本研究目的為探討國內海洛因戒治人的渴求經驗，試圖檢驗藥物渴望量表(DDQ)(Franken, 2002)在台灣樣本的信效度，同時了解不同渴求構念與焦慮、憂鬱以及執行功能的關係。 首先根據過去渴求模式以及相關渴求量表發展，提出藥物渴望量表的兩個不同因素結模型，分別為模型一正增強、負增強以及控制，模型二渴望與意圖、結果預期以及控制，由探索性因素分析與驗證性因素分析結果顯示，藥物渴望量表的控制因素無法穩定反應渴求構念，但正增強與負增強、渴望與意圖與結果預期兩模型則可得到良好的支持，其中正增強與負增強之模型顯著優於單因素模型。 相關分析結果顯示，渴求的正增強與負增強兩構念皆與焦慮、憂鬱情緒達顯著正相關，淨相關分析中顯示排除正增強影響後，負增強仍與焦慮強緒有顯著相關。渴求也與執行功能中的工作記憶、訊息處理速度有顯著的負相關。研究結果初步顯示國內海洛因戒治人之不同渴求狀態與焦慮、憂鬱以及執行功能之關係，顯示在成癮治療過程中，不僅須處理渴求經驗，同時也須針對焦慮、憂鬱情緒做介入，並考慮認知功能對治療、復發的影響，以降低個案復發的風險。 / The purpose of the present study was to discuss the craving experience of heroin addicts during compulsory treatment in Taiwan. Drug Desire Questionnaire (Franken, 2002) was used to investigate different craving constructs that were positive reinforcement, negative reinforcement and control. DDQ was validated in this research. This study also examined the relationships between heroin craving, depression, anxiety and executive function. According to models of craving and research, the present study tried to examine the two models of DDQ simultaneously. Two models were also accepted but the model composed positive reinforcement and negative reinforcement was better than one-factor model. Control factor of DDQ was not validated. The result of partial correlation analysis revealed that negative reinforcement was significantly related to anxiety after control the effect of positive reinforcement. According to the results of correlation analysis, two different craving construct were also significantly related to working memory and not related to the other ability of executive function. Implications for clinical applications and future research were also suggested.

本研究主要是利用國內的海洛因戒治者，透過神經心理作業探討長期使用海洛因對於個體在注意力偏誤、轉換彈性和抑制能力上的影響。 根據Robinson和Berridge（1993, 2003）的理論認為成癮嚴重度越高，藥物相關線索的注意力偏誤越明顯；然而，根據Di Chiara（2000）提出關於整合誘因和習慣的觀點，認為成癮的注意力偏誤和趨向行為會受到不同的成癮嚴重度(輕度或重度成癮)或成癮階段(早期或習慣化後期)而有不同的結果，另外，以往的執行功能損害也支持Robinson和Berridge（1993, 2003）成癮嚴重度的觀點，因此本研究企圖同時檢驗上述兩者觀點。 本研究篩選111名台中戒治所和看守所的海洛因戒治者，分別根據不同的成癮嚴重程度分類方式分組(依賴嚴重度量表、不同頻率、施用方式)，加上29名健康對照組，共140名受試均需完成自陳氏量表、紙筆測驗和各項神經心理測驗（Stroop叫色作業、威斯康辛卡片分類測驗、Go/No Go作業）。 研究結果指出海洛因戒治者相較對照組確實在注意力偏誤、認知彈性轉換、以及反應抑制能力有損害的趨勢，而且似乎較符合Di Chiara（2000）提出整合誘因和習慣的觀點，認為成癮者的認知功能會與成癮嚴重度成負向關係。

本研究目的主要在探討海洛因成癮者是否具有決策判斷的問題與抑制控制能力缺損，利用數理認知模型的參數值檢驗受試者在新式Go/No-Go作業的表現，該作業結合IGT與原先Go/No-Go作業的特性，並將作業刺激改為中性與海洛因相關的圖片，探討海洛因成癮者在此作業的決策歷程與抑制反應功能，並與控制組作比較。另者，根據誘發─敏感化理論 ( Robinson & Berridge, 1993 ) 與誘發─習慣化模式 ( Di Chiara, 2000 ) 的預測，前者認為成癮越嚴重者的抑制缺損情形會越嚴重，對藥物相關刺激的注意力偏誤也越明顯；後者則認為藥物依賴階段的初期會發生較嚴重的注意力偏誤情形，但隨著依賴程度增加而對藥物相關刺激已習慣化，尋求藥物行為也已變成自動化反應，故注意力偏誤的情形反而會減少。因此，本研究試圖在加入藥物相關刺激的Go/No-Go作業中驗證這兩種理論的預測。 本研究以48位一般控制組、88位海洛因受戒治人為樣本，利用Go/No-Go作業與線索依賴學習模式 ( CD model ) 分析受試者對酬賞或處罰的注意力 ( w參數 )、學習率 ( 參數 )、反應一致性 ( c參數 )、以及海洛因圖片價值的影響 ( I_Heroin參數 )，結果發現，比起控制組，海洛因成癮者對酬賞的注意力較低、受到藥物相關刺激影響較明顯。另外，將戒治組分為物質高依賴組與低依賴組時，比起控制組，高依賴組對酬賞的注意力較低；而低依賴組受到海洛因圖片價值影響較明顯。結果證實當面對同時具有中性與藥物相關刺激時的情況下，海洛因成癮者與過去古柯鹼成癮者在決策作業上的表現不同，不僅受到酬賞或處罰的影響，藥物相關刺激本身亦帶有某種價值，影響成癮者的決策與抑制能力；另外，結果部分支持誘發─習慣化的預測。 / The purpose of present study was to investigate the decision making and inhibitory problem in heroin addicts, and to use the mathematics cognitive model parameters to examine performance in a new Go/No-Go Task of subjects. The task combined the characteristics of IGT and original Go/No-Go Task. We changed the task’s stimuli to neural and heroin related pictures, to explore the decision making and inhibitory reactive function in the task, and compared with control group. On the other hands, according to Incentive-sensitization theory (Robinson & Berridge, 1993) and ‘Incentive ─ habit’ model (Di Chiara, 2000), the incentive-sensitization thoery thought that people with increasing severity of addiction get more inhibitory problems and attentional bias toward drug related cues, but the incentive-habit model suggests that attentional bias for drug cues will be more severe in the early stage of drug dependence., but with the increase in dependence and habit to drug cues, drug-seeking behavior has become automatic reaction, so attentional bias will be attenuated when abusers get more dependence. Therefore, this study attempted to verify the prediction of two theories in the Go / No-Go Task with drug-related stimuli. This research was based on the data collected from the 48 normals and 88 heroin addicts, using Go/No-Go Task and Cue-dependence learning model ( CD model ) analysis their attention to reward or punishment ( parameter w ), learning rate ( ), reactive consistence ( c ), and valence of heroin pictures ( I_Heroin). The result revealed that compare to controls, heroin addicts had fewer attention to rewards, and more obvious influenced by drug related stimuli. Otherwise, to divided addicts group into high dependence group and low dependence group, compared to control group, the high dependence addicts had lower attention to reward, and the lower dependence addicts was higher influenced by drug related stimuli. It confirm that when heroin abusers faced to neural and drug related stimili, their performance in decision making task was different from cocaine abusers, it’s not only influenced from reward or punishment, but also from the valence of drug related cues. In addition, the result partially support the prediction of the incentive-habit model.

本研究的主要目的在於探討美沙冬的使用者是否具有抑制控制能力缺損、對海洛因相關刺激是否具有注意力偏誤，以及是否有彈性認知轉換能力上的問題。 研究使用的是Noel等人（2005,2007）發展出來的Go/No-Go作業，並使用海洛因圖片與中性圖片為作業刺激，分別測量受試者在作業中的反應正確率、反應遺漏數、反應犯錯數、平均反應時間、決定偏誤與區辨度，並且使用依賴嚴重度量表，以了解受試者對海洛因的依賴嚴重度與Go/No-Go作業各指標之間的相關。 　　美沙冬組樣本選取自八里療養院土城門診部之接受美沙冬治療者，共17人，經由網路招募之健康控制組十九人，受試者一共三十六人。共變數分析之結果顯示在Go/No-Go作業的正確率、遺漏數、區辨度和決定偏誤等指標上，發現組別與情境轉換之交互作用，顯示使用美沙冬之受試者具有彈性認知能力上的缺損，因此在有轉換的區段之中，無法快速地適應新的作答規則。此外，Go/No-Go作業結果未發現美沙冬使用者之抑制缺損與對海洛因相關圖片之注意力偏誤之現象。 　　依賴嚴重度與Go/No-Go作業的指標相關研究則發現，其依賴嚴重度越高，其在非轉換情境中對海洛圖片的犯錯數越低、決定偏誤越高，顯示美沙冬使用者似乎在沒有情境轉換的區段中，會將其注意力資源分配在海洛因圖片上，忽略非海洛因圖片，顯示其注意力較具選擇性。 / The goal of this study is to explore the inhibitory deficits、attentional bias towards heroin-related cues and cognition flexibility of current methadone users. The Go/No-go task used here was previously developed by Noel et al. (2005, 2007). Heroin-related pictures and neural pictures were presented as targets or non-targets. Accuracy rate、omission、commission、average reaction time、decision bias(C) and discrimination (d’) were being measured individually. The relation between the severity of heroin dependence and task performance was also investigated. The 17 subjects in methadone group were currently methadone maintenance treatment patients from Bali psychiatric center, and the 19 control group subjects without a drug using history were recruited by internet advertisement. The covariance analysis revealed interactions of group and shift/non-shift condition on accuracy rate、omission、decision bias(C) and discrimination (d’), indicating a cognitive flexibility deficits in methadone users. They had difficulty adapting to new rules in shifting conditions. No inhibitory deficits or attentional bias were found so far in this study. The relation between heroin dependence and Go/No-go task performance revealed that the more dependent the methadone subjects were, the less commission errors they made, the higher decision bias score they got towards heroin pictures in non-shifting conditions. It seemed that the methadone users were prone to allocate more attention resource to heroin-related pictures in non-shifting conditions, suggesting a more selective attention process.