背景
在愛滋病與藥癮治療的成效評估中，個案穩定復元是維持 Undetectable = Untransmittable（U=U）狀態的關鍵。實務經驗顯示，可透過三大指標監測復元穩定度：睡眠品質、飲食規律性，以及是否設定職務以應對壓力。台灣朝露治療性社區主要服務愛滋感染且合併藥物成癮的個案，並採取外控環境進行多專業合作的減害與戒治處遇。然而，過往經驗顯示，個案在長假期間（如春節）離開社區後，因復用誘因增加，即便假期前已訂定預防計畫，仍易發生非預期藥物使用，進而擾亂其穩定復元歷程。
目的
基於減害處遇理念，避免個案重蹈過往混亂用藥模式所導致的身心社會傷害，本社區在個案放長假前，均會與其共同制定減害與預防復用計畫，並建構多軌支持網絡以因應突發情況。透過多年經驗的累積與調整，本研究探討 2025 年春節長假期間之最新減害防護策略與應對機制，並分析其如何成功突破「長假即混亂用藥」的既有困境。
介入策略
本次長假減害防護策略依時程分為三階段：假期前的預防性機制、假期中的支持暨監督性機制，以及假期後的回觀反思機制。
- 假期前：透過減害團體討論，促使學員共同思考風險因應策略，並藉由社工個別會談，協助制定個人化的假期生活規劃與減害防護計畫。
- 假期中：為延續社區外控功能與強化支持系統，團隊與個案共同建構四項機制：定時回報機制確保個案於約定時間向社區回報當日狀況；同儕輪值互助安排同儕彼此關懷與督促，形成支持網絡；每日線上夜間分享透過線上交流檢視當日狀態，提升復元意識；復元培力圈支持結合線上與線下資源，提供即時陪伴與應變機制，並視情況提供「提早收假」選項，以降低高風險情境下的復用機率。
- 假期後：透過減害團體及個別會談，回顧假期經驗，探討影響物質使用的環境因素與個人狀態，強化未來復元策略。
透過這些多層次介入策略，我們期望逐步提升個案面對高風險情境的應對能力，減少長假期間因非預期物質使用帶來的傷害，並維持穩定的復元歷程。
結果
經由系統性的三階段減害防護策略，我們觀察到以下顯著成效：尿液篩檢陽性率由往年平均 80% 大幅下降至 27%，減幅超過五成；90% 個案表示獲得充足的情感支持，75% 學員肯定即時支持資源對其度過假期的幫助，特別是在高風險時刻能獲得立即諮詢與協助。本研究證實，多層次防護策略能有效降低個案於長假期間的物質使用率，並為減害與 U=U 醫囑順從提供了實證參考。
結論
未來，本社區計畫進一步精進以下三項策略：第一、強化同儕互助機制，透過發展同儕倫理規範與界線劃分能力，減少互動過程中的負面影響，提升支持效果。第二、增進個案的求助與共病因應能力，優化辨識高風險情境與求助流程，降低因精神症狀導致的危機事件。第三、穩固長假期間的支持機制，探索如何延續社區的外控功能，逐步建立個案的自我管理能力，確保治療性社區的療效能延續至出社區後的長期復元歷程。
(English Version)
Preventing Relapse During Holidays: Strategies for Maintaining Adherence to Medical Treatment—A Case Study of the Chaolu Farm Therapeutic Community in Taiwan
Background
For individuals with HIV and substance use disorders, recovery stability is essential for maintaining U=U status. Practical experience suggests three indicators can be used to assess the stability of recovery: sleep quality, dietary habits, and structured stress management activities. Chaolu Farm Therapeutic Community in Taiwan serves this population through externally controlled environment to implement multi-disciplinary harm reduction and rehabilitation interventions. During extended holiday breaks like Lunar New Year, residents face significant relapse triggers when leaving this structured environment, often resulting in unexpected substance use despite careful prevention plans.
Objective
Following harm reduction principles, the therapeutic community works to prevent chaotic substance use patterns. The community develops personalized harm reduction plans and multi-level support networks before long holidays. The 2025 Lunar New Year implementation of an enhanced protection strategy aimed to break the persistent "holiday relapse cycles" that had previously challenged recovery progress.
Methods
The holiday harm reduction strategy is structured into three phases:
- Pre-Holiday (Preventive Mechanisms): Group discussions facilitate risk assessment and strategy development. One-on-one sessions with social workers help individuals create a personalized harm reduction holiday plan.
- During the Holiday (Support and Supervision Mechanisms): To extend the protective function of the therapeutic community and strengthen the safety network, scheduled check-ins require residents to report their daily status to the community. Peer support rotation provides a system of mutual support among peers for accountability. Daily online evening sharing through virtual gatherings encourages self-monitoring and reinforces recovery goals. Recovery Empowerment Group combines online and offline support to ensure real-time crisis intervention. Additionally, a "return early" option allows individuals to voluntarily shorten their holiday if needed.
- Post-Holiday (Review and Reflection Mechanisms): Group discussions and one-on-one counseling sessions facilitate reflection on holiday experiences. Individuals analyze environmental triggers, personal conditions, and usage patterns to strengthen future prevention strategies.
By combining comprehensive and embedded harm reduction measures, this strategy aims to enhance participants' ability to navigate high-risk situations, minimize substance use harm, and ensure continued progress in long-term recovery.
Results
The structured, three-phase harm reduction strategy achieved significant success: Urine test positivity rates dropped from 80% in previous years to 27% in 2025, a reduction of over 50%. Enhanced emotional and social support was evident as 90% of participants reported receiving sufficient emotional support, and 75% expressed that immediate access to support resources played a crucial role in navigating holiday challenges. These findings confirm that multi-level protection strategies effectively reduce substance use during long holidays and provide empirical evidence for harm reduction and adherence to U=U medical guidelines.
Conclusions
Future community efforts will focus on three key areas: enhancing peer support mechanisms by developing ethical guidelines and boundary-setting training to minimize potential negative influences while improving overall support quality; strengthening crisis response by improving risk identification and emergency protocols for better management of mental health symptoms during holiday periods; and sustaining long-term recovery by exploring how structured external support can gradually transition into effective self-managed recovery beyond the community setting.
引用方式
Hsu, S. J., Lin, Y. X., Chang, L. L., Yilu, S., Ku, J. B., Chiu, C. H., & Lin, X. R. (2025, June 18–20). Preventing relapse during holidays: Strategies for maintaining adherence to medical treatment—A case study of the Chaolu Farm Therapeutic Community in Taiwan [Poster presentation]. 11th Asia-Pacific AIDS & Co-Infections Conference, Chiba, Japan.
