In america apart the NY,NJ and the other east coast cities the american mafia lost barely survive.
The reasons are that the recruitment pool are skhrinking and that the young italian-american prefer to go to the university that be made and who want to be made are the waste of the society.

the mob butter and bread are vanishing,the bank give more loan,the gambling was legalized ecc

Remain only the street crimes (murder,drug traffick ecc) but in the last years due to the long sentences more mobster had flipped and the small families don't have the manpower to compete with the street gangs. How could survive ?

In my opinion the solution is to made how the Outfit: few but trusted made men and more associates that had the same respect of the capos and a more large bases and maybe to made who is italian only on the mother side but is white and loyal.
Or made an alliance with the ndrangheta gruops in the USA.