Country Profile - Italy

Since alcohol consumption is integrated into the diet, it follows that, in Italy, society is highly tolerant towards alcoholism and alcohol-related problems (1). It is a peculiar feature of Italian life that young people are taught to drink in the family at a very early stage (2) and the family generally plays a major rôle in maintaining control on drinking, as well in the treatment of alcoholism.

Policies to prevent alcohol-related problems are quite recent. The Drug Abuse Act (1990) and a Decree for Suggesting Standards for the Prevention, Screening, Treatment, and Rehabilitation of Alcohol Dependence (1993) include educational interventions. However, education on the effects of alcohol (either positive or negative) is concentrated in primary and secondary school. In some regions (especially in Northern Italy) these educational programmes are well implemented at provincial level under the co-ordination of the Department of Education. Strong societal actions for change meet resistance (3), but, in general, preventative educational programmes targeting young populations are well accepted by all the different interest groups. Recently even the Brewers' Association with the support of the EU Commissions organised an experimental educational campaign involving teenagers (students in school or in search of an occupation) in different Italian areas and its preventive targets had been successfully met (4). Other educational programmes address specific populations. For example, alcoholics treated in rehabilitive programmes, or treated as an alternative to imprisonment. Educational programmes for subjects arrested for drinking and driving do not exist as yet. Other programmes dealing with alcohol and drug education are organised in the Army. Community educational programmes have been offered on a regular basis in the last 20 years by Associations dealing with alcoholics (AA, Clubs) along with the organisation and development of their networking activities.

The medical sector continues to be ambivalent on the issue of education in alcohol-related problems. The reason for this is the moral stigma attached to the consequences of heavy alcohol consumption. This acts as a barrier to medical intervention, and consequently there tends to be very late recognition and treatment of alcohol-related health problems.

There is a sort of vacuum at undergraduate level. Further alcohol education will only continue in postgraduate school after the students received early information in the context of health education in primary and secondary schools. Some information is given in an unstructured way as part of the different courses at the Medical Schools, education on alcohol not being specifically addressed. In places of greater awareness faculty members of universities are organising pilot courses but with uncertain administrative support, lack of structure, and scarce integration with community health programmes. The Nursing Schools, recently reorganised by the Medical School of Italian Universities, could be an important source of alcohol education.

A greater involvement of the universities in this area is envisaged in the future. Since April 1998, legislative norms have granted universities autonomy in the organisation of medical curricula. Thus, local universities will establish priorities on health education in line with the interests of the regional Authorities (which will replace the National Agencies as funding resources). A comprehensive national Act on the Prevention, Treatment, Rehabilitation, and Social Integration of Alcoholics is also pending for discussion in parliament, incorporating teaching activities and the institution of chairs on Alcohol-Related Problems at University Medical Schools.

Finally, at postgraduate medical education levels, where implementation of programmes is a local responsibility, several initiatives have recently been developed. Short courses of continuing medical education (less than 200 hours) are coordinated by Departments of Gastroenterology, Pharmacology, and Psychiatry at different universities. Even doctorates on alcohol studies (requiring 3 years attendance) are offered.

Courses specifically aiming at training General Practitioners are sponsored locally by GP Associations, Regional Health Authorities or Universities with scarce efforts at co-ordination. Specific treatment programmes for Impaired Health Professionals still do not exist in Europe. Recognition of the risk of alcohol abuse among heath professionals (eg medical doctors and nurses), and its major implications for effectiveness in any programme of prevention and treatment of alcohol-related health problems, will probably foster co-operation between different organisations, and greater efforts in training GPs.

Because of the few years experience and the lack of methodology in implementing them, evaluation of effective programmes is very scarce. It is known that medical students, even if exposed to limited information on alcohol-related problems, develop better attitudes in dealing with these health problems in the future (5). However, evenif the students receive adequate information during the teaching of Psychiatry, the space given to the subject is still limited compared with Britain and Canada (6).

Pr F. Poldrugo

References:

1) Poldrugo F and Urizzi R (1992) The Italian Paradox: treating initiatives and falling alcohol consumption. In: Cure, Care or Control: Alcoholism Treatment in Sixteen Countries (Kliongemann H, Takala JP, Hunt G eds), pp 191-204 State University of New York Press, Albany.
2) Poldrugo F and Stratta P (1993) Alcoholism among young people in Italy: an attempt to analyse the phenomenon. Journal on Alcoholism and Related Addictions 29: 73-79.
3) Poldrugo F and Patussi V (1996) Alcoholism and alcohol-related problems in Italy: an overview on recent developments in societal responses and treatment systems. Journal of Addictive Diseases 15: 59-65.
4) The Permanent Observatory on Youth and Alcohol (1997) Young People Between School and Work. Volume 9, Logica, Rome.
5) Poldrugo F, Modonutti GB and Buttolo R (1986) Attitudes towards alcoholism in Italian future teachers and health professionals. Drug and Alcohol Dependence 17: 31-36.
06) Poldrugo F (1992) Esperienza di un programma integrato di ricerca, didattica e terapia dell' alcolismo all' Universita di Trieste. Archivio di Psichiatria Generale 2: 253-256.