San Patrignano: I Went as a Sceptic

Some months ago Liz and I were graciously hosted at a gathering by a gentleman named Angelo Moratti. Whilst at dinner he asked what I did for a living and he reacted with pleasure when I told him. He asked whether I was familiar with San Patrignano. I was indeed familiar with it. It has been whispered about with an air of mystery since I first came into the field in the 90’s. It is a legendary therapeutic community. I have always wanted to go, but have never come across anyone connected with the place. I told him that indeed I did know of it but had never been there. He then told me it was started by his father and that his family were still the main benefactors. He asked whether we would like to visit to which I said yes immediately. Fast forward to last week and Liz and I find ourselves driving in a van with Angelo, his wife Nadia and their three wonderful children from Rimini airport to San Patrignano. Our driver is a resident. He was there when he was a little younger and now has returned there to give back to the community where he lived previously for 4 years. He speaks fluent English and answers all my questions and recounts his own experiences of being a resident. His love for the place is evident.

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I have spent much of my professional life working in addiction treatment. Over the years I have visited countless treatment centres around the world, worked with different therapeutic approaches and developed some fairly strong views about what helps people recover.

I have also long believed in the importance of peer support. Coaching, mentoring and the relationships people develop with others who have experienced similar difficulties have been central to much of my work.

So when I visited San Patrignano, the extraordinary recovery community in the hills near Rimini, it wasn't the concept of peer-led recovery that was unfamiliar to me.

It was the scale of what could happen when that principle became the foundation upon which an entire community was built.

I should say that I arrived with some scepticism.

I was familiar with the troubling stories surrounding San Patrignano's early history, and its model was very different from the predominantly clinical approaches I had spent much of my career working within.

I wasn't expecting to be quite so impressed.

An entire community

The first thing that struck me was the sheer scale of the place.

San Patrignano is difficult to describe as a treatment centre in the conventional sense. It is more like a small village, with hundreds of people living, working, eating and spending their days together.

And they really were together.

I remember being struck by the sight of hundreds of people talking to one another, with scarcely a mobile phone in sight.

In an age when even family meals are frequently interrupted by screens, there was something remarkable about seeing so many people simply engaged with one another.

It also made me reflect on how we think about peer support in addiction treatment.

I have always been passionate about coaching and mentoring, and have seen first-hand the difference that relationships with people who understand addiction can make. But in most treatment settings, peer support is one element of a wider clinical programme.

At San Patrignano, the relationship between peers is not an adjunct to treatment. It is the organising principle.

People learn from one another, take responsibility for one another, work alongside one another and become part of something larger than themselves.

That distinction matters.

The extraordinary Moratti family

To understand San Patrignano, one also needs to understand something of its history.

The community was founded in 1978 by Vincenzo Muccioli and a small group of volunteers. Gian Marco and Letizia Moratti became involved in its early development, and their commitment helped turn what began as a relatively small initiative into the institution it is today.

What struck me was not simply the scale of the family's financial support, but the depth of their personal involvement.

I met one of the Moratti brothers who lives at San Patrignano. He explained that, as children, they had spent their holidays there. Many of his closest friendships had been formed with residents, some of whom remain in the community. For him, it was quite simply where he felt most at home. He also works in film production, but finds he can mostly achieve that remotely from San Patrigiano, flying out to LA when he must.

I found that rather moving.

Here was somebody from one of Italy's most prominent families, for whom a community established to help people struggling with addiction was not primarily a charitable project or an institution to support from a distance.

It was home.

I think there is something important in that distinction.

We talk a great deal about creating therapeutic communities, but genuine communities cannot simply be commissioned, staffed and opened for business. They develop through shared experiences, relationships, history and a sense of belonging.

Those things take time.

Building what people needed

Another aspect of San Patrignano that particularly interested me was the way it had developed over the years.

Rather than starting with a fixed idea of what an addiction treatment programme should provide, the community appears to have grown by responding to the needs of the people living there.

During the AIDS epidemic, when people with HIV faced enormous stigma and barriers to healthcare, the community developed its own medical facilities.

When dental problems among residents became apparent, it developed extensive dental services and opportunities for training.

The same principle seems to have informed much of the community's development.

A need arose, and rather than accepting that it fell outside the remit of addiction treatment, they found a way to address it.

I found this particularly interesting because it challenges the way many of our services are organised.

We tend to develop treatment programmes with defined boundaries. We decide what we provide, employ the relevant professionals and establish referral pathways for everything else.

There are good reasons for doing this. Specialisation matters, and no organisation can or should attempt to do everything.

But the difficulty is that people's lives do not divide themselves into the same neat categories as our services.

Someone recovering from addiction may also need dental care, education, employment, meaningful relationships, help with their family, somewhere to live and a reason to get out of bed in the morning.

At San Patrignano, the answer seems to have been to develop a community capable of responding to an extraordinary range of those needs. You need milk, so develop a herd of cows, then when you have enough milk become experts at cheese making. Believe me, the cheese was good. Really really good.

The pursuit of excellence

Perhaps nothing demonstrated this philosophy more clearly than the workshops.

I was genuinely astonished by the quality of what was being produced.

The textile workshop was particularly memorable. The craftsmanship was exceptional, and the wallpapers, carpets and other textiles produced there have found their way into some of Europe's most prestigious interiors.

San Patrignano's design workshops have become something of a destination for leading designers and architects, drawn by the quality and individuality of the work.

There is something almost surreal about this.

A community established to help people recover from addiction has become a place where some of the most discerning people in the design world seek out exceptional craftsmanship.

But what stayed with me was not simply the quality of the products.

It was the pride people took in making them.

In treatment we talk endlessly about self-esteem, confidence, identity and purpose. We develop therapeutic exercises to help people recognise their strengths and believe in themselves.

All of that has value.

But there is something profoundly different about learning a difficult skill, making something beautiful and discovering that other people genuinely value what you have created.

The pride doesn't have to be manufactured through a therapeutic intervention. It arises naturally from achievement.

I was struck by the food for much the same reason. It was extraordinarily good.

Again, this might seem a minor detail, but I don't think it is.

There seemed to be an expectation that whatever the community did, it should be done well.

People were not simply being kept occupied. They were being encouraged to develop skills, take responsibility and produce work of which they could be genuinely proud. It is one of the reasons the programme is so long. To become a master at something takes time. Or to complete a degree takes time, or to train as a dentist. All of which you can learn there.

More than addiction treatment

I was also surprised by the breadth of the community's activities.

I was told that a very substantial proportion of residents had entered through the criminal justice system, with San Patrignano providing an alternative to imprisonment.

I also heard about work with vulnerable young women who had been rescued from trafficking situations, and about the community's involvement in rescuing and rehoming dogs.

Each of these activities seemed to reflect the same underlying idea: that people, and indeed the wider community, have needs that cannot always be separated into convenient institutional categories.

It also raised an interesting question for me.

When we talk about rehabilitation, what exactly are we trying to achieve?

Is it simply the absence of substance use? Is it psychological stability? Is it improved functioning?

Or is it helping people develop the relationships, responsibilities, abilities and sense of purpose that allow them to participate meaningfully in the world?

I suspect most people working in addiction treatment would say that all of these things matter.

But I am less convinced that our treatment systems are always organised in ways that reflect that belief.

I desribe PBH as a meaning and purpose company. You may need to have therapy, be coached or go to treatment along the way but the aim is to help people find meaning and purpose and this is definitely what I saw reflected here.

The people I met

Of course, an impressive institution is one thing. The experience of the people living there is another.

I only spoke to a relatively small number of residents, and I wouldn't pretend that those conversations amounted to a meaningful assessment of the programme's effectiveness.

But I was struck by how happy they seemed.

One gentleman I met was American, from Chicago. He was in his second year at San Patrignano and had become fluent in Italian.

It was a small detail, but one I found rather wonderful. Here was somebody who had come to Italy to recover from addiction and, in the process, had acquired an entirely new language.

I also spoke to people who had previously left the community and subsequently returned.

I had wondered about the length of the programme and the extent to which people were separated from their previous lives. But residents were free to leave, and I was told that those who wanted to return were welcome to apply again, although there was a waiting list.

There is an obvious temptation, particularly when you have worked in an industry for many years, to assess everything against the standards and conventions with which you are familiar.

But who am I to say how long somebody should remain in a community they have chosen to be part of?

If someone is developing friendships, learning skills, finding purpose and building a life they value, at what point does that stop being treatment and become simply living?

I don't know the answer to that question.

And perhaps it is the wrong question.

An institution with a place in national life

The day before my visit, I was told, the Italian Prime Minister had been at San Patrignano to open its new conference centre.

It was another reminder of how unusual this institution is.

Here was a recovery community that had developed not only workshops, healthcare services and residential facilities, but also the infrastructure to host major events and attract national political attention.

It was difficult not to be impressed by the ambition.

But what interested me more was that so much of this development seemed to have emerged organically from the community itself.

Rather than remaining a narrowly defined addiction treatment service, San Patrignano had continued to evolve, developing new capabilities, enterprises and facilities as opportunities and needs arose.

It made me wonder how many other treatment organisations have the freedom, imagination or commitment to evolve in this way.

What I took away

San Patrignano has a complicated history, and I would not want my admiration for what I saw to be mistaken for an endorsement of everything that has happened there.

Its earlier controversies deserve to be understood, and questions about outcomes, autonomy and clinical effectiveness remain legitimate.

But I also think we should be careful about approaching unfamiliar models with the assumption that our own way of doing things is necessarily better.

I have spent years arguing that addiction treatment should not be understood simply as an isolated clinical episode.

The work that happens in a treatment centre can be enormously important, but it is only one part of a person's life.

What happens afterwards matters at least as much.

San Patrignano made me reflect on this from a slightly different perspective.

Rather than asking how we can provide treatment and then help people return to their lives, it seems to ask how we can create an environment in which people begin rebuilding those lives while they are recovering.

The work, friendships, shared meals, responsibilities, skills and sense of belonging are not separate from the recovery process.

They are part of the recovery process.

I don't believe San Patrignano offers a model that can or should simply be replicated everywhere. Different people need different approaches, and I remain convinced of the importance of good clinical care, individual assessment and appropriate psychological treatment.

But I came away wondering whether we sometimes underestimate what can happen when we give people genuine responsibility, surround them with others who care about them, and provide opportunities to do things that have real value.

Perhaps we have become so focused on treating addiction that we sometimes forget to create the conditions in which people can build meaningful lives.

I went to San Patrignano as a sceptic.

I left with considerable admiration, a great many questions and a renewed appreciation of something I have believed for a long time.

Recovery is not simply about helping somebody stop doing something.

It is about helping them discover what they want to do with the rest of their life.

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