1. How did Italy manage to reduce alcohol-related harm ?
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

2. Country profile 2014 - ITALY

3. The European Alcohol Action plan 1992 - 1999

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

5. Istituto
Superiore
di Sanita’

6. ITALIA - 2001 FRAME LAW ON ALCOHOL 125/2001.

7. The Frame Law on Alcohol (nr 125/2001)
All over Europe, the 2001 n. 125 Italian law represented a unique example of implementation and full endorsement of the WHO European Alcohol Action Plan and of the European Charter
on Alcohol main principles
reported in the Italian aims
at the art. 2 of the law as the
aims of the law.

8. 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.

9. CHARTER ENDORSEMENT IN ITALY FROM PRINCIPLES TO RIGHTS

10. ITALY. Alcohol policy development

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

12. The National Health Plan
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.
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.

13. National Alcohol and Health Plan (PNAS)
Strategic areas of intervention
Information and education
Drinking and driving
Alcohol and work
Treatment of harmful/hazardous alcohol consumption and alcohol dependence
Production and distribution’s responsibility
Social network to face risk factors alcohol related
Strengthening NGOs, voluntary organizations, self-help and mutual aid groups
Monitoring harm done by alcohol and strengthening alcohol policy

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

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

16. ALCOHOL - ASSESSMENT & MONITORING ISS-WHO CC FORMAL ROLES

17. ALCOHOL PREVENTION DAY 2001-2014
INCREASING AWARENESS
ALCOHOL PREVENTION DAY 17

18. 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
FURTHERMORE
6) all individuals who consume on one occasion more than 6 glasses (binge drinking).
1 standard unit = 12 grams

19. Low-risk drinking guidelines

20. LESSONS LEARNT: There is still room for supporting decrease in per capita alcohol consumption
Emanuele SCAFATO 25/10/2012
INVERSE RELATIONSHIP BETWEEN Alcohol Dependency rates AND Per capita alcohol consumption

21. PREVALENCE (%) of DAILY CONSUMERS by U.A. (1 UA= 12 gr)
MALES (age >11) YEARS
Different needs for intervention at population level having in mind that the decrease in alcohol consumption is mainly achieved in moderate consumers and that a hard target is stil represented by harmful consumers (as an example males drinking more than 4 units per day)

22. TO PREVENT HARMFUL DRINKERS to become ALCOHOL DEPENDENTS
THE GAP TO BE BRIDGED
TO PREVENT HARMFUL DRINKERS to become ALCOHOL DEPENDENTS
Among 8 mln of HEAVY DRINKERS there are AT LEAST
male HARMFUL drinkers
and more than
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 .

23. HARMFUL DRINKERS vs ALCOHOL DEPENDENTS
THE GAP TO BE BRIDGED
HARMFUL DRINKERS vs ALCOHOL DEPENDENTS

24. HARMFUL CONSUMERS AND ALCOHOL DEPENDENTS
DETECTION – EMERSION – INCLUSION
Alcohol dependents
already in charge
by NHS services
NEW PATIENTS
20.623
OLD PATIENTS
49.147
HARMFUL
DRINKERS
Harmful drinkers
(M= F= )
ALCOHOLDEPENDENTS

25. Lesson learnt : EIBI – IPIB implementation

26. EIBI-IPIB

27.
E. SCAFATO, ISS CNAPA 22/10/2013 Luxemburg

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

29. SCREENING AND BRIEF INTERVENTION as investment for health - ITALY

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

31. THE NEED FOR ALCOHOL RESEARCH FUNDING…

32. 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.

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

34. The need for RENEWING the challenge for the FUTURE is STILL
The need for RENEWING the challenge for the FUTURE is STILL ... INVESTING FOR HEALTH
SEOUL 2015

35. THANK YOU
THANK YOU FOR
YOUR ATTENTION

36. 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 from 16 to 18

37. Main actions implemented in Italy during the last decade
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

38. Main actions implemented in Italy during the last decade
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