John Douglas has seen it over and over in his years working with men and women who use street drugs in Port Alberni, a tough resource town on Vancouver Island. A guy starts using drugs and spends years in their grip, often ending up homeless or in jail. He finally decides he has had enough and decides to seek treatment. He does six or eight weeks at a program, going to meetings and staying off drugs. He comes out of treatment, falls in with his old friends and goes right back to using again.

Most treatment programs last only a few weeks or months. Even if clients finish – and many quit or get kicked out before they do – they often return to drug use when they go back to the communities and bad influences they left behind. Some suffer overdoses almost as soon as they get out, joining the thousands who have lost their lives in Canada’s continuing opioid crisis.

Mr. Douglas, a former mayor of Port Alberni, decided there had to be a better way. He found it half a world away in the green hills of northern Italy. This month, he is overseeing the opening of a so-called therapeutic community (TC) modelled on a famous program near Rimini. Residents there stay not just for weeks or months but for years, rebuilding their lives from the bottom up.

Interest in the TC model is rising in this country as the overdose epidemic grinds on and frustration rises over the quality of treatment. British Columbia already has a handful of such programs, though the one in Port Alberni will be the first in Western Canada for women alone. The Alberta government is investing heavily in the model. It announced this summer that it was spending $25-million to build five new therapeutic communities with a total of 400 new beds.

Mr. Douglas says it is unrealistic to rely on short-term programs to treat a long-term problem such as substance addiction. “We are using, I think, a rather outdated model. We need a community approach: being with other people, setting goals, learning to achieve them. Then a good exit strategy: a job, a place to live. You just can’t do that in six weeks.”

Mr. Douglas learned about overdoses when he worked as a paramedic, reviving drug users over and over on the streets of Vancouver and then Port Alberni. He learned more when he confronted the opioids crisis as a city councillor, then mayor.

Now, at 68, he works on special projects for the Port Alberni Shelter Society, which helps the city deal with its chronic drug and homelessness problem.

Port Alberni, he tells a visitor, does a lot of things right. It hands out clean needles and naloxone, a drug that reverses the effects of overdoses. It has a busy overdose prevention site where drug users can come to smoke or inject in secure and sanitary surroundings, a sobering centre where they can come to recover instead of being confined to a police cell, and a spotless new shelter complex where they can get a warm meal and a safe bed.

Where it is failing, he says, is at helping those who want to control or overcome their drug addiction in the first place. “We’ve done lots of work keeping people alive, but not much helping them recover.”

To bring home the point, he likes to tell the story of the ogre and the village. The villagers see a drowning person being swept down the river. They jump in to save her. Then they see another – and another and another. They jump in to save them, too. They are so busy rescuing people that they fail to find the source of the problem: an ogre upstream is tossing people into the river.

Though British Columbia declared the overdose epidemic a public-health emergency five years ago, the province is still recording an average of more than five deaths a day. Last year was the worst on record and this year is looking worse still.

Port Alberni has been especially hard hit. The decline of the forest industry on Vancouver Island has left pockets of poverty in the once-booming community, where kids could quit high school and get good-paying mill jobs the next day. As of 2019, 34 per cent of children and youth lived in low-income households, compared with 20 per cent for the province at large. Its troubles are hard to miss in the city’s downtown. In one notorious, rundown trailer park known on the streets as “the ghetto,” fights often break out and overdoses are common.

A recent consultants report on the therapeutic-community plan said that the Alberni Valley had 23 fatal overdoses in the past two years, “a rate twice the B.C. average and four times the national average.” As Mr. Douglas puts it, “That ogre on the river is a very busy monster.”

A big reader who likes to dig into something by Malcolm Gladwell or Hilary Mantel when he is not out on his boat fishing for salmon in the Alberni Inlet, he studied up on what other places were doing. After hearing about Portugal’s experiment with decriminalizing drugs, he travelled there twice and researched how it had slashed overdose rates. He even wrote a paper on the subject.

Then he heard about San Patrignano. Dog breeder and farmer Vincenzo Muccioli opened the program in 1978 at a time when Italy was gripped by a plague of heroin overdoses. Today about 1,000 people recovering from drug addiction and homelessness reside on the 650-acre property. Residents live there for three to four years at no cost to themselves. They work at one of the outfit’s business units, making wine, cheese, olive oil, furniture and scarfs, among many other things. The revenue helps pay for the program. Donations from private individuals and companies contribute, too.

With its formula of hard work, mentoring and communal living, San Patrignano has become a popular blueprint for successful addiction recovery. Proponents of the program say the connection and purpose that residents find through the SanPa family helps them shake off their dependence on drugs. Despite the unusual length of stay, only a quarter of entrants fail to complete the program, a spokesperson says. One study showed that 72 per cent of those who stayed to the end were still drug-free after five years.

Mr. Douglas and his friend Wes Hewitt, executive director of the shelter society, went to San Patrignano in 2019. They stayed for seven days, shadowing residents as they did their chores and went to workshops. Inspired, the pair made plans to set up a small therapeutic community for women on a 172-acre farm run by the shelter society. They hope to welcome its first residents soon to the verdant spread just outside Port Alberni.

The program will start small, with a maximum of six residents in a small house on the farm. The women will initially stay for a year or so, Mr. Hewitt says. Over time, he hopes it will take in more residents and ask them to stay longer.

They will work on the farm, learn skills and take part in counselling. The enterprises they run will contribute to their keep and care. A million-dollar grant from the provincial government will help cover the first three years of operating costs.

The community will draw on the experience not just of San Patrignano but of similar outfits in Norway, Utah and other parts of British Columbia, where residents do everything from build fences to run moving companies. Most are at least partly self-funding.

In Victoria, the three-year-old New Roads centre welcomes men aged 19 and up for stays of from nine to 24 months. They learn life and jobs skills, go to therapy, exercise and work on maintaining the centre. The 25 men who live there are mostly serious drug or alcohol users who have spent time on the streets or in jail. The emphasis is on self-help. The men make their own meals, do their own cleaning and spend most of their time in groups, adhering to an orderly daily schedule.

As their stay draws to an end, they work on a re-entry program that prepares them for work and life in the community. Residents pay no fees, so the program is paid for by government grants, donations and a small income from things the residents make, such as hanging planters. If the cost is high, so is the cost of dealing with people who are cycling through the justice, health and social-welfare systems because of chronic drug use.

Don Evans, who helped start New Roads and advised Mr. Douglas on Port Alberni’s effort, says it is too early to say for sure what the success rate for New Roads will be, but the rate for the alternative – short-term treatment – is generally poor. Residents often go in and out, risking overdose when they start using again after a spell of abstinence.

In therapeutic communities, residents have the time to develop skills, make connections and learn to trust each other. “They live together, they eat together, they work together and they rely on each other.” He says that such communities are the principal form of addiction treatment in Portugal, which decriminalized the personal possession of drugs in 2001.

One New Roads graduate, Mitchell Wallace, 34, says the program helped him become more self-reliant. A former figure skater who competed at the 2007 Canada Winter Games then went pro, he got fired from his skating job for drinking and smoking weed, went into a downward spiral and did stints homeless or behind bars. He spent 13 months at New Roads, working in the kitchen, being coached by a mentor and coaching newcomers himself.

Now he is living on his own in an apartment in Victoria and working as a first-year carpenter. He says the extended stay at New Roads was critical. “It took six to eight months to say, ‘You know what? I kind of like myself, and I want to continue this path.’

A report by the British Columbia Centre on Substance Use (BCCSU) says that several reviews of therapeutic communities around the world “have found that compared to other treatment approaches, the TC model results in similar or superior abstinence and substance use outcomes, with some studies reporting greater improvements in legal issues, employment status and psychological functioning.”

It says the model seems to work particularly well for drug users who have severe addictions, poor support networks and a record of failing at other forms of treatment. It also appears to work well for prisoners, who are less likely to reoffend and end up back in jail after spending time in a therapeutic community. Guthrie House program at the Nanaimo Correctional Centre on Vancouver Island “has reported a 33-per-cent reduction in reoffence rates among TC participants compared to similarly matched individuals not enrolled in the program.”

One expert with more than 30 years in addiction treatment, Steve Low of the Aurora Recovery Centre in Gimli, Man., says that the long-stay, community model makes a lot of sense. “Come in for 30 days, we’ll polish you up and then away you go – it just doesn’t work.”

No one claims therapeutic communities are a silver bullet. Some advocates say that programs that insist on abstinence are often ineffective, and that a better way to save lives would be simply to take the criminal sanction away and provide users with a safe supply of regulated, non-toxic drugs – or prescribe them substitute drugs such as methadone or suboxone. Others say a big part of the answer is to address the trauma and mental illness that often lead to addiction. That takes skilled therapy and psychiatric help.

Still others say therapeutic communities sometimes exploit their residents. A recent Netflix series, SanPa: Sins of the Savior, examines the controversies that cloaked the early years of the program, when it was accused of abusing and forcibly confining some residents and Vincenzo Muccioli was sentenced to jail for aiding and abetting in the death of a resident. In a statement in January, San Patrignano condemned the documentary’s “spectacularized, dramatized and simplistic approach.”

Mr. Douglas is quick to acknowledge that the therapeutic-community idea is not for everybody. Many will balk at giving up their freedom to stay in recovery for such a stretch. The challenge, he says, “is getting people to accept that they can’t just walk in and change in 30 days or 60 days.”

But he insists it is worth a try. In a paper he wrote on the issue, he called the state of drug treatment in British Columbia nothing short of “shameful.” Parents, he says, can spend tens of thousands of dollars on private addiction programs, only to see their sons or daughters fall back into a life of drug use.

The current mayor of Port Alberni agrees. Sharie Minions, 33, has a sister who has struggled for years with her addiction and been to drug treatment no less than eight times. Ms. Minions says recovery programs need to help clients not just quit drugs but to function afterward. “I think a lot of people enter treatment and then fail when they get out because they still don’t know how to get a job, keep a job, shop, budget – just the basic life skills,” she says.

Mr. Douglas says that, at the very least, the community on the farm will add “one more tool to the toolbox.” The current tools – harm reduction for users, short-term treatment – aren’t doing the whole job. Unless Port Alberni can find a better way, he says, the ogre will keep on tossing bodies in the river.