“Our bill makes it clear that any savings from the merger will be reinvested in the system,” said Senator Harckham. “But the unions in particular have been scarred by the struggle, and it’s hard to blame them.” Governor Cuomo reduced the Office of Addiction Services and Supports, or OASAS, by some 150 positions during his tenure. Governor Kathy Hochul has taken steps to reverse that damage by allocating approximately $402 million in new funding to the agency and appointing a new commissioner to lead it. But this welcome development also poses a challenge to the fusion movement. “It’s the first time in all that OASAS is getting a boost rather than a cut,” Joelle Foskett, Senator Harckham’s legislative director, told me. “The instinct will be to hold on to that, not to risk it in a merger.”
There is also the question of history: OASAS was founded in 1992, when the substance abuse services were extracted from another, larger agency and merged into one new entity. Philip Steck, chairman of the Assembly’s Substance Abuse Committee, says the whole point of that reconfiguration was to improve the state’s addiction treatment apparatus by separating it from everything else. “Drug abuse was neglected when it was part of a larger agency,” Mr Steck told me. “The people who now want to merge addiction and mental health seem to forget that.”
Mr. Steck agrees that the current setup – mental health in one instance, 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 solve that than trying to smear two giant desks together. His own proposal, for example, is to simply “infuse” more mental health services into the 12 addiction treatment centers that OASAS already presided over. This move would not only lead to more integrated treatment for people with co-occurring conditions, he said, but would also help increase the workforce because state utilities pay more than the nonprofits. “The idea of a new health behavioral department sounds very forward-thinking,” said Mr. Steck. And I’m not saying it should never happen. But to recreate the system like that could take ten years, and we now have people who are suffering.”
Those are valid concerns, but for Ms Marquesano and the hundreds of lawyers and officials who agree with her, the time for partial corrections is long gone. “We’ve been begging for these systems to integrate and coordinate more for 21 years,” said Paige Pierce, a parent attorney and CEO of the nonprofit Families Together. “Opponents continue to insist that a merger will not work. But what we have now really doesn’t work and hasn’t worked for decades.”
The federal government also seems to want to recognize that. This spring, the Office of National Drug Control Policy unveiled a new “government approach to defeating the overdose epidemic.” The National Drug Control Strategy, as it’s being 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.” Those are welcome developments, but for the wider effort to succeed, officials at every level will have to grapple with a range of deeper flaws in the national approach to addiction. Laws will have to change: Some drug war-era statutes must be repealed. Others, including those focusing on equal insurance coverage for behavioral problems, 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 completely erased. And funding flows will need to be reworked so that they support rather than hinder evidence-based practices.
For that to happen, however, policymakers and proponents will have to overcome the same apathy and inertia that thwarted decades of previous reform efforts. And the rest of us will have to confront our enduring ambivalence about what addiction really is and what the people who suffer from it need and deserve.