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Società Italiana Psichiatria delle Dipendenze

Sezione Speciale della Società Italiana di Psichiatria

 
In un tossicodipendente non è solo il corpo a chiedere aiuto

 
 
Storia


THE ITALIAN ASSOCIATION ON ADDICTION PSYCHIATRY

Formerly The Italian Association on Abuse and Addictive Behaviours
Giuseppe Carr๠& Massimo Clerici ²

¹ Department of Applied Health and Behavioural Sciences. Section of Psychiatry.
University of Pavia.
² Department of Psychiatry. San Paolo’s Hospital Medical School.
University of Milan.

Correspondence to:
Giuseppe Carrà. Department of Applied Health and Behavioural Sciences. Section of Psychiatry.
University of Pavia. Via Bassi 21, 27100 Pavia. Italy.
Phonel: +39 0382 507249; fax: +39 0382 526723;
E-mail: carra_giuseppe@fastwebnet.it

THE ITALIAN ASSOCIATION ON ADDICTION PSYCHIATRY
Giuseppe Carrà & Massimo Clerici

The Italian Association on Addiction Psychiatry (SIP.Dip.) is a special section of the Italian Psychiatric Association (SIP). It started, under the name of the Italian Association on Abuse and Addictive Behaviours (SICAD), in 1989 from the awareness that the addiction field had been starved of a psychiatrists’ contribution since 1975. SIP.Dip. aims to improve and implement study, clinical, research and educational topics about substance abuse and addictive behaviours. The National Board composition aims to provide an equal distribution of psychiatrists working in psychiatric and addiction facilities inside the National Health System, and private non-profit agencies. All psychiatrists and members of the Italian Psychiatric Association can become SIP.Dip. ordinary members, while other health professionals working in psychiatric and addiction fields can become associate members.
SIP.Dip. has its National Congress every second year. In 2001 it promoted a network called the National Council of Addiction Disorders. It is officially recognized by the Drug Policy National Department and was created under the direct authority of the Prime Minister. In this SIP.Dip. is particularly involved in review groups relating to ethical issues, substitutive therapies and dual diagnosis. Furthermore, it intends to organize the first Consensus Conference on Dual Diagnosis, under the sponsorship of the Italian Psychiatric Association. This will be held in June 2003, and is intended to implement relevant national guidelines. The SIP.Dip. main topics that will be addressed in the near future are: psychiatric comorbidity in substance related disorders; intervention efficacy assessment; and special populations and novel addictions. The National Board meeting on 15th December 2002 decided to submit to the General Assembly in April 2003, a motion to modify the Association’s bye-laws and to rename the organization The Italian Association of Addiction Psychiatry.
KEYWORDS Substance use related disorders, psychiatry, Italian drug policy.

HISTORICAL BACKGROUND
The Italian experience in the field of substance-related disorders is quite different from that of many others countries. Only the last Reform of Act 309/90 ratified a network of addiction facilities within the National Health System. One of the most peculiar elements of Italian health culture in the addiction field has been an ideologically-oriented approach to addiction as a phenomenon, and to the organisation of related services. This approach is linked to historical “anomalies” which have accompanied and influenced not only professionals’ views but also public opinion about addiction issues.
Among these historical “anomalies” it is appropriate to remember the key-elements, which, for a long time, have had a strong influence on its development. They are:
a) The virtual expulsion of psychiatry from the addiction field by the first reform Act 685/75. This occurred during a deep crisis in Italian psychiatry following on from an anti-psychiatric wave that led to the well-known psychiatric Reform of Act 180/1978 (inspired by Franco Basaglia);
b) The temporary role of private non-profit agencies, especially therapeutic communities -generically inspired by the Daytop model - in the addiction field. This was greatly developed because of the lack of psychiatric skills in diagnosis and treatment of substance-related disorders, and the uncertainties and delays in establishing a network of addiction facilities inside the National Health System;
c) Public and political opinions are still engaged, much more than physiological debate could justify, in an ideological argument with little scientific basis about the causes of addiction and related therapeutic tools. These are firstly, a socio-genetic point of view about the causes and the psychologically-oriented option for interventions among professionals and public opinion which denied for many years the illness model of addiction. Secondly, never-ending and useless debates about the unique validity of specific therapeutic options (e.g. methadone maintenance versus therapeutic communities, or psychopharmacological treatments versus environmental therapies), which prevented any empirical efficacy evaluation of treatment options, and created barriers among professionals as well.
d) Furthermore, we have to mention the necessary and deep changes since 1999 in the health and welfare systems caused by the growing lack of economic resources, and the re-organization of the National Health System according to a business-oriented model. This has concentrated the limited resources for addictions on selected programs, often with little scientific or evidence-based criteria.

SIP.Dip.’S START UP
The Italian Association on Addiction Psychiatry was established - under the name of the Italian Association on Abuse and Additive Behaviours (SICAD) - in Rome in 1989 during the 37th Italian Psychiatric Association (SIP) Congress as a special section affiliated to the mother society. It started from the Italian Psychiatric Association’s awareness that the addiction field had been starved of psychiatrists’ contribution for a long time, since 1975 when ACT n° 685 (“bye-law of abuse and psychoactive substances. Prevention, treatment and rehabilitation of addiction related conditions”) set up, in regional catchement areas, specific addiction facilities. These were medically oriented but with a strong component of social work (Nizzoli & Foschini, 2002). This act was strongly innovative overall for the de-criminalization of personal substance use, and emphasised voluntary treatment and confidential characteristics. Unfortunately the Act introduced a vague concept of “a moderate amount”, provoking lively controversies because it can be interpreted in many different ways by different judges who could prescribe relevant and compulsory treatment in addiction facilities. Furthermore, international scientific stimuli by the World Psychiatric Association (WPA) and the Association of European Psychiatrists (AEP), have been underlining analogous needs and projects.
In 1997, again in Rome, byelaws were reviewed and updated to be congruent with the mother association and be correctly affiliated. Periodically – as recently in July 2002 and April 2003 - general assembly voted additional changes in byelaws for analogous reasons (Carrà & Clerici, 2003) .

SIP.Dip.’S AIMS
SIP.Dip. aims, as a special section of the Italian Psychiatric Association, are (based on our statutes) to improve and implement, among mental health professionals, clinical, research and educational topics about abuse and addictive behaviours, especially those related to addictions to licit and illicit substances, including alcohol and, generally speaking, compulsive behaviours. These aims are pursued through research and educational projects, spreading and exchanging knowledge, and sponsoring and supporting health policy initiatives.
THE ASSOCIATION’S FRAMEWORK
All psychiatrists and members of the Italian Psychiatric Association can become SIP.Dip. ordinary members if they are interested in addiction issues, even if they don’t actually work in addiction facilities. The membership fee is 40 euros per year. Related benefits are free attendance at SIP.Dip. scientific meetings, i.e. a National Congress each second year (but renewal of the Board takes place every fourth year) and CME courses for psychiatrists and different health professionals. In addition, health professionals working in psychiatric and addiction facilities within the National Health System and private non-profit agencies (e.g. physicians, psychologists, social workers, psychiatric rehabilitation technicians, etc.) can become associate members. Among SIP.Dip.’s main purposes we emphasise the need to spread, as much as possible, knowledge about psychopathological and psychosocial issues of substance-related disorders, in order to provide a properly integrated theoretical and operative perspective. For this reason the National Board composition aims, as much as possible, to provide an equal proportion of psychiatrists working in psychiatric and addiction facilities, within the National Health System, and private non-profit agencies too. Current officers, elected in Milan on the 8th July 2002 by the General Assembly are listed as in Table 1.

Honorary President E.Tempesta (Roma) National Board
E .Aguglia (Trieste), G. Bellio (Treviso)
F. Bonfà (Piacenza) , F. Catapano (Napoli)
M. Diana (Cagliari), M. Di Giannantonio (Chieti)
R. Gatti (Milano), L. Janiri (Roma)
S. Lucesoli (Macerata),  G. Mammana (Foggia)
P. Miragoli (Milano), G. Pozzi (Roma)
M. Sanza (Rimini), G. Zanda (Lucca).
Past President I. Carta (Milano)
President M. Clerici (Milano)
President Elect A.Fioritti (Bologna)
Secretary G.  Carrà      (Pavia)
Vice-Secretary S. Biscontini (Spoleto)
Treasurer R. Scioli (Pavia)
Auditors of accounts
D. Banon (Treviso), C. Barile (Torino), L.Restani (Pavia)

Current membership is 434 ordinary members and 512 associate members. Each member signs a form in which, according to the national privacy law, restricts access to his/her membership. Membership fees are essential to the association’s survival and its educational and training activities; related budgets are funded by public bodies, such as the National and/or regional government, or by unrestricted educational grants by pharmaceutical companies.
Every fourth year SIP.Dip. has its own National Congress, organized by the current national board. SIP.Dip. publishes National Congress proceedings. On the subject of SIP.Dip. National congress topics, we should mention, under the name of the Italian Association on Abuse and Addictive Behaviours (SICAD): abuse behaviours and addictive states: from research to interventions. Rome, 7-10, October 1992. (More than 500 participating professionals); abuse behaviours and addictive states: integrating interventions. Catania, 16-22 June 1996. (More than 400 participating professionals); addiction and dual diagnosis in European metropolis. Milan, 8-9 July 2002. (More than 600 participating professionals).

PUBLICATIONS AND WEBSITE
Since 2002 the Association has had its own web site in the Italian language (www.doppiadiagnosi.it). This obviously is a work-in-progress for the continuing development of the Association’s role and issues.
The aims of such a tool are: a) spreading dual diagnosis knowledge among Italian health professionals; b) providing national and international links to analogous organisations; c) showing an overview of national original research works in related fields.
SIP.Dip. edits its own monograph series by Franco Angeli (Publisher, Milan), with seven volumes published up to now by authors such as John Markowitz and Joel Solomon and several Italians.

PARTNERSHIPS
SIP.Dip. promotes and supports links with public and non-profit agencies at regional, national and international level in pursuit of its aims.
In the previously mentioned historical account SIP.Dip., with great difficulties, worked to spread among professionals and public opinion, substance abuse-related issues. It established links with ERIT and ITACA (European networks of Professionals Associations working in the field of drug abuse), SITD (the Pharmacological Society in the addiction field), SIA (specifically alcohol field association) and ALEA (a gambling-related issues association). These organizations in 2001 established a network, The National Council of Addiction Disorders, officially recognized by the Drug Policy National Department and created under the direct authority of the Prime Minister. Inside the National Council of Addiction Disorders, SIP.Dip. is involved in a number of scientific review groups on different topics i.e. ethical, substitutive therapies and dual diagnosis issues.
Furthermore, as a scientific association, SIP.Dip. has collaborated, through the organization of symposia, in the development of meetings and/or congresses with the following associations: the World Federation of Societies of Biological Psychiatry, the World Association for Social Psychiatry, the Italian Association of Biological Psychiatry, the Italian Psychiatric Association, the International Institute on the Prevention and Treatment of Alcoholism, the Institute on the Prevention and Treatment of Drug Dependence, the Conférence Européenne del Intervenants en Toxicomanie, the World Psychiatric Association, the Association of European Psychiatrists, the Federation of European Professionals Associations Working in the Field of Drug abuse (ERIT), the Italian Psychopathology Association.

TRAINING ACTIVITIES
SIP.Dip. has organized a number of training activities throughout Italy on diagnosis (Clerici et al. 1989; Clerici & Carta, 1996) and psycho-educational treatments (Clerici et al. 1988) in the substance abuse fields. Furthermore it supports the spreading of Italian versions of Europ-ASI (Kokkevi & Hartgers 1995) and the Maudsley Addiction Profile (Marsden et al. 2000) to support the assessment and evaluation systems in dual diagnosis and substance abuse fields among Italian professionals working in psychiatric and addiction facilities’. Many SIP.Dip. board members act as supervising counsellors for local and regional trusts about dual diagnosis and substance abuse topics.

SIP.Dip. AND POLICY
The National Council of Addiction Disorders, of which SIP.Dip. is a founding member, is the cornerstone of lobbying activity in the substance related disorders field through National Government policy. We very much appreciated the excellent response by all the associations involved in the substance abuse field to our proposal to establish the National Council of Addiction Disorders. Within the National Council we should develop a lobby to favourably influence National Government and Local and Regional Trusts - previously quite exclusively conditioned by private non-profit agencies. SIP.Dip. is particularly involved in trying to suggest the best strategies in private and public mass-media campaigns to spread correct and continuous information about addictions. Furthermore SIP.Dip. submits to the Drug Policy National Department up to date and evidence-based reviews to influence the National Health System guidelines in related fields.
What we could learn from past experience is that funding difficulties often induce delays, shortages or set backs in the provision of resources. It means that a scientific association can never have any certainty even if it has a long history and a strong presence among professionals and institutions.

STANDING ACTIVITIES
In 2002 SIP.Dip. stated its aim to link the regional sections of the Italian Psychiatric Association, and to promote dual diagnosis guidelines as a practical tool for psychiatrists working both in mental health and substance abuse fields. This was in order to develop further knowledge about theoretical and operational issues related to psychiatric comorbidity in substance users. Accordingly, SIP.Dip. is going to bring about the first Consensus Conference on Dual Diagnosis, under the sponsorship of the Italian Psychiatric Association, that will be held in Turin in June 2003, with the participation of 120 psychiatrists from mental health and substance abuse services from the five northern Italian regions (Lombardy, Piedmont, Triveneto, Emilia-Romagna and Liguria) and national opinion leaders among professionals involved in substance abuse and psychiatric field. The Consensus Conference on Dual Diagnosis will be repeated in a few months in the Central and Southern regions.

CONCLUSIONS
Fundamental to SIP.Dip.’s purposes is to involve as many members as possible from the mother association, the Italian Psychiatric Association. We are witnessing a satisfying trend of growing interest in dual diagnosis and psychopathological comorbidity in substance-related disorders in Italy, above all among health professionals whose interest is born out by the large number of applications to the Consensus Conference.
We believe that the previously described pattern actually explains why at the last National Board meeting, held on 15th December 2002, it was decided to submit to the General Assembly - the last under the name of SICAD - held in Pescara on 11th April 2003, the proposal to modify the Association’s bye-laws and change the name to the Italian Association of Addiction Psychiatry (Società Italiana Psichiatria delle Dipendenze-Sip.Dip.). The General Assembly has approved emphasizing that we may more effectively influence the scientific and cultural debate in our specialist field. We support the view that different associations could develop similar good results in the Addiction field from their own standpoint.
To summarize: the SIP.Dip. Board stated that for the next five years the following main topics are to be stressed among our members and National and Local authorities: psychiatric comorbidity in substance-related disorders; intervention efficacy assessment; special populations (prisons and outside-EU immigrants); novel addictions (e.g. Gambling, Bulimia, Sex, Fitness and Doping related).

Address for correspondence with The Italian Association on Addiction Psychiatry
(Società Italiana Psichiatria delle Dipendenze-SIP.Dip.)
Via Bassi 21. 27100 Pavia, Italy.
Tel: +39 0382 507249; fax: +39 0382 526723.
e-mail: carra_giuseppe@fastwebnet.it
Website: www.doppiadiagnosi.it

REFERENCES
Carrà G, Clerici M. (2003) The Italian Association on Addiction Psychiatry (SIPDip), formerly The Italian Association on Abuse and Addictive Behaviours. Addiction, 98(8):1039-42.
Clerici, M., Zardi, L., Garini, R., Capitanio, C., Carta, I. & Gori, E. (1988) Involvement of families in the group therapy of heroin addicts. Drug and Alcohol Dependence 21, 213-216.
Clerici, M., Carta, I. & Cazzullo, Cl. (1989) Substance abuse and psychopathology. A diagnostic screening of Italian narcotic addicts. Social Psychiatry and Psychiatric Epidemiology 24, 219-226.
Clerici, M. & Carta, I. (1996) Personality disorders among psychoactive substance users: diagnostic and psychodynamic issues. European Addiction Research, 2, 147-155.
Kokkevi, A. & Hartgers, C. (1995) EUROP-ASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. European Addiction Research, 1, 208-210.
Marsden, J., Nizzoli, U., Corbelli, C., Margaron, H., Torres, M., Prada De Castro, I., Stewart, D. & Gossop, M. (2000) New European instruments for treatment outcome research: reliability of the Maudsley Addiction Profile and treatment perceptions questionnaire in Italy, Spain and Portugal. European Addiction Research, 6, 115-122.
Nizzoli, U. & Foschini, V. (2002) ERIT-Italia, the Italian Federation for Professionals Working in the Field of Drug Abuse. Addiction, 97, 1365-1367.


 
 
 
     

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