Transfer and adaptation of a drug recovery model from San Patrignano, Italy to River Garden, Scotland: a qualitative study

Abstract

Innovation in addiction recovery in Scotland includes the transfer of effective models from other countries, such as San Patrignano, Italy and Basta, Sweden. Independence from Drugs and Alcohol Scotland (IFDAS) was founded to develop a new model for Scotland, based on social enterprise. Drawing on the San Patrignano programme theory, this prospective study investigates IFDAS stakeholders’ perspectives on which mechanisms should be transferred, and which require adaptation of the delivery mode, for the Scottish context. Data collection included interviews with ten stakeholders with expertise including: drugs policy, social enterprise, alcohol and drug partnership practice and therapeutic community methods. Drawing on realist principles, data were analysed using inductive and deductive approaches and synthesised using frameworks. San Patrignano mechanisms identified for transfer include: the need for motivation, recovery peer mentors, visionary leadership and social enterprise. Adaptations from Basta include: extending abstinence to alcohol and creating a smaller, semi-permeable, residential community. Further adaptations to mechanism delivery include a ‘step-wise’ model of housing and work. Scottish contextual factors shaping adaptations include: the culture of alcohol misuse, social care standards, housing regulations and socio-cultural acceptability. This study contributes to the evidence on international transfer and adaptation of complex interventions and documents stakeholders’ theory-informed decision making in the development of a new Scottish recovery model.

Keywords:

• Transferability
• programme theory
• complex intervention
• mechanism
• context
• AOD addiction
• residential recovery community
• adaptation
• social enterprise
• Scotland

Acknowledgements

We express our sincere thanks to the Founder of Independence from Drugs and Alcohol Scotland (IFDAS) and River Garden. We are grateful to all other stakeholders for participating in research interviews and sharing their knowledge and insight on the early development of the River Garden community. We thank Dr. Emily J. Tweed of the MRC/CSO Social and Public Health Sciences Unit, for providing valuable feedback on an earlier version of the manuscript. Finally we wish to thank the anonymous reviewers whose comments helped improve the article.

Author contributions

DW initiated the study and determined its aims. AD liaised with stakeholders and carried out data collection. Data analysis and synthesis was conducted by AD and DW. AD drafted the article with significant input from DW. Both authors have read and approve of the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research study was funded by the Complexity in Health Improvement Programme of the Medical Research Council (MRC) United Kingdom (UK) Grant number: MC_UU_12017/14 and CSO (SPHSU14).