司法系統中女性成癮與精神共病者的需求──美國處遇經驗對附條件緩起訴之啟發

The Needs of Women with Substance Use Disorders and Co-occurring Mental Illnesses in the Criminal Justice System−Inspiration for Conditional Deferred Prosecution from the U.S. Experiences

物質成癮者多數合併精神疾患，共病增加再犯與藥癮復發。女性成癮與精神共病者曾遭受暴力與創傷經驗比例遠高於男性，有其特定需求，但卻經常被忽視。鑑於附條件緩起訴處分已成為國內司法轉向處遇最重要政策之一，本文藉由探討女性成癮與精神共病風險因子與康復因子，以及美國司法系統之藥癮精神共病處遇作為，從而瞭解可供我國參採之處。本文首先探討國內外女性成癮與精神共病的相關因素，歸納風險因子包括多重創傷、扭曲人際互動基模、負面情緒與壓力、健康問題、多重藥物副作用等內在風險因子，以及恥感與性別歧視、欠缺經濟資源、居住處所、社會支持不足、單一服務模式等外在風險因子。康復因子則有：提供支持性輔助措施、強化家庭與社會支持、創傷與多元文化問題回應等。其次，檢視美國司法部司法與心理健康合作計畫（Justice and Mental Health Collaboration Program, JMHCP）、Stephanie Covington採取創傷與性別知情角度所發展的「女性整合性處遇」（Women’s Integrated Treatment, WIT），指出適合於藥癮精神共病女性的處遇模式原則與實施基準及網絡合作重點，並討論臺灣附條件緩起訴處分的實施程序與落差。
本文根據檢視結果，提出以下幾點建議供臺灣相關政策與實務參考：一、建立具創傷與性別知情的評估與戒癮程序；二、建構與啟動跨網絡司法照護體系；三、整合社區資源發展女性需求為本的多元處遇模式；四、提升專業人員的創傷與性別知情知能；五、深化女性成癮與精神共病實證研究與循證治療模式發展。

Most individuals with substance addiction also have cooccurring mental disorders. Female substance addiction patients are more likely to have experiences of violence and trauma, but these specific needs are often overlooked. This article explores factors related to female addiction and comorbid mental disorders, as well as integrated treatment approaches in the United States, providing insights for our country.
The article analyzes factors related to female addiction and comorbid mental disorders. Internal risk factors include multiple traumas, interpersonal difficulties, stress, and health issues. External risk factors encompass shame, gender discrimination, economic difficulties, housing instability, and insufficient social support. Recovery factors involve providing supportive interventions, strengthening family and social support, and addressing trauma and cultural diversity issues.
Based on the research findings, the article proposes the following recommendations for Taiwan’s policies and practices: 1.Establish trauma-informed and gender-responsive assessment and treatment procedures; 2.Construct and launch a cross-network Justice and Mental Health care system; 3.Integrate community resources to develop a diverse treatment model based on women’s needs; 4.Enhance the knowledge and skills of professionals in trauma and gender responsiveness; and, 5.Deepen evidence-based research and the development of evidence-based treatment models for female addiction and comorbid mental disorders.