青少年使用安非他命研究：濫用與復發預測相關因子之調查

Correlates of Methamphetamine Misuse and Predictors for the Relapse of Misuse among Adolescents

顏正芳(Cheng-Fang Yen)

指導教授 ： 張明永博士 ； 劉金昌教授

高雄醫學大學/醫學院/醫學研究所/博士(2003年)

摘要

台灣自民國80年代掀起安非他命濫用狂潮，且青少年使用者眾多。由於安非他命會造成嚴重身心影響，而青少年處於人生發展的重要階段，有必要了解與青少年使用安非他命相關的因子和使用行為復發的預測因子，作為建立預防和介入策略的基礎。本研究以個案對照研究方式，來調查與青少年使用安非他命相關的個人和環境因素；並對使用安非他命的青少年進行追蹤，以了解哪些因子能預測青少年在一年內再次使用安非他命。
本研究包含前驅研究和主研究兩部份。在前驅研究方面，首先以中文版Kiddie-SADS-E（The Kiddie epidemiologic version of the Schedules for Affective Disorders and Schizophrenia）進行100位因使用安非他命而接受觀察勒戒的青少年所合併精神疾病之調查，並就其個人和環境背景進行初探，作為擬定主研究調查問卷之基礎；接著就此100位青少年進行為期一年的追蹤，以了解一年內使用安非他命行為復發狀況，以及與合併精神病的關連性。前驅研究結果發現：使用安非他命的青少年所合併的精神疾病以行為規範障礙症最多，合併重度鬱症則有性別之差異；出所後一年內共有30%再次因使用安非他命而接受觀察勒戒，而再次接受觀察勒戒者中有較高比例先前使用安非他命程度已達安非他命使用疾患之標準。
在主研究中包含兩部份：（1）青少年使用安非他命相關因子研究：邀請200位因使用安非他命接受觀察勒戒且尿液檢查為呈安非他命陽性反應之青少年為個案組個案，社區中400位未曾使用安非他命之青少年為對照組個案，以個案對照研究方式，調查青少年使用安非他命和社會人口學資料、精神病理、態度知識、家庭和同儕因子間的關連性。青少年所合併的精神病由一位兒童青少年精神科醫師依據中文版Kiddie-SADS-E進行診斷性會談，其餘因子的調查在個案組部份以一對一訪談方式進行，對照組部份則以自填問卷方式進行。調查結果再以單變項和多變項分析方式比較兩組間各因子之差異；（2）青少年使用安非他命行為復發之預測因子一年追蹤研究：以青少年的主照顧者之觀察，和司法單位提供觀察勒戒記錄，追蹤200位使用安非他命的青少年在離開觀察勒戒處所後一年內使用安非他命行為復發情形，並比較復發者和未復發者在各因子之差異。
主研究的結果發現：使用安非他命的個案組青少年較多有使用毒品的朋友、父母婚姻不完整、合併有行為規範障礙症、與同儕互動較活躍、對於使用安非他命的態度傾向接受和知識較不佳、主要照顧者的教育程度較低；200位使用安非他命的個案組青少年中有19位（9.5%）在出所一年內使用安非他命行為復發，復發的青少年比未復發的青少年先前有較高的安非他命使用頻率，同時有較高比例先前使用安非他命的程度達到安非他命使用疾患的診斷標準。其餘之社會人口學資料、個人犯罪前科、合併精神疾病、對使用安非他命的知識和態度、家庭因子和同儕因子方面，兩組則無明顯差異。
本研究結果顯示：與青少年使用安非他命相關的因子橫跨個人、家庭、同儕等領域，並非單一因子可完全解釋。相關的因子不僅可作為對於青少年行為監測以早期發現安非他命使用行為和擬定預防策略的基礎，並提醒防制策略的擬定者考慮使用危險性較高的青少年具備特殊個人、家庭、同儕背景，必須調整反毒宣導策略，才能擴大對青少年對使用毒品態度的影響範圍。由於青少年使用安非他命的使用程度愈嚴重，未來復發的危險性愈高，故應及早發現青少年使用安非他命，阻止使用行為進展到較嚴重程度，才能降低未來復發的危險。

關鍵字

安非他命 ； 青少年 ； 危險因子 ； 復發 ； 個案對照研究

並列摘要

Methamphetamine (MAMP) use among adolescents in Taiwan has received much public attention in recent years. While various strategies have been adopted to help prevent MAMP use, they are generally considered to be less effective than the related factors approach. At the moment, no research is available in Taiwan about relapse in MAMP use. Elucidation of predictors for the repeated use of MAMP among the adolescents is important because these predictors could help in monitoring outcome. This study was done 1) to examine the associations between MAMP use and psychiatric comorbidity, individual attitudes and knowledge about MAMP use, family characteristics and peer factors in Taiwanese adolescents, and 2) to follow up the subjects, who had been discharged from detention centers, to check for relapse and evaluate the factors we hypothesized would affect relapse of MAMP use.
This study includes a pilot study and the main study. The pilot study recruited 100 consecutive juveniles with drug offenses related to MAMP use in a detention center. They were assessed for extent of substance use and psychiatric morbidity. The assessment was done by a psychiatrist using the modified Chinese Version of Kiddie-SADS-E (The Kiddie epidemiologic version of the Schedules for Affective Disorders and Schizophrenia). The subjects were followed up one year after discharge. The risk of being recommitted to a detention center against use of various drugs and psychiatric morbidity was determined. The results showed that conduct disorder was the most prevalent among the psychiatric morbidities. Amphetamine use disorder was more prevalent in those who were recommitted. No significant difference was found with subjects’ use of legal substances, psychiatric morbidity, or number of substances used in the group who was recommitted and those who were not.
The main study recruited 200 consecutive juveniles with MAMP use in two detention centers as the index group and 400 adolescents without MAMP use as the control group. We systematically assessed all for psychiatric comorbidity and their attitudes and knowledge about MAMP use. Their family characteristics and interactions with their peers were also assessed. Univariate and multivariate analyses were done to study the association between MAMP use and the above-mentioned factors. The 200 subjects in the index group received follow-up assessments for the relapse of MAMP at one-year interval after discharge from the two detention centers. Using conditional logistic regression, we found the significant associations of MAMP use and comorbid conduct disorder, favorable attitudes toward MAMP use and poor knowledge about the dangers of MAMP use, disrupted parenting, lower education level of the caregiver, the presence of friends who use or provide MAMP and active interaction with peers. The presence of amphetamine use disorder and frequency of MAMP use in the index interview were found to be associated with the relapse of MAMP use.
Adolescents’ MAMP use was correlated to multiple factors that lie within individuals and the interaction with their family and peers. Correlates of MAMP use identified in this study may be helpful for the design and implementation of preventive intervention. In view of the association between high frequency of MAMP use and the relapse in the follow-up period, early detection of MAMP use would probably best prevent relapse of its use.

並列關鍵字

Amphetamine ； Adolescent ； Risk factor ； Relapse ； Case-control study

參考文獻

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