第五章 綜合討論
第三節 研究限制與未來方向
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第三節 研究限制與未來方向
壹、研究樣本特性
一、性別
本研究之戒治人全數皆為男性，過去研究亦發現在某些成癮的相關變 項上有性別的差異，如女性成癮者有較多情感性疾患的共病、不同的使用 物質的理由、不同的治療進程等差異(Brady & Randall, 1993)，因此研究結 果是否能類推至女性海洛因戒治人則需進一步研究與探討。
二、 渴求經驗差異
本研究樣本設定對象為戒治所內海洛因戒治人，故測量的渴求狀態為 在無法獲得物質、全面控制且沒有戒斷症狀的狀況下所經歷的渴求經驗，
此種渴求可能不同於當個體能夠使用物質、沒有限制的狀況下所經歷的渴 求狀態，故結果可能無法類推至其他狀態下的渴求，例如個體仍經歷戒斷 症狀時，渴求的經驗意涵是否不同於已無戒斷症狀、無法取得物質的情況，
因此其他不同狀態下的渴求經驗意涵則需進一步研究探討。
三、期別與海洛因使用情形
戒治所內將戒治人分為三期，分別為社會適應期、心理期與調適期，
不同期別由於戒治時間長短、期別規定等不同，也可能導致三種不同期別 的戒治人有不同的渴求經驗與情緒改變，於本研究中並未將三種不同期別 區分開來，因此，後續研究也可針對不同期別的海洛因戒治人進行探討，
了解是否有不同的渴求經驗、情緒改變，以期能更精準的描繪戒治人之渴
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求經驗與變化。
目前於戒治所內之戒治人除了以海洛因使用者占大多數外，安非他命 使用者亦占多數，雖然本研究目的欲探討海洛因戒治人之渴求經驗，但單 純使用海洛因者人數並不多，因此本研究之受試者雖皆為慣用海洛因者，
大部分受試仍同時使用其他物質，如安非他命、搖頭丸等，若將樣本人數 侷限於單純使用海洛因者，雖在研究上可以獲得較單純的結果，然而也可 能失去了研究的生態效度與結果的類推性。故本研究仍將受試者樣本設定 為慣用海洛因者，因此無法排除在作答時，受試者受其他使用物質的影響，
干擾對海洛因渴求的經驗狀態的評估，無法了解單純使用海洛因者與慣用 海洛因但仍持續使用其他物質者，是否在渴求經驗上有所差異。
貳、研究方法
一、社會期許效果
本研究工具除測量執行功能的神經心理測驗工具外，均使用自陳式量 表，因此研究結果亦需考慮自陳式量表的特性與影響，首先在社會期許部 分，自陳式量表會受到社會期許、社會價值觀等影響，導致受試者在填答 時可能較容易有修飾、或迎合社會價值觀的答案，加上本研究測量的渴求 變項，對於處於戒治所全面控制戒毒環境下的戒治人來說，是具有較多威 脅性的測量，當面對較具威脅性的測量時，社會期許的影響可能會更大 (Marissen、Franken、Blanken、Brink & Hendriks, 2006)，因此，即使本研 究在施測過程中，盡可能說明資料保密性，並保證資料結果不會影響戒治 權益，但戒治人仍然可能受社會期許影響，導致填答上的偏差，如填寫較 低的渴求程度、或故意採用特定的作答模式等情形，影響研究結果的分 析。
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二、相關分析限制
本研究結果採取相關檢驗做為研究分析方法，需注意的是變項之間的 相關並非代表因果關係，因此在推論上需謹慎，後續研究也可再進一步探 討渴求執行功能的影響，例如採用線索誘發典範，操弄成癮者的渴求狀態，
並測量執行功能表現的差異，焦慮、憂鬱情緒的變化，以驗證上節討論中 所推論的四種不同關係，以期能對這三個變項做更深入的了解。
叁、未來研究方向
本研究再考量樣本數與刪去不恰當之題項後，假設的兩個模式雖皆能 得到恰當的接受結果，但不排除仍有其他可能的模式值得驗證，未來研究 可針對渴求其他多向度概念進行探討，雖本研究發現藥物渴望量表之控制 因素無法在台灣海洛因戒治人樣本獲得良好驗證，但此概念與討論中題及 在實務介入上亦頗具價值，故後續研究也可針對自我知覺控制物質使用程 度的概念作探討。本研究中也初步揭露渴求與工作記憶、訊息處理速度、
憂鬱與焦慮情緒有顯著的相關，後續研究可採取其他研究方法探討渴求與 這些變項之間的因果與方向關係，如線索誘發典範等研究設計，進而發展 成癮治療的介入方案。藥物渴望量表的正增強與負增強兩份量表可獲得初 步的信、效度支持，後續研究也可探討兩分量表的預測效度、增列更多題 目或使用生理指標作為效標變項，以捕捉更細緻的渴求現象並發展衡鑑與 治療工具，增加渴求概念在成癮治療中的應用。
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參考文獻 中文部分
李志恆（民97）。我國藥物濫用防治現況。林信男主編。藥物濫用與防治。
台北:橘井文化。
貝克憂鬱量表第二中文版指導手冊（陳心怡譯）（民89）。台北市：中國 為科學研究社。(原手冊出版年：1994 年)。
貝克焦慮量表中文版指導手冊(林一真譯)(民 89)。台北市：中國為科學研 究社。(原手冊出版年：1990 年)
胡海國、林信男編譯(民 85)。精神與行為障礙之分類－臨床描述與診斷指 引。中華民國精神醫學會。
洪嘉璣(民 92)。藥物濫用者之渴想歷程－以強制戒治者為例。台灣心理學 研究所碩士論文。
邱皓政(民95) 。結構方程模式：LISREL 的理論、技術與應用。台北市
：雙葉。
黃芳銘(民95)。結構方程模式－理論與應用。台北市：五南。
網頁資料
行政院衛生署管制藥品管理局(2008)。藥物濫用案件暨檢驗統計資料。網 址:http://www.nbcd.gov.tw/home/dep/list.aspx?did=200507071156777777777
&pid=989
行政院法務部(2009)。最新統計資料。
網址: http://www.moj.gov.tw/ct.asp?xItem=35128&CtNode=11604&mp=001 楊永年(2008) 。海洛因防制政策-海洛因毒品防制政策。
http://www.tcf.tw/index.php?option=com_content&task=view&id=638
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
英文部分
American Psychiatric Association(2000).Diagnosis and Statistical Manual of Mental Disease (Fourth Edition, Text Revision ).Washington, DC：
American Psychiatric Association.
Andersohn F.& Kiefer F.(2004).Depressive mood and craving during alcohol withdrawal: association and interaction. German Journal of Psychiatry 7, 6-11
Anton, R. F.(1996).Neurobehavioral basis for the pharmacotherapy of alcoholism: current and future directions. Alcohol & Alcoholism,
31(Suppl) , 43-53
Anton, R.F. (1999)What Is Craving? Models and Implications for Treatment.
Alcohol Research & Health, 23(3),165-173.
Anton, R. F., & Drobes, D. J. (1998). Clinical measurement of craving in addiction. Psychiatric Annals, 28, 553−560.
Anton, R. F., Moak, D. H., & Latham, P. (1995). The Obsessive-Compulsive Drinking Scale: A self-rated instrument of the quantification of thoughts about alcohol and drinking behavior. Alcoholism: Clinical and
Experimental Research, 19, 92−99.
Bagozzi, R. P., and Yi, Y. (1998), “On the Evaluation of Structural Equation Models,” Journal of the Academy of Marketing Science, 16 (1), 76-94.
Bohn, M. J., Krahn, D. D., & Staehler, B. A. (1995). Development and initial validation of a measure of drinking urges in abstinent alcoholics.
Alcoholism Clinical and Experimental Research, 19, 600−606
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Brand M., Roth-Bauer M., Driessen M., Markowitsch H J. (2008) Executive functions and risky decision-making in patients with opiate dependence.
Drug and Alcohol Dependence, 97, 64–72.
Breiner, M. J., Stritzke, W. G. K., & Lang, A. R. (1999). Approaching avoidance: A step essential to the understanding of craving. Alcohol
Research & Health, 23, 197−206.
Baker, T . B., Sherman, J. E. & Morse, E. (1987).The motivation to use drugs:
a psychobiological analysis of urges, In: Rivers, C. (Ed.) The Nebraska
symposium on motivation: Alcohol use and abuse( pp.257-323 ).Lincoln,
NE, University of Nebraska Press.Conklin, C. A., & Tiffany, S. T. (2002). Applying extinction research and theory to cue-exposure addiction treatments. Addiction, 97, 155−167.
Cox, L. S., Tiffany, S. T., & Christen, A. G. (2001). Evaluation of the brief questionnaire of smoking urges in laboratory and clinical settings.
Nicotine & Tobacco Research, 3, 7−16.
Collins, R. L., & Lapp, W. M. (1992). The Temptation and Restraint Inventory for measuring drinking restraint. British Journal of Addiction, 87,
625−633.
Castro V. D., Fong T., Rosenthal, R. J.,& Tavares H. (2007).A comparison of craving and emotional states between pathological gamblers and
alcoholics .Addictive Behaviors,32,1555–1564
Crews F. T., Boettiger C.A.(2009)Impulsivity, frontal lobes and risk for addiction.Pharmacology, Biochemistry and Behavior,9, 237–247
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Dijkstra A., &Tromp D.(2000).Is the FTND a measure of physical as well as psychological tobacco dependence? Journal of Substance Abuse
Treatment ,23,367– 374.
Dijkstra B. A. G., ,De Jong C.A.J., Bluschke S.M. , Krabbe P.F.M., van der
Staak C.P.F. (2007) Does naltrexone affect craving in abstinent opioid-dependent patients?, Addict Biol 12, 176–182.
Domier, C. P., Monterosso, J. R., Brody, A. L., Simon, S. L., Mendrek, A.,
Olmstead, R., et al. (2007). Effects of cigarette smoking and abstinence on Stroop task performance. Psychopharmacology, 195(1), 1-9
Dom G, Sabbe B, Hulstijn W, van den Brink W (2005) Substance use disorders and the orbitofrontal cortex: systematic review of behavioural
decision-making and neuroimaging studies. Br J Psychiatry,187, 209 –220 Drummond, D. C. (2001). Theories of drug craving, ancient and modern.
Addiction,96, 33−46.
De las Cuevas., C., Sanz, E. J., de la Fuente, J. A., Padilla, J. & Berenguer, J.C.
(2000).The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction, 95 (2), 245‐250.
D'Elia, L.F., Satz, P., Uchiyama, C.L. and White, T.(1996) Color Trails Test.
Professional manual, Psychological Assessment Resources, Odessa, FL
Fernández-Serrano, M.J., Pérez-García, M., Perales, J.C., Verdejo-García, A.(2010) Prevalence of executive dysfunction in cocaine, heroin and alcohol users enrolled in therapeutic communities. European Journal of
Pharmacology, 626, 104-112
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Franken, I. H. A. (2003). Drug craving and addiction: Integrating psychological and neuropsychopharmacological approaches. Progress in
Neuro-Psychopharmacology & Biological Psychiatry, 27, 563−579.
Franken, I. H. A., Hendriks, V. M., & van den Brink, W. (2002). Initial validation of two opiate craving questionnaires: The Obsessive Compulsive Drug Use Scale and the Desires for Drug Questionnaire.
Addictive Behaviors, 27, 675−685.
Franken, I. H. A., Stam, C. J., Hendriks, V. M., & Van den Brink, W. (2003).
Neurophysiological evidence for abnormal cognitive processing of drug cues in heroin dependence. Psychopharmacology, 170(2), 205-212.
Fishbein, M., & Ajzen, I. (1975). Belief, Attitude, Intention, and Behavior: An
Introduction to Theory and Research. Reading, MA: Addison-Wesley
Field, M., Cox, W.M., (2008) Attentional bias in addictive behaviors: a review of its development, causes, and consequences. Drug Alcohol Depend. 97, 1–20.
Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B.,& Hall,W. (1995).
The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and
amphetamine users. Addiction, 90, 607−614.
Gawin, F.H. and Kleber, H.D. (1986) Abstinence symtomatology and psychiatric diagnosis in cocaine abusers. Arch. Gen. Psychiatry 43, 107-l 13.
Gifford E. & Humphreys K.(2006)The psychological science of addiction.
Addiction, 102, 352–361
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtis, G. (1993).
Wisconsin Card Sorting Test (WCST). manual revised and expanded.
Odessa: Psychological Assessment Resources Inc.
Heishman, S. J., Singleton, E. G., & Liguori, A. (2001). Marijuana Craving Questionnaire: Development and initial validation of a self-report instrument. Addiction, 96, 1023−1034.
Heishman, S. J., Singleton, E. G., & Moolchan, E. T. (2003). Tobacco Craving Questionnaire: Reliability and validity of a new multifactorial instrument.
Nicotine & Tobacco Research, 5, 645−654.
Heishman, S. J., Singleton, E. G., & Pickworth, W. B. (2008). Reliability and validity of a short form of the Tobacco Craving Questionnaire. Nicotine &
Tobacco Research, 10, 643−651
Hung V. C., Chen, C. H., Lin, T. Y. , Chou, H. H. , Lai, T. J., Ferri, C. P. ,&
Gossop, M.(2008)Severity of heroin dependence in Taiwan: Reliability and validity of the Chinese version of the Severity of Dependence Scale (SDS[Ch]). Addictive Behaviors 33 ,1590–1593
Heinz, A., Lober S., Georgi, A., Wrase J., Hermann D., Rey, E.R., Wellek , S.,
&Mann, K.(2003)Reward craving and withdrawal relief craving:
assessment of different motivational pathways to alcohol intake. Alcohol
& Alcoholism .38(1), 5–39.
James, D., Davies, G., & Willner, P. (2004). The development and initial validation of a questionnaire to measure craving for amphetamine.
Addiction, 99, 1181−1188.
Joreskog, Karl G. & Sobom, Dag(2003).Lisrel 8.54 manual.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
non-Korsakoff alcoholics: planning and spatial working memory.
Neuropsychologia,29, 709– 723.
Kaye, S., & Darke, S. (2002). Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence. Addiction, 97, 727−731.
Kamarajan C, Porjesz B, Jones KA, Choi K, Chorlian DB, Padmanabhapillai A, Rangaswamy M, Stimus AT, Begleiter H (2005) Alcoholism is a
disinhibitory disorder: neurophysiological evidence from a Go ⁄ No-Go task. Biol
Psychol,69:353–373
Koob GF, Le Moal M (October 1997). "Drug abuse: hedonic homeostatic dysregulation". Science 278 (5335): 52–8
Kozlowski, L. T. and Wilkinson, T. A. (1987) Use and misuse of the concept of craving by alcohol, tobacco, and drug researchers. British Journal of
Addiction 82, 31–36
Lezak, M.D., Howieson, & Loring, D. (2004). Neuropsychological Assessment.
(4th Ed.). New York: Oxford University Press
Love, A., James, D., & Willner, P. (1998). A comparison of two alcohol craving questionnaires. Addiction, 93, 1091−1102.
London ED, Ernst M, Grant S, Bonson K, Weinstein A (2000). Orbitofrontal cortex and human drug abuse: functional imaging. Cereb Cortex
10(3):334-42
Ludwig, A. M., & Wikler, A. (1974) 'Craving' and relapse to drink. Quarterly
Joumal of Studies on Alcohol, 35, 108-130.
Ludwig, A. M., Wikler, A. & STARK, L. H. (1974) The First drink:
psychobiological aspects of craving. Archives of General Psychiatry,30, 539–547.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Marlatt, G. A. (1985) Cognitive factors in the relapse process, in: Marlatt, G. A.
& Gordon, J. R. (Eds), Relapse prevention,( pp. 128-200).New York:
Guildford Press.
Madden CJ, Zwaan RA (2001) The impact of smoking urges on working memory performance. Exp Clin Psychopharmacol, 9:418–424.
Marissen, M., Franken, I. H. A., , Blanken P., van den Brink, W.& Hendriks, V.
M. (2006). The relation between social desirability and different measures of heroin craving. Journal of Addictive Diseases, 24, 91-103.
Marissen, M., Franken, I. H. A., Blanken P., van den Brink, W.& Hendriks, V.
M. (2006). Attentional bias predicts heroin relapse following treatment.
Addiction, 101 , 1306–1312
McEvoy, P. M., Stritzke, W. G. K., French, D. J., Lang, A. R., & Ketterman, R.
L. (2004). Comparison of three models of alcohol craving in young adults:
A cross validation. Addiction, 99, 482−497.
Mol, A. J. J., Oude Voshaar, R. C., Gorgels,W. J. M. J., Breteler, M. H.M., van Balkom, A. J. L.M., van de Lisdonk, E. H., et al. (2003). Development and psychometric evaluation of the Benzodiazepine Craving
Questionnaire. Addiction, 98, 1143−1152.
Martin, G., Copeland, J.,Gates, P., &Gilmour S.(2006).The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users:
Reliability, validity and diagnostic cut-off. Drug and Alcohol
Dependence,83,90–93.
Makris N, Oscar-Berman M, Jaffin SK, Hodge SM, Kennedy DN, Caviness VS, Marinkovic K, Breiter HC, Gasic GP, Harris GJ (2008). Decreased
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
volume of the brain reward system in alcoholism. Biol Psychiatry 64(3):192-202
Modell, J. G., Glaser, F. B., Mountz, J. M., Schamltz, S., & Cyr, L. (1992).
Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire.
Alcoholism: Clinical and Experimental Research, 16, 266−271
Noël X, Van der Linden M, D’Acremont M, Colmant M, Hanak C, Pelc I,Verbanck P, Bechara A (2005) Cognitive biases toward alcohol related words and executive deficits in poly-substance abusers with alcoholism.
Addiction,100, 1302–1309
Noel X, Van Der Linden M, d’Acremont M, Bechara A, Dan B, Hanak C, Verbanck P (2007) Alcohol cues increase cognitive impulsivity in individuals with alcoholism. Psychopharmacology 192, 291-298
Ollo, C., Alim, T. N., Rosse, R. B., Cunningham, S., Gillis, T., Khan,M., et al.
(1995). Evaluating craving in crack-cocaine abusers. American Journal of
Addiction, 4, 323−330
Powell, J., Dawkins, L., & Davis, R. E. (2002). Smoking, reward
responsiveness, and response inhibition: Tests of an incentive motivational model. Biological Psychiatry, 51, 151-163.
Rosenberg(2009 )Clinical and laboratory assessment of the subjective experience of drug craving.Clinical Psychology Review,29 ,519–534.
Robinson, T.E., and Berridge, K.C. (1993). The neural basis of drug craving:
an incentive-sensitization theory of addiction. Brain Res. 18, 247–291.
Robinson, A. L., Heaton, R. K., Lehman, R. A., & Stilson, D. W. (1980). The utility of the Wisconsin Card Sorting Test in detecting and localizing
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
frontal lobe lesions. Journal of Consulting and Clinical Psychology, 48, 605–614.
Siegel, S. (1989) Pharmacological conditioning and drug effects, In: Goudie, A.
J. & Emmett-Oglesby, M. W. (Eds) Psychoactive Drugs: tolerance and
sensitization.( pp. 115–180 ).Clifton, NJ, Humana Press.
Solomon, R. L. & Corbit, J. D. (1974) An opponentprocess theory of
motivation. I. Temporal dynamics of affect, Psychological Review, 81, 119–145.
Stewart, J., Dewit, H. & Eikelboom, R. (1984) Role of unconditioned and conditioned drug effects in the self-administration of opiates and
Stewart, J., Dewit, H. & Eikelboom, R. (1984) Role of unconditioned and conditioned drug effects in the self-administration of opiates and