How to help young people with addictions: who to turn to and all the stages of the journey

Addiction is a sucking vortex. And no one saves themselves.
«When the pursuit of the substance or behavior becomes uncontrollable, repeats itself incessantly and occupies a good part of the mental space taking away time and commitment from work, family, friends and hobbies, even though the person is aware of the harmfulness of that consumption or activity, you have to ask for help to 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 still weighs heavily of being branded as a drug addict. «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

To Services for pathological addictions, known by the acronym Serd (or Sertif they maintain the old attribution of «Drug Addiction Services»), you can access it 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 dependencies treated are those recognized by the LEAs (the essential levels of assistance covered by the NHS, ed.), i.e. those to be 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 professionalpsychotherapist 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 it is necessary for global management, from diagnosis to socio-work reintegration” observes Sanza. The first stage of the journey 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 ultrasound of the abdomen, and the physical and mental comorbidities. 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, a therapeutic rehabilitation project individual with care and assistance needs”.

Complete return to life project

At an outpatient level, pharmacological treatments are offered to control withdrawal symptoms, treatments with psychotropic drugs, psychotherapy individual and group courses psychoeducation (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 take care of some paperwork, we help her manage the accommodation, organize group outingsto 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 integrate 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 personal autonomy, which involves reintegration into the life of relationships and work, through the involvement of associations and businesses in the territory. 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 communitywhich 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 phase of detoxification for those who need it, before starting the outpatient procedure. «Where present, you can spend a period of 3-6 months in specific residential facilities for detoxification» adds Sanza. Who points out: «At the basis of addiction there is aneurobiological alteration that exposes one to risk even after many years from 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 regains self-control, returning to having a normal life; half enjoy prolonged remissions, has a good life but occasionally relapses; 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 approximately 6% of the total (but they 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 hook up the underground, 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 courses have been activated at 20 secondary schools. listening centers to intercept adolescents already implicated or at risk of addictive conduct at an early stage.
Another initiative of the Department is the «school for parents»: «We organize two groups a month on different themes 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 signs of alarm – reports Lilia Nuzzolo, the director -. Many parents tend to “normalize” youth drinking and the fact that their child can sleep all day on weekends, without imagining that he may 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 offering listening and counseling: smettodifumare.iss.it (with knowledge test on tobacco and nicotine and on health risks), platformdisturbialimentari.iss.it, amministrazioneinternet.iss.it and exitalgioco.iss.it (with self-assessment tests). For each selected centre, address, contact details, website, opening hours, manager, team, type of treatments offered and access methods are provided. 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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