It a hierarchical and deeply traditional organization, consisting of "families" with a Cupola (ruling council) headed by a "capo di tutti capi" (boss of bosses). Don Camillo Spinelli of the powerful Feretti family is the capo di tutti capi. The majority of its "made men" are advisers and dealers who run smaller syndicates, finance illegal gambling and prostitution, and broker illegal drugs, BTL chips, and guns to supply their partners and street operators.
The Mafia is the defacto government on Sicily, taxing everyone on the island. Like the other Italian syndicates they run protection rackets and are into gambling and drugs. La Cosa Nostra is the most wealthy and best connected syndicate in the Alta Commissione, with deep inroads into Europe 's financial backbone. It provides the connections, money, and intelligence for transnational crime in exchange for a cut.
The Sicilian Mafia has been eclipsed internationally and domestically, weakened by the brutal war among its families for control of the heroin trade (from Turkey) in the 1980s and anti-Mafia crackdown by the Italian government in the aftermath due to the wave of terrorism waged against the state by the Mafia.
Within Italy it has been eclipsed by the Calabrian N'drangheta and Neapolitan Camorra whose rise to primacy was made possible by the cocaine trade. Across Europe, it is now the Russian Vory V Zakone, the Turkish mafia, and the Italian N'drangheta and Camorra who dominate. In the heroin trade, where it used to be the 2nd biggest heroin traffickers (with the Chinese Triads being the biggest), it lost it's heroin market in the United States to the Colombians and Mexicans and in Europe to the Turks.