Inside the black box
: an exploration of change mechanisms in drug and alcohol rehabilitation projects

  • Tim Leighton

Student thesis: Doctoral ThesisPhD


This research addresses the question ‘How does transformative change occur in rehabilitation programmes, and how is it facilitated or constrained by contextual factors?’ The study, carried out in three community-based intensive rehabilitation projects for alcohol and drug dependent people, is designed to specify and explain change mechanisms, understood as the processes through which programme resources influence the intentional actions of participants. A critical realist theoretical frame is used, drawing on the work of Margaret Archer and John Greenwood.The study consisted of two phases: in Phase 1, fourteen client interviews and eight counsellor interviews were carried out in two treatment programmes, and these were analysed abductively to produce a set of tentative contexts, mechanisms and outcomes. Phase 2 consisted of ten theory-driven interviews (Pawson 1996) with clients in a third programme, designed to elaborate the emerging theory. An explanatory model was produced, in contexts-mechanisms-outcomes form. This showed that the institutional context of active warmth and acceptance, combined with a clear, predictable and transparent structure, allowed participants to build trust, bond with the peer group and become ready to accept and process respectful challenges to their perspective or their interpersonal behaviour. This facilitated a change in the clients’ internal conversation (Archer 2000), permitting new emotional responses and the formation of new attachments, values and commitments. The programme was seen as a place which facilitated the development of a revised personal and social identity.The study contributes to the understanding of these programmes by clarifying how participants change or fail to change. It responds to recent calls for more useful forms of evidence, to complement the sparse and equivocal experimental evidence base. The study findings have the potential to improve counsellor training and programme development.
Date of Award27 Jun 2017
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorJill Porter (Supervisor), Jennifer Scott (Supervisor) & Seth Chaiklin (Supervisor)


  • Drugs
  • Alcohol
  • treatment
  • rehabilitation
  • Critical Realism
  • mechanisms
  • Substance misuse
  • Identity
  • recovery

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