alcohol users
In the case of problematic drug or alcohol users who have a sentence of less than four years, and who have participated in a rehabilitation programme for drug addiction, it is possible to request the intervention of UEPE (Office for the External Execution of a Sentence) in order for the person to continue the programme or to undertake it outside prison. The rehabilitation programme must be agreed with the professionals of the Local Health Service and of the Services for the Drug Addiction (SERT). The request for an alternative to prison can be presented by the prisoner with the necessary documentation, to the Director of the prison who sends it to the Probation Court and to the supervisory magistrate who has agreed the alternative. If the sentence remaining to be served is within the limits, the judge orders the release of the prisoner.
The requirements for this measure are:
• a sentence no longer than 6 years;
• the sentenced person must be a drug addict or alcohol dependent who is already in a rehabilitation programme or who is going or willing to start one;
• the therapeutic programme must be agreed with the health service, sometimes, be in accord with other private agencies specifically identified by law (art.115 D.P.R. n. 309/90);
• drug addiction or alcohol dependence must be medically supported and the suitability of the programme itself for the rehabilitation process must also be medically supported. The benefit of the alternative to prison for drug or alcohol dependence can only be granted on two occasions.
The option of alternatives to prison are often denied by judges for prisoners who are in methadone therapy, because abstinence is considered in relation to whichever opiate the prisoner may be using, thus judges often confuse methadone therapy with the use of a drug. Moreover, alternatives to prison are often revoked because of relapses (again considering compliance to the programme only on the basis of abstinence), showing an insufficient consideration of the real problems and a substantial closure in relation to alternatives to prison. It is important that the use of methadone is recognised as
an appropriate means to prevent drugs use, and that staying in therapy is considered a successful alternative to prison (Berto 2006).
3.6.6 The prison system
The Prison System, which is under the direction of the Ministry of Justice, is divided into regional offices that control the activities of individual penal institutions located in each regional territory. At the time of the research (20,060 the prison population was 61,721, with 35.9% on pre-trial detention.
Foreign prisoners make up 33.2% of the overall population, and the number of establishments is 225 (163 remand prisons, 36 institutions for the execution of prison sentences, 8 institutions for the execution of security measures, 18 penal institutions for juveniles). The official capacity of the prison system is 42,959, therefore the current occupancy rate is 138.9% (World Prison Brief 2006).
Along with security staff and officials, personnel in each prison include the correctional police corps (to maintain the order of the prison), social service staff, educators and healthcare staff. Rehabilitation of prisoners is done through educational, work, religious, cultural, recreational and sporting activities as through well as ensuring prisoners maintain regular contact with their family and the outside world.
At the end of June 2005, there were 59,125 prisoners in the Italian prisons, of these, 40,054 were Italians and 19,071 non-Italian nationals. In all, 16,179 were people with problematic drug use (15,511 men and 668 women) of these, 3,016 were non-Italian national prisoners with problematic drug use (2,935 men and 81 women). (Further details on problematic drug users in custody are presented in the next section). Amongst the imprisoned people with problematic drug use 1,525 were HIV-positive in 2005. As the test for HIV is voluntary this number could be underestimated. It is interesting that within Italian prisons, every prisoner can access a certain amount of alcohol, despite all the problems related to alcohol use (security between the prisoners and with the guards, alcoholism, violence).
3.6.7 Drug and alcohol use
In Italy, as in many countries, the real number of people with problematic drug use is difficult to estimate. The only definite number of problematic users are the clients of the Services for the Drug Addiction (SerT). Data from the Annual Report to Parliament on the Situation of Drug Addiction in Italy (2001) show an increasing number of clients from 140,307 in 1998 to 150,327 in 2001 who are receiving treatment. In 2004, the number of clients receiving treatment at SerT was 171,724, of which 17,143 clients have been sent to rehabilitation organisations.
Approximately 15% of those in the general population who visit their GP have alcohol-related problems, and 5% are alcohol dependent. Although it is difficult to appraise, scientific data estimates that mortality rates attributable to alcohol are between 30,000 and 50,000 each year, and 30% of road accidents and 10% of incidents in the workplace are alcohol-related. An additional important aspect is alcohol consumption among young people, who mostly abuse alcohol by ‘binge drinking’.
The use and the abuse of alcohol is also very common in prison and it is often used with pharmaceutical drugs. People with problematic drug use in prisons often replace their primary drug with alcohol and pharmaceutical drugs. Often the beginning of alcohol use or the increase of alcohol consumption corresponds with a period of imprisonment. Epidemiological data about prescribed drug and alcohol use in prison is lacking, one survey on the drug- and alcohol-dependent prisoners was carried out by the Ministry of Justice, which identified 1.3% alcohol-dependent prisoners.
At the end of June 2001, according to the survey of the Ministry of Justice, there were 55,261 prisoners in Italian prisons, among which 15,173 were people with problematic drug use equating to 27.46% of the prison population (data collected on voluntary screening). Without relevant variations from the previous three years, the drug addicts entering prison in 2004 were approximately 29% of the total number of prisoners (Annual Report to the Parliament year 2005).
Drugs users aged between 35 and 44 years old are particularly represented among patients in methadone treatment programmes, while young adults (23–
34 years old) are represented in higher percentages among the patients of the Therapeutic Communities (Relazione Annuale 2004). Psychological treatments provided by drug services represent approximately 49% of all treatments, and this percentage has increased from 2001 to 2004. In these four years, detoxification treatments with medications have decreased, from approximately 3% of all pharmacological treatments in 2001 to 1% in 2004. 82% of pharmacological treatments involve methadone. From 2001 to 2004 there was an increase in the number of long-term therapies, compared to a slight decrease in the number of short-term therapies. Prescription of buprenorphine has been increasing in recent years. In 2004, compared to the previous years, a reduction in the use of naltrexone has been registered; residential treatment continues to be very common for heroin dependency and a great number of clients in therapeutic Communities have a history of poly-drugs use or cocaine dependence (Relazione Annuale 2004).
The IPSAD Study (2001–2003) shows an increasing rise in the consumption of cannabis (compared with 2001) for all ages. Among men, the highest percentage of consumption is between 25 and 30 years olds. Among women, the highest percentage of consumption is among the 24 and 25 years olds. In 2003, 5.4 % of respondents interviewed reported having used cocaine at least once in their lifetime and 1.5% in the last 12 months (IPSAD 2001–2003). The use of cocaine has shown a substantial increase between 2001 and 2003.
Cocaine is used more commonly by young people (15–24 years) compared to adults (25–34 years), however, the greatest increment, in recent years is shown by young adults (25–34 years) and by adults (35–44 years). Heroin use once or more in a person’s lifetime is reported at 1.2% of the population aged between 15 and 44 years in 2003, while 0.25% of the population report using heroin in the last 12 months. The use of heroin at least once in a lifetime, in comparison with the 2001–2003 data, shows an increase in use by 25–34 year olds, and even more of an increase in the 35–44 age group. A decrease in the number of young people who refer to heroin use once or more in their lifetime has been observed. In the last 12 months (2006) heroin use has reduced to half of the frequency found in 2001, showing a significant reduction. There is a decreasing trend (2001–2004) in the use of cannabis and heroin, whereas there has been a significant increase in the use of cocaine and the quantity of amphetamines being used has stabilised (Relazione Annuale 2005)
3.6.8 National drug strategy
In Italy the law regulating the sentences for the sale of illegal drugs is Testo Unico (TU) 390/90. A new law was approved on 21st February 2006, n°4994 that integrates and modifies DPR 390/90, article 4 regarding the execution of preventive jail sentences for drug addicts in recovery programmes:
Anyone, without the authorization referred to in article 17, who cultivates, produces, extracts, refines, sells, offers or puts on sale, yields, distributes, trades, transports, provides to others, sends, passes or sends, delivers any part of drugs or psychotropic drugs can be punished with imprisonment from six to twenty years and with a fine from 26,000 Euros.
In the case of people with alcohol dependence there are no regulations, since alcohol is a legal substance, except for the rules applied to drink driving or in the workplace, or violations of the law under the effects of alcohol.