深淵尋光：藥癮者的社會復歸路

Abstract

在個人、家庭、教育，以及社會等角色失能的影響下，台灣二十餘萬民眾施用非法藥物，卻逃不脫多重困局。本深度報導論文將專注於藥癮者的社會復歸路程，意欲從醫療處遇、司法處遇，以及社區處遇三個面向，探究以下問題：台灣現行藥物施用者處遇模式的成效如何？ 本報導透過採訪藥癮者、成癮治療醫事人員與學者、矯正體系內工作人員、民間戒癮機構內工作人員，以及其他相關單位負責人，試圖呈現出立體的藥癮者形象，繼而在爬梳個人生命故事的基礎上，解剖現今藥癮處遇模式背後龐大的制度機器，剝離出政策計畫在推進過程中的阻力，並提出相應解方。 在醫療處遇方面，訪談發現，部分醫療院所出於維安與盈利考量，又缺少人力與資源挹注，在主客觀原因的雙重作用下，成癮治療被簡化。而醫療場域內的諸多角色，在訓練養成過程中，鮮少接觸成癮治療；實務工作中，高度困難的藥癮個案、冗雜的行政庶務，以及外部市場的高薪誘惑也正將他們推離。因此，應完善教育養成體系，呼喚專業人員進場，保證治療質與量，亦應構建有效的分工與合作機制，加大資源挹注，提高人員給付，減少人才流失。 在司法處遇方面，訪談發現，不同時期進出過矯正機關的藥癮者，大多對處遇內容持否定態度，而收容人改變意願的高低，又是影響其戒癮成效的關鍵。目前，矯正機關與相關機構的個案銜接品質，主要受限於各單位居高的案量比和參差的專業素養。因此，應明確銜接機構權責，優化人力進用方式，深化職業教育培訓，如此，貫穿式保護方能有望落實，藥癮者才不至於頂著社會汙名，還寸步難行。 在社區處遇方面，訪談發現，民間戒癮機構的經費狀況，在很大程度上受制於政府補助的撥款情況，因而週轉資金短缺是其運作的主要痛點。此外，扮演模範角色的過來人，在學歷方面本就先天不足，卻只能透過拿文憑考證照的方式，補齊身分落差，可終究還是消抵不了荒唐過往，無人敢替他背書。因此，應設置彈性靈活的專案補助計畫，適度放寬過來人的身分認定條件。 在嚴肅討論過後，本報導期望鬆動社會區隔的擋板，讓道德高地中被認作理所當然的譴責與排斥，稍許被更深一層的公共議題省思所替代。

Influenced by the role incapability of individual, family, education, and society, more than 200,000 people in Taiwan use illegal drugs. However, they still cannot extricate themselves from multiple predicaments. This in-depth reporting focuses on the recovery of drug users and intends to assess the effectiveness of current treatment model for drug users in Taiwan. By interviewing drug addicts, healthcare professionals, correctional officers and social welfare managers, this in-depth reporting attempts to present three-dimensional images of drugs users, based on which find out the resistances to promote plans and policies and finally propose the corresponding solutions. In terms of medical treatment, some medical care institutions simplify the drug treatment services due to the shortage of manpower and resources, also out of the consideration of public security and profit and loss ratio. Besides, many roles in the medical field had little knowledge about drug treatment before in their training process. Now in practical work, highly difficult cases, heavy administrative affairs, and external tempting salaries also are pushing them away from this field. Therefore, a sound cultivation system should be established to ensure the quantity and quality of treatment; an efficient division and cooperation mechanism should be built, and the personnel payment should be improved to reduce the brain drain. Towards the judicial treatment, most inmates who used drugs hold a negative attitude while their willingness to detox is the key to the treatment effect. At present, the quality of post-imprisonment referral is mainly limited by overwhelmed cases and uneven professionalism. Thus, it is eager to optimize the recruiting way and strengthen the vocational skills training. Only in this way can the through-care system be truly implemented. When comes to community treatment, social welfare organizations which devote to addiction treatment services are lack of fund to turnover. In addition, when some social workers who own detox experience play a model role, they still face a huge difficulty in getting a recognized certificate. Accordingly, the government should provide more flexible subsidy plans and soften recognition terms moderately as well. After a serious discussion, this in-depth reporting hope to loosen the barrier of social separation and replace the condemnation to drug users who strive for recovery with a deeper reflection on public health issues.