San Patrignano confronts suffering honestly

American culture promotes drug usage while Monica Barzanti promotes a clear mind

If there is any one statement that is emblematic of the absurdity at the core of contemporary progressive drug addiction and homelessness policies it may be LA Mayor Karen Bass’ proposition that repairing the teeth of methamphetamine addicts constitutes a meaningful solution to the drug and homeless crisis. One wishes this was satire. Yet it’s not. It is an all-in conviction that putting lipstick on a pig can substitute character building. In her view, people ”can’t succeed without teeth” (that are rotted by doing meth). In other words, they need dental work, not moral rehabilitation, disciplined sobriety, or responsibility.

That is the logic of a civilization terrified of confronting suffering honestly.

At its core, the modern therapeutic worldview that is sold as “compassion” tends to regard human suffering less as a consequence of personal moral error and more as the result of addiction, brain disease, injury, deprivation, economic conditions, racism or discrimination. The sufferer is therefore understood primarily as a victim of circumstance rather than an agent responsible for his condition. When suffering is viewed as a pathology rather than a moral failure, the person’s identity becomes their situation—and that confusion, in and of itself, is crippling and defeating.

Bass subscribes to the now-dominant yet failed doctrines of “Housing First” and “Harm Reduction”— ideologies that place unconditional shelter and medication management above the necessary but often brutal process of genuine transformation. These approaches are embraced throughout California under Gavin Newsom and were supported in federal overdose policy during the Biden administration. Their defenders justify these policies through deceptive studies. For instance, they say those who are provided housing are more likely to be housed than those who aren’t given housing. Forgive me for being blunt, but “duh.” This is tautological. If you place someone in state-funded housing, of course they will no longer be categorized as homeless.

The more fundamental questions, however, remain unanswered: Are people becoming capable of sustaining meaningful, responsible lives, independently? Have they become productive, contributing, socially-integrated citizens?

Of course not. Use of methamphetamine has gone up over the past decade, as have overdose deaths. Since Newsom came into office as governor, homelessness has grown by about 20% from 2019 to 2024, despite $40 billion spent on supposedly creating housing. In fact, California has about 12% of the U.S. population but about 45% of the homeless population. It is why the cities of San Francisco and LA receive tens of thousands of complaints about human waste littering the streets. Moreover, the sad truth about this situation, that is never brought up, is that many of these so-called homeless people are drug addicts struggling to accept housing because complying with even the most simple basic societal rules—no overnight noise, cleanliness for shared spaces, behavioral expectations, routine maintenance—impedes their freedom.

The reality is that drug usage is a symptom of the underlying agony the majority are experiencing when they’ve lost their identity. The addict has lost his place in the world. He no longer knows who he is, what he should strive toward, or why his life matters. He’s turned to drug usage as a counterfeit form of transcendence; a pathological imitation of the divine, a cheap, easy, fleeting escape from the crushing weight of being human.

Pogressive compassion tells him his primary identity is victim. Conservative Christians say he is a child of God, worthy and capable of redemption. Matthew 19:26, Jesus says, “With man this is impossible, but with God all things are possible.”

If we want to fix the drug and homeless problem, we need to fix the identity problem. No amount of housing supply or Naloxone will fix a person struggling with this.

Drug free, long-term commitment, labor

That is precisely why institutions like San Patrignano (SanPa) are so compelling. Located in Rimini on Italy’s Adriatic coast, the rehabilitation community, or healing farm, has spent decades treating addiction not as a permanent medical identity but as an existential crisis of meaning, discipline, belonging, and selfhood. It is a model that is austere by modern standards: no drugs, no substitution therapies, no quick exits, and a minimum commitment of three years. Residents work. They build skills. They contribute. They participate in a structured moral order larger than themselves.

And that matters profoundly because dignity only emerges through a sense of agency, and responsibility to oneself and others, not learned helplessness and passivity.

The program works because its goals are rooted in an understanding of what legitimate recovery requires and looks like. Individuals must have authentic buy-in to their own recovery. Individuals must sacrifice comfort to make the right choices. They must aspire to achieve a sense of purpose. They must want to contribute to society. They must be drug-free.

Compare those aims to Housing First programs that measure success by asking, “How many people have good teeth?” or "How many people did we house?" rather than, "How many people rebuilt their lives?" It's analogous to declaring a school thriving because every student receives a diploma, regardless of whether anyone learned to read, think, or shoulder the burdens of adulthood. It is analogous to a permissive parent who thinks they’ve done a good job if their child is occupied, non-violent and stable vs resilient, strong and capable to withstand adversity.

San Patrignano promotes fortitude. It recognizes that addiction is not merely an external problem to be managed, nor simply a neurological malfunction to be medicated. While the prevailing “brain disease” model of addiction contains elements of truth, particularly in late-stage dependency, it is catastrophically incomplete when elevated into a total explanation of human behavior. As Monica Barzanti, head of international relations at San Patrignano, observed, many addicts arrive there after childhood trauma, social alienation, bullying, abandonment, or profound existential dislocation: a feeling of inferiority, a lack of self-worth and not measuring up.

Therein lies the central requirement in the methods of SanPa: a sustained period, free from chemical dependency of any kind to avoid mistaking the effects of chronic drug use for immutable psychiatric identity.

SanPa’s mandatory stay and labor of multiple years is also psychological architecture. Residents learn a skill—building, farming, cooking, repairing, creating or organizing. These activities are not merely to keep the addict busy. Nor is the addict just cheap or free labor. Work is required to rebuild oneself. The addict is helping himself reconstruct an identity. He is discovering that he can become someone reliable. Someone useful. Someone needed. Someone with a purpose. Someone appreciated.

The addict must pass through suffering

A person cannot be rescued from a chaotic life by being insulated from the necessity of confronting the chaos. Genuine recovery or reclaiming of identity therefore requires something modern therapeutic culture has become deeply uncomfortable acknowledging: suffering. Not pointless suffering. Not cruelty. But the suffering inherent in transformation itself.

The Bible tells us so. In Romans 5:3 - Suffering produces endurance, endurance produces character, character produces hope. Another favorite of mine: Hebrews 12:11 - “No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.”

C.S. Lewis put it this way in his book “The Problem of Pain.”

“No doubt Pain as God’s megaphone is a terrible instrument; it may lead to final and unrepented rebellion. But it gives the only opportunity the bad man can have for amendment. It removes the veil; it plants the flag of truth within the fortress of a rebel soul.” The rebel soul is the one who lives a life morally asleep. Pain wakes up the rebel soul by removing the illusion that life can be unexamined. Pain is a confrontation with reality. As Lewis said, God “shouts in our pains; it is a megaphone to rouse a deaf world.”

Modern therapeutic and coddling culture do not understand the rebel soul or the necessity of pain. It recoils at such ideas because goodness in a secular society is often equated with the minimization of suffering. It cringes at the notion that God is our creator because in their belief humans are soulless clumps of atoms and particles that can be manipulated through modern medicine to overcome toil, labor and pain. Suffering is a bug not a feature. Suffering is to be defeated.

This, of course, is a bunch of baloney. As Paul wrote in 1 Corinthians 1:18 - God will “destroy the wisdom of the wise; the intelligence of the intelligent I will frustrate.” Shielding people from suffering - the very ingredient God says we need for transformation - is not mercy nor is it scientific progress, it is infantilization.

Critics of SanPa

Robert F. Kennedy Jr. brought renewed attention to San Patrignano during his 2024 presidential campaign, presenting it as a possible model for the United States.

Yet despite the ongoing disaster that is America’s addiction-response systems, there has been remarkably little movement toward establishing similar recovery communities across rural America. The political resistance has been immediate and unrelenting. Every pillar of SanPa’s philosophy - long-term commitment, sobriety and work - has been lambasted by large segments of the American scientific and therapeutic establishment. Much of the critique centers on ethical and historical concerns.

The program’s three-year requisite stay and labor has been vilified for controversial tactics in its past. Netflix even produced a documentary series, SanPa: Sins of the Savior, highlighting coercive practices such as restraining residents to prevent them from leaving. These critics also invoke historical precedent. In the early 20th century, many institutions offered to educate and care for the socially marginalized, the “feeble-minded”- individuals mentally unwell or with learning disabilities. In the absence of effective treatments, such institutions became custodial rather than therapeutic. By the mid-twentieth century, investigative reporting and documentaries revealed conditions in many state hospitals that were, in numerous cases, degrading and dehumanizing. Think One Flew Over the Cuckoo’s Nest, which dramatized the oppressive, exploitative, and undignified environment of institutional psychiatric treatment.

Then during the civil rights era of the 1960s, formal concern extended toward these socially marginalized groups and was later standardized in large-scale anti-poverty initiatives, including federally funded job training and welfare programs aimed at increasing economic participation among the disadvantaged.

Against this backdrop, contemporary therapeutic communities such as SanPa have become points of contention. Although the program offers extensive internal work opportunities, critics argue that such participation does not constitute “meaningful employment” because individuals don’t receive paychecks.

Finally, the program’s mandatory sobriety commitment on the part of residents is also seen as unscientific. A recent NPR article quoted Yale Professor Dr. Robert Heimer who opposed SanPa’s regimen of medication-free treatments by saying, “This is very hard to answer without getting angry.” His view is part of the pharmaceutical culture that exploded circa 80’s-90s, where antidepressants like Prozac became not merely medications but cultural symbols of scientific achievement—promising relief and symptom management.

Full circle

As should now be evident, both our culture and our understanding of humanity have undergone a profound change. Yet one critical factor has stayed the same.

Historically, societies often treated maladaptive behavior as effectively fixed—whether attributed to heredity, fate, or moral defect. The individual was, in practice, regarded as incapable of meaningful transformation.

Contemporary progressive frameworks reject this explicit determinism. But inadvertently reproduce another version of it. By minimizing demands for responsibility, structure, and sustained effort, those who hold this view assume that expectations themselves are either unrealistic or unnecessarily harsh. They abandon the idea that individuals can shoulder responsibility, overcome their suffering, and rebuild themselves. They have replaced faith in human potential with the management of permanent dysfunction. How, precisely, is this an advance?

And why should society bear the escalating costs of behaviors that are plainly harmful—to the individual and to everyone around him—while being prohibited from making moral judgments about those behaviors? Why is it considered merciful to tolerate conduct that leaves communities degraded, public spaces unusable, and lives increasingly fragmented? This is not compassion. It is abdication and laziness masquerading as virtue.

Real compassion is far more demanding. It requires the courage to ask difficult questions. It requires us to decide whether we still believe that human beings possess the capacity for profound and even miraculous transformation.

Whatever its imperfections — and no institution dealing with human brokenness will ever be without them — San Patrignano has produced outcomes far better than the solutions that dominate the United States today.

Withdrawal and sobriety sans medication can be harrowing experiences, but they are steps required for the excruciating death of a shattered identity before another can be pieced together. The despair, emptiness, and disorientation that accompany recovery are not unfortunate side effects to be medicated away at all costs. This labor is not to be bypassed. Neither is the labor toward building skills and contributing to society.

This work may not be dignified, or safe and certainly not pleasant. It may even feel like suffering. But this suffering, this work, this toil, is part of the psychological and spiritual reckoning required for rebirth.

Suffering can accomplish what comfort cannot. For that reason, recovery should not be understood as the elimination of suffering. Or freedom with little to no constraints, expectations or accountability. Recovery is learning how to bear suffering voluntarily in pursuit of something better.

A person who can remain sober for one day gains evidence that sobriety is possible. A person who can endure one anxious hour without surrendering to impulse discovers that he is stronger than he believed. A single victory, however small, becomes the foundation for another. Confidence emerges. Competence develops. Hope returns. That is recovery.

That is the joy and hope we must maintain, not despite suffering, but through it.

Stay tuned for my upcoming interview with Monica Barzanti.

(Image source: Cornell Medicine)