Paolo Severi’s mind keeps replaying what happened three decades ago when he entered addiction treatment at San Patrignano in Italy.
The 47-year-old program is one of Europe’s best-known rehab centers. It requires long-term stays, and patients work at the facility, without pay, as they undergo care. Today, prominent U.S. health officials, like Robert Kennedy, Jr., tout San Patrignano as a “beautiful model” in the fight against addiction.
Kennedy, the nation’s health and human services secretary and a recovering heroin addict, said he wants to build a network of San Patrignano-style rehabs in rural areas to help people swept up in America’s ongoing opioid crisis.
“Our country, you know, has a kind of chronic inflammation — spiritually, mentally, emotionally,” Kennedy said in a town hall on NewsNation last year as he promoted the idea and suggested legalized marijuana could fund it. “We need to start healing ourselves — and we need to be compassionate.”
“Our country, you know, has a kind of chronic inflammation — spiritually, mentally, emotionally. …”Robert F. Kennedy Jr.
Severi, who is now 60, said his experiences in the 1990s at San Patrignano were hardly compassionate. He said he witnessed violence and attempts by the program’s leaders to isolate and marginalize residents who disagreed with the rules. He said residents were not allowed to leave and were locked in rooms if they tried to get away.
Severi and some other former residents, along with addiction and health policy experts, said they’re alarmed by Kennedy’s push to adopt similar centers. Some places like San Patrignano, they argued, haven’t embraced more modern practices for treating addiction. And a few of them have histories of abuse.
“San Patrignano was oppressive,” Severi said. “It was a total institution, controlling every aspect of my life.”
Severi left San Patrignano after he was sentenced to a month in prison for a crime he committed before entering drug treatment. He wrote in his diary that prison offered greater freedoms.
He now lives in northeastern Italy and said he’s “dedicated his life” to exposing the rehab center. His apartment is filled with books and reams of court documents about it.
But alongside San Patrignano’s fervent critics, some current residents say the controversies are old news — and their lives are being transformed for the better.
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How San Patrignano grew
San Patrignano was founded in 1978 by Vincenzo Muccioli, a charismatic businessman who felt the Italian government and public health system were failing to address the nation’s opioid crisis.
On his small farm in the Emilia-Romagna region of Italy, not far from the Adriatic Sea, Muccioli began taking in people addicted to drugs. His efforts were widely praised, even after he was accused of imprisoning residents, and by the 1980s, a few hundred people lived at San Patrignano.
By the time Severi arrived about a decade later, the population had jumped to almost 2,000 residents. Much of the growth was funded by donations, Muccioli’s ties to wealthy, powerful Italians and the unpaid labor of its residents.
“This is the only place in Italy, and maybe in Europe, where people are working for free, not even in jails.”Paolo Severi
Under what’s known as a “therapeutic community” model, San Patrignano offers years-long residential addiction treatment led by peers in recovery, rather than medical experts. Work and being part of a community member are key parts of the therapy, under the theory that productivity improves self-esteem, helps residents connect with others and provides training that may lead to jobs later on.
But Severi said the mental health issues that led to his addiction were never properly addressed. He also criticized the program’s use of unpaid labor.
“This is the only place in Italy, and maybe in Europe, where people are working for free, not even in jails,” Severi said.
Controversies deepened at San Patrignano during Severi’s time there. In a high-profile trial, Muccioli stood accused of participating in the coverup of the murder of a man who fled the rehab.
In 1989, Roberto Maranzano was found beaten to death near Naples, wrapped in a San Patrignano blanket. In 1993, evidence revealed at the trial suggested that Muccioli had been aware of the crime, but didn’t notify authorities and appeared to discuss killing another resident who threatened to divulge the circumstances of Maranzano’s death.
Muccioli was convicted, and he died in 1995, while the case was on appeal.
“SanPa: Sins of the Savior,” a 2020 Netflix documentary, examined the trial and other claims of abuse and corruption since San Patrignano’s founding. Severi said he agreed with much of what the film detailed.
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How San Patrignano operates today
Fabio Cantelli Anabaldi, 63, was a key San Patrignano leader and ran its press office during the Muccioli trial involving Maranzano’s death.
He first entered San Patrignano in 1983, seeking help for heroin addiction. He stayed for about six years and finished high school on the farm. He later lived in a house in Bologna that Muccioli had rented for residents who wanted to attend university.
Cantelli Anabaldi moved back to San Patrignano from 1991 to 1995, after the program had grown rapidly. He said Muccioli was overwhelmed and delegated authority to people who were not aligned with the mission.
“The community was too big,” Cantelli Anabaldi said, through an interpreter. “Muccioli gave power to people who weren’t really capable.”
But Cantelli Anabaldi still supports what he described as Muccioli’s core beliefs: that treatment must be personalized, led by peers who’ve experienced addiction, and designed to help residents find purpose and training to support themselves. He said without techniques that focus on why someone turned to drugs and the healthier habits they can adopt instead, people in treatment simply follow the rules by “wearing a mask” that will “melt like snow in the sun” once they leave.
“The only way out of the addiction is to find something like a passion, hobby or professional activity that fills your life just like the drug normally does,” Cantelli Anabaldi said. “If there is no such profound transformation, communities are simply parking lots, shelters, where things do not change.”
Many of those ideas still influence San Patrignano today.
Residents are assigned to work in one of several jobs across the bucolic 700-acre campus. Some prep dining hall meals for San Patrignano’s 850 residents, or help out in a bakery that sells hundreds of loaves of bread each day. Others care for animals or do landscaping. Some tend to plants in the vineyard. The rehab’s winery sells hundreds of thousands of bottles each year.
Several residents said they enjoy the sense of accomplishment they get from working and helping to sustain the community.
“ I’m not in love with folding sheets and towels. But if I had work that was more mentally challenging, I would have less opportunity to have meaningful conversations … .”Louretta Landon
Louretta Landon, 38, works in laundry services. The American and Scottish citizen said the job helps her connect with the other women who work there, and she enjoys the responsibility and routine. Landon also said San Patrignano is known for helping residents find jobs and become independent once they leave.
“ I’m not in love with folding sheets and towels,” Landon said. “But if I had work that was more mentally challenging, I would have less opportunity to have meaningful conversations with the women while I’m working, and I would have less time to be introspective.”
Several residents said they knew about the scandals outlined in the Netflix documentary, but many countered that those problems occurred decades ago, and they’ve seen no signs of similar issues. San Patrignano leaders said the program has evolved, adopted greater oversight, and over the years, served more than 26,000 people.
“The soul of this place is so strong it can surpass any difficulties,” said Monica Barzanti, who came to San Patrignano as a volunteer in the late 1970s and is now in charge of its international relations arm.
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Rage as a rehab ‘game’
As San Patrignano faced its woes, another addiction treatment program in the U.S. — one with a strikingly similar history of rapid expansion and controversy — more decisively fell from grace.
Synanon, a California-based rehab center, also was founded by a magnetic leader who grew his wealth and influence alongside his drug treatment business. Charles Dederich created Synanon in 1958 as a self-sustaining therapeutic farming community and touted it as the answer to drug addiction.
The rehab grew quickly and moved far beyond farming, amassing riches through businesses like gas stations, moving companies and specialized business advertising sales.
Eventually Dederich faced criminal charges, including corruption and trying to kill a prosecutor by putting a rattlesnake in his mailbox. During its years of acclaim, and after its fall, Synanon was the subject of books, articles and documentaries, including “The Synanon Fix,” by Rory Kennedy, Robert F. Kennedy Jr.’s sister.
The program was perhaps most famous for its use of the so-called “Synanon game.”
Neil Rice, 78, was a Synanon resident for two years, starting in 1968. Rice, who now lives on Martha’s Vineyard, described the game as a type of “group therapy,” where about a dozen residents would gather every day and express strong emotions, usually screaming and insulting each other.
“I would say that the ‘Synanon game’ was 80% the rage game,” Rice said, “where the deepest rage and anger and frustration and intolerance was expressed.”
There were two main rules, Rice said: No violence or threat of violence; and once the game ended, your feelings were left in the room. He enjoyed the chance to vent pent-up emotions, he said.
Rice entered Synanon not so much as a chance to stop using heroin, but as an opportunity to travel and get away from his family’s home in New York. When he first arrived, Rice tried to leave the program and was punished. Peer leaders shaved his head, he said, assigned him to wash dishes, and made him wear a sign that said, “I’m an a–hole.”
“So I was basically humiliated, humbled and that chip was getting knocked off my shoulder,” Rice said. “I just suffered through all that. And certainly they could not say anything bad to me that I hadn’t said to myself already.”
The Synanon game became popular, even among people who weren’t addicted but were attracted to the group’s utopian ideals. By the 1970s, it was reported that Synanon had 10,000 members, vast real estate holdings and tens of millions of dollars in revenues.
During this explosive growth, Dederich reportedly became violently paranoid and created Synanon’s own military force. He also forced the sterilization of some male residents and described the group as a “religion.”
Synanon collapsed almost as quickly as it grew. The organization’s tax-exempt status was revoked in the 1980s, and it was officially disbanded in 1991. Dederich died in 1997.
Unlike San Patrignano, Synanon couldn’t outlive its controversies. But small programs created by former Synanon members are still operating today, and it’s widely credited with creating the therapeutic community treatment model. Despite Synanon’s controversial methods and spectacular demise, Rice doubts he would have recovered from drugs without it.
“I learned sales in Synanon, so later in life I was able to have a very fulfilling career,” Rice said. “Synanon is directly responsible for recognizing my talents. I met my wife-to-be in Synanon, and we’re still married 55 years later.”
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Reforms wanted — but which ones?
Addiction experts point to the histories of these two prominent communities as a reason why they should not be the future of addiction treatment.
Maia Szalavitz, an American author who writes about addiction and has studied treatment, said the idea of the federal government expanding use of therapeutic communities is “ridiculous.” She said therapeutic communities are not well regulated and many programs rely on making residents vulnerable, which opens the door to abuse.
“These programs are based on the idea that we have to break people to fix them,” Szalavitz said. “It is quite possible to have an institution that is not harmful, but institutions with unchecked power almost always come to no good.”
She’s also concerned that some therapeutic communities, including San Patrignano, do not follow evidence-based practices. Many of them, she said, do not follow medical standards or use addiction medicines, such as methadone and buprenorphine, that stave off withdrawal symptoms and reduce overdose deaths. Szalavitz said people struggling with addiction need immediate access to care that is compassionate and doesn’t require them to leave home for years.
“These programs are based on the idea that we have to break people to fix them.”Maia Szalavitz
Hundreds of therapeutic communities operate in the U.S., according to the advocacy group Treatment Communities of America.
Seep Varma, the group’s board president, said the programs are now better regulated and better run. He pointed to research indicating therapeutic communities can be effective, especially for those with severe substance use disorders. Varma said attention should shift to the thousands of people the programs have helped, not just the few places that faced scandals.
“I wish folks would make movies and talk about things like all the successes going on at these centers every single day,” Varma said.
Determining the effectiveness of addiction treatment is fraught. Little uniformity exists among programs, especially therapeutic communities. Researchers often face challenges verifying who remains in recovery and convincing them to participate, in addition to confirming their claims about drug use.
San Patrignano leaders cite studies by Italian researchers that suggest more than 70% of residents remain drug-free years after leaving the program.
But critics, like Paolo Severi, question those numbers. He said there are no current, scientifically verified studies on whether most participants succeed long-term.
Severi also thinks there should be more oversight of the San Patrignano Cooperative, an eight-member board responsible for reviewing the center’s operations and finances. The Cooperative’s annual report shows it is regularly audited by the firm Price Waterhouse Coopers.
Over the last several years, programs like San Patrignano were set up in Sweden, Scotland and Canada. Some research suggests such efforts need to adapt to an area’s cultural norms to succeed. Even San Patrignano leaders acknowledge their program is a sophisticated operation that would take significant time and resources to recreate.
Lorenzo Leporoni, a current San Patrignano resident, has worked in the center’s vineyard for about a year. He said the time and structure has made all the difference for him.
“Before, I don’t want to live anymore,” he said. “I trust that one day all this can be useful to me.”
This article was originally published on WBUR.org.
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