Earticle

본 연구의 주요 목적은 “마약사용장애치료의 국제방안과 개입의 함의”에 대한 탐색, 리뷰, 소개 하는 데 있다. 마약은 지난 세기 중반부터 우리 생활문화의 일부가 되었다. 과도한 마약남용으로 인한 신체적·정신적 의존을 초래하고, 이는 결국 마약사용장애(Drug Use Disorders)가 된다. 흔히 마약사용장애자의 체포, 유죄판결, 치료명령으로부터 치료중단/실패, 재발, 투옥/사망/비 참함 등의 과정은 악순환을 가져온다. 마약사용장애는 중독자가 일상에서 흔히 경험하는 디스트 레스(Distress)를 대처하기 위한 회피수단의 산물이다. 극도의 걱정, 극도의 슬픔, 극도의 고통 등이 동반하는 감정인 디스트레스는 급성대인관계위기, 애착과 생물심리사회적 취약성, 부적절 한 사회지원 등의 대인관계삼제로 인해 발생한다. 유엔마약범죄국(UNODC)과 세계보건기구 (WHO)는 마약사용장애로 인한 건강과 사회적 손실을 줄이기 위한 증거기반 윤리적 치료정책, 전략, 개입을 지원하기 위해 마약의존치료 및 관리에 관한 글로벌 프로그램을 공동으로 확립했다. 또한, 이를 위해 두 조직은 우수한 치료실제를 전파하고 다른 만성질환에 대해 의료시스템을 제공 하는 것과 마찬가지로 마약사용장애에 대한 치료의 질(quality), 가용성(availability), 경제성 (affordability)을 촉진하기 위해 노력하고 있다. 특히 마약사용장애가 있는 사람들에 대한 낙인과 차별은 치료에 주요 장벽이다. 마약사용장애가 있는 사람들에 관한 인식을 높이고, 비낙인화태도 (non-stigmatizing attitudes)를 장려하고, 구조적인 차별을 해결하기 위해 모든 노력을 기울일 필요가 있다. 국내에서도 마약사용장애를 겪고 있는 사람들의 회복여정에서 다양한 시점의 다양 한 서비스와 개입이 필요로 할 수 있으며, 치료, 돌봄서비스, 회복관리의 연속성을 보장하는 것이 중요하다. 또한, 국내 정책입안자, 건강전문가, 대중은 마약사용장애에 대한 인식의 변화가 필요 하다. 물질사용장애는 심리사회적·환경적·생물학적 결정요인이 있는 복잡한 건강상태라는 인 식이 더 크며, 이는 서로 협력하는 다양한 기관과 조직의 다학제적·포괄적·공중보건지향적인 대처가 필요하다. 마약의존은 “자기가 습득한 나쁜 습관(self-acquired bad habit)”이라기보다 사회적 불이익과 역경을 포함한 생물학적·환경적 요인이 장기적으로 상호작용한 결과이며, 이를 예방하고 적절히 대처해 국민의 건강과 공공안전을 향상할 수 있다는 인식이 필요하다. 아울러 치료시스템자원(treatment system resources)에 기반한 다양한 마약사용장애치료와 치료연속 체를 소개했다.

The main purpose of this study is to explore, review, and introduce “International Alternatives and Implications of Interventions in the Treatment of Drug Use Disorders.” Drugs have become a part of our life culture since the middle of the last century. Excessive drug abuse results in physical and mental dependence, which eventually leads to drug use disorders. Often, the process of a person with a drug use disorder from arrest, conviction, and treatment mandate to treatment dropout/failure, relapse, and incarceration/death/misery creates a vicious cycle. Drug use disorders are a product of avoidance means used by addicts to cope with distress they commonly experience in their daily lives. Distress, which is an emotion accompanied by extreme worry, extreme sadness, and extreme pain, is associated with the interpersonal triad such as acute interpersonal crisis, attachment and biopsychosocial vulnerability, and inadequate social support. The United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) jointly established a global program on drug dependence treatment and management to support evidence-based ethical treatment policies, strategies, and interventions to reduce health and social losses caused by drug use disorders. To this end, the two organizations are also working to promote quality, availability, and affordability of treatment for drug use disorders, just as they spread good treatment practices and provide medical systems for other chronic diseases. In particular, stigma and discrimination against people with drug use disorders are major barriers to treatment. There is a need to make every effort to raise awareness of people with drug use disorders, encourage non-stigmatizing attitudes, and address structural discrimination. Various services and interventions at different points may be required in the recovery journey of people suffering from drug use disorders in Korea, and it is important to ensure the continuum of treatment, care services, and recovery management. In addition, domestic policymakers, health experts, and the public need to change their perceptions of drug use disorders. There is greater recognition that substance use disorders are complex health conditions with psychosocial, environmental, and biological determinants, which require a multidisciplinary, comprehensive, and public health-oriented response from various agencies and organizations working together. Drug dependence is not a “self-acquired bad habit,” but rather a result of the long-term interaction of biological and environmental factors, including social disadvantage and adversity. There is a need for awareness that people's health and public safety can be improved by preventing and responding appropriately. Furthermore, various treatments and treatment continuum of drug use disorders based on treatment system resources were introduced.

Background: Poor sleep quality is associated with psychoactive substance abuse/addiction/withdrawal. Auricular acupuncture (AA) is a nonpharmacological method used for the treatment of sleep disturbances. This study aimed to examine the quality of sleep before and after AA in participants with mental and behavioral disorders due to prior multiple drug use in the therapeutic community. Methods: This was a consecutive case series of 27 participants (25 male [92.6%]). The median age was 35.0 years (interquartile range [IQR], 29.0?37.2 years), methadone/buprenorphine were not used, and the participants were treated with AA (median number of treatments, 15.0 [IQR, 12.0?18.0]) during a median period of 51.0 days (IQR, 49.0?51.0 days) according to the National Acupuncture Detoxification Association (NADA)-Acudetox protocol. Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire that assesses sleep quality and disturbances over a 1-month interval. Results: The global PSQI score dropped (indicating better sleep quality) by a median of 3.0 points (IQR, 0.0?8.0 points) after treatment. In the multivariate logistic regression analysis, with an increase in global PSQI score during AA by 1 point, there was a 0.73-fold reduction in the risk of poor sleep quality post-AA (adjusted odds ratio, 0.73; 95% confidence interval, 0.52?1.01; p<0.055; Nagelkerke’s R2=0.66). Conclusion: The results revealed a positive effect of AA (by the NADA-Acudetox protocol) on sleep quality (as measured by PSQI) among participants in a treatment center with mental and behavioral disorders due to multiple drug use.