男海洛因勒戒犯之再犯率的危險因子

Risk Factors for Recidivism in Incarcerated Male Heroin Addicts

10.29478/TJP.200603.0004

江淑娟(Shu-Chuan Chiang)；張景瑞(Ching-Jui Chang)；孫效儒(Hsiao-Ju Sun)；陳炯旭(Chiung-Hsu Chen)；詹宏裕(Hung-Yu Chan)；陳為堅(Wei J. Chen)

海洛因 ； 成癮 ； 復發 ； 再犯 ； heroin ； addiction ； recurrence ； relapse

台灣精神醫學

20卷1期（2006 / 03 / 01）

32 - 43

繁體中文

目的：了解被評定為「無繼續施用傾向」之男性海洛因勒戒犯勒戒後的再犯毒品案率與再犯因子。方法：以民國88年間某男子勒戒所內判定為「無繼續施用傾向」之海洛因毒品犯為研究個案，追蹤出所後至91年6月30日間，再接受觀察勒戒率；回顧其資料與有無繼續施用傾向評估記錄探討再犯相關因子。結果：研究個案共93位（佔當年度海洛因勒戒犯的23%），其中43（40位）於兩年的追蹤期間內再度接受觀察勒戒處分。其案發時、入所時以及勒戒前主要濫用安非他命者、工作的類別為攤販或運輸業或工人者，出現再執行觀察勒戒處分的危險比顯著較高；愈年輕的世代出現再執行觀察勒戒處分的危險比可能較高。結論：海洛因為高成癮的物質，即使被判定為「無繼續施用傾向」的海洛因濫用者斷癮後再復發的情形仍相當普遍。目前最迫切需要的，是勒戒處置期間提供更有效、更全面的「再犯預防」相關處遇，以達有效預防復發。

Objective: To investigate the rate and risk factors for recidivism among incarcerated male heroin addicts classified as having low relapse tendency in a male detention center. Methods: All incarcerated heroin-addicts in a detention center in northern Taiwan in 1999 classified as having a low tendency for relapse and released after short periods of detoxification were included. These subjects were followed-up for any recidivism due to illicit drug use by June 2002. Subjects' characteristics prior to recidivism were retrieved from what specific type of records maintained by what type of professional individual who assessed risk of relapse in the subject according to what specific set of criteria during the detention and explored for possible association with recidivism. Results: Among the 93 incarcerated heroin-addicts classified as having low relapse tendency in 1999, 43 (43%) had recidivism during the follow-up period. Young age, multiple substance uses (methamphetamine and heroin), and occupation (vendors or drivers) were the major risk factors associated with recidivism of illicit drug use. Conclusion: Heroin addicts have a very high recidivism rate even when classified as having a low relapsing tendency based on what specific criteria set at the end of detention. More efficient and comprehensive detention-based treatment programs are urgently needed to help prevent heroin addicts' relapse.

1. Chen CC,Tsai SY, L,Su LW(1999).Psychiatric co-morbidity among male heroin addicts: differences between hospital and incarcerated subjects in Taiwan.Addiction,96,825-832.
2. Chiang SC,Chen SJ,Sun HJ,Chan HY,Chen WJ.Heroin Use Among Youths Incarcerated for Illicit Drug Use: Psychosocial Environment, Substance Use History, Psychiatric Comorbidity, and Route of Administration.Am J Addict
3. Chong MY,Chan KW,Cheng AT(1999).Substance use disorders among adolescents in Taiwan: prevalence, sociodemographic correlates and psychiatric co-morbidity.Psychol Med,29,1387-1396.
4. Chou P,Liou MY,Lai MY,Hsiao ML,Chang HJ(1999).Time trend of substance use among adolescent students in Taiwan, 1991-1996.J Formos Med Assoc,98,827-831.
5. Fernandez-Hermida JR,Secades-Villa R,Fernandez-Ludena JJ,Marina-Gonzalez PA(2002).Effectiveness of a therapeutic community treatment in Spain: a long-term follow-up study.Eur Addict Res,8,22-29.
6. Friedman PD,lemon SC,Stein MD,Etheridge RM,D`Aunno TA(2001).Linkage to medical services in the drug abuse treatment outcome study.Med Care,39,284-295.
7. Gossop M,Stewart D,Browne N,Marsden J(2002).Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses.Addiction,97,1259-1267.
8. Graham K,Gillis K(1999).The relationship between psychosocial well-being and alcohol and drug use following substance misuse treatment.Subst Use Misuse,34,1199-1222.
9. Jaffe SL(2002).Treatment and relapse prevention for adolescent substance abuse.Pediatr Clin North Am,49,345-352.
10. Kirchmayer U,Davoli M,Verster AD,Amato L,Ferri A,Perucci CA(2002).A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence.Addiction,97,1241-1249.
11. Marlatt GA,Blume AW,Parks GA(2001).Integrating harm reduction therapy and traditional substance abuse treatment.J Psychoactive Drugs,33,13-21.
12. Marlatte GA,Gordon JR(1985).Relapse prevention.London:Guilford Press.
13. Maulik PK,Tripathi BM,Pal HR.(2002).Coping behaviors and relapse precipitants in opioid dependence: a study from North India.J Subst Abuse Treat,22,135-140.
14. McKay JR(1999).Studies of factors in relapse to alcohol, drug and nicotine use: a critical review of methodologies and findings.J Stud Alcohol,60,566-576.
15. McKay JR,Weiss RV(2001).A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups. Preliminary results and methodological issues.Evaluation Review,25,113-161.
16. McLellan AT,Lewis DC,O`Brien CP,Kleber HD(2000).Drug dependence, a chronic medical illness implications for treatment, insurance, and outcomes evaluation.JAMA,284,1689-1695.
17. McNulty J,Kouimstidis C(2001).Outcomes of treatment interventions in drug abuse.Curr Opin Psychiatry,14,201-205.
18. Regier DA,Farmer ME,Rae DS. LB,Keith SJ,Judd LL,Goodwin FK(1990).Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study.JAMA,264,2511-2518.
19. Schonfeld L,Dupree LW,Dickson-Euhrmann E(2000).Cognitive-behavioral treatment of older veterans with substance abuse problems.J Geriatr Psychiatry Neurol,13,124-129.
20. SPSS international company(1999).SPSS Base 10.0 Software.
21. Warner LA,Kessler RC,Hughes M,Anthony JC,Nelson CB(1995).Prevalence and correlates of thug use and dependence in the United States. Results from the National Comorbidity Survey.Arch Gen Psychiatry,52,219-229.
22. Weinstein HC,Carracansi A,Collins GR,Katez CL,Pandya AA(2002).Outcome mesurements in psychiatry-a critical review.Washington DC:American psychiatric publishing com.
23. White WL(2002).Addiction treatment in the United States: early pioneers and institutions.Addiction,97,1087-1092.
24. 江淑娟、孫效儒、韋海浪、郭錫卿、張一心(2003)。衛生署補助研究計畫期末報告衛生署補助研究計畫期末報告,未出版
25. 李怡慧、楊延光、葉宗烈、羅信宜、李毅達、周裕軒、陳純誠(2001)。看守所藥物濫用勒戒者臨床特徵之性別差異。台灣精神醫學，15，106-115。
26. 李俊穎、林俊輝(2001)。海洛因濫用病患的治療預測模式。台灣精神醫學會四十週年慶祝大會醫學會暨學術研討會論文摘要集
27. 林式穀(1999)。法務部委託台灣精神醫學會研究計畫報告法務部委託台灣精神醫學會研究計畫報告,未出版
28. 林式穀、束連文、蔡長哲(1999)。以拿淬松作鴉片劑成癮維持療法之雙盲研究。中華民國精神醫學會88年度年會暨學術研討會論文摘要
29. 毒品防制條例
30. 法務部、教育部、行政院衛生署(2002)。反毒報告書。
31. 孫效儒、陳美珠、江淑娟、邱瑞祥(2003)。桃園縣政府委託研究計畫報告桃園縣政府委託研究計畫報告,未出版
32. 陳明哲、黃蓉蓉、陳麗櫻、林麗瑞(1999)。台東勒戒治療模式：門診勒戒治療成效評估。中華民國精神醫學會88年度年會暨學術研討會論文摘要
33. 蕭正誠、林式穀、劉興政、呂少鈞、江原麟、陳志根(2003)。勒戒所與精神專科醫院男性安非他命濫用者之臨床比較。台灣精神醫學，17，180-188。
34. 羅信宜、楊延光、陳純誠、葉宗烈、李怡慧、李毅達、周裕軒(2002)。看守所藥物濫用高再施用傾向勒戒者之臨床症狀。台灣精神醫學，16，285-291。

1. 蔡毓瑄、黃心蔓、張永源、秦文鎮、侯瑞瑜(2010)。美沙冬替代療法對於海洛因成癮者藥物濫用信念及生活適應之成效分析。臺灣公共衛生雜誌，29(5)，420-430。
2. (2024)。從毒癮犯罪者在精神醫學之本質談其犯罪預防之保安處分運用。刑事政策與犯罪防治研究專刊，38，149-190。