臺灣藥癮者健康行為模式與社會服務取向

The Health-Seeking Behavior of Drug aAddicts in Taiwan and a Social-Services Approach

對藥癮者而言，是需要互相信賴的合作與協調的處遇方法，須由社會與藥癮者共同面對的困難，本研究期待探討推動社區化藥癮戒治方案的成效與困境。首先以戒治所收容的藥癮者為研究對象，參考健康信念模式（health belief model）瞭解其就醫行為，再者針對毒品危害防制中心相關業務負責人員及醫療機構執行美沙冬（methadone）療法之團隊成員進行焦點團體訪談，以進一步了解推動藥癮戒治個案社區化工作模式的看法。研究分析歸納出藥癮戒治服務團隊面臨的困境包含：（1）各機構間的個案管理工作權責有待協調整合；（2）藥癮個案聯繫追蹤困難重重，需要更多配套機制及技巧；（3）仍需加強各機構間垂直委任關係並提高其互動緊密度。藥癮戒治工作模式儼然發展出團隊工作模式，本研究依輔導人員服務面臨的困境，期能透過（1）以個案管理模式來整合藥癮戒治服務團隊；（2）政府政策是推動個案管理工作的重要主導力量；（3）儘速法制化毒品危害防制中心的組織定位，以發展出整合及協調的機制。此外，藥癮個案接受減害計畫方案確實能使其情況日漸穩定，團隊服務的成效也獲得個案肯定，為達藥癮個案面對藥物濫用的成癮行為與藥癮戒治的管理之雙贏局面，建議加強各機構間個案管理工作的統合，並建構更具持續性、多元性的藥癮戒治社區化政策，同時法制化及強化毒品危害防制中心的功能。

Drug addicts are in need of a reliable community scheme that encourages them to make a determined effort to turn over a new leaf. Given that drug addicts are isolated in the state from the society. This study first employed the health belief model to investigate the health-care-seeking behavior of drug addicts at a treatment center and then conducted focus-group interviews with practitioners at drug abuse prevention centers and with methadone replacement therapy to explore their opinions on the implementation of a community-based customized drug treatment program. The plight faced by drug addiction physical therapy services team comprises: (1) the jobs and duties of the local drug treatment practitioners should be integrated to handle individual cases; (2) drug treatment institutions should coordinate their authority and responsibility regarding case management; (3) government intervention is the driving force behind the implementation of case management. Team to develop integration and coordination mechanisms: (1) the considerable difficulty in tracing individual addicts should entail more contingency approaches; (2) supervisor-subordinate communication at drug treatment institutions should be improved; and (3) drug abuse prevention centers should be empowered to exercise some extent of legal authority. This study also found that drug addicts previously involved in a harm-reduction program would live a progressively better life. Therefore, to create a win-win situation between drug addicts and drug treatment management systems, case management tasks performed by each treatment institution in a local region should be coordinated, thereby yielding a sustainable, varied community-based treatment program and enhancing the capabilities drug abuse prevention centers.