by Chiara Daina
The abuse of illegal substances, psychotropic drugs, alcohol or smoking as well as gambling (including online) are increasingly widespread. Addiction Services work, but too many kids (and families) hesitate
Addiction is a sucking vortex. And no one saves themselves.
«When the search for the substance or behavior becomes uncontrollable, it is repeated incessantly and occupies a large part of the mental space, taking time and commitment away from work, family, friends and hobbies, despite the person being aware of the harmfulness of that consumption or of that activity, you need to ask for help from the dedicated care services in the area. The longer it takes to do so, the more difficult it becomes to get out of it – declares Michele Sanza, director of the Department of Mental Health and Pathological Addictions of Forlì-Cesena (Ausl Romagna) and co-president of the Italian Society of Addiction Psychiatry -. Unfortunately we can only cure the tip of the iceberg. It is very difficult to intercept who could benefit from the service. The stigma of being labeled a drug addict still weighs heavily. «But it is important to make people understand that drug, alcohol, gambling and internet addiction, which today affects the entire population, of any economic, social and cultural status, and not just the marginalized, is a health problem like any other”.
Free and anonymous appointments
The Services for pathological addictions, known by the acronym Serd (or Sert, if they maintain the old attribution of «Drug Addiction Services»), can be accessed directly, that is, without a doctor’s referral, without a waiting list. «The first meeting is scheduled within 48-72 hours», informs Sanza. And totally free, that is, without paying tickets, from Monday to Friday. You can make an appointment in person, on the phone or even via email. «The person can request anonymity» recalls Sanza. The team is multidisciplinary and is made up of a psychiatrist, toxicologist, psychotherapist, educator, social worker and nurse. «The addictions treated are those recognized by the LEAs (the essential levels of assistance covered by the NHS, ed.), i.e. those involving illegal substances, psychotropic drugs, alcohol, gambling, including online gambling» explains the psychiatrist. There are also anti-smoking centers to stop smoking, which may belong to the Serds or other health facilities.
The stages
«There are those who choose to be followed by a private professional, psychotherapist or psychiatrist, underestimating that the problem is complex and must be addressed on multiple fronts, health, psychological and social, and the work of a team is necessary to take it into account. global load, from diagnosis to socio-work reintegration” observes Sanza. The first stage of the process is the welcome interview, which serves to frame the situation. The second appointment consists of the medical examination. «Toxicological tests are prescribed to detect the substances that the person uses, tests for HIV and hepatitis C, blood tests to check the functionality of the liver, possibly an abdominal ultrasound, and the physical and psychic. More and more frequent conditions are depressive, bipolar, borderline, sometimes psychotic disorders. If serious, the person is also followed in parallel by the mental health center – continues Sanza -. Once the diagnosis phase is completed, an individual therapeutic rehabilitation project is defined with the treatment and assistance needs”.
Complete return to life project
At an outpatient level, pharmacological treatments are offered to control withdrawal symptoms, treatments with psychotropic drugs, individual and group psychotherapy courses, psychoeducation courses (to help become aware of the pathological condition and manage symptoms and stress), also aimed at family members, and mutual help groups. If more intensive rehabilitation is necessary, the person is referred to a day centre, which offers psychotherapy and family relationship support, recreational activities, job training and art therapy. «Health intervention can be integrated with social help, also in collaboration with the third sector. In the most fragile situations, in fact, the pharmacological approach is not sufficient because the addiction impacts the person’s entire life – comments Roberta Balestra, director of the Serd of the Trieste healthcare company and vice-president of Federserd (the Italian Federation of department operators and addiction services) —. In these cases, home visits are carried out, the person is accompanied to medical visits, because otherwise they would not go alone, or to the Municipality if they need to complete some paperwork, they are helped to manage the accommodation, group outings are organised, to the cinema, to a pizzeria, to the theatre, to museums, and trips to the mountains and the sea to relearn how to be with others and enjoy the things that once thrilled us.”
Health budget
To support the individual therapeutic plan, the “health budget” can be used, a tool that integrates the resources of the health service with those of the social services and those of the user or his family, to build a personalized project to strengthen autonomy personal, which involves reintegration into the life of relationships and work, through the involvement of local associations and businesses. The person participates directly in the definition of the rehabilitation path that concerns him. «The purpose of the health budget is to keep the person in his living environment, avoiding institutionalization and the use of less effective healthcare services» underlines Sanza. However, the adoption of this tool is still limited at the national level.
A third of patients make it
Residential treatment in the community, which normally does not exceed 24 months, is intended for the most compromised cases, when the person is unable to work and look after himself, his loved ones and his home.
While hospitalization for a maximum of 15 days is indicated to deal with the acute detoxification phase for those who need it, before starting the outpatient process. «Where present, you can spend a period of 3-6 months in specific residential facilities for detoxification» adds Sanza. Which points out: «At the basis of addiction there is a neurobiological alteration that exposes one to risk even many years after overcoming the problem. Our goal is to prevent relapses and improve the person’s quality of life as much as possible. About a third of those assisted stop and regain self-control, returning to having a normal life; half enjoy prolonged remissions, have a good life but relapse every now and then; and 20% have chronic addiction but reduce consumption or gambling. The path to the Serd lasts on average 5-7 years for those who use substances, 3 years to quit gambling and about one from alcohol.”
Who asks for help
In 2022, we read in the latest report to Parliament from the Department for Anti-Drug Policies, drug addicts assisted by the Serds were 127,365 and 14% were new users. The majority (85.5%) are male and those under 25 represent around 6% of the total (but correspond to almost 20% of new entries). The Serd’s activities include prevention initiatives against addictions, in schools, drug-dealing intersections, public gardens, stations, nightclubs. «A mobile team reaches the groups most at risk and provides education on overdose management, delivering heroin antagonist drugs, to reduce the damage – says the director of the Serd of Forlì-Cesena -. The operators try to engage the underground economy, who otherwise would not turn to the Serd.” Through the «Overnight» project of the Trieste Health Authority, breath tests, taxi vouchers, information material, and counseling and first aid interventions are distributed in discos and concerts.
Prevention at school and advice to parents
An example of prevention at school is that carried out by the addictions department of the Caserta Local Health Authority. Self-awareness tests and discussion groups are offered to students and listening centers have been activated at 20 secondary schools to intercept adolescents already implicated or at risk of addictive behavior at an early stage.
Another initiative of the Department is the «school for parents»: «We organize two groups a month on different topics each time, in which teachers can also participate. We explain, for example, what polyabuse of alcohol, cannabis and pills is, what the risks are and how to recognize the warning signs – reports Lilia Nuzzolo, the director -. Many parents tend to “normalize” teenage drinking and the fact that their child can sleep all day on weekends, without imagining that she might have taken drugs at night. Or they are convinced that having many friends and not lacking anything it is impossible for him to fall into a bad situation. I recommend parents to rely on experts when they realize that there is something wrong with their children and they can’t talk about it with them.”
How to find the care service closest to home?
The National Center for Addiction and Doping of the Higher Institute of Health (ISS) has created interactive platforms dedicated to smoking, food, internet and gambling addiction, with maps of the help centers to turn to, information material and toll-free numbers that offer listening and counseling: smettodifumare.iss.it (with knowledge tests on tobacco and nicotine and health risks), platformdisturbialimentari.iss.it, amministrazioneinternet.iss.it and exitalgioco.iss.it (with self-assessment test). For each selected center we provide address, contacts, website, opening hours, manager, team, type of treatments offered and access methods. The list of addiction services (Serd/Sert), broken down by region, is available on the portal of the department for anti-drug policies of the Presidency of the Council of Ministers (www.politicheantidroga.gov.it).
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January 14, 2024 (modified January 14, 2024 | 07:38)
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