From the top of the hill, Sara Carrena could see the sea. The community of San Patrignano is like a little town comprised of two large hills and standing on its high point, Carrena looked around to see green scenery and blue salty water below. In a larger context, this community is in the city of Rimini and if Italy really was a boot, Rimini and San Patrignano would sit on the calf muscle just before bend of the knee. When Carrena took in these views of the Adriatic Sea, she was mid-run with the girls on her team and she hadn’t felt so liberated in years. “I felt free,” she says in her smooth Italian accent. “In that moment, I could do what I wanted. It was a good feeling.”

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San Patrignano is many things but mainly it’s a rehabilitative centre for those struggling with addiction. That moment on the hill was a just a few years ago, in 2013, when Carrena was three years into her four-year program. She was on her first run with the centre’s running team. Like many, she arrived at the rehab community having reached a pivotal point in her history of substance abuse. Making it onto the running team was a reward and running itself gave Carrena the emotional tools to put the addiction in the past. The New York City Marathon has been the place where she and others from the San Patrignano team annually put their skills to the test.

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If the name San Patrignano rings a bell at the mention of New York, it might be because last year, one of the runners from the team got lost in New York after the marathon and wandered around the city before found by authorities. That runner has since returned home, is safe with family and runs on a team in his home city. But for many, that incident sparked a question: what exactly is the story with these runners who come from an Italian rehab centre to run in New York?

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San Patrignano was started by Vincenzo Muccioli as a response to the rampant drug use of the 1970’s. The rehab centre usually hosts about 1,300 men and women annually— the vast majority of whom are working their way through the standard four-year program. Each has a different story as to how they got to San Patrignano. The centre approaches rehabilitation through rebuilding lifestyle habits and working on the psychological aspect as opposed to targeting recovery through a medical-only standpoint. An example of how they do this is by accepting the men and women onto a sports team—running, basketball, football, volleyball or dance— towards the end of their stay. If their philosophy isn’t what brings people there, two points in particular likely have a draw: for one, it’s completely free and two, 72 per cent recover from their addiction completely.

Falling for heroin

“In that moment, I couldn’t face my emotions. It was so strong. I couldn’t be sad because my mother and my sister needed me to go on to live. I didn’t live my sadness at that moment.”

That 72 per cent includes Carrena. Growing up in Cuneo, Italy, her life didn’t look like one that would lead to a heroin addiction. “I didn’t have any family problems. I was a really normal girl. I studied, I did university, I studied economics,” she says. But when she was 16, her dad died after surgery. It was an unexpected death and so it hit Carrena, her sister and her mother quite hard. He was only 47. They were in shock. “In that moment, I couldn’t face my emotions,” says Carrena. “It was so strong. I couldn’t be sad because my mother and my sister needed me to go on to live. I didn’t live my sadness at that moment.”

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By the time Carrena went to university, she had developed an eating disorder through her grief. She was 18. That continued so that by the time she was nearing the end of her studies, she was sick and weak from malnutrition. She had to get treatment to recover. During that point, it was while she was on medication that she felt at ease. It was the first time she felt peaceful in a while. “I didn’t feel anything,” she says. “No sadness, no pain, everything was so good.”

Not long after, she moved to Spain. That’s when her drug habits really started. She lived and worked there and started using cannabis, cocaine and heroin. “I especially loved heroin,” she says. She became an addict. Soon, that habit starting draining her funds. To finance it, she stole money from the cash register in the shop where she worked. She got caught. After five years of living in Spain, she lost her job. When her boss found out she stole, he gave her two options: repay the money or deal with the police. Carrena knew she was in trouble. Not knowing what to do, she called her mom in Italy for help. Her mother’s response was firm: she would help but this was to be the last time and she would help only if her daughter would go to rehab. “So I had no choice really,” says Carrena. “During that time, I realized that there was no other solution.”

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When Carrena spotted the pool of salty blue water on that first run in rehab, it was a pretty sight. She couldn’t have run down to dip her feet in the water or splash in the waves though because it was out of bounds. She hadn’t been to the beach since she was accepted into San Patrignano. Instead, she looked from afar on that run with two female team mates.

When people come to San Patrignano, they know they have to first put in a lot of the work before being accepted onto one of the teams. “I had to wait a long time before I entered the team,” says Carrena. She remembers the moment when they told her that she was joining the running team. “I was so, so happy,” she says. On those first few runs, she had to stay on rehab property. Then one day, a staff member went running with her. He led her down to the shore. It had been a few years since she had been to the beach and since that last time, she had been living without heroin. “It was a big emotion really,” says Carrena.

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Welcome to San Patrignano

Once Carrena’s mother gave her that ultimatum for stealing the money, Carrena accepted that she was going San Patrignano. That was August of 2010. She first set foot inside San Patrignano in December of that year. It was overwhelming. Having just spent her spare time alone, she had to adjust to living with strangers also kicking an addiction. They would ask her questions about how she was doing. She never answered. “I didn’t want to tell them how I felt because I didn’t know if I trusted them,” she says.

“You don’t have to give up. You have to continue to fight for what you want and to reach your ambitions. Running gives you strength, I think, to face all the difficulties during the race and in your life.”

A runner who has three months from their first run to their first marathon might panic. If that runner has spent the past three years learning how to not be a heroin addict though, three months of training to run 42.2 kilometres pales by comparison. The athletes from San Patrignano run to keep from rekindling an old addiction and so it’s safe to say that their perspective on marathon training is different from your average recreational runner. It’s less about times and more about taking lessons from training and applying them day-to-day. And there’s the gratitude that comes with understanding the value of being able-bodied to run in the first place.

Not too long after first running with her team, Carrena ran in New York for the first time. Rather than worry about performance, she focused on the people who spent their Sunday morning encouraging strangers from the sidelines. She took in the setting of a peacefully quiet Jewish neighbourhood which bordered an area that gave off an opposite, booming and energetic vibe. Running in New York then, she says she was overcome with satisfaction on what she had accomplished. “Running teaches you tenacity and determination,” says Carrena. “If you want something, you can have that thing. You don’t have to give up. You have to continue to fight for what you want and to reach your ambitions. Running gives you strength, I think, to face all the difficulties during the race and in your life.”

Carrena completed her four years at San Patrignano in 2014. She runs with the team still but as someone who works at the centre. This year, she returned to New York City to enjoy the route through the five boroughs. She finished in 3:44.26.

Trekking in Cuneo

Sometimes Carrena goes home to visit her mother and her mother’s boyfriend in Cuneo. There, the three of them trek through the mountains as high up as they can go. Her mother is at peace now. “She always said to me that I came back to the first Sara— the Sara before. Because there was a period when I wasn’t me. She always said that I came back to her as I was before and she is really proud of me.”