HIV毒癮者與非HIV毒癮者接受戒治處遇前後之心理適應比較評估研究

A Comparative Study of Psychological Adaptation between HIV Drug Abusers and Non-HIV Drug Abusers in Pre-test and Post-test of Treatment

一、研究目的：了解HIV毒癮者與非HIV毒癮者在進入戒治機構初期與後期在創傷自我檢測、用藥風險情境、情緒、身心狀況、強制戒治壓力、物質渴想、自我效能、風險情境之自我效能等差異，據以提出對HIV毒癮者處遇措施之建議。二、研究方法：收集戒治機構內HIV毒癮者46位、非HIV毒癮者268位，分析其創傷自我檢測、用藥風險情境、情緒、身心狀況、強制戒治壓力、物質渴想、自我效能、風險情境之自我效能等量表前、後測資料，採用t檢定、卡方檢定等統計方法進行資料處理，了解兩組之差異。三、研究結果：（1）HIV毒癮者與非HIV毒癮者在入所前主要施用毒品種類、主要施用毒品之方式有顯著差異，前者施用海洛因高達95.5%，後者施用海洛因亦高達75.9%。前者入所前主要施用方式為注射（高達85.7%），而後者以吸食最多（占51.2%），注射次之（占42.3%）。（2）在入所後兩週內新收調查發現，創傷自我檢測表之社交障礙、現實喪失及其總分，HIV毒癮者顯著高於非HIV毒癮者；此外，HIV毒癮者比非HIV毒癮者有較高的負向因應高風險情境的行為模式；有明顯較高的情緒失調與身體化症狀，且整體身心狀況較不佳； HIV毒癮者有明顯較高的憂鬱傾向與焦慮傾向，且整體的情緒狀況亦較不良； HIV毒癮者有明顯較高的比較擔心在戒治環境內會受到同儕欺壓之心理，與擔心未來社會生活之適應，且整體而言，HIV毒癮者較明顯的感受到戒治的壓力。在物質渴想方面，HIV毒癮者有明顯較高的情境誘發渴求的心理狀態、想要用藥的想法及整體的物質渴想。另則，HIV毒癮者有較高的負向自我效能感，而整體的自我效能上HIV毒癮者也較低；至於在風險效能的因應方面，HIV毒癮者比非HIV毒癮者明顯較低的毒品接觸因應效能、負向壓力因應效能與目的性因應效能，且整體的風險因應效能上，HIV毒癮者亦明顯較低。（3）個案完成戒治社會調應期後出所前進行之後測呈現多元整合戒治策略對HIV毒癮者具心理與生活調適作用，在前測時HIV毒癮者明顯表現不良非HIV毒癮者的心理變項中，僅有戒治壓力量表之分量表「擔心未來社會生活之適應」一項，HIV毒癮者仍明顯高於非HIV毒癮者，其他變項在經過戒治各階段後，HIV毒癮者與非HIV毒癮者已無明顯的差異，且從兩組風險情境自我效能總分觀之，平均分數均是向上提升，而情緒量表、身心狀況量表、強制戒治壓力量表、物質渴想量表等負向分數，HIV毒癮者均已下降。戒治壓力量表之擔心未來社會生活之適應在前測及後測上，HIV毒癮者均明顯高於非HIV毒癮者，此顯示HIV毒癮者面對未來出所後的社會生活適應將背負著更大的心理壓力，此與HIV者的身份應有直接相關連。四、研究建議：（1）加強毒品注射之不安全：用藥行為與HIV感染相關之衛教。（2）在入所矯治難度條件上，HIV毒癮者高於非HIV毒癮者。因此，加強初入所個案的心理評估與處遇，並注意其因感染HIV所呈現的身心症狀之困擾，對於情緒狀況不穩的個案加強心理諮商。（3）就後測結果顯示以多元整合性的戒治模式，符合HIV毒癮者戒治處遇在實務推行的方向與需求，此外，應發展對HIV毒癮者專屬的團體方案。（4）對毒癮HIV感染者出所的社區庇護轉銜機制將是持續治療的重要工作。此外，在戒治期間應加強毒癮者的家庭處遇與家屬衛教，提高家屬接納度將有助減緩毒癮HIV感染者將來出所後社會生活適應的壓力。 Purpose: The purpose of this study was to investigate the differences between the HIV drug addicts and non-HIV drug addicts in trauma, risk situation of drug abuse, mood, physical and mental conditions, stress of mandatory treatment, craving for drugs and self-efficacy etc. Methods: In total, 46 HIV drug addicts and 268 non-HIV drug addicts were surveyed in a compulsory drug detention centre. Statistical methods such as t-test and chisquare test were used to process the data to estimate the difference between the two groups. Results: There were significant differences between the two groups in ways of drug using and drug types. HIV drug addicts used heroin up to 95.5%, and non- HIV drug addicts applied heroin was 75.9%. The pre-test surveys in this study showed that the scores of social barriers, lack of sense of reality and trauma scales for HIV drug addicts were significantly higher than those of non-HIV drug addicts. HIV drug addicts have a high pattern of negative behavioral in response to high-risk situations; mood disorders and physical symptoms are significantly higher, and overall physical and mental conditions are poorer. HIV drug addicts have a significantly higher tendency to depression and anxiety tends, and a lower overall emotional state; HIV-infected drug abusers are much more fearful of being bullied by their peers and worry about social life in the future. Compared with non-HIV drug addicts, HIV drug addicts have significantly higher cravings for induction of drugs. In addition, HIV drug addicts have higher negative self-efficacy, and have lower overall self-efficacy than non- HIV drug addicts. The two groups had positive psychological and life- adjusting effects after multi-integrated treatment. After various stages of treatment, most variables were not significantly different between HIV addicts and non-HIV addicts. But the variable of “Worried about the adaptation of social life in the future” in the group of HIV drug addicts is still significantly higher than non-HIV drug addicts. About the variable of “fear of social life in the future” in the pre-test and post-test, the HIV drug addicts are significantly higher than the non-HIV drug addicts, which shows that HIV drug addicts will face social life adaptation problems after release. Recommendations: The implications of these findings for HIV drug abuser’ research and services are discussed in this study.