改善藥癮治療性社區居民外出外宿飲酒行為方案

An Intervention Program for Drug Addicted Patients Receiving Community Therapy to Overcome Alcohol-Drinking Problems

10.6847/TJPMHN.201410_9(1).0003

林春旭(Chuen-Shiuh Lin)；邵亞婷(Ya-Ting Shao)；黃惠寬(Hui-Kuan Huang)；邵文娟(Wen-Chuan Shao)；李世凱(Shi-Kai Lee)

藥癮 ； 治療性社區 ； 標準流程 ； 飲酒行為 ； Drug Addiction ； Therapeutic Community ； Standard Procedure ； Alcohol-Drinking Behavior

精神衛生護理雜誌

9卷1期（2014 / 10 / 01）

20 - 29

繁體中文

本專案旨在降低居民外出外宿飲酒行為；統計2010年某精神科專科醫院藥癮治療性社區居民外出外宿飲酒行為達86.2%。經心理社會相關因子評估、會談、觀察法及蒐集其他資料並進行分析，發現主要問題為居民錯誤飲酒認知、安全檢查流程未統一、個案管理師會談內容遺漏外出外宿飲酒行為、會談時間與外出外宿時間間隔太久、無飲酒規定供居民遵守、外出外宿無聊時不知如何排遣時間、無酒精檢測工具等。本專案小組人員針對以上問題提供居民認知團體治療與行為治療並建立安全檢查流程、飲酒規範、設計休閒計畫表及評值表、修訂會談時間及會談指引內容、增設酒精測試儀等。結果居民外出外宿飲酒行為降至39.2%。藉此專案經驗改變居民飲酒動機，內化社會規範，並建立標準化作業，使此治療模式的運作與執行更為具體，以永續提供安全穩定的治療性社區。

Alcohol-Drinking problems seem commonly occur among drug addicts. In 2010, a drug addicted therapeutic community managed by a psychiatric hospital in central Taiwan estimated 80.6% of their residents have had alcohol-drinking problems while taking leaves or staying in outside accommodation away from home. This program in our paper is aimed to assess, from both sides of patients and providers, the contributable factors to the existing alcohol-drinking problem and further to present an intervening strategy to decrease the phenomenon of drinking alcohol. According to the psycho-social aspects, the causes for residents who have suffered from alcohol-drinking were investigated and assessed through evaluation scales, interviews and observation. The data on practice guidelines and performance of the staff were also collected. The research results suggested that individual factors responsible for alcohol-drinking addictive deeds should possibly include: the residents' misperception toward alcohol consumption, peer influence, emotional fluctuation, incapability of managing time and stress, and craving mind for substances. Based on the case manager's observation, other professional factors affecting alcoholic addiction could be junior nursing staff lacking capability of rendering behavioral assessment to those patients, intervening alcohol-drinking problems inconsistently. The effect of drinking was overlooked in patients' behavioral assessment, and there were no guidelines provided for interviews in time. As to the administrative aspect, the compliant regulations and tools were not available, such as security procedures, rules for alcoholic drinks, alternative recreation plans and criteria during taking leaves or staying in accommodation away from home, and as well as alcohol-breath detector. From the above-accumulated analyses, several intervention measures were recommended to be taken into consideration as follows: 1. adopting cognitive-behavioral group therapy; 2. designing a standard procedure for safety check, recreation plan and criteria while taking leaves or staying in accommodation away from home; 3. Setting necessary guidelines for nursing staff to do interviews. As a result, in 2011, the rate of drinking alcohol while taking leaves or staying outside accommodation dropped from 86.2% to 39.2%. This intervention program successfully enhanced the drug-addicted residents' motivation to modify their alcohol-drinking behaviors. Once the residents receiving therapy have shown their improvement in self-efficacy meeting internalized social norms, the therapeutic community provided with safety and stability for drug addiction would be sustained as well in the future.