反覆進出愷他命成癮治療系統的經驗與相關因素：愷他命長期使用者與成癮治療專業醫事人員的深度訪談

Abstract

背景與目的 娛樂性愷他命長居台灣近二十年內非法藥物使用種類的前三名，其中，根據使用非法藥物遭到逮捕的數據，使用愷他命的再犯率仍然很高。然而，反覆使用和犯罪背後的原因很少被調查，可能是由於愷他命使用者尋求專業治療的比例較低及逮捕時僅援引行政處罰。在此情況下，深入了解愷他命使用者的質性研究方法可以及時洞察他們的使用行為。因此，本研究旨在探討長期愷他命使用者即使有強烈的戒癮意念仍反覆使用的背景，他們在成癮治療過程中遇到的障礙，以及這種反覆使用對他們日常生活的影響。 方法 作為一質性研究，本研究透過台灣北部一家當地醫院之精神科招募五名成癮治療專業醫事人員和兩名長期愷他命使用者，並以半結構式深度訪談法蒐集訪談資料。由於愷他命使用者多為社會弱勢群體且較難觸及此群體，兩名長期愷他命使用者首先由醫院照護人員邀請受訪，然後由研究團隊完成招聘流程。此外，深度訪談由具有豐富質性研究經驗並熟悉訪談技巧的訪談人員進行，每個受訪者都接受了大約一小時或更長時間的採訪，並在知情同意的情況下完整錄音訪談過程。每個受訪者的錄音檔隨後由中華民國無障礙科技發展協會的成員打成逐字稿。分析時首先根據紮根理論的框架對逐字稿進行分析以提取相關概念，然後將概念歸納形成核心主題後再進行主題分析。在研究過程中，筆者與訪談人員保持密切討論並反覆確認訪談過程中的細節，以確保訪談當下的特殊情境和重要訊息均被描述清楚且無遺漏。 結果 本研究研究發現，與愷他命長期使用者反覆使用相關的重要因素是他們的社交網絡連接方式，以及配偶關係、家庭、朋友和工作場所關係等重要關係的密切程度。這些關係的連接和建立代表愷他命使用者的社會支持和網絡。此外，台灣社會長期缺乏對成癮的認識，可能導致吸食非法藥物的污名化和標籤化，可能進一步影響使用者自身對成癮治療的理解和信念。由於他們在尋求治療過程中遇到的複雜性和障礙，將愷他命造成的腦部損傷無法充分解釋反覆使用愷他命的背後脈絡。 結論 反覆使用愷他命的背後脈絡涉及許多生物學和社會心理的多方面向，未來需要將其使用的緩解或戒治納入有關成癮知識的政策宣傳和健康教育中。

Background Recreational use of ketamine has ranked among the top three types of illicit drug use in Taiwan in the past two decades. Based on drug arrest data, the rate of recidivism has remained high among offenders of ketamine use. However, the reasons behind repeated use as well as offense have been rarely investigated, probably due to the low rate of seeking professional treatment among ketamine users and only administrative penalty is invoked upon arrest. Under these circumstances, a qualitative approach toward in-depth understanding among ketamine users may provide timely insight into their use behavior. Hence, this study aimed to explore the context that long-term ketamine users keep repeated use even though they might have a strong desire to quit, the obstacles they encountered in the process of addiction treatment, and the way such repeated use impacted their daily lives. Methods In this qualitative study, semi-structured in-depth interviews were conducted with five medical staff members and two long-term ketamine users recruited through a local psychiatric hospital in northern Taiwan. Since ketamine users tend to be vulnerable people in the society and difficult for out-reaching, the two long-term ketamine users were first invited by the care-providing personnel in the hospital and then completed the recruitment documents by the research team. Besides, the in-depth interview was conducted by researchers who had ample experience with qualitative research and acquainted with the interview skills. Each participant was interviewed for approximately one hour or longer, which was fully recorded under informed consent. The recording of each participant was then transformed into transcriptions by members from the Technology Development Association for the Disabled. The transcriptions and interview notes were first analyzed using the framework of the grounded theory to extract relevant concepts, and then thematic analysis was conducted by grouping the concepts to form core themes. The author maintained close discussions with the interviewers, followed up and confirmed the details repeatedly to ensure the special situation and important information at the moment of the interviews being well-described and not missed. Results The study found that the important factors related to repeated use among ketamine long-term users were the way their social networks connected, and the closeness of important relationships such as consort relationship, family, friends, and workplace relationships. The connection and establishment of these relationships represented the users' social support and networks. In addition, the long-standing lack of knowledge about addiction in Taiwan society might have led to the stigma and labeling of illicit drug use, which might further affect the understanding and belief of the drug users themselves about addiction treatment. With the complexity and obstacles they encountered in the process of treatment seeking, sorely attributing to the brain damage caused by ketamine cannot explain sufficiently the context of repeated use of ketamine. Conclusion The context underlying repeated ketamine use involves many biological and psychosocial aspects, and its mitigation needs to be incorporated into policy promotion and health education about the knowledge of addiction.