Addiction disorders: a need for change. Proposal for a new management

Study Committee of SIA (Società Italiana di Alcologia), Gianni Testino, Luigi C Bottaro, Valentino Patussi, Emanuele Scafato, Giovanni Addolorato, Silvia Leone, Doda Renzetti, Patrizia Balbinot, Giovanni Greco, Tiziana Fanucchi, Giorgio Schiappacasse, Paola Cardinale, Pierluigi Allosio, Rinaldo Pellicano, Fabio Caputo

Research output: Contribution to journalArticle

Abstract

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 To date, the term "addiction" has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics.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.
Original languageEnglish
Pages (from-to)369-385
Number of pages17
JournalMinerva Medica
Volume109
Issue number5
Publication statusPublished - Oct 2018

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Keywords

  • Addiction Medicine/organization & administration
  • Alcoholism/epidemiology
  • Choice Behavior
  • Combined Modality Therapy
  • Comorbidity
  • Continuity of Patient Care
  • Diagnostic and Statistical Manual of Mental Disorders
  • Disease Management
  • Disease Susceptibility
  • Government Agencies/organization & administration
  • Hospitalization
  • Humans
  • Interdisciplinary Communication
  • Italy
  • Life Style
  • Primary Prevention/organization & administration
  • Psychotic Disorders/epidemiology
  • Self-Help Groups
  • Social Determinants of Health
  • Substance-Related Disorders/epidemiology

Cite this

Alcologia), S. C. O. SIA. S. I. D., Testino, G., Bottaro, L. C., Patussi, V., Scafato, E., Addolorato, G., Leone, S., Renzetti, D., Balbinot, P., Greco, G., Fanucchi, T., Schiappacasse, G., Cardinale, P., Allosio, P., Pellicano, R., & Caputo, F. (2018). Addiction disorders: a need for change. Proposal for a new management. Minerva Medica, 109(5), 369-385.