戒除抑或減害：台灣藥愛防治專業人員之處遇經驗與觀點

Abstinence versus harm reduction: experiences and perspectives of chemsex service providers in Taiwan

目標：本文旨在探討藥愛防治專業人員之處遇取向觀點及可能影響因素。方法：經立意取樣招募17位具有藥愛防治經驗的專業人員進行深度訪談，調查其專業訓練習得之處遇取向，及其執業場域和工作經驗對該取向的影響。結果：受訪者的處遇取向可分為戒除、減害，以及介於兩者之間這三類。受訪之精神科醫師與臨床心理師多數傾向支持戒除，其依據理由為：腦科學實證、重建社會適應，及施用成癮物質的刑責。減害傾向的受訪者之專業背景較多元，主要在民間機構從事性健康與愛滋防治，其主張為：停用成癮物質非唯一目標、重視個案參與復元的動機，並提供務實協助。實務上，半數戒除取向的受訪者調整為「在戒除與減害之間」或減害取向，只有一名減害取向的受訪者往兩種取向之間調整。處遇調整的考量有：以個案需求為中心以及如何落實處遇。結論：專業人員面對藥愛議題時須以個案為中心，並體察法規、社會與照護系統對於藥愛處遇近用的障礙，從而開發友善、支持的處遇方案。

Objectives: This study explored the perspectives of chemsex service providers and the factors influencing their treatment approaches. Methods: Through purposive sampling, this study interviewed 17 experienced chemsex service providers to examine approaches acquired during training and how practice settings and experiences influence approach. Results: Participants were categorized into three groups on the basis of their treatment approach: abstinence, harm reduction, and an approach situated between the aforementioned two approaches. Most participants supported abstinence, basing their approach on evidence-based neuroscience, social reintegration needs, and the legal ramifications of substance use. Participants favoring the harm reduction approach were from diverse professional backgrounds, primarily working in nongovernmental organizations focused on sexual health and HIV prevention. They argued against a sole focus on abstinence, prioritizing the client’s motivation and participation and providing pragmatic assistance. In practice, half of those in the abstinence group adapt their methods to incorporate more flexibility or to align with the harm reduction approach. By contrast, only one participant from the harm reduction group modified their stance. Shifts in approach generally reflect an emphasis on client needs and the effective implementation of treatment plans. Conclusions: Chemsex service providers must embrace client-centered approaches and recognize the barriers to care imposed by legal regulations, social contexts, and the health-care system and develop supportive and inclusive treatment strategies.