Complexity in health improvement evaluating the implementation of the San Patrignano recovery model in Scotland
Problem alcohol and other drug (AOD) use is a major global disease burden and worse in Scotland than the rest of the UK and Europe. A global recovery movement has created space for new recovery communities to be developed in Scotland. Recovery may sustained by developing a recovery-oriented social identity defined by membership of groups whose norms and values encourage recovery.
Participants (n=10) were sampled from a recovery community in the West of Scotland. They mapped their current social networks and, retrospectively, their networks during AOD use. These maps were prompts for a qualitative interview. Network structure and composition were analysed quantitatively and integrated with the analysis of interview transcripts.
Social relationships significantly improved between AOD use and the present. Negative relationships fell from 56% to 0% (p=<0.001) while positive relationships rose from 35% to 91% (p=<0.001). AOD using peers fell from 42% to 0% (p=<0.001) while peers in recovery rose from 3% to 43% (p=<0.001). Qualitative themes demonstrated peer influence on AOD use and recovery. Lack of significant change in some network structures indicate that a recovery network replaces the close, densely-knit relations of an AOD network. Peer support also replaced professional intervention. There was weak evidence that recovery was associated with larger networks (p=0.1). Self-imposed isolation was an issue for most participants in early-recovery, described as a way to avoid relapse. Participants had strong personal motivations to endure this transition period. The recovery community provided a new social network, a sense of belonging and identity, peer support, purposeful activity, and a framework of volunteering opportunities. The study demonstrates how social identity change relates to dynamic changes in relations with others and underpins behaviour change. The methodological approach is now being used to evaluate the IFDAS River Garden project, a residential recovery community, and some preliminary results are available.