社區女性非法藥物使用者童年逆境經歷與不良親密關係之相關性探討

Association Linking Adverse Childhood Experiences with Unhealthy Intimate Relationships among Women Who Used Illegal Drugs in Community

目標：針對生育年齡女性毒品使用者，探討其童年逆境經歷暴露與不良親密關係的相關性。方法：2021年9月至2023年5月於十所台灣北部、南部服務毒品使用者之社區機構進行收案，219名以電腦輔助自我訪談方式完成問卷。十項童年逆境經歷含家庭失能、疏忽、虐待三構面，不良親密關係為未成年性行為、藥愛及親密暴力；相關性分析以邏輯斯迴歸模型進行檢驗。結果：75.3%女性毒品使用者經歷至少一項童年逆境，其中四項（含）以上者佔其中38.8%；四項（含）以上童年逆境經歷暴露顯著增加藥愛以及親密暴力勝算126%及368%。目睹女性照顧者受暴（調整後勝算比=3.08）和性虐待（調整後勝算比=3.55）與藥愛風險增加相關性最強；情感疏忽（調整後勝算比=2.63）、同住家人有物質濫用（調整後勝算比=2.45）則分別與親密暴力和未成年性行為風險增加有關。結論：童年逆境經歷為女性毒品使用者不良親密關係樣態的重要生命早期危險因子。服務方案應考慮將童年逆境經歷納入評估及介入依據，以期減少毒品施用族群之健康傷害。

Objectives: This study investigated the association between adverse childhood experiences (ACEs) and unhealthy intimate relationships among community-dwelling women of reproductive age (16-45 years) who use illegal drugs in Taiwan. Methods: Based on a cross-sectional study design, data were collected using computer-assisted self-interviewing questionnaires (n=219) from September 2021 to May 2023. A 10-item checklist was used to assess the three domains of ACEs (i.e., household dysfunctions, neglect, and abuse). Unhealthy intimate relationships include early sexual initiation, sexualized drug use (SDU)/chemsex, and intimate violence victimization (IPV). Logistic regression analysis was used to evaluate the association estimates. Results: 75.3% had experienced at least one ACEs and 38.8% had four or more ACEs. Exposure to 4+ACEs may increase the odds of early sexual initiation by 101%, and the corresponding risks for SDU/chemsex and IPV were 126% and 368%, respectively. Having a substance-using family member in the household was associated with early sexual initiation (adjusted odds ratio [aOR]=2.45). Witnessing domestic violence (aOR=3.08) and sexual abuse (aOR=3.55) were strongly associated with SDU/chemsex, while parental divorce/separation (aOR=2.21), emotional neglect (aOR=2.63), and emotional abuse (aOR=2.13) were strongly associated with increased IPV. Conclusions: These findings indicate that childhood adversity is common in women who use drugs. The observed increased risk of unhealthy intimate relationships associated with ACEs may highlight the need to address ACEs in addiction intervention or treatment to reduce unfavorable outcomes.