Scafato lesson learnt alcohol italy

O s s e r v a t o r i o N a z i o n a l e A l c o l - W o r l d H e a l t h O r g a n i z a t i o n C o l l a b o r a t i n g C e n t r e f
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Emanuele Scafato
Direttore, WHO Collaborating Centre for Research & Health Promotion on Alcohol and Alcohol-Related Problems
Direttore, Osservatorio Nazionale Alcol - CNESPS
Direttore, Salute della Popolazione e suoi Determinanti
Centro Nazionale Epidemiologia, Sorveglianza e Promozione della Salute- CNESPS
ISTITUTO SUPERIORE DI SANITA'
Presidente SIA, Società Italiana Alcologia
Vice Presidente EUFAS, European Federation Societies on Addictions
Board Advisor, APN Alchol Policy Network e INEBRIA
Rappresentante Gov. CNAPA, Committee on National Alcohol Policies and Actions
What has Italy got right?
Three decades of lessons learnt
for the decrease
in alcohol consumption and
related public health impact

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Country profile 2014 - ITALY

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
Per capita alcohol consumption
WHY HAS DECREASED ?
WHO HAS REDUCED ?
IS THIS ENOUGH ?

Fonte: Dalla presentazione del Ministro della Salute della relazione al Parlamento 2011

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Monitoring and reporting alcohol : basic for policy

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ALCOHOL EPIDEMIOLOGICAL TRENDS AND
HEALTH MONITORING ORIENTING POLICY
The hard work of monitoring
can be felt as a sailing through
a sea of indicators never fixed
and always changing…
… a nightmare, probably the
Hell for the epidemiologist …
but also a Paradise if you
learn how to sail…

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To measure is the best
way to understand …
Monitoring and reporting is
the best way to support our
and policy makers
understanding and actions
WHAT‘S BEST ?

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ALCOHOL - ASSESMENT & MONITORING
ISS-WHO CC FORMAL ROLES

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The European Alcohol Action plan
1992 - 1999

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European Charter on Alcohol
Paris, december 1995
Alcohol? Less is better !

Istituto
Superiore
di Sanita’

Alcohol as health target in
public policy: Italy targets
Emanuele SCAFATO MD
Laboratorio di Epidemiologia e
Biostatistica
Istituto Superiore di
Sanita’
Rome , ISS, 12/10/1997

National Health Plan
CORE SET DEFINING HEALTH TARGETS ON
ALCOHOL
 TARGET : DECREASE OF PEOPLE WHO DRINKS DAILY
MORE THAN A SPECIFIC LEVEL OF ALCOHOL (specifically
wine and beer - accounting for the 90% of a daily drinker
alcoholic intake in Italy)
 INDICATOR : PREVALENCE OF CONSUMERS DRINKING
INADEQUATE LEVELS OF ALCOHOLIC BEVERAGES
(frequency:daily ;quantity: M>40 F>20 gr/day)
 BASELINE : 1995 ISTAT official statistics
 ACTIONS : INFORMATION, EDUCATION, LEGISLATION,
TRAINING OF PROFESSIONALS, REGULATIONS
Istituto Superiore
di Sanità

ITALY. National Health Plan 1998-
2000
Health Targets on ALCOHOL
To reduce by 20% the prevalence of male and
female drinkers consuming more than 40 gr and
20 gr alcohol a day, respectively.
To reduce by 30 % the prevalence of drinkers
consuming alcohol between meals.
(Starting from the 1995 baseline ISTAT data)
Istituto Superiore
di Sanità

Osservatorio Nazionale Alcol - ISS-CNESPS - World Health Organization Collaborating Centre
for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
1. IMPROVING ALCOHOL USE MONITORING
ISTAT YEARLY "MULTISCOPO" SURVEY
on Lifestyle and Health Status

(ADDED in 2001)

2. IMPROVING NUTRITIONAL GUIDELINES

According to the Italian guidelines for a healthy diet developed by
INRAN/ ISS/SIA hazardous drinkers
are subjects who fulfil one of the following criteria:
1 standard unit = 12 grams
2. IMPROVING NUTRITIONAL GUIDELINES

http://www.epicentro.iss.it/alcol
3. INCREASING AWARENESS
ALCOHOL PREVENTION DAY 2001-2014

The definitions used for “hazardous drinkers” are based on
those of the World Health Organization (WHO), which defines
“hazardous” consumption as levels or behaviours that can
result in harm if they persist.
The modalities of consumption that are generally
considered to identify the risk are:
→ the frequency of alcohol consumption
→ the quantities of alcohol consumed
→ the frequency of binge drinking
4. UPDATING NATIONAL RISK DEFINITION
The definition of hazardous drinkers (ISS criteria)

4. UPDATING NATIONAL RISK DEFINITION
The definition of hazardous drinkers (ISS criteria)
According to the Italian guidelines for a healthy diet
developed by INRAN hazardous drinkers are subjects
who fulfil one of the following criteria:
1) women who consume more than 20 grams per day (1-2 glasses)
2) men who consume more than 40 grams of alcohol per day (2-3
glasses)
4) people aged 16-18, who consume more than 1 glass of any alcoholic
beverage per day
5) people aged over 65 who consume more than 1 glass of any
alcoholic beverage per day
6) all individuals who consume on one occasion more than 6 glasses
(binge drinking).
FURTHERMORE
1 standard unit = 12 grams

sono inoltre considerati comportamenti a rischio
Ø il Binge drinking, cioè il consumo in un’unica occasione di 6 o più UA
Ø il consumo di alcolici per le donne in gravidanza e in allattamento
Ø il consumo di qualsiasi bevanda alcolica per gli alcolisti in trattamento e gli ex alcolisti
EMANUELE SCAFATO 25/10/2012
Unità Alcoliche equivalenti (contenenti 12 g di alcol )
0-18 anni 18-20 & 65+ Donne Uomini
0 Unità 1 Unità 1 Unità 2 Unità
Tra 16 e

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http://www.gencat.net/salut/phepa/units/phepa/html/en/dir360/doc8870.html
5. IMPROVING PREVENTION
PHEPA1 and PHEPA2 – EIBI. 2002-2014

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AUDIT-C National validation
PRISMA Project

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Early Identification and Brief Intervention EIBI – (IPIB)
PHEPA- IPIB
TRAINING PROGRAM

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2010, http://www.epicentro.iss.it/temi/alcol/linee/linee_guida_cliniche.pdf
PHEPA
EIBI CLINICAL
GUIDELINES

6. IMPROVING NHS MONITORING
Hospital’s discharge data (SDO/DRG system).
Admission / discharge Form

Hospital’s discharge data (SDO). DRG System
Full alcohol-attributable rates (by 100.000 residents)

7. IMPROVING PLANS MONITORING
National Plan for MONITORING the National Alcohol and Health Plan
(PNAS 2009-2012)

Monitoring INDICATORS of the
National Alcohol and Health Plan
(PNAS 2009-2012)

Alcohol MONITORING SYSTEM FLOW
MINISTRY OF HEALTH
PREVENTION DPT STATISTICAL SERVICE
HEALTH REGIONAL AUTHORITY
STATISTICAL SERVICE REFERENCE CENTRE
LOCAL HEALTH BODY UNIT
SERT CENTRES
ISTITUTO SUPERIORE DI SANITA’
OSSERVATORIO NAZIONA LE ALCOL _ CNESPS
Epidemiological Report

Periodical evaluation
• Services activities
• Regions’ activities devoted to the Law 125/2001 aims
implementation
Minister of Health yearly report to PARLIAMENT
(set by Law 125/2001)
8. IMPROVING ALCOHOL SERVICES MONITORING

FORMAL REPORTS MoH / ISS-CNESPS
Alcohol services
NHS SERT-Centres
Law 125/2001
implementation.
Epidemiological report
Policies by Regions
Actions by MoH
ALCOHOL REPORTS

A summary of the
information is included
in the Report of the
Minister of Health to
the Parliament on the
Health Status of the
Country

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Monitoring alcohol : basic for policy

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The European Alcohol Action plan
2000 - 2005

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Framework for Alcohol Policy
2006-2010

Health and
Consumers
Il 5 settembre 2007 il Parlamento
Europeo ha adottato una
Risoluzione sulla strategia
comunitaria per contrastare l'abuso
di alcol P6_TA-PROV(2007)0377 )
European Union strategy to support Member States in
reducing alcohol-related harm (2007/2005(INI)
2006
Comunicazione
Commissione Europea
2007
Risoluzione Parlamento EU

Reparto Salute della Popolazione e suoi Determinanti - CNESPSReparto Salute della Popolazione e suoi Determinanti - CNESPS
2007 EU Alcohol Strategy to support Member
States in reducing alcohol-related harm
Five priority areas
1)protect young people, children and the unborn child
(restrictions on availability, special taxation)
2)reduce injuries and deaths from drink-driving
3)prevent alcohol-related harm among adults
4)raise awareness on the impact of alcohol
5)develop and maintain a common evidence base

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Endorsed the
Global strategy to
reduce the harmful
use of alcohol in
the WHA resolution
63.13
63rd World Health Assembly (17-21 May, 2010)

Expenditures of the families 1962- 2011
Food, drinks and tobacco
9. REAL ECONOMY

Food expenditure composition 1973-
2009

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Food expenditure 1973-1996

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WATER …

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Consumer’s changes in behaviours and in perceptions
… values not only purchasing power…
 HEALTH (overweight, diseases…)
 AGEING
 TRAVELS, BEAUTY FARM, FITNESS,
HOUSING, FASHION

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 NATIONAL HEALTH PLAN
 LAWS and REGULATIONS
 NATIONAL ALCOHOL AND
HEALTH PLAN
 NATIONAL COMMITTEE
(Consulta Nazionale Alcol)
10. ALCOHOL : the framework for action in ITALY

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The Health Planning perspective in Italy
Over the last two decades Italy has experienced a
deep change in the health planning definition. A
general population approach, based on
epidemiological findings in their different contexts
and social realities, and the setting of “evidence-
based” targets, objectives or goals have replaced
the usual approach commonly oriented to mainly
deal with the management of health system
issues. Starting from year 2000, this kind of
approach received a renewed impetus from
suggestions of WHO Health 21, as well as from
the documents, recommendations and
programmes of the European Commission,
Council and Parliament.

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The devolution of competencies on health
After the introduction of the devolution of health
matters to the Region’s authonomy, the National
Health Plan, even if produced in form of a
framework document, has started to represent a
process and a matter of negotiation of priorities
agreed between the Government and the Regions,
recognising different possible ways of managing
health problems in different social, economic,
cultural and epidemiological contexts.

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52
The National Health Plan
The last NHP renewed the need to implement actions
and strategies that can help in:
 Promoting healthier lifestyles and habits (life skills);
 Tackling misleading risk-taking cultures;
 Improving settings (family, schools, communities);
 Strengthening health protection of the vulnerable groups;
 Decreasing “gradients” within and between groups
(inequalities in health) and reduce harm;
 Ensuring a wider range of initiatives devoted at the early
detection of alcohol abuse.
Source: Ministry of Health, “National Health Plan 2006-2008” available online at:
http://www.ministerosalute.it/dettaglio/phPrimoPiano.jsp?id=316
A National Prevention Plan is agreed by the STATE-REGIONS Conference mostly
leaving to the regional autonomies the setting and the implementation of strategies and
programs that are ONLY oriented by the National Health Plan.

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The need for the specific training standard and
consequent activities outlined by the
PHEPA/EIBI Country strategy found a relevant
inclusion among the activities of the National
Alcohol and Health Plan 2007-2010. (Piano
Nazionale Alcol e Salute – PNAS)
National Alcohol and Health Plan (PNAS) 2007-2010
endorsed in April 2007 by the State-Regions Conference
Source: Ministry of Health, “National Alcohol and Health Plan 2007-2010” at:
http://www.ministerosalute.it/imgs/C_17_pubblicazioni_623_allegato.pdf

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Strategic areas of intervention
1. Information and education
2. Drinking and driving
3. Alcohol and work
4. Treatment of harmful/hazardous alcohol
consumption and alcohol dependence
5. Production and distribution’s responsibility
6. Social network to face risk factors alcohol related
7. Strengthening NGOs, voluntary organizations,
self-help and mutual aid groups
8. Monitoring harm done by alcohol and
strengthening alcohol policy
National Alcohol and Health Plan (PNAS) 2007-2010
endorsed in April 2007 by the State-Regions Conference

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Gaining Health Programme -
GHP

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ITALIA - 2001 – Legge quadro 125/2001.

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The Frame Law on Alcohol (nr 125/2001)
All over Europe, the 2001 n. 125 Italian law
represents a unique example of implementation of
what was established in accordance with the
principles of the European Parliament Resolution (12
March 1982) on alcohol related problems in the
European Community countries, the Council
Resolution and the Resolution of the Government
representatives of Member States (29 March 1986)
on alcohol abuse, and the World Health
Organisation guidelines. Actually this is the only one
example of a full endorsement of the WHO
European Alcohol Action Plan and of the European
Charter on Alcohol principles reported in the Italian
aims at the art. 2 of the law as the aims of the law.

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The Frame Law on Alcohol (nr 125/2001)
Art. 2 - Aims
This law:
 ensures all people’s rights, especially children and
adolescents, to a family, community and working life
protected from the consequences of alcoholic beverages
abuse;
 fosters access to health and social treatment services for
heavy drinkers and their families;
 promotes information and education on the negative
consequences of alcohol consumption and abuse;
 promotes research and ensures adequate standards of
training and updating for professionals dealing with alcohol
related problems;
 supports non profit non-governmental and voluntary
organisations which aim is to prevent or reduce alcohol-
related problems.

E M A N U E L E S C A F A T O 2 0 1 4
PRINCIPLES vs RIGHTS :
but are they really rights ?

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Main immediate
results of the NHP and of the 125/2001 law
YEARS 2000-2005
A tight connection between Laws, the National Health Plans
and the policy level ensured in many areas some important
results:
 The reduction of BAC (actually 0.5)
 The prohibition of spirits sale on highways (between 10pm-
6am)
 The prohibition of drinking in the majority of workplaces
 A more strict level of (self)-regulation of the advertising of
alcoholic products

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Main actions implemented in Italy
during the last decade
 Enforcement against serving intoxicated persons,
new rules on sales of alcoholic beverages
forbidden in discos after 2 a.m. (by law 3/10/2007)
 Mandatory BAC and drugs controls for public
transport driver and for a long list of working
activities considered at higher risk for community
safety (by State-Region agreement 16/03/2007)
 Better enforcement of age limits for serving
ban for serving complemented with ban for
selling to underaged with increase of minimum
legal age form 16 to 18

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 Significant Increase in nr. of controls/ breath testing on
the roads and at the exit of discos; tightening of fines
and penalties for drunk-drivers causing accidents: from
1-3 to 5-10 imprisonment in case of death of the road
accident victim
 Prohibition by law of sales of all alcoholic beverages on
the highways between 10 pm and 6 am; self-regulation
of the AUTOGRILL complemented the national law
limiting the prohibition of sales ONLY for SPIRITS;
Autogrill have also self-introduced, befoire the adoption
of the national law, the ban of sales – integrating the
national legal ban for serving – alcohol to underaged

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 Zero BAC for young (aged<21) or inexperienced
drivers (< 3-5 yrs drive licence)
 Designated driver National and Regional
campaigns realized by the Istituto Superiore di
Sanità - MOH (Il Pilota)
 National Campaigne on drink driving within the
high schools (Se guidi non bere) by the Istituto
Superiore di Sanità – MOH and at the gasoline
pumps
 Introduction of formal educational programmes
school-family to increase ability of young people
and parents (risk/protective factors) to be launched
and integrated as a school activity

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NON C’E’ VITA DA BUTTARE
CAMPAGNA
2006
CONTRO
L’ABUSO DI
ALCOL
SPOT VIDEO
GIGI
D’ALESSIO
“LA BOTTIGLIA
NON E’ UN
GIOCO”

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IL PILOTA
www.ilpilota.it
CAMPAGNA 2006-7
CONTRO L’ABUSO
DI ALCOL

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1996
1997
1998
1999
20002001
2002
2003
2004
2005
2006
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
11.0
12.0
7.80 8.00 8.20 8.40 8.60 8.80 9.00 9.20 9.40
TassoSTDutentitotalideiservizidietà10+(*10.000)
Consumo medio pro_capite (15+ anni)
r (coefficiente di pearson) = -0,933;
INVERSE RELATIONSHIP BETWEEN Alcohol Dependency rates AND Per capita alcohol consumption
EMANUELESCAFATO25/10/2012
LESSONS LEARNT: There is still room for supporting
decrease in per capita alcohol consumption

Uomini >11 anni
10,5 10,7 10,3 10,3 10,2 10,6
20,6 19,8 20,6 19,3 18,3 17,7
5,0 4,8 5,0 5,3 3,6 3,4
9,3 9,7 7,4 8,2 8,5 8,3
0,0
10,0
20,0
30,0
40,0
50,0
60,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Nel corso degli anni la persistenza dello “zoccolo duro” dei consumatori
a rischio è la testimonianza che la riduzione dei consumi medi giornalieri
ha interessato prevalentemente coloro che erano già moderati e inclini
ad una ulteriore moderazione.
Agire attraverso la prevenzione e le norme facendo leva sul senso di
approvazione e/o disapprovazione sociale del consumo rischioso
potrebbe essere la chiave vincente per far DECRESCERE i consumi
nelle categorie evidentemente a maggior rischio.
PREVALENCE (%) of DAILY CONSUMERS by U.A. (1 UA= 12 gr)
MALES (age >11) YEARS 2003-2009

Uomini 11-15 anni
0,5 0,4 0,6 0,4 0,5 0,4
0,3
1,1 0,6 0,7 0,3
0,1
0,4
0,1
0,1
0,0
0,1
0,2
0,0
0,1 0,3
0,2 0,4
0,3
0,0
0,5
1,0
1,5
2,0
2,5
3,0
3,5
4,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Uomini 16-18 anni
2,6 3,5 3,6 3,8 2,8 2,9
3,1
3,3 3,6
5,4
2,0 2,2
1,1
0,5 0,1
0,4
0,5 0,6
0,8
1,3 1,0
1,1
0,9 0,7
0,0
2,0
4,0
6,0
8,0
10,0
12,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Uomini 19-64 anni
11,0 10,8 10,1 10,4 10,2 10,7
20,9 20,1 20,6 18,8 17,4 17,1
5,3 5,1 5,4 5,7 4,0 3,7
9,7 10,1 7,5 8,5
8,8 8,2
0,0
10,0
20,0
30,0
40,0
50,0
60,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Uomini 65-74 anni
13,2 14,3 13,5 13,8 13,5 14,5
31,3 29,1 31,4 29,9 29,7 27,8
6,8 6,1 6,8 7,8 4,4 3,8
14,5 15,6 12,4 12,3
12,4 14,3
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Uomini >74 anni
15,6 15,9 18,0 14,8 15,4 15,2
29,1 25,8 29,0 29,6 29,7 28,0
4,8 5,9
4,0 4,3 3,2 3,3
11,1 8,3 7,2 9,0 9,8 8,7
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Uomini >11 anni
10,5 10,7 10,3 10,3 10,2 10,6
20,6 19,8 20,6 19,3 18,3 17,7
5,0 4,8 5,0 5,3 3,6 3,4
9,3 9,7 7,4 8,2 8,5 8,3
0,0
10,0
20,0
30,0
40,0
50,0
60,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Obiettivo
ZERO ALCOL
MALES (age >11) YEARS 2003-2009

Donne >11 anni
7,9 8,7 8,1 7,9 7,7 7,4
7,1 6,9 6,9 6,5 5,7 5,6
0,7 0,8 0,8 0,8
0,4 0,5
1,2 1,3
0,6 1,0
1,0 1,2
0,0
5,0
10,0
15,0
20,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Sfruttare la naturale tendenza femminile ad una minore abitudine al bere
è l’elemento fondamentale per far DECRESCERE da un lato i consumi
nelle categorie evidentemente a maggior rischio e dall ’ altro per
rinnovare e rafforzare la centralità della funzione di EDUCAZIONE,
REGOLAZIONE, CONTROLLO di cui la donna è stata tradizionalmente
depositaria nei confronti dei figli, del partner, della famiglia.
FEMALES (age >11) YEARS 2003-2009

Donne 11-15 anni
0,5
0,2 0,1
0,4
0,3 0,3
0,3
0,2
0,0
0,3
0,2
0,2
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,1
0,0
0,0
0,1
0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Donne 16-18 anni
1,7
0,6
1,2
0,6 0,4 0,2
1,1
0,2
0,5
0,8
0,4
0,3
0,0
0,1
0,0
0,2
0,0
0,2
0,1
0,5
0,6
0,1
0,3 0,6
0,0
0,5
1,0
1,5
2,0
2,5
3,0
3,5
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Donne 19-64 anni
7,6 8,0 7,5 7,4 7,0 6,4
7,0 6,8 6,8 6,3 5,3 5,1
0,7 0,8 0,8 0,9
0,4 0,5
1,1 1,4
0,7 1,0
1,0 1,2
0,0
5,0
10,0
15,0
20,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Donne 65-74 anni
11,3 13,3 13,0 11,2 11,9 11,9
11,2
10,7 10,5
10,1 9,9 10,9
1,3
1,1 1,2
0,8 0,7 0,5
2,4 1,8 0,9
1,7 1,9 1,8
0,0
5,0
10,0
15,0
20,0
25,0
30,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Donne >74 anni
11,6 13,8 12,3 12,1 12,2 13,5
8,8
8,4
8,0 8,5 7,4 6,3
0,4
0,5
0,6 0,7 0,4 0,51,3
1,1
0,3 0,7 0,9 1,0
0,0
5,0
10,0
15,0
20,0
25,0
30,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Donne >11 anni
7,9 8,7 8,1 7,9 7,7 7,4
7,1 6,9 6,9 6,5 5,7 5,6
0,7 0,8 0,8 0,8
0,4 0,5
1,2 1,3
0,6 1,0
1,0 1,2
0,0
5,0
10,0
15,0
20,0
2003 2005 2006 2007 2008 2009
>4 UA
3 UA
2 UA
1 UA
Obiettivo
ZERO ALCOL
FEMALES (age >11) YEARS 2003-2009

Osservatorio Nazionale Alcol-ISS
World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL-RELATED HEALTH PROBLEMS
Alcoholics in treatment and public services in Italy
Trend (Years 1996-2009)
Source: Ministry of Health, (2011). Annual report of the Ministry of Health to the Parliament for the implementation of the
frame law 125/2001 on alcohol and alcohol related problems 2009-2010 available at:
http://www.salute.gov.it/imgs/C_17_pubblicazioni_1686_allegato.pdf

ISS - ALCOHOL DEPENDENTS IN TREATMENT
(TASSI*100.000) & forecast
By age classe – YEAR 2012
R² = 0,69526
R² = 0,902
R² = 0,920
R² = 0,900
R² = 0,896
R² = 0,871
R² = 0,911
0
50
100
150
200
250
300
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2011 2012
10-19 anni 1,6 2,6 2,6 3,3 3,7 3,7 3,6 5,0 5,7 7,3 7,7 7,5 6,9 6,3 4,8 6,6
20-29 anni 19,4 23,5 26,1 36,2 37,2 37,9 54,1 64,5 73,2 87,5 87,8 80,0 95,2 103,3 83,4 92,1
30-39 anni 55,2 63,0 66,2 83,4 88,8 88,8 119,4 130,0 137,1 144,8 155,9 145,7 165,5 164,5 150,2 168,3
40-49 anni 82,9 87,4 98,0 116,3 121,4 124,8 158,8 180,2 186,2 186,7 202,7 192,1 214,7 205,9 188,7 225,8
50-59 anni 77,8 76,1 91,2 113,1 117,4 112,8 146,6 167,9 162,3 161,4 180,4 170,2 191,9 187,5 169,3 210,0
>=60 anni 22,7 23,4 30,8 35,1 36,3 38,5 42,4 49,2 52,5 51,5 58,5 55,2 62,6 57,5 49,7 64,4
Tasso STD
pop (2001) 42,3 45,1 51,8 63,4 66,2 66,8 85,5 97,1 100,8 104,1 113,1 106,3 120,4 118,0 105,1 125,1
TASSISPECIFICIeTASSOSTDUTENTITOTALIINCARICOAISERVIZI
*100.000

Among 8 mln of
HEAVY DRINKERS
there are AT LEAST
- 400.000 male
HARMFUL drinkers
and more than
- 320.000 females
HARMFUL drinkers.
According to DSM V Harmful drinkers and Alcoholdependents are
in need for TREATMENT AT LEAST in order to STOP harm
progression and to avoid further consequences .

Figura. 2 Alcodipendenti in carico ai servizi per tipologia di accesso e consumatori dannosi di alcol - Anno
2012
THE GAP TO BE BRIDGED
HARMFUL DRINKERS vs ALCOHOL DEPENDENTS

HARMFUL CONSUMERS AND ALCOHOL DEPENDENTS
DETECTION – EMERSION – INCLUSION
MALES
9.311.832
(35,6%)
FEMALES
3.489.521
(12,5%)
Alcohol dependents
already in charge
by NHS services
NEW PATIENTS
20.623
OLD PATIENTS
49.147
HARMFUL
DRINKERS
Harmful drinkers
622.848
(M=403.651-F=219.197)
83,3
12,4
4,3
bassorischio [M=1-3UA;F=1-2 UA] mediorischio [M=4-5UA;F=3] altorischio [M:>5 UA;F:>3 UA]
83,3
12,44,3
90,7
3,06,3
ALCOHOLDEPENDENTS

o r
Evidence Based Services Organizations
National Guidelines

o r
Lesson learnt : ALCOHOL AS A PRIORITY

o r
Criteria for priority setting
(SIVEAS Risk model)

http://siveas.cnesps.it/

Lesson learnt : Mortality

ITALY- Alcohol attributable deaths (%)
17.000 DEATHS/YEAR (ITALIA 2010)
11.670 5.159
ITALIA
15+
ITALIA
15+

ANNO 2010
Decessi alcol-attribuibili
Frazioni
alcol-attribuibili (%)a
Maschi Femmine Maschi Femmine
MALATTIE TOTALMENTE ALCOL ATTRIBUIBILI 1.185 377 0,40 0,12
Neoplasie maligne 4.066 1.564 1,38 0,51
Altre neoplasie 373 137 0,13 0,04
Diabete mellito -566 -616 -0,19 -0,20
Condizioni neuropsichiatriche (Epilessia) 161 84 0,05 0,03
Malattie del sistema circolatorio 710 824 0,24 0,27
Malattie del sistema digestivo 2.096 693 0,71 0,23
Malattie della pelle e del sottocutaneo 5 3 0,00 0,00
MALATTIE PARZIALMENTE ALCOL ATTRIBUIBILI 6.845 2.689 2,32 0,88
Incidenti non intenzionali 3.082 1.956 1,05 0,64
Incidenti intenzionali 558 137 0,19 0,04
CADUTE, OMICIDI, SUICIDI E ALTRI INCIDENTI 3.640 2.093 1,24 0,68
TOTALE DECESSI
ALCOL-ATTRIBUIBILI
11.670 5.159 3,96 1,68
ITALY . Alcohol attributable deaths
(Nr of eaths by main death categories)
a la stima è stata effettuata rapportando i decessi alcol attribuibili al totale dei decessi nella popolazione

Fully and partially alcohol attributable deaths (%)
By age and gender
La percentuale di decessi
registrati nella classe di età 15-29
attribuibili al consumo di alcol
(M=15,07%; F=5,41%)
è molto più alta rispetto a quella
registrata nelle altre classi di età
MAIN CAUSE
ROAD ACCIDENTS
Dopo l’età adulta la percentuale dei
decessi attribuibili al consumo di
alcol aumenta nuovamente ed tra
gli anziani per cause di morte
parzialmente attribuibili.
MAIN CAUSES
CANCER
ROAD ACCIDENTS/DRAWINGS
15-29 30-44 45-59 60-69 70+ 15-29 30-44 45-59 60-69 70+
15,02% 8,84% 2,14% 0,81% 0,69% 5,41% 2,52% 0,78% 0,39% 0,65%
0,00% -0,36% 0,12% 2,88% 2,60% 0,00% 0,35% 0,51% 1,31% 0,87%
0,05% 1,27% 1,59% 0,83% 0,17% 0,00% 0,83% 0,88% 0,34% 0,06%
TOT 15,07% 9,75% 3,85% 4,52% 3,46% 5,41% 3,70% 2,17% 2,04% 1,58%
0%
2%
4%
6%
8%
10%
12%
14%
16%
≥15 ANNI
M=3,96%
≥15 ANNI
F=1,68%
MASCHI FEMMINE

o r
There is room for updated adn
reinforced information

o r
ALCOL & CANCRO
ESISTE una relazione CRESCENTE tra QUANTITA’
consumate di ALCOL e RISCHIO di 14 tipi di
CANCRO a partire da QUANTITA’ MINIME
Fig. 1. Relazione tra i livelli di consume di alcol e il rischio di 14 tipi di cancro (Relationship between
levels of alcohol consumption and risk for 14 types of cancer. Source: Corrao et al. 2004)
(Fotoda:BagnardiKAlcoholConsumptionandtheRiskofCancer)

o r
Adattamentodelledifferentilineeguidainternazionali:EMANUELESCAFATO,ISS-ONA25/10/2012
0 UA 1 2 3 4 5 ALCOLDIPENDENZA
(1- 2 UA)
BASSO RISCHIO
(1-3 UA)
BASSO RISCHIO
(2-3 UA)
A RISCHIO “HAZARDOUS“
(4-5 UA)
A RISCHIO “HAZARDOUS“
(>3-UA)
DANNOSO “HARMFUL“
(> 5UA)
DANNOSO “HARMFUL“
gr 12 24 36 48 60 72 84 96 108
Alcohol drinking RISK as a continuum
E. SCAFATO, SIA 2013, ROMA

o r
Lesson learnt : EIBI – IPIBimplementation

SCREENING AND BRIEF INTERVENTION - ITALY

EIBI-IPIB

E. SCAFATO, ISS CNAPA 22/10/2013 Luxemburg
http://www.amphoraproject.net/w2box/data/e-book/AMPHORA%20ebook.pdf

INEBRIA, Rome, September 19th-20th 2013

o r
INFORMATION
&
EDUCATION
promote life skills
support environments
provide protection
reduce harm
Information
by medical service
providers
Peer information
and partner
information
Sport’s, culture’s,
music’s
leaders
Health education by schools,
universities, etc.
Health education by parents,
grandparents and relatives
Community
leaders
Information by
pharmacists
The mass media:
- radio
- press
- television
GPs and social
councelling
FUTURE ACTIONS
INFORMATION, EDUCATION, TRAINING, RULES…

o r
Actions:
 To engage in and train on EIBI of alcohol-related
risk people all the PHC professionals (particularly
GPs, pediatricians, prevention department’s
physicians).
 To strength an integrated approach including
health services, GPs, voluntary organizations,
self-help and mutual aid groups, educational
institutions, work, justice and other institutions.
 To disseminate standardized tools and
methodologies for EIBI to be used for harmful
and hazardous alcohol consumption and alcohol
dependence evidence- and also need’s
evaluations- based.

o r
THE NEED FOR ALCOHOL RESEARCH FUNDING…

o r
EUROPEAN ALCOHOL RESEARCH I.S.S. PARTNERSHIP
SMART
Standarising
measurement of
alcohol-related
troubles

o r
AMPHORA 2008
Alcohol Measures for Public Health Alliance
www.amphoraproject.net

o r
CONCLUSIONS
Far to represent a goal already achieved, the
need for a reduction of the risks related to
alcohol use will continue to represent a main
aim in public health supporting the need for a
change toward a more healthy drinking
culture, re-discovering and strengthening the
formal control of the society and remarking to
individuals that drinking is perhaps one of
their own responsibility.

Outcomes for the Third Millennium
INVESTING FOR HEALTH
• H. EDUCATION
• H. PREVENTION
• H. PROTECTION
• SOCIAL INFLUENCE
• FACILITATION
• ADVOCACY
EMPOWERMENT & PARTECIPATION
Rome ISS 1999

The need for RENEWING the
challenge
for the Third Millennium is STILL ...
INVESTING FOR HEALTH
Rome ISS 1999

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