30 2 CHAPTER 2 was to examine barriers and facilitators of treatment seeking for MHC/SA in the military, using a qualitative approach from multiple perspectives. Specifically, the research questions were (1) ‘What are barriers and facilitators for treatment seeking within the military?’ and (2) ‘What are differences and similarities in views between the 3 groups?’ METHOD The COREQ-checklist, a guideline for reporting qualitative research, was used in reporting this study (19). Setting The study took place within the Dutch military – a military force with approximately 40.000 soldiers and no compulsory military service. Mental health care is organized internally and is available relatively close to a soldier’s home. Soldiers can seek treatment for both mental health conditions and substance abuse and costs are covered by a military specific insurance. For ‘soft drugs’ (e.g. marijuana, hash, sleeping pills.) and alcohol, treatment is provided within the military, for ‘hard drugs’ (e.g. heroin, cocaine, amphetamine.) soldiers are referred externally. A soldier can also individually decide to seek treatment outside of the military; however, these costs will not be covered by their insurance. As for the policies for SA, there is a zero-tolerance policy for use of hard drugs, with the sanction being discharge. The use of alcohol is only prohibited during training and deployment. Use of soft drugs causes an official warning. However, when substance (ab)use is reported to a MH professional, there are confidentiality agreements, and treatment is possible. When a soldier seeks treatment, their treatment and diagnosis are not reported to their supervisor. The soldier can decide whether he/she tells the supervisor about the MHC/SA. Ethical considerations Anonymity in reporting of results was guaranteed to all participants. All procedures were approved by the Tilburg School of Social and Behavioral Sciences Ethics Review Boards (approval number EC-2018.107) and the Military Ethics Review Board. The authors assert that all procedures contributing to this work complied with ethical standards of relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Design Qualitative research was chosen, as this is the preferable method for exploratory research when subject matters are complex or sensitive, which is the case for the current study (20). Specifically, focus groups were used as interaction among participants creates in-
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