Details
Study title
Treatment Outcome and Temporality: Matching "Social Time" and "Clock Time" in Addiction Treatment
Ref study 7264
Study language English
Contributing institutions
Authors
Keywords
  • Addiction
  • Drop out
  • Inpatient treatment
  • Social time
  • Time perspective
  • Time orientation
  • Time experience
  • Processes of change
Disciplines
Period
2001-2004
Geographical space
German speaking part of Switzerland
Country
  • Switzerland
Abstract
Research into therapeutic interventions and the efficacy of treatment services considers only "clock time" - that is, "time" as a technical, "objective" consideration. This is the first study to apply the concept of "social time" to the inpatient treatment of addiction in alcohol and drug clinics in Switzerland. It is based on an extensive pilot study which has shown that treatment optimism and other variables are relevant to treatment and correlated with general concepts of time (e.g. "future orientation") as well as with styles of time-use during treatment (e.g. "killing time"). Specifically, it addresses the following questions:
- Do alcohol and drug users have shorter time-horizons and share less dynamic images of "time" than control groups? Do drug users do so even more than alcohol users?
- Do conflicting time-concepts of patients and staff and the management of "private" and "public time" in alcohol and drug clinics influence treatment outcome in general and drop-out rates in particular? (hypothesis of the sup-optimal matching of "social time" and "clock time")
- What is the relationship between general future orientation, self-efficacy and stages of change in recovering from addiction?
- Do individual time budgets prior to treatment, such as living on the street, being homeless and having served time in prison, influence strategies of time use (e.g. "killing time" or "waiting") and time reckoning in inpatient treatment?
- Are health status (e.g. HIV infection; chronic use of alcohol or drugs), age, ethnicity, predictors of expected time needed for change?
- How do subjective speed of time and time dynamics vary among patients with the same objective time in treatment?
Results
Between 1999 and 2000 a pilot study titled "social time in treatment process and treatment success" was carried out. In doing so, Patients (n=159) as well as staff members (n=107) of two alcohol clinics and four specialized drug treatment centers were interviewed. These facilities differed in their treatment modalities, size, age, and target groups. They all take part in a national client monitoring system (SAKRAM and FOS reporting systems) which enabled the research team to link the 'time data" with the extensive body of general statistics on treatment. The questionnaires for both staff and patients included the Stanford Time Perception Inventory and time-metaphor items. The patient questionnaire had a specific section measuring various styles of time usage and modes of adaptation to the organizational environment. As a control group served a representative 'omnibus-multiple topics' survey in the German-speaking part of Switzerland with n=700 interviews.
Results from the pilot study:
- Comparisons of the clinical samples with the population sample showed a certain robustness of the dimensions "Future and Past Orientation" measured with The Stanford Time Perception Inventory (STPI) (in it's 1990 version) in the Swiss context. However, given the limited number of times of this earlier version of the STPI, the factor structure remained partially inconclusive and a new 'risk behavior factor' emerged, which was difficult to interpret. To capture the notion of time dynamics, time metaphors were tested, which proved of limited use, at least when replicating the metaphors used in earlier studies.
- In addition to a first exploration of the dimensions of individual time perspectives, the pilot study covered also group comparisons between staff, patients and the general population, testing simultaneously group differences between alcohol and drug treatment settings. It highlighted styles of time use and views on time in the organizational context. More specifically, the study tentatively support previous research findings, that patients at both alcohol and drug clinics have a lower degree of 'Future Orientation' and a higher 'Past Negative Orientation' than the general population. At the same time, the patients scored unexpectedly significantly lower on the 'Present Hedonistic' time perspectives. All clinical samples shared less dynamic images of time than the general population. A surprising finding was the similarity of the staff's orientation with the temporal orientations of their clients, e.g. in terms of lower future orientation. Unfortunately, the very short staff questionnaire did not allow to probe for the underlying reasons of these similarities.
- The analysis of the organization's highlights as perceived by the patients ('marking time'). This analysis showed a remarkable difference between drug and alcohol patients - the former emphasizing 'success events' much more than the latter. The lower achievement orientation of the alcohol patients correlated with program acceptance. Adopting the working typology from Calkins (1970) for the identification of styles of time use, a clear preference for more active ways of time handling could be observed in drug centers as compared with alcohol treatment centers. However, Calkin's typology of time use was of limited use; having been developed for conditions of 'time affluence' in a rehab center. Typologies for the addiction treatment centers have to take the varying time regimes into consideration which grant more or less time to be structured by the patients including the regulation of TV time and time outside the institution. Unfortunately no data from participant observation or qualitative interviews based on daily life in the clinic were available for the pilot study.
- As to the outcome variables, using time orientation indicators as predictors, a multiple regression analysis of extra- and intra-organizational time perspectives of patients' treatment optimism (as a preliminary outcome variable) explained 17% of the variance and showed that the slower time passes subjectively in the clinic and the more positively patients see their past as addicts, the lower their treatment optimism. A group-specific analysis for drug patients explained 57% of the total variance and revealed the time use style of 'Killing time' (together with Future Orientation, 'subjective speed of time in the facility' and 'temporal benchmarking') as the most important predictor of 'treatment optimism'. The subcultural time definition of 'killing time' showed an unexpected positive impact on treatment optimism. A relationship which needs further in-depth exploration.
Methods (description)
Multivariate methods (e.g. logistic regression, linear regression) will be combined with qualitative methods (e.g. computer-assisted content analysis with TEXTPACK of open-ended questions; triangulation of various data sources; and different versions of optimal scaling to establish client typologies).
The study will first perform a cross-cultural validation of the Zimbardo Time Perception Inventory (ZTPI). It will then compare individual time perspectives of a representative population sample with those of patients and staff in inpatient drug and alcohol treatment. It will analyze the role of future and present perspectives and the perceived dynamics of time. This individual perspective is complemented by a description of the patterns of time-use during treatment in facilities for alcohol and drug treatment.

Erhebungsverfahren I: Standardized written survey
Erhebungseinheiten: - Organizations (inpatient treatment facilities) - Patients from inpatient drug- and alcohol treatment facilities - Staff from inpatient drug- and alcohol treatment facilities - Population from the German speaking part of Switzerland
Auswahlverfahren: - In a first step, an "organization selection short questionnaire" is conducted with all inpatient drug- and alcohol treatment facilities in the German speaking part of Switzerland, participating in a client monitoring statistic (FOS or SAKRAM). In a second step, a further selection of the treatment facilities will be guided by a typology of 'organizational time regimes'. A two-fold typology will be constructed according to the results of the organization survey, distinguishing between facilities with high and low 'organizational time consciousness'. - All patients admitted to the selected treatment facilities. - All staff (all staff members who interact regularly with the patients) working in the selected facilities. - Population sample is selected randomly.
Anzahl Untersuchungseinheiten: - 1. Step: Drug treatment facilities approx. n=60. Alcohol treatment facilities approx. n=9. 2. Step: Still open. - Patients approx. n=320 (n=160 patients of alcohol and drug facilities each. Half in facilities with high "time consciousness", categorized as such by the earlier organization mail survey). - Staff approx. n=300 - Population approx. n=500
Untersuchungsdesign: First, as mentioned above, the two-step selection of the treatment facilities will be conducted. The following patient admission interviews will be conducted with all patients admitted to the selected treatment centers and, as soon as they leave the clinics (drop outs included) a discharge interview follows. Parallel, field-work for the representative population survey as well as the interviews of staff members will be carried out.
Durchführung der Feldarbeit: - Organization, patient and staff survey will be conducted by the research team. - Population survey will conducted in the context of a Univox-survey by the Gfs-Forschungsinstitut, Zürich.
Erhebungsverfahren II: Content analysis (standardized)
Erhebungseinheiten: - Organizations (inpatient treatment facilities)
Auswahlverfahren: - All inpatient drug- and alcohol treatment facilities in the German speaking part of Switzerland, participating in a client monitoring statistic (FOS or SAKRAM)
Anzahl Untersuchungseinheiten: - Drug treatment facilities approx. n=60. Alcohol treatment facilities approx. n=9.
Untersuchungsdesign: In the "Organization Selection Short Questionnaire" treatment facilities are asked to enclose a current weekly timetable. These weekly timetables are content analyzed to provide further information for the construction of the typology "high vs. low time consciousness".
Durchführung der Feldarbeit: Conducted by the research team. Erhebungsverfahren II: Qualitative interview
Erhebungseinheiten: Patients from inpatient drug- and alcohol treatment facilities.
Auswahlverfahren: All patients admitted to the selected treatment facilities.
Anzahl Untersuchungseinheiten: Patients approx. n=320 (n=160 patients of alcohol and drug facilities each. Half in facilities with high "time consciousness", categorized as such by the earlier organization mail survey).
Untersuchungsdesign: A face-to-face patient "middle-phase-interview" will be conducted with each patient after 50% of regular treatment-time has elapsed.
Durchführung der Feldarbeit: Conducted by the research team.
Erhebungsverfahren III: Secondary analysis of individual data
Erhebungseinheiten: Patients from inpatient drug- and alcohol treatment facilities
Auswahlverfahren: All patients admitted to the selected treatment facilities.
Anzahl Untersuchungseinheiten: Patients approx. n=320 (n=160 patients of alcohol and drug facilities each. Half in facilities with high "time consciousness", categorized as such by the earlier organization mail survey).
Untersuchungsdesign: All the treatment facilities chosen for this study take part in a national client monitoring system (SAKRAM and FOS reporting systems). Therefore, general statistical data on treatment is available for every patient and can be used for a secondary analysis. By granting anonymity 'time data' can be linked with this extensive body of general statistics on treatment.
Durchführung der Feldarbeit: Conducted by the research team and student assistants.
Methods (instruments)
Publications
  • Klingemann, Harald. 2001. The time game: temporal perspectives of patients and staff in alcohol and drug treatment. In: Time & Society, 10 (2/3): 303-328, 2001.
  • Klingemann, Harald; Schibli, Daniela. 2001. Uhrzeit und soziale Zeit im Therapieprozess in Alkohol- und Drogenbehandlungseinrichtungen: Ergebnisse einer Pilotstudie. In: Abhängigkeiten, 2: 21-30, 2001.
  • Klingemann, Harald. 2000. "To every thing there is a season": social time and clock time in addiction treatment. In: Social Science and Medicine, 51: 1231-1240, 2000.
  • Klingemann, Harald; Schibli, Daniela. 1999. Times for healing: towards a typology of time-frames in Swiss alcohol and drug clinics. In: Addiction, 99(11), 1418-1429, 1999.
  • Schibli, Daniela. 2003. Time clashes - negotiating "time" in Swiss drug treatment organizations. 29th Annual Alcohol Epidemiology symposium of the Kettil Bruun Society, Krakau, Poland, 2003.
  • Klingemann, Harald. 2002. Social and conventional times. A research note on the temporal structure of alcohol and drug clinics in Switzerland. 28th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society, Paris, France, 2002.
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Study type
Data availability
Source (Updates) Web
Date created 11.01.2002
Date modified 05.07.2005
Start - End date 01.10.2001 - 28.01.2005