For example, in fiscal year 1995, nearly one-half of veterans in substance abuse treatment inpatient units were homeless at the time of admission, and 35 percent had both substance abuse and one or more psychiatric disorders. In addition, veterans treated in substance abuse treatment units were chronically unemployed, had problems maintaining relationships, reported low incomes, or were criminal offenders. VA Offers a Variety of Substance Abuse Treatment Services

VA strives to offer a continuum of services to treat veterans nationwide with substance abuse disorders. Like other providers, VA uses a variety of approaches in treating veterans with substance abuse disorders. As shown in figure 2, obligations for VA substance abuse treatment programs increased about 45 percent, from $407 million to $589 million from fiscal years 1991 to 1996. VA Is Changing Its Quality Management Philosophy

VA currently lacks the necessary data to adequately measure and fully evaluate the efficacy of its many treatment programs. VA is therefore developing a new performance monitoring system, using new outcome measures, to compare treatment and program effectiveness both internally and with non-VA substance abuse treatment providers. Central office officials do, however, monitor the many substance abuse treatment programs by reviewing (1) annual reports on the substance abuse treatment programs at each medical center; (2) reports on program services, staffing, and utilization from VA’s Program Evaluation and Research Center; (3) the Quality Improvement Checklist, a systemwide quality improvement tool that includes one indicator about the rate of readmission for alcohol- and drug-related disorders for patients discharged from inpatient substance abuse treatment units; and (4) the results of patient satisfaction surveys. The revised performance measures will be used to evaluate individual substance abuse treatment programs and compare them with each other as well as with non-VA programs. Community Services Are Available to and Used by Veterans

Non-VA substance abuse providers and programs are also available to and used by veterans. If VA were to stop treating veterans for substance abuse, societal costs would likely increase. VA lacks information on the health care needs of eligible veterans, the number of veterans who might seek care if it were more accessible, the actual cost of treating such veterans, and the outcomes of specific treatments. The lack of this information limits our ability to evaluate the cost-effectiveness of contracting out program services and the implications of this action on the relative quality of services veterans might receive.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) substance abuse program and the effect of VA reorganization on this program, focusing on: (1) characteristics of veterans who receive substance abuse treatment; (2) services VA offers to veterans with substance abuse disorders; (3) methods VA uses to monitor the effectiveness of its substance abuse treatment programs; (4) community services available to veterans who suffer from substance abuse disorders; and (5) implications of changing VA methods for delivering substance abuse treatment services.

What GAO Found

GAO found that: (1) in fiscal year 1995, VA substance abuse treatment units served about 180,000 veterans; (2) about one half of the inpatients were homeless at the time of admission and about one third had psychiatric disorders; (3) many of these veterans were chronically unemployed, had problems maintaining relationships, reported low incomes, or were criminal offenders; (4) VA provides a variety of treatment settings and approaches; (5) between fiscal years 1991 and 1996, VA funding for treatment increased from $407 million to $589 million to accommodate growth in the substance abuse treatment program; (6) VA lacks the necessary data to adequately measure and fully evaluate the efficacy of its many treatment programs and has primarily relied on utilization information and recidivism rates to monitor the quality of its substance abuse treatment programs; (7) VA is developing a performance monitoring system based on treatment outcome measures; (8) numerous non-VA substance abuse treatment programs are also available to and used by veterans; (9) many veterans treated in community-based public programs are like those treated in VA programs; (10) if VA stopped treating veterans for substance abuse, resulting societal costs may shift to welfare or other social services, other federal or state substance abuse treatment programs, and the criminal justice system; (11) VA cannot ascertain the implications of contracting for these services, since it lacks critical information on the health care needs of eligible veterans, the number of veterans who might seek care, and actual cost of treating veterans with substance abuse disorders; and (12) VA officials have not decided how substance abuse treatment services will be delivered and what outcome measures will be used to evaluate treatment and program effectiveness.