Reporter's notebook: Our 3-part series on San Patrignano's drug rehab model

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About a decade ago, I read about a group of runners from a drug treatment center in Italy who ran the New York City Marathon. I had been covering addiction for a few years at that point, and I couldn't imagine a U.S. rehab taking people across the Atlantic Ocean, really for any reason, but certainly not for a road race.

It was the beginning of a years-long fascination with the program, called San Patrignano.

I tried to convince my editors to send me to there on assignment, and this year I was finally able to go, thanks to a grant from the Pulitzer Center.

What happens at San Patrignano is particularly relevant now. U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has repeatedly said he would like to replicate it in this country and create what he calls “healing farms” to address addiction.

While many addiction experts said they'd welcome increased federal investment in treatment, they’re nervous about this approach. Part of the reason is that San Patrignano supports its operations through the unpaid labor of its residents. They work long hours in jobs like baking, landscaping and textile workshops. They receive little to no formal therapy and, for the the most part, take no addiction medications.

Working and living in the community is considered the therapy, with an emphasis on behavior modification.

One of the biggest concerns I've heard is that a presidential administration that seems to favor punitive measures in response to drug use could create rehabs ripe for abuse.

So, here's what I saw when I visited the campus.

Like most of Italy, San Patrignano is a beautiful place. The 700-acre site sits among rolling hills in Coriano, a short drive from the Adriatic Sea. The meticulously landscaped grounds feel like a village, with dozens of buildings. During my visit in September, there were more than 850 people receiving treatment there.

Some of the buildings house businesses, called “enterprises,” where participants work and produce goods that are sold to fund the treatment. The enterprises include a nationally renowned pizzeria dubbed Sp.acchio — the rehab's initials followed by the Italian slang for drug dealer. There's also an award-winning cheesemaking operation, leather goods, decor including hand-painted wallpaper and a winery that sells 400,000 bottles a year.

Yes, you read that right. There's wine production at the rehab. San Patrignano leaders said the wine is not for the residents to drink, except for one glass on a single Sunday each month to mark birthdays.

It's all part of a treatment model known as the “therapeutic community,” which typically involves long-term residential stays, is primarily peer-led and focuses on being part of a community. The model has been around for decades, and there are estimated to be hundreds of therapeutic communities in the U.S. — but none are as large or as varied as San Patrignano.

(You can read the first story of our three-part series on the model here.)

Some addiction experts I spoke to say it may be possible to create more programs like San Patrignano in the U.S., with a few modifications and guardrails in place. For one, it's long been clear that the typical 28-day stay in rehab is not nearly long enough, and that the "sober homes" where many people stay after rehab too often fall short. But not everyone can — or needs to — stay in rehab for two or more years.

There would also need to be strong regulations to expand these communities in the U.S. and some level of involvement from professional medical staff. There are too many stories of abuses and too many competing philosophies about addiction treatment to simply build more of them without oversight.

San Patrignano's own history speaks to this lesson. One man I spoke to who was there in the 1990s said it was a violent, controlling place. San Patrignano's scandalous past is the focus of the second story in our series, coming this Wednesday.

But today, its leaders say policies are in place to prevent abuses. And there are local efforts to replicate the model. In part three of the series Thursday, we'll take you to a Massachusetts farm for men with mental health and addiction issues that opened a few years ago, with the belief that community-type programming is the way forward.

I spent just a few days at San Patrignano, and its leaders arranged my tour and my interviews with English speakers. So there were things I didn't see, and people I didn't talk to. But what I did see appeared to be authentic camaraderie among residents and staff and — most importantly — hope.

I watched parents break down while visiting their adult children for the first time in months — and seeing them drug-free. One resident told me how eager he was to see his family after years of being "out of it" whenever he spent time with them.

While the debate over addiction treatment continues (as it has for decades), I would say there's something here worth considering, and that's the core belief that people need support, and time, and they need to feel positive about the future if they're going to take steps toward change.