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The principles of the San Patrignano Community
• Founders were “normal people”. • They had no competences on medicine, psychology, and sociology. • They had no personal or relatives experience on drug addiction, nor some
knowledge about this problem. • They were driven only by humanistic ideals, and by the desire of helping
the suffering people. • In the late 70’s the heroin addiction epidemic was the true social
emergency. • Founders considered their social activity not as a work, nor as civil
commitment, but as an absolute mission.
what remained the same
• Drug addicts are not «patients»
• No political, religious, or social discriminations.
• Volunteering, self help, and peer to peer education
• Free of charge
• All the drugs are dangerous.
• Education and rehabilitation are the mainstay of treatment and recovery.
• Medical, legal, and global full support to addicts needs.
• Some epidemiological evidences on drug addiction
san patrignano June, 9, 2015
The principles of the San Patrignano Community
• Drug users were considered simply as human beings who need help,
house, family, comprehension, and finally an opportunity to change their life.
• They were never stigmatized or judged for their past.
• They were not considered “patients” or affected by a pathology.
• At that time also biological sciences considered addiction as a behavioral disease (generally a symptom of a personality disorder) and the only (and unsuccessful) medical treatment was the detoxification.
The principles of the San Patrignano Community
• There were no religious, political, or social discriminations among residents.
• In Italy (and South Europe), therapeutic Community were generally founded by Catholic priests. To believe in God was generally the main reason and strength to win against drugs and, in the same way, the aim of the therapeutic program.
• San Patrignano founders were not priests, even if influenced by catholic culture. Religions, or also politic or philosophical ideals, were never considered as a means of recovery, but something that could by choose after recovery from addiction.
• The strong ethical basis of the program are probably derived by catholic culture, but they can be easily recognized and accepted by people believing in others other Religions, and also by non believers.
The principles of the San Patrignano Community
• Volunteering, self help, and peer to peer education
• During the first years of the San Patrignano experience, under the strong living example of founders, a small group of “first generation” rehabilitated drug users, choose to remain in the Community, driven by the desire to give others the same help and experience received by them in the past.
• A large part of them died in 90’s during the AIDS epidemic
• Nevertheless most of staff components, mainly Educators, but also other professional team components like Physicians, Nurses, Lawyers, etc. are former addicts rehabilitated in this Community
The principles of the San Patrignano Community
• All drugs are considered dangerous for brain and personality
development, especially if the consumption started during adolescence. Moreover every drug predisposes to other drug experiences.
• The treatment is the same independently by the different drug used
The principles of the San Patrignano Community
• The residential treatment, and all services provided by San Patrignano are free of charge for the guests, their families, and for Public Health, or for National or Regional governments.
• This choice was the natural consequence of the spiritual approach of founders, and of refusal of considering them as “patients”
• Autonomy from families and Public Health “welfarism” is also a pillar of the community
• In our view, the self-sufficiency has tremendous educative value for our guests, because it demonstrates the possibility of living life free from welfare dependency, and from the idea of rights without corresponding duties (widespread among drug users).
• This model teaches them the value of their own efforts, awakening in them the need to be protagonists in their own rehabilitation, teaching them that personal dignity also means economic independence and the ability to satisfy, through their own work, life’s material needs
What has been changed
• Drug use and addiction.
• More attention to sustenibility.
• Admission criteria.
• More knowledge on biological and psychological co-factors of addiction.
• The governance of San Patrignano.
• More attention and investment on vocational training.
san patrignano June, 9, 2015
A tendency to poly-drug use/addiction
san patrignano June, 9, 2015
Sustenibility and financial support
• Financial support for the activities of the community comes from its own enterprises (45%) or from donations (55%)
• More than 50% of educators and professional are volunteers
Admission criteria • There are no formal admission criteria: only a genuine motivation to
change is required for entry in the therapeutic program
• Guests are generally referred by way of other voluntary San Patrignano associations operating throughout Italy, and others European countries (UK and Croatia), and USA but also through
Local Health Service Units, courts and prefectures
Admission criteria • Sometimes admission is a result of a simple telephone call or letter.
Assuming a place is available, entry is immediate, without the sort of waiting periods which very often put at risk the resolve of the addict to seek help.
• Entering addicts are advised that they are not simply making an attempt to stop using drugs, but that they are choosing a radical change in their life.
• Only a major psychiatric disease is a medical contraindication to the therapeutic program.
Basic informations on therapeutic program • Treatment is essentially educative and rehabilitative, and individualized on
specific subjects needs.
• Addiction is considered a multifactorial disease: the initial social and existential interpretation has been integrated and enriched with biological and genetic evidences.
• Treatment is not pharmacological nor based on maintenance substitutive opioids.
Education and Rehabilitation
• The rules which govern the life of the community are based on an essential respect for oneself, for others, and for the environment.
• The community is a microcosm where the intensive relationship between and among guests gradually wears away the artificial personality of the addict, destroying the suspicion and close mindedness which is part and parcel of addiction.
Education and Rehabilitation
• The residential nature of the community demands a long-term (3-4 years) and uninterrupted stay, to reduce the probability that, when encountering the expected frustrations of his new life, the former addict does not revert to past behaviours.
• Like in a double track, the capability in undertaking responsibilities and in feeling gratification grow toghether in the different daily activities.
A full loading of the person, with all his problems • Detoxification
• Educational Activities
• Health care
• Psichiatric and Psychological assistance
• Legal assistence
• School and Professional Training
• Family support
The Detoxification Phase • Since the beginning of the program every guest is followed by a tutor, also
former addict in in the advanced stage of the therapeutic program
• Immediately he (or she) stops using drugs (and cigarettes)
• Substitutive treatment (methadone, buprenorphine) is used only in selected cases (pregnancy, very hard withdrawal syndrom, very young subjects, or very sick patients, etc) and always with tapering scheme
• For the withdrawal syndrome symptomatic treatment (clonidine, anxiolytics, pain-killers, anti-emetics, etc.) are used.
Activities (in order of timing)
All of these activities are fundamental educative instruments because they can give gratification but, at the same time, demand engagement in progressive responsibilities.
• Work
• Other Community Activities (collective housework and services)
• Recreational activities (sport, music and chorus, theatre, culture, etc.)
• To be a tutor for a new entry addict
• Study, Professional Training Courses, etc.
• Assistance to patients of Community Hospital
• Guide for Community Visitors and Guests.
• Taking part to Prevention Programs for Students (We Free)
The meaning and importance of work • Educate in interaction and collaboration with others persons. • Trains in timing and engagements respect.
• Gives the means of personal gratification and realization.
• Gives the tools to pursue the professional skills,
indispensable for the social rehabilitation.
• Work is a tool of independence and autonomy from parents, family, etc.
• Contributes to the economic support for the Community (45%).
Sport • Is one of the first and more gratifying activities, associated with physical and
mental well-being, and increased self esteem
• High educational instrument
• It learns to play and interact with other people, and to control impulsivity
Football
Basket
Volley
Aerobic dance
Running
School and Professional Training Schools (inside or outside the Community):
• Primary school.
• Secondary Schools (High, School, Technical and Professional Institutes, Dental Technology, Social School, Agronomy, etc.)
• University (Psychology, Economy, Medicine, Nurse Training, etc.).
Scholarity - education
(data on15,432 individuals)
0
10
20
30
40
50
60
70
80
%
scuole sup. università elementari medie inf
School and Professional Trainings Professional Trainings (inside the Community):
• Socio-sanitary Operator, dental nurse.
• Computer graphics, handicraft.
• Carpenter, hydraulic, electrician, baker, gardener.
• Groom, pet therapy.
• Chef, maitre, etc.
Health Care A complete medical evaluation is completed in the first weeks:
• Medical and toxicological history
• Medical, dermatologic, and gynecologic visit (for STD, scabies, and other diffusive diseases)
• Blood screening for HIV, hepatitis B and C, Syphilis
• Chest x ray and intradermal-PPD (for tuberculosis)
• ECG and respiratory functional test (also for sport)
• Dental examination and treatment
• Blood and serum samples taken from each subject and stored for medical research
Prevalence of HIV and HCV infection in drug users
by year of admission
0
10
20
30
40
50
60
70
80
90
100
19801983
19861989
19921995
19982001
20042007
20102013
%HCV
HIV
Prevalence of HIV and HCV infection by
year of starting drug use
0
10
20
30
40
50
60
70
80
90
100
<19701973
19761979
19821985
19881991
19941997
20002003
2006
%HCV
HIV
Non parenteral cocaine use by year of starting
cocaine use
0
10
20
30
40
50
60
70
80
90
100
1970
1976
1982
1988
1994
2000
2006
%
Non parenteral heroin use by year of starting
heroin use
0
10
20
30
40
50
60
70
80
90
100
19711974
19771980
19831986
19891992
19951998
20012004
%
More knowledge on biological and psychological co-factors of addiction:
in some cases an educational program is not enought
Psychiatric and psychological
support
san patrignano June, 9, 2015
Psychodiagnostic evaluation
(Rorshach)
0,00%
20,00%
40,00%
60,00%
80,00%
100,00%
120,00%
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
no
yes
Psychiatric assistance • The San Patrignano therapeutic program is not designed and adequate
for subjects with major psychiatric disorders (schizophrenia, etc.)
• “Minor” psychiatric symptoms or syndromes are very frequent in drug users, sometimes pre-existing and predisposing to addiction, sometimes as a result of subsequent dramatic life events or to neurotoxicity of drugs.
• Adjustment symptoms are not considered pathological, but generally as evolutionary phase of individual change for the better.
• Only a minor part of subjects (20%) needs a psycho-pharmacological treatment during the therapeutic program.
• Episodic and transitory psychotic symptoms (generally observed in those subjects addicted to cocaine, other stimulants, cannabis, etc).
• Eating disorders: actual prevalence of about 40% of females and 3% of males
• Mood disorders, depression, bipolar disorders.
• Anxiety disorders (panic attacks, OCD, etc)
• Borderline and other personality disorders.
The most frequent psychiatric symptoms or syndromes are:
Psychiatric assistance
Psychiatric evaluation
0,00%
20,00%
40,00%
60,00%
80,00%
100,00%
120,00%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
no
yes
Pharmacological treatments data on 8666 subjects
0,00%
20,00%
40,00%
60,00%
80,00%
100,00%
120,00%
no
yes
Psychotherapy is not prescribed to treat addiction disorder per se, but to treat other individual problems arising during the therapeutic program.
About 30% of subjects, during the therapeutic program, needs an individual psychotherapy, for an average length of 18-24 months.
Psychological Assistance
Individual psychotherapy is generally prescribed for the following reasons:
• Sexual identity disorders.
• Major trauma in childhood (physical or sexual abuses).
• PTSD (Post Traumatic Stress Disorders).
• Borderline Personality Disorders.
Psychological Assistance
Individual psychotherapy
0,00%
20,00%
40,00%
60,00%
80,00%
100,00%
120,00%
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
Eating disorders in females
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
60,00%
70,00%
80,00%
90,00%
100,00%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
missing
no
yes
san patrignano June, 9, 2015
Legal assistance and young people treatment • A legal office with a criminal and a civil lawyer provides counseling
and assistance to those who need it: 35% of males and 25% of females have experienced jails before entry in the Community.
• Alternative sentencing is offered to persons coming from prisons, because of drug related offences
Prison experiences (data on 12.997 individuals)
0
10
20
30
40
50
60
70
80
90
100
%
1980 1986 1992 1998 2004 2010
maschi femmine
Family Support • The families or relatives of addicts, during the period of therapeutic
program, are supported and trained through regular meeting in local associations who collaborate with San Patrignano.
• Parents, wives, husbands, and children, are regularly welcomed in the community, also for periods and holidays.
• Inside the community, a special environment and treatment is reserved to very young addicts, and to mothers with children, because of peculiar needs of these populations.
A child sized world • San Patrignano welcomes families as well pregnant women
and young mothers with babies.
• The parent’s situation most often inevitably prevents them from taking proper care of their children.
• This is why a special structure was created expressly for this purpose; for children aged 0 to 14
A child sized world • An invaluable support for parents during their recovery program,
who can nevertheless build they parenting skills and strengthen the relationship with their child.
• A team of psychologists, neuro-psychiatrists, child educators, pet therapy practitioners, etc. provide a professional support network for children and their parents.
• Founded in 1979, since then over 25.000 drug users received hospitality in the Comunity and have been treated
• 80% males, 20% females.
• Average age at entry: 27 years (range 13 to 55 yrs old).
• Retention in treatment (a survey between 1999 and 2001): 55% after 2 ys., and 45 % after 3 years.
• About 70% of recovery (long term abstinence from drugs after rehabilitation and social autonomy) according to a survey concluded in 2005, in which only those who complete the full program were considered.
• 1300 drug addicts actually in program.
• About 30 admission/month.
Some numbers
Gender females = 18,9%; males = 81,1% (data on16.296 individuals)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
females males
Average age at entry females = 25.8 yrs; males= 27.8 yrs data on 15.296 individuals
10
15
20
25
30
35
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
età
Previous residential treatments (data on 12.113 individuals)
0
10
20
30
40
50
60
70
80
90
100
%
1980 1986 1992 1998 2004 2010
maschi femmine
