跨理論模式於臺灣酒依賴住院病人改變歷程的質性研究

Qualitative Study for Processes of Stage of Change by Transtheoretical Model among Alcohol Dependent Inpatients in Taiwan

本研究旨在以跨理論模式為架構，以深度訪談收集資料及內容分析法分析20位臨床酒依賴住院病人行為改變階段歷程。結果發現，病人在改變成癮過程中，歷經無意圖期、意圖期、準備期、行動期，與維持期，每階段皆有其特徵。在無意圖期，病人缺乏改變飲酒動機，相信自己能控制並合理化問題飲酒行為，在意圖期，病人承認飲酒造成自己身心社會各方面失去功能，感受到自己無法控制飲酒行為及心靈的無助與痛苦，並想挽回自己喪失的身體與社會功能。在準備期，則承認自己不易戒酒，有強烈口頭意願戒酒但行動遲疑，會出現掙扎退縮意圖。在行動期，病人開始嘗試戒酒方法，接受戒酒處置，但易故態復萌。進入維持期時，病人已從酒精中康復，呈現正向的日常生活功能。此一改變歷程，酒癮患者易於意圖期、準備期或行動期反覆復發，而這也是戒酒成功與否的關鍵所在。處在不同改變階段宜採取不同戒治策略，本研究結果期能作為酒依賴病人臨床評估及治療策略依據。

The purpose of this research is to study the behaviors of alcohol dependent patients during stage of change under a framework of the trans-theoretical model. We studied 20 patients in total by in-depth interview and content analysis. The result show that the alcohol dependent patients would experience five stages, namely pre-contemplation, contemplation, preparation, action, and maintenance, in the processes of stage of change and each stage was marked by specific nature. In the pre-contemplation stage, the alcohol dependent patients were short of motive for change. The visited patients had positive expectancy for drinking alcohol and did not consider their drinking problems seriously. The patients rationalized their behaviors of problem drinking and believed they were able to take full control of their drinking behaviors. In the contemplation stage, the patients realized their problems in drinking behavior and were willing to listen to their own inner voice at heart and also admit their failure in health and social function due to drinking. They figured out that they had lost control in drinking behavior and felt hopeless and painful, and thought about to retrieve their failed health and social function. in the preparation stage, the patients admit the difficulty in quitting drinking and show strong desire for abstinence. However, they hesitated to take action and showed the intention of withdraw. The patients begin to try various ways to quit drinking during the action stage, and recover from alcohol dependence and demonstrate positive characteristics towards to normal daily life function during the stage of maintenance. In the processes of stage of change, the alcohol dependent patients had recurrent relapse easier during the contemplation, preparation, or action stage. However, this is key focus on successful abstinence from alcohol dependence. The different stage of change has to apply the appropriate strategies, and we hope that the results will serve as criteria for evaluating alcohol dependent patients in stages of the results will serve as criteria for evaluating alcohol dependent patients in stages of change and adopting treatment strategies, which will benefit the efficiency of alcohol treatment.