Substance Use and Moral Injury

The concept of moral injury is often discussed as it applies to service members and military veterans. As you might imagine, the stresses and unique challenges of deployment and combat provide ample opportunity for morally injurious experiences. However, moral injury is applicable to a variety of experiences outside of the military context. One such example is addiction. Though the relationship between moral injury and addiction is (unfortunately) not often discussed in addiction treatment settings, moral injury remains a powerful force that can thwart recovery efforts. The significant emotional impacts of moral injury in relation to substance use warrants careful attention and consideration.

So, what is moral injury?

Disabled American Veterans, a nonprofit veteran service organization, defines moral injury in this way:

"Moral injury is when one feels they have violated their conscience or moral compass when they take part in, witness or fail to prevent an act that disobeys their own moral values or personal principles” (DAV site).

Put simply, moral injury is the result of doing something that is inconsistent with what one believes to be right or morally correct. Moral injury can have deep and pervasive effects on one’s mental health, causing guilt, shame, avoidance, substance use, interpersonal difficulties, and many other problems in living that significantly and adversely impact wellbeing.

The Cycle of Moral Injury and Addiction

Moral injury may be the cause of substance use or, just as easily, its result. The inverse of the previous statement is also true. For this reason, moral injury and substance use frequently co-occur. Many individuals struggling with moral injury find themselves trapped in a cycle of substance use as a means of escaping the emotional pain. The temporary relief provided by drugs or alcohol can offer a reprieve from intrusive thoughts, emotional turmoil, and overwhelming feelings of self-condemnation. However, these substances only offer fleeting solace, ultimately deepening the sense of moral injury and perpetuating a cycle characterized by ever-increasing suffering.

Even prior to developing into addiction, use of substances can impair judgment and decision-making abilities, making it more likely for individuals to engage in behaviors that perpetuate moral injury. Under the influence of drugs or alcohol, individuals may act in ways that are in conflict with their moral beliefs, leading to feelings of regret, guilt, and self-loathing once sober. As substance use becomes more frequent and more intense, substance use interferes more significantly with relationships and valued activities, and moral injury and substance use become more entangled. Consider the defining characteristics of addiction: compulsive use of substances, failed attempts to reduce or cease substance use, prioritization of substance use over other important components of one’s life, using a substance more or over a longer period of time than intended, and continued use of the substance despite adverse consequences. Each of these characteristics demonstrates the power of the brain’s reward system – it’s dopamine system - to motivate behavior, even when those behaviors are out of step with one’s values, goals, and moral beliefs. The insidious and cyclical nature of these dynamics further underscore the value in exploring and understanding the relationship between substance use and moral injury.

Recovering from Addiction and Moral Injury

Therapy can provide an opportunity to explore the underlying factors contributing to both substance use and moral injury. Through evidence-based interventions such as cognitive-behavioral therapy (CBT), Dialectical Behavior Therapy (DBT), mindfulness, and trauma-focused therapies, individuals can learn healthier coping strategies, rebuild a sense of self-worth, and process their experiences in a supportive environment.

If you are interested in discussing how therapy can help you on your recovery path, feel free to reach out today for a free consultation. I would love to speak with you.