藥癮治療性社區概念與本土個案復元歷程之探討

Addiction Therapeutic Community: Concept and Recovery Process of Local Cases

藥癮治療性社區發軔於 1958 年之Synanon，此種治療模式於1960 年代之美國嶄露頭角，並逐步擴張至歐洲，乃至世界各地。有鑑於我國近年來擴大發展此種治療模式，本研究即以此作為研究主題，透過國內外相關文獻之梳理與探討，以增進藥癮治療性社區之文獻論述；同時，本研究訪談藥癮治療性社區之居民、已復元之前居民與工作人員，試圖建構藥癮治療性社區本土個案之復元歷程。藉由文獻回顧與質性研究，期能對藥癮治療性社區有更為全面之理解，以提供學術研究者與實務工作者參考。
關於藥癮治療性社區之概念，本研究發現，藥癮治療性社區是一種充滿希望的人本治療模式，具備關於「違常」、「人」、「復元」、「正確生活」之觀點，在認為人有改變潛能之前提下，將治療重點置於居民本身之改變，並試圖透過各種正向經驗達成之，此與正向犯罪學所採行之方式不謀而合。而藥癮治療性社區亦與時俱進，發展出女性治療性社區、青少年治療性社區、具精神相關問題藥癮者之治療性社區、監獄治療性社區、減害治療性社區、宗教治療性社區等類型，並於社區中採取多元之治療方法，屬富有彈性之治療模式。
此外，本研究訪談利伯他茲治療性社區之3 位居民、2 位已復元之前居民以及5 位工作人員，採取建構主義式扎根理論作為本研究之方法論，以瞭解藥癮治療性社區居民之復元歷程。研究結果發現，居民是透過「建立穩定性」、「取代用藥之價值」以及「減少自我中心」此三個改變以朝向復元邁進。首先，穩定性包含環境穩定性、生理穩定性、關係穩定性、情緒穩定性四者，於藥癮治療性社區中，居民將於各層面建立起穩定性，有別於過往用藥時之不穩定。其次，用藥對於居民而言有其價值，於藥癮治療性社區中，居民將以復元為目標，並透過課程、活動等使居民探索生命之不同可能，從中建立其他努力之方向。居民於追求目標時將付出相應之代價，並於達成目標時將獲得一定之回饋，當面臨復發與否之選擇時，其將對追求目標之價值與用藥之價值進行價值衡量，最終由其他價值取代用藥之價值。最後，居民透過藥癮治療性社區成為榜樣之訓練，以及一直以來感受到被幫助之溫暖，於潛移默化下，逐漸減少自我中心。
根據上述研究發現，本研究提出五項建議：（1）發展上應因應不同需求而細緻化；（2）執行上應注重改變意願之提升；（3）處遇上應強化居民之後續照護與持續支持；（4）研究上應納入發展與生命歷程犯罪學以及復元資本之視角；（5）社會上應減少對於藥癮者之汙名。

The addiction therapeutic community originated from Synanon in 1958. This treatment modality then emerged in the United States in the 1960s and gradually expanded to Europe and around the world. In light of the recent expansion of this treatment modality in Taiwan, this study focuses on it as its main research topic. By reviewing and discussing relevant domestic and international literature, the study aims to enhance the discourse on the addiction therapeutic community. Additionally, this study interviewed residents, ex-residents, and staff of the addiction therapeutic community, aiming to construct the recovery process of local cases. Through literature review and qualitative research, this study seeks to provide a comprehensive understanding of the addiction therapeutic community for academic researchers and practitioners.
Regarding the concept of the addiction therapeutic community, this study finds that it is a hopeful, humanistic treatment modality that includes views of the disorder, person, recovery, and right living. It emphasizes the potential for change in individuals, focusing on the residents’ changes and aiming to achieve these through various positive experiences. This aligns with the related approaches of positive criminology. Moreover, the addiction therapeutic community has evolved over time, developing types such as the female therapeutic community, the adolescent therapeutic community, the therapeutic community for co-occurring disorders, the prison-based therapeutic community, the harm reduction-based therapeutic community, and the religious therapeutic community. In the addiction therapeutic community, diverse treatment methods are provided, resulting in a flexible treatment modality.
Furthermore, this study interviewed three residents, two ex-residents, and five staff members of the Libertas Therapeutic Community, using constructivist grounded theory as the research methodology to understand the recovery process of the residents. The study finds that residents recover by making three key changes: establishing stability, replacing the value of drug use, and decreasing self-centeredness. First of all, stability includes environmental, physical, relationship, and emotional stability. In the addiction therapeutic community, residents establish stability in all these aspects, contrasting with the instability during drug use. Secondly, drug use holds certain value for residents. In the addiction therapeutic community, residents aim for recovery and explore different life possibilities through courses, activities, and other means, thereby building new directions for their efforts. They invest corresponding efforts in pursuing their goals and receive rewards upon achieving them. Thus, when facing the choice of relapse or not, residents weigh the value of pursuing their goals against the value of drug use, ultimately replacing the latter with other values. Finally, through training to become role models for other residents and experiencing the constant warmth of receiving help, residents gradually decrease their self-centeredness.
According to the findings of this study, the following five recommendations are proposed: (1) In the future development of addiction therapeutic communities, approaches should be customized to address the diverse needs of residents; (2) Addiction therapeutic communities should focus on enhancing residents’ willingness to change; (3) Aftercare and continuous support for residents should be strengthened in addiction therapeutic communities; (4) Developmental and life-course criminology, as well as recovery capital, are suggested as perspectives for future research; (5) Society should consider addicts from a more inclusive perspective, instead of stigmatizing them.