甲基安非他命使用者成癮嚴重度與職能平衡之相關性

Abstract

甲基安非他命為國內使用盛行率最高的非法成癮物質，甲基安非他命成癮將導致個案功能受損，且即使接受治療仍容易復發。過去研究發現生活參與可能是影響個案復元的主要因素之一，參與用藥以外的活動可以維持停用，反之生活若呈現失衡狀態則可能導致個案再次復用。因此，本研究期望進一步探討職能平衡與甲基安非他命成癮嚴重度間的關係。 本研究採橫斷性研究，於指定藥癮戒治機構的門診招募50名甲基安非他命使用者參與進行單次的評估。以職能平衡問卷 (Occupational Balance Questionnaire, OBQ-11-C) 、職能活動問卷 (Occupational Questionnaire, OQ) 評估職能平衡，以物質依賴嚴重度量表 (Severity of Dependence Scale, SDS) 、目視渴癮量表 (Visual Analogue Scale, VAS) 、30日時光回溯法 (30-day Time-Line Follow Back, TLFB)評估成癮嚴重度，另外以神經疾患生活品質應用認知量表 (Neuro-QoL Applied Cognition) 以及Snaith-Hamilton愉悅量表 (Snaith-Hamilton Pleasure Scale, SHAPS) 評估現有文獻中成癮可能對生活參與造成影響的認知功能受損與失去樂趣症狀。 研究結果發現，使用甲基安非他命的期間較長、較早的初次使用年齡以及較高的物質依賴嚴重度量表分數與較差的主觀職能平衡感受呈現顯著相關，主觀渴癮強度與過去一個月使用甲基安非他命的天數則未有顯著相關。在時間安排部分，亦發現成癮嚴重度較高與花費較長時間在日常生活活動有關。另外，認知功能受損對於物質依賴嚴重度量表與職能平衡間的關係有顯著的中介效果。 根據研究結果，甲基安非他命使用成癮嚴重度與職能平衡以及時間分配具有相關性，且可能部分為認知功能受損的影響。未來可進行縱貫性的研究確認因果關係。針對甲基安非他命成癮個案的臨床介入中，應將成癮個案的職能平衡納入考量，並留意認知功能的影響。

Background: Methamphetamine is the most commonly used illicit addictive substance in Taiwan, posing a significant threat to both individual functioning and public health. Despite treatment, relapse rates remain high. Participation in substance-free activities is crucial for recovery, as a balanced lifestyle supports abstinence, whereas an imbalanced one may contribute to relapse. This study aimed to examine the relationship between methamphetamine addiction severity and occupational balance, which reflects the distribution and diversity of an individual’s daily activities. Methods: This cross-sectional study recruited 50 methamphetamine users from the outpatient department of an addiction treatment hospital. Participants completed the 11-item Occupational Balance Questionnaire (OBQ-11), the Occupational Questionnaire (OQ), Severity of Dependence Scale (SDS), Visual Analogue Scale (VAS) for craving, and 30-day Time-Line Follow Back (TLFB). In addition to assessing addiction severity and occupational balance, this study explored the potential mediating effects of cognitive impairment and anhedonia on the relationship between addiction severity and occupational balance. Cognitive impairment was assessed using the NeuroQOL Applied Cognition General Concerns Scale (NeuroQOL-AC-GC), while anhedonia was measured with the Snaith-Hamilton Pleasure Scale, SHAPS. Result: A longer duration of methamphetamine use, an earlier age of first use, and higher SDS scores were significantly associated with poorer occupational balance, while craving levels (VAS) and methamphetamine use in the past month (TLFB) showed no significant association. Participants with higher addiction severity tended to allocate more time to daily living tasks. Furthermore, cognitive impairment significantly mediated the relationship between addiction severity and occupational balance. Conclusion: Methamphetamine addiction severity appears to be associated with occupational balance and daily activity patterns, with cognitive impairment playing a mediating role. Longitudinal studies are needed to establish causal relationships. Clinicians should consider both occupational balance and cognitive impairment when treating individuals with methamphetamine addiction.