RISULTATI RICERCA

The use of tobacco is one of the major social and health problems of our times, the leading cause of preventable death.The steady reduction in the prevalence of smoking in the general population in recent decades has not been observed in populations with psychiatric disorders.Hence a pilot project that aims to promote a territorial network between the Mental Health Services and the Anti-Smoking Centers for a global intervention strategy to combat smoking in patients with psychiatric disorders trying to create conditions of “Tobacco Services-Free”, including employees, at any point inside and outside the structure.The experience made with a Protocol is particularly significant in the first place to dispel the clichés on the problem of smoking and mental illness in accordance with the scientific data present in the literature.The treatment of these patients can be successful if psychiatric services in addressing the problem offer behavioral motivational support to their patients.Collaboration with specialist Centers is essential for the treatment of addiction.Varenicline was effective in helping patients achieve abstinence or reduce the number of cigarettes smoked, and did not show a significant increase in neuropsychiatric adverse events.It is desirable that all Mental Health Services be able to carry out informational-motivational counseling onsmoking-related risks, favoring access for motivated patients to specific cessation programs in collaboration with specialized services (Anti-Smoking Centers).

Although Gambling Disorder has been recognized in disease classification systems as an addictive behaviour with the V edition of the DSM (2015), addiction services have long since highlighted the presence of Gambling disorder as an additional diagnosis in patients with substance use disorder.Many services have begun to treat the DGA even before it was included in the essential levels of assistance (LEA) based on the request of the same patients who recognized themselves in the characteristics of patients with drug, alcohol or tobacco addiction and therefore accessed the SerDs recognizing them as appropriate services.Comorbidity rates have been established as significant, particularly with substance use, personality disorders, mood disorders, and anxiety disorders as the most common concomitant disorders with gambling. Evaluation of the effects of gambling symptoms on other psychiatric conditions is also extensive, concluding that in both cases, the co-presence of multiple disorders exacerbates any existing pathology, worsens treatment outcomes, and compromises overall functioning. This effect appears to positively correlate with the number of associated disorders.

The arrival of the Covid-19 pandemic has significantly changed the approach to various intervention modalities in the Ser.D. and with the arrival of the lockdown, many projects and operational paths that were not of an urgent nature were postponed, including above all the prevention and health promotion activities.Group activities were also blocked, consequently the final meetings of the experiential groups aimed at restoring personal well-being were canceled.These paths were stopped, precisely, in a final phase of verification and restitution, leaving the members of the groups and the operators in a temporary state of suspension.Are illustrates the alternative strategies adopted and the adhesion and the experiences of patients.

Introduction. The issue of assessing effectiveness is attracting more and more interest in those who work in the addiction field. From an economic point of view, there is now a need to keep public expenditure as low as possible. All states need to find the best possible treatment in terms of maximum effectiveness at a minimum cost, which means spending the money allocated in the best possible way. In order to make this possible, it seems necessary to think of an effective type of intervention defined as such when it reaches the objective for which it was implemented.Materials and method. The purpose of the study is to evaluate the effectiveness of therapeutic programs activated at the therapeutic community "Casa di Giano" of a sample of 48 subjects who have carried out a therapeutic path in the period between 2014 and 2018. To carry out the follow-up, a structured questionnaire has been developed, consisting of 44 questions, administered by telephone interview.Results. The majority of the subjects who have carried out a therapeutic path in "Casa di Giano" are mostly males and in almost three-quarters of cases, the sending to "Casa di Giano" by the local services was requested for a problem related to an alcohol addiction. Those who enter the community have a low level of education, are unemployed and have no stable relationship. Age differences are observed in genders with a male population tending to be younger than the female population.Conclusions. The results of the study made it possible to clearly outline the characteristics of the respondents and to investigate their condition of well-being in the period following the conclusion of the therapeutic program at "Casa di Giano" highlighting that the maintenance of abstinence in the post-community period is associated with the completion of residential treatment, the duration of treatment and participation in another therapeutic program of recovery from addiction (e.g. Ser.D., A.A., C.A.T. etc.).

The World Health Organization (WHO) has set up the elimination of hepatitis C virus (HCV) worldwide by 2030. The main aims of this study were to evaluate in HCV positive PWIDs: 1) the cost of patient’s journey of treated subjects; 2) the cost saving induced by HCV treatment for the public health system; 3) the potential cost for a national HCV elimination plan in drug users. We performed a non-interventional study including 1,333 PWIDs attending the Drug Abuse Units of the Public Health Service ASST Melegnano-Martesana (Milan, Italy), over one year (January–December 2017). The direct cost for the health services received by each patient during HCV treatment (excluding the cost of drug treatment) was collected using the electronic clinical database of the public health service.In the cohort of 1,333 patients we found 257 RNA HCV-positive PWIDs, 65 of which were treated. The mean health direct cost per each treated patient was € 1,418, while the mean the annual cost for each patient in waiting list for treatment was € 214. Considering that a HCV-positive PWID may infect within 3 years from infection at least 20 other new subjects, we may suppose that a HCV treatment may save about € 30,000 for the public health system. The study shows that HCV treatment in PWIDs can significantly reduce both individual and community health costs and that HCV elimination plans may be sustainable for the public health system by avoiding the enormous costs of the disease burden.

The epidemiological data suggests that people who use drugs (PWUDs) are the most important “reservoir” for the spread of HCV infection. For this reason PWUDs should be included in all HCV elimination plan as priority target for treatment.We performed an observational study in 5 Italian Drug Abuse Services (SerDs) with the main aims to determine: 1) the prevalence of HCV infection in PWUDs; 2) the most important barriers to HCV treatment.Of the about 4,000 drug users included in the study only about the 36% was tested and of them the 20% were anti HCV positive; only about the 60% of the HCV RNA positive patients were treated.The study showed several important barriers to the screening, especially when cannot used rapid tests and/or if test is not proposed periodically, and to the linkage to care, in particular when the HCV treatment cannot be given inside the SerDs.The study has also revealed as the harm reduction measures as suggested by WHO are not offered to all PWUDs. In conclusion the study suggests how inside the SerDs the barriers for HCV treatment that can be overcome with a simpler model of treatment as represented by the point of care.

In Italia, la pandemia virale SARS-CoV-2 impatta su un'organizzazione territoriale delle dipendenze diffusa su tutto il territorio nazionale. In provincia di Bergamo sono presenti 6 servizi territoriali per le dipendenze. La normativa nazionale e regionale ha definito ESSENZIALE l'erogazione dei servizi per le dipendenze e, per questo motivo, durante la fase più drammatica del contagio i servizi sono rimasti aperti, garantendo l'andamento con un inevitabile processo di riorganizzazione. Il lavoro descrive i cambiamenti organizzativi che i servizi dovevano attuare, l'impatto dell'infezione sui pazienti, quali cambiamenti si sono verificati nell'accesso dei pazienti ai servizi e come sono stati gestiti i trattamenti farmacologici con agonisti degli oppioidi.

BackgroundPeople Who Use Drugs (PWID) play a crucial role in the goal of eradicating hepatitis C and, despite the high efficacy and tolerability of Direct Acting Antivirals, many PWID still have to be treated and there are many barriers that slow down the process. An exploratory pilot survey was conducted to determine service providers' current condition and the barriers experienced by PWID in accessing HCV treatment.  MethodsSeven selected clinical centres completed a 27-item online survey addressing the current treatment situation in PWID hepatitis C treatment, related barriers and linkage to care.  ResultThe survey mainly involved central-northern Italian clinical centres (71.4%), with less than 4 prescribers (71.4%) despite they are currently treating around 500-1000 patients for Hepatitis C (>50% current or former PWID). In most cases, they carried out the necessary checks (100% blood sample, 85.7% fibroscan and 43% ultrasound) in few visits (85.7%) to deliver drugs in about one month (71.4%). They all agree on the need for fast-track for PWID and therefore they are all engaged in dedicated projects. The commitment to eradication is, in most cases, based on personal efforts, which despite the few prescribers, the lack of institutional support (85.7%) and the impossibility to use simplification scores since prescription and drug delivery portals (AIFA and regional) still require a lot of information. Although the centres questioned express the need for a simplification of the bureaucratic processes, however, they scrupulously follow PWID. For 57.4% of the centres, Linkage to Care remains the most problematic moment, to follow equally the lack of a correct epidemiological estimate and the implementation of the harm reduction policies. Finally, most of the centres don’t find particular barriers related to PWID’s features, but analysing them individually the main ones are: the difficult social background, the reinfection risk and the patient’s poor motivation. ConclusionsThe needs emerged from this survey are: to work on PWID de-stigmatization, to simplify the prescription/drug delivery portals in order, to increase PWID social assistance network and institutions support in HCV eradication programs.