At San Patrignano, individuals are completely immersed in an environment that supports their recovery. The residents are not permitted to have contact with the outside world for their first year, with the exception of letter writing. Following completion of their first year, in-person contact is reintroduced with family members and usually increases in frequency to three to four visits per year for their remaining time at SanPa. After three years, the residents are permitted to return home for 7-10 days. If residents feel that they are unable to comply with these rules, they are permitted to leave at any time. If they ask to be readmitted at a later time, a new assessment will be made. San Pa believes that an increased determination and greater awareness of their individual needs may lead them to obtain a new opportunity to be readmitted to the program.
This is guided by statistics that demonstrate those who leave SanPa without community consent are at significantly higher risk to relapse than those who leave with consent (37% vs 17.6%, respectfully) 34. Long-term commitment and strict immersion are believed to transform recovery attitudes into those of patience and introspection required for long-term healing.
San Patrignano is also drug-free facility. However, if a resident cannot detox on their own, they are supported with medication-assisted withdrawal and maintenance medications (MATs). Primary care medical services are also housed directly on its campus and are used for assessment, monitoring, or intervention on patient’s co-occurring medical conditions. Paired with these medical interventions, psychotherapeutic elements are carried out by professionals on site, including cognitive-behavioral and dialectical-behavioral therapies, motivational interviewing, and relapse prevention training.
Immersion within the community also circumvents environmental triggers, which are believed to be one of the greatest threats to recovery. These are the associations with past drug use (e.g. family, friends, locations) that ultimately drive cravings, sustain motivations for drug-related behavior, and often lead to relapse or escalated use. In a recent outcomes study at SanPa, higher relapse rates were found in those who completed SanPa and returned to their previous home and/or returned to live with their families 41. Complete removal of the individual from drug-associated triggers (including prior activities, relationships or living arrangements) is one of the many reasons why TCs are successful.
- 34. Manfre, G., & Aldo, P. (2010). "Beyond the Community". Multidisciplinary study of retention in treatment and follow-up on former residents of San Patrignano.
- 41. Manella, G., Pieretti, G., Landi, A., & Genetti, B. (2019). San Patrignano: Lessons from the Italian Experience. In The Opioid Epidemic and the Therapeutic Community Model (pp. 133-148). Springer, Cham.