A comprehensive review of the literature on ethical decision-making models in counseling is presented, beginning in the fall of 1984 through the summer of 1998. (Materials "in press" were considered.) A general overview of the literature is provided. Theoretically or philosophically based, practice-based, and specialty-relevant approaches are surveyed. The literature is rich with publications describing decision-making models, although few models have been assessed empirically, and few models seem well grounded philosophically or theoretically.

No abstract

High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.

Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) indexes, and sampled 256 programs across the United States. Approximately 18% of addiction treatment and 9% of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures.