------------------------------------------------

EMPLOYMENT AND TRAINING ADMINISTRATION ---------------------------------------------------- Appendix IV:6.0.1

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

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

DEPARTMENTAL MANAGEMENT ---------------------------------------------------- Appendix IV:6.0.2

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

DEPARTMENT OF DEFENSE -------------------------------------------------------- Appendix IV:7

Table IV.32

Department of Defense Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $82.4 $88.4 $90.4 Treatment 6.2 6.7 6.8 ========================================================== Total $88.6 $95.1 $97.2 ----------------------------------------------------------

Table IV.33

Department of Defense Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Demand reduction $88.8 $96.0 $97.8 ---------------------------------------------------------- The Department of Defense's counterdrug strategy has among its objectives to reduce the demand for illegal drugs within the Department and its surrounding communities. The demand reduction program supports a counterdrug strategy of early drug abuse identification through testing and treatment of drug abusers and outreach programs for at-risk youth through the military departments and the National Guard Bureau. For community outreach pilot programs, congressional authorization is required to permit counterdrug funds to be spent on programs targeting youth outside the traditional Department community boundaries.

THE FEDERAL JUDICIARY -------------------------------------------------------- Appendix IV:8

Table IV.34

The Federal Judiciary Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention 0 0 0 Treatment $63.0 $70.4 $82.8 ========================================================== Total $63.0 $70.4 $82.8 ----------------------------------------------------------

Table IV.35

The Federal Judiciary Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Drug treatment under $63.0 $70.4 $82.8 U.S. court supervision ---------------------------------------------------------- The U.S. Courts operate the Substance Abuse Treatment Program. Offenders in this program are referred by the Judiciary and the Bureau of Prisons. The basic goal of the program is to identify and treat substance abusers who are under the supervision of the U.S. Probation Office. The program tries to protect the community by helping these offenders stop their substance abuse.

CORPORATION FOR NATIONAL SERVICE -------------------------------------------------------- Appendix IV:9

Table IV.36

Corporation for National Service Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $28.2 $39.4 $53.9 Treatment 0 0 0 ========================================================== Total $28.2 $39.4 $53.9 ----------------------------------------------------------

Table IV.37

Corporation for National Service Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Domestic Volunteer $9.9 $10.7 $13.0 Service Act activities National and Community 18.3 28.8 40.9 Service Act activities ---------------------------------------------------------- The Corporation for National Service administers programs that address the nation's education, human service, public safety, and environmental needs through the activities of volunteers and that expand the involvement of volunteers in responding to a wide range of community needs, including drug abuse prevention, by reaching high-risk youth and the communities in which they live.

SOCIAL SECURITY ADMINISTRATION ------------------------------------------------------- Appendix IV:10

Table IV.38

Social Security Administration Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention 0 0 0 Treatment $18.8 $157.9 $202.4 ========================================================== Total $18.8 $157.9 $202.4 ----------------------------------------------------------

Table IV.39

Social Security Administration Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Referral and $18.8 $109.0 $148.0 monitoring (Title XVI) Demonstration projects \a 10.0 \a (Title XVI) Disability Insurance \a 38.9 54.4 Trust Fund (Title II) ---------------------------------------------------------- \a Program not in existence or program restructured into another program.

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

DEPARTMENT OF AGRICULTURE ------------------------------------------------------- Appendix IV:11

FOOD AND CONSUMER SERVICES ----------------------------------------------------- Appendix IV:11.1

Table IV.40

Food and Consumer Services Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $14.6 $13.9 $15.4 Treatment 0 0 0 ========================================================== Total $14.6 $13.9 $15.4 ----------------------------------------------------------

Table IV.41

Food and Consumer Services Budget Authority by Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Special Supplemental $14.6 $13.9 $15.4 Program for Women, Infants, and Children (WIC) ---------------------------------------------------------- WIC provides nutritious supplemental foods to low-income pregnant, postpartum, and breastfeeding women and to infants and children younger than age 5 who are determined by professionals such as physicians, nurses, and nutritionists to be at nutritional risk. Funds flow through participating state agencies to local agencies, which provide supplemental foods to WIC participants along with nutrition education, breastfeeding promotion, and health care referrals. As part of nutrition education, WIC counsels participants about the dangers of substance abuse, including smoking during pregnancy. When appropriate, participants are referred to drug abuse counseling.

DEPARTMENT OF STATE ------------------------------------------------------- Appendix IV:12

BUREAU OF INTERNATIONAL NARCOTICS AND LAW ENFORCEMENT AFFAIRS ----------------------------------------------------- Appendix IV:12.1

Table IV.42

Bureau of International Narcotics and Law Enforcement Affairs Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $9.9 0 0 Treatment 0 0 0 ========================================================== Total $9.9 0 0 ---------------------------------------------------------- The ONDCP budget summary and the budget justification do not identify specific prevention program or activity dollars.

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

DEPARTMENT OF TRANSPORTATION ------------------------------------------------------- Appendix IV:13

FEDERAL AVIATION ADMINISTRATION ----------------------------------------------------- Appendix IV:13.1

Table IV.43

Federal Aviation Administration Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $7.4 $8.9 $9.2 Treatment 0 0 0 ========================================================== Total $7.4 $8.9 $9.2 ---------------------------------------------------------- Neither ONDCP nor the agency's justification of estimates identifies specific prevention components by budget expenditure. However, prevention descriptions are identified within the following FAA program listings.

OPERATIONS --------------------------------------------------- Appendix IV:13.1.1

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

RESEARCH, ENGINEERING, AND DEVELOPMENT --------------------------------------------------- Appendix IV:13.1.2

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

DEPARTMENT OF THE INTERIOR ------------------------------------------------------- Appendix IV:14

BUREAU OF INDIAN AFFAIRS ----------------------------------------------------- Appendix IV:14.1

Table IV.44

Bureau of Indian Affairs Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $4.1 $3.2 $3.2 Treatment 0 0 0 ========================================================== Total $4.1 $3.2 $3.2 ---------------------------------------------------------- The ONDCP budget summary and the budget justification do not identify specific prevention program or activity dollars. However, prevention activities are identified within the following Bureau programs:

OFFICE OF ALCOHOL AND SUBSTANCE ABUSE PREVENTION --------------------------------------------------- Appendix IV:14.1.1

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

EDUCATION --------------------------------------------------- Appendix IV:14.1.2

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

DEPARTMENT OF THE TREASURY ------------------------------------------------------- Appendix IV:15

U.S. SECRET SERVICE ----------------------------------------------------- Appendix IV:15.1

Table IV.45

U.S. Secret Service Budget Authority

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Function actual estimate request ---------------------- ---------- ---------- ---------- Prevention $4.6 $4.7 $6.6 Treatment 0 0 0 ========================================================== Total $4.6 $4.7 $6.6 ----------------------------------------------------------

Table IV.46

U.S. Secret Service Budget Authority Program or Activity

(Millions of dollars)

FY 1994 FY 1995 FY 1996 Program or activity actual estimate request ---------------------- ---------- ---------- ---------- Administration $4.6 $4.7 $6.6 ---------------------------------------------------------- The U.S. Secret Service considers a portion of its costs for full-time- equivalent employees' pay, benefits, and support to be attributable to drug enforcement activities. These activities include criminal investigations, task force involvement, employee and applicant drug testing, and protection involved in other drug-related activities.

CHANGE IN STATE, COUNTY, AND LOCAL SUBSTANCE ABUSE TREATMENT AND PREVENTION EXPENDITURES BY STATE, FISCAL YEARS 1990-94 =========================================================== Appendix V

Percentage change FY State FY 1990 FY 1991 FY 1992 FY 1993 FY 1994 1990-94\a --------------- ----------- ----------- ----------- ----------- ----------- ----------- Alabama $6,015,962 $3,198,355 $3,692,995 $3,663,113 $4,063,707 -32 Alaska 16,570,035 16,164,265 23,752,975 20,580,391 20,406,824 23 Arizona 12,507,395 13,079,377 14,728,976 15,598,434 14,413,557 15 Arkansas 2,597,138 3,339,927 3,395,226 3,292,059 4,807,185 85 California 94,873,676 85,757,118 95,009,024 102,137,050 113,051,430 19 Colorado 16,989,173 17,758,971 17,194,534 16,677,795 13,955,399 -18 Connecticut 38,673,686 39,277,060 38,836,198 39,934,097 41,540,112 7 Delaware 4,010,051 3,249,548 3,532,478 3,553,440 3,716,925 -7 District of 29,989,600 26,538,000 23,740,200 24,064,000 25,112,569 -16 Columbia Florida 78,901,232 80,653,965 86,911,469 85,876,085 115,360,465 46 Georgia 28,057,655 28,780,471 26,546,906 32,132,524 32,806,673 17 Guam 170,100 317,127 349,336 607,800 \b \c Hawaii 4,635,160 5,849,122 7,207,642 7,550,115 7,627,032 65 Idaho 1,479,600 2,119,100 2,402,000 2,448,500 2,448,500 65 Illinois 71,987,404 72,972,278 67,291,600 83,321,336 90,866,796 26 Indiana 16,332,566 17,763,487 19,805,472 16,604,150 16,720,910 2 Iowa 10,863,566 12,262,950 12,937,779 14,300,639 15,546,719 43 Kansas 27,840,402 11,132,884 6,453,255 6,464,438 6,290,761 -77 Kentucky 6,688,470 8,330,562 10,869,754 9,170,705 8,332,986 25 Louisiana 2,896,952 3,859,623 9,972,390 11,583,250 11,081,311 283 Maine 6,704,603 6,475,747 4,637,679 5,179,742 6,998,350 4 Maryland 47,261,282 50,736,466 43,463,724 33,832,201 31,350,611 -34 Massachusetts 46,709,828 48,494,200 60,987,141 35,330,659 36,706,826 -21 Michigan 30,244,907 27,003,799 36,064,568 41,427,498 39,389,686 30 Minnesota 43,775,000 43,445,230 35,664,691 45,405,778 46,871,064 7 Mississippi 2,466,339 2,631,504 2,717,493 3,125,000 3,453,142 40 Missouri 10,590,205 10,760,813 15,549,647 20,284,662 27,143,146 156 Montana 3,387,093 3,368,329 2,680,000 3,133,829 3,650,582 8 Nebraska 5,664,786 5,834,670 5,813,233 5,924,952 5,849,430 3 Nevada 1,871,255 1,825,158 2,661,131 2,473,700 2,339,809 25 New Hampshire 1,904,722 2,226,854 2,302,036 2,120,338 2,983,378 57 New Jersey 32,051,000 32,381,000 32,731,000 33,096,000 36,312,641 13 New Mexico 10,187,543 10,184,437 11,468,412 7,636,631 6,983,874 -31 New York 269,154,952 275,916,505 251,956,233 324,435,303 335,573,353 25 North Carolina 30,513,724 22,982,262 17,978,348 23,415,200 26,882,080 -12 North Dakota 2,880,891 807,702 1,674,544 1,942,000 1,900,000 -34 Ohio 18,764,851 30,189,093 38,541,617 40,768,553 41,225,306 120 Oklahoma 11,438,220 11,011,003 11,591,171 11,647,103 11,283,276 -1 Oregon \b 21,971,352 \b 32,874,732 35,494,554 \c Palau \b \b \b \b 70,800 \c Pennsylvania 49,362,416 55,845,777 52,853,571 49,356,790 67,824,525 37 Puerto Rico 15,126,234 14,144,476 16,904,671 19,319,195 14,285,245 -6 Rhode Island 13,532,404 13,877,293 14,124,000 15,846,309 14,406,000 6 South Carolina 23,694,744 23,655,350 22,320,887 26,185,613 27,941,502 18 South Dakota 1,369,602 1,527,744 1,978,484 2,656,966 3,667,372 168 Tennessee 14,238,516 7,612,300 7,301,707 7,633,305 \b \c Texas 12,552,222 14,369,946 20,193,320 31,660,636 53,339,240 325 Utah 8,287,824 8,395,316 9,776,204 10,395,890 10,639,584 28 Vermont 16,175,473 3,278,922 3,358,697 2,875,175 2,857,367 -82 Virginia 24,369,394 40,089,545 40,405,772 43,715,044 44,748,436 84 Washington 32,298,476 37,348,640 31,700,221 32,633,197 33,018,119 2 West Virginia 11,097,043 5,579,479 6,692,356 7,125,634 6,850,107 -38 Wisconsin 32,806,528 66,113,500 57,087,056 62,702,100 61,270,000 87 Wyoming \b \b \b \b \b \c ============================================================================================= Total $1,302,561, $1,352,488, $1,337,809, $1,485,719, $1,591,459, 22 900 602 823 656 266 ============================================================================================= Total in 1994 $1,475,155, $1,466,907, $1,405,262, $1,520,695, $1,591,459, 8 dollars 040 377 419 656 266 --------------------------------------------------------------------------------------------- \a Individual state percentage changes are not adjusted for inflation.

\b Data were not available.

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

Source: NASADAD.

STATE, COUNTY, AND LOCAL SUBSTANCE ABUSE PREVENTION EXPENDITURES BY STATE, FISCAL YEARS 1990-94 ========================================================== Appendix VI

Percentage Change FY State FY 1990 FY 1991 FY 1992 FY 1993 FY 1994 1990-94\a --------------- ----------- ----------- ----------- ----------- ----------- ----------- Alabama $960,000 \b \b 0 0 \c Alaska 3,341,193 1,460,733 5,639,713 3,313,208 3,257,502 -3 Arizona 68,794 97,804 156,746 156,746 103,227 50 Arkansas \b \b \b 20,000 \b \c California 19,914,021 15,264,388 11,366,836 14,032,165 16,106,249 -19 Colorado 3,370,653 3,745,631 3,809,573 3,837,412 354,325 -89 Connecticut 1,273,218 1,997,668 1,242,236 3,185,833 2,418,097 90 Delaware 118,749 51,195 99,862 126,418 274,834 131 District of 2,525,440 870,000 1,582,680 1,200,000 969,262 -62 Columbia Florida 2,526,725 3,275,975 3,215,991 4,045,044 3,381,367 34 Georgia \b \b \b \b 63,660 \c Guam 130,100 0 110,838 258,350 \b \c Hawaii 1,107,284 839,446 3,200 10,511 35,619 -97 Idaho \b \b \b \b \b \c Illinois 6,291,219 6,305,523 5,779,800 4,052,420 4,163,165 -34 Indiana 95,083 248,963 816,200 478,101 679,927 615 Iowa 1,898,738 2,124,903 2,170,903 2,623,046 3,426,825 80 Kansas 5,569,668 1,247,517 751,538 368,142 338,850 -94 Kentucky 190,938 388,451 592,764 1,140,518 463,241 143 Louisiana \b 222,461 427,883 428,662 110,000 \c Maine 777,149 595,680 98,200 41,606 673,686 -13 Maryland 3,550,000 3,580,000 3,400,000 3,599,492 725,463 -80 Massachusetts 3,657,261 353,700 495,587 498,650 1,236,019 -66 Michigan 6,136,843 6,637,017 8,998,678 9,045,775 8,359,190 36 Minnesota 1,232,000 1,307,000 2,072,112 1,297,572 3,629,305 195 Mississippi \b \b \b \b \b \c Missouri 30,000 30,000 30,000 30,000 435,367 1351 Montana 96,440 90,000 72,216 62,500 60,000 -38 Nebraska 457,021 382,831 389,060 497,663 502,908 10 Nevada 207,728 123,013 100,898 103,269 42,000 -80 New Hampshire 295,850 542,240 527,062 682,722 552,947 87 New Jersey 4,678,000 4,107,000 4,335,000 2,210,000 2,154,034 -54 New Mexico 695,435 383,954 833,829 \b \b \c New York 71,235,233 67,979,621 65,671,500 65,560,636 68,052,768 -4 North Carolina \b \b 3,595,670 4,683,040 \b \c North Dakota \b \b \b 7,000 15,000 \c Ohio 3,075,409 7,214,858 8,622,848 9,234,174 7,050,687 129 Oklahoma \b \b \b 149,340 93,478 \c Oregon \b 12,526,400 \b 13,285,456 14,028,852 \c Palau \b \b \b \b \b \c Pennsylvania 8,563,192 10,840,486 9,034,254 7,801,403 7,922,798 -7 Puerto Rico 2,002,370 2,221,975 2,016,100 1,896,710 1,260,746 -37 Rhode Island 3,042,892 3,116,451 4,228,000 4,326,425 3,388,000 11 South Carolina 9,093,954 9,608,744 8,126,297 10,589,208 6,580,117 -28 South Dakota 154,228 420,095 \b \b 288,691 87 Tennessee 3,082,074 1,484,300 711,174 1,969,334 \b \c Texas 4,434,827 6,007,753 6,414,086 3,316,236 5,013,080 13 Utah 2,595,440 2,091,593 2,196,996 1,905,567 2,309,706 -11 Vermont 856,956 514,654 1,098,726 651,582 498,256 -42 Virginia 2,546,279 6,152,242 3,410,604 3,401,746 4,028,958 58 Washington 91,000 57,128 55,909 55,910 21,342 -77 West Virginia 216,682 232,309 167,039 \b \b \c Wisconsin 3,515,764 12,840,300 9,693,798 9,945,800 9,487,251 170 Wyoming \b \b \b \b \b \c ============================================================================================= Total $185,701,85 $199,582,00 $184,162,40 $196,125,39 $184,556,79 -1 0 2 6 2 9 ============================================================================================= Total in 1994 $210,307,87 $216,466,38 $193,447,90 $200,742,46 $184,556,79 -12 dollars 1 0 5 9 9 --------------------------------------------------------------------------------------------- \a Individual state percentage changes are not adjusted for inflation.

\b Data were not available.

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

Source: NASADAD.

STATE, COUNTY, AND LOCAL SUBSTANCE ABUSE TREATMENT EXPENDITURES BY STATE, FISCAL YEARS 1990-94 ========================================================= Appendix VII

Percentage change FY State FY 1990 FY 1991 FY 1992 FY 1993 FY 1994 1990-94\a --------------- ----------- ----------- ----------- ----------- ----------- ----------- Alabama $5,055,962 $3,198,355 $3,692,995 $3,663,113 $4,063,707 -20 Alaska 13,228,842 14,703,532 18,113,262 17,267,183 17,149,322 30 Arizona 12,438,601 12,981,573 14,572,230 15,441,688 14,310,330 15 Arkansas 2,597,138 3,339,927 3,395,226 3,272,059 4,807,185 85 California 74,959,655 70,492,730 83,642,188 88,104,885 96,945,181 29 Colorado 13,618,520 14,013,340 13,384,961 12,840,383 13,601,074 0 Connecticut 37,400,468 37,279,392 37,593,962 36,748,264 39,122,015 5 Delaware 3,891,302 3,198,353 3,432,616 3,427,022 3,442,091 -12 District of 27,464,160 25,668,000 22,157,520 22,864,000 24,143,307 -12 Columbia Florida 76,374,507 77,377,990 83,695,478 81,831,041 111,979,098 47 Georgia 28,057,655 28,780,471 26,546,906 32,132,524 32,743,013 17 Guam 40,000 317,127 238,498 349,450 \b \c Hawaii 3,527,876 5,009,676 7,204,442 7,539,604 7,591,413 115 Idaho 1,479,600 2,119,100 2,402,000 2,448,500 2,448,500 65 Illinois 65,696,185 66,666,755 61,511,800 79,268,916 86,703,631 32 Indiana 16,237,483 17,514,524 18,989,272 16,126,049 16,040,983 -1 Iowa 8,964,828 10,138,047 10,766,876 11,677,593 12,119,894 35 Kansas 22,270,734 9,885,367 5,701,717 6,096,296 5,951,911 -73 Kentucky 6,497,532 7,942,111 10,276,990 8,030,187 7,869,745 21 Louisiana 2,896,952 3,637,162 9,544,507 11,154,588 10,971,311 279 Maine 5,927,454 5,880,067 4,539,479 5,138,136 6,324,664 7 Maryland 43,711,282 47,156,466 40,063,724 30,232,709 30,625,148 -30 Massachusetts 43,052,567 48,140,500 60,491,554 34,832,009 35,470,807 -18 Michigan 24,108,064 20,366,782 27,065,890 32,381,723 31,030,496 29 Minnesota 42,543,000 42,138,230 33,592,579 44,108,206 43,241,759 2 Mississippi 2,466,339 2,631,504 2,717,493 3,125,000 3,453,142 40 Missouri 10,560,205 10,730,813 15,519,647 20,254,662 26,707,779 153 Montana 3,290,653 3,278,329 2,607,784 3,071,329 3,590,582 9 Nebraska 5,207,765 5,451,839 5,424,173 5,427,289 5,346,522 3 Nevada 1,663,527 1,702,145 2,560,233 2,370,431 2,297,809 38 New Hampshire 1,608,872 1,684,614 1,774,974 1,437,616 2,430,431 51 New Jersey 27,373,000 28,274,000 28,396,000 30,886,000 34,158,607 25 New Mexico 9,492,108 9,800,483 10,634,583 7,636,631 6,983,874 -26 New York 197,919,719 207,936,884 186,284,733 258,874,667 267,520,585 35 North Carolina 30,513,724 22,982,262 14,382,678 18,732,160 26,882,080 -12 North Dakota 2,880,891 807,702 1,674,544 1,935,000 1,885,000 -35 Ohio 15,689,442 22,974,235 29,918,769 31,534,379 34,174,619 118 Oklahoma 11,438,220 11,011,003 11,591,171 11,497,763 11,189,798 -2 Oregon \b 9,444,952 \b 19,589,276 21,465,702 \c Palau \b \b \b \b 70,800 \c Pennsylvania 40,799,224 45,005,291 43,819,317 41,555,387 59,901,727 47 Puerto Rico 13,123,864 11,922,501 14,888,571 17,422,485 13,024,499 -1 Rhode Island 10,489,512 10,760,842 9,896,000 11,519,884 11,018,000 5 South Carolina 14,600,790 14,046,606 14,194,590 15,596,405 21,361,385 46 South Dakota 1,215,374 1,107,649 1,978,484 2,656,966 3,378,681 178 Tennessee 11,156,442 6,128,000 6,590,533 5,663,971 \b \c Texas 8,117,395 8,362,193 13,779,234 28,344,400 48,326,160 495 Utah 5,692,384 6,303,723 7,579,208 8,490,323 8,329,878 46 Vermont 1,768,727 2,764,268 2,259,971 2,223,593 2,359,111 33 Virginia 35,372,905 33,937,303 36,995,168 40,313,298 40,719,478 15 Washington 32,053,000 37,291,512 31,644,312 32,577,287 32,996,777 3 West Virginia 3,856,887 5,347,170 6,525,317 7,125,634 6,850,107 78 Wisconsin 36,468,714 53,273,200 47,393,258 52,756,300 51,782,749 42 Wyoming \b \b \b \b \b \c ============================================================================================= Total $1,116,860, $1,152,906, $1,153,647, $1,289,594, $1,406,902, 26 050 600 417 264 467 ============================================================================================= Total in 1994 $1,264,847, $1,250,440, $1,211,814, $1,319,953, $1,406,902, 11 dollars 169 997 514 187 467 --------------------------------------------------------------------------------------------- \a Individual state percentage changes are not adjusted for inflation.

\b Data were not available.

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

Source: NASADAD.

TOP 25 FOUNDATIONS CONTRIBUTING GRANTS TO SUBSTANCE ABUSE TREATMENT AND PREVENTION PROGRAMS, 1993-94 ======================================================== Appendix VIII

Foundation State Amount ---------------------------------- -------- ------------ The Robert Wood Johnson Foundation NJ $18,495,740 Conrad N. Hilton Foundation NV 2,740,000 The Ford Foundation NY 1,863,000 Richard King Mellon Foundation PA 1,335,000 Meadows Foundation, Inc. TX 1,257,000 The Pew Charitable Trusts PA 1,243,500 Carnegie Corporation of New York NY 1,150,000 The Aaron Diamond Foundation, Inc. NY 1,066,609 Open Society Institute NY 1,053,000 The Kresge Foundation MI 1,000,000 Scaife Family Foundation PA 980,600 The California Wellness Foundation CA 730,000 Hartford Foundation for Public CT 707,554 Giving The Annie E. Casey Foundation MD 625,000 Joseph B. Whitehead Foundation GA 625,000 Lettie Pate Evans Foundation, Inc. GA 600,000 Marin Community Foundation CA 573,250 The McKnight Foundation MN 535,000 The Commonwealth Fund NY 513,000 Charles Hayden Foundation NY 510,000 W.K. Kellogg Foundation MI 494,100 John S. and James L. Knight FL 342,966 Foundation The F.J. O'Neill Charitable OH 325,000 Corporation Hall Family Foundation MO 312,841 R.J. Maclellan Charitable Trust TN 306,342 ========================================================== Total $39,384,502 ---------------------------------------------------------- Source: The Foundation Center, Grants for Alcohol and Drug Abuse (New York: The Foundation Center, 1995-96).

(See figure in printed edition.)Appendix IX COMMENTS FROM THE OFFICE OF NATIONAL DRUG CONTROL POLICY ======================================================== Appendix VIII

(See figure in printed edition.)Appendix X COMMENTS FROM THE NATIONAL ASSOCIATION OF STATE ALCOHOL AND DRUG ABUSE DIRECTORS ======================================================== Appendix VIII

(See figure in printed edition.)

RELATED GAO PRODUCTS =========================================================== Appendix 0

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

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

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

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

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

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

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

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

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

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

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

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

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

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