社會支持網絡之再建構：民間宗教型戒癮安置服務內涵的質性分析

Rebuilding Social Support Network of Substance Abusers: A Qualitative Inquiry into the Services in Faith-based Residential Treatment Centers

10.6171/ntuswr.202112_(44).0002

韓意慈(Yih-Tsu Hahn)

社會支持網絡 ； 物質濫用處遇 ； 戒癮治療性社區 ； 福音戒毒 ； 復元 ； social support network ； treatment for substance abuse ； therapeutic community ； faith-based treatment for addiction ； recovery

臺大社會工作學刊

44期（2021 / 12 / 01）

45 - 84

繁體中文

目標：當前的戒癮處遇工作由單純的監禁與醫療，轉向更多元、長期的服務，但關於安置處遇模式的文獻有限。本研究的目的是以社會網絡處遇的概念，分析民間戒癮安置服務如何進行中長期服務的內涵及其運作方式。方法：本研究以質性研究的焦點團體訪談法進行，針對三所成立已久的民間宗教型戒癮機構，邀請組織內八個不同安置處所之生輔人員及社工等（共計13位）進行焦點團體訪談，並將逐字稿內容運用質性研究軟體Nvivo 12加以分析。結果：在社會網絡處遇的服務模式內涵上，分析為建立內部新連結、重塑家庭舊連結、增進外部連結，以及連結同儕工作者與非過來人的經驗。結論：藉形塑內部規範、文化與信仰，戒癮社區協助戒癮者建立新的認同；藉減少或增加與家庭互動，戒癮安置服務協助形成正向的復元支持資源；藉向外擴展連結關係，穩定戒癮者社會適應的其他資源；藉同儕工作者與非過來人合作，增強戒癮復元的成效。建議戒癮安置服務應更著重發展同儕為基礎的各樣支持服務、應更為關注女性戒癮者及其家庭獨特的需求、應對內更深入文化與認同議題、對外更擴大與教會以外單位的連結。目前政策上戒癮同儕工作者缺乏明確的認定，相關方案補助辦法中皆具高中以上學歷之要求，使部分具正向戒癮經驗者不易留任成為同儕工作者。建議政府相關單位正視此問題，以增進戒癮處遇的多元性，鼓勵民間組織投入中長期戒癮安置服務。

Objectives: Substance abuse treatments are gradually replacing incarceration with multiple, longitudinal treatment arrangements in Taiwan. Few studies have been conducted on how substance abusers are guided in rebuilding social support networks during recovery. The purpose of this study was to investigate social support network implications of services for recovery in nonprofit residential treatment centers. Methods: This study adopted a qualitative research design, and conducted three focus-group interviews with 13 living care assistants, social workers and directors from 8 residential centers. The interview data were converted into transcripts for analysis with Nvivo12. Results: The social support network implications of services for recovery include four dimensions: rebuilding new connections with people in the centers, reframing original connections with family members, extending outside connections with people outside the centers, and enhancing collaboration of peer workers and professional workers. Conclusions: It is recommended that residential treatment centers increase resources on services of social support network for abstinence. Peer support services are valuable in the service model. Specific services for female substance abusers and their families are needed in the treatment procedures. Policy should evaluate the subsidy requirements linked to education level to encourage people with recovery experiences to remain as peer workers.

1. 陳玟如, W.-J.,鄭麗珍, L.-C.(2017)。飲鴆止渴的病人：徘徊於正規醫療與自助醫療的毒品使用者。臺大社會工作學刊，35，47-92。
   連結：
2. 陳碧珍, P.-T(2011)。宗教戒毒歷程中生命轉化與家人關係復和的探究。犯罪學期刊，14(2)，1-39。
   連結：
3. 蔡佩真, P.-J(2019)。藥癮康復者復元評估與社會復歸之相關性研究。東吳社會工作學報，36，57-85。
   連結：
4. 蔡佩真, P.-J.(2019)。兒女傷、父母痛：K 他命成癮者父母的傷痛經驗與搶救行動。臺大社會工作學刊，39，1-55。
   連結：
5. 蕭怡真, Y.-C.,陳俊元, C.-Y.(2014)。保護傘或雙面刃：談社會資本對多重物質濫用之影響。中華心理衛生學刊，27(1)，1-36。
   連結：
6. Biegel, D. E.,Tracy, E. M.,Corvo, K. N.(1994).Strengthening social networks: Intervention strategies for mental health case managers.Health & Social Work,19(3),206-216.
7. Cano, M. Á.,Sánchez, M.,Rojas, P.,Ramírez-Ortiz, D.,Polo, K. L.,Romano, E.,De La Rosa, M.(2018).Alcohol use severity among adult Hispanic immigrants: Examining the roles of family cohesion, social support, and gender.Substance Use & Misuse,53(4),668-676.
8. Comfort, M.,Sockloff, A.,Loverro, J.,Kaltenbach, K.(2003).Multiple predictors of substance-abusing women’s treatment and life outcomes: A prospective longitudinal study.Addictive Behaviors,28(2),199-224.
9. Eddie, D.,Hoffman, L.,Vilsaint, C.,Abry, A.,Bergman, B.,Hoeppner, B.,Kelly, J. F.(2019).Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching.Frontiers in Psychology,10
10. Evans, E. A.,Glover, D. L.,Washington, D. L.,Hamilton, A. B.(2018).Psychosocial factors that shape substance abuse and related mental health of women military veterans who use community-based services.Substance Use & Misuse,53(11),1878-1892.
11. Flora, K.,Stalikas, A.(2012).Factors affecting substance abuse treatment in Greece and their course during therapy.Addictive Behaviors,37(12),1358-1364.
12. Gunn, A. J.,Canada, K. E.(2015).Intra-group stigma: Examining peer relationships among women in recovery for addictions.Drugs: Education Prevention and Policy,22(3),281-292.
13. Harvey, R.,Jason, L. A.(2011).Contrasting social climates of small peer-run versus a larger staff-run substance abuse recovery setting.American Journal of Community Psychology,48(3-4),365-372.
14. Hussey, D.,Flynn, K. C.(2019).The utility and impact of the addiction comprehensive health enhancement support system (ACHESS) on substance abuse treatment adherence among youth in an intensive outpatient program.Psychiatry Research,281
15. Kitzinger, J.(1994).The methodology of Focus Groups: the importance of interaction between research participants.Sociology of Health Healing and Illness,16(1),103-121.
16. Lipira, L.,Williams, E. C.,Nevin, P. E.,Kemp, C. G.,Cohn, S. E.,Turan, J. M.,Rao, D.(2019).Religiosity, social support, and ethnic identity: Exploring “Resilience Resources” for African-American women experiencing HIV-related stigma.Jaids-Journal of Acquired Immune Deficiency Syndromes,81(2),175-183.
17. Lister, J. J.,Brown, S.,Greenwald, M. K.,Ledgerwood, D. M.(2019).Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic.Substance Abuse,40(2),185-193.
18. McCarron, H.,Griese, E. R.,Dippel, E.,McMahon, T. R.(2018).Cultural and social predictors of substance abuse recovery among American Indian and Non-American Indian pregnant and parenting women.Journal of Psychoactive Drugs,50(4),322-330.
19. McGaffin, B. J.,Deane, F. P.,Kelly, P. J.,Blackman, R. J.(2018).Social support and mental health during recovery from drug and alcohol problems.Addiction Research & Theory,26(5),386-395.
20. National Institute on Drug Abuse. (2019). Science Highlight: Cues give clues in relapse prevention. Retrieved from https://www.drugabuse.gov/news-events/science-highlight/cues-give-clues-in-relapse-prevention
21. Panebianco, D.,Gallupe, O.,Carrington, P. J.,Colozzi, I.(2016).Personal support networks, social capital, and risk of relapse among individuals treated for substance use issues.International Journal of Drug Policy,27,146-153.
22. Paterno, M. T.,Low, M.,Gubrium, A.,Sanger, K.(2019).Mothers and mentors: Exploring perinatal addiction and recovery through digital storytelling.Qualitative Health Research,29(4),545-556.
23. Tarantino, N.,Kuperminc, G. P.,Parrott, D. J.,Latzman, R. D.(2013).Family support mediates the association between substance use severity and suicidal ideation in early adult emergency department patients.International Journal of Mental Health and Addiction,11(6),672-681.
24. United Nation Office on Drugs and Crime(2020).World Drug Report 2020.
25. Vaughn, M. S.,Deng, F.,Lee, L. J.(2003).Evaluating a prison-based drug treatment program in Taiwan.Journal of Drug Issues,33(2),357-383.
26. von Greiff, N.,Skogens, L.(2017).Positive processes of change among male and female clients treated for alcohol and/or drug problems.Journal of Social Work,17(2),186-206.
27. White, W. L.(2010).Nonclinical addiction recovery support services: History, rationale, models, potentials, and pitfalls.Alcoholism Treatment Quarterly,28(3),256-272.
28. White, W. L.,Evans, A. C.(2014).The recovery agenda: The shared role of peers and professionals.Public Health Review,35(2),1-15.
29. 王皇玉, H.-U.(2010)。台灣毒品政策與立法之回顧與評析。月旦法學雜誌，180，80-96。
30. 朱群芳, D.,巫梓豪, T.-H.,李潼蕙, T.-H.,賴苓蕙, L.-H.(2019)。負面情緒、自我效能、治療同盟與同儕支持對毒癮戒治處遇效果影響程度之探討。藥物濫用防制，4(2)，75-103。
31. 宋麗玉, L.-Y.(2012)。社會支持網絡、壓力因應與社會網絡處遇。社會工作理論：處遇模式與案例分析，台北=Taipei, Taiwan:
32. 李自強, T.-C.(2002)。安置輔導執行的因應策略―從社工與司法的觀點出發。朝陽人文社會學刊，1(1)，101-120。
33. 李思賢, S.-H.,徐倩, Q.,蔡孟璋, M.-C.(2019)。分流處遇模式的提出與推行：以高雄毒品犯緩起訴分流處遇為例。藥物濫用防治，4(2)，57-74。
34. 李思賢, S.-H.,吳憲璋, S.-C.,黃昭正, C.-C.,王志傑, C.-C.,石倩瑜, C.-Y.(2010)。毒品罪再犯率與保護因子研究：以基隆地區為例。犯罪學期刊，13(1)，81-105。
35. 法務部（2015）。〈矯正機關收容施用毒品者及其再犯情形〉，取自 https://antidrug.moj.gov.tw/lp-1197-2.html
36. 高明瑞, M.-R.,林美專, M.-C.(2020)。毒品戒治之跨域治理解析－以台灣基督教福音戒毒為例。公共事務評論，18(2)，79-105。
37. 高明瑞, M.-R,林美專, M.-C.(2020)。福音戒毒在兩岸四地之發展初探。公共事務評論，18(2)，1-40。
38. 高迪理, T.-L.(1991)。社會支持體系概念之架構之探討。社區發展季刊，54，24-32。
39. 張芬芬, F.(2010)。質性資料分析的五步驟：在抽象階梯上爬升。初等教育學刊，35，87-120。
40. 張淑慧, S.-H.,張文賢, W.-H.(2019)。施用毒品者家庭的社會安全網。社區發展季刊，165，220-235。
41. 莫少珍, S.-J.,李文茹, W.-R.(2014).雕鏤三十：臺灣晨曦會福音戒毒三十年成長路.新北市=New Taipei City:財團法人基督教晨曦會=Operation Dawn.
42. 郭玟蘭, W.-L.,王振宇, J.-Y.(2011)。藥癮者家屬負荷量初探。社區發展季刊，134，559-567。
43. 楊士隆, S.-L.,李思賢, S.-H.,鄭凱寶, K.-P.,顧以謙, Y.-C.,劉子瑄, T.-H.,溫梅君, M.-C.(2017)。緩起訴與觀勒戒治第二級毒品施用者施用相關經驗之比較研究。藥物濫用防制，2(4)，1-32。
44. 楊冀華, C.-H.,林健陽, C.-Y.,陳佑杰, Y.-C.,陳玉書, Y.-S.(2020)。毒品施用者司法處遇效能之定群研究。藥物濫用防制，5(2)，55-88。
45. 劉亦純, Y.-C.,李昆樺, K.-H.,蔡協利, S.-L.(2014)。毒品成癮者及其家人在家庭功能與家庭需求之比較。矯正期刊，3(1)，1-42。
46. 潘秋月, C.-Y.(2011)。Pingtung, Taiwan，美和科技大學健康照護研究所=Meiho University。
47. 蔡佩真（編）, P.-J. (ed.)(2016).物質濫用社會工作實務手冊.高雄市=Kaoshung, Taiwan:巨流=Chuliu.
48. 衛生福利部心理及口腔健康司（2020）。〈醫療、司法及毒防中心齊聚，強化緩起訴附命戒癮治療制度共識與藥癮服務網絡〉。取自 https://www.mohw.gov.tw/cp-16-55979-1.html 【Department of Mental and Oral Health, Ministry of Health and Welfare. (2020). Medical, judicial, and drug prevention centers gather to strengthen the consensus on the prosecution and addiction treatment system and the drug addiction service network. Retrived from https://www.mohw.gov.tw/cp-16-55979-1.html】
49. 衛生福利部食品藥物管理署=Food and Drug Administration(2019)。衛生福利部食品藥物管理署（2019）。〈108 年度藥物濫用防制指引〉。取自https://www.fda.gov.tw/tc/includes/GetFile.ashx?id。https://www.fda.gov.tw/tc/includes/GetFile.ashx?id=f637096824037400269
50. 謝臥龍（編）, Vincent(Ed.)(2004).質性研究.台北市=Taipei, Taiwan:心理出版社=Psychological publishing.
51. 謝雨生,Y.-S.(2012)。研究設計。社會及行為科學研究法：總論與量化研究法，台北市=Taipei, Taiwan:

1. 韓意慈(2022)。規模重要嗎？民間宗教型戒癮安置機構的組織運作差異。行政暨政策學報，75，69-102。
2. 謝沛怡,陳星宜,陳昕榆,朱群芳(2023)。憂鬱、賦權、家庭支持與在監個人進展之相關性：針對台灣女性受刑人的實證研究。臺大社會工作學刊，47，1-53。
3. (2023)。誰會待得久？戒癮者於宗教型戒癮安置機構留置期間的影響因素。中華心理衛生學刊，36(4)，361-385。
4. (2023)。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。刑事政策與犯罪防治研究專刊，36，139-191。
5. (2024)。戒癮動機中的處遇準備與家庭支持的關聯性：針對社區處遇中物質使用者的分析。台灣公共衛生雜誌，43(4)，371-382。