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題名：安眠藥物長期使用型態之探討
作者：陳昌偉
作者(外文)：Chen, Chang Wei
校院名稱：國立政治大學
系所名稱：心理學研究所
指導教授：楊建銘
林耀盛
學位類別：博士
出版日期：2014
主題關鍵詞：安眠藥物；長期使用；型態；歷程；Hypnotics；Long-term user；pattern；process
原始連結：連回原系統網址new window
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研究目的：失眠盛行率高且易發展為慢性問題，安眠藥物是最常使用的治療選項。臨床上有高比例的安眠藥物使用者屬於長期使用狀態，然而，研究證據對於長期使用的有效性與安全性仍有爭議。在逐漸演變為長期使用的歷程中，過去未有研究從使用者的角度來理解藥物使用態度的內涵，及使用型態的差異與轉變歷程。本研究目的為探討長期安眠藥物使用者的藥物使用型態與歷程，及其相關心理變項，以建構安眠藥物長期使用心理歷程模式。
研究方法：研究先以質性研究來蒐集訪談資料，藉由分析訪談資料來建構安眠藥物長期使用型態的理論，再由量化資料來驗證理論。本研究分為兩個部分，研究一採用紮根理論（grounded theory）方法，透過深度訪談22位平均安眠藥物服用期間為6.75年的長期使用者（男性6位、女性16位），蒐集訪談資料、進行編碼，最後抽取核心概念，提出安眠藥物長期使用之型態與歷程及相關心理向度。研究二則是將168位長期安眠藥物使用者，根據研究一所歸納出的分類核心特徵做出使用型態的分類，並採用結構式問卷，比較不同使用型態的安眠藥物使用者相關睡眠脆弱性、壓力知覺反應、症狀嚴重度、用藥行為、藥物相關態度與反應等差異形態，以驗證研究一所建構之理論，並延伸對於不同使用型態剖面特徵的了解。
研究結果：研究一發現長期安眠藥物使用者可分為「過渡情態」、「矛盾控制」與「慣性平衡」三種型態。「過渡情態」者，低頻率且彈性的服用藥物，藥物屬於短期救急的性質。「矛盾控制」者對於藥物的態度衝突，企圖控制服藥行為，情緒上較為苦惱。「慣性平衡」者，對藥物解釋為身體需要，習慣性的持續服藥以維持身心平衡。而在長期使用的歷程中，各型態會隨著「知覺藥物效果」、「知覺壓力與因應資源的平衡狀態」、及「對安眠藥物的負向感受」的動態性改變而互為轉換。研究二以結構式問卷將使用型態分類並測量三組在可區隔三組之相關概念上的差異，分類後「過渡情態」共34人、「矛盾控制」共43人、「慣性平衡」共91人，比較三組在各量表上的差異，發現三組同具備失眠脆弱特質，且在睡眠失功能信念、用藥相關的性格傾向與情緒調節策略上未有顯著差異，而在壓力知覺、症狀嚴重度、藥物態度與相關渴想反應上，「矛盾控制」與「慣性平衡」皆顯著大於「過渡情態」。此外，「矛盾控制」者在藥物渴想反應上的得分顯著大於「慣性平衡」。
結論: 研究結果可發現安眠藥長期使用至少可分為三種使用型態，共通的部分是三種型態皆具備失眠脆弱特質，且長期頻繁地經驗到失眠，同時傾向使用藥物來因應失眠。而三組在壓力與症狀嚴重度上呈現差異，且對於藥物的態度、及對藥物的渴想反應亦呈現差異。對於「過渡情態」者，由於知覺到的壓力程度較低，且失眠與情緒症狀是三組當中最輕微的，因此需要使用藥物的機會較少，反應在使用藥物的頻率較低，且較未呈現出安眠藥物渴想反應。「矛盾控制」者對安眠藥物處於高正向與高負向態度，由於對藥物使用的憂慮，因此除了原有的壓力外，使用藥物本身形成了續發性的壓力，使得「矛盾控制」者的壓力知覺較高，失眠與情緒症狀的嚴重度也較高。此外，由於需頻繁地使用卻又嘗試控制服藥，因此「矛盾控制」者在三組當中使用藥物頻率是高於「過渡情態」但低於「慣性平衡」。對「慣性平衡」者，藥物為因應外在壓力的內化資源，為維持身心平衡的慣性使用型態，在三組當中，「慣性平衡」知覺壓力與症狀嚴重度亦高，但由於規律地使用，對藥物的渴想程度低於「矛盾控制」者。上述三種型態會隨著「知覺藥物效果」、「知覺壓力與因應資源的平衡狀態」、及「對安眠藥物的負向感受」的改變而變動。本研究結果可提供臨床工作者，在協助安眠藥物長期使用處遇上的重要參考。此外，亦可提供後續研究進一步探討使用型態之相關變項與預後的關係。
Objective: Insomnia has high prevalence and is prone to develop into a chronic problem. Hypnotics are the most common choice of treatment for insomnia. Clinically, high proportion of hypnotic users is long-term user. However, the studies show disagreements over the effectiveness and safety of long-term use of hypnotics. Studies on the process of developing long-term hypnotic usage have never been done from the perspective of the users to gain insight into the connotation of drug use attitudes, differences of the patterns of medication, and the transformational process. The objective of this research is to explore the medication pattern and process of the long-term users of hypnotics and the related psychological variables to construct the psychological process model of long-term hypnotics usage.
Methods: In order to construct the psychological experience and behavioral theory of the long-term hypnotics users and then verify the theory with quantized data, this research is divided into two parts. The first part of the research adopts the method of grounded theory to conduct in-depth interviews with 22 long-term users of hypnotics with the average usage period of 6.75 years (6 males and 16 females). Data of the interviews are collected, coded, and then the core concept is extracted in order to propose the long-term pattern and process of hypnotic usage and the related psychological dimensions. The second part of the research conducts classification of the medication patterns of 168 long-term hypnotics users based on the core feature classification concluded in the research part one. The structural questionnaire is used to compare and contrast the differences of the insomnia fragile tendency, perceived stress responses, severity of symptoms, related effect factors of medication, and drug use attitudes and responses of the hypnotic users with different medication patterns. The second part of the research verifies the theory constructed in the first part and enhances the understanding of the profile features of different medication patterns.
Results: Research part one found that long-term hypnotic users could be divided into three pattern groups: transitional state of mind, paradoxical control, and habitus equilibrium. The users with transitional state of mind pattern take hypnotics flexibly in low frequency and their medication is for emergency and short-term use. Users with paradoxical control pattern have contradictory attitudes toward medication and attempt to control the drug use behavior, and thus often experience more distressed emotions. Users with habitus equilibrium pattern believe that they are taking hypnotics to fulfill the physiological needs and habitually accept the medication to keep both the physical and psychological balance. In the process of long-term medication, each pattern could interchange along with the dynamic shift among perception of drug effect, balance between perceived stress and coping resources, and the negative affection toward hypnotics. Research part two uses structural questionnaire to classify and measure the differences in the distinguishing concepts of the three pattern groups. 34 participants are classified into the pattern group of transitional state of mind, 43 paradoxical control, and 91 in habitus equilibrium. After comparing the differences in the scales among the three groups, the research found that all three group show insomnia fragile characteristics and display no significant differences in the aspects of sleep dysfunctional beliefs, drug use related personality tendency and emotion regulation strategies. Paradoxical control and habitus equilibrium have scored significantly higher than the transitional state of mind in the aspects of perceived stress, severity of symptoms, and drug use attitudes and related craving responses. In addition, paradoxical control group scored significantly higher than the habitus equilibrium group in the aspects of drug craving responses.
Conclusions: The findings of this research show that long-term hypnotics use could be classified into three medication patterns. The common traits of all three pattern groups are that they all possess insomnia fragile characteristics, have experienced insomnia frequently over an extended period, and incline to use hypnotics to cope with insomnia. The three groups show differences in the aspects of stress, severity of symptoms, attitudes toward sleep and hypnotics, and craving responses. Users in the group of transitional state of mind have perceived the lower level of stress and experienced the mildest insomnia and affective symptoms. As a result, they have the least chance to use hypnotics, lower frequency of medication, and less craving responses. The users in paradoxical control group have either highly positive or highly negative attitudes toward hypnotics. On top of the original stress, they develop anxiety about the drug use and thus the medication becomes a source of secondary stress that causes higher perceived stress and severer insomnia and affective symptoms. In addition, due to the needs of frequent medication and the attempt to control it, the users in paradoxical control group have higher medication frequency than the users in the transitional state of mind group and the lower frequency than the users in the habitus equilibrium group. Hypnotics are an internalized resource to cope with the external stress for the users in the inertia balance group. They use hypnotics habitually to maintain the physical and psychological balance. Among the three groups, inertia balance has the highest level of perceived stress and the severity of symptoms. However, due to the regular use of hypnotics, they have less craving responses that those in the contradictory control group. The three patterns will change along with the dynamic shift among perception of drug effect, the balance between perceived stress and coping resources, and the negative affection toward hypnotics. It is anticipated that this research will shed lights on the treatment of long-term hypnotics medication for the clinical practitioners and provide a foundation for the future study on the relationship between the related variables of the medication patterns and the prognosis.
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