“Our bill makes it clear that the savings generated by the merger will be reinvested in the system,” says Senator Harchcam. “But especially the unions have been hurt in the fight and it’s hard to blame them.” Governor Cuomo reduced the Dependence Services and Support Agency (OASAS) by about 150 during his tenure. Governor Kathy Hokul has taken steps to undo the damage. He allocated about $ 402 million in new funds to the agency and appointed a new commissioner. But even this welcome development presents a challenge to the merger movement. “For the first time in my life, OASAS is the first to get a boost, not a cut,” Senator Harchcam’s legislative director, Joel Foskett, told me. “The instinct is to hold it, not to endanger it in a merger.”
There is also a historical issue. OASAS was founded in 1992, where alcohol and substance abuse services were extracted from another larger institution and integrated into a single new entity. Philip Stick, chairman of the Parliamentary Commission on Alcohol and Substance Abuse, said the overall point of its restructuring was to improve the state’s addiction treatment equipment by separating it from everything else. I say that. “When it was part of a larger institution, substance abuse was ignored,” Steck told me. “Now, those who want to combine addiction with mental health seem to forget it.”
Steck agrees that the current settings (mental health in one institution and addiction in another) do not meet the needs of people suffering from both. But he and others say there is a faster and more cost-effective way to fix it than trying to crush two huge agencies together. For example, his own suggestion is to simply “inject” more mental health services into the 12 Addiction Treatment Centers that OASAS already presides over. Not only will this move lead to more integrated treatments for people with co-occurrence disabilities, but it will also help increase the workforce as state facilities pay more than nonprofits, he said. I did. “The idea for the new behavioral health department sounds very progressive,” Steck said. “And I’m not saying it never happens, but it could take 10 years to recreate such a system, and people are suffering now.”
These are fair concerns, but for Mrs. Marquesano and the hundreds of supporters and officials who agree with her, the time for partial amendments is long ago. Paige Pierce, parent and CEO of the nonprofit Families Together, said: “Oppositions continue to insist that the merger doesn’t work, but what we have now isn’t really working, and it hasn’t worked for decades.”
The federal government also seems ready to admit it. This spring, the National Drug Control Policy Department announced “a government-wide approach to overcoming the overdose epidemic.” The National Drug Management Strategy, as it is called, has billions of new funds for evidence-based therapeutic initiatives, new commitments to combat drug traffickers, and data to guide all these efforts. Includes “Better Use” plans. These are welcome developments, but for a broader effort to succeed, officials at all levels need to work on a list of deeper flaws in the national approach to addiction. The law needs to be changed. Some war-on-drug era legislation needs to be abolished. Others, including those that focus on equal insurance coverage for behavioral health, need to be better implemented. Institutions need to be restructured so that addictions, mental illnesses, and other misleading medical distinctions are eventually completely eliminated. And the funding process must be redesigned to support, rather than prevent, evidence-based practices.
But for either to happen, policymakers and supporters will have to overcome the same indifference and inertia that have hampered decades of previous reform efforts. And the rest of us must confront our lasting ambivalence about what addiction really is and what those who suffer from it need and deserve.