Is it hard to drive in Italy?

On highways and country roads it's easy; in cities and hill towns it's genuinely demanding. Italian drivers are fast, decisive and closer to your bumper than you'd like, but they're predictable and rarely aggressive in the American sense. The real difficulties are narrow medieval streets built for carts, roundabouts taken at speed, scooters appearing from nowhere, and signage that assumes you already know where you are. Autostrada driving is calm and well maintained. Keep right except to pass — the left lane is genuinely for passing and someone will be behind you flashing if you linger.