San Patrignano and the Italian Model

San Patrignano (SanPa) is a TC for individuals with severe SUDs located in Cariano, Italy. The community is grounded in the cultural values of Italian life, including social traditions within the Christian faith and importance for the essentials of life (e.g. family, service, production, consumption of food). To date, the treatment community holds a capacity of 1,300 residents and 250 employees, thereby making it one of the largest TCs in the world.

Founded in 1978 by Vincenzo Muccioli, the community was created with the intention to altruistically support those who were suffering from addiction. The program has been free-of-cost for residents since its origin. Furthermore, no monthly fees are charged to residents and their families. Since January 2020, 100 beds out of the 1,300 available beds are free of charge. These are dedicated to patients referred directly by the National Health Service, which partially covers the costs of their stay normally totally covered by the community. The services are instead self-sustained through participation by the residents, as well as the patient-led commercial efforts within the community. The free-of-cost structure not only facilitates treatment availability for those who otherwise might not have access due to financial barriers, but it instills a greater trust for those who have had frequent experiences of being betrayed or taken advantage of in their past 33. Since its founding, over 26,000 individuals have successfully completed the program and the successes in recovery prove to be unmatched. An outcomes study at SanPa found that 72-78% of individuals sustained abstinent recovery 2 to 4 years following their discharge. This is considerable given the fact 38% of individuals surveyed previously held a SUD for a duration of at least 11 years 34.

Like many individuals with severe SUDs, those who arrive at SanPa often suffer from multiple SUDs, poor employment history, involvement in the criminal justice system, and psychiatric comorbidity. Such illnesses include those on anxiety-spectrum, depression, and personality disorders 17 35. In order to address multiple domains of poor functionality in SUDs, the therapeutic frame at San Patrignano takes an eclectic approach 36. It addresses "whole-person" transformation, including changes in identities, attitudes, lifestyle engagements, and ultimately discontinuation of their substance use. SanPa carries the belief that each individual brings a unique background filled with certain experiences, struggles, and strengths relevant to their recovery. Such factors become integral in understanding the timeframes within each individual’s progress. This sentiment also pushes back against the notion that individuals hold predetermined courses of treatment that must be adhered to without fail. SanPa residents are discouraged from fitting into an "ideal" recovery and are instead urged to explore what is meaningfully effective for them.

In order to facilitate long-standing lifestyle changes, the duration of residency at SanPa is considerably longer than typical rehabilitation programs. On average, length of stay (LOS) is three to four years, with one year dedicated to reintegration into society. This stands in contrast with typical residential rehabilitation programs that are 30- or 60-days in length 37. In fact, SanPa does not offer short-term treatments. Research has demonstrated that longer durations of treatment at SanPa are associated with an increased likelihood of stable recovery, particularly through lower rates of relapse. Rates are lowest in those who spend 60+ months (11%), followed by 48-59 months (16%), and lastly 36-47 months (28%) 38. In addition, participants in the TC system often have better prognoses compared with non-TC outcome studies, including better employment rates, fewer psychological symptoms, as well as improved family and social relations 39 40.

  • 33. Kast, K. A., Manella, G., & Avery, J. (2019). Community as Treatment: The Therapeutic Community Model in The Era of The Opioid Crisis. J Addict Behav Ther Rehabil 8: 2. of, 5, 2.
  • 34. Manfre, G., & Aldo, P. (2010). "Beyond the Community". Multidisciplinary study of retention in treatment and follow-up on former residents of San Patrignano.
  • 17. De Leon, G. (2015). "The Gold Standard" and related considerations for a maturing science of substance abuse treatment. Therapeutic Communities; a case in point. Substance Use & Misuse, 50(8-9), 1106-1109.
  • 35. De Leon, G., & Wexler, H. (2009). The therapeutic community for addictions: An evolving knowledge base. Journal of Drug Issues, 39(1), 167-177.
  • 36. Hinshelwood, R. D. (2010). Manual or matrix: How can we know our outcomes?. Therapeutic Communities, 31(4), 228-337.
  • 37. Condelli, W. S., & Hubbard, R. L. (1994). Relationship between time spent in treatment and client outcomes from therapeutic communities. Journal of Substance Abuse Treatment, 11(1), 25-33.
  • 38. Pieretti, G. (2016). Per un modello italiano delle comunità terapeutiche. Comunità terapeutica e comunità locale: dalla vulnerabilità alla condivisione. Milan: FrancoAngeli, 33-47.
  • 39. Sacks, S., & Sacks, J. Y. (2010). Research on the effectiveness of the modified therapeutic community for persons with co-occurring substance use and mental disorders. therapeutic communities, 31(2), 176.
  • 40. De Leon, G. (2010). Is the therapeutic community an evidence-based treatment? What the evidence says. Therapeutic communities, 31(2), 104.

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