物質使用障礙症個案之矩陣治療模式：系統性文獻回顧

The Matrix Model for Patients with Substance Use Disorder: A Systematic Review

研究目的：矩陣治療模式是一種結構化的密集治療方案，主要針對古柯鹼或甲基安非他命使用障礙症的患者，該治療模式結合了多種心理治療方法，已被廣泛運用於物質使用障礙症的治療當中。本研究有三個主要目的：第一，藉由回顧矩陣治療模式的療效研究，探究其發展脈絡及理論架構，歸納其治療性因素及限制；第二，回顧不同文化背景下應用矩陣治療模式的成效，歸結出可能影響治療效果的潛在因素；第三，考量臺灣的社會文化，提出矩陣治療模式應用在國內藥癮治療領域中的建議。研究方法：本研究檢索國際醫療實證資料庫及國內中文資料庫，由兩位精神專科醫師評讀文獻，評估其實證證據等級，最終從377篇文獻中篩選出9篇符合矩陣治療模式設計架構，並提供尿液藥物篩檢結果、成癮嚴重度、留置率和停用成癮物質時間等療效指標的文獻進行分析。研究結果：第一，矩陣治療模式具有結構化課程、操作手冊及定期監測機制，可在不同的場域中使用，而其治療效果與留置率和參與程度有關，因此個案須持續投入治療活動才能有所成效；第二，個案接受治療的時間會受經濟收入及社會地位的影響；第三，與回顧的文獻相比，臺灣有高比例非自願就醫的緩起訴個案，治療者需考慮如何提升他們的治療意願。研究結論：由於矩陣治療模式有劑量–反應關係，如何在治療頻率與治療效果之間取得平衡，將會是臺灣發展本土化矩陣治療模式的一大挑戰。此外，考慮到臺灣的社會文化背景，將司法和社會福利系統與醫療保健系統整合也相當重要。

Purpose: The Matrix Model is a structured, intensive treatment protocol that has been widely used in the treatment of substance use disorders, especially for cocaine or methamphetamine use disorders. The model has also been combined with numerous psychological treatment approaches. This study has 3 primary purposes. The first is to abstract the therapeutic factors and limitations of the Matrix Model by exploring the developmental context and theoretical framework presented in the literature. The second purpose is to summarize the potential factors that affect treatment results, which we achieve by reviewing the relevant literature on the effectiveness of the Matrix Model with people of different cultural backgrounds. Our third purpose is to suggest precautions for applying the Matrix Model in Taiwan. Methods: We first searched international medical empirical databases and domestic Chinese databases to identify 377 potential articles for analysis. Two reviewers, who were psychiatrists, independently selected 9 focal studies for the literature review that conformed to the Matrix Model design and included outcome measurements such as addiction severity, urine toxicology results, retention rates, and the length of abstinence. Results: The literature review confirmed that the Matrix Model has a structured curriculum design with specific operation manuals and a routine monitoring system that can be used in different clinical settings. Therapeutic effectiveness corresponded to the retention rate and the degree of participant engagement. Clients needed to engage constantly in intensive interventions to achieve positive outcomes. According to the literature review, the amount of time a patient spent on interventions may be affected by income and social status. As compared to the patient populations in the review articles, Taiwan has a relatively high proportion of clients who were judicially referred for treatment as part of a deferred prosecution program. These clients do not necessarily have enthusiasm for participating in mandatory treatment. How to enhance their willingness to participate is an open question. Conclusions: The Matrix Model appears to have a dose-response relationship with positive outcomes. Achieving a balance between treatment frequency and therapeutic effects is the key to culturally adapting the Matrix Model in Taiwan. Additionally, it will be important to integrate the judicial and social welfare systems into the health care system in order to maximize results in mandatory treatment programs.