Three Federal Agencies Operated 12 Grant Programs That Funded Services Specifically Targeting Adolescents and Young Adults in Fiscal Year 2017

		Eight of the 12 Federal Grant Programs for Adolescents and Young Adults Funded Substance Use Prevention Services

We identified 12 federal grant programs within three of the four agencies  in our review that funded substance use prevention, treatment, and  recovery services in fiscal year 2017 and targeted adolescents’ and  young adults’ use of illicit substances. In total, the 8 grant programs targeting the prevention of substance use  among adolescents and young adults had 1,146 active grantees in fiscal  year 2017. In total, the 4 grant programs that targeted substance use treatment and  recovery services among adolescents and young adults had 57 active  grantees in fiscal year 2017. In total, active grantees from 2 of the 4 programs  were awarded about $23 million in fiscal year 2017. Other Federal Grant Programs Fund Prevention, Treatment, and Recovery Services, but Do Not Specifically Target Adolescents and Young Adults

Other federal grant programs beyond the 12 we identified provide funds  for substance use prevention, treatment, and recovery services across  age groups but do not specifically target adolescents and young adults. The Substance Abuse Prevention and Treatment Block Grant is the  largest of such grant programs that fund prevention, treatment, and  recovery services across age groups. NIDA Had 186 Active Grant-Funded Research Projects Focused on Substance Use Prevention, Treatment, and Recovery among Adolescents and Young Adults in 2017

		Most of NIDA’s 186 Active Grant-Funded Research Projects for Adolescents and Young Adults in 2017 Focused on Substance Use Prevention

Our analysis found that HHS’s NIDA had 186 active grant-funded  research projects focused on illicit substance use prevention, treatment,  or recovery among adolescents and young adults in October and  November 2017, and most of these projects addressed substance use  prevention. This study  was established as a result of the collaboration of several federal  agencies that determined such a study was needed because of gaps in  knowledge about how substance use and other factors affect brain  development. Stakeholders Identified Gaps in Services and Research for Adolescents and Young Adults, and Ongoing Federal Efforts Aim to Address Gaps Stakeholders Identified Gaps in Services for Adolescents and Young Adults, and Federal Agencies Have Ongoing Efforts to Address Them

Stakeholders that we interviewed identified various gaps in services, and  among the most frequently cited were a lack of available recovery  services and treatment providers for adolescents and young adults with  substance use disorders. In general, officials from the  agencies in our review agreed that these gaps exist, and described  actions the agencies are taking that may help address them. Gaps in substance use research related to adolescents and young  adults. Officials from NIDA agreed that  these gaps in research exist and explained that while additional research  is needed to address them, the process by which NIDA funds research  through grants ultimately relies on researchers to submit proposals for  consideration. While NIDA officials stated that researchers can submit  proposals for research projects addressing adolescent or young adult  substance use prevention, treatment, or recovery under general funding  announcements for grants, NIDA also had eight funding announcements  (as of May 2018) that either focused on these age groups or included  them as a population of interest, three of which were new as of fiscal year  2018. Agency Comments

We provided a draft of this report to HHS, DOJ, ONDCP, and Education  for comment. HHS, DOJ, and ONDCP provided technical comments,  which we incorporated as appropriate. We are sending copies of this report to the appropriate congressional  committees; the Secretaries of the Departments of Health and Human  Services, Justice, and Education; the Director of the Office of National  Drug Control Policy; and other interested parties.
Why GAO Did This Study

According to the Surgeon General, adolescence and young adulthood are critical at-risk periods for illicit substance use, and such use can harm the developing brain. Congress included a provision in law for GAO to review how federal agencies, through grants, are addressing substance use prevention, treatment, and recovery among adolescents and young adults.
Related to prevention, treatment, and recovery targeting adolescents (aged 12 to 17) and young adults (aged 18 to 25), this report describes (1) grant programs to provide services; (2) NIDA grant-funded research, and (3) gaps stakeholders identified in related services or research.
GAO selected four agencies to review—HHS, ONDCP, DOJ, and Education—the key agencies that fund grant programs for services for adolescents and young adults. GAO analyzed documents on grant programs and on research funded by NIDA. GAO interviewed officials from the four agencies and 20 stakeholder groups (including advocacy and education, and research organizations, as well as a non-generalizable selection of state substance abuse, education, and judicial agencies in four states) about gaps in services or research and agency efforts to help address them. States were selected for variation in geography and overdose rates.
HHS, DOJ, and ONDCP provided technical comments on a draft of this report, which GAO incorporated as appropriate.

What GAO Found

GAO identified 12 federal grant programs within three federal agencies that funded substance use prevention, treatment, and recovery services in fiscal year 2017 and targeted adolescents' and young adults' use of illicit substances such as marijuana and nonmedical use of prescription opioids. The three agencies included the Department of Health and Human Services (HHS), the Office of National Drug Control Policy (ONDCP), and the Department of Justice (DOJ). While the Department of Education (Education) has grant programs that can fund prevention services for adolescents, they do not specifically target such services.
Eight programs targeted substance use prevention. In total, they had 1,146 active grantees in fiscal year 2017 and provided about $266 million in awards that year.
Four programs targeted treatment and recovery services. In total, they had 57 active grantees in fiscal year 2017. Two of the 4 grant programs awarded about $23 million in funding in that year (the other two awarded funding in prior years).
In addition, other grant programs beyond these 12 also fund substance use prevention, treatment, and recovery services across age groups, but are not specifically targeted to adolescents and young adults.
HHS's National Institute on Drug Abuse (NIDA)—the agency that is the primary funder of research on illicit substance use—also had 186 active grant-funded research projects focused on substance use prevention, treatment, and recovery among adolescents and young adults as of October and November 2017.
Most of these research projects—126—were examining prevention, 45 were examining treatment, 4 were examining recovery, and 11 were examining a combination of research categories.
In total, these 186 research projects received about $61 million from NIDA in fiscal year 2017.
Most of the 20 stakeholders GAO interviewed identified gaps in services for adolescents and young adults, including insufficient access to recovery services and a shortage of treatment providers, and described financial and other reasons that likely contribute to these gaps. Federal agency officials GAO interviewed agreed that these gaps exist, and described grant programs and other efforts to help address them, such as a grant program that HHS established in 2018 to expand recovery services for these age groups. Stakeholders also identified gaps in research, such as too few treatment studies with adolescent participants, and described reasons for these gaps, including too few federal grants focused on adolescent research. NIDA officials agreed that these gaps exist, and stated that NIDA had eight grant opportunities (as of May 2018) that focused on these age groups or included them as a population of interest, three of which were new in 2018.