Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.
Am J Addict. 2012 Nov;21 Suppl 1:S43-8. doi: 10.1111/j.1521-0391.2012.00301.x.
This study proposed and examined an expanded self-medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self-efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self-efficacy between negative emotional states and heroin use.
A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self-efficacy. Structural equation modeling was used to examine the eSMH model.
Results showed that the eSMH model displayed proper goodness-of-fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self-efficacy was not a significant predictor. Additionally, positive self-efficacy was a mediator between negative emotional status and heroin use.
Results support a reduced eSMH model and suggest a significant role of positive self-efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states.
本研究提出并检验了一个基于认知行为决定因素的扩展自我药疗假说（eSMH）模型，包括负性情绪状态、积极结果预期和拒绝自我效能对海洛因使用的直接影响，以及积极结果预期和拒绝自我效能在负性情绪状态和海洛因使用之间的中介作用。
从台湾一家药物滥用治疗中心招募了 360 名男性海洛因滥用者。要求参与者完成一组关于海洛因使用频率、焦虑/抑郁情绪、积极结果预期和拒绝自我效能的问卷。采用结构方程模型检验 eSMH 模型。
结果表明，eSMH 模型具有适当的拟合优度。积极的结果预期和负性情绪状态是海洛因使用的显著预测因素，而拒绝自我效能不是显著的预测因素。此外，积极的自我效能在负性情绪状态和海洛因使用之间起着中介作用。
结果支持一个简化的 eSMH 模型，并表明积极的自我效能在负性情绪状态和海洛因使用之间的关系中起着重要作用。这种关系应该在纵向研究中进行检验，并在治疗与海洛因滥用和负性情绪状态作斗争的个体时给予临床考虑。
