It is commonly accepted that a drug user should be considered as a sick person, and that therefore drug abuse is a disease. But can we say it is an epidemic disease?
In my opinion, we can say that drug abuse is such a disease, and many facts buttress this statement.
If we consider the number of drug users who are in prison for crimes related to drug dealing (in most cases for small-scale dealing), we see that such number has increased constantly over the last years. On the other hand, it is obvious that if a drug user becomes a dealer, this is essentially out of need to raise money (a user needs to sell 6 or 7 doses of heroin in order to have the money to buy his own drugs). While not all drug users become drug dealers, those who do this kind of work in any case need to have a sufficient number of clients at all times. While not indispensable, proselytizing is therefore appropriate. Every drug user who needs to deal drugs, therefore, tends to transmit his own "disease" to other people; to this we should add the proselytism which is carried out "theoretically" directly by the criminal organizations.
If drug dependency is a disease, which is transmitted by "contact", then it is possible to handle it as an infective disease and, in certain conditions, it is possible to monitor and foresee the development of epidemics.
In order for an epidemic to develop, it is necessary (but simply sufficient) for each (drug-addicted) infected individual to transmit his disease to more than one non-infected individual (we will refer to such non-infected individual with the standard definition "susceptible"). It is also evident that in a population where the totality of individuals is infected, the epidemic is bound to cease, because it is no longer possible to fulfil the above mentioned condition; in other words, it is no longer possible to spread the disease. There can basically be two outcomes for such situation: either all the infected individuals die (if the disease is lethal), or else some of them die and others recover (we will not consider the possibility of relapses, which would not alter the general situation). In the latter case, a new wave of epidemic could develop once again if new susceptibles become part of the population (immigrants or individuals who reach the age of risk). However, the new group must be of a certain size
in order for the contacts with infected individuals to be sufficiently frequent, and in order to reinstate the necessary conditions for the spread of the epidemic. In other words, all epidemics have a typical temporal course, characterized by periodic waves (for example, we can refer to children's exanthematic diseases, which reappear periodically as soon as the environmental conditions enable their development), that are more or less extended according to the cases (we will not consider the causes of a greater or smaller extension of the waves in order not to complicate things).
The data concerning the progress of the drug dependency phenomenon in Italy contained in the last Jervolino report, while not entirely reliable, seem to point to the fact that the drug dependency epidemic among the young Italians is possibly starting to regress. The causes of this lie essentially in the smaller number of individuals at risk, both for the diminution of the number of young people (due to the zero birth rate phenomenon) and for the possible impact of information campaigns and because the susceptible individuals (because they are somehow alienated) are by now almost all infected, and no longer represent that indispensable reservoir for the development of an epidemic wave. We should bear in mind that not all Italian young people are to be considered susceptible to be infected, and that the epidemic's reservoir is therefore based only on those who are in such conditions as to be effectively liable (to be attracted into the drug circuit). It is in this group, not in the young population generally s
peaking, that a saturation is taking place. Someone could be tempted to conclude that the problem is somehow finding a solution, and that the drug market is bound to follow the same fate of the epidemic. This seems to be a miscalculation. While slight signals of improvement can be noticed in the Italian population, the same cannot be said for the totality of the young people who live in Italy. As for AIDS, which, after attacking the homosexual population (1st epidemic), "moved" to the population of drug users (2nd epidemic) and is now starting to massively attack the so-called "normal" population (3rd epidemic), drug dependency, after attacking "our" youths, is now starting to attack the foreign youths who live in Italy, who are in such social and environmental conditions as to become a new reservoir of susceptibles.
To convince ourselves of this phenomenon, we need only "take a look" at the following diagram, taken from the account of the Minister of Justice contained in the Jervolino report of 26/6/92, and that part of the account - unabridged - which concerns the interventions on minors.
Italians are possibly starting to detach themselves from the drug market, but this market is more flourishing than ever, thanks to the presence of new groups at risk.
SURVEY ON POPULATION IMPRISONED FOR CRIMES CONTAINED IN TU 309/90 AND FOR OTHER CRIMES, WITH REFERENCE TO THE MOVEMENT OF THE SEMESTER 01/07/91 TO 31/12/91.
NATIONAL RECAPITULATION
NEW PEOPLE IMPRISONED
------------------------------------------------------------------
REGION
REDUCED I REDUCED
REGIONE FOR ART. 73 FOR OTHER CRIMES TOTAL
---------------------------------------------------------------
ABRUZZO 160 340 500
BASILICATA 39 200 239
CALABRIA 278 923 1.201
CAMPANIA 1.954 3.850 5.834
EMILIA ROM. 1.449 1.407 2.856
FRIULI 165 444 609
LAZIO 3.221 2.382 5.603
LIGURIA 804 902 1.706
LOMBARDIA 2.478 3.146 5.624
MARCHE 256 268 524
MOLISE 22 66 88
PIEMONTE 1.781 2.081 3.862
PUGLIA 1.226 1.650 2.870
SARDEGNA 474 893 1.367
SICILIA 1.021 2.115 3.136
TOSCANA 1.006 825 1.831
TRENTINO 182 131 313
UMBRIA 153 158 311
VENETO 942 789 1.731
V. AOSTA 43 94 137
---------------------------------------------------------------
NATIONAL TOT. 17.174 22.694 40.408
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DRUG USERS
---------------------------------------------------------------
REDUCED REDUCED
REGION FOR ART. 73 FOR OTHER CRIMES TOTAL
---------------------------------------------------------------
ABRUZZO 98 100 198
BASILICATA 21 33 54
CALABRIA 107 150 257
CAMPANIA 542 667 1.209
EMILIA ROM. 986 759 1.745
FRIULI 90 95 185
LAZIO 837 772 1.609
LIGURIA 581 295 876
LOMBARDIA 1.466 1.214 2.680
MARCHE 142 138 280
MOLISE 11 13 24
PIEMONTE 835 866 1.701
PUGLIA 644 504 1.148
SARDEGNA 262 240 502
SICILIA 319 407 726
TOSCANA 488 277 765
TRENTINO 95 53 148
UMBRIA 115 33 148
VENETO 686 211 897
V. AOSTA 18 19 37
--------------------------------------------------------------
NATIONAL TOT. 8.343 6.846 15.189
--------------------------------------------------------------
NON DRUG USERS
---------------------------
REDUCED REDUCED
REGION FOR ART. 73 FOR OTHER CRIMES TOTAL
---------------------------------------------------------------
ABRUZZO 62 240 302
BASILICATA 18 167 185
CALABRIA 171 773 944
CAMPANIA 1.412 3.213 4625
EMILIA ROM. 463 648 1111
FRIULI 75 349 424
LAZIO 2.384 1.610 3.994
LIGURIA 283 607 890
LOMBARDIA 1.012 1.932 2.944
MARCHE 114 130 244
MOLISE 11 53 64
PIEMONTE 946 1.215 2.161
PUGLIA 582 1.146 1.728
SARDEGNA 212 653 865
SICILIA 702 1.708 2.410
TOSCANA 518 548 1.066
TRENTINO 87 78 165
UMBRIA 38 125 163
VENETO 256 578 834
V. AOSTA 25 75 100
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NATIONAL TOT. 9.371 15.848 25.219
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FOREIGN INMATES
DRUG USERS
---------------------------
REDUCED REDUCED
REGION FOR ART. 73 FOR OTHER CRIMES TOTAL
---------------------------------------------------------------
ABRUZZO 1 0 1
BASILICATA 0 0 0
CALABRIA 1 0 1
CAMPANIA 46 9 55
EMILIA ROM. 135 178 313
FRIULI 4 2 6
LAZIO 376 163 539
LIGURIA 50 55 105
LOMBARDIA 133 131 264
MARCHE 3 0 3
MOLISE 0 0 0
PIEMONTE 131 52 183
PUGLIA 8 7 15
SARDEGNA 11 14 25
SICILIA 10 3 13
TOSCANA 70 35 105
TRENTINO 30 6 36
UMBRIA 23 4 27
VENETO 35 11 46
V. AOSTA 4 0 4
------------------------------------------------------------------
NATIONAL TOT. 1.071 670 1.741
------------------------------------------------------------------
FOREIGN INMATES
NON DRUG USERS
---------------------------
REDUCED REDUCED
REGION FOR ART. 73 FOR OTHER CRIMES TOTAL
---------------------------------------------------------------
ABRUZZO 4 23 27
BASILICATA 0 6 6
CALABRIA 3 28 31
CAMPANIA 150 148 298
EMILIA ROM. 238 175 413
FRIULI 32 72 104
LAZIO 2.200 684 2.884
LIGURIA 154 360 514
LOMBARDIA 328 610 938
MARCHE 11 34 45
MOLISE 0 2 2
PIEMONTE 250 216 466
PUGLIA 19 69 88
SARDEGNA 29 24 53
SICILIA 22 103 125
TOSCANA 277 153 430
TRENTINO 32 7 39
UMBRIA 5 24 29
VENETO 73 225 298
V. AOSTA 9 18 27
------------------------------------------------------------------
NATIONAL TOT. 3.836 2.981 6.817
------------------------------------------------------------------
MINISTRY OF JUSTICE
CENTRAL OFFICE FOR JUVENILE JUSTICE
REPORT ON DRUG USERS PASSED THROUGH JUVENILE SERVICES IN YEAR 1991
In year 1991, the Office developed a system of six-month monitoring on drug users through five monitoring models, divided according to the type of service (Juvenile Penal Institutes, Social Service Offices, First Reception Centres, Communities).
The five models concern:
1. Minor who consume drugs, divided according to type of substance, sex, age, nationality;
2. Way in which the drug assumption was observed by the service's operators;
3. interventions activated within the service;
4. co-operation in the interventions with other public or private services;
5. medical controls carried out for the screening of the HTLV-III/LAS virus.
The data that have been collected aim to give a picture of the importance of the phenomenon inside the juvenile services.
Because it has not been possible to devise a system for the monitoring of the phenomenon enabling to have reliable data in terms of quantity, the elements of information on the general progress of the problem are the ones found in the context of the juvenile Services.
In the second semester of 1991, the results obtained during the first semester of the same year are essentially confirmed.
A slight diminution in the percentage of drug users has been noticed in the 2nd semester compared to the 1st one, and the institutes where such presence is most evident are those of Campania and a number of institutes in Northern Italy (Turin, Treviso and Bologna).
A strong diminution in the number of users has been noticed in Rome (from 23,33% in the 1st semester to 8,56% in the 2nd one). The institutes in Sicily show low percentages of the presence of the phenomenon, as for the 1st semester.
The most frequently used substances are opium derivatives and cannabis, with a clear prevalence of the former. This datum is extremely different from that of the other services, and confirms the hypothesis made in the previous report concerning the quality of the users of this type of service, which shows levels of gravity that are greater compared to the others, both in terms of crimes committed and in terms of personal and/or family problems.
The Italians clearly prevail over the foreigners (137 to 13), and men prevail on women (141 to 9) of the total of new inmates, which consists of 85 Italians and 46 foreigners.
The quasi totality (12 out of 13) of the foreigners pointed out as drug consumers in the second semester has entered an institute for crimes committed against the drugs law. Such high presences are not to be found among the Italians (45 out of 137), for whom the incidence of crimes related to the same law appears to be lower.
The most frequent way in which the presence of drug users in the service has been noticed is the "voluntary declaration".
From the point of view of the interventions carried out in the institutes, there is a prevalence of the psychological one; co-operations with U.S.L. day hospital services and with non-residential public or private structures are carried out more frequently. Relations with residential therapeutical communities seem to be less used; such centres tend to take care of minors with serious problems of drug use.
3 minors of 137 have tested HIV positive in the group of drug users, whereas no case has been noticed among the foreigners.
FIRST RECEPTION CENTRES
A slight increase in the number of drug users - 16,15% - has been noticed in the second semester, compared to 14,98% in the first one.
The first reception centres where the percentages are higher are the ones in Rome, Genua, Bologna and of Campania; the centres of Sicily have the lowest percentages. Of a total of 2,117 incomers, 342 are drug consumers.
In this service as in the previous one, there is a clear prevalence of Italians over foreigners (284 to 58), and of males over females (329 to 13).
Unlike the Juvenile Penal Institutes, the most widely used substance in the First Reception Centres is cannabis (167 minors), compared to "two or more types of substances" (81) and opium derivatives (78).
The situation is very different from that of the institutes also in terms of charges: during the 2nd semester, 158 Italians out of 342, and 26 foreigners out of 58 have been charged with drug dealing; compared to the institutes, therefore, there is a greater incidence of this type of crime among the Italians, with high percentages compared to the first semester.
The most widely used way of screening the users is through the "voluntary declaration".
Among the interventions carried out by the Institutes, there is a prevalence of pharmacological interventions, probably related to the short periods of permanence of the minors in this type of structure, which does not enable to plan long-term interventions. On the other hand, the services of the territory with which there is greater co-operation are the day hospital services of the UU.SS.LL.
The datum relative to the screening of the HTLV - III/LAS virus does not appear significant in relation to the short periods of permanence of the minors in the structures.
SOCIAL SERVICES OFFICES FOR MINORS
The Social Service for Minors has noticed 643 consumers out of 9,133 subjects which whom it has had contacts in the first semester of 1991, whereas in the second semester the users were 423 out of 8,109 subjects. In this type of service, therefore, there is a significant percent diminution between the first and the second semester, corresponding to 7,04% and 5,22%. The areas where the phenomenon is most relevant are those of Rome, Florence, Ancona, L'Aquila and the Social Service Offices of Campania.
There is a clear prevalence of Italian minors (419) compared to foreign ones (4), and of males (387) compared to females (36). The most widely used substance for this group is cannabis, followed by opium derivatives.
The most frequent system of detection is the voluntary declaration, as for the other services.
There is a clear prevalence of the psychological type of intervention, and the co-operation with the day hospital services of the UU.SS.LL. There is a greater co-operation with the residential therapeutical communities compared to other types of services.
The results concerning the entire year 1991 confirm the findings of the first semester.
The various services propose an extremely diversified picture of the minors who use drugs, strongly related to the context in which the phenomenon is noticed.
At a closer examination of the data on the interventions carried out, here too there is a clear differentiation.
In the First Reception Centres, the intervention is prevalently pharmacological, whereas in the Institutes and social services, where the interventions are longer, the psychological and/or supportive one are most used.
The datum relative to the relation with the other services is extremely interesting: it recalls one of the chief functions of the minor justice operators: that of possible detectors and translators in situations of difficulty expressed through penally punishable behaviours, of needs for which people can find answers out of the penal context. In this case, the role of the minor services becomes that of "sending" the patients to the most appropriate offices to meet this type of needs.
Concerning this point, throughout 1991, the Central Office for Juvenile Justice has reached agreements with therapeutical communities for drug users on the entire national territory (10 communities). Throughout the year, the presences have gradually increased starting from a minimum of 487 to a maximum of 835.
In the case of problems related to the use of drugs, it has already been pointed out that it is important to make a distinction between the answer to a deviant action and the answer to the drug user's condition.
The number of interventions carried out in co-operation with other services is not very high, and this points out to the operators the difficulty, in situations of drug assumption, to create a point between context of control and context of therapy.
A fiery debate is under way among the operators, the services of the local boards, the judiciary, etc, to devise more effective systems of intervention which, considering the answers to the crime, with their time requirements, the ways, the objectives, and the answers to the drug dependency, can seek areas of compatibility between the two sectors.
