“Our bill makes it clear that any savings generated by the merger will be reinvested in the system,” Senator Harckham said. “But especially the unions have had fights, and it is difficult to blame them.” Governor Cuomo reduced the Office of Addiction Services and Support, or OASAS, by about 150 posts during his tenure. Gov. Kathy Hochul has taken steps to reverse that damage – by 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. “This is the first time in a row that OASAS is getting a boost instead of a reduction,” Joelle Foskett, the legislative director of Senator Harckham, told me. “The instinct is going to be to hold on to it, not to risk it in a merger.”
There is also the matter of history: OASAS was established in 1992, when alcohol and drug abuse services were withdrawn from another, larger agency and merged into a single new entity. Philip Steck, chairman of the Assembly Committee on Alcohol and Drug Abuse, 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,” he said. Steck told me. “People who now want to merge addiction and mental health seem to be forgetting it.”
Mr. Steck agrees that the current setup – mental health in one agency, addiction in another – does not meet the needs of people suffering from both. But he and others say there are faster, more cost-effective ways to fix it than trying to put two giant agencies together. For example, his own proposal is to simply “infuse” more mental health services into the 12 addiction treatment centers that OASAS has already chaired. This move will not only lead to more integrated treatment for people with co-occurring disorders, but will also help increase the workforce, as government facilities pay more than the non-profit organizations. “The idea of a new department of behavioral health sounds very progressive,” he said. Steck said. “And I’m not saying it should never happen. But rebuilding the system in this way can take 10 years, and we have people who are currently suffering. ”
These are fair concerns, but for Mrs. Marquesano and the hundreds of lawyers and officials who agree with her, the time for partial corrections is long gone. “We have been begging for these systems for 21 years to integrate and coordinate more,” said Paige Pierce, a parent advocate and CEO of the nonprofit Families Together. “Testanders insist that a merger will not work. But what we have now really does not work and has not worked for decades. ”
The federal government also seems ready to acknowledge this. This spring, the Office for National Drug Control Policy unveiled a new, “whole government approach” to overcoming 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 combating drug smugglers and a plan to “make better use of data to guide all these efforts.” These are welcome developments, but for the broader effort to succeed, officials at every level will have to grapple with a list of deeper flaws in the country’s approach to addiction. Laws will have to change: Some laws in the drug war era 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 distinction between addiction, mental illness and the rest of medicine will eventually be completely eradicated. And funding flows will need to be reworked to support rather than hinder evidence-based practices.
For any of this to happen, however, policymakers and advocates will have to overcome the same apathy and inertia that have thwarted decades of previous reform efforts. And the rest of us will have to confront our lasting ambivalence about what addiction really is and what the people who suffer from it need and deserve.