What to Know
Peter Piraino, a former nightclub owner from Long Island, spent years addicted to opioids and other drugs
With treatment, he's been clean for over 9 years and is now running a treatment facility in Texas
He says he's saddened by the lack of good treatment on Long Island: "People are dying because of limited or poor treatment options"
Peter Piraino was born and raised on Long Island, graduating from Mattituck High School and SUNY Stony Brook. A former nightclub owner and drug addict, he's now been clean for over nine years and is running his own drug treatment facility in Texas. Below are his words, as told to NBC 4 New York's Michelle Kim.
When I was 16, my older brother was hit head-on by a drunk driver, and he got a settlement of money from it. He decided he was going to open a nightclub and asked me to go run the kitchen for him.
I had a great time and made a lot of money. My brother and I, from that point on, worked as partners opening nightclubs all along the East Coast together with a bunch of his partners. I was partial owner slash manager of a nightclub by the time I was 17. We opened up a bunch of clubs out on the East End, out on Long Island, and then we opened up some in Philadelphia and Boston.
While that was going on, there was obviously a theme of sex, drugs and rock and roll, and I started doing a lot of substances, and by the time I was 23, 24, I was fully addicted to drugs. I was kind of doing whatever you had in your pocket but the main things I was doing was pills, opioids and cocaine.
We had been in Philadelphia and Boston and came back to Long Island to open up a place called Hurricane O’Malley’s in Centereach, and that was kind of my last foray into the nightclub world. I was 23, 24, just miserable, I hated myself. I had money, girls — and no sense of happiness. Just hated myself.
I stopped doing the nightclub thing and decided I was going to be an X-ray technician because they make good money. I went and got a job at a local hospital in Riverhead because that was a good way to get my foot in the door, at the X-ray school that was in the hospital. I thought that getting out of the nightclub scene would stop me from doing drugs.
One night, I did a lot of cocaine and pills and had some severe chest pain and spent the night in the ICU of that hospital, where my mother happened to be an ICU nurse.
At that point, cat’s out of the bag. My family knew that I had a drug problem but my family’s kind of tough-love, Italian Catholic, “pull yourself up from your bootstraps and quit being an idiot” kind of stuff. I don’t think they understood how severe it was, and they didn’t really understand addiction. So in their mind if I got out of the nightclub scene and get myself together, I would stop doing drugs. And a lot of people who weren’t addicts would. I mean, a lot of people could stop. It just didn’t work for me.
I had a good friend from high school who had started seeing Dr. Kardaras as a patient. That friend was also going to AA meetings, so he gave me Dr. Kardaras’ number.
Dr. Kardaras was very up front. When you’re sitting in a session face to face with him, he’s a no-nonsense, no bullsh-t kind of guy. I would come to him with these delusions of what was owed to me and how I felt how stuff was unfair. And he would smash that in a second. He would kind of get right into it, and get in my face about it. And when I was going to 12-step meetings, I had sponsors who did the same thing. I would go to my sponsor and whine about how my family didn’t trust me. And they would look at me like I was insane and be like, “Peter, you were just sniffing cocaine in their basement and stealing their money, why would they trust you? You’re a drug addict.”
I’d gotten 11 months clean, and then I smoked a joint -- and then I was kind of off to the races. Dipped my toe back into drugs, and it went really bad. And Dr. Kardaras said, “You need to go to treatment.” So I went to LICR and my insurance cut me off after 7 days. I returned to see Dr. Kardaras, I went to meetings, and went to intensive outpatient treatment. From June 1, 2008 on, I have not touched drugs.
I was sitting in Dr. Kardaras’ office one day, and he said, “Hey, what are you going to do with your life?” And I was like, “Well, I’m thinking of becoming a nightclub consultant.” And he kind of snickered and said, “Well, that’s not going to work.”
He said, “Why don’t you go back to social work school? You can go back to school and become a social worker and help people.” And he explained to me that I could work in the addiction field and that I could still be an entrepreneur, and that kind of spoke to me because I didn’t really want to work for somebody else. I didn’t like it. I liked when me and my brother owned businesses — you know, we had the nightclubs and restaurants, we also opened a driveway paving business, we were just always doing something like that.
So I went back to school and got my bachelor’s in social work and then my master’s in social work. And started dipping my toes in local rehabs. Got a job in one local rehab as a cook because I had cooking experience and they really wouldn’t give me a job doing anything else.
Years went on, and there was a rehab out in the Hamptons that had opened called the Dunes, and they needed a family therapist. So Dr. Kardaras suggested I go drop my name in the hat, and I did. And I ended up developing and running their family program for about a year and a half. And they asked me to come on full time as a therapist, and I agreed. The day that I came on full time, the executive director and the clinical director quit, both in the same day.
So I walked into the owner’s office and I was like, “Hey. So, I’m all you’ve got. I want to be your clinical director.” I was a young kid and ambitious and cocky, but he was like, “Look, I’ll give you a shot for 30 days.” There was a state audit coming up, and he said, “If you can get us past our state audit, I’ll let you stay on.” I got them past the state audit in 30 days, and I also got them at the highest rank that a facility can get.
So he let me stay on. I stayed on as program director for three years, at which point, you know, New York is a really expensive place to live. And I was working at the Dunes, which is a high-end, high value treatment facility. I was working with the type of people from my nightclub days, but they weren’t my people. My people were blue-collar, middle-class people -- you know, kids who were drug addicts, who were broken, who had no place else to go. Those were my people.
It was hard for me to connect with people who were flying in on helicopters and buying brand-new Bentleys when they were leaving the place and were able to put their entire treatment stay, which was extremely expensive, on an American Express black card. My heart wasn’t in it.
I was young and running this facility, and the facility was doing really well underneath me, I kind of started to get a name for myself in the industry. And a couple of headhunters reached out to me and had me interview at different places all across the country. They asked me to go down and interview for a place called Origins, which was down on South Padre Island in Texas. And I looked on a map and I said, “There’s no way I’m going there.”
But I did. I went down there and I interviewed and I loved the place. I loved the staff and I loved the people who were running the place. So I took that job and we grew that company substantially. It’s now one of the largest treatment companies in the country. I started as their clinical director and ended as their executive director, and eventually just wanted to do something different, so now I’m running a facility in Smithville, which is just about 30 minutes outside of Austin.
The guys who come here are pretty broken. The name of the place is called Last Resort, and for a lot of these guys, it is. They’ve entered 20, 30, 40 treatment centers before they get here. I would say 80 percent of them are coming for some form of opioid addiction, whether it’s heroin or pills.
Our program is high structure, high accountability. It’s extremely rigid. We do that on purpose. Our treatment facility, the one that I run, is not perfect for everybody. It’s good for a specific, usually 18-to-36 year old man who has used up a lot of resources in the family and spent a lot of his life not only being involved in addiction, but oftentimes with addiction comes a feeling of being entitled, a lot of self-centeredness. So we’re trying to kind of dismantle that. A lot of them come in acting like entitled boys, and the product we produce is recovered men. That’s our product.
A lot of people in the treatment industry disagree with me. There are lots of people who look at it a different way. But for what we do here, our treatment philosophy is that we’re gonna provide really good clinical care and really good 12-step care and a really high-accountability program. And that’s why, somebody who’s going to treatment for the first time, this is probably not the right treatment facility for them. We’re probably too hard and too rigid for them. We might scare them away. We’re really built for those guys who cannot stay clean. Your real hardcore drug addict is who comes here.
Clients who come here and follow our aftercare recommendations have a near-80 percent success rate. Which for the treatment industry is amazing. Now, clients who come here and don’t follow our aftercare recommendations have almost a zero percent success rate.
One of our philosophies here is that we are blunt and honest with our clients and our families. And at the end of the day, if our client leaves and isn’t following our recommendation, we can sleep at night knowing that we’ve done everything we could to try and make that client follow our aftercare recommendation. We’ve talked to family, we’ve talked to lawyer, we’ve talked to the client. We’ve sent letters. We’ve done everything in our power.
Addicts need to be hypervigilant on how they’re being treated and making sure that their doctors know. I mean, my doctors, all my doctors know that I’m a recovered drug addict. So when they ask me what I’m allergic to, I tell them narcotics and they kind of look at me funny, and I tell them, “Look, you give me narcotics and I break out in handcuffs. Every time. I’m not taking them.”
I think it’s about letting the people around you know and making sure they’re aware so they can treat you — obviously, a doctor needs to treat you the right way but also cautiously.
When you see alumni come back, you get to talk to Johnny a year later at the alumni reunion and Johnny’s got a great job, or Johnny’s got a newborn, and Johnny’s back together with his wife. Johnny just finished school that he had failed out of. We had one alumni who just came back who became a mechanical engineer and this kid was like, dope-fiend degenerate, you wouldn’t let him into your house -- and you kind of look at him in awe, you know, like, wow. That is food for the soul, chicken soup for the soul in that kind of way. Just to get to see how far these guys have come. And really how far their families have come. That’s the important thing, and you know when there are children involved, oftentimes children get their parents back.
One of the reasons I like Texas treatment is because it’s so drastically different than New York treatment. And to be honest with you, I don’t think there’s any good treatment out on Long Island. There’s people trying to do a good job but I don’t think there’s any good state-of-the-art treatment and it’s sad.
The thing that calls me back to New York often is thinking about how many people are dying because there’s limited or poor treatment options. I’ve thought about bringing a treatment philosophy like this back to New York. And to be completely honest, every time I’ve approached it, I’ve hit walls of red tape – from town supervisors who don’t want it in their towns, even though they have people dying every day; from state licensing, the process they want to open a facility. So that’s really discouraging to me. The fact that bureaucracy and NIMBYism is killing local youth on a daily basis.
A lot of people in New York are getting sent down to Florida, which is unfortunate because Florida is the most corrupt treatment market in the country, and a lot of people from the tri-state area are dying in Florida. A lot of our young people from the tri-state area are dying because the treatment is so corrupt down there.
In Austin alone, there’s, I want to say, 18 treatment centers in the Austin area. So being in an area where not only is treatment recognized but embraced, it makes it so much easier to help people. So, would I go back to New York? I don’t really see that in my future. I love New York, I grew up out there, I grew up on the North Fork, I just can’t –- it’s really hard to sit back every day and watch the bureaucracy and the local officials, in my mind, murder people.
The other part of it is, New York has one of the highest state income tax rates and pays mental health care professionals the lowest. So a counselor in Texas makes more than a counselor in New York. Now think about that, the cost of living is half in Texas. And they’re paid more here than they’re paid in New York. Because the mental health profession just isn’t valued there. I mean, I was working two full-time jobs, my wife was working two full-time jobs, and we were barely making ends meet. I was running a treatment facility, working as a case worker on the weekends. Now down here, I’m running a treatment facility and make two and a half times what I was making up there.
What’s crazy to me is New York is fundamentally a liberal state and fundamentally talks about caring for the impoverished and caring for the weakest people and caring for the underserved. And when a businessperson attempts to open up a business there to serve those people, we’re consistently shut down. So if it was a nonprofit they might let it in, maybe, but the truth is, if you’re looking at the people who are providing the best treatment in the country, in the world, they’re not nonprofits. It’s for-profit people. And you know, the people who are providing the cheapest treatment, 99 percent of the time, they’re for-profit organizations.
So that is just so disheartening to me, to see that happen up there. I have friends there in New York who are dying all the time from overdoses, from drug overdoses, who I’ve kept in touch with. You know, it’s sad. It’s just so drastically different than what I feel that area deserves.
** This interview has been edited for length and clarity.