探討認知行為治療對緩起訴藥癮個案之影響

藥物濫用及藥物依賴不僅是健康問題、治安問題，也是精神醫學研究的重要課題，對於醫務管理尤其重要，因為可以協助解決個人身心健康與社會治安問題。依據臺灣地區精神醫療院所通報藥物濫用個案件數，2012年1-11月安非他命藥癮人次與去年同期比較成長更高達32.3%，在安非他命藥癮人數的逐年增加的情形下，探討認知行為治療對於安非他命之成效與應用是重要的。本研究之目的希望能透過量表評估的方式，了解個案對於認知行為治療的介入，是否能改善緩起訴個案之物質使用、危險注射行為、犯罪行為及健康狀態與社會功能等方面之情形。本研究之對象為經地檢署轉至北部某精神專科醫院之藥癮且判緩起訴個案共296名個案，使用療效評估表(treatment outcomes profile,TOP）進行為期一年的認知行為治療，記錄藥癮個案過去四週物質使用、危險注射行為、犯罪行為及健康狀態與社會功能的評分。初診時接受認知行為治療的當日接受TOP之問卷前測，進行為期14次/年之團體認知行為治療，最後一次的團體認知行為治療課程結束後當日進行TOP之問卷後測。在本研究中，個案經過認知行為治療後，安非他命的物質使用上有明顯減少的情形，藉由認知行為療法的介入可以減少安非他命的使用，但對於酒精使用天數上並未有明顯的減少。此外，危險注射行為之評估上，較不適合臺灣地區藥癮之個案，因為臺灣地區安非他命的使用多為吸食性，與國外以注射方式使用有不同的差異。犯罪行為的評估會因個案擔心影響本身利益而容易有與違反事實的選項之產生，因此在本研究中無法得到具體的結果。此外，針對本身的心理健康狀態的評分、身體健康狀態的評分及對自己生活品質整體評估等的評分在本研究中皆呈現增加的情形。性別、年齡、教育程度、是否合併其他精神疾病及是否合併安眠藥使用等的探討，在本研究並未發現與結果有明顯的相關。本研究針對北部某精神專科醫院探討，其研究結果無法推論至其他醫院，及僅針對藥癮且為緩起訴個案進行研究，無法推論至所有二級毒品的藥癮個案。在目前安非他命藥癮人次逐年成長的情況下，本研究的結果可以提供精神專科醫療團隊，做為臨床治療對藥癮個參考，透過認知行為治療，讓戒癮者能夠辦識自己使用毒品的危險情境，同時學習拒絕毒品的引誘，以達到更有效的治療目的。關鍵字：認知行為治療、療效評估表、藥物成癮

關鍵字

認知行為治療；療效評估表；藥物成癮

並列摘要

Drug abuse and drug dependence are not only a health issue, public security issue, but also an important topic of psychiatric study. This is especially important in health care administration, because that can facilitate individual health promotion physically and mentally as well as public security. Based on the number of drug abusers reported by psychiatric facilities in Taiwan, the number of amphetamine abusers documented between January and November 2012 had increased by 32.3% than the previous year. Given the annual increase in amphetamine abusers, it is important to determine the effectiveness and application of cognitive- behavioral therapy on amphetamine use. The purpose of this study is to explore whether intervention of cognitive- behavioral therapy can improve substance abuse, dangerous injection behavior, criminal act, and health status and social function of deferred prosecution defendant via scale assessment. Study subjects include 296 defendants with drug addiction and sentenced to deferred prosecution who were transferred from the District Prosecutors Office to a psychiatric facility in Northern Taiwan. The treatment outcomes profile (TOP) was used in a 1-year cognitive- behavioral therapy to record the score of substance use, dangerous injection behavior, criminal act, and health status and social function of drug addicts in the previous 4 weeks. During the initial visit, a pre-test TOP questionnaire was carried out on the same day of receiving cognitive- behavioral therapy. Subjects received 14 group sessions of cognitive- behavioral therapy over one-year period. On the day of the last group session of cognitive- behavioral therapy, a post-test TOP questionnaire was conducted at the end of the session. In this study, substance use involving amphetamine was significantly reduced in subjects receiving cognitive- behavioral therapy. The intervention of cognitive- behavioral therapy successfully reduced the use of amphetamine, but failed to substantially reduce the days for alcohol use. In addition, the assessment of dangerous injection behavior was less suitable for drug addiction cases in Taiwan as amphetamine use in Taiwan were mostly by inhalation, instead of the injection method commonly used in other countries. The assessment of criminal act was susceptible to false answers as subjects were concerned about their own benefits. Therefore, no concrete result was acquired in this study. In addition, the self-assessment score improved in psychological health status, physical health status and overall quality of life in this study. No significant correlation was observed in this study between the outcome and the sex, age, level of education, presence of other psychological disorders and combined use of sleeping pills. This study involves only one psychiatric facility in Northern Taiwan and therefore the result cannot be extrapolated to other facilities. Also, as the study was only conducted on drug addicts who were under deferred prosecution, the result cannot be extrapolated to all drug addicts using Class II drugs. As the number of amphetamine addicts increases every year, the result of this study will serve as a reference for psychiatric teams when conducting clinical treatments for drug addicts. Via cognitive- behavioral therapy, addicts in rehabilitation programs will become aware of the danger they are in by using drugs and at the same time learn to reject the temptation of drugs, which helps achieve better outcome. Keywords: cognitive-behavioral therapy, treatment outcomes profile, drug addiction