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FrancoAngeli Journals

Saggi, Studi e Ricerche

No. 71 (2025)

Troppo complessi da trattare? Un appello per programmi residenziali informati sull’ADHD in Italia

DOI
https://doi.org/10.3280/mis71-2025oa20400
Submitted
giugno 19, 2025
Published
2025-10-23

Abstract

Despite extensive documentation of the comorbidity between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs), the Italian addiction treatment system remain inadequate in supporting individuals with this dual diagnosis. Therapeutic communities – still the cornerstone of residential addiction care in Italy – are typically based on rigid behavioral models, abstinence-focused approaches, and highly regulated group routines. These structural characteristics are often inconsistent with the cognitive, emotional, and behavioral profiles of individuals with ADHD, leading to exclusions during the initial access phase or early abandonment of treatment.
This commentary highlights a blind spot, both structural and cultural, in the Italian system, where ADHD is still underdiagnosed in the adult population with DUS and often misunderstood as mere behavioral opposition. Although some addiction services (SerD) have recently introduced screening protocols using tools such as the Adult ADHD Self-Report Scale (ASRS), most residential programs remain unprepared to address the specific needs of ADHD.
The exclusion of patients with dual ADHD-DUS from therapeutic communities represents a systemic gap in care, which compromises both treatment effectiveness and the principle of equity.
This contribute calls for multilevel change: clinical recognition of ADHD in addiction settings, structural adaptations in therapeutic communities, and political incentives to promote inclusive and evidence-based care pathways.
Integrating ADHD-sensitive approaches into existing models is no longer an option – it is a clinical and ethical imperative. Closing this gap would improve not only treatment outcomes, but also the protection of the right to care for a population disproportionately affected by comorbidity and stigma.

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