不同線索情境下海洛因濫用者其渴想之生理心理反應

Psychophysiological Responses under Different Cue-Induced Heroin Craving Conditions

邱惟雅(WEI-YA CHIU)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2010年)

https://doi.org/10.6840/CYCU.2010.00552

摘要

研究背景與目的：
「渴想」（craving）為成癮範疇中的重要研究議題，是物質使用者普遍而強烈的經驗之一，過去常以線索暴露典範（Cue-Exposure Paradigm）的方式，使物質使用者暴露於物質相關線索下，誘發其渴想感受，並同步進行口語與非口語等主、客觀渴想測量進行研究。結果指出暴露於物質線索下，多有主觀渴想增加、客觀生理心理的改變，然而目前在生理心理測量結果，仍未有一致之定論。過去研究較少排除焦慮干擾、及探討不同使用情境對渴想的影響，因此本研究目的欲了解不同藥物使用情境下，海洛因使用者在主、客觀渴想表現是為何？以及其主、客觀渴想表現是否有差異存在？
研究方法：
本研究共選取51名男性、因海洛因案或半年內曾使用海洛因之判刑確定受刑人為主要研究對象，分成中性線索組15人，單獨使用組18人，團體使用組18人。以視覺類比量尺、渴求量表及生理回饋儀測量心跳速、膚電流與膚溫，並比較各組表現。
研究結果：
研究結果發現，主觀渴想部份，三組在主觀渴想未達顯著，但以是否暴露於物質線索重新分組後，則發現主觀渴想差異接近顯著，客觀生理心理測量部份，在排除焦慮之後，三組在心跳反應率與恢復率差異達顯著、膚電流反應率與恢復率接近顯著，膚溫則未達顯著。相關方面，主觀指標渴求量表與視覺類比量尺呈現正相關。生理心理指標間的相關，膚電流恢復率與膚溫恢復率呈負相關。主、客觀渴想指標間之相關：基準期的主觀渴想VAS2分別與操弄期心跳、恢復期心跳達正相關，其餘主、客觀指標間無顯著相關存在。
結論：
研究結果僅部分證實海洛因使用者暴露於海洛因相關線索下主觀、客觀生理心理渴想指標有差異。主觀渴想表現僅達邊緣顯著，但與過去研究相比趨勢上仍是一致的。客觀生理心理渴想指標部份，心跳反應率與恢復率達顯著，膚電反應率與恢復率接近顯著，但表現趨勢與過去多數研究略有不同：心跳呈現下降、膚電上升與膚溫下降的表現，因此心跳速率為較好的客觀渴想測量指標。最後，文中亦指出一些研究可能的限制及干擾因素，並於文末討論未來研究之方向。

關鍵字

線索暴露 ； 渴想 ； 膚溫 ； 膚電 ； 心跳速率 ； 海洛因 ； 生理回饋

並列摘要

Object: A craving, which is one of the common but strong experiences of substance-abusers, is an important issue in the field of addiction. We used to apply Cue-Exposure Paradigm to the study by exposing the abusers to substance-related cues to induce their cravings and simultaneously to measure the verbal and the nonverbal, the subjective and the objective cravings. The results indicated that abusers, exposed to the substance-related cues, showed an increase of the subjective cravings, and changes of the objective psychophysiology. However, the results of the measurement of psychophysiology so far do not come to a final conclusion. The former studies seldom excluded the anxiety interference and explored less the influences of different abuse circumstances on the cravings. Therefore, this study aims at what are the expressions of the subjective and the objective cravings of the heroin-abusers under different abuse conditions, and whether there is a difference between their expressions of the subjective and the objective cravings.
Method: In the study, there are 51 male participants, chosen as main objects of the study out of the inmates, of heroin cases or determinately sentenced for heroin-abuse within half a year. They are divided into groups of neutral cues (15), single user (18), and group user (18); the VAS, the craving questionnaire, and the biofeedback instrumentation are applied to the measurement of their heart rates, skin conductance, and skin temperature. The expressions of these groups are further compared.
Results: The result indicates that the subjective cravings of three groups are not significant, but if the groups are rearranged in terms of their exposure to substance cues, the difference of the subjective cravings becomes marginally significant. In aspect of the objective psychophysiology, when the anxiety is excluded, the heart response rate and recovery rate are significant, and the skin conductance response rate and recovery rate are marginally significant, but the skin temperature is not significant. As to correlations, the subjective-index craving questionnaire and the VAS are positive correlated; the correlations between the psychophysiological indexes, the skin conductance recovery rate and the skin temperature recovery rate are negative correlated. As to correlations between the indexes of the subjective and the objective cravings, the subjective cravings VAS2 at baseline separately with the heart rate at the exposure stage and that at the recovery stage is positive correlated. There is no significant correlation between the rest of the other subjective and objective indexes.
Conclusion: Only parts of the results of the study prove the differences between the subjective and the objective psychophysiological indexes under the abusers’ exposure to the heroin-related cues. The expression of the subjective cravings is only marginally significant, but consistent in tendency compared with the former studies. As to the psychophysiological indexes, the heart response rate and recovery rate are significant, and the skin conductance response rate and recovery rate are marginally significant, but the expression tendency is somewhat different from the results of most of the former studies: the heart rate decreasing, the skin conductance increasing, and the skin temperature decreasing; therefore, the heart rate is a better index of the objective craving measurement. Finally, the text also indicates some possible factors of limits and interference, and future foci of the study.

並列關鍵字

skin temperature ； skin conductance/GSR ； biofeedback ； heroin ； cue-induced ； craving ； heart rate

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