Up First (NPR) – RFK Jr lauds Italy's addiction treatment. Can it work here?
Date: March 29, 2026
Host: Ayesha Rascoe
Guest: Deborah Becker (WBUR Senior Correspondent)
Episode Overview
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.
Key Discussion Points & Insights
1. Addiction Treatment Crisis in the U.S.
- Statistics: ~50 million Americans struggle with addiction; most never get treatment, and about half relapse within a year.
- U.S. Model:
- Short-term, insurance-driven (typically 28 days)
- Relies heavily on 12-step programs like Alcoholics Anonymous (AA)
- High relapse rates; limited access and affordability for longer-term care
Notable Quote
"We are talking about really a five year risk... after initial remission has been achieved."
— John Kelly, Recovery Research Institute ([05:27])
2. Inside San Patrignano (Italy’s Model)
- Description: A sprawling, self-sustaining “village” on 700 acres, resembling a campus with workshops, farmland, and restaurants ([01:02], [12:34]).
- Scale: 850 residents; supports itself financially through resident-run enterprises.
- Businesses: Vineyard, bakery, cheese-making, textiles, animal shelter, restaurants ([13:00]).
- Vineyard sells ~400,000 bottles/year ([14:13]).
Notable Quote
"I just can't believe how big it is. It's like a city."
— Deborah Becker ([11:17])
- Resident Experience:
- Long-term commitment (average stay: 3 years)
- Work is central (residents are not paid; profits support the program)
- Structured schedule; communal living; peer-based “guardian angel” system ([17:04])
- Treatment is the community itself (no regular therapy or AA, limited medication)
Resident Voice
"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])
3. Comparison to U.S. Approaches
- 12-Step Dominance:
- AA/12-step is central and free, but limited data on effectiveness (~30% sobriety at 3 years, [07:51]).
- U.S. treatment industry is expensive, fragmented, and sometimes corrupt (“big rehab,” “Florida shuffle”).
- Medications:
- San Patrignano eschews addiction medications, unlike the U.S. standard of care ([18:33]).
- Dr. Antonio Buschini (medical director, former resident):
"Addiction is a brain disease, but also a soul disease." ([18:33])
4. Outcomes and Criticisms
- Effectiveness:
- University of Bologna study: >70% of those completing San Patrignano are drug-free 3 years later ([22:22]).
- Critiques:
- Concerns about unpaid labor, oversight, and potential for exploitation ([22:54]).
- Maya Salovitz, addiction researcher:
"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])
- Institutional power can lead to abuses; San Patrignano has a checkered past (forced stays, abuse in early years, [25:42]).
"San Patrignano was oppressive. It was like a total institution controlling every aspect of my life." — Paolo Severi, former resident ([26:21])
5. Historical Parallels: Synanon (U.S.)
- Similarities: self-sustaining, charismatic leader, became a cult and ended with scandal ([27:41]).
- Former resident Neil Rice credits Synanon for changing his life, but practices were abusive ([28:39]).
6. Could the San Patrignano Model Work in the U.S.?
- Barriers:
- San Patrignano took 40+ years to evolve, relies on philanthropy and business ties ([29:16])
- U.S. “therapeutic communities” exist, but are small, specialized, and sometimes expensive
- RFK Jr.’s vision for “healing camps” not yet realized ([10:24], [29:16])
- Voluntariness versus compulsion: President Trump has voiced support for forced treatment, which failed in Italy ([30:43])
Notable Quotes & Memorable Moments
-
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])
Important Timestamps
- 00:00: Introduction to the scale of addiction in the U.S.
- 01:02: Arrival and description of San Patrignano
- 02:22: U.S. addiction treatment limitations broken down
- 05:27: John Kelly on long-term risk of relapse
- 10:24: RFK Jr.'s advocacy for the Italian model
- 12:34: Description of San Patrignano campus and enterprises
- 17:04: Daily life, application process, and resident assignment
- 18:33: San Patrignano’s philosophy on “soul disease”
- 22:22: Study on San Patrignano’s success rates
- 25:42: History of forced stays and abuse at San Patrignano
- 27:41: Synanon and the U.S. history of therapeutic communities
- 29:16: Barriers to replicating San Patrignano in the U.S.
Conclusion
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.