保護傘或雙面刃？談社會資本對多重物質濫用之影響

Protective Umbrella or Double-Edged Sword? The Impact of Social Capital on Multiple Substance Abuse

研究目的：物質種類越趨多樣化，不少使用者逐漸從單一物質轉為混用多重物質。鑒此，發展多重物質防制模式有其必要性，且首要任務在於尋找不同物質的共同保護及危險因子。近十年來，建置社會資本被視為疾病預防與健康促進的重要策略，本文透過文獻回顧，探究社會資本對於物質濫用行為的影響，並嘗試解決以往單一物質防制模式所面臨的侷限（如不同物質之間的高度替代性）。研究方法：以ISI Web of Knowledge、PubMed與Airiti Library華藝線上圖書館文獻資料庫為主，搜尋並整合相關實徵研究，釐清下列問題，包括：社會資本是什麼？社會資本能夠降低物質濫用的風險嗎？影響機制為何？有無可能作為多重物質的防制策略？研究結果：社會資本的核心本質係人際關係與互動，其結構與功能面向密不可分。社會資本對多種物質濫用行為具保護效果，以其來規劃多重物質防制策略應可避免物質濫用者在介入方案實施後轉用其他物質。但必須注意，社會資本功能在不同結構下可能產生不同影響。研究結論：社會資本在多重物質防制的應用上相當具有潛力，但策略規劃應同時將結構與功能面向納入考量。本文針對未來研究方向提出建議：（1）設計細緻的社會資本指標；（2）探討不同社會資本的互動關係；（3）分析社會資本對物質濫用行為的各種效應；（4）採縱貫式研究設計以確立因果關係；（5）探討各種社會資本運用於多重物質防制模式之成效。本文除了希望能夠激發討論外，亦提供吸菸、酗酒、藥物濫用之預防及治療實務工作的新思維。

Purpose: Substance abuse has become increasingly diverse in recent years. Many abusers have moved from using one to multiple substances. It is necessary to develop a multiple substances control policy. The first task towards this goal is to identify the common protective and risk factors for various substance abuse behaviors. For nearly a decade, building social capital has been viewed as an important strategy for disease prevention and health promotion. The aim of this study is to explore the impact of social capital on substance abuse and to try to resolve the constraints that single substance prevention policies have encountered (i.e., most substances have a variety of substitutes). Methods: We review and integrate empirical research based on a search conducted on the ISI Web of Knowledge, PubMed, and Airiti Library databases to clarify the following issues: What is social capital? Can social capital reduce the risk of substance abuse? What is the mechanism? Can social capital be a useful preventive strategy for abuse of multiple substances? Results: The core essence of social capital is interpersonal relationships and interactions; its dimensions of structure and function are inseparable. Social capital is protective against many kinds of substance abuse behaviors. Planning multiple substance prevention strategies by building social capital may be integral to preventing abusers from moving to other substances after implementation of the intervention program. However, the functional elements of social capital may have a different impact on different structures. Conclusions: Health educators should apply social capital in multi-substance abuse prevention, but they should consider both the dimensions of structure and function in strategy development. We suggest future research should focus on: (1) identifying detailed indicators of social capital; (2) exploring the interactions between different forms of social capital; (3) analyzing various effects of social capital on substance abuse; (4) designing longitudinal research to explore causality; (5) exploring the effectiveness of multi-substance abuse prevention plans with social capital. We hope to stimulate discussion on preventing and treating smoking, alcoholism, and drug abuse.