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

0:00I'm Aisha Roscoe and this is a Sunday Story where we go beyond the news of the day to bring you one big story. 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 relapse 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 Patriciano where they're, it's good.

0:44And 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've 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-colored building surrounded by black iron fencing. I'm here at the main entrance, and I'm going for a tour.

1:28When we come back, a visit to a different style of drug treatment.

1:41These days, it feels like the news changes every hour. Well, NPR has a podcast that does that, too. NPR News Now brings you a fresh five-minute episode every hour of the day with the latest, most important headlines in episodes that are clear, fact-based and easy to digest. Listen to NPR News Now on the NPR app or wherever you get your podcasts. We're back with the Sunday 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.

2:30So what makes San Patrignano different? Well, first of all, it's huge. There are hundreds of people there, And it's really like its 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 Patrignano 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.

3:17And 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 refer 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.

3:55We 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. Right, right. If someone qualifies for residential treatment paid for by health insurance, they typically have a significant addiction.

4:43So 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.

5:25So once people are a year sober, if you will, or a year in remission, their risk remains elevated for relapse for another four to five years. So, Aisha, when 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 cost 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 residence. But the main source of the treatment is 12-step meetings.

6:06And 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, it's 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. God, grant us the serenity to accept the things we cannot change, the power to change the things we can, and the wisdom to know the difference, please.

6:56Basically, 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. This 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 two in the cooker. Do we know how well AA works at keeping people sober? Well, if only people could agree on how to define what works.

7:39Is 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.

8:23Right. 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, but unlike AA, rehab programs are not free. Right, right. And we keep spending more and more. In drug addiction circles right now, rehab is sometimes called big rehab, the same as 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.

9:05There 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 Casey O 'Brien. She experienced the so-called Florida shuffle. Now, Florida has 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.

9:45And really, like, it's seedy, 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. as 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, for 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 camps where people can go, where our American children can go and find themselves again and come back, become contributing members to our society and stop the mayhem and the carnage.

10:35So what is so different about the style of treatment in Italy at San 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 Emilia-Romagna region of Italy to tour the San 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. I say village. A village, okay. It's like a village. When we come back, we return to Italy.

11:13I'm Aisha Roscoe, and you're listening to The Sunday Story. We're talking to journalist Deborah Becker about drug treatment and a model drug treatment community in Italy. So, Deb, tell me more about the design of San Patrignano. 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, there are cottages and facilities for several of the industries there, like a farm, bakeries. We do pizza, focaccia up there, and over here we focus on the bread. That's resident Luca Zulli.

11:56There's also cheese making, a leather workshop, and textiles where fabric is woven on large wooden looms. and basically we do blankets and scarves. That's Carol Rocco in the textile workshop. There's also an animal shelter. And there's a vineyard, winery, restaurants. One of them is called Spaccio, S-P for San Patroniano's initials. And the word Spaccio 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, you know, the first thing that comes to my mind is like, well, how is all this funded? When I visited, there were about 850 residents.

12:49And it's the residents who do all the labor. And the profits from these enterprises are enough to fund more than half of the program's annual$26 million operating budget. And Aisha, 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 Leperoni, and I asked him why he had come to San Patroniano almost two years earlier. The first reason is because my family in a certain moment says to me, OK, I don't have the tools, I don't have the possibility to help you.

13:38If you decide to die, die away from us. At first, Leperoni 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 one of us is paid for our walks. If you want to watch it in an economical way, we walk for sleeping and eating what we eat. And for sustaining the community. I think what really saved 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.

14:35Like, how do you become a resident of San Patrignano? 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 U.S. 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 in America. I can't speak for, obviously, every rehab center in the United States, but San Patrignano 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.

15:22I think it really 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 most important work. He says it took him a couple of months to go through the application process. As 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.

16:04You'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 and still is in the program. And then you're assigned a 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, why 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 is considered the treatment. There's no AA meetings.

16:44One resident told me that all he knew about AA was what he saw in movies from the U.S. 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 Patroniano, addiction medications are not used. Medication for opioid use disorder is considered the first line of treatment in the U.S., but San Patroniano's medical director, Dr. Antonio Bischini, who's also a former resident, says he does not support using meds.

17:27It's impossible that a drug treatment, pharmacological treatment, could be like the years of experience, mental experience I had 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 Patroniano tries to create an almost family-type culture. And the meals are the main gathering times. And Aisha, 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 Valerio Barati. I like to serve the people, to serve at the table, to stay, 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.

18:46I mean, so what was on the menu? Well, pasta, no surprise, with pesto-type sauce the day I visited. And there was prosciutto, 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?

19:32And they said they would let them back. But if it happens a lot, that person is not ready and they would leave. The San Patroniano 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. word. A woman working in the laundry, Loretta Landon, she's 38 years old, dual citizen who grew up in Scotland and Texas. And she told me she came to San Patrignano for treatment and for something more.

20:18I also knew that if you finished the course here, San Patrignano would help you financially to find a job, to get back on your feet. And really, I had burned everything. I'd was here alone in Italy with nothing and I needed help. And so I thought, okay, this is a way to get help and to help myself. So the follow-up is a big part of the program. Some former residents become what are called responsibles 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 Patroniano use it almost like an apprentice program, and they might hire residents for jobs once they leave.

21:07So there is a real focus on training for future employment. What do we know about whether this all works? Again, tough to measure. Researchers at the University of Bologna found that if someone completes the program, which means staying until Until Sampatrino says you're ready to leave, more than 70 percent were drug free three years later. Well, I mean, that sounds amazing. But I mean, I just imagine that because this sounds perfect. It sounds almost too good to be true. There 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 Patroniano was too focused on getting residents to do the work.

21:59He 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 Patroniano, 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 SEMPA. It has to be meaningful employment that allows a 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.

22:51And Salavitz also says it's not uncommon for therapeutic communities to tip into corruption with those in charge acting with unquestioned authority. Institutions 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 Patroniano representatives say they do have strong oversight now after a sordid past where the community nearly collapsed. It was absolutely impossible to leave the 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.

23:45More on that when we come back.

23:51We're back with The Sunday Story and journalist Deborah Becker talking about the drug treatment community San Panchignano. So what is this story of how San Panchignano nearly fell apart? So San Panchignano started in 1978 when Italy had a massive heroin epidemic. This businessman, Vincenzo Muccioli, 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. Muccioli 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 Patrignano in the early 1990s.

24:39Here he is speaking through an interpreter.

24:46San Patrignano was oppressive. It was like a total institution. It was controlling every aspect of my life. But San Patrignano had a lot of support across Italy, a lot of wealthy benefactors, and it kept expanding. But Muccioli got into more trouble and even was charged with covering up a San Patroniano resident's murder. He died disgraced in 1995, but the program continued and gradually evolved 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.

25:34has 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? There isn't really a program that goes on for years or certainly that has the variety of vocational training. There was once a huge therapeutic community in the United States, the first of its kind for heroin addicts. It was called Synanon. It's been the subject of many books in movies, including one back in 1965. Synanon. The House Life magazine calls a tunnel back into the human race. The parallels between Synanon and San Patroniano are really interesting. Synanon was also founded by a charismatic leader.

26:21It 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 Synanon 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 Synanon with keeping him off drugs. I learned sales in Synanon.

27:06Later in life, I was able to have a very fulfilling career in sales. Synanon's directly responsible for recognizing my talent then. I met my wife-to-be in Synanon. We're still married today, but 55 years later. And unlike San Patroniano, Synanon never really resurrected itself after its fall. Okay, so RFK Jr. says San Patrignano 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 San Patroniano has been built over more than four decades, and it's a comprehensive, established community, well-connected to a lot of businesses and philanthropists.

27:57So 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 RFK Jr.'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.

28:47But in terms of creating a version of San 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 note 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, this is really interesting. Well, thanks for having me.