RISULTATI RICERCA

Opioid prescribing in Italy remains cautiously conservative, with national data showing stable and comparatively low use of medium-potency opioids relative to other European countries.
Migrants and ethnic minority groups, however, display increased vulnerability to substance use disorders due to linguistic, cultural, and religious barriers that hinder access to and continuity of care.
The case concerns a 19-year-old North African male presenting with a severe iatrogenic opioid use disorder involving tramadol, oxycodone, and benzodiazepines, accompanied by detailed self-monitoring of substances, dosages, routes, and psychoactive effects.
His tramadol use, initially therapeutic, rapidly evolved into complex experimental practices informed by online psychonautic resources, producing atypical euphoria and sensory distortions even at standard doses.
Family opposition, rooted in strict religious norms, significantly interfered with treatment, leading to compromised methadone adherence, suspected diversion, and eventual relapse with periods of homelessness.
Cultural tension intensifi ed during Ramadan, a period associated with autonomous modifi cations of oral medications.
The subsequent transition to long-acting injectable buprenorphine provided a culturally acceptable alternative, enhancing adherence and clinical stability.
Pharmacogenetic considerations, particularly the higher prevalence of CYP2D6 ultrarapid metabolizers in North African populations, may have contributed to the heightened psychoactive responses and misuse risk.
Overall, the case illustrates the necessity of integrating cultural, religious, and pharmacogenetic factors into individualized treatment strategies to improve engagement and long-term outcomes.

This paper examines the integration of EMDR (Eye Movement Desensitization and Reprocessing) therapy and the Polyvagal Theory in the treatment of cocaine addiction, one of the most complex challenges in the fi elds of psychotherapy and public health. After outlining the severity of the phenomenon in Italy – marked by an increasing health and social impact, a rise in drug-related hospitalizations, and significant involvement of both young people and adults – the theoretical foundations of the two approaches are explored.
The article illustrates this perspective through the clinical case of Vito, a patient with cocaine dependence and a history of early relational trauma, treated with an integrated EMDR-Polyvagal approach within a Gestalt-oriented psychotherapy framework.
The case highlights how the combined work on trauma reprocessing and neurophysiological regulation promotes a reduction in substance use, improved body awareness, relational trust, and emotional self-regulation.
The paper emphasizes the importance of the therapeutic relationship as a space of safety and co-regulation, and the need for an integrated treatment approach that unites neuroscientifi c and humanistic perspectives to foster recovery, autonomy, and quality of life in individuals affected by cocaine addiction.

The present study compared the acceptability of two methadone formulations (syrup vs tablets) in a sample of 44 patients with Opioid Use Disorder (OUD).
The analyses revealed signifi cant differences in favor of the tablet formulation in six of the seven dimensions investigated.
Notable advantages emerged in terms of taste, ease of transport and storage, maintenance of privacy, reduction of dosing issues, and positive impact on daily life.
Most patients receiving the tablet formulation also reported no difficulties in switching from the liquid formulation, expressing an intention to continue with tablets and to recommend them to other patients.
These results suggest that methadone tablets may improve the patient experience and promote greater treatment adherence, while also reducing the indirect costs for services. Future studies with larger samples and attention to pharmacoeconomics will be needed to confirm these findings and support clinical and organizational choices aimed at personalization and sustainability of treatments.

Background: In prison, there is an increasing tendency toward self-medication and/or misuse and diversion of certain potentially addictive pharmaceuticals, such as benzodiazepines, gabapentinoids, and synthetic opioids, for which effective counter-strategies are required.
The proposed project work was developed and discussed within the managerial course Dirigenti Struttura Complessa and implemented at the Ivrea prison.
Methods: Organizational, training programs, process-related, clinical (VAS and WHOQOL-BREF scale), and economic approaches.
Expected Results: Primarily qualitative, in terms of the implementation of care pathways, monitoring of pharmacological prescriptions at risk of misuse, reduction of related critical events, and enhancement of prisoners’ quality of life.
Conclusions: It is necessary to share technical tools, training programs, and PDTA (Diagnostic and Therapeutic Care Pathways) with all units operating in prison.

Obiettivo La presente ricerca intende indagare la qualità delle relazioni d’oggetto e le rappresentazioni delle figure parentali in soggetti con addiction a seconda del tipo di sostanza e del programma di trattamento, attraverso il test di Rorschach, cercando di rispondere alla seguente domanda: si può ipotizzare che dinamiche relazionali precoci con i caregiver corrispondano ad una maggiore vulnerabilità alla dipendenza da una tipologia di sostanza piuttosto che un’altra? Metodo sono stati considerati i protocolli Rorschach di 196 soggetti dipendenti da eroina, cocaina, alcol suddivisi in due differenti programmi di trattamento residenziale comunitario (alcoldipendenti e tossicodipendenti). Per studiare le relazioni oggettuali sono state analizzate le risposte date alle tavole bilaterali II, III, VII classificando il tipo di relazione individuata dal soggetto, mentre per studiare le rappresentazioni parentali sono state analizzate le risposte date alle tavole IV e VII, considerate rispettivamente la tavola paterna e materna, classificando il contenuto delle risposte a seconda delle proiezioni di aspetti positivi, depressivi, aggressivi, persecutori e di identificazione proiettiva, con l’intento di indagare le differenze tra soggetti alcoldipendenti e tossicodipendenti. Risultati L’analisi delle risposte date alle tavole bilaterali ha rilevato una prevalenza delle risposte basate principalmente sulla forma e, secondariamente, risposte basate sull’azione generica e sull’interazione, mentre la proiezione di figure in relazione fra loro è risultata povera. Riguardo l’analisi delle rappresentazioni parentali, vi è un’associazione significativa tra il programma di trattamento e le risposte fornite alla tavola IV (p=0.001), con maggiore concentrazione di rilievi depressivi nei soggetti tossicodipendenti e maggiore frequenza di proiezioni correlate all’aggressività nei soggetti dipendenti da alcol. Dall’analisi delle risposte alla tavola VII, inoltre, risulta evidente come i soggetti tossicodipendenti proiettino aspetti positivi fino a tre volte di più rispetto ai soggetti alcoldipendenti, mentre entrambi i gruppi di soggetti proiettano massicciamente e in ugual misura aspetti aggressivi a questa tavola.

Conclusioni Questo studio evidenzia la difficoltà dei soggetti con addiction di investire nelle relazioni oggettuali che, quando presenti, si rifanno a modalità arcaiche relative alle primissime fasi di costruzione della relazione d’oggetto. Se da una parte questa ricerca conferma l’inconsistenza della rappresentazione della figura paterna nelle addiction come da letteratura, con vissuti di vuoto, deterioramento di tipo depressivo-anaclitico e attacchi distruttivi verso l’oggetto, dall’altra apre a nuove riflessioni sull’ambivalenza della relazione positivo-distruttiva riguardo la rappresentazione della figura materna. I risultati sembrano confermare la direzione teorica secondo cui la tipologia di sostanza primaria potrebbe essere una scelta d’oggetto coerente con le rappresentazioni parentali introiettate.