Doppia diagnosi in Italia: evidenze dal PADDI (Psychiatric and Dual Diagnosis in Italy) Study

Objective: PADDI-DSM Study: a) to estimate the overall and macro-area prevalence of Dual Diagnosis (DD) among patients cared in Italian Mental Health Care Trusts in 2005; b) to identify sociodemographic and clinical characteristics associated with a specialist treatment for substance use disorders; c) to identify risk factors for developing an alcohol or substance dependence syndrome. PADDI-TC Study: a) to estimate the prevalence of DD and to study correlates of patients cared in Italian Therapeutic Communities (TCs) with a traditional and a modified for DD program; b) to identify characteristics associated with the outcome “being cared in an outpatient service for psychological problems” among patients cared in traditional programs. Methods: PADDI-DSM Study: cross-sectional study on DD patients cared in Italian Mental Health Care Trusts in 2005. PADDI-TC Study: cross-sectional study on patients cared in Italian TCs. Results: PADDI-DSM Study: the overall prevalence of DD was 3.89%, higher in the Northern (4.23%) and in the Centre (3.83%) and lower in the Southern (3.13%) Mental Health Care Trusts. Data on 2390 patients were collected. The mean age was 42 years among females and 39 years among males (male:female ratio 3:1). Alcohol was the most used substance. Only half of the sample had been specifically treated for a substance use disorder. PADDI-TC Study: 22 TCs were recruited. Data on 138 patients of modified for DD programs and 131 patients of traditional programs were collected. Patients cared in modified for DD TCs were older, more frequently unemployed, more impaired in the medical and psychiatric areas, but less impaired in the substance area. 78% of the patients cared in traditional TCs had a comorbid psychiatric disorder, but they had less frequently received a specialist treatment. Being cared in an outpatient service for psychological problems was associated with a previous outpatient treatment for alcohol and substance abuse and with a more severe impairment in the psychological area. Conclusion: PADDI-DSM Study: the prevalence of DD is not homogeneously distributed nationwide, thus supporting the hypothesised influence of the sociocultural context on the prevalence of DD. Results indirectly confirm that an integration between psychiatric and addiction services for such patients is needed. PADDI-TC Study: the prevalence of DD among patients of traditional programs is unexpectedly high, probably related to the services’ not homogeneous screening and assessment systems and procedures and referral criteria adopted. The association between “being cared in an outpatient service for psychological problems” and being cared for alcohol and substance problems suggests an integration between psychiatric and addiction services.