| Summary: | 研究目的：失眠影響國人身心健康甚多，藥物取向治療為當代最廣泛的失眠治療方式。研究顯示許多失眠患者，可藉由短期服用助眠藥物改善失眠，避免個體失眠慢性化，且於停藥後未有任何藥物副作用困擾。然而，臨床上仍觀察到不少個案，對助眠藥物產生依賴，需長期服用助眠藥物，此舉不僅造成醫療資源之浪費，其安全性與有效性仍受爭議。而心理因素在藥物依賴扮演重要的角色，同樣是長期服用助眠藥物，不同的助眠藥物使用者卻可能存有相異的用藥心態，因此助眠藥物使用者的用藥行為以及用藥相關心態，可能會組合成不同的用藥型態，而探討助眠藥物之不同使用型態與其心理機轉，有助於進一步瞭解助眠藥物使用現象。故本研究旨在用量化方法探討助眠藥物使用型態之差異，試圖將不同的助眠藥物使用型態進行分群，並提出可能影響助眠藥物使用型態的相關因子。
研究方法與結果：本研究招募了272名曾經或目前正在服用助眠藥物的使用者填寫研究問卷，透過對兩個外顯用藥行為變項（用藥總時間、用藥頻率）與六個用藥相關心理變項（對助眠藥物的渴求程度、對助眠藥物的正、負向態度、主觀規範、以及促進、抑制之知覺控制）的集群分析，我們將助眠藥物使用型態分為「慣性使用」、「矛盾依賴」、「控制使用」以及「輔助使用」四種型態。在外顯用藥行為方面，「慣性使用」集群與「矛盾依賴」集群皆展現較長的用藥時間與高頻率的使用，「控制使用」群集與「輔助使用」群集則展現較短的用藥時間與低頻率的使用。然而，四組群集皆展現其獨特的心理特徵。「慣性使用」群集對助眠藥物的渴求程度最強，正向態度比負向態度高，主觀認為重要他人支持自己服用助眠藥物，傾向持續服用助眠藥物；「矛盾依賴」群集呈現對助眠藥物正向與負向態度皆高的矛盾狀態，且主觀認為自己無法控制藥物之使用；「控制使用」群集雖也對助眠藥物出現正向、負向態度皆高的表現，但其可對藥物使用進行控制；「輔助使用」群集的個案對於助眠藥物的負向態度高於正向態度，藥物渴求程度低，且傾向避免使用助眠藥物。多項式邏輯斯回歸的分析結果則進一步顯示年齡較大、失功能睡眠信念問卷分數較高的個案，較容易落入「慣性使用」組；被診斷過情緒疾患、失眠時間較長、睡前激發程度問卷分數較高的個案，較容易落入「矛盾依賴」組；受教育年限較高的個案，較傾向落入「控制使用」組；最後，年紀較輕、失功能睡眠信念問卷分數較低的個案，則容易落入「輔助使用」組。
結論：本研究結果顯示相似的用藥行為仍有相異的用藥相關心理狀態，且部分心理相關變項可能會影響助眠藥物之使用型態，故推測用藥心理與助眠藥物使用者的特質扮演影響用藥型態的重要因素。此結果可提供臨床工作者，初步了解助眠藥物使用之心理機轉，亦能將其運用於協助不同類型的安眠藥物使用者擬訂減藥處遇。
=== Purpose：Insomnia has great impact on people's health in Taiwan. Pharmacological approaches are the most commonly used treatment for insomnia. Although short-term hypnotic use could improve sleep, however some patients use hypnotics for a prolonged period of time and have difficulty to discontinue using them. This would lead to great cost of the individuals and societies. Psychological factors have been found to play an essential role in the long-term use of other substances. Clinical observation also showed that there were individual differences in the psychological aspects of medication use in spite of similar medication use behaviors. Therefore, it is possible to use hypnotic-related behaviors and psychological factors to categorize hypnotic users in order to further the understanding the mechanism underlying chronic hypnotic use. The purpose of this research is to identify hypnotic use patterns by exploratory quantitative method and the characteristics associated with different hypnotic usage patterns.
Methods and Results: 272 previous or current hypnotic users were recruited to complete a package of questionnaires. Through cluster analysis with two explicit medication behavior variables (total duration of hypnotic use, frequency of hypnotic use) and six hypnotic-related psychological variables (craving for hypnotic, positive and negative attitudes towards hypnotic, subjective norm, facilitating and inhibiting perceived behavioral control), four hypnotic usage patterns were identified, which were “habitual use”, “paradoxical dependence”, “controlling use”, and “supplementary use”. In terms of explicit medication behaviors, “habitual use” and “paradoxical dependence” clusters both show longer time and higher frequency of hypnotic use. On the other hand, “controlling use” and “supplementary use” clusters showed similar medication use behaviors with shorter duration and lower frequency of hypnotic use. In addition, the four clusters exhibited different psychological profiles. Users in “habitual use” cluster have strongest craving for hypnotic, higher positive than negative attitude toward hypnotic use, and believe that significant others support their medication behavior. Users in “paradoxical dependence” cluster showed paradoxical attitude toward hypnotics, and reported less control over their hypnotic use. Users in “controlling use” cluster also had paradoxical attitude toward hypnotic, but their craving level of hypnotic was lower than users in “paradoxical dependence” cluster. In addition, users in “controlling use” cluster feel they can control their hypnotic use. Users in “supplementary use” cluster had lowest craving level, higher negative attitude toward hypnotic, and tend to avoid taking hypnotic when possible. Multiple logistic regression further showed that (1) people with older age or higher score on the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) tend to classified into “habitual use” cluster; (2) people with mental disorder diagnosis, long history of insomnia, or higher score in Pre-Sleep Arousal Scale (PSAS) tend to be classified into the "paradoxical dependence " cluster; (3) patient with more years of education more likely fall into “controlling use” cluster, finally, (4) the hypnotic users who are younger or lower score in DBAS are easier classified into the “supplementary use ” cluster.
Conclusions：The results of the current study indicates that similar medication behavior could have different hypnotic-related psychological status. Therefore, psychological factors are needed to be assessed in order to understand the process of long-term hypnotic use. The results provides a further understanding of the psychological mechanisms of hypnotic use, and also help clinician in related-field to develop insomnia treatment plan or hypnotic discontinuation program based on insomniacs’ characteristics and their psychological variable toward hypnotic use.
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