支持性就業於物質使用障礙症的應用

Application of Supported Employment in Individuals with Substance Disorder

對於物質使用障礙症者來說，復健的路是漫長的，尤其在就業這一塊，穩定維持是困難的，其就業史、社會烙印和曾有刑事司法案件現象可能造成求職困難。研究顯示，物質使用障礙症者就業的負向行為與阻力包括：出勤不一致、應對壓力障礙、組織問題和集中注意力困難；而且物質使用障礙症多為低自尊、尋求立即滿足等特質，不僅受雇率低，就業後的就業穩定性也低。目前支持性就業的職業重建模式，是國內外針對有就業困難的身心障礙者發展較為成熟的就業協助服務。國外文獻顯示，支持性就業服務模式不僅有利於提高身心障礙者的就業率，對物質使用障礙症者的受雇成效也有所探討。而我國對身心障礙者的支持性就業服務成效，仍以就業人數為主要成效指標，但並未應用於物質使用障礙症者。本文採用文獻回顧方式，了解11篇文獻中之支持性就業方案之需求與成效評估方式，以了解物質使用障礙症者之就業協助服務模式，並探討應用於國內物質使用障礙症者之可行性。文獻回顧發現，國外針對物質使用障礙症就業協助服務方案之需求研究，探討物質使用者出監、出院轉銜都確有就業需求，認為職業協助是轉銜的重要內涵之一。另針對支持性就業之成效分析，支持性就業對物質使用障礙症者之就業確實有所助益，研究顯示，對物質使用障礙症者施行支持性就業服務的6個月至1年內，對就業率和就業穩定度有顯著幫助，但追蹤期拉長至1年至2年後，則和無施予支持性就業組沒有顯著差異。因此，傳統支持性就業服務模式可能對物質使用障礙患者的長期助益較弱，此一特殊族群所需要復健治療必須是多元且複合式（涵蓋家庭、社區、雇主、就業輔導、提高出監後就業支持頻率與延長支持期程…等），職業向度猶如拼圖中的一片，可讓對這一族群之治療與服務更完整。 Rehabilitation for persons with substance use disorder (PSUD) is a long process, especially when the goal of rehabilitation is sustained employment. PSUDs often experience difficulty finding employment because of poor working history, social stigma, and criminal justice events. Studies have shown that the barriers of employment in PSUDs include unstable attendance, stress management deficits, disorganization and poor attention. Other factors associated with low rate of employment and unstable employment in PSUD are low self-esteem and impulse seeking immediate fulfilment of needs of substance. Supported employment is a mature service model helping persons with severe disability finding and sustained a job position. Results of literature review showed that supported employment service can improve rate of employment and other employment related issues in both persons with disability and SUD. However, supported employment has not implemented in PSUDs in Taiwan. This report aimed to explore the potential of implementing supported employment service in PSUDs in Taiwan and the possible effects of supported in improving employment and work ability of PSUDs. The results of literatures review showed that there are needs of transition into employment among PSUDs when released from the prison. Furthermore, the literature showed that PSUDs can benefit from supported employment service in terms of rate of employment and sustaining a job when they were followed at 6 months to one years after the supported employment was implemented. But the long-term effects of supported employment were minimal. We therefore suggested that traditional supported employment might not as effective as multiple and compound rehabilitation model which in-cooperates family members, community, employer, placement specialist, extended period and frequency of support, might be indispensable in the rehabilitation of PSUDs.