“Our bill makes clear that any savings the merger generates will be reinvested into the system,” Senator Harckham says. “But the unions, especially, have been battle-scarred, and it’s hard to blame them.” Governor Cuomo downsized the Office of Addiction Services and Supports, or OASAS, by some 150 positions during his tenure. Gov. Kathy Hochul has taken steps to reverse that damage — allocating some $402 million in new funding to the agency and appointing a new commissioner to head it. But even this welcome development presents a challenge to the merger movement. “It’s the first time in forever that OASAS is getting a boost instead of a cut,” Joelle Foskett, the legislative director to Senator Harckham, told me. “The instinct is going to be to hold on to that, not to risk it in a merger.”
There is also the matter of history: OASAS was established in 1992, when alcohol and substance abuse services were extracted from a different, larger agency and combined into a single new entity. Philip Steck, chair of the Assembly Committee on Alcohol and Drug Abuse says that the whole point of that reconfiguration was to improve the state’s addiction treatment apparatus by separating it from everything else. “Substance abuse was neglected when it was part of a larger agency,” Steck told me. “The people who now want to merge addiction and mental health seem to be forgetting that.”
Mr. Steck 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 that there are faster, more cost-effective ways to fix that than to try smushing two behemoth agencies together. For example, his own proposal is to simply “infuse” more mental health services into the 12 addiction treatment centers that OASAS already presided over. This move not only would lead to more integrated treatment for people with co-occurring disorders, he said, but also would help increase the work force, because state facilities pay more than the nonprofits. “The idea of a new behavioral health department sounds very progressive,” Mr. Steck said. “And I am not saying it should never happen. But to remake the system like that could take 10 years, and we have people suffering right now.”
Those are fair concerns, but to Mrs. Marquesano and the hundreds of advocates and officials who agree with her, the time for partial fixes is long past. “We have been begging for 21 years for these systems to integrate and coordinate more,” said Paige Pierce, a parent-advocate and C.E.O. of the nonprofit Families Together. “Opponents keep insisting that a merger will not work. But what we have right now is really not working and has not been working for decades.”
The federal government seems ready to acknowledge that, too. This spring, the Office of National Drug Control Policy unveiled a new, “whole-of-government approach to beat the overdose epidemic.” The National Drug Control Strategy, as it’s called, includes billions in new funding for evidence-based treatment initiatives, a renewed commitment to combating drug traffickers and a plan to “make better use of data to guide all these efforts.” Those are welcome developments, but for the broader effort to succeed, officials at every level will have to grapple with a roster of deeper flaws in the nation’s approach to addiction. Laws will have to change: Some drug-war-era statutes need to be repealed. Others, including those that focus on equal insurance coverage for behavioral health conditions, need to be better enforced. Agencies will have to be restructured so that false distinctions between addiction, mental illness and the rest of medicine are finally, fully erased. And funding streams will have to be reworked so that they support rather than impede evidence-based practices.
For any of that to happen, though, policymakers and advocates will have to overcome the same apathy and inertia that have thwarted decades’ worth of previous reform efforts. And the rest of us will have to confront our enduring ambivalence about what addiction actually is and what the people who suffer from it need and deserve.