“Our bill makes it clear that any savings generated by the merger will be reinvested in the system,” says Senator Harkham. “But the unions have been particularly hard hit in the fighting and it’s hard to blame them.” Governor Cuomo has reduced the Office of Substance Abuse and Support Services (OASAS) by approximately 150 positions during his tenure. Gov. Katie Hochul has taken steps to reverse this damage by highlighting some $402 million in the new funding of the agency and the appointment of a new commissioner at its head. But even this long-awaited event challenges the merger movement. “For the first time in a long time, OASAS is getting a raise, not a cut,” Joel Foskett, Senator Harkham’s director of legislative affairs, told me. “The instinct will be to keep it, rather than take risks with the merger.”
There is also a question of history: OASAS was created in 1992 when the alcohol and drug services were spun off from another, larger agency and merged into a single new organization. Philip Stack, chairman of the Assembly’s committee on alcohol and drug abuse, says the whole point of this reconfiguration was to improve the state’s drug treatment apparatus by separating it from everything else. “Substance abuse was ignored when it was part of a larger agency,” Stack told me. “People who now want to combine addiction and mental health seem to be forgetting about it.”
Mr. Stack agrees that the current setup – mental health in one agency, addiction in another – does not meet the needs of people who suffer from both. But he and others say there are faster, more cost-effective ways to fix this than trying to push two giant agencies together. For example, his own proposal is simply to “introduce” more mental health services into the 12 addiction treatment centers already run by OASAS. Not only will the move lead to more comprehensive treatment for people with comorbidities, he said, but it will also help boost the workforce, as government agencies pay more than nonprofits. “The idea of a new department of mental health sounds very progressive,” said Mr. Stack. “And I’m not saying it should never happen. But it can take 10 years to remake such a system, and now people are suffering in our country.”
These are legitimate concerns, but for Mrs. Marchesano and the hundreds of supporters and officials who agree with her, the time for partial corrections is long past. “For 21 years, we have been asking for these systems to integrate and coordinate more,” said Paige Pierce, parent advocate and CEO of nonprofit Families Together. “Opponents continue to insist that the merger will not work. But what we have now really doesn’t work and hasn’t worked for decades.”
The federal government also seems ready to admit it. This spring, the Office of National Drug Control Policy disclosed a new “whole-of-government approach to combating the overdose epidemic”. The National Drug Control Strategy, as it is called, includes billions in new funding for evidence-based treatment initiatives, a renewed commitment to fighting drug traffickers, and a plan to “better use data to guide all of these efforts.” These are welcome developments, but for the broader effort to succeed, officials at all levels will have to grapple with a range of deeper flaws in the country’s approach to addiction. Laws will have to be changed: some laws from the drug war must be repealed. Others, including those focusing on equal coverage for behavioral illnesses, should be more restrictive. Agencies must be restructured so that the false distinctions between addiction, mental illness and the rest of medicine are finally completely erased. And funding streams need to be redesigned to support, not hinder, evidence-based practices.
However, for all of this to happen, politicians and supporters will have to overcome the same apathy and inertia that has hampered previous reform efforts for decades. And the rest of us will have to face our enduring ambivalence about what addiction really is and what the people who suffer from it need and deserve.