REVIEW   

Minerva Medica 2018 October;109(5):369-85

DOI: 10.23736/S0026-4806.18.05741-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Addiction disorders: a need for change. Proposal for a new management. Position paper of SIA, Italian Society on Alcohol

Gianni TESTINO ^{1, 2, 3} ✉, Luigi C. BOTTARO ⁴, Valentino PATUSSI ^{2, 3, 5}, Emanuele SCAFATO ^{2, 3, 6}, Giovanni ADDOLORATO ⁷, Silvia LEONE ^{1, 3}, Doda RENZETTI ^{3, 8}, Patrizia BALBINOT ^{1, 3}, Giovanni GRECO ^{3, 9}, Tiziana FANUCCHI ^{3, 5}, Giorgio SCHIAPPACASSE ¹⁰, Paola CARDINALE ¹¹, Pierluigi ALLOSIO ^{3, 12}, Rinaldo PELLICANO ¹³, Fabio CAPUTO ^{3, 14, 15} Study Committee of SIA (Società Italiana di Alcologia) 

¹ Alcohological Regional Center, Ligurian Region, ASLe c/o San Martino Policlinico Hospital, Genoa, Italy; ² World Health Organization, Collaborative Center for Health Promotion, Research on Alcohol and Alcohol Related Health Problems, ISS, Rome, Italy; ³ Italian Society on Alcohol, Bologna, Italy; ⁴ General Direction, ASL3, Genoa, Italy; ⁵ Alcohological Regional Center, Tuscanian Region, Careggi Hospital, Florence, Italy; ⁶ National Institute of Health, Rome, Italy; ⁷ “AUD and Alcohol Related Diseases” Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, University of the Sacred Heart, Rome, Italy; ⁸ Unit of Medicine, Ospedale Mater Dei, Bari, Italy; ⁹ AUSL Romagna, Ravenna, Italy; ¹⁰ Unit of Addiction, ASL3, Genoa, Italy; ¹¹ Psychiatric Clinic, Policlinico San Martino Hospital, Genoa, Italy; ¹² Unit of Alcohology, ASLTO1, Turin, Italy; ¹³ Unit of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy; ¹⁴ Department of Internal Medicine, Hospital of S. Annunziata di Cento, Ferrara, Italy; ¹⁵ “G. Fontana” Center for the Study and Multidisciplinary Treatment of Alcohol Dependence, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

Various epidemiological and biological evaluations and the recent publication of the DSM-V (diagnostic and statistical manual of mental disorders) has imposed on the scientific community a period of reflection on the diagnosis and treatment of what in the DSM-IV was defined as “addiction”. To date, the term “addiction” has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics. This, we will talk about substance/alcohol use disorders (SUDs/AUDs) and disorders related to behavioral alterations (DBA) that can generate organic diseases, mental disorders, and social problems. In the first psychotic episode 40-70% of subjects meet the criteria of a SUDs/AUDs, excluding tobacco dependence. Substances can not only be the cause of a psychotic onset, but they can also disrupt a psychotic picture or interfere with drug therapy. The pharmacodynamic profiles of many substances are able to provoke the phenomenology of the main psychotic symptoms in a way that can be superimposed onto those presented by psychotic subjects without a history of SUDs/AUDs. The Department of Addictions (DAs) must not be absorbed by or incorporated into the Departments of Mental Health (DMH), with which, however, precise operational cooperation protocols will have to be defined and maintained, but it will have to maintain its own autonomy and independent connotation. Addiction Medicine is a discipline that brings together elements of public health, prevention, internal medicine, clinical pharmacology, neurology, and even psychiatry. The inclusion of the DAs in those of DMH refers purely to a problem of pathology that has to do with lifestyle, choices, and behaviors. These, over time, show their dysfunctionality and only then do related problems emerge. Moreover, epidemiological, social, and clinical motivations impose the creation of alcohological teams dedicated to alcohol-related activities. The collaboration with self-help-groups (SHGs) is mandatory. The action of SHGs is accredited in numerous international recommendations both on the basis of consensus and evidence in the literature.

KEY WORDS: Alcoholism - Behavior, addictive - Substance-related disorders - Self-help groups