國內辦理藥癮治療醫療機構提供之戒癮醫療現況分析

The Investigation into the Current Management Work of Substance Use: In Institutions Assigned by the Department of Health Executive Yuan

林皇吉(Huang-Chi Lin)

指導教授 ： 楊明仁

高雄醫學大學/健康科學院/行為科學研究所/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00047

摘要

物質使用問題以及相關疾患是台灣面臨的重大議題。儘管主流的成癮物質使用種類隨著時間的演進，時有更迭，但物質使用所造成個人身體健康、角色功能、家庭及社會心理的衝擊並未改變。
本研究的目的是調查衛生署委辦的121家戒癮醫療機構，人力配置、軟硬體設施以及物質戒癮的治療模式、面臨的戒癮醫療執行困境，以及對於未來戒癮政策的建議。
研究方法:先選定在戒癮業務有相當經驗的八家衛生署委託辦理藥癮治療機構的主負責醫師進行深度訪談。其後，依照訪談內容及文獻回顧的結果擬定問卷，並針對121家衛生署委辦藥癮治療機構進行調查。
本研究的問卷的回收率為71.7%，分析結果發現：在提供戒癮醫療的物質種類方面，以酒精(97.7%)、鎮靜安眠藥物(90.7%)及甲基安非他命及其類構物(82.6%)為最多；主要的提供的服務方式為門診、住院和急診。設有專職戒癮治療專業人員的機構比例僅有3.5%到27.9%。naltrexon、methadone、disulfiram在台灣使用並不普遍，當前仍是以benzodiazepine、抗精神病劑、抗憂鬱劑、情緒穩定劑及鋰鹽為戒癮藥物治療的主軸。在急性脫癮治療之後，有74.4%機構會進行個別心理治療，72.1%會安排家族治療或一般家族危機介入處遇，但僅有52.3%的機構會安排結構性的戒癮衛教課程。
在調查機構所面臨的執業困境當中，以「人力缺乏」的比例最高(74.4%)，其他所遭遇的困難分別為「如何有效保障參與戒癮治療人員之安全」(64.0%)、「未有足夠接受相關戒癮治療訓練的工作人員」(55.8%)、「健保無法支應相關戒癮治療費用」(51.2%)、「缺乏有效之戒癮藥物可應用」(50.0%)等。
在當前的醫療政策方面，贊成「開放更有效的戒斷期置換治療藥物」的機構有88.4%，「提供免費針頭，杜絕血液傳染疾病」有75.6%，「非法物質成癮應予以除罪化，以利個案接受醫療介入」為68.6%；對於主管機關之其他建議方面，高達75%以上的機構認為應該「設立跨部會，更高層級之成癮防治部門，擬定國家戒癮政策」、「明確擬定戒癮治療之內容及相關標準」、「安排戒癮治療之從業人員之相關訓練」、「擬定相關獎勵政策」、「擴大成癮防治相關預算」。
本研究顯示：國內的戒癮機構提供多樣化的物質的戒癮服務療，但相關的專責編制與各領域專業人員的戒癮醫療業務的時間分配有限，恐限制提供足夠脫癮治療之後後續處遇的可能。此外，戒癮醫療政策調查的結果，也可以提供有關當局政策規劃的參考。

關鍵字

物質使用相關疾患 ； 成癮

並列摘要

Substance use problems are worldwide that is also unquestionably a big issue in Taiwan. The majority of substance abuse changes from time to time. However, the impact of substance related problems on health, role functioning, family and society still remains.
The current study investigated the management work of substance related problems is provided by the hospitals and clinics in Taiwan. We conduct a comprehensive inquiry toward eight specialists and review literatures that are substance abused related issues to design the questionnaire.
The questionnaire is to evaluate the manpower, software and hardware setting, substance related disorders treatment models, obstacles and difficulties of the work, and opinions/suggestions regarding the National policies within the 121 hospitals and clinics assigned by the Department of Health Executive Yuan for substance related disorders. The response rate for this study is 71.7%. The results show that they provide services for several kinds of substance related disorder. The most popular substance use associated services are alcohol (97.7%), sedatives and hypnotics (90.7%), and methyamphetamine and analogues (82.6%). In the meantime, outpatient (100%), inpatient (66.3%), and emergency room (66.3%) care are the most common way for using this service. The rate of hospitals and clinics equipped with full-time multiple disciplinary staff is from 3.5% to 27.9%. Although the use of Naltrexon, Methadone, and Disulfiram are very mature in the United States and Europe, however, they are hardly ever adopted in Taiwan. The main prescriptions for substance related disorders are benzodiazepine, antipsychotics, antidepressants, mood stabilizers and lithium. Since psychosocial involvement is vital for successful treatment, yet the rate of individual psychotherapy and psychosocial involvement is 74.4% and 72.1%. In addition, only 52.3% of the institutions have provided structured psycho education of substance use related knowledge courses. More than 50% of the subjects are regarding to
(1). Manpower shortage
(2). How to assure staff’s security
(3). National health insurance cannot afford treatment of substance related disorders
(4). Well disciplinary staffs are insufficient
(5). Lack of effective medication
When speaking of the national policies associated with substance use problems, there are more than 75% of the subjects agree with the current harm-reductive trials, and assent to
(1). Coordination of the related department of the government to deal with the substance related problems”,
(2). Formulation of the definite content and standard for treating substance related disorders”,
(3). Arrangement of thorough training program for the staff
(4). Establishment of reward policies
(5). Expansion of budget for substance related problems management
The current study also reveals that the ability to provide numerous kinds of services of substance related problems within institutions is assigned by the Department of Health Executive Yuan. But due to the time allowance and limited manpower of multiple disciplinary staff, the quality of the aftercare will deserve more investigations. Furthermore, the opinions and suggestions of the policies might serve as references for the government’s substance use related policy measurement and establishment in the near future.

並列關鍵字

substance use related disorder ； addiction

參考文獻

參考文獻

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