臺灣博碩士論文加值系統

研究背景與目的：
「渴想」（craving）為成癮範疇中的重要研究議題，是物質使用者普遍而強烈的經驗之一，過去常以線索暴露典範（Cue-Exposure Paradigm）的方式，使物質使用者暴露於物質相關線索下，誘發其渴想感受，並同步進行口語與非口語等主、客觀渴想測量進行研究。結果指出暴露於物質線索下，多有主觀渴想增加、客觀生理心理的改變，然而目前在生理心理測量結果，仍未有一致之定論。過去研究較少排除焦慮干擾、及探討不同使用情境對渴想的影響，因此本研究目的欲了解不同藥物使用情境下，海洛因使用者在主、客觀渴想表現是為何？以及其主、客觀渴想表現是否有差異存在？
研究方法：
本研究共選取51名男性、因海洛因案或半年內曾使用海洛因之判刑確定受刑人為主要研究對象，分成中性線索組15人，單獨使用組18人，團體使用組18人。以視覺類比量尺、渴求量表及生理回饋儀測量心跳速、膚電流與膚溫，並比較各組表現。
研究結果：
研究結果發現，主觀渴想部份，三組在主觀渴想未達顯著，但以是否暴露於物質線索重新分組後，則發現主觀渴想差異接近顯著，客觀生理心理測量部份，在排除焦慮之後，三組在心跳反應率與恢復率差異達顯著、膚電流反應率與恢復率接近顯著，膚溫則未達顯著。相關方面，主觀指標渴求量表與視覺類比量尺呈現正相關。生理心理指標間的相關，膚電流恢復率與膚溫恢復率呈負相關。主、客觀渴想指標間之相關：基準期的主觀渴想VAS2分別與操弄期心跳、恢復期心跳達正相關，其餘主、客觀指標間無顯著相關存在。
結論：
研究結果僅部分證實海洛因使用者暴露於海洛因相關線索下主觀、客觀生理心理渴想指標有差異。主觀渴想表現僅達邊緣顯著，但與過去研究相比趨勢上仍是一致的。客觀生理心理渴想指標部份，心跳反應率與恢復率達顯著，膚電反應率與恢復率接近顯著，但表現趨勢與過去多數研究略有不同：心跳呈現下降、膚電上升與膚溫下降的表現，因此心跳速率為較好的客觀渴想測量指標。最後，文中亦指出一些研究可能的限制及干擾因素，並於文末討論未來研究之方向。

Object: A craving, which is one of the common but strong experiences of substance-abusers, is an important issue in the field of addiction. We used to apply Cue-Exposure Paradigm to the study by exposing the abusers to substance-related cues to induce their cravings and simultaneously to measure the verbal and the nonverbal, the subjective and the objective cravings. The results indicated that abusers, exposed to the substance-related cues, showed an increase of the subjective cravings, and changes of the objective psychophysiology. However, the results of the measurement of psychophysiology so far do not come to a final conclusion. The former studies seldom excluded the anxiety interference and explored less the influences of different abuse circumstances on the cravings. Therefore, this study aims at what are the expressions of the subjective and the objective cravings of the heroin-abusers under different abuse conditions, and whether there is a difference between their expressions of the subjective and the objective cravings.
Method: In the study, there are 51 male participants, chosen as main objects of the study out of the inmates, of heroin cases or determinately sentenced for heroin-abuse within half a year. They are divided into groups of neutral cues (15), single user (18), and group user (18); the VAS, the craving questionnaire, and the biofeedback instrumentation are applied to the measurement of their heart rates, skin conductance, and skin temperature. The expressions of these groups are further compared.
Results: The result indicates that the subjective cravings of three groups are not significant, but if the groups are rearranged in terms of their exposure to substance cues, the difference of the subjective cravings becomes marginally significant. In aspect of the objective psychophysiology, when the anxiety is excluded, the heart response rate and recovery rate are significant, and the skin conductance response rate and recovery rate are marginally significant, but the skin temperature is not significant. As to correlations, the subjective-index craving questionnaire and the VAS are positive correlated; the correlations between the psychophysiological indexes, the skin conductance recovery rate and the skin temperature recovery rate are negative correlated. As to correlations between the indexes of the subjective and the objective cravings, the subjective cravings VAS2 at baseline separately with the heart rate at the exposure stage and that at the recovery stage is positive correlated. There is no significant correlation between the rest of the other subjective and objective indexes.
Conclusion: Only parts of the results of the study prove the differences between the subjective and the objective psychophysiological indexes under the abusers’ exposure to the heroin-related cues. The expression of the subjective cravings is only marginally significant, but consistent in tendency compared with the former studies. As to the psychophysiological indexes, the heart response rate and recovery rate are significant, and the skin conductance response rate and recovery rate are marginally significant, but the expression tendency is somewhat different from the results of most of the former studies: the heart rate decreasing, the skin conductance increasing, and the skin temperature decreasing; therefore, the heart rate is a better index of the objective craving measurement. Finally, the text also indicates some possible factors of limits and interference, and future foci of the study.

摘要 I
英文摘要 II
謝誌 IV
目錄 VI
圖表目錄 VIII
第一章 緒論 1
第一節 研究動機與目的 1
第二節 藥物濫用者的渴想 3
一、 藥物濫用者的渴想與精神醫學診斷 3
二、 渴想的定義 4
第三節 渴想的表現與評估 8
一、 渇想的認知與行為表現 8
二、 渴想的心理生理表現 9
三、 渴想的測量方式 9
四、 小結 13
第四節 線索暴露典範誘發渴想 15
一、 線索暴露典範（cue-reactivity paradigm）及其理論 15
二、 線索暴露典範中線索與渴想的關係 16
三、 虛擬社交情境與線索誘發渴想的關係 23
四、 小結 28
第五節 研究假設 29
第二章 研究方法 32
第一節 研究對象 32
第二節 研究設計與測量 37
一、 實驗設計 37
二、 實驗作業與設備 37
三、 測量工具 39
第三節 實驗程序 44
一、 階段一 45
二、 階段二 46
三、 階段三 49
第三章 研究結果 51
第一節 三組受試者在主觀渴想反應之比較 52
一、 三組渴求量表前、後測差異檢定 52
二、 三組的主觀渴想（視覺類比量表，VAS）的差異檢定 53
第二節 三組受試者在客觀渴想生理心理反應比較 57
一、 心跳速率、膚電流、膚溫的平均數差異比較 57
二、 三組反應率與恢復率的差異檢定 64
第三節 各渴想指標間之相關、海洛因使用史與渴想的表現 67
一、 視覺類比量尺與渴求量表間的相關 67
二、 客觀生理心理指標間的相關 67
三、 主、客觀渴想指標間的相關 67
四、 海洛因使用史在渴想間的差異 70
第四章 綜合討論 74
第一節 研究結果與摘要 74
一、 主觀渴想指標方面 74
二、 客觀生理心理指標方面 74
三、 渴想指標間之相關 75
四、 海洛因使用史在主、客觀指標間的差異 76
第二節 綜合討論 77
一、 主觀渴想指標部份 77
二、 客觀生理心理渴想指標的部份 79
三、 不同海洛因使用史在渴想表現上的差異 81
第三節 研究限制、未來研究方向與研究貢獻 84
一、 研究限制 84
二、 未來研究方向 85
三、 研究貢獻 86
參考文獻 88
附錄一 研究參與同意書 96
附錄二 基本資料問卷 97
附錄三 物質渴求量表 98
附錄四 中文版情境特質焦慮量表-情境焦慮部份（STAI-S） 99
附錄五 海洛因使用史調查表 100
附錄六 視覺類比渴想問卷 101
附錄七 中文版情境特質量表-情境焦慮部分 授權同意說明 102

圖表目錄
表目錄
表1-2-1 過去學者對渴想的描述或定義 4
表1-3-1 多題項渴想問卷整理 10
表1-3-2 測量渴想的神經心理方法相關文獻 13
表1-4-1 線索暴露典範之研究—錄影帶、錄音帶暴露 21
表1-4-2 線索暴露典範之研究—虛擬社交情境 25
表2-1-1 人口學變項描述統計與檢定 34
表2-1-2 各組多重藥物使用描述統計表 35
表2-1-3 海洛因使用史統計數據 36
表2-2-1 各組所觀看影片之安排 37
表2-2-2 暴露影片各片段之內容 38
表3-1-1 三組情境焦慮量表之數據 51
表3-1-2 三組渴求量表前、後測之數據 52
表3-1-3 各組渴求量表前、後測平均值重複量數比較 52
表3-1-4 三組主觀渴想視覺類比量尺(VAS)平均數M、標準差(SD)數據 53
表3-1-5 各組VAS1、VAS5 得分平均值重複量數比較 53
表3-1-6 各組VAS2~4 得分平均值重複量數比較 54
表3-1-7 線索有、無的VAS2~4 得分平均值重複量數比較 55
表3-1-8 各組VAS2~4 得分平均值重複量數比較 55
表3-1-9 藥物線索有、無兩組之單純主要效果檢定 56
表3-2-1 三組在適應期的心跳速率、膚電、膚溫平均值之數據與差異 57
表3-2-2 三組各階段的心跳速率平均值之數據 58
表3-2-3 三組在基準期、操弄期、恢復期之心跳速率平均值差異 58
表3-2-4 線索有無分組在基準期、操弄期、恢復期之心跳速率平均值數據 59
表3-2-5 兩組在基準期、操弄期、恢復期之心跳速率平均值差異 59
表3-2-6 三組各階段的膚電流指標平均值之數據 60
表3-2-7 三組在基準期、操弄期、恢復期之膚電流指標平均值變異數分析 60
表3-2-8 線索有無分組在基準期、操弄期、恢復期之膚電流平均值數據 61
表3-2-9 兩組在基準期、操弄期、恢復期之膚電流平均值差異 61
表3-2-10 三組各階段的膚溫指標平均值之數據 62
表3-2-11 三組在基準期、操弄期、恢復期之膚溫指標平均值變異數分析 62
表3-2-12 線索有無分組在基準期、操弄期、恢復期之膚溫平均值數據 63
表3-2-13 兩組在基準期、操弄期、恢復期之膚溫平均值差異 63
表3-2-14 客觀生理心理指標反應率與恢復率之數據 65
表3-2-15 藥物線索有、無分組之客觀生理心理指標的反應率與恢復率之數據65
表3-2-16 生理心理指標反應率2 與恢復率2 之數據 66
表3-3-1 主、客觀渴想指標間之PEARSON 積差相關 68
表3-3-2 主觀渴想指標與反應率、恢復率之PEARSON 相關 69
表3-3-3 半年內是否使用海洛因在渴想表現達顯著之數據 71
表3-3-4 海洛因使用方式在渴想表現上之T 檢定差異 72
表3-3-5 海洛因使用多久在渴想表現上的T 檢定差異 73
表4-2-1 過去以生理心理測量之研究結果 83
圖目錄
圖2-3-1 總實驗流程圖 44
圖2-3-2 階段二實驗程序圖 46
圖3-2-1 三組受試者在四個階段心跳速平均值的趨勢圖 59
圖3-2-1 三組受試者在四個階段膚電流平均值的趨勢圖 61
圖3-2-1 三組受試者在四個階段膚溫平均值的趨勢圖 63

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