Drug addicts under house arrest: why the law is putting a strain on the treatment system

The final decision therefore rests with the Court, which may grant the application if it considers that the programme contributes to the applicant’s genuine rehabilitation and prevents the risk of them committing further offences.

Once admission has taken place, the manager of the facility where the residential or semi-residential social and rehabilitative treatment programme is being carried out shall submit to the public addiction service and the U.E.P.E. a half-yearly report, without prejudice to the obligation to report at any time to the judicial authorities any breaches committed by the individual, including for the purposes of revoking the house arrest order. Finally, if the therapeutic programme is successfully completed, the supervisory judge may order probation under the supervision of social services or house arrest.

At first glance, on paper, the system seems to work. But what about in reality? The law itself provides an answer to the objection regarding the application of uniform criteria at national level for assessing whether a person is actually suffering from drug or alcohol dependence, and whether this assessment is up to date. In fact, the law provides for guidelines to be drawn up within four months by a central commission attached to the Department for Policies on Drugs and Other Addictions within the Prime Minister’s Office.

But other questions arise. Firstly, there is a critical shortage of professional staff within public addiction services and within the U.E.P.E.s themselves, as well as within the Supervisory Judiciary, which needs to be addressed in order to cope with the increase in requests for assessment and monitoring, as well as correspondence with lawyers and other parties.

Not to mention that addiction may be associated with co-occurring mental health conditions – the so-called ‘dual diagnosis’ – which means that mental health centres are also involved in the programmes, placing further demands on services already facing staff shortages. The same issue of resources concerns the capacity of the treatment network, which has around 14,000 places – over 95 per cent of which are managed by accredited private providers – and is already close to full capacity. The number of drug users in prisons is estimated at around 20,000, although less than half of them would be eligible to benefit from the new law.

The risk is that the system will become overburdened, which could lead to waiting lists, the possible continued detention in prisons of those who could instead benefit from alternative programmes, with all the potential consequences that entails, but also to a ‘forced’ increase in home detention for those who have access to accommodation, thereby excluding the vast majority of migrants. Moreover, the push to accept new arrivals risks undermining the effectiveness of rehabilitation programmes and increasing reoffending rates. It should also be noted that the law establishes a fund within the Ministry of Health amounting to approximately 19.5 million euros per year from 2026 onwards, equivalent to around 600 full annual places in accredited private residential facilities. Beyond this initial allocation, the relevant authorities – primarily the Regions and the Ministry of Justice – must, in accordance with the law, ensure its implementation without imposing any new or additional burdens on public finances.

Then there is the issue of raising the minimum sentence to eight years; this can certainly be reached by combining several minor offences – as is the case for those who commit crimes solely to obtain drugs – but it could also be imposed as the sentence for a single offence.

This is a restriction that is provoking some concern regarding public safety, even though the law excludes the most serious offences. On the other hand, one of the aims of the law – although not explicitly stated in the text but merely declared – is to reduce the prison population, which currently stands at around 63,500 against a regulatory capacity of approximately 51,300 places.

Finally, there is a more general cultural issue concerning the mental health and substance misuse system, to which – as the years go by and new legislation is passed – there is a tendency to delegate an increasing number of social control tasks and an ever-decreasing number of care-related tasks. This issue is also addressed in the National Action Plan for Mental Health 2025–2030, which reaffirms that the objective of healthcare staff is always focused on care.

In conclusion, the new law, whilst based on a sound principle, paves the way for a new approach that will involve overcoming various obstacles – ranging from the need for adequate resources and the implementation of proven approaches, to safeguarding the clinical expertise of healthcare professionals, whilst ensuring that responsibilities are not delegated in a way that compromises public safety.

* Head of the Mental Health Department, ASL Roma 2