The challenge of psychiatric comorbidity to the public services for drug dependence in Italy: A national survey

We evaluated the availability of resources and specific expertise for treating comorbidity at the Italian public Services for Drug Dependence (SerTs). A stratified sample of 100 SerTs was constructed and a specific questionnaire mailed to the clinical managers. The interview aimed at: characteristics of the respondent; theoretical knowledge of comorbidity; influence of dual diagnosis on clinical practice; general, human, and organisational resources; quality evaluation. Main results: (a) 90% of managers are medical doctors but <50% have a specialisation in psychiatry or qualification in psychotherapy; (b) about half of the managers have a fair knowledge of comorbidity; (c) the managers’ estimate of prevalence is 25% for Axis I and 25–50% for Axis II comorbidity, and they consider the bad course of illness as the main cause of increased costs; (d) the SerTs’ resources appear incomplete: psychiatric consultation and collaboration with therapeutic communities are available in about 90%, but routine assessment of psychopathology and day hospital or day care programs are lacking in over 50%; (e) about half of the managers declare themselves fairly satisfied about the treatments offered, but 80% complain about inadequate cooperation of the mental health services and >95% claim about inadequate education of their staff. The results were also analysed by factors of stratification: regional distribution, urban/rural location, and number of clients in care. In conclusion, the problem of comorbidity should be faced more effectively, particularly by means of improved organisational resources and continuing education of staff members.