The goal of the proposed 3.5-year program of qualitative research is to identify, explain and thereafter provide guidelines for eliminating individual, socio-cultural, and structural barriers to treatment for alcohol and drug use disorders and Post-Traumatic Stress Disorder among U.S. National Guard service members returning from deployment in Afghanistan and Iraq. Psychological barriers veterans face to seeking treatment include stigma. Socio-cultural barriers may include culturally-prescribed beliefs about help-seeking and the influence of social settings such as the family, community and the civilian workplace. Additionally, treatment access policies, deployment exit procedures, employment policies and other structural factors may also systematically deter soldiers from seeking help, despite substantial efforts by the armed forces and the VA to encourage personnel to seek treatment. The objectives by which we will meet this goal are as follows:
Specific Aim 1 : To identify and provide contextual understandings of individual-level barriers (e.g., stigma, fear of jeopardizing future government and civilian employment) that inhibit National Guard members from seeking treatment for PTSD or alcohol or drug use disorders after they return home from deployment.
Specific Aim 2 : To identify and describe barriers for treatment-seeking in the cultural and social environment (e.g., workplace, community and family settings) for post-deployment National Guard personnel as they return to civilian life.
Specific Aim 3 : To identify and provide understandings of the structural barriers (e.g., military and civilian employer screening procedures, lack of military confidentiality, insurance coverage, promotion policies and procedures, etc.) that impede treatment seeking in this population. We propose to conduct semi-structured qualitative interviews with a stratified random sample of 120 members of the Hawaii and Arizona National Guards who indicate symptoms of PTSD or substance use disorders in a screener administered to 1000 personnel with combat exposure during deployment. Interviews will occur at least six months after their return from Afghanistan and Iraq. We will also interview 20 key informants (e.g., family support providers, chaplains, counselors, and officers) who have practical experience regarding treatment-related issues. A dynamic critical incident approach that elicits narratives illustrating the treatment seeking process, including individual, socio-cultural, and structural impediments, will provide evidence for each of the three specific aims.
The proposed project will analyze the individual, socio-cultural and structural contexts of barriers to diagnosis and treatment for substance use disorders and post-traumatic stress disorder among National Guard personnel returning from combat-exposed deployment. The results will offer relevant guidelines for removing these barriers, thereby facilitating appropriate diagnosis and healing procedures for returning veterans. The study will identify successful examples of early identification and treatment both during and after deployment and during reintegration to civilian life.
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