RFK Jr lauds Italy's addiction treatment. Can it work here?

It's estimated about 50 million people in the United States struggle with an addiction to drugs or alcohol.

Most never get treatment of those who do about half relaps in the first year.

But in Italy, there's an addiction treatment program that appears to be having huge success at getting and keeping people sober. The program has a big fan in the U.S. Health and Human Services Secretary Robert F. Kennedy Jr. I've seen this beautiful model that they have in Italy called

“San Patrick and I know whether it's good and that's what we need to build here.”

San Patroniano is one of the largest addiction treatment facilities in the world. Recently Deborah Becker, a senior correspondent at WBUR went to see how it works. Well, I arrived here at San Patroniano in Italy. I'm surrounded by rolling farmland, vineyards, olive trees, mountains, it's beautiful. And I'm going to what looks like a college campus. There's a large terracotta color building surrounded by black iron fencing.

I'm here at the main entrance and I'm going for a tour. When we come back, a visit to a different style of drug treatment. We're back with a Sunday's story talking about the quest for a drug treatment program that actually

“works. I'm joined by Deborah Becker from WBUR in Boston. Hi, Deb. Hello. So, Deb, you've been covering”

the business of drug treatment in the U.S. for years. But you traveled all the way to Italy for

this story. So what makes San Patroniano different? Well, first of all, it's huge. There are

hundreds of people there. And it's really like it's own self-contained village with a bunch of its own businesses that are run to help keep the treatment program funded. When I got there, I met San Patroniano representatives who showed me around from the various workshops to the medical center, to the dining hall, the bakery, it went on and on. And it's just out there in the Italian countryside. Yep. It's at the top of a mountain really, a 700-acre campus in the middle of nowhere.

But it is very well known. It's attracted tens of thousands of people over the years,

including some from the United States. And my first day there, I met one of them.

“I'm from Boston. Where are you from? Detroit. Detroit. Yeah. How long have you been here?”

Almost seven months now. Now, this is Michael, a 20-year-old man, who was taking a break from his work in the dining hall when I met him. He asked that we referred to him by Michael, which is his middle name because of the stigma associated with substance use. He had been struggling for a few years and his dad heard about San Patroniano and urged him to apply. I was having trouble staying away from drugs, staying sober. It just kept being a cycle that

continued on repeating itself. We have treatment facilities in the U.S., so I mean, did he really need to go all the way to Italy? Well, he told me he had been to various programs in the U.S., but he said he needed something like San Pa as they call it that would give him structure for a longer period of time. In the U.S., the model is very different. It tends to revolve around what insurance is willing to pay for. And generally, for someone who needs

inpatient residential help, most often insurers will pay for only about 28 days. And I'm assuming that's not enough. All right. If someone qualifies for residential treatment paid for by health insurance, they typically have a significant addiction. So first, they would go to detox, to get through withdrawal, and then about 28 days of residential treatment. That typically involves psychotherapy and 12 step meetings. Some research suggests that people's brains need

much longer than that to rewire. I spoke with John Kelly, who's the founder and director of the Recovery Research Institute at Mass General Hospital in Boston about this. And he says recovery from substance use really takes a while. And we are talking about a long gang here. We're talking about really a five year risk relative risk for reinstatement of these disorders after initial stabilization. And even after initial remission has been achieved. So once people are a year sober,

years. So I issue many people leave after the 28 days. They go back to their lives. And there is a

“high rate of relapse. Someone could go to sober housing, but they would have to pay for it.”

The average costs to live in a sober house in the U.S. is about $1,500 to $2,000 a month. That's typically not covered by insurance. And these houses can help. They often have a curfew and a manager who makes sure that people stay sober in the residents. But the main source of the treatment is 12 step meetings. And 12 step meetings. That's like alcoholics anonymous, right? Right. Which is essentially peer-led recovery. RFK Jr. has said that AA meetings helped him kick a 14-year-long heroin

addiction and he still goes to daily meetings. Now these meetings AA is the most well-known and well-used programming in the U.S. Some of the main ideas behind the 12 steps ask the person to surrender control to go through intense self-reflection and to seek spiritual growth. Here's a bit of the

serenity prayer, which is said at every meeting. Basically these meetings are about relating

with the group and with a peer leader or a sponsor and openly talking about your challenges.

“One AA adherent Jim Dorita told me that it's the connections that are the key. It's stuff is all”

about relationships. If there's no ability or there's no connection anywhere, then you're alone again. And I don't know how many addicts that can be alone feeling miserable before that little thing in their brain starts saying you don't have to feel like this. Put you in a cooker. Do we know how will AA works that keep in people sober? Well, it's only people could agree on how to define

what works. Is it substance-free forever? If not, how long is it functioning in the world, but still

using sometimes? Is medication okay? There isn't really a standardized way to measure. And because of course AA is, as the name suggests, anonymous, it's not clear whether those who participate in

“surveys are truly representative of the entire group, right? So there are no hard numbers,”

but several studies on the effectiveness of AA for all those who try it show success rates averaging about 30% after three years. That percentage, I would have thought it would have been higher. I mean, that doesn't seem like a lot, right? It's not, but it is free. And it is the most widely used form of talk therapy, if you will, for addiction. And it's worth noting that most of the rehab in America is based on the 12 steps. Well, and what unlike AA rehab programs are not free, right? And we

keep spending more and more in drug addiction circles, right? Now rehab is sometimes called big rehab. The same is big pharma. Most estimates suggest that annual treatment costs in the U.S. are in the tens of billions of dollars, depending on how you calculate rehab money. And addiction treatment operates in this quasi-medical realm. There hasn't really been a lot of strict oversight. There have been a lot of stories about corruption in the rehab industry, even criminal negligence.

I spoke with KCO Brian. She experienced the so-called Florida shuffle. Now Florida seen a proliferation of treatment programs over the years, and O'Brien told me she went from one program to another before she stabilized when she returned home to New England. My experience in Florida, I ended up you know, going from flophouse to flophouse, homeless, strung out, given all of these promises of, you know, the luxurious life of I live where you vacation. And really like it's CD, it's dark,

it's not something you would ever imagine when you hear the words treatment. And RFK Jr. has characterized a lot of the treatment programs in the U.S. his predatory. He says his vision is to create in America the solution Italy has embraced. It is a high priority to me, and it's something that, from me, this is going to be my Peace Corps program. And my uncle had the Peace Corps. I'm going to build these rehab centers all over the country,

these farms, healing, healing camps where people can go where our American children can go and find

and the carnage. So what is so different about the style of treatment in Italy at Sloan,

“Patroniano? Well, what makes it different is what I wanted to find out, and that's why I”

traveled there, I flew to Rome, took a train to Bologna, and then drove to the Amelia Ramana region of Italy to tour the Sant Patroniano campus. I just can't believe how big it is. I don't think I expected it to be so. It's like a city. Because I see the village, a village, okay? It's like a village. When we come back, we return to Italy. I'm Ay Sharasko, and you're listening to the Sunday story. We're talking to journalist Debra Becker

about drug treatment and a model drug treatment community in Italy. So Debt, tell me more about the design of San Patroniano. Well, you take this winding country road, right? Through rolling hills, and at the top of one hill is this sprawling campus, and it's like its own village. There are dozens of terracotta colored buildings, terracottages, and facilities for several of the industries there, like a farm, bakeries. They do pizza for cacha, up there, and over here we focus on the bread.

That's resident Luca Zuli, and there's also cheese making, leather workshop, and textiles,

where fabric is woven on large wooden looms. And basically we do blankets and scubs.

That's Caro Rocco in the textile workshop. There's also an animal shelter. And there's a vineyard, winery, restaurants. One of them is called Spacho, S.P. for Sam Patroniano's initials, and the word Spacho is Italian slang for drug dealing. So somebody has a sense of humor. So how does all of this work? Like who runs all these businesses? And the first thing that comes to my mind is like, well, how is all this funded? When I visited, there were about 850 residents, and it's

the residents who do all the labor. And the profits from these enterprises are enough to fund more than

half of the programs annual $26 million operating budget. And I wish I was told the vineyard alone

“sells 400,000 bottles of wine a year. Oh my goodness, I mean, that's a large enterprise, right?”

Right. So really, the residents work to pay for the program. I took a tour of the vineyard and the winery with 29 year old Lorenzo Leparoni. And I asked him why he had come to Sam Patroniano almost two years earlier. The first reason is because my family in a certain moment says to me, okay, I don't have the tools. I don't have the possibility to help you. If you decide to die, die away from us. At first, Leparoni says he didn't like the work in the vineyard. But now,

he feels it gives him a sense of accomplishment and purpose. It gives to me the feeling to be able to do also something that I don't like. Now, I'm not paid. No, no one of us is paid for our works.

“If you want to watch it in a economical way, we work for sleeping and eating what we hit.”

And for sustained the community. I think what really save your life here is to discover again the possibility that you have to interact with other people in a healthy way. Okay, well, help me understand this model. How do you become a resident of San Patroniano? Well, the residents don't pay. The treatment is free. Most of the residents are from Italy or other parts of Europe. About 10% are from the US. Remember 20 year old Michael, the resident

from Detroit. He says the experience is completely different than what it was like for him at the handful of programs. He went to an America. I can't speak for obviously every rehab center in the United States, but San Patroniano is more of a community. I wouldn't define it as rehab. Obviously, you're coming here to rehabilitate yourself, but more so than that, you're coming here to fundamentally change everything. I think it really, it gives you the chance to get all the drugs out of your

system, but you still have a lot of work to do on yourself. And to me, that's the the most

San Patroniano officials say they don't have a big waiting list and they screen people really

well to make sure that they're motivated to change. A potential resident has to convince them that they're committed to a new life without substances. So if you're selected, what is the

“commitment? Well, you should expect to stay about three years. And it's tough. You're in the middle”

of nowhere. Right away, you're assigned to someone who stays with you 24 hours a day. This person's called a social or guardian angel. And this partner really is another resident who has been in still is in the program. And then you're assigned to job. There's a strict work schedule,

six days a week. You're always with your group of residents and former residents talking about

your life, while you want to be drug free. And then you gain privileges and more independence as you progress. So what's the treatment element? Well, the community, really. It is considered the treatment. There's no AA meetings. One resident told me that all he knew about AA was what he saw in movies from the US. Some of the principles of AA, like connecting with others

“and discovering a purpose, are a focus. There is very minimal, traditional therapy. Only if it's”

necessary. And these types of communities generally see addiction as a symptom of someone's deeper pain. Also, at San Pactorniano, addiction medications are not used. Medication for opioid use disorder

is considered the first line of treatment in the US. But San Pactorniano's medical director,

Dr. Antonio Biscini, who's also a former resident, says he does not support using meds. It's impossible that a drug treatment, pharmacological treatment, could be like the years of experience, mental experience, high-head in this place. It's impossible because, in my opinion, addiction is a brain disease, but also a soul disease. And so to address this, soul disease, as he calls it, San Pactorniano tries to create an almost family type culture. And the meals are the main

“gathering times. And Daisha, I went into the massive dining hall at lunchtime when I was there”

and residents assigned to the kitchen were spooning out food and filling water glasses. Here's resident, Bolario Barotti. I serve the people, serve at the table to distribute the water, the bread, everything. And this dining hall was so beautiful. Beamed ceilings, long wooden tables, covered in checkered cloths, one wall of enormous fish tanks, and then on the other side, floor to ceiling windows overlooking this gorgeous view of rolling hills and farmland. And also

the delicious smell of garlic. I mean, so what was on the menu? Well, pasta, no surprise, with a pesto-type sauce, the day I visited. And there was Prashuto, cheese, roasted vegetables, chicken, wine used to be allowed at the meals. But now it's only one glass a month to celebrate residents who have birthdays that month. I mean, that sounds very European. I mean, even allowing a little wine at the drug treatment facility. But what if someone breaks the rules? And

relapses do they get kicked out? Yeah. Well, I asked that. They told me that if someone wants to relapse, they usually leave. So then I asked, do you let them back? And they said they would let them back. But if it happens a lot, that person is not ready, and they would leave. The San Pachrano officials I spoke with say, if someone's not motivated, they don't want their program to be added to what is likely a list of failures. So they will work with people who are having trouble to a point.

Well, what happens when residents complete the program? There are enormous resources to help people get jobs and remain drug free afterward. A woman working in the laundry, Loretta Landon, she's 38 years old, dual citizen who grew up in Scotland in Texas. And she told me she came to San Pachrano for treatment and for something more. I also knew that if you finished the course here, San Pachrano would help you financially

to find a job to get back on your feet. And really, I had burned everything. I burned everything. I really was here alone in Italy with nothing and I needed help. And so I thought, okay,

Some former residents become what are called responsibilities, and they help oversee and run

“many of the enterprises. I met some of them. They live in these small houses on the campus with”

their families. Also, some big businesses who help pay for the training at San Pachrano use it almost like an apprentice program. And they might hire residents for jobs once they leave. So there is a real focus on training for future employment. What do we know about whether this all works? Again, top to measure researchers at the University of Belonia found that if someone completes the program, which means staying until San Pachrano says you're ready to leave,

more than 70% were drug free three years later. Well, I mean, that sounds amazing. But I mean,

I just imagine that because the sound's perfect, it sounds almost too good to be true.

“They have to be some people who have some criticism of it. Right, right. I met one man who”

left after just two weeks. He said San Pachrano was too focused on getting residents to do the work. He said he needed time to reflect and he felt like he was being used as cheap labor. Also, addiction researcher and author Maya Salovitz, not a fan of San Pachrano, she has studied therapeutic communities. And she says most do not have the oversight they need to prevent the exploitation of vulnerable residents. Salovitz has concerns, for example, about

the mandatory work requirement without pay at San Pachrano. It has to be meaningful employment that allows the person to make a living. We do know what works and what works tends to be

“treating people kindly with dignity and respect using medications where appropriate”

and having them have access to education, meaningful employment, and community. And Salovitz also says it's not uncommon for therapeutic communities to tip into corruption, with those in charge acting with unquestioned authority. Institution with unchecked power

almost always come to no good. And the way the therapeutic community has been set up has been

with unchecked power. Now, San Pachrano representatives say they do have strong oversight now after a sorted past where the community nearly collapsed. He was absolutely impossible to live to community. I mean, there were plenty of people trying to run away. Some of them attempted like many times to run away. But the other members of the community used to run after them. More on that when we come back. We're back with a Sunday story and journalist Deborah Becker

talking about the drug treatment community, San Pachrano. So what is this story of how San Pachrano nearly fell apart? So San Pachrano started in 1978 when Italy had a massive heroin epidemic. This business man then chenzo mutually thought he had a solution. He started this community on his family's farmland, but it was very strict and people were forced to stay, mutually received a suspended sentence at one point for chaining residents, so they

didn't run away. I met with 60-year-old Paolo Severi who spent about three years at San Pachrano in the early 1990s, here he is speaking through an interpreter. San Pachrano era allora estremamente invasiva de la personalidad. San Pachrano was oppressive. It was like a total of institutions. It was controlling every aspect of my life. But San Pachrano had a lot of support across Italy, a lot of wealthy benefactors and a kept expanding, but mutually got into more trouble.

And even was charged with covering up a San Pachrano resident's murder. He died, disgraced in 1995, but the program continued and gradually involved into a more voluntary, gentler program with more oversight. It's now treated more than 26,000 people around the world and it's been a model for other smaller programs in other countries. So this is the program that RFK Jr. has said should serve as a model for treatment in the U.S.

Do we have anything remotely like this in the U.S. right now?

vocational training. There was once a huge therapeutic community in the United States,

“the first of its kind for heroin addicts. It was called Sinanon. It's been a subject of many”

books in movies, including one back in 1965. Sinanon, the house life magazine calls a tunnel back into the human race. The parallels between Sinanon and San Pachrano are really interesting. Sinanon was also founded by a charismatic leader. It amassed enormous wealth through donations and the work of residents. But then it evolved into a cult. By the 1970s, it had started calling itself a religion. It formed its own army. And it really went downhill.

It was officially disbanded in 1991. I spoke with former Sinanon resident Neil Rice. He's now

“78 years old. He spent two years there in the 1960s and he admits that there were practices”

that would never be allowed today. Like forcing residents to shave their heads and humiliating

them as a form of so-called therapy. But he credits Sinanon was keeping him off drugs. I learned sales in Sinanon. Later in life, I was able to have a very fulfilling career in sales. Sinanon's directly responsible for recognizing my talent then. I met my wife to be in Sinanon. It was still married today with 55 years later. And unlike San Pachrano, Sinanon never really resurrected itself after its fall. Okay, so R.K. Junior says Sinan Pachrano is a model to bring

“to the U.S. But what kinds of barriers exist to making that happen? Well, there's no question”

that the country needs new options for treating addiction. But Sinan Pachrano has been built over more than four decades. And it's a comprehensive established community well-connected to a lot of businesses and philanthropists. So it would take many years and a lot of money to try to recreate that here. There are hundreds of small therapeutic communities in the U.S. But many are for specialized populations like people leaving prison or those with significant psychiatric

issues. Some are private and those can be quite expensive. I visited a relatively new treatment farm in Massachusetts, which is free. It accepts 16 low-income men who have both mental health and addiction issues. As to R.K. Junior's plans for treatment farms here, he has not yet gotten his grand vision launched. He has made state grants available for more addiction treatment and his office just expanded funding for faith-based addiction treatment. But in terms of creating a version

of some patroniano in this country, that's going to take a while and a major commitment that we're just not seeing yet. And I might know President Trump has said that he supports forcing people into treatment rather than making it voluntary. Something that of course failed in Italy. Well, Deb, thank you so much for bringing us this story. I mean, it's really interesting. Oh, thanks for having me. That was Deb Rebecca. A senior correspondent at Boston Public

Radio Station WBUR. You can find more of Deb's reporting on San Patroniano at WBUR.org. Funding for this reporting was provided in part by the Pulitzer Center. This episode of the Sunday Story was produced by Andrew Mombo. It was edited by Jenny Schmidt. The engineer was Robert Rodriguez. We got fact-checking help from SACO Davis Vaskas. The rest of the Sunday Story team includes Justin Yan and Leonis Sumshrum. Our executive

producer is Irene Negucci. I'm Isharasco and up first we'll be back tomorrow with all the

news you need to start your week until then have a great rest of your weekend.