Substance Abuse and Mental Health Services Administration

Agency Budget Summary

Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
I. Resource Summary

II. Methodology

Funding for SAMHSA's Substance Abuse Prevention and Treatment Knowledge Development and Application (KD&A) activities and funding for OAS Data Collection Activities are considered to be 100 percent drug-related.

Funding for SAMHSA's Substance Abuse Prevention and Treatment Targeted Capacity Expansion activities are considered to be 100 percent drug-related.

Funding for SAMHSA's Substance Abuse Prevention High Risk Youth (HRY) program is considered to be 100 percent drug-related.

Funding for the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) is considered drug-related to the extent that these funds are used by the states/territories for treatment and prevention of the use of illegal drugs and used by the Agency for technical assistance, data collection, and program evaluation. For the Substance Abuse Block Grant, SAMHSA uses a methodology in estimating drug related activities that is consistent with the earmarks required by P.L. 102-321.

Five percent of the block grant is required to be used for the SAMHSA set-aside activities which support data collection, technical assistance, the National Data Center, and program evaluation. The remaining 95 percent is distributed to the states and territories where at least: 35 percent must be used for alcohol prevention and treatment activities; 35 percent must be used for other drug prevention and treatment activities; and, the remaining 30 percent is to be used at state discretion, either for alcohol alone, for drugs alone, or shared by both alcohol and drug programs. For budget formulation purposes, SAMHSA and ONDCP agreed to score the discretionary amount equally for alcohol and drugs, with 15 percent assigned to alcohol programs and 15 percent assigned to drug programs.

Funding for Program Management activities is considered drug-related to the extent that funds are used to support the operations of the Center for Substance Abuse Treatment (CSAT), the Center for Substance Abuse Prevention (CSAP), and the activities of the Office of Applied Studies (OAS) that are supported by Set-aside funds from the SAPTBG.

III. Program Summary
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.

Financial support for this goal includes funding for Prevention Knowledge Development and Application (KD&A) programs, Prevention Targeted Capacity Expansion (TCE) programs, the High Risk Youth Program, Data Collection Activities (administered by OAS), and 20 percent of the drug-related funding within the SAPTBG, as well as program support for these activities.

Funding for Prevention KD&A programs supports defined population studies to field test controlled study findings under varying real-world conditions and with diverse populations. Knowledge application programs help substance abuse prevention practitioners and policy makers in states and communities systematically deliver and apply skills, techniques, models, and approaches to improve substance abuse prevention services.

Funding for Prevention Targeted Capacity Expansion programs supports efforts designed to address the specific and immediate prevention service capacity needs within the states and communities. Targeted Capacity Expansion programs represent a comprehensive effort toimprove the quality and availability of effective research-based prevention services and to help states and communities address and close gaps in prevention services which often cannot be addressed via the block grant funding process.

Funding for High Risk Youth (HRY) supports testing of a wide variety of interventions to prevent substance abuse among children and youth. This program focuses, in particular, on those youth who are at high risk for becoming substance abusers and/or involved in the juvenile justice system. Specifically, the new HRY - Project Youth Connect program targets youth ages 9-11 and those ages 12-18, and seeks to intervene with these youth while they are at a period in their lives when positive influences can still have an effect. Mentoring as a substance abuse prevention strategy is featured in this program.

SAPTBG activities include state expenditures of 20 percent of their block grant allotment for prevention services as well as 20 percent of the Block Grant Set-Aside for the collection and analysis of national data, the development of state data systems, provision of technical assistance, and program evaluations. Also, this program supports oversight of Synar Amendment implementation requiring states to enact and enforce laws prohibiting the sale and distribution of tobacco products to persons under 18 so as to reduce the availability of tobacco products to minors.

SAPTBG activities include state expenditures of 80 percent of their block grant allotment for treatment services as well as CSAT and OAS expenditures of 80 percent of the Block Grant Set-Aside for the collection and analysis of national data, the development of state data systems (including the development and maintenance of baseline data on the incidence and prevalence as well as the development of outcome measures on the effectiveness of treatment programs), provision of technical assistance, and program evaluations.

Goal 2: Increase the safety of America's citizens by substantially reducing drug-related crime and violence.

Financial support for this goal includes criminal justice-related treatment funding from the Treatment KD&A program. Funding for Treatment KD&A programs includes continuation of pre-1996 demonstration awards for Criminal Justice programs (adult, juvenile, institutional, and community based).

Goal 3: Reduce health, welfare, and crime costs resulting from illegal drug use.

Financial support for this goal includes funding for Treatment KD&A, Targeted Treatment Capacity Expansion programs and 80 percent of the drug-related funding within the SAPTBG, as well as program support for these activities.

Funding for Treatment KD&A programs includes continuation of pre-1996 demonstration awards including funding for the Target Cities program, Women and Children programs (Pregnant and Postpartum Women, Residential Treatment for Women and Children), Critical Population programs, AIDS program (Linkage, Outreach), and training programs. Theremainder of the Treatment KD&A portfolio includes knowledge development and application activities to: Bridge the Gap Between Knowledge and Practice; Promote the Adoption of Best Practices; and Assure Services Availability/Meet Targeted Needs.

Targeted Treatment Capacity Expansion programs have been established to focus more funding toward decreasing the substance abuse treatment gap. The Targeted Treatment Capacity Expansion program is designed to address gaps in treatment capacity by supporting rapid and strategic responses to the demand for alcohol and drug abuse treatment services. The response to treatment capacity problems may include communities with serious, emerging drug problems or communities struggling with unmet need.

The Federal Drug Free Workplace and National Laboratory Certification Programs reduce adult substance abuse demand in the federal service and promulgate scientific and technical guidelines for federal employee drug testing programs. NLCP certifies drug testing laboratories, provides guidance for self-sustaining drug testing programs, and is the federal focal point for developing and implementing non-military, federal workplace drug testing related technical, administrative and quality assurance programs.

IV. Budget Summary
1999 Program

The total drug control budget supported by the 1999 appropriation is $1.481 billion, including $433.6 million for Goal 1, $10.6 million for Goal 2, and $1.037 billion for Goal 3.

Goal 1: Educate and enable American's youth to reject illegal drugs as well as the use of alcohol and tobacco.

A total of $265.1 million (including $43.3 million in Set-aside funding for SAMHSA's Office of Applied Studies) is available for Goal 1 substance abuse prevention activities from the SAPTBG. Activities funded through the Block Grant prevention funds include state expenditures of a minimum of 20 percent of their block grant allotment for primary prevention, as well as CSAP expenditures of 20 percent of the block grant set-aside for the development of state data systems, provision of technical assistance, and program evaluations. Funds also support facilitating and monitoring states' compliance with the Synar Amendment that is designed to reduce accessibility of tobacco to minors.

A total of $78.7 million is available for Goal 1 Knowledge Development and Application activities including funding for the following:

Starting Early Starting Smart which is generating new empirical knowledge about the effectiveness of integrating substance abuse prevention, substance abuse treatment and mental health services for children ages zero to seven who experience multiple risk factors for substance abuse or mental health problems.

Developmental Predictor Variables 10-Site Study which is developing and evaluating prevention interventions identified in NIH controlled studies within four age cohorts starting at age three, following each age cohort for two years, and then linking the cohorts together to capture the developmental range from 3- to 14-years of age. This program is also testing the effectiveness of strategies tailored for children living in urban and rural areas.

Community Initiated Prevention Interventions program which supports field-initiated projects that test or replicate research-based substance abuse prevention interventions having high potential for preventing, delaying, or reducing alcohol, tobacco, or illicit drug use among high risk populations.

Parenting Adolescents program which is building the knowledge base about the effects of welfare reform on parenting teens and measuring the effects of preventive interventions tailored to this population.

Children of Substance-Abusing Parents (COSAPS) is generating knowledge about the most effective prevention models and associated services for enhancing protective factors and minimizing risk factors for developing substance abuse. Projects are implementing, refining and adapting established and effective scientifically defensible prevention intervention programs for this vulnerable population to assess their effectiveness in local community settings.

Alcohol Research programs to determine whether alcohol advertising affects the initiation of drinking among youth, whether alcohol advertising affects their consumption patterns and to identify, test, and/or develop effective interventions to prevent and reduce alcohol-related problems among college students.

National Strengthening the Family Initiative which includes a dissemination research program that is determining cost effective methods for disseminating information and training on science-based family-focused prevention strategies and demonstrated effective models in order to extend the application of these models to multiple communities across the country.

Workplace Programs engage the business community and the private and public sectors with both drug testing and drug free workplaces. Working with other federal agencies, states, the business community, labor organizations, and national organizations, the Federal Drug Free Workplace and National Laboratory Certification Programs are reducing adult substance abuse demand in the federal service and developing and implementing non-military, federal workplace drug testing related technical, administrative and quality assurance programs.

Prevention Enhancement Protocol System (PEPS) is a pioneering initiative that develops program and intervention guidelines for the field using established "rules of evidence" for assessing practice and research findings and combining this evidence intoprevention approaches.

National Center for the Advancement of Prevention - II (NCAP II) makes knowledge-based tools, principles and models useful for developing prevention plans and programs available to states, communities, and local prevention practitioners and policy makers to improve the effectiveness of prevention efforts across the nation.

Faculty Development Program (FDP) is continuing to develop a cadre of physicians and other health professionals with an expertise in teaching and advocating for substance abuse prevention.

National Clearinghouse for Alcohol and Drug Information continues to answer inquiries generated by the ONDCP National Anti-Drug Media Campaign and respond to public requests for information about causes, consequences, and effective strategies used to address substance abuse and its related problems.

Public education/ mass media efforts include support for ONDCP's Anti-Drug Media Campaign; a media campaign entitled Your Time - Their Future that is highlighting the importance of positive skill-building activities in preventing and reducing substance abuse among youth ages 7-14; and other efforts.

A total of $78.3 million is available for Goal 1 Prevention Targeted Capacity Expansion activities including funding for the following:

State Incentive Grant (SIG) Program extends CSAP's ability to help states to improve their prevention service capacity. Funding will enable states to examine their state Prevention Systems and redirect state resources to critical targeted prevention service needs. Eighty-five percent of SIG funds are directed toward implementing best practices within local programming to reduce the gap in prevention services.

Centers for the Application of Prevention Technologies (CAPTS) in five regions and at the U.S.-Mexico Border provide support to the SIGs, other states and communities by transferring research-based knowledge and delivering tailored technical assistance, training, and supportive materials to meet the unique needs of communities and states in their respective geographical areas.

Services to Address HIV/AIDS and Substance Abuse Among African American and Hispanic Youth and Women. This Targeted Capacity Expansion program supports establishment of a Substance Abuse and HIV Prevention Consortium to enable provision of policy advice and consultation on issues related to improving SA/HIV prevention services to these specific population groups; supplements to CSAP's six Centers for the Application of Prevention Technologies to enable integration of HIV prevention into their substance abuse prevention materials and curricula expanding the focus of training and TA for community based organizations and consortia; and a program to initiate or strengthen the integration of HIV and substance abuse prevention at the local level andincreasing local capacity to provide integrated services to African American and Hispanic youth and women. In addition, CSAP's Youth and Women of Color Initiative continues to identify specific interventions tailored for youth and women of color at risk for substance abuse and HIV disease and to develop strategies with emphasis on reducing known risk factors, increasing protective factors, building resiliency, and addressing multiple risks that cross domains.

A total of $7.0 million is available for Goal 1 High Risk Youth as follows:

High Risk Youth: Project Youth Connect is determining if an intensive mentoring/advocacy prevention intervention model and associated services are effective in preventing, reducing, or delaying the onset of substance abuse, improving school bonding, academic performance, family bonding, family relationships, and life management skills among children ages 9-15 and their families.

Goal 2: Increase the safety of America's citizens by substantially reducing drug-related crime and violence.

A total of $10.6 million is available for Goal 2 Knowledge Development and Application activities including funding for the following:

Criminal Justice Treatment Networks, Criminal Justice Diversion and Drug Court Activities. The Criminal Justice Diversion study will identify methods for diverting individuals with substance abuse disorders from the criminal justice system to community treatment alternatives. It will assess the following outcomes: criminal recidivism, time incarcerated, continuity of participation in treatment, emergency treatment utilization, and reduction of frequency of substance abuse.

Goal 3: Reduce health and social costs to the public of illegal drug use.

A total of $1.585 billion is available for the SAPTBG in FY 1999. Approximately 71 percent of this total, or $1.123 billion, is related to drug abuse activities. Drug abuse treatment funding is primarily directed at efforts to close the public system treatment gap. The Administration does not propose to bridge this gap entirely with direct funding but rather with significant infusions of Federal funds to leverage state, local, third party and other resources to grow effective systems of care. Activities supported by SAMHSA include:

A total of $116.6 million is available for Goal 3 Knowledge Development and Application drug-related activities in 1999, including funding for the following activities:

Addiction Technology Transfer Centers will transfer technology from science to practice through knowledge development, dissemination, and application, incorporating such things as needs assessment, multi-disciplinary linkages, curricula development, and other special initiatives.

Identification of Exemplary Treatment Models create partnerships between states, communities and the federal government to explore the development of knowledge and its application in the development of effective treatment approaches for replication.

Special Drug Studies (Alcohol, Methamphetamine and Marijuana). The Treatment for Adolescent Alcohol Abuse and Alcoholism program will contribute to the identification and development of efficacious treatment interventions for adolescent alcohol abusers and alcoholics. CSAT supports a study examining the Effectiveness of Treatment for Marijuana Dependent Youth, and will evaluate a variety of treatment interventions for adolescents. The Replicating Effective Treatment for Methamphetamine Dependence study will contribute to the development of knowledge of psychosocial treatment of methamphetamine dependence as well as providing an opportunity to determine the problems involved in technology transfer.

The Persistent Effects of Treatment Study which will evaluate the long-term effectiveness of substance abuse treatment services through a series of grants and cooperative agreements and conduct a number of special studies and policy analyses that address specific drugs of abuse, methods of treatment, populations or policy issues.

Recovery Community Support Program (RCSP) grants to state, provider, and community-based organizations for enhancing substance abuse treatment programs. These programs are intended to give persons in recovery a stronger voice in substance abuse services policy and planning at the state and local levels. It will involve persons with co-existing disorders, as well as their families, in the design and evaluation of substance abuse treatment services. A major focus will be to identify barriers to treatment in local settings, as well as to recommend ways to overcome or reduce them.

A total of $55.2 million is available for Goal 3 Targeted Treatment Capacity Expansion activities in 1999, including funding for the following:

Continuation of 41 Targeted Treatment Capacity Expansion grants awarded in 1998 which support states, cities, and/or other government entities in creation and expansion of comprehensive substance abuse treatment services, promoting accountability and enhancing the quality of and access to treatment services. A comprehensive service system will be developed aimed at providing a clinically appropriate range of services, reducing service gaps and reducing drug use and abuse by under-served populations.

2000 Request

A total of $1.537 billion is requested for the drug abuse budget, representing a net $55.7 million increase over the prior year. This reflects an increase of $55.0 million for Targeted Treatment Capacity Expansion, an increase of $24.8 million in the drug abuse-related portion of the Substance Abuse Prevention and Treatment Block Grant, and an increase of $1.9 million in drug abuse program management funding. These increases, however, are partially offset by a reduction of $26.0 million in the Substance AbusePrevention KD&A discretionary grant and contract funding. Requested treatment funding increases are expected to result in treatment services being provided to approximately 19,200 additional persons over 1999, for a total of almost 405,000 persons served with direct federal funding.

Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.

Funding for the FY 2000 KD&A program provides for continuation of projects initiated in FY 1998 and FY 1999. No new funding for KD&A substance abuse prevention grants is requested.

CSAP proposes the following new initiatives/program expansions within the SAPTBG and Prevention Targeted Capacity Expansion programs in support of Goal 1 in FY 2000:

The Set-aside of the Substance Abuse Prevention and Treatment Block Grant is increased by approximately $5.0 million in drug-related prevention funding over FY 1999 levels, providing resources for states to support additional primary prevention services at the local level.

$12.0 million of the funds available in FY 2000 as a result of expiring grants and will be used to support four new State Incentive Grants. Funding will enable states to examine their State Prevention Systems and redirect state resources to critical targeted prevention service needs within their states. This will bring the SIG program to approximately 25 of the 60 states and territories by FY 2000.

Goal 2: Increase the safety of America's citizens by substantially reducing drug-related crime and violence.

There are no proposed new initiatives in support of Goal 2 for FY 2000.

Goal 3: Reduce health and social costs to the public of illegal drug use.

CSAT proposes the following new initiatives/program expansion in support of Goal 3 in FY 2000:

Targeted Treatment Capacity Expansion ($55.0 million): SAMHSA proposes to award approximately 60 - 90 new grants in FY 2000 to continue reducing the treatment gap.

Substance Abuse Prevention and Treatment Block Grant ($19.8 million): Of the proposed $24.8 million increase in drug-related funding for the SAPTBG, 80 percent, or $19.8 million, would support state treatment initiatives. This formula-driven grant is the cornerstone of the states' substance abuse programs, accounting for approximately 40 percent of public funds expended for treatment and prevention (1995). In 19 states(1997), the block grant provided the majority of funding available to support substance abuse treatment services.

V. Program Accomplishments

CSAP's first Knowledge Development study, the Developmental Predictor Variable 10-site Cross-site Study is only 21 months old, yet it has already generated statistically significant positive outcomes with all sites using the same core process and outcome instruments. Investigators in Utah, Georgia, North Carolina and Washington report decreases in family conflict, aggression, conduct disorders, improved cooperation and academic performance, and decreases in substance use as a result of program interventions. As an example, the Coping Power: Kids and Parents Program reported significant reductions in teacher's ratings of aggression (a major precursor of drug use) in 9-10 year old African-American and white students.

CSAP's High Risk Grantee Cross-site Study has gleaned new knowledge on the major precursors of drug use in a large sample of youth, confirming a variant of the Social Ecology Model of Adolescent Substance Abuse and providing new data on the most powerful pathway to drug use: 1) poor family relationships, leading to 2) poor family supervision and discipline, and 3) family norms conducive to drug use. Detailed information on these program findings has been published in CSAP's "Understanding Substance Abuse Prevention - Toward the 21st Century: A Primer on Effective Programs."

The Prevention Enhancement Protocol System (PEPS) is a CSAP initiative to develop evidence-based program planning and intervention guidelines for the field of substance abuse prevention. To date, two PEPS guides have been published: Reducing Tobacco Use Among Youth: Community-Based Approaches and Reducing Substance Abuse and Children and Adolescents: family-based Approaches. Two additional PEPS guides are nearing completion: Reducing Problems Related to Retail Alcohol Availability: Environmental Approaches; and Mass Media: Approaches to Substance Abuse Prevention. A fifth PEPS guideline, School-Based Strategies for Substance Abuse Prevention, is being developed in conjunction with the U.S. Department of Education's Safe and Drug-Free Schools Program.

Tobacco Control Efforts/Synar Implementation. All 50 states, and the District of Columbia are in material compliance with the Synar Regulation. They have laws prohibiting the sale or distribution of tobacco to minors, and they are enforcing those laws. The median noncompliance rate of sales to minors as reported by the states in 1998 was 24.4 percent. This is a significant reduction from the median rate of 40 percent reported in 1997 and pre-1997 studies that found noncompliance rates ranging from 60 to 90 percent.

Core Data -- Discussions with the five SIG grantees over the past year have resulted in a mutual agreement as to the need for states to collect data in common to improve accountability for their use of block grant funds. SIG states have agreed to collect core data at the state, substate and program levels. Variables and instruments have already been identified for use. This practice will not only yield impressive data concerning the processand outcomes of the SIG activities, states are also using these data to field test the feasibility of using these measures as we move towards the implementation of performance partnership grants.

In September 1998, CSAT awarded 41 Targeted Treatment Capacity Expansion grants to municipal, county, state, tribal governments, and their respective service providers to help close the gap in treatment for emerging substance abuse problems in 22 states. The grantees will provide services for substance abusing women and their children, clients participating in welfare reform programs, juvenile and adult criminal justice-referred offenders, dually diagnosed offenders, substance abusing physically and cognitively challenged individuals, and hard-to-reach intravenous drug users. The program supports the cultivation of a substance abuse treatment system that is responsive to emerging trends.

In 1998, CSAT convened four state team building meetings that brought together key stakeholders from each state responsible for implementation of the Welfare-to-Work initiatives and substance abuse treatment. Approximately one-third of the stakeholders reported that these state team building meetings brought many of these individuals together for the first time. As a result of these interactions, states have reported outcomes such as the designation of the Department of Labor's welfare-to-work funds administered by the Private Industry Councils for substance abuse treatment services, work training services for persons recovering from addiction, the implementation of cooperative efforts to provide appropriate substance abuse screening of welfare recipients and the enhancement of vocational services within substance abuse treatment programs.

The Identification of Exemplary Adolescent Treatment Models is designed to identify those regimens of care that appear to be exemplary and may be useful for further replication and dissemination. The major focus of the five projects funded in 1998 is to evaluate and measure the level of success in terms of client outcomes and effectiveness. A special emphasis in some of the sites will be on treatment of adolescent heroin abusers.

The National Spending Estimates for Substance Abuse Treatment study was released in 1998. The first such study published by CSAT, it estimates substance abuse treatment expenditures adapting data and methods that the Health Care Financing Administration (HCFA) uses for estimates of national health expenditures. Consequently, the estimates for substance abuse are comparable to those produced by HCFA for health care. This study is expected to produce such estimates on an annual basis for the foreseeable future. Tracking treatment expenditures is essential for understanding the effect of the dynamic changes occurring in the health care industry. When linked with prevalence and utilization data, information about expenditures can also be used to better describe health care patterns.

The Treatment Improvement Protocols (TIP) Series provide state-of-the-art, consensus-based treatment protocols. In 1998, five more TIPs were published by CSAT: 1) Guide to Substance Abuse Services for Primary Care Clinicians; 2) Substance Abuse Treatment and Domestic Violence; 3) Substance Abuse Among Older Adults; 4) Comprehensive Case Management for Substance Abuse Treatment; and, 5) Naltrexone and Alcoholism Treatment.

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1999 National Drug Control Strategy
Budget Summary Office of National Drug Control Policy