中文摘要：

對於毒品施用者，我國自1997年毒品危害防制條例將其定位為「病患性犯人」後，先後規劃了「觀察勒戒、強制戒治」、「緩起訴處分附命完成戒癮治療」等方案，試圖改變以往單純處罰的處遇模式，藉由醫療、團體治療、監控等方式，使毒品施用者改善毒品問題。然而，司法體系中的毒品施用者迄今仍過半在監獄中，相關處遇方案之成效不如預期。
對於毒品施用者處遇之議題，以往多著重個別處遇方案之內容或成效研究，較少著眼於制度架構之探討，然而制度架構之規劃會高度影響整體政策成效，其重要性不可小覷。鑒於規劃合適的處遇方案，以及將毒品施用者配對至適當處遇方案之分流機制，是毒品施用者處遇工作之重要基石，本研究首先藉由文獻回顧了解影響毒品施用者處遇政策之觀點、美國及葡萄牙有關毒品施用者分流處遇之經驗及我國毒品施用者分流處遇制度之建構過程；其次，再以深入訪談了解現行分流處遇制度運作時所發現之問題；最後，再就訪談發現進行探討，提出在處遇方案、分流機制兩方面之建議及整體性規劃。此外，由於毒品施用者分流工作中最重要的緩起訴戒癮治療對象篩選缺乏客觀、標準之評估工具，本研究也以文獻回顧、深入訪談及多目標決策分析之方式，建構合適之篩選項目。
在處遇方案方面，經由深入訪談發現緩起訴處分附命條件之內容缺乏彈性、觀察勒戒在現行法規架構及毒品情勢下不合時宜、機構式戒癮治療方案有待充實、處遇期間個案管理機制仍有待加強等問題，本研究對該等問題提出「廢除不符現代毒癮戒治需求之觀察勒戒」、「將強制戒治轉型為嚴重個案之處遇方案」、「改善毒品施用者處遇體系下之刑罰策略」3項建議；而在分流機制方面，經由訪談發現以初\再犯為分流依據問題重重、現行處遇方案之內容多元性不敷個案需求、缺乏分流篩選指標、缺乏分流評估團隊、缺乏個案管理團隊等問題，本研究對該等問題提出「以緩起訴處分制度發展多元處遇方案」、「強化毒品施用個案分流評估及追蹤管理」、「建立標準化個案評估工具」3項建議。
在建構緩起訴戒癮治療對象篩選項目方面，本研究以文獻回顧及深入訪談，尋找出C1「個案健康改善」、C2「社會治安影響」及C3「家庭功能維護」等3個構面，在每個構面下，各別再有3個項目，對於這個3構面9項目的層級架構，經以多目標決策分析得出各項目整體權重，由高而低依序為「個案對醫療協助需求較高（C1-1）：14.21%」、「個案戒毒動機較強（C1-3）：12.13%」、「個案較適合在社區戒毒（C1-2）：12.03%」、「販毒、暴力等重大犯罪前科較少（C2-2）：11.92%」、「可使家庭成員受照顧（C3-3）：11.20%」、「從事施用毒品以外犯罪之可能性較低（C2-1）：10.42%」、「有利於個案家庭經濟狀況（C3-1）：10.03%」、「有利於個案家庭和諧（C3-2）：9.70%」、「吸毒行為之可責性較低（C2-3）：8.37%」。
綜整前述之研究成果，本研究建議毒品施用者應不分初、再犯，皆由檢察官決定起訴或緩起訴，若決定為緩起訴，可附命接受「社區觀護方案」、「社區戒癮方案」或「機構戒癮方案」等不同處遇方案，個案分流之決定，檢察官應依據專業的「分流評估團隊」以評估工具評估後所得資訊為之。個案進入緩起訴處分之各項處遇方案後，應由「個案管理團隊」追蹤個案狀況，表現較好或較差時，可經檢察官同意後決定是否調整處遇內容，遇有得撤銷緩起訴之情形時，亦同樣可由個案管理團隊提供資訊供檢察官參考。此外，對於被起訴之個案，仍應規劃適當之戒癮方案及後續追蹤機制，協助個案在刑事處罰中改善其毒品使用問題。而本研究所建構之9項篩選項目，則可分拆為「是否適合社區處遇」及「是否需要戒癮協助」兩大面向，提供個案分流至起訴或緩起訴之3類處遇方案時，有更明確之分流標準。

英文摘要：

Since the definition of drug users as “patient-offenders” by the Narcotics Hazard Prevention Act in 1997, initiatives such as “Monitored Detoxification and Compulsory Treatment” and “Deferred Prosecution with Completion of Addiction Treatment” have been successively planned, with the intention of replacing simple punishments with therapy, group treatment and supervision to improve the conditions of drug users. However, more than half of the drug users processed by the criminal justice system remain in prisons demonstrating the unexpected ineffectiveness of related interventions.
When it comes to the processing of drug users, most attention has been placed on the treatment content and its impact among individual cases, but the structuration of the treatment system highly affects the overall performance of implemented policies and thus its importance should not be overlooked. Given that a triage mechanism that matches drug users to appropriate treatment options is an important foundation of effective treatment, this researcher set out to first review extant literature to understand drug abuse treatment policies, the experiences of the United States and Portugal in triaging drug users, and the articulation of the triage process in Taiwan. Then, in-depth interviews were conducted to identify problems in the existing triage process. And lastly, recommendations on how to better plan and organize the triage process were offered based on the findings from the interviews. In addition, since there has have been no objective and standardized instruments for treatment matching among drug users receiving deferred prosecution with completion of addiction treatment, this study also relied on literature review, in-depth interviews and multi-objective decision analysis to construct adequate indicator for treatment matching.
In regard to the treatment, in-depth interviews have found the following: the regimen of the compulsory treatment from the deferred prosecution lacks flexibility; the practice of monitored detoxification is outdated in relation to the current legal framework and drug use trends; the capacity of institutional treatment needs to be improved; and the case management during treatment has to be strengthened. Therefore, this study recommends the abandonment of monitored detoxification that no longer complies with contemporary treatment practices, the requirement of compulsory treatment open for all serious cases, and the reform of penal sanctions for drug users. In relation to the triage mechanism, interviews reveal the following: the dual classification of first-time offenders vs. chronic offenders is troubling; the existing treatment options are not diverse enough to address the multiple needs of the cases; there are no screening and triaging criteria; there are no assessment teams specialized in triaging; and there is a lack of case management teams. In response to these challenges, the study proposes the support of the deferred prosecution system with the diversification of treatment options, the strengthening of case triaging and follow-up management, and the standardization of case evaluation instruments.
In regard to the screening criteria for addiction treatment in lieu of prosecution, this study has identified three major dimensions based on literature review and in-depth interviews: C1 “Health Improvement of Participants”, C2 “Impact on Public Safety”, and C3 “Maintenance of Family Function.” Three indicators has also been developed for each of the three dimensions. Multi-objective decision analysis was performed to rank the nine indicators measuring the three theoretical constructs: Stronger needs for medical assistance (C1-1): 14.21%; stronger motivation for treatment (C1-3): 12.13%; better fit for community-based treatment (C1-2): 12.03%; fewer serious criminal records such as drug sales and violence (C2-2): 11.92%; better care of family members (C3-3): 11.20%; lower risk of engaging in crime other than drug use (C2-1): 10.42%; greater financial support to the family (C3-1): 10.03%; greater contribution to family harmony (C3-2): 9.70; and lower accountability for drug use (C2-3): 8.37%.
Summarizing study results presented above, this study proposes the abolition of the differentiation between first-time offenders and chronic offenders, and instead, prosecutors should be empowered to initiate or defer prosecution. If deferred prosecution is indicated, three options including community supervision, community-based treatment, and institutional treatment should be made available. Prosecutors should consider the recommendations based on the data collected with evaluation instruments by a professional triage assessment team. Once a defendant is mandated to a treatment program, a case management team must follow up on the progress of the client. Based on the treatment performance of the client, the prosecutor can adjust requirements imposed on the client. When the deferral is revoked and the prosecution is resumed, information provided by the case management team can also be used to inform prosecutorial decision-making. Even when prosecution is resumed, treatment support and follow-up services can still be planned to help the offender to reduce drug use while awaiting disposition or sentence. And the nine indicators developed in this study can be broadly grouped into “fit for community-based treatment” or “in need of addiction treatment services”. When the case is considered for prosecution or its deferral, the decision on the kind of treatment to impose must be guided by clear triage criteria.

文章連結：

https://hdl.handle.net/11296/4jevjs

資料來源：

臺灣博碩士論文知識加值系統