Recovery, relationships, and identity : a mixed methods process evaluation of the formation of a therapeutic community

Background: Scotland has the highest rate of drug-related deaths in Europe. Since 2008, the concept of 'recovery' has had an important role in Scottish drug policy. Central to this is the proposed development of community resources to help people overcome addictions. This project evaluated the early establishment of a new residential rehabilitation project called River Garden, opened in 2018, which used a training and social enterprise model to support people into abstinent recovery. The project was inspired by the San Patrignano recovery community and was an attempt to transfer the principles of that model to a new international setting. Methods: This longitudinal mixed-methods process evaluation was based on data from residents, staff, and trustees of River Garden, gathered through participant observation, surveys, social network ('egonet') interviews, and theory-testing interviews. Twenty-seven interviews were conducted with seventeen people (nine residents, four staff, and four trustees). Analysis involved the development of programme theories, informed by principles of realist evaluation. Findings: This intervention worked better for some individuals than others, despite exhaustive screening before entry. The work-based challenges of the social enterprise model were less effective for people requiring greater relational support, resulting in high levels of attrition and relapse. The key mechanisms were trust, respect, and motivation (as responses to instrumental and relational resources). The project was adapted in several ways to increase stability, such as restricted intake of new residents and reduced integration with external recovery communities. Differences of opinion about the necessity of adaptions led to significant attrition from the Board of Trustees. Conclusion: The extent to which necessary adaptions to the San Patrignano model for a successful transfer to a new context could be foreseen was limited. After three years River Garden is best considered as a social integration model that can support the next steps of recovery once an individual is sufficiently stable and motivated. It should not be considered as an intervention that could reduce drug-related deaths, because of its limited capacity to manage the highest levels of risk. Whether this limitation is specific to early community formation or fundamental to the model will be a key question as the programme expands.