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Deborah Becker
Aisha.
Aisha Rascoe
I'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.
John Kelly
I've seen this beautiful model that they have in Italy called San Patricanano where they're it's good and that's what we need to build here.
Aisha Rascoe
San Patrignano 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.
Deborah Becker
Well, I've arrived here at San Patrignano 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. I'm going for a tour.
Aisha Rascoe
When we come back, a visit to a different style of drug treatment.
John Kelly
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Aisha Rascoe
We're back with the Sunday Story, talking about the quest for a drug treatment program that actually works. I'm joined by Debra Becker from WBUR in Boston. Hi, Deb.
Deborah Becker
Hello.
Aisha Rascoe
So, Deb, you've been covering the business of drug treatment in the US for years, but you traveled all the way to Italy for this story. So what makes San Patrignano different?
Deborah Becker
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.
Aisha Rascoe
And it's just out there in the Italian countryside?
Deborah Becker
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.
San Patrignano Residents
Where are you from? Detroit.
Deborah Becker
Detroit? Yeah. How long have you been here?
San Patrignano Residents
Almost seven months now.
Deborah Becker
Yeah. 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 Patrignano and urged him to apply.
San Patrignano Residents
I was having trouble staying away from drugs, staying sober. It just kept being a cycle that continued on, repeating itself.
Aisha Rascoe
We have treatment facilities in the U.S. so I mean, did he really need to go all the way to Italy?
Deborah Becker
Well, he told me he had been to various programs in the U.S. but he said he needed something like San Pas, as they call it, that would give him structure for a longer period of time. In the US 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.
Aisha Rascoe
And I'm assuming that's not enough, right?
Deborah Becker
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.
John Kelly
And we are talking about a long game 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, if you will, or a year in remission, their risk remains elevated for relapse for another four to five years.
Deborah Becker
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 US 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 cur and a manager who makes sure that people stay sober in the residence. But the main source of the treatment
Aisha Rascoe
is 12 step meetings and 12 step meetings. That's like Alcoholics Anonymous, right?
Deborah Becker
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 US. Some of the 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. 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. 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 Derrita, told me that it's the connections that are the key.
John Kelly
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.
Aisha Rascoe
Do we know how well AA works at keeping people sober?
Deborah Becker
Well, if 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.
Aisha Rascoe
That percentage, I would have thought it would have been higher. I mean, that doesn't seem like a lot, right?
Deborah Becker
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.
Aisha Rascoe
Well, but unlike AA, rehab programs are not free.
Deborah Becker
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 US 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 Casey o'. Brien. She experienced the so called Florida shuffle. Now, Florida's seen a proliferation of treatment programs over the years, and o' Brien told me she went from program to another before she stabilized when she returned home to New England.
Aisha Rascoe
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 seedy, it's dark. It's not something you would ever imagine when you hear the words treatment.
Deborah Becker
And RFK Jr. Has characterized a lot of the treatment programs in the US as predatory. He says his vision is to create in America the solution Italy has embraced.
John Kelly
It is a high priority to me, and it's something that for me, this is going to be my Peace Corps program. 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.
Aisha Rascoe
So what is so different about the style of treatment in Italy at San Patrignano?
Deborah Becker
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 Romana region of Italy to tour the the San Patrignano 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.
Aisha Rascoe
I say village.
Deborah Becker
A village. Okay. It's like a village.
Aisha Rascoe
When we come back, we return to Italy.
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John Kelly
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Aisha Rascoe
I'm Aisha Rascoe 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 Pantrignano.
Deborah Becker
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.
San Patrignano Residents
They do pizza focaccia up there. And over here we focus on the bread.
Deborah Becker
That's resident Luca Zulli. There's also cheese making, a leather workshop and textiles where fabric is woven on large wooden looms.
Aisha Rascoe
And basically we do blankets and scarves.
Deborah Becker
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 sp for Sam Patrignano's initials. And the word spaccio is Italian slang for drug dealing. So somebody has a sense of humor.
Aisha Rascoe
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's all this funded?
Deborah Becker
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 program's annual $26 million operating budget. And Aisha, I was told the vineyard alone sells 400,000 bottles of wine a year.
Aisha Rascoe
Oh, my goodness. I mean, that's a large enterprise, right?
Deborah Becker
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 to San Patrignano almost two years earlier?
San Patrignano Residents
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.
Deborah Becker
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.
San Patrignano Residents
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 sustain the community. I think what really save your lives here is to discover again the possibility that you have to interact with other people in a healthy way.
Aisha Rascoe
Okay, well, help me understand this model. Like, how do you become a resident of San Patrignano?
Deborah Becker
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.
San Patrignano Residents
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. 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 most important work.
Deborah Becker
He says it took him a couple of months to go through the application process. San Patrignano 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.
Aisha Rascoe
So if you're selected, what is the commitment?
Deborah Becker
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 socho, 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.
Aisha Rascoe
So what's the treatment element?
Deborah Becker
Well, the community really 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. A symptom of someone's deeper pain. Also at San Patrignano, addiction medications are not used. Medication for opioid use disorder is considered the first line of treatment in the U.S. but San Patrignano's medical director, Dr. Antonio Buschini, who's also a former resident, says he does not support using meds.
John Kelly
It's impossible that a drug treatment, pharmacological treatment could be like the years of experience, mental experience I had in this place is impossible because in my opinion, addiction is a brain disease, but also a soul disease.
Deborah Becker
And so to address this soul disease, as he calls it, San Patrignano 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 Berati.
San Patrignano Residents
To serve the people, to serve at the table, to stay, to distribute the water, the bread, everything.
Deborah Becker
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. Mmm.
Aisha Rascoe
I mean, so what was on the menu?
Deborah Becker
Well, pasta, no surprise, with a 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.
Aisha Rascoe
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?
Deborah Becker
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 Petrognano 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.
Aisha Rascoe
What happens when residents complete the program?
Deborah Becker
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 and Texas. And she told me she came to San Patrignano for treatment and for. For something more.
Aisha Rascoe
I 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 burned everything. I really 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.
Deborah Becker
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 Patrignano 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.
Aisha Rascoe
What do we know about whether this all works?
Deborah Becker
Again, tough to measure. Researchers at the University of Bologna found that if someone completes the program, which means staying until San Patrignano says you're ready to leave, more than 70% were drug free. Three years later.
Aisha Rascoe
Well, I mean, that sounds amazing, but I mean, I just imagine that. Cause this sounds perfect. It sounds almost too good to be true. There have to be some people who have some criticism of it, Right?
Deborah Becker
Right. I met one man who left after just two weeks. He said Sam Patrignano 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 Salovets, not a fan of San Patrignano. She has studied therapeutic communities, and she says most do not have the oversight they need to prevent the exploitation of vulnerable residents. Salovets has concerns, for example, about the mandatory work requirement without pay at sampa.
Aisha Rascoe
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.
Deborah Becker
And Salovets also says it's not uncommon for therapeutic communities to tip into corruption with those in charge acting with unquestioned authority.
Aisha Rascoe
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.
Deborah Becker
Now San Patrignano 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.
Aisha Rascoe
More on that when we come back.
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Aisha Rascoe
We're back with a Sunday story and journalist Debra Becker talking about the drug treatment community San Panchignano. So what is this story of how San Pantriglano nearly fell apart?
Deborah Becker
So San patrignano 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. Here he is speaking through an interpreter. San Patrignano era allora extremamente invasiva de la personalita.
San Patrignano Residents
San Patrignano was oppressive. It was like a total institution was controlling every aspect of my life.
Deborah Becker
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 Patrignano 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.
Aisha Rascoe
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?
Deborah Becker
There isn't really a program that goes on for years or certainly that has the variety of vocational training there was. 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 and movies, including one back in 1965,
John Kelly
Synanon, the House Life magazine calls a tunnel back into the human race.
Deborah Becker
The parallels between Synanon and San Patrignano are really interesting. Synanon 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 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.
John Kelly
I learned sales in Synanon. Later 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, 55 years later.
Deborah Becker
And unlike Sam Patrignano, Synanon never really resurrected itself after its fall.
Aisha Rascoe
Okay, so RFK Jr says San Panchignano is a model to bring to the U.S. but what kinds of barriers exist to making that happen?
Deborah Becker
Well, there's no question that the country needs new options for treating addiction. But San Patrignano 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 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. But in terms of creating a version of San Patrignano in this country, that's gonna 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.
Aisha Rascoe
Well, Deb, thank you so much for bringing us this story. I mean, it's really interesting.
Deborah Becker
Well, thanks for having me.
Aisha Rascoe
That was Deborah Becker, a senior correspondent at Boston Public Radio station wbur. You can find more of Deb's reporting on San patrignano@w WBUR.org Funding for this reporting was provided in part by the Pulitzer Center. This episode of the Sunday Story was produced by Andrew Mambo. It was edited by Ginny Schmidt. The engineer was Robert Rodriguez. We got fact checking help from Sacio Davis Vasquez. The rest of the Sanae story team includes Justine Yan and Lianna Simstrom. Our executive producer is Irene Noguchi. I'm Aisha Rascoe. 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.
Date: March 29, 2026
Host: Ayesha Rascoe
Guest: Deborah Becker (WBUR Senior Correspondent)
This episode of Up First’s “Sunday Story” takes a deep dive into alternative models for addiction treatment, focusing on Italy’s San Patrignano community, recently praised by U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. WBUR’s Deborah Becker travels to Italy to explore what makes this 46-year-old treatment center unique and asks if its approach could work in the U.S., where relapse from addiction is common and the rehab industry faces accusations of being costly and corrupt.
"We are talking about really a five year risk... after initial remission has been achieved."
— John Kelly, Recovery Research Institute ([05:27])
"I just can't believe how big it is. It's like a city."
— Deborah Becker ([11:17])
"It gives to me the feeling to be able to do also something that I don't like… What really saves your life here is to discover again the possibility that you have to interact with other people in a healthy way."
— Lorenzo Leperoni, resident ([14:58])
"Addiction is a brain disease, but also a soul disease." ([18:33])
"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." ([23:32])
"San Patrignano was oppressive. It was like a total institution controlling every aspect of my life." — Paolo Severi, former resident ([26:21])
RFK Jr.’s Vision:
"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… and come back, become contributing members to our society and stop the mayhem and the carnage."
— RFK Jr. ([10:24])
On U.S. Rehab Model:
"Rehab is sometimes called big rehab, the same as big Pharma."
— Deborah Becker ([08:59])
Daily Life at San Patrignano:
"To serve the people, to serve at the table, to stay, to distribute the water, the bread, everything."
— Valerio Berati, resident ([19:22])
On Post-Treatment Support:
"San Patrignano would help you financially to find a job, to get back on your feet… I really was here alone in Italy with nothing, and I needed help."
— Loretta Landon, resident ([21:23])
The San Patrignano model is a striking contrast to the U.S. addiction treatment industry—communal, work-based, holistic, long-term, and largely self-funding. Despite impressive outcomes for those who complete it, critics argue about labor, oversight, and suitability for vulnerable populations. RFK Jr. is championing the idea, but replicating the model stateside faces significant social, economic, and political barriers.
For those interested in a transformative, alternative approach to addiction recovery, this episode spotlights both the promise and the pitfalls of looking abroad for solutions.