Ioana Popa

Correlates of dependence and treatment for substance use among people with comorbid severe mental and substance use disorders: Findings from the "psychiatric and Addictive Dual Disorder in Italy (PADDI)" Study

OBJECTIVE People with severe mental illness (SMI) have often comorbid alcohol and other substance disorders but substantial barriers to addiction care remain. The study is aimed at describing correlates associated with dependence and with treatment for substance use among people with SMI and comorbid substance disorders cared in community mental health teams (CMHTs). METHODS This study capitalized on data from a national survey on comorbid severe mental and substance use disorders, among 2235 subjects in 42 CMHTs nationwide. RESULTS 26% of people with SMI and comorbid misuse suffered from dependence on alcohol and 21% on any other substance. Use of opioids, liver diseases, involvement with criminal justice system, but also area of residence, all were associated with dependence in people with SMI. As regards treatment for substance use, only 50% of comorbid people with SMI were treated by specialist services in the past 12 months. This was associated with opioids and cocaine use, as well as with liver diseases, and involvement with criminal justice. People with schizophrenia and those living in Central and Southern Italy, had the lowest chances to be treated for their comorbid substance use disorder. CONCLUSIONS There are extensive unmet treatment needs among comorbid individuals with SMI. Better integration of substance abuse and mental health care systems, and more effective reciprocal referral procedures, are needed.

Area-Level Deprivation and Adverse Consequences in People With Substance Use Disorders: Findings From the Psychiatric and Addictive Dual Disorder in Italy (PADDI) Study

ABSTRACT Background: Environmental factors may operate with individual ones to influence the risk of substance use. Research has focused on severe adverse consequences influenced by contextual variables. However, the literature on community level factors influencing substance use behaviors is relatively limited across Europe so far. Objective: We capitalized on data from a National survey, exploring individual and contextual characteristics, to study adverse consequences among people with substance use disorders. Methods: The impact of area-level deprivation on nonfatal overdose, hepatitis C or B infections, and major involvement with the criminal justice system, was explored. Logistic regression models with cluster-robust errors, modeling subject-level and area-level effects, were used. Results: Living in deprived and intermediate areas, as compared with affluent ones, was associated with greater likelihood of both nonfatal overdose and jail sentences longer than 6 months, though not of active viral hepatitis. Conclusions: Area-level deprivation may play an important role in determining adverse consequences in people with substance use disorders, also after controlling for individual-level characteristics. More research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed.

S14-01 Geographical variations for addiction risk among dually diagnosed people cared in parallel systems

Objective Concerns are growing from increasing prevalence rates for comorbid substance misuse and mental illness. Along with understanding which clinical populations are at high risk, an epidemiologically informed approach is needed to assess effectiveness of established service delivery. The aims of the study is to investigate the risk of developing an alcohol and other psychoactive substances dependence syndrome according to area of residence. Method A cross-sectional survey design was used analysing data from the Psychiatric and Addictive Dual Disorders in Italy Study. Staff rating was used to assess comorbid substance use. Results Significant differences were found between different geographical areas (Northern vs. Centre vs. Southern Italy). Peculiar diagnostic subgroups showed higher risk to develop such comorbid condition, whilst a number of clinical and sociodemographic variables, including area of residence, were associated with the risk to develop a dependence syndrome. Conclusions High comorbid rates do not seem necessarily the direct result of biological features inherent in schizophrenia, but social factors play an important role. A number of risk factors associated with dual diagnosis could build up an evidence base about how many people with dual diagnosis present and what the nature of their substance use is, providing targeted service planning and policy making. The higher risk of developing a dependence syndrome as associated with area of residence, could be considered as a reliable proxy measure of effective integration between mental health and addiction services. There is the need for implementing appropriate shared programmes to fill this gap in targeted areas.

Juvenile delinquency in Romania: a comparison between minors in prisons and re-education services

ABSTRACT This article assesses the relationships between the individual and family characteristics of minors and juvenile delinquency in Romania. This cross-sectional study involved Romanian delinquent minors, 285 of whom were incarcerated in prisons in Romania and 280 subject to educational measures in re-education services in Romania. The multivariate logistic regression analysis showed that delinquency in incarcerated minors is associated with age, the offence committed, drug use, school dropout rates, recidivism, family alcoholism, the relationship with the biological parents, and the number of biological siblings. The study provides baseline data to identify at-risk minors in order to develop prevention programmes. We have adopted a public health approach to analysing delinquency and targets risk factors.

Bicycle helmet use patterns in Italy. A description and analysis of survey data from an Italian friends of cycling association

Cycling is becoming one of the most popular forms of recreation and transport the world over, but cyclists still have a high level of vulnerability. A bicycle helmet is an important safety device available to cyclists, but little is known regarding possible determinants of helmet use among adults. This study aims at providing information on helmet usage patterns in Italy and identifying the factors associated with bicycle helmet use. Data on 2072 bicycle riders from an Italian friends of cycling association aged 18 years or older who had ridden a bicycle in the last month were collected using an ad-hoc questionnaire via the web. The sample was equally distributed among subjects who always, most of the time, sometimes, rarely, or never use a helmet. To evaluate the association among socio-demographic and bicycle use characteristics and helmet use, a multinomial logistic regression model was performed. The results show a higher propensity to use a helmet among males, riders coming from Central and Southern Italy, people who cycles more than 60kilometres in a week, cyclists who have already had a crash, people who do not cycle daily or almost daily, riders of sport bikes. Moreover, the propensity to use a helmet increases with age. The survey provided a first step in approaching the lack of data on cycling behaviour and the wearing of a helmet in Italy.

S62-02 Alcohol misuse in people with schizophrenia: Findings from the paddi (psychiatric and addictive dual diagnosis in Italy) study

Background Comorbid alcohol misuse in schizophrenia and severe mental illness is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for alcohol misuse. Most evidence about the prevalence of this comorbidity comes from the USA, Canada and Australia, and, though at a different pace, also from Europe. Method A cross-sectional survey design has been used to determine the prevalence In Italy of comorbid drug and alcohol and any - even minor - mental disorders. Staff ratings was used to assess comorbid substance use. Results Though overall dual diagnosis prevalence is around 2%, significantly higher rates were found in inner cities. Furthermore significant differences were found between different geographical areas (Northern vs. Centre vs. Southern Italy). Peculiar diagnostic subgroups showed higher risk to develop such comorbid condition, whilst a number of clinical and sociodemographic variables, including area of residence, were associated with the risk to develop a dependence syndrome. Conclusions Sampling and assessment procedures are major limitations which might explain the lower rates as compared with the current Anglo-Saxon literature. However, such variability emphasizes also that high comorbid alcohol misuse rates are not necessarily the direct result of biological features inherent in schizophrenia, but that social factors play an important role. Finally, a number of risk factors associated with dual diagnosis could build up an evidence base about the nature of their substance use, providing targeted service planning and policy making.