ABSTRACT
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.
Subject(s)
Counseling/ethics , Decision Making/ethics , Ethical Analysis , Ethics, Professional , Models, Theoretical , Empirical Research , HumansABSTRACT
To examine the substance abuse recovery process from a treatment-career perspective, this study compared the profiles of clients entering treatment for the first time versus those returning to treatment. Clients (N = 7,092) presenting for publicly funded treatment were assessed as part of the St. Louis Target Cities project. Previous treatment clients were more likely to have more severe substance abuse problems, additional psychiatric problems, and greater problems in other life areas. Comorbid psychiatric problems and motivation to change were identified as areas of focus for clinical intervention. Discriminant analysis yielded a significant function that accounted for 6.5% of the variance between groups. Results suggest that change occurs via multiple processes.
Subject(s)
Substance Abuse Treatment Centers/statistics & numerical data , Substance-Related Disorders/rehabilitation , Adult , Alcoholism/diagnosis , Alcoholism/rehabilitation , Alcoholism/therapy , Attitude to Health , Behavior, Addictive/psychology , Behavior, Addictive/rehabilitation , Diagnosis, Computer-Assisted , Diagnosis, Dual (Psychiatry) , Discriminant Analysis , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Mental Disorders/rehabilitation , Motivation , Patient Acceptance of Health Care , Personality Inventory/statistics & numerical data , Psychiatric Status Rating Scales/statistics & numerical data , Quality of Life , Recurrence , Severity of Illness Index , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapyABSTRACT
OBJECTIVES: Plasma cholecystokinin increases with enteral feeding. Cholecystokinin increases intracellular calcium in lymphocytes/monocytes and is a lymphocyte co-mitogen. We hypothesize that decreased cholecystokinin production with "bowel rest" and parenteral nutrition may be beneficial in inflammatory bowel disease by down-regulating gut immune/inflammatory mechanisms. The majority of cells observed in mucosa of inflammatory bowel disease are monocytes and neutrophils. Cholecystokinin effect was therefore measured on monocyte production of proinflammatory mediators (tumor necrosis factor alpha, interleukin-1 beta, interleukin-6) and neutrophil chemotaxins/activators (interleukin-8, granulocyte-macrophage colony stimulating factor, and leukotriene B4). METHODS: Peripheral blood monocytes (0.5 x 10(6)) from healthy donors in 1 mL of RPMI 1640 plus 5% fetal calf serum were cultured for 24 h in 5% CO2 at 37 degrees C with 5 micrograms/mL endotoxin, 1 x 10(-7) M cholecystokinin, or no agonist. Supernatants were analyzed by ELISA for cytokines and leukotriene B4. RESULTS: Endotoxin-stimulated monocytes produced 1130 pg/mL tumor necrosis factor versus 81 pg/mL for cholecystokinin, 612 pg/mL interleukin-1 versus 10 pg/mL, 694 pg/mL interleukin-6 versus 30 pg/mL, 4531 pg/mL of interleukin-8 versus 3848 pg/mL, 21 pg/mL granulocyte-macrophage colony stimulating factor versus 9 pg/mL, and 21 pg/mL leukotriene B4 versus 12 pg/mL. Controls produced no cytokines/eicosanoids (N = 8, p < 0.001). CONCLUSION: Cholecystokinin increase with enteral feeding may up-regulate gut immune response. Cholecystokinin suppression with parenteral alimentation may decrease inflammatory mediator production.
