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系統識別號 U0026-0812200911510035
論文名稱(中文) 那淬松合併心理治療對預防酒癮復發的效果討論
論文名稱(英文) Effectiveness of Naltrexone Combined with Psychotherapy in the Relapse Prevention of Alcohol Dependence
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 94
學期 1
出版年 95
研究生(中文) 謝兆翔
研究生(英文) Chao-Hsiang Hsieh
學號 s8689405
學位類別 碩士
語文別 中文
論文頁數 68頁
口試委員 指導教授-柯慧貞
口試委員-陸汝斌
召集委員-謝碧玲
中文關鍵字 動機增強治療  認知行為治療  酒癮  那淬松  心理治療  復發預防 
英文關鍵字 Motivational Enhancement Therapy  Cognitive-Behavioral Therapy  Alcoholism  Naltrexone  Psychotherapy  Relapse Prevention 
學科別分類
中文摘要 研究背景與目的:酒癮造成許多社會問題,也耗費相當高的社會成本;如何有效治療酒癮,並預防再度復發已是許多學者努力的重點。許多研究嘗試以藥物或心理治療的模式來降低酒癮復發率;目前已被支持使用的藥物;如:那淬松;而不同的心理治療如:支持性心理治療、認知行為治療、動機增強治療等,均被探討其在酒癮治療與復發預防上的成效。而進一步如何結合藥物與心理治療的問題,也持續被研究。由於那淬松對國人酒癮的療效研究資料仍不足;而且,從改變的歷程來看,動機增強治療結合認知行為治療會有較佳的效果。因此,本研究擬探討那淬松合併不同的心理治療模式在不同的療效指標上的效果。
研究方法:本研究使用次級資料研究法,資料庫來源取自柯慧貞等(民90)衛生署研究計劃中所搜集的資料。最初進入研究的249名受試者當中,經收案研究程序篩選後剩213 名(98.2%),再取至少完成治療八週以上者157 名(73.7%)為最後分析的個案。所有個案進入研究的第一週均使用安慰劑,同時使用測量工具收集治療前的飲酒行為。之後,隨機派入雙盲控制之那淬松組或安慰劑組,然後再將個案隨機分派至支持性心理治療組、認知行為治療組或動機增強加認知行為治療組。藥物治療與心理治療組別配對後,共分為「那淬松與支持性心理治療組」、「那淬松與認知行為治療組」、「那淬松與動機增強加認知行為治療組」、「安慰劑與支持性心理治療組」、「安慰劑與認知行為治療組」、「安慰劑與動機增強加認知行為治療組」等六組,再進行12 週治療,治療後並追蹤三個月。在治療進行的每一週及追蹤期的每個月均繼續收集其當時的飲酒行為。
研究結果:(一)治療期間:以三因子混合設計變異數分析(是否服用那淬松x三種心理治療x四個時間點:治療前,治療期第一至三個月)分析資料,結果發現:「飲酒量指標」和「飲酒天數指標」上,時間的主要效果達顯著:治療期的三個月均顯著比治療前佳;藥物治療與心理治療之主要效果與交互作用均未達顯著。以Kaplan-Meier生存分析進行六組之間「持續天數指標」上的比較,結果發現:六組之間均未達顯著。以卡方檢定進行六組之間在「人數比指標」上的比較,結果發現:不同的六組之間未達顯著差異。(二)追蹤期間:以三因子混合設計變異數分析(是否服用那淬松x三種心理治療x四個時間點:治療期最後一週,追蹤期第一至三個月)分析資料,結果發現:「每日平均飲酒量」上,時間的主要效果達顯著:治療期最後一週顯著比追蹤期第一至三個月高;藥物治療與心理治療之主要效果與交互作用均未達顯著。「每次平均飲酒量」上,時間的主要效果達顯著:治療期最後一週顯著比追蹤期第一至三個月低;藥物治療與心理治療之主要效果與交互作用均未達顯著。在「戒酒天數百分比」上,時間的主要效果達顯著:治療期最後一週顯著比追蹤期第一至三個月高,追蹤期第一個月顯著比第二個月高;藥物治療的主要效果達顯著:那淬松組顯著比安慰劑組低。在「重度飲酒天數百分比」上,時間的主要效果達顯著:治療期最後一週顯著比追蹤期第二至三個月低,追蹤期第一個月顯著比第三個月低;藥物治療與心理治療之主要效果與交互作用均未達顯著。以Kaplan-Meier生存分析進行六組之間在「持續天數指標」上的比較,結果發現:六組之間在「持續未飲酒天數」上未達顯著;在「持續未重度飲酒天數」上,「那淬松與支持性心理治療」比「那淬松與認知行為治療」和「安慰劑與支持性心理治療」佳,而「那淬松與認知行為治療」又比「安慰劑與支持性心理治療」佳。以卡方檢定進行六組之間在「人數比指標」上的比較,不同治療模式在「完全戒酒人數」上未達顯著差異;「未重度飲酒人數上」,「安慰劑與支持性心理治療」顯著低於「那淬松與支持性心理治療」和「安慰劑與認知行為治療」及「安慰劑與動機增強加認知行為治療」,「那淬松與認知行為治療」顯著低於「那淬松與支持性心理治療」。(三)在「重度飲酒天數百分比」上,雖然不同治療模式之間在治療期與追蹤期均未顯著差異,但「那淬松與支持性心理治療」在治療一開始的重度飲酒天數最低,但到治療結束後第三個月時已接近於一直最高的「安慰劑與支持性心理治療」;「那淬松與認知行為治療」在治療開始至治療後的第三個月之重度飲酒天數就一直維持在很低的狀態;「動機增強加認知行為治療組」雖然在治療開始時相當高,但隨著治療的進行至追蹤期均持續降低。
結論:所有的治療模式的治療介入均具有效果,在「飲酒量指標」上的效果至少可維持至治療結束後三個月,在「天數指標」上的效果至少可維持至治療結束後二個月。在「持續未重度飲酒天數」與「未重度飲酒人數」上,那淬松在治療結束後三個月的效果比其他治療模式佳。雖然研究結果只在時間因素上符合研究假設,而動機增強治療對於增加治療的順從性與參與治療動機的效果並未如同研究假設的結果。但本研究的結果仍可給國人在酒癮戒治與酒癮復發預防的治療模式的選擇上提供參考。
英文摘要 Objective:The Problem of Alcohol Dependence makes many severe influences and social cost. To mitigate Alcohol Dependence more efficiently and to prevent from the relapse is the focus of the recently researches. Many studies trying medication or psychotherapy intervention to decrease the relapse rate of Alcohol dependence, thus, Naltrexone, supportive psychotherapy, cognitive behavioral therapy, motivational enhancement therapy etc. And further, the effectiveness of combining medication and psychotherapy has been exploring. Because of the effectiveness of the Naltrexone was not sufficiently enough in Taiwan, and the better effectiveness of motivational enhancement therapy to affect the course of changing. This study is planning to probe into the effectiveness of Naltrexone combining with different psychotherapy on different effectiveness indicator.
Method:This study cites a secondary data from Ko (2001) Research Project. There were 249 subjects participated, 213 subjects(98.2%) matched the of including and excluding criteria, 157 (73.7%) attended at least 8 weeks of therapy at the final. All the subjects had Placebo at the first week of the study, and measured their drinking consumptions before attend the therapy at the same time. The subjects had a double-blind design to assign to either Naltrexone or Placebo and randomly assigned with either supportive psychotherapy (SPT) or Cognitive-behavioral therapy (CBT) or Motivational- enhancement therapy (MET) with CBT. The subjects have 12-week treatment and 3 months flow-up. We concern about the drinking consumptions and the indicators of effectiveness in 12-week treatment and the follow-up period.
Result:1) At the period of treatment: The outcome of ‘consumption indicators’ and ‘drinking days indicators’ showed a main effect of time. All these indicators in three months of treatment were better than in the 90 days before treatment. No main effects and interactions among different medication and psychotherapy and time frame of these indicators in three months of treatment were seen. There were no significant differences among each group in the outcome of ‘maintenance days indicators’ and ‘survival counting indicators’ in three months of treatment. 2) At the period of follow-up: A main effect of time was found in the outcome of average drinks per day (ADD). The ADD of all the combinations of therapy in the last week of treatment was higher significantly than the ADD in the 3 months of follow-up. There was a significant difference was found at the main effect of time in the outcome of drinks per drinking day (DDD). The DDD of all the combinations of therapy in the last week of treatment was lower significantly than the DDD in the 3 months of follow-up. The outcome on the percentage of abstinent day (PAD) showed a main effect of time and medication. The PAD of all the combinations of therapy in the last week of treatment was higher significantly than the PAD in the 3 months of follow-up, and the PAD in the 1st month of follow-up was higher significantly than the PAD in the 2nd month of follow-up. The PAD of the Naltrexone groups was lower significantly than the PAD of the Placebo groups. The outcome on the percentage of heavy drinking day (PHD) showed a main effect of time and medication. The PHD of all the combinations of therapy in the last week of treatment was lower significantly than the PHD in the 2nd and 3rd months of follow-up, and the PHD in the 1st month of follow-up was lower significantly than the PHD in the 3rd month of follow-up. There was no significant difference on time to first drink among all six combinations of treatment. The subjects treated with Naltrexone with SPT took longer time to heavy drinking significantly than whom treated with Naltrexone with CBT and Placebo with SPT, and the time to first relapse of Naltrexone with CBT was longer significantly than Placebo with CBT. The number of subjects with complete abstinence showed no significant difference among all combinations of therapy. The number of subjects who never relapse, which with Placebo with SPT was lower significantly than which with Naltrexone with SPT, Placebo with CBT and Placebo with MET with CBT, and which with Naltrexone with CBT was lower significantly than which with Naltrexone with SPT. 3) Although, the PHD among the different combinations of therapy showed no significant differences in the period of treatment, Nalterexone with SPT could not maintain PHD from the lowest at the beginning of treatment till the 3rd month of follow-up, it almost near the highest PHD, which treated with Placebo with SPT. However, Nalrexone with CBT could maintain the lower PHD at the beginning of treatment till the 3rd month of follow-up. Whereas, MET with CBT showed the highest PHD at the beginning of treatment, but it had been getting more lower with the course of treatment even of follow-up.
.Conclusion: The all combinations of therapy had just the main effect of time in the period of treatment, matched the hypothesis of treatment intervention of this study , but MET didn’t show the significant effectiveness of motivation enhancement than other psychotherapy. Another result of this study is that Naltrexone seemed to show better effectiveness in PHD, but Nalrexone with CBT seemed to keep lower PHD till the 3rd month of follow-up, and MET with CBT seemed to keep decreasing PHD. These results still can offer various choice of therapy to the relapse prevention of alcohol dependence.
論文目次 目錄
第一章 緒論 ................................................................... 1
第一節 酒癮問題研究的重要性 ............................................................ 1
第二節 酒癮的治療模式 .................................................................. 2
一、藥物治療 ........................................................................ 2
二、心理治療 ..............................................................................4
三、藥物治療結合心理治療 ..................................................................5
第三節 酒癮治療療效指標 ....................................................................7
一、治療參與度與服藥順從性 ............................................................7
二、飲酒量 …................................................................................8
三、飲酒天數 ...............................................................................9
四、持續天數 ................................................................... 9
五、人數比例 ..............................................................................…10
六、飲酒慾........................................................................11
第四節 治療模式之療效研究 ............................................................ 12
一、藥物治療之療效研究 ..............................................................12
二、心理治療之療效研究 .................................................................. 14
三、藥物結合心理治療之療效研究 ...................................................... 15
第五節 研究目的與研究假設 ............................................................ 19
一、研究目的 .............................................................................. 19
二、研究假設 .............................................................................. 22
第二章 研究方法 ............................................................ 23
第一節 研究設計 ........................................................................ 23
第二節 研究對象 ........................................................................ 23
一、個案取樣 .............................................................................. 23
二、受試者人口學變項特性與追蹤狀況 ................................................ 24
第三節 研究流程 .............................................................................. 25
一、 研究分組 .............................................................................. 25
二、 研究步驟 .............................................................................. 25
第四節 研究工具 .............................................................................. 28
一、診斷工具 .............................................................................. 28
二、測量工具 .............................................................................. 28
第五節 統計分析 .............................................................................. 29
一、人口學變項之比較 .................................................................. 29
二、治療介入前之各種臨床特性 ...................................................... 29
三、治療參與度和服藥順從性 ............................................................ 30
四、治療期之各種療效指標 ............................................................ 30
五、追蹤期之各種療效指標 ............................................................ 32
第三章 研究結果 ...................................................................34
第一節 人口學變項與臨床特質分析 ........................................................34
一、六組於治療前在性別與婚姻狀態上的比較 .................................... 34
二、六組於治療前在年齡與教育年數上的比較 .................................... 34
三、六組於治療前在每日平均飲酒量、每次平均飲酒量上的比較 ............ 34
四、六組於治療前在飲酒天數百分比與重度飲酒天數百分比上的比較 … 34
第二節 治療參與程度與追蹤率 ............................................................ 36
一、六組在平均藥物治療週數與平均心理治療週數上的比較 .................. 36
二、六組在服藥順從性高於75%以上人數的比較 .................................... 36
第三節 治療期之各種療效指標 ............................................................ 38
一、每日平均飲酒量 ........................................................................ 38
二、每次平均飲酒量 ........................................................................ 38
三、戒酒天數百分比 ........................................................................ 38
四、重度飲酒天數百分比 ............................................................ 38
五、持續未飲酒天數 .................................................................. 41
六、持續未重度飲酒天數 ............................................................ 41
七、完全戒酒人數百分比 …............................................................. 41
八、未重度飲酒人數百分比 …............................................................. 41
第四節 追蹤期之各種療效指標 ............................................................ 45
一、每日平均飲酒量 ........................................................................ 45
二、每次平均飲酒量 ........................................................................ 45
三、戒酒天數百分比 ........................................................................ 45
四、重度飲酒天數百分比 …............................................................. 46
五、持續未飲酒天數 …................................................................... 46
六、持續未重度飲酒天數 …............................................................. 46
七、完全戒酒人數百分比 …............................................................. 47
八、未重度飲酒人數百分比 ….............................................................47
第四章 討論 .........................................................................52
第一節 本研究之主要發現與解釋 ...................................................... 52
一、人口學變項與臨床特性上的探討 ................................................ 52
二、治療參與程度與服藥順從性的探討 ................................................. 53
三、不同治療模式在飲酒量指標上的效果 .......................................... 54
四、不同治療模式在飲酒天數指標上的效果 ..........................................55
五、不同治療模式在持續天數指標上的效果 ...........................................59
六、不同治療模式在人數指標上的效果 .................................................59
第二節 本研究之限制與未來研究方向.....................................................61
一、樣本的限制 .......................................................................... 61
二、研究設計的限制 ........................................................................ 61
三、研究工具的限制 ........................................................................ 62
四、治療介入的效果限制 .................................................................. 62
五、統計分析方法的限制 .................................................................. 62
第三節 本研究之理論貢獻與應用價值 ................................................ 64
第五章 參考文獻 .............................................................................. 65
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