K他命使用者中止歷程之復原力探究

The studying of Resilience on Ketamine abuser desistance process

齊沛瑜(Pei-Yu Chi)

指導教授 ： 童伊廸 ； 陳心怡

中山醫學大學/醫學人文暨社會學院/醫學社會暨社會工作學系碩士班/碩士(2016年)

摘要

近年來毒品濫用情況，非法藥物緝獲量屬第三級毒品最多，其中又以K他命為大宗，歷年趨勢呈現使用者漸增且年輕化，使用的反覆性與再犯現象。然而，因相較輕微的罰則和傾向年輕族群為主的使用者彼此相互侷限，代表存在隱藏濫用人口，經歷著K他命對生理、心理、社會層面影響，不僅是成癮依賴問題，一點一滴侵蝕正向生活，長時間施用則可能造成K他命膀胱炎等，長期、甚至永久的健康損害。K他命使用者可能因產生不適症狀尋求醫療協助，突顯醫療體系，是少數可接觸隱藏性K他命使用者的重要管道，也是促進改變的機會之一。
在毒品濫用社會、心理成因及認知態度的知識基礎下，本研究不同以往，轉由正向角度，看見使用毒品和主動且穩定就醫行為，所傳遞的處理問題之潛能，深入發現隱身於日常中的K他命使用者，能夠不再陷入用藥循環或進階藥物使用關鍵，在於人際網絡、支持系統、生活型態的變化與重建，還有個人特質，以及對現狀、期望、比較性的覺察反思能力，保護因子在過程中整合作用，使能增強並展現，邁進中止歷程的復原力。
透過質性深度訪談曾有K他命濫用經驗，且因K他命膀胱炎而接受過長期醫療處置，目前已中止K他命使用的三位受訪者，以動態脈絡來檢視復原的進程，分析其成長背景、K他命使用經驗、進入中止歷程，以及穩定中止的保護因子，於各階段如何共同作用累積復原力量，得出以下重點結論與建議:
一、 了解毒品使用成因，應從脈絡來檢視影響行為的問題，以及問題所影響的確切需求。因此專業工作者需不斷充實綜融知識，以多元角度理解藥癮者，擺脫刻板與迷思，並以需求為中心，規劃合適而關鍵的處遇。
二、 促進中止歷程展開階段，重建家庭關係、友善醫療經驗、宗教支持系統，是推動及維持中止的關鍵。醫務社工和醫療人員能藉由提升對隱藏性藥癮者的敏感度，意識到社會職業角色對藥癮患者的影響力，以專業態度合作，建立不受司法干擾的保護性通報機制，提供醫療和社會整合式協助的機會。
三、 促進穩定中止的復原力要素，包括健康信念因身體狀態改善而發揮保護力；具備比上不足，比下有餘，幽默感，調適能力等個人特質；進行過去與現在比較，覺察與反思所擁有的生活、健康、人際正向資本之能力。工作者能依據此特質和能力面向，引導、培養藥癮者進行持續性的資本重建與累積。
四、 強調健康損害的反毒、戒毒講習宣導效果有限，可應用說服技巧，搭配成功中止者做經驗分享，回應用藥行為背後的綜合成因與問題，引發共鳴，以提升行政罰促進藥物濫用中止的影響力。

關鍵字

K他命 ； 復原力 ； 中止歷程 ； 保護因子

並列摘要

For the past few years drug abuse in Taiwan, the third grade drug Ketamine is the largest amount of drug seized. The trend of abusers showing increasing and younger, and the recidivism phenomenon of drug abuse behavior. However, because of the light punishment don’t need to be in jail or rehab, and manly to younger abusers, that means there is hiddden population of Ketamine abusers suffering from physical, psychological and social problem. Due to health damage such as severe symptoms of Ketamine cystitis and so forth, Ketamine abusers probably seek medical care. Medical system and health care system are one of the few opportunities can contact Ketamine hidden abusers, play an important role in promoting positive change.
There are many studys about causes of drug abuse from social, psychological, cognitive perspect. In this study, will through different way to see drug abuse behavior, and active and stable medical seeking behavior as the potential capability to deal with problem. The study found that key point which can keep Ketamine hidden abusers no longer fall into the cycle of drug abuse, including social network, support system, lifestyle change and rebuild, as well as personality traits, ability of self awareness include situation, expectation, comparison of past and present overall situation. The resilience on Ketamine abuser desistance process is promoted and enhanced by integration of these protect factors.
This study uses qualitative research depth interviews, accessing 3 participants with Ketamine abused experience before, and received long-tern medical treatment and follow up to Ketamine cystitis, for now Ketamine use behavior has been stopping. Through analyze background, Ketamine use experience, into the desistance process, figure out the protect factors of stable desistance how to work together to build up resilience in each phase of process. Get the following conclusion and suggestions:
1. The causes of Ketamine abuse and the exact needs should be accessed on dynamic context. workers have to keep enriching generic knowledge, use diversified perspect to comprehend drug abusers, get rid of stereotype, taking the abusers needs as the center to plan appropriate and critical treatment or intervention.
2. At the beginning of desistance process, the key of promoting and preserving desistance are family relation, friendly medical experience and religious support system. Medical social workers and medical personnel should improve the sensitivity about drug hidden abusers and being a impactful professional socal role, in order to cooperate on establishing protective notification system without justice interference, and providing integrated medcial and social support.
3. The key protect factors on stable desistance process are health belief work after health improved, and personality traits include to fall short of the best,but be better than the worst, sense of humor, adaptability, self awareness ability to compare life, health and interpersonal relation capital in past and present. Workers can base on and cultivate drug abusers ability to rebuild positive capital.
4. In order to enhance the administractive sanction effectiveness of drug abuse, we can use techniques of persuasion, and with successful case sharing their experience, responding the causes and problems behind abuse behavior.

並列關鍵字

Ketamine ； Ressilience ； Desistance process ； Protect factor

參考文獻

籃婉鳳(2011)。高風險青少年非法藥物使用之風險及保護因素─以韌性觀點探究(碩士論文)，台灣大學社會工作研究所碩士論文。

許春金、陳玉書、洪千涵(2009)。犯罪青少年中止犯罪歷程及影響因素之研究，犯罪防治學報，10，43-91。

李思賢、林國甯、楊浩然、傅麗安、劉筱雯、李商琪(2009)。青少年毒品戒治者對藥物濫用之認知、態度、行為與因應方式研究，青少年犯罪防治研究期刊，1(1)，1-28。

林志哲(2007)。發現復原力∼一個來自心理脈絡的觀點，輔導季刊，43(1)，1-8。

洪福原(2005)。強化個人生活的力量與自信-復原力的觀點，輔導季刊，41(2)， 37-45。