以Engel模式为中心实施自愿戒毒的研究
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摘要
[研究背景]
1、现状:药物滥用已成为世界性公害,全球每年毒品交易额已超过5000亿美元,成为一种特殊流行病。中国自80年代中期开始,这一丑恶现象又沉渣泛起,且发展迅猛,每年毒资的直接消耗几近2000亿元之巨,更为严重的是它引发一系列社会问题,使劳动力丧失、家破人亡、道德沦丧、犯罪增加、艾滋病传播。截止2003年底,全国累积登记在册吸毒人数105万,(平均现患率80/10万),其中海洛因成瘾者74万(占70.5%),分布在全国2148个县市。而至2004年,累计在册吸毒人员总数达114万。资料显示:从戒毒所出来的吸毒人员复吸率在95%到100%之间,这样的结果,对于少数盲目乐观地谈论戒毒成绩的人来说,或许有些沮丧,吸毒人员每年都在攀升的事实,更让人们不得不更新观念,清醒地面对戒毒新形势。
目前,戒毒工作亟需科学的眼光,用科学态度来看待戒毒工作。科学眼光要求我们运用医学、心理学、社会学、行为学等学科知识来对待吸毒者。譬如,从医学观点看,吸毒者就是脑疾病患者,他们需治疗;而从心理学层面看,吸毒者有严重的药物依赖症状。对待吸毒者,不是仅凭思想政治工作就可以说服他们,“让他们如梦初醒”。过去,把吸毒人员弄到强制戒毒所或戒毒治疗中心去,只要他们当时不再吸毒了,就宣布他们已经戒毒。现在,一种观念已成共识:戒毒包括生理脱毒、康复、社会回归三个阶段。对仅仅生理脱毒的戒毒者就认为已经戒毒,就好比万里长征才走了第一步,不注意吸毒者脱毒后的康复、回归,就是纵容他们陷于“吸而戒,戒复吸”的循环怪圈。
2、自愿戒毒模式的主要缺陷:①缺乏生物-心理-社会的综合评价。多数自愿戒
[Background]Present situation: Up to 2004, the total amount of registered drug addicts is 1,140,000 in our country. By the end of 2003, the accumulation of the registered drug addicts is 1,050,000, among them the heroin addicts are 740,000(constitute 70.5%), with the distribution of 2,148 cities and counties of the country. The rate of those drug addicts'relapse after coming out from the detoxification center is between 95% to 100% according to the data from some areas. Some medical experts think that this data can be believable. The result is somewhat depressive to the small number of people who are unrealistically optimistic boasting the drug-free achievements. But the fact of the annually increasing number of drug addicts urges us renew our ideas and keep awake while facing the new situation.Currently, detoxification work is in urgent need of scientific vision. The scientific vision means to take a scientific attitude towards the detoxification. The scientific vision demands the view of medical science, psychology, sociology, behavioral science and other branches of science to treat the drug addicts. For example, the drug addicts are taken as those who have the brain disease according to the medical science. They need treatment. The drug addicts have the serious symptom of drug dependence according to the psychology. They cannot be persuaded through the only ideological work just as our purpose to let them have the sudden awakening from a dream. In the past, if the drug addicts stop taking drugs after their being taken to the compulsory detoxification center or the therapeutic center, it will be announced as their successful detoxification. Now, people have agreed on this kind of view that detoxification, includes the three
stages of the physiological drug-free, the recovery from drug addiction and the return to society. To take those physiological drug-free as the successful distoxification is just like to announce the victory only after the first step of the long march. Taking no attention of the drug addicts' recovery and their return to society after their stopping drug taking is to over indulge them in a strange circulation of relapse after their detoxification.The defects of the model for voluntary seeking detoxification are as the below: ①Lacking in the comprehensive evaluation on biological, psychological and social dimensions. Most of voluntary detoxification centers mainly evaluate the drug addicts according to their dependence on the drugs and neglect the comprehensive assessment. So the specific details of the addicts cannot be known completely. Because of the lagging behind of the psychological interference and social support, the addicts leave the treatment center ahead of time schedule and make the detoxification a failure.②Lacking in the overall treatment on biological, psychological and social dimensions. Voluntary detoxification means that the drug addicts go to the detoxification centers voluntarily to stop drug taking. Those organizations are in charge of the health department and supervised by the public security organizations. Generally speaking voluntary detoxification lasts about 10 to 20 days. Because the main purpose of those treatment centers is a help to the drug addicts to get away from the dependence on the drugs and to be drug-free physiologically. So their dependence on the drugs is mainly considered after being hospitalized and the means and methods of overall observation are insufficient. Though the addicts can depend on medicine to detoxificate successfully, the rate of relapse after their leaving the hospital is very high. It is because the addicts'motivations are complicated, their dependence on the drugs are different and the ways of treatment are unitary focusing on the medicine. Thus different methods cannot be used to meet the different individual needs and the different ways of taking drugs. The overall treatment and interference for the addicts are neglected.③Lacking in the scientific valuation and discrimination of the ways for the detoxification. In many voluntary detox
1、现状:药物滥用已成为世界性公害,全球每年毒品交易额已超过5000亿美元,成为一种特殊流行病。中国自80年代中期开始,这一丑恶现象又沉渣泛起,且发展迅猛,每年毒资的直接消耗几近2000亿元之巨,更为严重的是它引发一系列社会问题,使劳动力丧失、家破人亡、道德沦丧、犯罪增加、艾滋病传播。截止2003年底,全国累积登记在册吸毒人数105万,(平均现患率80/10万),其中海洛因成瘾者74万(占70.5%),分布在全国2148个县市。而至2004年,累计在册吸毒人员总数达114万。资料显示:从戒毒所出来的吸毒人员复吸率在95%到100%之间,这样的结果,对于少数盲目乐观地谈论戒毒成绩的人来说,或许有些沮丧,吸毒人员每年都在攀升的事实,更让人们不得不更新观念,清醒地面对戒毒新形势。
目前,戒毒工作亟需科学的眼光,用科学态度来看待戒毒工作。科学眼光要求我们运用医学、心理学、社会学、行为学等学科知识来对待吸毒者。譬如,从医学观点看,吸毒者就是脑疾病患者,他们需治疗;而从心理学层面看,吸毒者有严重的药物依赖症状。对待吸毒者,不是仅凭思想政治工作就可以说服他们,“让他们如梦初醒”。过去,把吸毒人员弄到强制戒毒所或戒毒治疗中心去,只要他们当时不再吸毒了,就宣布他们已经戒毒。现在,一种观念已成共识:戒毒包括生理脱毒、康复、社会回归三个阶段。对仅仅生理脱毒的戒毒者就认为已经戒毒,就好比万里长征才走了第一步,不注意吸毒者脱毒后的康复、回归,就是纵容他们陷于“吸而戒,戒复吸”的循环怪圈。
2、自愿戒毒模式的主要缺陷:①缺乏生物-心理-社会的综合评价。多数自愿戒
[Background]Present situation: Up to 2004, the total amount of registered drug addicts is 1,140,000 in our country. By the end of 2003, the accumulation of the registered drug addicts is 1,050,000, among them the heroin addicts are 740,000(constitute 70.5%), with the distribution of 2,148 cities and counties of the country. The rate of those drug addicts'relapse after coming out from the detoxification center is between 95% to 100% according to the data from some areas. Some medical experts think that this data can be believable. The result is somewhat depressive to the small number of people who are unrealistically optimistic boasting the drug-free achievements. But the fact of the annually increasing number of drug addicts urges us renew our ideas and keep awake while facing the new situation.Currently, detoxification work is in urgent need of scientific vision. The scientific vision means to take a scientific attitude towards the detoxification. The scientific vision demands the view of medical science, psychology, sociology, behavioral science and other branches of science to treat the drug addicts. For example, the drug addicts are taken as those who have the brain disease according to the medical science. They need treatment. The drug addicts have the serious symptom of drug dependence according to the psychology. They cannot be persuaded through the only ideological work just as our purpose to let them have the sudden awakening from a dream. In the past, if the drug addicts stop taking drugs after their being taken to the compulsory detoxification center or the therapeutic center, it will be announced as their successful detoxification. Now, people have agreed on this kind of view that detoxification, includes the three
stages of the physiological drug-free, the recovery from drug addiction and the return to society. To take those physiological drug-free as the successful distoxification is just like to announce the victory only after the first step of the long march. Taking no attention of the drug addicts' recovery and their return to society after their stopping drug taking is to over indulge them in a strange circulation of relapse after their detoxification.The defects of the model for voluntary seeking detoxification are as the below: ①Lacking in the comprehensive evaluation on biological, psychological and social dimensions. Most of voluntary detoxification centers mainly evaluate the drug addicts according to their dependence on the drugs and neglect the comprehensive assessment. So the specific details of the addicts cannot be known completely. Because of the lagging behind of the psychological interference and social support, the addicts leave the treatment center ahead of time schedule and make the detoxification a failure.②Lacking in the overall treatment on biological, psychological and social dimensions. Voluntary detoxification means that the drug addicts go to the detoxification centers voluntarily to stop drug taking. Those organizations are in charge of the health department and supervised by the public security organizations. Generally speaking voluntary detoxification lasts about 10 to 20 days. Because the main purpose of those treatment centers is a help to the drug addicts to get away from the dependence on the drugs and to be drug-free physiologically. So their dependence on the drugs is mainly considered after being hospitalized and the means and methods of overall observation are insufficient. Though the addicts can depend on medicine to detoxificate successfully, the rate of relapse after their leaving the hospital is very high. It is because the addicts'motivations are complicated, their dependence on the drugs are different and the ways of treatment are unitary focusing on the medicine. Thus different methods cannot be used to meet the different individual needs and the different ways of taking drugs. The overall treatment and interference for the addicts are neglected.③Lacking in the scientific valuation and discrimination of the ways for the detoxification. In many voluntary detox
引文
[1] Fuentealba R, Cumsille F, Araneda JC, Molina C. Illicit drugs in Chile: the 1998 study and comparison with the 1994 and 1996 studies[J], Pev Panam Salud Publica, 2000, 7 (2) : 79-87.
[2] Dennis McCarty, Milton Argeriou. Public Sector Managed Care for Substance Abuse Treatment: Opportunities for Health Services Research[J]. Journal of Behavioral Health Services & Research. 2001, 28 (2) : E3-E3
[3] Joseph Guydish, William J. Woods. Does centralized intake improve drug abuse treatment outcomes?[J]. Journal of Substance Abuse Treatment. 2001, 20 (4) : 265-273
[4] Philip W. Appel, Herman Joseph, Alan Kott, et al. Selected In-Treatment Outcomes of Long-Term Methadone Maintenance Treatment Patients in New York State[J]. Mount Sinai Journal of Medicine. 2001, 68 (1) : 55-61
[5] 秦伯益.戒毒现状纵横谈[J].中国药物依赖性杂志.1999,8(2):81-85
[6] 新华网记者杨维汉、田雨.公安部:截至2003年底中国现有吸毒人员超过74万news.sdinfo.net/
[7] 邵春红,江开达,李一峰.多巴胺D2受体TaqIA多态性与海洛因渴求程度的关联分析[J].上海精神医学.2004,16(1):10-14
[8] 刘明旭 王福生.中国人群中HIV—1辅助受体CCR5基因新突变位点及CCR5—894C缺失基因多态性分析[J].中华医学杂志.2002,82(21):1468-1472
[9] 景晓娟,张雨青.药物成瘾者的感觉寻求人格特征[J].心理科学进展.2004,12(1):67-71
[10] Compton P, Athanasos P. Chronic pain, substance abuse and addiction[J]. The Nursing Clinics of North America. 2003, 38 (3) : 525-537
[11] M. D. , Ph. D. Charles P. O'Brien. Research Advances in the Understanding and Treatment of Addiction[J]. American Journal on Addictions. 2003, 12 (Sup2) : S36-S47
[12] Richard Hammersley, Marie Reis. Why the Pervasive Addiction Myth is Still Believe[J]. Addiction Research and Theory. 2002, 10 (1) : 7-30
[13] 张富强,杨国栋.药物成瘾行为的非药理影响因素[J].中国药物滥用防治杂志.2003,9(5):1-5
[14] 王浩然,高祥荣,张开镐等.药物成瘾及成瘾记忆的研究现状[J].生理科学进展.2003,34(3):202-206
[15] R. Andrew Chambers, Jane R. Taylor, Marc N. Potenza. Developmental Neurocircuitry of Motivation in Adolescence: A Critical Period of Addiction Vulnerability[J]. American Journal of Psychiatry. 2003, 160 (6) : 1041-1052
[16] Graeme Hawthorne, Jan Garrard, David Dunt. Does Life Education's drug education programme have a public health benefit?[J]. Addiction. 1995, 90 (2) : 205-216
[17] 高英东.美国对毒品犯罪的惩治与防范[J].社会.2000,11:112
[18] McLellan A T. An improved evaluation instrument for substance abuse patients: The Addiction 7. Severity Index[J]. Journal of Nervous and Mental Diseases. 1980, 168: 26-33
[19] 赵敏,杨德森.对海洛因依赖者康复训练的半年随访[J].中华精神科杂志.2001,34(2):102-105
[20] J. D. Jentsch, J. R. Taylor. Impulsivity resulting from frontostriatal dysfunction in drug abuse: implications for the control of behavior by reward-related stimuli[J]. Psychopharmacology. 1999, 146 (4) : 0373-0390
[21] 杨廷忠主编.健康教育理论与方法[M].第一版.杭州:浙江大学出版社,2005,229-231
[22] 梁建辉,刘锐克.药物渴求对复吸行为的始动作用[J].中国药物滥用防治杂志.2001(4):31-33
[23] 肖水源,郝伟,杨德森.非法成瘾物质使用的流行学研究方法[J].中国心理卫生杂志.1997,11 (2):124-127
[24] 郝伟.中国吸毒现状、相关问题与对策[J].中国药物依赖性杂.2004,13(3):227-230
[25] 刘志民.当前禁毒形势及预防[J].中国药物依赖性杂志2001,10 (4):315
[26] 国家禁毒委员会.2004禁毒论坛综述.人民公安报.2004年08月04日
[27] Richard AJ, Bell DC, Montoya ID. Age and HIV risk in a national sample of injection drug and crack cocaine users[J]. Subst Use Misuse. 2000, 35 (10) : 1385-1404
[28] Brehmer C, Iten PX. Medical priscription of heroin to chronic heroin addicts in Switzerland-a review[J]. Forensic Sci Int. 2001, 121 (1-2) : 23-26
[29] 李超,毛富荣.120名老教人员三年后复吸的调查[J].中国药物依赖,1999,(1):67—68
[30] 程艺萍、刘湘、张秉益.海洛因依赖者脱毒后的康复治疗及回归社会[J].中国药物依赖,1999,(1):23-25
[31] 杨征,江孝香.梯度用药方案到阿片类依赖者脱毒治疗及预防复吸的疗效[J].中国药物滥用防治杂志.1996,19 (4):293-295
[32] 龚幼龙主编.社会医学[M].第一版.北京:人民卫生出版社.2000,19
[2] Dennis McCarty, Milton Argeriou. Public Sector Managed Care for Substance Abuse Treatment: Opportunities for Health Services Research[J]. Journal of Behavioral Health Services & Research. 2001, 28 (2) : E3-E3
[3] Joseph Guydish, William J. Woods. Does centralized intake improve drug abuse treatment outcomes?[J]. Journal of Substance Abuse Treatment. 2001, 20 (4) : 265-273
[4] Philip W. Appel, Herman Joseph, Alan Kott, et al. Selected In-Treatment Outcomes of Long-Term Methadone Maintenance Treatment Patients in New York State[J]. Mount Sinai Journal of Medicine. 2001, 68 (1) : 55-61
[5] 秦伯益.戒毒现状纵横谈[J].中国药物依赖性杂志.1999,8(2):81-85
[6] 新华网记者杨维汉、田雨.公安部:截至2003年底中国现有吸毒人员超过74万news.sdinfo.net/
[7] 邵春红,江开达,李一峰.多巴胺D2受体TaqIA多态性与海洛因渴求程度的关联分析[J].上海精神医学.2004,16(1):10-14
[8] 刘明旭 王福生.中国人群中HIV—1辅助受体CCR5基因新突变位点及CCR5—894C缺失基因多态性分析[J].中华医学杂志.2002,82(21):1468-1472
[9] 景晓娟,张雨青.药物成瘾者的感觉寻求人格特征[J].心理科学进展.2004,12(1):67-71
[10] Compton P, Athanasos P. Chronic pain, substance abuse and addiction[J]. The Nursing Clinics of North America. 2003, 38 (3) : 525-537
[11] M. D. , Ph. D. Charles P. O'Brien. Research Advances in the Understanding and Treatment of Addiction[J]. American Journal on Addictions. 2003, 12 (Sup2) : S36-S47
[12] Richard Hammersley, Marie Reis. Why the Pervasive Addiction Myth is Still Believe[J]. Addiction Research and Theory. 2002, 10 (1) : 7-30
[13] 张富强,杨国栋.药物成瘾行为的非药理影响因素[J].中国药物滥用防治杂志.2003,9(5):1-5
[14] 王浩然,高祥荣,张开镐等.药物成瘾及成瘾记忆的研究现状[J].生理科学进展.2003,34(3):202-206
[15] R. Andrew Chambers, Jane R. Taylor, Marc N. Potenza. Developmental Neurocircuitry of Motivation in Adolescence: A Critical Period of Addiction Vulnerability[J]. American Journal of Psychiatry. 2003, 160 (6) : 1041-1052
[16] Graeme Hawthorne, Jan Garrard, David Dunt. Does Life Education's drug education programme have a public health benefit?[J]. Addiction. 1995, 90 (2) : 205-216
[17] 高英东.美国对毒品犯罪的惩治与防范[J].社会.2000,11:112
[18] McLellan A T. An improved evaluation instrument for substance abuse patients: The Addiction 7. Severity Index[J]. Journal of Nervous and Mental Diseases. 1980, 168: 26-33
[19] 赵敏,杨德森.对海洛因依赖者康复训练的半年随访[J].中华精神科杂志.2001,34(2):102-105
[20] J. D. Jentsch, J. R. Taylor. Impulsivity resulting from frontostriatal dysfunction in drug abuse: implications for the control of behavior by reward-related stimuli[J]. Psychopharmacology. 1999, 146 (4) : 0373-0390
[21] 杨廷忠主编.健康教育理论与方法[M].第一版.杭州:浙江大学出版社,2005,229-231
[22] 梁建辉,刘锐克.药物渴求对复吸行为的始动作用[J].中国药物滥用防治杂志.2001(4):31-33
[23] 肖水源,郝伟,杨德森.非法成瘾物质使用的流行学研究方法[J].中国心理卫生杂志.1997,11 (2):124-127
[24] 郝伟.中国吸毒现状、相关问题与对策[J].中国药物依赖性杂.2004,13(3):227-230
[25] 刘志民.当前禁毒形势及预防[J].中国药物依赖性杂志2001,10 (4):315
[26] 国家禁毒委员会.2004禁毒论坛综述.人民公安报.2004年08月04日
[27] Richard AJ, Bell DC, Montoya ID. Age and HIV risk in a national sample of injection drug and crack cocaine users[J]. Subst Use Misuse. 2000, 35 (10) : 1385-1404
[28] Brehmer C, Iten PX. Medical priscription of heroin to chronic heroin addicts in Switzerland-a review[J]. Forensic Sci Int. 2001, 121 (1-2) : 23-26
[29] 李超,毛富荣.120名老教人员三年后复吸的调查[J].中国药物依赖,1999,(1):67—68
[30] 程艺萍、刘湘、张秉益.海洛因依赖者脱毒后的康复治疗及回归社会[J].中国药物依赖,1999,(1):23-25
[31] 杨征,江孝香.梯度用药方案到阿片类依赖者脱毒治疗及预防复吸的疗效[J].中国药物滥用防治杂志.1996,19 (4):293-295
[32] 龚幼龙主编.社会医学[M].第一版.北京:人民卫生出版社.2000,19