第五章 結論與建議
第二節 研究限制與建議
壹、研究限制
一、戒癮動機評估難避免出現社會期待的反應心向
戒癮動機是一種很難評估的心理狀態，尤其針對看守所中觀察勒戒的毒品 犯，當牽涉到他們可能的法律裁判時，不論其是否真的有戒癮動機，在評估時都 會努力表現出自己有戒癮動機，以獲得釋放的判決。本研究雖以戒癮循環階段為 架構，再根據各階段的定義，訂出必要的條件，使評估醫師在評估時可以有較明
確的判斷依據，但毒品犯出現符合社會期許的反應仍是難以避免的現象，尤其是 在自填量表的部分。
二、評估時的戒癮動機難預測未來的再犯行為
評估毒品犯戒癮的動機，經常被賦予預測其是否再犯的目的。從本研究評估 醫師間的信度雖可以反應出評估者之間的一致性，但評估的結果也只能反應評估 當下的動機狀態，換了一個環境可能又改變了。由於戒癮動機會隨著吸毒者的環 境與想法而改變，因此戒癮動機評估的限制在於只能反應毒品犯當下的心理狀 態，要用吸毒者當下的動機去預測其未來的行為，因存在太多變數事實上有其困 難。
貳、建議
一、發展有信、效度的戒癮動機評估量表
動機是個人內在的心理狀態，動機的評估必須要由接受相當程度會談技巧訓 練的專業人員執行。雖然參與本研究的三位評估者之間有相當高的一致性。但在 實務上，很難有這麼多的專業人員進行一對一的會談，雖然本研究的自填量表未 達預期的目的，但如何發展一套有信、效度的動機評估量表，仍是未來可以進行 研究的方向。
二、修訂觀察勒戒評估項目的計分比重
目前觀察勒戒評估項目的計分比重，無法反應出毒品犯的戒癮動機。未來在 討論或修訂評估分數時，建議減低「毒品犯罪相關司法紀錄」以及「戒斷症狀」
的評分比重；增加「短期內再犯」與「注射使用毒品」的評分比重。
參考文獻
壹、中文部分
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貳、英文部分
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附 錄
附件一 CMRS ( Circumstances, motivation, and readiness scale for
substanceabuse treatment)
附件二
URICA (University of Rhode Island Change Assessment)
There are FIVE possible responses to each of the items in the questionnaire:
1 = Strongly Disagree 2 = Disagree 3 = Undecided 4 = Agree
5 = Strongly Agree
1. As far as I'm concerned, I don't have any problems that need changing.
2. I think I might be ready for some self-improvement.
3. I am doing something about the problems that had been bothering me.
4. It might be worthwhile to work on my problem.
5. I'm not the problem one. It doesn't make much sense for me to be here.
6. It worries me that I might slip back on a problem I have already changed, so I am here to seek help.
7. I am finally doing some work on my problem.
8. I've been thinking that I might want to change something about myself.
9. I have been successful in working on my problem but I'm not sure I can keep up the effort on my own.
10. At times my problem is difficult, but I'm working on it.
11. Being here is pretty much a waste of time for me because the problem doesn't have to do with me.
12. I'm hoping this place will help me to better understand myself.
13. I guess I have faults, but there's nothing that I really need to change.
14. I am really working hard to change.
15. I have a problem and I really think I should work at it.
16. I'm not following through with what I had already changed as well as I had hoped, and I'm here to prevent a relapse of the problem.
17. Even though I'm not always successful in changing, I am at least working on my problem.
18. I thought once I had resolved my problem I would be free of it, but sometimes I still find myself struggling with it.
19. I wish I had more ideas on how to solve the problem.
20. I have started working on my problems but I would like help.
21. Maybe this place will be able to help me.
22. I may need a boost right now to help me maintain the changes I've already made.
23. I may be part of the problem, but I don't really think I am.
24. I hope that someone here will have some good advice for me.
25. Anyone can talk about changing; I'm actually doing something about it.
26. All this talk about psychology is boring. Why can't people just forget about their problems?
27. I'm here to prevent myself from having a relapse of my problem.
28. It is frustrating, but I feel I might be having a recurrence of a problem I thought I had resolved.
29. I have worries but so does the next guy. Why spend time thinking about them?
30. I am actively working on my problem.
31. I would rather cope with my faults than try to change them.
32. After all I had done to try to change my problem, every now and again it comes back to haunt me.
Scoring
Precontemplation items 1, 5, 11, 13, 23, 26, 29, 31
Contemplation items 2, 4, 8, 12, 15, 19, 21, 24
Action items 3, 7, 10, 14, 17, 20, 25, 30
Maintenance items 6, 9, 16, 18, 22, 27, 28, 32
附件三
SOCRATES
(The Stage of Change Readiness and Treatment Eagerness Scales)
附件四
觀察勒戒 評估紀錄
編號：___________姓名：_________________ 性別：□男 □女 出生年：民國 _____年 學歷：□國小 □國中 □高中、職 □大專 □研究所 □其他 _______ □畢 □肄 勒戒藥物：□海洛因 □安非他命 □搖頭丸 □K 他命 □其他__________
本次為第幾次觀察勒戒：□第一次 □第二次 □第三次
是否曾經自行戒毒：□否 □是 (□門診 □住院 □其他__________________) 此次勒戒為何時的案件：民國______年_______月
三、注射使用
附 件 五
戒 癮 階 段 評 估 表
編 號決定期：決定要對自己成癮的問題有所作為。
紀錄 □ 自首勒戒
□ 入所時 尿液檢驗為陰性反應 (必要) 提示 你打算怎麼戒藥呢?
反應 □ 具體的計畫/而且已經開始安排 □ 我已經在 (南部)找好工作…
□ 改變環境 (換手機、搬家、換工作…)
□ 正在接受治療（美沙冬… .）
□ ___________________________________________________
復發期：曾經戒除毒癮後，又出現使用毒品的行為。
紀錄 □ 有毒品前科紀錄，前次前科執行完畢距離此次勒戒案件超過五 年以上。且入所勒戒時，毒品檢驗呈陰性反應。入所前有固定生活
環境（工作、家庭… ）。 (必要)
反應 □ 無毒品前科，自述使用毒品的歷史，此次毒品案之前曾經兩年未再 使用毒品。且入所勒戒時，毒品檢驗呈陰性反應。
□ ________________________________________________________
評估結果 ：
□懵懂期 □沉思期 □決定期 □復發期
說 明 ：
(評估表內選項僅提供評估者參考及勾選，未涵蓋在內者請簡述評估結 果的理由)評估醫師 ___________________
附件六
毒品戒癮治療評估問卷--- 預試初編量表
非 不 沒 同 非
附件七
毒品戒癮治療評估問卷 --- 正式題本 毒 品 戒 癮 治 療 評 估 問 卷
這份量表主要目的在評估使用毒品對你的影響，以及你對自己是否成癮的看 法，提供治療者了解治療對你的幫助。此問卷以不記名方式填寫，請你根據你目 前的情形來回答。本問卷共有 16 題，每一題的回答從非常不同意到非常同意，
分為五個等級。請在題目後適當的框格內打勾。
非 不 沒 同 非 常 同 意 常 不 意 見 意 同 同 意 意
1. 使用毒品已經造成我生活作息不正常 □ □ □ □ □ 2. 毒品已經影響我的工作 □ □ □ □ □ 3. 毒品影響我和朋友的關係 □ □ □ □ □ 4. 毒品已經影響到我的身體健康 □ □ □ □ □ 5. 使用毒品讓我的生活越來越糟糕 □ □ □ □ □ 6. 毒品可以讓我忘記煩惱的事情 □ □ □ □ □ 7. 我覺得要把毒品戒掉是很困難的事情 □ □ □ □ □ 8. 我試過戒毒但真的很困難 □ □ □ □ □ 9. 戒毒的過程太痛苦令人難以忍受 □ □ □ □ □ 10.毒品可以讓我解除我身體上的不舒服 □ □ □ □ □ 11.毒品可以幫我舒解壓力 □ □ □ □ □ 12.毒品造成我與家人的衝突 □ □ □ □ □ 13.我認為搬到新的地方，對戒毒有幫助 □ □ □ □ □ 14.我相信參加治療會對我有幫助 □ □ □ □ □ 15.為了戒毒我打算換新的工作 □ □ □ □ □ 16.我願意嘗試不同的戒毒治療課程 □ □ □ □ □