December 9, 2021

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Substance Use Disorder: Reliable Data Needed for Substance Abuse Prevention and Treatment Block Grant Program

13 min read
<div>According to Substance Abuse and Mental Health Services Administration (SAMHSA) data, the number of substance use disorder (SUD) treatment facilities and services increased since 2009. However, potential gaps in treatment capacity remain. For example, SAMHSA data show that, as of May 2020, most counties did not have all levels of SUD treatment available, including outpatient, residential, and hospital inpatient services; nearly one-third of counties had no levels of treatment available. Stakeholders GAO interviewed said it is important to have access to each level for treating individuals with varying SUD severity. Availability of Substance Use Disorder Treatment Levels, by County, as of May 2020 SAMHSA primarily relies on the number of individuals served to assess the effect of three of its largest grant programs on access to SUD treatment and recovery support services. However, GAO found the agency lacks two elements of reliable data—that they be consistent and relevant—for the number of individuals served under the Substance Abuse Prevention and Treatment Block Grant (SABG) program. For example, grantee reporting includes individuals served outside of the program, which limits this measure's relevance for program assessment of access. SAMHSA plans to implement data quality improvements for the SABG program starting in fiscal year 2021. However, the agency has not identified specific changes needed to improve the information it collects on individuals served. As SAMHSA moves forward with its plans, it will be important for it to identify and implement such changes. Doing so will allow SAMHSA to better assess whether the SABG program is achieving a key goal of improving access to SUD treatment and recovery services or whether changes may be needed. Treatment for SUD—the recurrent use of substances, such as illicit drugs, causing significant impairment—can help individuals reduce or stop substance use and improve their quality of life. SUDs, and in particular drug misuse, have been a persistent and long-standing public health issue in the United States. Senate Report 115-289 contains a provision for GAO to review SUD treatment capacity. This report, among other things, describes what is known about SUD treatment facilities, services, and overall capacity; and examines the information SAMHSA uses to assess the effect of three grant programs on access to SUD treatment. GAO analyzed national SAMHSA data on SUD treatment facilities and providers, and reviewed studies that assessed treatment capacity. GAO also reviewed documentation for three of SAMHSA's largest grant programs available to states, and compared the agency's grant data quality to federal internal control standards. Finally, GAO interviewed SAMHSA officials and stakeholders, including provider groups. GAO is recommending that SAMHSA identify and implement changes to the SABG program's data collection efforts to improve two elements of reliability—the consistency and relevance—of data collected on individuals served. SAMHSA concurred with this recommendation. For more information, contact Alyssa M. Hundrup at (202) 512-7114 or HundrupA@gao.gov.</div>

What GAO Found

According to Substance Abuse and Mental Health Services Administration (SAMHSA) data, the number of substance use disorder (SUD) treatment facilities and services increased since 2009. However, potential gaps in treatment capacity remain. For example, SAMHSA data show that, as of May 2020, most counties did not have all levels of SUD treatment available, including outpatient, residential, and hospital inpatient services; nearly one-third of counties had no levels of treatment available. Stakeholders GAO interviewed said it is important to have access to each level for treating individuals with varying SUD severity.

Availability of Substance Use Disorder Treatment Levels, by County, as of May 2020

SAMHSA primarily relies on the number of individuals served to assess the effect of three of its largest grant programs on access to SUD treatment and recovery support services. However, GAO found the agency lacks two elements of reliable data—that they be consistent and relevant—for the number of individuals served under the Substance Abuse Prevention and Treatment Block Grant (SABG) program. For example, grantee reporting includes individuals served outside of the program, which limits this measure’s relevance for program assessment of access. SAMHSA plans to implement data quality improvements for the SABG program starting in fiscal year 2021. However, the agency has not identified specific changes needed to improve the information it collects on individuals served. As SAMHSA moves forward with its plans, it will be important for it to identify and implement such changes. Doing so will allow SAMHSA to better assess whether the SABG program is achieving a key goal of improving access to SUD treatment and recovery services or whether changes may be needed.

Why GAO Did This Study

Treatment for SUD—the recurrent use of substances, such as illicit drugs, causing significant impairment—can help individuals reduce or stop substance use and improve their quality of life. SUDs, and in particular drug misuse, have been a persistent and long-standing public health issue in the United States.

Senate Report 115-289 contains a provision for GAO to review SUD treatment capacity. This report, among other things, describes what is known about SUD treatment facilities, services, and overall capacity; and examines the information SAMHSA uses to assess the effect of three grant programs on access to SUD treatment. GAO analyzed national SAMHSA data on SUD treatment facilities and providers, and reviewed studies that assessed treatment capacity. GAO also reviewed documentation for three of SAMHSA’s largest grant programs available to states, and compared the agency’s grant data quality to federal internal control standards. Finally, GAO interviewed SAMHSA officials and stakeholders, including provider groups.

What GAO Recommends

GAO is recommending that SAMHSA identify and implement changes to the SABG program’s data collection efforts to improve two elements of reliability—the consistency and relevance—of data collected on individuals served. SAMHSA concurred with this recommendation.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or HundrupA@gao.gov.

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  • Clean Water Act: EPA Needs to Better Assess and Disclose Quality of Compliance and Enforcement Data
    In U.S GAO News
    What GAO Found Since 2015, the Environmental Protection Agency (EPA) has modified one of its three national initiatives emphasizing compliance with the Clean Water Act and has discontinued two others (see fig.). The goal of the modified initiative is to reduce significant noncompliance with National Pollutant Discharge Elimination System (NPDES) permits by half by the end of fiscal year 2022. Such permits set limits on discharges of wastewater from point sources, such as a pipe from an industrial facility. This goal supports EPA's strategic objective to increase compliance with environmental laws in its strategic plan for fiscal years 2018-2022. EPA discontinued its initiatives focused on animal waste pollution and raw sewage and stormwater runoff, returning these areas to the core enforcement program in 2018 and 2019, respectively. As a result, these areas no longer receive the heightened attention and focused resources of the national initiatives, but the agency still pursues enforcement actions when needed. Changes in EPA's Clean Water Act National Initiatives EPA posts data that states report on their NPDES compliance and enforcement activities to its website, but the data are not reliable for identifying changes in the number of activities states conducted since 2015. EPA's most recent assessment of states' data showed that two of 17 states met expectations for the accuracy and completeness of the data recorded in the agency's national database. EPA is working with states to improve their data, and it includes on its website disclosures by some states about problems and limitations with their data. However, the agency has not ensured that all states' disclosures are consolidated, complete, and updated. Until it does so, potential users of the data may not fully understand the data or the data's limitations. EPA developed a measure to track progress toward its goal for reducing the rate of significant noncompliance by NPDES facilities with individual permits by the end of fiscal year 2022. While the measure tracks changes in the number of facilities in significant noncompliance, the results of the measure are unclear because data EPA needs to track compliance are incomplete and contain inaccuracies. According to EPA, about 70 percent of NDPES facilities have sufficiently complete data in the national database for EPA to track compliance. EPA is working with states to improve data quality, but it does not have a plan to assess the overall accuracy of the data. Until it does so, EPA cannot be certain what its measure is showing and if EPA is making progress toward its goal. Why GAO Did This Study EPA partners with states to oversee compliance with and enforcement of the Clean Water Act. In fiscal year 2020, there were roughly 335,000 facilities with active NPDES permits, which are used to regulate wastewater discharges under the act. In 2015, EPA began requiring states and facilities to electronically report data on their NPDES activities. EPA estimated that in 2018, nearly 11,000 facilities significantly exceeded their permit limits and illegally discharged pollutants into nearby waters, which may pose serious threats to human health and the environment. GAO was asked to review EPA's enforcement of the Clean Water Act. This report examines (1) changes since 2015 in EPA's national initiatives for ensuring compliance with the act, (2) changes in NPDES compliance and enforcement activities since 2015, and (3) the extent to which EPA is measuring progress toward compliance with the NPDES program. GAO reviewed and analyzed EPA documents and data on NPDES compliance and enforcement activities. GAO also interviewed officials from eight states, selected in part by EPA region, to learn about their NPDES compliance and enforcement activities and data reporting.
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